It was mid-July 2014. I was 58 years old and after more than three decades in the Army, I was a two-star general and President of the National Defense University, the nation’s highest military educational institution, located in Washington, D.C. NDU fell under the supervision of the Chairman of the Joint Chiefs of Staff, the country’s top-ranking military officer. And the Chairman had just ordered me to report to his office at the Pentagon the next day.
Something was up. Until very recently, my job performance had been rated as exemplary, and I had received extremely positive feedback. Had the Chairman approved my request for a three-year extension at the university? Did he want to reinforce what a great job I was doing and give me guidance for my upcoming third year at the helm? Was he unhappy with me and about to terminate my presidency? Or, was it something else? I would soon find out.
The Chairman was a brilliant, inspirational, and friendly man. He had been a fabulous boss, as well as a colleague, mentor and friend for nearly 20 years. When I walked into his office, I noticed his lawyer was in the room, which was not a good sign. I saluted the Chairman and he walked over and gave me a hug.
“Gregg, I love you like a brother,” he said. “But your time at NDU is done. You have until 1700 today to submit your letter of resignation to me or I will fire you. Is that clear?” Had I been in a normal state of mind, with a healthy brain, I probably would have been stunned, upset, or disappointed. But I was in a state of acute mania, and I had none of those feelings or reactions. I was already anticipating my next grandiose mission from God.
“A lot of people think you have serious mental health problems. I’m ordering you to get a command-directed psychiatric health exam at Walter Reed. You need to go this week.”
Indeed, my behavior had become erratic and disruptive to the mission. I had lost the confidence of much of the staff and faculty of National Defense University. I resigned that afternoon. My 35-year career would end sooner than I had anticipated.
To be clear, I was not wronged. The Chairman made the absolute right decision. He was taking good care of my own health and welfare, as well as his university’s welfare and mission success. Had I been in his shoes, I would have made the exact same decision. NDU benefited greatly under the leadership of the ambassador who took my place as interim president. I do not dispute any decision, medical or administrative. Furthermore, I am not a medical doctor and I believe that the clinicians at Walter Reed are true professionals who did their best.
But consider this: One week before I was asked to resign, two medical doctors — my general practitioner and a psychiatrist — had evaluated me and given me a clean bill of health.
“It is my professional opinion that [Major General] Martin is physically and mentally fit for duty,” wrote one.
The psychiatrist wrote: “I do not find evidence of psychiatric illness. Specifically, he does not have depression, mania or psychosis…he is psychiatrically fit for duty.”
The reason I say this is not to criticize, but to emphasize how devilishly difficult it is even for medical professionals to recognize and correctly diagnose bipolar disorder, even when it is in an acute state.
That day in the Chairman’s office, it had never crossed my own mind that I was mentally ill. I felt terrific and was full of energy, drive, enthusiasm and ideas. There was important work to be done. In fact, the week after I had resigned, I was given yet another unremarkable medical examination: “fit for duty.”
Yet the truth is that for more than a decade, I had unknowingly served as a senior leader in the U.S. military with undiagnosed bipolar disorder. According to medical authorities, my bipolar disorder was “triggered” in 2003 when I was serving as a colonel and brigade commander during the U.S. invasion of Iraq. It grew worse for nearly a decade, and between 2012 and the summer of 2014 my mania became “acute.” At last, in late 2014, four months after my resignation from NDU, I spiraled, then crashed, into hopeless, terrifying depression and psychosis. From late 2014 through 2016, I was in a battle for my life.
Had there been warning signs and indications? How did I myself miss them? How did my family, friends and colleagues miss them? How did the institution I worked for so long miss them? If there were warnings, what were they?
Bipolar disorder in a nutshell: What exactly is it?
Formerly known as manic depression, bipolar disorder is a general term that, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), comprises a cluster of related disorders that are characterized by distinctive and extreme shifts or cycles, in mood. These moods oscillate between varying degrees of two poles: mania and depression, or “highs” and “lows.”
Manic states are typically marked by elevated, expansive or irritable moods and increased energy; feeling overly happy and optimistic; being highly talkative but with pressured speech; having an inflated self-esteem or feeling grandiose or religious, as if on a mission directly from God. There’s often little need for sleep, since it’s common to feel rested after three hours, but the mind is always racing with ideas and distracted, which can lead the afflicted to take part in high risk, dangerous, or potentially painful activities, such as drug and alcohol abuse, high risk sex, affairs, and extravagant spending sprees.
