Facing The Demon

Sorry for the dearth of posts.  I’ll try to do better.

About ten days ago I had a colonoscopy.  My first.  It’s sort of a middle aged rite of passage.  The procedure itself was nothing.  They just put you out cold for thirty minutes or so while they shove a tube up your ass.  It’s actually a long, flexible, lighted tube called a colonoscope.  A small camera mounted on the scope transmits a video image from inside the large intestine to a computer screen, allowing the doctor to examine the lining of the colon.  The scope also inflates the large intestine with carbon dioxide gas to give the doctor a better view.  The doctor looks around for polyps and whatever is there that shouldn’t.  If s/he finds one — and in my case they didn’t — they can usually get rid of it on the spot.  Polyps are usually benign in and of themselves, but if and when colon cancer appears it nearly always starts on a polyp.

The real issue is the preparation phase, which, not to be indelicate, is essentially a matter of ingesting more laxatives in a 6-hour period than one would normally take in two or three lifetimes.  The idea is to flush out your colon to the point where there’s nothing to impede the view.  Trust me, it works. (See the Billy Connelly video for full particulars.)

I realize this doesn’t have much to do with bipolar disorder, except… Some years ago I had a pretty bad hypomanic episode that took several weeks to get completely under control.  One night during that period I had a flash of insight.  I could almost feel the bipolar disorder as an entity — not an illness but a thinking adversary that was actively at work figuring out how to kill me.  And it came to me that while it was a good thing that I paid such close attention to the disorder, that very attention might be a trap.  Put in military terms, an enemy will sometimes try to fix your attention in one direction so that it can ambush you from another.

In fact that was the very dynamic that pretty much killed my father.  Because by the age of forty-five he had suffered two heart attacks and undergone a quadruple bypass, he got a thorough annual physical from a cardiologist.  In and of itself that was a good idea.  But cardiologists specialize in cardiology.  They don’t offer the sort of full spectrum, 360 degree physical exam a person really ought to have.  As a result, by the time my father discovered he had lung cancer, the cancer had invaded so much of his torso the surgeon could do nothing but sew him up and send him home to die.  But on the plus side, his heart was in terrific shape.

This was a mistake I decided to avoid.  And as soon as I could after gaining that insight — that sense of an illness trying to kill me by indirection — I headed to the gym that I’d joined, but wasn’t really using, and hired a personal trainer to ensure that I’d get enough exercise.  Since then I’ve tried to improve my diet and build other things to my life that make for better health.  Because if the bipolar disorder can’t get you one way, it’s going to try and figure out another.

Cross-posted from Blog Them Out of the Stone Age

[At first glance this will seem completely unrelated to bipolar disorder, but give it a few paragraphs.]

Last Friday I sat on a panel at a Strategy Workshop at the U.S. Army War College, along with John Nagl, president of the Center for a New American Security; and Andrew Bacevich, a professor of international relations at Boston University, both very prominent in national security affairs. Our assignment: to offer our views on this question: “Is the Senior Service College Approach in Need of Radical Reform in Order to Serve Effectively in the Post-9/11 Environment?”

We each had about twenty minutes in which to make opening remarks. Here are mine:

I feel privileged to be invited to contribute to this worthwhile dialogue, and while I have learned much about Professional Military Education, I want to preface my remarks by saying that I come to you as an interested outsider—a visiting professor from Ohio State, not an expert on PME. Consequently I am going to offer these opening remarks in the form of some personal observations gained from two terrific years at a place that, alas, I must shortly leave.

John Nagl has adorned his presentation with visual aids. I am wearing mine. Those of you who recall the 1960s and 70s will recall an enduring cigarette ad campaign: “Us Tareytown smokers would rather fight than switch.” To prove it, each of those Tareytown smokers proudly sported black eyes. Well, when it comes to the question of whether senior service colleges are in need of radical reform, we all know that there are plenty of people out there who are devoted smokers of the current PME model, would emphatically rather fight than switch, and will not easily be denied.

