The Dreadful Toll of Alcoholism and Mental Illness

The Dreadful Toll of Alcoholism and Mental Illness

The comorbidity of alcohol use disorder and depression is well documented. For those with both, they are co-dependent with the other. It is estimated that 1/3 of people with severe depression are also addicted to alcohol at one time or another.

I was one of them. 

Although I was initially diagnosed with depression (and later bipolar ll), it was usually during the depressive periods that I depended on liquor to self-medicate, even after I started taking anti-depressant pills. In turn, the alcoholism exacerbated my depression, social discomfort, and anxiety when I wasn't drinking. I never thought about the warnings on most anti-depression medications to not drink alcohol.

However, I never drank during the day at my various jobs or at home until my family went to sleep. In fact, I was energized by my work in my remission phases. I became obsessively absorbed in the details of my day-to-day tasks, leading me to excel and become extraordinarily successful in many different areas.

There were times during my periods of hypomania and racing thoughts that the pressure of working at a Herculean breakneck pace also led me to drink excessively at night. This was a pattern that lasted off-and-on for decades, except for the short or long periods of remission.

On vacations overseas, my addiction to alcohol was incessant and unquenchable. During the days on such trips, I stayed sober, but at nights and when flying, all bets were off.

It was at Narita Airport in Tokyo in 2019 that I reached my abject nadir, as my wife and I were waiting at the gate for a plane to transfer to Hanoi to begin a three-week vacation in Southeast Asia.

My wife is an avid reader and when she is absorbed in a book, there is very little that can distract her. I told my wife that I was restless -- which given my racing thoughts was not entirely untrue --  and needed to walk around. In a duty free shop I bought some miniature Absolut bottles and guzzled down six of them in a washroom stall. My wife was still absorbed in her novel when I returned, and she didn't notice that I was inebriated.

Alcoholic debauchery was not infrequent when flying to stave off my depression, my anxiety, and my desire to avoid interacting with people, such as strangers sitting next to me in an airport waiting area or on the plane.

When we arrived back to the O'Hare international terminal, after our trip to Vietnam, Cambodia, Laos and Thailand, I had already made the decision to go cold turkey, and I did.

I have not had a drink since that day, I have never attended an Alcoholics Anonymous meeting, gone through withdrawal, or received therapy for my former alcoholism. Like many conundrums associated with mental illness, it remains a mystery that I had the willpower to stop so abruptly. 

I didn't become what is known as a dry drunk, which is someone who still craves alcohol; I became stone cold sober, losing any desire to become drunk. I no longer walked through aisles of liquor shelves at supermarkets with a compulsive craving for the gleaming bottles and the temporary relief that came with intoxication.

It was then, when I was no longer waking up after blackouts, that I was ultimately diagnosed as being bipolar II.

There is no doubt in my mind that my closet alcoholism was precipitated by my vacillating moods (most notably depression) as a bipolar.

 It has been five years since my last drink. I think with more clarity, I am more open to relationships, emotions, and social engagement. I avidly volunteer for a variety of causes in my retirement, with my mental health under control due to an effective "cocktail" of medications and therapy.

I occasionally remember when we socialized with a colleague of my wife's and her boyfriend when I was in my mid-20’s. I got blindingly drunk. I was beyond remembering what transpired, a total blackout, and only afterward, my wife thanked me for driving the couple to their hotel. 

As I look back, I feel grateful beyond words that I did not get into a catastrophic accident and kill anyone, including myself. Fortunately, I had the good sense after that not to drive after drinking.

But that horrifying, irresponsible behavior is behind me. I finally feel that I have arrived home, and the possibilities of such disasters and dissolution are no longer on the horizon.

Mark Karlin is retired, after a long career in advocating against gun violence, as a hospital executive, an online journalist, a consultant, and founder of a progressive website. He graduated from Yale University, cum laude, with an honors degree in English and received his MA from the University of Illinois.


Many Insurance Companies Are Refusing to Pay for Mental Health Care Despite Federal Law

Many Insurance Companies Are Refusing to Pay for Mental Health Care Despite Federal Law

According to the US Centers for Medicare & Medicaid website, the federal Mental Health Parity and Addiction Equity Act (passed and signed into law in 2008),"generally prevents group health plans and health insurance issuers that provide mental health or substance use disorder (MH/SUD) benefits from imposing less favorable benefit limitations on those benefits than on medical/surgical benefits."

