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Dr. Maurice Pickard:
Personal recognition of mental illness is a threat to anyone, but does it have added implication to a creative artist? I'm your host, Dr. Maurice Pickard, and you're listening to Book Club on ReachMD.

With me today is the author, Ellen Forney. She is the author of the recent graphic memoir Marbles: Mania, Depression, Michelangelo, and Me. Ellen, thank you very much for joining us today.

Ellen Forney:
I'm so happy to be here.

Dr. Maurice Pickard:
To begin with, why this title?

Ellen Forney:
When creating a book title, or any comic title, really, what I'll do is I'll brainstorm. I'll think about what is it that I want to get across? And for this, there is kind of crazy and there is that creativity. So I brainstormed a lot of, you know, like ups and downs and the mountains and valleys, and just a page of brainstorming, and I got to nuts. I wanted it to be kind of kicky so that you get this sense that it's a fun read, I guess, because the subject, of course, is so serious. So I wanted to draw people in. So I got to words like Nuts. I'm like, "No, that's a Barbara Streisand movie," and Bananas, "Well, that's a little too much," and there is...

Dr. Maurice Pickard:
That's Woody Allen.

Ellen Forney:
Is it? Nuts.

Dr. Maurice Pickard:
No, Banana. Top Banana?

Ellen Forney:
Oh. Oh. And Bananas, right? Exactly. Well, Bananas.

Dr. Maurice Pickard:
Yes, Bananas.

Ellen Forney:
Right. From a while ago.

Dr. Maurice Pickard:
Yeah. Before your time, but not mine.

Ellen Forney:
So I got to Lose Your Marbles. I was like Lose Your Marbles, Find Your Marbles. And I realized, you know, Marbles works, because it suggests your mental health. Whether you lose it or you find it, it's just kind of the topic. And it's also something that we have some familiarity with. It's something that is really neither serious nor funny but somewhere in the middle, and so then I put the more descriptive subtitle, Mania, Depression, Michelangelo, and Me to bring in the message that it's about bipolar disorder. And it brings in artists through history, and so that was how it all wrapped together.

Dr. Maurice Pickard:
Very interesting. Ninety percent of our audience are physicians. What can they gain from reading this story?

Ellen Forney:
I would say from my, especially from my recent experience as a keynote speaker at the Comics in Medicine conference at Johns Hopkins, that one concern that doctors have these days is to really bridge the gap between doctor and patient and rather than have kind of a traditional doctor tells patient what's going on, but to really listen to the patient and then in that way get a more holistic idea of what's going on with the patient and to have more trust built, as well.

So one thing that graphic novels can do is to allow the doctor to really get inside the author patient's head and really know what it is that it feels like. So one of the things about a graphic novel is that there are the words that describe a personal story, first of all, that it's a personal story, and then there are also the pictures that really give a sense of mood and tone. And since bipolar disorder is all about mood, it really kind of ties in that way and is particularly expressive.

When Marbles had just come out, there was a doctor at Penn State Medical School who got in touch with me because he has a Humanities class for seniors in med school, and they read a graphic novel that has to do with a health issue. And they read it, and they talk with the author if possible, and then they do their own comics. And these are people who aren't cartoonists, don't mean to be cartoonists, but find a lot of value in that kind of observation, in that kind of expressing their own experience, getting into the shoes of others.

And that was a really strong experience for me, to know that a graphic novel, and in particular my graphic novel, was being used in a medical school. It was one of my big hopes when I put Marbles out, that it would be useful in a clinical context. I put in a lot of information, very specific information about symptoms and treatments and medications and folding that into a personal story is a way to kind of get a lot of information across, kind of with a spoonful of sugar, you know?

Dr. Maurice Pickard:
Even the side effects that you went into that certainly I saw in my practice. You know, the theme, or one of the major themes, is your fear of losing your creativity if your disease was treated. And certainly, Karen, who was your therapist, sounds like the ideal therapist I would like to have if I have a therapist. One, she was understanding and very knowledgeable, and there was a mixture of psychotherapy and drug therapy. Did Karen use it professionally, since she's the physician that we might identify with?

Ellen Forney:
Well, you know, it's a tricky situation for her, because confidentiality is a priority for her, and she's in it. And I do her not exactly like her, I mean, it doesn't look exactly like her, but it kind of suggests her in a way. You know, it takes place in Seattle. And so she's given it to her patients, but we actually talked about this not that long ago, she really feels like she wants to be able to use it more, but I think it's her own apprehension knowing that she's in it. She was absolutely essential in my putting the book together, both my experience with her, obviously, is a major part of my story, but also my med history, but in particular, supporting me emotionally through the course of putting Marbles together. It was a very, very thorough experience for me, reliving those times that were so painful for me and really untangling a lot of knots and interviewing my friends and family about what I was like at that time in ways that we had never talked about before. So it really was going through a lot of very intense, immersive therapy I'm really glad to have gotten to the other side of, frankly. Its' one of the hardest projects that I've ever done and one of the most satisfying.

