Happy Anniversary, "Coming Out Crazy"...

We're two years old today. I cannot believe it and what an education writing this blog has been for me.

IN THE BEGINNING...

On April 9, 2008, I posted my first blog, called Welcome to Coming Out Crazy – and we weren't even live and on line, right at the beginning. (Now everything I've ever posted is archived and online.)

I was just beginning to toy with my own blog and didn't really have a clue about what blogging and the blogosphere was all about, when Brandie Weikle sent me an email asking me if I'd be interested in blogging about mental health for a then-new website The Toronto Star was building called Healthzone.ca.

I just reread that opening post. When I think back to what I thought I would be doing, I'm shocked at how much I've learned and how innocent I was.

As I mentioned, we were not interactive, like we are now. Any feedback came via email that went either to Brandie or directly to me. Our correspondence was strictly one-on-one and a ton of work. 

POSTS FROM THE FIRST FEW MONTHS AND OUR FIRST AWARD

At the beginning, it was just a trickle, but the initial reactions were positive and I kept plodding on writing about some of the topics I'm passionate about – like labeling, language, lessons we can learn from abroad, Recovery and Denial, mad pride, madness and more, "framing" or "the 'S' word", ECT and other current therapies, mental health in the workplace and suicide. 

I shared stories, like the challenges of living with my pregnant Dandie Dinmont terrier bitch, Lucy – who is not pregnant again, I'm sad to report. And this one I discovered on www.TED.com by Sir Ken Robinson. I called it Shall We Dance. 

On October 22, 2008, I turned 60 and that morning, we won our first award as one of the Best Bipolar Blog on the Web Award! We won another in 2009.

Most of all, I was learning how much I didn't know and how much more I wanted to know. I made some enemies, but more friends. I began to familiarize myself with the other mental health bloggers on the Internet – and there are millions of them all over the world – but mainly from the U.S., in England and Canada. 

I quickly discovered that there were very few newspaper mental health bloggers at that time – besides Liz Spikol in Philadelphia, who writes about her bipolar disorder. I've linked you to other bloggers who have intriguing ideas to share. The more we can share, the more we can learn from each other.

In Canada, to the best of my knowledge, I'm still the only person writing regularly and candidly in a major daily about my personal mental health issues, my recovery, and mental health and wellness in general. If not, please let me know who you are, where you are and join our conversation.

I wrote about one of the most remarkable psychiatrists I've ever known, about schizophrenia, about depression, about my teaching, how I came out in class to my students about my mental health issues, about my hearing loss, about how friendship heals, about "living out loud", about my ongoing battle with food and my moods, about letting go, about stress and about hope.

And I wrote about you. 

And Angela and her electroconvulsive therapy, which will be finishing very soon. And I'll be reporting on that, rest assured. Will she need maintenance ECT? I'll keep you informed.

Yet, I've just scratched the surface. There's so much more.

I answered your questions, or tried to, and I explored some of the issues in your comments. I've come to care about you, became acquainted personally with some of you, and even met and befriended some of you.

Now, because of this blog, I have new friends and I'm so grateful to you. This is a dialogue. I thrive on your input. Yes. I live for your comments.

I'VE LEARNED SO MUCH FROM YOU...

I learned so much about you and from you. 

How much you need to share, to speak about your personal pain, your traumas and psychic scars, your stresses and anxieties, your feelings of abandonment and loneliness, your fears and frustrations trying to find compassionate listeners who will help you develop the tools for living meaningfully, instead of or in addition to dispensing medications.

And I've made lots of mistakes. One worked out wonderfully. As a result, I met psychiatrist Ron Pies, a professor of psychiatry at Boston's Tufts University and the S.U.N.Y. Upstate Medical University in Albany, N.Y. He has generously helped me with much of my research and become our resident expert and my friend. 

From the beginning, and especially after we moved to Typepad in June of 2008, I began to dream of creating, here, a safe and supportive virtual community, where you can share your stories, perspectives, complaints and opinions openly with me and each other.

And once I began linking, I began to love sharing all I was learning with you, too, by giving you sources and seeking out the best references I can find for you. Dr. Pies calls me a "public educator" but we're all educating each other, contributing to a body of knowledge here that can help challenge discrimination and prejudice with information and discussion. Openness. Coming out and staying out comfortably. 

Changing the landscape about mental health. Though change doesn't come easily and there's always resistance. We must keep trying.

THANKS FOR THE MEMORIES

For the last few hours, I've been traveling back, touring the archives of this blog. I'm amazed at how much territory we've covered. 

And how much more we must cover.

As a little anniversary gift to you, the links above will take you back, too. To some posts that were never on line and are now available as well as others you may remember.

So, I'm wishing you a Happy Anniversary, too. Because without you, I simply couldn't do what I do.

