No answers. Just some soup to stew on. Part Two

I'm afraid I cannot easily answer the questions I posed last week. I promised but I cannot. I'm overwhelmed.

I've dug myself into a deep dark philosophical/medical/epistemological hole out of which I feel unable to tunnel my way out.

I'm just a humble scribe. I find the answers from wise people. I research and read and ask questions and think and try to assimilate. Then I write. Sometimes I like to think I also right, but that's when I'm a little high, exuberant.

This happens, mostly, when I'm exhausted. Often in November. Never a good month for me. And never  sweet for teachers or their students. Buried under mountains of marking, classes are interrupted by the sounds of students snoring — suffering from burnout after pulling too many all-nighters.

So, today, I'm throwing a whole slew of ingredients into my little soup pot here at Coming Out Crazy, so you can inhale their aroma and let your native wisdom draw you to your own conclusions.

First Ingredient: This from Benedict Carey of  The New York Times, courtesy of BipolarConnection.com on a novel new theory about the origins of mental disorders. Competition from the male and female genes. Think of it.

Carey reports on the theories of Bernard Crespi, a biologist at Simon Fraser University and Christopher Badcock, a sociologist at the London School of Economics. Both are outsiders in the field of behaviour genetics yet they've published their findings in several journals.

According to their intriguing research, Carey wrote: "An evolutionary tug of war between genes from the father’s sperm and the mother’s egg can, in effect, tip brain development in one of two ways. A strong bias toward the father pushes a developing brain along the autistic spectrum, toward a fascination with objects, patterns, mechanical systems, at the expense of social development. A bias toward the mother moves the growing brain along what the researchers call the psychotic spectrum, toward hypersensitivity to mood, their own and others’. This, according to the theory, increases a child’s risk of developing schizophrenia later on, as well as mood problems like bipolar disorder and depression."

That's just the beginning. There are mind-boggling implications for mental health in Crespi and Badcock's inventive and groundbreaking genetic research. It's firing the imaginations of clinicians, researchers and scientists everywhere.

“I think this work is often brilliant,” said Dr. Stephen Scherer, of the University of Toronto and the Hospital for Sick Children, by e-mail of Dr. Crespi. Still, Scherer added, “For autism there will not be one unifying theory but perhaps for a proportion of families there are underlying common variants” of genes that together cause the disorder."

Second Ingredient: Thanks to Dr. Ronald Pies and my friend and mentor, professor Harold A. Maio when it comes to talking about "mental" issues, specificity is the key.

"Be Specific," Harold said. "We don't talk about having 'physical illness,' so why do we talk about having  "mental illness?"

Good point. Dr. Pies agrees. "As for how people diagnosed with so-called mental disorders ought to refer to their conditions, I think it's often best to name the specific condition, such as "I have an anxiety disorder" or "I have bouts of depression."

Third Ingredient: a tantalizing item from the multiple award winning Furious Seasons and the ethical, Seattle-based journalist Philip Dawdy, a Herculean Sherlock on mental health matters pertaining to the nefarious shenanigans of Big Pharma and other dubious psychiatric types.

Watch out for some "goofy" new disorders you may be diagnosed with when the new and improved, revised DSM-V is published in 2011, as reported yesterday by Northwestern University English professor Christopher Lane in the L.A. Times, writes Dawdy.

• Apathy Disorder
• Parental Alienation Syndrome
• Premenstrual Dysphoric Disorder
• Compulsive Buying Disorder
• Internet Addiction
• Relational Disorder (Aren't all human beings relational? I teach a course on the Relational Model of Leadership. I'd love to know what this one means. If we're not Relational, I wonder what we are?)

"They'll all be considered full-fledged psychiatric illnesses," writes Lane in his Op-Ed, Wrangling over psychiatry's bible.

Better start looking for a psychiatrist now because we're ALL going to have "mental health issues" or "mental disorders" or "mental illnesses" or "diseased minds."

Which brings me to my Fourth and Final Ingredient in today's soup! From Dr. Pies on the difference between illnesses, disorders, diseases, "You are raising extremely complex questions — we are all in 'over our head'! In brief, I believe that 'disease' [etymologically, dis-ease] is a pre-biological concept that has its roots in suffering and incapacity — not in demonstrating biochemical or anatomical lesions. The distinction with disorder is very confused in medical history. I also believe — along with psychiatrist Robert Kendall (former president of the Royal College of Psychiatrists) — that 'disease' ought to be predicated of persons, not 'minds' or 'brains' or 'bodies'."

Hence — specificity and how you feel, your level of suffering and incapacity determine whether you have a disease, a disorder, an illness, a condition. Whatever. This is the bare bones of it. Just a taste of a very complex issue. But perhaps it will be thought provoking. 

Have a gander at Objectivity in Mental Health: Who Has a Real Disease? — this is a most entertaining and informative talk Dr. Pies gave at the Cambridge Saloon Salon on March 2006.

I hope you enjoy my soup. I hope it's soul soothing and stimulating. If you have any other ingredients or seasonings that may improve it, please share them.

Have a good meantime. Keep warm and stay cool!

On a New Reader's fascinating question. Part One.

A New Reader posed a fascinating question, based on yesterday’s post.

“I guess I would like to ask you (and I am highly interested in your answer as someone with so much experience), what other term would you use instead (of 'mental')? Madness doesn't apply to all mental disorders, e.g. anxiety, depression. And yes there are grey areas and people diagnose everything under the sun now as mental disorders, but how about the real, palpable issue of mental health in Canada or world for that matter?

“I just think we can make the word ‘mental’ become a neutral word, like sinusitis, or myocardial infarction, etc., so that when someone says I have a mental disorder, we can understand that they are not to be discriminated against or treated as 'abnormal' just by the virtue of having a disease.

“Or if they are to be treated as ‘abnormal,’ it should be a part of a treatment protocol so this becomes routine and we recognize that we are treating them differently, and not ignoring the elephant in the room.”

Great question. I’m glad you asked it and I hope you don’t mind if I share it here.

