Friday, December 09, 2011

GW Psychiatric Treatment: Lithium Prescription

 From the Seinfeld episode, "The Seven."

(Kramer takes a firm grip of each side of Elaine's head. Elaine looks really worried now. She grabs a hold of Jerry's shirt and the arm of the couch, and her feet stamp on the floor.)

KRAMER: From pain, will come pleasure.

(Kramer violently twists Elaine's head to the left. There's a loud crunching sound, and Elaine cries out in shock. Kramer lets go of her head and steps away, job done.)

KRAMER: Uh? Voila.

ELAINE: (pleasantly surprised) Oh my god!


(Elaine rolls her head around, completely comfortable.)

ELAINE: Wow! That is unbelievable. The pain is totally gone!

JERRY: What's even more amazing is his formal training is in pediatrics.

February 12, 1993
3801 Connecticut Avenue, NW
Apt. 136
Washington, DC  20008

Suzanne M. Pitts, M.D.
Department of Psychiatry
George Washington University 
   Medical Center
2150 Pennsylvania Avenue, NW
Washington, DC  20037

Dear Dr. Pitts:

I would appreciate your considering the following issues that I would like to discuss with you regarding the lithium prescription.

1.  Have you ruled out a hormonal disturbance as a factor in my illness?  Note that prior to my blood test on February 5, 1993 I had not consumed caffeine, other than that contained in decaffeinated tea, since January 5, 1993.  Any test of norepinephrine level as of February 5, 1993 would not have been significantly affected by caffeine.

2.  Would an individual suffering from an illness responsive to lithium likely derive significant benefit from a benzodiazepine tranquilizer?  I had derived significant benefit from Ativan in the past; is the response consistent with a mood disorder responsive to lithium?

3.  How is the diagnosis “mood disorder” consistent with profuse sweating and early morning awakening, symptoms that were especially pronounced in adolescence?  Note that Bellergal (a parasympathetic nervous system inhibitor) was prescribed by a previous psychiatrist.

3.  If I suffer from a bipolar disorder, why did the results of psychological testing at the Hospital of the University of Pennsylvania, prior to entering a drug study in the fall of 1978, indicate that I should be placed on a trial of an anxiolytic rather than an anti-depressant?

4.  How is my purported mood disorder specifically related to my interpersonal difficulties, and how might lithium modify my interpersonal difficulties?  To date, you have not stated a causal link between my purported mood disorder and my interpersonal difficulties.  With specific reference to my difficulties at my previous place of employment note that I was described by two supervisors at various times during the period November 1988 through May 1991 in the following manner:
  • There is no task too much to ask of Gary.  It is nice to have Gary around.  He is always stable in the [midst] of other inconsistencies.  Gary is dependable [].  He is always enthusiastic [].  I appreciate the job that Gary has done and look forward to other projects with Gary’s help.  Totally independent, self-sustaining and committed to his work.  Extremely solid and aiming to please.  I trust Gary’s ability to meet whatever the demand with little guidance.  Gary is receptive no matter what the task and takes every assignment seriously.  Great pressure buffer.  I can be at ease knowing Gary will prevail.  Gary is a self-starter in all respects.  Gary is the soul of dependability and responsibility.  He is a self-starter and thoroughly dependable.  Always know he can be relied upon to complete a project with no supervision, and it will be done accurately and efficiently.  Gary seems as close to the perfect employee as it is possible to get!  A self-starter--he works efficiently and consistently enjoying maximum productivity on a daily basis.  He is reliable, hard working and extremely responsible.

It seems of special significance that during the entire period that the above observations were made, I was “delusional” (I had suspicions of harassment by co-workers and paranoid delusions of surveillance by my employer).  What is the significance of (1) the co-existence of severe delusions and (2) the perception by others that I was emotionally stable, and how might this peculiar conjunction be affected by lithium?  Specifically what type of mood disorder are we dealing with?

(In late 1981 a previous employer described me in the following manner: “He has consistently demonstrated the spirit of cooperation in an easy manner under stress that endear him to all within this firm.”)

5. At the risk of sounding grandiose, how would you distinguish the “spurts of energy” characteristic of mania from the vigor observed in creative individuals.  See e.g., Barron, P. “The Disposition Toward Originality.”  In Taylor, C.W. and Barron, F. (eds.) Scientific Creativity: Its Recognition and Development, pp. 139-152 (Wiley: 1963) (contending that creative persons are more vigorous from a physical point of view).  Accord, Eissler, K.R. Talent and Genius (citation?) (discussing Freud and his eel experiments).


Gary Freedman


Gary Freedman said...

Creative people have a great deal of physical energy, but they're also often quiet and at rest. They work long hours, with great concentration, while projecting an aura of freshness and enthusiasm. This suggests a superior physical endowment, a genetic advantage. Yet it is surprising how often individuals who in their seventies and eighties exude energy and health remember childhoods plagued by illness. It seems that their energy is internally generated, due more to their focused minds than to the superiority of their genes.

This does not mean that creative people are hyperactive, always "on." In fact, they rest often and sleep a lot. The important thing is that they control their energy; it's not ruled by the calendar, the dock, an external schedule. When necessary, they can focus it like a laser beam; when not, creative types immediately recharge their batteries. They consider the rhythm of activity followed by idleness or reflection very important for the success of their work. This is not a bio-rhythm inherited with their genes; it was learned by trial and error as a strategy for achieving their goals.

One manifestation of energy is sexuality. Creative people are paradoxical in this respect also. They seem to have quite a strong dose of eros, or generalized libidinal energy, which some express directly into sexuality. At the same time, a certain spartan celibacy is also a part of their makeup; continence tends to accompany superior achievement. Without eros, it would be difficult to take life on with vigor; without restraint, the energy could easily dissipate.

Gary Freedman said...

Mihaly Csikszentmihalyi (born September 29, 1934, in Fiume, Italy – now Rijeka, Croatia) is a Hungarian psychology professor, who emigrated to the United States at the age of 22. Now at Claremont Graduate University, he is the former head of the department of psychology at the University of Chicago and of the department of sociology and anthropology at Lake Forest College.

He is noted for both his work in the study of happiness and creativity and also for his notoriously difficult name, in terms of pronunciation for non-native speakers of the Hungarian language, but is best known as the architect of the notion of flow and for his years of research and writing on the topic. He is the author of many books and over 120 articles or book chapters. Martin Seligman, former president of the American Psychological Association, described Csikszentmihalyi as the world's leading researcher on positive psychology.

Csikszentmihalyi once said "Repression is not the way to virtue. When people restrain themselves out of fear, their lives are by necessity diminished. Only through freely chosen discipline can life be enjoyed and still kept within the bounds of reason." His works are influential and are widely cited.

Gary Freedman said...

As it turned out, I never did have bipolar disorder.