This is the second part of our 3-part conversation with Major General Gregg Martin about his journey through diagnosis with bipolar I and his path toward recovery. His book, “Bipolar General: My Forever War with Mental Illness,” provides an important glimpse into the thought processes and perceptions of someone living with a bipolar brain. DISCLAIMER: This episode includes discussions of mental illness, delusions and psychotic episodes. Please listen with care.
Alex Leow, PhD
Professor of Psychiatry
University of Illinois Chicago
On X @alexfeuillet and LinkedIn
Gregg F. Martin, PhD
MajorGeneral, U.S. Army (Ret.)
Author of Bipolar General: My Forever War with Mental Illness
On X @GenGreggMartin & LinkedIn
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0:00 VO: Disclaimer
This episode includes discussions of mental illness, delusions and psychotic episodes. Please listen with care.
TEASER CLIP:
0:08 DR. LEOW
Given your insight in your metacognition nowadays, what are the early signs of an episode that you would pay attention to? And what kind of things you would do when you see these early signals?
0:28 GENERAL MARTIN
I have little seedlings; little seedlings start sprouting up, and I'll start thinking, “Aha! That person doesn't like me. That person's out to get me. They're talking bad about me. They want to hurt me.” Now at the point I'm at with stable brain chemistry, I’ll essentially practice metacognition, and I'll say, “Okay, Gregg, step out of your own head and look at this objectively. Why do you think this is true? Why do you think this person is out to get you?” Then I'll quickly be able to reason my way to the fact that not only are they not out to get me, they're probably not thinking about me at all.
1:10 VO:
This is the second part of our 3-part conversation with Major General Gregg Martin about his journey through diagnosis with bipolar I and his path toward recovery. His book, “Bipolar General: My Forever War with Mental Illness,” provides an important glimpse into the thought processes and perceptions of someone living with a bipolar brain.
We are back on Zoom, this time joined by Dr. Alex Leow, professor of psychiatry at UIC. You may recall that Dr. Leow met the general at a conference earlier in the year. It is clear that the two have become friends in the ensuing months and have developed a comfortable rapport, which made my job as moderator very easy. And a quick aside- because there are three of us on this call, and Zoom audio is not the same as being in a recording studio, you may here some digital distortion from time to time. You’ll also hear some laughing, because in spite of the subject matter, the mood is light.
We started the conversation with a concept General Martin mentioned in our first episode, metacognition, and the role this plays for those struggling with mental illness- or anyone trying to maintain general mental health. Here’s Dr. Leow…
02:30 DR. LEOW
The way I conceptualize this notion of metacognition- or insight- is that a person would need to have this ability to more objectively evaluate your version of the reality and compare that version to what other people are actually reporting back to you about what they are observing from a third person perspective. As psychiatrists, I think it’s so important the kind of story we tell ourselves, right? Because we all live inside our brain. So Greg and I, we had a discussion about what happens when there is a misalignment between what the patient wants and what a provider wants. And I think having that insight is so important, because then you can align the two different goals. And it's so important for a person's recovery, as far as bipolar is concerned, to have that alignment between the individual, the patient, and the provider.