Finally, I want to give special thanks to my editor Brandie Weikle. She not only edits me and all of HealthZone brilliantly, but also ParentCentral, where she writes a charming and informative blog about raising her two adorable young sons, Cameron and Alister. Their cute kid quotes of the day are guaranteed to give you a lift.

Her guidance is invaluable. She works like a trojan and she is endlessly patient with me and my occasional emotional outbursts. Brandie, you're a dream of an editor. I adore you!

I want to say a special thanks to the powers-that-be, and all the editors and moderators at thestar.com for having the wisdom and courage to launch a mental health blog. It's crucially important to give all health issues fair treatment, time and space ~ physical and emotional and mental. It's validating for us and empowering for everyone touched directly or indirectly by mental health issues. And we're all touched in some way, somehow. No one is immune.

With heartfelt thanks and gratitude to all of you.

So far, it's been a fascinating ride – not without a few bumps, mind you. I learn lots from those bumps.

So, here's to continuing on our journey of discovery and self-discovery together for another year ~ in health.

Speak soon.

Hugs to you all!

Angela's ECT continues, but I'm having side effects...

Angela is a seven!

A few minutes ago, I asked her, "On a scale of 1 to ten, if one is suicidal and 10 is normal, where would you say you are?"

"Hmmmmm," she said and within a second. "Seven ... but I just want it to be faster."

She's done a ton of reading and I think she was hoping she would snap out of her suicidal depression after one ECT treatment. There are apocryphal early accounts floating around that report dramatic, seemingly instantaneous response to one or two ECT treatments. They make for a good story.

THE ITALIAN PIONEERS OF ECT

I'm reading about the Italian psychiatrist Dr. Ugo Cerletti and his team in Rome who pioneered modern electroconvulsive therapy in 1938 in Shock Therapy – A History of Electroconvulsive Therapy in Mental Illness by University of Toronto medical historian Edward Shorter and Cardiff University psychiatry professor David Healy.

Their sources include a lab notebook describing the April 11, 1938 first-ever treatment performed on a human being – earlier testing was done on pigs who survived these experiments – by Cerletti and his team.

Doctors had already observed that patients with epilepsy and clinical depression, following a grand mal seizure, found that their depression lifted quite dramatically.

Hence the connection between inducing grand mal seizures in patients with depression to alleviate their symptoms. Electricity seemed much faster and less invasive than insulin or other drugs that were being tried with moderate success at that time.

Cerletti administered ECT to  man called Enrico X, who was homeless, delusional and speaking gibberish. After three weeks of observation, Cerletti and his team had diagnosed him with schizophrenia and without anaesthesia, he was given his first dose of 80 volts of electricity. He didn't lose consciousness, but it did not induce a grand mal seizure and his condition didn't change. After several attempts that day, with almost no effect, Enrico X walked back to his room and Cerletti deemed this first attempt at ECT a failure.

However, on April 20, less than two weeks later, Enrico X was given another slightly higher, 92 volt dose of electricity, and this time, he did have a grand mal seizure and after several minutes, he was able to respond lucidly to questions. 

After six or seven more treatments, eleven in all, Enrico X was not only able to speak, "he was able to write to the physicians of the Clinic a well-composed letter, in which he gave information about his previous illnesses and the attempted treatments and thanked the physicians," Shorter and Healy wrote.

ECT TAKES TIMES

So, even the first, most primitive ECT experiment took time.

After Angela's 7 a.m. treatment yesterday – her fourth – which again went smoothly, she had what she typically calls "a bit of confusion." She came out of the anaesthesia quickly with only a mild headache that was relieved with two Tylenols, and no muscle pain at all. That happened only once, after her first treatment.

Last evening, she said she felt "regular" and "not suicidal" – bordering on "glum."

She reflected on all the other "life" issues she's facing right now, complexities that have nothing to do with her psychiatric condition, but influence how she feels emotionally. We are all "package-deals," mind-body-spirit. These are problems of everyday life that anyone would find perplexing. But strictly speaking, she admitted she was beginning to feel a little better. And she sounded more upbeat. She joked with me and laughed. Not typical of a severely depressed personality.

This morning, she said, "I'm feeling better today than yesterday. Yesterday was a little tough, with the confusion. I was putting away my socks and pyjamas and I forgot wear they go. I thought for a minute, and I remembered," she said. "And I'm not as tired as I've been, but there are a lot of other things on my mind. My mother is coming today."

She was about to leave to see her psychiatrist. I asked her if they had discussed the frequency issue and whether she could have three treatments a week instead of two.

"No yet, but I'm going to ask her. I suspect it's determined by the study I'm on," she said, signing off by saying. "I don't feel bad."

MY SIDE EFFECTS FROM ALL THIS "ECT"

This morning I slept in.

I couldn't get out of bed until 8:40 a.m. Very late for me. Usually, I'm up no later than 6 a.m. and working here at my iMac by 7 a.m. 

