Interview with a Bipolar General -- Part II

This is the second part of my interview with Major General Gregg Martin, U.S. Army (Ret.). Read below for General Martin's experience with electroshock treatment, lithium, and recovery. General Martin gives his opinion on bipolar in the military and in politics, as well as how to fight the stigma of mental illness.

Is there anything during the war that you witnessed that could have triggered PTSD?

Yeah, I’ve got what they call moderate PTSD. So I do not have severe PTSD, if you look at what the elements of severe PTSD are. What did I see? I mean, nothing compared to the infantry or the armor or the Special Forces or my own combat engineers, who were really tip-of-the-spear groups that were upfront, you know, killing people, seeing bodies explode, ripped apart, and blood and gore everywhere. I saw, for the most part, given the nature of my job, my mission was for the corps commander, my three-star boss — my place was not at the tip of the spear. It was orchestrating, managing, and leading engineer efforts, really behind the main attack element, which was the Third Infantry Division. So I saw a lot of stuff blown up, burnt, dead bodies, stuff like that. You know Baghdad Airport was just a scene of carnage. Then when we got into the guerrilla warfare phase of the war, I saw the aftermath of IEDs and ambushes that basically ripped people apart, so I saw that stuff. But not nearly what other people saw or what an A-10 pilot or some of the Air Force guys flying in and getting shot at by anti-aircraft fire, and stuff like that.

What were the anonymous complaints you were getting at the National Defense University?

The anonymous complaints started when I was at NDU between 2012 and 2014. In all my different jobs, with General Dempsey, the watchword was “transformation.” And so everybody was trying to transform. And what transform basically meant was do a better, more quality job with less money and fewer people. That was it in a nutshell. It was a tough, hard mission that involved a lot of downsizing, reshaping, revamping, fewer dollars, fewer people, expanded problem mission set. So when I was at the Army War College, 2010 to 2012, I launched a big transformation called “Army War College 2020,” and that was my blueprint, which received great acclaim by the Army. And then Dempsey got moved to be the Chairman of the Joint Chiefs. So he picked me to be the NDU president. And it was basically the same mission in a joint environment, a bigger organization, in DC.  As soon as I got there, the bureaucratic resistance began. You know the NDU organization, mostly the higher ranking civilians who had the most to lose in terms of their job security, changes to the way they did their jobs, changes to the required collaboration among the five colleges, which they weren’t used to and hadn’t been done before, and budget cuts, etcetera. They got good intel from the Army War College what my modus operandi would be. And I had the full backing of the Chairman. But as soon as I got there — and I understand strategic management, strategic leadership, get consensus, get buy-in and all that kind of stuff — I wasn’t new to this kind of work because I’d done it in different jobs as a general. But the resistance was fierce, and immediately people dug in, resisted. It was kind of a stealthy guerrilla warfare, where people would make pretend they were on board, they would make pretend they were trying to make the changes, but in reality they were doing everything to undercut, undermine, and sabotage the movement that I was trying to do on behalf of the Chairman. And then outwardly the first big thing was a series of articles where senior NDU people essentially wrote articles and gave them to Tom Ricks, the Pentagon reporter. He’s a great author, written some superb books, very smart guy. So he published some articles and his blog that basically said — he did lay out what I was trying to do — but then described me as kind of a mad man, without using the word he really described somebody with bipolar disorder, which we now know I had. So his descriptions were not inaccurate. And he sort of depicted a mad man, which I was. And I know it’s politically incorrect to say mad or a maniac or insane, but I was going and then became insane. 

It sounds like mania wasn’t what caused your problems there, but it gave ammunition to your critics. 

Exactly. That’s exactly right. One thing that the mania did do though is, as my mania increased, naturally with the progression of bipolar and the stress of the job working for the Chairman in DC. As the pressure increased and the resistance grew, it was like pouring gasoline onto the flames of my bipolar, and my mania increased. And as it increased, people resisted me more, it increased more, so it became an upward cycle. What’s interesting is that Ricks’s articles weren’t that far off the mark in retrospect, but he was a gadfly who senior Pentagon generals paid no attention to, because he had a reputation as just a gadfly, a trouble maker, a thorn. And he had written negative, scandalous articles about most of them, so they said don’t worry about it, that’s what this guy does. You know, so don’t pay any attention, we don’t give any credence to Tom Ricks. So then what happened though in my last six months, the spring of 2014, I really went off the rails, and I could give examples of that, but probably up to a hundred anonymous complaints from staff, faculty, students started going up my chain of command, saying this guy has a mental illness, a severe mental issue, and here’s why we think that.

Senior officers?

