RealMental

Yeah, hi.  That’s me.  I know I’ve been away for a while, but what better occasion for a return than to tell the world just how horrible a person I am?

My bipolar husband, despite doing all the right things, has been deep, deep, deep in an atypical (for him) depressive cycle for at least the last six months.  It’s actually probably lasted longer, but that’s about how long it’s been debilitating to the point that he can’t work or maintain normal function.  I won’t go into details about everything that’s been tried for him so far, but let’s just say it’s been a LOT.  And that he has cooperated whole-heartedly with every treatment, regardless of how horrible the side-effects may be, because he wants his life back.  Badly.

You know, depression has never been the bugaboo for us.  It’s always been the threat of a manic episode that loomed nearby, and kept us ever-vigilant for the slightest symptoms and early-warning signs.  It’s mania that has scared the stuffing out of us both, because we both know that a good, strong florid mania is capable of ruining our marriage and our family, despite whatever good intentions we may have.  Mania has always been, for us, the Other in our marriage–a beast to fight and fear.  I even used to joke, “Where is the other pole in this bipolar disorder?  I think we could use a swing toward depression right now!”

Ha, ha.  It’s not funny any more.  I am so sorry, but I really had no idea.  I thought I did, which now is very nearly hilarious–I thought I “got it.”  I didn’t.

I did not anticipate, in my wildest dreams, the depth, the blackness, the despair of this depression.  That it could affect my brilliant spouse’s cognitive abilities and physical coordination.  It’s like a malicious, transient form of brain damage, really, and stunning in its power.

And my response to it has been, well…less than stellar, at least lately.  I have been so wrapped up, in the years since the diagnosis, in watching for and combating the manic side of the spectrum, that the depression caught me completely flat-footed.  My troops were all amassed at the Hypomanic Border, and the few straggling sentries and scouts who brought reports from Depressive Kingdom were brushed off as insignificant, or addled.  If only I’d known.

Who knew–turns out that my moods cycle, too.  And that cycle, in regard to my mentally ill spouse, appears to go something like this: Patience, understanding, patience, kindness, patience, concern, patience, frustration, worry, frustration, resentment, impatience, fear, deep frustration, RIP YOUR HEAD OFF AND DISEMBOWEL YOU WITH UNKIND WORDS.  Nice, huh?  I honestly, and truly suck.

That’s right–when a loved one is down lower than you can even imagine being, why not give him a good swift kick, you know, as long as he’s down there?  Go ahead, vent your spleen–after all, you have feelings, too, right?  And you’ve bottled this up for so long, why save it for therapy?  I’m sure that the person who is clinging to you like the only life-raft in a raging sea of misery won’t mind ONE BIT.  Let him know just how displeased you are with this whole depression thing, because almost certainly he’s been doing it ON PURPOSE, and just needs to feel your wrath, resentment, and maybe even a smidgen of contempt, to snap right on out of it, get back to work, smile, and be happy!  RIGHT?

I feel about two inches tall, and I’m so, so sorry.  I wish that what I’d done was to recognize and appreciate the things that he is amazingly ABLE to do right now, even through a thick black fog.  That is true courage, and I DO see it.

Going back to my best attempt at being positive (which is where I should’ve stayed all along, more’s the pity), we’ve pushed the doctors to make some fairly radical (for us) and frightening  (for us) changes in medication regimen, and I can’t help but think that something’s going to happen soon.  It may be too much, but at this point, anything different will be welcome, at least at first.

One of two mood stabilizers has been removed entirely, as has the benzodiazepine.  This will be the first time since diagnosis without Depakote and Klonopin.  This is terrifying.  To exponentially enhance our trepidation, factor in a huge increase in anti-depressant dosage.  Now, realize that this is exactly the time of year when the “ramping up” usually begins, and you have a real “YIKES” element going.

Of course, this is all pretty much what we asked for.  Much the same way ECT jolts the brain out of a repetitive, destructive pattern, we’re hoping to shake up the med cocktail SO much, while at the same time hopefully harnessing some of that very manic energy that we normally fear so greatly every spring, that my dear husband’s brain will HAVE to let go, and emerge from the depths.  I’m just hoping that we have time, once the climb begins in earnest, to get the lid on before it’s too late.

I’m also hoping to be less of a jerk about the whole thing.

