Noteworthy News Articles on Mental Health Topics, April 28-30, 2008



Michael White, 59, Dies; Used Stories as Therapy
Jeremy Pearce, New York Times- 4/28/2008

Michael White, a social worker and family therapist who developed an innovative and highly practical technique using storytelling to help patients of all ages deal with childhood traumas, died on April 4 in San Diego. He was 59. The cause was a heart attack, said a spokeswoman from the Dulwich Centre, a counseling service in Adelaide, Australia, where Mr. White had practiced family therapy since the early 1980s.
      With a colleague, David Epston, Mr. White explored the power of shaping personal accounts and memories in facing the lingering effects of childhood inadequacies and other obstacles in patients’ lives. Their technique was explained in an influential 1990 book, “Narrative Means to Therapeutic Ends,” and has since become known as narrative therapy. The technique is based in part on having a patient externalize a condition or problem — like obesity, loss of a parent or resentment of a sibling — and come up with stories and metaphors to re-evaluate the situation, usually from a more positive perspective. Narrative therapy has been used successfully to help bed-wetting children distance themselves from shame and anxiety, so they can consider their condition more objectively and not necessarily as a permanent character flaw. Some practitioners encourage patients to write stories, letters, essays or poems and to recall actual events in which they vanquished a concern or responded to a family member with cathartic satisfaction.
     A practitioner of narrative therapy, Dr. Gene Combs, an associate professor of psychiatry and family medicine at Loyola University in Chicago, said Mr. White emphasized the need to “elevate the person you’re working with, instead of elevating the therapist,” so that discussions with patients, alone or in family groups, can ensure that individuals are not viewed as “generic carriers of problems, or only as pathologies and not people.” The eventual goal of the technique is to help a patient recognize personal strengths and supportive relationships that can aid in surmounting a given problem, leading to what Dr. Combs termed the “preferred stories” of success and achievement in the patient’s life.
     Michael Kingsley White was born in Adelaide. He worked briefly as a probation and welfare officer before earning an undergraduate degree in social work from the University of South Australia in 1979. He then became a psychiatric social worker at Adelaide Children’s Hospital before starting his private practice at the Dulwich Centre. He further refined his ideas in a book published last year, “Maps of Narrative Practice.” Mr. White often traveled abroad to present case histories and refinements of narrative theory and was on a similar journey in San Diego when he died.
     Although narrative therapy has had relevance in treating anorexia, school-related anxiety and problems common in children and young adults, its uses continue to broaden. Beginning in the 1990s, Mr. White applied it to Aboriginal communities in New South Wales, and found that storytelling could be an incisive tool in helping tribesmen come to terms with dispossession and forced relocation from their ancestral lands.



Quieting the Demons and Giving Art a Voice
Abigail Zuger, M.D., New York Times- 4/29/2008

Madness: A Bipolar Life
By Marya Hornbacher. Houghton Mifflin. 299 pages. $25.
Poets on Prozac: Mental Illness, Treatment and the Creative Process.
Edited by Richard M. Berlin, M.D. Johns Hopkins Press. 200 pages. $21.95

Marya Hornbacher is a virtuoso writer: humorous, articulate and self-aware. She is also, as she has now documented in two books, incurably mentally ill. Even on the best possible treatment, Ms. Hornbacher tiptoes along the same high wire as Plath, Lowell, Woolf and the rest of the unbalanced artistes. Off medication, she reliably falls into a turmoil of confused self-destruction, which, as she would be the first to acknowledge, means heartbreak and worry for her friends and relatives, challenges for her doctors, and, in the age-old contradiction, new fodder for her muse.

For scientists trying to parse the mystery of brain and mind, she is one more case of the possible link between mental illness and artistic creativity. With all our scans and neurotransmitters, we are not much closer to figuring out that relationship than was Lord Byron, who announced that poets are “all crazy” and left it at that. But effective drugs make the question more urgent now: would Virginia Woolf, medicated, have survived to write her final masterpiece, or would she have spent her extra years happily shopping?

Ms. Hornbacher brings to the discussion more than the usual pairing of disturbed brain and talented mind. Her talent has created a third self, an appealing, rueful narrator who can look back on three decades of manic-depressive illness, much of it untreated, and spin a story that is almost impossible to put down. In the same way that the psychiatrist Kay Redfield Jamison experienced, recorded and then analyzed her own case in the 1995 classic “An Unquiet Mind,” Ms. Hornbacher provides the perfect trifecta of perspectives.

Readers of her well-received book “Wasted,” published in 1998 when Ms. Hornbacher was 24, left her in a state of tenuous recovery from a long struggle with anorexia. The first pages of “Madness” describe how illusory that recovery was. Prescribed an antidepressant, the common treatment for anorexia, she took a slow-motion swan dive into the full-blown anxiety, agitation and despair of bipolar disease made worse by exactly the wrong medication. Her plunge went unrecognized by her attendant mental health professionals, including one who suggested a regimen of candles, baths and aromatherapy.

Hot water did nothing to help; neither did alcohol, lots of it. Ms. Hornbacher finally picked a psychiatrist at random from the Minneapolis phone book and happened onto a good one. Her illness was accurately diagnosed and properly medicated in short order.

On television, that encounter would cue the credits, but the book has barely begun. What follows is an unsparing saga of severe refractory manic-depressive illness, with treatment often undermined by Ms. Hornbacher herself. “For years after I was diagnosed, I didn’t take it seriously. I just didn’t feel like thinking about it. I let it run rampant, and these are the results” — a jagged decade of health and productive work alternating with relapses, hospitalizations, electroshock treatments and slow climbs back to tenuous health.

The self-absorption of mental illness can be off-putting, or just plain dull. It is a testament to Ms. Hornbacher’s talent that her book is neither. She writes in a fluid staccato well suited to her stuttering reality, with a wicked ear for dialogue and a baseline common sense that contrasts with the immense senselessness of her worst manic episodes.

As for the central question of whether treating the illness impairs the creativity, Ms. Hornbacher weighs in firmly on the side of her meds, imperfect though they may be. “For me, the first sign of oncoming madness is that I’m unable to write.” Depression silences her; mania may flood her mind with glittering words, but they scatter before she can get them down. Only the prosaic morning meds (21 pills, at last count) will let her trap the words on the page.

More reflections on the same subject can be found in “Poets on Prozac,” a collection of essays solicited from published poets with psychiatric illness. Most of the 16 contributors are decades older than Ms. Hornbacher, but while they may lack her vivid prose style, they do supply a long-term perspective on the terrain.

With problems ranging from mild unmedicated depression to schizophrenia treated with an unorthodox megavitamin technique, these writers also focus on trapping the words — and all agree that the sick brain often spells catastrophe for the creative mind. While mental illness may form a part of the creative cycle, if untreated its own cycles invariably take over. “Depression steals the voice,” writes Liza Porter. “Silence breeds depression. Depression breeds silence.”

Meanwhile, the actual hard work of editing a mass of thoughts into a finished product is purely linear. It requires detachment and perspective, what Andrew Hudgins calls the “chemical Zen” of Paxil. “I have no idea if the drug has changed my work at any fundamental level,” writes Mr. Hudgins, a professor at Ohio State University, “but I doubt that it did, which is a great comfort.”

Even the poet’s reliable liquid elixir of inspiration is given short shrift here. Dylan Thomas be damned: it is the first national poet of Wales, Gwyneth Lewis, who writes: “I used to keep notes of my altered states of mind under the influence of drink in the hope that they would offer startling new images for poems. They didn’t. It was impossible to decipher my handwriting, and I kept throwing up. Another poetic myth bites the dust.”