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The Artist: A prolific and well-known artist, Ike Morgan resides at Austin State Mental Hospital. He works from photos and images found in books and magazines. This piece and is pastel on scrap cardboard. Photograph by Jim Rendon Friends in High Places Call me crazy, but it seems like everyone I know is manic-depressive. By Kelly Luker IT'S THE THIRD CALL of the day from my friend Phil, updating me on his latest plans to start a new magazine. The phone calls follow on the heels of about a half-dozen emails he's blasted out since midnight on the same subject. No matter that we haven't spoken for over a year; he picks up the conversation as if we were interrupted in mid-sentence. Phil's already talked to big honchos who will pony up venture capital, he says, and he's ready to tap a half-dozen folks to sit on this new magazine's board of directors. He banged out the business plan around 6 this morning, so I should receive it in the mail in a few days to review and add my comments. On second thought, maybe he'll email it. This is Phil's third magazine concept in as many years. There was the time he was going to move to Russia and start an English-speaking journal for entrepreneurs (Phil doesn't speak Russian). Then there was the monthly glossy aimed at hip middle-agers. But this latest one may be his best idea yet, embracing a concept Phil has lived with intimately. It has left him at various times famous, hospitalized, wealthy, homeless, medicated and, finally, on disability. Although he's still toying with titles--Up the Down Staircase or See-Saw Scenes, for example--he's already picked out the subtitle for his new magazine: "Better Living for Manic-Depressives." Phil has what the shrinks call bipolar disorder, what you and I know better as manic-depression. It affects people with various degrees of severity, but is most often characterized by moods swinging from euphoria, grandiose thinking, hallucinations and delusions at one end of the pendulum to tar-thick, suicidal depression at the other. That Phil came up with this idea of a monthly missive for other bipolars during his latest manic phase paints an entertaining trompe l'oeil of our flurry of communications. If his latest brainstorm lasts longer than his hypomanic phase--typically about four days--Phil may find an ever-expanding subscription list for See-Saw, or whatever he ends up calling it. Due to a variety of reasons--mental illness' lessening stigma, better diagnostic tools and, perhaps, an ever-widening lasso around what defines this particular disorder--more folks with manic depression are starting to survive, if not thrive, in the mainstream. Silicon Valley and the Bay Area are a hotbed. Phil is but one of at least three people in my circle diagnosed with bipolar disorder. There's my friend Kimberly, who's checked into the mental-health unit about four times in the past 10 years. Although we live a state apart, I know when a bad one is coming on. She's a live wire by nature, but every so often, those wires start crossing. She tells me of jumbled, racing thoughts and then, ominously, she starts ducking my phone calls. I know that the depression and shame are shoulder-to-shoulder, and it's time to put her someplace where someone else has the keys. Then there's my neighbor Stella, a delightful woman who creates stunning gardens around her hillside home. Periodically, she will drop by to visit late at night, breathless from her rapid-fire delivery of conspiracy theories. Once the mania told Stella that it was a good idea to jump on a plane to Europe and live on park benches for six weeks, which she did. She doesn't talk about it much, but people were kind to her, she says. Manic Stricken: Bipolars are in the good company of many well-known athletes, writers, actors and musicians. Deep End of the Ocean IT'S NOT THAT I'M LUCKY enough to surround myself with interesting high-intensity people, mind you. A quick check with other colleagues and acquaintances finds that just about everyone knows someone with bipolar disorder--even if they don't have a name for it yet. Harrison Pope, M.D., professor of psychiatry at Harvard Medical School, explains that the incidence of manic-depression in the general U.S. population--about 1 percent, or currently about 2 million people--has remained relatively constant throughout history. We're not getting crazier, opines Pope, it's that manic-depression is moving out of the shadows. He points to three reasons. "It's publicly more acceptable to reveal you have a psychiatric illness," Pope says. "Also, until the last 20 years, many with bipolar disorder were misdiagnosed as schizophrenic. And, there's been tremendous advances in treating bipolars." The illness' duality has been recognized since long before Freud and his profession showed up on the scene. "The ancient subcategories of madness tended to revolve around mania and melancholia," says Andrew Scull, Ph.D., a professor of sociology at UC-San Diego, who focuses on