It’s been a rough spring around our house. But at the same time, it’s been better than each one before it. So I feel like I should be grateful, and I feel guilty for feeling emotionally exhausted all the time, but there you have it. I feel what I feel, and it is what it is.

I belong to some support groups for “significant others” of people with bipolar disorder, and I can tell you from years of observation and experience that, among our ranks, May is a rough, rough month. In a bit of black humor, someone somewhere began referring to this month as “May-NIA,” and that stuck. Even my own spouse, who is faithful and dedicated to his mental wellness, and takes his meds and tries to stick to healthy routines, has periods of “breakthrough” hypomania in the spring. Do what we will, the force of springtime will not be denied. Every year I’m struck with jealousy over other people’s rejoicing in the coming of spring…they’re planning their flowerbeds, washing their windows, de-winterizing their mowers, while I’m monitoring the bank account, trying to keep things quiet, and generally just scattering a fresh layer of eggshells across the floor for us to walk on. I dread spring. And to be honest, I resent having to feel that way.

In the beginning of our journey with this illness, post-diagnosis, I lived in a state of wary watchfulness. In the first year, there was a significant relapse, so after that I was pretty much in constant readiness, watching for that sign that would indicate that everything was about to go south again. If he was 5 minutes late, or didn’t answer his cell phone one time, I just knew that “it was happening again;” that he’d disappeared, he’d “run,” and that, since that was the line I drew in the sand when we decided to stick this thing out together, that our marriage would, consequently, be over. I literally went through this entire thought process on a regular basis. It was a long, long time before I could make myself continue to breathe normally in the face of even a small unknown. But I learned, as time went on, how to focus on myself, to trust myself, and to breathe.

As more time went by with no full-blown episodes, something odd happened. I did manage to stop living mentally perched on the precipice of disaster. I remembered who I was before I ever tangled with bipolar disorder. I realized that I’m smart (enough), capable (enough), and tough (enough) to handle whatever it could throw at me. And with that knowledge, I relaxed. A lot. But I didn’t anticipate what came next–what has been happening for the last couple of years.

My husband has expressed to me, often, the irony of managing a mental illness well–that is, that since he stays on top of his medication regimen, sees his doctor regularly, performs well at a regular job, etc., that people tend to “forget” that he has bipolar disorder. Then, when there is an episode of breakthrough depression or hypomania, the reaction is one of disappointment, like, “I thought you had this thing beat.” No one understands that it’s an ongoing, daily battle, and that there is no magic pill that’s going to work all the time. We “tweak” his med cocktail once or twice a year, at the very minimum.

I have caught myself falling victim to this same phenomenon, in a way, and I’m not sure it’s any better than the way I used to live. Instead of being constantly on edge, expecting things to fall apart any second, I now let even a couple of weeks of good times lull me into near-total complacency, so that, when there is a bump in the road, as there most assuredly always will be, I’m left gobsmacked, the rug pulled entirely out from under my happy little world. Every time this happens, I feel so stupid, because, of course, I knew better. But it is so altogether soul-wearying to live in that watchtower, that sometimes I just desperately want to come down for a while. To stay up there, watching, watching, watching, is to admit defeat, in a way…but more than that, that sort of life is really no life to have. It’s not just emotionally tiring; I can feel it chipping away at my physical health, with all sorts of symptoms I never knew before I met bipolar disorder, like anxiety, panic, depression, irritable bowel, nausea…this disease that I don’t even have is shortening my life.

But the alternative–life without my husband? No, that’s no life for me, either. Somewhere, somehow, there must be a way to find balance. I wish this post were more about answers.

That you are more irritable, more angry, every day.

That I am not The Enemy.

That I am here because I choose to be.

That there are so many landmines around currently, I can’t take a step in any direction without setting one off.

That I have made, and continue to make, sacrifices of myself in order to be with you.

That I make these sacrifices because I love you.

That I do not feel like a martyr.

That  following a burst of anger just before bedtime, while you go to sleep with the aid of sedatives and sleeping pills, I am left awake, crying, hurt.

That I don’t have anyone to confide in–not really–partly because I want to protect the way you are perceived by others, and “this” is not “you.”

That I feel very, very alone.

That I temper every single decision I make, no matter how seemingly insignificant, with what possible effect it may have on you.

That I resent not only not being able to look forward to Springtime, but having to dread its coming.

That I feel like I’m being “used up” faster than I should be.

