Run to Failure - Pt 2
Saturday, December 10, 2005, 08:42 AM - Combat as Metaphor"Run to failure" is a term I learned many years ago in a war and technology course. It's used by engineers when designing something that has lots of moving parts. You design, say, an aircraft engine. You build a prototype and let it run until it fails. Then you root around the prototype until you locate the specific part that failed. You figure out why it failed, design and manufacture an improved version of the part, install it and then run the engine until the next failure. You repeat the process until you have an engine that meets or exceeds the required specifications. That's "run to failure."
Over the last two decades, I've used "run to failure" numerous times to improve the system I've evolved to protect myself from the sort of acute manic episode that evidently killed Rigoberto Alpizar. An analogous concept would be the "lesson learns" analysis commonly employed by the armed forces: you create a doctrine, then revise it in light of practical experience--war games or actual battle.
I described the core of the system in a previous post. Briefly, it's to marshal as many resources to combat the illness as I can: medications, therapy, good sleep hygiene, regular exercise, and so on. Equally important is to have in place a strong network of friends and colleagues who know that I have the disorder and have been briefed about its symptoms. This network has proven itself so thoroughly that the question of whether to be private or "out of the closet" about the disorder is a settled issue with me. It is better to have as many people know about the condition as possible.
True, there are downsides. I've no doubt that my openness makes some people uncomfortable and that they rationalize their discomfort by telling themselves--and perhaps others--that it is "inappropriate" or that I have "boundary issues." It is even possible that I could never get a job in another university. Tough. One of the things I learned in the Army is that you do what is necessary to accomplish the mission. My first mission is survival. Other considerations take a back seat.
The network protects me in two basic respects. First, I have around me a number of people who have received a memo detailing the symptoms of bipolar disorder and explaining what to do in the event they develop concerns about my behavior. The first step is to approach me and inquire. If they're not satisfied with my response, the memo has the name and phone number of my therapist and psychiatrist. The next step is to contact them and relay their concerns. As a last resort, they are authorized to direct me to go to a hospital emergency room, in which I event I am to go there, period. I get no say, since in the nature of the case, my ability to make wise judgments is in question.
Second, on very rare occasions, when I know that I have "decompensated" to a fairly serious degree but when my psychiatrist and I are on the case, so to speak, and working through a treatment plan to get me "recompensated," I will employ a regimen borrowed from one of my hospital stays but which I conceptualize in military terms. At the heart of it are the three general orders I learned in basic training and which are so ingrained in me I can recite them from memory even in the midst of a complete psychotic break:
1. I will guard everything within the limits of my post and quit my post only when properly relieved.The idea of adapting these general orders to cope with the bipolar disorder occurred to me when I was first hospitalized for mania in 1986. I felt that I could not fully trust the medical professionals around me--they gave me meds that back-fired, for instance--and at the same time I understood that something was definitely very wrong with my own capacity to judge. It seemed a no-win situation.
2. I will obey my special orders and perform all my duties in a military manner.
3. I will report violations of my special orders, emergencies, or anything not covered by my instructions, to the commander of the relief.
Trying to think while acutely manic is like trying to read a newspaper in a high wind. I remember saying to myself, "A no-win situation. A no-win situation. I've been in a no-win situation before. When was it?" Finally it came to me: Phase I--the indoctrination phase--of basic combat training. During that phase, recruits are constantly placed in situations or asked questions to which there is no correct response: you'll get bitched out for anything you do or say. The purpose is to break down a recruit's resistance and to make them more receptive to training. It also reproduces, in very modest fashion, some of the stress one is apt to experience in combat.
One of the first things we had to do in that environment was to memorize those three general orders. In many respects they were the key to getting out of Phase I and into more advanced phases (there were four in all) in which we were treated more and more as real soldiers. As soon as my manic mind was able to grasp Phase I as the no-win situation I had previously experienced, the next step was obvious. I would use the three general orders as the template to regulate my conduct in the hospital.
