Double Trouble: The Bipolar Brain 

DSM – 5: Changes in Psychiatric Diagnosis Proposed

It may take a few years to be fully implemented, but suggested changes to the manual known as the “psychiatrist’s bible” could have an impact on many people.

A word of explanation: the Diagnostic and Statistical Manual of Mental Disorders (DSM) is the standard classification of mental disorders used by mental health professionals and contains a listing of diagnostic criteria for every psychiatric disorder.

Version 4 (known as DSM-IV) was published in 1994 and work is well under way for a major revision. A draft of version 5 has recently been published for comment. Two years of field trials will follow, with the final version to be published in 2013

So what are the major changes proposed? Based on an initial study of the draft, here (in no particular order) are a few headlines.

For adults with Bipolar Disorder, there are no major changes planned.

It is proposed to add an anxiety dimension across all mood disorder categories as well as a suicide assessment dimension. A substance abuse severity dimension is also under consideration. These additions might well give a more accurate picture for many people.

But there is a significant change in relation to the diagnosis of childhood bipolar – a controversial area.  Some diagnoses of bipolar disorder have been made in patients as young as two, leading to many children being given powerful antipsychotic drugs, which can, of course, have serious side effects.

It is proposed to add a childhood disorder called temper dysregulation disorder with dysphonia. In simple terms, this would mean that very young children would be diagnosed with a behavioural problem rather than a mood disorder.

And this makes a lot of sense. Quite how you could diagnose a two year old with bipolar is beyond me. Exactly how do you take a history of depression or mania?

Sure to generate debate, the draft proposes diagnosing people as being at high risk of developing some serious mental disorders - such as dementia or schizophrenia - based on early symptoms, even though there's no way to know who will worsen into full-blown illness.

It's a category that must be used with caution, as scientists don't yet have treatments to lower that risk but also don't want to miss people on the cusp of needing care. But this must be balanced against the possible stigma that a diagnosis may lead to.

The Mood Disorders Workgroup is considering whether Premenstrual Dysphoric Disorder (PMDD) should be a separate and distinct disorder from mood disorders.

It is suggested that several disorders with a high likelihood of future tabloid use be added. One, a new description of s*x addiction, is “hypers*xuality,” which, in part, is when “a great deal of time is consumed by s*xual fantasies and urges; and in planning for and engaging in s*xual behaviour.”

Another is “binge eating disorder,” defined as at least one binge a week for three months — eating platefuls of food, fast, and to the point of discomfort — accompanied by severe guilt and plunges in mood.

The category “Addiction and Related Disorders” would replace “Substance-Abuse” and “Substance-Dependence”, and could include non-substance addictions, such as gambling.

There has been some debate about whether internet addiction should be included, but it is likely to be left out as there is currently no clear definition of exactly what it would comprise.

There have been proposals to eliminate Asperger's syndrome as a separate disorder, and instead merge Asperger’s under Autism Spectrum disorders. There have been mixed responses on what is likely to be a controversial move and to generate much debate.

And the phrase "mental retardation" is to be removed - the new term is "intellectual disability."

These are just some of the headlines. The debates are only just beginning. And there is a long way to go yet until the final document is published.

More details of the process can be found at http://www.dsm5.org/

Can Andy Murray Win Down Under?

Back in September, I wrote an article for a new online magazine called La Vie (http://www.la-vie.co.uk/) about Andy Murray’s ultimately unsuccessful quest to win the US Open.

I finished said article by predicting that 2010 could turn out to be the Scot’s year – and here he is in the final of the very next grand slam.

It has been a fine display from Murray so far in the heat of Melbourne. His first four opponents were disposed of without the loss of a single set; a relatively easy route to a quarter final clash with Rafael Nadal.

In an eventful match, Murray took the first set and then went two up by winning a tie breaker, after fighting back from being a break of service down. Murray was 3-0 in the third set when a knee injury forced the Spaniard to retire. The injury may have hampered Nadal to some extent towards the end of the match, but that does not take away from a very good performance by the Scot.

The semi-final saw Murray take on the big serving Croat Marin Cilic – the man who had ended his US Open dreams. And the contest started badly, with the Scot losing his first set of the tournament. But he gradually began to come to terms with the power game of his opponent and levelled the match. As the Croat tired, Murray became even stronger, taking the next two sets to reach his second career Grand Slam final.

So will Andy Murray become the first Scot to win a Grand Slam tournament, and the first British man to win one since Fred Perry in 1936? He could not have a tougher test than to face the brilliant Roger Federer; a man who has already amassed 15 career Grand Slam singles titles – more than any other man.

Murray definitely has the game to win this one: after all, he has beaten Federer in six of their ten previous encounters. But will he have the mental strength to do it in the biggest match of his career so far. Federer, quite naturally, has tried to raise doubts in Murray’s head.

“I think he really needs it more than I do, so I think the pressure's big on him," said Federer. "But we'll see how he's going to handle it. It's not going to be easy for him, that's for sure."

Murray, however, remains confident that he can make the leap from top player to Grand Slam winner.

“There's a lot of pressure in Slam finals and he's going to have the edge in experience”, he said. “It will take a special performance to win against him, but I feel like I can do that."

So can Murray come up with that special performance? I’ll be watching early on Sunday morning to find out. Go Andy!

Lacey Turner's Award for Bipolar Portrayal

Some months ago I wrote about the excellent acting performance of Lacey Turner in the soap opera Eastenders, where she portrays Stacey Branning, a young woman with a diagnosis of bipolar disorder.

It looks like I was not the only one to impressed: Lacey has just won the award for the Best Serial Drama performance at the National Television Awards.

She also deserves immense credit for helping to raise public awareness of the condition. And this is demonstrated by the increased number of young people who are now seeking help, which has been reported by the BBC.

To recap, Stacey has long been carer to her mother, Jean, who also has bipolar disorder. But then Stacey began to display her own symptoms and was eventually hospitalised after a major episode. She comes out of hospital and tries to come to terms with her diagnosis, which of course is not easy.

More difficulties follow and Stacey responds by stopping her medication. This, of course, leads to another spell in hospital.