That when I am sick, like I am now, I try to somehow “schedule” my illness and treatments around what I think you can handle.

That I sometimes feel trapped, even though intellectually I know that I’m not.

That I have learned more than you’d believe about detachment.

That I refuse to be manipulated by The Bipolar Beast.

That a great deal of my strength in dealing with these bad times comes from knowing that I am only here by choice, and that the power to stay or leave is all mine.   I can say “I don’t have to take this,” and mean it.

That the fact that, so far, I have chosen to, and have been able to “take this,” does not mean that I always will be able to.

That you do keep getting better.  Even the worst times now are better than the best times “then.”

That I appreciate when you try.

That I understand that it is hard.

That I KNOW it’s not fair.

That I am your single most loyal ally on all of God’s earth.

That if I don’t figure out how to get some of myself back, there won’t be anything left to give to you.

That by the time you could read these words with understanding and empathy, they will no longer be relevant, because you’ll be “yourself” again.

That I’m not sure how long I can hold out waiting for that time to come this year.

You know how in action movies, when there’s a bomb set to detonate any minute, and they call in the bomb squad, there’s always that tension-heavy scene with the guy defusing the bomb? You know the one I mean. He’s got all these wires, and he has to cut one to de-activate the explosive device, but there always seems to be some doubt as to which wire it is. He hovers his snippers over one, then the other, having a debate with himself: “Is it the red one? No, I think it’s the blue one. No, definitely red.” He looks like he’s on the edge of a heart-attack, and rightfully so, because if he snips the wrong wire, then KABLOOEY.

Well, I feel like a bomb squad guy sometimes. Only I seem to have MUCH less information about the construction of the bomb, and even if I do manage to snip the right wire, it may stop the immediate threat, while merely re-setting the bomb to go off at another time. And here’s the Big Stupid: Sometimes I see the right wire, know what I can do to at least make the clock stop ticking…and I don’t do it. Because it would hurt my pride, or my feelings, in some way. Most usually it would require me to, you know, SHUT UP. And I’m not such an expert at the shutting up.

We’ve recently had a bomb squad incident in our life. Everything’s OK now, crisis averted, no one went off the rails, nothing exploded (well, maybe some small explosions, but nothing nuclear). But while it was going on, it was miserable. We were both miserable. And I couldn’t help, which is frustrating. I could keep from making it worse, but that was about all that was in my power. Part of the reason that I couldn’t help is because I was faced with thought processes that, to me, just did not make any sense. There were questions I couldn’t answer, because I simply could not view them in a rational light. Most frustrating of all, things kept going in circles–there was no logic which could prevail that would lead, in a linear fashion, to a CONCLUSION. For someone like me, this is crazy-hard.

I like to think I learned a little from our recent difficulty, and I hope that I can utilize it in the future. But, MAN, is it ever not easy. I have long known that there are certain “symptoms” of what I think of as “bipolar logic,” and also that there is no use in trying to circumvent that thought process in my husband. It won’t last long, and if I can just SHUT UP and ride it out, and not feed into it or make it worse, it will be over even faster. Have I mentioned how difficult that last part is for me? The shutting up part? Because it is. Particularly suppressing the impulse to say, “You are acting like a CHILD,” which, as you can imagine, really helps things get resolved. /sarcasm.

For me, dealing with a problem goes something like this: See problem. Recognize source of problem. Evaluate whether anything can be done toward solving problem. Take what steps I can to actively accomplish those things, including engaging the assistance of others who might be able to help with problem. Move on. Admittedly, with me, there’s a lot of anxiety and stress wrapped up in this process, but I don’t waste a lot of energy on things I can’t control–I concentrate my anxiety on the things I can do something about.

This is not far from my bipolar husband’s approach to problem-solving, either…eventually. But first, for him, a stressor is a “trigger.” It puts his brain into a fight-or-flight mode that is counter-productive to the problem-solving process. He stalls after that first stage, and gets caught in a loop of arguing with the problem, usually about how unfair it is. He gets combative, first railing against the upsetting thing itself, then eventually at me, because, you know, I’m THERE. I’ve gotten better at not taking this personally, though I won’t lie and say it doesn’t hurt. In my mind, I’m his ally, his supporter, his #1 fan, me and him against the world, but for a little while in his mind, I am “other,” and I am, like everyone and everything, “against” him. I really hate that part.

