TABLE OF CONTENTS - New Directions Support Group, Inc. … · The Compass - Page 2 FALL/WINTER 2011 EDITOR’S CORNER by Ruth Z. Deming, MGPGP Director of New Directions There are

TABLE OF CONTENTS

Editor’s Corner by Ruth Z. Deming, MGPGP, director of New Directions . . . . . . . . . . . . . . . . . . . . . .2

Letter to the Editor by Nursing Student . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4

The Joy of Being a Bipolar Stay-at-Home Mom by Judy Kroll . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4

These are a Few of my Favorite Therapists: by Mulhearne, Bleiler, Lokoff. . . . . . . . . . . . . . . . . . . . . .5

A Tale of Two Kidneys: Profile of Sharon Piercy: On the waiting list since lithium ruined her kidneys . . . . . . . . . . . . . . . .6Denis Hazam: After six years, his new kidney failed and now he’s on dialysis . . . . . . . . . . . . . . .8

Ask the Doctor: Dr. David Abel answers two important questions . . . . . . . . . . . . . . . . . . . . . . . . . . .10

Family members at New Directions have many concerns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11

The 302 Process: Truths and Misconceptions by Tony Salvatore . . . . . . . . . . . . . . . . . . . . . . . . . . . .12

News Roundup: Psychotic Depression, Why Lithium Works, Inquirer op-eds and more . . . . . . . . .13

Pursue the Wonderful: Exploring the Wonders of Autumn, Folk-dancing, and Morning Glories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16

My Life as a Peer Specialist by Frank K. Wolfe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17

Celebrating the late Glenn Koons by Jen Kramer of PMHCA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18

Peace of Mind, Peace in Love by Matthew Connell . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19

The Sweet Smell of Success: Kathy Sharp, Bob, James and Joe Moore . . . . . . . . . . . . . . . . . . . . . .20

The Bipolar Bear Comes Out of the Darkness by James Vincent . . . . . . . . . . . . . . . . . . . . . . . . . . .23

Pinching Pennies: The Art of Saving Money: Gerri Bleiler, Rob Lokoff, Deb Less (Queen of Thrift) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24

John P. O’Reardon, MD: Hope for Treatment-Resistant Depression . . . . . . . . . . . . . . . . . . . . . . . . .25

Substance Abuse and Bipolar Disorder: Talk by Barry Lessin and Chad Coren . . . . . . . . . . . . . . . .29

KaleidOScope, poems by Wolfe, Moisset, Constable, Marcolina, Hunter, Barrett, Lande, Deming, Cohen, Krause and . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32

The Compass FALL/WINTER 2011

The Compass is a yearly publication of New Directions Support Group of Abington, PA. Founded in 1986, we welcome newmembers. Contact us at [email protected] or 215-659-2366. View our website at NewDirectionsSupport.org. Donationsalways welcome.To help support publication, mail tax-deductible contributions to New Directions, Box 181, Hatboro, PA 19040,or donate through our website. Our evening meetings are at Abington Presbyterian Church, daytime meetings at the WillowGrove Giant Supermarket, upstairs classroom. See website for more information.

The Compass - Page 2 FALL/WINTER 2011

EDITOR’S CORNERby Ruth Z. Deming, MGPGPDirector of New Directions

There are four major problems, and about athousand minor ones, facing our members at NewDirections Support Group here in Abington, PA.Certainly this is also true for patients with mooddisorders around the country.

First is the difficulty of getting a timely psychiatricappointment when a crisis occurs.

Second is getting on medication that works.

Third is what to do when your meds stop working.

Fourth is how to get a manic or psychoticindividual hospitalized.

This issue of the Compass addresses theseconcerns.

Recently, I spoke to a 25-year-old bipolar womanfrom our group. “Susie” recognized she was gettinghypomanic and wanted to nip it in the bud. Shesaw her usual psychiatrist at her community mentalhealth center and got a medication change,which did not substantially help her.

There are a few basic things to know aboutmedication. Antidepressants act as “energizers.”They push your sluggish or depressed mood uptoward normalcy. Now, if you’re manic, like Susiewas, the question is: should you be on twoantidepressants and nothing else? No, indeed. It’slike pouring gasoline on a fire. At Susie’s request,the psychiatrist lowered one of herantidepressants, which made her feel less revvedup. However, she is still “speeding.” Thepsychiatrist, said Susie, has always been “rude” toher, but this was the last straw – rudeness and aninability to properly medicate.

Susie decided to change psychiatrists. Shelearned from hours of making phone calls todifferent agencies – her family will help her payout of pocket - that the next availableappointments are between six and eight weeks inthe future. Downright outrageous!

Medicating for bipolar or depression is a complexmatter. Be sure to ask your own psychiatrist toexplain what your drugs do, how they shouldmake you feel, what class they fall into (moodstabilizer, antidepressant, antipsychotic,antianxiety) and if you really need a particulardrug you’re on. Schedule lab tests if you’re ondrugs including lithium, Depakote or Tegretol andothers. Check with your doctor.

If your drug “poops out” or stops working, makesure your doctor has a Plan B.

If you’re afraid to ask your doctor these questions,bring a support person with you. This is your life!Remember, everyone is unique. What works forone person may not work for another.

New Directions maintains a Top Doc/Top Therapistlist. Since meds and therapy are cornerstones tostaying healthy, it’s imperative to have only the best.

On Nov. 2, Carole Hodges, co-leader of our FamilyMember Group, and I attended a focus group atCreekwood Mental Health Center in Willow Grove.The purpose was to “better the services” at theircenter. The meeting was a travesty. Some of thequestions presented to the 21 people inattendance were: How do you like the atmosphereof Creekwood? Would you like better lighting?More pictures on the walls?

Carole and I were there for one purpose: toadvocate for timely appointments for newpatients who attend Creekwood, especially aftera hospital discharge. Average waiting time is sixweeks. During this time, the patient may easilydecompensate and need rehospitalization. Ithappens!

A good idea after a hospital stay is to enter apartial hospitalization program. Most psychiatrichospitals offer them.

As I’ve written about before, both here in theCompass and in two Guest Columns I wrote forthe Doylestown-based Intelligencer newspaper,we had a young man attend New Directions acouple of years ago. Justin Hawkes was 27 yearsold, a young businessman who gave thecommencement address at his business school.

He came to our group with his mother Dorrie,expecting help. I believe we referred him toCreekwood, which is actually a fine facility onceyou get in.

But Justin, who completed an in-person financialappointment with them, was never able to see apsychiatrist for his all-important meds. Creekwoodwould make appointments, then cancel them ormove them farther into the future. All the while, hisdepression and hopelessness deepened. Finally,the agony was unbearable. In August 2010, Justintook a fatal overdose of one of his meds.

His funeral in Hatboro, PA was mobbed. His highschool and college classmates flew in from aroundthe country to pay tribute to this wonderful youngman. I will always remember the silence in the roomas we shared condolences with the family.

Because of Justin, Carole and I went toCreekwood. I followed up from the time-wastingfocus group by writing a letter to the CEO ofAbington Memorial Hospital (AMH), of whichCreekwood is the psychiatric arm.

In the letter, I said we strongly advocate for theimplementation of the OpenAccess system of careat Creekwood. This method sets aside several crisisspots per day so that desperately ill patients can beseen the same day or the next day. If you Google“open access scheduling” you can read about thegreat success of this new system.

Abington hospital itself, to remain competitive,has changed its own infrastructure toaccommodate a lessening patient populationand to shore up certain departments that theaging population demands. It it too much to askCreekwood to be equally responsive to the needsof mentally ill patients?

The CEO did write me back. Sadly, he has nointerest in implementing OpenAccess atCreekwood. He missed a wonderful opportunityto make lasting changes in the lives of vulnerablepsychiatric patients, some only a whisper awayfrom suicide.

Paul Fink, MD, a prominent psychiatrist here inPhiladelphia has written extensively about stigma

in educated individuals – such as hospital CEOs –and particularly in physicians and mental healthprofessionals. Find his columns on ClinicalPsychiatry News online.

In our “News Round-up” section, check out anarticle that describes a brand-new hypothesis ofhow medication works, displacing an old theory.We also have an article that describes how lithiumworks, something that was previously unknown.

Lithium, which I had taken for nearly 17 years,ruined my kidneys. When I went off in 2000, Idiscovered that my bipolar disorder had vanishedfor good. However, my kidney function continuedto decline so that, on April 1 of this year, I had akidney transplant, the gift of my daughter, Sarah.Today I have the heart of a 65-year-old womanand the kidney of a 37-year-old. While I’m doingvery well, more and more lithium-users in their 50sand older are getting similar news about theirdeclining kidney function. The dire words “end-stage renal disease” tell them their only hope tosurvive is dialysis or a transplant.

My nephrologist (kidney doctor), Dr. Shiang-Cheng Kung at Einstein Medical Center inPhiladelphia, told me, “It’s well-known that lithiumcauses kidney injury. Kidney function should beclosely monitored, especially in long-term use. Ihave a patient who absolutely needs his lithium,so we monitor him very closely. Usually there areno physical signs of kidney failure.”

Within these pages we tell the story of two peoplewho were on lithium whose kidneys have beencompromised: Sharon Piercy, who’s on the cover,and Denis Hazam.

Visit the website of the Brain and BehavioralFoundation (BBR), formerly NARSAD, of Great Neck,NY. Their private foundation funds researchers inmental illness. You’ll be cheered by the multitudeof new discoveries by these scientists. We hosted aprogram in April when Dr. John O’Reardon, thenhead of the treatment-resistant depression unit atUniversity of Pennsylvania, spoke about the manytreatments available for unyielding depression. InO’Reardon’s name, we sent BBR a donation tohelp researchers like O’Reardon find causes andcures for these brain disorders.

FALL/WINTER 2011 The Compass - Page 3

Did you know that we love to have fun at NewDirections? Our annual bonfire, hosted by Helen -who runs our daytime meetings at the WillowGrove Giant Supermarket - and husband LarryKirschner, was attended by 25 members. Asalways, we met in the most miserable weatherimaginable, an October night of pouring rain. Inaddition to the usual hot dogs and burgers, wedrank hot chocolate, hot apple cider and roastedS’mores by the roaring fire. Todd is our six-foot-twowood-bringing elf.

Ada’s Monthly Outings are always a joy. Ada,head of our depression group, and husband, Dr.Rich Fleisher, find extraordinary places in thePhiladelphia area to take our group, for free. Ourlast trip to the Glencairn Museum in Bryn Athynwas an escape to the ancient times of the Greeks,Romans, Etruscans and Egyptians, all withoutgoing to the Uffizi.

Our new program Mike’s Hikes is drawing more andmore people. We had about 12 when we went tothe beautiful cliffs of Lorimer Park in HuntingdonValley where we climbed to the top of CouncilRock, where Native Americans once met to smoketheir peace pipes and compromise on land issues.Chief Tamanend, where are you now?

My daughter Sarah and I are writing a mother-daughter memoir of our kidney transplantadventure. She’s the boss, since she’s a publishednovelist. Watch our Facebook page or my blogabout eight months from now to see if we’vefinished. Her husband, Ethan Iverson, a renownedjazz musician, has arranged a musical fundraiser forNew Directions at Chris’s Jazz Cafe in Philadelphia.Think of us swinging cats on Monday, Nov. 21.

Nothing like being alive and feeling good. That’smy wish for all of our readers. I invite you tobecome part of New Directions. Call us at 215-659-2366 or view our website atNewDirectionsSupport.org

This issue of the Compass is partially funded byEthan Iverson of the jazz trio “The Bad Plus,”Montgomery County Office of Behavioral Health,our New Directions’ members and other generousindividuals. .

LETTER TO THE EDITOR

I just wanted to thank you again for allowingElaine and me to observe your support group. Asa nursing student [from Thomas Jefferson] who isinterested in psych nursing, I found it veryinformative to hear each individual’s story, his orher coping techniques and how it relates to theirpharmaceutical therapy. Your session andpersonal experiences drove home the point ofevaluating and re-evaluating treatments andmedications (and even doctors for that matter!).It’s shocking that sometimes treatments causemore harm than good. Please pass my thanksalong to the group again as their growth andgenuine support for each other has left a greatmark in my life. - Rachel Moore

THE JOY OF BEING A BIPOLARSTAY-AT-HOME MOM

by Judy Kroll

I met an old friend for dinner last week whom Ihadn’t seen in 13 years. As we were catching up,she asked me why I wasn’t using the degrees Iearned - BA in English and a Master’s in SecondaryEducation - to work outside the home. She askedme if it was my choice to stay at home, or if it wasmy husband’s idea. She said that I was so intoeducation, that she couldn’t believe I wasn’tusing my degrees. For that matter, neither could I!

Motherhood was not something I initially embraced,nor was it an easy role for me to accept. In facthaving one child rocked my world so completelythat I decided I wouldn’t have another. It took metime and intense struggling to see its rewards. At firstI stayed home because I couldn’t figure out how tomanage the complexities of bipolar disorder, workingoutside the home, being a mom and wife, andmaintaining a home. These were tasks I mostcertainly didn’t learn in school.

I soon realized, however, that I was the pivot uponwhich my family rested, and came to embraceparenting my now 10-year-old son Max. I evenbought a mini-van and volunteered to be classroommom, surrendering to my fate! I love being Max’smom now and am proud of it.


eeeeeeeeeeeeee

We travel a lot because I like Max to see things cometo life rather than reading about them in books.We’ve gone to Paris, Aix-en-Provence, where wehave an aunt and uncle who retired there 12 yearsago, the Grand Canyon and the Rock and Roll Hallof Fame. We saw the Hollywood sign in Los Angelesand a famous pier in Santa Monica. I take him torock concerts and we go skiing in Colorado.

I am here for my boy when he wakes up and goesto bed. I am here for him when he comes homefrom school to hear about his day. I am here for himto drive him to baseball, and Hebrew school andto hear him practice piano. I am here to pack hislunch and walk him to school every morning. I amhere to read Harry Potter books with him andwatch the movies. I am his biggest advocate andam here to cheer him on but also his sternest critic,and discipline him when he does something wrong.I am here to teach him how to be a good person.