And now Stacey is pregnant. This gives both an opportunity to develop the story further and for viewers to gain more information about the condition. There are of course a large number of considerations for new mothers with a mental health issue: medication, hormonal changes and the risk of post natal depression amongst them.

As an aside, Bipolar Scotland (of which I am now Chair) is currently planning a seminar on prenatal services.

So, again, I applaud the BBC for giving us this storyline. Tackling the stigma still associated with mental illness is not easy, and every opportunity to show the real story is welcome.

And of course big congratulants to Lacey on her latest award.

I don’t normally watch soaps but will be following this one with interest!

Farewell George Burley - Now Who Wants a Poisoned Chalice?

The recent 3-0 defeat to Wales in a meaningless friendly saw Burley’s two year tenure end with a whimper rather than a bang. But Burley has been on borrowed time for months and the decision to dismiss him was about as predictable as an X Factor contestant being number one at Christmas. 

George Burley, former Ipswich Town and Scotland defender, took charge of the national team, in January 2008. His appointment was badly handled by the Scottish Football Association (SFA), with one contender for the post stating that he was never told that his application had been unsuccessful. Hardly the most auspicious of starts.

On the field, a number of friendly defeats and an ultimately unsuccessful World Cup qualifying campaign left Burley with a record of only three wins in fourteen games. Poor even by the low standards set by recent national bosses. But there were factors outside the manager’s control that perhaps go some way to mitigating that record. 

Firstly it has to be said that he had a pretty poor group of players at his disposal. Back in the seventies and into the eighties, every successful English club would have Scottish stars amongst its players. The likes of Bremner, Law, Dalglish and Jordan were Scotland regulars. Who are the stars of today? Darren Fletcher at Manchester United? Is there even a single Scot at Arsenal or Chelsea?

Secondly, Burley had to cope with a number of players becoming unavailable to him for various reasons. Petulant overpaid “stars” feeling unloved decided to turn their backs on Scotland. His captain and goalkeeper were dropped for disciplinary reasons following an all night drinking session. And a succession of injury call offs weakened his squads, with in almost every occasion the players exhibiting remarkable recoveries and turning out for their clubs only days later. 

Thirdly, his bosses at the SFA badly mishandled the scheduling of the World Cup qualifying campaign. An away tie with Macedonia was arranged in the heat of September and Scotland visibly wilted. A vital tie in Norway took place before the start of the league season, giving a great advantage to the opponents, many of whose players were in the middle of their season.

But ultimately it is the manager who must take responsibility for results on the pitch. The buck stops with him.

Yet again the handling of the situation by SFA chiefs left a lot to be desired. There were media calls for Burley to be sacked on failing to qualify for the World Cup Finals. The SFA decided to back him, stating that he was to be given the chance to rebuild, a decision that I agreed with at the time. Creditable performances in the last two games had shown some signs of promise for the future.

A couple of friendly matches later, the team has apparently not shown sufficient improvement. To me, that seems a ridiculously short time to revitalise a squad of players after a failed qualification. And of course an international manager cannot simply go out and spend to improve his squad. He has to work with the players he has available, and that takes time. But that is exactly what Burley has not been given.

So Scotland is seeking a new manager. But who will be willing to take on the job? It pays much less that a club management role and doesn’t afford the day to day coaching that many modern managers love. And a poor squad of players, media ridicule as a response to any setbacks and unrealistically high expectations from the supporters can be expected as part and parcel of the task. A poisoned chalice awaits.

The early favourite for the post is Craig Levein, manager of Dundee United. Young and articulate with a reputation as a fine coach, he has many of the qualities required. But would he leave a full time club position for the much less involved life of an international manager? And he has had several high profile run ins with SFA chiefs in the past.

Rangers manager Walter Smith is the only other short priced candidate at present. But would the SFA be willing to appoint a man who had previously held the post before walking out in the middle of a qualifying campaign to return to Rangers?

It is well known that Smith’s club side is in a financial mess with massive debts and an owner who cannot sell his shares. Smith’s current contract runs out in January 2010, and he may desert the sinking ship at that point. Now, the SFA has announced that it will wait until next February to announce its new manager. Coincidence or the basis for a good conspiracy theory?

It is perhaps noting that Scotland are currently ranked as number 46 in the international rankings. To put that into perspective, teams ranked higher include Costa Rica, Honduras, Algeria, Egypt and the Ivory Coast, not exactly traditional powers in the game.

Perhaps one of the requirements on the person specification should be possession of a magic wand?

God and Guns

God and Guns is the first new material from southern rock super group Lynyrd Skynyrd in six years. This is the twelfth studio release over the band’s tumultuous history, and it is a decent offering, even if it doesn’t reach the high standards that the band has previously set.

Recently inducted into the Rock n Roll Hall of Fame, Skynyrd is best known for a three guitar sound that gave such lasting Southern anthems as Sweet Home Alabama and Free Bird, which still features near the top of every list of the greatest ever rock songs.

The band was formed in Florida in the late 1960s by Johnny Van Zant and Gary Rossington but did not come to prominence until the 70s. Their patented fusion of rock, blues and southern country music, mixed with lyrics based on the philosophy of the South gave them a massive hardcore following and a reputation as one of the hardest working and best live acts on the circuit.

But in 1977, just days after the release of their fifth album, a plane taking members of the band from Greenville, South Carolina, to Baton Rouge in Louisiana crashed killing Ronnie Van Zant, guitarist Steve Gaines and his sister Cassie Gaines. The surviving members immediately disbanded the group.

It was 1987 before Skynyrd reformed, with Johnny Van Zant, younger brother of Ronnie, taking over as lead singer and primary songwriter. The band has continued to tour and record since, although tragedy has never been far away. Several members of the band have since died and legal issues with the widows of Gaines and Ronnie Van Zant have also been problematic. Rossington is now the only original member left in the band.

The new album opens strongly with the single, Still Unbroken, a defiant tribute to the band’s former members and indeed to the longevity of the band itself. It is a heavy track, so don’t expect to hear it too often on mainstream UK radio.

Other highlights are Southern Ways, perhaps the nearest to a classic Skynyrd track and Unwrite That Song, a slower, country tinged song of sadness with a story of unrequited love. Those apart, the CD tails off into mediocrity.

