Category Archives: Mental Health

Vraylar Vagaries & Verities


Television Advertisement for Vraylar, 2018

A great pile of aluminum foil-wrapped sandwiches surrounds the manic mother who stands at her kitchen counter atop a pyramid of playing cards in beautiful suburbia.  Bipolar I Disorder could topple her reality, perhaps smothering her in ham sandwiches, but there is a solution in Vraylar, a drug from Forest Laboratories Holdings Ltd, an Allergan affiliate. In a second video, a woman in her office on top of a similar stack of playing cards, madly posts “Post It Notes” to a window wall. Vraylar will calm her down. Bipolar Disorder is endemic in 21st Century America. If you’re going to have a mental health issue, this is a good one to have.


Celebrities have admitted to being bipolar, and “Silver Linings Playbook” portrays a bipolar man who falls in love with a depressed woman. Jennifer Lawrence, who plays the woman in this offbeat romantic comedy, won the Academy Award for Best Female Actor in 2013.  The entertaining attention and the Vraylar commercials trivialize a serious mental condition. They make Bipolar I Disorder an attractive alternative if you are going to be crazy.  Patients eager to improve their perceived or diagnosed screwed-up lives can ask their doctor to give them Vraylar.  No more sandwich marathons. No more blizzards of “Post It Notes.”  You can live happily ever after with the help of a pharmaceutical.


The trouble is that Bipolar I Disorder is a serious mental condition. Many afflicted with Bipolar Disorder commit suicide. Many engage in behavior that is extremely dangerous. Illegal drug use, extreme risk taking, violent irritability, and a grandiose sense of self can lead to living on the edge of disaster.  The thrills of these behaviors are far more problematical than excessive “Post It Notes,” and creating too many sandwiches.  The person who loves to be besieged with ideas or gets off in marathon lunch-making is but a tip of the iceberg. Bipolar Disorder people love the up of mania. They want to go even higher, which can lead to psychotic behavior and dangerous actions. Still they love the up.  Unfortunately, I know. I have been there. The illness came close to destroying my life. The ups are followed by severe downs that are characterized by severe depression, isolation, and morbid thoughts of death. I call this the “Bipolar Coaster.” Once I attempted suicide but was saved in a hospital where my stomach was pumped. Many times, I have been close to killing myself. A particularly close encounter was the thought of jumping off a bridge into on-coming freeway traffic. Standing on the bridge, I decided I couldn’t risk someone’s else life by my body falling on or in front of their car. The Vraylar commercials fail to portray this other side of manic/depressive illness. The iceberg crushes the unwary.


This is not to say Vraylar is useless. I discussed Vraylar with my psychiatrist not to use, but to understand the effectiveness of the drug. She prescribes the drug for patients who have a combination of anxiety and depression. For these people, Vraylar has a calming effect. However, like all psychiatric prescriptions, one size does not fit all. What works for one person doesn’t for another, and could create conditions of undesirable side effects. I know because it took a long time for me, working with my doctor, to find the right drugs that worked long term and did not make me gain excessive weight or increase my manic behavior. Taking one of the first drugs prescribed for me, my weight escalated by 60 pounds. The Vraylar commercial doesn’t reveal that the use could be ineffective, or counter-effective.


The side effects of Vraylar can be catastrophic like:  stroke in elderly patients with dementia, tardive dyskinesia,  a condition in which the patient experiences uncontrolled movements of the body and face, muscle stiffness, or feelings of restlessness that can become permanent, problems with metabolism, Neuroleptic Malignant Syndrome (NMS) (a potentially fatal condition in which high fever; stiff muscles; confusion; changes in pulse, heart rate, or blood pressure; or sweating that can lead to death. Per government regulation these side effects and more common ones are verbalized in the commercial, but they are quickly passed through as the benefits are extolled and visualized.


There is the question of cost. Vraylar is very expensive. A month’s supply is over $1,000. Contrast this with Lamotrigine, which costs about $7 a month with insurance. The high cost of Vraylar would force most health insurance companies to try to demand the patient take a drug of lower cost.  Unless you have a good plan or are rich, Vraylar will set you back more than $14-1/2 grand a year.


