let your light shine. we are in need of your light.

~ Yep, it's ok to love yourself just the way you are.

Let's Change the Conversation Around Mental Health                                    Michelle Obama

Her Royal Highness The Duchess of Cambridge has been a passionate voice on so many important issues, and I'm grateful that she is using her day as Guest Editor to shine a bright light on mental health, particularly children's mental health, and on the tens of millions of people who suffer in silence - people like Ryan Rigdon.
Ryan joined the Navy when he was 20 years old, and he was deployed to Iraq for the first time a few years later. He served on a team that disarmed roadside bombs and IEDs, and when those bombs exploded, they would rush to the scene to clear any remaining explosives while sorting through unimaginable wreckage and carnage. In recognition of his incredible valour, Ryan was awarded a Bronze Star and an Army Commendation Medal. 
But when Ryan returned home to his wife and two young daughters after his second deployment, the war stayed with him. He had constant splitting headaches, nightmares and panic attacks, and his ears just wouldn't stop ringing. He would pace his home at night, worried that his family was in danger. One evening, he finally hit rock bottom. After laying awake in bed crying, he got up, headed to the bathroom, and prepared to take his own life.
Through my work with service members and veterans as part of Joining Forces - the initiative Dr Jill Biden and I launched to rally Americans to honour and support our veterans and military families - I've seen that Ryan's experience isn't unique. Like Ryan, some of our heroes on the battlefield struggle with the wounds of war - both visible and invisible - when they come home, but hesitate to ask for help. 
Of course, it's important to remember that most of our veterans don't experience any mental health challenges at all. 
But the veterans and service members who do struggle are not alone - not by a long shot. In fact, roughly one in five adults - more than 40 million Americans - suffer from a diagnosable mental health condition like depression or anxiety. These conditions affect people of every age and every background: our kids and grandparents, our friends and neighbours. 
Sadly, too often, the stigma around mental health prevents people who need help from seeking it. But that simply doesn't make any sense. Whether an illness affects your heart, your arm or your brain, it's still an illness, and there shouldn't be any distinction. We would never tell someone with a broken leg that they should stop wallowing and get it together. We don't consider taking medication for an ear infection something to be ashamed of. We shouldn't treat mental health conditions any differently. Instead, we should make it clear that getting help isn't a sign of weakness - it's a sign of strength - and we should ensure that people can get the treatment they need.
That's why the Affordable Care Act expanded mental health and substance use disorder benefits and parity protections for more than 60 million Americans and required new plans to cover depression screenings for adults and behavioral assessments for kids.
That's also why my husband put more mental health counsellors in place for veterans and signed a bill to help prevent veteran suicide. 
And that's why, last year, we worked with an organisation called Give an Hour and a coalition of other partners to launch the Campaign to Change Direction to raise awareness about mental health, give people tools to help those in need, and change the conversation about mental health in this country. This campaign includes leaders from every sector: business, government, nonprofits, medicine, education, the faith community and so many others. 
As part of this effort, we released a list of Five Signs to help people recognise when someone needs help. Signs like agitation, withdrawal, hopelessness, a decline in personal care and a change in personality can be indications that someone is dealing with a mental-health issue. By recognising these signs, we can help the people we know get the help they need before it's too late.
That brings me back to Ryan. Thankfully, Ryan didn't end his life that night. Instead, he summoned the courage to tell a co-worker that he needed help. They reached out to the local VA [US Department of Veterans Affairs], and Ryan got the medication and counselling he needed to start getting better.
Just as people in Ryan's community stepped up for him, we need to step up for people in our lives. We need to learn to identify the signs of mental-health issues. We need to have the courage to reach out and have tough conversations with our friends and family members -- and get help ourselves when we need it. And we need to recognise that our mental health is just as important as our physical health, and start treating it that way. 
Visit www.changedirection.org to learn the Five Signs and find out how you can join this movement. 
Credit: www.changedirection.org. 
Young Minds Matter is a new series designed to lead the conversation with children about mental and emotional health, so youngsters feel loved, valued and understood. Launched with Her Royal Highness, The Duchess of Cambridge, as guest editor, we will discuss problems, causes and most importantly solutions to the stigma surrounding the UK's mental health crisis among children. To blog on the site as part of Young Minds Matter email [email protected]

Renaming Schizophrenia Could Combat Stigma And Help Patients Recover

Huffing Post Science February 2016      
Carolyn Gregoire

A psychiatrist calls for scientists and the public to abandon the term "schizophrenia." 
The stigma that surrounds mental illness is not only insulting to the roughly one-quarter of the world's population that has one, it can also negatively impact their willingness to seek help and their recovery.
But perhaps no mental illness is more stigmatized than schizophrenia, a devastating ailment that affects around 1 percent of the general population. The poorly understood condition is characterized by symptoms including delusions, hallucination, abnormal social behavior, paranoia and cognitive impairments.
The term "schizophrenia" itself tends to call to mind split personalities, disturbing imaginary voices and visions, and violent outbursts, according to health advocates including Brian Semple of the British non-profit Rethink Mental Illness.
"Unfortunately, there is still a great deal of misunderstanding around schizophrenia," he told Medical News Today. 
For this reason, Dr. Jim van Os, a psychiatrist at Maastricht University Medical Centre in The Netherlands, is one of a growing number of clinicians calling for updated classifications around schizophrenia and other psychotic disorders as a way to reduce prejudice and misperceptions. 
In a paper published in The British Medical Journal on Tuesday, van Os argues that the term "schizophrenia" -- which he says may needlessly scare patients by calling to mind a debilitating brain disease -- should be removed from the International Classification of Diseases, which is now being revised, and the Diagnostic and Statistical Manual of Mental Disorders. He suggests replacing it with a more neutral, updated label such as "psychosis spectrum disorder."  

