Manic Moments

One evening about eight years ago, I decided I wanted to be a Sunshine Girl.

At 50 and five-foot-one, with some good air brushing, anything’s possible.

 

Wouldn’t it be ironic if The Sun’s token feminist popped up on Page Three, as the cheesecake symbol enraging so many women and titillating so many men?

I’d bridge the gender gap.

I got on the phone and called The Toronto Sun  photo-editor and brokered my brilliant idea to him. Then, to Sun Media’s vice-president. I tracked down The Sun’s  publisher on vacation. Finally, The Sunday Sun  editor silenced me.

 

He wisely advised me to stop phoning people and take a few days off.

If anyone asked me–– no one did–– my eccentric behaviour made perfect sense.

People do strange things when they fall in love. The first time. Call it extreme infatuation.

Why? The object of my affections really existed. I wasn’t hallucinating. And he was in love with me, too. He saw no reason why I couldn’t be a Sunshine Girl. Maybe he was hallucinating.

Love is potent. So, yeah, I was a little high. You would be, too.

Dr. Bob had put me on a “drug holiday” for nine months. It hadn’t made any difference, until then.

 

Now, he wanted me in hospital and back on my mood stabilizer. It affects all my kidney drugs, so in hospital, my blood work could conveniently be done every morning at 6 a.m.

Infatuation is intoxicating. A great sleep thief. I hadn’t been sleeping. At all. Without sleep, getting a little high–– read manic–– is perfectly normal for me.

In his book, Solitude, the late British psychiatrist Anthony Storr writes about the necessity of sleep.

We spend a third of our lives asleep. Our brains need sleep. Depriving prisoners of sleep is a quick way to break them down. After a few days without sleep, the most “normal” of people begin exhibiting psychotic symptoms–– hallucinations and delusions.

Here is Storr’s most intriguing statement.

“It is also worth noting that many episodes of mental illness are preceded by periods of insomnia.”

 

Where’s the line between normalcy and insanity if the cause of hallucinations, delusions and other psychotic symptoms is the same–– sleeplessness?

Recently, I met a young woman diagnosed with bipolar disorder. She knows there is severe emotional trauma in her background. Sexual abuse. She’s blocked it from her memory. Good thing.

As 18, she was hospitalized after only one psychotic episode, triggered by sleeplessness. Prescribed Lithium and Tegretol, two mood stabilizers.

After a few weeks, she stopped taking them. Never told anyone. She was fine. Went on to finish university, marry, have a child and now she works in the mental health sector.

Ten years later, she tracked down her psychiatrist to tell her how well she was, without medication.

“You have a serious mental illness and must take those drugs as a preventive measure,” her former doctor sternly warned. This woman was shocked.

Once diagnosed, never undiagnosed. Psychiatric labels stick.

Maybe. It’s possible, isn’t it? Labels and the labelers can be wrong.

Te Hononga - New Zealand's Take On Mental Health

I’m reading a vision statement from the Mental Health Commission of New Zealand called Te Hononga 2015, Connecting for greater well-being.

I’m drooling.

In Maori, “Te Hononga” means to be connected, physically, socially and spiritually.

It’s Utopian. Why isn’t Canada striving for this?

What lessons we could learn.

Here’s one small snippet from the chapter on values in Te Hononga, written by Sarah Porter, one of many New Zealanders who contributed their personal perspectives. She was diagnosed and treated for a mental illness from the age of nine and has more than 30 years of experience of recovery. She’s worked in the community mental health sector since 1992.

“The idea of mental illness being a disease will give way to a more holistic view of mental distress being a normal part of the human experience. This change will enable people to better understand and support people in their communities. Huge progress made at the beginning of this century means we have learned that the key characteristics of recovery are hope, a sense of belonging, self-determination and a sense of meaning and purpose.”

Mental distress instead of mental illness as normal part of human experience.

Recovery.

This isn’t just semantics. These ideas represent a major paradigm shift in the way mental health is perceived and people are treated.