Then there is the issue of “Big Pharma,” which may or may not be a problem for you.

It is for me. Allergan, the company marketing Vraylar, is the world’s 20th largest pharmaceutical company with revenue at $15.9 billion in 2017, an operating income of $5.9 billion, and a net income of $4.4 billion a year. This translates into 27.6% profit per year.  Pharmaceutical Companies are very profitable. Allergan’s most important drug now is Botox, the beauty treatment popular from Hollywood to Bollywood. Sales were $3.2 billion, and Botox’s market share is 70%, but the drug is under pressure.  A new competing drug is coming to market, and its effects last longer.  The treatment, called RT002, lasts six months compared to three or four months for Botox. Thus, Allergan is seeking new money makers.


Vraylar is one of the new money makers. Vraylar’s net revenues grew 72.2% in the second quarter of 2018 to a $114.2 million increase from the prior year’s second quarter. Allergan, an Irish-headquartered corporation, with its affiliate Forest Laboratories, licensed Vraylar from Gedeon Richter PLC, who developed Cariprazine for the treatment of schizophrenia.  Allergan, renaming the drug, is looking to expand the use and develop a large American market, of which the television advertisements are an important part. However, the corporation’s reputation is not very good.


Allergan ranks in the middle of the twenty best and worst pharmaceutical companies according to the Reputation Institute.  Its Rept Trak score is 71.8. Its affiliate Forest Laboratories, headquartered in New York, was sued for systematic gender unfairness. The U.S. District Court for the Southern District of New York found Forest Laboratories guilty, after six years of litigation, of discrimination against its female employees. This is the court in which Michael Cohen (Trump’s lawyer) pleaded guilty.  I guess his pockets were not deep enough to sustain six years of lawyers’ fees. In 2018, Allergan, along with several other drug manufacturers and distributors, was sued by several municipalities and states in the U.S. owing to the company’s manufacture of opioids. After Trump’s tax cut, Allergan’s Board of Directors authorized repurchase of its stock. No benefits were given to its employees.  Allergan is driven to strong growth, i.e. profit. Vraylar patients beware.

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Closure Blooms

Closure Blooms

I have added this link to the website for new documentary by film maker Lisa Klein, with her husband Doug Blush, producer, “The S Word.” The film is about suicide and suicide survivors, of which I am one. “Closure Blooms” is a piece about my return to the 5oth reunion of the class of 1966, the class I didn’t graduate with, because my suicide attempt ended with leaving school and a time in the mental hospital. The article was specially edited for inclusion on “The S Word’s website.

I was featured in Lisa and Doug’s previous film, “Of Two Minds,” about Bipolar Disorder. Persons with Bipolar Disorder frequently commit suicide. I have survived one serious attempt told in “Closure Blooms,” as a young student, and one almost attempt when much later in life I became a crack cocaine addict. Crack cocaine was my failing self-medication for the severe depression of the mental condition I have always had, but didn’t know about when I was a student. Bipolar Disorder wasn’t a diagnosis 50 years ago.


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Cairo Killed, the American Nightmare 2016


Cairo, (pronounced Kay-ro), Illinois, lies at the confluence of the Ohio and Mississippi Rivers. This town was murdered. White right wing racism killed it. The ruin is testament to the negative forces of American history. What I saw, quite by accident, reminds me of our situation in 2016 with the candidacy of the demagogue Republican Donald Trump.

We were lost after crossing the two bridges between Missouri and Kentucky on our trip across the United States in April. After visiting the Kentucky mounds of the ancient Indian civilization from long before there was an American republic, we took the wrong road toward our destination of Harrodsburg in bourbon country. Our backtrack landed us in the southern tip of Illinois, in an area called Little Egypt, where we saw four wrecks of 19th Century buildings off the main highway at the intersection of Commercial and 7th Streets. Elegant old street lamps lined the streets. The biggest structure, the Famous-Barr building, was vacant. A large pile of bricks could be seen through an open doorway and the destroyed back wall. The second building, its ground floor boarded up, had two old battered air conditioning units projecting from upper story and an older model panel truck parked at the curb. The third building was a seedy looking nightclub, its exterior painted pale blue. The gap of a demolished building separated the nightclub from the fourth, a three-story empty structure. We drove over to have a closer look. I was shocked. Neither side of street that extended six blocks north had any buildings, yet the lovely old street lamps remained in place on a broad sidewalk in front of grass or rubble-covered properties. I photographed the ruins while elderly man in a power-operated wheelchair rode down the eerily empty street.