PLoS One
fMRI brain scans show differences in brain activity in people diagnosed with schizophrenia.Taken from Greek words meaning "split" and "mind," the term schizophrenia dates back to the inhumane treatment of psychotic patients in "insane asylums" in the late 19th and early 20th centuries, and still carries these unfortunate connotations. It doesn't refer to any actual symptoms of the disorder. 
"If you have depression, then people understand this disease about feeling depressed -- I feel depressed sometimes so I know where this patient is coming from," van Os told The Huffington Post. "But schizophrenia is a rather mystifying term that has nothing to do with psychosis itself... It doesn't help explain to the public what psychosis is about in a way that people can relate to their own experience, which is very important." 
Japan and South Korea have already dropped the term, to positive results. After replacing it with a less negatively charged and more accurate descriptor ("integration dysregulation syndrome"), patients were better able to cope with their diagnoses. They were also more likely to seek help and less likely to commit suicide, according to a 2013 study published in the journal Psychological Medicine.

The real entity that we should be studying and diagnosing is psychosis spectrum disorder." Dr. Jim van Os, of Maastricht University Medical CentreThese illnesses are classified in many different categories. Van Os also argues that current classifications do not acknowledge the continuity between schizophrenia and other psychotic disorders, including schizoaffective disorder, delusional disorder, bipolar disorder with psychotic features and depression with psychotic features.
Instead, psychotic disorders including schizophrenia exist on a spectrum, much like the autism spectrum of disorders, according to van Os. Such a spectrum ranging from mild psychotic episodes to severe schizophrenia. 
"The real entity that we should be studying and diagnosing is psychosis spectrum disorder," van Os said. 
The problem is that schizophrenia is separated from these other ailments and put into a worst-prognosis category unto itself. In this case, word choice is more than mere semantics.
Van Os hopes that changing the way we talk about the disorder can help us to decrease stigma while also encouraging public understanding and compassionate psychiatric care. 
In a response to the BMJ article, Dutch psychiatrist Jan P.L. Leijten said that following van Os's suggestions had yielded positive results with his patients. 
"In my own practice I tell people with psychotic problems the same as Jim van Os suggests in this article," Leijten wrote. "It gives the patient a positive perspective and appears the best way to commit [them] to the necessary treatment."

Fast Talk: Growing Older with Bipolar
Whether I like it or not, I’m growing older and I’m growing older with bipolar. And with my wellness plan intact, I can only think of the possibilities!
By Julie A.  Fast
bphope.com, February 2016

My body is finite. It’s getting older, and at age 50 I have no choice but to face the reality of my aging body along with my aging mind. I’m not ashamed of getting older. But I am well aware that I need to be more appreciative of, and careful with, my life and body—starting now.
My face didn’t show any wrinkles until I was in my late 40s. It’s genetic, and the result of having a mom who was emphatic about sunscreen. I’ve always looked much, much younger than I am. But last year, time caught up with me and I suddenly started looking my age. For the first time in my life, I found myself staring at my reflection in the mirror, scrutinizing the lines around my mouth and eyes, and almost--almost— falling into the Hollywood-style pit of wanting and needing to look younger.
I knew life had caught up with my face when a participant in one of my workshops looked at my business card and said, “Why do you have a picture of your daughter on your card?” I wanted to say, “What? That picture is only a few years old! How could you say something like that to me?” Then I realized that anyone who has such poor social skills deserves my pity more than my outrage. I also asked myself why it hurt so much. Did I really expect aging to pass me by?
Aging gracefully requires a conscious decision to face reality and then give the finger to a world that says older people are not beautiful. With bipolar disorder, I know that burdening my already fragile mind with the added pressure of trying to look younger would be just too much, a truly slippery slope that would probably end up with my lips going halfway across my face like the Joker in Batman!
Instead, when I see an older woman looking back at me from my mirror, I choose to look directly at her instead of turning away. I don’t avoid her; I embrace her. Getting older—especially when you have bipolar—sure beats the alternative.
I’m lucky to have parents who personify the positive rewards of lifelong exercise and healthy eating. My father ran half marathons throughout his sixties. My mother gardens up to five hours a day in the summer, and she still looks gorgeous. She started medication for her depression at age 61, and I know this has been an important part of helping her age gracefully, as well. Their health reminds me that we don’t have to fall apart as we get older. Their actions remind me that it’s never too late to get healthy. What I do now creates the person I will be at 70.

Growing older is a privilege I don’t want to waste. I want to make sure I treasure my time here, and my loved ones.
I do worry about how getting older will interact with my bipolar, largely because living longer means I will outlive people I love, and I don’t know how I will handle that. I’m concerned about how my mother’s aging—she’s my biggest supporter—will impact my balance and emotional stability. But you know what? I’ve spent the past 20 years building skills to manage my bipolar and I know they will get me through the future.
Growing older is a privilege I don’t want to waste. I want to make sure I treasure my time here, and my loved ones.
Last week my mother gave me a ride to a speaking gig because a pinched nerve in my back from an old bike wreck made it too painful for me to drive. We had two hours in the car together, and as I sat in the passenger seat, I felt so lucky and blessed. After all we’ve been through together, here I am at 50 years old, alive and well, and my 72-year-old mother is still around to take care of me during my time of need.
Time is moving forward even as I write. Whether I like it or not, I’m growing older and I’m growing older with bipolar. As I start this next chapter, I’m embracing my relationships and looking ahead to a promising future. With my wellness plan intact, I can only think of the possibilities! I can still make the most of this life—and so can you.

