Beyond Brain Chemistry: Exploring the Wider Context of Mental Illness

by Hilary Smith

When I wrote the first edition of Welcome to the Jungle: Everything You Ever Wanted to Know About Bipolar But Were Too Freaked Out To Ask, my mission was to provide positive, engaging companionship for young people being diagnosed with bipolar disorder. My goal with the second edition, Welcome to the Jungle: Facing Bipolar Without Freaking Out, was a little bit different: to help people understand the wider context of their diagnosis, and encourage them to think about bipolar as not only a matter of biochemistry, but as a complex interplay between a person and his or her cultural, social, economic, geographic, political and environmental contexts.

Why is it important to see bipolar disorder in a wider context? Didn’t that public service announcement I saw last week explain that bipolar disorder was a chemical imbalance, best managed by taking lifelong medication? While the biochemical model has been useful for some, it has had the unexpected consequence of blinding us to the other factors feeding into mental distress, and to the many free, healthy and safe ways that people experiencing mental distress can help themselves.

For example, the destruction of the natural world and lack of access to nature are both factors that increase a person’s stress levels, yet people diagnosed with bipolar are rarely encouraged to reconnect with nature. Homelessness and economic pressure can give people symptoms resembling mental illness, yet most books about bipolar disorder do not consider housing status or economic security. Social isolation, not brain chemistry, is one of the greatest predictors of suicide, yet the biochemical model of mental illness makes no allowance for this or other crucial facts.

My hope is that Welcome to the Jungle: Facing Bipolar Without Freaking Out will help individuals, their families and friends, and their doctors make wiser decisions about dealing with depression and mania—decisions that go beyond the limited “brain chemistry” model to take the whole person, and their whole environment, in mind.

The subject of mental health has fascinated Hilary Smith since being diagnosed with bipolar disorder in college. She is the author of the novels Wild Awake and A Sense of the Infinite, both of which explore the themes of mental health and illness. She lives in Portland, OR. Visit her at

From the Introduction to Leaving the OCD Circus

When I was nine, I started developing obsessive-compulsive disorder (OCD). And I lived in its grip for over twenty years. People without OCD often ask me what it feels like. Imagine you are building a house of cards. Your OCD is the blowing fan right next to it. You can’t stop yourself from building the house of cards because your brain has a hiccup, and the fan will never shut off. And, oh yeah, there is someone holding a gun to your head demanding that you perform perfectly.

Frustrating doesn’t come close to describing it, but complete madness does.

I have learned how to stop building the house of cards, doing what my OCD tells me to do, and most importantly, I have shut off the fan.

In this book I tell the story of how I learned to take down my obsessive-compulsive disorder. I will show you how to do the same thing. Yes, you heard that right. YOU are BIGGER than YOUR OCD, and of this I am sure. What’s different about this book than others you may have read is that it’s written not by a doctor or therapist or expert, but from the perspective of someone who has lived through the disorder—from what my editor calls “the street level.” I’ve read a lot of books, met with a lot of doctors, and fought a lot of OCD battles, and this book gives me the opportunity to share with you what I’ve learned about what OCD is and how to work with it until you are back in charge of your life. I know it might sound cliché, but if I can do it, so can you.

Artist: Doug Pagacz
Artist: Doug Pagacz

OCD comes in many different forms; it all depends on the person. Some people are afraid and crippled by the thought of contaminants and are cleaners; others are driven to madness with the overwhelming need to be perfect; there are compulsive checkers, hoarders, and repeaters, also orderers, those who require that the things around them be arranged in a particular and rigid way; there are thinking ritualizers; and the list goes on from there. However, we are all human, and we are all so much more than these labels! Maybe we don’t fear the same things, maybe the form of your OCD is different from mine (I experienced most of the things on that list), but we all want the same peace, don’t we? That’s why we do such crazy things! We’re chasing that elusive mental stillness. My intention is to give you a book that is protein-packed for the mind and the soul.

I constructed this book—text and pictures—to help you out of your own constriction.

I have been collecting imagery, especially vintage art and ephemera, nearly all my life. Pictures and words that really spoke to me at a core level. Some seemed to capture exactly what I was feeling. Some reminded me of pain, some of hope or freedom. I have a feeling these images and words will hit you like that, too, and I’ve sprinkled them like bread crumbs throughout the book to help guide you out of your dark forest or show you a different path. I want you to feel seen and heard. I hope these pictures help you feel my presence in your life. I hear you. I get you.

