Bipolar General: My Forever War with Mental Illness

By Gregg F. Martin

Maj. Gen. Gregg Martin cut a striking figure in the Army: athletic, quick witted, devout, and studious, he was a natural leader. Thanks to his engineering and leadership knowhow, Martin was chosen to lead the thousands of combat engineers who paved the way for 100,000 Army troops to battle their way to Baghdad in 2003. Martin was astonishing to watch as he led this effort, his mind laser focused and body vibrating with energy. He made quick decisions, often anticipating and solving problems before orders came down. Only years later would he learn how the pressure of organizing dozens of simultaneous life-or-death missions each day altered the biochemistry of his brain. Since adolescence he’d had what psychiatrists call a ‘hyperthymic personality’ – an exceptionally positive, energetic, and can-do disposition. But the Iraq War triggered what military and Veterans Administration psychiatrists ultimately diagnosed as late-onset bipolar disorder, a chemical imbalance that sends sufferers whipsawing between grandiose imaginings and suicidal depressions. His increasing erratic behavior led to his forced resignation as president of the National Defense University and ended his military career.
 
Bipolar General offers a candid account of Martin’s personal journey with undiagnosed mental illness as he rose through the ranks of the U.S. Army. The author provides a first-hand look at the various treatments available for bipolar disorder ranging from powerful medications to electroconvulsive therapy. He discusses why his condition went undiagnosed for so long and explores what can be done both within and outside  the armed forces to diagnose and treat mental illness. Bipolar General should be of value to those with mental illness and to the communities of family, friends, and caregivers surrounding them. 

• Language: English
• Publisher: Naval Institute Press
• Release date: Sep 15, 2023
• ISBN: 9781682473948

Book preview

Introduction

I Love You, but You’re Fired

It was mid-July 2014. I was fifty-eight years old, in my thirty-sixth year of active-duty Army service, and the president of National Defense University (NDU), the nation’s highest military educational institution, located in Washington, D.C. (DC). NDU falls under the supervision of the chairman of the Joint Chiefs of Staff, at that time Gen. Martin E. Dempsey, America’s top-ranking military officer. I was summoned to report to the chairman, my boss, at his office in the Pentagon.

As my driver, Army paratrooper SFC Bryan Alexander, drove the black Army SUV from Fort McNair across the Potomac River to the Pentagon, my aide, naval aviator Lt. Hunter Scott, sat quietly, wearing his Top Gun aviator glasses and looking out the window. My wife, Maggie, was next to me in the back, and she too was quiet, gazing out the window. She rarely came to official meetings, but Chairman Dempsey had requested she join me. No one spoke during the drive.

I wondered if this unusual summons meant that the chairman had approved my request for a three-year extension in the job, if he wanted to reinforce what a great job I was doing and give me guidance for my upcoming third year at the helm, or if he planned to fire me. In my manic and deluded brain, I figured there was about an equal probability for each outcome.

General Dempsey is a brilliant man I have known and worked for and with for seventeen years, since 1997. He had been an excellent boss, colleague, mentor, and friend during that time. We had a great professional and personal relationship, and he had handpicked me to be NDU president, which was the third straight job I had worked for him.

When I walked through the office door, I noticed his lawyer in the room and thought, This is not good. I saluted the chairman, and he walked over and gave me a hug. He said, Gregg, I love you like a brother, but your time at NDU is done. You’ve done an amazing job. No one else could have done what you’ve done, and in just two years! Nevertheless, my presidency of the school was over. You have until 1700 [5 p.m.] today to submit your letter of resignation to me, or I will fire you. Is that clear? The chairman noted the numerous reports he had received about my recent behavior and actions at NDU, with many deeply concerned about my mental health. He knew it was a bad situation and got me out of there. And there was one other thing: I’m also ordering you to get a command-referred psychiatric-health exam at Walter Reed this week.

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 full-blown mania, and I had none of those reactions. I was already anticipating my next grandiose mission from God.

Indeed, my behavior had become erratic and disruptive to the mission. I had lost the confidence of much of the staff and faculty of NDU. I resigned that afternoon.

To be clear, I was not wronged. Chairman Dempsey made the right decision. He was taking good care of my own health and welfare, my marriage and family, as well as his university’s welfare and mission success. Had I been in his shoes, I would have made the same decision. NDU benefited greatly under the leadership of Amb. Wanda Nesbitt, 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 professionals who do 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.… [H]e is psychiatrically fit for duty. The reason I say this is not to criticize but to emphasize how 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, and ideas. 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 unrecognized, undiagnosed bipolar disorder. According to medical authorities, my genetic predisposition for the illness 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 first acute, then full blown. In late 2014, four months after my resignation from NDU, I spiraled, then crashed into severe depression and psychosis. From late 2014 through 2016, I was in bipolar hell, battling for my life.