Bring it on!
Julie
Julie A. Fast is the bestselling author of Loving Someone with Bipolar, Take Charge of Bipolar Disorder and Get it Done When You’re Depressed. She is an award winning columnist for bp Magazine ("Fast Talk") and has one of the top bipolar disorder blogs on the internet. Julie is the bipolar disorder management specialist on the Oprah and Dr. Oz website www.ShareCare.com. She was the original consultant for Claire Danes on Homeland. Julie is not only a leading expert on helping those affected by bipolar disorder and depression, she was diagnosed with bipolar disorder in 1995 and successfully (as best she can!) manages the illness with medications and the strategies in her books. Julie knows firsthand about living with and loving someone with bipolar disorder within her own life and helps family members, partners and health care professionals understand and support those with the illness. Julie is a highly in demand family and partner coach, speaker and educator who is passionate about changing the way the world views and manages mood disorders.​

DBSA's news to all chapters today:

Our new online support groups start tomorrow night! They are a great opportunity for chapter participants to get additional support between your in-person meetings. They are on a great new platform which allows web-conferencing as opposed to the chat room format we previously used. Learn more at DBSAlliance.org/OSG and spread the word!

Here is an article from 2003 that startled the community of married folk challenged with mental illness. I find the personal stories informative and encouraging for those married and single. Dating and partnering are difficult undertakings for all folk. However, most of us with mental illness agree that marriage brings a challenge of its own.


Partners for life: Beating the marriage odds
BP magazine, November 2003
By Michelle Roberts


Daniel, a computer software engineer in Portland, Oregon, was used to solving complicated problems.
But when his wife, Julie, was diagnosed with bipolar disorder in 2001, he didn’t know what to do. Her moods could be described in two ways: So irate she would scream obscenities at him, or so depressed she could barely get out of bed. “It was pretty hard,” he recalls. “Of all the problems I thought we’d encounter during our marriage, mental illness wasn’t something I’d ever considered.”
The erratic behavior of a person in the throes of mania or depression can shake the foundation of a marriage. The diagnosis of a lifelong, life-threatening illness can scare a spouse away. Of course, no marriage or long-term partnership is easy. In the United States and Canada, at least 40 percent of all marriages fail. But the statistics for marriages involving a person who has bipolar disorder are especially sobering—an estimated 90 percent of these end in divorce, according to a November 2003 article, “Managing Bipolar Disorder,” in Psychology Today.
Despite these odds, bp Magazine has located and spoken with several long-term couples facing bipolar issues who nonetheless are making it work. They all admit that their partnerships have been rocky at times, but that with counseling, love, and acceptance of the illness, they have not only stayed together, but have also grown stronger as a couple.
For example, Daniel—amid the cacophony and confusion of Julie’s ever-changing moods—made a decision that would save his now 24-year marriage. Instead of seeing his relationship with Julie as “something I would have to write off and cut my losses,” he decided to view his continued support of her as “an investment in something worthwhile.”
When the symptoms of mental illness first begin to surface, most spouses don’t know what to think. They’re confused and feel like they’re drowning in chaos. “I was afraid I’d never [again] see the man I’d fallen in love with,” says Laurie, of San Antonio, Texas, whose husband, Michael (nicknamed Doug), was hospitalized with his first bipolar episode in 1998.


When sympathy’s not enoughFollowing a diagnosis, the first and most dominant response from a spouse usually is sympathy, says David A. Karp, professor of sociology at Boston College and author of The Burden of Sympathy: How Families Cope with Mental Illness (Oxford University Press, 2002). “But further down the road, a spouse may experience emotions they don’t think they should be having—anger, frustration, and even hate.”
Indeed, caring for someone who has a mental illness can be more draining than caring for someone with cancer, says Dr. Karp. When a spouse does something for a mate with a physical illness, they are usually met with gratitude. People who have bipolar disorder, on the other hand, often deny the diagnosis, are unwilling to comply with medication, and—worst of all—treat one’s spouse like the enemy.
Laurie recalls the pain she felt when her husband, convinced he could control the “thunder” with his thoughts, screamed angrily at her for having him hospitalized. “For a few days,” she says, “he wouldn’t even see me.”
If a spouse can move through these times, he or she will reach a place of acceptance, Dr. Karp maintains. Those difficult emotions will then be replaced with softer feelings like love and compassion. Of course, this kind of transformation requires redefining spousal expectations and also redrawing the picture of what they had once thought life would look like.
For some couples, that may mean having to rely on only one income, going without annual vacations, or choosing not to start a family. For others, it may mean that many of the responsibilities of daily life fall on the well partner.
Exhausted with the demands of raising children and caring for her husband, Laurie says she yearned for the day when “someone would take care of me instead of the other way around.” She has had to accept that it’s okay if her life looks different than she once imagined. “You just need to accept that it is a loss,” she says. “That doesn’t mean you can’t still have a good life, just maybe not the one you’d envisioned.”


Sharing responsibilityCouples who seem to have the most success share the belief that the partner with bipolar disorder has an equal responsibility in the relationship with the well spouse. Most people embrace the idea that bipolar disorder is biological. If so, partners wonder: “Does my mate have any control over his or her personal behavior? Do they shoulder some responsibility to help themselves?”
… successful couples say they have used periods of wellness to prepare for episodes that may lie ahead.

The answer is “yes” on both counts, according to Dr. Karp. Although extremely manic or depressed individuals may be temporarily unable to help themselves, it’s important that they remain self-sufficient during periods of wellness. In cases where one partner has bipolar and the marriage ends, it’s usually because the healthy spouse feels he or she has done everything they can to help the other person become well. They have given unconditional love, scheduled counseling appointments, and monitored medications, but nothing has made the situation any better.
“As much as it’s a biomedical condition, people with mental illnesses can’t be let completely off the hook,” says Dr. Karp, who himself has major depression. “Of course, we can’t expect them to pull themselves up by their bootstraps when they’re acutely ill, but during periods of wellness they owe it to their spouses to do whatever is in their power to help themselves.”
This can be as simple as taking medications, working out regularly, or eating healthy. Without such actions, spouses can feel burned out if there’s “no reciprocation of their efforts,” Dr. Karp says.
Julie says it’s easy for her to become “very selfish” when she’s either manic or depressed. At one point, Daniel sat her down and told her, “I need you to pay attention to what’s going on here.” “It was a real wake-up call,” she says. “It hurt at first to know I was hurting him, but it made me realize that I had a responsibility to him and our marriage, not just to myself.”
Mark, who lives in Ontario and has bipolar, says he sometimes worries about the burden his illness places on Jody, his wife of one year. Taking care of himself, he says, is like investing in his marriage.
“I don’t drink, smoke, or take drugs,” says Mark, who admits he has struggled with all those things in the past. “I exercise regularly, eat right, and study hard,” he says. “I’m doing these things not only for myself, but also for Jody. I don’t want her to ever feel like I’m not working as hard as I can to stay well.”


