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!

The gifts of giving back...

In my early adolescence, I remember struggling to learn to play George Gershwin's "Rhapsody in Blue" on the piano. How perfect for a budding manic-depressive, years before psychiatrists branded me that way. Back then, my diagnosis was schizophrenia, though I didn't know it. Nor did my family. 

OBSESSED WITH "RHAPSODY IN BLUE"

I was different. And difficult. Histrionic. My nickname was Sarah Bernhardt. I was also taking drama classes, then. My mother considered drama to be a "good outlet" for me, and those classes kindled a lifelong love of the theatre.

But at home, I was obsessed with "Rhapsody in Blue." Mysteriously it whispered to me, deep down. I couldn't explain it. I tingled with exhilaration. Its manic rhythms resonated emotionally. Not rationally or intellectually or verbally. It calmed and excited me simultaneously. Not only listening to our Oscar Levant recording with Paul Whiteman and His Orchestra – but attempting to play this complicated jazz concerto on the piano, myself. 

I have no musical talent whatsoever, but my persistent pounding on the keyboard of our baby grand demanded concentration and focus. It transported me far from my anxieties at that time. Was I making music? I wouldn't call it that, but whatever I was doing was transforming. Tranquilizing. For me.

I felt a little guilty about the way I was mangling Gershwin's masterpiece. He was probably twirling in his grave, but that didn't seem to matter because his music and my attempt at playing it were magical. It had to be therapeutic, though this was years before music therapy was as prevalent as it is today. It felt good. Liberating. It was a healthier emotional release than my acting out.

Until someone in my family, driven mad by my painful practising, demanded I stop. I did. My lessons were stopped, too, I'm sad to say, though I never lost my love of Gershwin and his music.

THE TRANSFORMATIVE POWER OF MUSIC AND THE ARTS

I was very lucky. My parents were vigilant. My mother could see early on that I was struggling in school and needed other more artistic outlets beyond what was offered there. Not all kids are so blessed.

That's why am I talking about the transformative power of music and the arts.

Last Thursday evening, I attended the Annual General Meeting of the Cabbagetown Community Arts Centre where I was elected to the volunteer board. I'm so excited about this. 

For me, helping this small, grassroots organization in any way I can, transports me back to my youth and, in a curious way, to my unfinished performance of Gershwin's piano concerto. 

The CCAC was founded in 1979 by a local Cabbagetown resident, the late David Blackmore, to offer arts programming to children in nearby Regent Park. In 1985, it became a registered charity and now serves all Toronto inner city children. 

"The bulk of our children come from single parent families earning incomes of less than $20,000 per year," CCAC Board President Peggy Weir said. "They have to register with us and we have a sliding scale of fees." 

Individual lessons are offered in instrumental music, and classes in vocal music, drama, visual arts, photography and karate. Homework tutouring is available, as well as pre-school art, reading circles and creative movement classes for moms and tots.

"We focus on individual music lessons and we have qualified teachers who are more than role models and mentors. For many of our children, meeting with their music teacher is the only chance they have each week to engage with an adult, one on one," Weir said. 

 AN OASIS OF LEARNING WHERE CHILDREN ACQUIRE AN EXTRAORDINARY SENSE OF SELF

"Our vision," according to a one-page overview of the CCAC's mandate, "is to be an oasis of learning where children acquire an extraordinary sense of self, of a world where all children and young people have a sense of belonging and are loved and valued. A world where they can fulfill their potential, shape their destiny and experience the joy of life."

Its mission is to do this by "providing them with arts and music lessons focused on building character, discipline and skill."

One woman at the meeting, clearly passionate about the work of the CCAC, sent her son there when he was a child. She talked about how she used to clean the Centre to earn extra money so she could take him to concerts to "see and hear" the music he was learning, being played by the Toronto Symphony or other professional musicians.

Though he's now 29, he did not follow his musical muse professionally, his mother reported. Instead, he became a medical doctor and he's now studying in Florida.

"But he went through the University of Toronto," she said, stressing that the values, skills, disciplines of his musical training and the sense of community at the CCAC equipped him to carry on with his higher education. It changed the course of his life.

Other students have gone on to study music at the Royal Conservatory of Music and funds raised by the CCAC can cover the costs of their entrance examinations. 

MUSIC MAKES EVERYONE FEEL GOOD

"There are oodles of studies showing that studying the arts, particularly music, promotes learning," Weir said.

"Children who take music lessons often become quite enamoured and end up practicing. We give them instruments to take home – violins and keyboards. They have the responsibility of taking care of them. Also, if you're practicing, you're less likely to be hanging out at the corner with friends who may be offering you illegal substances."