Had there been warning signs and indications? How did I 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?

My resignation from NDU was the climax where I reached the peak of full-blown mania, following an eleven-year rise, and the beginning of the subsequent spiral into severe depression and psychosis (delusions and hallucinations). My condition would get far worse over the next two years. I would soon devolve into a husk of who I had been. This would be the hardest combat I would ever face.

Bipolar Disorder in a Nutshell—What Exactly Is It?

Derived from a different and broader conception—called manic-depressive illness (MDI)—bipolar disorder is a term created by the American Psychiatric Association for its official diagnostic textbook, the Diagnostic and Statistical Manual of Mental Disorders (DSM), in 1980 for its third revision and has continued in use, the manual now in its fifth revision (DSM-5). Bipolar disorder is a general term that, according to DSM-5, involves the presence of long and discrete manic episodes, usually alternating with even longer depressive episodes. It comprises a cluster of related disorders that are characterized by distinctive and extreme shifts or cycles. These moods oscillate between varying degrees of two poles: mania and depression, or highs and lows. This is important because the DSM concept of bipolar disorder requires long durations of discrete episodes, unlike MDI, which can involve short rapid oscillations with or without long discrete episodes.

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, or having an inflated self-esteem and or feeling grandiose or religious. There’s often little need for sleep, since it’s common to feel rested after three or four 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, and extravagant spending sprees.

Mania is much more than feeling 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 overproduction 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, confusion, indecisiveness, 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 have little interest or pleasure in most activities, and often have significant change in weight or appetite.

But depression is much more than having a bad day or feeling 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 underproduction and distribution of those same critical chemicals that create and regulate mood—dopamine, endorphins, and others. Bipolar disorder and other types of mental illnesses are real physical illnesses that occur within the complex biochemical and neurological components of the 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. So we must treat it as we would a person with cancer, diabetes, or a broken arm—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 bipolar disease or other mental illness deserve and need the same support.

That said, a person afflicted with bipolar disorder, through no fault of their own, may damage relationships—sometimes like a human wrecking ball—in their marriage and family, with friends, and with colleagues.

In addition to these more severe manifestations, bipolar illness can present other times in mild enough ways that people don’t even notice it.

Background

My brain burst into full-blown mania in 2014 at the age of fifty-eight. This is called late onset bipolar disorder and is rare, with only about 5 percent of diagnosed cases occurring this late in life. I may very well have had an undiagnosed case of the disorder earlier, but there were no obvious bipolar symptoms that were recognizable to myself or others until I was fifty-eight. In retrospect, however, the warning signs—milder symptoms of the illness—were all there for more than a decade.

It is likely that before diagnosis, bipolar illness lifted me up, boosted my performance, and helped make me more successful than would have otherwise been the case. My extraordinary energy, enthusiasm, and extroversion were key to my high achievements. But after a tumultuous ride and a life of mostly high achievement, it eventually brought me down.

Even up until the time I was in full-blown mania, it was very tricky for everyone—myself, family, work colleagues—to differentiate between the normal Gregg Martin, hypomanic Gregg Martin, and even full-blown manic Gregg Martin; the same was also true regarding the depressive side of the disorder. There are often no clear lines between personality and the various stages of the disease as it progresses. Bipolar disorder can hide itself in and among normal, healthy personality traits. It frequently masks itself, making it difficult for doctors and other concerned individuals to detect and diagnose it. As bad as my situation was, I had an extraordinary safety net and supportive family. Many who are struck by this devastating disorder are not as fortunate. They go from being confused, lonely, and poor to being broken, penniless, and in jail—or dead.

The Effects of Bipolar Disorder on Others

Bipolar disorder does not limit its effects to the afflicted individual. More often than not, it becomes a family affair and often a community affair—no man is an island. The consequences on others is often destructive. The illness indiscriminately shreds marriages, families, friendships, careers, and finances. In my case, it pushed our family relationships right to the edge of breaking. We came almost to the point of irreparable damage.

Thankfully, my marriage and family relationships survived the experience, healed over time, and have been continually strengthened in recent years. I’ve been truly blessed to have such a caring and loving family—Maggie and our three sons—who never gave up on me. My two sons who have also been diagnosed with bipolar disorder have been especially helpful and empathetic, given their own situation. Bipolar disorder has forged a powerful common bond that we never expected. But in its own unusual way, it has proven to be a unique blessing.

