
‘I Don’t Believe in God, but I Believe in Lithium’ - pepys
http://www.nytimes.com/2015/06/28/magazine/i-dont-believe-in-god-but-i-believe-in-lithium.html
======
jrapdx3
Lithium, as medication, has been a benchmark of my life, though in a different
way than portrayed in the nicely written article.

When I was in school back in the 60's, I had the chance to see the healing
effects of lithium before it was approved here in the US in 1970. I saw a man
in a florid manic state dramatically improve in two week's time, kind of
magical and it left a lasting impression on me.

A few years later I happened to be walking in town, and a man stopped me. "I
know you. You were one of those students there when I was in the hospital."
Only then did I know who he was. I asked how he was doing. He said "I'm doing
quite well. Lithium saved my life and I'm still taking it."

Since then I've had the responsibility of treating many people with mood
disorders, and I didn't forget what I'd learned. Anyway, lithium is still a
godsend for many people, but of course it really isn't a magic bullet, nothing
is.

Like all medications it can produce bad effects. I've seen that happen too.
Renal failure is a risk as the article points out. Careful monitoring can
prevent some bad outcomes, though not all. Doing whats best requires utmost
dedication by patient and doctor to the cause of stability and quality of
life.

In the words of Spinoza, "all things excellent are as difficult as they are
rare." Success is possible, we just have to find the courage and strive to get
there.

~~~
phren0logy
I was reading some of your other comments, and what a pleasant surprise to
another Portland psychiatrist on HN. Small world.

~~~
jrapdx3
> ... what a pleasant surprise to another Portland psychiatrist on HN. Small
> world.

Pleasant surprise indeed, what are the odds? Obviously writing here is
motivated by interests in computing as well as brains. Your comment a few
weeks ago about SICP strongly resonates.

Scheme has been a productive language for me, I've done useful things with it.
Curiously along the way it's taught me subtle lessons applicable in my _other_
work.

That's not every doc's taste to be sure, no doubt an angled view among a
quirky subset. Maybe not so strange finding unusual souls in a place known for
its weirdness.

~~~
dang
What a wonderful subthread. Care to describe any of those "subtle lessons
applicable in [your] other work"?

~~~
jrapdx3
OK. Being _subtle_ it's hard to put into words, but I'll try.

Scheme has a certain beauty, and symmetry when well-expressed. Paradoxically,
a seemingly simple application can be perplexing on first glance, its meaning
not immediately clear. Sure, the formal elegance is there, but how does it
work?

The Lispy recursion vital to Scheme won't easily yield to cognitive brute
force, when it's obscure to me, it has to sink in over some time.

It's not pure thought, one has to see it or feel it. More than just
_understanding_ , it has to _make sense_ to me, that is, achieve a higher
level of integration among my internal processes than the term "understanding"
implies.

But once I "got it", it seems simple, a mystery whatever made it hard in the
first place. Creating a useful program it's necessary to make sense of the
tasks in order to translate into compilable expressions. It really is a kind
of conversation in a peculiar language.

As I see it, there's a parallel in approaching human illness as a set of
algorithmic processes, albeit extremely complex. Here we can apply a lesson,
avoiding the temptation to force fit signs and symptoms into some preconceived
template vs. what is learned during interaction, a more accurate, nuanced
picture of the problems can emerge.

The work of healing is recursive, similar elements occur again and again. But
as in a Scheme loop, recursion can end by trapping the right conditions. Wait,
there's a clue. What is the condition that ends, at least damps, the
troublesome recurring behaviors? Most of the time a "handle" can be found, an
opening for intervention.

Programming teaches there's no universal solution to problems, solutions have
to vary according to the situation. Each person with an illness has a unique
disease, no two diseases are alike. Each person speaks a different language,
we have to develop fluency in that language to be able to help. Skilled
healers learn to build "macros" that shape the tools to the problem, sort of
like evolving a DSL in Lisp/Scheme. Not exactly the same, but an element of
the "mental models" that support effective treatment decisions.