Weir has been involved actively with the CCAC for six years and has lived in Cabbagetown for 25 years. 

"I know this community and through my personal experience, I know that music is the great leveler," she said. "It doesn't matter where you come from, it's the international language. I moved to Canada from Brussels. Listening to music or playing an instrument, it no longer matters what language you speak or what your dad does or where you live. It makes everyone feel good. It lifts you up and takes you out of whatever closet you find yourself in."

My music making days are long gone and with my hearing loss, even listening to music is not what it used to be, but I have another source of pleasure that's even more rewarding.

Volunteering. I grew up with a mother who was always active in the community and I've been volunteering for years.  

GETTING OUT INTO THE COMMUNITY AND GIVING A HELPING HAND

There's tons of research proving how volunteering is beneficial for your physical and mental health. I believe in preventative health. Who knows what problems the CCAC may be preventing down the road for its children?

And everybody has something to give. 

That's why I'm so thrilled about joining the CCAC board. Meetings take place in the centre, a newly renovated, brightly-lit space in an old red brick house on Parliament Street. During our meetings, which take place there, we can watch young people bustling to and from their classes. 

You have no idea how exciting it is to watch how your efforts are transforming lives right before your eyes. I can't wait for the Spring Recital.

Not long ago, I met a woman who was struggling with depression. She decided to drive patients to and from their chemotherapy treatments for the Canadian Cancer Society. Her mother had died of cancer and she found that a meaningful way to give back. She admitted that it made her feel better. 

"I still have my dark days, but it gets me out and out of myself," she said.

You cannot buy these gifts of time and care that you're giving. No store carries them. They are priceless. As priceless and rewarding as the way giving them makes you feel.

Angela to continue bilateral ECT...

After meeting with her psychiatrist yesterday, Angela has decided to continue her bilateral electroconvulsive therapy treatments for intractable drug resistant depression and suicidal ideation. 

She told me that she had considered going back to unilateral ECT, which is gentler, but generally less effective. 

However, after consulting with her psychiatrist, she has chosen to solider on with bilateral ECT, which has proven considerably more beneficial in her case, despite developing problems with her memory. 

"The side effects are not permanent, so I will continue with the bilateral treatments," she said of her increasingly "annoying" memory issues. "And I have only three weeks left."

Angela is planning to go back to school in June and her psychiatrist assured her that she should be fine by then. 

Prior to having her fifth bilateral ECT treatment at 7:15 a.m. this morning, she had 12 unilateral ECT treatments. 

My lunch with Angela...

Angela and I had lunch last Friday and here's what's transpired since.

When she picked me up (on Fridays I'm carless as Marty teaches and needs our trusty 1999 Honda Accord) I couldn't believe how thin she looked.

Over the last few months, she's lost weight and claims she wants to lose more. Though she's often said she tends to forget to eat, lately she's been working out – and it shows. 

Also, last Friday was a dreary, windy, bone-chilling day. Raining hard. Miserable. Depressing. An old back injury of hers was acting up and she was in pain. She's so drug resistant, only morphine helps, she claims. She didn't have any handy, so she was trying to ignore the aching in her lower back, but I could see it in her face, and in her eyes.

Plus, she drives a sporty Jeep that prides itself, she informed me, in providing bouncy, bumpy, jerky, jarring rides. Ouch.

LAST FRIDAY'S FIRST BILATERAL ECT WAS NOT FULL-THROTTLE

We drove over to a local Middle Eastern restaurant about five minutes from here called Shoom Shoom, which means "Garlic, Garlic" in Hebrew. Angela likes the chicken Shawarma there and I like the fig and walnut salad. 

En route, she mentioned that her first bilateral electroconvulsive therapy treatment the previous morning (her 13th thus far in her 12-week course of 24 in all) "only brought me to a threshold because they wanted to see how I'd handle it," she said. "I'm going to get the full treatment on Monday."

Her psychiatrist had just told her that about 90 minutes earlier during one of their regular bi-weekly sessions.

She seemed more subdued than celebratory. The spunk and spirit I thought I had heard in her voice on the phone the night before had drained away. 

Over lunch, our conversation flipped around. We caught up, mostly. Small talk. Her sister was coming in for the weekend and we talked about her upcoming wedding. We discussed her mother's health. She chatted about the complications of her life. We shared stories about her therapy, and mine. 

She showed me pictures on her iPhone of her latest sculptures and the abstract paintings she has started. "I tore that one up," she kept saying, despite my pleading with her to never destroy her art.

HER MEMORY SEEMED FINE

I was mindful of the tempo of the conversation and there didn't seem to be much difference. Her memory didn't seem to be slowing her down. She wasn't searching for answers to my questions.

