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 The column is no longer active, though you can still view his 2001-2004 archive of questions and answers at Ask The Expert/Mental Health and, of course, the Random Wit and Wisdom is there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.

Our Curious World

“Curiouser and curiouser!” cried Alice (she was so much surprised, that for the moment she quite forgot how to speak good English). “Now I’m opening out like the largest telescope that ever was! Good-bye, feet!”

If Lewis Carol’s Alice was reading today’s headlines, she might say, “Good-bye footing!”

But no. Not me. I won’t say it. I’m no economist, but I refuse to let this economy get me down. What’s the point? Where will it get me? It’s all paper anyway.

As a lifelong optimist – cockeyed, perhaps – I have lots to be thankful for this Thanksgiving.

Maybe I’m living in Wonderland, but I’m not going to fret about the economy. I’m not going to worry about the future. I’m not going to pretend that I’m hard-done-by just because the financial markets and our “values” are playing dipsy-doodle every day.

There are other “values” that are priceless. They cannot be bought or sold or traded on any stock market. Anywhere. Those are the values that I’m focusing on this Thanksgiving.

I’m alive and well and living in Thornhill.

More than that, I’m happy. I’m loved. I share my life with a darling man. What more could a girl want than that? Especially a girl who’s about to turn 60 and is thrilled at the prospect.

(Crazy? You betcha!)

My husband, Marty, rarely appears here. He lives to make me laugh – and he’s incredibly sane. Why wouldn’t I be happy. He’s a screenwriter and one of his funniest lines, I think, is from one of his brilliant screenplays.

“What good is happiness? It doesn’t buy money.”

This week in my "Leadership in Society" classes at Seneca, the topic was Understanding Yourself. Part of that process is understanding your values. So, we had a Values Auction.

I gave each student a list of values – “a sense of accomplishment,” “family relationships,” “financial stability,” “loyalty,” “education” – there were 19 different values.

They were given $5,000 to budget on the values they wanted most. They also had to note the top amount they were willing to bid. And they were allowed to reallocate money they had budgeted on the values they didn’t win during the auction.

Once the auction began, the bidding was heated and exciting. The students fought for the values they wanted most and were visibly disappointed to lose certain values to a higher bidder. Once they had spent their $5,000 all they could do was watch.

The most hotly contested value wasn’t “financial stability” or “being financially successful.”

It was “family relationships.” Followed by “Maintaining friendships,” and “Helping others,” and several others. None of them had anything to do directly with money.

The young woman who wanted “family relationships,” didn't any chances. Her opening bid was $5,000 – her whole budget.

When the auction ended, I posed this question: “Were you able to buy the values you wanted most?  And if not, why?”

Almost all of them wanted “Family relationships” more than anything else. They felt short-changed when they lost it. “Financial stability” and “Being financially successful,” just didn’t stack up against relationships with people they love, people who love them.

I have two Leadership in Society classes. About 40 students in all. This week, I staged this Values Auction in both classes. Both auctions were almost identical. And the discussions that followed mirrored each other.

Many of my students are in the Faculty of Business at Seneca. They know what's happening around the financial world. They have concerns.

But they also have sound values and I'm proud of them.

Yes, I live in a wonderland in my work and with my delicious husband of eight years. He's the only man in the world who loves me exactly as I am. He's magnificent and I’m the richest woman in the world.

I wish you a warm and wonderful Thanksgiving surrounded by the loving people you love most.

No Place Like Home

This past weekend, my husband and I voted at the advance poll in our neighbourhood.

One week from today, we’re all going to the polls.

The day after Thanksgiving.

If you’re reading this right now, you have a great deal to be thankful for, including a place to call home. An address. A place to receive your mail.

Unsheltered homeless people don’t have that, although a remarkable municipal, provincial and federal government funded program called Streets to Home is helping these individuals with no "place like home" find supportive housing.

The key word is supportive.

According to "We Are Neighbours," a compelling new study by "The Dream Team and the University of Toronto" Supportive housing transforms lives. All lives. The lives of people who move into their new homes. Their neighbours’ lives, too.

Here's how "Street to Home" works.

People with no place to live except the street are given a range of services to help them find a subsidized apartment to suit them.

They’re given a whole lot more.

For one year, they receive individualized, one-on-one follow-up care, outreach, and social services of all kinds to help them secure identification (which many people on the street don't have), access to income supports, medical counselling and social supports of all kinds.

With supportive housing, the quality of their lives improves. Safety from the brutality of the street transforms them. A significant majority stop drinking alcohol and abusing drugs. Their physical and mental health improves. They stay out of emergency rooms, hospitals and jails, saving the city and province money. They begin to think about their futures instead of their survival from minute-to-minute.

In short – they get a life.