Why don’t we hear more about recovery and mental health in this country?

What does recovery mean?

There is no rigid definition. The American approach differs from New Zealand’s approach. Recovery is a personal experience. It can be a journey that lasts a lifetime, or a single epiphany. But in New Zealand, social context and societal responsibility are crucial for recovery.

One woman, Mary O’Hagan, is the powerhouse behind New Zealand’s enlightened approach to mental health.   

In the 1970s, in her late teens, she was diagnosed and hospitalized for a mental illness. Humiliated and disturbed by the insensitive, patriarchal treatment she received at the hands of her psychiatrists, she started working and agitating for a new humanitarian approach to mental health care.

She rallied others with “lived experience” of mental illnesses and started New Zealand’s first “service user” group. They’re changing that society’s cultural view of mental health.

In 1998, O’Hagan introduced the landmark Blueprint for Mental Health Services, which mentioned “recovery” in a central government agency document for the first time.

It stresses the importance of hope. Living well in the presence or absence of one's mental illness. And personal and social responsibility. Everyone –– families, communities and people with mental health problems –– must actively participate in the recovery process.

Discrimination is the biggest barrier to recovery.

Recovery is bubbling under the surface here. Ontario’s “Making It Happen” implementation plan for mental health reform mentions “recovery.” Is this just lip service?

Do mental health professionals give out hope with all their diagnoses and prescriptions?

Why isn’t our new Mental Health Commission enshrining recovery principles in a national mental health care action plan? This week, they announced a public forum in Vancouver about its four-year study of homelessness and mental illnesses. This is just one small part of the picture. We need an inclusive approach for everyone in mental distress.

Canada lags light-years behind other countries. It’s time we caught up.

The Power of Words

Words matter. Language is powerful. It shapes what we think and how we perceive.

“Seeing is believing,” as the saying goes, but it’s quite the opposite.

Believing is seeing.

What you believe is what you see. What you believe is your reality. With education, your belief system changes. Change your beliefs and the world becomes a different place.

Yet with mental health, our language is often misleading and toxic, inadvertently spreading misinformation.

I hate the word “stigma.” Every time I see it, I cringe. It’s imbued with negativity going back centuries to Biblical times and it’s used almost exclusively in relation to people with mental illnesses.

Linguistically, it’s a “praeteritio,” a negated negative. A rhetorical figure of speech. A writer or speaker invokes a subject by denying this subject should be invoked.

Here’s how our language can work on our minds.

Let’s say I ask you to think of a “short-necked pink giraffe.” You’ll immediately try to imagine a short-necked pink giraffe. You may even succeed in conjuring up such a creature in your mind –– though no such animal exists.

Now, here’s this same process. Different context.

In the 1950 California Senate race, Republican candidate Richard Nixon faced down New Deal Democrat Helen Gahagan Douglas in a debate. He stated: “I do not say my opponent is a Communist. I do not say that at all.”

That statement planted in the minds of the American public the notion that Gahagan Douglas was indeed a Communist, though she was the opposite. It effectively scotched her political career.

That was a negated negative. A subversive ad hominem attack. A device Nixon used to distance himself from his unfair claims while still bringing them up.

The word “stigma” works the same way. Subversively. It’s an ugly old word, with an uglier meaning.

By definition, a stigma is a mark of disgrace associated with a particular circumstance, quality or person.

In medicine, although the term is no longer used, it is a visible sign or characteristic of a disease.

It originated from the Greek “stigma” as in a “mark made by a pointed instrument, a dot,” related to a stick.

In ancient Greece, slaves or criminals were literally branded with hot pokers to be made visible to the general public.

Today, using the word “stigma” automatically and unfairly victimizes people with psychiatric conditions, branding them with dishonour and shame. There’s the negated negative.

Yet people with mental illnesses don’t have the stigma. Society does.

Society has been branded by its own ignorance and fear.