However, this week, since her Monday "full-throttle" ECT treatment, that tempo and her tone has changed.

On Monday afternoon, about six hours after her treatment, she seemed more volatile than I remember her. Frustrated. Anxious. Angry. She was feeling "ripped off" – but definitely spirited. There was an edge in her voice that I didn't recognize. I had some thoughts about what was happening, about the relationship between anger and depression. Was the ECT doing this? I'm no expert. 

AFTER HER STRONGER MONDAY ECT TREATMENT, SHE SOUNDED ANGRY

Rather than speculate, I consulted my resident expert, Dr. Ron Pies, Editor-in-Chief of Psychiatric Times, professor of psychiatry and lecturer on bioethics and humanities at SUNY Upstate Medical University in Syracuse and clinical professor of Psychiatry at Tufts in Boston. He is, with S. Jacobson and I. Katz, author of Clinical Manual of Geriatric Psychopharmacology, and a number of psychiatric texbooks. His most recent book is Everything Has Two Handles: The Stoic's Guide to the Art of Living his upcoming book, "Becoming a Mensch", is to be published late this year by Hamilton Books.

I've never been depressed. I tend to voice my frustrations. Loudly. But, I'm not Angela, and I've have many more years of psychotherapy than she has. I'm also a lot older, though not necessarily wiser, than she – 24 years older.

Ron responded quickly, as always to my question about whether "depression is anger turned inwards." 

IS DEPRESSION ANGER TURNED INWARDS?

Here is a section of his answer. It's general. I never ask him specific questions about Angela as that would be betraying a confidence and unethical:

"The notion that depression is ''anger turned inward' has a long pedigree — it goes back at least as far as Freud and his theory of 'melancholia'; he held, in effect, that after the death of a loved one, the melancholic’s unconscious anger with the deceased becomes directed at the self, which has 'incorporated the lost person through introjection''. If it sounds complicated and dubious, it is!," Ron wrote.

"To my knowledge, there are few empirical studies that have supported the 'anger turned inward' model of depression. I also think there is very little empirical evidence that 'getting mad' as such is of any real help to people with serious depression. I think this is mostly part of the 'let it all hang out' philosophy that dominated the late 60s, and I think most mood disorder experts don’t put much stock in it. 

"There is some truth to the idea that if you constantly walk around feeling that you have been “short-changed in life”, “ripped off”, “victimized”, “screwed over”, etc., you will undoubtedly feel angry, and probably depressed as well—or at least demoralized and impotent," Ron continued.

"The idea, then, is to examine your presuppositions about what the world 'owes' you—as in, 'Who said the world is fair? Who said that the world owes you what you think it owes you?' etc."

This really resonated with me because Dr. Bob has often said, "Who said life is fair?" when I bemoan the fact that I'm now chronically ill because a former psychiatrist of mine neglected to monitor my Lithium levels properly and I lost my kidney function and had to have a kidney transplant after two years of dialysis. The drugs I take to prevent rejection have dire side-effects, like chronic anemia.

Or because I was raped at the age of 14 in a psychiatric ward by an orderly when I was there for observation and that assault precipitated my psychotic episodes and has left me with permanent emotional scars. 

However, the difference between me and Angela is that I don't blame anyone for anything. What's the point? 

Blame is a waste of time and solves nothing. Just like guilt and worry. They're not part of my emotional make up anymore, but I work hard at this. I guess that's what more than 49 years of psychotherapy has taught me. You don't get that kind of insight out of a pill bottle and all the time and work in psychotherapy makes for a much more peaceful psychic existence. 

IS BILATERAL ECT FINALLY HELPING HER DEAL WITH HER REAL FEELINGS?

I kept wondering if the ECT was freeing Angela's mind and helping her to get closer to her real feelings.

Ron continued...

"Here is where REBT (Rational Emotive Behavioural Therapy), CBT (Cognitive Behavioural Therapy), and other cognitive-behavioral therapies come in — as well as the stoic philosophers discussed in my "Handles" book. Another approach is to teach the chronically angry and depressed person to be more assertive, in a constructive way — not throwing tantrums or screaming, but taking assertive, appropriate action to bring about desired change. (It is a misunderstanding of stoicism to think of it as saying, 'Just accept things the way they are' or 'Suck it up!'. Rather, stoicism is more like the now well-worn maxim usually attributed to Reinhold Niebuhr:

God, grant me the serenity

To accept the things I cannot change;

The courage to change the things that I can;

And the wisdom to know the difference.

"All that said, the relationship between anger and depression is probably very complicated, with a question as to which is the 'chicken' and which, 'the egg.' A full answer to your question would probably take a book, Sandy, but the bottom line for me is that when people are chronically angry, it probably has an 'erosive' effect on their mood."