Mania is much more than feeling up, happy or energetic. It can be life-threatening and highly destructive, with some manic symptoms being severe enough to cause marked social or occupational impairment or require hospitalization to prevent harm to self or others. And it is driven in large part by the over-production and distribution of critical chemicals that create and regulate mood, most notably dopamine and endorphins.
The lows of depression, meanwhile, often result in decreased energy, diminished interest, worthlessness, hopelessness, lack of focus, and recurrent thoughts of death. A depressed person is depressed most of the day, nearly every day, and often feels sad, empty, and hopeless. They take little interest or pleasure in most activities, and often have significant change in weight or appetite.
But depression is not like having a bad day, or feeling down, low, or sad. True medical depression is a life-threatening condition that inspires recurrent thoughts of suicide. The mirror opposite of mania, it is driven in large part by the under production and distribution of those same critical chemicals that create and regulate mood — once again, dopamine, endorphins, and others.
The fact is that bipolar disorder and other types of mental illnesses are real physical illnesses that occur within the complex biochemical and neurochemical components of the human brain. Bipolar disorder and other brain maladies are not the “fault” of the afflicted person or evidence of moral failings, flawed character, or a lack of willpower.
They didn’t ask for it, and it’s not their fault. So we must treat it as we would a person with cancer or a broken arm: recognize it, get medical help, diagnose it, treat it, heal it, and get them back to a healthy, happy life. And we don’t criticize the afflicted patient — we love, support and help them — because people with mental illness deserve and need the same support.
That said, a person afflicted with bipolar disorder, through no fault of their own, may damage, harm and erode relationships — sometimes like a human wrecking ball — in their marriage and family, with friends, and with colleagues. I believe that the millions of Americans affected by bipolar disorder who have harmed relationships while in a state of mania or depression regret that these relationships have been damaged, including me.
Bipolar disorder helped me — until it didn’t
My first four decades of life were healthy, happy and successful, from childhood through West Point and throughout most of my military career. I was an accomplished student, athlete and leader, known for high levels of energy, enthusiasm and drive. I completed the Army’s elite and grueling Ranger school, ran seven marathons (each under three hours, including a 2:36), and completed a Ph.D. at the Massachusetts Institute of Technology, plus much more; aIl while happily married and helping my wonderful wife raise our three talented sons.
But in 2003, something seriously changed. I thrived while commanding and leading a combat engineer brigade of thousands of soldiers in the Iraq War, including the attack on Baghdad. The more intense the pressure, stress, and danger, the happier, more exuberant, energetic and enthusiastic I became. Indeed I had never felt so alive, so focused, and so high on life as while leading soldiers in combat. I marveled at the courageous and amazing things our engineers did on the battlefield. Perhaps this confession alone is evidence of mental illness. But either way, my combat euphoria — like other chemical intoxicants — would have long-lasting physical effects on my brain, particularly the neurological circuitry and elements responsible for producing and regulating the mood-related chemicals of dopamine and endorphins. Too much of these chemicals create mania, and too little leads to depression.
What I did not realize at the time was that this fabulous euphoria and ‘high’ was my brain’s response to the intense elevation of stress, a high-performing state of mania or hypomania. My doctors suspect that my genetic predisposition for bipolar disorder was activated by the intense stress of the war. I suddenly went from having latent bipolar potential to actual, activated bipolar disorder. This Iraq War “triggering event” is the confirmed opinion of the Army Medical Department and the Department of Veterans Affairs in their medical analysis and assessments of my condition.
But at the time, no one, myself included, knew any of that.
In fact, extra energy, enthusiasm, focus and creativity generated by my mania significantly enhanced my performance in combat. I felt like I was a kind of superman, overflowing with confidence, able to accomplish anything. But feeling like superman should have been a warning sign.
Over the next decade, my performance and recognition by my superiors continued to rise. I was promoted twice and assigned to seven increasingly complex and difficult assignments by the Army. Yet during this time — most of which I was a general officer — my manic highs surged higher and depressive lows sank lower. Yet neither my family, friends, work colleagues, nor my doctors had any idea that I was afflicted with a brain malady, let alone bipolar disorder.