Wow, that's pretty long. I don't know how good an answer it is, though a
worthy question.

~~~
marincounty
I'm on board with you with your sentiments on Lisp. I like this statement,
"Scheme has a certain beauty, and symmetry when well-expressed."

As to comparing programming to the current state of Psychiatry(I'm assuming
you're a Psychiatrist?) in 2015; I don't see any similarities?

Personally, I don't find much beauty, symmetry, or even much logic in the
practice of Psychiatry these days. What I have witnessed is give a drug the
FDA approved, and hope for the best, and this is what the better Psychiatrists
do. The lousy ones don't take risks, and just blame the non-responsive
patients--on the art of the profession, and "That's all I can do--sorry--and
my fee is going up next visit. I can see you in three months from now?"

Don't get me wrong, I glad your are practicing, but this speciality has taken
a beating in the last decade. We were all lied to by the drug companies! It
took a Psychologist to expose the hidden lies in the excluded meta data in
those studies? It seems like lately, another study comes out questioning the
use of a particular class of drugs.(The latest study that comes to mind is the
one that found Schizophrenic's might have a better quality of life if Not put
on medication long term.)

That said, I'm not attacking your profession, but right now it is as much of
an art as it was 50 years ago. Because the medical speciality is such an art
right now; I don't find any irony in the fact you like programming. If I had
to dole out dubious(cure rates, in so many instances, close to placebo)
expensive, addictive drugs to alling patients, I would cherish my alone time
programming. I have a feeling HN probally has more Psychiatrists interested in
Programming than any other medical speciality?

(I am not bashing the Psychiatry profession. I just don't see the beauty/magic
in it anymore. I do think it's one of the harder jobs out there--if done
right? Doing it right is taking on a few Medi-cal patients, when no one is
looking? And, not charging out of pocket patients $300-400 hr.; especially the
patients that are just addicted to said dubious psychotropic drugs. I probally
sound angry? It's more like disappointment?)

~~~
fnordfnordfnord
>I am not bashing the Psychiatry profession.

I think it's fine to bash the Psychiatry profession; it doesn't mean you can't
appreciate the work of good psychiatrists when you meet them, and there are
probably a lot of psychiatrists who would join you.

------
nkurz
_A study in Japan has shown a sample population to be less likely to commit
suicide after drinking tap water containing lithium._

Notably, there is enough lithium in the groundwater in certain areas of the US
that this "study" has been happening for a long time. El Paso, Texas has high
naturally occuring lithium in the groundwater, and is widely reputed to have
less violence than comparable cities with less lithium in their water. I
haven't read the whole thing, but remarkably, a recent paper seems to have
shown this to be true, at least for suicide mortality.

Lithium in the public water supply and suicide mortality in Texas (Blüml et
al, 2013)

    
    
      ￼￼￼There is increasing evidence from ecological studies that 
      lithium levels in drinking water are inversely associated 
      with suicide mortality. Previous studies of this 
      association were criticized for using inadequate 
      statistical methods and neglecting socioeconomic 
      confounders. This study evaluated the association between 
      lithium levels in the public water supply and county-based 
      suicide rates in Texas. A state-wide sample of 3123 lithium 
      measurements in the public water supply was examined 
      relative to suicide rates in 226 Texas counties. Linear and 
      Poisson regression models were adjusted for socioeconomic 
      factors in estimating the association. Lithium levels in 
      the public water supply were negatively associated with 
      suicide rates in most statistical analyses. The findings 
      provide confirmatory evidence that higher lithium levels in 
      the public drinking water are associated with lower suicide  
      rates. 
    

[https://www.gwern.net/docs/lithium/2013-bluml.pdf](https://www.gwern.net/docs/lithium/2013-bluml.pdf)

Edit: I just realized that the Op Ed linked from the main article mentions the
same evidence, although without reference to that particular paper:
[http://www.nytimes.com/2014/09/14/opinion/sunday/should-
we-a...](http://www.nytimes.com/2014/09/14/opinion/sunday/should-we-all-take-
a-bit-of-lithium.html)

~~~
x5n1
Yes let's drug all the population. Soma anyone?