"DIFFICULTY RETRIEVING INFORMATION FROM MY BRAIN, BUT IT COMES BACK IN A MINUTE"

Yesterday, when we spoke on the phone, 36 hours after her second bilateral ECT treatment on Monday, Angela sounded less frustrated and angry, much calmer. We talked about The Serenity Prayer, which she'd heard of and then I asked her about her memory.

"It's interesting," she said, sounding perfectly fine, intrigued by the way her mind and memory were reacting to this new-for-her ECT modality – she's switched from unilateral ECT. "The things I'm forgetting now are the things I know, but it takes me extra time to find them. It takes more concentration. Like if I'm driving somewhere and I know that I know the route, I have to concentrate on where I'm going, whereas before, I didn't have to think about it. It was automatic," she said.

"I'm have difficulty retrieving information from my brain, though in a minute or two, it comes back. I wouldn't call it memory loss because the information is there and I know it. I just need a little more time. I have to put extra cognitive thought into strategically focussing on finding it. But it's there and it always comes back."

Meanwhile, she's getting things done. She's out and about, working on getting her life back in order with more energy and determination than she's shown in months.

Tomorrow morning, she'll be having her third bilateral ECT treatment. I'll keep you posted.

Angela goes bilateral...

Wednesday, March 10 at 4:45 p.m. The phone rings.

"What do you think of the idea of me trying bilateral?" Angela asked.

Her psychiatrist in charge of her current course of Electroconvulsive Therapy had raised the issue in a telephone conversation earlier that day. 

WE DISCUSSED MAKING THE SWITCH

For about 15 minutes we discussed her concerns about making the switch, much in the way we had when she called and asked me, "What do you think of ECT?" back in early January. 

Angela explained that her doctor had made the suggestion because was she might progress more quickly with bilateral versus unilateral ECT. She has had 12 unilateral ECT treatments over the last six and a half weeks. 

"I'm definitely going for the extra four weeks," she said, referring to the option she was given when she first discussed her treatment course and the study on memory loss in which she's involved. "But I'm worried about changing things mid-stream." 

Ultimately, I suggested she speak to her outpatient psychiatrist, who knows more about her psychiatric history and about the differences between unilateral and bilateral ECT than I do. 

She agreed and signed off.

In the meantime, I started nosing around the Internet for a good, reliable distinction between the two variations on ECT administration, without much luck. Most sources were dated in the last century and not very reliable, as far as I could tell.

Within 10 minutes, Angela called again.

"I'm having my first bilateral ECT treatment tomorrow," she said. "I'm going to try it. I discussed it with my psychiatrist and she thinks is a good idea. If I find it's too hard on me, I can always go back to unilateral."

UNILATERAL VERSUS BILATERAL ECT

Wednesday, March 10, 5:41 p.m. 

I fired off a note to my mentor and friend, fellow blogger and sage, Tufts University clinical professor of psychiatry Ronald Pies, MD. 

"I have a question for you. Angela has decided on her doctors' recommendations to try bilateral ECT. She's not progressing fast enough, I guess. She's going to have her first bilateral treatment tomorrow. I want to post about it on Friday. Although, I see an impressive improvement. It's not enough. She's in week seven and has decided to go for 12 weeks. 

"If I could quote you and link to a good article that describes the pros and cons of bilateral versus unilateral ECT, something recent, in this century, that would be perfect. I've looked and I cannot find anything. Am I missing something? Is there something in the archives of Psychiatric Times that I cannot see? I'd rather quote you and link to an article on this ultra controversial subject, but I'm a little stumped." 

At 8:07, Ron's email arrived:

"Given that these are very technical matters, I thought the comments from the Royal College of Psychiatrists, 2008, would be more helpful than a journal paper," he wrote. "I think this really summarizes the situation, as I understand it, quite well. It comes down to a trade-off between very high efficacy, significant cognitive side effects [bilateral ECT] and high efficacy, mild-to-moderate cognitive side effects [unilateral, non-dominant ECT]. There really is no “right” or “wrong” decision."

NO "RIGHT" OR "WRONG" DECISION 

"In bilateral ECT, the electrical current is passed across the whole brain; in unilateral ECT, it is just passed across one side. Both of them cause a seizure in the whole of the brain. Although there is a lot of research being done, it's still not clear which type of ECT is 'best'. 

"Bilateral ECT seems to work more quickly and effectively and it's probably the most widely used in Britain; however bilateral ECT seems to cause more side effects. Unilateral ECT has fewer side effects, but may not be as effective; unilateral ECT is also more difficult to do properly. 