Today, thousands of people with mental illnesses function fully in our society, actively engaging and making valuable contributions.

What if educational institutions, governments and the media stopped using the word “stigma”?

Why not call it like it is? “Prejudice” and “discrimination.” That’s what stigma really is and that can be addressed.

It’s about time.

Instead of mounting “anti-stigma” campaigns, start “education campaigns.”

Every time you see or hear the word “stigma,” it reinforces the negative, outmoded message that people who have experienced altered states of mind, emotional traumas, and psychiatric labelling should be “marginalized,” “branded” and “feared.”

This is inhumane. Unfair. Cruel.

Stop using the word “stigma.” Change the language. And beliefs will change.

The word “stigma” is like a “short-necked pink giraffe.” It’s imagined. It’s mythology.

And it’s damaging our public discourse on mental health that’s desperately in need of healing.

Side Effects

You’ll begin to notice a theme in these posts.

I’m very wary of pill-pushers in matters of the mind.

In January 1991, during Desert Storm, I almost died of acute iatrogenic end-stage kidney failure in the Emergency Room of Women’s College Hospital.

The cause? Lithium toxicity.

“Iatrogenic” means treatment-caused. My lithium levels weren’t monitored carefully enough. My case was rare, but not unheard of.

The Lithium Carbonate I took for close to 16 years to treat my manic depression permanently damaged my only kidney. It seems I was born with just one.

There was no going back. I would never get better. Just worse. Sicker. Until I had to go on dialysis. For two years.

On March 7, 1994, I had a kidney transplant. My sister Glorianne gave me one of her kidneys and saved my life. Now we both have just one.

Ever since, I’ve taken mouthfuls of pills every day.

The longer I have my transplanted kidney, the more pills I need to ensure my body doesn’t reject it, and for other complex reasons.

Once a week I inject myself with EPO because I’m chronically anaemic. You'd better believe that all these drugs have their side-effects.

Back in the 1970s, Lithium Carbonate was hailed as a psychiatric revolution –– the first drug to treat the mental illness, not just the symptoms.

It would supercede psychoanalysis and psychotherapy. Imagine.

Sigmund Freud was thrown into the dumpster.

It was quite the fad.

Choreographer Joshua Logan took it and swore by it.

It hit big after TIME magazine published an article titled “Maude’s Mania” on February 9, 1976.

It discussed how the temperamental diva in that popular sitcom was going to take Lithium, “the first wonder drug of psychiatry.”

Why?

Norman Lear, the show’s creator-producer, witnessed firsthand the results in one of his relatives on the drug.

My shrinks compared my mental illness to diabetes. A common analogy.

Both are chronic conditions. Both can be managed with medication.

Manic depression with Lithium. Diabetes with insulin.

It's really bad analogy, but I bought it. What did I know in 1975? What did anyone know?

Even the shrinks.

Lithium robbed me of my health. And it didn't even work for me.

Back then, it was prescribed in doses five times higher than today. I was a guinea pig. And it was the only game in town.

Now, psychopharmacologists know more. Lithium may be helping you. If not, there are other mood stabilizers that might. With fewer side effects.

The point is, find the right drug for you.

I found mine. Tegretol. It's very innocent, for me. After I started taking it in 1988, I never had another major manic episode.

I never stopped my psychotherapy, either.

Drug therapy should be one part of a mental health strategy that must include good “talk therapy.”

If your psychiatrist won’t help you, find someone who will.

A psychologist. Social worker. Consider group therapy. Peer support. Find a community mental health centre. There’s help out there, but you have to find it.

And start talking.

Mental illnesses are emotionally traumatic. Drugs are tools. Talking heals.

I’m not advocating that you make a decision in isolation to go off your Lithium. That's never advisable. Adjustments should always be medically supervised.

But you can see why I’m skeptical about drugs for the mind and psychiatry by prescription.

Teen Suicide

Sometimes I think the whole world is crazy.

Last week was one of them.