~~~
jganetsk
Lithium, like lead, is an element, not a drug. And lithium, like lead, has a
significant environmental impact on the general population -- specifically, on
behavior. And the current lack of lithium in our environment is detrimental to
us, and not what we evolved for, just as the past prevalence of lead within
our environment was.

~~~
henryaj
Without touching any of the other things you said, the lithium that's given as
medication isn't elemental – it's in the form of lithium carbonate.

~~~
logfromblammo
If elemental lithium were given, it would react violently with the water in
the patient's body:

2 Li + 2 H2O --> 2 LiOH + H2

You can't really find elemental lithium anywhere on Earth, for much the same
reasons you can't find elemental sodium or potassium.

------
phren0logy
I'm a psychiatrist, and I prescribe lithium quite a bit. It really is the gold
standard for treating Bipolar I Disorder.

Aside: If you are a person who uses the word "bipolar" as a synonym for moody
or indecisive, I hope reading this will help you understand what actual
bipolar mania looks like.

~~~
schoen
Any other favorite examples of disorders whose names get misused as metaphors?
(I guess "OCD" is a common one -- and indeed "depressed" and "schizophrenic"
too.)

~~~
DanBC
I quite like the word "schizophrenic" to refer to someone "in two minds" (but
not with multiple personalities), and I prefer "psychosis" (or other more
accurate terms) to "schizophrenia". But I don't ever user schizophrenia this
way because a lot of people strongly dislike it.

People use "psycho" to mean "violent". Psycho is close to psychotic, and you
sometimes see people use psychotic to mean violent. This ignores the fact that
people with psychosis are overwhelmingly not a danger to other people. The
psycho there refers to psychopath, which is now rolled into the list of
different personality disorders.

I think that this is harmful. When people see someone having a psychotic
episode in public they'll call the police. If they saw someone having a
cardiac arrest or epileptic fit they'd call an ambulance. The police are
probably not trained to deal with people who have a mental illness, which
results in some police shootings of people with mental illness. (About half
the people shot and killed by police each year are people with a mental
illness. Since we know that violence is not more prevalent in people with a
diagnosis this demonstrates huge over-representation).

------
the_rosentotter
Ever since reading the referenced op-ed from the New York Times, I have been
curious about the effects of low dosages of lithium. If a large dose can
counteract bipolar disorder, it seems reasonable that a low dosage would have
at least some amount of calming effect (which is what the NYT article claimed,
with reference to some studies done on populations with naturally high
occurences of lithium in their water supply).

So about eight months ago I started taking a low dosage of lithium, in the
form of drops added to my drinking water, in a dosage that amounts to about
2-3mg per day - similar to the amounts in naturally occurring high-lithium
drinking water. (In comparison, therapeutic doses are several 100 mgs per
day).

Anecdotally, it might just be placebo effect, but I do feel it has had some
effect. I have always been a bit anxious, particularly socially, and I feel
that has diminished over this period. However, this experiment coincides with
a better exercise regimen, and also simply growing older, so it's difficult to
100% attribute the effect (if any) to the added lithium. It would be very
interesting to see more studies on this.

If anyone's interested you can buy these drops as 'trace mineral drops' from
the Great Salt Lake.

------
yeahdude
There was a study in Italy of a patient who was cured of a severe form of
bipolar called rapid cycling bipolar with "darkness therapy". They locked him
in a dark room for 14 hours a night and after a couple months his sleep and
his mood stabilized. No medication.