"Sometimes ECT clinics will start a course of treatment with bilateral ECT and switch to unilateral if the patient experiences side effects. Alternatively they may start with unilateral and switch to bilateral if recovery isn't happening. The choice of bilateral or unilateral ECT will depend on the needs and wishes of the patient, the opinion of their doctor and the skills of the ECT team." 

(The boldface is Ron's – not mine.)

Thursday, March 11 at 4:05 p.m.

When I get home from Seneca, I pick up a voicemail message Angela left on my home phone at 1:13 p.m. 

"Hi. It's me. Just checking in. Call me."

HER VOICE SOUNDED COMPLETELY DIFFERENT...  NEW

It doesn't sound like her. At all. I barely recognize her voice, but from the log on my telephone screen, I know it is.

Instantly, I call her back. 

"How are you?" I ask.

There's a liveliness in her voice I've never heard before. Ever. We met in 2006, on the phone. She called me when I was still working at The Toronto Sun. I knew nothing, then, of her psychiatric history or her depression.

"I feel good, but confused," she says.

I can't get over her tone. It's sharper. Stronger.

"Can you describe your confusion?" 

"It's a little bit of confusion, like I can't remember everything I'm supposed to remember," she says.

"What do you mean?"

"Well... it like my thoughts are dull," she says. "I guess I'd call it mild confusion, but it's more pronounced than before."

She said she slept most of the afternoon, following her first bilateral ECT treatment at 7:15 a.m. that morning.

"I just got up," she said. 

I couldn't believe the way she sounded. 

"Maybe I'm spunky. The bilateral treatment was great!" she said. "There were three medical students with the psychiatrist and so she explained everything she was doing very carefully to them, and to me. She told them that I had been having unilateral and that now I'm having bilateral. And so far, I think I can handle it, so I'm going to continue with it." 

Then she started chatting about how much money she had spent that day on new brakes and tires for her car.

"It needed to be done, so we finally got our act together and did it," she said.

TODAY, SHE'S COMING UP HERE AND WE'RE CELEBRATING!

This was the most proactive thing she had done in months. Two weeks ago, she couldn't get it together to get out of her apartment and go for a walk on a sunny day. 

"Oh, and you know what? I had a good time with my anaesthesiologist today," she said. "When he gave me my drugs, he said, 'Have a good sleep.' And you know what I said to him?"

"No, Angela. Tell me."

"I said, 'Night, night!'" 

She was laughing. Really laughing. 

So, today we're celebrating. Right after she sees her psychiatrist this morning at 10 a.m. she's driving up here and we're going out for lunch. 

And I can't wait to see her!

 

Angela's progress ...

Hi there.

I'm back! How are you?

You have no idea how much I've missed you. So much has happened over the last week – my Reading Week. There were times I ached to sit down here at my trusty iMac and write to you – what a relief it would have been to interrupt the monotony of "marking midterms," but I needed a break.

I've continued speaking with Angela daily over the last 13 days even though I've not been posting about her progress. I take notes. I have an Angela journal.

She's had a few little ups and downs but nothing dramatic – with one exception – and this would definitely qualify as an "up"... she's sleeping well. Better than she's slept in years. 

Angela is athletic. She loves to snowboard. Watching hockey is one of her passions. You know where she is every Saturday night and could safely bet money on it. It's a good thing she doesn't have her Electroconvulsive Therapy treatments on Saturdays.

On a few occasions, over the last week and during the Olympic Hockey matches, she slept through the games. 

And she wasn't upset about it.

Once, she said she went to sleep "to escape my mind," a curious phrase. When I asked her why, she mentioned some long running personal concerns, matters of everyday living that no ECT treatment can or ever has been able to resolve. The stuff that can turn a good day sour for anyone. The stresses that wear you down emotionally.

ECT IS GRADUALLY TRANSFORMING HER OUTLOOK ON LIFE

These issues are not the cause of her drug-resistant clinical depression. They could be filed in a drawer called "Life Sucks" and we all have those drawers. Sometimes, I think unhappiness is confused with depression. Both can be exhausting and stressful, but for Angela, her ECT is gradually transforming her outlook on life. Brightening it. Refreshing her mind. Buoying her on so she can better handle the real consequential issues in her life.

Not just those "Life Sucks" issues, but even tougher stuff. 

SLEEP HEALS

Sleep, as I've often said, heals. So it is, often, for Angela. She's an early riser and not only on the two days a week when she must awaken at 6 a.m. to be at the University Health Network at 7 a.m., hopefully to be the first in line to receive her ECT treatment, which she prefers.

Since she began her eight or possibly 12 weeks of bi-weekly ECT treatments on Monday, January 25, she's has changed dramatically, although it's a slow and steady transformation and she's not entirely aware of it. These posts have become a mirror for her.

