In the first part of this 3 part series, we meet retired Major General Gregg Martin, who shares his remarkable journey with bipolar disorder from onset through diagnosis to recovery. DISCLAIMER: This episode includes discussions of mental illness, including personal experiences with psychotic episodes and passive suicidal ideations. Please listen with care.
Gregg F. Martin, PhD
Major General, U.S. Army (Ret.)
Author of Bipolar General: My Forever War with Mental Illness
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0:00 Voice Over, Episode Disclaimer:
A note to our listeners. This episode includes discussions of mental illness, including personal experiences with psychotic episodes and passive suicidal ideations. Please listen with care.
0:13 INTRO TEASER (MARTIN):
I think part of the problem is there's this misunderstanding of mental illness that says it's due to a lack of character or a lack of willpower. But that's not true. It's physiologically based. Mental illness is just as physiologically real as diabetes, cancer, heart disease, and there's no stigma against those people, and so there shouldn't be one against people who have mental illness either.
0:40 Voice Over (VO), Lauren:
Welcome to Collaborative Endeavors, a podcast about how scientists from different areas of research come together to tackle big health challenges, leading to better therapies and healthier communities.
A few months ago, I was contacted by Dr. Alex Leow, a professor in UIC’s department of psychiatry. We talked with Dr. Leow back in Season 2 about her smartphone intervention for bipolar disorder, BiAffect (and if you haven’t listened to this episode, I strongly suggest you check it out). Anyway, Dr. Leow had met Major General Gregg Martin at the International Society for Bipolar Disorders conference. He was talking about his upcoming book, “Bipolar General: My Forever War with Mental Illness.” They had struck up a friendship, and she was hoping to host a fireside chat of sorts about his personal experience living with bipolar I.
While this approach differed from our typical format, it is important to consider individual community members as key players in transdisciplinary teams, as their unique perspectives and personal experiences can be integral in creating better interventions, improving clinical care and changing public health conversations. So for that reason, I jumped at the opportunity to get involved.
But before we dive into that conversation, you need to understand General Martin’s past and his journey toward diagnosis and recovery. So that’s where I started, on a Zoom call with the general, Gregg, who is grinning ear to ear, ready to share. When Gregg talks, you lean in. So get ready to hear a remarkable- and hopefully informative and inspiring- story!
To kickstart our conversation, I asked the general to tell me about his time in the army, his success as an officer, and if, in those early years, there were any indications of bipolar.
02:25 General Martin:
I actually entered the army in 1975 when I went to West Point, which was the best education for the price that I could find, and really fell in love with the army. And then graduated, went to Army Ranger School, went to Germany for my first assignment, was a platoon leader in charge of 30 combat engineers. Then was a company commander in charge of about 150 combat engineers. We had a really intense, exciting, important mission along the inner-German border where we were the deterrence against the Soviet Union. But I loved leading soldiers. I loved the excitement, the travel, the adventure, and it just hooked me. I got all top ratings for my jobs. And then the army said, “Hey, how'd you like to go to graduate school?” I said sure! I went to MIT. I got two Masters and a PhD. You know, typical real overachiever. I got married- been married for 41 years, 3 terrific sons- and I just continued to do really well in the army. All of those things did not indicate bipolar disorder at all at the time. It was just high performance. Lots of energy, drive, enthusiasm, problem solving skills. But looking backwards and connecting the dots, the early signs of bipolar disorder were there. I had what we now know to be a hyperthymic personality, which is a near continual state of mild mania. Basically, my brain being flooded with dopamine, endorphins and other energizing chemicals that gave me unusual levels of energy, drive, enthusiasm- and that kept increasing year after year. Again, for someone looking at me, all they could see is success. But it crept up the bipolar spectrum, until, by the time I was in my forties, I probably already had a somewhat mild case of bipolar disorder. And then, of course, my official onset was in 2003 during the Iraq War. I had one low in my entire life, and that's when I went to college at the University of Maine when I was 18 years old. I went from high school hero, captain of all the teams, honor roll, leader, all that stuff to this big state university. Big classrooms, big lecture halls. The instructors don't really have time for you, and I was failing every single course except Army ROTC. I had terrible grades, and it sent me into a depression for a month or two, but I was able to pull out of it.