[http://psycheducation.org/treatment/bipolar-disorder-
light-a...](http://psycheducation.org/treatment/bipolar-disorder-light-and-
darkness/dark-therapy/)

------
nthitz
I'm reminded of a previous NYT article about Lithium:
[http://www.nytimes.com/2014/09/14/opinion/sunday/should-
we-a...](http://www.nytimes.com/2014/09/14/opinion/sunday/should-we-all-take-
a-bit-of-lithium.html)
[https://news.ycombinator.com/item?id=8314188](https://news.ycombinator.com/item?id=8314188)

------
ars
Just be careful on long term lithium. Even when taken at the proper dosage it
will destroy the kidneys, eventually leading to death. This is not as well
disclosed/known as it should be.

~~~
tjradcliffe
Probably because it is extremely implausible:
[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2516429/](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2516429/)

And let's be clear about this: you have claimed lithium _" will destroy the
kidneys, eventually leading to death"_. This is the claim you made, not some
other unrelated claim, and it is wildly implausible.

A plausible but completely unrelated claim is, as reported in this paper:
"lithium can be safely prescribed over a protracted period of time, even in
elderly populations, but should be monitored closely under specialist
supervision, to ensure early identification and management of adverse
effects."

This proposition offers no support whatsoever to the claim that lithium "
_will_ destroy the kidneys, eventually leading to death". It is not evidence
for it, it is contradictory to it.

I'm over-emphasizing this because I've too often seen people make wildly
implausible claims like the one you have made and then try to claim that some
totally unrelated but plausible claim like the one in this paper somehow
supports their position. It does not. Your position is not in any way
supported by a paper that directly contradicts it.

~~~
pc2g4d
Counter-article:
[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4456600/](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4456600/)

~~~
throway4truth
Page 1 of your link, "Lithium-induced nephrogenic diabetes insipidus is
usually self-limiting or not clinically dangerous."

So that's exactly in line with what you propose this counters.

~~~
pc2g4d
Key word: "usually".

After that qualified reassurance we read that "In recent years, large-scale
epidemiological studies have convincingly shown that lithium treatment
elevates the risk of chronic kidney disease and renal failure."

And further, "Other patients may be able to switch to a different mood
stabilizer medication, but kidney function may continue to deteriorate even
after lithium cessation. Most, but not all, evidence today recommends using a
lower lithium plasma level target for long-term maintenance and thereby
reducing risks of severe nephrotoxicity."

The risk of nonreversible kidney damage seems to counter your claim that
"lithium can be safely prescribed over a protracted period of time". Even
careful monitoring isn't sufficient since detecting these kidney problems does
not guarantee they can be corrected ("may continue to deteriorate even after
lithium cessation".) Thus a more accurate formulation would be "lithium can be
safely prescribed over a protracted period of time... as long as you're lucky
enough not to incur this dangerous side effect." Or possibly, "lithium can be
safely prescribed over a protracted period of time when it is administered in
low doses."

------
shirro
I wonder if things like bipolar disorder fall on a broad spectrum and a lot of
people might not have very mild and perhaps undiagnosable mood disorders that
might benefit from very low level lithium supplements. Is lithium
supplementation a thing (can you buy it in "health food" stores) and is there
any evidence of efficacy for non psychiatric cases?

~~~
jerf
There's definitely reason to believe it's on a "spectrum", and I seem to
recall I've seen studies that suggest probably everybody is on some sort of
months-long cycle (not always directly correlated to the calendar, which would
be relatively uninteresting). Many creative people who squeeze their
creativity dry as coders or artists or whatever have observed this seems to
exist. I've noticed it myself, here's another person who recently observed it:
[http://www.shamusyoung.com/twentysidedtale/?p=26444](http://www.shamusyoung.com/twentysidedtale/?p=26444)

In people with pathological bi-polar disorder, it may be the case that rather
than some sort of novel problem, it's just that the amplitude and the
frequency can be much larger and higher, where "creativity" and "energy" shoot
beyond the realms where either of those words quite properly applies anymore.

But in the end, we don't really know enough about the brain to be sure about
this. A proper, correct model of the brain might be able to prove this by
showing the drivers of such a long-term oscillation, but we're a long ways
away from the requisite level of detail. Even with the suggestive studies it
can only be called an interesting theory.

~~~
shirro
Thanks.

I am guessing lots of people have cycles. I feel I do to some extent,
especially when it comes to creativity and insightfulness. Those cycles might
actually be a good thing as long as they don't swing wildly.