Part 1 - Part 2 - Part 3 (link not yet active)
Run to Failure - Pt 1
Friday, December 9, 2005, 07:25 PM - Combat as Metaphor
Anne Buechner and her husband, Rigoberto Alpizar
Two days ago the couple in the photo were returning to Florida after a brief missionary trip to South America. The international leg of the flight was behind them. They had cleared customs, boarded a second aircraft, and faced only the final, brief trip from Miami International Airport to Orlando. Suddenly the man, 44-year old Rigoberto Alpizar, began acting in a way that attracted the attention of the flight crew and an air marshal on board the craft. The marshal became convinced that Alpizar had a bomb and, when he bolted from the plane rather than heed the marshal's command to halt and lie down, the marshal shot him dead.
The story has been international news for a couple of days now. The dominant theme has been that it was a "good shoot"--that is, the air marshal behaved properly in the circumstances--and serves as evidence that security measures entrenched since 9/11 are working as they should. But it soon transpired that Alpizar was not, in fact, carrying a bomb. His behavior owed not to lethal intent but rather to his medical condition: He suffered from bipolar disorder and, in medical terms, had "decompensated," apparently because he was off his medication.
The fate of Rigoberto Alpizar has begun attracting comment within the mental health segment of the blogosphere. Shrinkette, a psychiatrist in Eugene, Oregon, poignantly juxtaposed a news excerpt with a passage from Kay Redfield Jamison's famous memoir of her struggles with bipolar disorder:
Witnesses aboard an American Airlines jetliner say that Rigoberto Alpizar's wife pursued him, saying he was mentally ill, just before federal marshals shot and killed him. Air marshals said Alpizar had announced he was carrying a bomb.One of Shrinkette's readers left this comment:
Later, no explosives were found. The incident remains under investigation.
"She was chasing after him," said fellow passenger Alan Tirpak. "She was just saying her husband was sick, her husband was sick." When the woman returned, "she just kept saying the same thing over and over, and that's when we heard the shots."
"Manic-depression distorts moods and thoughts, incites dreadful behaviors, destroys the basis of rational thought, and too often erodes the desire and will to live. It is an illness that is biological in its origins, yet one that feels psychological in the experience of it; an illness that is unique in conferring advantage and pleasure, yet one that brings in its wake almost unendurable suffering..."
-Kay Redfield Jamison, Ph.D., An Unquiet Mind, 1995, p. 6.
I understand 100% why the air marshall did what he did. I really do. But I can seriously imagine the turmoil and pain the man was in. I'm bipolar. I've been in a psychotic state, I've heard things, seen things, nearly cut off my own hand because something in my head was telling me it would be a good experiment. Being bipolar we have a responsibility to take our medication, but even then it can be difficult, a daily struggle. I am not saying that the air marshall was wrong: he discerned a threat to the larger group and was doing as he was trained. But I have an incredible amount of compassion for the man and his wife. NO ONE knows, nor will they ever, what that couple went through, both at that moment, and the days leading up to it.But Becky, a 22-year old Indiana woman who blogs about her struggles with bipolar disorder at Tidal Moods, was less sympathetic--in fact, not sympathetic at all:
Some people are suggesting that the air marshals behaved inappropriately. Those people are wrong. A clearly insane person can still have a bomb and just because someone is behaving bizarrely does not mean they aren't dangerous. This man said he had a bomb and authorities have no choice but to take him seriously.Becky's post has so far attracted 21 comments, though most of them are off-topic--early in the thread someone criticized her for being foolish and "narcissistic" to write publicly about her bipolar disorder. (That little gem of idiocy generated a spate of coments and counter-comments from Becky, the idiot, and several of Becky's readers which is worth reading for its own sake.) But of the responses that addressed her post directly, opinion was about evenly split between those who thought Becky was being harsh on Alpizar and those who thought she had a point.
As a person with bipolar, I'm outraged by the media's obsession with the fact that the man's family claimed that he suffered from bipolar disorder. It's irrelevant. It doesn't factor into the air marshalls' deliberations about whether or not the man is a threat and the only reason the media even mentions it is because it makes the air marshalls look like assholes when they aren't.