I‘ll do my best to live up to your expectations and share some thoughts with you, but I don’t think there is any ONE answer. This is really a book!

It’s going to be in two parts. And if you don’t mind, I’m going to consult two far more experienced people than I, Tufts University psychiatrist and professor Dr. Ronald Pies and Harold A. Maio, another one of my sages.

In the meantime, here goes:

If you believe "mental illnesses" are diseases, you could use the word "psychiatric," instead of "mental."

But that’s not a very good solution because “psychiatry” is not seen in the world of medical science as real “science” since so much of psychiatry, like diagnostics, is very subjective.

No blood tests, X-rays, scans, urinalyses, or other concrete tests can yet definitively confirm a psychiatric diagnosis.

Many psychiatric patients, myself included, have had several different diagnoses, depending on who makes the diagnosis, when it was made and what the so-called “condition” is.

This can be true in physical medicine, too, but not to the same degree.

And that’s the point.

It’s “mental” versus “physical” medicine.

I do not believe that "mental illnesses" are caused only by "malfunctions of the brain structures/molecules."

What about emotional trauma? Childhood sexual, emotional and physical abuse? They can cause what look like “mental illnesses,” too. Can’t they?

What about genetics? What about other environmental issues? And personal experiences?

Cannot they also cause mental distress?

Also, I don't see mental illnesses as "diseases."

Are disorders and illnesses the same as diseases? Are they interchangeable? If so, then why aren't Bipolar Disorders — and there are several types — called Bipolar Disease? Or even Bipolar Disorders?

Cancer is Cancer, but any doctor will tell you that Cancer is 20,000 different diseases.

It's just not that simple.

Our minds are not organs, like hearts or kidneys. If they were, I'd ask for a transplant! Just kidding. I’ve grown accustomed to my mind. I rather like it, despite its “issues.” It’s mine and there’s no other quite like it. And isn’t that the point?

Is a broken leg like a broken mind?

Is a mental illness a brain disease? That’s an ongoing debate.

My psychiatrist, Dr. Bob, says neuropsychiatry may be making a comeback. It existed until 1948, when it was split into two different specialties —neurology and psychiatry. Organic and inorganic or ... ethereal?

Medicine and Psychoanalysis.

And where does Psychology fit into all this?

Some might say we’ve come a long way, but I’m not so sure.

I think this is not only a philosophical question but also a political one. The American Psychiatric Association, which is currently revising the Diagnostic and Statistical Manual of Mental Disorders, is a highly political organization.

Disorders and Diseases are not exactly the same. Would you say you have a "diseased mind?" I don’t think so.

Mental isn't really a noun. It just feels that way when someone says, "You're mental." Like you're a "Diabetic."

And that’s the classic comparison. But it doesn’t hold because the mind is a different paradigm than the physical body.

Like Mac computers that are on a different platform than PC's and rarely if ever catch “viruses.”

I believe this. And I don’t know if anyone can prove me wrong.

Mental Illnesses are not the same as Physical Illnesses.

I am not my mental illness. I do not believe that "mental illnesses" will be seen as neutral as long as universities teach doctors that there is a "stigma" around them that we have to get rid of because no one will ever take responsibility for any “stigma.”

The word "stigma" is a problem. It reinforces "stigma" and it's a linguistic problem.

Language is very powerful in creating and perpetuating our beliefs.

If people would erase the word "stigma" from our lexicon and instead talk about ignorance, fear, prejudice and discrimination, then society might take responsibility for its systemic ignorance, fears, prejudices and discrimination.

And do something about it. Using education. But first, people must be aware of their own fear and ignorance, discrimination and prejudice.

The answer is in education.

But the same old problem arises. People don’t know what they don’t know. So they blindly accept what they think is true.

And there are no absolute truths. Except that one!

I’ll stop here and continue next week!

About the words "mad" and "madness"

Recently, an anonymous person disagreed with an earlier post on my use of the words "mad" and "madness" and the fact that I do not like psychiatric diagnoses or labeling. And I don't.

Disorder: what a scary word that has become these days. Anyway, more on that later.

These diagnoses haven't done me any good, especially because they were schizophrenia, which was a misdiagnosis that stuck for 13 years, from the time I was 12 to 25. Then, manic depression — even though I have never been clinically depressed. Then bipolar disorder — though I am no in any way "bi," but "uni."

Diagnoses can and often are wrong. They were with me and they did me a great deal of harm.

Anonymous describes him/herself has having diagnoses of anxiety, social phobia, and Obsessive Compulsive Disorder and he/she is "currently" on medication and doing very well. I'm glad to hear it.

A few years ago, researching another story, I remember reading in a comprehensive Canadian Alliance on Mental Illness and Mental Health May 2007 report titled Mental Health Literacy in Canada: Phase One Report, Mental Health Literacy Project that according to its findings the words and conditions "anxiety" and "depression" are considered among the general populous to be within the realm of "normal" – a loaded word with many meanings.

This is a question of the history of language and usage. Etymology. Everyone experiences normal levels of "anxiety" and "depression." Those words are part of our lexicon. Some people cannot imagine what "clinical" anxiety or depression look or feel like.

Not true for the words, "schizophrenia" or "mania." These are not "everyday" words. "Maniac is an everyday word, but it's not pretty." It's "mania" as a noun. That's one reason why psychiatrists changed the term "manic depression," to bipolar, thinking it would "de-stigmatize" the implications of the term. It didn't work.

To quote Anonymous: "I have called myself 'mad' and 'mental' on plenty of occasions, to break the tension or make myself feel better, but I would never want to define myself by my mental illness. I've always been anxious, but my anxiety got much worse in my first year of university; I've partially recovered though. I don't consider my 'madness' to be a part of me; I consider that there is a difference between my natural tendencies towards worrying and shyness, and my anxiety disorder. I don't understand why some people are so opposed to diagnoses. I found that getting an official diagnosis of social phobia actually helped me, because then I realized that I wasn't just 'stupid' or 'socially retarded' as people used to call me, I actually did have a problem, one that had been untreated for 15 years."