society and mental health. Manic-depression, like all physical or mental abnormalities, was seen through the prevailing culture at the time. "In the 17th century, there was an enormous range of explanations," Scull explains. "Like astrology, witchcraft, the devil or the divine." By the mid-20th century, many mental illnesses, including manic-depression, were thought to be treatable by a stint on the psychiatric couch, laying blame on one's forebears. "The amount of blame that those early models put on parent figures was great," says Scull, who notes that neurobiology's advent has belatedly removed Mom and Dad from many psychiatric patients' hit list. It looks more and more like Phil's dizzying heights and crashing lows emanate from his brain's synapses and neurons, from complex and still-mysterious biochemical interactions. Phil could blame his forebears if he wanted to; evidence is pointing a weighty finger toward manic-depression as a genetic disease. IF THE TRUTH BE KNOWN, bipolars are, generally speaking, in good company. It is no mere coincidence that Phil is a tremendously gifted writer, editor and musician, or that Stella paints masterpieces with lavender and salvia, foxgloves and dahlias. Pondering the link between madness and creativity has nurtured countless novels, biographies and, in the past 100 years or so, clinical studies. More recently, Johns Hopkins University School of Medicine professor of psychiatry Kay Redfield Jamison addressed this in a book that examines manic depression's relationship with the artistic temperament. Titled Touched by Fire (1993, Free Press: New York), it reviews studies that found depressive and manic-depressive illness in at least half of the well-known composers and visual artists reviewed. Another study found that 43 percent of writers interviewed suffered from bipolar disorder, compared with 10 percent among the control group. The fire of manic-depression has illuminated a long line of extraordinary talent, from Gustav Mahler to Kurt Cobain in the music world, from Gauguin to Georgia O'Keeffe on canvas, and from Dylan Thomas to Virginia Woolf in the written word. (See sidebar.) The narcissism and omnipotence that accompanies many a manic-depressive has also served many of the world's leaders, for better or for worse. Josef Stalin, Adolf Hitler, Theodore Roosevelt and Winston Churchill have all been posthumously diagnosed as bipolar. Peak Performance ALTHOUGH manic-depression appears wedded to the Muse, it is sometimes a short-lived marriage due to one of the illness's most devastating side effects: suicide. Phil and Kimberly tell me they periodically fight with the voice that says to end it all. Fortunately, they are still alive to do battle. On average, 20 percent of manic-depressives die by their own hand. According to a study in Jamison's book, suicide is almost 80 times more likely among patients with bipolar or unipolar (depressive) illness. On one hand, there is a brutal finality that Hemingway found at the wrong end of a shotgun or Plath found in her oven. But then again, there is mania's explosive high before it takes its sufferer over the cliff. "It's the only catastrophic illness that allows you to become euphoric and very creative over short periods of time," Phil explains when I call and ask him for more information about manic-depression. "It's like a cocaine high." Phil knows both real well. A manic episode propelled him to start a magazine for the AA recovery crowd while he was still drying out from a particularly bad bout of booze and cocaine. The magazine debuted at the height of the self-help movement during the mid-1980s and became a huge success. "I was at the peak of my performance when [the magazine] got established," Phil recalls, then sighs. "Unfortunately, your manic stages don't last." As with a cocaine high, what begins as euphoria, omnipotence and brilliance soon moves to a hundred different thoughts trying to shove one another out of the way. The mania snakes out of control like a runaway locomotive--restlessness, irritability, maybe violence or those voices that sound like they're coming from a cheap transistor radio, and eventually, lockdown. Or, if you work in the high-tech industry, back to writing more code. "I can work effectively even when I'm wigging, even when I'm hallucinating, even when I'm severely depressed," says Mike Crawford, a Santa Cruz-based software developer who consults worldwide. While the artist lofts of SoHo and studios of Tinseltown bask in the incandescence of manicdepression, Silicon Valley may run a close third as another safe haven for brilliant madness like Crawford's. "I chose programming so I could stay up all night," Crawford says. He has always had weird sleep habits, irregular hours that were stretched further by his manic episodes. Like many bipolars, Crawford's first experience was with disabling depression in his teens, which returned when Crawford enrolled in CalTech as a young adult. That darkness lifted by summer, and Crawford remembers feeling on