Likewise, friendships were put under enormous strain. I had some strong, loyal friends who stuck with me through the hardest of times, and they gave me steadfast support and friendship; they believed in and practiced the Army ethos of never leave a fallen comrade. One great friend—retired Army colonel Bill Barko—was critical in saving me. My West Point classmates have been fantastic, keeping faith and remaining loyal—a true band of brothers. I had some very supportive senior leaders as well. On the other hand, some friends, colleagues, and mentors faded away. Although to be fair, most did not understand what I was going through, while for some, the experience was too painful, and they wanted to forget it.

As far as my career, I believe bipolar disorder helped me enormously, until such time as it went out of control and caused the inglorious end of what was otherwise a distinguished Army career. I was fortunate that the disease didn’t go acute until very late in my career—at which time I was removed from command—when I was less than a year from my scheduled retirement. And my actual medical diagnosis of bipolar disorder came just six months before retirement. Had I been diagnosed earlier, I would have lost my security clearance and been medically boarded out of the Army. This truth motivates others with mental illness to hide it, not confront it.

My breakdown had a serious, disruptive effect on the university I had been leading. They had to pull a senior leader—Ambassador Nesbitt—from her senior vice president position and put her into a temporary, acting president role until such time as my permanent replacement could be identified and installed. Likewise, the unit that accepted me for ten months after NDU—the Army Corps of Engineers—had to provide a variety of support while figuring out how to suddenly integrate a two-star into the leadership mix and organizational chemistry. My situation caused extensive disruption to both organizations.

Some of my subordinates from the bad times of my mania either ignore me or refuse to speak with me, even when I tell them that I was ill and that their candid observations could help save lives. Unfortunately, they were so traumatized by the experience, remain angry with me, or both that they choose not to revisit that painful chapter of their life. At that time, I was a maniac. I scared them, and it shook them to their core.

In retrospect, it is likely that I was living on the bipolar spectrum and had a mild form of sub-bipolar disorder from my teenage years on, with symptoms that increased over the years as part of a gradually intensifying mental illness. But like a frog in a slowly heating pot of water, there was no recognition of my illness until the pot boiled over, until I had gone acutely manic and then crashed into severe depression.

Decades of mild, low-level manic behavior in the Army did not trigger any recognition of bipolar symptoms. An acclaimed psychiatrist has since diagnosed me with hyperthymia—which is not a mental illness, but an abnormal personality, a near-continual form of mini-mania in which mild manic traits are part of the personality—from my teenage years on. If anything, my extreme energy, enthusiasm, and drive were prized personality traits that led to my steady advancement in the Army. Even the diagnosis of first my oldest teenage son with severe bipolar disorder in 2001, then my youngest son with cyclothymia (a milder form of the disease) in 2010 as a twenty-one-year-old were not enough to make either me, my family, my friends, my professional colleagues, or the institution stop and think about my own potential for bipolar disorder, a completely genetic condition.

1

Accidental Soldier

I grew up in Holbrook, Massachusetts, near Boston. My mom, Patricia Kelly, was from Boston. Her mother died suddenly right in front of her when she was a teenager, causing her to grow up fast. Her dad, Jim Pop Kelly, was a World War I Navy veteran, electrician, and Boston police officer. She also had two brothers, Jim and Joe Kelly, who both graduated from the U.S. Coast Guard Academy, served full careers in the Coast Guard, and achieved the rank of captain. Mom was very smart and a terrific athlete, had tremendous energy, enthusiasm, and a great sense of humor, and was partial to tough love. She could also display an explosive temper, was a career woman ahead of her time, and was tough as nails. We nicknamed her the Irish Drill Sergeant. After my dad died, she became increasingly extroverted, at seventy-three, and transformed into a dynamo of epic proportions. She became legendary in her adopted home of Gilford, New Hampshire, for her levels of energy and enthusiasm right up until she died at age ninety-one. She was still downhill skiing, biking, hiking, swimming, snowshoeing, and more until she was almost ninety, when a bad heart slowed her down. Of our two parents, she was the one in charge.

My dad, Donald Martin, was from Chelsea, Massachusetts, and served in the Navy as an enlisted man during World War II in the Pacific theater. His three brothers all served as well—two Navy, one Army. His father, Tom Martin, was a typewriter repairman, so as my dad was growing up, the family was very poor. The Navy was my dad’s single-biggest life event along with having his own family. He always said that Harry Truman was his favorite president for dropping the atomic bombs, bringing World War II to an end and saving many American lives, which would have been lost in the planned invasion of Japan. After the war he used the GI Bill to attend the University of Kansas, where he earned a business degree, and afterward started a professional career in Missouri. In 1954 he moved our family back to Massachusetts, where I was born, two years later. He was a mostly easygoing, friendly extrovert; a good athlete, with high levels of energy and enthusiasm; and loved to play outside sports and to go on adventures with my mom and the family. But while he loved to joke and laugh, he had an occasional explosive temper. He also could not say no to his friends, who encouraged him to run for local office and serve on a number of school, church, and civic activities and committees, thus taking him away from home on many evenings, which angered my mom. Both my parents were Irish-Catholic Americans whose grandparents had emigrated. They were products of the Great Depression and World War II. They also were part of the Greatest Generation.

