The Meadows Blog

By Stephen Brockway, M.D.
Staff Psychiatrist for Inpatient and Outpatient Services at The Meadows

A college student whom we’ll call Jim is experiencing a profound sense of despair. Dragging himself out of bed is becoming increasingly more difficult; brushing his teeth is a tall order; fixing himself a sandwich seems insurmountable; and doing his homework is too much to ask given his bleak emotional state. As his symptoms progress into an even more downward spiral and become more debilitating, Jim discovers through trial and error that taking a potpourri of uppers such as cocaine, speed, and self-prescribed amphetamines helps to ease his depressive symptoms. In his quest to devise a creative solution to his dilemma, he never considers he could be facing a psychiatric illness such as bipolar disorder. Months later, Jim’s mood shifts and he becomes restless and agitated. Thoughts of leaving college to become a racecar driver sound appealing – and reasonable. Sleep isn’t on the radar. Jim feels ecstatic as if he’s the big man on campus and believes he’s the quintessential heartthrob. He spends excessive amounts of money on women he barely knows and is on the path to financial ruin.

Soon though, his thoughts begin racing so fast he can’t concentrate or focus. He’s unable to sit still and it’s unnerving. Jim figures out that a cocktail of alcohol and Valium can calm him down. Though, he begins to need more and more of both of the above to achieve the desired effect, and he begins spending an excessive amount of time (and money) at bars or at home with bottles of pills and alcohol in hand.

There’s a saying that goes, “All of our problems started out as solutions” – and this scenario fits the bill. Jim’s attempts at creative problem solving have gone awry. As Jim continues to self-medicate in an attempt to balance out his highs and lows, he needs more of these uppers and downers to regulate his symptoms. Jim believes he’s doing himself a service by self-medicating and spends a good deal of time trying to keep his fluctuating moods in check.

At the same time, Jim’s life is passing him by. He isn’t enjoying his precious youth, his peers, potential love interests, and the invigorating atmosphere of college life. The abundance of beauty in the world escapes him – genuine laughter, the kindness of others, and the miracle of feeling truly alive – aren’t in reach.

The severity of his depressive symptoms finally brings Jim into the medical clinic on campus where he is diagnosed with depression. This sounds like a reasonable diagnosis. The symptoms conveyed by Jim to the physician on campus certainly fit the criterion for depression. What the physician doesn’t know is that Jim has a family history of bipolar disorder and, in the past, has also experienced manic symptoms. The physician only captures a fragment of Jim’s medical picture. It’s important to note that individuals with bipolar disorder may suffer from hypomanic and depressive episodes (which are indicative of bipolar II disorder.) Hypomanic behavior is not as severe and pronounced as the full-scale mania associated with bipolar I disorder.

After his doctor’s appointment, Jim is handed a prescription for antidepressants and his depression soon lifts – but is followed by a manic episode. The antidepressants, he believes, have done its job, so he figures he doesn’t need any more meds. Jim now feels energized, invigorated, and ready to conquer the world. He is, once again, the big man on campus. This, he believes, is the way life should be. It feels good.

This scenario plays itself out over and over again during the next ten or so years. Unfortunately, depressive episodes tend to worsen with age and persist for longer periods of time. One reason for this is that people experience more losses – deaths of loved ones, health problems, and employment issues – as they age.

During Jim’s manic episodes after graduate school, he accumulates major debt causing friction in his current relationship and stress on the financial front. His life is unraveling and his dependence on drugs and alcohol escalates. Life has become unmanageable.

The grim reality is that Jim is not alone. Many people – especially young people – with undiagnosed bipolar disorder become addicted to drugs and alcohol in an attempt to self treat a wide range of symptoms. Unable to thrive, it’s the only way they feel they can survive. What once seemed like a perfectly logical solution to these mood swings is now its own problem. Drug and alcohol addiction is no stranger to people suffering from bipolar disorder.

Ten years after college graduation, Jim finally consults with a seasoned psychiatrist and is accurately diagnosed with bipolar disorder. He is put on an appropriate medication regimen and now must also seek help for his drug and alcohol abuse.