Sufferers will relate; the people who love us will learn. If you are an OCD hostage like I once was, or if you wish to understand and help someone who suffers from OCD, this book is for you. It is about claiming your freedom and getting your life back. If you feel alone and isolated, or know and love someone who does, I hope this book will become a good friend and a valuable resource. We are all at different places on the OCD and wellness spectrum, and I wrote this book with the intention to meet you right where you are, wherever you are.

Kirsten Pagacz is the founder of Retro-A-Go-Go, an online seller of retro kitsch. She suffered from OCD for two decades before discovering that it had a name (and a cure). Before founding her own company, she worked in marketing and sales for a number of Fortune 500 companies. She is a member of the International OCD Foundation and won first place in one of their art competitions.


Dr. Peter Bongiorno on Anxiety Medications

Dr. Peter Bongiorno discusses anxiety medications and his book Put Anxiety Behind You in the conversation below.

Disclaimer: This conversation is not to be intended as professional medical advice. If you are experiencing difficult symptoms with anxiety, please contact your healthcare practitioner.

Why not just go with medications when you’re anxious? Don’t they help?

While medications can help symptoms, research clearly shows that in the long term, use of anxiety and sleep medications greatly increase chance of death significantly. Also, the medications, when they work, tend to just cover up the symptoms and do not allow a person to process their feelings to actually heal the underlying issues. Anxiety is not a Xanax deficiency, and to truly heal, many factors should be considered. To get off the medications, a person still needs to learn what the underlying physical, emotional, and spiritual factors that lead to this anxiety. The drugs do not help us do that.

If a person is on anxiety medications and they don’t feel like they are working, what should they do?

In conventional medicine, when a medication does not work, typically the psychiatrist will start jumping around from medication to medication, in hopes of finding the one that works. However, there are studies showing how natural remedies can help medications work better in situations where they are not working. I have seen amazing results using these to help a person who was not able to get relief before using the medications. Once they feel better, then we can talk about working on some other underlying issues specific to them and possibly move to the place where the medications will not be necessary because the body is now nourished.

Should a person stop taking their medications and try natural medicine?

If someone is already on a medication they should never take themselves off a medication without speaking to their prescribing physician, for this can be dangerous, especially if someone stops using the medication too quickly. If someone is interested in natural therapies, they should remain on the medications they are using, and start working with a naturopathic physician or other well-trained practitioner in natural medicine to start working on the underlying causes of his or her anxiety. Once a person is on this path, and is stronger, then he or she can start thinking about slowly weaning off medication.

Most patients, and doctors, are afraid to use conventional medications along with natural remedies. Do you believe it is safe to use natural medicines with conventional treatments?

Most of the patients I see are already on anti-anxiety medications. My research and clinical experience tells me that not only are natural remedies safe to use with conventional therapies, they also will help the conventional medicines actually work better— and work in ‘treatment resistant’ cases, meaning the natural supports can actually help the medications work, when the medication by themselves would not. Even more, there are a number of studies I talk about in my book where natural remedies are used with conventional care quite successfully, and quite safely. Of course, I recommend each patient works with a naturopathic physician or someone who is knowledgeable and educated about natural remedies, for there are possible interactions with drugs. But when used properly, natural medicines are quite safe.

Disclaimer: This conversation is not to be intended as professional medical advice. If you are experiencing difficult symptom with anxiety, please contact your healthcare practitioner.

Dr. Peter Bongiorno is a naturopath and acupuncturist with offices in NYC and Long Island. He is licensed as an acupuncturist in the State of New York and as a naturopathic doctor in the State of Washington. He is an adjunct faculty member at NYU, where he teaches classes on holistic healing. He also writes for PsychologyToday,, and

Bongiornos Books

Put Anxiety Behind You | How Come They’re Happy and I’m Not

How Dance Helped Me Heal Depression, Anxiety and PTSD

by Michele Rosenthal

When I first stepped into a ballroom dance class I was pushing forty years old, depressed to the point of despair, delirious with insomnia and feeling insane from symptoms of posttraumatic stress disorder (PTSD). I didn’t know a soul in the class or a pattern in the dance and I didn’t have the right shoes. What I did have was a burning desire to escape the suffering of my mind.