It's all a question of degree. And your inner vision. How you "see" and "perceive" yourself. We often conceptualize our feelings, verbally. That's why language is so powerful. Words define our feelings outwardly, to others, and inwardly, in our self conscious, to ourselves. That's why I've always said, "It's not seeing is believing, but believing is seeing."

I think, however, that the words "mad" and "madness" are a whole lot better, worlds better, and more accurate, than "mental" – especially when it's used as a noun.

This is delicate stuff and I don't want to force you into a dictionary, especially as dictionaries are not bibles, but social documents that reflect the times in which they were written.

Words also resonate with one's personal experience.

Let me give you an example, and maybe you'll see what I mean.

On November 12, in the print edition of The Globe and Mail, John Doyle, my all time favourite TV writer, was writing about political humour.

Let me quote you the first two paragraphs of his story:

"'Now the real story begins.' That's the slogan Fox News is using to promote its coverage of the Barack Obama presidency. It's going to be "fair and balanced," of course. "No spin," that kind of stuff," Doyle wrote.

"People, fear not. There are four glorious years of U.S. all-news coverage and TV comedy shows coming. It is going to be mental."

I stopped reading and saw red.

He was not writing about mental illnesses. He was writing about something entirely different, completely unrelated. No remote connection to mental health issues. Nothing. Nada.

He could have said, "It's going to be crazy."

He could have said, "It's going to be nuts."

He could have said, "It's going to be madness."

I wouldn't have blinked an eye.

But he said, "It's going to be mental."

I wanted to write him a letter to tell him how offensive his use of the word "mental" was for me, but I got busy and it slipped my mind. I was so upset I didn't finish reading his column, though. And I haven't read him all week.

I am very comfortable with who I am. I like myself with all my idiosyncrasies, my faults and foibles, my quirks and crazinesses. But, when I was a kid, I was called "mental," among other things because I never dreamed that going to a psychiatrist was any big deal, any different than going to an allergist. No one in my family ever gave me any sense whatsoever that going to a psychiatrist was different than going to any other kind of medical specialist.

Wow, what an innocent, was I.

But so much is language.

Once, years ago, I remember interviewing a UCLA English professor who explained a 16th Century condition in women known as "Lovesickness," which sounded a lot like me. Their mania was caused by falling in love with men who were in no way available to them. Men who were married to other women. People sometimes treated these mentally vulnerable, volatile women with compassion. More often, people treated them as witches, stuffing their pockets with stones and tossing them in ponds.

They were considered mad. They were probably delusional. They had lost touch with reality.

Today, they may be considered to have a psychiatric or psychological condition of sorts.

But when the word "mental" is used as a noun, as far as I'm concerned, it's ethically wrong because it colours the whole person or whole situation as having some form of psychiatric condition. No one and no situation are totally "mentally ill." You are not born with a mental illness. Or conceived with a mental illness.

We're all "mental." We all think. No one and no situation is monolithic. I am many things other than my so-called mental illness. A woman, a writer, a teacher, a wife, a daughter, a sister, a stepmother, a dog owner. You want labels? I've got lots of 'em.

But one I will not accept as me, is "mental." You will never hear me say, "I'm mental."

I'm mad! Sure. It's a word that diffuses the whole notion of having a mental illness in our society. A society, I'm might add, that is still ignorant, fearful, prejudiced and discriminates against people diagnosed with mental illnesses or perceived to behave in ways that are a little too different.

It's so subjective.

Like psychiatric diagnoses.

But as a noun, the word "mental" turns my stomach.

I've often said here before, "we all can be crazy, sometimes... we're human, after all." We think. We have minds. We have brains and souls and experiences upon which we base our thinking.

This harkens back to the dark ages of my youth when I was diagnosed with schizophrenia and you never saw stories about "psychiatry" and "mental illnesses" in the newspapers, or any of the media. It was a dark age for the medical specialty of psychiatry.

Mental illnesses were completely misunderstood.

When the word "mental" is used as a noun, it is really insidious. It's a dirty word, a slur. "You're mental." It hurts.

We're all mental beings and as an adjective, "mental" is fine.

But not as a noun. It stinks of centuries of abuse, misuse, ignorance, stereotyping, brutality, prejudice, torture and isolation.

We've come a long way.

We have a long way to go.

Thanks, Anonymous, for sharing your story so honestly and openly. Not all psychiatry is bad and I am in no way anti-psychiatry. I go to a wonderful psychiatrist and I take medication for my mania twice a day. It helps me and I'm glad it helps you, too.

But, I am not bipolar. I have a diagnosis of bipolar disorder, from which I am in recovery.

I am many people. We all are. As for mad? Sure, I'm mad. Also capable of being angry. That's me and anyone who knows me, knows it.

And it's a fine madness!

Hearing your body...

I've had the flu. That's why I haven't been here. I've missed you.

Honestly, I just thought it was a reaction to the flu shot I had last Monday. Along with the pneumovax shot I need every five years. Because of my kidney transplant I'm immune suppressed. This year, I had both shots at the same time.

Also, because I teach and could not let my students down, I kept on teaching. Only death or surgery keeps you from teaching when you're on contract.

I love my students.

So, bundled up in a shawl and sweaters, feeling queasy and shivery, I dragged myself to 10 hours of classes last week complaining about how cold Seneca College felt.

My students thought I was crazy when I kept asking if it was uncommonly chilly in class. "No, Miss. It's really hot."

I kept at it. I lost five pounds because I ate almost nothing. Just sipped water all day long. At home, all I did was sleep. I missed history in the making by sleeping through the U.S. election on Tuesday. I slept every evening after that. Right through til morning. Until Friday, the first day I began feeling better.

That day, my husband Martin Lager a.k.a. Marty had his flu shot. His doctor told him my ailment was some "bug" I must have picked up a few weeks ago, probably around the college. Not a reaction to the shot.

"He said it doesn't work that fast," Marty explained, as I felt guilt layering itself onto all my biliousness.

OMG! What if I infected someone, I thought.

Then something else occurred to me. Maybe my "bug" was my body telling me something.

For once, I decided to listen.