05:20 VO: General Martin went on to describe the circumstances that he believes triggered his genetic predisposition to bipolar disorder.
05:30 General Martin:
So, looking backward from the official onset I was creeping up the bipolar spectrum, I was getting higher and higher. After 9/11, I became a brigade commander, which is thousands of soldiers. It can range from 2 or 3,000 up to 10 or 15,000. We were in Germany training extremely intensively for the Iraq War. We knew we were going to go and invade Iraq, interpose Saddam Hussein. We did all the logistical preparation and planning, we did all the equipment maintenance, we had lots work to get our soldiers up medically with all the vaccinations and all the physical health things that you have to do to get ready to deploy to a really harsh climate and environment. And then lots of administration work. I mean, everybody has to do a will. You have to take care of finances and powers of attorney. And so, for 6 months I was working pretty much around the clock, extremely intense, because soldiers’ lives really depended on how well we did our job. In January of 2003, we deployed from Germany and we shipped all our stuff to Kuwait, and we trained intensively for about another month in the Kuwaiti Desert. Very high stress rehearsals, planning to make sure everything was set for the invasion, so that we could get there and save as many lives as we could. When we finally attacked and crossed the border from Kuwait into Iraq, I felt this huge burden lifted from me. I've never had a baby, but I think it must have felt like I had a baby, and was so happy that the baby had been born. The thrill, the euphoria, the stress, the trauma of that whole experience, and the months and months of intense combat ended up being a year that triggered the genetic predisposition for bipolar disorder. I already had the genes for bipolar disorder latent in my brain, but it got triggered by all of those events, and when it happened, of course I didn't know it happened. I didn't realize I had bipolar disorder for 12 more years, but I felt phenomenal. I felt like Superman. I felt like I could fly. My brain was operating faster, more efficiently, more creatively than it ever had in my life. I was anticipating problems and solving them before anybody else knew there was a problem. I mean, I was all over this deadly battlefield completely fearless, and having the time of my life. I've never experienced a high anything like it, and my performance was through the roof. And so that's what the onset was like.
08:35 VO: I asked the general to explain how his tendency toward mania suddenly went from something that had, up until that point, helped him succeed to something that ultimately led to his dismissal from National Defense University and forced retirement from the army.
08:50 General Martin:
When I got back from a year in Iraq, of being a high-performing modest level of mania, which really helped me, I fell into depression for 10 months. And that did not help me. I was in very deep depression, but I could still function. And when I would go into depression, I would isolate myself. I didn't want to be around people. I was indecisive. I was often confused, and as a senior army officer, you can't have that. I mean, you have to be sharp, on your toes, making rapid decisions all the time. But then the depression lifted, and I went back into a high performing mania, and I was mostly in a state of high performing mania for the next decade. It was just like the hyperthymia, only it was more so. It elevated me. It boosted me with energy, drive, creativity, problem solving skills. With only occasional dips into depression, I was mostly in a state of mania, which meant I performed unbelievably well. What really killed me, though, was by 2014, I went into what they call full blown mania, where I literally went into a state of madness. I went insane. Extreme grandiosity, where I thought I was this apostle from God to the Department of Defense, extreme religiosity, where I was doing 25 or 30 religious events per week. I had hallucinations of the Holy Spirit, as well as the devil and demons attacking my house. I started talking faster and faster for longer periods of time. Sometimes I would talk nonstop for hours. My meetings would run way over. I lost track of time. I started missing things altogether, just forgot them. Stopped doing administration and paperwork. If you read DSM V, I was like a textbook bipolar patient.