But the centrepiece of the album is two overtly political tracks that set out what might be seen by British audiences as a rather right wing, redneck philosophy, although it will undoubtedly play well in the American South. Guitarist Rickey Medlocke stated on the band’s website, "We've never been a political band, but if you listen to the lyrics, you'll know where we're coming from".

That Ain’t My America attacks the nation’s PC agenda, and in particular smoking bans, calling for a return to simpler times, with the narrator telling us, ”You know I still bleed red, white and blue.”

And the title track is even more explicit:, with the refrain, “God and guns keep us strong/ That’s what this country was founded on”. It finishes with a plea for opposition to the perceived progressive agenda: “Don’t let them take our God and guns.”

The final song of the album proper is Gifted Hands, a tribute to fallen keyboard player Billy Power. Ironically, this excellent hard rocker includes the best guitar solo of the collection.

The de luxe version of the CD comes with an additional disc featuring three additional outtakes and three live tracks, including a fine version of Sweet Home Alabama. But this closing blast of vintage Skynyrd simply puts the newer offerings into something of a shade in comparison.

Overall this is a fair collection of country rock songs, with the occasional sprinkling of the band’s hard rocking past. It may not be a vintage Lynyrd Skynyrd album, but fans of southern nock will no doubt enjoy it anyway.

Healthy Body, Healthy mind?

You don’t have to be some sort of Eastern guru to realise that the health of the body and the health of the mind are linked. But can a healthy body really have a positive effect on the life of someone with a mental health issue?

Getting fit can’t cure a mental illness. It would be crazy to suggest that. And I honestly believe that there has to be a role for medication in managing conditions like bipolar disorder for many people. Some seem to manage to control their conditions fairly successfully without the use of pills, and good luck to them, but I don’t think that approach works for everybody. And of course no one should stop taking any prescribed medication without seeking medical advice first. 

Over the past couple of years I’ve taken quite a few steps to improve my physical health, and I can say that it has definitely had a positive impact on my mind. I know that one person doesn’t exactly constitute a scientific study, but my own experience is what I know best! 

Firstly, I gave up drinking. Well, I had to really or I probably wouldn’t be alive now (which is a whole other story). Next was increasing the amount of exercise I take. OK, it was zero so probably taking some exercise is more accurate. But I’m now in the habit of going to the gym three times a week and I actually do feel much better for it. I’ve also made considerable changes to my diet. Out are sweets, snacks and takeaways; in are low calorie alternatives, fruit and vegetables.

The net result of these changes is a weight loss of 30kg (that’s 66 lbs in old money) so far. And I am certain that my new regime has played a part in my condition being relatively stable in recent times. 

Now comes the technical bit.

A chemical called Serotonin (5-hydroxytryptamine to serious scientists) is a neurotransmitter in the brain. Serotonin appears to have some control over appetite, sleep, memory and learning, temperature regulation, mood, behaviour, cardiovascular function, muscle contraction, endocrine regulation, and depression. It’s pretty important then! 

In very simplistic terms (and I’m not a neurobiologist!) low serotonin levels will generally mean depression. And many anti-depressants simply work to increase the serotonin levels within the brain. What does the second S in SSRIs stand for?

But most of the serotonin receptors in the body are actually located in the gut.  

When I first head that fact mentioned in a talk by Dr Liz Miller at the recent Bipolar Fellowship Scotland conference, I was amazed. I had always associated it purely with the brain. But Liz, of course, is 100% correct.

And that means the food we eat has an effect on our body’s serotonin levels. It’s why chocolate can have a short term feel good effect! But for a more lasting impact, it means that a well balanced diet can lead to better mental health – and that’s a scientific fact! 

A great book that gives far more details on this is The Good Mood Diet by Wurtman and Marquis. Check it out here:

Amazon - The Good Mood Diet 

So there we have it. A healthy body can indeed help towards a healthier mind.

Myths and Stigma

Living with a mental health problem isn’t easy. Indeed, some days it seems downright impossible.

But it is made worse by attitudes that still exist in our society. We are a little better at being tolerant than we used to be, but even in the twenty first century there are still some very nineteenth century views of mental illness out there.

There are many myths about people with mental health issues that can create stigma. Myths about mental health are often incorrect and portray a very negative image of those suffering from a mental illness

This can stop people getting help when they need it, or prevent them talking openly about their problems. It can also make people feel guilty, isolated or ashamed if they become unwell. The reasons for this stigma vary but it seems that a general lack of understanding contributes – many people seem scared by the whole subject of mental illness.

Here are some of the common myths:

Only weak people have mental health problems.

What about Winston Churchill, Theodore Roosevelt or Buzz Aldrin? They all suffered from bipolar disorder and achieved a great deal in their lives.

Psychiatric disorders are not true illnesses like heart disease or cancer; people who have a mental illness are just "crazy."

Unlike cancer or heart problems, easily detected by simple tests, mental illness has always been an invisible disease. This inability to see what's wrong may add to the negative public perception, and even fear, of mental illness. But mental illnesses are bona fide medical conditions. They involve complex physiological processes, as well as changes or imbalances in brain chemistry,

Mental health problems are for life.

Not always true. While some people may experience problems over a long period, very many people may experience a single episode of illness. This is as true of schizophrenia as it is of depression. People can and do recover from mental health problems.

You brought it on yourself so pull yourself together.

There are many factors that can contribute to someone becoming unwell and most are outwith an individual’s control. You can no more simply decide not to have a mental illness that you can decide not to have cancer.

People who have mental health problems are stupid.

Totally untrue. Dickens, Byron, Hemingway and Van Gogh all had bipolar disorder. And medical evidence shows that those with the disorder generally have IQs that are well above average.

People with mental health problems are violent.

Sensationalist media reporting perpetuates this myth but the sad truth is that people with mental health problems are much more likely to harm themselves than anyone else.

People with mental health problems are weird and different.

The majority of Scots say they know someone close to them who has been diagnosed with a mental health problem at some point - that’s a awful lot of weird people!

All people who suffer from depression are suicidal.