Anonymous complaints eventually made their way to my boss. And by the time my family realized something was seriously wrong, I had resigned from NDU and the moon of depression had begun to eclipse the sun of mania.
Dealing with depression and psychosis
I gradually spiraled then crashed into a depression after my resignation that was increasingly characterized by diminished energy, hopelessness, anxiety and psychosis (mainly delusions.) It was at this point, in November 2014, that I was diagnosed with Bipolar Disorder Type I.
Now I was in the depression phase of bipolar disorder, formerly known as manic depressive illness. My major depression and psychosis worsened steadily through my retirement from the Army in May 2015 and continued through a move to New Hampshire in June 2015. In March 2016, I was admitted to the Psychiatric Inpatient Ward at the Veterans Affairs Hospital in White River Junction, Vermont.
In hindsight, in the years following my 2003 Iraq War experience, I had experienced periods of depression, though none were crippling enough to prevent me from doing my assigned duties. I powered through, with my own form of self medication — hyper religiosity and positive thinking, intense exercise, and off-duty, non-deployed alcohol consumption — and gradually regained my interest, drive and motivation in order to achieve and succeed.
But now I was severely crippled by depression and terrified by the delusion that I had committed financial fraud against the U.S. government. I lived in perpetual fear that I would be arrested, convicted, tortured, and murdered in prison. Or I would imagine being stripped of my achievements and retirement, retroactively demoted, and lose my pension and medical benefits, leaving my wife in poverty, and me homeless and dying on the streets. I believed that my closest colleagues were conspiring against me. Although it had worked for years, my previously successful formula for self medication no longer helped.
My depression and delusions were so powerful that eventually I did not even have the energy or will to try the self medication that had pulled me through previously.
These delusions were totally fabricated by my own damaged brain, but I believed them to be completely true. I was absolutely convinced that the delusions were real. I was certain that I would be better off dead — dying before “they” could arrest me. My psychotic mind was filled with thoughts of death and vivid ideas of how I quickly and painlessly could be killed. I later learned in the VA that these thoughts are called “passive suicidal ideations.” By the grace of God, my suicidal ideations remained passive and never became active. I never wanted to take my own life — which so many people with bipolar and other brain maladies do — but could not see any other viable alternative to dying. And the sooner I died, the better, before ‘they’ came to arrest me.
Recovery
One of my sons insists that a major difference between my own case of bipolar disorder and many millions of others’ cases is that I was fortunate enough to recover. Indeed, I was alive and recovered with my marriage and family intact, a pension, medical care, no addictions, and no criminal record. While I understand that I worked hard to earn these benefits, millions of Americans are nowhere near as fortunate as I was. More important is the fact that even with these benefits, my recovery took years, and for two of those years I was largely incapacitated and virtually on life support.
My recovery simply could not have happened without a myriad of willing actors, compassionate institutions and the networks among those actors and institutions. When one wasn’t enough, family saved me. When family wasn’t enough, friends helped out. When friends did all they could, institutions were necessary. When the institutions had done all they could, it was once again family who stepped in.
First among those actors were my wife and close family members who refused to give up on me. My wife calls her secret the “P” Word, for perseverance. She just kept on going, one foot in front of the other, one day at a time, while I was largely in a zombie-like state. After a year of paranoid delusions my youngest son confronted me and pushed me, yet again, to call one of my closest former colleagues and last boss — a three-star general — to have him confirm or deny that I was justified in my psychotic beliefs that I was under secret surveillance and would be arrested. When my old friend and boss heard what I was asking him he was in shocked disbelief, and worked quickly to connect me with other options for medical care.
For nearly 15 months I had been too terrified and depressed to ask this question, afraid that my inquiry would speed up my arrest and conviction. I required a few conversations with old colleagues to believe their assurances, but once I allowed myself to trust them, my delusions faded, although my depression continued to hold me in its unyielding grip. I’m forever in my son’s debt for that push I needed to begin re-engaging reality; and my friend’s empathy and pushing me to get more medical help. My old boss and friend, along with other senior Army leaders, never abandoned me, and treated me like a wounded comrade. They continued to support me and my family. And they lived up to the Soldier Creed to never leave a fallen comrade.
