Friday, April 03, 2009

From Tragedy to Triumph

Scientist at Work: Alice W. Flaherty
From Bipolar Darkness, the Empathy to Be a Doctor

By Elissa Ely, MD
The New York Times
March 17, 2009

I’m glad to be writing about someone who used a personal tragedy to help others. Dr. Alice W. Flaherty had achieved more as a medical doctor, neuroscientist, and published researcher by the age of 35 than most people accomplish in a lifetime. However, a postpartum crisis of grief following the delivery of stillborn twins triggered the onset of mania that was characterized by hypergraphia, the compulsion to write anything and everything, anywhere and everywhere, including the use of her own body as a manuscript page. Dr. Flaherty was ultimately hospitalized for bipolar disorder. Her experience with mental illness led to a bestselling book, “The Midnight Disease: The Drive to Write, Writer’s Block and the Creative Brain,” and a new, empathetic approach to treating patients that stemmed from her own need for empathy during her illness.

Ten years after the initial onset of mania, Dr. Flaherty is director of the movement disorders fellowship at Massachusetts General Hospital, specializing in deep brain stimulation, and an assistant professor of neurology at Harvard Medical School. She applies her preoccupation with the neuroanatomy of empathy to the treatment of her own patients, always aware of the fact that she is also a patient. She has been able to channel this seeming disability into something greater: the ability to relate to patients from a place of experience, especially depression, that allows them to identify with her. Dr. Flaherty manages her illness with medication, but she still has periods of mania and she still writes on her arms. But she wouldn’t have it any other way. She uses her manic episodes as the driving force for new ideas about treatments and theories of the mind; the subsequent depressions are used to consolidate her thoughts and edit the flood of writing from the manic wave.

Such creativity and brilliance are characteristic of many patients with bipolar disorder: Jim Carrey, Robin Williams, Robert Downey Jr., Tracey Ullman, Sting, Jane Pauley, Winston Churchill, and Virginia Woolf are some names that may be familiar. Robert Downey Jr., one of the “brat pack” of the 1990s, attained notoriety for his well-publicized struggle with drugs and the law, as much as for his brilliant acting. Drug and alcohol abuse, hypersexuality, excessive spending, psychosis, and violence are all characteristics of the manic phase of bipolar disorder. The suicide rate is high. Many don’t achieve the level of insight that Dr. Flaherty has been able to attain in order to transform the mood swings into something constructive. Many patients don’t adhere to their treatment regimens and wind up losing careers, relationships, and even their lives.

Bipolar disorder is so difficult to treat because it often takes years to diagnose accurately. The standard therapies are valproic acid (an anti-seizure medication) or lithium (a mood stabilizer) and adjunctive anti-depressant and atypical anti-psychotic medications. These drugs cause numerous side effects, including weight gain, hyperglycemia, sexual dysfunction, and feelings of dullness. Many patients who have enjoyed the euphoria and high energy of hypomania and mania can’t tolerate the “earthbound” heavy feeling caused by their medications. An acute episode of mania or depression or refractory chronicity that result in hospitalization can take months and even years to rebound from. Not to mention the stigma of having a mental illness. Another physician and well-known spokesperson for mental disorders, Kay Redfield Jamison poignantly described her journey into madness in the autobiography, “An Unquiet Mind.” Dr. Jamison survived numerous suicide attempts before she was finally able to gain control of her disease and reclaim her life. Such is the course of bipolar disorder.

According to Dr. Flaherty, “Neurology and psychiatry should be treating the same organ.” Indeed, some psychiatrists do treat bipolar disorder as a neurological condition. But a mental illness is more than a condition; it is a person’s life. What distinguishes Dr. Flaherty from most caregivers of psychiatric patients is her own patient status. The injection of empathy and identification into the patient-physician relationship can have a more profound effect on the prognosis for that patient than simple adherence to a medication regimen. This type of relationship provides hope to patients. They are able to see a successful, healthy individual who had to transcend many of the barriers that they now face and translate that picture into a possibility for their own lives. Dr. Flaherty is able to empower her patients because she sees things as they would and can adjust her treatments accordingly. Caregivers in any situation have the opportunity to transform lives with a simply shift in perspective in their communication with patients. And it wouldn’t cost anything in terms of time or money.

Donna Proszynski

1 comment:

Anonymous said...

Robert Downey Jr has publicly denied being bipolar.