After this last storm passed (and you know, I should mention here that TREMENDOUS progress has been made by my husband in the last few years, and that things that would have previously sent him into weeks-long tailspins now maybe just partially derail him for a day or two), and Alex was apologizing to me for his misplaced anger and hostility (he doesn’t call me names or abuse me in any way–he just directs some of his anger at the only other person around: me), I took the opportunity to ask him, “When this was going on, and you were going around and around in circles with your thinking, and lashing out about things–like the weather–that no one could control, what would have been a response from me that would have helped in any way?” He didn’t have an answer for me. I asked, because, when a storm in brewing in his brain, there really seems to be no “correct” response that I can make–no matter which wire I snip, something’s gonna get asploded.

I’d like to think that I’ve at least gotten better about not making the explosions BIGGER, which I used to do with no small frequency, pushing buttons that I should have been mature enough not to push, especially since I was supposed to be the “rational” one, whatever that means.

Support groups, online forums, and written resources everywhere are full of advice about how not to escalate irrational behavior, or at least how to remove yourself from the equation. I’m pretty much all set there. I know all the buzzwords and phrases: Detach, Do Not Engage, Take Care of Yourself. That’s all fine and good. But–and here is where I expose my inner co-dependent who never really goes away–when someone I love is in pain, and is suffering due to non-productive anger and frustration…isn’t there something, anything that I can do to alleviate that at the time, instead of just retreating to an emotional storm shelter and waiting it out?

Ironically, these questions have only just begun plaguing me since the “bad times” have become far less frequent, less lengthy, and with less lingering aftereffect. Maybe I’m fooling myself into thinking, since things are so much better, that if I just had a better bomb squad, we could avoid this kind of tension altogether.

Does any of this make any sense at all?

I wrote this in part (in comments) on Belinda’s post about Kendra’s Law and wanted to elaborate considerably:

My 15 year old cousin is showing severe signs of Borderline Personality Disorder and Bipolar. My grandmother’s mother seems to have had it, my mother had it, and now this (female) cousin.

This isn’t teen angst – we all know what that is – it’s clearly, most certainly, 100% Borderline Personality and possibly Bi-polar. BPD isn’t often alone.

She has left home, is living in a drughouse with her 18 year old boyfriend, is violent to the point of knocking my 26 year old female cousin out with a glass mug. She skips school, swears at everyone, yelling, screaming death threats and worse, and at times is docile, shy and sweet.

There are rumors flying through her small town that she has been promiscuous and involved in sexual experimentation with more than one person at a time, been filmed, and possibly took money for favors.

Her parents (my uncle is the brother to my mother) have gotten her an appointment with a psychiatrist at a high financial cost and just tonight, she agreed to go. Here (we aren’t in the states) there are no laws to force anyone of any age into treatment. Even despite my cousin having hurt family members and completely outlining to her sisters how she is going to kill them in their sleep – detail by chilling detail. The only way they could force her into help should she change her mind now is to call the children’s aid authorities and place her in a group home — and obviously that is a mess they don’t want to bring on to the family, reason one being that they would lose her trust and possibly lose her forever.

We tiptoed around her at Christmas, with my grandmother agreeing to send food with her to the boyfriend’s drug house, just to avoid an eruption. Had she said no, we are certain this cousin would have gone crazy for not getting her way.
Everyone in the family is terrified of what she will do if her parents force her to give up the boyfriend and come home. She is a time bomb at all times.

If she hadn’t agreed to see this professional, I really don’t know what my uncle and aunt would have done. I do hope she gets the help she really needs, which will include therapy and drugs, probably for the rest of her life.

Her appointment is in January and all of us are holding our breath, waiting for her to blow up at her parents the next time around and refuse to go. If she does go, this could all go sour anyway – she is an expert liar and we have no idea what will come out of her mouth. Her recollection of angry outbursts are minimal, or she claims to remember nothing. She takes no accountability for any of her actions, she owns no blame for her situation and everything is someone else’s fault. She would rather live in the boyfriend’s drug filled, filthy, dangerous apartment, where his female roommate deals crack cocaine, and have the boyfriend’s roommate (another female) pick on her, use her toothbrush to clean the toilet and be abused in the house she is in, then go home and be without boyfriend. We as a family simply don’t understand this self abuse.

When I reached out to her, I was slapped in the face with “I’m smart and strong. If I need help, I’ll tell you. Stop worrying.”