I was thinking it would be nice to pin the needle slightly on the
creative/active side of the equation but it seems lithium doesn't do that.
Getting sun and being active probably makes more sense. Time to put the
computer away and spend the rest of my day bike riding :-)

~~~
mirimir
I have cycles too. Some psychiatrists say that I'm bipolar. Others use other
words. Fortunately, I've never been manic enough for long enough to do serious
damage. Mostly I've been prone to disappointment, burn out and depression.

Anyway, the combination of lamotrigine, modafinil and caffeine works well for
me. Lamotrigine (an antiepileptic like divalproex aka Depakote) helps to
stabilize my mood. And it's easy to adjust modafinil and caffeine as needed to
keep me happy and productive.

------
shiggerino
Apparently 7-up contained lithium citrate until 1950 for its mood stabilizing
effects:

[https://en.wikipedia.org/wiki/7_Up](https://en.wikipedia.org/wiki/7_Up)

Coke, on the other hand, lost its cocaine content much earlier, in 1903.

------
learc83
I live a few miles from the lithia springs that Lithia Springs GA is named
after. I still haven 't been able to find out how much lithium there is in our
tap water.

~~~
digler999
send it to an assay lab ?

------
Altay-
I thought this was going to be an article about batteries and the quote would
be attributed to Elon Musk or some other tech billionaire.

I was pleasantly surprised.

~~~
ExpiredLink
The title is really idiotic.

------
smsm42
It is great that there's a way to improve the lives of these suffering people.
Still, it scares me how little we know about how these drugs work (and by "we"
I don't mean myself, but the summary state of human knowledge, as it appears
to me) and that we still - at least as it looks to me, admittedly knowing very
little on the subject beyond popular press - that we still rely mostly on luck
and trial/error in figuring out how to mitigate mental illness. That sounds
like we'd write code by just mostly randomly putting words together and then
run through a battery of unit tests and see if something works. And if some
unit test passed we'd declare that code a function implementing that unit
test's functionality. I imagine you can get somewhere this way, but it's kind
of scary we don't have something better.

------
bite_victim
Side rant:

Claiming that you don't believe in God is equally annoying as those sect guys
knocking at your door. I do believe in God and I find the use of lithium in
treating these illnesses a hope (with potential dead serious side effects:
[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4456600/](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4456600/))
but not the potential meaning of life (?! how can you compare lithium with the
notion of God?!).

~~~
_s
Lithium gives her [her] life back, in much the same you believe god gave you
yours.

~~~
bite_victim
I don't believe God made me specifically and I don't believe in God because I
own him something. Also, God isn't slowly killing me by poisoning my body.
Other people do that though (pollution). Other people do that whose end
product(s) my life depends on (for instance electricity or food) and I don't
believe them to be some kind of a deity.

~~~
MacsHeadroom
OP doesn't believe lithium to be some kind of deity either. It's just a
metaphor. Lithium gave them life, creator gods give life.

If lithium were a deity, it wouldn't exist.

~~~
bite_victim
> It's _just_ a metaphor.

In your opinion perhaps. In my opinion it's a perfectly good example of poor
writing as well as a superiority complex.

> If lithium were a deity, it wouldn't exist.

Please.

------
atmosx
IIRC the main problem with lithium is the narrow therapeutic window, hence
potential toxicity. But I had no idea it was that good. Actually reading
studies I wasn't quite sure of many drugs psychiatrists prescribe, especially
serotonin re-up takes... But out of experience they seem to work in many
cases.

------
jldugger
> After I was admitted to the institute's adolescent ward, I thought the
> nurses and doctors and therapists were trying to poison me.

Well, they kinda are. Theraputic doses of lithium are disturbingly near
toxicity levels.

