Great Manics of History

We can’t pick our diagnoses like we pick what outfit we are going to wear.

I remember an encounter where the psych symptoms had political overtones, although I’ve handled plenty of other cases that had the same resistance to being diagnosed.

“I’m scared of this bipolar thing,” he said.  “Everyone I know who has it is really sick — like crazy — and I’m not sure I want to take medication for it.”

So many antidepressants are being dished out today that levels of these drugs have been discovered in the water supply on both sides of the Atlantic.  They are being given out by general practitioners like candy  — write about 80% of these prescriptions — but the OB/GYN and Pediatrician and Internist and just about everybody prescribes them too.

The newer antidepressants are considered “safe” and a doctor is often pressured to prescribe something — anything — for a wide range of symptoms.

But with the widespread distribution of this “safe” drug, we may be creating bipolar illness in mildly or moderately depressed people.

This patient was a “right winger,” what I would call a Fox News Republican and thought — for God knows what reason — that I would be on his side.

So I usually answer questions about a diagnosis and talk to people a little more than the run-of-the-pill-mill doc, but I felt giving him a little of his own politics.  I was in one of those moods where I thought this would be good for us both.

“Manic people made this country great” I said.  And I’ve given this speech many times.  “Manic people founded this country.  The gene is still in the gene pool because the great achievers were all manic when they did good things.”

I had his whole attention now.

“On the other side of the pond, the chief psychiatrist of England said Winston Churchill would never have been able to get them through World War II without his incredible manic optimism.”

“But for us, it was cute little Ben Franklin with the coonskin cap — when everyone else was wearing periwigs — coming on to French noblewomen, getting them to write fat checks for weapons for the Continental Army, making up news for his newspaper.  He was bouncing-off-the-walls manic.”

“Abraham Lincoln,” he started to say, but I jumped right in. “Yep, him, too.”

“Thomas Jefferson,” he tried again, but I knew where he was going.

” — did not have the worst case in the world, ” I said, finishing his statement. I told about all his original scientific activity and how he made a hole in the anteroom of Monticello for a scientific experiment, and was so smart he knew everything, had this great library, oversaw college curriculum for William and Mary, etc.

My patient was starting to get the idea.

“So you think Rush Limbaugh could have it?” he asked.

This was my patient’s idea of today’s great statesman.

“No, I think he was a substance abuser.  But as for you, say it out loud — I am American, I am manic, and I am proud.”

He accepted the prescription.