But Max has taught me so much more. My son hastaught me about responsibility and how to be agrown-up. He has taught me about trust andkindness and sharing, and not yelling, which I stilldo at times. He has taught me how to rediscoverthe joy in boogie boarding, sledding, roller-coaster riding and just plain silliness that only a 10-year-old can conjure up.

Mostly, he has taught me how to give and receivean unconditional love I never knew or thoughtwas possible. He has taught me the importanceof using my tools and taking my medicine andkeeping myself well so that I can be the kind of me- and mother - he deserves. He has taught mehow to be the best person I can be. For that, I amtruly grateful and wouldn’t change a thing.

The degrees will still be there when he is grown!

Judy Kroll lives in Holland, PA with son Max andhusband Barry.

THESE ARE A FEW OF OURFAVORITE THERAPISTS

New Directions’ Keys to Recovery from BipolarDisorder and Depression include: Get a goodpsychiatrist, get a good therapist, make lifestylechanges to help stabilize your moods, andsurround yourself with people who make you feelgood about yourself. Other keys include get dailyexercise, develop hobbies and interests, callpeople in your support system when you haveproblems, and help others.

MARION MULHEARNE of Chalfont, PA. “I’m seeinga new therapist, Sharon Katz, head ofCollaborative Care in Abington, PA, who washighly recommended by a friend. I found myselfopening up right from the beginning. She has suchan accommodating way about her. She told meto call her anytime. She delved into mybackground and I felt so comfortable with her Irevealed many things it would have taken me along time to tell someone. It’s important you feelintimate with your therapist. She makes light ofcertain things, putting them in perspective.

“I find it’s very good to have someone soavailable and accessible. In only five visits I’vemade a lot of progress, including setting up ameeting with my family members.”

GERRI BLEILER of Cheltenham Village, PA. “I’vebeen going to Betsy Goettle of Holy RedeemerCounseling Center in Meadowbrook, PA, for years.She’s down to earth, very understanding and Ican tell her anything. I always feel better when Ileave there.”

Gerri is also a big fan of the Horsham Clinic DayProgram – also known as the Partial Program - inAmbler, PA. “The day program is much better thanbeing in the hospital. We meet five days a weekfrom 9 to 3. The therapists are very good. They giveyou information on the reasons why you feel likeyou do. Every day there’s two educational classesin the morning plus “What’s on Your Mind” at 1pm. They do med checks also and have excellentpsychiatrists.”

When she graduated from the Day Program, shegot the names of several nice women she wantedto stay in touch with. “You’ve gotta be very


careful who you choose to contact after theprogram,” she said.

ROB LOKOFF of Conshohocken, PA. “While thereare many positive reasons to seeing apsychologist, there are also plenty of negatives.My feeling has been the same for years. What Icall the “human factor” is hard to overcome byany therapist, especially at critical times.Psychological therapy is not an exact science.When you break your arm the doctors know howto treat the problem. When you get depressedand you need a therapist there are a lot of factorsthat go into whether you will respond totreatment. The human factor comes into playbecause therapists have their own experiences,their own biases, and their own personal problemsthat can often get in the way of helping a person.I’m not making an indictment for all therapy andall therapists. I just believe the greatestresponsibility for achieving a healthy mind falls onan individual themselves. That said, there aremany positives where a good therapist can helpachieve mental health and mental stability.

“MARNA BARRETT of the University of Pennsylvaniahas studied the field extensively. Degrees aregood but interpersonal skills are better. Marna is agood listener which is a key to any therapist orpsychiatrist. Where Marna excels is in availability. IfI need to see her right away she will squeeze mein. I can email her and she will respond the sameday. I can call her office or her personal cellphone number. Most of the time she eitheranswers right away or will promptly call me back.At critical times you want your doctor or therapistto immediately get back to you.

“Another important trait of a good therapist is timemanagement. Most of the time when I come for anappointment she is on time or I only wait a fewminutes. During my appointment she doesn’t rushme through, often allowing me extra time to finish mythoughts. Marna makes me feel like she understandswhere I’m coming from and often gives feedbackbased on her own personal experiences.

“Since I see her every three or four weeks – andbecause she has many other patients – she oftencan’t remember what happened at our lastsession. It would help if she reviewed her notesfrom the last session.

“In my life I have found there are no perfectpsychiatrists or therapists. One doctor told me thata therapy office is like a laboratory. You should beable to try any mixtures of cognitive behaviorsand talk therapy to achieve your goals. Thatshould mean not being afraid to challenge yourtherapist’s viewpoints.”

COVER STORY ...

SHARON PIERCY:PSYCH NURSE IS ONE MORECASUALTY OF LONG-TERM

LITHIUM USE

Sharon Piercy has always been one of thosestrong independent women, a regular ClaraBarton. Her happy childhood was scarred by anearly year-long period of sexual abuse when shewas 6 until the young man molesting her movedout of town.

With her buoyant spirit and good sense, shecarved out a career as a nurse, married, had achild, divorced her husband, then raised hertalented artist daughter Tisha by herself. She alsogot an advanced degree in nursing.

Living in the Philadelphia suburbs, she worked atEinstein Medical Center as a research nurse onvaccines, earning high praise from her physiciancolleagues.

Times were good for Sharon and would get evenbetter when a beloved aunt left her moneyenough to buy a home in the Poconos.

Did I mention she has bipolar disorder? At 61, shefaithfully takes her Depakote. “It works muchbetter than the lithium,” she said. “When I was onlithium I had a lot of breakthrough delusions andintrusive thoughts.”

She was also an integral part of New DirectionsSupport Group, giving educational talks to groupslike the nursing students at Abington MemorialHospital’s Dixon School of Nursing.


Four years ago, she moved from Philadelphia toher tranquil mountain home in a secure gatedcommunity among the trees and broad skies. Shegot a job as a psychiatric nurse 45 minutes fromhome at Pocono Medical Center.

Then, in 2001, her string of successes was broken.Lab tests revealed her kidney function wasdeclining.

Like a small but growing number of people whotook lithium for many years, Sharon’s kidneys arenow failing badly. She is in end-stage kidneydisease.

“At last the truth is coming out about lithium,” shesays.

She cites an article from the May 2011 journal“American Association of Kidney Patients” bynephrologist Sean P. Harvey, DO. “Ten or moreyears of lithium causes permanent renaldamage,” he wrote.

“And psychiatrists are still prescribing it,” saysSharon.

Lithium, Sharon noted, is a “great drug” whenused appropriately. “I can see giving it for acutepsychosis and getting a patient stabilized, butthen the doctor should prescribe something else.”

Her own bipolar is well-managed. So is her end-stage renal disease.

Although kidney disease has been called a “silentkiller,” with few symptoms, the case was differentfor Sharon.

Eleven years ago, she experienced excrucatingpain in her kidneys. We have two, located deepinside our lower back on either side of the spine.Her primary care doctor in Philadelphia told herher creatinine level was rising. This measurementdetects how well the kidney is filtering out toxicwastes from the body. The higher the number, theworse the kidneys are doing.

“When they did a CT scan with contrast,” she says,“my kidneys lit up with all these cysts, cysts all overthe outside of the kidneys. That’s from the lithium.”

Her nephrologist reassured her that kidney diseasefrom lithium toxicity progresses slowly. The doctor

also told her, “Once the kidney damage is done,it continues to the end.” She urged Sharon toregister on the Kidney Transplant List, which she did2-1/2 years ago.

She chose the University of Pennsylvania becauseboth her nephrologist and family doctor are thereand vouched for its excellence.

There are two types of transplants: those involvinga living donor and those with an organ fromsomeone who has recently died, called acadaver donor. The only requirement is that theblood of the donor and recipient be a match.Studies show that live donor organs tend to lastlonger in the recipient than cadaverous organs.

“I have 10 percent kidney function,” she says. “Theonly symptoms I have are sometimes I get a littletired and may lie down for a nap.”

Of course, every individual is different and plentyof people outlive the statistics.

In less than three years, Sharon’s name climbed tothe top of the list, thanks to her rarer blood typeAB positive. She also upped her chances forsuccess by accepting cadavers over the age of60.

So far, Sharon has avoided the rigors – and perils –of the dreaded “D” word: dialysis. But becauseher kidneys may suddenly fail without warning,which is not uncommon, she had a “peritonealcatheter” inserted in her belly in April to enableimmediate dialysis.

She’s been able to hold on without it. “I credit thisto working with my horse, lots of fresh air, sun andexercise.”

Not to mention diet. Smart, disciplined kidneypatients limit their intake of phosphorus (includingdairy products and nuts), potassium (includingtomatoes and oranges), sodium and protein.

Although she loves her job as psych nurse – “We’reseeing more and more drug and alcohol cases atthe hospital, along with the usual cases of bipolar,depression, schizophrenia, anxiety” – what sheloves most is her horse Charlie.

She sees him just about every day. A fellow nurseat work kept talking about the horse farm she and


her husband own. “I got tired of hearing about it,”says Sharon, “so I went over to visit and rode oneof their horses.”

She was overwhelmed by the experience andknew she must have a horse. She found “Charlie”on the Internet, a 9-year-old palomino quarterhorse. (Palomino refers to color of coat: yellowwith white mane. Quarter horse is a fast sprinter,going a “quarter of a mile” at speeds up to 55mph.)

“Now that’s a spunky horse,” she says proudly. “Iftreated well, a horse can live to 30 years.” Charlielives with five other horses and has always beenwell cared for.

He’s the love of her life. She knows he will outliveher. In fact, she wanted an older horse when shegot him and thought he was 11. Visits to the vetproved otherwise.

One night Sharon’s phone rang. When you’re on“The Transplant List” any phone call, at home orelsewhere, could be the call you’re waiting for.

“It’s very stressful,” she says.

Many people are called - numerous times - butfew get the transplant.

Sharon was called many times even though otherswere before her on the list. Potential recipientsmust be lined up and ready for the cadaverwhether or not they are the first on the list. When acadaver is available, many people on the list arenot ready. They may be out of town or ill or can’tget a ride.

On a clear summer night in August, the call she’dbeen waiting for finally came.

Sharon packed her bags, put her dog and cat inthe car, made arrangements for Charlie, anddrove 2-1/2 hours to Philadelphia to stay at 32-year-old Tisha’s, and await further instructions fromPenn.

When Penn called, her friend Denise, a researchnurse, drove her to the hospital.

“I was admitted and given a room,” says Sharon,“They did a work-up to make sure I was a goodmatch.”

More waiting. Then a phone call to her hospitalroom said that everything was a go. The nurse toldher to expect another phone call in a few hours,after which the four-hour procedure would begin.

At 1:30 a.m., the call came. It was not what shehad expected. The news was heartbreaking.

“Sharon, this is Stephanie,” the familiar voice said.“I’m so sorry to tell you this, but they nicked thedonor’s bowel. The kidneys are contaminated.”

The kidney was from a child. “A six-year-olddrowning victim,” says Sharon. “I feel really sorryfor the parents.”

The only good thing about this tragedy is thatSharon is now at the head of the list.

In mid-November, as this article goes to press,Sharon writes, “I’ve had three more kidney offers,but all three were bad when they got them out.What a roller coaster!”

Ever the philosopher, Sharon says simply, “There’snothing I can do to control it. It’s in the hands ofGod.”

DENIS HAZAM:HIS KIDNEY TRANSPLANT WORKEDFOR SIX YEARS UNTIL UNKNOWNFACTORS CAUSED REJECTION

Denis Hazam, 69, took lithium for his bipolardisorder for 10 years. It was one of the keys to hissuccess. He has run a mood disorders supportgroup, helped by his wife Fran, for 17 years. Theyboth work as consumer advocates at the MentalHealth Association of Southeastern Pennsylvaniain Philadelphia. Denis is the benefits manager.

Six years ago, his kidneys began to fail due to hisyears on lithium. He was put on the transplantwaiting list at Thomas Jefferson University Hospital.“I was on the list for about a year,” he said. “Oneday they called and said to get ready, I’mnumber three on the list.”

Usually, the third in line rarely gets the kidney. ButDenis was extraordinarily lucky. The first two


candidates were not prepared for the operation.As next in line, Denis would get the kidney. It wasFeb. 9, 2005.

At Jefferson, during the four-hour operation, Denisreceived the kidney of a 24-year-old man, whichhad been flown across the country. He wasadvised that the kidney might not work right awaydue to the long wait before it arrived and hemight have to go on dialysis. “To my surprise,” hesaid, “the kidney worked right away.”

Transplation is a remarkably seamless, well-coordinated program operated by the OrganProcurement & Transplantation Network, whichmaintains a centralized computer network linkingall regional organ-gathering organizations andtransplant centers around the country, accordingto its website. In addition to the kidney, otherorgans that are transplanted are the heart, lungs,pancreas, intestines and liver.

The average wait for a kidney is from three to fiveyears. Nearly 73,000 people are on the waiting listtoday. 4,600 people die each year because oflack of donors.

He had six good years with the transplantedkidney until his body began to reject it.

Denis married late in life. At 57, while running hissupport group, the affable, talkative Fran Scullionwalked in. She was previously married and hadthree grown children. They found they had a lot incommon. “I’m drawn to politically active womenwho share my point of view and concerns forsocial justice,” said Denis. It didn’t hurt that Franwas also a polymath.

They were married at St. Mary’s Episcopal Churchon the Penn campus.

Little did they know how important Fran wouldbecome when Denis got sick.

Disaster struck Denis’s kidney this May, when labtests revealed the BK virus appeared in Denis’sbloodstream. Since he was on antirejection medsfor his transplant, which lower the immune system,his body could not guard against opportunisticviruses like the BK. The virus is fairly common in

transplant patients. Doctors lower theantirejection meds in an attempt to enable thebody’s natural immune system to fight off the virus.

Other factors were also against him, includinghigh blood pressure. Lab tests showed hiscreatinine level was skyrocketing and his redblood cell count was going down, producinganemia.