"You've been working too hard," it whispered. "Take a break. Do something nice. Be good to yourself."

So, when my flu-ish feelings began lifting, I knew I needed a real tonic. Despite mountains of marking, I decided we were going to a movie, the first movie we've seen since sometime last summer, before classes began in September. I can't even remember what we saw.

Besides my teaching and writing for you, for the last six weeks, I've also been taking a six-week certificate course on teaching through Continuing Education at Seneca. Free to part-time staff, all day Saturday I sat at a classroom at the college, as a student. I was at Seneca five days a week. Exhausting days, when you factor in the lesson planning. An average of about four hours for every hour of teaching, but I was learning the art of andragogy – the art of teaching adults. Hours of marking, on top of that.

Plus, I polished off a short piece for The Walrus that will appear in the January/February 2009 issue.

I was caring for baby Dandie Dinmont Auggie, who was returned to his breeder last week at 13 weeks of age, to go to his permanent home in Cleveland. And when I had time, I was editing my late father's memoirs.

Quite a lot.

Marty picked me up at 2:45 p.m. after my last class of the week and we went to 4:20 p.m. screening of Rachel Getting Married, the one movie I've been salivating to see for weeks. On Friday, it moved north into my neighbourhood.

It was free because I had racked up enough Scene points to get both of us in.

Why am I telling you all this?

For two reasons.

Reason number one: When it comes to your health and your body, including your mind, no one knows how you feel better than you.

Trust yourself. A diagnosis of a mental illness somehow diminishes this ability. Saps your self-confidence. You lose your sense of self. This is one of the worst residuals of a psychiatric diagnosis and most shrinks don't get it. Part of the treatment morphs into part of the disease. It's almost intractable after it's happened. I struggle with this still. And I'm in my 49th year of psychotherapy.

Listen actively to what your body is telling you. With your all your senses plus your soul. Become sentient. Listen to your mind. Listen especially to the non-verbal cues. The feelings. Hear them. Don't be an idiot like me and wait until you get so physically sick you collapse. I desperately needed that "movie" break from my breakneck routine in front of this 24-inch iMac screen to which I'm glued too much of the time.

The movie was bliss. Ever since, I've had more energy. More focus. More joie de vivre. I'm more "me."

For two hours, I sat in the dark holding my exquisite husband's big, warm, safe hand. It was almost like our first date, except this movie was better. (In July 1999, we watched Runaway Bride and we didn't hold hands, but that's another story.)

For more than two hours in Cinema Four at The Sheppard Grand, we sat enthralled with this bittersweet, joyful, tearful, tragic film about a family. Real people with real issues. Humanity. In microcosm. A story about the perverse power of emotional trauma, the complexities of our minds, our primal relationships. The magnitude of family matters.

That's reason number 2.

See Rachel Getting Married. If you don't believe me, read A.O. Scott's superb New York Times review – the best one I've seen.

If you have a family, this Jonathan Demme film written by Jenny Lumet, Sidney's daughter, slices to the bone. It's a clean cut, but it tingles. If mental health issues are touching you and your family, you will be touched more. Truly. Madly. Deeply. This story will resonate. It won't leave you alone. I promise.

So good to be back.

The Wisdom of Dr. Pies, Part Two

Yesterday, I blew it. Though I think you'll understand.

I mistakenly gave Tufts University School of Medicine professor and psychiatrist Dr. Ronald Pies credit for the charming Random Wit and Wisdom quoter.

In an email on Thursday afternoon, he was quick to correct me, claiming that he wasn't responsible for this little device that turned up on a website where he used to answer questions as the resident expert. The column is no longer active, though you can still view his 2001-2004 archive of questions and answers at Ask The Expert/Mental Health and, of course, the Random Wit and Wisdom is there and a great little pick me up.

Example, apropos of today's economy: "To know you have enough is to be rich."

I'm happy Dr. Pies corrected my mistake and I respect him even more for his honesty.

Yesterday, he wrote: "I always joked to my wife that the column should have been called, 'Ask the So-called Expert', since none of us (as we discussed) has all the answers. The human mind and soul are far more complex than we know, as you have pointed out. In any case, I thank you for your appreciative comments and look forward to Part Two."

Well, Dr. Pies, here goes! Part Two.

What I appreciate so much about you and your approach is that you're a thoughtful and insightful psychiatrist willing to accept that psychiatry doesn't know everything and have all the answers.

What we know as mental illnesses or "the big 3" as he calls them – schizophrenia, bipolar disorder and major depression – is that their causes "are a very complex set of variables: genetic, intrauterine, biochemical, environmental, social, cultural, and certainly, 'psychological' (you will see presently why I put this in quotes)," wrote Dr. Pies.

This is such a rarity in this profession, from my perspective. I have interviewed dozens, perhaps hundreds of psychiatrists in my career and most tend to be arrogant and very certain about what they promote as "the answers." This certainty has always made me uncomfortable. How can there be certainty about "the mind"? About human behaviour? About the uncountable variables that influence how people perceive their reality.

We all perceive the world and our own world uniquely. It's not seeing is believing, but believing is seeing. What we know changes the way we see the world and ourselves in it. How can there be certainty about that?

Dr. Pies wrote, "It is unlikely that any one of these factors alone (genetic, intrauterine, biochemical, environmental, social, culture, 'psychological') could account for most cases of these illnesses. Just to cite one concrete example: we know that in identical twins – even when raised in separate households – the 'concordance rate' of bipolar disorder (the chances that if one twin has the condition, the other will, too) is upwards of 50%."

My question is, and his too, is that why isn't it 100%? What about the other 50%? That's a major unknown.

Dr. Pies rightly insists that, "We must be missing something! No doubt the other factors (besides genetic ones) are operating in some mysterious way.

That mystery is, I think, that we are all unique and unclassifiable. That labelling us is more damaging than what we're labelled with. We internalize those labels. They haven't help rid the world of fear and ignorance of "mental illnesses" or prejudice and discrimination against those of us with those labels or diagnoses.