Since this program was launched in 2005, 87% of the 1,500 people who’ve moved into "Street to Home" supportive housing have stayed housed.

This works.

Two years ago, I had the privilege of spending Thanksgiving morning at The Scott Mission with about 400 people who cannot all count themselves so lucky. Young and old, women and men, a complete cross-section of ethnicities and cultures reflecting the diversity of our great city.

Too many of us call them “the homeless.”

Just like too many people, including the media, call people like me “the mentally ill.”

It’s time to accept that we’re all individuals with our unique life stories – and reasons why people on the street have lost their addresses.

I spoke to a gentleman that Thanksgiving morning who was living under a bridge near the Lake. He had a bipolar disorder. I showed him my Medic Alert bracelet, which says I have a bipolar disorder, too. We bonded instantly and spent a few minutes talking about our mental health histories.

When his Ontario Disability Benefits were cut back, he couldn’t afford his room and was forced onto the street. He was sleeping in a cardboard box.

A young woman, 16, blonde, blue-eyed, sweet, ran away from home in some northern Ontario town because her stepfather was sexually abusing her. “Being on the street is safer than being at home,” she said.

Another man was laid off a few years earlier. When he couldn’t find a job, and money got tight, his wife left him. Eventually, he lost his house, and ended up in a rooming house. He had a home, if you can call a room a home, but he couldn’t afford rent and food, so he ate at The Scott Mission on Thanksgiving morning.

Not all people living on the street have mental illnesses, but after a few months on the street, you become invisible. Most passers by never look you in the eye. Never talk to you. Never smile or say, “Hi,” or “Good Morning.” The constant cold shoulders, the elements, the mean streets – this life, if you can call it that – can drive anybody insane.

Being invisible to the world you around is crazy-making.

So here’s the question. What comes first? Madness or Homelessness?

Why not do something to stop it. NOW!

Educate yourself. Read Ten Things You Should Know About Housing and Homelessness and Toronto Star columnist Carol Goar's recent story on failed Toronto mayoral candidate Jane Pitfield's passionate and winning campaign to help people off the streets of Toronto.

You can help, too. Speak out. Make homelessness an election issue. Put your heart into it. Talk to your local federal candidates about “Streets to Homes,” this cost-efficient program that saves lives for people who are barely living.

Speak up. You can make a difference this Thanksgiving and this election by making Toronto a kinder city for everyone.

Let's Get Together!

I would like to invite you to a special event in a couple of weeks.

No, it’s not Bill Clinton speaking about the global economy on Thursday, October 16 at the Four Seasons Centre for the Performing Arts.

Or Barbara Walters hosting a “Lifetime of Learning Day” on October 21.

Just me.

On Wednesday, October 15. At 7 p.m. In the auditorium of the Branson site of the North York General Hospital at 555 Finch Avenue West, just west of Bathurst.

Free of charge. Open to one and all.

Over the last six months, since “Coming Out Crazy” launched here at Healthzone.ca, it’s been fascinating engaging with you online or in a few cases, by email.

To be perfectly honest, I would love to meet you. In person.

Also, there is another little detail. The auditorium seats 250 and it would be great to fill the place, but that’s just a minor issue. What matters most to me is to be able speak with you face-to-face. Hear your voices. In real life. Not Memorex. Or in the toneless realm of cyberspace!

Theresa Claxton, the fabulous coordinator of the Central LHIN Consumer/Survivor Network has generously given me free rein to talk about whatever I want, and I’ve decided not to make it a monologue.

I want you to interrupt me with questions and comments. Don’t wait until the end. What fun is that? Ask me anything you want. When it pops into your mind. Challenge me. I may even challenge you back.

Let’s have a good time.

Let’s dialogue!

Let’s discuss!

Let’s disagree!

Let’s be dynamic!

I’m sure you are.

I know many of you feel uneasy about my using the term “madness” and “crazy.”

You may not agree with my focus on the power of language in fighting fear and ignorance, discrimination and prejudice against mental illnesses and all of us who deal with them. Which is about everybody, when you think about it.

You may take issue about my ideas about recovery.

You may completely disagree with my insistence that chemical imbalances in the brain do not cause mental illnesses. That this is just a theory.

You may think I’m off my rocker because of my acceptance of ECT and the other “current” treatments for intractable depression. And my obsession about the deleterious effects of psychiatric labelling.

Let’s talk about it. Air our ideas. I want to hear from you. How you feel. I want to learn from you. The best way to learn is to communicate with each other.

Best of all, if you come to see me on Wednesday, October 15 at 7 p.m. in the Branson auditorium at 555 Finch Avenue West, you can still go down to see Bill Clinton talk about the global economy the next afternoon. You can also hear Barbara Walters on October 21.

No conflict whatsoever.

And I’m free! There’s no better deal than that!