“I felt really sick. I had no energy,” he recalled.

Sadly, his new kidney was useless. For the first time,he went on dialysis.

A mellow individual with a radio announcer’svoice, Denis is handling dialysis well. “I can’tbelieve it’s six months already,” he said. “Dialysis isnot disabling. I do have a reaction right away. I’mtired and drained, but the next day I’m fine.”

There are three different dialysis options:hemodialysis in a center, hemodialysis at homeand peritoneal dialysis at home. “I chosehemodialysis in a center because I wanted a setplace three times a week away from home. It’s asimpler approach than the others. I rely oncompetent professionals to do the job Thedrawback is that if there are transportationcomplications, such as bad weather, I might notmake it.”

The dialysis session lasts four hours. A normal kidneyfilters toxins from the blood stream into the urine. Ineffect, the dialysis machine becomes thepatient’s kidney, filtering toxins out of the blood.

Denis attends a DaVita Dialysis Center onTuesdays, Thursdays, and Saturdays in the WalnutTowers downtown, close to home and work.

Since the kidneys fail to work, many people ondialysis do not pass urine. Denis is one such person.The act of “peeing” is so natural to people, it’shard to believe that some people simply don’t.

“I don’t have the urge,” he said.

“Dialysis is a lonely situation,” he said. “You sit witha group of about 20 people. We all have a TV. It’sgood if there’s an exciting sports game on that


holds my interest.” Because his body is hooked upto various monitors, he’s not able to read. Herecently purchased a Barnes & Noble “Nook.” Assoon as he learns how to use it, he’ll read histhrillers and history books to help pass the time.

Transplant patients eat what they wish butpatients on dialysis must adhere to a strict diet. “Imonitor my potassium, phosphate and sodium. Ican only drink a litre of fluid a day, slightly morethan a quart,” said Denis.

Denis continues to work full-time. “I have time toreceive dialysis treatment by taking IntermittentFMLA (Family and Medical Leave) from work. Thispermits me to retain my full-time position, maintainmy benefits and take two afternoons off a weekfor dialysis. This will continue until early January, atwhich time I will have to select other options, suchas taking a part-time position or even retiring.”

Possibly, within a year Denis’s virus will go away,which means he can have another transplant.“I’m on the list right now,” he said, “earning time.”

Many kidney patients have had more than onetransplant. There is plenty of room in the abdomento hold the fist-sized organ. The old kidneys are leftin the body, residing toward the back.

Fran takes good care of him and cooks deliciousmeals. “She is very sensitive to what foods I shouldeat,” he said. “She cooks for both of us so she’srestricted, too, unless she’s home alone, whenshe’ll eat anything she wants.”

Recently the Hazams, who live in Center City,were visited by Denis’s sister Ronda who lives inCanada. “That’s ‘Ronda’ without an ‘H,’ just likeI’m Denis without the second ‘N,’ he laughed.

“Your life shouldn’t center around dialysis. Stayactive,” he said, in his always chipper voice. “Lifegoes on.”

ASK THE DOCTOR

We asked Dr. David Abel, MD, psychiatrist, twoquestions.

Question: If a person is on psychiatric medicationfor bipolar disorder, what lab tests should he or shehave done?

Dr. Abel: People on the mood stabilizers lithium,Depakote and Tegretol require ongoing bloodtests.

Lithium can affect thyroid and kidney function.These blood tests should be done every three tosix months. People on lithium should get acomplete blood count (CBC). They should also betested for their lithium level, which should bebetween .5 and 1.2. Levels above 1.2 approachlithium toxicity, which can be dangerous.

Depakote (valproic acid) requires a periodiccheck of the complete blood count (CBC) andliver function tests. The Depakote level should alsobe tested. Levels should be between 50 and 100.

Tegretol (carbamazepine) requires a periodiccheck of the complete blood count (CBC) andliver function tests. The Tegretol level should alsobe checked. Levels should be between 4 and 12.

People on atypical antipsychotics (Geodon,Seroquel, Risperdal, Abilify, Zyprexa, Clozaril,Saphris, Invega) need lab tests to follow the lipidlevels, which include cholesterol and triglicerides.The fasting blood glucose level must also bechecked.

The BMI or body mass index needs to be followed,as well, because of the risk of developingmetabolic syndrome.

Risperdal, in particular, runs a higher risk ofdeveloping hyperprolactinemia, which can bechecked through a blood test.

People on Clozaril must check for their whiteblood cell count on a weekly or bi-weekly basisbecause of the risk of agranulocytosis.

Question: Are there any new medications thathave recently been marketed?


ABABAbABABA

Dr. Abel: Viibryd is the newest antidepressant. Itried it with one patient and it didn’t seem to help.Its claim is that is has fewer sexual side effects thanmost of the antidepressants. Wellbutrin andRemeron also make the same claim.

I usually don’t prescribe the newest drugs rightaway, at least not for several months. Themanufacturers may make claims that don’talways turn out to be true. We need to have lots ofpeople taking the medications to really find outhow good they are and what all the side effectsare. This can only be accomplished over time.

When I prescribe mood-stabilizing medication, Iam particularly aware of the possibility of weightgain and its deleterious effects. Among theatypical antipsychotics, Abilify has been shown tocause the least amount of weight gain. As a result,it is currently very popular.

Each person can have a different response to anyparticular medication. What helps one personmay not be helpful for another, even if they havesimilar symptoms.

When I prescribe a medication for someone, Iexplain the risks and benefits, as well as thereasoning behind my recommendation.

There have been rare circumstances where aperson is suffering greatly and has not benefitedfrom any medication or therapy. In thosesituations, I have referred people for treatmentwith electroshock therapy (ECT) and in somecases, this has been very helpful to them.Unfortunately, some patients who haveundergone ECT do suffer from some residualmemory loss.

Although we’re talking about medication, I can’temphasize enough the importance ofpsychotherapy as a valuable tool to help peoplewith mental health problems. I believe thatsuccessful psychotherapy leads to biologicalchanges in the brain just as medications do.

It’s been exciting over the past 25 years to see thenew developments in the mental health field andto have had the opportunity to help so manypeople over the years. People have put their trustin me and I am truly grateful.

Dr. David Abel is in private practice in Doylestown, PA,and in the Rydal section of Jenkintown. He’s both achild and adult psychiatrist. Visit his website atDrDavidAbel.com or call him at his Rydal office at 215-885-2911 or his Doylestown office at 215-489-2998. He ison the board of directors of the National Alliance onMental Illness (NAMI), Bucks County.

FAMILY MEMBERS AT OURSUPPORT GROUP HAVE MANY

QUESTIONS

At New Directions, our support group for peoplewith mood disorders and their loved ones, we areseeing an increase in family members. Sometimeswe get as many as 20 per meeting at AbingtonPresbyterian Church. New to the world of mentalillness, they come to us with loads of questions thatthe leaders of our family group - Greg and CaroleHodges, parents of a successful bipolar daughter- answer patiently, with the help of the entiregroup. People thank them profusely upon leaving.

Since patients with bipolar disorder often go offtheir meds or have relapses while on their medsrendering them psychotic, angry or combative,the parents or spouses are at a loss what to do.

Says Carole Hodges: “Many of our members don’tknow what a “302” is (mandatory hospitalization).Others who do know are afraid of committing aloved one. These are desperate individuals whohave called the police many times but when thepolice arrive, the loved one “pulls himselftogether” and talks calmly and sensibly to thepolice officer. Some parents have learned to wait“for the right moment” to call the police, “whenthe ill individual is more out of control than ever.”

We asked mental health advocate Tony Salvatoreabout the “302” process.


THE 302 PROCESS: TRUTHSAND MISCONCEPTIONS

by Tony Salvatore

This article does not give legal advice. Suchquestions should be directed to an attorney or aMental Health Delegate. Involuntary evaluationadministrative practices may vary by county.

The process for ordering of an involuntarypsychiatric evaluation in Pennsylvania is popularlyknown as a “302.” This provision of the statemental health law is not well understood. Here wewill take a brief look at some of the most commonmisunderstandings about 302s.

A 302 is not an inherent right. There must be avalid reason. Requests are screened in terms ofthe law and for credibility. Statements arereviewed before going to a Mental HealthDelegate who is authorized by the County MentalHealth Administrator to approve or deny petitions.

A 302 is not granted on the basis of referral source.The law treats 302 requests from police andphysicians differently, but it does not empowerthem to imply the approval of petitions fromothers. They may suggest that a 302 be pursuedbut the filing must stand on its own merits.

A 302 is a means of emergency intervention. It isa response to a serious mental health emergencyas evidenced by recent actual behavior. Itcannot be invoked in the absence of such asituation or in anticipation that one may occur orbecause one happened in the past.

A 302 puts someone in front of a physician. Thephysician determines the severity of theindividual’s psychiatric needs. Any treatmentdecision is based on the 302 petition, theevaluation interview, and sometimes also on thephysician’s questions to the petitioner.

A 302 may lead to emergency care withouthospitalization. Individuals are counseled beforeand during the evaluation (and often after) andthis, plus a referral, may address their needs.Admissions are only made when there is a needfor immediate inpatient psychiatric care.

A 302 is not an admission order. It is not a means of“signing somebody in” or “committing” someoneto a psychiatric hospital. This may be aconsequence of a 302 but its primary purpose isto help someone who appears to need animmediate psychiatric evaluation.

A 302 has limited scope. The law explicitly statesthat persons who are developmentally disabledor suffering from dementia, or alcohol or drugdependence, cannot be compelled to receivean involuntary psychiatric evaluation when theseconditions are the main problems.

A 302 requires that serious mental illness bepresent. The intent is “to assure the availability ofadequate treatment to persons who are mentallyill.” It does not automatically apply to those whoare “drinking themselves to death” or “killingthemselves because of drugs.”

A 302 is not issued on a diagnosis or suspectedmental illness alone. There must also be behaviorin the past 30 days (that may reoccur in the next30 days) showing that, because of serious mentalillness, someone is a “clear and present danger”to others or to herself or himself. This meansattempted suicide, severe self-mutilation, orinability to care for one’s self.

A 302 is based on first-hand knowledge of anindividual’s dangerous behavior. This must bedirectly witnessed (i.e., observed, heard, or read)as opposed to what a third party reported.

A 302 is a response to high-risk “behavior.” Threatsmay be frightening but they do not representimminent danger. There must be “acts infurtherance of threats to commit harm.” Theperson must have harmed or attempted to harmsomeone or herself or himself. At the very least theperson must do something showing intent to carryout the threat (e.g., seeking a weapon).

A 302 may address someone’s inability to care if“without care, supervision and the continuedassistance of others, to satisfy his need fornourishment, personal or medical care, shelter, orself-protection and safety” there is a “reasonableprobability” of death or serious harm. The harmmust be likely to occur within 30 days and theincapacity must be due to serious mental illness.


A 302 does not over-ride all personal choices. Itdoes not apply to individuals who opt to declinemedical care, even non-elective surgery, or whorefuse treatment, to bathe, to change (or wear)clothes, or to otherwise maintain their personalhygiene, to clean up after pets, and so on.

A 302 is not a “Plan B.” It is not an option whereother civil or criminal avenues for dealing withproblems have failed or not even been tried. It isnot a recourse for those who have “had it,” wantsomeone out of their home or out of their lives, or“put in rehab,” etc.

A 302 is county-specific. It must be filed in thecounty where the problematic behavioroccurred. A warrant will only be honored in thecounty where it originated.

A 302 is not a fugitive warrant. It not will lead to anall-points search except in a very dire situation(e.g. imminent danger of a lethal suicideattempt). A 302 does not relate to departures inthe absence of serious mental illness andbehaviors associated with danger to self or others.

A 302 is a critical resource despite its limits. It helpsmany individuals who would otherwise faceserious injury or debilitation, possibly incarceration,or, very often, even death. However, it mustbalance the need for treatment, the safety of thecommunity, and individual rights.

Tony Salvatore lives in Springfield, PA, and works incrisis intervention and suicide prevention.

NEWS ROUND – UPWOMEN AND SLEEPING MEDS.Mothers around thecountry are increasingly turning to sleepmedications to help them fall asleep at night orfall back to sleep when they awaken in the middleof the night, according to a November article inthe New York Times. America has the highestinsomnia rates in the world. A 2007 poll showedthree out of 10 women take a sleeping aid a fewtimes a week. Conscious of dependency, manywomen stop using the aid after a few nights butthen resume taking it. Last year more than 15million women – between ages 40 and 59, the

ages when women turn to sleep meds – gotprescriptions for Ambien, the top-selling sleep aid.One reason for sleeplessness, the articlementioned, is “the creep of technology into theafter-hours,” such as checking emails for onemore email. “Just the light from the electronicbook or the iPad is stimulating,” said one sleepdoctor. (New York Times, Nov. 2011)

HOW TO PREVENT TRAGIC SHOOTINGS. TwoPhiladelphia Inquirer op-eds offered ideas toprevent tragic shootings by mentally ill personssuch as the Arizona shooting which killed six andwounded 14, including US Rep. Gabrielle Giffords,in January 2011. A new approach is needed, saidthe Inquirer, not only in high-profile shootings, butalso in lesser-known run-ins with the law, whichresult in arrests of thousands of non-violentmentally ill people, who languish in prison.

Public opinion surveys suggest that many peoplethink mental illness and violence go hand-in-hand.Not true. While most individuals with mental illnessare not violent, a subset of them is. Those withschizophrenia or bipolar disorder, who have asubstance abuse problem, are three or four timesmore likely to be violent. Absent substance abuse,research shows that rates of violence are notclosely correlated with psychiatric disorders. Incertain circumstances, detention may benecessary. However, violence can be preventedif there is a sustained public will to providecomprehensive treatment of mental illness andsubstance abuse.