Second was another former colleague, Army comrade and friend with whom I had served very closely for years. Although my family supported me, effectively making sure I was still breathing and eating without abandoning me, they and I were not enough to help me get the proper level of professional medical treatment. I was seeing a local doctor, but the fit was not right and the confidence was not there. My great friend realized that a more serious intervention was needed. I needed inpatient care, both the right inpatient care, and the right team. He helped make this happen. He was relentless in facilitating and basically holding my wife and my hands to get me into the particular VA hospital he had in mind. Sometimes we need a helping hand.
It is no stretch to proclaim that the staff at the Veterans Affairs hospital in White River Junction, Vermont — where my friend helped arrange for me to go, and where I lived for six weeks, two weeks as an inpatient and four more as an outpatient — saved my life. The VA inpatient treatment was a game-changer. My VA team and I tried different medications, psychotherapy, 14 treatments of electroconvulsive therapy, chaplain counseling, marriage counseling and more. But again: my depression was intractable. Even with world-class care I remained deeply depressed and mostly hopeless. While it pains me to write this, my lifelong go-to of prayer and the reading and recitation of powerful Bible verses, along with hearing inspirational religious music and positive thinking that had lifted and empowered me my whole life, had little effect on my depressed mood. Nor did exercise. But God’s grace would soon lift me up and out of depression through the expertise of VA medical professionals and the wonders of modern medicine and science.
Exasperated by my seemingly unending depression, my determined wife persevered in pushing me and my psychiatrist to try a stronger pharmaceutical intervention. In August 2016 — over two years after mania had shattered my career — my doctor and I agreed to begin lithium carbonate, a naturally occurring salt and tried-and-true mood stabilizer for bipolar disorder. Unfortunately, lithium comes with significant side effects, which up until then, my doctors and I had not wanted to risk.
Astoundingly, I began to feel better within one week of starting lithium. I was rising out of depression. Soon, I had new energy and hope and began to enjoy my life again. Lithium helped construct a floor and ceiling inside my brain: a floor to prevent me from sinking back into depression, and a ceiling to keep me from shooting back into mania. Almost like a kind of magic bullet, lithium worked — and continues to work for me — despite the negative side effects, principally hand tremors at this point, in my fifth year of use. Lithium is a miracle medicine found in nature that works wonders for many bipolar patients – God’s grace at work.
My road to recovery would be incomplete if I left out the fact that, shortly after commencing with lithium and raising myself out of depression, my wife and I relocated from New Hampshire to Florida, where the summer lasts most of the year and the weather is much sunnier and warmer than in the northeast. In addition to the subtropical climate, we also live in a fun community full of happy, fit, friendly people who enjoy the healthy, laid back lifestyle. We have built a whole new life, and are loving it.
But I will always have bipolar disorder. The disorder seems to be an inextricable part of my brain’s physical design. And there is no known cure. Yet bipolar disorder can be effectively managed, and people who have bipolar disorder can live healthy, fulfilling, successful lives. The list of famous people with bipolar disorder is very long and includes people in virtually every profession.
According to my doctors, the keys to my staying healthy and preventing another onset of mania or depression, are to religiously take my medications; get plenty of sleep – at least seven to eight hours per night; exercise regularly, and stay fit – mind, body, spirit, emotions; eat a healthy diet; make friends, be a friend, enjoy friends; avoid stress, construct guardrails to protect myself from known stressors, and cultivate calmness; have fun and enjoy life.
It’s okay to admit you’re not okay
Bipolar disorder can strike virtually anyone, regardless of gender, race, education or class, from pre-teens into our sixties. It is an equal opportunity destroyer of lives and health, marriages and families, careers, friendships, and finances.
Many people with bipolar disorder are not as fortunate as I was. Between 25 to 50 percent of the five million or more people with bipolar disorder in the U.S. attempt suicide at least once. Eight percent succeed in killing themselves, and the suicide rate for people with bipolar is four times higher than the general population. Although it’s not known how many on active-duty may have bipolar disorder, some 700,000 veterans suffer from it.
