Iraq War Triggers Bipolar with General Gregg F. Martin [Part 1]

Major General Gregg F. Martin had, for the most part of his life, lived with hyperthymia, a continuous low-level mania that ultimately helped his military performance because he was energetic, creative, and driven. But after commanding a 10,000-soldier combat brigade in Iraq, Gregg’s descent into mania and depression would span a decade.

With a late diagnosis at age 58, Gregg challenges our understanding of bipolar disorder, revealing his belief that mental illness can progress along a spectrum rather than appearing suddenly. For Gregg, the Iraq War became the tipping point, transforming his beneficial hyperthymic traits into dangerous mania, and ultimately life-threatening depression. As his condition worsened, colleagues reported his erratic behavior, leading to forced retirement and   removal as president of the National Defense University.

The most haunting aspects of Gregg's story involve his descent into psychosis and passive suicidal ideation –  such as experiencing fear from an "invisible force" that could take hold of him and thrust him into oncoming traffic.  His journey from battlefield commander to psychiatric patient illuminates the complex relationship between trauma, high-stress environments, and mental health. Now an author and advocate, Gregg's experiences offer profound insights for anyone struggling with mental illness or supporting someone who is. 

This episode contains detailed discussions of suicide and suicidal ideation.

Gregg's book:

Bipolar General: My Forever War with Mental Illness (Association of the United States Army)

Transcript

Janine: We are supported by the SOAR with Tapping app. Tapping is a powerful science-backed tool that calms your nervous system. I've been using SOAR with tapping nightly for insomnia, and I am sleeping well. Visit the SOAR with Tapping app at Apple and Google Play Stores to start your journey towards freedom, right from your phone.

Welcome to Bipolar She, I'm your host, Janine Noel. In this episode, we do talk about suicide and suicidal ideation in detail. Please listen as you see fit. If you're ever in need of immediate help, dial 988 A Suicide and Crisis Lifeline. 

Today I sit down with Major General Gregg F. Martin. Gregg commanded and led a combat engineer brigade of more than 10,000 soldiers during the Iraq war.

At this time, Gregg was living on the bipolar spectrum. A decade later, he would learn that his full-blown mania and psychosis were triggered by the events of war. In this episode, we talk about Gregg's moods over a lifetime, how bipolar illness made him high achieving, why he wasn't diagnosed until age 58 and the dark days, that would follow a lifetime of highs.

Gregg holds a doctorate degree with the US Army and is author of Bipolar General. My forever war with mental illness. All right on with the show.

Janine: Hi Gregg. Thanks so much for coming out to do the show today. How are you doing?

Gregg: I'm doing well Janine. Thank you.

Janine: And you're in Florida right now? Yes. And it's nice and sunny. I assume. 

Gregg: It sure is.

Janine: Good. So we talked a little bit about a new story or a crisis time that you could share with us.

Gregg: So here's a story - just popped into my head this week - I, I've never talked about it or shared it, but it definitely fits in my journey with bipolar disorder. When I was probably in about fifth grade, I loved basketball and my dad loved basketball and our hometown had a really good high school team, and I used to go to the games with my dad and really, really enjoyed them.

It was so much fun, you know, I loved the game, knew the players, and then, you know, had sort of special time with my dad and myself. So it was a, a Tuesday night and I had gotten all ready to go and my dad said, Hey, it's time to go to the game. Let's go. And then this feeling of just despair and sadness and loneliness just sort of overtook me.

I just said, Hey, I, I, I, I can't go. I feel really, I feel really terrible. I don't want to go, and my dad's like, What? You don't want to go to the game? Come on. It'll be a great game. We're playing our archrival, and you know, both teams are undefeated. It'll be so much fun. I said, Oh, Dad, I'm, I'm sorry. I just, I, I don't, I don't wanna go.

He tried to persuade me and convinced me to go to the game with him. 'cause I know he was disappointed too, but I just said, No. When he left, I just turned off the light and went to bed. I felt terrible. I felt so horrible that I didn't go to the game, but it was this, being to between the two. And so it was really kind of an emotional, traumatic experience that I sort of tucked away and, and didn't even have in my head until it popped out this week.