Dr. Maurice Pickard:
And if you're just tuning in, you're listening to Book Club, ReachMD. I'm your host, Dr. Maurice Pickard, and joining me today is Ellen Forney. Miss Forney is the author of the graphic memoir Marbles: Mania, Depression, Michelangelo, and Me. You talk about a great deal about the creative artist and its significance in creativity. But you know, there are other fields that are bipolar. Certainly, I've known, whether they have been diagnosed or not, people I thought who were bipolar or manic depressive who were scientists, colleagues, computer programmers. Do you think they also have this fear that if I bring my disease under control that I will lose my creativity or my ability to communicate in whatever field it might be, making this much more of a global thing, which indeed it is?

Ellen Forney:
If you take a look at the possible side effects of any of the psych drugs that we are or might be put on, it's terrifying. In particular, like cognitive stalling...there's a million...of course you don't want that, and it's going to interfere with your sharpness, with your smarts, with your associations that you've gotten really used to. I think it comes into play for anyone. I think there's some fields, also, that are much harder to come out, you might say, as bipolar. I'm an artist, and I think that it doesn't necessarily lower other people's perception of my ability to do my work. Necessarily. We have talked about it, and we'll talk more about what that might do to my creativity, but I think for someone in an occupation like a rocket scientist or a surgeon to come out as having a mental disorder could interfere with their professional work, possibly, more than it might for an artist.

Dr. Maurice Pickard:
You know, you gave such a long list of famous artists and writers, most of whom I was familiar with, but I never knew that they had bipolar disease, and certainly, when I was growing up, there was a singer, Rosemary Clooney, who really became a spokesperson for manic depressives, and it affected her career. You may not remember Mambo Italiano or Come On-A My House. I'm not going to sing them, because I think we'll lose our audience, but do you think being an artist, you're much more likely to have an audience that will become aware of the disease and its implications?

Ellen Forney:
I don't know how many people would assume or jump to the conclusion that there's any mental illness going on. I think it's considered part of the occupation to have a lot of passion and moods and acting out, and that's not really considered a mental illness. That's considered part of the job, which is one of the things that makes it really complicated for people who are bipolar to actually recognize that there might be something wrong. That what is being so tough for them isn't just a part of the profession but is actually something that they might think about evening out.

Dr. Maurice Pickard:
In my experience in watching Jonathan Winters and unfortunately, the tragic death of Robin Williams, I often, although was entertained, often moved by how difficult it must be to whom they were, their gift and how difficult it was to have this gift. Let me ask you this. You talk a lot about, going back to your book, as you struggled with your drugs from Karen, did you sometimes find a conflict using other, so we say, recreational medication?

Ellen Forney:
I think what you're referring to is marijuana use that I was still engaging in during the beginning couple of years of my treatment. You know what? I almost didn't put that into Marbles. I didn't want to...I thought...I came down with all sorts of rationalizations, like I didn't smoke that much and it really wasn't a problem and it would be inconsistent with my character as someone who is fighting as hard as I could to get healthy, but the more research that I did about bipolar disorder in general, and just how calm it is for people with mood disorders to have some sort of substance, something, either abuse or use or struggles, in any case, more than half of sufferers, I guess, and I realized that my own use really needed to go into the book, and that if I didn't, it was a certain denial on my part.

So with much self-understanding and sympathy and not getting too judgmental with myself, I included that in the book and showed that I didn't tell my doctor about it. You know, I think that one of the main things for me is that I felt so controlled by this disease and so controlled by my treatments and what I needed to do and what was good and what I couldn't do any more, and my whole identity as this rebel, artist, seemed to be getting swept out the door, and I wanted to still have something. It was illegal and it was underground, but at some point, I was having trouble with my memory, and I suggested to Karen that it might be the lithium. And as she was looking through my chart to see what my dosage was and you know, what the pattern had been, I realized that I really needed to examine my relationship with pot.

So that was when I admitted that to her, and I cut that out of my array of medications, I guess. You know, one thing that I was also really careful of was to not alienate other people who use pot, in particular recreationally or lightly. The literature and every message that I had gotten up to that point when I decided that I needed to stop smoking was that it's dangerous for abusers and heavy abusers, and I didn't consider myself an abuser. I still consider a certain amount of use, whether it's for medicinal reasons or light recreational reasons, especially now that it's legal in Washington State, where I live. It's just sort of showing that a lot of others think that "Well, it's okay, too, in certain contexts and for certain people." So I wanted to make it clear that I don't think it's something that's necessarily bad for everyone but that there are a lot of us that it is not healthy for and that it's worth examining the risks.

Dr. Maurice Pickard:
Today we talked about a lifelong struggle with bipolar disease with Ellen. Her story and her art is inspirational. And maybe many of us will pause when we look at her last graphic as she brushes her teeth and is able to say, "I'm okay." Thank you, Ellen, very much for joining us today.

Ellen Forney:
Well, thank you so much for having me.

Dr. Maurice Pickard:
This is Dr. Maurice Pickard, and if you've missed any of this discussion, please visit ReachMD.com/Book Club to download this podcast and many others in this series. Thank you for listening.