Thinking aheadRather than fearing the future, successful couples say they have used periods of wellness to prepare for episodes that may lie ahead. In the grip of mania, a person who has bipolar can easily wipe out joint checking and savings accounts. Without a second thought, they may leave the family with no money for groceries, let alone a mortgage payment.
Our couples suggest opening up accounts in the well spouse’s name for all expenses. Some couples also agree to give power of attorney or extend other means of limited control to the well spouse—this for occasions when the spouse with bipolar is ill.
It’s also helpful to write down in advance a list of symptoms the spouse with bipolar exhibits when on the cusp of a manic or depressive episode. This way, both spouses can agree at what point to seek help for the spouse who has bipolar. With this approach, emotions are taken out of the equation, if and when the spouse with bipolar refuses help later on.
Partners become very good at identifying their mate’s symptoms. Often they can help the spouse seek help before the mania or depression spirals out of control. It’s also helpful if a couple designs a “road map for what to do,” according to Dr. Karp, when those symptoms appear. “It helps diffuse any anger or guilt that may come up when difficult decisions, such as hospitalization, are made,” Dr. Karp says. “It’s a plan that empowers both people in the relationship.”


Burdens and boundariesMany spouses struggle with how to honor their commitment to help the person they love, without becoming engulfed in the spouse’s misery or mania. When a person is acutely ill, it may become necessary for the well spouse to take the other to physician appointments, make certain the person is taking his or her medication, even watch over the individual for safety. All this is in addition to taking over all the other household duties, such as paying bills or caring for children.
Often, caregivers’ relationships with other family members begin to suffer. They may begin to feel like their own identities are being buried—they are losing themselves or jeopardizing their own health.
“I do feel both afraid and burdened from time to time,” Laurie says. “In the midst of everyday deadlines and my personal issues, I have had to stop and deal with [my husband] going through mania or depression. It’s very hard.”
Spouses must learn to draw a boundary line, or risk losing themselves, Dr. Karp says. But it likely won’t be a permanent marked boundary. Wherever they draw the line, “the unpredictable winds of mental illness come in and blow it away,” Dr. Karp explains. As a result, “people have to keep redrawing the boundaries.”
Furthermore, Dr. Karp argues that sometimes people have to do the emotionally counterintuitive thing and withdraw. It may sound harsh, but it’s healthy. Spouses, he says, must learn to take care of themselves before they can take care of others.
Laurie has learned to put herself through school, something her husband, Doug, wasn’t always able to support. Manic and angry, Doug announced he wouldn’t attend her college graduation.
“I was determined not to let anything or anyone ruin that day—it was mine and I didn’t deserve to have it taken away just because my husband has an illness,” she says. “He ended up going after all, and I love him for that.”
Now, she is working toward a master’s degree.
“It’s important that I feel like my life can continue to move forward, even when my husband is struggling.”


Laurie and DougIt rained the day Doug and Laurie were married 25 years ago. Doug’s mother said it was a sign of good luck. It rained again the day their first child was born, convincing the couple that the superstition was true.
But it also rained the day eight years ago when psychiatrists wrapped Doug in a straight jacket and told Laurie she needed to commit him to a psychiatric hospital. Laurie, shaken and unsure of everything she thought she knew about her life and marriage, recalls, “I’ll never forget watching them drive away with Doug. He was screaming and strapped to the gurney. I felt like I’d stepped into a different world.”
Laurie and Doug, of San Antonio, Texas, had been married for 18 years and had four children, ages 10, 12, 13, and 16, when Doug had his first psychotic episode in 1998. Doug, a manager at a municipal water and sanitation plant for nearly two decades, had always been a loving, stable provider. It was terrifying, Laurie remembers, to see him so out-of-control, speaking incoherently, and insisting he was God.

… despite their many years together, she and Doug still take it day by day.
“I felt like I had just been led into a very dark place and, quite honestly, I didn’t think he or I would ever find our way out,” says Laurie, a teacher. When Doug’s psychiatrist told Laurie that Doug had been diagnosed as having bipolar disorder, she remembers asking, “‘What is that?’ I didn’t have a clue—had never heard of it before in my life,” she says. “I went home, got on the Internet and cried as I read about it. I thought it was something he would never recover from.”
Doug was in the hospital for nearly two weeks. After being stabilized on medication and seeing glimpses of Doug’s old personality, Laurie says she began to feel hope. Still, she found she was left with most of the responsibilities of their life together—from caring for the children to paying the bills. Even though she loved Doug, she still felt burdened.
“I had to seek counseling for myself after my husband’s second hospitalization because I felt cheated somehow,” she says. “I felt overburdened with having to make certain decisions on my own and feeling that I had to act a certain way.”
For a long time, it was difficult for Laurie and Doug to talk about anything except Doug’s illness. But as time passed, both learned to step back and enjoy the periods in which Doug is stable. Laurie says she has attended bipolar support groups with him, but not on a regular basis. “I don’t want him to feel like I’m constantly watching over him…that he [can] build his own networking system.”
At the same time, Doug says he feels reassured by Laurie’s presence in his life. “I don’t expect Laurie to hold my hand, but at certain times my mind is not completely there and it’s great to know that she stands by my side in the event I need her.”
Last summer, Doug was hospitalized a third time. Laurie says she seriously considered leaving him. Not because he was ill, but because she didn’t believe he was doing all that was in his own power to get better. “I thought, if he’s not going to make that extra effort to help himself, then I don’t have to stay,” she says. “I love him, but I just didn’t feel that that was my responsibility anymore. I’m giving myself that choice.”
Doug says his wife’s resolve to take care of herself made him want to get better. “It made me see that she’s not just sticking around because she feels sorry for me,” he says. “She can step away from it.”
Since his release three and a half months ago, Doug has never done better. Both he and Laurie have quit smoking cigarettes and drinking alcohol. They also began counseling for couples and joined a gym, where they work out at least three times a week.
Laurie says she feels more confident about her marriage than she has in years. Still, she knows that despite their many years together, she and Doug still take it day by day.
“His caseworker asked me during his last hospitalization if I was ever afraid,” she says. “I’d be a liar if I said no. I’m always afraid that another episode is possible. Mostly, though, I’m afraid of what I would do without him.”