But then over a period of years, especially after the bipolar disorder got pronounced, I would have more and more events and situations like that where there was something that I really wanted to do and then I would be overcome by some feeling of depression and then not go and then feel even worse.

Janine: And were those events all through your childhood?

Gregg: That was the only one I knew of as a child.

Janine: Okay, so it wasn't a super rapid cycling where you went from enthusiasm into despair. It was a low level of depression going on.

Gregg: Yes, I would say so, but most of the time I was very enthusiastic, energetic, upbeat, positive, and had what I now know is a condition called hyperthymia.

Which is pretty much a continuous low level mania. And so to dip into, you know, this really more than subdued, I would say it was sort of a, some level of depression, was very, very unusual for me. Although it would become more and more common the older I got.

Janine: It's interesting 'cause there is a statistic out there that if you have a depressive episode before adolescence, you're at 50% higher risk to have bipolar disorder.

I also know that for you there's a very specific trigger for your bipolar and that it was late onset. I, I'd love to hear about that.

Gregg: When I got diagnosed at age 58 years old, and then when I went to the VA medical system, both the Army Medical Department and the Veterans Affairs asked the question, how did this 58-year-old general come down with bipolar disorder?

And so they both did independent inquiries to answer that question, and essentially they both came to the same conclusion that prior to the Iraq war, while I had, you know, I was on the bipolar spectrum and clearly, you know, hyperthyrmic, that the actual triggering event was during the Iraq War where my genetic predisposition was triggered by the really intense thrill, euphoria, pressure, stress of the trauma of the war, that that's what actually triggered it.

Janine: I think we should just pause for a second because this is the first time on the podcast. I've heard the term hyperthymia. For listeners, how is that different from hypomania? 

Gregg: So. This whole idea of a spectrum of bipolar disorder is something that it, it's not in the DSM, but in, you know, for many years now, leading researchers and scholars of bipolar disorder and mood disorders have said, you know, it's not an on off switch.

Like you don't suddenly go from not having bipolar disorder. To suddenly you flip a switch and you do have it. It's, it's much more of a gradual spectrum approach. And so like with me. I asked my doctors, I said, okay, I believe that, you know, 2003 Iraq War was the triggering event, but what did I have the day, the year, five years before that?

It didn't suddenly go from nothing to something. There was a definitely, you know, there was a, a glide path and I talked about it and explained it to them. Basically, my psychiatrist said, Nope, you know, here's what the DSM says. It says, you know, this is it. You don't have it, and then you do have it. And to me that just didn't make sense.

It didn't pass the common sense test. Particularly as I wrote my book and I did more and more research, you know, there's a whole body of, of evidence and thought with really the leading researchers on mood disorders that talk about this idea of the bipolar spectrum. And so with the bipolar spectrum you have on the, you have euthymia, which is just a steady state where you don't have either any, any trend towards mania or towards depression at all.

So that's euthymia. Then hyperthymia - not to be confused with hypomania, but hyperthymia is consistently above the line of the steady state line. So you have this near continuous level of mild mania, whereas hypomania is episodic. So. So essentially, think of it as hypomania is episodes of mild mania.

Hyperthymia is continuous low level mania, and then dysthymia is continuous mild depression. 

Janine: So did you alternate between the two?

Gregg: No, very, very little. I only occasionally dipped into depression during, I would say that whole period up until my bipolar disorder was triggered in 2003. During that whole period from the incident I described in grade school all the way through, I probably only had, I'd say less than a dozen episodes of some level of mania.

The rest of the time I was hyperthymic. Very positive, enthusiastic, upbeat, energetic, creative, driven.

Janine: And that fit your work well, right?

Gregg: It really did. I was, I mean, it's kinda like I hit the jackpot. I was so fortunate 'cause it helped me. I mean, essentially living on the bipolar spectrum with hyperthymia, it enhanced and boosted my performance and capability for decades, you know, with all those positive traits and attributes, which made me better.