Cairo, Illinois, in the 1970s already an nearly dead city

After reaching our final destination in Pennsylvania, I researched the history of Cairo. What I found was a devastating history. Cairo was destroyed by racism. The town’s commercial buildings and industries were owned by white people who refused to hire the black population of the city. In the 1960s, Little League baseball was canceled to keep black children from playing. By 1969 black people were not allowed to gather for sports, to march, or to congregate in local parks. A racist white man rammed his pickup truck into a demonstration protesting a whites-only swimming pool, severely injuring a young girl. The vigilante group called the White Hats policed the town. In 1969 the African-Americans formed the United Front of Cairo to end segregation and boycott white businesses. The white business owners refused to give in, choosing instead to close up their shops. They abandoned their businesses and fled town. Slowly most of the idle buildings were demolished. By 2010 the population was 2,800 persons of whom 72% were black.


Civil rights protesters in the 1960’s

Cairo-12-1ps.jpg                                             White marchers barring the stores

This sad story typifies the long history of a city that was once, before St. Louis arose, the main terminal of shipping and crossing on the Mississippi and Ohio rivers. In 1838 Cairo was booming, growing to 15,000 at its largest by 1900. A grid of four by six blocks defined the center of this metropolis-to-be located on land near where Lewis and Clark first camped to begin their exploration of the upper reaches of the Louisiana Purchase. A quay along the Ohio River edge serviced the ferries and the steamboats that paddled up from New Orleans and across the two big rivers. During the Civil War General Grant used Cairo as his supply and troop headquarters for the invasion of the South. During this period slaves sought freedom by escaping to the protection of the Union stronghold at Cairo. The town was an important transfer point on the Underground Railway.

cairoplan1838-1ps .                                                                      Plan of 1838


Postcard of mid-20th Century with automobile bridges

This was the beginning of a large African-American population in the city, much to the annoyance of the white inhabitants. The railroads finally killed the boom in Cairo when the Eads Bridge, completed in 1874 and the longest arch bridge in world at the time, crossed the Mississippi, directing river traffic north to St. Louis. In 1905 the decline was complete when a new railroad bridge crossed the Mississippi at Thebes, a town northwest of Cairo, ending the ferry traffic. After the automobile bridges bypassed the city in the 20th Century, the capitol of Little Egypt became an isolated backwater controlled by a white majority. Yet throughout the late 19th and 20th Centuries Cairo had a large African-American population that was routinely discriminated against. The population of Cairo by 1909 was approximately 13,000 of which 5,000 were African American, a high percentage for a small town that considered itself a place with white traditional southern white heritage.


November 11, 1909 Lynching of Will “Froggie” James

On November 11, 1909, tensions exploded, a lynch mob hung two men. The first was the African-American Will James, accused of murdering Alla Pelly, a young white woman. The mob strung him up below the arch of new electric lights on Commercial Street at the corner of 8th, one block down from the surviving remnants of the town. Will “Froggie” James didn’t die as intended. The raging population pulled the hung, but still living, James, down from the rope strung across Commercial Street. They burned him, dismembered him, and mounted his head on a pole. James, before he died, implicated another man whom the town pursued without success. They did find a white man, Henry Salzner, who had been on the run for nearly a year for slaying his wife. The mob strung him up too, but didn’t inflict the savagery on him that they did to “Froggie.” He was white, after all.