Jim’s story is not uncommon. One of the greatest tragedies of bipolar disorder is that many people who are afflicted with this serious and debilitating condition are often diagnosed ten or more years after the initial onset of their symptoms. It is estimated that people with bipolar disorder are up to 15 to 20 times more likely to commit suicide than the general population. Many people with bipolar disorder are great talents in the art world – writers, painters, and comedians. Such individuals add flavor, color, and a sense of style to the world, and it’s sad to hear about all the hardships they’ve endured during their lives. What’s more, Abraham Lincoln and Theodore Roosevelt are said to have suffered from bipolar disorder.

What’s most unsettling is that bipolar disorder is treatable. Becoming aware of the symptoms of bipolar disorder is instrumental in securing an accurate diagnosis. Family history is an integral component in the process, along with obtaining a complete medical history. Looking at just one piece of the picture can result in a faulty diagnosis.

The Meadows Can Help

The Meadows psychiatrists and other members of our clinical team have helped and continue to help individuals with bipolar disorder, many of whom also struggle with substance abuse. The good news is that help is available. There’s no reason why such individuals have to miss out on all the beauty and splendor in life – falling in love; doting on newborns; exploring foreign lands; forging life-long friendships; and learning to love themselves for who they are no matter how many struggles they’ve endured over the years.

Feel free to contact The Meadows Intake Team at 800-244-4949 or visit us here. We’re the most trusted name in treating addiction, trauma, and co-occurring disorders. Give us a call if you or a loved one is in need of the best available care. We’re here for you.

Published in Treatment & Recovery

How many significant figures of history actually suffered with PTSD? We may never know. The diagnosis, now part of our collective 21st century lexicon, did not exist before 1980. Many historians point to the Civil War with the description of Soldier's Heart as the earliest attempt to describe emotional consequences of war. Jonathan Shay wrote about warriors from Greece who incurred the invisible injuries we now diagnose as PTSD. The earliest medical descriptions of PTSD started in the 1830s during the early era of railroads. Numerous collisions and explosions resulted in a condition called "Railway Spine", something akin to mild traumatic brain injury at first, but later described as a psychiatric condition consistent with PTSD.

Did Clara Barton suffer with PTSD? On the basis of Melinda Henninberg's article, (, I would say it was quite likely. More importantly, what can we learn from Clara Barton's rather extraordinary life? I think there are many lessons applicable to modern observers:

  • Her childhood was filled with fear. She grew up in a chaotic and likely violent family. The article describes pervasive and dramatic mental illness, a sister locked away and a brother who committed suicide; another brother robbed banks. As noted in her diary: "In these later years I have observed that writers of sketches, in a friendly desire to compliment me, have been wont to dwell upon my courage, representing me as personally devoid of fear, not even knowing the feeling. However correct that may have become, it is evident I was not constructed that way, as in the earlier years of my life I remember nothing but fear."

Does growing up in a dysfunctional family better prepare you to survive during war, chaos and/or insanity? There is no absolute answer to this question, but a dysfunctional family may actually help you endure the unmanageable. No exotic constructs needed here; if you grew up having to dissociate to survive, you may simply have "more practice"- the equivalent of early military training. Conversely, some individuals are less prepared for chaos if they grew up in a "crazy" family. A lot depends upon context, types of stressors, etc.

My personal observation is that a dysfunctional family background may make you stronger during a crisis, but in the long term it might make recovery, or at least a balanced recovery, much more difficult. Early studies conducted at the University of Minnesota described a population of "invulnerable children". These were kids who grew up with schizophrenic and alcoholic parents but did not have overt problems as adults. In fact, many were highly adaptive and showed no signs of outward difficulty. When this population was studied more closely, researchers learned that outward coping masked many harsh consequences. They later gave up their quest and decided "invulnerable" was a flawed concept. On the flip side, growing up in a safe and nurturing family is no guarantee you will not develop harsh symptoms. We need to consider multiple variables- including frequency of exposure to trauma, intensity of the trauma, duration of the trauma and age of exposure. Invulnerability is a seductive illusion, but even those who look intact may endure severe suffering.