Yeah, I think there were a number of colonels and Navy captains. You know, I had a number of flag officers who worked for me — I think they may have written stuff. But I think it mainly came from high level civilians on the staff and faculty, I’d say anywhere from GS-13 to GS-15, which is colonel equivalent, Senior Executive Service — flag level civilians putting in complaints. It was both faculty and staff and students. As these things built up, General Dempsey became more and more concerned, and people on the Joint Staff were more concerned. So Dempsey treated me very fairly. He did three assessments where he brought in people from outside NDU, like a panel of experts who had no dog in the fight, had nothing for or against Gregg Martin. Panel number one assessed the students, what do the students think about what’s happening at NDU, what do they think about Gregg Martin. Number two was the faculty, what does the faculty think about the changes in curriculum, how the faculty’s doing, and then what do they think about Gregg Martin. Assessment three was just focused on me. And all three of the assessments to Dempsey said Martin is generally liked, admired, respected. People think with the transformation he’s doing a really good job, and he’s carrying out what you, the Chairman of the Joint Chiefs, want done. People generally like Martin, but we think he has lost it and has some sort of mental disorder that’s undermining his credibility, and we think he has a mental illness of some type. And so Dempsey got all three of these, and finally there was a weird event that led to a 15-6 investigation. I can tell you about that. And so it was kind of like three strikes and then strike four, and he decided that for the good of the university, and for my good — I worked for him four times and he was kind of a mentor — he said for the university’s sake, for your sake, for your family’s sake, you gotta go. I gotta pull you out of there. And so he did.

One experience I never had was ECT [electroconvulsive therapy]. What was that like?

So I had been in the inpatient ward for two weeks, and I was rapid cycling into mania, down into severe depression. They tried different medications, therapies, etcetera. And at the end of two weeks they said this isn’t working, nothing’s working, would you think about doing ECT? I found out pros and cons and said, sure, let’s do it. So, a full round is 14 treatments. They can only do it three days a week with a day in between. So they do it Monday, Wednesday, Friday. For me, they did it in the morning. And they discharged me from the inpatient locked-up ward into a dorm. So I lived in a dorm on the hospital campus, and then I reported each morning at the right time for my ECT. I did other therapies, other treatments for the extra month I was up there. Anyway I’d go in there, let’s say at nine in the morning, I would meet the nurse, they would take vitals and all that. Then you’d walk in, put in one of those hospital robes and lie down on a recliner with your head kind of elevated, and I think they’d give you some Tylenol and water. Then they would inject anesthesia. So you’d go completely out. I have no feeling, no memory, nothing. And then what they’d do is they hook you up to all kinds of electronic sensors, and then they put the nodes on different parts of your skull. And then you’re asleep, and they inject electrical voltage into your brain, and they monitor it on their screening device. They send you into low level convulsions, and they hold the convulsions for a certain amount of time. So the idea is to stimulate or shock or convulse the brain, and the idea that it can break the depression. And it works for quite a large number of people, like Kitty Dukakis, who’s famous — it cured her depression.

Did you have any side effects? 

I had a headache each time I woke up, and so you sort of hang out in the room for 30, 60 minutes. They monitor you. You can take water, fruit juice, Tylenol. And then somebody would walk back with me to my dorm room, and they’d tell you to just lie down and take a nap. Then when you wake up, if you have any problems, call them. So I would just go back, take a nap, wake up, have a little headache, take another Tylenol, and go about my business for the day 

I think of it as this barbaric procedure that Nurse Ratched threatened Jack Nicholson with in One Flew Over the Cuckoo’s Nest. Has the procedure gotten better since then?

[Laughs.] Yeah, totally. It’s really nothing like that at all. Other than electricity being put into the brain, it’s nothing like One Flew Over the Cuckoo’s Nest. In fact, that was the question I asked them. I said, hey, am I gonna be Jack Nicholson versus Nurse Ratched? They said no no no, it’s not like that at all. And so it was very calm, professional. It was, to me, no big deal. It was cool. I’m sort of glad I had it, because now I can say, yeah, I had ECT. It’s kind of like a badge of honor. The problem was it didn’t do anything for me. It didn’t solve the depression.

So what stabilized you?

Ultimately it was lithium. So I was in the VA inpatient and ECT in March of 2016. The depression just didn’t go away. Over a period of months, my wife couldn’t take it anymore. She called my doctor and said you gotta try something else. And so really the last big thing left was, which I’m sure you know, there are significant side effects of lithium. So we talked about it, but the chance that it might fix my depression to me was well worth it. So I said let’s give it a try. This was late August, early September 2016. And within a couple few days, I felt better. The depression went away. Within a week, I really felt like my old self. Energy, drive, enthusiasm came back. I started being active again. And so they monitored me on lithium for a few weeks. And then we decided to move to Florida, so we got a place down there, picked up and moved.