So there are really two questions here. First, are there compelling reasons to fight those who would rather fight than switch? Second, what would it take to prevail in such a fight?

This black eye has a second use. It looks as if I got it in a fight. I didn’t, unless I was attacked by a towel rack, but in point of fact I have been in fights, and by far the most important of them is underway even as I stand before you today.

Some 25 years ago I was diagnosed with bipolar disorder—what used to be called manic depression. It’s a mood disorder caused by certain abnormalities in the brain’s biochemistry. I mention this because it is relevant to today’s discussion in two respects.

First, I have been here at the Army War College now for almost two years, and they have been two years in which I have found the disorder easiest to manage. I don’t think that’s a coincidence, and I think it says something important about the war college. I’ll get to that later.

Second, an aspect of bipolar disorder is periods called hypomania. These are times when a person like me appears to be, and actually is, more creative and high functioning than usual. Many writers and artists with bipolar disorder consider these hypomanic episodes indispensable to their creativity. I don’t share that view, but I do recognize that during such episodes one has flashes of insight that are perfectly valid. I had such an insight almost twenty years ago.

I’ve spent literally a lifetime immersed in the study of military history and national security affairs and along the way spent eight years in the Army National Guard. What I suddenly realized, in that flash on insight, was how regularly and comprehensively I drew upon that trove of knowledge as a tool for understanding and managing the disorder. I also realized that what I had been doing, in a pre-conscious way, was actually very astute and something that I ought to start doing consciously. So for many years now I have regarded myself as at war with an adversary that will never cease in its attempts to destroy me, either by tempting me to fatal manic heights or by plunging me into a depression so black that I end my life by suicide.

My favorite Clausewitz quote is this: “In war, the best strategy is always to be very strong.” In the context of bipolar disorder, this functions as a reminder to identify and exploit every possible resource for managing the illness. Available resources include medications, on-going therapy, good sleep hygiene, regular exercise, and the support of friends. One indispensable resource is knowledge. What is the nature of this adversary? What means will it use to attack? And since, when it does attack, in the nature of the case I may not be able to judge clearly, how can I organize my life in such a way as to maximize my chance of survival and to make that life as fulfilling as possible?

In the 19th century, military commanders would speak of a “true line of operations”—the logical base from which to pursue a given objective. I have had to consider the question in reverse: In the event I decompensated, where did I want to end up? I reached the counterintuitive conclusion that I wanted to end up in a psychiatric ward. And what I’ve done over the years is to structure my life in such a way that I can conduct a fighting retreat that, if necessary, can only end in that place. If I could sum up in a sentence what my encounters with the military have taught me, it is this: You do what is necessary to accomplish the mission. So basically I have discovered ways by which the very nature of the disorder’s symptoms can be used to propel me to a place I’d rather not go but is actually the safest place to be.

I hope by now it’s obvious to you that this illness has made me into a natural strategist. I habitually think in strategic terms.

One thing I expected to find here at the war college were a lot of natural strategists. It turns out I was dead wrong. Gifted leaders and terrific human beings I have found in abundance, but few of them think like strategists and what is more, few of them want to think like strategists. They have excelled in the tactical and operational worlds, they like those worlds, and they are reluctant to leave them. And most of them are convinced that to get ahead in their careers they probably should not leave it, that the avenue to the best assignments and even to flag rank is strong operational performance. They are convinced of this because the armed forces have convinced them of it. You can plaster “strategic” or “strategy” on every course—Strategic Thinking, Theory of War and Strategy, Strategic Leadership, National Security Policy and Strategy, Theater Strategy and Campaigning, and a capstone Strategic Decision Making Exercise. But you’re not going to make strategists of people by incantation. Strategists are made, not born—rather than “natural strategists” it would be more exact to say “fluent strategists”—but to become fluent in anything you have to want the skill and you have to be convinced of its utility.

(Continued)