Suicide is not a mental illness. Not everyone who is depressed will consider suicide. It is as inaccurate as saying that all football fans are hooligans. However it is true to say that individuals experiencing a mental health problem are, generally, associated with a higher risk of suicide.

People are born with mental illness.

Increased risk of mental illnesses can be hereditary; however many people will still develop mental illness even if there is no family history of it. Many factors can cause the onset of a mental illness.

In Scotland an alliance of five leading mental health organisations runs the ‘see me’ anti-stigma campaign. It aims to tackle stigma and discrimination against those with mental health issues through a programme of public information. You may well have seen adverts in the press or on tv.

For more information about ‘see me’, visit the website at www.seemescotland.org.uk

81% of people with lived experience of mental ill-health told ‘see me’ that they had experienced stigma, and yet nearly half of the public thinks that people with mental health problems have the same rights as anyone else.

Most of us will come across mental illness somewhere in our lives. According to ‘see me’, nearly two thirds (61%) of Scots know someone close to them who has experience of mental ill-health.

Changing attitudes won’t cure the mental health issues that many of us live with every day. But it can make our lives just that bit easier – and that has to be a good thing!

Diagnosis

Someone recently asked me what it was like to be diagnosed with a mental illness aged 42! A very good question.

Many words came to mind immediately as I thought back: confusing, frightening, bewildering, upsetting, perplexing and downright scary amongst them.

But over a couple of weeks, spent in a locked psychiatric ward in New York City I began the process of coming to terms with my diagnosis. And now, more than two years on, I think I can now make some sense of the experience.

There is a theory which describes the five stages of grief, first proposed by the Swiss psychiatrist Elisabeth Kübler-Ross. It describes, in five discrete stages, a process by which people allegedly deal with grief and tragedy, or with other major life events

Kübler-Ross claimed these steps do not necessarily come in order, nor are all steps experienced by all patients, though she stated that a person will always experience at least two

The stages are Denial, Anger, Bargaining, Depression and Acceptance. On reflection, I think that these stages are a pretty good description of what I went through.

Denial – This can’t be happening to me. Surely I would have known by now if I had a mental illness? It’s a mistake. It just can’t be true.

Anger – Why me? What did I ever do to deserve this?

Bargaining – This is probably the one I skipped. Many people try to make a pact with a higher power: give me time and I will live a good life. Perhaps as an atheist this simply didn’t occur to me.

Depression – Now this one lasted a while. My life as I knew it is over. I won’t be able to cope. Another episode could happen at any time.

Acceptance – Finally, somewhere around two years later I think I managed to reach a state of acceptance. I have a condition, but it can be managed to an extent. I know I need to lead my life differently, avoiding the triggers and watching for the warning signs. But it’s not the end of the world and I can still lead a productive life.

I think having time in hospital when I was diagnosed was very helpful. It gave me the opportunity to think without the stresses of everyday life, and to decide on many changes I had to make.

Being diagnosed with a mental illness is clearly a major trauma. But it doesn’t have to mean that your life is over.

EastEnders and Bipolar Disorder

For those not in the UK, or anyone who has been on the moon for the last 20 years or so, Eastenders is a BBC soap opera shown at peak evening viewing times. And almost since the first episode it has been one of the most watched programmes on British television.

It has a reputation for being gritty, at times depressing, and for an approach of “social realism”, tackling subjects not usually seen in soaps, including drugs, cot death, homophobia, HIV, euthanasia and child abuse.

In recent months it has become clear that the character Jean Slater has bipolar disorder. Jean, a middle aged woman with two children, had been featured occasionally over a few years, but has only recently become a regular in the show.

While I was delighted at the exposure that bipolar disorder was given, I have always had my reservations about the character of Jean. She comes across as very nervous, almost neurotic and unable to cope with life. She is a figure of pity to many of the regulars and every storyline she is involved in seems to show her being ill.

Of course those of us with bipolar do have episodes of illness, mild and severe. But we also have long periods of stability, where we live full and productive lives. My concern with Jean is that she never seems to have these periods of being well.

Many people have asked me my view on Jean’s character, and I always say that while I know many people with the diagnosis, I have never met one who behaves like Jean. It is, for me, a very unsympathetic portrayal of someone with bipolar.

But Jean does have some powerful scenes and simply showing those on mainstream TV does help to break down the barriers surrounding mental illness.

The situation has changed over the last few months. Jean’s daughter, Stacy, a streetwise and feisty teenager, has shown growing signs of becoming ill. Unable to come to terms with the death of her best friend, Stacy falls into despair. But then she starts to drink heavily, goes on extreme spending sprees, behaves erratically and embarks on a series of ultimately unsatisfying one night stands.

In other words, she has exhibited the classic signs of the depression and mania that make up bipolar disorder.

Jean, of course, recognises the symptoms, leading to feelings of guilt that she has passed the condition on to her daughter. And there is scientific evidence that there is a genetic component to bipolar disorder.

The situation has led to a complete reversal in the relationship between mother and daughter. For many years, Stacey has been her mother’s carer, but now Jean attempts to persuade her daughter to seek help. Stacey, of course, refuses, stuck in her own denial.

She does get as far as talking to a psychiatrist, who diagnoses bipolar disorder very quickly. (Too quickly to be realistic, really, but I suppose we should grant some artistic license.) But Stacey runs away before she can be admitted to hospital – and that’s where the story stands right now.

As a character, Stacey is far more sympathetic than her mother. She has had her wild side and her dark moments, but then what teenager doesn’t? And the clear message is that bipolar disorder can hit anyone; with the devastating effect on Stacey’s life increasingly clear for all to see.

So well done to the BBC for featuring a storyline on bipolar disorder. I hope that many viewers now know more about the condition than they did, and will have a better insight into what many of us live with.

And well done to Lacey Turner, the actress who plays Stacey, for a performance of depth and substance that belies her youth. A truly fine display of acting indeed.

I will be watching with interest to see what happens next!

Bruce Springsteen, Glasgow, 14 July 2009

Over the years I’ve seen Bruce Springsteen live almost fifty times, starting in Newcastle in 1985. I’ve travelled all over the UK and even to the USA for shows, spending a fortune along the way. Obsessive? Perhaps, although I don’t regret a single trip.