Do you think bipolar disorder, even if it’s being managed, should be disqualifying for the military?

That is a great question, one I really want to do more research on. And I would say, given my experience, I was bipolar. And I did a great job as brigade commander. I was one of the most highly rated commanders in the entire organization of the corps. I continued doing a really great job, even when I was manic. You know, it was a high performing mania. I did a terrific job when I was in depression before it went acute. I was proof — and my wife thinks I had bipolar several years before the Iraq War, and I did a great job. I was rated number one, got promoted early to colonel. So I was living proof that someone with bipolar can perform very well.

Well I’m thinking in terms of grunts, NCOs, junior officers. Do you think they can function with managed bipolar?

I think they can. I think bipolar is much more widespread in the military than anyone realizes or acknowledges. And here’s why I say that. The population at large they estimate at about four percent  — it depends what study you read, some say two percent, some say four percent of the adult population have bipolar disorder. Let’s just assume it’s either one of those numbers. If you think about who comes into the military, the profile is mostly high energy, lots of drive, lots of enthusiasm. That’s who we recruit, that’s mostly who come in. And that tends to be more bipolar. Then number two, the age that bipolar mostly strikes or afflicts people is between 18 and 25. And that’s the predominant age. Well that’s the predominant age people come into the military, between 18 and 25. And then thirdly, what typically triggers or kicks off bipolar is a very high stress environment. From the minute you join the military, the stress is high, from the minute you report to the drill sergeant. So I think we have the perfect conditions for probably a higher amount of bipolar. And then what happens is if you do have bipolar, high performing mania, then you’re rewarded for it. That excess of enthusiasm, drive , energy — you get a boost, you’re rewarded, you’re ahead of your peers. So I think there’s a lot of unknown, undiagnosed bipolar going on in the military that serves the military well. Until the person goes off the rails into a high level state of mania. So I think there’s like a point…well, people have asked me this: if my bipolar had been detected earlier, and you had gone on a manageable dosage of lithium and controlled and managed your bipolar, do you think you could have served successfully? And I think I could have. But the danger is the military is, by definition, stressful, so would the subsequent stress have elevated me into more serious levels of bipolar and mania? I don’t think anybody has the answer.

How about for a political career? Do you think it’s a disqualifier for a political career, and at what level?

I think that someone who is a politician, as long as their bipolar disorder does not become serious or acute, they should be fine. And again I think it would enhance their performance in so many ways, the way it did mine. But, given the stigma and discrimination that exists regarding mental illness in general, and probably bipolar in particular, I think it would be very difficult for a politician probably to keep their job and certainly to get re-elected or elected if it became publicly known that they had bipolar disorder. I think in the primary or in the election, it would be such a hammer to be used against them that they probably wouldn’t get elected. I don’t think it’s as bad as that guy Thomas Eagleton…

Well, I was going to ask you about Thomas Eagleton. Do you think he should have been dropped because he’d gone through ECT?

I would say no. But back in those days — that was in the seventies — and the stigma and the discrimination and the lack of understanding fifty years ago was way worse than it is today. I think we’ve come leaps and bounds forward. So I don’t think getting ECT or getting treated or getting diagnosed with some kind of mental illness should be a disqualifier. I really don’t. And again, as I give the example, so many high performers have it or probably have it.

What’s the best thing we can do to end the stigma?  

I think, number one, people need to recognize and accept that mental illness is physiologically real. It’s not just something in the mind, the imagination. It’s not a lack of character, a lack of willpower. It’s real. It’s just as real as cancer, diabetes, heart disease. But it’s inside the brain, and it’s invisible, and we don’t understand the brain that well. So it’s real. Number two, there is no stigma attached to other physiological diseases that I just mentioned. So if there’s no stigma or discrimination attached to those, it’s really unfair and kind of discriminatory and barbaric to attach it to a mental illness. Number three, people battling mental illness — it shouldn’t be seen as a stigma or something to be embarrassed about. It should really be viewed in the light of a person fighting a heroic cause. And I say that and point to the example of breast cancer. If you go back 50 years ago, breast cancer was stigmatized, was shameful, embarrassing, people kept it in the closet until Betty Ford came along, and she was brave and courageous, and she said I have breast cancer. And that was revolutionary. Over the next 50 years, look at where we are with breast cancer today, women with breast cancer are held up as role models, as courageous, as warriors. The NFL during breast cancer awareness month, they wear pink shoes. I think mental illness needs to be recast and reframed in the same way today.