At the risk of sounding like a heinous bitch, I have little sympathy for this man and his family. By the time you're 44 years old, you know what it's like to live with bipolar disorder and you know whether or not you're one of those people who requires medication to maintain sanity. Clearly, this man could not behave normally without his medication and there is absolutely no reason for him not to take it. It's not like a bipolar person is going to fly off the handle if they miss one dose of their meds. For his wife to be aware of his failure to take his meds, he had to have missed more than a dose and at that point, my sympathy dies. Even if he lost his bag and his medication was gone, he could still go to a hospital or contact a pharmacy and his psychiatrist to get more. There is no excuse for not taking your meds if you know that you pose a danger to others without them. None at all.
My personal view is that Becky has a point and also that her stridency on the subject stems from fear. Anybody with bipolar disorder--me, for instance--can't help but reflect that in the right circumstances, we ourselves could suffer Rigoberto's Alpizar's fate. One way to deal with this fear is to blame Alpizar for what happened: Alpizar had bipolar disorder. Alpizar did not take his meds. Alpizar got in a situation where he was killed. I myself will take my meds and therefore I will never get in such a situation.
Actually, you can take your meds and still get in precisely that situation. Six years ago I was hospitalized for acute mania exactly one day after a blood test showed that the correct level of lithium was present in my body.
No: meds alone aren't a guarantee. The strategic problem of survival is more complex than that.
It is no coincidence that in the last decade, a significant amount of my research as a military historian has focused on situations in which people have tried to frame workable strategies for resistance in an intractable environment, when the odds are stacked heavily against them. I live that situation every day of my life. And over time I've brought my military training as well as my historical training repeatedly to bear on the problem.
Let me tell you some of the tactics I've evolved to address it.
Part 1 - Part 2 - Part 3 (link not yet active)
Friday, August 5, 2005, 11:57 AM - Combat as Metaphor
"Politics is a continuation of war by other means." Pop art on the East Side Gallery, a 1.3 kilometer remnant of the Berlin Wall.
Hat tip to my advisee, Alison Efford, who sent me this image. She is currently studying in Germany.
Tuesday, July 12, 2005, 06:34 AM - Combat as MetaphorIt's been nearly a month since my last blog post. That's partly because I have adhered to my rule of making this blog an aid to productive scholarship, not a diversion from it. It's partly because the next posts that follow logically from Crash and, especially, Shadow Warriors, Pt 8, are ones that I have been reluctant to write, much less publish--though I guess in the next few days I will have to embark on them. But mostly it has been due to the fact that I've spent much of the period in a state of clinical depression.
What does that mean? Well, according to the standard diagnostic manual used by the American Psychiatric Association, it means that I met the criteria listed in Facing the Demon.
As I mentioned in a previous post, I have bipolar disorder, also called manic-depressive illness. The condition was diagnosed when I was 26; I am now 45; I will have this condition for the rest of my life. I have seen it blight the lives of some people but in most cases I have found that people manage the illness fairly well. The medications now available help a good deal, as does the diminishing stigma attached to illnesses of this sort, which makes it easier for people to get treatment rather than avoid it from a sense of shame. In my own case, I have also found it useful to keep a very tight handle on the diagnostic criteria associated with the disorder. (In Facing the Demon, I tried to give an impressionistic sense of this utility.)
Nevertheless, if you look over the criteria you'll find that by definition a major depressive episode can be identified only after a significant amount of time has passed. Officially the period is a full two weeks, though to be sure, a psychiatrist closely acquainted with a patient seldom hesitates to intervene long before then. Still, it takes time for a pattern of symptoms to emerge. Even the depressed person isn't always aware of being depressed until a few days have gone by. And although this site typically gets around 80-120 hits per day, it was not until yesterday that anyone inquired whether the dearth of blog entries might indicate that something was amiss with my health.
I knew that such an inquiry would come eventually, however. I knew which person was most likely to inquire. I knew it would come as an email, and I knew what the subject line would say: "SITREP?"
SITREP is military speak for Situation Report. If somebody asks for a situation report they are asking to know the status of your unit and the progress of its mission.
The person who requested the SITREP was an officer currently posted in Baghdad. I wrote back:
Thanks for checking up. I appreciate it.
