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The “4 Ps” of mental recovery: medical care and health

PATIENT PERSPECTIVES

In his new book, Healing: our journey from mental illness to mental health, Renowned psychiatrist and neuroscientist Thomas Insel, MD, points out that although drugs and healthy living can be necessary to recover from a mental/brain illness, they are insufficient. For an effective and lasting recovery, the individual’s life must be built on a social foundation of “people, place and purpose” – what he calls the “3 Ps”.1 To this, I add a fourth P: perseverance.

This article illustrates and animates the 4 Ps by analyzing my ongoing recovery from an acute bipolar crisis, which was based on medication, therapy and healthy living, grounded in the 3 Ps and steeped in perseverance (Figure 1).

My recovery efforts were conceived and launched in 2016, after studying recovery and how to build a successful retirement life – years before I heard of Dr Insel’s 3 P’s in 2022.

What I discovered then is that recovery requires:

  • Good medical care and a healthy lifestyle
  • Build a vibrant network of friends and people you enjoy being with
  • Live in a place that makes you happy, energized and safe
  • Building a life of meaning and purpose that inspires, motivates and fulfills
  • Infuse everything with persistence and never give up the will to recover

My story offers an example of the 4 Ps (Figure 2) and how someone recovering from mental illness can use this concept.

Background

I was struck with bipolar disorder in 2003 at the age of 47, when the intense stress of leading thousands of soldiers in the war in Iraq triggered my genetic predisposition to bipolar. For the next 11 years, my condition remained unknown, undetected and undiagnosed. My mania went up and my depression went down, until I went into real mania in 2014 as a 58 year old 2 star general I was removed from my command of National Defense University , then I fell into a severe, hopeless depression with a terrifying psychosis.

After 3 misdiagnoses as “Fit for Duty”, in July 2014, I was correctly diagnosed as Bipolar 1 4 months later, over 11 years from onset. Then for 2 years I was dysfunctional, in crisis and fighting for my life, tortured by ‘passive’ suicidal thoughts – vivid images of my own morbid, violent and bloody death, which was anything but ‘passive’ for me. I didn’t want to kill myself, but I believed my family and I would be better off if I was dead, and I would gladly die to escape the bipolar hell of my depression and psychosis.

I was hospitalized in March 2016 at the superb Veterans Administration (VA) hospital in White River Junction, Vermont. Even though I was still months away from the start of “recovery”, this hospitalization marked the embryonic beginning of my journey towards well-being. My VA healthcare team prescribed me medication, therapy, electroconvulsive therapy (ECT) and other treatments, but to no avail until we tried lithium, which cleared up my severe depression within a few days and for me to start feeling like my old, pre-bipolar self. The combination of my previous bipolar medications of Lamictal and Latuda, along with the “heavy artillery” intake of lithium, was badly needed and provided the biochemical basis for recovery.

For my recovery to be built on solid ground, however, I had to build my own 4P foundation. With the combination of the right medications, a healthy lifestyle, my expert and compassionate VA care team, and the 4 P’s, I have constantly rebuilt my bipolar broken life and continue my recovery (picture 3).

My wife, Maggie, and I realize how lucky we were, and we are so grateful!

People

Connection creates hope, and hope saves lives. People are the engine of hope, which is essential for recovery. When Maggie and I left New Hampshire and arrived in Cocoa Beach, Florida, we knew each other, but we didn’t know anyone else. We still had family and good friends, but hardly anyone around. We decided to connect with people and make friends in our new city. Our strategy was to “make a friend and be a friend” (MAF-BAF) every day. Making a friend is as easy as saying “hello”-being a friend is the endeavor of a lifetime. We learned this powerful concept at a retreat shortly after moving to Florida.

We organized our people-to-people efforts and targeted MAF-BAF in our neighborhood, church and community gymnasium. To our surprise, the gym, especially the dance group “Gotta Dance!” and fitness classes – was the biggest producer of friends in terms of quantity, common interests and depth of friendship.

Maggie and I talk about MAF-BAF every day: Did you make any new friends today? What have you done to be a friend and strengthen existing friendships? These friendships have been essential in my recovery efforts.

As a mental health advocate and mental wellness warrior, I’ve also made dozens of new friends and colleagues across the country by sharing my story, writing and speaking. My network is growing week by week.

Unlike MAF-BAF, I also eliminated or contained a number of toxic relationships – people who generate turmoil, anger, stress or anxiety – that threatened my recovery and my stability. Cutting or building “guardrails” around friends and toxic subjects was not pleasant, but it was necessary and constructive for recovery.

