A lot is going on today.
Benedict Carey reported in the New York Times the latest intriguing and provocative news in the ongoing and contentious debate over the DSM-V. I'm not going to weigh in on all this, but here are a couple of interesting preliminary analyses from two bloggers I respect though they don't always agree – psychologist John M. Grohol of PsychCentral and Philip Dawdy of Furious Seasons.
Trust me, there will be tons of people, professionals, bloggers, patients, parents, anyone who has ever been diagnosed or misdiagnosed will discussing this crucial publication when it's released, and Carey explains why:
"The eagerly awaited revisions — to be published, if adopted, in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, due in 2013 — would be the first in a decade.
"For months they have been the subject of intense speculation and lobbying by advocacy groups, and some proposed changes have already been widely discussed — including folding the diagnosis of Asperger’s syndrome into a broader category, autism spectrum disorder.
"But others, including a proposed alternative for bipolar disorder in many children, were unveiled on Tuesday. Experts said the recommendations, posted online at DSM5.org for public comment, could bring rapid change in several areas.
“'Anything you put in that book, any little change you make, has huge implications not only for psychiatry but for pharmaceutical marketing, research, for the legal system, for who’s considered to be normal or not, for who’s considered disabled,” said Dr. Michael First, a professor of psychiatry at Columbia University who edited the fourth edition of the manual but is not involved in the fifth.
“And it has huge implications for stigma,” Dr. First continued, “because the more disorders you put in, the more people get labels, and the higher the risk that some get inappropriate treatment.”
You can be sure, I'll be watching and commenting, too. But not today.
Darby Penney is a well-known anti-psychiatry activist who vehemently opposes ECT. Among her accusations against me is that I have a "bias toward this brain-damaging treatment." (Darby, you'll be happy to learn that Linda Andre's book finally arrived in the mail this morning, so I'll be adding it to my list of resources.)
ANTI-PSYCHIATRY ACTIVIST CONTENDS THAT ECT CAUSES "BRAIN DAMAGE"
Penney contends that ECT causes "brain damage" and supports her statement with three clearly "anti-ECT" perspectives.
Nevertheless, this statement, in spite of her supporters, appears to have no bearing whatsoever on the way Angela is responding to her ECT treatments.
My question is, "Is memory loss brain damage?" But that's another story.
The point is, I'm trying to be as fair and balanced as I can be. Follow the comments to this series and you'll see all kinds of reactions. They're not edited in any way. I invite all of you with strong feelings about ECT to weigh in. This is a public forum. It's too bad Penney chose to express her opinions on my Facebook page instead of here, but that was her choice.
This is Week Three of Angela's eight-week course of ECT treatments – that could possibly stretch to 12 weeks, depending on her progress and her results. She is also participating in a long-term Toronto-based study involving four University of Toronto-affiliated teaching hospitals that is investigating ECT and the nature of its possible resultant memory loss at a cellular level. This study is in its fourth year and the results will be available in 2011. Although she wanted to increase the frequency of her biweekly treatments to three times a week, because of the design of the study, her psychiatrist told her that wasn't possible.
Since Monday, when Angela had her fifth treatment at 7 a.m., she's been perkier than I've heard her sound in ages. We speak every day. At least once. Often more.
During our conversations this week, we've been carefully distinguishing between how she perceives her mood as compared to how she's feeling about other issues in her life which are problematic, but have nothing to do with her psychiatric condition – her intractable depression with suicidal ideation.
"I'D RATHER HAVE MEMORY PROBLEMS OR BE A BIT CONFUSED THAN BE DEPRESSED"
On Monday, following her treatment, Angela said she was feeling "a little depressed but not suicidal," stressing that she had no memory problems at all. "To be honest, I'd rather have memory problems or be a bit confused, than be depressed," she admitted.
It was her 37th birthday, but she wasn't celebrating in any dramatic way. "We're ordering in Chinese food and watching the hockey game," she said, adding, "and my mother made me fudge, but she overcooked it. It's hard fudge."
Angela was laughing during this conversation. I could hear her mother joking with her in the background. She was having fun. It was wonderful to hear.
On Tuesday, admittedly less depressed, Angela was annoyed because one of her cats was "misbehaving" – missing the litter box. "But I'm not feeling unhappy," she said.
This morning, she said, "Monday's ECT treatment was the best one I've had so far as far as side effects because there was a minimum memory loss," she said. "And you know, I feel like the treatments are definitely making an improvement over where I was. My affect is not nearly as flat and I'm handling my emotions better."
She said her mother's visit "went really well. I told her about my ECT and I was worried about how she'd react, but essentially she's quite supportive and just wants me to be healthy."
There are other personal issues that are bothering her, but Angela admitted, "I'm handing them better than I know I would have before the treatment."
THIS MORNING, SHE'S A GOOD SEVEN AND A HALF
On our scale of one to 10, she says she's a good seven and a half – a slight improvement over how she was feeling last week.
"If ECT allows you to be better prepared to handle those adversities, then it's worth its weight in gold," she said.
Angela has a small studio in her home where she enjoys sculpting. When she's depressed, she never feels like working with her clay, but when we ended our conversation this morning, she signed off saying, "I feel like sculpting... and I think I'm going to go back to it."