~~~
phren0logy
Prescribing a medication with a narrow therapeutic window is not the same as
intentionally trying to poison someone.

~~~
aaronem
I could see describing it as intentionally trying to _almost_ poison someone.
But that's just snark, really.

------
adamclayman
| i do believe in Gd, but i do not believe in lithium.

Please, everyone, let's stop talking such nonsense and missense. There's a
framing error at play here, at a very fundamental level, and a whole field has
gone down this rabbit hole for far too long. There is no such illness called
"manic depression"; there is a symptome called "hope-despair spectra
dysregulation disorder". The phrase "manic-depression", like the word
"harassment", is a confusing misnomer almost deliberately invoked by a
langauge switcheroo, mostly by professionals who are never trained in the
original humanisms from which the word originated and is imparted and
imported. As with harassment, which is more clearly expressed as "exhaustion",
the term "mania" is more clearly expressed as an assessed "unreasonable and/or
extreme hope, leading to reckless energy or cognitive chain investments or
behavioural drivers". The term "depression" is simply a prolonged despair,
wherein a person is seen to be desperate for air. Psychiatrists and
psychologists who speak of manic depression as something more than a
persistent "hope-despair dysregulation" are usually, in my experience, blowing
smoke, and owe a duty to assess whether the hope-despair complex is the result
of illogic, illmotion, or both, and whether that illogic, illmotion, or both
is exogenous or endogenous. The postulations in the DSM are not credible, as
the Director of NIMH, the National Institute of Mental Health, asserts in
pointing out that the field of psychiatry is terrible at identifying causes,
and dresses up symptom complexes and symptomologies to look like mechanical
medical dis-eases. There are very few diagnoses that psychiatrists can do, and
calling "hope-despair spectra dysreg disorder" (or, manic depression, as the
DSM calls it) a diagnosis is, in my humble opinion, a fraudulent claim. It's
not a diagnosis... it's a symptosis, or [symp]tomosis.

It's also completely imprecise and inaccurate, rather like saying,
"@phren0logy has a cough", rather than saying "@phrenology has a rhinovirus" .

Hope-Despair Dysregulation Disorder (HD3), from.... Manic = A state of
prolonged hope Depression = A state of prolonged despair

It's only natural that We should have evolved, have had revealed, been given,
and overwritten and at times, overridden environmental and social
expectancies, and that those should altar the pattern of our hope and despair.
The persistence of these patterns can, in the eyes of another, be seen as
"abnormal" and an "unwanted deviance from socially integrated expectancy
patterns". The response pattern from terrapists is to feed a salt pill to the
patient as a placebo, in the place of a more obvious sugar pill, so that the
patient returns regularly for talk therapy sessions or has a few weeks to
stabilize their native sense of the statistics of life, wearing out their own
misweighting of cued and observed probabilities. But... this same effect would
happen if they were to be fed NaCO3, or NaCl. Lithium, i posit, has no effect
other than as an off-grid placebo pill to give terrapists time to try to
figure out the root cause and failure modes in cognition. i do not believe the
statistical effects of natural experiments yet; i have not come across a
convincing study yet, and it's my belief that study non-publication bias for