Things are OK now, but as you surmised, until recently they weren't going so well. I had another depressive spell, this one longer than usual--probably long enough to qualify formally as a clinical depression. It may have been due in part to some tweaking in my medication. The meds have been tweaked again, and I'm doing better, though whether this is a cause and effect relationship, or correlation, or coincidence, just plain beats me. All I know is that I have had more trouble with the bipolar disorder this year than in any preceding year I can recall.
A subsidiary reason I haven't been keeping a blog is that when I am OK I'm busy doing other things. At the moment, for instance, I'm writing a 5,500-word chapter for The Osprey Companion to the American Civil War. If I needed the blog to help with my productivity I'd use it, but I've never wanted to get in the trap of letting the blog distract me from the stuff I really need to do.
I hope things are going OK at your end. Thinking about what "at your end" signifies sort of puts what's going on in my life into perspective.
Afterward it occurred to me that dealing with this bipolar disorder is a little bit like combatting an insurgency, and vice versa. For instance, I can say in retrospect that a depressive episode occurred, but neither I nor anyone else can say with much certainty what caused it, when it began, why it reached the level of intensity it did, and why it finally lifted. Similarly, although it is obvious that the United States is contending with an insurgency in Iraq, I don't think anyone can say exactly when it began, or explain the dynamic that feeds it, or gauge--save in a very rough way--the progress the United States has made in fighting it. Or say when it will end. In the case of bipolar disorder, it will never end, though I am told that the disorder tends to be roughest on people in their thirties and forties and tends to abate with age. Yet the presence of the disorder doesn't preclude the possibility of leading some measure of an ordinary life, just as the presence of an insurgency doesn't necessarily halt the normal functioning of a society. As military historian Eliot Cohen observed in a recent op/ed piece, "Counterinsurgency is inherently a long, long business. Conceivably, the Iraqi insurgency could collapse in a year or so, but that would be highly unusual. More likely Iraq will suffer from chronic violence, which need not prevent the country as a whole from progressing."
"The history of a battle," the Duke of Wellington famously maintained, "is not unlike the history of a ball. Some individuals may recollect all the little events of which the great result is the battle won or lost; but no individual can recollect the order in which, or the exact moment at which, they occurred, which makes all the difference to their value and importance." He wrote those words to dissuade a would-be historian of the battle of Waterloo, but of course his injunction did nothing to inhibit the crafting of hundreds of books on the battle. Societies have a need to find meaning in events just as individuals have a need to find meaning in their own lives. Yet when thinking about this latest depressive episode, I wonder. . . . "The meds have been tweaked again, and I'm doing better, though whether this is a cause and effect relationship, or correlation, or coincidence, just plain beats me." The only battlefield was my own life, and yet I can see what Wellington was driving at. I wonder what simile Wellington would have found to describe the history of an insurgency?
Saturday, June 18, 2005, 07:39 AM - Combat as MetaphorTuesday afternoon a week ago (June 7), my colleague Hasan Jeffries stopped by my office and asked if I'd seen the film Crash. Actually, "stopped by" is too mild a way to phrase it. Hasan is a fairly charismatic guy under the most ordinary circumstances, and on this occasion he was as animated as I've ever seen him. I told him I'd been meaning to see the movie since reading critic Roger Ebert's review back in May, but had not yet gotten around to it. "You have got to see this movie," Hasan said.
So that evening I did, and the next day Hasan and I met over lunch to discuss it.
"Crash," explains Ebert in his review, "tells interlocking stories of whites, blacks, Latinos, Koreans, Iranians, cops and criminals, the rich and the poor, the powerful and powerless, all defined in one way or another by racism. All are victims of it, and all are guilty of it. Sometimes, yes, they rise above it, although it is never that simple. Their negative impulses may be instinctive, their positive impulses may be dangerous, and who knows what the other person is thinking?" Hasan and I liked the film as a film, but we were most attracted to its ability to act as a catalyst for dialogue about racism. Yet Crash can be seen just as readily as a commentary on the ways in which we imprison ourselves behind walls of anger and how hard it is to escape those walls. I know that I myself have been, throughout my life, an intensely angry person, though I have tried very hard to control it and feel deeply chagrined and ashamed whenever I lose my temper. That's not just my personal struggle, however. It's the world's struggle. And the study of military history has much to do with understanding that.
