Brought to you by the Depression Is Real Coalition, The Down & Up Show is dedicated to the reality of depression. Each week our hosts will talk with some of the world's top experts on depression, as well as people who have been impacted by this illness. The reality of depression is that it is a debilitating and potentially deadly medical condition that affects more than 15 million Americans every year. The other reality of depression is that there is hope.

Down & Up Show #54: Living With Bipolar Disorder

DR. REEF KARIM:
Welcome to the Down and Up Show on DepressionisReal.org, I'm your host Dr. Reef Karim, psychiatrist, addiction specialist and relationship therapist. Today we'll be speaking with Larry Fricks, who is vice president of Peer Services for the Depression and Bi-Polar Support Alliance, member of the Depression is Real Coalition.

We will talk to Larry about his personal story of living with bi-polar disorder, previously known as manic depression. Larry shared a story in Richard Cohen's book, "Strong at the Broken Places" which shared several different stories about living with a chronic illness.

Like diabetes and multiple sclerosis, clinical depression and bi-polar disorder are both chronic illnesses. As you may know, chronic illnesses are recurrent and long-lasting and patients with chronic diseases treat their illnesses for their lifetime. Before we started the show I want to give you a little background on bi-polar disorder for our listeners.

Basic depressive disorder and manic depression or bi-polar disorder differ significantly although the symptoms for the depressive phase of the illness are similar. A person living with bi-polar disorder experiences changes that alternate between the two poles or highs and lows.

The highs are periods of mania, the lows are periods of depression and these changes in mood or mood swings can last for hours, days, weeks or even months. A person living with major depressive disorder or clinical depression does not experience mood swings between these two poles, but instead experiences a consistent state of depression or sadness.

Alright, so now that we have our summary there... thank you for joining us today, Larry.

LARRY FRICKS
Thank you.

DR. REEF KARIM
Alright, so can you tell us a little bit about yourself, you know what you do for a living now, how living with bi-polar disorder has influenced you to pursue the career that you're in?

LARRY FRICKS
Well I think many of us as we sort of process the pain and suffering, we may go through as a result of a diagnosis, on the other side of that is often an opportunity for some personal transformation and many of us decided to get involved with supporting other people in their recovery.

And so that's exactly you know what gives me some of the main purpose in my life and for 13 years I served as director of the Office of Consumer Relations and Recovery for Georgia's Division of Mental Health. And in that time started the first Medicaid billable peer support services that are now spreading across the country.

And I left that position two years ago and have worked in 20 states helping setup Medicaid billable peer support with the focus shifting to our strengths rather then our illness or disability.

DR. REEF KARIM
And in "Strong at the Broken Places" you tell the author, Richard Cohen, about the difference between a stigma of mental illness compared to other chronic illnesses like multiple sclerosis and others. Could you... could you tell your audience a little bit... our audience a little bit about how the stigma around mental illness is different then other diseases?

LARRY FRICKS
Well Richard uses a beautiful example in the opening and closing of the chapter on-- on my life and he does that by taking you to the state hospital, called Central State Hospital in Millersville, Georgia that opened in 1842. And on the grounds of that state hospital are some 25,000 patients who are buried pretty much, forgotten died, buried and forgotten.

And over the years, their graves were actually neglected and so that's sort of a snapshot of an illness where historically we were removed from society, segregated, many of us actually died and families had forgotten us and no one came and got us, there was usually not a service.

And you know this is true in all 50 states, it just so happens to be that Georgia has the largest cemetery of people with mental illness that we know of. And we still experience discrimination; we're the most unemployed of any disability group in the country, that number hovers around 85 percent unemployed. I think some of the discrimination is tied to a belief that our thought process is broken and you know, maybe during the acute phase of our illness, there was some behavior that indicated that we needed support and -- and you know getting support is a good thing.

So a belief that our thought process is broken and that's permanent and we can never really be trusted, for many of us, we believe, is at the core of the discrimination.

DR. REEF KARIM
Yeah and it's interesting, as the technology of medication has changed and we're better equipped to deal with treating the illness and treating the symptoms of the illness, you would think that either discrimination or the -- the employee, the job offerings all of that would change. But it sounds like it really hasn't changed that much.

LARRY FRICKS
And that's exactly why when we go out and train a peer work force, we... we explain that there's really three things that disable you. One is symptoms and historically, that's all that was addressed were the symptoms. And in the mid-‘80s when I was hospitalized three times, that was the focus, the symptoms.

But if you think that's the only thing that disables us, you miss, you miss out on what we really need for recovery. We say there's actually three things that disable you, it's the symptoms, it's the stigma and it's the negative self-image. What you believe about mental illness maybe more disabling then the illness itself.

So we go out and train peers that when you consider that all three disable you, then you begin to see how a peer workforce can help you change beliefs and some of that is... is what you know your own self-image and what you've internalized.

DR. REEF KARIM
Why do you believe that people with depression and other mental illnesses need to attend support groups and hear and learn from each other's experience. I mean it seems obvious to me though, but what... what do you think is the... is the big recovery draw there?

LARRY FRICKS
I just think it's just huge, I mean... and you know in my own peer personal experience, I had become so hopeless about the prognosis of my illness because of some of the messages that I was getting, that I might not be able to work and of course my first marriage unraveled under the stress of the illness.

