Warning: This Movie May Have Psychiatric Side Effects

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Well, the sword swallower, he comes up to youAnd then he kneelsHe crosses himselfAnd then he clicks his high heelsAnd without further noticeHe asks you how it feelsAnd he says, “Here is your throat backThanks for the loan”

Because something is happening hereBut you don’t know what it isDo you, Mister Jones?

-from Ballad of a Thin Man, by Bob Dylan

You could substitute Ross McKenzie for Mister Jones, and you will get a sense of what the movie Bipolarized: Rethinking Mental Health is all about. It is a documentary of a man searching for the answers to what happened to him psychologically after a childhood of high achievement . . . a kind of Joseph Campbellian attempt of a heroic journey to try to find wellness after much suffering.

By chance, my wife and I recently saw this movie at the ReelAbilities Festival in Houston-a “free city-wide film and arts festival to promote inclusion and celebrate the lives, stories, and talents of people with disabilities.”

The introduction to this 2014 movie briefly mentioned that the sponsoring mental health organization had mixed feelings about showing the film. There was concern that others might try to imitate Mr McKenzie’s journey and not question his message.

We all know about the so-called side effects of most any medication, including aspirin. There can also be side effects from many aspects of mental health care. For example, psychotherapy can cause temporary escalation of anxiety. Administrative policies can limit useful resources. Teachers and journalists can cause side effects if they provide misinformation, or even if they provide the right information if it is misinterpreted. Popular and entertaining movies can do the same.

Mr McKenzie decided to make this movie when he was trying to recover from an apparent psychotic manic episode in early adulthood. We see him buying a camera so that he can document his ensuing quest for the mental gold. As such, it is a sort of movie selfie, and thus subject to his subjective decision of what to shoot and show.

McKenzie is from Toronto, apparently from a wealthy family, given his trips around the world to seek treatment. Most of the focus is on the assumption that he not only suffered from lithium side effects, but also from lithium withdrawal and ongoing lithium toxicity for years after the drug was stopped.

Some of his depicted side effects while taking lithium, such as lethargy and mental confusion, seemed accurate enough to be true to me. But severe lithium withdrawal? I’ve never heard of this or saw it. I checked the literature just to be sure and couldn’t find any reputable scientific support. Yes, there can be a kind of discontinuation syndrome: lithium is best stopped gradually (about 10% per month).

However, withdrawal, in the common sense of desiring the drug again, seems to be a misnomer. And chronic lithium retention and toxicity, requiring chelation treatment like lead poisoning? This too was news to me. Speaking of lead poisoning, McKenzie’s neuropath claims that he had high lead levels, as well as mercury, though the source is never described. These, too, were said to need chelation.

After a childhood of great success (apparently demanded by his father), McKenzie goes from a psychiatric-enforced hospitalization to various alternative treatments. His journey is like a psychiatric version of Anthony Bourdain’s CNN travelogues in tasting foods from different places around the world.

In a fascinating scene, McKenzie goes to Colombia to see a shaman at the recommendation of his mother-in-law. The shaman calls on the help of Mr McKenzie's dead father. The treatment-ironically depicted as if he were in restraint sheets like those back in the hospital-ends when he spits into a cotton ball. He brings the cotton ball home with him for testing in a lab and lithium is reportedly found in the expectorant.

McKenzie experiences cupping, acupuncture, and yoga, among other treatments along the way. He also meets an ex-pharma rep, who rails on against polypharmacy, although McKenzie only ever took lithium. Whether he ever took street drugs is unclear.

However, curiously enough, there is no discussion or depiction of traditional psychotherapy. The closest we get is the interview of Mr McKenzie by a psychologist in front of a large audience. This psychologist hones in on possible abuse by his late father, although even that was on the fringe. The psychologist uses a regression technique and asks McKenzie to visualize both himself and his father together as 7 year olds. McKenzie believes that the therapy helps him feel more compassion for his father, who apparently also suffered emotional abuse as a child.

The documentary journey ends in 2014, when McKenzie has a suggested diagnosis of PTSD. Certainly, it is gratifying and worth celebrating that McKenzie feels that he can focus better and is more in touch with his anger. However, he apparently does not work other than on this movie, and it seems like his marriage may have ended.

The movie is technically and creatively very well done. It moves back and forth through time, and it includes family movies and interviews with relatives. Nevertheless, my own subjective reaction as a mainstream psychiatrist is that psychiatry is scapegoated for McKenzie’s many years of suffering. As such, it may discourage people from getting the help they need.

Mental health care, like cancer care, is ripe for charlatans and incompetence. Why? Because so much is unknown about how treatment works and because a trusting relationship is so essential, a patient or would-be patient can be led astray. Although the placebo effect is a crucial component of psychiatric care, this is never mentioned in the movie.

This situation is what for-profit managed care companies pounced on to deny care.

Certainly, we need to rethink and improve mental health care in both the US and Canada. Certainly, we need to be careful when we make a diagnosis. Certainly, we are concerned about short and long-term medication side effects. Certainly, we have to avoid the traumatic effects of forced hospitalization. Certainly, alternative therapies may help some individuals, although the scores of untested psycho-therapies are of concern. Certainly, the opinion of the patient is crucial to try to achieve recovery.

But if Mr McKenzie was inadvertently Bipolarized, we may continue to be polarized, pitting alternative treatments against mainstream treatments.

If you are a mental health care professional, by all means see this movie. If you have already seen it, what is your opinion? I would be very cautious, though, in recommending it to a patient or the public.

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