disconfirmations on lithium's environmental effects will explain the rest.

As for what to do with people who are thinking about survival rather than
thriving, and considering survival failure, tell them they are on the hope-
despair dysregulation spectra, and ask them to consider how many years left
they have until they reach 100 years old, and set that as their new age. 22?
Your real age is not Your chronological age (cage) of 22; it is Your survivor
age (sage) of 78. Reinforce it by teaching them the Periodic Element that
their Steam Age corresponds to, in this case, Platinum, or Pt, and ask them to
go for physical therapy by going out for a long run with a friend, or, if they
have legal woes instead of psychiatric woes, arrange for them to speak with
whoever it is that is the cause of their woes in a safe space, rather than
aggravating or papering over the lack of ethical calmunity care.

Lastly, read Seligman's Flourish with them, and other works of positive,
social, and cognitive bias psychology. The attempt to use diagnostic langauge
in a root-cause-agnostic is fraudulent; please stop doing it. It causes far
more damage than psychiatrists and other psycholory specialists take
responsibility for, particularly as families, calmunities, and institutions
abuse the indeterminacy, soft, nearly unfalsifiable nature of psychiatric
labels as a means of social control for those they consider inconvenient
gadflies suffering from too much institutionally-wrought despair.

Also, the DSM Criteria are foolish to apply against certain classes of the
population. For instance, with hope-despair dysreg, one of the symptoms is
written up as "Flights of Ideas", with some modifiers. Intellectuals and
designers cultivate the capacity to undergo "flights of ideas". That's what
these people do. Why would You count that as a bullet point toward
psycholore.ical sympagnostics, when it is part of their professional duties?
That just weakens the whole meaning of the sympagnostic for that whole sector
of the population.

Those are my 2 calming sense on the problem. PERMA, Exercise, Resiliency
Training, Socialization, Uninterrupted Purpose, Daily Progress all add up to
an end to depression; talking to a blank face of a false friend with no power
to convene the social world to determine and test the reality described may
help tune, slow, or stop survival fail, but only for a time. Inverted ages
(Pb-Ar) and Fundamental, sustained purpose mixed with calming human life stage
activities will stabilize most, on a complete review of their ethics, i.e.
their character. Lastly, if there's loneliness or a reflective solitude
involved, You'll want to review and perhaps fix that as well, as the case
requires.

Best wishes, everyone. Let me know if You're ever in need of a call to point
out how many Years You'd be sacrificing should You go "Canary" prematurely.
Reach out to me; i can help you Flag Sentinal instead of losing Your life to
self-organized survival fails.

------
MichaelCrawford
Lithium works well for my symptoms but I do not tolerate it. When I learned
that it only reduces hospitalizations by half I stopped taking. I did just
fine for six years but became psychotic in graduate school.

Since then Ive taken valproate which works well and so far I tolerate well.
However there is significant risk to my liver. I take regular blood tests to
watch for that.

Lately Ive been feeling physically ill, as if I have been poisoned. I dont
know the cause but will request a liver function test this week.

------
IshKebab
I thought this was going to be about batteries.