Janine: 'Cause you are able to pinpoint really the year where things unraveled or the mania was triggered. I'm curious what those moments were like for you. What was going on internally and externally, what you remember?

Gregg: So I was a brigade commander in charge of what ended up being about 10,000 troops. And we trained in Germany and we prepared for what would then become the Iraq war.

So it was very, very intense, tremendous pressure, you know, and basically the performance of my brigade would, was gonna be key to the entire operation. So in other words, if we did well, 'cause I commanded all the combat engineers and if we did well and did our job, the attack to Baghdad would. Probably be pretty smooth and we wouldn't lose that many people.

But if we didn't do well and we made mistakes, things went the wrong way, we would ended up, the whole operation would've taken much longer, would've had much higher casualties, a lot more Americans would've died. And so, you know, the stress and the pressure of knowing all that, I think sort of took a toll on me for a while.

And then we deployed from Germany to Kuwait. Then we trained even more in the desert and got ready, you know, to really the highest level of readiness. And I remember when we attacked, I felt like Superman. It was the most thrilling experience of my life. I just felt great like a, you know, a thousand pound weight had been lifted off my shoulders and I was just filled with a surge of energy, creativity.

Didn't need sleep. Moved, maneuvered all over the battlefield. My mind was like some kind of supercomputer where I could anticipate and solve complex problems before anybody else knew there was even a problem to solve. It was just an unbelievable experience. And so that went on for the whole ground invasion, which was about a month, and I felt amazing, super energized and, and, uh, euphoric.

It was absolutely a thrilling experience. Then after we got to Baghdad and certain political decisions were made by the US government, we went from being liberators to occupiers. And the war turned from this high speed maneuver, uh, operation to us being bogged down in a gorilla war counter-terrorism and that sort of thing.

And so suddenly we were surrounded, swallowed up in a sea of people who hated us and wanted to kill us. We started losing more and more soldiers being killed and blown up and wounded, and that sent me from euphoria, sort of this euphoric mania into angry full of rage. Fear and then I would spike down into depression.

And so I had, I ended up going from this very high euphoric mania to this mixed state where I was manic, and then I was angry and full of rage, and then I dive into depression. All of this was swirling around in my brain and meanwhile, more and more people being killed and wounded. And so that went on for a year and uh, I continued to perform really well.

Then finally after a year, we redeployed back to Germany, and then I fell into a depression that lasted about a year, and so that was my first full up down manic depressive cycle.

Janine: I would think having anger and frustration would be part of the job too. It wouldn't make you stand out. Do you think that any of your fellow soldiers were noticing a difference in you?

Gregg: So. This entire time, I, I did not realize that I had bipolar disorder. I didn't think there was anything wrong with me. I didn't notice anything. Nobody around me said anything, and that went on for 12 years until I finally got a diagnosis 12 years after the Iraq war. But subsequent to that. After I, when I was writing my book, I got ahold of as many people as I could who I served with, you know, subordinates, peers, superiors, and said, Hey, I've been diagnosed with bipolar disorder.

I'm doing research on it. Do you have any recollections of me demonstrating any of these different symptoms? And I told them what the symptoms of mania and depression were, and then they said, oh yeah, as a matter of fact, I do. I do remember. Incidents and episodes where, you know, now that you bring it up, I did see where you were acting, you know, really kind of bizarre and strange. And they would describe what was manic episodes and then they would describe periods of depression where I was isolated, withdrawn, indecisive. Lackluster, subdued. And so they did see it, but of course, like most people, they didn't know what they were seeing because they were completely untrained in mental health issues.

They didn't have any training in it, so they didn't really know what. What they were seeing.

Janine: So many of us with bipolar when we're in mania or even psychosis, our behavior can be bizarre. And it can be strange. What kind of bizarre behavior did they notice? I mean, some of my behavior has been so bizarre, like I can't really share it on the podcast at this point. Were they able to pull out moments or that. You go, whoa, that was bizarre or even shameful. A lot of my experience hold a lot of shame. Like, Ugh, I can never really say this. And I know for you, it seems like you were, I don't wanna say like quick to heal, but you did. Get better quite quickly. Get your book out, have this real sense of purpose, probably faster than most. So I guess my question is, was the bizarre behavior that bizarre or like at what level was. Your illness?