The solution has created another ill. Is it possible that the labelling, the diagnostics outlined in any psychiatric classification system like the Diagnostic and Statistical Manual of Mental Disorders cause a more serious problem than the disorders those labels or diagnoses describe?

And there are so many. One for every kind of behaviour. Normal? What's normal anymore? How can medications solve these mysteries, even if they are, as Dr. Pies describes below, "bridges" to feeling better?

He writes, "As for the role of medication, no competent psychiatrist would assert that these are somehow curative for any major mental illness; alas, we really have no "cures--at least, not yet.  

"I agree with you that medication is no "panacea." I agree that they are but one "tool" in the therapeutic "tool box" to extend your metaphor.  In fact, I nearly say the same thing – using a different metaphor – in another essay I wrote on the PsychCentral blog site, which may also be of interest. I write:
 
"Psychotropic medications, as I tell my patients, are neither a crutch nor a magic wand; they are a bridge between feeling bad and feeling better. The patient must still walk — sometimes painfully — across that bridge. This means doing the hard work of changing thoughts, feelings, and behaviors. Medications can often aid that process, and are sometimes needed to get the patient’s work in therapy moving."

The problem is that too many people are only given medication and no other therapy. Pills they think will "cure" their problems. Are there "cures" or simply ways of meaningfully living well with one's condition. Managing it. Pills don't give you those skills and we are a pill-popping society. We want the quick fix and aren't interested in the years it takes to work through all those other "factors" that may have made us the unique individuals we are.

The media doesn't help. For the most part, the media instantly and thoughtlessly trumpets inaccurate messages about how violence and mental illnesses go hand in hand. This is wrong.

But, it's another quick and easy assumption. Blame people who have no voice and cannot speak for themselves. The status quo!

Recently, Liz Spikol, executive editor of the Philadelphia Weekly in her award winning bipolar blog, The Trouble with Spikol asked her readers to weigh in on which of the following words were most offensive when used in a "punny" headlines in a newspaper?

"Madness. Insanity. Crazy. Lunacy. Madhouse. Bedlam."

Context is everything. None of these words bother me in and of themselves.

However, if they are used to describe someone who has been arrested for some alleged act of violence, I say, they are more than offensive in a newspaper headline or story. To use any of these words is not only misleading, it is morally and ethically wrong. A serious crime that can have irreparable consequences to the person it may be describing.

Instead of educating the public, the media insists on perpetuating potentially dangerous misinformation.

What right does a headline writer have to diagnose another human being? Or a police spokesperson?

Psychiatric diagnostics are far from objective. At best, it takes years of training and no headline writer, anywhere, has that training.

Dr. Pies continues...

"'Wellness' – in the full, humanistic sense of the word – requires, as you suggest, more than just medication – though sometimes medication may be the "bridge" to wellness.
 
"And, yes, certainly: peer support is important, and I believe the "recovery movement" has some very positive features (though some advocates seem to have a strong anti-psychiatry stance, and believe that psychiatry has little to offer them – which I believe is an unfortunate, even if understandable, position)."

Recovery, I would add here, involves much more than peer support.
 
Dr. Pie writes, "My personal view is that 'mind' and 'brain' are not two different things; rather, what we call 'mind' is essentially the faculties and functions of brain (a view that actually goes back as far as Aristotle, and is also found in Spinoza). But in our everyday work with those who suffer with mental illness, it is important to address many 'non-biological' aspects of the patient's experience, including creative and spiritual strivings – certainly, there is much more to understand than merely the function of the patient's neurons! 

If you want a fascinating discussion on this, have a look at Dr. Pies paper The anatomy of sorrow: a spiritual, phenomenological, and neurological perspective in the journal Philosophy, Humanities and Ethics in Medicine or PHEM.

"Moreover," notes Dr. Pies, "I believe that spiritual and philosophical approaches can sometimes do more than psychiatry alone can do, as I try to illustrate in my book, Everything Has Two Handles: The Stoic's Guide to the Art of Living (Hamilton Books). 
 
"I hope this long-winded response at least explains my position to some degree, and why I believe that psychiatry is, in its heart and soul, a humane and broad-based discipline. That serious error and even mistreatment have occurred in its name, I do not deny. But I believe that these failings have Occurred despite, not because of, the ideals and paradigms of the profession."

I cannot agree more, Dr. Pies, which is why I continue to see my psychiatrist, and we continue to work on my "creative and spiritual" and I would add "emotional" strivings or, as Dr. Bob calls them, "the old records," that continue to play and perplex me.

That's it for now, Dr. Pies. Here's to our continuing the dialogue.

Be well!

The Wit and Wisdom of Dr. Ronald Pies, Part One

What a week.

I've marked 47,372 Seneca College essays. That's a slight exaggeration, but it feels that way. I finished the last one at 12:48 a.m. this morning. A new batch will arrive today. It's mid-term season at Seneca. Don't ever underestimate the teaching profession. It's slugging, slogging, slaving, backbreaking and (sometimes) mind-numbing work.

So first, I have a little celebratory gift for you. Try it. It's fun.

I found it on the Healthier You website of Dr. Ronald Pies.

It's his Random Wit and Wisdom and just keep clicking away. Bookmark it. It's like an emotional antidote for anything that ails you. Bound to make you smile and you know the power of humour and laughter to heal almost any ill. If you're having a bad moment. Let's say you wake up on the wrong side of the bed. Dr. Pies "Random Wit and Wisdom" will brighten your mood. I promise. It's perfectly safe. There are no noxious side effects.

Now then, back to this week and Dr. Ronald Pies. He is a clinical psychiatrist and professor at the Tufts University School of Medicine in and around Boston. He is also the editor-in-chief of Psychiatric Times, and a frequent contributor. As well, Dr. Pies writes articles for PsychCentral, The Boston Globe and The New York Times.

He has also a published volumes of poetry and fiction, has written on philosophy, ethics, and has researched and written several texts on psychopharmacology and other facets of psychiatry.

He's definitely a polymath, who keeps an amazingly low profile. I first saw his name in The New York Times article Redefining Depression as Mere Sadness and posted about it here on September 26 in a post called Depressed about the economy? It's healthy!