03:43 GENERAL MARTIN
As far as metacognition goes, thinking about my own thinking and insight, I had been crippled and terrified by a delusion I had that I was being watched and spied on. That people were out to get me arrested, convicted, lose all my military retirement benefits- which would leave Maggie in poverty- get me in jail where I would be beaten and murdered, and I totally believed that. And the delusion went on for about a year and a half or more, and I couldn't break out of it. My psychiatrist at the time, as well as my therapist, would say, “Greg, you're a smart guy, you're a general, you went to MIT. You surely must know that this is not true, that it's false. Therefore you should just dismiss it, let it go and get on with your life. But I couldn't because it was a delusion, and I fervently believed it was true. Even though other people knew it wasn't true. And so the advice I was getting was completely unhelpful. My wife, Maggie, told me a number of times, “Call the people that you think are in this conspiracy against you.” But I wouldn't do it because I was afraid, and I thought that if I called them, it'll hasten and speed up my arrest, conviction, jail time and murder. So I wouldn't call them, and I wouldn't call them. And then one time our son Conor, our youngest son who also lives with bipolar disorder, he came and visited us at our house. He saw how miserable and depressed and frightened I was. And he looked me right in the eye, and he grabbed my shoulders, and he was only about a foot away from my face, and he said, “Dad, you are living in hell. You owe it to yourself and everybody else to confront this situation, and either it's true or it's not true. If it's true, you're better off going to jail than you are living in this prison of hell that you're now in. And if you find out it's not true, then you can break free from these shackles.” Basically, he told me to objectively confront the situation and just step up and do it. For some reason, it got through to me. I was jarred, startled. It pushed me into doing something. And what I did is, I said, “Okay, I'm going to call these two guys, and I'm gonna write out my questions: Are you in a conspiracy against me? Were you videotaping my every move? Were you wearing a wire and tape recording what I said? Are you talking to police to get me arrested? Are there undercover people following me up in New Hampshire where I live now?” And so on, and so forth. So I called them that day, and both of them were shocked. They were stunned. And they were really concerned for my mental health because they knew I had been diagnosed with bipolar disorder, but they had no idea how bad it had gotten. They said, “Whoa, this is completely not true. We've never been out to get you. We love you, we care about you, and we think you're really sick, and you need to go get help. And here are some people that can help you medically.” When I was done with the conversation, I said, “Aha! There is no conspiracy, nobody's out to get me.” But then, within about an hour, I said, “Well, of course, they said that they're not part of the conspiracy; they've been told to say that for me to lose my guard.” And I went right back into the depression and the psychosis again. But I called them again two days later, and that conversation was the same, and for some reason I believed them. I objectively believed that they were telling the truth, and then that particular delusion broke, and I was free of it. I shot into mania. I went from severe depression into serious mania, and I put my winter clothes on, because it was in February, and I went out and hiked all through the mountains, through the snow. I felt great. I started getting visions for the rest of my life. And then the next day I fell back into depression again. But it was depression without that particular delusion.
08:17 DR. LEOW
For whatever reason, the second conversation you were having with your superior, somehow there was something that just clicked that made you realize that there is a mismatch between your reality up until that point and what the real reality is. I was wondering if you could maybe elaborate more in hindsight. What do you think was that sudden click?
08:51 GENERAL MARTIN
Both Maggie and Connor were with me in the house. They listened to the conversations, and so forth. They both knew General Bostick, who was a 3 star, they knew him very well for many years. General Bostick is one of the kindest, most caring, compassionate leaders ever in history. And he loves me, and has for my whole career. I mean, he really cares. And so, after we were done with the first go-round, Maggie kept repeating, “Gregg, how can you possibly believe this about General Bostick? He's one of the best, nicest, kindest guys in the world, and he would never do anything to hurt you.” And she kept pushing that point. I think that in combination with Connor, his pushing the conversations, and then Maggie really interjecting on behalf of General Bostick. I think that together caused me to believe it, and thus break the stranglehold that the delusion had on me.
10:14 DR. LEOW
And that brings up a very interesting question that I’ve meant to ask you for a while. Given your insight in your metacognition nowadays, what are the early signs of an episode that you would pay attention to? And what kind of things you would do when you see these early signals?
10:40 GENERAL MARTIN
When I was in bipolar hell, I had terrible paranoid delusions that people were out to get me. Now that I'm in recovery for seven years, I haven't had any delusions like that. But I have little seedlings; little seedlings start sprouting up, and I'll start thinking, “Aha! That person doesn't like me. That person's out to get me. They're talking bad about me. They want to hurt me.” Now at the point I'm at with stable brain chemistry, I can say, “Okay, I’ll essentially practice metacognition.” And I'll say, “Okay, Gregg, step out of your own head and look at this objectively. Why do you think this is true? Why do you think this person is out to get you?” Then I'll quickly be able to reason my way to the fact that not only are they not out to get me, they're probably not thinking about me at all. They're thinking about themselves and their own problems. And so, it dissipates and it goes away.
The other thing is, on the other side of the spectrum, if I feel myself going up into hypomania, what I'm able to do talking to Maggie is say, “Okay, I'm having too much fun. I need to back off the fun a little bit.” Maybe not do karaoke for a while, maybe do a little less dancing and sort of back it off a little bit. And then the hypomania will subside, and I'll be steady again for a while. But I haven't been getting that hypomanic injection lately. It hasn't happened for quite a while; it's kind of leveled off. It’s not a thrill like it was a few years ago.
12:38 DR. LEOW
It's such a fascinating story. It just brings up another concept that we've been discussing between you and me, this kindling phenomenon. When it comes to bipolar, this kindling phenomenon is basically saying that both very positive events and very negative events can really sensitize the brain of a person who is living on the spectrum. Reading the book, I realized that you can really see this kindling process early on in your 20s or even earlier than that. I was wondering if maybe you could walk us through some examples of kindling.