Anger is everywhere. You never know when you'll encounter it. Last Friday (June 10) my significant other and I went out for a beer at a nearby bar called Caddo's. It affects a country-and-western atmosphere and is pretty laid back. (I think that for all my life I will be in the academy but not of it. I'm always most comfortable in what might be called working-class environments, and one of my favorite country songs is Aaron Tippin's "Working Man's PhD". Even though, strictly speaking, the song is sort of contemptuous of people with actual PhDs.)
We weren't there long. I spent most of the time chatting with a guitarist over a Corona beer and my SO, I belatedly discovered, spent a few hapless moments fending off a rather incompetent pass by one of the clientele. We had to be up early in the morning to drive out to Indiana so we left around 12:30 a.m. I backed my car out of its parking space and paused as a car two or three spaces away also began pulling out. For a couple of seconds it was no big deal; I figured he'd see me and pause to let me by before completing his maneuver. But then I realized he was getting closer and closer to my car and then he just hit me. Tapped me is more like it. No big deal. Here's a photo of the damage. You can click for a larger image; indeed, you may have to; otherwise you may not be able to make out the damage. . . .
I got out of the car to do the routine exchange of insurance information. The other driver got of his car and started into one of those what-the-hell-were-you-doing-there-and-it's-all-your-fault routines.
"We're not going to do that," I said, mildly--emphasis on mildly because I could see that this guy was belligerent and probably drunk. "We're going to exchange insurance information as the law requires."
He said that he didn't have the information on him but that had coverage with State Farm, so it was OK, and anyway there wasn't any real damage, and so on.
I said, "One of two things is going to happen here. Either we are going to exchange information or I am going to call the police."
He told me I could just call the police, then, since he had no insurance information and no intention of sticking around at the scene to undergo a potential sobriety test. I called out the number of his license plate to my SO and she wrote it down. The guy got back into his car. I walked around to the passenger's side and asked him to reconsider, which may sound nuts on my part except that as soon as I refused to get caught up in the moment and insisted on keeping things businesslike, he calmed right down. In response to my request for him to reconsider, he told me candidly that he already had several DUIs (Driving Under the Influence) and preferred to be cited for leaving the scene of an accident. "Good luck," I said quietly--no sarcasm, I really meant it, because he obviously had problems and there wasn't anything I could do but hope that he got home okay.
I called in the accident report. The officer who came told me that ordinarily the police do not respond to accidents on private property, so the dumbest thing the guy could possibly have done was to leave the scene. That made him the subject of a criminal investigation--though the officer told me not to hold my breath for any quick resolution. He ran the plate number. Information about the person to whom the plate was registered came up on a computer screen in the middle of the cop's dashboard--the technology these days is amazing. He asked if the photo of the person looked like the guy with whom I'd spoken. I said it did. He said the guy was driving under a suspended license and, sure enough, had three DUIs.
So that was that. The next morning I took a few photos of the damage and then my SO and I headed off for Indiana. Claypool, Indiana, to be exact. Population 308 and falling, 97 percent white, median age 31.5 years, median household income $33,833, median house value $62,500. Not much goes on in Claypool, Indiana. Someone had recently tried to have a cockfight, and two roosters had been driven up from Kentucky for that purpose. No one seems to have explained the point of a cockfight to the roosters, however, and when thrown into the ring they just sort of regarded one another with a sort of isn't-this-odd incredulity. The organizer of the cockfight, disgusted and disappointed, simply turned them loose into the neighborhood, where they are now known as Lunch and Dinner, respectively. I saw them several times during my visit. Mahatma Gandhi was more belligerent than the two of them combined.
My SO has a friend living in Claypool and we were in her father's yard chatting when just beyond a row of hedges we heard a truck slam on its brakes, tires squealing, and then a voice screaming at the top of his lungs. We couldn't make out exactly what was said except that it involved a threat to kill whoever the screamer was talking to. Apparently the screamer felt that he had in some way been disrespected.