I was blessed to have these two terrific, loving, and caring people as my parents. They raised me well and gave me a great start.

Childhood

I had a happy childhood, with three older sisters—Donna, Denise, and Kelly—and a younger sister—Jill—but no brothers. My family did not treat me any differently because I was the only boy. I was not spoiled. My second-oldest sister was legendary and even a bit feared in the neighborhood because she was tall, very tough and intimidating, and could beat up just about any boy around. She was our protector.

We all stayed close, and my sisters came and visited me many times at West Point as well as overseas and in other areas of the United States. Along with my parents, three of us bought a ski chalet in Gilford, New Hampshire, that was ideal for both summer and winter activities, which we owned jointly from 1984 until 2012. The arrangement worked great while all the kids were young and we lived within driving distance in the Northeast.

Our house in Holbrook had a yard, woods nearby, and plenty of kids for my sisters and I to play with. The post–World War II baby boom generation was thriving in our neighborhood and town. There were kids my age bursting out of many of the houses. I was very active: climbing trees, playing in the dirt with construction engineering toys, playing cowboys and Indians, and of course, playing army. Later this energy shifted into sports.

I went to a one-room schoolhouse for first grade. During our daily walk to school, we had to be on guard against dog attacks. Our neighborhood had a lot of big, mean dogs, some of which threatened me and my sisters on a regular basis, creating in me a strong fear and dislike of dogs that lasted well into my adult years. My parents also had a powerful fear and dislike of dogs—they had dealt with too many mean ones in the city. As soon as I could, I became a paperboy with my own route, which gave me some money but exposed me daily to many of the fiercest dogs. I learned to fend them off in a number of different ways, some clever, but others requiring brute force.

As I grew up, I became devoted to basketball; my goal was to become a professional basketball player. I did just about everything humanly possible to achieve that goal, but physical constraints (size, speed, jumping ability) prevented me from reaching that dream. My hero and role model was John Hondo Havlicek, number seventeen of the Boston Celtics, who was legendary for his enthusiasm, hustle, and energy. I did basketball drills continuously, attended basketball camps every summer, played in summer leagues, watched countless professional, college, and high school games live and on television, ran to and from the town basketball courts (a mile each way) doing dribbling drills and offensive moves the whole way, and shoveled snow off the courts so we could play full court. When I got home at night, I’d go out and practice on the hoop in our driveway with a spotlight.

My life revolved around basketball. In the summer when the family would go to the lake or beach for sailing, boating, and water skiing, I would usually stay home and play basketball. This aggravated my parents somewhat, but they were generally supportive of my passion. Later in life my mother believed that this was an early expression of mania.

Unbeknown to me or anyone else, and only recently diagnosed by acclaimed psychiatrist Nassir Ghaemi, I had a hyperthymic personality from my teen years onward, and it is still with me today. Hyperthymia is being in a near-continual state of mild mania (not to be confused with hypomania, which is periodic episodes of mild mania), giving the person the advantage of unusually high levels of energy, drive, creativity, enthusiasm, and optimism. It enhances and boosts natural talents and performance. In many ways it gives the person a significant advantage over those without hyperthymia. On the opposite side of the coin, however, it puts the person at higher risk for going into full-fledged mania, depression, and extreme mood swings that are indicative of bipolar disorder. Over the years hyperthymia benefited me greatly, but as it inched its way toward mania and bipolar disorder, it became a danger. (It is important to note that people with hyperthymia do not necessarily develop bipolar disorder, and people with bipolar disorder may not have been hyperthymic.)

High School

A multisport all-star athlete and team captain in high school, honor roll student, Boys State delegate, and voted most likely to succeed and most athletic in my class, I had unusually high levels of energy, enthusiasm, exuberance, and creativity—traits that have remained with me throughout my life.

There were no indicators that I possessed the genetic predisposition for bipolar disorder. With the exception of an aunt on my mother’s side who was diagnosed with bipolar disorder, there wasn’t any other known family history of it nor any other brain malady or mental illness. Of course, in those days mental illness held a terrible stigma and shame, and such matters were kept secret. Persons with mental illness became nonpersons, even within their own families. Knowing what I know now, I believe that other members in my direct family may have had undiagnosed bipolar disorder, though never as bad as what my son Phillip and I experienced. I can now recognize the symptoms

Reviews for Bipolar General

[Jacqueline Parker · Rating: 5 out of 5 stars]

Knowing General Martin personally, it was so informative to read his journey and glean insights. Great read!