A psychiatric chuckle...

As you know, on Wednesday, I attended a memorial celebration of the life of my husband's closest friend, film and television producer, director, screenwriter, and poet, Bill Davidson.

Actually, Marty was the M.C. I sat with about 40 of Bill's nearest and dearest, including his wife Mary, his two daughters, Wendy and Ann, and his granddaughter, Tabitha.

Tabby chose to read several of her grandfather's poems from a little collection called "A Baker's Dozen," that he sent to a very select group about eight years ago. As it happens, we were among them. 

I had read Bill's "things" as he called them at that time. They were enchanting, as I recall. Then Marty took them from me for safekeeping – I tend to misplace things – and stowed them in his office. I'd forgotten them, until Tabby started her charming recitation. One in particular stood out as being perfect for you. 

And as November is such a dreary month, especially for teachers overwhelmed with end-of-term marking, I thought we could all use a little chuckle from our darling friend Bill. 

Last evening I called Mary, and she gave me permission to post it.

I want you to know that Bill loved reading Coming Out Crazy, so I know he wouldn't mind my sharing one of his poems with you. He was a loyal member of our community.

First, these were written on a typewriter. A manual typewriter. You can tell, which makes them even more endearing. In his covering letter, he explained that he had written his poems at his cottage on Pig island near Whitefish Falls and Manitoulin Island, southwest of Sudbury. His motivation came from an old friend, retired Rutgers University psychology professor John L. Falk.

"We had been out of touch for over fifty years. To re-introduce himself, he sent me a classy, slim volume of poetry published here in Canada by Guernica Press.

"Apparently, during all his teaching years he had been writing poetry, over three thousand poems," Bill wrote in his covering letter, titled "Explanation" ... "For Sandy and Martin."

"I thought, why not just knock off some stuff that pops into my mind, for my own pleasure (and maybe for Mary, too) to entertain myself. 

"Now, I did something else to get myself kickstarted. I didn't want to poke fun of John's book, but I wanted to clearly establish my imposter credentials, my colossal conceit in pretending to write a short book of poems (things). So I claimed to have a publisher, Howler Monkey Press, and even wrote a series of reviews of my own work for the back cover."

Indeed, the return address on the manilla envelope that we received was "From the publisher's office: Howler Monkey Press, Port Hope, Ontario – no address, no phone, no email, no fax, no anything."

Imagine a big man, a commanding presence at 6-ft, 2-inches, with a broad smile and sparkly blue eyes, perched on a rock on his island, his typewriter on his lap, pounding away at his poetry. He was blissfully unwired up there.

His covering letter ended:

"I said, why not share this wacky stuff with my dear friends, Martin and Sandy, and maybe, just maybe, brighten up their day with a few twinkly chuckles. Enjoy!

"WARNING: If too painful, take this stuff with Celebrex!"

Tabitha read several of her grandfather's creations. Here's the one I think you'll appreciate most, including a few of his "advance reviews and comments"...

"A stunning disaster. A tribute to man's folly. Beats the Titantic. Sank immediately after launching." – Rear Admiral Ahab, retired skipper, Toronto Island Ferry.

"Highly recommended for infants and toddlers. From the Hickory-Dickory-dock school of poetry. Pablum for the masses." – The Brothers Grimm, professors of pornography, Humpty Dumpty Institute.

"The work of a buffoon. Forgettable, but not forgivable. His movies weren't so hot either." – Crusty McNasty, entertainment critic, The Toronto Star Weekly.

At the Annual Convention: The Return of the Fairytale Shamen. 

Based on an old English folk song.

These fellows, me thinks, 

are rinky dink shrinks, 

Willy Winky, Tom Cobly and all.

***

They're here to discuss

the probing of us, 

Uncle Siggy, Pope Carl and all.

***

They peddle their pills 

to cure all our ills,

Oedipus Rex, bad sex and all.

***

They stir up a gumbo

of cool mumbo jumbo,

bipolar, postpartum and all.

***

They unscramble our brains

for capital gains,

Lamberghinis, sunny condos and all.

***

It's buyer beware

at this sordid affair,

turkey niblits, juicy giblets and all.

***

They feed on our fear

they'll be back next year,

Goldilocks, Goosey Gander and all.

* FOOTNOTE: Proud to say, the fairytale shamen, good sports all, have asked Leonard Cohen to sing this rollicking folk song, during the opening banquet at next year's convention. If we wake him up in time. I need the royalties."

By the time Mary Davidson called me last night, I had already written another post. I'll save it for next week. It won't go stale. And I hope you don't mind this little detour from my usual harder focus on mental health and wellness.

Call it a "mental health day" post.  A break from the routine. A non-medicinal bromide. This has been a very difficult week for us. I'm glad that I was able to end it on a light note, and especially to be able to share with you the magic that was Bill Davidson. 

Speak soon and have a lovely and restful weekend. Be well and be good to yourselves. You deserve it!

Chewing the fat about Fat Talk...

On our first week at Weight Watchers, I lost 2.8 lbs. and Marty lost 4.6 lbs. 

On our second, I lost .4 lbs. and he lost .6 lbs. – the morning after a seven course dinner the night before.

As of last Sunday, week six, I had lost 6.8 lbs. and he had lost 7.6 lbs.

So on we plod, turning every meal into an exercise in higher mathematics, discussing weighing, measuring, calculating and counting the calories, fat grams, dietary fibre and points-values in every mouthful we eat. 

He refuses to measure. I weigh every milligram. He loses like a dream. I struggle. We're doing this for health reasons. High blood pressure and cholesterol. Yesterday, we joined the Fitness Club at our local Community Centre. We're adding regular exercise to our healthier eating regime. 

I'm a Lifetime member of Weight Watchers. I've fallen off the wagon too many times to remember. Yet, even at my goal – 128 lbs. – I still felt fat. I always feel fat. That's how I see myself. Even in a size 6.

This brings me to the subject of Fat Talk. All that diet talk I was just doing? It's a form of Fat Talk. And it''s a bore. I've got to stop!

A few weeks ago, during the Second Annual Fat Free Talk Week I was so stressed out, I couldn't get my head around posting about my life-long weight problem. Or my negative body image.

Today, I'm feeling better. So, I'm revisiting this spiny issue now.

Do you know I have never met a woman who likes her body? Tall. Thin. Elegant. Beautiful. They all have some problem with the way they look.

Fat Talk promotes our collective negative body image. It dangerous.

Are we all doomed to feel Rubenesque in a thin-obsessed, air-brushed, digitally-manipulated, Photoshopped world? 

Being aware of Fat Talk and stopping it demands more than one week a year. It's a huge issue. It's everywhere. You can't avoid it. It insidiously feeds mental and emotional health issues that devour our sense of self-worth. Worse, it can be deadly. Increasingly, the lives of children and teenagers are threatened by eating disorders.

Obesity is deadly, too. Fat and Fit? How do you begin to like the way you see yourself in your mind's eye?

I'm the Queen of Fat Talk – I Fat Talk to myself all the time. Whether the scale says 128 lbs. or  242 lbs. As a chronic Yo-Yo dieter, I'm always in flux. Losing or gaining. Never maintaining. 

Fat Talk is my constant internal dialogue.  

"Do I look fat? Oh, God, look at that bulge showing. I feel like a blimp. I don't want to see that person. The last time I did, I was 40 lbs. thinner. What will she think? I look like a whale. A petite whale. I can't stand the way I look. Keep smiling, Sandy, maybe that will distract people from your hugeness."

