Over the last two episodes, Major General Gregg Martin regaled us with stories about his forever war with bipolar disorder, including early warning signs and his recovery journey. We also listened to his insightful exchange with Dr. Alex Leow, which provided insight into how textbook concepts in bipolar disorder can play out in the day-to-day life of a patient. In the final part of our series, we return to the conversation between Dr. Leow and General Martin to hear one last incredible story, and examine how the greater research community can translate the information gained through personal stories into better interventions, medical practice and public policy. 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
If you would like to see your interdisciplinary team featured on the podcast, reach out to me at laurenw@uic.edu.
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The University of Illinois Chicago Center for Clinical and Translational Science is supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant UL1TR002003. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
0:00 Voiceover (VO)
This episode includes discussions of mental illness, delusions and psychotic episodes. Please listen with care.
0:08 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.
0:24 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.
0:47 VO:
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.
Over the last two episodes, Major General Gregg Martin regaled us with stories about his forever war with bipolar disorder, including early warning signs and his recovery journey. We also listened to his insightful exchange with Dr. Alex Leow, which provided insight into how textbook concepts in bipolar disorder can play out in the day-to-day life of a patient.
In the final part of our series, we return to the conversation between Dr. Leow and General Martin. The general had just finished sharing examples of kindling phenomenon during his school years and how those early instances of his hypothymic personality slowly snowballed toward full bipolar disorder.
01:40 DR. LEOW
As we're talking about these stories, I can sense your enthusiasm and your excitement. So it's really fascinating to see that. But that brings up another concept that we have been discussing. Say, for example, an individual comes to my office, and they are describing depressive symptoms. As a psychiatrist, it is so important for us to make sure that your depression is not secondary to bipolar, which is the bipolar depression versus the more quote unquote standard depression because the treatment can be very different. And as we know, if you don't a properly diagnose someone with bipolar disorder, that can have really, really unfortunate consequences down the road. One of the things we look for as a trained a psychiatrist is this mood reactivity; sometimes you see this sudden shift. In your case you were depressed for a while and then suddenly there is this potentially very positive life event, and there's a sudden shift in your mood. And then you become basically on the other end of the spectrum.
This is also very related to another important concept, as we try to understand bipolar disorder. This concept is called reward sensitivity or reward hypersensitivity. And the definition of this concept is basically that people with bipolar disorder can be easily excitable by potentially very rewarding events or experiences. These events and experiences can potentially create urgency because you want to go after them. And then urgency can lead to disruptions in social rhythm, and disruption in social rhythm then leads to disruption in circadian rhythm. As we know, maintaining the regularity of circadian rhythm is so important in bipolar disorder. I know there are some great examples of this concept in your book. Could you talk about them a little bit?
04:29 GENERAL MARTIN:
The one that comes to mind first is the trip in June of 2014 to go to my son Patrick's special forces graduation at Fort Bragg, North Carolina. So we were in DC, and we had to drive. It's about 6 hours or so down to Fort Bragg. I had gone out early that morning and done PT, physical training, and I was still in my gym clothes when the president of the National Defense University Foundation Board walked by our house. He saw me and said, “Hey, General Martin, you know the board is meeting right now. I know you're going on this trip, but could you just come over and say a few words? They'd love to see you. They'd love to hear from you. You know, just say hi for 5 minutes and then head out and go get ready for the trip.” I said, yeah, I'd love to do that, not thinking there was any danger involved.
We were supposed to leave for Fort Bragg at 9 o'clock. That was the plan. I walked with the president over to the meeting room and had a cup of coffee. Everybody's in business suits. I'm in my gym clothes, and so I'm dressed improperly, but I thought it was worth it to say hi to them. So I start talking, and I knew I was only supposed to talk for like 5 minutes, 10 at the most, and I just couldn't stop talking. That reward urgency- I just thrived, and I got dopamine rushes and endorphin rushes by talking to these people who were interested, and, you know, believed in me as their leader and that kind of thing. So I kept talking and talking, didn't realize that I had gone on for about a half an hour, and then finally the president pulled me aside and said, “Hey, sir, we gotta start the meeting. You gotta go home and get ready for your trip. Thanks a lot, that was great.” Everybody clapped, and I walked out the door.
Well then, I start seeing students and faculty members and interns and administrative staff, and I was so charged up that there was this this positive urgency that I had to talk more, and I had to say hi to everybody. And I had to tell them about Global Security University and how it was the key to world peace, and this was the a brilliant idea that was gonna take National Defense University and the Department of Defense to the next level. And I literally roamed around the half dozen college university buildings, just going into classrooms and taking over and giving a little lecture. And this went on. I didn't have my cell phone with me. I lost total track of time. I didn't really know where I was. I just knew I was loving it, and I was having a blast, and I was so happy and so intensely manic.
Then suddenly my aide, who was a young naval officer, he came running up to me, said, “Sir, I've been looking for you for hours. I had no idea where you were. Maggie's been calling me. She doesn’t know where you are. She's in a panic because you were supposed to leave hours ago on your trip. Sir, you have to come with me.” And he grabbed me, and he basically dragged me back to our house, which was on the base thankfully. And Maggie was furious. She was so mad at me. We were supposed to leave at 9, it's now 4pm. We have a long drive in front of us, and now we have rush hour traffic in Washington, DC. And she's like, “I can't believe you did that. That's so rude. That's so inconsiderate.” And now I'm trying to avoid the negative urgency of getting yelled at by my wonderful wife. And my son Connor was there. He's like, dad, I can't believe you did that. That was so selfish and so wrong. Finally, I said, well, I have to go pack for the trip and get some food; I'm starved because I hadn't eaten all day. And Maggie said, “No, I've got food in the car, and I've got clothes for you. Just get in.”