Dr. Pies commented, very graciously, correcting a misunderstanding in my post and directed me to a longer version of his column on PsychCentral. It cleared up the confusion.

Then the next day, he commented again, thanking me for writing about his article. This struck me as rather unusual and charming and I also wanted to acknowledge my misunderstanding, so I emailed him back.

Thus began our amazing correspondence which Dr. Pies has given me permission to share with you. It sheds a great deal of light on some of the recurring themes I write about here. More important, it also shows a side of psychiatry we, who see psychiatrists professionally, rarely see. A humility and wisdom that OHIP doesn't certainly cover in my lively interlocutions with my most humane psychiatrist, Dr. Bob.

It begins with this:

"I am sorry to hear that you are dealing with these very difficult health issues. I can also understand how--given your extremely unfortunate experience with lithium--you might be very dubious about the benefits of psychotropic medications. Ironically, for many with bipolar disorder, lithium is literally a life-saving medication. In very rare instances, though, it can cause serious problems, as you well know," wrote Dr. Ronald Pies in his email to me last week. On my birthday, no less. As I was rushing off to my semi-annual kidney transplant clinic.

"On a deeper and more philosophical level," he continued, "I believe you are raising important questions regarding not only the limitations of psychotropic medications, but also as regards the whole relationship between 'brain' and 'mind,' as well as the ultimate causes of what are usually called 'mental illnesses' or 'psychiatric disorders.'

"Nobody, in my view, has all the answers to these questions, and I agree that we have much, much, more to learn. Nobody knows this better, in fact, than psychiatrists! (At least, we should....there are, of course, some in my field, as in any field, who arrogantly believe they have all the answers--these are usually the least knowledgeable members of the profession).

"In truth, very few psychiatrists these days believe that, 'chemical imbalances are the cause of what we know as mental illnesses.' I know this is the line that many pharmaceutical companies push, perhaps because they believe it will sell drugs, or (more charitably) because they think that this 'model' of mental illness will remove the 'self-blame' and stigma that many who suffer with these disorders (or their family members) carry around. Whatever the motives of 'Big Pharma' might be, it is naive and simplistic to claim that 'chemical imbalances' are the sole cause of mental illness."

In my next post, we will continue with Dr. Pies and his wisdom.

Just one note. Do not for a moment think that I am abandoning my focus on the Recovery Movement. I am not. The more we can learn about all points of view and all approaches to "wellness," the healthier we will be.

So, stay tuned. Tomorrow, part two.

Thanks, PsychCentral, for a great 60th Birthday!

Yesterday, my 60th birthday, began at 4:30 a.m. when the alarm went off. My husband, Marty, teaches miles away and I had an 8 a.m. appointment downtown at Toronto General Hospital for a bone density scan followed by my semi-annual kidney transplant clinic appointment at 8:15 a.m.

Some birthday.

Except I am corresponding with a wise and enlightened psychiatrist named Dr. Ronald Pies and he sent me an amazing email. Marty was a little annoyed because I was late, but I felt Dr. Pies’ missive demanded an immediate response. (There will be more of this correspondence in future blogs, I promise.)

Back to yesterday.

In 1991, I lost the functioning of my only kidney after 16 years of badly monitored prescribed Lithium for severe mania. This “iatrogenic” or “treatment-caused” acute end-stage kidney failure nearly killed me.

Now, I’m fine, except I have a 20% higher chance of getting cancer because of all the immunosuppressant drugs I need. My health is a numbers game. Every six months I see my kidney transplant specialist who schedules regular tests and looks gravely at all my numbers on his computer screen.

Yesterday, my blood pressure was a high – common with kidney transplantation. Otherwise, things seemed reasonably “normal” for me. He told me to check my blood pressure more often and have blood work done every three months.

Then he said, “I’ll see you in nine months!”

This was a first. What a great birthday present.

I was thrilled as I waltzed across University Avenue to Mt. Sinai Hospital to meet my mother. She is having radiation at Princess Margaret Hospital, next door, for Basel cell carcinoma on her nose. She loves kibitizing about looking like Rudolph the Red Nosed Reindeer. I adore her.

We went back to her condo for lunch, where Marty was picking me up on his way home from the community college where he teaches film history. It was a great day.

While waiting for him I decided to check my email.

I couldn’t believe it.

Subject Line: “Congratulations from Psych Central on your blog!” from John Grohol PsychD.

As you know, my friend Susan Schecter of If you’re going through hell keep going sent a note around last week urging a bunch of us to “nominate our favourite bloggers” for one of Psych Central’s Top Ten Bipolar Blogs of 2008.

PsychCentral is "the Internet's largest and oldest independent mental health network created and run by mental health professionals to provide reliable, trusted information and self-help support communities, for over 16 years."

I nominated Susan because I love her writing. She’s gifted. Her struggles with her bipolar disorder and her frantic adjustments to her medication cocktail jump off the screen. She’s a generous, passionate and forthright writer. A good and gracious human being.

I nominated Philip Dawdy’s Furious Seasons. His penetrating investigative journalism and relentless research are always on top of the Machiavellian machinations of Big Pharma and the psychiatrists in bed with them.

Then, I nominated myself and Coming Out Crazy, figuring I didn’t have a chance because I’m so new to blogging, but if you don’t play, if you don’t win, right?

Wasn’t it the great Jewish rabbi Hillel who said, “If I am not be for myself, who will be for me?”

I made the list.

It’s an amazing list.

Congratulations to everyone on it. I look forward to reading all of you.

A special congrats to Philip at Furious Seasons who’s been struggling with a bad back lately. He deservedly topped the list. I hope this lifts your spirits, Philip!

And to Susan at If you're going through hell keep going, who received an honourable mention for her "sincerity and introspection."

Coming Out Crazy is Number 3.

Thank you, John M. Grohol and Sandra Kiume of PsychCentral. I am humbled and honoured by this award.