Jody and MarkMark was afraid to tell his new girlfriend that he suffers from bipolar disorder.
But just two weeks after he started dating Jody, the woman who would become his wife, he mustered his courage and “just went for it.”
“I was nervous and pretty much afraid that that might be it,” says Mark, 37, who recently got a job as an addiction counselor for the Social Rehabilitation Program of the Canadian Mental Health Association. “Based on past experience, I would meet somebody and start liking them, spend some time with them,” he says. “Then they’d find out I have bipolar and they’d split.”
But Jody, 46, didn’t flinch. “I’m pretty open-minded,” she says, adding that she’d already looked past Mark’s earring, tattoos, and wild way of dressing. “I decided not to judge a book by its cover.”

I believe Jody made a point not to argue with me, as she felt that would be pointless when I was hypomanic.
During the three years they’ve been together, Mark has showed only mild symptoms of mania or depression. He attributes this to the fact that his and Jody’s primary focus as a couple is their mutual and personal wellness.
The couple, who live in Ontario, exercise daily at the gym and eat only natural foods. They also get plenty of sleep and have cut out all alcohol and cigarettes. Mark’s illness has become a secondary issue to the benefits they both get from living a healthy lifestyle.
“We just focus on that—wellness,” Jody says. “Wellness of mind, body, and spirit.”
That doesn’t mean it’s always easy. There are times when Mark suffers from anxiety, as when he was interviewing for his current job. Mark says he felt comfortable talking to Jody about it, but then she “gave me my space when I needed it and rest when I needed it.
“I believe Jody made a point not to argue with me, as she felt that would be pointless when I was hypomanic,” he recalls. “In other words, she backed down. She may have lost the battle, but in the end [she] won the war because the situation wasn’t escalated out of control.”
Mark says that part of his commitment to Jody entails doing everything he can to stay well. “From my end, I slept when I needed and disciplined myself to get up when I felt I should,” he says. “I also saw my doctor and had him tweak my medication to suit my needs at the time.”
The couple recently celebrated their first wedding anniversary.
“It does occur to me that I could get ill—manic, depressed, or hypo-manic for an extended period of time—[and] that could cause problems in my marriage,” Mark says. “However, I have a good understanding of my condition and take excellent care of myself today, perhaps better than some who do not have bipolar.”
Mark attributes his wellness in recent years to the love that he and Jody share. “I would have a much more difficult time without her,” he says. “She gives me a reason to work my hardest and to overcome this illness.”


Julie and DanielDaniel, 49, admits he’s never been one of those touchy-feely kind of guys. When it comes to expressing his feelings, he’d usually rather not.
But a few years ago, that changed.
Daniel’s wife, Julie, 47, who has bipolar disorder, was lost in a depressive state. And Daniel, after months of frustration and fear, finally decided to speak his truth.
“I had to tell her, ‘I’ve been cutting you a lot of slack lately, but I’m suffering in this relationship,’” Daniel recalls telling Julie. “I’ve kept this inside for a long time, but I’m dying on the vine here.”
The Portland, Oregon, couple have faced many challenges since Julie began showing symptoms of bipolar disorder more than a decade ago. She was diagnosed in 2001 after several years of unsuccessful treatment for anxiety and depression. But even with proper treatment, Julie still struggles—often finding herself stuck in either a hypomanic state—chatty, hyper, and angry—or a depression that zaps her energy and makes it difficult for her to get out of bed.
“The first couple of times Daniel told me my illness was hurting him, it would make me feel really guilty,” Julie says, “like I was a bad person, a complete screw-up. But as I gained more insight into the disorder—therapy, talking about it, and living right—I was able to take it in better.”
Julie attributes the continued success of her and Daniel’s 24-year marriage to her husband’s newfound voice. “It’s important that the person who doesn’t have the illness feels that they can express their feelings, too,” Julie says. “Mental illness can make you very selfish without [your] even realizing it.”

The real bottom line is you have to decide that you want this relationship to work.
One of the most important things the Williamses have learned is to recognize the symptoms of Julie’s illness and respond to them clinically, rather than emotionally. For example, Daniel tries not to internalize the hurtful things Julie often says while in a hypomanic state. Julie, on the other hand, tries to forgive herself when she does. “When I become really, really, really vicious, he gets his feelings hurt,” she says. “Then he expresses that to me. Then I feel just like the worst person on the planet.”
The truth of her husband’s heart shines through when “he’s the one who’s hurt, but he turns and comforts me, because Daniel knows I hate myself when I hurt someone’s feelings.”
Daniel says his and Julie’s communication skills are still evolving. “I don’t want it to sound like I’m some kind of saint or something,” he says. “The first few times I told her how I was feeling were not pretty. I wasn’t a happy camper. But I soon realized that getting all angry and worked up was not going to solve the situation. It’s just going to make Julie suck it up and act like it’s better, when it’s not. I didn’t want that, either.”Julie says she still has to work at not instantly turning to guilt and self-loathing when Daniel expresses his needs. “Now, Daniel can say something to me and I listen,” she says. “I’m not saying I won’t feel bad, but I don’t have a complete breakdown. I tell myself, ‘It’s not your fault. You’re not doing this because you’re a bad person. Daniel is just saying that to you because he’s a real person with real needs, too.’ I talk myself through it and I’m okay.”
Rather than focus on the illness and what separates them, the Williamses say they have learned to focus on what they share—their three cats, their love of the Oregon Symphony, long walks in the woods behind their home.
“The real bottom line is you have to decide that you want this relationship to work,” Daniel says. “You start looking for ways to make it work.”