That's what happens when you've lived for years being assaulted by external "Fat Talk."

"You have such a pretty face," people would often say to me in my youth. At 16, my father bribed me with a new car, if I'd lose weight. Another time, with a trip to New York and a new wardrobe. I dieted. Lost. Regained more. Felt worthless. Unloved. Hideous.

These days, one of my students says at the beginning of each class, "I have to ask. How much weight have you lost now? You're looking better every day." That's perfect example of Fat Talk.

Stupid me, I tell her. And the whole class. What's worse is that I feel flattered. I like it. I've been socialized and brainwashed into believing that if I'm not slim or slimmer, I'm deficient. No good. Fat and Ugly. Always "fat and ugly." 

I do this to others, too, reinforcing a damaging value I detest. 

When I like someone, I don't see extra pounds. I see the person I like. I see their eyes. Their smiles. All the characteristics I love about them. Yet, when we engage in Fat Talk consider the consequences.

Someone says, "You've lost weight. You look great!" What they're really saying is that you didn't look great before. Your value as a human being is gauged by your size. Your shape. Your thinness. That's the implication and it plays havoc with your self-esteem. 

You can't escape advertising, marketing, Hollywood, and the media. But you can devalue it. Beauty is relative. Arbitrary. Who makes the decision? 

You can become more aware and Stop Fat Talking! To yourself. And to others. You can help begin a paradigm shift. Starting with yourself. 

Change the record. Break it. Don't only comment on what someone looks like, comment on other facets of their character, accomplishments, intellect, skills, activities and abilities. Be positive about people and about yourself.

On November 2, PsychCentral launched a new website called Weightless.

It's "about well-being, not weight; about fostering body image regardless of your size. It's about exposing women's magazines and so-called experts, when they're touting unhealthy tips and promoting restrictive standards," psychologist John M. Grohol wrote in this introduction.

So now, besides all the global awareness raised by Dr. Carolyn Becker, the founder and one of the researchers of the Reflections Body Image Program and the sponsor of the Second Annual Fat Talk Free Week, you can begin to work on your own body image issues. You can begin to re-educate yourself every day.

You can start to feel good about who you are, just because you're you! 

Let's face it. The holidays are approaching.  Party Time. Socializing. Every event revolves around food and everyone wants to feel beautiful. For too many years I cloistered myself at this time of year because I felt self-conscious about the way I felt I looked. No more.

I'm starting now. Let's all start to stop the Fat Talk.  

There's so much more in this world to talk about, don't you think?

Letting things go...

Problems have a curious way of working out. With work.

Nothing happens all by itself. Timing is everything. 

Today, I'm feeling weightless. This has nothing to do with the seven pounds I've lost at Weight Watchers in the last five weeks.

I'm feeling lighter emotionally. Less stressed. Relaxed. So much so, I've cancelled this week's session with Dr. Bob.

Without going into specifics, I'm delighted to tell you that after two years of shouldering a distressing personal problem, weightier than you can imagine, it's finally resolved. 

Until now, I just couldn't process it, so it was festering and fermenting. 

Process is the key word. 

You've heard me use it often. It's a driving force in my life. Everything we do, I think, is process-oriented. Talking therapies have taught me how to process. My husband often accuses me of psychoanalyzing him and everyone else. Not true. But, I admit, my modus operandi tends in that direction.

I try to live in the present, but old records keep playing and even the work I do in my psychotherapy at times runs at odds with my deepest instincts. I feel I'm listening to the cross talk of two voices in my head – reason versus emotion. They argue. Never agree. It's dizzying.

We're such complex creatures psychologically, which is why pills aren't the only way to deal with emotional or psychiatric issues. They're not that simple. Medications may numb our feelings for a while, but they don't resolve root problems.

I was harbouring a lot of pain. It was distracting and debilitating. So, over the last few weeks, somehow I was ready and able to begin to try working things out. 

And now, the problem is gone. Over. No more pain. Old chapter closed. New chapter opened. I let it all go and learned so much through the process.

It's all about interpersonal communicating without getting emotional. It takes time to reach that place in your head and your heart to be able to discuss your real feelings and your pain without an overlay of toxic emotions – resentment, mostly anger – without taking things personally.

With Facebook and texting and email – all toneless – this deeper level of interpersonal communication seems to be waning – like the art of conversation – the ability to express your feelings openly and directly. My friend and sage, psychiatrist Ron Pies hints at this trend in his recent essay on the current narcissism of our age. 

As far as communication goes, it's the listening more than the talking that oils the process. Empathic listening. Active listening. With your ears, your eyes and your heart. For some reason, maybe maturity, the other day I was able or willing to listen more than spout or shout – and remarkably, my two-year stand-off smoothly sorted itself out. No fuss. No muss.

On the same day, coincidentally, one of my favourite bloggers, Therese J. Borchard who writes an eclectic, spiritually inspirational and often surprisingly practical blog called Beyond Blue, posted a piece on PsychCentral's World of Psychology called 5 Clues You Should Be Letting Go of Something.

It really hit home. I was guilty on almost all five counts. I discovered that the answer to "letting go" is to be willing to change. To take action. Sounds simple, but change is probably the toughest thing anyone can do. 

Ironically, this is one of the models I teach in my "Leadership in Society" course at Seneca. It's well-explained in the text, Exploring Leadership for College Students Who Want to Make a Difference.

The essence of leadership is change. 

This model is called "Knowing-Being-Doing" or "Knowledge, Attitudes and Skills" or "Head-Heart-Practice." The U.S. Military coined the phrase "Know-Be-Do." 

Knowing – "Know thyself" – means knowing yourself and others, how change occurs and how and why others may view things differently than you do.

Being – means being open to differences and valuing other perspectives. 

Doing – means you must act. Take action! Practice listening skills, coalition building, interpersonal communication skills and effective conflict resolution.

My favourite Barack Obama-ism is his habit of listening carefully, actively, and thoughtfully to people from all sides of any question and then admitting honestly, "I respect your point of view and your opinion, but I'm afraid in this case, we're going to have to agree to disagree."

Whenever I use this approach, conversation doesn't stop. It continues and flows – because it's respectful.

Everybody wants to feel respected. 

Most of our interpersonal problems stem from communication problems. Lack of listening. Which leads to miscommunication and compounded problems.

Between communications and miscommunications, messages are confused. Emotions flare. Anxieties. Anger. Both blinding. And Bingo! Feelings bruise. Communication breaks down, or stops entirely.

That was the life-lesson I learned this weekend when I was able to resolve my problem and to let it go, at last. 

It felt extraordinary. That's why I'm floating right now.

Be well and thanks for listening.

Fort Hood: Psychiatrists & Stress...

No one will ever know exactly what snapped in the psyche of U.S. Army Major Nidal Malik Hasan, but something surely did. 

How else can you begin to fathom why this highly-trained medical doctor and psychiatrist started blindly shooting innocent young soldiers at close range on yesterday afternoon at Fort Hood, Texas – the largest military base on U.S. soil.

I'm not making excuses for his unspeakable behaviour. But what happened? Was he sleep-deprived? Why? This is bewildering so many of us.

Stress has been uppermost in my mind this week and if anything illustrates the staggering power of stress on the human mind, body, spirit and soul, surely this horrifying catastrophe does. Thirteen people died. Twenty-eight others are seriously wounded. Hundreds of families and friends are in shock and grieving, desperately in need of counsel and support. A whole country is mourning.