It's blatantly obvious to me that she's joking and laughing more these days than I've ever known her to do – and we've known each other for years. When I called last night, she was watching the Toronto-Boston Hockey Game and not sleeping.

"It's tied right now," she said, sounding anxious to get off the phone. I let her go back to her passion. Three months ago, Angela felt no passion for anything. She complained constantly of feeling "flat" or "feeling nothing" or "being blah." She was immobilized by her severe depression.

Last night, her gusto for the game she loves seemed a significant benchmark in the headway she's making.

SUICIDAL THOUGHTS SEEM LIKE A THING OF THE PAST – FOR NOW

After 12 treatments, her suicidal thoughts seem a thing of the past. She hasn't mentioned them in several weeks. This doesn't mean she is perfectly recovered. ECT doesn't purport to solve all your problems and cannot. She knows this. She sees her psychiatrist twice a week. She takes all her medications.

She also knows that she may need follow-up weekly or semi-monthly treatments when this current treatment course finishes because ECT is not permanent. Depression can be cyclical. So she may need ECT on an ongoing basis or every three or four or more months. But it should keep her suicidal thoughts at bay and help her function better than she has in years.

ECT IS NO ONE SHOT DEAL

No responsible, knowledgeable and experienced psychiatrist who routinely administers ECT would ever suggest that ECT is a one-time only treatment course. For some people, not all, it's not. 

Like medication, it may have to be part of an ongoing treatment protocol for mood stability. (Like the Tegretol that I take twice a day for my mania. I've been taking it for 22 years. It's one of my major recovery tools.) Any follow-up ECT regime, its schedule, differs depending on each individual ~ as does everything in life, it seems. 

Since her first course of ECT treatments in 2001, Kitty Dukakis has follow-up "sets of ECT treatments," on average, every seven or eight months, when her depression returns. The wife of Michael Dukakis, former Massachusetts governor and 1988 Democratic Presidential candidate, bravely and with brutal, visceral honesty writes about her ECT experiences in Shock – The Healing Power of Electroconvulsive Therapy. It ended her lifelong struggle not only with severe drug-resistant depression, but with her alcohol and amphetamine addictions that masked it for years.

HER MEMORY HAS STAYED PERFECTLY INTACT

Angela is now in Week Seven of her treatment course. It may end next week or continue for four more weeks. She doesn't know. So far, her memory has stayed perfectly intact. Sometimes, like this past Monday morning, 90 minutes after treatment, when I called her from Seneca, she sounded groggy.

It was 10:30 a.m. "What day is it?" she asked.

She had been sleeping and my call woke her.

"It's Monday and I'll call you later."

Let's be honest. Don't you find that sometimes, it you take a nap in the late afternoon and wake up at 9 p.m. you feel a little disoriented. "Did I sleep through the night?" you ask yourself. You search for a clock wondering, "What time is it?"

By Monday night the disorientation Angela felt earlier in the day had disappeared. It always does within a few hours of her ECT treatments, always with healing sleep. To the best of her knowledge, she is experiencing no permanent or even temporary memory loss whatsoever, thus far.

Time will tell. And I'll tell you.

Now, then. Let me know how you're faring. Comment. Comment. Comment. 

I've missed your voices. Your ideas. Even your criticisms. You inspire and stimulate me.

It's great to be back.

Speak soon!

Taking the myth and mystery out of Adult ADHD...

I am no expert on Attention Deficit Hyperactivity Disorder. 

Although between you and me? When I read the following list of common symptoms, I was sure I had eight-and-a-half out of nine of them:

• trouble maintaining focus or often being distracted

• lots on the go but nothing ever finished

• perpetual financial problems

• piles of paperwork scattered around home and office

• poor listening skills and talking excessively

• impulsive behaviours

• impatience

• frequent traffic accidents or routine speeding

• difficulty maintaining friendships or romantic relationships

When I confessed this to Marty, he straightened me out in one split second.

Isn't this what happens to you when you start reading about the symptoms of any health issue? 

Suddenly, you have most or all of them. You really feel them. That's what's so dicey about having too much information at your fingertips. Sometimes, it's not healthy. What do all these symptoms mean? In truth, it may seem that you have enough symptoms for a million and one disorders or diseases from Lupus to Leprosy, when in fact, you're fine. 

That's the power of suggestion. The trick is to be savvy and smart about the sources you use and to find the best information in the Internet. I'll get back to that in a minute. 

ADULT ADHD IS REAL AND NOT JUST FOR KIDS

I do not, to the best of my knowledge, have ADHD. (I'll check with Dr. Bob next week.) But some adults do. 

ADHD is not just for kids. In fact, the symptoms of child and adolescent and adult ADHD differ. (I mean how many five-year-olds have frequent traffic accidents or routinely speed?)