And... and I think a peer group... first of all, the first thing it does is it challenges your thoughts about whether or not you can recover because there are people in that group who are experiencing recovery. So they right away challenge those negative thoughts you maybe having. And I... you know, I think that someone who's walked in your shoes, can in some ways be more convincing then anyone else.

The other thing that happens is a peer, you can talk to almost anytime, unfortunately a doctor under managed care, you may not be able to get to for weeks. And so if you have somebody that can help you when that spiral starts, and is available almost anytime, I think that's very powerful.

I think Dr. Abraham Lowe at the University of Illinois in the 1930's, that was the basis of Recovery Incorporated and his work as a psychiatrist was... he started putting together peer groups to help each other with their emotions. And... so there's a history here, and the other thing is, peers can share real successful options for managing your recovery.

I mean... you know they say, you know this helped me... you know I can see where peers can actually also recommend doctors and say you know this doctor really took the time to do... person centered planning with me and really cared about... you know the things... the... my book, my environmental and personal supports. So I think the peer movement, well quite frankly... you know the federal government, SAMHSA, the Substance Abuse and Mental Health Services Administration, has documented that it's the fastest growing mental health service in this country.

And so that's why I think DBSA, I mean they probably saved my life.

DR. REEF KARIM
In... in 1999 you spoke at the White House, right, where the first Surgeon General's report on mental health was being released? And during that meeting you introduced Tipper Gore and spoke about her genetic component to mental illness. Can... can you tell us, can you tell our listeners a little more about what you spoke about and what your experience was?

LARRY FRICKS
I just shared with people a little bit about the power of peers and about how appreciative I was that we were starting to have federal documents like a Surgeon General's report, you know, listing in there the evidence-based practices.

But also a... an overarching theme of recovery. Now I think the '99 Surgeon General's report was the first major federal document that... that really said in it that... recovery should be expectation and it also listed three peer support studies. So it gave peer support the... sort of credibility that it was an evidence based practice, that was huge for us.

But you know in the speech I basically talked about... this opportunity for... a major report coming of the Surgeon General's office to talk about recovery, to talk about peer support... and to basically... take on some of the ignorance and... and stigma... and list some of the really good evidence-based practices.

And I also related the fact that my grandmother, you know, had experienced mental illness and nobody ever talked about it. I also talked about the fact that, my senior year in high school, we took a field trip to Millersville and they let us go through these units and stare at patients who were, some of them unclothed, some of them in fetal positions on the floor.

And how badly I felt about their dignity and respect, they let people come through and look at them. Now this was in 1968, my senior year in high school. And I shared that I thought probably the worst thing that cover happen to a human being was mental illness, never knowing that years later, I would be in seclusion and restraints and people looking at me, you know, through a little window in the door.

And so somehow, that speech got a lot of play around the country, and I ended it by saying that the greatest potential for recovery is not in the system, it's within the person. And I think great doctors... believe that and they invest in us being able to self-manage our illness and trusting us to learn, you know, how to do that, and of course, the power of our peers.

So that's kind of what I covered in the speech.

DR. REEF KARIM
You dedicated your career to d-stigmatizing mental illness, what needs to be done to create more awareness around depression and bi-polar disorder at this time?

LARRY FRICKS
Well, I tell you somebody that I just adore, and that's Rosalind Carter. The Carter Center and Mrs. Carter's number one project is trying to change policy. And so I think we need more of what Rosalind Carter and you know people like Tipper Gore...what those folks are doing to raise awareness.

I also think that advocacy organizations like DBSA are really... you know really need to be supported because you know we've got support groups in 1000 support groups in all 50 states, but you know the truth is that non-profits that are advocacy organizations, you know, Mental Health America, NAMI, they struggle and you know it's very hard for them to survive. And in particular, it's been really hard the last few years because there have been significant cuts to human services.

And so my feeling is more of, you know, real exposure to our issues. More things like the President's Commission Report in 2003 on Mental Health, more things like the Institute of Medicine Report in 2006. And just really starting to support, you know, some of these advocacy issues.

I mean we need parity in this country. I mean what a statement it makes-- you talked about stigma earlier-- what a statement it makes that if I have a mental illness, I'm treated totally different when it comes to insurance. And yet what we know is that, with the right supports, right medication, people could experience a very strong recovery. Recovery is the expectation.

DR. REEF KARIM
Good, any closing thoughts you'd like to add?

LARRY FRICKS
No, I just... I mean this is an example... you creating this forum and this opportunity to speak about these issues. And I just want to thank Richard Cohen too, for including bi-polar illness in his book. I think in the past we weren't always included in the club of illnesses or chronic illnesses. In some ways we actually were discriminated against.

So Richard Cohen made a real statement when he said, one out of five people experience mental illness in their life and I want bi-polar illness to be part of my book. But thank you for this opportunity and what you're doing to educate people.

DR. REEF KARIM
Well thank you, thanks for speaking with us today Larry about your really, truly extraordinary story. Join us next week for another segment of the Down and Up Show on Depression is Real dot org, I'm Dr. Reef Karim.