In 2010, the Patient Protection and Affordable Care Act (Obamacare) added the mental health requirement to include individual health insurance policy holders.

However, a blockbuster ProPublica investigative article, aired by NPR on August 25, details how a large number of insurance providers are evading the requirement using a number of different subterfuges. The lengthy news story details how many patients are being denied care. Furthermore, many therapists and psychiatrists are leaving the commercial and non-profit insurer networks because of obstacles that include denial of care, delays in payments and impediments to communicating patient needs.

ProPublica found that,

It is often the insurers, not the therapists, that determine who can get treatment, what kind they can get and for how long. More than a dozen therapists said insurers urged them to reduce care when their patients were on the brink of harm, including suicide.

All the while, mental health providers struggled to stay in business as insurers withheld reimbursements that sometimes came months late. Some spent hours a week chasing down the meager payments, listening to hold music and sending faxes into the abyss.

The news site interviewed more than 500 providers across the nation and found the outlook for adequate provision of mental healthcare by insurance companies -- particularly for long-term maintenance -- to be generally difficult, with lives often at stake. The exodus of providers and insurance companies overruling recommendations by therapists means that those who seek mental health care may often have to pay for it out-of-pocket. For severe mental illnesses, this could cost thousands, even tens of thousands of dollars.

Persons seeking therapy are confronting "a system to squeeze them out" because their conditions can be "chronic and costly." In short, they are "bad for business."

ProPublica reported, "There are nowhere near enough available therapists in insurance networks to serve all of the people seeking care....The consequences can be devastating."

In a previous NoShameonU blog, I detailed the growing shortage of psychiatrists and identified other options for care. But many of these non-psychiatric mental health providers are now finding it untenable to wrestle with the insurance companies for authorization of care and reimbursement, among other issues. Many psychiatrists and alternative therapists are no longer affiliated with insurance companies and will only see clients for cash.

The federal laws don't define how the insurance companies determine mental health standards of care. ProPublica found that "They often create their own internal standards instead of relying on ones developed by nonprofit professional medical societies. These standards can then be used to challenge diagnoses or treatment plans."

There are less than nine states (Illinois is one of them) that have set minimum criteria for what is considered medically necessary care for mental health patients, and it is likely that there are still loopholes that the insurance companies will exploit. In a hopeful sign, California, which has passed minimum standards, fined the giant non-profit Kaiser Permanente system $50 million for violating state guidelines and required the 12.5 million member provider to invest $150 million in behavioral health care. The reality, however, is that 41 states still do not have any minimum required standards for insurance companies.

Given that numerous sources cite that approximately 50% of Americans with mental health needs do not receive care, let alone those who receive inadequate care, the ProPublica article should be a wake up call to Congress to rectify this gaping hole in the Mental Health Parity and Addiction Act.

Mark Karlin is retired, after a long career in advocating against gun violence, as a hospital executive and founder of a progressive website. He graduated from Yale University with an honors degree in English. 







The Misdiagnosis of Severe Mental Health Disorders

The Misdiagnosis of Severe Mental Health Disorders

It would be ideal to visit a mental health provider and receive an accurate diagnosis of your illness. That is, hopefully, most often the case.  However, several studies have shown that a wide variety of psychiatric conditions may be initially misdiagnosed.

The peer-reviewed journal "Psychiatry" published a research paper in 2006 that cited a study that found "As per the survey taken by the National Depressive and Manic-Depressive Association (DMDA), 69 percent of patients with bipolar disorder are misdiagnosed initially and more than one-third remained misdiagnosed for 10 years or more."

A 2011 study in "The Primary Care Companion for CNS Disorders" found that primary physician "misdiagnosis rates reached 65.9% for major depressive disorder, 92.7% for bipolar disorder, 85.8% for panic disorder, 71.0% for generalized anxiety disorder, and 97.8% for social anxiety disorder."

Borderline personality disorder is difficult to diagnose, as another example, and is often mistaken for bipolar disorder or even unipolar depression, or not considered a mental illness at all.

Other studies have shown appreciably lower rates of misdiagnosis, but clearly individuals with a mental health disorder are more likely to be misdiagnosed than someone who has pneumonia, for instance.