PBS repeated its disturbing documentary, The Medicated Child, about six million American children taking psychiatric drugs that have never been tested on children.

Russian roulette, one expert called it.

The next morning, front-page headlines reported a new University of Manitoba study suggesting a rise in teenage suicides may be linked to a health warning alerting doctors to the potential risks of prescribing antidepressants to children and adolescents.

Did this warning stop them from taking their meds and seeing their doctors for treatment for depression? Not clear.

Was this treatment psychotherapy? Who knows?

The results were vague and raised more questions than answers.

I'm no expert, but I do know that all psychiatric drugs, including antidepressants and antipsychotics, affect people differently.

The only way to know is by trying them. Like guinea pigs.

These days, it's not uncommon for children to be prescribed cocktails of drugs meant for adults.

Drugs that affect children differently than adults.

Drugs interacting with drugs on young, developing brains.

One more thing. This is going to sound heretical. The medical establishment isnt going to like it. Or the drug companies. But it's true.

Since the 1970s, psychiatrists have asserted that mental illnesses are caused by neurological dysfunctioning  chemical imbalances in the brain treatable by drugs that target neuroreceptors.

This widely held assumption has not yet been proven. Its still theory.

And it excludes context.

Why would parents hand over responsibility for their children's emotional well-being to doctors who seem to have only one tool in their tool box?

Drugs.

This is terribly complex. Today's depressed, often sleep-deprived teens can be emotionally traumatized. Divorcing parents. School issues. Peer pressures. Hopscotching hormones. Social problems. Uncertainty about the future.

Adolescence has never been a picnic.

What about environmental toxins, excessive television and other technologies, modern agricultural effects on the contents of food nutrients.

There's also a terrible inequity in Canada's healthcare system.

You need a medical doctor to give you a diagnosis to get coverage for an emotional problem.

Your healthy-but-unhappy child could use some good old fashioned talking therapy. Support. Peer support. Help that takes into account all the context most psychiatrists ignore.

Where to find it? All you hit are endless waiting lists.

Psychologists, social workers, trained psychotherapists fit the bill, but they aren't covered by provincial health insurance.

Meanwhile, your kid is really worrying you, so off you trot to your GP.

Before you know it, your healthy-but-unhappy child is labeled with the diagnosis du jour, bipolar disorder, and handed a prescription. Fast and easy.

There are other approaches.

Like Parents for Youth.

In 2001, my husband and I were settling into our new marriage with his 13-year-old daughter.

Volatile times.

Dr. Bob suggested we contact child psychiatrist Harvey Armstrong who works with parents of difficult children.

Armstrong facilitates groups of parents who learn from each others experiences how to parent more effectively.

Sometimes its tough, but it works.

After a year of weekly 90-minute sessions with ten other parents, we left our group with pocketsful of skills and strategies.

Today we have a much happier, harmonious household, and a fantastic kid.

All About Labels

 In 1975, my psychiatrists had a “Eureka” moment. They decided I no longer had schizophrenia.

 

This was enouraging. That year, I was planning to apply to Ryerson’s School of Journalism.

Imagine a reporting student with “a psychosis marked by withdrawn, bizarre and sometimes delusional behaviour, and by intellectual and emotional deterioration, also called dementia praecox.”

That’s how my 1966 edition of The Random House Dictionary of the English Language, defined “schizophrenia.”

I was mighty happy to hear I didn’t have it.

It never felt like me, anyway.

Those fellas down at The Clarke Institute of Psychiatry just jumped ship. One day they believed I had a “thought” disorder. Then, bingo! They decided I had a “mood” disorder.

Cooooooooool.

They called it an Affective Mood Disorder, but it was also known as Manic Depression.

That “label” didn’t feel right to me either. The “depression” part.

I knew all about mania. I’d had several manic episodes.

I’d stopped sleeping and my mind started racing. Then I didn’t need sleep. The delusions of grandeur started. I’d spend hours at my typewriter creating brilliant prose which turned out to be brilliant ghibberish.