Perhaps Major Nidal Hasan desperately needed but didn't have any support because of the nature of the harrowing emotional demands of his profession. 

Surely, what happened to him to cause him to act out as he did had to be related, in part, to the mounting stress, anxiety and fear he must have been feeling at the prospect of his imminent deployment to Afghanistan on November 28.

But I have another thought.

Remember, he's a psychiatrist specializing in "disaster and preventive psychiatry." Post Traumatic Stress in a specific demographic – veterans of war.

He has been treating soldiers returning from intense, active combat in Iraq and Afghanistan – shattered emotionally, spiritually, mentally and physically – after fighting in these two endlessly gruesome, fruitless wars. When his patients unburdened themselves on him, confided in him, vented on him, where did this single, 39-year-old man go to get help for himself. How did he manage to shoulder all that pain?

How do psychiatrists deal with stress?

"Doctors, who ought to be in the best position to help the public, are not distinguished by their own ability to help one another or themselves," psychologist and prolific writer Kay Redfield Jamison wrote in her groundbreaking book Night Falls Fast – Understanding Suicide, published in 2000.

"They are, to start with, twice as likely to kill themselves as other people are," writes Jamison, who has lived with bipolar disorder since her teens and has seriously attempt suicide. "Doctors, more often than not are left alone to struggle with their suffering. Many find it hard to ask for help, or, indeed, to acknowledge needing it: they are trained to be independent, to be accountable for decisions that cost or save lives, and to assume an undue portion of the miseries of others. They function within a closed system that too often discourages seeking treatment ..."

I'm sure the military would be especially tough here.

This morning, I sent an urgent request for help with this question to my muse, friend, mentor and polymath, Tufts University clinical psychiatrist and professor of psychiatry Dr. Ron Pies. He answered quickly, admitting candidly that he didn't have "any profound or learned comments, except to recognize that mental health professionals and physicians of all stripes are under extraordinary levels of stress, a great deal of the time."

He wrote to me, understandably briefly, because he was "on the road," as he often is, adding that "without prejudging anybody, I think it is fair to say that the horrific shootings at Ft. Hood represent a terrifying illustration of how one's emotional turmoil can be fuelled by a specific set of environmental factors. If not detected early, and followed by timely clinical intervention, the results can often be tragic."

Then Dr. Pies added a more personal perspective.

"I have always found it important to have many interests, supports, and creative outlets, beyond my profession as a psychiatrist. I always worry about colleagues who say, "Psychiatry is my life!" and who spend every waking hour thinking about nothing else. 

"Balance and perspective are great stress-busters, and I have always found these in areas such as literature, philosophy, and creative writing. Others will find relief and solace in sports, music, or spending time with family. 

"The important point is that all of us need to find ways of monitoring our levels of stress, and to provide ourselves with fulfilling activities that help us achieve emotional balance."

So, I leave you with these wise words on stress from my dear friend, Dr. Pies. 

Think balance. Perhaps that's what was lacking in the tragic, tormented life of U.S. Army Major and psychiatrist Nidal Malik Hasan. Who will ever know for sure?

This, however, I do know. 

From now on, every weekend, my husband and I plan to take a few hours to do something for ourselves. Nothing major. A movie. A walk in the park with the dogs. Just a little something to divert ourselves from the ongoing pressures of our work – we both teach at community colleges.

Because nothing. No job. No deadline. No pressure. No virus. Nothing is worth sacrificing one's emotional, spiritual, physical and mental health and well-being. One's psyche. One's hope.

Take care and enjoy this brisk, November weather!

Speak soon!

Hope and Recovery...

Tomorrow I have a 9:30 appointment with my psychiatrist Dr. Bob. It's been too long.

The last time I saw him was on Monday, September 1, almost two months ago. Before school started. Everything was going tickety-boo. 

Since then, it's been a rather rocky ride. Up and down. I'm overdue for a 60-minute session with him and I always feel 100 lbs. lighter when I leave his office. I'm counting the hours. He's been out of town and my killing teaching timetable this term at Seneca has taken its toll.

In exactly 24 hours, I'll be sitting in his plant-filled office across his desk, eye-to-eye pouring my heart out. Crying, too. That's how I feel right now. Fragile. 

Did I ever promise you that recovery was going to be a rose garden? Well, it's not. Mental Health Recovery has many meanings, depending on where you live on this planet.

For me, it's lifelong learning. Growing pain. The more I learn, the less I know. Wonderful.

For Elly Litvak "recovery is a self-directed journey, process of healing, growth and self-discovery that has its ups and downs while striving toward balance and enriched quality of life." 

For Priscilla Ridgway and her former University of Kansas team, it's a Strengths Recovery Self-Help Workbook called Pathways to Recovery.

For Mary Ellen Copeland it's a Wellness Recovery Action Plan called WRAP.

For psychiatrist Daniel B. Fisher, in recovery from schizophrenia, it's his National Empowerment Center.

That's just the tip of the iceberg. 

For everyone, anywhere on earth Mental Health Recovery is an individual journey. Unique. Your personal story. We all have our own recovery stories. They're ongoing. All different. So perhaps it's healthy to start talking, because as you talk, you learn as you go.

That's what happens to me in Dr. Bob's office.

Mental health recovery is ever changing and evolving. Everybody defines it differently. For me, it's sleep, psychotherapy and gaining insight. 

What is it for you? Let me know. Let's share our definitions here!

I haven't been sleeping well lately. So my mind isn't clicking along as it usually does. 

I cannot focus. All I did yesterday was walk my dogs. Riley and Lucy and I went for a 90-minute walk to check out the Halloween decorations in the neighbourhood. It felt good until the guilt set in because I knew I should be doing other things. 

Recovery is hard work. It demands one thing. HOPE. Without it, we cannot heal! 

Despite what one of my favourite writers Barbara Ehrenreich asserts in her latest book – Bright-Sided – How the Relentless Promotion of Positive Thinking has Undermined America – which I have not yet read, only read about, I still can't help being a cockeyed optimist – "stuck like a dope with a thing called hope and I can't get it out of my heart."

Does that mean I wander about in a golden haze of mindless bliss? Please. I'm too passionate, too driven, too obsessed to see a better world. To help make it happen. I'm too impatient.

I'm sure my positive outlook would make Ehrenreich cringe. I consider my psychiatric history a gift. It's given me a raison d'etre. A passion. A cause. You. Coming Out Crazy. My craze for change. It hasn't really stopped me.

I'm innately positive. Resilient. I've learned to be. Without optimism or hopefulness, the foundation of mental health recovery – not anger, which I think is too toxic an emotion – there can be no recovery, no healing.

Without anticipation for a better tomorrow, without believing there is a chance for a better life, I wouldn't be here.

Why else get out of bed every morning?

The promise of a little more learning, new experiences, meeting new people – even if all this knowledge is acquired through my genius for making mistakes – I learn from everything and everyone. 

It's exciting. Painful sometimes. With indelible lessons.

Too many mental health professionals deny their patients hope by doling out dire prognoses and prescriptions. Not much opportunity for talking. "You'll have to take this medication for the rest of your life because you have a chronic mental illness, a disease – like diabetes."

Talk about dashing hopes. People report this all the time and it infuriates me. It's not necessarily true.

We deserve the right to choose our own pathways to recovery. It's tough but hope paves the way.

Recovery means hope! Hope leads to mental health recovery.

So here's to hope for a better day. Do a little something for yourself to make it happen.