Almost thirty years earlier a horrific childhood trauma hijacked my life, causing me to feel unrelenting anxiety, overwhelmed by memories and intense emotions, and fearful in every moment. Controlled by PTSD symptoms my life had withered like an unwatered plant. I was without a profession, relationship or meaningful purpose. I only left the house when necessary and rarely socialized. Recovery efforts had brought more fear and anguish than healing. I was quickly losing hope that I could survive the constant psychological pain when some small inner voice softly spoke: “You need to feel the opposite of all this pain.” Joy, the voice suggested. You need to feel joy.

In response I launched a quest to experience joy (no matter how briefly) at least once a day. I knew that I felt joyful when I danced, so I signed up for dance classes every night of the week. When I took a deep breath, straightened my slumping posture and walked into my first salsa class I had no idea that I was about to find exactly what I needed to deliver me out of the pain of the past and into a present and future that I love.

How Dance Helped Me Heal Depression, Anxiety and PTSD

Learning To Be Present, Connect And Trust

From dissociation to isolation I’d perfected the art of living a life apart. The necessities of dance, however, immediately demanded that I release these PTSD coping mechanisms. Face to face, partnered with a stranger, I quickly learned that if I had any hope of coordinating how I heard the beat, correctly interpreted my partner’s lead and skillfully executed a move I had to stay present, plus connect to and trust myself, my partner, the music and the dance. In a jumble of missteps, apologies and the sinking sensation that I was irretrievably clumsy I miserably failed at all of this in my first class.

There was, however, a positive outcome: Despite the many embarrassing moments some part of me was having fun. Some part I had long ago forgotten existed actually loved and yearned and wanted more of the training to focus, the challenge to achieve and the glorious, joyful freedom that dance promised. This long-forgotten self wanted to transcend the herky-jerky PTSD lifestyle. She wanted to be wrapped in the flow of notes, instruments and creative patterns—and I loved her for it. By the end of class I was hooked.

At home I practiced patterns in the living room and on the pavement outside at night. I listened to salsa music incessantly trying to hear the beat and match it to steps. At last, I’d found a passion that lured my mind away from the past by promising something that felt wonderful in the present.

The Healing Power of Courage

Slowly, through hours of classes and practice my dancing improved. I learned from repetitive experience that I could trust my body to follow my mind and that my mind could stay present and create an organic flow of movement. I found a consistent dance partner with whom I felt comfortable to be myself. He was kind, accomplished and encouraging, which let me develop a safe space of experimentation. More than anything, I started allowing myself to get used to having a good time. I started sleeping more, crying less and waking up each morning looking forward to something for the first time in almost three decades. Soon, I heard myself laugh at mistakes in class and whoop at flawlessly executed patterns. The icy terrain of PTSD began to thaw and inside myself I found a verdant landscape of hope, belief and possibility that made me feel courageous. I returned to PTSD recovery with increased energy, engagement and determination. This time I succeeded.

By the time my fortieth birthday rolled around I was 100% free of PTSD symptoms. Throughout the final, difficult process of making peace with the past dance sustained me with a life-affirming connection to joy in the present. That connection—to life, myself, purpose and passion—helped me renegotiate a vision of myself. I transformed my survivor identity into a woman who is happy, healthy and giving back. Years have passed. Though I continue to change and grow one thing remains the same: Dancing continues to set my soul free. That life-affirming part of me now sits at the center of who I am. What a glorious guide she turned out to be.

Michele Rosenthal is an award-winning PTSD blogger, bestselling and award-nominated author, host of the radio program, Changing Direction, and founder of The Washington Post calls her most recent book,  Heal Your PTSD: Dynamic Strategies that Work “a cheerleading, you-can-do-it kind of book, with step-by-step lifestyle modifications.”

A former faculty member of the Clinical Development Institute for Timberline Knolls Residential Treatment Center, Michele is also a trauma survivor who struggled with posttraumatic stress disorder (PTSD) for over twenty-five years before launching a successful “healing rampage.” Happily, Michele has been 100% free of PTSD symptoms for a very long time. When she’s not trying to help heal the world Michele can be found walking on the beach or dancing salsa.