top of the world. Although he had wanted to be a scientist his whole life, Crawford suddenly decided he knew all there was to know about physics and abruptly changed his major to literature. Such began the first of his rounds in hospitals, accompanied by what often happens in the early stages of manic-depression--a wrong diagnosis. Professor Jamison estimates that patients often live with manic depression for at least 10 years before it is properly diagnosed. Crawford was lucky; he was correctly diagnosed after that first year. However, that didn't keep the mania from busting through. "I've only gotten severely manic about five times in my life," Crawford figures, "but they've been whoppers." The past five years have been relatively quiet for Crawford. The answer for him--and many manic-depressives--is tinkering with medications, a process that can take years before the magical alchemy is achieved. For Crawford, freedom comes from letting people know about his illness. "If people are going to live with mental illness, someone has to do it," he shrugs. Crawford also put up a page on his website that addresses the relationship between high-tech work and manic-depression. "The response has been overwhelming," Crawford says. Although he tries to keep up with correspondence generated by the website, Crawford says he receives four or five requests a day for more information, often from other programmers who wonder if they are also manic-depressive. "Programming is more tolerant of eccentric activity," Crawford says. "Even though I might have been weird, I was a good worker." Photograph by George Sakkestad Bonanza Split: Marketing manager Diana Grippo, now under meds that work, channels her high-energy periods toward helping bipolar teens. Cycle Enthusiast LIKE CRAWFORD, Diana Grippo has found a comfortable niche in Silicon Valley, but that wasn't always so. She tried working for Intel, but its stark cubicles were sucking out her life. "No outside, no music, no plants--my soul was dying," Grippo remembers. She switched to marketing for a smaller company and, like Crawford, makes no secret of her illness. Although Crawford has had less than a half-dozen manic episodes in his life, Grippo is what is known as a "rapid cycler." "I used to think that the smell of a hospital gave me my period," Grippo says. "Then I realized that, every month when I was premenstrual, I'd get psychotic, arrested and locked up." She pauses. "It took me a long time to figure that out." Like Crawford, Grippo suffered a severe bout of depression when she was younger. When it finally lifted, the young woman was euphoric, then confused and finally, delusional. "Going up is really fun," she laughs. "If I could only bottle that feeling, I'd be rich." Although Grippo used alcohol to self-medicate the moods, she was two years sober when the madness drove her to homelessness. After almost two dozen hospitalizations, Grippo finally found the right recipe of medications. One would think that the ticket that gets punched over and over--jails, hospitals, institutions--would get a manic-depressive to seek out help when things start looking too good or too bad. But the reason that Grippo kept finding herself in handcuffs, or that Stella decides one morning to fly to Europe that afternoon, is something the professionals call "anosognosia" (pronounced ah nah sog no' see ya). It's the inability to recognize that the cheese is slipping off the cracker. Phil tells of the time he was escorted to a mental-health ward during one high-flying episode. Asked to provide information about himself and his illness, he could not stop at filling in the blanks. Instead, he edited and rewrote the intake form itself. "It's a biological phenomenon," Pope explains. "The region of the brain that is able to distinguish what is real is affected by the mania. Even those who've had several episodes of manic behavior can't tell [when an episode is imminent]." For manic-depressives like Phil, Mike and Diana, lithium, Depakote, Inderal, Risperdal and a dozen other concoctions marshal a thin pharmaceutical line between here and hell. But anosognosia isn't the only barrier to taking those meds. "If you think you're Jesus Christ," figures Pope, "why would you want to lose that?" Diana tells a particularly harrowing anecdote of being gang-raped while living on the streets. I watched Phil destroy a thriving business, burn through his elderly parents' life savings and tumble into a solitary life on disability. And still, I envy them those days of pure ecstasy and omnipotence--of not even being able to fathom the grip of insecurity and neurosis. "There's no fear," Grippo says. And how could there be, when the Almighty Himself had picked you to be His messenger? It's bad enough when the designated medications steal that. But imagine if the pills left in its place a flat and affectless emotional landscape, tremors, a perennially tinny taste in the mouth and nausea. This is the legacy of lithium, one of the first medications--and still the most