But only once before have I seen Bruce live in my home town. That was in 1993 and while it was a great show, he didn’t play with the E Street Band. Every tour since I’ve waited eagerly for UK dates to be announced, but there has not been a single Glasgow show since.

So when this summer’s dates were announced I was ecstatic to see that Bruce was returning to Glasgow after a sixteen year wait.

Finally the day of the show came around. I had set my alarm to get there really early, but was wide awake long before it was due. I arrived at Hampden Park, just two miles from my home, before 6am – and there were over 100 people already there!

It was a long day, passed by chatting with friends and acquaintances from other shows and dodging the July showers. Don’t you just love Scottish weather? The doors finally opened at 5:40pm and I secured a spot near centre stage with only one person in front of me. Not bad, considering there were around 50,000 at the show.

Nils Lofgren was first on stage, playing Flower of Scotland on the accordion as the rest of the band took their places. Bruce arrived last, as befits The Boss and crashed straight into Badlands. And there wasn’t much talk over the next three hours, just non stop rock.

I’ve reviewed a lot of Bruce’s shows over the years and frankly I’m running out of adjectives and superlatives to describe the incredible levels of performance. High energy, slick and immensely professional come immediately to mind, but they don’t do justice to the legendary E Street Band. Thirty plus years of playing together has honed a tight knit band which knows Bruce’s every move. In my opinion, there is simply no better live show in all of rock n roll.

The set list was along familiar lines for anyone following the current tour, mixing new songs with classics and a few surprises along the way, all delivered with Bruce’s usual passion and showmanship. His energy is almost superhuman, especially for a man of 59 years old.

My personal highlights were Outlaw Pete, a song from the latest album fast making a bid for inclusion on the list of live classics, a tender rendition of The River and a rare full band performance of Incident on 57^th Street from the 1973 second album.

Other requests, selected by Bruce from among signs collected in the front part of the audience, were the rare Pink Cadillac and Cover Me, another song not played nearly often enough.

The show closed with sing along favourites Bobby Jean and Dancing in the Dark, followed by a raucous version of Twist and Shout. By this time the crowd was ecstatic, expending the last of its energy and contributing fully to the incredible atmosphere. The band finally left the stage to thunderous applause after a show lasting just over three hours.

All in all it was a great day out. And hopefully the next Glasgow show will be somewhat less than sixteen years in coming around.

Of course, as well as the fun of seeing my favourite band in my home town, there was the bonus of a very short journey home – which is why I am able to post this an hour after the show ended!

As we say in Scotland, haste ye back, Bruce.

Bipolar Disorder: Diagnosis and Self Management

Bipolar Disorder is a very difficult condition to diagnose. There are no biological markers that can be tested for, nothing to be found in the blood, no signs that will show up on scans or MRIs. A diagnosis can only be made on the basis of a psychiatrist’s interpretation of what the patient reports.

There are two components to bipolar disorder: depression and mania, or lows and highs.

Diagnosing depression is the easier part of the equation. We are likely to go to the doctor’s if we are feeling down, losing appetite, sleeping too much or too little. And most people understand in general terms exactly what depression is.

Diagnosing mania is the more difficult factor. Who goes to the doctor complaining of feeling good or of being productive and creative? It is only when mania gets totally out of control that you may realise something is wrong, or more likely that someone else notices for you.

And all of this means many people with bipolar are likely to be wrongly diagnosed initially as having depression. Anti-depressants are therefore likely to be prescribed, which alone can force someone with bipolar to go high.

It can take a staggering 10 years before a correct diagnosis is made. And this also means that the patient won’t have the correct information to make informed choices about how best to live with the condition.

Drugs are one part of the solution for many people with bipolar. But equally important are the lifestyle choices we make and the awareness of our own condition that we can develop – and this is what we call self management.

Being as physically healthy as possible will, of course, help your mental health. A good diet, exercise, relaxation and regular sleep patterns can all assist in staying well. That’s not exactly rocket science – although it can be easier said than done!

Allied to this is the awareness of exactly how bipolar affects each individual differently and of what factors can make the condition worse. What are the triggers that can set you off? What sort of situations is it best to avoid? And what are the early warning signs that show an episode of depression or mania may be on the cards for you?

It can take time to learn to read your own condition properly. But there are techniques that can assist in raising self awareness.

I am currently involved along with colleagues from Bipolar Fellowship Scotland in redesigning materials for a Self Management Training course. Over an intensive three day period we introduce the concepts, teach the techniques and hopefully leave the participants with a set of tools that will allow them to manage their condition more effectively.

And external evaluation of sessions carried out to date has been very positive.

It can be very difficult to come to terms with a mental health diagnosis, especially if it happens later in life. I was 42 when told that I had bipolar, and shock does not begin to describe how I felt.

But the extremes can be controlled to some extent if you know how to do it. Self management is basically the key to leading as healthy a life as possible for someone with bipolar disorder.

Hard Rock Calling, Hyde Park, London, 28 June 2009

London’s Hyde Park was again the setting for this three day festival. The Killers and Neil Young were the headline acts for the first two days, with Bruce Springsteen closing the festival on Sunday night.

Springsteen was, of course, the primary draw for me. I’ve been a fan for around 30 years, and have seen close to 50 shows in that time. In fact this was the fifth different Bruce venue for me in London alone. But there were other bands on the line up I was interested to see and I have been looking forward to this trip for a couple of months now.

I took a whole bunch of photographs, which you can see on my Flikr page – link on the right.

I arrived in the park at 7am on Sunday morning after a short walk from my Paddington hotel. A tad early perhaps, but I was number 71 in the line that had been started the previous night! I’m not a great fan of festivals, or indeed large stadium/ arena type shows in general. For me the only way to make it worthwhile is to arrive very early in order to get a place near to the stage. The alternative is standing well back and watching on the big screens, which is no fun. That’s much the same as sitting at home and watching on tv, but with less comfort.

At least the weather was good, very good in fact. From the early hours the sun was beating down and except for one brief shower it continued to be glorious all day.

Five hours or so of sitting in the sun and mingling with Bruce fans was a very pleasant way to spend a morning. Around 12:30 we were finally allowed through the barriers and the mad dash to the stage began. I’m not the fastest of runners, but it was at least 300m and so stamina was more important than speed. I was delighted to capture a spot on the barrier very close to centre stage.