I’m trying hard to understand how both my mother and my cousin ended up this way — both have been raised in loving homes, free of abuse and full of family time and lots of love. I welcome any insight, advice, whatever.

My next therapy session is mid-January and my focus has shifted to my cousin so I haven’t really thought too much about the re-telling of history I have been doing with the therapist. She did mention EDMR as a therapy we might try for me.

Reading Belinda’s thought-provoking post about forced commitment and medication, and the thoughtful comments people have since made, caused me to think a little bit more about how medication, while a lifesaver when appropriately prescribed, is only the first step.  Once you’ve gotten past the big ifs of a proper diagnosis and a proper prescription, you’ve got to be willing to use the equilibrium that the meds bring you to eradicate the mindset that meds are a “cure,” rather than merely a means toward maintenance and repair.  It’s my personal opinion that even the mentally ill person whose “only” life trauma is the toll of the disease itself has serious mental work to do, adapting to the concept of being “mentally ill,” redefining their sense of self around the diagnosis, and adapting to the medical and emotional features of their long term diagnosis.  The grief, regret, relief, anger and confusion that come with a proper diagnosis can’t be overstated, and it’s not something to be gone through without the aid of a therapist.  Too, medications don’t work forever– even once you’ve hit on a good combination, it may not work indefinitely– and being able to identify that your mood is changing despite being good about your meds is crucial.

From my own experience, I’ve built up a variety of coping skills to deal with my anxiety, depression, and need to people-please that are very unhealthy and counterproductive as I approach the worst end of my depressive spectrum, and it’s hard for me to recognize, when I am in the midst of a depressive phase, what I am doing.  But once I’ve recovered some stability, I can use that solid ground as a base to look back from the corner I’ve worked myself into this time.  I can look back and try to figure out when I first started the most recent downslide, and see if there were any causes.  I can then try and map out what I did and didn’t do during that period, identify whether anyone tried to warn me (and if they didn’t, possibly why not), and look at what coping mechanisms came into play, and what resulted.

There are lots of good books on the subject of eradicating bad mental habits out there, but I think a good therapist is really key.  (The subject of finding a good therapist, with whom you can work, is a whole post unto itself.)  Working with friends or family to identify your “bad behaviors,” your mood cycles, your triggers, just won’t be complete, because they’re not objective, and inclined to either overlook unhealthy or exaggerate healthy behaviors.  While friends and family can be the best first defense against a recurrent episode, and have the concrete experience of your past episodes to guide them, you need these folks to be focused on the micro level, not the macro/meta level.  A therapist outside your circle, however, is objective, has training, and is someone in whom you can confide and to whom you must be accountable.

Support groups outside your circle can also be therapeutic– because they don’t know you, and take you at face value when you take part, there’s an objectivity there that allows a freedom of expression you might not have with friends or family.  Hearing others say they’ve gone through something similar, and come out on the other end, is tremendously encouraging.  And knowing that someone else understands the swirl inside your own head lends credibility to their advice and encouragement that a “normal” source doesn’t have.

The most important thing to be gained from therapy is a firm sense of your self, knowing what you need and what you don’t need.  Personally, I’ve never joined a bipolar support group because the way my bipolar has manifested itself has been primarily anxiety and depression, and the course of my illness was and is usually very different from that of others in the groups I’ve tried.  Having never been frankly manic, psychotic, or delusional, much less hospitalized, I knew I didn’t “need” what these groups are offering.  But depression and anxiety sufferers?  I crave their company, search regularly for a group that meets after the end of the business day, eagerly read posts by others suffering from the same symptoms– because in hearing their stories, I learn something new about myself.  And by collecting these tidbits, I can hope that the next episode won’t be as long, as bad, as deep, because the work that I’ve done will allow me to see that it’s coming, and know that it’s arrived.  The meds provide the viewpoint, but I’ve still got to be willing and able to look around me– the therapy allows the rest.

I’ve been thinking a good bit this weekend about the issue of “forcing” treatment upon mentally ill people, particularly those who are in immediate and ongoing danger of being hurt by their illness, or at risk of causing others to be hurt. OK, I confess–“Grizzly Man” is playing on cable this weekend, and Treadwell‘s story rips at my heart, because when you watch the footage of him, he is so obviously ill. Brilliant, creative, with a big heart…but sick. He was diagnosed with bipolar disorder and other things, but always refused treatment, and, I feel, ultimately died as a result of that refusal.