​Maybe you are a person with a faith system that requires believers, such as yourself, to “evangelize the world.” In that system, it is the life-purpose of saved believers to attempt to tell the gospel to anyone, anywhere. For some believers, they take the charge to evangelize the world to be without bounds, for “they know God’s law (and ethics) trumps man’s.” Of course, in reality, it is they, not God, choosing to violate and victimize others’ personal liberty while using God as cover.  Many times the most vulnerable among us are the victims of these religious zealots, stepping across cultural and professional boundaries in efforts to accomplish their self-ordained mission.
            There are some mental health professionals who inject religious and supernatural concepts into the care they provide clients and view this as an acceptable means of “treating” clients.  Dr. Darrel Ray, who practiced in a clinical psychology setting for 10 years and authored several books, views this method of treatment by therapists as problematic. During these years, many potential clients wanting treatment by secular therapists contacted Dr. Ray.  Several people wrote to him sharing that they saw a therapist for months only to have the therapist recommend they pray, go to church, or use some New Age method to address their problems. As a result, he founded the Secular Therapist Project, which includes a website that connects potential clients with therapists who adhere only to secular, evidence-based treatment and avoid the supernatural and religious approaches.
            Ray believes that the problem with therapists not adhering to methods with clinical testing and peer review grew over the last ten or twenty years, in part because many religious schools incorporated counseling programs for students to major in.  Thus, graduates from these programs inject their religious views into their relationships with their clients.
            Through Ray’s website, www.seculartherapy.org, secular therapists and potential clients use this free and confidential service to connect with each other. The website is like the popular dating sites OKCupid.com or Plentyoffish.com. With seculartherapy.org, therapists register and describe their practices on the public parts of their profiles, along with a checklist of conditions they are qualified to work with. The identities of the therapists are protected. And no other information such as email addresses, phone numbers, office addresses, or websites are available to prospective clients on these public profiles.  Dr. Ray and, the other site developer, Han Hills, use a secure process to screen and approve therapists. Four very experienced secular therapists look at each application and evaluate the applicants’ use secular methods.  All personal information of the clients using their website is kept confidential as well. The way it works: Clients and therapists correspond through a system a few times until they feel comfortable and believe they are a good fit to work together. 

Schizophrenia Causally Linked To Specific Gene Variants

A landmark study, based on genetic analysis of nearly 65,000 people, has revealed that a person’s risk of schizophrenia is increased if they inherit specific variants in a gene related to “synaptic pruning”—the elimination of connections between neurons.

The findings represent the first time that the origin of this devastating psychiatric disease has been causally linked to specific gene variants and a biological process. They also help explain decades-old observations: synaptic pruning is particularly active during adolescence, which is the typical period of onset for schizophrenia symptoms, and brains of schizophrenic patients tend to show fewer connections between neurons.

The gene, called complement component 4 (C4), plays a well-known role in the immune system but has now been shown to also play a key role in brain development and schizophrenia risk. The insight may allow future therapeutic strategies to be directed at the disorder’s roots, rather than just its symptoms.

The study, led by researchers from the Broad Institute’s Stanley Center for Psychiatric Research, Harvard Medical School, and Boston Children’s Hospital, has the potential to reinvigorate translational research on a debilitating disease.

Schizophrenia is a devastating psychiatric disorder that afflicts approximately one percent of the population and is characterized by hallucinations, emotional withdrawal, and a decline in cognitive function. These symptoms most frequently begin in patients when they are teenagers or young adults.

First described more than 130 years ago, schizophrenia lacks highly effective treatments and has seen few biological or medical breakthroughs over the past half-century. In summer 2014, an international consortium, led by researchers at the Broad Institute’s Stanley Center, identified more than 100 regions in the human genome that carry risk factors for schizophrenia.

The newly published study now reports the discovery of the specific gene underlying the strongest of these risk factors and links it to a specific biological process in the brain.

Black Box

Said senior author Steven McCarroll:

“Since schizophrenia was first described over a century ago, its underlying biology has been a black box, in part because it has been virtually impossible to model the disorder in cells or animals. The human genome is providing a powerful new way in to this disease. Understanding these genetic effects on risk is a way of prying open that black box, peering inside, and starting to see actual biological mechanisms.”

Adds Bruce Cuthbert, acting director of the National Institute of Mental Health:

“This study marks a crucial turning point in the fight against mental illness. Because the molecular origins of psychiatric diseases are little-understood, efforts by pharmaceutical companies to pursue new therapeutics are few and far between.

This study changes the game. Thanks to this genetic breakthrough we can finally see the potential for clinical tests, early detection, new treatments, and even prevention.”

The Path to Discovery

The remarkable story of discovery involved the collection of DNA from more than 100,000 people, detailed analysis of complex genetic variation in more than 65,000 human genomes, development of an innovative analytical strategy, examination of postmortem brain samples from hundreds of people, and the use of animal models to show that a protein from the immune system also plays a previously unsuspected role in the brain.

Over the past five years, geneticists led by the Broad Institute’s Stanley Center for Psychiatric Research and its collaborators around the world collected more than 100,000 human DNA samples from 30 different countries to locate regions of the human genome harboring genetic variants that increase the risk of schizophrenia.

The strongest signal by far was on chromosome 6, in a region of DNA long associated with infectious disease, causing some observers to suggest that schizophrenia might be triggered by an infectious agent. But researchers had no idea which of the hundreds of genes in the region was actually responsible or how it acted.