Last night, I couldn't fall asleep. I couldn't turn my thoughts off. I couldn't stop thinking about ECT. About what I've been learning and researching. About how much I don't yet know and comprehend. About all your different fervent comments and reactions to this series. About how emotional this issue is. About how some of you have reported suffering from ECT and others have been miraculously helped by it. About how angry some of you are. About how others have made peace with the cost of some memory loss for a far greater gift, a vastly improved quality of life.

Last night, I had to take a small 0.5 mg dose of Clonazepam in order to be able to fall asleep. 

So this morning, I made a decision. I'm going to take a brief respite from this series, slow it down a bit. 

I'll continue to give you regular updates on Angela's progress. She'll be having her treatments until March 18 at the earliest and possibly for four more weeks after that.

I'll continue reading medical journals and studies, plus the books I have already started, including the Shorter/Healy history and a fascinating book by Kitty Dukakis and medical journalist Larry Tye called Shock, The Healing Power of Electroconvulsive Therapy – combining a contemporary personal story and a journalistic commentary on ECT.

Linda Andre's book, Doctors of Deception, What They Don't Want You To Know About Shock. It's on order, but Amazon hasn't yet shipped for some reason. When it arrives, I'll read it, too.

There are, however, lots of other interesting and newsworthy stories unfolding around mental health and wellness that I want to explore and that, I am sure, interest you, too.

So, I hope you'll understand. 

And I have another life. I teach at a Toronto community college. I'm not even going to go into the possibility of a Ontario province-wide faculty strike that is looming. I'm not even in the union. I'm not going there right now. All I can say is this is a stress that's weighing hard and heavy on my students and on me.

On a lighter note. My gorgeous four-year-old female Dandie Dinmont Terrier Lucy has just gone "into season" and there's a good chance that we'll be breeding her within the next few weeks. So, perhaps, if all goes well, we'll have new life in this house come spring.

Puppies. 

There is absolutely, positive nothing more delicious and delightful than the prospect of Dandie Dinmont Terrier puppies in the house.

Have a great weekend.

Speak soon!

You...

If you read the comments to this blog with any regularity, you know that I am enormously grateful for your feedback. They are a rich dialogue between you and with me, because I try my best to answer as many comments personally. Often, ideas evolve through the comments that further the discussion in the main posts. They're synergistic. Like brainstorming session because your ideas and reactions and experiences are so stimulating and inspiring to me.

WITHOUT YOU, I WOULDN'T BE HERE

The main point is, without you, I wouldn't be here. And between you and me, I love being here. This blog is my passion. I love writing it. It's the most satisfying journalistic experience of my 38-year professional journalistic career. (I started young, very young. Trust me.)

You, as veterans of the mental health system, know more than most people - especially doctors and psychiatrists and neuroscientists - about how it feels to be on the other end of a "notebook." Collectively, your expertise, your insights, your experiences in the mental health world is monumental. 

So, today, I'm going to muse about why, share the spotlight with you, and share some insights that have come my way in particularly in personal correspondence from those of you who struggle with and have learned so many "truths" travelling along their roads to Recovery, but are a little shy about being in the limelight.

I REMEMBER HOW ANXIOUS I WAS COMMENTING FOR THE FIRST TIME

Believe me, I empathize. I remember how anxious I was commenting for the first time on Liz Spikol's high-profile and multiple award winning Philadelphia Weekly bipolar blog The Trouble With Spikol. 

Liz hooked me immediately because she used to post short videos of herself and she seemed so friendly and down-to-earth and lacking in ego, which she is, by the way. But she also has a huge following and she monitors her comments, so I didn't know if mine would make it. This was nerve-wracking for me. 

At the time, I knew nothing about blogging. It was in April 2008, just after we launched HealthZone and Coming Out Crazy - this link is my inaugural post, which ran on April 9 of that year.

Back then, I was just getting my feet wet as a blogger. (Until I began blogging, I had never read a blog and knew little about the blogosphere. In our embryonic days, we were not live and interactive, so being interactive and engaging publicly and openly with the Internet was scary. I didn't know, then, that the blogosphere could be very forgiving, but at the same time, risky, too.

You put yourself out there, less so in The Comments, than in my main posts. Still, it's a daunting experience until you've done it a few times. As Malcolm Gladwell asserts in his controversial, highly readable and bestseller Outliers, The Story of Success, it takes practice. Not 10,000 hours, but a few.

This week, one of my regular "anonymous" readers sent me the following note in response to Wednesday's post.

"So sorry to hear you are still under the weather, but I hope you can give in to your 'rest' regimen. Thank you for your most recent effort on your blog, despite ill health.