13:26 GENERAL MARTIN
So first off, the kindling theory is brilliant. It absolutely applies to me, and I had never heard of it until speaking with you, Alex. So thanks. As I thought about kindling in my earlier years, I realized I had left out a whole stretch of really important information that should have been in the book, and it would have been great in the book. So in high school, I was sort of the all-American guy- student, athlete, leader. I got along with everybody, the jocks, the smart kids, the nerds, the hippies. And I really started getting into a runner's high, which was probably a form of hypomania. I loved concerts with rock music, it would raise my spirits up into what I'm sure was hypomania. Then, when I went to the University of Maine, and I went from being the high school hero to the college zero because I didn't have any good study habits- my high school was too easy- I fell into depression. I wasn't crippled, but it was serious. And I was in that depressed state for about two months, and I really was functioning very poorly. Then I had this- they call it a born again experience- where these missionaries knocked on my dorm room door. I think I was in bed in the afternoon, and they said, “Hey, do you know if you're going to heaven? Do you know God? Are you a Christian?” And I said, “I don't know. I'm not sure. I don't really know.” “Would you like to know? With certainty?” And I said, “Yeah, sure, go ahead, lay it on me.” And so they came in, and they had a very well organized spiel that they would give as part of their missionary work evangelization. They walked me through this thing, and I said, “So, if I pray this and say that and believe this, I'll go to heaven?” And he's like, “Yes, you will go to heaven.” So I did. I said the prayer and became a born again Christian. It was October 17, 1974. And I'll tell you what, Alex, I felt like 1,000 pounds had been lifted off of me. It was like the best high I ever had in my life. I felt like right there, my life changed. When they left, they gave me these Bible verses to memorize, and I memorized them that night. Then I cleaned my room, I got my books and notebooks out and got organized, and I went to class the next day. I was paying attention, taking notes, preparing. Suddenly my life went into this orderly organized laser-focused thing, and I pulled my grades from Fs to Dean's list. I started going to the Protestant Church. I started going to Bible studies, and prayer groups and prayer breakfasts. And I'll tell you what, it was either a total infusion of the Holy Spirit or a total infusion of dopamine and endorphins, or it was some combination of both, because that carried me for not only the rest of that year, it carried me in my life for years and years. And those Bible verses I memorized, I was reciting those when we were in the Iraq War decades later.
I'll just tell you another one. When we graduated from West Point, we went to Fort Belvoir, Virginia, right outside of Washington, DC. I had a bunch of friends, and after class would get over, say 5 o'clock, we would work out like you wouldn't believe. Run 10, 12 miles, do tons of push-ups, pull ups, lift weights, swim, and then we would have a communal dinner. About half a dozen guys. Somebody would cook. We'd all eat. Then we would go into Washington, DC and party. And we would basically party and dance and sing and drink until all the clubs closed, until everything was closed. And then we would drive back to Fort Belvoir, and we would stop and have breakfast at a Howard Johnson's along the way, and then we would show back up at the fort just about on time to go do PT early in the morning at 6 AM. And we did that night after night, week after week, month after month. And, you know, these were hypomanic experiences, if not manic. I think and I could go on, but you get the idea. I think that the kindling effect it started a little probably in high school, and then the little twigs turned into bigger twigs, into little sticks, bigger sticks, little logs, and it just continued. Then fast forward to 2014, it was humongous logs thrown on, and we had a raging bonfire. But it didn't happen all at once.
Outro Music, final episode teaser
18:19 GENERAL MARTIN:
I would say everybody in society needs to get training and education on mental health, and one of the pieces needs to be the basic symptoms of the most common mental illnesses or mental conditions.
18:35 DR. LEOW:
I’d like to think of our conversation today as a conversation between two bipolar experts. I am a psychiatrist with expertise in treating people with bipolar disorder, and Gregg is a bipolar expert by lived experience.
18:56 VO:
That’s next time, on the final part of our 3-part conversation with General Gregg Martin.
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 Dr. Alex Leow, 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. You can find more episodes of Collaborative Endeavors on Apple Podcasts, Spotify, Amazon Music & Google Podcasts. While we do not monetize this podcast, we do love positive feedback! If you like what you hear, go ahead and give us a 5 star rating to help spread the word.
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