Here’s the citation:

“Sandy Naiman is a skillful storyteller and hers is a highly readable pro blog. She uses an intimate style to share anecdotes and opinions as well as current issues. It’s like chatting with your friendly next-door neighbor — who happens to be an award-winning career journalist and prominent mental health advocate. Her posts are engrossing, sometimes tragic, and quite inspiring.”

When I was 50, I met my husband, an exquisite man who has transformed my life.

Now this! On my 60th birthday.

You know what? Getting older is getting better! Celebrate every passing year.

And have a great weekend!

 

Being "Better" versus Being "Well"

I must make something very clear. I am not anti- psychiatry. Not by a long shot. Were it not for my psychiatrist, Dr. Bob, I wouldn't be the person I am today, sitting here at 6:48 a.m. writing to you, which, by the way, I consider an enormous privilege.

However… I just wish that Psychiatry would more openly and genuinely embrace Recovery.

Too many people tell me their psychiatrists insist that they have bipolar disorder and they'll never be well. That it's a chronic disease like diabetes which must be controlled by medication, like insulin, that they must take for the rest of their lives. I hear this all the time. It really upsets me, especially when the medication these people are prescribed often makes them feel awful.

This doesn’t have to be true. Medication is a tool. In many cases, it doesn't need to be taken for life. That's a decision the person who is taking their medication must decide. Often the decision rests between two polarities.

Are you going to be ill for the rest of your life? Or are you going to begin your recovery journey to wellness.

That journey may involve your taking some medication, for a while. Or not. It's your body. It's your life. You decide.

Recently, Dr. Bob and I had this discussion because I was thinking about going off my medication. He left the decision up to me and I decided, for now, to stay on my Tegretol, an anticonvulsant, which is my mood stabilizer and keeps me from becoming manic. Had I decided to go off it, Dr. Bob would have taken me off the drug very gradually, as it has dramatic implications on the way the other drugs I take for my kidney transplant react in my body. It’s a tricky business.

Dr. Bob is a most unusual psychiatrist. He cares about the whole person – all of me. Mind. Body. Soul. Spirit. My health and wellness. He treats me, and I'm sure all the people with whom he works, with enormous respect and dignity. He is a humble man despite his enormous accomplishments.

Let me tell you a story. It's true.

Once years ago, he was planning an academic one-day conference for all the in-patient doctors, nurses, psychologists and occupational therapists working at the hospital where he is clinical head of the psychiatric  in-patient ward. The topic of this conference, I recall, was how to improve the in-patient unit and in-patient care. Dr. Bob asked me if I would be willing to speak for about 10 or 15 minutes at the beginning of the day about what I thought might make things better for in-patients, as I had been a guest on his unit several times.

Not only that, he offered to pay me for my time.

The point is, how many psychiatrists in his position would turn to one of their patients to enlighten doctors, nurses, and all the professionals working on a psych ward about how to improve conditions for their in-patients?

Brilliant idea, when you think about it.

Who knows better than a patient? But how many patients are invited to present at medical or psychiatric conferences about this, our field of expertise?

I cannot remember what I said, but apparently, my remarks set the tone for the day. Have things changed? I don't know. I haven't been back, but knowing Dr. Bob, they probably have.

Recently, I was reading John McManamy's wonderful blog on at BipolarConnect and he made a fascinating point.

If you haven't read John, I recommend him. He's one of the "experts" writing at BipolarConnnect and as you'll see from his profile, he is eminently qualified to write about bipolar disorder as he's the author of Living Well with Depression and Bipolar Disorder: What Your Doctor Doesn't Tell You... That You Need To Know, the first and most comprehensive book on mood disorders from a patient's perspective. He has several different online venues and he’s definitely worth a look.

In one of his postings about Recovery, here's what John wrote about psychiatric medication – getting better and being well – which are not the same.

"Meds will make us better, after all, but they will not necessarily make us well," McManamy wrote. "Psychiatry is very good at getting us to 'better.' The success rates for 'better' are very high, backed by impressive research. 'Well' is far more problematic. Virtually no research exists. There is no evidence base, no way of determining how successful psychiatry is in this regard, if at all."

Do you want to be better? Do you want to be well?

You can be both, but it takes time and a lot more than popping pills.

Tomorrow, I turn 60. I've been in psychotherapy of several different kinds over the last 48 years. I've been hospitalized about 20 times for mania. I've read a great deal about the mind and mental illnesses and mental health. I am constantly learning and open to new ideas. I've also spoken at a variety of conferences all over Canada and in some spots south of the border. Knowledge about psychiatry and mysteries of the mind and the brain is growing exponentially. It's hard to keep up, but I'm learning all the time.

This is a life-long journey. I'll never graduate with my PhD in me, but the course is fascinating because there's so much to learn. It's never ending. How exciting!

Be well!

Thoughts on awards and neuropsychiatry...

I just nominated "Coming Out Crazy" for an award. I cannot believe I did this. It's not my style.

If this represents a huge step for me, I don't know if it's forwards or backwards.

It's the first time I've ever nominated myself for an award. No, that's not true. On two occasions, years ago, I nominated articles I had written for awards. I didn't win and gave up on the "self-nomination" business.

I got back into it because I heard via the blogosphere that PsychCentral has awards for best "bipolar blogs." Now, "Coming Out Crazy" isn't just a bipolar blog, but since I have a diagnosis of bipolar disorder, I guess it qualifies.

However... before I nominated myself, I nominated two other bloggers for this award. I read them both religiously.

I've mentioned them both here before. Philip Dawdy's Furious Seasons and Susan Schecter's If you're going through hell keep going – very different blogs. Both, remarkable. For completely different reasons.

I'm not sure what winning this award means but I just got into the nominating mood and once I had nominated Philip and Susan, I figured, why not me? What I love most about blogging is that anything goes.

However... I have not sent notes to everyone in my entire address book – everyone in my world – asking them to nominate me. I'm just getting into being shamelessly self-promotional and that would be going too far for a neophyte like me. Maybe I'll try that next year.

Anyway, the deadline for nominations is today.

Now then, onto to other things.

Next week, I turn 60. I was born in 1948, the same year that neuropsychiatry split into two specialties – Neurology and Psychiatry.