It got to the point where people really noticed, and they sent in anonymous reports to my boss, who was the 4-star Chairman of the Joint Chiefs of Staff, which is the top military officer in the country. He did some investigations and assessments, and he came to the conclusion that he needed to get me out of National Defense University. I got a call on a Friday that said report to the chairman's office on Monday morning at 10. I was so high; I didn't know if he was going to promote me or fire me. But I went in, and the first thing I saw was the lawyer. I said, “Whoa! No promotion today!” I mean, that's always a bad sign. The chairman came across the room and gave me a big hug and said, “Gregg, I love you like a brother, but your time at National Defense University is over. You have till 5pm today to resign or I'll fire you, and you need to get a mental health evaluation this week at Walter Reed.” And you would think I would be disappointed. Instead, I said, “Thank you, sir, so much. God put me here to do great things. And now he's going to put me somewhere else to do even bigger things.” And I was high as a kite. That was basically the end of my army career. I was fired from my 2-star command after nothing but top ratings. I was forced to retire early. I was given a mental health exam. I actually got three, and they misdiagnosed me on all three. They said I was perfectly healthy, nothing wrong, fit for duty. But then, I went into terrible depression over the next four months. Finally, in November of 2014, I was diagnosed properly with bipolar disorder. And that's when I entered bipolar hell.
12:45 VO: It really caught my attention when the general said he was misdiagnosed three times. I wanted to understand more. Some research estimates that up to 40% of patients with bipolar disorder are misdiagnosed, particularly with major depressive disorder in the case of people with bipolar II. Bipolar disorder symptoms can be similar to those of other illnesses, which can make it challenging for a health care provider to make a diagnosis. Moreover, many people have bipolar disorder coupled with another mental disorder or condition, such as anxiety, substance use or eating disorders- more information on this can be found in our show notes. I asked General Martin to elaborate on his experience.
13:30 General Martin:
During that early period of bipolar disorder from 2004 up till 2011, three times when I was in the depressive side of the bipolar cycle. I went to the doctor and said, “Hey Doc, something's wrong with me. I'm depressed. I never get depressed. I'm always up.” I said, “Check me out. I think there's something wrong.” And all three of those times the doctor said, No, you're fine, there's nothing wrong with you. Jump forward to July 2014, when I was in full blown mania, three times I went in, and what happened? The reason they misdiagnosed me- or failed to diagnose me- was, number one: the doctors were, I think, intimidated by me because I was a general. And they were mesmerized by my success. And they're used to seeing people 18 to 25 with bipolar disorder, not a 50-something general. It kind of blew their frame of reference. They couldn't deal with it. The other thing is, they didn't share information between my chain of command that fired me and the medical people who were evaluating me. They didn't have a clear picture. I think if they had read those reports, which I've seen a bunch of them, they would have had a textbook description of DSM V, but they didn't do it. So that was bad practice. When I went in in November, I went in terrible shape. The doctors were then able to kind of connect the dots from when they had seen me in July to when they were seeing me in November, and they were able to see, okay, this guy used to always be high energy, high drive. And now he's practically the walking dead with his depression and this psychosis. They were able to put it together and say, bipolar disorder type one with psychosis.
15:30 VO: The National Institutes of Mental Health defines psychosis as, “a collection of symptoms that affect the mind, where there has been some loss of contact with reality. During an episode of psychosis, a person may have difficulty recognizing what is real and what is not.” In bipolar disorder specifically, psychotic symptoms often match the person’s extreme mood. For example, someone having psychotic symptoms during a depressive episode may believe they’re in financial ruin while someone in a manic episode may believe they are famous or have special powers. General Martin described some of his experiences psychosis and explained why these episodes can be so dangerous.
16:15 General Martin
The psychosis started just a little bit back in Iraq in 2003, but over the ensuing years it got stronger, more intense, more serious. I saw demons and devils attacking our house, and I put like Bibles and crucifixes and crosses in all the windows and doors to repel them. I could see them flying, and they would like bounce off the house when they bumped into the Bible. And then I would see the Holy Spirit come down to protect us. In my retirement, everything went from bad to worse. Maggie thought things would get better when the stress was reduced, but my depression intensified, the hallucinations and delusions intensified, and so I was pretty much nonfunctional for about 2 years in this depressed state. Could hardly think, lost interest in everything, had no energy. I thought my wife and kids would be better off without me. And then I started having these delusions of death. And one of them was that the people who I thought were out to get me had created a conspiracy, and I was going to get arrested, put in jail, and then I would be beaten and stabbed to death in jail, and I would die on a cold prison floor. And this vision kept cycling through my mind over and over. And it was real, I mean, when you have a hallucination or a delusion, someone outside of you may say, “Oh, it's not real. Just get over it. It's not real.” But for the person that's having it, it is real in your brain.