One of my conceits, which will probably get me slugged one day, is that I can defuse pretty much any hostile situation. I have a great belief in the power of remaining calm. It seems to evoke calm from the other person, almost despite themselves. So I walked around the row of hedges and saw that the screamer was a man in his mid-twenties who had stopped his pickup truck in the middle of the road. He had gotten out of his truck to berate--wait for it--a boy who could have been no more than twelve. Having gotten things off his chest, he was stalking back to his truck.
A small puppy followed him on the theory that, since in his young life he had gotten only petting and tummy tickles from human beings, this guy offered another fat opportunity for a little loving. The puppy got under the truck right about where the rear tire would crush him as soon as the screamer put the truck in gear. A little girl desperately ran out to the truck and begged the screamer not to drive away. "Aw, he'll be all right," the screamer said. The little girl grabbed the puppy and ran away just as the screamer threw the truck into gear and accelerated away. This time I did not get the license plate.
This time I could barely believe what I'd just seen.
I walked over to the group of kids that included the little girl and the twelve-year old boy. I asked what that had been all about. The boy, obviously shaken, had no idea. He'd simply been waving to trucks and cars as they went by and the screamer seemed to interpret this as some sort of mortal insult. (When I tell this story I am sometimes asked if I believe that the kid was really just waving hi. In fact I do. It was consistent with what I'd seen of the little group before and the kid showed none of the little signs that betray prevarication. But the main thing I say is, So what? What could possibly justify a grown man to do something like that? Why is the screamer getting the benefit of the doubt here?)
In a previous and for some reason slightly controversial entry, I suggested that military historians had something relevant to say about bullies. I now told the kids that I was a military historian who had active duty officers among my students. I said I liked to think about things like what had just happened as if they were military problems to be solved. I was the readier to address this particular "military problem" because the kids told me--and after a few more hours in Claypool and the nearby town of Pierceton, I heartily believed it--that around here some people engaged in this sort of random hostility all the time.
I stood where the boy had stood. I waved to an imaginary truck. I imagined the truck screeching to a halt. I imagined the driver storming toward me. I imagined what sort of man could be filled with so much rage, and concluded that it was most likely a man who had been beaten down by life. Maybe he'd lost his job. Maybe his girl friend had dumped him. Most probably, given the depressed area, he felt that life had given him a raw deal. He got so little respect that when a kid waved hello to him, he interpreted it as more disrespect. And although he might have to take it from adults, he wasn't going to take it from some damned twelve-year old twerp.
I said to the kids, "A basic rule in war is that, unless you have a very good reason, you do not give the enemy what he wants. A guy like this wants to pick a fight. He wants an excuse to be mad. He needs to be mad. How about if you said something like, 'Hey, mister, I really like your truck. What kind is it?' And so on."
One of the kids pointed out that maybe the guy would think this was sarcasm. I thought the kid was exactly right. I tried again.
"How about if you say, 'Mister, you scare me.'" That instantly struck me as the right answer. He comes raging up, expecting the satisfaction of a confrontation, and gets instead to see himself as what he is, a scary man bullying a small kid. I notice that the door to a house is a few feet away. "How about if you run inside the house," I continue.
It all makes sense, but I know it also sounds like running away. If this is going to work, the kids have to have a sense of empowerment. "You say this happens a lot?" I ask. They nod.
"Then here's what you do. Write down the make and model of the vehicle and the color. Write down whatever you can about the driver. If you can, write down the license plate number." They note that they have no pen and paper. "You say this happens a lot," I say, "so keep pen and paper handy. And then call the police."
My talking to them like this seems to have calmed them all down. Better yet, they're starting to think of this as a problem to be solved. They don't feel helpless. I leave them a business card. It's just a stunt. I want them to feel like they really have just had a consultation with an actual military historian. I say before I go, "Remember, don't give your enemy what he wants. If he wants a fight, deny him that. Get him onto your ground, not his. Can you imagine what a weak man that driver was to think he had to pick on kids half his age? He wanted a fight on those terms. Get him into a fight with the police instead."