Gregg: Yeah, so I ended up with the initial onset being triggered was in 2003 in Iraq that I described, and so from that point on higher and higher levels of energy, less and less sleep, talking faster and faster.

More and more, you know, quote, great ideas, the flight of ideas, more and more grandiosity. And then so you carry that through to about over this 12 year period, and I was pretty much outta my mind by 2014. I went a period of months with no sleep at all. I believed I was the Apostle Paul in the US military to transform the military. I believed in, talked about how I was the smartest person in the world that I had developed the key to world peace, became extremely religious. You know this idea called religiosity where, I mean, I was going, I was probably spending. Over 30 hours a week in religious activities. I was going actively to four different churches.

I was leading bible studies, prayer, breakfast, discipleship seminars. I was proselytizing on the streets of Washington dc. I was probably spending a couple hours a day studying the Bible, memorizing Bible verses, meditating, sitting up on the roof of the house overlooking Fort McNair. My meetings, like, let's say it was a, a supposed to be a 50 minute meeting. Oftentimes the meetings would run to, you know, well over an hour, maybe to two hours. I would just talk continuously override people, just endless talking.

I started riding my bike around Washington, DC you know, after midnight and other people didn't see this, but I started having hallucinations that I was flying over the city over the monuments.

Like I actually would ride it into National Stadium where the Washington Nationals pro baseball team played. There was a way I always wore a yellow safety vest so that I was, you know, safe and cars would see me. There was a way in the back of the stadium that I would ride my bike in and I would ride it around, out in the bleachers, in the outfield would be riding all around during a pro baseball game.

Oftentimes I would park the bike and I would link up with one of the beer guys that sell beer in the stadium, and I would go up and down the stadium steps, you know, helping the guy sell beer. When we would finish, I would peel off. I would go round and round the stadium going up and down the stairs. I was in what they call full blown mania.

It basically got to the point where my students, faculty and administrators, I was the president of the National Defense University. They said, this guy has, he's always been, you know, kind of out there and doing things like this. But now. He is scaring us. He's so outta control, so erratic has gone so off the rails.

He's so impulsive that they wrote dozens of non attribution letters to my boss, who was the chairman of the Joint Chiefs of staff outlining my bizarre behavior, which I had access to a bunch of those letters later. And I mean, it was basically. All the things in DSM five, pretty much, not every single one, but most of the DSM five criteria for bipolar disorder.

It was very, very pronounced, very significant descriptions of that. And so my boss, he basically fired me, so I got fired as a two-star General, forced me to retire from the army. Ordered me to get a psychiatric evaluation, and then I was later hospitalized. And then from that high level of full-blown mania, I crashed into crippling depression for over two years, where I was, you know, hopelessly crippled, had terrifying psychosis, thought continuously about my own death and dying morbid thoughts, which is passive, passive, suicidal ideations.

So the psychiatric community, both in the army, the VA and the civilian world labeled me as having severe bipolar disorder with severe psychosis. So I, I mean, it was about, probably about as serious as it gets.

Janine: I'm actually interested. Religiosity, because that sounds very high functioning to me in the sense that you're going to all these meetings, you're studying the Bible and you're memorizing things. And in a lot of manic or psychotic states, you certainly have trouble with concentration, so you're kind of just showing up and doing the moves. But this sounds like it was very controlled and regulated. It could be, you know, pass for quite normal behavior. 

Gregg: Right. Well, I mean, so for that entire time. Or most of that entire time from Iraq forward, I was in some level of mania almost the whole time.

I'd say at least 90% of the time, I did have dives and dips into depression, and some of them even went days or weeks. And the longest was a period of a couple of months. That was about two years before I went into the full-blown mania and what the psychiatrist call it is a high performing mania. Where my mind was working unbelievably well, I kept getting promoted, kept getting put in one harder, more prestigious job after another, given the mission to transform these organizations.