Paul Heroux examined the relationship betweenincarceration and mental illness in thePhiladelphia prison system. He found the mostserious charge against 44 percent of the mentallyill offenders was violence-related, often resistingarrest. The most serious charge against another 25percent was drug-related. Both kinds of chargesare highly correlated with mental illness. Herouxwas struck by the very strong correlation betweenthe number of incarcerations and diagnosis ofserious mental illness. Among those incarcerated16 times, more than 50 percent had beenidentified as having a serious mental illness. Whilemental disorders are relatively common in thegeneral population – about 26 percent ofAmericans – only about 6 percent suffer from aserious mental illness. He concluded, “Jails are thenew American asylums.” Heroux noted that wecan either see that there are sufficient servicesavailable or we can continue to fill our jails andprisons with those suffering from mental illness.(Philadelphia Inquirer, two editorials in January2011)

MENTALLY ILL ARE DYING BECAUSE OF A FAULTYAND CONTROVERSIAL LAW. A Philadelphia Inquirerop-ed, from December 2010, supports a bill thatwould mandate court-ordered treatment formentally ill individuals with a history of violence.Repeatedly introduced by State Sen. StewartGreenleaf (R-Montgomery), the bill would makeinvoluntary commitment to outpatient care ameans of preventing psychiatric tragedies. Thelegislation has the support of many statewidegroups representing people with mental illnessand their families, as well as police and sheriffs.However, the bill has been consistently fought bymisguided defenders of mentally ill people’s“right” to refuse lifesaving treatment. The op-edurges lawmakers to pass a more humane andeffective commitment law in order to preventtragedies such as the one that happened to onePennsylania woman.

Susan froze to death on the back porch of avacant house. The cause of death was“hypothermia by psychosis.” She was too mentallyill to keep herself alive.

The current law in Pennsylvania requiring that anindividual constitute a “clear and present danger”to himself or others, in order to be involuntarily

committed, does not work. Intervention is neededwhen the person is on the way to becoming aclear and present danger, when he or she isrefusing treatment for chronic and severe mentalillness.

As of August 2011, Greenleaf’s bill was still incommittee.

Read Tony Salvatore’s article on mandatoryhospitalization above, which offers a differentperspective. (Inquirer, December 2010)

PSYCHOTIC DEPRESSION OFTEN TRAGICALLYMISSED. Psychotic depression, which is a majordepressive disorder combined with psychoticdelusions or hallucinations, often goesundiagnosed, according to Anthony J. Rothchildof University of Massachusettes Medical School.Delusions that typify this condition often involvefears, such as the loss of a home, or supposedthreats by the IRS, which may not be apparent tothe attending psychiatrist. The patient also maynot divulge his fears out of shame or distrust. Suchpsychotic depressions may occur at the rate of 14to 50 percent of all depressed patients. The higherpercentage is usually found in geriatric patients.

Other symptoms include increased motordisturbances, either severe agitation or severeslowing up, cognitive impairment, feelings of guiltand hopelessness, hypochondria, anxiety andsleep disorders. The suicide rate is five times higherthan other depressions.

Two treatments are recommended: anantipsychotic medication combined with anantidepressant or electroconvulsive therapy (ECT).Most of the time, however, only antidepressantsare given, which, studies show are ineffective.Rothschild and his team - one of a handful ofinvestigators in psychotic depression - found thatonly 5 percent of these patients are properlymedicated. The irony, he said, is that when givenproper treatment, patients will find completerelief. (Brain and Behavior Research Quarterly,Summer 2011)

NEW THEORY ON BRAIN PLASTICITY ANDTREATMENT: WHY MEDS DON’T ALWAYS WORK.“Bipolar disorder, we now believe, isn’t a diseaseof too much or too little serotonin or dopamine.We now think of the problem as being in the


machinery of signal transmission,” according torenowned researcher Husseini K. Manji, MD. It’s notabout neurotransmitters, but about synaptic andneural plasticity, said Manji, a drug researcher atJohnson & Johnson, and a visiting professor atDuke University.

Plasticity is the attribute that enables the billions ofnerve cells to change and adapt on amillisecond-by-millisecond basis. “What we’velearned in the last 10 years,” he said, “is thatwhether we’re talking about memory or mood ormovement, all advanced brain functions involvethe ability to convey information betweensynapses in different circuits.”

While there is atrophy or shrinkage of neurons(nerve cells) in certain brain areas of people withmood disorders, the neurons are not dead. Theycan regenerate. Neurons, said the article, have aprofusion of tree-like branches. Theycommunicate with one another by forming amultitude of synapses or the tiny gaps acrosswhich the neuron sends a message to a receivingneuron. “If that branch shrivels up, you losesynaptic contacts,” said Manji, and, therefore,communication stops.

Manji and others helped demonstrate in the 1990sthat lithium, the oldest and most successful moodstabilizer, has “neuroprotective” effects. It booststhe levels of proteins that help neurons function,and other proteins that help neurons and theirtree-like branches grow.

This fact seems to explain why lithium is effectiveover long periods of time. It doesn’t simply addressa short-term problem [such as mania ordepression] but contributes to the long-termmaintainance of the machinery within nerve cellsthat enable signals to pass properly from one cellto the next.

Not only did lithium’s neuroprotective qualitieshelp explain resilience, it also provided plausibleanswers to why it takes several weeks for SSRIantidepressants to take effect. In short, the SSRIsare going after the wrong target, said Manji.Antidepressants address the balance ofneurotransmitters, while the real antidepressant’sresponse may come from modifying synapticplasticity.

As more evidence of the plasticity theory,researchers cite bipolar patients who haveparticipated in sleep deprivation studies.Overnight, they switched from depression tomania.

Another exciting finding was the discovery thatthe anesthetic drug “ketamine” helpeddepressed people almost immediately. Whengiven to people with severe depression, thedepression “melted away in a few hours,”according to the article. To read more, viewBBRFoundation.org. (Brain and Behavior ResearchQuarterly, Summer 2011)

BIPOLAR DISORDER SURVEY HIGHLIGHTS NEED FORRECOGNITION AND BETTER TREATMENT. The survey,published in Archives of General Psychiatry,March 2011, found the severity and impact ofbipolar disorder is similar around the world. Thisincluded bipolar I (the classic form with recurrentepisodes of mania and depression), bipolar II(hypomania alternating with depression), andbipolar not-otherwise-specified. The overallbipolar spectrum rate was 2.4 percent of thepopulation. The US had the highest rate; India thelowest.

More than half of the adults with bipolar disorderreported the illness began when they wereadolescents. 75 percent of those with bipolardisorder had at least one other disorder. Anxietydisorders, especially panic disorder, were the mostcommon co-existing disorders, followed bybehavior disorders and substance abuse.

Less than half of those with bipolar symptomsreceived treatment; in low income countries, only25 percent received treatment.

The study confirms that bipolar disorder has aninternational impact. Because so many peoplenoted that their illness began in adolescence,early detection, intervention and possibleprevention of subsequent co-existing disorderswas emphasized. (National Institute of MentalHealth Science Update, from Archives of GeneralPsychiatry, March 2011)


rrrrrrr

PURSUE THEWONDERFUL

CAROLYN CONSTABLE of Chalfont, PA, is a former teacher-naturalist at Peace Valley Nature Center in Doylestown. Sheand husband Ron participate in the hawk migration countat Scott’s Mountain at Merrill Creek Reservoir in New Jersey.Their biggest day so far was Nov. 9 when 18,621 broad-wing hawks flew overhead. Gliding effortlessly in windthermals, they’re on their way to Texas, then across the Gulfof New Mexico to South America. Resident red-hawks staythroughout the winter. The following is from Carolyn’s series for us called “Pursue the Wonderful.”

into Autumn

It begins subtly. Queen Anne’s Lace and Black-Eyed Susans in the fields yield to Goldenrods andlavender Asters. Meadow grasses begin tochange from bright green to soft brown stubble.Grasshoppers, crickets, and katydids increasetheir tempo as though preparing for the grandfinale. Hot sultry evenings are replaced by cooldamp nights, shrouding the lake with mist. Latemorning sun pierces the fog, then peeks intothickets awakening chilly insects. Sunnyafternoons bring out garter snakes basking tocatch the last rays of the season.

Frost is a catalyst. Frosted meadows are silentnow. Only a few hardy crickets remain hidden inmatted grasses chirping pathetically. Now is thetime for the Master Artist with palette of gold,

scarlet, maroon, and brown to stroke his brush andadorn tree leaves in magnificent colors. As theleaves descend, woodland floors are transformedinto a kaleidoscope of shapes and colors.Amanita mushrooms with their golden bumpycrowns pop up amid the soft brown pine needles.Cool rains produce mud which reveal deer,raccoon, and pheasant tracks.

Hickories, walnuts and oaks drop nut treasures forsquirrels and children to find. Plump milkweedpods disperse “wind dancer” seeds which twirland pirouette in the crisp clean air. Jewelweedseeds explode on touch to the delight ofyoungsters. Mother Nature with her prolificproduction of seeds insures future generations offlowers, grasses and trees.

Humans notice Mother Nature this time of year.They climb mountain tops to view migratinghawks. There is time for a walk in the woods orapple picking in a country orchard. Raking leavescan become a chore or a chance to discover themyriad shapes and colors of leaves. Jumping inthe pile is not just for children. Try it!

Autumn is one last burst of glory before Earthsleeps in somber tones.

JOHANNES PONSEN does a superb job running many ofNew Directions’ daytime meetings at the Willow GroveGiant Supermarket. Born in the Netherlands, he now livesin the Mt. Airy section of Philadelphia. Newly retired,Johannes had worked for more than 20 years with anonprofit that established school-business partnerships. Hehas immersed himself in numerous hobbies includinggardening. His hibiscus dominate the garden, with theirhuge red blooms that last only one day. We asked him totell us about the most unusual of all his hobbies.

I got into Lithuanian folk dance about four yearsago. I dance with a group called Zilvinis, whichmeans serpent, a symbol that appears on theLithuanian flag. The majority of the group is first orsecond generation Lithuanian. Some of the oldermembers are immigrants, devoted to passingalong their many traditions.

When I first started, I felt like an uncoordinatedklutz. I considered myself lucky that I didn’t fall onmy face. If you’re new to the dance, there’s agreat deal to learn, but after a while, it does get


easier. If you have a good partner, they can leadand push you in the right direction.

These dances are tied to seasons, festivals, andcourtship. They all have a meaning within theculture. We practice two hours every week. It’s areal workout. I’m usually panting.

I’ll never be great because I’m dancing withpeople who have been doing this since theystepped out of the cradle. And also because I’molder, 68.

We perform in The Lithuanian Hall, Allegheny nearI-95. Formerly it was a Lithiuanian neighborhood,now it’s mostly working-class Polish. In addition tobeing a challenge both physically and mentally,I love the camaraderie with the other dancers. Weall went to Australia together for the InternationalLithuanian Festival.

We perform four to six times a year. Come see us!

JUDY DIAZ of Bensalem, PA, retired psychotherapist, hasprobably never had a boring moment in her life. A movie buff,she’s practically the Roger Ebert of Bucks County, and wassupremely annoyed when she fell asleep during Channel 12’s“The Razor’s Edge” with Tyrone Power. Her blue-eyedSiamese cat, Missy, enjoys movies, too, but certainly notHurricane Irene, which had her shadowing Judy for theduration of the storm. After Judy retired, she discovered,much to her surprise, she has an unerring green thumb.

“In my garden I found humility. You realize youcan’t control everything. You can participate innature but can’t control it. I have such a tiny littleplace but am deeply grateful.

“I had a transcendent experience this morning. Iplanted a couple of morning glories and now I’vegot them all over the yard. I also bought hyacinthbean vines at my nursery. When you get into vinesyou see all the wonders available. Morning gloriesand hyacinth – beautiful together: lavendar color,bright shiny magenta, and blue.

“Of course, it’s all goodbye by noon, they closeup and don’t bloom again until the morning.

“I am telling you, it’s so divinely gorgeous. They’reso beautiful but you can’t hold onto them, a little

bit like life itself.”

PEER SUPPORTAS I’VE LIVED IT

by Frank K. Wolfe

Peer support is about relationships. It’s about trust.It’s about every peer being special. Peer supportwalks the line between professional and personal.A certified peer specialist (CPS) must be honestand willing to share his or her story, but also keepthe focus on the peer. A CPS can be a role modeland an inspiration. It is an opportunity to give backand share our paths to recovery.

It’s Monday morning. I can usually tell my moodfrom the way I wake up. Today I jumped out ofbed bright-eyed and bushy-tailed, truly lookingforward to the day. I always try to dress well andkeep up with personal hygiene. A lot of this effortcomes from my Dad. He would basically not letme out of the house looking shabby. He alsoreminds me to carry a comb and handkerchief.Taking care of myself shows the peers I work withthe importance of taking pride in one’sappearance.

I leave my house at seven-fifteen, and drive aboutthree miles to the Southeastern PennsylvaniaVeterans Center to meet a peer. It’s early, but Ihave become a morning person and it’s good forthe peer to wake up and get a good start on theday. Let’s call him “George.” George and I havebeen working together for a couple of years. Iusually sit with him while he eats breakfast. Afterbreakfast we usually play poker. Nothing fancy,just five card draw. Right now he is taking all ofmy mini-marshmallows. George likes to talk. Henever forgets a name.

It has been frustrating to see George withoutinterest in much more than eating, sleeping andsmoking, but we have had a success. Georgeexpressed an interest in reading westerns. I gothim a couple of Louis L’Amour books and he hasbeen reading them voraciously. He also seems tocare more about his appearance now, and hewears fresh clothes every day, and showers andshaves as scheduled. He still doesn’t carry thehandkerchiefs I got him as a gift last year, but lifeis usually one step back, two steps forward.


It’s nine o’clock and I shake George’s hand andsay I will see him next Monday. It’s a sunny dayand I realize how blessed I am to have this job. Iwork full time. I keep really busy. I have beenencouraged to relax to reduce stress, but itdoesn’t seem to be my M.O. Back at the office, Ihave some paperwork to catch up on. The CPS‘sat Creative Health Services in Pottstown, where Iam employed, diligently keep charts on the peerswe work with.