"A HOT BATH AND GREAT LITERATURE AS A SLOW CURE FOR DEPRESSION" 

"I had a laugh about you mentioning the comparison between diabetes and depression, often put forth by every garden variety shrink. I had a similar experience with a well-meaning but distinctly insipid psychiatrist, soon after returning from living abroad. I told her I was a great follower of The Greeks. The Greeks suggested a hot bath and great literature as a slow cure for depression. 

"I find at the depths of sadness, one must go inside oneself, that the remedy comes from within. We slowly come back to our essential self or soul, and there we find peace.

"Yet in our rapid age, no one seems aware that quick cures are often only superficial. So far, I have avoided antidepressants, yet I suppose they work for some people. I think I am with Tennessee Williams who reportedly once said, 'If I lose my demons, I may lose my angels, too.'"

In a subsequent note that arrived a few minutes later, this reader added:

"Couldn't resist firing off this quote to you. Seemed somehow relevant in the light of my last message.

"'All great truths begin as blasphemies.' This, from George Bernard Shaw. I guess he was a bit of a contrarian, and somehow when I question the status quo on mental health I feel like one, too. Something to ponder. I found it an interesting quote."

And ponder, I did. I love pondering.

YOU GIVE ME SUCH RICHES

See? You give me such riches. This is just one recent example. I have dozens in my inbox. I hope one day this exquisitely enlightened person will be able to make the leap into the Comments so her wisdom, insight and literary largesse will be seen and shared with everyone in our community. So she can engage with all of you who are similarly thoughtful, understanding, empathetic, in endlessly diverse and fascinating ways. Experts on mental health and wellness and Recovery.

Now, you know why I am so beholden to you. All of you. Why I thank you constantly.

I'll rest my case. And rest, too.

Have a great weekend. For me, school starts on Monday morning at 8 a.m. I have much to do. I need my energy.

Be good to yourselves and speak soon.

My newest truths about food and mood...

Okay. I know what they say. Diets don't work.

If you take the "t" off the word "diet" – what you have? Die.

Anyone who's struggled with his or her weight all their lives knows all these cutesy cliches. We now know our weight is genetically predetermined, but that doesn't help. We still have to lose weight to be healthy. Genes or no genes.

The bottom line is, if you want to lose weight to be healthy you have to consume fewer calories than you burn.

That means either continuing to eat they way you like and spending 23 out of 24 hours seven days a week working out ... or cutting back on calories. 

And if you want to live long, it helps to eat a healthy diet. As Susan, a friend and one of my regular commenters mused yesterday:

"Why is it that all the good things in life are fattening, and stuff like carrot sticks, eewww."

It's not fair, but as my psychiatrist, Dr. Bob, often reminds me: "Life isn't fair." 

So, I'm now on Day Six of my first week of Weight Watchers. I'm dieting. They call it a lifestyle, but not yet for me. Right now, it's a diet.

I know I'm not going to lose weight on a diet of toasted whole wheat baguettes slathered with sweet butter. Or egg white omelettes loaded with melted cheddar. Or chocolate covered almonds. I'm feeling a craving coming on. 

The point is I'm in the midst of changing my habits. It takes a long time.

A lot longer than they tell you at a Weight Watchers meeting. 

My friend psychologist John M. Grohol found a new source of information about changing habits "across the pond" at University College London – from scientific psychology researcher Jeremy Dean and his PsyBlog. 

In a recent post, How Long to Form a Habit? Dean says it takes on average –  66 days to change a habit – with no guarantee this new habit will stick. He cites a July 2009 study in the European Journal of Social Psychology. 

It's complicated. Depends on the habit. Eating habits are probably among the hardest to change permanently along with quitting smoking and giving up alcohol or breaking a drug addiction. (What's the difference between an addiction and a habit, I wonder?)

If I could abstain from food altogether, it would be easier than moderating what I eat. One chocolate covered almond is harder to eat than none at all. 

At Weight Watchers they tell you it takes 31 days to change a habit. Marty will love this news. According to Dean, we're in for another 60 days of struggling to change our eating habits. If I announce this at my Sunday meeting, I'll be pelted with two-point snacks.

Here's my problem. 

I take one (1) 200 mg tablet of an anti-convulsant called Epival/Tegretol/Carbamazepine twice daily to stabilize my manic tendencies. It works for me. 

I also take eight (8) other different drugs, including three (3) different immunosuppressants, to keep me alive with my transplanted kidney. 

My complex daily cocktails of drugs don't exactly ease the weight loss process. 

Monica, pointed this in a comment to yesterday's post: 

"It could be your med making you hungry. I gained 100 lbs. while on Epival/Depakote, and I met a man in a bipolar support group who had the same experience. He lost it all when they switched him to Topamax. Me, I'd manage to lose 20 or 30 lbs. but then I'd start a new med and gain it all back. 

"Since I started Truehope and got off all my meds my appetite has plummeted. I eat a fraction of what i used to eat. I just am not hungry all the time any more.