The site in Chromosome 6 harboring the gene C4 towers far above other risk-associated areas on schizophrenia’s genomic “skyline,” marking its strongest known genetic influence. The new study is the first to explain how specific gene versions work biologically to confer schizophrenia risk. Credit: Psychiatric Genomics Consortium

Based on analyses of the genetic data, McCarroll and first author Aswin Sekar focused on a region containing an unusual gene called complement component 4 (C4). Unlike most genes, C4 has a high degree of structural variability: different people have different numbers of copies and different types of the gene.

McCarroll and Sekar developed a new molecular technique to characterize the C4 gene structure in human DNA samples. They also measured C4 gene activity in nearly 700 post-mortem brain samples.

They found that the C4 gene structure (DNA) could predict the C4 gene activity (RNA) in each person’s brain – and used this information to infer C4 gene activity from genome data for 65,000 people with and without schizophrenia. These data revealed a striking correlation: patients who had particular structural forms of the C4 gene showed higher expression of that gene and, in turn, had a higher risk of developing schizophrenia.

Connecting Cause and Effect Through Neuroscience

But how exactly does C4—a protein known to mark infectious microbes for destruction by immune cells—affect the risk of schizophrenia?

Answering this question required synthesizing genetics and neurobiology. Beth Stevens, recent recipient of the MacArthur “Genius Grant,” had found that other complement proteins in the immune system also played a role in brain development by studying an experimental model of synaptic pruning in the mouse visual system.

Michael Carroll, professor at Harvard Medical School and researcher at Children’s Hospital, had long studied C4 for its role in immune disease, and developed mice with different numbers of copies of C4. The three labs set out to study the role of C4 in the brain.

They found that C4 played a key role in pruning synapses during maturation of the brain. In particular, they found that C4 was necessary for another protein (a complement component called C3) to be deposited onto synapses, as a signal that the synapses should be pruned.

The data also suggested that the more C4 activity an animal had, the more synapses were eliminated in its brain at a key time in development.

The findings may help explain the longstanding mystery of why brains from people with schizophrenia tend to have a thinner cerebral cortex with fewer synapses than unaffected individuals do. The work may also help to explain why the onset of schizophrenia symptoms tends to occur in late adolescence: the human brain normally undergoes widespread synapse pruning during adolescence, especially in the cerebral cortex (the brain’s outer layer, responsible for many aspects of cognition).

Excessive synaptic pruning during adolescence and early adulthood, due to increased complement (C4) activity, could lead to the cognitive symptoms seen in schizophrenia.

“Once we had the genetic findings in front of us we started thinking about the possibility that complement molecules are excessively tagging synapses in the developing brain,” Stevens said.

“This discovery enriches our understanding of the complement system in brain development and in disease, and we could not have made that leap without the genetics. We’re far from having a treatment based on this, but it’s exciting to think that one day, we might be able to turn down the pruning process in some individuals and decrease their risk.”

A Path Toward Early Detection and Potential Therapies

Beyond providing the first insights into the biological origins of schizophrenia, the work raises the possibility that therapies might someday be developed that could “turn down” the level of synaptic pruning in individuals who show early symptoms of schizophrenia. This would be a dramatically different approach from current medical therapies, which address only a specific symptom of schizophrenia (psychosis) rather than the disorder’s root causes, and which do not stop cognitive decline or other symptoms of the illness.

The researchers emphasize that therapies based on these findings are still years down the road.

Still, the fact that much is already known about the role of complement proteins in the immune system means that researchers can tap into a wealth of existing knowledge to identify possible therapeutic approaches. For example, anti-complement drugs are already under development for treating other diseases.

“For the first time, the origin of schizophrenia is no longer a complete black box,” said Eric Lander, director of the Broad Institute. “While it’s still early days, we’ve seen the power of understanding the biological mechanism of disease in other settings. Early discoveries about the biological mechanisms of cancer have led to many new treatments and hundreds of additional drug candidates in development. Understanding schizophrenia will similarly accelerate progress against this devastating disease that strikes young people.”

“In this area of science, our dream has been to find disease mechanisms that lead to new kinds of treatments,” said McCarroll. “These results show that it is possible to go from genetic data to a new way of thinking about how a disease develops—something that has been greatly needed.”

Top Illustration: Imaging studies showed C4 (in green) located at the synapses of primary human neurons. Credit: Heather de Rivera (McCarroll lab).

Schizophrenia Causally Linked To Specific Gene Variants

A landmark study, based on genetic analysis of nearly 65,000 people, has revealed that a person’s risk of schizophrenia is increased if they inherit specific variants in a gene related to “synaptic pruning”—the elimination of connections between neurons.

The findings represent the first time that the origin of this devastating psychiatric disease has been causally linked to specific gene variants and a biological process. They also help explain decades-old observations: synaptic pruning is particularly active during adolescence, which is the typical period of onset for schizophrenia symptoms, and brains of schizophrenic patients tend to show fewer connections between neurons.

The gene, called complement component 4 (C4), plays a well-known role in the immune system but has now been shown to also play a key role in brain development and schizophrenia risk. The insight may allow future therapeutic strategies to be directed at the disorder’s roots, rather than just its symptoms.

The study, led by researchers from the Broad Institute’s Stanley Center for Psychiatric Research, Harvard Medical School, and Boston Children’s Hospital, has the potential to reinvigorate translational research on a debilitating disease.

Schizophrenia is a devastating psychiatric disorder that afflicts approximately one percent of the population and is characterized by hallucinations, emotional withdrawal, and a decline in cognitive function. These symptoms most frequently begin in patients when they are teenagers or young adults.

First described more than 130 years ago, schizophrenia lacks highly effective treatments and has seen few biological or medical breakthroughs over the past half-century. In summer 2014, an international consortium, led by researchers at the Broad Institute’s Stanley Center, identified more than 100 regions in the human genome that carry risk factors for schizophrenia.

The newly published study now reports the discovery of the specific gene underlying the strongest of these risk factors and links it to a specific biological process in the brain.