You know, which required incredible thinking powers. So I would go into these jobs and I would be on overdrive. My mind was like a laser focused computer. And so I did, you know, by all accounts, an incredible job. Even the day that I got fired by the chairman of the Joint Chiefs of Staff. What he told me when I came to his office, he said, First off, you've done an amazing job.

No one could have done what you did. I give you a grade of A plus on your work performance, but it's all these other bizarre behaviors that are of concern. And then he went ahead and fired me. So the answer is, you are right. My mind was working unbelievably well, but it was also sort of twisted up with worsening delusions, hallucinations, and then when I finally did go into a significant long lasting crippling depression, I couldn't concentrate at all.

I couldn't focus, my mind didn't work. I was confused, indecisive, lost interest in everything. So when I did go into depression, all the things you talked about, lack of concentration and so forth. All of that took over and my performance was really bad. But while I was on active duty, the periods of depression, for the most part were pretty brief, like I mentioned, you know, usually a couple days, maybe a week or two.

Then once it got pretty bad, it was a couple of months and that was not good at all. I was isolated, withdrawn, indecisive, didn't want introverted, didn't want to be around people, which was a complete turnaround from my normal state of personality.

Janine: The idea of passive suicidality or passive suicidal ideation is, is another symptom that we haven't really talked about on the show. So for you, what are some examples of that? Okay, so a passive suicidal ideation means you want to die, but you don't want to kill yourself. You don't be want to be the one who does it. And so when I went to the VA for my first hospitalization, the. The intake, they always ask the question, are you suicidal?

And my answer was, No. Do you want to hurt yourself or hurt others? And I said, No. And then this one psychiatrist, he asked the one question nobody's ever asked before or since. He said, Do you ever have morbid thoughts of death or dying? I said, Yeah, I have them all the time, continuously throughout the day, every day.

He said, Okay, describe them to me. Here are some of the things that I, I told him, I said, well, when I'm driving in a car, I don't put my seatbelt on so that, you know, if I get in a crash, I'll go, I'll fly through the windshield and get killed. The second thing is, if I'm walking down a road and, and there was a sort of a, a very busy state highway near where I was living that 18 wheeler trucks would go, you know, really fast down this road, but in order to go to different spots, you kind of had to go along that road for a little way, either, you know, on your bike or walking.

There was no other way to get from point A to point B except going along this road. When I would walk along that road, I would, you know, feel this invisible, powerful force come up behind me and wrap its arms around me and throw me underneath the wheels of the rapidly moving truck. And then I would feel myself just getting ripped apart and I would see the bloody. Stumps of body parts flying out to the side of the road. So I would see my arms and legs and head thrown to the side of the road that after being ripped apart by the truck. And that would happen to the point where if I was walking along that road, I got to where I would go into the woods and I would hold onto trees, and I would go from tree to tree, wrapping my arms around it so that this invisible force couldn't pull me out and throw me under the truck.

And then another one would be if I was driving in my car, I would feel the same invisible force. It would come across the front seat and grab my hands and steer me head on into an oncoming truck, you know, killing me instantly. 

So, I mean, those were just a, a few of the things, and I, I explained that to the psychiatrist and he said, Whoa, that's really, really serious. Those are passive suicidal ideations, and the danger is that they can morph from passive to active. Then the next thing you know you're going to develop a plan and then you could take your own life. So he said, We need to deal with this like now. And he, and he couldn't force me to go into the hospital, but he said, you know, you really need to stay and go into the psychiatric ward and get intense help. And uh, and he said, I'm really worried about you becoming actively suicidal. So I said, okay. 'cause I wanted to get better. And so I went in and spent, you know, a good bit of time in the psych ward in the hospital.

Janine: Okay, so we're gonna go ahead and pause here. As I mentioned, if you're ever in need of immediate support. There is help out there at 988, A Suicide and Crisis Lifeline. Next week in part two, we'll learn how Gregg breaks free from depression and builds a healthier and happier life.

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