They like that idea. The twelve-year old and I shake hands. I walk away. I feel good that I've been able to help--and yet somewhere down deep, I feel a rage, an odd kinship with the screamer in the pickup truck.
The Four Classes of Co-Workers
Thursday, June 9, 2005, 05:52 AM - Combat as Metaphor
"I divide my officers into four classes; the clever, the lazy, the industrious, and the stupid. Each officer possesses at least two of these qualities. Those who are clever and industrious are fitted for the highest staff appointments. Use can be made of those who are stupid and lazy. The man who is clever and lazy however is for the very highest command; he has the temperament and nerves to deal with all situations. But whoever is stupid and industrious is a menace and must be removed immediately!" -- General Kurt Hammerstein-Equord (1878-1943)
(Hat tip to Miscellaneous Military Anecdotes)
Facing the Demon
Sunday, June 5, 2005, 12:42 PM - Combat as Metaphor
But besides the achievement of this functional and corporate aim, the rote-learning and repetitive form and the categorical, reductive quality of officer-training has an important and intended--if subordinate--psychological effect. Anti-militarists would call it de-personalizing and even de-humanizing. But given--even if they would not give--that battles are going to happen, it is powerfully beneficial. For by teaching the young officer to organize his intake of sensations, to reduce the events of combat to as few and as easily recognizable a set of elements as possible, to categorize under manageable headings the noise, blast, passage of missiles and confusion of human movement which will assail him on the battlefield, so that they can be described--to his men, to his superiors, to himself--as "incoming fire, "outgoing fire," "airstrike," "company-strength attack," one is helping him to avert the onset of fear or, worse, of panic and to perceive a face of battle which, if not familiar, need not, in the event, prove wholly petrifying.
-- John Keegan, The Face of Battle
Diagnostic Criteria for Major Depressive Episode
For a diagnosis of a major depressive episode, these are the signs and symptoms doctors are looking for:
A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
Note: Do not include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations.
1. depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful) Note: In children and adolescents, can be irritable mood.
2. markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)
3. significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: in children, consider failure to make expected weight gains.
4. insomnia or hypersomnia nearly every day.
5. psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness of being slowed down)
6. fatigue or loss of energy nearly every day
7. feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
8. diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
9. recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
B. The symptoms do not meet criteria for a Mixed Episode [i.e., a Mixed Bipolar Episode in which manic and depressive features are simultaneously present].
C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).
E. The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.
Reference: These criteria are excerpts from Diagnostic and Statistical Manual of Mental Disorders, DSM-IV, p. 327, © 1994, American Psychiatric Association.
Adapted from HealthyPlace.com
National Public Radio interview with Andrew Solomon, author of The Noonday Demon: An Atlas of Depression (you'll need RealPlayer to access; it's worth it)
"The Scare" - Pt 2
Thursday, April 28, 2005, 10:13 PM - Combat as Metaphor
Deception is a fundamental aspect of war. The enemy systematically tries to mislead you as to his real intentions and capabilities, which leads to uncertainty and therefore often anxiety. The most formidable adversaries are usually masters of this. I once wrote on this subject using as my example Confederate cavalry general Nathan Bedford Forrest:
Warfare, despite its various refinements, touches basic human emotions. The most fundamental of these is fear. It is not difficult to imagine that Forrest's [prewar] days on the Mississippi frontier had educated him in the coarse art of instilling fear. The key was to rattle an opponent and keep him rattled. Forrest had an expression for it: "Keep up the scare." When he advanced toward [the Federal garrison at] Jackson [Tennessee] with kettle drums beating to simulate infantry, and when he suddenly swung on his pursuers at Parkers Crossroads, Forrest was doing his best to generate fear. There was nothing really novel in this approach: the violence of war can have no other purpose than the creation of fear through the threat of wounds and death. But Forrest was unusually clear-eyed about the value of inflicting fear. He did it instinctively and he did it well.