Black Box

Said senior author Steven McCarroll:

“Since schizophrenia was first described over a century ago, its underlying biology has been a black box, in part because it has been virtually impossible to model the disorder in cells or animals. The human genome is providing a powerful new way in to this disease. Understanding these genetic effects on risk is a way of prying open that black box, peering inside, and starting to see actual biological mechanisms.”

Adds Bruce Cuthbert, acting director of the National Institute of Mental Health:

“This study marks a crucial turning point in the fight against mental illness. Because the molecular origins of psychiatric diseases are little-understood, efforts by pharmaceutical companies to pursue new therapeutics are few and far between.

This study changes the game. Thanks to this genetic breakthrough we can finally see the potential for clinical tests, early detection, new treatments, and even prevention.”

The Path to Discovery

The remarkable story of discovery involved the collection of DNA from more than 100,000 people, detailed analysis of complex genetic variation in more than 65,000 human genomes, development of an innovative analytical strategy, examination of postmortem brain samples from hundreds of people, and the use of animal models to show that a protein from the immune system also plays a previously unsuspected role in the brain.

Over the past five years, geneticists led by the Broad Institute’s Stanley Center for Psychiatric Research and its collaborators around the world collected more than 100,000 human DNA samples from 30 different countries to locate regions of the human genome harboring genetic variants that increase the risk of schizophrenia.

The strongest signal by far was on chromosome 6, in a region of DNA long associated with infectious disease, causing some observers to suggest that schizophrenia might be triggered by an infectious agent. But researchers had no idea which of the hundreds of genes in the region was actually responsible or how it acted.

The site in Chromosome 6 harboring the gene C4 towers far above other risk-associated areas on schizophrenia’s genomic “skyline,” marking its strongest known genetic influence. The new study is the first to explain how specific gene versions work biologically to confer schizophrenia risk. Credit: Psychiatric Genomics Consortium

Based on analyses of the genetic data, McCarroll and first author Aswin Sekar focused on a region containing an unusual gene called complement component 4 (C4). Unlike most genes, C4 has a high degree of structural variability: different people have different numbers of copies and different types of the gene.

McCarroll and Sekar developed a new molecular technique to characterize the C4 gene structure in human DNA samples. They also measured C4 gene activity in nearly 700 post-mortem brain samples.

They found that the C4 gene structure (DNA) could predict the C4 gene activity (RNA) in each person’s brain – and used this information to infer C4 gene activity from genome data for 65,000 people with and without schizophrenia. These data revealed a striking correlation: patients who had particular structural forms of the C4 gene showed higher expression of that gene and, in turn, had a higher risk of developing schizophrenia.

Connecting Cause and Effect Through Neuroscience

But how exactly does C4—a protein known to mark infectious microbes for destruction by immune cells—affect the risk of schizophrenia?

Answering this question required synthesizing genetics and neurobiology. Beth Stevens, recent recipient of the MacArthur “Genius Grant,” had found that other complement proteins in the immune system also played a role in brain development by studying an experimental model of synaptic pruning in the mouse visual system.

Michael Carroll, professor at Harvard Medical School and researcher at Children’s Hospital, had long studied C4 for its role in immune disease, and developed mice with different numbers of copies of C4. The three labs set out to study the role of C4 in the brain.

They found that C4 played a key role in pruning synapses during maturation of the brain. In particular, they found that C4 was necessary for another protein (a complement component called C3) to be deposited onto synapses, as a signal that the synapses should be pruned.

The data also suggested that the more C4 activity an animal had, the more synapses were eliminated in its brain at a key time in development.

The findings may help explain the longstanding mystery of why brains from people with schizophrenia tend to have a thinner cerebral cortex with fewer synapses than unaffected individuals do. The work may also help to explain why the onset of schizophrenia symptoms tends to occur in late adolescence: the human brain normally undergoes widespread synapse pruning during adolescence, especially in the cerebral cortex (the brain’s outer layer, responsible for many aspects of cognition).

Excessive synaptic pruning during adolescence and early adulthood, due to increased complement (C4) activity, could lead to the cognitive symptoms seen in schizophrenia.

“Once we had the genetic findings in front of us we started thinking about the possibility that complement molecules are excessively tagging synapses in the developing brain,” Stevens said.

“This discovery enriches our understanding of the complement system in brain development and in disease, and we could not have made that leap without the genetics. We’re far from having a treatment based on this, but it’s exciting to think that one day, we might be able to turn down the pruning process in some individuals and decrease their risk.”

A Path Toward Early Detection and Potential Therapies

Beyond providing the first insights into the biological origins of schizophrenia, the work raises the possibility that therapies might someday be developed that could “turn down” the level of synaptic pruning in individuals who show early symptoms of schizophrenia. This would be a dramatically different approach from current medical therapies, which address only a specific symptom of schizophrenia (psychosis) rather than the disorder’s root causes, and which do not stop cognitive decline or other symptoms of the illness.

The researchers emphasize that therapies based on these findings are still years down the road.

Still, the fact that much is already known about the role of complement proteins in the immune system means that researchers can tap into a wealth of existing knowledge to identify possible therapeutic approaches. For example, anti-complement drugs are already under development for treating other diseases.

“For the first time, the origin of schizophrenia is no longer a complete black box,” said Eric Lander, director of the Broad Institute. “While it’s still early days, we’ve seen the power of understanding the biological mechanism of disease in other settings. Early discoveries about the biological mechanisms of cancer have led to many new treatments and hundreds of additional drug candidates in development. Understanding schizophrenia will similarly accelerate progress against this devastating disease that strikes young people.”

“In this area of science, our dream has been to find disease mechanisms that lead to new kinds of treatments,” said McCarroll. “These results show that it is possible to go from genetic data to a new way of thinking about how a disease develops—something that has been greatly needed.”

Top Illustration: Imaging studies showed C4 (in green) located at the synapses of primary human neurons. Credit: Heather de Rivera (McCarroll lab).