I think this is really interesting. Neurology was designated for the branch of medicine or biology dealing with the anatomy, functions, organic disorders of the nerves and nervous system, including the brain.

Psychiatry was designated as the study and treatment of mental illnesses, emotional disturbances and abnormal behaviours.

One – neurology – was tangible, diagnosable through medical testing like x-rays. Newer diagnostics have been developed since then, like C-scans and MRIs, PET scans and more.

The other, psychiatry, went off into the ether of the impalpable, ethereal, and abstract, where, to this day, it remains.

Psychiatrists have always wanted to be more scientific, more organic, but when it comes to human emotions and behaviours, it's still a little hard to apply the principles and disciplines of science because we're all different. Even identical twins.

Not long ago, Dr. Bob informed me that neuropsychiatry may be coming back. With the global explosion of research into the biochemical functioning of the brain, science appears to trying to explain the wonders and mysteries of human behaviour and emotions. Normal. Abnormal. Who knows?

Psychiatric disorders are abounding. I'm sure everyone has at least one!

As someone who has lived through several generations of psychiatry, including the revolution of drug treatments for psychiatric illnesses – in particular Lithium, which destroyed my kidney function and my health permanently – I think this is a very dangerous development.

And if anything should be re-examined, it's psychiatry by prescription.

What should be coming back?

Talk therapy. Psychoanalytic Therapies. Cognitive Behavioural Therapies

Or the therapies that zero in on the way people discuss and/or express their emotions and feelings. Dance therapy. Art therapy. Music therapy. Play therapy.

Right Brain Therapy.

This isn't scientific. It's the antithesis of empirical. It's holistic. Impossible to measure.

Most of all, it demands that we all learn to be empathetic listeners. Attentive, active listeners. That means listening with our ears, our eyes and our hearts.

Dr. Bob listens like this. You can listen like this. Anyone can. Humans are capable of this. Humans can heal each other.

But there's no prescription drug that can do this, yet.

If drugs are prescribed, some form of expressive talk therapy must be prescribed, too. Support. Not just 15 minutes. Drugs are complex. So are we. We all deserve at least a 50-minute hour! Regularly. Weekly, at least.

Making Friends With Your Mental Illness

We had a lively, intimate gathering at Branson Hospital last evening.

My husband Marty and I were greeted by the amazing Theresa Claxton, the coordinator of the Central LHIN Consumer/Survivor Network, who planned this event. She had placed dozens of bright blue “Coming Out Crazy – an evening with Sandy Naiman” signs along the circuitous halls of Branson to ensure no one got lost.

Tanya Shute, the electrifying executive director of Richmond Hill’s Krasman Centre for Community Mental Health was buzzing about, too. Tanya never stops. We’ve become friends because I’m putting the finishing touches on a Field Note for The Walrus magazine about one of her programs.

The Branson Hospital auditorium seats about 250, but it was more like a private party. About 30 people chose to forgo the third televised presidential debate to attend. Quite the sacrifice, I thought.

A few minutes before we began, I asked everyone to move close to the front. I wasn’t planning a formal talk, but more of a “Phil Donahue.” I moseyed around, chatting “up close and personal,” introducing myself, shaking hands, thanking people for coming and trying desperately to remember their names.

The first person to approach me was Sonia – a familiar name to you. Sonia responds often, eloquently, and with exquisite insight, sharing snapshots of her life here at Coming Out Crazy. For me, sitting here in the quiet isolation of my little study as I write these posts, Sonia has become a cherished confidante. We share some of our innermost secrets without ever hearing each other’s voices or looking into each other’s eyes. If a reader’s comment is in the least disagreeable, she always bolsters me with her calm, comforting, encouraging wisdom.

Sonia, meeting you last night was thrilling for me. Thank you for trudging up from downtown Toronto to attend this gathering and for giving me a copy of your book. I will cherish it and can't wait to read it.

Another reader, Brandon, attended. He was one of the first to respond to Coming Out Crazy, long before we were interactive. He emailed me from Europe while travelling and studying. What a kick to meet you now that you’re home, safe, continuing your studies here.

After Tanya’s gracious introduction, the evening began, with a question from me.

“What would you like to hear?”

One lovely gentleman asked, “How can I become friends with my mental illness?”

What a great question! It set the tone for the evening. I think we should all become friends with our so-called mental illnesses. Then we become friends with ourselves. And we can begin our recovery.

My knee jerk reaction was to say, forget the mental illness and start loving yourself exactly as you are. After all, who says you have a mental illness? It turns out he has an obsessive-compulsive nature. He refers to it as a disorder. That’s who he is.

Believing is seeing, I suggested. It’s what you believe that you see. Perhaps you can change your belief system around this “disorder.” See yourself differently

He said he has overcome about 80% of this "disorder," but it’s that 20% that’s still nagging at him. He wants to be rid of it all. Why can’t he accept that’s who is? Now? He has a fraction of the obsessive-compulsiveness that he used to have – 20% of what it used to be. Why can’t he become friends with himself, accept himself and that 20%? Why cling to the idea that something’s wrong with him, when so much is right. When 80% is right? Nobody’s perfect.

He was a darling. Lovely. And at 80%, he’s an “A,” I told him.

Another woman wanted to know how to better treat patients on an in-treatment unit.

“Start thinking of them as people, not patients. We’re all people first. Human beings.”

Oh, how I hate those diagnostic labels. Trying to fit individuals – unique – into the a set of categories. The fit is never right.

Another lively young woman bravely confessed she’s finally learned to accept herself exactly as she is, despite the expectations of her family, who have always seen her as “different,” as “mentally ill,” and never accepted her just the way she is. It was thrilling to hear her celebrate her natural “exuberance.”

We’re all unique. Special. Different.

There were many questions. The discussion was lively. Finally, after 90 minutes, we adjourned for coffee, fresh fruit, cheese and pastries. Everyone continued talking, sharing with each other, mixing and having a great time.

What was billed as a public forum turned into a celebration of all our uniquenesses.

We were all Coming Out Crazy together. Free to be exactly who we are.