Every encounter is documented and related tothe peer’s current goals. There are now seven ofus working, some full-time, some part-time, andone intern. Our job is as professional as any otherhere at Creative Health Services. Our services arebillable and help support our organization.

Personally, I have had some setbacks in the four-and-half years I have been here. FortunatelyCreative Services has worked with me in a verysensitive way. Recovery is a process and there willbe struggles. I am a fighter. I have a strong supportsystem. I love my job and I do it well.

Peer support is still rather new. It is constantlyevolving. I can go as far as I want to go. I plan tofurther my education and never stop growing. Thefuture looks bright for peer support. The phrase,kind of our motto, is “We are the evidence.” It isalso the web address of our totally awesome blog:WeAreTheEvidence.org. Check it out!

Frank Wolfe of Royersford, PA, is an award-winning poet, a visual artist, and a performer atSteel City Coffeeshop. He was recentlyinterviewed by Patch.com, Spring City, Royersfordand Limerick edition, to highlight local artists.

CELEBRATING THE LATEGLENN KOONSby Jen Cramer of PMHCA

On Sept. 8, family and friends celebrated the lifeand legacy of Glenn B. Koons. Glenn was a“mover and shaker” in the mental healthmovement: locally, nationally, and internationally.He worked as a certified peer specialist atWernersville State Hospital near Reading, PA,served on many boards and committees, andprovided numerous trainings on mental health

issues and concerns. He was our co-worker hereat the Pennsylvania Mental Health Consumers’Association (PMHCA), a peer, advocate, andfriend.

When a friend asked me to describe Glenn in oneword, I said, “grand.” Everything about Glenn wasGRAND: his spirit, laugh, personality, and passionto make this world better. At Glenn’s funeral, I toldthis to his mom, Joan, and she said, “Oh, he lovedgrand buffets too.” So, we were able to share alaugh and a hug through our tears. May Glennmove forward on his journey, knowing that hemade a difference. We on earth have lost a pillarin the mental health movement, but I’m sure he’salready advocating for others in heaven! Rest, myfriend, in peace.

Glenn Koons Scholarship

The Mental Health Association in Pennsylvania andPMHCA have committed to honoring Glenn throughthe creation of an annual scholarship to beawarded to a promising Pennsylvania candidate forcertified peer specialist training. The scholarship willbe awarded to a person who demonstrates theability to engage people, to share life experiences inrecovery, to provide leadership and to teach othersthese skills. The cost of each year’s scholarship isapproximately $1,000.

Jen Kramer is Director of Administrative Servicesat PMHCA in Harrisburg, PA. The organizationwelcomes donations to the Koons Fund. Viewtheir website at PMHCA.org.


PEACE OF MIND,PEACE IN LOVE:

Thoughts on Mental Healthand Dating

by Matthew Connell, New Directions

About four years ago I had had my last crazybipolar relationship disaster. I was diagnosed in2000 and got serious about my illness in 2007. As ofthis writing I am 34 years old. This means that fromthe age of 16, when I began dating, to the age of30, all my intimate relationships happened withinthe context of untreated bipolar disorder.

After awhile the pattern became pretty obvious:cycles of intense passion, all winding down into apit of depression, ambiguity, anger and confusion.In the following article I’m going to share a bit ofmy experience, the steps I’ve taken to interruptthis cycle and the goals I have for my future. Mypremise is this: Taking the time to care for myselfand to build mental wellness will lead naturally intomore loving relationships, to greater success inlove.

After I began to stabilize on my meds I noticedsomething very odd: the feeling of stability. It wasentirely new to me. I had had periods in my lifewhen I was better or worse, but I was never stable.I was always shifting from one pole to the other,always in transit. I began to have whole days andweeks when I felt normal, when I acted prettymuch like everyone else. It was weird!

Here’s my first point: I was stabilizing because Iwas faithfully taking the right meds. Neurology isthe bottom line. My pituitary gland does notsecrete appropriate levels of serotonin, thechemical that helps my brain regulate mood (seeBipolar Disorder: A Guide for Patients & Families,Dr. Francis Mark Mondimore, M.D.; John HopkinsPress). Finding the right meds takes time and is avery annoying and sometimes upsetting process,but the fruit of the labor is sweet when the rightmatch is found!

So life began to change for me. I was gainingmental health and all of my world —my ideas, mymemories and my present relationships - wereopen for reevaluation. But I was doing it all on myown. Well, now it was me and my meds, but

reconstructing a whole life is kind of a big projectfor one person!

And it was during this time that I got into trouble. Ifell in love. But from the beginning of thisrelationship I knew that I wasn’t ready, it washappening too soon. I was in recovery but wasnot yet well. That relationship ended nearly fouryears ago. I’m okay now, but wasn’t for a verylong time. Really not okay.

This brings me to my next point: I got a therapist Itrusted and faithfully saw her every week for overa year. I needed to rewrite my script. Years ofuntreated bipolar disorder had really distorted myview on, well, on almost everything. I needed amajor mental overhaul and the stability providedto me by my meds gave me a place to start. Ideliberately engaged in a process of self-examination from a place of non-judgment. Thiswas also a new approach. Before I had soughttherapy because I was depressed (I never wentwhen I was manic) and I hated myself. The medsgave me the objectivity to begin to observemyself without all that depressed criticism.

Non-judgmental self-study reveals our patterns ofbeing and gives us the information we need tochange. I began to realize how I was playing out


my childhood relationship dramas with the peoplein my present adult world. I began to “see myselfcoming,” and began to find the time to makenew choices. Slowly, new habits of relating andloving began to emerge. I discovered that therewas a lot of good love in me and I began to investit into all my non-romantic relationships.

All of those relationships have radically improved.I am close with my people and my people areclose to me. This was not always the case.Through many years of untreated bipolar disorderI had created a lot of social wreckage and, nearthe end, was extremely isolated. Good news,friends! Many relationships can be fixed, far morethan I once ever thought possible.

This brings me to my last point: I have learned new,more loving ways to communicate with myselfand with others. I recently watched adocumentary on renowned feminist GloriaSteinem. She offered up a very simple statementthat goes right to the heart of loving relationships(pun totally intended). She said, “Love is not aboutpower.” Friends, I don’t want to be right, thewinner or on top of the heap. I want to be lovingand to receive love from others.

These days I do my very best to put love first in allmy communications. If I’m buying shoes, talkingmyself out a bad place mentally, having adisagreement with my ex-wife, or tutoring my sonin guitar, I want to do so lovingly. It’s not easy, butit gets easier with practice! I am aware of mytone, my body language and I am honest withmyself and others about my feelings. Honest like achild, without shame or explanation for myfeelings, just saying it like it feels. And I havelearned when to retreat. Not all disagreementsmust be resolved in the moment!

Now, I look into the future. I have agreed withmyself to remain single until the summer of 2012 -roughly, five years without dating in total. Ineeded time to really understand myself, learn tolive healthfully as a person with bipolar disorder,change my patterns and change my mind. Ithought yesterday how fast that summer seems tobe approaching (when once I thought it wouldnever come!).

I’m not ready now, but I will be then. Personalgrowth and change are real things. When theday comes for me to turn my eyes outward oncemore into the world of intimate relationships, I’mgoing to have a lot more confidence than I everhad before. I’m going to keep taking my meds,see my therapist as needed, objectively evaluatemyself without judgment, and do my best to putlove first in my communications.

And I’m going to keep this in mind too: Love is ahuman challenge, just like mental illness. Beinghuman means struggling with the head and theheart, and everybody feels that challenge,everybody.

May we all have peace and love.

THE SWEET SMELLOF SUCCESS

KATHY SHARP’S “REACH OUT” FACESCOST CUTS BUT, HEY, THEY’RE

SURVIVORSby Ruth Deming

Kathy Sharp is a master at surrounding herself withgood people. When she first came to NewDirections Support Group of Abington, PA, in theearly ‘90s, I thought, “This woman is fantastic. Sheneeds a group of her own.” Since she andhusband Chris, both originally from Ireland, live inLevittown, Kathy eventually found space for hernew group in a large facility at a Morrisvilleshopping strip, near a Chinese restaurant andpizzeria.

It’s become more than a support group. ReachOut is the best drop-in center around – there areabout 30 in the state - drawing large numbers ofpeople with every psychiatric diagnosisimaginable and helping them move on with theirlives.

In June, Reach Out Foundation achieved thenear-impossible. It was featured in a front pagestory in the Bucks County Courier Times, circ.52,000. The caption for the black-haired Sharp, 61,in dangling earrings read, “Executive DirectorKathy Sharp worries about maintaining funding...and about safeguarding its independence.”


With a modest budget of $150,000, fundingsources have dried up in the poor economy.That’s where psychiatrist David Nova, MD, comesin. This devoted advisor, from Reach Out’s earliestdays, has helped them create numerous ways toraise money.

The most recent was a fundraiser at an Italianrestaurant in Bensalem, followed by a play at alittle theater. They pocketed $8,000. “Dr. Novainvited his wealthy friends,” said Sharp.

When Reach Out volunteers recently set up abooth outside a Walmart, providing literature anddiscussion about their services, the small changethey earned was $400. Every little bit helps pay thebills.

Kathy has always had a special interest in thedowntrodden, especially the homeless. Her lateaunt, Sister Christina O’Neill, known as “The PeaceNun,” was an activist in Ireland, working for peacein the century-long struggle between Ireland andGreat Britain, and Ireland’s Catholics andProtestants. Kathy and her aunt had manydiscussions. The Peace Nun’s legacy lives on withniece Kathleen.

Kathy’s special love for the homeless is manifestby how much she knows about them. “Well over50 percent are under 30 years old,” she said. “Theyget thrown away from the family, but we meetthem in recovery.”

They often divulge their whereabouts to her,knowing she won’t tell the police. “There are tentcities all over,” said Kathy.

Reach Out is successful in finding homes for thehomeless. “We recently had a 20-year-oldhomeless man from the Haiti hurricane who wehelped get services,” she said. He left Reach Outbecause he found a job and a place to live.

All because he came to Reach Out through anational program called Code Blue.

In cities across the country, when the wintertemperature gets below freezing, churches andhomeless shelters who belong to Code Blue willtake in the homeless. When the police spot them,they’ll drive them to shelters.

Reach Out partnered with 21 local churches inBucks County who take turns sheltering homelesspeople at night. In the daytime they must be outof the buildings, and many of them attend ReachOut programs during the day.

When the Haitian came to Reach Out, he was somotivated to get help he left them fairly quickly.

Reach Out hooked him up with the necessaryservices. “There’s a lot of paperwork involved,”said Kathy, “but we have a volunteer lawyer whogives us her services for free.”

Referral to housing services is provided by thePenndel Mental Health system. “They’reexcellent,” said Sharp.

The young Haitian, who is an artist, had beenconnected to housing services for those under 21,and found an apartment. He’s now earning hisGED, and has found a job through CareerLink.

He no longer sleeps in the woods in a tent city offRoute 1.

Reach-Out runs 19 groups a week – all run byvolunteers - including “Schizophrenics Anonymous.”

“It’s a small cozy group,” said Kathy, whooccasionally makes an appearance, though it’sled by a person with the illness.

Forget the stereotypes for people withschizophrenia. Like most illnesses, there’s a widerange of what people with this brain disorder areable to do.

“Our former leader,” said Sharp, “went back tocollege and now has his PhD in psychology. He’spracticing in Florida.”

Reach Out’s daily “Rap Group” meets at 11 a.m.Because of the Courier Times article, said Kathy,“we have a lot more clients and a lot morevolunteers.”

“We catch up in the Rap Group and see if anyoneneeds immediate help.” They also pick adiscussion topic. Some of the 40 topics include,“How can you recover when you haven’t gotmuch support, how to be more social, how tobuild your self-esteem.”


“Double Trouble” is a nationally knownorganization for people with both a psychiatricdiagnosis and a drug or alcohol addiction. ReachOut’s Double Trouble meetings are held in theirsatellite office at Warminster Hospital. As many as30 people attend each meeting.

“Bright Perspectives” is another rap group held atWarminster.

In these hard economic times, Kathy is happy tobe able to pay her rent. She and the landlord,who she’s rented from since 1996, have anexcellent relationship, she said. Nonetheless, cost-cutting measures have forced her to close thedrop-in center on Fridays.

Nothing, however, will stop her Code Blueprogram which approaches as the days shortenand get colder. Sharp is an everpresent visitor atthe offices of local legislators. She got Code Blueoff the ground by a simple visit or two. “I went andtalked to the Bucks County Commissioners andthey said yes.”

Soon the homeless from tent cities – which aregrowing as the economy continues its slump - willarrive at Reach Out in the Code Blue bus fromDecember to April.

Sharp and Reach Out will warmly welcome them.“They’re just people down on their luck who willrecover,” she said.

When Kathy started her foundation 15 years ago,her first member was David Kime of Fairless Hills.Now he runs his own group at Reach Out. “We’veseen David grow from a hippie to a respectedmember of the community.”

Kime, a visual artist, activist and poet, is active inhis church, writes frequent letters to the editor, sellshis visionary artwork in both Philly and New York,has published a poetry and lit magazineTranscendent Visions for nearly 20 years, and runsCreative People in Recovery every Saturday at1:30 pm at Reach Out, according to David Kime.

“David made a Halloween mask which is justoutrageous,” Sharp said.

Kathy Sharp was born to an Irish Catholic family inLimerick, Ireland. “Bipolar disorder is in my family,”

said Sharp, who was diagnosed at age 19. “Twoof my cousins killed themselves but the familydoesn’t acknowledge it.”

She returned to Ireland four years ago for thefuneral of her 75-year-old father. Her mother haddied earlier, a woman she never got along with. “Inever had my day in court with my mother,” saidSharp.

Always at her side in her battle with life struggles isher psychologist, Dr. Ronald Langberg. “He reallysaved my life,” she said. “He got me back to workwhen I was really struggling.” He’s a tough guy,“not a softie. He doesn’t treat you as if you’remade of glass.”