What works for Monica would kill me. I need my drugs to survive. 

We're all as chemically different as we are emotionally different.

I'm going to struggle to lose my weight and reach my goal, again. 

For 60 more days – to change my habits – and every day after that.

Life isn't fair. It's life. That's the point.

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!

The Family's Resident Nut Case

Last night, I was talking to one of my cousins. I'm the eldest of three girls. As far as I'm concerned, he's as close as any man I've ever known to being my brother. We're just a year or so apart – I'm older – and we grew up together every summer at The Family Cottage. He is one of only three people who gets away with calling me by my real name – Sandra Lee. The other two are my sister, Glorianne, and his sister, Linda Sue. Don't get me started.

Anyway, in the context of a conversation about our family, I told him that "I know I'm the family's resident nut case." He laughed and said, "The whole family's filled with nut cases." 

Very sweet and kind of him. But, in truth, it's quite true. This role belongs solely to me, and always will. I can't seem to stop that particular old record from playing. Currently, I lead the pack. Others may have preceded me. Others may come along. Right now, however, this is my starring role in my family. Nothing else I do ever seems to dull my glow in the family constellation. 

Later that evening, I sent him an email and signed it, "The Family's Resident Nut Case," and boy, did that feel good.

That's the power of "Coming Out Crazy" – as far as I'm concerned. I shared a little laugh with my closest cousin. I didn't take myself too seriously. (Rare, trust me.) In fact, I joked about myself. And guess what? It felt fantastic.

Try it sometime. You might like it.

*   *   *

Now, on to bigger and better things.

The print edition of The Toronto Star is to be congratulated for brilliantly deciding to enlist the genius, wisdom, knowledge, humour, medical expertise and humanity of Dr. Rob Buckman as a regular Friday Living section columnist.

Bravo, Toronto Star! With this kind of decision, your print edition will last forever!

Rob and I are long time friends. We've known each other since 1986, when I profiled him for The Toronto Sun. He is a leading oncologist at Princess Margaret Hospital/University Hospital Network, with professorships at the department of medicine at the University of Toronto and the M.D. Anderson Cancer Center, University of Texas. He has an ecclectic list if outstanding accomplishments and he authored a long list of books.

He is also my "spirit doctor" – but that's another story. 

Read him. I promise you that he will not disappoint you.

Today, his column is called Of bats and balls and baptisms and the first line is amazing, especially for me, as I teach a Community Service course at Seneca.

"Nothing provides a sense of community better than a community." 

That's Rob. Concise. A man for all seasons and reasons. A Humanist. A master of language. An original thinker. A true Renaissance man. We just spoke on the phone for about a half an hour and I am promoting him because I know how much integrity he has. I cannot recommend him highly enough. Aside from the fact that I absolutely adore him!

He's soul tonic.

• • •

I found an interesting blog, The Healthy Skeptic. 

I found it from my sweet, literary, New Jersey friend Susan Schechter, on her fine, often funny bipolar blog – If You're Going Through Hell Keep Going.

This blog is "published" – his word, not mine – by a fresh-faced and fascinating fellow named Chris Kresser. Right now, he's studying at the Acupuncture & Integrative Medicine College in Berkeley, California. 

I respect Kresser's goals for writing his blog and the way he expresses them. Particularly in terms of psychiatry, which needs to be held in check, I believe, for its unbalanced emphasis right now on the neurosciences. I find this is very problematic. 

"I launched The Healthy Skeptic last year to help others see through the common myths and misdirections peddled by the media and medical establishment. It is my sincere hope that the information on this blog will lead to greater health and well-being for you and those you love."

I love his last three words – "and those you love."

You should know where Kresser is coming from.

He is well-travelled, well-informed, well-read and passionate. Personal experience with a serious illness will do this every time. In his case, a mysterious tropical illness he contracted turned chronic. Twenty doctors around the world and thousands of dollars later, still sick, he decided to heal himself. Not by becoming a doctor, though he considered it, but by studying Chinese medicine, "which has been successfully used for over 2,000 years to promote health and longevity in addition to treating disease," he explains.

Our conventional, mainstream Western biomedical model cannot always make that claim.

This is a definition of Integrative Medicine. It's more than allopathic, alternative and complementary. Its synergistic. The whole is greater than the sum of its individual parts. I attended a conference on Complementary and Integrative Medicine in Mental Health in Toronto last June. Every presenter had an M.D. from a leading university medical school – like Harvard – but sadly, few medical doctors touch these methods and I didn't meet any at that conference. Most tend stick with what they know. What they've learned and how they've been taught. More invasive treatments. Surgery. Radiation. Side-effect causing drugs and chemicals. Often good. But not always. Why not use every tool in the world's biggest international tool box?