We started driving, and things kind of settled down. Then I started furiously doing stuff on my phone. Just tons of emails and messages and calling people. And then the phone started running out of juice. I said, oh, my god. I have to have a phone. I'm a 2 star general. I'm the president of NDU. I said, you have to pull over at this place, and I need a new phone charger for the car. So then that killed another 20 to 30 minutes, but I got it. Then, I'm doing my texting and everything, and there was road construction and now we're in a huge traffic jam. Maggie's following the rules in the traffic, and I said, get off the road! Go into that construction road, just go, pass all these cars. I was just so urgent that I said, if you're not gonna do it, I'll do it. Let me drive. And she said, “no, the cops will pull us over.” And I said, yeah, let them pull us over. I'll tell him I'm a general, and I'm going to a graduation at Fort Bragg, North Carolina, and they'll let us go. She said, “you're crazy; they won't let us go.” We finally drove all the way there. I was mostly manic. I had totally succumbed to all the urgency, it had completely disrupted the social rhythm, and then it completely annihilated my circadian rhythm because I didn't sleep for 10 seconds that night. I was up all night, out power walking to the gym early, talking to people on the phone. We missed my son's graduation party. We made it to his graduation the next day, but the trip was terrible.
10:10 VO: After listening to General Martin’s stories and his dialogue with Dr. Leow, I kept coming back to one question: As academic researchers, what can be learned from General Martin’s experiences? The general had previously remarked that his 2-star status may have contributed to his repeated misdiagnosis, so what other assumptions and stereotypes are made when designing treatments for those with mental illnesses? Regardless of your discipline- bench researcher, medical practitioner, pharmacist, social worker, policymaker- how can we translate the information gained through personal stories into better interventions?
Dr. Leow shared her thoughts about what she has gained as a researcher and clinician by reading General Martin’s book and through their subsequent conversations.
10:58 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. It's like, you can become an expert in the city of Paris if you read a lot of books and you learn all the facts about Paris. But, you can also become an expert in Paris by living in Paris. This is so important, because this ability to experience something first hand, it's so powerful. Ever since we first started chatting a few months ago, I feel like I learned so much about what it actually means to be living inside the brain that has bipolar disorder. A lot of the concepts that we talked about today, these are important concepts for us to understand bipolar disorder. But reading the book really makes me appreciate what these concepts mean for people like you. And so, what I would like to say is that these concepts are not only important for us to understand bipolar disorder, but also potentially as a framework for us to think about early interventions to prevent another episode from happening.
12:50 VO:
General Martin went on to detail some of the ways that we, as a society, can transform the way we address mental illness.
13:00 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. I mean, I was around people for years and years, and I had a raging bipolar brain, but nobody recognized it because they were completely untrained. And that training and education on mental health should be seen the same way we do first aid training. Pretty much everybody gets some degree of first aid training, and so, mental health should be on the same level as physical health, at least, if not more so, since the brain is the most important organ. So that would be one.
I think we need to figure out how to normalize the conversation about mental health, mental illness. You know, it’s so stigmata stigmatized. And we need to educate people that it's just as physiologically real to have a mental illness as it is to have diabetes, cancer, heart disease. And we need to teach people that because the stigma is largely based on ignorance and fear, people still think, “Oh, you have a mental illness because you lack character, or you don't have will power, or you're a bad person,” and they blame the afflicted person for being ill. It makes no sense at all.
In addition to the training and education, we need to have a society-wide program kind of like the military has. They call it having a battle buddy. Outside, the civilian world calls it a peer support group where you have a peer who is a trusted advisor, confidant, someone that will tell it like it is, won't sugar coat it, and you will not take retribution against them or get mad at them if they tell you something that hurts your feelings. I think you need that. When you have that battle buddy or that peer, they can observe you and see if there are troubling signs or something that causes concern and then help you go get evaluated medically. And you know, maybe there's nothing wrong. Maybe there is something wrong that’s concerning. But I think this idea of having a battle buddy or a peer support system throughout the entire society is really important. You could do it in schools; you could start in kindergarten and work your way up. I think society needs to invest more in mental health because it's such a huge problem. And so many of our people with mental illness end up, by default, in prison where they get worse. I mean, that tells me we need more resources. We need, as a society, to figure out how to incentivize more people to be brilliant psychiatrists and researchers, like Professor Leow. Also, in society, and in the military for sure, you need safe channels of conversation. So what do I mean by that? I mean, people saw Gregg Martin and many of them probably thought, “Wow, this guy's kind of lost it. He's out of control.” But they were afraid to say anything. If we had pre-established safe channels where a lower ranking person could go to somebody who is a peer of mine and say, “Hey, I'm really concerned about General Martin. Here's what I'm seeing. Could you help him get help?” That's another thing that that could that could have helped.
Let me throw in one other little thing that's a huge lesson learned for me. When I was in bipolar hell: crippling, hopeless depression, with terrifying delusions and hallucinations. I thought there was no hope that I was ever going to get better. All I wanted to do was die. I had a friend of mine whose son has bipolar disorder, and he said, “Gregg, you're going to recover. My son is living a good, happy, healthy life right now. You can do that, too.” I think it's really important to understand that there is hope and hope will carry us forward, because without getting help in treatment, bipolar disorder and other mental illness will destroy families, careers, marriages, finances. It will lead to addiction, homelessness, prison, death. But with help, you can live a happy, healthy, purposeful life, and I'm living proof of that. And so, for anybody out there listening, there is hope. There is always hope. But if you do have a mental condition, you’ve got to start with professional medical help. Go see an expert in the field; somebody like Professor Leow.
17:55 VO:
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.
To learn more about how you can work with the CCTS to make a positive impact on the health and wellbeing of our community, visit ccts.uic.edu or follow us on X @UIC_CCTS.