And then it was back to waiting for the show to begin.

The planned start time was 2pm and the first act was there ready to go, right on time. The crews actually did a superb job all day of clearing the stage between acts and building a new set up in record time. The whole day ran exactly to the schedule, which isn’t at all easy to do.

First up were Jean Beauvoir and Micki Free: two names I had heard of but wasn’t really familiar with. They made a contrasting pair visually: Beauvoir tall and dressed all in black, top hatted and elegant., and Free shorter with flowing scarves and a white Strat, an image that simply screamed Hendrix. And the highlight of their short but entertaining bluesy set was a cover of Voodoo Child.

Next on stage was Gaslight Anthem, a young, four piece New Jersey rock band that has quickly established a very fine reputation. I love their second album and was really looking forward to seeing what they can do live for the first time. And I wasn’t disappointed. Their brand of high tempo Jersey shore rock n roll really electrified the crowd. The set was mostly selected from their most recent album and from the number of people singing along it is obvious that they have quickly gained a fan base in the UK.

It is well known that Springsteen has assisted in Gaslight Anthem’s rise to prominence and has guested with them several times. So when the “Bruuuuuce” chant came from the crown, frontman Brian Fallon merely smiled and responded with, “Ask and you shall receive!” The great man then joined him on stage for an energetic duet on “The '59 Sound”, the title track of the Gaslights outstanding album.

An excellent set was enthusiastically delivered by a band that clearly loves playing live, although they could have done with much longer than the forty minutes they had been allocated. The crowd was now really getting into the mood.

Unfortunately, James Morrison came on next to kill the momentum of the day. His brand of slightly down tempo pop simply didn’t fit into an otherwise rocking line up. Not his fault of course; more a very bad piece of scheduling by the promoters. It really was a case of the wrong man on the wrong stage at the wrong time.

Morrison’s backing band comprised of guitar, bass, drums, two keyboards, two backing signers and a three man brass section. But his voice simply wasn’t powerful enough to dominate a sometimes chaotic background. His songs all sounded very similar, and frankly most people around me seemed bored long before the end of his set. Overall I guess it was nothing more than fifty minutes of my life I that will never get back.

The Dave Matthews Band had the task of livening things up again, a job they did reasonably well. They had a lot of enthusiastic fans mixed into what was largely a Bruce crowd and their 75 minute set was generally well received.

While they are clearly excellent musicians, especially the guy playing a very strange looking electric violin, I wasn’t convinced by Matthew’s voice, or his rather strange brand of dancing and gyrating. Think embarrassing uncle at a wedding.

Their music was a series of fairly formulaic three minute songs that were inexplicably extended to at least eight minutes each. There was even a lengthy drum solo, a real 70s throwback. And the set ended with an odd version of All Along The Watchtower which had a couple of verses of Stairway to Heaven thrown in midway through.

Matthews’ fans were obviously thrilled with his performance, but I don’t have any great desire to see them play again any time soon.

At last the final stage changes were made and the familiar elements of the E Street Band’s set were in place. Roy’s piano, Charlie’s keyboards and the Big Man’s throne were all there.

Bruce Springsteen and the band took to the stage shortly after 7pm and for the next three hours they owned Hyde Park, if not the whole of London town. Bruce doesn’t use support acts and this was the first time I had ever seen him play after other bands. Frankly everything that had gone before was made to look like amateur hour compared with the slick professionalism and excellent musicianship of the legendary E Street Band.

Springsteen as always blended old songs with new with his own inimitable brand of rock n roll star meets revivalist preacher, delivered with all the showmanship and stagecraft he has built up over his long career. His energetic playing, strong vocals and frequent forays down to the front of the crowd were nothing short of incredible for a man in his sixtieth year. The Boss was in charge and everyone knew it.

He opened up, appropriately enough, with a cover of the classic Clash track London Calling, moving seamlessly onto Badlands, a classic of his own. Already the atmosphere was electric, just two songs in, with the crowd pressing forward to get nearer to the stage and a forest of fists pumping as thousands sang along with every single word.

There is simply no finer spectacle in the world of rock music than Bruce and his band doing what they do best and performing at the very top of their game.

The set simply tore along at breakneck pace, with favourites from the back catalogue like She’s The One, Night and The Promised Land blended with Outlaw Pete and Working On A Dream from the most recent album.

Highlights for me were a beautiful tender rendition of Racing In the Streets, an energetic Rosalita and Nils Lofgren’s incendiary guitar solo on Youngstown that can only be called downright brilliant.

There were no real surprises on the set list, with most songs played having been on the regular rotation in recent shows. There were not even any rarities among the requests, which Bruce chose from the many signs he collected from the front of the audience, although Jungleland, one of my favourites, was the last to be selected. It isn’t so much a song as a full blown symphony and it was delivered with all of the considerable feeling and passion at Springsteen’s disposal.

The three hour set closed with Glory Days and Dancing In The Dark, both exuberantly performed to a crowd now whipped into a frenzy. Finally the band left the stage to rapturous applause from the breathless fifty thousand strong crowd, who all knew that they had just witnessed something very special.

Overall, it was a great day out in London. Hyde Park is a fine venue for this sort of occasion and the organisation was of a high standard rarely seen at major musical events. Rock n roll in the sun: does it get any better than that?

I’ll be looking out for next year’s line up, and a trip back to London is a real possibility, depending on the line up of course. But if Bruce is on the bill, count me in right now!

Still, it’s only a couple of weeks until the Springsteen bandwagon rolls into Glasgow. After travelling all over to see Bruce do his thing it will be great to have a show in my home city for a change. And Hampden Park is only two miles from my house.

Football's Confederations' Cup: A Review

What is football’s Confederations Cup, you may ask? Well basically it is a competition involving the champions of all of the geographical confederations, such as Europe, South America, Africa, etc.

This year’s competition was especially important as it is being held in South Africa, which next summer will host the first World Cup ever to be held on the African continent. This is something that many prominent footballing figures have long campaigned for, as well as being an obvious opportunity for the Rainbow Nation to shine on a world stage.