Speak soon!

What "Mental Illness Awareness Week" means

This is Mental Illness Awareness Week.

Here at Coming Out Crazy every week is Mental Illness and Mental Health Awareness Week. 

If you're like me, every day is "mental illness awareness day." I am reminded of my psychiatric diagnosis and my 49 year psychiatric history when I take my 200 mg of Carbamazepine every morning and again every night. 

But, at the same time, I consider myself to be mentally healthy – in Recovery – most of the time. (There are many different perspectives on Recovery and mental health and they vary vastly. Hope must be a constant. Hope is one of the primary foundations of Recovey.)

Then there are those moments of madness. I believe we all have them. After all, and I've said this before, I am convinced we're all Next to Normal. Even if we try not to show it or deny it.

The point is, I'm human. Over the last two weeks, since my husband was rushed to hospital and I came down with a wretched fever and flu the day after he came home – which I'm still fighting – things are feeling a little more challenging than usual for me. 

We're fine. My husband's fine. I'm reasonably fine. It's just been one of those rocky stretches. And wouldn't you know... my psychiatrist Dr. Bob is on vacation. In France somewhere. Provence, I think. 

So I'm working without a net. When I'm writing here, I want to give you intriguing ideas to think about. That's why I'm musing about "Mental Illness Awareness Week" and what it really means. What it accomplishes. I'm really confused.

There's so much in life these days that's confusing. Although I don't live with depression, I can understand why our environment can seem really overwhelming and depressing.

On Monday, I received a book in the mail called "Depression is Contagious" by U.S. psychologist and hypnotist Michael D. Yapko.

I laughed when I saw the title. It's a clever marketing ploy. It's may even sell books. But is it furthering knowledge and awareness? Or promoting hypnotism as a treatment for depression? On the other hand, maybe hypnotism works for you. I tried it once and it didn't do a thing for me. But that's just me. 

The title also reminded me of the olden days when mental institutions were built out in what was then "the countryside" in the 1800s, so the "normal" citizenry, it was assumed, wouldn't be victims of the contagion thought to exist within its walls.

So they wouldn't catch whatever madness infected the "inmates" – like the flu. This was rumoured to be true of two of Ontario's Provincial Lunatic Asylums – The Toronto Lunatic Asylum on Queen Street West built in 1850 (now the site of the Centre for Addiction and Mental Health) and Lakeshore Psychiatric in Mimico, now Etobicoke in southwest Toronto, built in 1871. That latter mental hospital is now the site of Humber College where my husband teaches. 

That was the thinking back then. Mental illnesses or Madness was like the flu. Get too close and you can catch it. 

That was, I suppose, another way to explain the unexplainable. To talk about what was never talked about. The fear people harboured about mental illnesses and madness. Ignorance and Fear. The same fears and ignorance that Mental Illness Awareness Weeks are trying to combat. 

Through education. But what does that mean? Does that mean that the media is doing the educating about people, like me, who live with psychiatric diagnoses and are in recovery?

How much do you read in the mainstream media about mental health recovery?

Think about it. Do you ever read good stories about people overcoming serious mental illnesses and going on to live rich and meaningful lives? They do, you know. Lots of people. But too often, they don't live their lives out loud like I do.

You cannot catch depression like the flu. Depression can be caused by many, many things. It's still a mystery because every person's depression is specific to him or her. It's individual. But to the best of my knowledge, depression isn't a bacteria or a virus. It's not spread like a bacterial infection or a viral infection. Through sneezing. Or coughing. However, you can be affected by your environment, and with the "viral nature" of digital telecommunications, the title of Yapko's book – "Depression is Contagious" – a metaphor at best, I suppose, may have some meaning.

But, I think it's tenuous. We all have good days and bad days. Days that make us feel blue. That's not necessarily "clinical depression." Depression can be a very serious emotional disorder. Life-threatening. 

Yapko's title is more a marketer's ploy than a medical truism. I don't like it. I think it's misleadling. 

Just like I think "Mental Illness Awareness Week" is misleading. I don't know how educational it is and I question its validity when mental health and mental illnesses, like physical health and physical illnesses are a life-long, permanent concern for all of us, all the time.

We cannot be healthy physically if we're not healthy mentally and emotionally. 

What does "Mental Illness Awareness Week" mean? What does it do? Who is it in aid of? Who benefits from it.

Is it a promotion for psychiatrists? Many really care about their patients, but many others have lost their way and succumbed to the pharmacological, biochemical approach to treatment. They don't practice "talking therapies" anymore. And too many people want quick fixes. Demand them. I am highly skeptical about this, as you know. We're all different and we need to be treated as individuals. We need to work at our mental health and fitness, just like we need to work at our physical health and fitness.

(Have a look at the Mood Disorders Association of Ontario pro-active approach to mental and emotional fitness. Check Up from The Neck Up. It's never too late. Contact Kim Umbach at kimu@mooddisorders.on.ca)

I wonder. Is Mental Illness Awareness Week a way to help people overcome their denial and face their own personal issues and seek whatever help they need, be it psychiatric, psychological, peer support, community mental health, hypnotism or an empathetic ear? Someone who knows how to listen actively. Perhaps it's good supportive housing and employers willing to give people with psychiatric histories a chance to work, develop skills, achieve and develop the self-esteem and confidence that comes from real accomplishment.

Maybe it's more humane working environments and more empathy in those who don't live with mental illnesses. Maybe it's a wake-up call that it's time for psychiatrists to re-examine what they're teaching medical students about psychiatry. About those of us deemed to have emotional issues that affect our thinking and our behaviour, our minds.

I keep on writing here because I want to see change. I believe change is possible. I know it's possible. I've seen it in my lifetime. I remember when you never ever read the word "psychiatrist" in any newspaper or  magazine. Psychiatry was like black magic. Maybe it still is, but I believe that a lot of what psychiatrists have learned and are still learning and trying to do can change and improve our collective mental and emotional health. I believe that psychiatrists who listen and practice psychotherapy and see beyond neurosciences to the individuals they attempt to help, are creating important changes.

And there are all kinds of other routes to mental and emotional health, too. Everyone needs to be open-minded and educated.

Physcians need to be educated just as much as the media and all of us. Medical practitioners need to accept that emotional and mental illnesses and health are not a "them" and "us" duality. We're all in this together. And talking is the key. Not only talking therapy, but talking out loud and talking to each other.

Honestly. Candidly. Without arrogance. With humility.

That's education. That's why I call this blog "Coming Out Crazy" and because "coming out' with who we are and how we feel and what we see and perceive is all valid and part of the educational process.

Medications are just tools. Minor tools, if you ask me. Useful at times. But there's more you must do to heal. You need to talk.

You need to have your medications very carefully monitored if you take them. Trust me. I lost my only kidney and ended up on dialysis and with a transplant because a psychiatrist I was actually seeing regularly neglected to monitor my Lithium levels.

It doesn't matter what "diagnostic label" you have. Don't allow anyone to define who you are. Don't internalize a label and believe that it changes who you are. It doesn't. Unless you allow it to.

Over my lifetime - and I'll be 61 in less than two weeks - I've spent months and months and months as a psychiatric in-patient in four different Toronto psychiatric hospital wards. My family, primarily my mother, instilled in me a basic belief that I was "me" first. That I was talented, ambitious and smart, even if I was also histrionic and emotional and even, at time, manic and psychotic.

I was never just my 'illness" or "disorder". I was me.

