A PATIENT'S PERSPECTIVE — ROBERT BOORSTIN, a report on an interview 1 of Robert Boorstin, Smooth Sailing, Spring 1994

Mr. Robert Boorstin, special assistant to President Clinton, presented a lively, candid, and often very humorous account of his experiences living with and learning to cope with his bipolar disorder.

He was first diagnosed with the illness in July 1987 after having been seriously depressed for over four years. During that time he made a number of attempts to learn what was wrong with him, but he continued to be tearful and often unable to get out of bed; and he called his parents frequently for sympathy and support.

His depression became worse as he pushed himself harder in his graduate studies at Cambridge, England. He was trying to learn Chinese and Russian, teach classes, and write his graduate thesis at the same time. Under this pressure he began to drink excessively, napped a great deal, failed to exercise, and was generally miserable. He had "suicidal flashes" but was never actively suicidal because he knew what his death would do to his mother.

After returning to the United States, he worked as a writer for the New York Times. In New York he had his first manic episode, which resulted in his first admission to the hospital. His symptoms of mania were sleeping only three to four hours a night, getting speeding tickets for driving at 120 mph, frantic socializing, and hypersexuality.

He describes his first hospitalization as "ego shattering. One day you are a writer for the New York Times and the next you are in a mental hospital." He developed a pattern of castigating himself for being mentally ill; then he said, "I would get mad at myself for getting mad at myself!" He humorously described the antipsychotic medication given early in his hospitalization as "steel wool to the brain." He does well on lithium, which he says keeps him from going too far up or too far down. He has a few side effects from lithium, such as a slight tremor, some slowing of his thinking, and some daytime sleepiness. He handles the sleepiness with daily half-hour naps, which he is entitled to as a "reasonable accommodation" under the Americans with Disabilities Act.

Mr. Boorstin is more concerned about the mania than the depression; the latter is well controlled with medication. A particularly poignant dilemma is his inability to trust his own emotions and, therefore, to completely enjoy being happy; he always wonders whether he is just happy or if he is headed for trouble in the form of a manic episode. He finds it helpful to direct his assistant to monitor his behavior, let him know if he gets too irritable or too "off the wall."

Mr. Boorstin was quite candid in his discussion of what he found helpful and unhelpful during episodes of his illness. He found participation in a support group enormously helpful. There he learned "how lucky (he) was" in that his illness was responsive to medication. His mother was helped greatly early in the course of his first hospitalization by the reassurance of a hospital nurse, who said that she should "relax; he will be out of here in a few weeks and he'll be good as new."

Despite some difficult experiences, Mr. Boorstin believes wholeheartedly in the value of psychotherapy. "Drugs alone are not enough," he says. Psychotherapy is especially useful to help the patient accept the reality of his or her illness and the need for continued and probably lifelong treatment. Mr. Boorstin is most pleased with his current therapist, who has helped him through various stages of understanding and accommodation to his illness. He describes these stages as self-pity (why me?), helplessness (I'm manic-depressive and I can't do anything about it), and objectivity (I'm a person who happens to have manic-depressive illness). Mr. Boorstin especially values the steadfastness of his current therapist—his never giving up on him.

The audience question-and-answer period was lively. In response to a question about obtaining a government security clearance, Mr. Boorstin explained that he was so open about his illness when the FBI agent questioned him that the agent revealed that his own sister had the illness as well! Mr. Boorstin has been equally open with his colleagues. When he became ill the first time, his colleague George Stephanopoulos visited him in the hospital.

He is very active in advising government officials on mental health issues, particularly with regard to national health insurance. To overcome stigma it is vital for patients and family members to be open about the illness. Mr. Boorstin urged that primary-care physicians be educated more thoroughly about mental disorders since they provide much of the diagnosis and treatment. And, finally, Mr. Boorstin encourages the use of a great deal of what was in frequent evidence throughout his talk—a sense of humor. Mr. Boorstin's presentation was candid, informative, and thought provoking, and his lively use of humor made it most enjoyable.

1 An interview at a DRADA/Johns Hopkins symposium, Baltimore, Maryland, April,1994

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