~~~
thecolorblue
I thought the same thing. It would make an interesting annecdote in the
article to talk about lithium ion batteries. I thought I read somewhere that
China has a large stock pile of lithium.

Still, an good read.

~~~
erichurkman
Here's a quick overview of the distribution of easily accessible lithium:
[http://large.stanford.edu/courses/2010/ph240/eason2/](http://large.stanford.edu/courses/2010/ph240/eason2/)

In short: Chile, Bolivia, China, United States.

------
adamclayman
| i do believe in Gd, but i do not believe in lithium.

Please, everyone, let's stop talking such nonsense and missense. There's a
framing error at play here, at a very fundamental level, and a whole field has
gone down this rabbit hole for far too long. There is no such illness called
"manic depression"; there is a symptome called "hope-despair spectra
dysregulation disorder". The phrase "manic-depression", like the word
"harassment", is a confusing misnomer almost deliberately invoked by a
langauge switcheroo, mostly by professionals who are never trained in the
original humanisms from which the word originated and is imparted and
imported. As with harassment, which is more clearly expressed as "exhaustion",
the term "mania" is more clearly expressed as an assessed "unreasonable and/or
extreme hope, leading to reckless energy or cognitive chain investments or
behavioural drivers". The term "depression" is simply a prolonged despair,
wherein a person is seen to be desperate for air. Psychiatrists and
psychologists who speak of manic depression as something more than a
persistent "hope-despair dysregulation" are usually, in my experience, blowing
smoke, and owe a duty to assess whether the hope-despair complex is the result
of illogic, illmotion, or both, and whether that illogic, illmotion, or both
is exogenous or endogenous. The postulations in the DSM are not credible, as
the Director of NIMH, the National Institute of Mental Health, asserts in
pointing out that the field of psychiatry is terrible at identifying causes,
and dresses up symptom complexes and symptomologies to look like mechanical
medical dis-eases. There are very few diagnoses that psychiatrists can do, and
calling "hope-despair spectra dysreg disorder" (or, manic depression, as the
DSM calls it) a diagnosis is, in my humble opinion, a fraudulent claim. It's
not a diagnosis... it's a symptosis, or [symp]tomosis.

It's also completely imprecise and inaccurate, rather like saying,
"@phren0logy has a cough", rather than saying "@phrenology has a rhinovirus" .

Hope-Despair Dysregulation Disorder (HD3), from.... Manic = A state of
prolonged hope Depression = A state of prolonged despair

It's only natural that We should have evolved, have had revealed, been given,
and overwritten and at times, overridden environmental and social
expectancies, and that those should altar the pattern of our hope and despair.
The persistence of these patterns can, in the eyes of another, be seen as
"abnormal" and an "unwanted deviance from socially integrated expectancy
patterns". The response pattern from terrapists is to feed a salt pill to the
patient as a placebo, in the place of a more obvious sugar pill, so that the
patient returns regularly for talk therapy sessions or has a few weeks to
stabilize their native sense of the statistics of life, wearing out their own
misweighting of cued and observed probabilities. But... this same effect would
happen if they were to be fed NaCO3, or NaCl. Lithium, i posit, has no effect
other than as an off-grid placebo pill to give terrapists time to try to
figure out the root cause and failure modes in cognition. i do not believe the
statistical effects of natural experiments yet; i have not come across a
convincing study yet, and it's my belief that study non-publication bias for
disconfirmations on lithium's environmental effects will explain the rest.

As for what to do with people who are thinking about survival rather than
thriving, and considering survival failure, tell them they are on the hope-
despair dysregulation spectra, and ask them to consider how many years left
they have until they reach 100 years old, and set that as their new age. 22?
Your real age is not Your chronological age (cage) of 22; it is Your survivor
age (sage) of 78. Reinforce it by teaching them the Periodic Element that
their Steam Age corresponds to, in this case, Platinum, or Pt, and ask them to
go for physical therapy by going out for a long run with a friend, or, if they
have legal woes instead of psychiatric woes, arrange for them to speak with
whoever it is that is the cause of their woes in a safe space, rather than
aggravating or papering over the lack of ethical calmunity care.

Lastly, read Seligman's Flourish with them, and other works of positive,
social, and cognitive bias psychology. The attempt to use diagnostic langauge
in a root-cause-agnostic is fraudulent; please stop doing it. It causes far
more damage than psychiatrists and other psycholory specialists take
responsibility for, particularly as families, calmunities, and institutions
abuse the indeterminacy, soft, nearly unfalsifiable nature of psychiatric
labels as a means of social control for those they consider inconvenient
gadflies suffering from too much institutionally-wrought despair.

Also, the DSM Criteria are foolish to apply against certain classes of the
population. For instance, with hope-despair dysreg, one of the symptoms is
written up as "Flights of Ideas", with some modifiers. Intellectuals and
designers cultivate the capacity to undergo "flights of ideas". That's what
these people do. Why would You count that as a bullet point toward
psycholore.ical sympagnostics, when it is part of their professional duties?
That just weakens the whole meaning of the sympagnostic for that whole sector
of the population.

Those are my 2 calming sense on the problem. PERMA, Exercise, Resiliency
Training, Socialization, Uninterrupted Purpose, Daily Progress all add up to
an end to depression; talking to a blank face of a false friend with no power
to convene the social world to determine and test the reality described may
help tune, slow, or stop survival fail, but only for a time. Inverted ages
(Pb-Ar) and Fundamental, sustained purpose mixed with calming human life stage
activities will stabilize most, on a complete review of their ethics, i.e.
their character. Lastly, if there's loneliness or a reflective solitude
involved, You'll want to review and perhaps fix that as well, as the case
requires.

Best wishes, everyone. Let me know if You're ever in need of a call to point
out how many Years You'd be sacrificing should You go "Canary" prematurely.
Reach out to me; i can help you Flag Sentinal instead of losing Your life to
self-organized survival fails.

Sent without much editing.