That's what Mental Illness Awareness Week should be about, I believe. About how special we all are.

You are not your "illness" - you are you! Multifaceted. With so many qualities and characteristics that make you the unique individual you are. You are special. You have potential. And you must believe that. That's recovery, that's hopeful. That's your responsibility. That's self-determination.

No matter what any psychiatrist tells you. I've had so many diagnoses - schizophrenia, catatonic schizophrenia, manic depression, bipolar, hypomania.

They are just one small part of me. I'm also energetic and passionate and excitable and larger than life.

As for labels, I accept only two for myself. 

One is "human" and the other is my name - Sandra Lee Naiman, qualified by my date of birth. Just in case there's another "human" named "Sandra Lee Naiman" kicking around. :)

You're human. Now then, besides any "diagnostic" label you've been given, ask yourself, who am I?

And have some fun considering all the intriguing qualities you have, your skills, your talents, your abilities, your hobbies, your passions, your interests. All those special uniquenesses of yours that have nothing to do with any mental illness.

Everything about you that makes you, you. The only "you" in the whole world. The only "you" who's ever lived. How remarkable you are.

Speak soon!

Say "Yes" to Mental Health Recovery...

Yesterday a gentleman named Stephen Batson sent me an email. 

The subject line? "another country heard from" ...

It turns out that Mr. Batson is the Project Coordinator of the Michigan Recovery Center of Excellence, where "Recovery is the foundation of service delivery in the Michigan community mental health system," it states under Welcome to Michigan Recovery" on this website.

"The Michigan Department of Community Health (MDCH) has charged mental health providers, consumer leaders and other community stakeholders to work together to promote recovery-based service delivery models."

Stephen wrote to me because he liked my last post on – Coming Out In Class. 

(By the way, I'm happy to report that 15 students showed up in my class this morning. Earlier this week, I had seven students attend with nine registered. This morning, I had 15 attend with 20 registered. This, after I shared with them the fact that my community service is mental health advocacy and I have a long history of mental health problems. I even told them about this blog. Things are looking up.)

Stephen told me in his note that he found me on a blog that's been running since 2006 called The Recovering Life with the tagline – Observations on a Cultural Phenomenon – written by his friend Norm DeLisle.

Norman G. DeLisle runs a small, non-profit organization called the Michigan Disability Rights Coalition and blogs like a house on fire, posting five or six times a day. He's worked in disability advocacy for 37 years, has background in education, Montessori, and psychology. He seems to me to be a powerhouse who works tirelessly to raise awareness and make a difference. He doesn't miss a trick and his blog is well worth investigating.

It seems he posted my Wednesday entry on his blog and that's where Stephen Batson comes in. "Every story makes us feel good about our decision to live real and open ourselves to others," he wrote, inviting me to check out his site. I did. It's amazing.

Then he invited me to a Recovery Conference in Detroit on October 6, sponsored by the Detroit-Wayne County Community Mental Health Agency, a real going-concern when it comes to recovery judging by its publication, The Advocate News, which is devoted entirely to mental health recovery and hope. 

Stephen asked me if I knew Dr. Daniel Fisher of the National Empowerment Center, which he founded in Lawrence, Massachusetts, near Boston. "Talk about leadership," Stephen said. 

As a matter of fact, I do. Though I've never met him. I know Dr. Fisher's remarkable recovery story and his spiritual and healing approach to severe emotional trauma, often the root cause of mental disorders. Having hope is crucial.

I've read several of his books including "One Vision of Recovery" – his personal story – and "A PACE/Recovery Reader" – an excellent historical anthology of writings about psychiatry, mental illnesses and recovery. 

My psychiatrist, Dr. Bob, was the first person to enlighten me years ago about the bogus claims that mental illnesses are caused by chemical imbalances in the brain – a theory that has never been proven. Fisher elaborates in his writings. I'm reading stories from substantial sources that corroborate this all the time, but still, especially here in Canada, the biomedical model which is grounded on this theory seems to stand firm. Psychiatrists prescribe cocktails of drugs and insist on diagnoses that rarely fit the individual. And people are getting sicker all the time, when they could, indeed, recover and live meaningful lives. 

We have universal health care here in Canada, but we're in the dark ages when it comes to mental health recovery. We're the only country in the G8 with no national mental health strategy.

Dr. Fisher subscribes to "recovery at your own pace." When I interviewed him several years ago, he stressed that medications can be helpful but only as tools, in the short term. There are other tools. Toolboxes full of them. He stated that he has not taken any psychoactive medication for more than 30 years. Community, inclusiveness, helping people to feel that they are not alone, that there is hope are among his prescriptions for recovery.

His story is recovery story remarkable. 

Years ago, as a PhD student, Fisher became delusional, ironically while researching the biochemistry of the brain in schizophrenia. He was hospitalized several times, treated like an animal, shut away and ignored. His psychiatric diagnosis? Schizophrenia.

So demoralized, appalled and angry at how he was treated as a psychiatric patient, Fisher vowed, then, that if he ever recovered, he would become a psychiatrist to ensure that people with psychiatric diagnoses would be treated with dignity and humanity. 

He finished his PhD, went on to complete his MD at Georgetown University and his psychiatry residency at Harvard. He has become a leading Recovery advocate, as well as a clinical psychiatrist – one of a tiny handful of psychiatrists who "are out" and openly discuss their psychiatric histories.

His interview on January 20, 2005 in Medscape is fascinating. Fisher is the featured keynote speaker at the Detroit conference, called Redefining Our Roles in Recovery: It's Everybody's Business. Sadly, my teaching schedule prevents me from attending, though I'd do anything if I could, I told Stephen.

But I'm following the activities of the Michigan Recovery Center for Excellence and Norm DeLisle's blog.

Then, this morning, when I came home after my class, there was another email from Stephen Batson.

"Hi again. I was thinking, on the way home last night, that we have recovery stories on this site. In fact, I will be spending the next seven days in Michigan's upper peninsula visiting drop-in and Clubhouses. While up there I will be video recording more stories to post on the site.

"I'm writing to you today because your article IS a recovery story. Perhaps not like the life stories many others have told, but yours talks about an important aspect of a person's recovery ... relationships' socially valued roles. So, I'm asking for your permission to include your story among the collection we have gathered."

Of course, Stephen. It would be an honour. My story is yours. As I tell my students, I have a mantra, one of several. "I live my life out loud. No secrets. No lies."

It's one way to find peace of mind.

Have a great weekend. I wish you the best, always.

Speak soon.

"Julie & Julia" and me...

I'm back. Refreshed. 

That's how Julia Child in Mastering the Art of French Cooking instructs you to prepare all green vegetables after they've been blanched in boiling water. Refresh them. Plunge them into a bath of ice-cold water for a minute and they retain their glorious colour and crispness. They stop cooking, too. 

That's how I feel right now. Crisp. Bright. Not raw but ready. Tingly and alive again. Yum.

When I left you two weeks ago, I was a limp, burnt out asparagus spear. Desperately in need of refreshing. Emotionally parched. Spiritually dried-out. (Oh, dear. That's quite the metaphor, isn't it? ;-)) 

Then, the next day, the day following my departure – after I hung out my "Gone Fishin'" sign – my alter ego, my trusty iMac, burnt out, too. First, it froze. Then it died. Its hard disc damaged beyond repair.  

Now, all that is behind us – as you may have read in last week's Postcard from the Edge – and we're cooking with gas again. 