An article by Michael G. Pipich in a 2021 edition of "Psychology Today" warns: 

Some [of my patients with bipolar disorder who have been misdiagnosed] have reported to me that while their pre-existing depressive episodes may improve with antidepressants, they often experience manic episodes that are more agitating and consequential than ever before. 

Schizophrenia is not infrequently misunderstood as a diagnosis. The National Alliance on Mental Illness flatly states on their website: "Diagnosing schizophrenia is not easy." The Johns Hopkins Early Psychosis Intervention Clinic reported in 2019 that "researchers report that about half the people referred to the clinic with a schizophrenia diagnosis didn't actually have schizophrenia." That is a stunning statistic, but representative of the fact that whether people with mental health issues are underdiagnosed or overdiagnosed, the result is the same. They are likely to be receiving medications and treatment that do not address their complete underlying condition.

In 2021, "The Huffington Post" ran an article entitled, "5 Mental Health Conditions That Are Way Underdiagnosed." 

Some conditions tend to be particularly underdiagnosed (meaning more people have them than get a diagnosis) or misdiagnosed (meaning they’re told they have something else). That means too many people continue to struggle on their own rather than connecting with the treatment they need and deserve. 

"Consumers" may be perplexed as to why providers using the Diagnostic and Statistical Manual of Mental Disorders (DSM-Edition 5) sometimes can't match the criteria listed with distinct mental disorders. There are many reasons for that, far too many to list here. 

However, a key factor may be the limited time period that most people with mental health problems have with providers.  Most complicated mental diagnostic categories require long-term interaction with the client and the ability to pick up on nuances in behavior and recollections.

Unfortunately, many clients don't know the specific language to use that reflects the medical criteria in the DSM, and so medical symptoms are sometimes not communicated clearly. Furthermore, many symptoms of mental health conditions overlap.

Also many beleaguered providers likely want to quickly establish a diagnosis because of time constraints or due to a lack of knowledge in the case of primary physician "screeners."  It can be speculated that hospitalized psychiatric patients may receive more accurate diagnoses because of the intensity of time spent observing, testing and talking with them and the long-term experience of psychiatric unit staff. However, misdiagnoses can happen even in these cases.

If you think that you are being misdiagnosed, you should strongly consider getting at least one second opinion as an option.

Mark Karlin is retired, after a long career in advocating against gun violence, as a hospital executive and founder of a progressive website. He graduated from Yale University with an honors degree in English.


13-1-18-1-20-8-15-14

13-1-18-1-20-8-15-14

 M-A-R-A-T-H-O-N


My name is Jack Simanek - new to 23 years old, new to Chicago, and new to marathons. Throughout my training I’ve been reflecting on the value of good mental health. I am excited to partner with No Shame On U as I have chosen to support their mission by fundraising during my preparation for the upcoming Chicago Marathon in October. 

 I would like to share what MARATHON means to me and how this training journey has given me the opportunity to take a moral inventory of myself. As a numbers guy, M-A-R-A-T-H-O-N and 13-1-18-1-20-8-15-14 are synonymous to me. 

Marathon is for Mindful - 13 

While I run, I am mindful of health, hunger, family, goals, emotions, faith, environment, hydration, career, surroundings, thoughts, anxiety, vices, and growth.

Novak Djokovic- "Mindfulness is an important aspect of my training. It helps me stay in the moment and focus on what I need to do, point by point.”

mArathon is for Although - 1

While I run, although I am mindful sometimes I feel like I am going to fail.

I have concluded there will always be an "although," and it's okay to have those feelings—we're human, after all. I've learned that it's important to acknowledge these emotions and lean into them, rather than turning away. By accepting the fear of failure that comes with the "although", and then recognizing it is a stepping stone to success has been a helpful strategy for me. Running has helped me accept the “although” as normal feelings of doubt and the fear of failure

Albert Einstein - "Failure is success in progress.”

maRathon is for Relax - 18 

While I run, I know that remaining relaxed is critical to my success. I am relaxed when I’m prepared, with friends, at the Free-Throw line, watching a show, in a bath, hydrated, doing yoga, stimulated, committed to a goal, comfortable, stretching, listening to music, supported by family and friends, in control, playing the game, driving with the windows down, well-rested, and healthy

Tom Brady - "You can only control the things you can control, so focus on staying relaxed and in the moment."

marAthon is for Anxious -

While I run, I have reflected on the fact I am anxious when I don’t have control.