The experience of depression is often much like this. Joy simply drains out of life, replaced by listlessness, anxiety, even outright dread. The actual cause of the depression may be biochemical but the mind, spurred by the illness, searches for a circumstantial explanation and always finds it. In broad outline the illness "keeps up the scare" by playing on universal fears: that one is a failure, that one is unloved and unlovable, that life itself is meaningless. But the details are insidiously specific to each individual because the illness, in effect, knows what scares you most.
Part 1 - Part 2 - Part 3 (link not yet active)
"The Scare" - Pt 1
Thursday, April 28, 2005, 08:25 AM - Combat as Metaphor
Part 1 - Part 2 - Part 3 (link not yet active)
My Favorite Clausewitz Quote
Wednesday, April 27, 2005, 06:12 PM - Combat as MetaphorIn a previous post, I alluded to having a mood disorder called bipolar disorder, once known as manic-depression.
Note the formulation: "I have bipolar disorder," not "I am bipolar." Though I'll need to sketch some background first, the thrust of this post turns on that distinction, and on the utility of combat as metaphor in making the distinction helpful.
Bipolar disorder is, strictly speaking, a malfunction of one's biochemistry whereby the mind is tricked into varying degrees of euphoria or despair with scant regard to the actual circumstances of one's life. I have often been discouraged by health care professionals from regarding it as a true mental illness at all. I tend, however, to regard such admonitions as well-intentioned efforts to spare me from the shame of mental illness. But rather than duck it, I'd rather work to dispense with the shame itself. If a tenured professor cannot summon the modest courage required to do so, then I don't know who could reasonably be asked.
Most of the stigma derives from the "mind/body split," the view that the mind and body are two almost completely different things and that the one does not influence the other: thus you cannot meditate your way out of a physical malady, on the one hand, and a physical malady does not affect the operation of your mind, on the other. While most people nowadays would reject so extreme a formulation, within broad limits the idea remains influential because it reflects our common experience of everyday life.
And because the mind is where we primarily locate our identities, a physical illness or impairment does not so readily shake our sense of who we are. There are always exceptions. An athlete might find her or his sense of self profoundly changed by the loss of a limb, for example. But a mental illness offers a fundamental challenge because it hits us where we are most intimately ourselves. The diagnosis of mental illness therefore confronts the affected individual with a basic choice: Is the illness something external to self, or is it a part of self? Most people, if asked, would promptly reply that the former is the correct formulation, but I have seen many instances in which people with bipolar disorder choose implicitly and sometimes explicitly to imagine the illness as a part of them. And why not? The whole thrust of the "mind/body split" argues that it is.
I have therefore always worked very hard to locate bipolar disorder as something external to myself, notwithstanding the fact that the biochemical fluctuations influence my moods and therefore my subjective experience of life.
As it happens, I can think of at least one other area of human life in which moods are artificially, systematically, and powerfully modified: war.
Indeed, I have found that war offers a very rich metaphor for understanding the illness and mobilizing one's resources to manage it. I consider myself to be in a permanent state of war against an enemy that will never cease in its efforts to kill me, one way or another--which is about as strong an "othering" of the illness as I can imagine.
"In war," wrote the Prussian military theorist Karl von Clausewitz, "the best strategy is always to be very strong, first in general and then at the decisive point." (On War, Book III, chapter 11) This point seems incredibly obvious, but like a lot of obvious points, it is easy to miss.
I have met my full share of people with mood disorders, for example, who were reluctant to take their prescribed medications because they thought they should be able to control the disorder by themselves. This sort of thinking is exactly like a general needlessly going into battle with only half his forces. Stupid, right?
Meet Maj. Gen. Joseph Hooker, a Civil War general who famously did go into battle with half his forces--and got his clock cleaned as a result. Indeed, as Clausewitz observes, "It seems incredible, and yet it has happened a hundred times, that troops have been divided and separated merely through a mysterious feeling of conventional manner, without any clear perception of the reason."
No self-respecting military historian wants to emulate Joe Hooker in any area of his life. Consequently, when a person with bipolar disorder is offered such things as medications, therapy, self-help books, support groups and/or the support of friends and colleagues, the correct response is not which of these resources to select. The correct response is to take as many of them as possible and to be continually on the lookout for even more.