As you may have already guessed, over the weekend, my husband Marty and I treated ourselves to Nora Ephron's new movie Julie & Julia and we emerged refreshed and ravenous. 

More than that, we felt validated, knowing our marriage is what keeps us alive and loving life. We held hands all the way through the film – I cried – convinced our "enough" has made us rich beyond belief.

It wasn't always that way for me. Just as Julia Carolyn McWilliams Child wasn't always "Julia" – I wasn't always the person I am today. 

Back in the early 1990s, I was on dialysis. For close to two years, I had to spend 12 hours every day, seven days a week, hooked up to a peritoneal dialysis machine – to stay alive. Nauseous most of the time, I couldn't eat well. I had to restrict foods drastically, especially salt. Still do. 

Tethered to my machine through a shunt in my gut, in bed, I watched Julia Child's television shows religiously. Her vitality, wit, energy and passion for life and delicious French cuisine kept me emotionally enriched and vicariously well fed. 

If I couldn't eat, at least I could watch ... and imagine how her exquisite-looking dishes tasted. 

Those were lonely years. I was single. Unable to work. My Endstage Kidney Failure was the result of Lithium toxicity caused because my psychiatrist at that time neglected to monitor my Lithium levels properly. I never knew they had to be monitored so carefully back in 1975 when I started taking it for mania. (If you are on Lithium, please be sure to have your levels checked!) 

So, I lost the functioning of my only kidney. Yes, that's right. I had only one to begin with – not that it would have made much difference. Lithium toxicity affects both kidneys if you are lucky enough to have two.

Anyway. That was then. This is now. My youngest sister Glorianne saved my life by giving me one of her two kidneys on March 7, 1994 and the rest is history. She's healthy and well. Transplant is no cure, but it sure beats dialysis.

I returned to work as a Lifestyle feature writer at The Toronto Sun and on August 13, 1997, two days before her 85th birthday, I interviewed Julia Child. 

We talked about butter. 

Julia Child's trademark was her love of butter and rich French cookery ... and her revulsion for trendy, nutritious, low-fat cooking. 

"It's adulterating good food," she trilled on the telephone, I recall, in her unmistakable vibrato. "I was in a restaurant the other night and they had quenelles, and someone in our party said, 'Gosh, I haven't had a quenelle in years.' But this chef had done them complete 'diet', and do you know what one of those bouchees tastes like with no cream? It was awful, like chewing a chunk of rubber."

Yet even Julia admitted she was cutting back on butter to try to keep her weight down. Her approach to "cutting back" is either taste something rich or don't serve it at all. 

"Make another recipe. Don't adulterate something that's supposed to be good and delicious," she sternly 

advised. "You have your mouth all set for food the way it's supposed to be and then you get foam rubber. It's much better to eat an apple than this fake food."

Until seeing Julie & Julia, I never knew much about Julia Child's personal life. In part, the film is based her autobiography My Life in France. She wrote it with her husband's great-nephew, Alex Prud'homme in the last few years before her she died on August 13, 2006 – two days before her 92nd birthday.

It's a charming love story. Not only about her passion for France and its food, but her zest for life and especially, her lusty loving husband, artist Paul Child. She had a glorious and relatively late-in-life marriage – she was 34 and a virgin – to the most delicious man in the world. Paul absolutely adored Julia, who was 10 years his junior. He supported her wholeheartedly during her close-to-10-year odyssey writing her first landmark cookbook and getting it published. He illustrated and took photographs of her culinary creations for this and many of her subsequent cookbooks all their married life. He encouraged her to try teaching cooking on TV and was thrilled watching her phenomenal rise in the world of cooking.

What struck me most was that he loved her exuberance. She was loud and big and wildly enthusiastic. All 6-feet, 2-inches of her. Decidedly, admittedly different and he was utterly smitten. She was the "butter to his toast" and their marriage was a valentine, year-round.

That pretty well describes how my husband feels about me. And I him. And our marriage. He's more than 12 years older than I am. He calls me his "child-bride." He sees me as beautiful, even first thing in the morning, fresh out of bed. Unbrushed. He loves my exuberance, my excitability, my over-the-top enthusiasms. My passions, many of which he is thrilled to share. I'm different, too. Very different, as you well know. He especially loves that about me. 

I am not 6-feet, 2-inches. Just over 5-feet. As tall as Julia Child was, so I am round. 

Well, not quite, but in truth, I've had a real problem with food and my weight for too many years. I eat when I'm stressed, bored, anxious, frustrated and upset, as well as when I'm hungry. For any reason. The only time I don't eat is when I'm asleep. 

I eat too much. I gorge myself to fill emotional voids by stuffing my mouth and my stomach, sometimes to the point of pain. Food is my drug of choice. Unlike Julia. She was happy with tastes. A good eater. I'm not.

There's a reason. It began following a sexual assault by an orderly in the psychiatric ward of the Toronto Western Hospital when I was there for a week of observation in the early-1960's. I was in my early teens. It was my first hospitalization. Within six months I gained 50 lbs. I suppressed that memory for 14 years. All too common a story. Build a wall of fat around yourself and no man will ever want in again. Eat away your unconscious psychic pain.

Today, you might call it Post Traumatic Stress Disorder but back then PTSD hadn't yet been invented. When I was about 28, the memory of that sexual assault suddenly came out during a therapy session with the same psychiatrist who neglected to monitor my Lithium levels. He didn't deal with it, so it festered for years. I ate for comfort. At one time, I weighed as much as 242 lbs. Now, I'm well under that, but by no means trim.

So, I am a perpetual yo-yo dieter. Marty met me when I was thin and fit. Now, I'm not, but he cannot see the difference. Like Julia and Paul Child's marriage, we are blindly in love and about to celebrate our ninth wedding anniversary on August 22. He's the most dashingly handsome man I've ever known.

Now, even my yo-yo dieting is less a problem.

As for the "Julie" in this film – Julie Powell and her account of her year-long adventure cooking all 524 recipes in Julia Child's Mastering the Art of French Cooking and blogging about it – that's me, too. 

I was new to blogging when we launched Coming Out Crazy on Healthzone.ca in April 2008. Since then, I've reinvented myself and I love my online life with you. My "other life." I live for your comments. I care about how you will react to my musings. Marty is my editor – he is also a writer – and although the New York Times has not come calling, I believe we're making a difference as one of the only online mental health blogs carried and promoted by a major urban daily newspaper. 

Sadly, I learned yesterday from Philip Dawdy at Furious Seasons that Liz Spikol is no longer writing her award winning bipolar blog The Trouble with Spikol at The Philadelphia Weekly – a loss for all of us.

I don't know what happened, but I hope she'll be back. Her voice is needed. The more voices, the stronger we become. Your voices, too. All our voices.

Meanwhile, on Saturday evening, following the movie, Marty and I picked up a fresh whole-wheat baguette, some luscious local Ontario strawberries, tomatoes-on-the-vine, a gorgeous bunch of fresh basil and a small triangle of Italian Parmesan cheese. I've discovered the most divine new salad, thanks to Mark Bittman and his New York Times blog, Bitten. 

Here's the recipe. It's easy. Perfect for right now. A seasonal summer "red salad" – divine.

Fresh strawberries, tomatoes, sliced parmesan, fresh basil and – get this – no fat. Just a good balsamic vinegar. Toss and enjoy. Julia wouldn't mind. I bet she'd love it because it tastes scrumptious – without a smidgen of butter. 