(Again, Dr. Rob Buckman – a researcher and clinician – thinks outside the box. In 2005, he launched a low-dose chemotherapy with no side-effects that, in some cases extends the lives of breast cancer, ovarian cancer and vulva Squamous cell cancer patients. He is about to introduce it in melanoma patients. It's called DalCM-P.)

Here's one of my favourite Kresser posts, which starts with this quote: "A theory that is wrong is considered preferable to admitting our ignorance." – Elliot Vallenstein, Ph.D.

The "chemical imbalance" myth. 

By the way, Vallenstein is a professor emeritus of psychology and neuroscience at the University of Michigan and the author of Blaming the Brain and about four or five other books on this subject. This is a man who knows of what he speaks. 

Kresser adds: "Even the most prestigious medical journals (dealing with mental health issues and psychiatric issues) have become nothing more than sales brochures for the pharmaceutical industry."  

Philip Dawdy on his award-winning, often-quoted-and-rarely-credited blog Furious Seasons, is consumed with posts supporting what Kresser goes on to observe: "I saw massive conflicts of interest between drug companies, doctors and researchers every I looked. I learned that errors in medical care are the third leading cause of death in the U.S. each year."

One more thing...

As you know, I'm a print journalist at heart. Can't help it. Old habits die hard. I love research. So, it seems, does Kresser. Sources are very important to me and to him. At the bottom of each post, he lists his recommended resources – not websites – books.

For The "chemical imbalance" myth, one book is by Vallenstein. Another – The Myth of the Chemical Cure: A Critique of Psychiatric Drug Treatment by J. Mondrieff, a medical doctor herself, recently received rave reviews in the British press. I really wanted to add it to my library, but it costs $75.96  at Amazon – a little too rich for my blood. 

The point is, Kresser does his homework and I like that about him.

So, have a look. Let me know what you think. I may muse more on The Healthy Skeptic sometime myself, but now here, not now.

Though I am going to review a book. Another book. 

Believe it or not, for about two years, I reviewed books full-time for The Sunday Sun. It was the toughest beat of my entire journalistic career. No one knows how hard it is to review a book, until you are told you're expected to deliver a book review a week, at least, one ... in no more than 800 words and preferably less. It almost killed me, but I loved it because it was so challenging. And for the first time in 35 years, I put the English Literature half of my Queen's University B.A. to good use. (The other half is drama.)

Except I just did a word count, so I'm not going to review this book right now. But I'm going to tease you and recommend it now. Review it next time. By then, perhaps you'll have read about it and we can discuss it. Have a little "Coming Out Crazy" book club chat.

The book I was going to review is called The Center Does Not Hold – My Journey Through Madness by Elyn R. Saks. 

She has "battled" – her word, not mine – schizophrenia all her life. And is in remarkable recovery. Primarily through psychoanalysis and medication, which she fought taking for years. Also, she is in recovery because of the love of her husband, which I completely understand. Her sheer will. And her beautiful mind.

My psychiatrist, Dr. Bob, recommended this book to me. Something he rarely does. I cannot recommend it enough. And you'll find out why. Here's a sneak preview and a riveting YouTube speech of University of Southern California Gould Law Professor Elyn R. Saks, talking and reading from her book.

Now, it's Spring and I'm going to take my dogs for a well-deserved walk.

This is the perfect day for Resident Nut Cases like me to be legitimately a little nutty! And that's how I feel. And I'm allowed. That's my role. One of them, anyway!

Enjoy your weekend.

Educating the Educators...

Last week, for the first time ever, I went to Kingston to speak to about 100 Queen's University first year medical students, the Class of 2012, during their Mental Health Awareness Week.

I was invited because of a question one of these students posed here about my ongoing campaign against the use of the word stigma. As I'm a Queen's alumna, Class of '74, she asked me to speak and I was happy to accept.

I was pretty nervous. I've never spoken to medical students before. I'm no scientist nor was I prepared to lecture. I wanted to initiate a dialogue. Engage these students. Challenge them. Get them asking questions.

After all, they're the next generation of doctors, perhaps psychiatrists. I was told that they hadn't heard one word in their classes about mental health/illnesses/psychiatry until the four 50-minute lunch time presentations last week. Mine was the last. 

It went very well. I had a full house and 95 per cent of them were medical students, along with a few psychology and occupational therapy students.

My introductory remarks were short – a quick overview of my mental health history, all my different diagnoses, my subsequent kidney problems caused by 16-years of badly monitored Lithium and the fact that despite "overcoming every psychiatric indignity short of a lobotomy, I'm still here."

I was hoping they'd be open to thinking about mental health outside the medical model. Consider the recovery model. I assured them that I was not anti-psychiatry but I wanted them to hear about the possibility of change. Desperately needed change in the way medical doctors are trained. So I chose to speak briefly about recovery, the power of language and mental health and why I detest the word "stigma" – and then open the floor up to them. They asked a steady stream of good, intelligent questions, especially about labelling.