Sharp and husband Chris recently vacationed inCleveland. Their destination? The Rock and RollHall of Fame. It’s a long way from Ireland but youmight also say that about another Irish activist -Bono from U-2. The two of them, in Bono’s words,are possessed with “Unforgettable Fire.”

Reach Out Foundation of Bucks County –ROFbucks.net - is located at 229 Plaza Blvd.,Morrisville, PA 19067. Contact them at 215-428-0404 or [email protected].

BOB from North Wales, PA. Writes Bob: ChuckPalahniuk, the author of Fight Club, once askedhis readers to send him a story about the mostamazing thing they’ve done. This is what I senthim:

By now you’ve received letters from people whohave kicked the heroin habit, rescued a hostage,or climbed Mount Everest. My story isn’t soexhilarating, but it still is a major accomplishmentfor me.

Every weekday morning, when the alarm goes offat 6 a.m., I get out of bed and go to work.

See, I told you it wasn’t exhilarating.

But several years ago I almost died from peritonitis,an abdominal infection, and that kicked into playa genetic time-bomb I inherited from my father:depression. I lost interest in life, my job, my kids, myfriends. I almost lost my house, my wife, andperhaps my life.


You probably know that the first antidepressantprescribed to patients often fails to workeffectively. When one drug doesn’t work, yourdoctor tries another. It takes time to find one thatworks well for you, and it may take weeks to startalleviating symptoms of depression. That makesyou depressed, too.

Add to that talk therapy sessions, support groupmeetings, marriage counseling and dealing withpeople who don’t understand why you just can’t“shake it off.”

My recovery took years, slowly assembling thebroken pieces of my life. First step: I got out of bedbefore noon and did trivial backyard chores. Nextstep was getting up on time and going to my“apron job.” It’s the job you take while you’relooking for a career job. The interim job is at HomeDepot, or Starbucks or a local grocery store. Youwear an apron.

I finally patched up my marriage, my relationshipwith my kids, and got back on track with the sametype of job I had before my depression. I’ve beenwith the company for a few years now, and I’mdoing quite well.

So every weekday when the alarm rings, I get outof bed and go to work.

I climb Mount Everest every day.

JOE MOORE is a born salesman. Ever bought anappliance at Gerhard’s Appliance in Jenkintownor Doylestown, PA? Maybe you’ve seen smilin’Joe Moore. He’s been there six years. When lastwe spoke, this top salesman had just sold amatching washer and dryer. Why are you sosuccessful, we asked. “I’m detail-oriented and I’vehad a lot of schooling about my products. I’m veryhonest with my customers. I tell people whichappliances are highly recommended, and why,and they trust me. If they like you, they’ll buy fromyou.”

Wife Janice works in the Hatboro-Horsham SchoolDistrict registering newcomers to the schooldistrict, including many families new to America,said Joe. His son Joey, 23, who designed theoriginal New Directions website, is interningbetween semesters at Millersville University at theNational Weather Service. He will graduate as a

meteorologist next May, and has a job at theWeather Service awaiting him. Little brother Drew,16, just won the “Bagger Competition” at theHorsham Giant supermarket. Sounds like he’skeeping up with the Moore tradition ofexcellence.

THE BIPOLAR BEAR COMESOUT OF THE DARKNESS

by James Vincent, New Directions

About four years ago I was suffering from a severedepression. I did not want to live anymore. Asconfused as I was, I knew enough to know that mythought process was seriously skewed. I reachedout to my family and the medical community toput things back together. Neither my family nor Iknew what was in store for us in the weeks, monthsand years to come; but perhaps that was for thebest. What we did find out was that beingdiagnosed with bipolar II disorder was not thedeath sentence I thought it was. Accepting thediagnosis was not easy and it wasn’t until I did thisthat the healing could begin.

Knowing that both my uncle and grandfather onmy Dad’s side had both taken their own lives,along with numerous relatives on my Mom’s, sidewho suffered from depression, the family geneticswere stacked against me. The initial diagnosis was“single episodic severe acute depression.” I wasout of work for two months and treated withCymbalta and talk therapy and went back towork. Three months later I lost my job due tocorporate downsizing. With a nice severancepackage and time on my hands to chill, I did justthat. Seven months passed, I got a new job andback to work I went.

With the pressure of a new job and a still as yetundiagnosed and untreated bipolar disorder, Iproceeded to move into my first (and only)hypomanic stage. It lasted for five months. Thetrail of destruction I left behind in those few shortmonths was significant. It took a while for me toget stabilized: two inpatient stays and anoutpatient stay at the Horsham Clinic, finding theright drug regimen, a good psychiatrist andtherapist and most importantly an outstanding


support system of family and friends. Finally, Ibegan to climb back to mood stability.

Two years ago, I read that Ruth Deming wasspeaking on bipolar disorder at the DoylestownHospital Wellness Center. My wife and I went tosee her. Having seen and heard other people’sstories in the audience, I began to realize I was notalone. Then I went to New Directions. Soon, Irealized that with the proper treatment andsupport I could be healthy and happy again. Itook on a part-time job at a retail store andworked there for a year and a half. I haveinterviewed with and accepted a position in myoriginal career. I look forward to staying well.

What was it that helped to turn things around? Itwas not any single thing but rather a series ofhealthy habits that have led to my renewedemotional stability: eating well, sleeping,exercising, medication, therapy, meditation andprayer. I had to make several changes in my life,perhaps the most difficult one was recognizingthat certain people are toxic to me and I have todistance myself from them. I have beenoverwhelmed by the love and support of so manyfolks. Perhaps the greatest lesson learned is that Iam very blessed by a support system second tonone. I have been symptom-free for over a yearand I look forward to continued wellness.

PINCHING PENNIES:THE ART OF SAVING MONEY

GERRI BLEILER of Cheltenham Village, PA. “Myfamily and I have cut back on our spending ofnecessity. I no longer use a credit card but paycash. We all shop together at Pathmark onMondays where people over 55 get a 5 percentdiscount. I really don’t like clothes shopping butwhen I need something I’ll go to Walmart andcheck the “sale” items. I do like my pocket booksand found a name brand at TJ Maxx for $26. I alsowent to Target and bought a $20 watch.

RICHARD POMPER, marriage and family therapist,of Eugene, OR. My wife and I are always lookingfor bargains. We’re members of CSA, CommunitySupported Agriculture (CSA). We pay a specificamount and get a box of organic produce on a

weekly basis for about five months at great prices.It’s a lot less expensive than in the store. Our 25-year-old college son also works at a CSA nearEvergreen State near Olympia, WA. By workingthere, he gets free produce for himself and hisrommates. We buy and sell things on Craigslist. Wehad an old tractor that was on our property whenwe moved in. We sold it for scrap metal. Someonepicked it up and we got a couple hundred bucks.

IRIS ARENSON-FULLER, life coach, Bloomfield, CT.My tips: Force yourself to think...”Do I want it or doI really need it?” This especially applies toimpulsive buying. If necessary, write down reasonswhy you want it and why you really need it. Makeyourself return to the store or Internet site in a dayor so. If it’s gone, it just wasn’t “meant to be.” If it’sstill there, review your reasons before opening yourwallet or clicking on “Buy it now.”

At least once or twice a month I make a “stonesoup” sort of dish, using up a lot of miscellaneousingredients and stretching out the intervalsbetween grocery-shopping trips. Mostly thesedishes come out great, though there is anoccasional flop. I usually eat it anyway but there’sno guarantee anybody else in my household will!

Make your own gift baskets and be creative if soinclined. You can make some very special oneswithout spending as much as you would on adifferent type of gift.

Shop around for auto and homeowner’sinsurance at least once, and maybe twice a year.You often get a better rate as a new customerthan as a renewing one.

MIKE ANTHONY, Philadelphia. “I saved a lot ofmoney by cutting out going out to eat so often.Also, instead of going to the movies, I rent them. Ialso got rid of cable TV.”

DEB LISS, Philadelphia. (In a previous issue of theCompass, we named Debbie “Queen of Thrift.”)“I save money by using cloth shopping bags - theycan be laundered when necessary - supermarketsgive a 2-5 cent per bag deduction from bill.

I also wash and dry plastic bags like Ziplocsandwich bags, to reuse many times, rather thanbuying new.


My aunt saves money by buying a large carton ofmilk, pouring it into many small clean jars, andfreezing them, thawing and using them one at atime (she lives alone).

I save money by never going shopping unless Ineed something (make a list too). I hike outside orswim for recreation, rather than going to a mall.

I save money by using small portable room fansrather than air conditioning.

I save water by running tap water into jugs, whilewaiting for it to get hot (before a shower) - thewater in the jugs can be used for houseplants, orpoured in the washing machine or even toilettank.

When eating out, I take home the small butterpackets as well as leftover bread. You can freezethe butter packets until you need them, so theydon’t get rancid.

I save money on beans by buying them dry,cooking them myself (very easy), and puttingthem in small containers in the freezer. This is muchcheaper than buying 15 oz cans of beans.

And I turn off lights when I leave a room. Andunplug appliances when possible to shut off redlights.

I have a small tire pump (foot powered) for mycar, so I don’t have to pay to get air.

And I bring a sandwich or other food when goingout for more than a few hours, to avoid having to

buy junk food or whatever when hunger strikes.

HOPE FOR TREATMENT-RESISTANT DEPRESSION:

A TALK BY JOHN P. O’REARDON, MD

John P. O’Reardon, MD, former head of theTreatment-Resistant Depression Unit of the Universityof Pennsylania, was our guest speaker at the WillowGrove Giant Supermarket in June. One of the mostknowledgeable speakers we’ve ever had,O’Reardon spoke to a filled room of about 25. Henow has offices at the University of Medicine andDentistry of New Jersey, Cherry Hill campus.O’Reardon does research on the new hands-ontreatment for depression called transcranialmagnetic stimulation (TMS). His phone number is 856-482-9000. Here are excerpts from his talk.

When you’re depressed, said O’Reardon, the firstthing to try is psychotherapy which createschanges in the neurons in the brain. We have 100billion neurons in our brain, as many as stars in thegalaxy. And 100 trillion connections.

Hope is an antidepressant.

Find support from family and friends and fellowsufferers. People look at “finding the rightantidepressant” as the biological quest for theHoly Grail. But it takes many things to get youbetter.

What causes depression? There are predisposingfactors to depression. If someone close to you hasit, this indicates you may be at risk. Your childhoodenvironment has a lot to do with it. Did you growup and suffer trauma? Were you abused,neglected or bullied? Did someone in the familycommit suicide?Sometimes, things just wear you down, such asgoing to college or getting divorced. Chronicpain can be a factor.

Good sleep hygiene is very important. Have aroutine where you awake at the same time of dayand go to sleep at the same time of night. Heemphasized the often-overlooked condition ofsleep apnea, which can lead to depression. Aperson may have this condition if he is constantlytired, which leads to depression. Seek out a sleepdisorders center and get tested, he urged.


We can help patients a lot by dealing with what’scalled their “perpetuating factors.” Try to stopsmoking. Engage in exercise which creates newneurons. Over time you’ll see a gradualimprovement.

What kind of therapy is the best? “Whatever worksfor you,” said O’Reardon. He does prefer cognitivetherapy (CT). “It’s the most studied of all therapies,”he said, “and is available at the Beck Institute in BalaCynwyd or the University of Pennsylvania’s CognitiveBehavioral Department.”

CT trains you to step back and look at what’shappening to you by looking at the facts, notemotions. “Is the situation really as hopeless as youthink? Is the future as bleak?”

Medication Review• The older antidepressants are the monoamineoxidase inhibitors (MAOIs) and tricyclics (TCAs).They are effective against depression but are nothelpful for anxiety, as are the newerantidepressants.

• There are two types of antipsychotic drugs: thenewer “atypicals” and the older, original“typicals.” The two classes are related but havedifferent effects on the brain. The atypicals workon dopamine, as well as serotonin and otherreceptors. They are very effective on mood.

Antipsychotics were first used with schizophrenia,but were found to “work really well for bipolar.”Abilify is a good “enhancer,” an add-on med thataugments other drugs.

• Different classifications for sleep aids or anxietyaids. One class is the hypnotics (Ambien, Restoril,etc.), the other benzodiazepines (Ativan,Klonopin, Valium, Xanax, etc.).

• “Benzodiazipines are not bad drugs,” he said.“They’re tricky, though, because over time theymay cause tolerance.” In that case, they may notwork as well or stop working entirely. People intheir 20s should be wary of the benzos in case theircondition becomes lifelong.

• “People with sleep problems should find out whythey’re not sleeping well. Do you lie in bed andworry? What can you do to prevent this?”

• Melatonin is an over-the-counter (OTC ) drugyou can take to help you sleep. Always checkwith your doctor before adding any OTC drug orherb.”

• “Non-drug treatments include ‘somatictreatments’ or hands-on treatments. This includeselectroshock therapy (ECT), transcranial magneticstimulation, vagus nerve stimulation, and newerDBS or deep brain stimulation.”

As we know, different brain chemicals areaffected by each drug. The selective serotoninreuptake inhibitors (SSRIs), such as Paxil andProzac, affect serotonin. SSRIs have bothantidepressant and antianxiety properties. It’shard to overdose on an SSRI.

The antidepressant Cymbalta affects bothserotonin and norepinephrine. As such, it is helpfulfor chronic pain and is prescribed for fibromyalgia.

Welbutrin has a variety of uses. Under the nameZyban, it helps people stop smoking. Wellbutrin isnon-sedating and is one of th few antidepressantsthat don’t impair sexual function.

For sleep, the drug trazodone (Desyrel) is oftenpresecribed. If you wake up during the nite, youcan then take Remeron, for those with “doubleinsomnia.”

O’Reardon’s Medication Tips • Make sure the meds are adjusted properly. Is thepatient on the right dosage? Has he or she been


on them long enough? You need at least onemonth before efficacy is shown. It’s not easy towait that long, but it’s necessary.