Julia always said, "We must have the courage of our convictions." In the kitchen. And in life, too. That's what "Coming Out Crazy" is all about. 

I'm so happy to be back. I've missed you. 

Speak soon!

Musings on schizophrenia...

On Monday, I had lunch with an old friend. It all started because of last week's newsmaking announcement about so-called new findings about the genetics of schizophrenia.

I sent my friend a piece in The New York Times by Nicholas Wade which seemed to me to put a sober perspective on all the hoopla that followed. Well worth reading. Rather than a major breakthrough – for nothing would delight psychiatric researchers more than finding a cause for a varied group of disorders described as schizophrenia – what was reported was a big deal about information that's been known for years.  At best, a tiny little piece of the puzzle was confirmed by three new studies. 

The mysterious causes of schizophrenia are linked to thousands of genes, not just a few. There's lots of work still to be done.

It was this study that reconnected me to my friend. He often remarks that the word "schizophrenia" really describes psychosis – or, to be more precise, a number of different psychosis with several widely varying classes of symptoms.

At 89 and utterly brilliant, he and I met while I was writing for The Toronto Sun on one of my extended forays into psychiatric research and we remain buddies, although I do not see him often enough.

Yesterday, we wandered along College Street until we could locate a Japanese restaurant to our mutual liking and had an enlightening and, as always, fascinating chat.

He is a rare bird in the realm of psychiatry. One of the only people I know who launched his career as a psychiatric social worker in 1948 – the year I was born – after graduating from the London School of Economics in Psychiatric Social Work and studying clinical psychiatry with William Mayer-Gross at the Crichton Royal Hospital in Dumfries, Scotland. Dr. Mayer-Gross authored a seminal text called Clinical Psychiatry published in 1954, before the advent of the earliest antipsychotic medications.

After finishing his training with Dr. Mayer-Gross at the Crichton Royal Hospital, my friend moved to Canada to become director of social work at the former Whitby Psychiatric Hospital. Then he was named advisor in social work in the mental health branch of the Toronto Department of Health before taking the post of Associate Director of Psychiatry at the Toronto Psychiatric Hospital, which became the Clarke Institute of Psychiatry in 1964 and part of the Centre for Addiction and Mental Health (CAMH) in 1998. He finished his career at McMaster University as a research scientist, Professor of Social Work and Associate Professor of Psychiatry before retiring in 1990. 

His professional career in psychiatry spans 42 years from the pre-Chlorpromazine Age to the age of the atypical antipsychotics. He is one of the most knowledgeable and reasoned professionals I have ever known and this week, schizophrenia was on our minds.

My very first psychiatric diagnosis was schizophrenia. A rather dotty and dusty old-maid psychiatrist named Margaret McQuaid gave me that diagnosis back in 1960 when I was barely into my teens. I didn't know it then, but ah, those labels. How they stick!

About six years later, I found out about it in a brutal way. Another mad shrink at The Clarke Institute of Psychiatry – I cannot name him as he's still kicking around – decided he had cured me, so one day, he put me in a glassed-in cubicle on the eighth floor and handed me my chart to read.

There, in correspondence and other documentation, I discovered I had schizophrenia and then, a few years later, the word "catatonic" was added. Scary words for an 18-year-old to absorb. I remember riding home on the subway shuddering. I ran up to my room where my 1966 edition of the Random House Dictionary of the English Language sat above my desk and looked those two words up. 

• "Schizophrenia – a psychosis marked by withdrawn, bizarre and somewhat delusional behaviour and by intellectual and emotional deterioration. Also called dementia praecox, which means premature dementia."

• "Catatonia – a syndrome seen most frequently in schizophrenia, with muscular rigidity and mental stupor."

I didn't recognize myself remotely. Why were these words applied to me, I remember wondering. Can you understand why I detest these psychiatric labels and why language is so important to me? Yet, for the next seven years, through Seneca College and Queen's University, in the back of my mind, that diagnosis was there, though never in my entire life have I ever been "withdrawn." 

In 1975, that diagnosis was changed to manic depression.

"You know, this is the 100th anniversary of the word schizophrenia," my friend announced as we perused the $5.99 specials. His first statement has been well documented. According to an article in the American Journal of Psychiatry Paul Eugen Bleuler and the Birth of Schizophrenia, on April 24, 1908, Swiss psychiatrist Bleuler first coined the term "schizophrenia" at a meeting of the German Psychiatric Association in Berlin – as opposed to the earlier label, dementia praecox.

Without recounting all this history of labels, let's just say that the term schizophrenia simplified what had been a grab-bag of other labels. Too bad. I've always thought that huge catch-all categories are more dehumanizing than specific ones.

According to former Boston Globe investigative reporter Robert Whitaker, in his book Mad in America – Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill, "Throughout the nineteenth century, physicians had conjured up a wild profusion of insanity types. Medical texts told of such ailments as "old maid's insanity," "erotomania," "masturbatory psychosis," "pauperism insanity," and "chronic delusional disorder."

Whitaker adds, "There was no rhyme or reason for these terms, and they provided little insight into what the future held for the patient." German psychiatrist Emil Kraepelin classified them into two streams – manic depression for those with psychosis and emotional disturbances, and dementia praecox for those with lack of emotion. The second group were given a less hopeful prognosis.

In 1908, Eugen Bleuler came up with the term "schizophrenia" which he viewed as a milder form of dementia praecox, according to my friend.   

Bleuler wrote a paper about his new term "schizophrenia" in 1911, so my friend considers 1909 – a point in between – as the true birth of the schizophrenia. 

Still, not much is really known about its causes today – probably because there are so many. I seriously doubt any one cause will ever be discovered. 

My friend announced that back in the 1940s and 1950s, close to 50% of patients who were diagnosed with schizophrenia went into spontaneous remission – complete recovery – with humane care and no medication. There were no antipsychotics back then.

"The prospects of lasting spontaneous remission are greatest during the first two years of illness," my friend quoted in an email from page 267 of Clinical Psychiatry (Cassell, London, 1954), co-authored by Wilhelm Mayer-Gross, Slater and Roth. "After five years of continuous illness they become negligible. If a series of patients whose illness have lasted a year are followed up, about half are found eventually to remit; if the illness lasts two years, the proportion is still about 45%. Thereafter it quickly declines."

My friend notes that with "effective community support, many former patients with longstanding schizophrenia were able to live satisfactory lives without or later with medication." 

Having a diagnosis of schizophrenia is not an easy one to live with and today, what we know about psychosis, no matter what you call it, is that early intervention is the key – especially for young people.

This also explains why so many leaders in the modern recovery movement – psychologist Patricia Deegan, Dr. Daniel Fisher and British psychologist Rufus May are three examples of countless people who have fully recovered from serious cases of schizophrenia and now live meaningful lives without medication. Others have succeeded brilliantly with psychoanalysis and medication, like law professor Elyn R. Saks, PhD. 

The question is, what about the other 50% who don't spontaneously remit? Why? And what about the standard contemporary biomedical approach that involves prescriptions of newer, very powerful atypical antipsychotics? Do they promote spontaneous and permanent remission? Or are they harmful?

A great deal in psychiatry has changed in the last 40 or 50 years, but not a great deal more is known about the causes of schizophrenia. Genetic testing and brain imaging will be studied in about 100 people with schizophrenia, bipolar disorders and depression at CAMH, the first hospital in the world to explore these newer avenues of therapy. 

We should be able to use all possible tools available for recovery. And recovery should be the goal. Not a belief that this condition is chronic. 