Square

Since being diagnosed with bipolar in 2014, Maggie and I have moved from army housing in Washington, DC, to our vacation home in New Hampshire, and then finally to Florida. For various health, climatic, social, and economic reasons, neither Washington, DC, nor New Hampshire was the right place for my recovery.

Our vacation home in New Hampshire was inexpensive and had beautiful views, clean air and water, no traffic, and low crime. We had taken many New Hampshire vacations – skiing, snowshoeing, swimming, boating and hiking – and really enjoyed it. However, I had not expected that my severe bipolar depression, exacerbated by Seasonal Affective Disorder (SAD), would be made worse by the long, dark, cold winter. New Hampshire was also too remote for us – not enough people nearby. And, of course, my depression made everything miserable, hopeless and dead. I found no pleasure in my previously enjoyable outdoor pastimes.

We researched SAD, consulted doctors, took an exploratory trip to Florida, then decided – pending the “green light” from my doctor for biochemical stability – to move, hoping that the heat, the bright sunshine and the laid back culture would help me. retrieve. We left behind home, family, friends and familiar paths. It was not easy. But what a great initiative! We rented the first two and a half years and then bought the house next door – a great house in a beautiful, safe neighborhood in a fun, friendly, happy town.

We loved our new life in Cocoa Beach! The place reinforces people dimension.

Objective

As an army officer, I to have to have a mission. From the time I was stabilized on lithium in September 2016 and arrived in Florida, I have thought, prayed and worked to develop a clear and inspiring mission, or objective, which has guided and energized my life. I wanted a purpose that had eternal value, that was bigger than me, and that made a positive difference in the lives of others.

I was drawn to the “golden rule”: “do unto others as you would have them do unto you”. Taken from the Gospels, which command us to “love your neighbor as yourself”, this mission uplifted, fueled and inspired me, and it helped to empower MAF-BAF.

In sharing my bipolar story, I encountered a thirst for boldness, honesty, and authenticity about mental illness. As a result, my life mission, or purpose, morphed into “sharing my bipolar story to help end stigma and save lives.” The more I shared my story, the more positive and encouraging the response. I believe my specific and clear purpose has eternal value and makes a difference in people’s lives.

I assess my life through the lens of this goal and prioritize and allocate my time and effort accordingly. The result is that with my wife, I have built a new life that inspires, energizes, connects with people, and gives hope to myself and others.

Perseverance

One of the most underestimated human virtues, perseverance is “a continuous effort to do or achieve something in spite of difficulty, failure or opposition”.2 Recovery is hard! Sometimes you take 1 step forward and then you are pushed back 2 steps. Nothing is easy. It can be discouraging.

Perseverance and willpower are no substitute for the right biochemical balance in the brain or a healthy life, but they are necessary ingredients to combat the pain, hardships and challenges of recovery. Perseverance must permeate and animate all that you are and all that you do, continually and forcefully. You must embrace the spirit that never gives up, always fights, and always perseveres.

Perseverance connects, energizes, and synergizes the right medications and therapy, a healthy lifestyle, and the 3 Ps: people, place, and purpose.

Final Thoughts

Lithium, other medications, and therapy have been essential to my continued recovery from acute bipolar disorder, but just as important has been my 4 P social foundation. The combination of medical care, a healthy lifestyle, and of the 4 P’s has allowed me to build an ongoing recovery that is built to last and gives me a healthy, happy and meaningful life with wonderful peoplein a beautiful squareinspired by the eternal objectiveand powered by perseverance that permeates and connects everything.

Dr. Martin is a 36-year-old army combat veteran, retired 2-star general, and bipolar, thriving, warrior survivor. A former president of the National Defense University, he is a trained airborne ranger engineer and strategist who has commanded soldiers in combat. He has led organizations ranging from a platoon of 30 soldiers to a base of 30,000 military and civilians. A graduate of West Point, MIT, and Army and Navy war colleges, he is a full-time mental health advocate. He lives with his wife in Cocoa Beach, Florida, where he writes, speaks and converses. His forthcoming book is titled Bipolar General: My “eternal war” against mental illness.

These views are those of the author and do not necessarily represent the views of the US Department of Defense or the US government.

References

1. Insel T. Healing: Our journey from mental illness to mental health. penguin press; 2022.

2. Perseverance. Merriam Webster. Accessed June 20, 2022. https://www.merriam-webster.com/dictionary/perseverance

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