So this Confederations Cup served as a rehearsal for the big one next summer. And the South African authorities were keen to put on a good show.

Eight nations were involved, split into two groups of four teams, with the top two from each group qualifying for the semi finals.

Group A involved European champions Spain, the hosts South Africa and the two outsiders, Iraq and New Zealand. All went to form with Spain winning their three games easily and scoring eight goals without reply, while South Africa also qualified for the next round. New Zealand were disappointing and Iraq didn’t manage a single goal, displaying an extremely negative approach throughout.

Group B boasted perennial fans favourites Brazil, an aging Italian side plus outsiders USA and Egypt. And this was the group that provided the greater excitement.

The first round of games saw Italy overcome the USA 3-1 after falling behind and then Brazil overcame Egypt 4-3 in an amazing game that ended with a controversial last minute penalty. Brazil then beat the USA comfortably, but the athletic Egyptians shocked the Italians with a single goal victory.

So the final round of games kicked off with Brazil already through to the final stages, but with the three other teams all on equal points and all with a chance of joining them. By half time Brazil were three goals up on the Italians while the USA were one up on the Italians. And the Americans scored two more goals in the second half, eliminating the Azure with an incredible six goal turnaround that no one expected.

The first semi final saw surprise package the USA taking on Spain, ranked the best team in the world, unbeaten in 34 matches and firm favourites to make the final. But despite a great deal of Spanish possession, two goals from defensive errors scored by Altidore and Dempsey saw a hardworking American side pulling off the biggest shock in world football for several years.

The New York Times, not a paper that routinely covers football (or should that be soccer?) was moved to carry the story on its front page. The report called the result “a miracle on grass” and “probably the second-biggest upset by any American team, behind only the 1980 “Miracle on Ice” by the hockey team over the Soviet Union in the Olympics.”

The second semi final saw the home nation facing up against the Samba stars from Brazil. But there was not to be a second major upset.

For 86 minutes the tactically astute and hardworking South Africans stifled Brazil, harrying and chasing, and refusing to allow them to settle into their normal passing rhythm. But then they committed the cardinal sin of giving Brazil a free kick on the edge of the box. Substitute Daniel Alves had clearly read the script and he unleashed an unstoppable shot into the corner of the net for the winning goal. Heartbreak for the home fans who nevertheless cheered their heroes off the park, recognising the mighty effort they had put in.

The Confederations’ Cup final was the classic sporting contest: favourites Brazil, a team with a rich footballing history and a string of tournament wins against the underdogs from the USA, a nation with no real footballing history.

Although Brazil had much of the early possession it was the Americans who took the lead through Dempsey. Brazil made a string of chances but were denied by goalkeeper (is that goaltender for US readers?) Howard. And unbelievably the underdogs scored again, this time through Donovan after a sweeping counter attack. 2-0 it was at half time and the footballing world was looking at a major upset.

But if any team in world football is capable of scoring goals when they are really required it is the Brazilians. And just under a minute after the restart Luis Fabiano halfed the deficit. Game on.

The Samba stars should have been level shortly afterwards when Kaka’s header was clawed away by Howard, but initial impressions suggested that the ball had crossed the line. Another strong argument for the use of TV replays, which would have confirmed the goal.

Instead it was Fabiano who pulled the Brazilians level with his second goal of the game, leaving 15 minutes for the game to be settled. But there was only one team who looked like coming up with the winner, and just five minutes from the end defender Lucio completed the comeback by heading home from a corner to claim the cup for Brazil.

So Brazil, not entirely unexpectedly, took the trophy home. But it is the performance of the USA that will long be remembered.

Overall this was an entertaining tournament with a lot of good football on display, and a touch of controversy thrown in. As a rehearsal for the World Cup it showed that the South African authorities still have a great deal of work to do before next summer’s World Cup. But they have shown the capacity to make it a tournament to remember.

Friday June 11^th 2010 sees the opening game in Johannesburg. I can’t wait.

"Townes" by Steve Earle

Don’t you just hate it when you really look forward to getting a new album and it turns out to be a big let down? But the opposite of this feeling is the delight when you buy an album with limited expectations and end up loving it.

This is an album I really was in two minds about buying, but I am now sure as hell glad that I did.

I like Steve Earle’s song writing and his music – well, his later stuff, not so much the earlier country recordings. An album of covers isn’t something I would normally buy though. The odd cover in an otherwise original recording: fine. But I generally prefer to hear a songwriter’s own voice.

Then I guess Steve Earle is the one man who can legitimately record a Townes Van Zandt cover and do it justice. The pair first met in 1972 and TVZ was Earle’s mentor for over twenty years, and the two shared a stage on many occasions. Earle even named his son (Justin Townes Earle) after his old friend.

For those unaware of the name, Townes van Zandt was an influential Texan singer/ songwriter who died in 1997, largely as a result of his long-term alcohol and drug abuse. He was a cult artist, although never achieving much commercial success, but the body of work he left behind has ensured his legendary status and spawned a whole host of covers and tributes by fellow artists.

The deluxe version of this CD comes with 2 discs, the first entitled Townes (which is also the one disc version) and the second called Basics: a bonus with acoustic versions of 11 out of the 15 songs.

I find that some of the Townes versions are a little over-produced with perhaps too many layers of music that takes away a little from the lyrics, the stories that TVZ was famous for. But the starker acoustic versions on Basics are simply superb, and much closer to the way Townes would sing these songs himself.

“No Place To Fall” perhaps demonstrates this the best. The first version has a bunch of instruments layered over the guitar and vocals, taking a little away from what is a beautiful love song. But in the acoustic version Earle nails it, with his gritty vocals filled with smoke and emotion.

Best of the Townes CD: a fast paced version of White Freightliner Blues, a bluesy interpretation of “Brand New Companion”, and quite beautiful renditions of “(Quicksilver Dreams of) Maria” and “Colorado Girl”.

Best of the Basics CD: the tremendous "Pancho and Lefty," a song much covered by others but now owned by Earle, the haunting “Rake”, the acoustic “Mr Mudd and Mr Gold”, a typically great story, and the closing “To Live Is To Fly”, another tender love song.