commonly prescribed--for manic-depression. Since it began being widely prescribed in the 1970s, lithium has been replaced or supplemented by a wide range of medications. The good news is that each new generation of mood stabilizers is getting better. The bad news is that taking one's meds--whether it's for manicdepression or for bronchitis--is a weak spot in the human psyche. "Patients of all types are noncompliant," Pope says. "Epileptics throw away their meds and are surprised when they get a seizure. Diabetics don't take their insulin. It's just human in some ways." Despite the life-threatening nature of Grippo's mental illness, damned if that siren call of mania doesn't still beckon. "I know I still go up a little each month," says Grippo, "but I relish it." When the thoughts begin racing each month, Grippo starts writing. She harnessed those thoughts and ended up creating a program for at-risk adolescents called Spirits Underground. Using a documentary format to let kids tell their own stories, Grippo hopes to develop a television program focusing on teens who have been to hell and back. "I think it's one of the reasons I'm feeling better," Grippo says. "I knew I was supposed to do something for teenagers." Like virtually every manic-depressive, Phil put the bottle of lithium back on the shelf several times over the years, each time with disastrous results. But he was beginning to think that medicated life wasn't much better. Not long before our most recent series of communications, Phil had been sleeping--for about 14 months straight. A full day lasted about an hour and a half, and then it was back to bed. Forget about creativity; Phil was lucky if he could get his laundry done once a month. But with dogged prescription-shuffling, Phil started gaining a few more hours in the day. Then, in what must have been an inspired moment for the former voice of drug-free living, Phil lit up a joint one evening. The Muse returned, and Phil discovered he could summon just enough of the mania to be effective. Clinicians call it hypomania, that glorious phase for a bipolar when ideas flow like cool mountain streams, and the world is once again populated with fabulous, wonderful people. Life is good, but it hasn't reached meltdown good, where one jets off to Vegas and bets the house, or trashes the nearest police precinct. Phil is convinced that marijuana allows him to achieve every manic-depressive's dream--a controlled "up." These herb-induced hypomanic states are no doubt couched in a grander, more long-term curve of generally feeling better. But Phil isn't about to look this gift pony in the mouth; he smokes and writes, happily churning out page after page of his autobiography. Phil tells me his psychiatrist finds this herbal therapy "interesting." But shrinks are good at sitting back, waiting to see if the patient's experiment succeeds or fails. Photograph by George Sakkestad Swing Shift: Software developer Mike Crawford says the demands of some high-tech jobs use his manic episodes to full advantage. Designer Labels MANIC-DEPRESSION PLAYS out along a wide spectrum--and perhaps growing wider all the time. Unlike diseases with physical markers--diabetes, for example, or HIV--bipolar disorder requires a best-guess diagnosis based on a constellation of symptoms. According to Pope, delusional and hallucinating manic-depressives were often misdiagnosed as schizophrenics, resulting in ineffective treatment. Then there's the milder weather down at the other end of the range. When I mentioned this article idea to another acquaintance, she announced, "Well, I'm cyclothymic, you know." Yup, cyclothymia is tucked away in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, that bible of mental dysfunction put together by the American Psychiatric Association. Cyclothymia's description--"presence of numerous hypomanic episodes ... and numerous periods of depression"--sounds suspiciously like what you and I used to call moody, intense. What Sinatra crooned as "riding high in April, shot down in May." In short, about everyone nowadays who hasn't found better living through Prozac. "At what point do you pathologize that?" asks UC-Berkeley's Scull rhetorically. "All of us have elements in our lives that we would wish elsewise. There's some comfort in 'It's not my fault.' " While my cyclothymic acquaintance may find solace in a label to hang her hat on, Phil thinks his mental illness sucks. "I wouldn't wish manic-depression on my worst enemy," he says flatly. He ticks off the ruined marriages, the nut wards and a booze-pickled liver as casualties in manic-depression's devastating path. But Phil has a theory, one also pondered by Jamison in Touched by Fire. "They're probably going find the manic-depressive gene one day," he figures. "And when scientists do, one of the first things they're gonna want to do is weed it out. "And when they do," Phil continues, "It's going be a much more mundane world. How many more Beethovens will there be?" [ San Jose | Metroactive Central | Archives ]