These days, Jim McNulty is known as a man with a mission. He spends a great deal of time and energy flying around the country speaking to politicians, policy makers, community advocacy groups, and family members affected by serious mental disorders. The immediate past president of the National Alliance for the Mentally Ill (NAMI), Jim is a respected friend to the mentally ill in the halls of Washington, the halls of the RI State House, and the halls of health care facilities like Butler Hospital.
It would be a mistake to conclude that this public limelight that he finds himself in is what matters to him. In reality, one of the most important activities that he looks forward to are the weekly, evening meetings at Butler's Ray Conference Center with the Manic-Depressive and Depressive Association (MDDA) support group. "MDDA is one of the keys to my survival," he says. "My doctor and my wife would be the other two."
Jim believes that behind every successful recovery there are groups of people who help to "make it happen." Nurses, social workers, even the environment you are living in can all contribute to one's recovery. "The only way to overcome mental illness is to fight it. But you will need a good doctor and support from wherever you can find it."
It was at Brown University in 1969 that he had his first "nervous breakdown." He recalls that in those days, "it was all about the family." There was no appreciation for the medical, biochemical underpinnings of mental disorders. It wasn't until the early 1980's that he heard terms such as major depression and bipolar illness used to describe his problems. He dropped out of Brown for one semester and saw a psychiatrist who "was sympathetic but not very helpful." Returning to Brown, he continued in counseling and took an additional two years of study to graduate. It was only many years later that he learned that he was exhibiting a pattern that can be common for people with bipolar disorder – major onset followed by seeming recovery.
In hindsight, he says that he was never the same after that. He finished school, started a career in the computer industry, but was never as relaxed or confident as he had been in his life prior to college. "I thought [my problem] was some sort of moral failing – that I was incompetent. Brown was so intensely competitive. I felt like a person who was broken and nobody ever acknowledged the trouble I was going through."
He would not have another major episode for 15 years, but he felt alone and out of touch with the world around him, and was struggling to maintain even the most basic of lifestyles. During this time his behavior would swing from working 20-hour days, with high energy, to not being able to get out of bed or carry out the simplest task. Eventually, it was the depression that became totally overwhelming and disruptive.
"I would be hypo-manic, which was great," he remembers. "But then I would crash. I started having friction with family members and colleagues," he remembers. "I was making promises that I didn't keep, was not fulfilling my responsibilities. I was in counseling during this time, and never once did anyone suggest that I was depressed."
In 1986, Jim went to Butler Hospital and, for the first time, was told that he had bipolar disorder. He began participating in a research study testing a new class of drugs known as Selective Serotonin Reuptake Inhibitors (SSRIs). Almost immediately, the depression lifted and for the first time since he had been an adolescent, he felt "normal." He did not know it then, but his worst bout of depression was yet to happen. With brain science just in its infancy, researchers did not realize that the SSRI compounds would actually increase the length and severity of mania in some people. Jim was one of those. As the decade of the 90's approached, he began to once again experience intense periods of hypomania. One such bout ended with the worst and deepest depression that he had ever had. Ironically, it was the fall of 1991; the same time that the now famous "perfect storm" ravaged the New England shoreline.
"It was the worst one of all," he says. "I spent weeks alone in my apartment. I was working from there for CompuServe. I was living on the East Side and would sneak into the local Almacs at 2:00 a.m. so that I wouldn't see anyone who might know me. I was living on peanut butter sandwiches and cigarettes. That was all I could afford. It was my worst time. It was because of that time that I stay in treatment now. I could never go through that again. Life was so bleak. I imagine it is what it would be like to be a survivor of a nuclear war."
Eventually he was re-admitted to Butler and the mood stabilizer Lithium was added to his medications. The combination of medications and therapy led to a full recovery, with no more serious bouts of mania or depression. He credits the hospital's staff for getting him stabilized and allowing him to begin the recovery process.
Today, Jim is a model-recovered patient. He takes his medications faithfully, sees his psychiatrist regularly, and actively participates in the MDDA support groups as well as education and legislative activities in NAMI.
He says he feels lucky to have recovered from his illness. As someone who has been on the national stage advocating for expanded research and better insurance coverage, he worries about people who, like him so many years ago, have a problem but don't know where or how to get help or are too ashamed to ask. He especially worries about people who have insurance that restricts and limits coverage for treating mental disorders. It is these "underinsured" people, many of them productive members of the middle class, that concern him the most. But a serious mental disorder can quickly rob people of their jobs, their families, their finances, and their dignity.
"What worries me is that we know what medications work, when and how to use them, what to do and not to do, but many people don't have the means to get help. Many psychiatrists and therapists are pulling out of insurance and only accepting private pay people. Every week at the MDDA meetings, I see people at all levels of recovery. But for each one of them, there is another one not being treated who should be getting help."
It is this thankfulness for overcoming his own illness, coupled with concern for others, that have led him to become one of the most respected advocates in the country today. He will continue working for the day when people will be able to quickly and effectively find help in overcoming their own behavioral perfect storms.
For information about Butler's Mood Disorders Research Programs visit our Web site at www.butler.org
For information about the Rhode Island MDDA call 401-309-7575. MDDA meetings are held at Butler's Ray Conference Center on Tuesdays, 7-9pm and the second and fourth Saturdays of the month from 10am to Noon.
For information on the The Depression and Bipolar Support Alliance (DBSA) visit www.dbsalliance.org
For information about NAMI-Rhode Island call 401-331-3060.