The first time I heard about adult ADHD was in May 2008. I'll never forget it.

I attended a weekend course for teachers in Collingwood sponsored by Seneca called The Great Teaching Seminar. During one session, we all sat around in a circle – about 40 of us. We were asked to disclose something personal.

One fellow I did not know – Seneca has eight campuses and thousands of faculty – started talking. He is a business professor, though he talked about how he used to work in a corporation.

He related how, several years before, while he was still working in business that he started having problems concentrating, having anxiety attacks, though he didn't know it was anxiety at the time. I can't remember all the details, but he said that gradually he began struggling so much at work – I'm sorry, but I don't remember exactly what it was he did – that his performance began faltering badly. He was forced to take some time off. He paid a visit to his doctor.

He was so stressed out, he could barely function, but it didn't take his doctor long to figure out that he was suffering with adult ADHD. This man admitted he was shocked.

WITH TREATMENT FOR ADHD HIS LIFE IMPROVED DRAMATICALLY

"I thought only kids get ADHD," he said to his doctor. Nope. His doctor prescribed some medication, helped to educate him on ADHD, gave him some strategies and tips to help him adapt to his new-found condition and carefully monitored how he responded to all his new treatment tools.

This man told us the difference in his life after he was treated for his ADHD was nothing short of miraculous. I'll never forget that he actually broke down and started to cry, the improvement in the quality of life had changed so dramatically. He decided, shortly after his symptoms began to subside and he was feeling better, to leave big business and take up teaching. He's never regretted his decision and it's paid off big time for his emotional health. He's so much happier, healthier and at peace with himself and his family.

ADHD IS MUCH MISUNDERSTOOD AND MALIGNED

Still, ADHD is among the most misunderstood and maligned mental health conditions. Left untreated, in adults, it can lead to addiction, divorce, bankruptcy, accidents, depression, anxiety, and even suicide.

Its symptoms are complicated because they can present in a multitude of different combinations with each individual. In addition to the devastating personal costs, ADHD in British Columbia alone directly and indirectly costs more than $500 million.

Like many people, Rick Green of The Rick Green Show, first suspected he had ADD, "when one of my kids was diagnosed," the Canadian actor/writer/director said, whose diagnosis was made after years of struggling with various symptoms. 

So high-powered Canadian entertainer Green teamed up with a high-voltage ADD medical specialist Dr. Umesh Jain, a psychiatrist and professor at the Centre for Addiction and Mental Health, the Canadian ADHD Resource Alliance, University of Toronto and the Centre for ADD Advocacy Canada and together they collaborated on a critically acclaimed documentary called ADD & Loving It.

Last year, they launched an absolutely riveting new web site called Totally ADD (www.totallyadd.com) – "A complete guide to ADD and ADHD in adulthood."

Then, with Jain, Green produced and directed an interactive workshop called Now What?! which helps adults recognize the symptoms of ADD. No easy feat.

THE NEW ADD WEBSITE IS FUNNY. ENGAGING. TERRIFIC.

First, I have to tell you in all honesty the website is terrific. Even if you don't have ADHD, you probably know someone who does. Why not learn about it? It will help you empathize. Besides, this website is fascinating to watch. Instructive. Engaging. Entertaining. And funny! Like nothing else I've ever seen.

Green said, "Based on personal experience and what I learned while developing the documentary and Totally ADD.com, I wanted to help people who were struggling but didn't know why or what they could do about it." 

He and Jain will be teaming up to offer their Now What?! workshop this Saturday, February 27 at The Ontario Science Centre in the Imperial Oil Auditorium from 1 p.m. to 4 p.m. for anyone over the age of 16. Tickets are $29 and available through www.TotallyADD.com.

Dr. Jain said the main message of this workshop is that life can be easier when you know what's causing your symptoms and you can get the help you need, help that's readily available.

"I am constantly inspired by what my patients are able to achieve," he said. 

UNDERSTAND YOUR STRENGTHS AND WEAKNESSES

"The key to success with ADD is to develop an understanding of your strengths and challenges, and then embrace those traits. When treated properly, ADD can be managed and even harnessed to the point that it becomes a driving factor in a highly successful life. 

"People such as Dr. Richard Branson, quarterback Terry Bradshaw, Olympic swimmer Michael Phelps, political savant James Carville, comedian Howie Mandel and many other famous and successful people have acknowledged that they had ADD."

The more you know about yourself, the more insight you have and the more emotionally healthy you can be.

So it is with my emotional and psychiatric health issues. That's why I continue to see Dr. Bob as often as I feel I need to see him. We work together peeling the onion, layer by layer. 