When I finally went to the VA to get help, the doctor, he's the only doctor who ever asked this question, “Gregg, are you suicidal?” I said, no. “Or do you want to hurt yourself or others?” No. He said, “Do you have any morbid thoughts of death or dying?” And I said, Yeah, I do. And I described what I just told you. And he said, okay, those are passive suicidal ideations, very dangerous. They can morph into active ones, and then you actually develop a plan and kill yourself. So that's when I went into the inpatient locked psych ward, and that was really good.
18:45 VO: The general went on to describe his time in the VA’s inpatient psych ward and his multidisciplinary approach to treatment.
18:50 General Martin:
When they finally diagnosed me, I thanked them and gave him a hug. At least I knew what was wrong, and now I had some formal path to recovery. The high point was every morning, at about 8 o'clock, there would be a panel of seven medical experts that would be at this big table, and I'd sit in a little chair in front of them. There were two psychiatrists, a pharmacologist, therapists, there was a chaplain, there were nurses- there was a whole bunch of people. And they were focused on me; I got to talk about me to all these medical professionals. It was really cool. They would basically give me their assessment and then open it up to me to ask questions. Most of the veterans didn't ask any questions. I had a whole page of questions that I would ask them. So, I think they thought I was a really interesting patient, and they enjoyed the interchange because I challenged them. They would then have to take a little break to talk about the questions that I asked them, and then they come back in, and we would have these wonderful conversations about what's going on with my brain, and how do I improve and get on a road to recovery. That would go on for maybe 45 minutes, and then we would break. We would have all kinds of different activities. I mean, I do intense psychotherapy. I'd be talking to the psychiatrists. The nurses would be checking on me, and we'd be talking about stuff. The chaplain was unbelievable. All this would kind of go on all day. I would tell you that it was a very good, professional, friendly, multidisciplinary approach that helped me a lot. But at the end of the day, when I left the hospital and went home, I sunk right back into depression and psychosis. I learned a lot about what I should be doing and thinking and mindfulness and letting problems go. I learned that from the VA people. But when I left the hospital, my brain chemistry was still out of whack. It wasn't right. And so all the therapy in the world didn't do me hardly any good, because my brain chemistry was out of balance. I still really had a sick, messed up brain. That went on from about March until August of 2016. Finally my wife was at her wit's end, as was I, but she called my doctor and said, “Hey, doctor, you’ve got to try something different on the medication. What can we do?”
We settled on lithium. End of August 2016, I was prescribed lithium, and within three days my depression lifted. Went away. My psychosis pretty much went away with just a few small exceptions. I felt really good. I felt energy, enthusiasm, drive. I felt like I did before I had bipolar disorder. I felt really, really good. I told the doctor, and he said, “okay, we need to monitor this closely. We need to do a couple of times a week will check your blood levels to see that the lithium doesn't get too high, that it's at the right level. I want to talk to you. I want to make sure this is going okay, that it is going to be sustained.” We had planned to move to Florida out of New Hampshire in order to get warm sunshine, you know, all the things that go with Florida. He said don't move until I give you the green light. Then we moved to Florida, and it's very healthy for my bipolar brain, and it's played a big role in my recovery journey.
22:45 VO: As our conversation neared its end, General Martin talked about the strategies he uses to stay on his path to recovery and the advice he likes to impart to others who are struggling on their own mental health journeys.