Most aspects of life—relationships, emotions, and external events—are beyond our direct control. I've learned that success in my marathon of life lies in focusing on what I can control: my attitude, my responses, my preparation, my support system, and even my breath. By focusing on these areas, I've found an effective way to navigate uncertainty and maintain a sense of calm.

Michael Phelps: "I think the biggest thing is that you have to be honest with yourself. If you're not feeling right, if you're feeling anxious or stressed, it's okay to talk about it. You can't let anxiety control you.”

maraThon is for Teams - 20 

While I run, I think about the teams I have been on and how I would not be where I am without my teammates. As T is the 20th letter of the Alphabet, I would like to share 20 of the teams I have been a part of, which have led me to where I am today. 

Team Simanek Family, Team Herzl Camp, Team Shapiro Family, Team Giolitos & Giordano's, Team Rubin Gilbert BBYO, Team IU AEPi, Team Chinasty, Team Paschal Varsity Basketball, Team North Texas Ruff Ryderz, Team Dynasty, Team KPMG Human Capital/HRBA, Team Walmart Cereal, Team Satori Capital, Team Indiana University ‘23, Team Ozo ‘18, Team Paschal Orchestra, Team College Station/Texas A&M Football, Team adidas, Team Academy 4 Org, Team TCU Athletics

 I am very excited to be “teaming” with No Shame On U raising money for this organization, and supporting their mission eliminating the stigma associated with mental health conditions.

Wayne Gretzky: "You miss 100% of the shots you don’t take, but with great teammates, you get the opportunity to take those shots. My success is a result of my team."

maratHon is for Hate - 8  

While I run, I am aware I hate losing, being wrong, being doubted, being jealous, feeling guilty, hating myself, complaining, and being blamed.

Hatred is a fascinating force, especially when I am on mile 5 of a 26 and realize that the only hatred I am facing is coming from within—something I can control. I'm used to dealing with hate from the crowds, where much of it is beyond my control. But I've found that recognizing my internal "haters" and focusing on what I can control has been transformative. By channeling that negative energy into fuel, I've been able to run faster and push further. There will always be hate in the marathon of life, but by developing strategies to turn it into fuel has been energizing.

Serena Williams: "If they don’t support you when you’re down, then they don’t deserve to be with you when you’re up. The hate I face fuels me to keep going."

marathOn is for Open-minded - 15

While I run, I am open-minded (curious) about myself, my career, meeting new people, when I travel, others' actions, nature vs. nurture, my faith, my behaviors, my biases, others' beliefs, what makes me happy, love, our healthcare, our existence, and our environment

Ted Lasso - “Be Curious, Not Judgmental.”

marathoN is for Numb - 14

While I run, I recognize that I feel numb when I am stressed, get knocked down, am overstimulated, am hurt, can't help out, am tired, overthink, am sick, feel powerless, behave outside of my values, take responsibility for others' emotions, don't take care of myself, don't have a direction, and cut corners.

Feeling numb is frightening. When my internal battery runs out, it can lead to system failures—depression, illness, heightened stress, decreased appetite, etc. When life hits me, and I feel my energy depleting, I’ve discovered it is crucial to pause, take a breath, recharge, and refocus on my purpose – winning the marathon of life. This way, I can function effectively and stay on course.

Ronda Rousey: "After so many hits, you start to feel numb to the pain. But you have to remember why you’re in the fight and keep going."

Overall, I've found that marathon training has given me valuable opportunities to reflect during my longer runs, and it's been incredibly rewarding for my mental health. Setting aside time to be mindful of how I am coaching myself has been essential for a healthier race in the marathon of life. I am excited to run the Chicago Marathon this October and encourage you to donate using the link below. Thank you for your support!

https://secure.lglforms.com/form_engine/s/89feI4dXjvjep0heIlW87w

While using the LINK please select the option to donate “Jack Chicago Marathon” 

Any donation is greatly appreciated as we are all running the MARATHON of life together. Here are some suggested numbers that are meaningful to me. 

Chai - $18 Jack’s # - $22 Marathon - $26.22 Double Chai - $36 Double Jack - $44 Chai Five -$90

Jack Simanek is a 23-year-old who is new to Chicago and marathons.