"Isn't calling yourself crazy a label?"

Sure, but I asked, "What do you think crazy means?"

"Being out of control."

Don't you get out of control sometimes?

"Yes."

So, we're all capable of being crazy sometimes. That's one word I think we all use. I happen to like it. In the same way the many people who are gay, lesbian, bisexual and transgendered like to call themselves queer.

I told them that I also love the word "mad" – because madness has always been part of the human condition. Long before it was pathologized into the sphere of medical/mental illnesses. Since biblical times, people who behaved irrationally or too differently were seen to have what are today considered mental or psychiatric problems.

Invariably, though, people perceived as mad were, and still are, dismissed and disregarded. Marginalized. Perceived as less than human. With no voice. And because we have no voice, change is slow to happen. No one wants to listen to us or take us seriously.

I cannot remember many other specifics about my talk – I don't use a script – my presentations are spontaneous. The students were very attentive and according to the feedback I received they found me refreshing. They were very surprised that I was so open about my psychiatric history.

This always amazes me. I have no reason to feel anything but proud of my life. With all its ups and downs.

Before my presentation, I met with Heather Stuart, a Queen's professor of community health and epidemiology. She gave a very informative and thoughtful lecture a few days before mine on "Mental Health Stigma and Health Care Delivery."

Stuart is a world leader in the field of "stigma" as it is associated with mental illnesses. She told me that only three medical students attended her talk, which is too bad because they would have benefitted enormously from her research and experience, her empathetic approach and her wisdom. She is a scientist, yet she is as passionate as I am about changing the public perception of people with mental health difficulties, their treatment and maltreatment 

One statement shocked me. She said that people are afraid to come to seek treatment for their mental health problems, because of the negative stereotyping of and discrimination against people with mental illnesses.

"Three quarters of people in Canada and worldwide who meet criteria for mental health diagnoses do not receive care," she said.

In 1998, when I first started publicly presenting my story, putting these issues of stereotyping and discrimination out in the open, that figure was 66 per cent. Now, it's 75 per cent. What's happened?

That's the subject for another post.

Stuart was very receptive to my ideas about problematic use of the word stigma. As I see it, that word is part of the problem.

As well, she said that in terms of change, "We know contact counts. When we put people with mental health problems with those that don’t and allow positive interaction, we can see the difference that it makes. We need to do that. More contact. And we need to focus. We shouldn’t be going about spraying the public population. We need to target groups. Here are some groups that can be targeted ... worthy of targeting. Understanding what they need is the important way to proceed: School, police, health care workers."

I say, start with the health care workers, especially the doctors.

Especially the doctors who are training doctors in medical schools.

Medical school curricula must be revamped so that health is considered. Physical, mental, emotional, spiritual, social. Holistically. Surely health is more than absence of disease. Yet, healing and doctoring by today's standards are very different.

Today, we are a series of body parts and systems. Medicine is so specialized and technological that the essence of the person seems lost. That's where complementary medicine, and other schools and approaches to health have so much to share.

Not in today's medical schools, where one model is taught. The biomedical model. Not the recovery model. Doctors are scientists. Psychiatrists are neuroscientists.

What about our minds?

Nothing in medicine is purely objective – writes psychiatrist Ron Pies in his fascinating essay "Psychiatry Clearly Meets the 'Objectivity' Test." According to Dr. Emmanuel Persad, psychiatry can be an intellectually vigorous and rich specialty if talking therapies are a mainstay of its practice. If they aren't, I would think psychiatry must be boring as hell.

How can the neurosciences – biochemistry, pharmacology of the brain and nervous system – help people with issues that relate to their life experiences? Their traumas? Their minds?

Brain disease? No way.

Drugging people is a quick fix that doesn't always work well. It can help, but pharmaceuticals can also have serious side effects. Without the insight that can only come, in tandem, with psychotherapy, the neurosciences are only a partial fix. They're only one set of tools in a therapeutic tool box filled with many other potentially more effective tools. Certainly, handing out drugs without any human, therapeutic support isn't the only answer.

You need to have an open mind. That was my parting shot to these future medical doctors.

An open mind.

A Letter to Carolyn

On the evening of Saturday, November 23, a woman named Carolyn commented on my post called "Storme." Here is my response. 

Dear Carolyn,

Thank you for your comment. It was, I sense, very brave of you to voice your pain so blatantly here and I'm glad you felt safe to do so. You raised some very provocative ideas and questions. 

For example, I'm not sure I understand what you meant by "Kindred Cafe on this website" — marijuana isn't prohibited here. This is an open-minded, freedom-loving blog. However, as a metaphor for survivors with no hope, it's both apt and tragic. Hope is one reason why we're here. I read every comment that arrives here. I take them all to heart. I've been reading and hearing similar sentiments for years. I repeat. That's why we're here. 