Deciding to publicly share my story is a serious matter, but something I had to do. Seeking mental health treatment should be destigmatized and dealt with the same way our culture deals with cancer or a broken arm. We recognize the symptoms, get medical help, recover, and get on with our lives. We don’t blame or shame the sick or injured person for what I call a brain malady. We love, support and help them get well.
But instead, with mental illnesses, we often wait for people to fail before we get them the help they need. How is it that failure — often with permanent family, legal, social, career, or academic consequences — tends to be the first and only indicator of brain maladies? How can we change this?
We need more scientific research on bipolar disorder and other mental illnesses, the “invisible wounds of war,” and brain health more broadly. We must identify the genetic early warning markers, find the causes, understand the disease mechanisms, develop preventive medications and better recovery treatments. We need earlier identification of symptoms, and even potential cures. This research is vital for our broader society, our veteran population, and our serving military.
Moreover, how can we accommodate people who have these maladies so they can continue their careers? The medical and academic professions have found a way to do so. Just look at world-renowned doctor and scholar Dr. Kay Redfield Jamison of Johns Hopkins University. She has suffered from severe bipolar disorder for decades, yet figured out how to manage it, and perform at a world class level. Can other professions follow suit?
Millions continue to suffer. Worse still, their suffering is compounded by the stigma many members of our society continue to attach to brain maladies. By some grim coincidence, I have found myself finally healthy enough to begin to tell my story during the worst public health crisis of our time. I hope it will be over soon. But even when the pandemic is over, our mental health crisis will remain, and even appears to have worsened.
I am absolutely not ashamed or embarrassed to be a Bipolar Survivor. In fact, I am thankful and proud to have survived this toughest of wars — with the support of my wife, family, friends, the VA, and Grace — and to be thriving once again, with the unexpected gift of a great new life. I ask you to help me abolish the stigma associated with bipolar disorder and other brain maladies, by admitting you or another needs help, and then by getting it.
Be strong and courageous
If you or someone you love is demonstrating the warning signs of bipolar disorder or other mental illness, seek medical help immediately. Engage your medical professionals, but understand that bipolar is difficult to diagnose and can blend and interweave with other brain maladies and personality traits, so it can take years to properly diagnose and treat. Read, study and learn all you can about bipolar and mental illness in general. Engage fully in this effort.
Once you are prescribed medication and treatment, stick to it religiously and maintain an informed dialog with your doctor and therapist. Steel yourself to be compliant for life. Bipolar disorder never takes a break or lets its guard down, and neither can you. You will be in a “forever war” that you cannot quit or walk away from, without potentially disastrous results.
The great news is that bipolar disorder is a treatable medical issue. With proper treatment and a positive, determined attitude, you can live a wonderful, successful, and happy life. Take hope that you will join the legions of bipolar survivors who have overcome this brutal malady and are now thriving. Be proud and grateful for how far you have come and will progress. Help abolish the stigma!
It takes courage and strength to admit you are broken, to get help, and to get fixed. Be strong and get help for yourself, your family member, your friend and your comrade. It’s okay to admit that you’re not okay. The only real stigma is not getting the help you need and becoming a statistic.
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Major General Gregg F. Martin, Ph.D., U.S. Army (Retired), is a 36-year Army combat veteran and bipolar survivor. He commanded an engineer company, battalion, and a brigade in combat. As a general officer he commanded the Northwest Division of the Corps of Engineers, was Commandant of the Army Engineer School, commanded Fort Leonard Wood, was Deputy Commander of 3rd Army/ARCENT, was Commandant of the Army War College and was President of National Defense University. A graduate of Army Ranger and Airborne schools, he holds degrees from West Point, MIT, and both the Army and Naval War Colleges. He lives with his wife in Cocoa Beach, Florida. He is the author of the forthcoming book Battling Bipolar Disorder – A General’s Invisible War.
Phillip Martin is a writer, linguist, former Staff Sergeant, and combat veteran who served with Army Special Forces. He is the son of Major General (Retired) Gregg Martin.
The views expressed in this publication are those of the author and do not necessarily reflect the official policy or position of the Department of Defense or the U.S. government, nor does DoD clearance of this op-ed constitute DoD endorsement or validate its factual accuracy.