Have you heard or read about “Kendra’s Law?” If not, go check out this story, and see what you think. I’m really interested in hearing others’ thoughts on this topic. When I hear the term “forced treatment,” my mind immediately conjures up images from Ken Kesey’s novel “One Flew Over The Cuckoo’s Nest”, and Jack Nicholson’s consequent film portrayal of its main character, who has “treatment” forced on him right up through lobotomy. But from what I can see right now, it apears that the goal of Kendra’s Law is just about the opposite of the nightmare created in”Cuckoo’s Nest.” It’s not about institutionalizing people, locking them up and keeping them in chemical straitjackets. It seems to seek to help people live connected, fulfilling, and maybe ironically, independent lives.

Consider the very nature of disorders like bipolar disorder and schizophrenia…they deny their own existence. That is actually a diagnostic criteria sometimes, which boggles my mind: “Oh, you don’t think you’re sick? Well, that PROVES you are.” Yikes! But in bipolar support groups, I have seen more heartache than I can stand to reflect on much, coming simply from the sick person’s lack of insight. I don’t really even like that term, “insight,” because it implies something you can choose to have, and for many mentally ill people, that choice just does not exist without medication. And to complete the catch-22, without insight, medication is never going to be chosen. So there you are, stuck in a truly vicious cycle. I’m not talking about people who don’t like meds, resent having to take meds, etc. I mean the greater-than-80% of affected people who cannot recognize that they have an illness. If you could, somehow, get proper medication into these people, then they would be able to achieve the insight they would need to recognize the need for the medication…see the problem, here?

So, what say you all? At what point do we have the right to step in and mandate that someone else take medication–of any kind? Do we wait until they’re harming themselves and/or others? That seems to be what happens currently, and results in involuntary commitments…what if we could get to the problem and treat it before someone had to crash hard, possibly taking other people down with them? And at what point do “we” step in? I’m wondering how you get a diagnosis on someone who is totally non-compliant in the first place. Seems like someone would have to have run up against “the system” at least once, resulting in, at the very minimum, a 72-hour hold, in order to be diagnosed with a mental illness. I can easily see a “slippery slope” argument here, too. If we can mandate treatment for one thing, then why not another, and another, until we’ve reached Brave New World status?

But then, I see so many people homeless, sick, miserable, addicted to drugs and/or alcohol, having lost everything…when just straightening out some brain chemistry might have given them completely different lives, if only.

It’s a good topic for discussion, and I’m going to be doing some more research into Kendra’s Law, to try and figure out the details. I don’t know what kind of “teeth” it has, or what the consequences are for non-compliance, or what criteria must be met to have it put into play. I thank God regularly that my husband is one of the “lucky” ones (Yeah, I know–funny, huh? Ha, ha.) who doesn’t have any compliance issues…but you know what? When he was undiagnosed, unmedicated, and unstable? He didn’t HAVE any insight, wasn’t capable of recognizing his illness. He had to first “hit bottom,” and be involuntarily hospitalized and medicated first. Even then, he was not initially treated correctly in the beginning, and suffered a relapse, and yet another involuntary hospitalization. That was the one that saved his life, and he’s been pretty stable for almost 4 years now. And I have to ask myself, is what he went through back then really that different from what Kendra’s Law proposes? The only real difference I can see is that once my husband was released from the hospital, there was nothing in place to ensure that he kept taking his meds–he was free to get off them and start cycling again at any time, as he is now. Fortunately, he doesn’t misinterpret “feeling better” with “being well.” But he’s not in the majority there.

If you have someone in your life who suffers from a mental illness, but who can’t recognize that fact, and it drives you to distraction, there are two sources I strongly recommend, both from Dr. Xavier Amador. One is his fantastic book, “I Am Not Sick; I Don’t Need Help,” and the other is this amazing lecture on the topic of anosognosia (lack of insight). This video can honestly change the way you look at mental illness, and in my opinion, applies in good measure to addiction, as well. Amador is inspirational, and speaks not only as a healthcare professional, but as the loving brother of a schizophrenic who refuses treatment. Do yourself a favor and block off a couple hours of time to view this lecture. Heck, even if you have to view it in 15-minute chunks here and there, it is SO worth your time.