Things are changing.

I know many people are insensitive to "mental health concerns." Years ago, people liked to tell me to "Buck up," too. "Why don't you just pull yourself up by your bootstraps," they'd say, perhaps meaning no harm. Oh, how I dreaded that potent phrase. I had no idea what "bootstraps" were, but I keenly felt the derision beneath those imperious words. I grew to cringe inside every time I heard them. I know now that no one knew any better back then in the dark ages of psychiatry. There was no vocabulary. No empathy. No communication. Sometimes I fear we're still there, but that's another story.

Now, looking back, I suspect the people who said those things to me and still say them to you may be terror-stricken, afraid of their own deeply closeted "mental health concerns." So they put us down instead. It makes them feel better, poor souls. Bullying, when you think about it.

I've learned not to hear them anymore, instead of getting upset. I listen, but I don't care how I'm viewed. It's how I view myself that counts. 

As for the "public's cry," why are they crying, I wonder? I prefer letting them see another side of "Crazy" here — if they care to look. Behind their tears. You can't force anyone to see things differently. They have to want to look. Be open to seeing things from another perspective. As I've often said, quoting another one of my sages, Los Angeles psychologist Michael T. Walker — it's not "seeing is believing," but the other way around. "Believing is seeing." 

Education, accurate information, strong sound voices, like many of those in the "Recovery Movement" — psychologist Patricia Deegan who was once diagnosed with schizophrenia, is one — insightful thinkers with lived experience of mental illnesses who have wisdom and meaningful lives, plus the courage to see beyond convention — with vision and hope. These are the voices that will quell the "public's cry" — those who view us diagnosed with mental illnesses as "weak and flawed."

Perhaps it's their tears that distort their vision.

There are millions of us not viewed as "weak" or "flawed." We refuse to be viewed like that. We certainly don't view ourselves like that. I don't.

"Recurrent melancholia" or Depression" ... I ask you, aren't these words just descriptors of deep, dark, deadening feelings? Suffering? Incapacity? There is a difference between the way mental illnesses and physical illnesses are seen. But, where do you draw the line? 

If you are suffering emotionally or physically or psychically, for whatever reason, how can anyone deny your suffering? How can anyone get inside your head or heart or soul or mind and say, "You don't really feel your pain. It's not real." And if they do, they can be wrong, can't they?

Being suddenly sexually, brutally, savagely attacked and violated by a superior with whom you have only a professional relationship is, for some, a more treacherous injury from which to recover than one incurred from falling off a ladder, I suspect. 

Depends on how hard you fall and what breaks. 

If it's your neck, who knows? That's no easy injury to heal. You have to rehabilitate yourself. (In many ways, the same applies to recovery from the diagnosis of a mental illness.) But you are right about one thing. People will happily visit you in a rehabilitation hospital if you have a broken neck. People stay away in droves if you're in a psychiatric hospital for any reason. No one sends you flowers. Or cards. You probably don't even have your own phone! 

Still. Keeping silent and "shutting up" doesn't work either. Everything turns inward. Festers like a boil. Eats away at you. No one is any better for "being silent." You don't have to listen, if someone tells you to "shut up." You can just keep on "talking." It's healing. 

If we don't stand up and speak out, how can we change the way people see and perceive us? How can we change anything? Change doesn't happen randomly, by itself. People make change. People like you and I can be change-makers. That's one reason why "Coming Out Crazy" exists. 

I've stood up to people for years. All my life. As a child, I was so innocent and naive, I never imagined there was anything wrong with going to a psychiatrist. Or having a mental illness. That was a gift from my mother. She still feels the same way. 

She stood up for me and helped teach me to stand up for myself. Dr. Bob helps immensely. Now, my husband of more than nine years, Marty, is my best help-mate. Everyone needs "a little help from their friends," to quote John Lennon.

I speak out to people who want and need want to better about their "issues." They're frightened, too. They have every right to be. Sometimes, they start to find their own voices. I hope they do, here, in this open forum. Maybe, then, they'll speak out in in other places, too. Join the crusade for change.

Carolyn, I'm so grateful that you opened up here and spoke out so passionately the other night. I hope you'll speak out more. You have a good, strong, resonant voice. Music to my eyes.

Take care.

Sandy

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

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

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

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

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

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

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

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

In the meantime, here goes:

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

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

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

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

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

And that’s the point.

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

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

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

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

Cannot they also cause mental distress?

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

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

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

It's just not that simple.

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

Is a broken leg like a broken mind?

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

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

Medicine and Psychoanalysis.

And where does Psychology fit into all this?

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

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

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

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

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

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

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

Mental Illnesses are not the same as Physical Illnesses.

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

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

Language is very powerful in creating and perpetuating our beliefs.

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

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

The answer is in education.

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

And there are no absolute truths. Except that one!

I’ll stop here and continue next week!