• Try meds that have been forgotten, such as theMAOIs (the first antidepressants invented, in the1950s) - Parnate, Marplan, Mannerix, Nardil, andthe newer Emsam patch. When invented, therewas no such category as “antidepressants.” Theywere known as psych “energizers.”

At the time, said O’Reardon, they were wayoverused, but subsequently psychiatrists have lostthe art of using them.• You don’t want to keep adding on more meds.You can make your condition worse. One woman in the audience was taking six meds.“You’re probably on too many,” he said. Shenamed her meds.

“You shouldn’t be taking three from the samegroup.”

“Unfortunately,” he said. “We don’t have a brainscan to help you.”

He mentioned psychiatrist Daniel Amen of TVfame whose brain scans are purported to pinpointwhat brain areas are affected by depression orother psychiatric conditions. “There is absolutelyno scientific proof validating his claims,” saidO’Reardon.

There is now a new technique which maysuccessfully predict whether an antidepressant willwork. A week after the patient has taken the newmed, he has an electroencephalogram (EEG),which measures electrical activity in the brain. Ifchanges are noted, the patient remains on thenew drug.

Good Success by Adding“Enhancers” – both over-the-counter and prescription medsIf a drug is working fairly well, but not up to its fullpotential, some enhancers include:

• 1 mg of folic acid

• Fish oil, which is often used as a mood stabilizer

• Sam-E

There are also enhancers that are drugs such aslithium, Synthroid, and Abilify.

Somatic TreatmentsElectroshock therapy (ECT) is the oldest treatment.Today it’s much safer and there’s less memory loss,said O’Reardon. In the past, electrodes wereplaced unilaterally across the scalp and bothsides of the brain were stimulated. Today it’s onlythe right side. A drawback is that anesthesia isused.

One of his patients gets monthly treatments of ECTand is on no medications.

Usually a series of treatments are prescribed. Youshould know after the fourth through sixthtreatment if ECT is working.

Transcranial Magnetic Stimulation is the safesttreatment

“Transcranial” means across the skull. Magneticpulses are delivered to the brain, the samestrength as an MRI.

Transcranial magnetic stimulation (TMS) is FDA-approved only for depression. Bipolar depressionresponds well, as does unipolar depression.

By applying the pulses to different brain areas,other conditions will be treated in the future:hallucinations in schizophrenia, migraines, post-traumatic stress disorder.

There’s no need to go off your meds whileundergoing TMS.

O’Reardon treats the toughest cases, usuallypeople who have had severe depressions for aslong as 25 years or more.

TMS is an effective treatment for pregnant womenas it doesn’t touch the fetus.

“Most people prefer it over drugs,” he said. “You sitin a comfortable arm-chair. Side effects areminimal.”

Success rate is calculated on longevity andseverity of each patient’s depression.


“Remember, these are severely depressedpatients,” he said.

The TMS success rate is about 50 percent, thesame as ECT.The major drawback is that insurance won’t pay.There are 200 centers that offer TMS across thecountry. The cost varies with your geographiclocation.

“We keep the cost as cheap as possible,” saidO’Reardon. “Think of it as an investment.”

In academic settings the cost varies from $300 to$500 per session. At Penn, it’s $200 a session.

The following is a description of TMS treatment, thistime by psychiatrist Terrence Boyadjis of WestChester, PA, who spoke to our group a year earlier.

Treatment lasts a full 30 days. Anything less doesn’tgive the brain the full benefit of this powerfultreatment modality. The patient comes in everyday, Monday through Friday, sits in a comfortablechair, not unlike at the dentist, and the doctorplaces the treatment coil atop the scalp.

A jolt of electricity is inserted into selected areas ofthe brain. If, for example, you suffer from anxiety, hewill set the machine to direct electricity into the rightside; for depression, on the left. For both depressionand anxiety, both sides will be tapped.

Electrical bursts are seven seconds long. A seriesof about 30 bursts are given for a total of a 37-minute treatment session. Not bad once youadapt to the rather noisy bursts. No one drops out.Side effects are minimal. No memory loss, noseizures, no cognitive distortion. The only sideeffect is the discomfort of the “taps” during thetreatment, which lessen with habituation. Thepatient drives himself home. Improvement can beseen immediately or more likely during the courseof the 30 days. All his patients have found success.

There is always hope

“I’ve not met a patient yet who has run out of thepotentially endless treatment options,” saidO’Reardon.

He emphasized the value of therapy, a good,

skillful therapist. If you’re not making progress,change therapists.

Also, make lifestyle changes such as your job oryour living situation. Although there is always hope, sometimes it’s bestto accept the fact that you’re living with a chronicillness, no matter what it is.

Ask yourself, “Can I function despite how ill I am?Even though you’re hardly as good as you want tobe, find satisfaction in what you can do. Countyour blessings.”

Illnesses always fluctuate. There are good daysand bad days. Sometimes there are evenspontaneous remissions that we don’t understand.

It’s hard to predict the course of an illness. Everybrain has a mind of its own.

Always get a second opinion, a fresh set of eyes.

But keep the door nicely open, don’t burn anybridges, in case you want to go back.

The Internet has good information but it’s alsoinaccurate.

Look at the time line for treating variousconditions. Hippocrates, the father of medicine,lived 2500 years ago. Insulin wasn’t invented until1930. The first effective antidepressant wasinvented in 1950.

Every patient is a textbook.

Audience Q&AA 66-year-old man on psych meds for bipolardisorder said his memory was failing. What shouldhe do?

O’Reardon doubted that he had dementia,stating that people with dementia are unawareof it.

He suggested taking a paper and pencil test todetect memory loss, available on the Internet.

O’Reardon said that meds that cause sedation doslow down your brain and affect memory.Depression itself robs people of their memory, asdoes excessive worry and stress.


He suggested relaxation exercises, as well asexercise.Can illicit drug use precipitate depression?

Yes, for both legal and illicit drugs, namely:cocaine, amphetamines, and opiates, whichdeplete some neurotransmitters like dopamineafter long-term use.The following drugs can change the immunesystem, which can affect mood: steroids andopiates such as Percocet/Percodan, Oxycodone,and Demerol.

Again, O’Reardon emphasized that the audienceshould remain optimistic and pursue all options.

BIPOLAR DISORDER ANDSUBSTANCE ABUSE

New Directions hosted a program in October atthe Willow Grove Giant Upstairs Classroom on“Bipolar Disorder and Substance Abuse.” Ourmasterful speakers were Barry Lessin, M.Ed.,CAADC, licensed psychologist and certifiedaddictions counselor, and Chad Coren, PsyD,CACD, licensed psychologist and certifiedaddictions counselor. Barry Lessin practices in FortWashington, PA. Chad Coren in Doylestown, PA.See their websites at DrChadCoren.com andBarryLessin.com.

Below is a synopsis of their talk.

Over 60 percent of bipolar people use drugs oralcohol to self-medicate.

Today nearly every teen-age party includes drugs.It’s part of the culture. At some parties, drugs arethrown into a circle on the carpet and kids choosewhat to take.

They go upstairs to the bathroom and rummagethrough the medicine chest looking for drugs suchas painkillers. They go in the parents’ bedroomand check the drawers for drugs.

The drug-abusing children of these parents takeonly a few pills at a time, believing the parents willnot notice.At parties, where are the parents?

At Lower Moreland High School today, said Chad,pot and other hallucinogens are popular.

Kids have no concept of how dangerous drugsare.Chad’s first job when he sees teenagers is toeducate them about what drugs do to your body.These kids have no idea.

And do they care? They’re young and invincible.

What kind of young person can refrain from takingdrugs?

Children whose parents are mindful of theproblem, he said.

The scourges of our modern drug culture are:Percosets, Oxycontin, or any other opiate.

Ritalin, prescribed for attention deficit disorder, isa popular “upper.” Today you can buy thesedrugs from your friends.

The speakers said there’s an overlap in theneurochemistry with drugs and bipolar disorder.

Alarmingly, drug use increases the risk fordeveloping bipolar disorder. The risk is greatestwith “uppers.”

Fortunately, most people do not become addicts,the speakers emphasized.

Why do people use drugs?

1 - To feel good - intoxication.

2 - To feel better - to manage their emotions.Once you get addicted, the drug hijacksreceptors on brain cells and changes them overtime. The brain has special opiate receptors. Butthey cause tolerance so that the user needs moreand more of the drug to get the same effect.

The brain on drugs goes through different stagesof change. Coming off the drugs depends onwhat stage you’re in.

The neurotransmitter dopamine has to do withreward and pleasure. Eating increases thedopamine level. So do illicit drugs.


Endorphins also function as neurotransmitters.They make a person feel good when they dothings like exercise or are in love or have sex.

3 - To improve function - better, faster, stronger.Certain ADD-type drugs can tremendouslyincrease concentration. People can sit and readfor hours and understand what they’re reading.

4 - To experiment. A person tries it, likes it, uses itand may become addicted. Most people whoexperiment do not become addicted.

Different strategies are used to help addicts whohave a co-occurring mood disorder. They may betaking medication for their moods.

When Chad sees young patients, he does athorough assessment first before coming up witha treatment plan.

Then he explains how the drugs work and what toexpect if the kid remains on them. He tells themabout the withdrawal effects of, say, Percosets:chills, the shakes, flu-like symptoms.

The kids had no idea.

Staying clean depends on what the kids arewilling to do to help themselves. If they’re notready to make some changes, they’ll come backlater. “When they’re in enough pain they’ll walkthrough that door again,” said Chad, who is 31.

Barry Lessin, who is in his late 50s, has seen hisformer patients return, now dealing with drugproblems from their own children.

The psychologists defined addiction as somethingthat rules your life.

You can’t leave home unless you take yoursubstance with you or know where you can get it.

If you’re going to a party where alcohol will beavailable, that should be fine.

An addiction impairs your family life, your work life,all your relationships, your physical and mentalhealth.

Said Barry: “For parents, it is a scary world out therein terms of the availability of drugs and alcohol.But the majority of kids get high and drink anddon’t develop problems. Parents need to getaccurate information and give kids theopportunity to talk about what they know. Theyneed to be actively involved in their kid’s lives,and help them understand that learning how tocope with drugs and alcohol is a normal part ofgrowing up.

Barry Lessin’s website is BarryLessin.com. Call himat 215-694-9146. Chad Coren’s website isDrChadCoren.com. Call him at 215-949-6844.

Co-occurring Disorders in Teens:Bipolar Disorder, the Great ImitatorThe following is reprinted, with permission, fromBarry Lessin’s website.

Angry outbursts, erratic sleep patterns, suddenmood swings, and changes in personality. If you’rea parent of a teenager, these behaviors can bethe status quo—actually, we often take thesebehaviors for granted. When teens are in trouble,when they are struggling to cope with issues thatare too difficult for them to handle, drinking orgetting high makes these behaviors worse, oftento the point of frightening us.

Symptoms of addiction often mimic otherbehaviors and make it hard to figure out exactlywhat’s going on in kids who are getting high. Weknow that kids (and adults) get high to helpmanage the difficult emotions associated withlife’s challenges. And we know that adolescencepresents them (and us!) with unique challenges.


Your parental instinct that something is wrong is oftencorrect, but understanding the difference in the rootcauses of your child’s erratic behavior will help youdecide what course to take with your child.

Sometimes the issues are normal, externalpressures like arguments with friends, academicexpectations and real or perceived rejections byothers.

Sometimes the issues are internal, relating to yourchild’s coping style, temperament, or ability totolerate frustration. When bipolar disorder ispresent, however, the internal issues are alsorelated to your child’s brain functioning.

How Addiction Symptoms Can MimicBipolar DisorderIt’s important to understand that bipolar disorder isa medical condition of the brain. The personexperiences extreme highs (mania) and extremelows (depression). When I explain below moreabout what bipolar disorder is, you’ll see howeasily it can be misdiagnosed in children andteens as major depression, attention deficithyperactivity disorder, oppositional defiantdisorder, and conduct disorder.

During a manic episode, a person’s mood isnoticeably euphoric, irritable, or aggressive. It iscommon for a person who is manic to think thatnothing is wrong with his behavior even though itis extremely distressing to family and friends.

During a depressive episode, a person may feelsad or lose interest in previously enjoyableactivities. When severe, thoughts of suicide maybe present. Someone with bipolar disorder canexperience a variety of mood patterns, such ashaving mostly episodes of mania or mostlyepisodes of depression. Another person maycycle rapidly between the two. It is also possiblefor someone to remain symptom-free forextended periods of time.

Bipolar Disorder and ChildrenAnother important thing to know is that bipolardisorder looks different in children and teens thanit does in adults. When children or teens havebipolar disorder, they have mood swings withextreme ups and downs. When they are up, they

have brief, intense outbursts or feel irritable orextremely happy (mania) several times almostevery day. They have a lot of energy and a highactivity level. When they are down, they feeldepressed and sad.Children more often experience several severemood swings in a single day versus the sustainedand clearly defined manic episodes that adultshave. These intense moods quickly change fromone extreme to another without a clear reason.Some children may briefly return to a normalmood between extremes.Many children change continuously betweenmania and depression, sometimes several times inthe same day. Sometimes children with bipolardisorder have symptoms of both mania anddepression at the same time, often showing itselfas agitation or extreme irritability.

But because of the “normal” ups and downs ofadolescents or for children with sensitivetemperaments, times of mania or depression may beless obvious in children and teens than in adults. It’soften difficult to sort out what exactly is going on.

Normal ups and downs of adolescence areexaggerated greatly when kids are drinking orgetting high. As with adults, children will resort togetting high in an attempt to feel “normal” orbalance out the “feeling crazy” that bipolarcontributes to. That’s why when substance abuseis in the picture things get even more confusing.

The good news is that bipolar disorder can beeffectively treated usually with a propercombination of medication and counseling.Getting a thorough evaluation by a professionalwho is experienced with mental illness andaddictions is your best bet in determining whatcourse of action to take.

As always, education and support are the bestantidotes to the fear and helplessness we feel asparents when our children are suffering frombipolar disorder.