Will James-2ps.jpg

Will “Froggie” James, November, 1909

101 years have passed since the racially inspired slaughter. “Kayro’s” KO-ed center is a total ruin. What’s left is an outlying ring of poor black people’s homes, a few imposing monuments of the past glories: the United States Customs House, the mansion Magnolia Manor of 1872, and a sad commercial strip on the highway north. Donald Trump would probably call this a ghetto, as he famously referred to African-American neighborhoods in bigger, more northern American cities. However the last time a grassroots conservative Republican presidential candidate with southern states’ rights and anti-civil rights views visited Cairo in Little Egypt, there were a lot of white people still around. They have mainly gone now to warmer, more hospitable places, like the aptly named Phoenix, Arizona. Here racists rising from Cairo’s ashes can rail against “Mexican rapists.”


Barry Goldwater in Cairo, Illinois, 1964

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Frustration is the great trigger for madness. Just getting to start a blog after you haven’t done it in a while is enough to make you go screaming from the room. Now I am Ok. I have found the right place to click and I have calmed down enough to write about this subject, which drives me mad. I confront frustration all the time and have through out my life. My favorite recollection is from college when I was typing a term paper. I was trying to type the word THE. Each time I typed it, it came out HTE. I would stop take out the white out, and correct the mistake. (This was in the days before computers). I would start again and type HTE. Out with the white out again. Correct the mistake and begin again. This act repeated itself again and again until there was so much goop on this point on the page, the typewriter letters were sticking in the mess and I was tearing my hair out.  At last in a fit of rage I picked up the typewriter and tossed it out the window.  I lived on the fourth floor of my dormitory.  I watched it sail out into the college courtyard and land a long distance from my building.  In my anger I had given the machine a mighty hurl.  Several students looked up at me in my window and laughed as they passed on toward the library on that windy fall evening.  My act had relieved my stress momentarily, but now I would have to retrieve my machine. I descended the stairs and walked out into the courtyard to find my typewriter jammed into the earth on one corner. It’s carriage was bent. I bent it back more or less straight and went back to my room, where I found the machine still worked, except the h would not strike. I didn’t have to worry anymore about typing THE because all I could get was T E or more likely TE.

Today with computers I don’t have that problem anymore, but there are thousands of other frustrations that can make a bipolar person go off his rocker.  All people deal with frustration, I just think we are more sensitive to it, and react less sensibly to it.  The other day, just before New Years,  I was taking a package which needed to go overnight to an editor for a project I am doing. I had the copy made and proceeded to place it in a FEDX box, when I noticed that FEDX does not deliver to a Post Office Box.  Frustration overwhelmed me. This was just one last thing in a whole string of small issues standing in my way to finishing my project. I started to curse and drive like a maniac to the US Post Office to get there before they closed for the day and the New Years Holiday.  I dodge in and out of traffic. Ran yellow  lights turning red. Pushed vehicles out of the way. Screamed and gave the finger to those I thought too slow. I made it, but realized I had acted in a fashion I hadn’t acted like in a long time. I had taken risks I shouldn’t have. I had put others at risk. These were the behaviors of a manic personality, a personality drunk on adrelin for whom payback would be depression.

Dealing with frustration requires taking a step back from the source of the frustration. Not an easy thing to do. Too often we are knotted into the situation that creates the upset and can’t let go.  The more the frustrations pile up on one another the more difficult it is too let go. If I can I try to walk away early from a circumstance that looks like it is going in a bad direction, take some deep breaths and come back to it later, it is always better. To often I am not wise enough to do this.

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An overmedicated nation?

Dr. Charles Barber, a lecturer in psychiatry at the School of Medicine, Yale University believes Americans are an overmedicated nation. With prescription medicines advertised on Television, there has been a demand created for powerful anti-depressant drugs, which might not be needed and could be better served by the utilization of cognitive therapy before the immediate reliance on drug therapy. This cultural change -only the United States and New Zealand allow televised advertisement of prescription drugs, in all other countries it is illegal -is assisted by our system of managed care, which has made it more difficult to see therapists for mental health problems and to get talk therapy. This too results in the prevalent prescription of antidepressants.