  • Clara Barton's father may have had PTSD. This may be mere speculation, but as noted in the article: "Her father, Capt. Stephen Barton, had served under "Mad Anthony" Wayne in the French and Indian War, and "his soldier habits and tastes never left him," she wrote. He and Barton's mother, Sarah, "... fought loudly and often." It is not unusual to see multi-generational trauma transmission. This is something rarely studied but worthy of serious consideration. When PTSD rates in current and past wars are sited, we really should include the family unit. Like so many conditions, PTSD becomes a family problem. Nihilism, cynicism, anger and emotional unavailability are features we often see. Overt family violence is not necessarily an outcome. In fact, emotional distance and avoidance is what we most commonly see, along with intermittent outbursts of anger, often directed at others (road rage is a common phenomenon). The likelihood of physical violence seems directly related to the use or non-use of alcohol and other drugs.
  • Clara may have also struggled with the bipolar disorder, a condition that is now known to have strong genetic foundations. Clara's brother committed suicide and her mother displayed possible features consistent with a mood disorder. Kay Jamison excellent book, Touched with Fire describes many figures of history, including Churchill, Lincoln and Hemmingway who probably suffered with the bipolar illness, often mistaken for simple depression. The swings of mood Clara described followed by fits of amazing endurance fit with patterns observed with the bipolar illness. In addition, risk of suicide is also much, much higher with those who so suffer. It is important to note that the bipolar condition increases risk for alcoholism and addictive disorders. It also increases risk for suicide, and the depth of depression is far in excess of situational depressions. Making this more exotic is the fact that PTSD also mirrors the extreme swings in mood we see with PTSD. Emotions and impulse rule, and dramatic shifts are quite common. Finally, alcoholism mimics the swings in mood observed in PTSD and Bipolar Disorder. And one more addition to this complexity: mild brain trauma (mTBI) mimics symptoms of PTSD, mood disorder and alcoholism. The bottom line for readers and diagnosticians: many of these conditions travel the same path and are hard to differentiate, even in the modern era.
  • She likely had problems with trust, attachment and relationships. Not much detail is provided in the article, but Clara never married. Out of the thousands of young men and officers she encountered, she fell in love with a married Union captain who was already married. I cannot speculate as to her actual attachment pattern, but I can say that individuals with early childhood trauma tend to avoid attachments with those who are available and loving, and too often chase the impossible or abusive partner. More of this will be reviewed in subsequent blogs, but for now, problems with core attachments and "recapitulation" of childhood rejection is an almost classic consequence.
  • Working with those injured or dying can produce PTSD. Originally, it was believed that in order to develop PTSD you had to have first-hand exposure to death and violence. If a bullet or rocket did not come toward you, how could you possibly develop PTSD? We now know that direct violence is sufficient but not necessary in the development of PTSD. Many studies show that those who clean up the aftermath of train wrecks, car crashes and fires have a high rate of PTSD. In fact, medics, nurses and physicians have very high rates of PTSD. It is a core principle we now accept: being witness to or part of the aftermath of violence can be as toxic as direct exposure to violence. Those who prepare or transport the dead are also vulnerable, even if they never heard a weapon fired in combat.
  • She found meaning and relief in her work. This is perhaps the most valuable lesson we can discern. As noted in the article "Her diaries (later discovered behind the wall in her former Glen Echo home, now a national historic site) reveal that she self-medicated through service: She used the most intense, bloody work imaginable to keep the "thin black snakes" of sadness from closing in." While sited in the article as an antidote to depression, Clara's dedication to helping others - at first her brother and later countless others - is a great example of "giving back" as a method of healing. I refer the reader to Victor Frankl for a more complete discussion of this potent factor in human survival and transcendence. Finding meaning by helping others is exceptionally effective, but Clara's story demonstrates another vital lesson. Any single strategy applied in excess may leave you exhausted, alone and struggling in isolation. As with all healing factors, helping others and finding meaning should be done as part of the journey of finding or rediscovering balance- emotionally, interpersonally, cognitively and in terms of meaningful action. Even good work can become excessive, unbalanced and perhaps shift from "self-medication", as noted by Clara, to a near addictive pattern depriving you of the satisfaction and balance originally displaced by exposure to trauma.