Other excellent resources to learn about bipolardisorder and get support are the Depression andBipolar Support Alliance and the Child andAdolescent Bipolar Foundation, which has a greatsite especially for kids.


Two poems by Frank K. Wolfe

FADE

I imagine them fading away

because they will be gone soon.

Brown like dark wood my father

warm ivory my mother

and everything is fading

along the spine of my day

each knuckle cracked

and dish washed

contortionist and clown

thinking things will get better

like obesity and cavities.

It is getting hard to ignore

my book

my pillow

my warm Nordic hat

they keep me moving all day

because I find it hard to sleep

and even harder to nap.

I am in other ways a cat

and we all know that cats

see through slitted eyes

humans fading and forgetting

every cotton picking second.

GUARD SHACK

I want to be the guy in the guard shack.

I may let you in.

I may not let you in.

I don’t have a gun

But you don’t know this.

I am allowed to listen to my radio.

My shack is air conditioned in the summer,

And heated in the winter.

Darling, I want to be the guard shack of your life.

I won’t let that crazy ex-boyfriend call you at two

in the morning.

I will filter your junk mail and spam.

You will pay me $15.00 an hour with benefits.

Show me your badge.

You’re looking for the first building on the right.

Drive through.

Frank Wolfe is an award-winning poet who lives inRoyersford, PA. Read his Compass article “PeerSupport as I’ve Lived it.”


Kaleidoscope

FORGOTTEN SOUND

by Beatriz Moisset, 2011

We carried his remains

To the little cemetery

In the little Midwestern town.

One of many little towns in the Midwest,

The one where he had lived a blissful childhood,

Where two generations of relatives

Were waiting for him.

Time moves very slowly

When you are hurting so much.

They said that after a year

The pain begins to ease out.

Not true!

How much longer would it take?

One day I was startled by a sound,

Once familiar but long forgotten:

My own laughter

At some silly little thing.

Then I knew.

Beatriz Moisset of Abington, PA, was born inArgentina and has been a resident of the US forabout 40 years. She is a biologist by profession,and a photographer and painter by avocation.


Two poems by Carolyn Constable

TABERNACLE LIGHT

Deep down in the recesses of your heart,

you feel worthless, alone, frightened.

You question your very existence.

A somber cloud hangs over you,

encircles your mind and soul.

Only a tiny flame is left to flicker.

That flame of hope is almost extinguished by

wretched oppression of negative thoughts.

Days of this gloomy isolation entrench you.

You cry out for relief!

Finally, that tiny spark fanned by help

from families, friends, physicians,

starts to grow.

Prayers and the grace of God are

fuel for the growing flame.

Soon it illuminates your whole soul.

Gratefully with a renewed spirit,

You come alive once again!

-1989

SPIRIT OF CANYON DE CHELLY

After a visit to Canyon de Chelly, May 2011

Our Native American guide, Adam Teller

drives us in his well used pick up truck

through Canyon de Chelly in northeast Arizona.

We cross shallow waterways, slide up muddy

banks,

wind around huge granite and sandstone cliffs.

This is Navajo land, a U.S. National Monument,

sacred to the Navajo Nation.

“This is where my grandmother lived”, relates

Adam.

“She grew corn, beans, and squash in A small

garden

near her home which was right over there.”

His grandfather, known for his stone work,

reconstructed ancient cliff dwellings during the

‘50’s.

High on the canyon walls, historic homes attest to

his skill.

Cottonwoods line the creek margins,

Lavender Tamarisk trees bend in the breeze.

Indian Paint Brush flowers grow on rocky

protrusions.

Adam brings us to a Navajo sacred place.

A large column of stone reaches the heavens.

A reverent hush pervades the canyon.

We sense the Navajo connection with the Creator.

Carolyn Constable has worked as a naturalist atPeace Valley Nature Park in Doylestown, PA.


Three poems by Cynthia Marcolina

PAIN

One windy November,

dozens flocked to heal

by talking, touching and

sitting silently. Geese flew

over pond and fountain

carrying pain. Distance

shortened by bridges of

hope, compassion and

encouragement. When

secrets are shared sacred

space forms. Depression

can’t be determined by

numerical codes and colors

can’t represent anxiety. I

guided souls through grief

and they?

Became my emissaries.

COMMON DENOMINATORS

Generation apart,

mutual interests. Love of gardening you

planting flowers outside me inside online. Sharing

passion for stories and music-different genres.

Letters nicely written

by you and poems neatly typed by me. We

play word games -Scrabble or Up Words. You’re

black coffee and I’m plain tuna.

One prefers Pinot Grigio the other Muscato. Not

ever agreeing just accepting differences now.

SPRING BREAK 2011

Sun bathing, wading,

shell seeking. Allowed

no worries. Friends

reminiscing. Floating

bubbles cast shadows

on ocean floor.

Vacation from stress.

Cynthia Marcolina of Harleysville, PA, is apsychotherapist.


FRAGILE ROSEby Martha Hunter

Falling petals in the wind

Stony soil bare and cold

Not a master to defend this fragile rose

Subtle fragrance of the past

Haunt my dreams of yesterday

This tender blossom couldn’t last the winter’s storm

Then the Gardener’s tender hand

Digs the weeds away

Watered with the dew of hope

Could it be I’ll bloom again?

I must trust a higher hand

To revive my life again

This the Gardener’s loving plan

For fragile rose!

Martha Hunter of Willow Grove, PA recently retiredafter 30 years as a child-care professional. A writersince childhood, she was mentored by her motherwho wrote until the last week of her life. Marthawrites music – sacred and children’s music –theme songs for occasions and scores for otherpoets’ work. She has written a book of historicalfiction centered around strong women of theBible and is seeking an agent.

THE MENOPAUSE EXPRESSby Linda Barrett

The Menopause Express hits you with freight-train

force,

speeds into you

When you least expect it.

You feel its sweaty friction

just before it charges into you

The Menopause Express

charges from down your head

along your back

flying through you

before flying away

to come back again

its wind makes you sweat gallons

Until you climb out of bed

to reach for a glass of water.

The Menopause Express

runs right into your face

then blows out of town

taking your hormones

and fertility with it.

as you suffer from its passing wind,

Take this with a cold glass of water,

This Express only runs once in

A Woman’s life.

Linda Barrett lives in Abington, PA, and works atthe Giant Supermarket.


Two Poems by Nadia Lande

COLORADO REPRIEVE

The din of croaking frogs has ceased

their throats tired and dried out

from the vibrant, midday heat.

Even so, the portable solar shower

perched precariously on a branch of aspen

drips still-too-cold water from its spout.

Camping in Pike National Forest

offers a more classic ritual for cleansing.

Inhaling deeply, I settle my

grimy body to the ground, and

gather my gaze…

I am a voyeur with VIP

privileges, an interloper

in this divine landscape, of

splendid rocky mountain sunshine,

columbines rest in the distant fields,

a fresh and exquisite meadow of

indian paintbrush carpets

neighboring valleys, ablaze

in crimson and purple majesty.

My spirit is steeped

with joy,

as I behold

America naked.

PARADISE FOUND

It was still sweltering that eveningIntense Florida moisture — oppressive but calmThe moment we met felt preciseYour presence settled meWe were cradled in each other’s gazeTucked in nicely, by that blanketOf loveandHumidity.

I had come to visit—Someone else.I was dazzled by the palm fronds fanning out,FlowingInto heart-shaped gifts of green—a welcome respite across every parking lot.You were from Pennsylvania tooAnd missed the autumn displayThe shifting light upon maple and oakThe crunch of the leavesYou could taste it, you said.

We laughed and listened to JoniI harmonized with every refrainAnd realizedI was a beacon, casting a glow—Reflected in your eyes As they fell softlyUpon me.

So I stayed with you in this land of perpetual haze Amid the worshippers of bronzeBasking in one hundred degree delightThe most loyal devoteesPlastic faces, perfect grins—The pressed autumn leaves I had packedprovided comfortfor a while—But the monotony of manicured terrainWas heavy, damp like the heatAnd revelation dripped through the shells on theshore.

We set out for homeWhich was wherever we went. Together.Heading north to the bristling tempo of branches whistling in the wind.

We heard a symphony There in the deciduous forest.


Nadia Lande of Fort Washington, PA, does socialwork with elderly patients and has written poemsabout many of them.

NAMELESS BOYby Ruth Deming

I will hover around

third on the list

unchosen but wanting.

I’ll watch as they cut your body open

I could’ve been in the next room

Not dead like you but doped,

awaiting resurrection.

You did yourself in, silly boy.

What if they told you

when you were a boy,

Son, you’ll be dead at 27,

not from a tainted needle

but from anoxia. X marks

the word and the spot in

your brain that gasps and gasps

for air.

Think on it, my son,

play with your schoolmates

swing on the ropeswing

watch the shooting stars come August

wade in the creek and

catch your salamanders,

always looking in your rear-view mirror

for anoxia, the thing that will kill you.

Envision a young man lying

on a slab naked – it’s You! -

No more happy thanksgivings

or blue light Christmas trees

and all them girls that were gonna be yours

forget ‘em all!

Your kidneys are being scuppered by masked men

With gloved fingers

The radio’s turned off

forever

can’t get to your guitar.

I covet your kidneys, my darling,

And pat my belly where it would slip in nice

And slow.

We would have ridden the world together,

nameless boy,

I would have proved myself worthy,

a girl from Ohio who likes her Pearl Jam

and Bach.

I’d have taken you on a sedate drugless ride

Shown you the street where I live

the birdbath and backyard maple

my new carpet and laptop

the shitload of pills I take each day

we’d talk over breakfast of eggs and toast –

do you like yours over light? -

As we step outside into the

bright kidney morning.

Ruth Deming of Willow Grove, PA, received herkidney transplant from her daughter Sarah on April1. Read more of her poems on her blogRuthZDeming.blogspot.com.


THE DARK PASSENGERby Kym Cohen

Thrown in a trunk and told to stay silent as the only option, the trunk door slammedclosed. The air grew stale. Hearing only the sounds of the tires along the open road,fear took over as time ticked forward.

Straightening out, desperately trying to keep the spine from cracking was the goal.Waiting. Not knowing what fate had in store.

The car came to an abrupt halt. Radio songs ended mid-sentence. Sounds of thingsshifting in the front seat. Fear was growing inside the trunk. The door slammed.Footsteps. Louder and louder, closer and closer. Keys jingled then entered the lock.

Slowly, the trunk creaked open. She stood there, staring down at me with an intensedetermination. Her right hand lurched forward and there was nothing I could do. Iwas helpless, awaiting my destiny.

A soft smile stretched across her face seconds before she cracked my spine. She laideyes on me as her fingers firmly grasped my sides with impatience, eager to learnmore about what I offered. Little did she realize I would leave her with a twistedending, one she would never forget. That was my promise, my gift, as each pagesilently sucked her in with each moment that passed. Drawing her into my world, Itaught her a valuable lesson, the unexpected adventure of reading.

Kym Cohen is an actor and screenwriter who lives in Bensalem, PA.



TWO POEMS BY DONNA KRAUSE

THE UNWANTED VISITORThere was a loud knock on my cracked ageddoor…….upon answering it …..I fell to my

knees….as the dark bleak hooded figure arrivedwithin a black cloud….terror washed through mybody….in a foggy abyss this figure screamedout….Bipolar Disorder, and it’s for life! It crept

back into its horrible domain….I’m left with darkdepressing thoughts….a chemical imbalance inmy brain…my blanket over my head…I want tosleep, to escape these pangs of sadness thatengulf me…there is no more salvation in lookingat the rays of the sun….suicidal ideations are soreal to me now…How can I live with this deepfeeling of doom….loved ones are pulling

me…and saying, you have to stay, we love you!….they don’t have a clue…the anguish is

pronounced now...my tasks are too much tobear…..while this disorder is pulling me down sofar…How can I get up, again? As I struggle withdeep depression….a new wild ride took me tothe land of euphoria…..Mania is causing mybrain to rush forward like a hamster on itswheel…There is nothing that I can’taccomplish…my credit cards are my

friends…..feeling incredibly agitated, as myquest to buy more increased….as I pedaledaway on my bike…I’m telling the world that Icould sing!......Don’t they know that I’m riding

away to OZ!....ah, sleep for me is rare…there wastoo much to do and see….my anxiety is onoverdrive….I feel like I am riding in a hot air

balloon…completely floating away from reality. Ichecked myself into a hospital, with a sense ofknowing that my actions are bizarre…..Lithium istheir drug of choice….a magic pill…..It’s causingme to feel more balanced and free….thirty-twoyears later I’ve scratched and clawed out ofmany deep dark depressions and manic

episodes….I’ve received very good care….mychildren and husband remind me that I’ve donesomething good...it has been my life’s goal, toignore that dark hooded figure when there is a

knock upon my door.

A TINY VISITORSweet expectation.

Awaiting a tiny miracle

God’s creation growing in the womb.

The baby, so softly rocked, will arrive in the fall.

A season filled with a tapestry of colorful leaves,

Barely hanging on the trees.

Baby will be adorned in rose petal pink or

Little boy blue.

We will sprinkle this new arrival

With love that is so pure.

Longing to touch the newborn’s skin,

So delicate, so divine.

A thousand kisses will be bestowed, ever so softly,

On the baby’s face.

The nursery is splashed with brilliant colors,

Found in the springtime flowers.

A gentle breeze from the nursery window,

Causes the cradle to creek and crack,

On the old wooden floor

Lullabies will be sung to the newborn

Throughout the night.

Tiny feet will be imprinted

For all the world to see.

The clouds are painting a pretty picture in the sky,

As the stars peek in and out.

They are dancing around the moon with silver linings.

Patiently looking out for the birth.

The world will stop

Hush!

Donna Krause lives in Rockledge, PA. She hasbeen published in the poetry journal Idea Gems.

Documents

TABLE OF CONTENTS - New Directions Support Group, Inc. … · The Compass - Page 2 FALL/WINTER 2011 EDITOR’S CORNER by Ruth Z. Deming, MGPGP Director of New Directions There are