I would progress to psychosis, madness, insanity. I'd lose touch with reality and soar. Up, up and away. Like Super Girl.

Locked away in The Clarke, nothing could bring me down except a drug called Chlorpromazine a.k.a. Thorazine a.k.a. Largactil.

Nicknamed “the chemical lobotomy.”

But clinical depression? Sorry. Never been there or done that.

Still, that label “manic depression” those Clarke shrinks gave me, stuck!

For 15 years.

It changed names. Became bipolar disorder. Still never felt like me.

Then I met Dr. Bob. He came to understand why I hated my label, so he designed one especially for me. A designer label.

He said I had a “unipolar mood disorder with vulnerability to mania.” Perfect.

A little unwieldy, but it fit.

For another 15 years.

Then, on March 22, 2005, my mother read a story in the New York Times by Benedict Carey, headlined –– “Hypomanic? Absolutely. But Oh So Productive.”

“I thought, this sounds like Sandy,” she told me.

My mother should know.

Hypomania is one of nine bipolar spectrum disorders, but way over to one side. It’s exuberance. Living with passion.

Dr. Bob agreed, “But it’s very rare.”

If there must be labels, we all deserve our own designer labels.

No two people have identical minds.

Psychiatric drugs are mass produced to treat psychiatric disorders, not individuals.

The tragedy is that without good “talk therapy” and only drugs, you’re treated like a generic person instead of the unique human being you are.

Welcome to Coming Out Crazy!

 When I walked into my first psychiatrist's office, back in the early 1960s, it never occurred to me that psychotherapy was a beginning with no end.

Can you ever get to the bottom of your mind?

Imagine waking up one morning and saying to yourself: That's it. I've arrived. I know myself. I'm healed. No more psychotherapy.

If you say it too loud and people hear you, they'll think you're crazy.

Then again, were all a little crazy sometimes, aren't we?

My current psychiatrist, Dr. Bob, has mused that psychotherapy is like peeling an onion, layer-by-layer — yet you can never quite reach your core.

I think of psychotherapy as my PhD in me — except I'll never graduate.

Dr. Bob and I have worked together for the last 19 years and counting. He's my coach: a brilliant, kind, empathetic, wise and fine psychiatrist who also happens to be a fine psychotherapist.

That's a rarity, these days.

We have a great relationship. I see him when I feel I need to, and when I leave his office I'm at least 25 pounds lighter, emotionally.

You're wondering what's wrong with me, aren't you? What's my diagnosis?

I've had quite a few — schizophrenia, catatonic schizophrenia, manic depression, affective mood disorder, bipolar disorder, bipolar 1 and hypomania.

You know what? I haven't changed. Only the psychiatric labels have.

Psychiatric diagnostics have always been subjective and unscientific. There is no blood test, x-ray, urinalysis —  no medical test that can diagnose a mental illness. Yet.

I don't care about diagnostics because today, I am well.

As a mood stabilizer, I use an anticonvulsant that also treats epilepsy. This one small pill morning and night takes the edge of my exuberant nature.

I am active and engaged with the world, not because of this or any drug. You won't find insight in a pill bottle alone.

I'm healthy because of my studies with Dr. Bob. As a lifelong learner, I'll never stop gaining insight through my psychotherapy.

Every day is a new beginning with new possibilities. A clean slate with no mistakes in it. I don't mind mistakes. They're tough, but they're the greatest teachers of all.

So, welcome to my world. Twice a week, I'm going to explore all kinds of mental health issues, news and views. Mine and yours. I invite your comments, questions, concerns and criticisms.

It's high time we face these mental health issues, take them out of the closet, and look them straight in the eye.

Who cares about diagnoses? They're just labels with a habit of sticking; labels that we tend to internalize. They never really fit and it's high time we peeled them away.

We're people first. Individuals. Unique. If there must be a label, the only one that works for me is human.

We have so much to share.

Let's talk.

This blog is for you.