Clara Barton, the founder of the Red Cross, and her struggle with the "black snakes" of depression, illustrates the complex consequences of exposure to and immersion in trauma. While she lacked comprehension to describe the extent of her suffering, her self-described "depression" was insufficient in capturing the multiple and complex symptoms of what we would now call PTSD and co-occurring disorders. Ironically, Clara Barton"s symptoms propelled her into an excessive, perhaps addictive attraction to violence and war, providing her partial relief and affording comfort and relief to millions as well.

Jerry Boriskin, Ph.D, a Senior Fellow at The Meadows, has been at the forefront of the treatment of PTSD, addiction, and co-occurring disorders for more than 30 years. He is the author of several books, including PTSD and Addiction: A Practical Guide for Clinicians and Counselors and At Wit's End: What Families Need to Know When a Loved One is Diagnosed With Addiction and Mental Illness. For more information about Dr. Boriskin, please visit his website at

For more about The Meadows'; innovative treatment program for PTSD and other disorders, see or call The Meadows at 800-244-4949.

Published in Blog
Thursday, 28 April 2011 00:00

Just what is Bipolar Disorder?

Just What Is Bipolar Disorder?

Catherine Zeta-Jones, Carrie Fisher, and Demi Lovato are among the celebrities to recently share with the public their struggles with bipolar disorder. Just what is Bipolar Disorder?

First, we should take a look at the big picture. Psychiatric diagnoses fall into several main categories, which include mood disorders, anxiety disorders, personality disorders, psychotic disorders, substance-related disorders, and others.

Bipolar disorder is one type of mood disorder. Others include depressive disorders, dysthymic disorder (a milder form of chronic depression), and cyclothymic disorder (frequent periods of highs and lows that are not severe).

There are different types of bipolar disorders; the two main types are Bipolar I Disorder and Bipolar II Disorder. Both include symptoms of mania or hypomania and may include periods of depression.

Bipolar I is the more severe type. People who have this disorder experience manic episodes - distinct periods that may be marked by expansive mood, need little sleep but feel well-rested, may develop grandiose notions, hallucinations, delusions, racing thoughts, pressured speech, intense activity, and poor judgment.

Such disturbances cause marked impairment in sufferers' work, home, and social functioning. Actress Carrie Fisher told USA Today, "A manic phase is not predictable... The last time, I hacked off my hair, got a tattoo, and wanted to convert to Judaism." People who have Bipolar I Disorder may also experience episodes of depression.

Bipolar II Disorder is a milder version of Bipolar I. Sufferers may experience symptoms similar to manic episodes, but are less severe. These are called hypomanic episodes. People who have Bipolar II do not
have hallucinations or delusions, and their symptoms are not severe enough to markedly impair their work or social functioning.

Bipolar I and II are thought to manifest in people who have a genetic predisposition. Even so, some stressors can worsen the symptoms, but they can be minimized. For example, Catherine Zeta-Jones told the press that stress from her husband's illness worsened her Bipolar II symptoms. She wisely obtained treatment soon after her husband's medical condition improved. Another common problem that can recipitate or worsen bipolar symptoms is a lack of quality sleep. Quality sleep is much more important than most people realize. In our country, people often sacrifice sleep in order to take care of other matters.

Mood-stabilizing medications are usually very helpful in treating these disorders. However, practicing good daily self-care can be one of the best deterrents in minimizing hypomanic episodes. This involves maintaining a healthy sleep schedule, using good talking/listening boundaries in interactions, maintaining self-esteem without going "one-up" or "one-down," and minimizing stress.

Thanks to the recent rash of celebrities talking with the press about their struggles with bipolar disorders, more people in the public may feel safer seeking treatment for their illnesses.

Shelley Uram, MD is a Harvard trained, triple board-certified psychiatrist who speaks nationally and internationally on topics related to psychological trauma, the underpinnings of depression/anxiety, and spirituality. Dr Uram conducts lectures, workshops, and seminars to audiences across the United States and co-facilitates lectures and workshops with Pia Mellody. At The Meadows, Dr. Uram conducts many of the patient lectures, provides ongoing training and consultation to the medical and clinical staff. Dr. Uram is a Clinical Associate Professor of Psychiatry at The University of Arizona College of Medicine, and treats patients at her office in Phoenix Arizona.

Published in Blog

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