The word "schizophrenia" carries enormous baggage. The media hasn't helped. But, I think it's interesting to learn from the past. If many people diagnosed with schizophrenia, experiencing abnormalities in perception, hallucinations, delusions and disorganized thinking have fully recovered with humane support and care – that, to me is a reason for hope. And an approach to be seriously considered. Not isolation, hospitalization, drugging and other inhumane treatments. Instead, inclusion, respect, education, accommodation, empowerment and nurturing. Give people a chance!

Schizophrenia is probably not chronic brain disease, as so many people would have you believe. It involves the mind and the soul, the whole of a human being. There is no scientific proof that it's a disease of the brain.

Trauma can play a part in the development of the symptoms that suggest a diagnosis of schizophrenia, as can genetics, intrauterine factors, early childhood environment, psychology, neurobiology, social and cultural influences – even drug abuse.

Until we have more information, the jury is out and anything is possible, including recovery! It's time to rethink our knee-jerk reactions to this condition. See it not just a medical context but in an historical context. In a post-psychiatric context, too, and in the context of the recovery movement. 

Madness, a word I prefer to all the others, has many meanings. Love. Anger. Insanity. 

Let's open our minds to all them.

"Schmoozing" with Ron Pies, M.D.

As many of you know, through this blog I've developed a friendship with Boston's Tufts University clinical professor of psychiatry Dr. Ron Pies. He's also a psychiatry professor and lecturer on bioethics and humanities at the S.U.N.Y. Upstate Medical University in Syracuse. Plus he's editor-in-chief of Psychiatric Times. 

Dr. Pies is a polymath.

He's written a novella based on the life of medieval physician-philosopher Maimonides who believed that "the physician does not cure the disease, he cures the diseased person."

As well, Dr. Pies has had several psychiatric textbooks published along with a volume of poetry, Creeping Thyme, a collection of short stories, Zimmerman's Tefilin, and Everything Has Two Handles – The Stoic's Guide to the Art of Living. 

This charming slim volume of essays weaves together the ancient wisdom of the Greek Stoics and many great Eastern and Western philosophical thinkers with his own insights drawn from years of psychiatric practice – case histories of real people. He demonstrates how Cognitive Behavioural Therapy – a psychotherapeutic approach based on rational thought and understanding the present – offers helpful tools in coming to terms with emotional difficulties. I've found his book to be endlessly re-readable and a great tonic for sleeplessness.

(NOTE: It's unavailable through Amazon.ca or Amazon.com. However, you can buy it online at Barnes and Noble.com and it sure beats medication.)

My psychiatrist Dr. Bob and Dr. Pies come from similar schools. Dr. Bob blends this rational approach and a psychoanalytical bent in his therapy with me. It works wonders.

Last night, I read the short chapter on "Morality and Self-Respect" and, to quote Marcus Aurelius – "I do my duty. Other things, trouble me not." 

Dr. Pies often illustrates the Stoics ideas with practical contemporary examples, in this case a woman who couldn't do enough to satisfy her mother – a problem I've had. 

Do I want to lose my soul in trying? No way. So, after reading Dr. Pies and the ancients, I fell asleep peacefully with the words of Epictetus ringing in my ears: "If you fulfill your duties, you have what belongs to you." Or as Dr. Pies suggests, "the only real possession to which we may lay claim is our own moral integrity. Everything else in life either belongs to someone else or is beyond our control."

How did Dr. Pies and I meet? Well, to be honest, we've never met. And until last night at 7:30 p.m., we had never even spoken on the telephone. I had never heard his voice, though I feel very close to this man. 

Our friendship began when I misinterpreted him in a September 26, 2008 post I wrote about an article of his in The New York Times on depression and grieving.

He commented, correcting me in a very gentlemanly way – very gently and thoughtfully. And I wrote back. Thus began our correspondence. 

On two occasions, I've written lengthy posts about Dr. Pies and his wit and wisdom. From time to time, he often enters into my posts with a thought, a nugget of wisdom or in many instances, the support he is so generous in giving. His words speak volumes because he is so wise, well-read, and open-minded. He also willingly acknowledges that modern, contemporary psychiatry may be losing sight of its roots – a belief to which I subscribe. Where other practitioners in his profession are blinded by their current intoxication with the neurosciences, Pies is not. He's endlessly curious and willing to learn and keep on learning – a real signal of wisdom.

Our correspondence has lasted for almost a year, during which he has opened my eyes to many truths about his world of psychiatry and psychopharmacology. I've learned so much from him. And I suspect that I, too, have given him some interesting perspectives to ponder. We don't always agree, but we can easily agree to disagree. With respect.

His post The "McDonaldization" of Psychiatry: Psychiatric Knowledge is Not the Equivalent of "Fast Food" in the Psychiatric Times blog The Couch in Crisis is a perfect example of this thoughtful self-analysis. It's a studied critique of today's psychiatric paradigm.I urge you to read it if you haven't already.

What better metaphor for the current "norm" in psychiatry than fast food and its "McDonaldization" – 20 minute diagnoses, 15 minute-appointments featuring a prescription pad more than a willingness to listen and engage in any form of talking therapy or psychotherapy. 

What I have never understood is why psychic healing is supposed to happen fast. We didn't become emotionally disturbed fast. Often, it takes years, especially if trauma is involved. I'm in no rush. My healing is going to take a lifetime. I'm always learning and healing – becoming more and more whole.

Also, and I love this in Dr. Pies. Like me, he is fascinated by etymology – the study of words. He pointed something out to me last night, during our pre-arranged telephone conversation. I've often said that there's a world of difference between "doctoring" and "healing." The words are interesting. Doctor means teacher. Healer derives from the  Old English or Germanic origin "heilen" which means "whole."

Have you ever considered the word "physician," he asked? 

No. I had not. He explained that "physician" means "a person qualified to practice medicine." I looked it up myself and found as well that it also means, "a healer, as in physicians of the soul." The origin of that word is from Old French – "fiscien," based on the Latin "physica" which means – "things relating to nature" or as he put it, "assisting nature."

I wonder if all these medications, these drug cocktails too many psychiatrists prescribe these days – the main tool in the modern psychiatrist's toolbox on this continent – are assisting nature or impeding it. 

What do these drugs do for the soul?

As I've often said, you'll find no insight in a pill bottle. I am not angry at psychiatry nor I do not believe in throwing the baby out with the bath-water. All knowledge is useful, depending on how you choose to use it and what you choose to use. Psychiatrist Sigmund Freud had enormous contributions to make, as did R. D. Laing and Philip Thomas who subscribes to "Critical Psychiatry."

I use one medication everyday. In 1988, it stopped, cold, my severe annual manic episodes. I take one 200 mg tablet of the anticonvulsant Tegretol morning and night. It stabilizes my manic mind. I can live without it, but I'm better with it. And it's perfectly innocent for me. I have no side effects whatsoever. It suits me. (Unlike Lithium, which for me, was toxic and destroyed my kidney function because my psychiatrist at that time neglected to monitor it. Be sure yours is monitoring you!)

But Tegretol hasn't given me insight or healed my soul. Dr. Bob has helped me to do that. And my loving husband, the first person on the planet who has ever loved me unconditionally.

I find other ways to peace of mind, too. Like reading Dr. Pies. Our easy and relaxed conversation will continue in the future. I'll keep you posted. 

Do whatever you have to do to wake up in the morning feeling happy to greet the new day.

All the best. Happy Canada Day!