These two CDs haven’t been much out of the player since I got the album. And a couple of Townes own CDs are now on order!

So, in conclusion: if you like Steve Earle you should buy this album. If you like Townes Van Zandt you should buy this album.

If you like good music you should buy this album!

Double Trouble: The Bipolar Brain

I’ve called my new blog Double Trouble – because that’s exactly what bipolar disorder feels like! The Bipolar Brain causes extreme lows that are awful; as well as extreme mania which can be dangerous. And when both hit you at once …

But let’s step back. What exactly is bipolar disorder?

Well, most people experience different moods with ups and downs, highs and lows. But when these become so extreme that they interfere with ordinary everyday activities this can cause people to behave in very uncharacteristic ways.

Previously known as manic depression, bipolar disorder is basically a chemical imbalance in the brain. No one knows where it comes from, although it appears to be partially genetic. The symptoms vary from person to person in severity, but there are two basic components: mania, which can be a wonderful high, but can hit like a tornado and a lead to dangerous loss of judgement and depression, which can leave you quite literally unable to function in a dark despair. There are drugs that can help to stabilise the condition, but there is no cure.

There is also a strong correlation between bipolar and addiction issues. There is evidence that suggests a weakening in the area of the brain that deals with impulse control may be the culprit. Many people with bipolar also have issues with drugs or alcohol.

This is partly self medication – finding a way to deal with life’s problems by blotting them out. Alcohol was always my drug of choice. And being bipolar is probably with worst condition to have: when feeling down, you have a drink, and when feeling high you want to party.

The key to living with bipolar for me is self management. Basically this is a technique that is used to learn how to recognise personal triggers and early warning signs, which in turn helps to understand how and when to take action to prevent the mood shift from escalating to severe depression or mania.

Another important source of information and understanding come from peer support groups, such as those run by Bipolar Fellowship Scotland. Who better to learn from than other who are also living with the condition?

So, are there any positives about having bipolar disorder?

There is a strong correlation between bipolar and intelligence. Studies have shown that those with bipolar generally have IQs that are well above average. And there is a link to creativity too, with many famous, artists, writers, musicians, etc, having the condition.

These include Lord Byron, Charles Dickens, Grahame Green, Jimi Hendrix, Ernest Hemingway, Spike Milligan, Sylvia Plath, Edger Allan Poe, Dylan Thomas, Mark Twain, Vincent Van Gogh and Townes Van Zandt, and in more recent times Russell Brand, Kurt Cobain, Francis Ford Coppola, Stephen Fry, Ozzy Osbourne, Axl Rose and Kurt Vonnegut

Others known to have bipolar include Buzz Aldrin, Winston Churchill, Marilyn Munroe, Theodore Roosevelt and Ted Turner.

Quite a list, isn’t it?

So that’s a quick guide to bipolar disorder.

One issue I should touch on in closing is the stigma that is still associated with having a mental illness. Many people, through ignorance, wonder if you might be dangerous. Potential employers are likely to be put off if you mention the illness on an application form. And relationships are difficult, to say the least.

But you have to try to keep a sense of identity outwith the illness. I never say that “I am bipolar”. My condition does not define me. I have bipolar disorder but that’s not who I am.

Much more information on bipolar is available on the excellent website of Bipolar Fellowship Scotland, of which I am a Director. See the Links section on the right.

To View or Not to View?

Yesterday afternoon’s Confederations Cup match between Brazil and Egypt was quite a spectacle. After 90 minutes the score was level at 3-3, with the African underdogs having recovered from a 3-1 deficit against the Samba stars.

But the game will be long remembered for what happened next.

As the clock ticked into added time, Brazil were awarded a corner. The ball was crossed into the area and Brazilian captain Lucio shot for goal. But the ball was blocked on the line by the arm of defender Ahmed El Mohamady, who immediately fell to the ground clutching his face – a clear attempt to con the referee.

And for a moment it appeared that his con trick had worked as English referee Howard Webb pointed for another corner rather than a penalty. A crowd scene ensued around the apparently stricken defender, with his team mates calling for treatment, while the Brazilians appealed for a penalty.

Webb then appeared to communicate with someone via his mic and earpiece, before finally making the correct decision by awarding the penalty and sending off the mendacious Egyptian. It appeared that his decision was made after consultation with an official who had viewed the incident on TV.

The crucial question is: was the referee correct to make a decision based on tv evidence?

Egypt complained after the match that a decision had been taken that was outwith the laws of the game. As Egypt coach Gharib Chawki correctly stated "As far as I am aware there is no rule allowing video evidence.”

The rules are indeed clear. The referee is in sole charge of the match and must make decisions based on what he and his assistants see. There is no TV replay system in football. Perhaps there should be, as it works successfully in many other sports? Indeed, but that’s an argument for another day.

Clearly a just outcome was arrived at: Brazil got their penalty and the offender was dismissed. However, the rules of the game, which the referee must of course uphold, say that the decision was made incorrectly.

So do two wrongs make a right? Should a decision made in direct contravention of the laws of the game stand because the ends justified the means? Should cheats really never prosper?

It feels like one of those courtroom dramas where everyone knows that the accused is guilty, but his clever defence lawyer then argues successfully that crucial evidence should be ruled inadmissible on a technicality. Is justice truly served in this instance?

What did FIFA, football’s governing body, make of the Egyptian complaint? Well, true to form for bureaucracies worldwide they fudged the matter!

A FIFA spokesman said: "A thorough analysis revealed that the decision in question was achieved through teamwork between the match referee and his assistant referee … who confirmed the offence to the referee from his clear viewing angle."

Now that, quite frankly, is nonsense. The linesman (I refuse to use the newfangled term assistant referee) was in no position to see the incident. He was on the opposite side of the pitch with at least two players blocking his view of the incident.

No, this is a cop out from FIFA. The referee was clearly advised by someone watching on TV. The BBC commentators at the time thought so, and players have been confirmed this. "The referee didn't see the penalty and the linesman didn't see it either. It looks like the fourth official told him over the radio," said striker Luis Fabiano.

To continue the legal analogy: a just decision was made on evidence that was inadmissible. But does that render the eventual verdict unsafe?

What do you think?