Making Piece With an Unquiet Mind

Making Piece With an Unquiet Mind

Anyone who wants a role model for wrestling with bipolar disorder must read the autobiography "An Unquiet Mind" by Kay Redfield Jamison.

The book reveals her harrowing challenges and thoughts as she grappled with bipolar disorder, rising to distinguish herself academically at the highest levels. Her journey is detailed in her astounding and revelatory tome published in 1995. She was first diagnosed with the illness in 1975, the same year that she received a PhD in clinical psychology from UCLA.

Jamison is currently the Dalio Professor of Mood Disorders and Professor of Psychiatry at the Johns Hopkins University School of Medicine.

She is achingly eloquent in detailing her personal path through bipolar disorder, while interspersing poignant literary quotations that illuminate her disclosures. It is grounded in courage and written as a cogent call to accept bipolar disorder as an adversary that can be managed.

Jamison reveals that she barely had the will to tell her prospective employer, the chairman of the Department of Psychiatry at Hopkins, that she was bipolar and taking lithium, but she decided that she had no ethical choice but to take the leap. They had an interview over lunch at which she disclosed her illness to him. She recalled her trepidation that not only did she have bipolar but she was seeking a medical professorship when she was not an MD. As she was holding her breath, Jamison describes the response to her disclosure:

"Kay dear," the [the chairman] said, "I know you have [bipolar illness]." He paused and then laughed. "If we got rid of all the [bipolar members] on the medical staff school faculty, not only would we have a much smaller faculty, it would be a far more boring one."

So began her distinguished career at Hopkins which continues to this day. The memoir itself was her ultimate coming out to the public at large.

Lithium had been her breakthrough drug. When she was younger, she had tried to stop taking it, but it did not end well. She attempted suicide, but was saved by a phone call from her brother. After this incident, she decided that she would not run the risk of going off lithium again, even though she felt that it frequently emotionally "blunted" her.

Redfield reveals that not all her coming outs were equally successful. In Malibu, while still in California, she told a former colleague, a psychoanalyst, of her condition:

He was, he said, "deeply disappointed." He had thought I was so wonderful, so strong: How could I have attempted suicide? What I had been thinking? I was such an act of cowardice, so selfish.

I realized to my horror, that he was serious. I was absolutely transfixed. His pain at hearing that I had [bipolar] was, it would seem, far worse than mine at actually having it. For a few minutes, I felt like Typhoid Mary.

Jamison is disarmingly frank in speaking of the often eviscerating pain of being severely bipolar. However, through perseverance and sheer grit, she has carved out a stellar career in academia, research, writing, teaching and assisting individuals with mood disorders. She recounts that despite her often desperate struggles, she has lived a full life including loving marriages and loving relationships.

However, she still sometimes is wistful about the exhilaration she felt in many of her manic states, the sheer elation of the spirit and soul:

I look back over my shoulder and feel an intense young girl, and then a volatile and disturbed young woman both with high dreams and restless aspirations: how could one, should one, recapture that intensity or re-experience the glorious moods of dancing all night and into the morning, the gliding through starfields and dancing along the rings of Saturn, the zany manic enthusiasms?

It is not uncommon for people with bipolar disorder who have experienced mania to -- while taking medications such as lithium -- miss the euphoric highs of unrestrained exultation. Jamison, in the end (as noted above), chooses to settle for the "flattened out" moods that come with taking lithium, but still occasionally regrets not experiencing her soaring highs.

Jamison also affirms that love has sustained her after her most dreadful bouts of major depression:

After each seeming death within my mind or heart, love has returned to recreate hope and restore life. It has at its best, made the inherent sadness of life bearable, and its beauty manifest.

She also gives a nod to how bipolar illness has allowed her to explore more of the "limitless corners, with their limitless views of life." Indeed, she offers an extraordinarily insightful and nuanced view on living with bipolar disorder and the personal decisions it demands us to make.

In the end she regards bipolar disorder as "a disease that both kills and gives life. Fire, by its nature, both creates and destroys. 'The force that through the green fuse drives the flower,' wrote Dylan Thomas, 'drives my green age; that blasts the roots of trees.'"

An Unquiet Mind, by Kay Redfield Jamison, Vintage Books.

Mark Karlin is retired, after a long career in advocating against gun violence, as a hospital executive and founder of a progressive website. He graduated from Yale University with an honors degree in English.