I have no arguement with Dr. Barber on his description of America as an overmedicated society. I would argue that there needs to be one word added to the phrase. We are an over self-medicated society.  And the addition of this one word opens up a whole range of criticisms about the overmedicated society and the cognitive therapy alternative. 

Americans seek self medication through alcohol and drugs, and they have for a long time. I dispute the commonly held theory behind the 12-step programs that chemical dependency is an question of low tolerance, an allergy if you will to chemical substances, and can be cured by  abstinance and cognitive therapy.  The success rate of these programs is only 33% or so I am told. I would imagine that a great deal of what motivates people to drink or drug is depression, and that is generally not cured by sobriety. It may be cured by cognative therapy, but that is not my experience.

I was a drug addict. I was hung up on marijuana and crack cocaine. For years I went to psychologists and psychiatrists trying to cure my periods of severe depression. Nothing worked, but drugs mitigated the effects of my disease. Indeed they made it better for a while and then made it worse. All the talking I did; all the journaling I did; all the personal self discovery I did; did nothing.  I went to drug rehab and relapsed. The more I followed the 12 steps, the more I wanted to use. Not until I reached my end point where I decided to commit suicide did I get the help I needed. 

This was not the end where I had reached a bottom that would make me embrace the 12 Steps of AA, but the bottom where I final received the help I needed as a person severely afflicted with Bipolar Disorder. Once I recieved the proper medication my desire for illegal drugs went away. I have never used them since. It has been more than five years now. 

I wonder what my life would have been if there had been the ads on TV 20 years ago for ABILIFY as I struggled in vain to free myself from the devils that plagued me.  But 20 years ago not many people knew much about Bipolar Disorder.  They were just ready to sell you some gin, rum, or whiskey to cool you out after a rough day.  Your analyst was always available at some outrageous sum per hour to talk to you about your problems. I always felt better for about an hour after I went for a talk.

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The Gift of Bipolar Disorder

Art Dockument

I have the gift of Bipolar Disorder; so it is believed did Leonardo DaVinci and Van Gogh, my mentors as artists and writers. For more than most of my life time, 20 years to be exact,  I didn’t know I had the illness, and just thought I was different from other people. I was crazy, wild, and had periods of severe depression,  where I went into my studio and hid in bed for days on end.  Most people did not know I was sick. They just saw me as erratic and difficult to get along with.

Often I felt life was not worth living. Like William Styron, who in his memoir of depression DARKNESS VISIBLE quotes Camus saying, “Judging whether life is or is not worth living amounts to answering the fundamental problem of Philosophy,” I was constantly asking myself that question. Twice I found myself answering that life wasn’t worth it and attempted suicide. Once in college I ingested 150 aspirin tablets and a bottle of scotch, but survived. I spent a month or more on the mental ward of a large hospital. I didn’t learn much except if you want to get out of the hospital, learn to play sane. Once when much older and it appeared that my life had completely failed.  (My life as an artist had gone nowhere. My career as an architect was a dismal failure. My writing was blocked.)  I attempted to jump off a bridge. But I couldn’t do it. I couldn’t put other people’s lives at risk in order to end my own.

I was placed in the hospital again and this time diagnosed as Bipolar One. The beginning of a big change happened for me. I finally got off drugs. For years I had self-medicated with cocaine and marijuana. I finally got the help I needed with my extreme mood swings. And it wasn’t the 12 steps, which hadn’t worked for me in the two times I placed myself in drug treatment programs where the prescription was to give it up to God. Well, God alone could not do it for me. I needed medication and I got it. Immediately, I didn’t want crack or pot anymore. Gradually my severe mood swings lessened and I began to feel like a whole person rather than two different people: one a likeable and gentle person and other a disagreable and violent person. The former was male, but the latter was female. I lived for many years a split life.

As legal medical drugs calmed me down, however I could see that all that happened  to me was not bad. My mania gave me an energy and the courage to try new things. My depression gave me an understanding of the low points life can reach. I have had a wide range of experiences, which are a gift to only the few, and if we can keep ourselves from self-destruction we have much to offer the world in terms of insight and compassion. I know now that I can answer the question “is life worth living?” in the affirmative.



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