23:00 General Martin:
I think the key to it was the lithium. Because, number one, you have to get your brain chemistry correct and stabilized. Second, I think the therapy has helped me think about my own thoughts, how to deal and think with and think through uncomfortable thoughts and things in your head and the whole bipolar cycle. Third is healthy living, you know, good diet, exercise, sleep, water, low stress. So those three are necessary, but not sufficient for recovery. I think you need to take those three and anchor them into the social foundation of the 5 Ps. The first P is Purpose. You have to have a purpose for your life that really motivates you. For me, my purpose that I discovered was sharing my bipolar story to help stop the stigma, promote recovery and save lives. So that’s what I do, I speak, I write, I confer. The second P is People. I think it's really important to surround yourself with energetic, happy, motivated, fun people that can lift you up. And then the third thing is, I think Place really matters. I think coming to Florida, because of what the sunshine does to my brain, was an important thing to do. The fourth thing that you need for recovery is Perseverance. You have to keep fighting. You can't ever give up because you're going to have setbacks, you're going to hit bumps in the road. You're going to get knocked down. I've had a few myself. You just got to get up and keep going. The fifth is Presence. Presence is learning to think about your own thinking. A fancy word for it is “metacognition,” thinking about your own thoughts. Because a lot of times what we think in our own brain is not true. It's not accurate; it's false. And so, being able to get outside of your own head and see reality is a very important element of recovery.
I never, ever want to go into an intense bipolar cycle again. Being bipolar one, I'm much more susceptible to mania than I am depression. But the danger with mania and going up, it's way stronger than the strongest drugs- cocaine, ecstasy. It's way more powerful. But the problem is, if you go off into mania, it's very, very dangerous. You can get reckless, violent, out of control. Bad, bad things can happen through mania. But what goes up must come down. And so, if I go into mania, I'm going to go into depression. It's a given. And depression is horrible. It's the worst thing I've ever experienced in my life, and so I never, ever want to have a relapse. I am really, I would say, quite disciplined about my lifestyle, disciplined on diet on exercise. Having Maggie as my battle buddy really helps. I take a fitness nap every afternoon for 30 minutes. No matter what I'm doing, I stop. I build it into my schedule. And that's really healthy for you and for your brain. But I think I'm really fortunate that I've got this very powerful purpose in my life. It's my mission, and I throw myself into it, and I work really hard at it every day, every week. I love it. It makes me so happy. And the feedback I'm getting from people is that it's really making a positive difference. I think I have to stay healthy. Don't get too wound up, even over my bipolar mission, and just keep moving forward and enjoying life and enjoying the people I'm with, and try to take the evenings off to watch a movie with Maggie. And then take some trips, get out of town.
Bipolar disorder and other mental illnesses are extremely serious untreated. They can lead to broken families and marriages, destroyed careers, ruined finances, addictions, homelessness, incarceration, and death, and that's the bad news. The good news is that with the state of medicine, and you know great doctors if diagnosed and treated properly, and then managed like a chronic disease. Then you can live a happy, healthy, purposeful life. But one of the things that prevents people from going in and getting help is the stigma, and the stigma is based on ignorance. I think part of the problem is there's this misunderstanding of mental illness that says it's due to a lack of character or a lack of willpower. But that's not true. It's physiologically based. Mental illness is just as physiologically real as diabetes, cancer, heart disease, and there's no stigma against those people, and so there shouldn't be one against people who have mental illness either. In fact, breast cancer, back in the 1970s and earlier, was stigmatized. It was shameful. People were embarrassed, and they kept it to themselves. Until First Lady Betty Ford got breast cancer, and she told everybody, this is the situation, etc., and that was 50 years ago. And look at where we've come now. I mean, women with breast cancer are seen as heroic figures battling this terrible cancer. That's where we need to get when it comes to mental illness because people who are fighting these really deadly brain diseases should not be stigmatized against, they should be held up as heroes.
29:20 Voice Over:
On the next part of this 3-part series, we will be joined by Dr. Alex Leow, professor of psychiatry at the University of Illinois Chicago. Dr. Leow and General Martin will chat about the ways in which common concepts in bipolar disorder have manifested throughout the general’s life.
Collaborative Endeavors is produced by me, Lauren Rieger, on behalf of the Center for Clinical and Translational Science (AKA the CCTS) at the University of Illinois Chicago.
To learn more about Major General Gregg Martin and his book, “Bipolar General: My Forever War with Mental Illness,” visit the links in our show notes.
The CCTS is supported by the National Institutes of Health’s National Center for Advancing Translational Science through their Clinical and Translational Science Award. Opinions expressed by guests of the show are their own and do not necessarily represent the views of myself, the CCTS or our funding agencies.
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