If you have any questions or concerns about ADHD, Saturday's interactive workshop at the Ontario Science Centre might help you face up to yourself and your fears. Once you know what's happening, your fears aren't so scary anymore.

Good luck and if you attend, please let me know what you learn. I'm always interested. Your sharing here will help lots of others.

*   *   *   *   *

I have intriguing and rather surprising news about Angela's progress with her ongoing ECT treatments as well as an unexpected announcement about my little Dandie Dinmont Terrier "bitch" Lucy, but I'm saving both for Friday morning's post.

See you then, have a lovely meantime, and speak soon.

An apology and Angela's "voluntary" ECT...

One of my goals as a blogger writing about mental health and wellness is to use "the language of respect" at all times. I am not perfect and sometimes I err, which I did, unwittingly and unknowingly, in my last post. 

I inappropriately referred to Darby Penney, an ex-patient and long-time activist in the movement to protect the human rights of people with psychiatric conditions, as "a well-known anti-psychiatry activist who vehemently opposes ECT." 

I thought I was accurately describing her. It never occurred to me that I wasn't. But I was wrong. She was quick to inform me that I had "misrepresented her beliefs" and "defamed" her. She stated that she does not believe she is "well-known" and that she is neither "anti-psychiatry" nor "vehemently anti-ECT."

THE LANGUAGE OF RESPECT 

She stated that she is "pro-choice, especially pro-informed choice" and she stressed, "I believe people should be free to make their own decisions about any treatment as long as they have full and accurate information about its risks and benefits."

I would like to apologize to Darby and to anyone else I may have offended by misinterpreting Darby's point of view. I was insensitive. I became emotional and, unfortunately, defensive. ECT is a highly emotional and political issue. As a result of our private exchange, Darby educated me as to why the terms "anti-psychiatry" and "anti-ECT" were offensive to her. Henceforth, I will be extremely careful when using them. 

Darby, I hope you will accept my sincere apology. I'm sorry that I misrepresented you and upset you. Thank you for taking the time to explain why my statements were so hurtful and for educating me on the nuances of "the language of respect." 

"COERCIVE PSYCHIATRY"

In one of the comments to this last post, the term "coercive psychiatry" was used. Angela's ECT is by no means "forced" or involuntary. She chose to have electroconvulsive therapy independently. She asked me "what do you know about ECT" one evening, out of the blue. We had never discussed it. She discussed it with her psychiatrist. She did her own research. 

She is having outpatient ECT and she's had six sessions over the last three weeks, although she said last night that she "wants it to be done." She has another five weeks of treatment, and possibly more. Perhaps 12 weeks in all.

"I'm feeling tired, but not depressed. Just a little down," she said last night at about 8:30 p.m. She has to get up at 6 a.m. on the days of her 7 a.m. ECT treatments. "And my hand looks like a pin cushion."

She sad that during her treatment yesterday morning, she had "a nice psychiatrist and a female anesthesiologist who was very good." She admitted that she had a "tiny bit of confusion," right after the treatment when she got home. "I couldn't remember where I keep the popcorn or where my little Crystal Lite juice packs were, but I took a minute or two and it came back to me."

This morning – we just spoke – she said she's feeling better than she was last night. "I'm about a seven," she said. My call interrupted the "work-out" she does every day, using a computer program. She saw her psychiatrist today and said, "Everything is good." This weekend, she'll be glued to the TV and The Olympics, but we'll be connecting each day.

"WE DON'T HAVE INVOLUNTARY ECT IN ONTARIO" 

I asked my psychiatrist Dr. Bob about Involuntary ECT yesterday. Here in Canada, health policy is provincially legislated (as it is by individual states in the U.S.) and in Ontario, we don't have involuntary ECT, he said. 

Everyone must sign a consent form, except in cases where a person may not be capable of making that decision. I remember, when I had my first course of ECT treatments in 1965, I was hospitalized because I was psychotic. At that time, my diagnosis was schizophrenia. During that seven-month hospitalization, I became catatonic and ECT was recommended because nothing seemed to be helping me. My parents signed the consent forms. 

In 1975, shortly after I left my first husband, again I was hospitalized for psychosis. My diagnosis was still schizophrenia. I wasn't depressed. I was clearly manic with psychotic features, though my diagnosis wasn't changed to manic depression – the term "bipolar disorder" wasn't in use yet – until later that year, when I was prescribed Lithium. This time, my estranged husband and my parents gave consent for the ECT course of treatments that was recommended by my team of psychiatrists. I remember that distinctly.

In cases such as mine, when someone isn't capable to make an informed decision or give informed consent, in Ontario, there is a hierarchy of people or "substitute decision makers" who are asked to make this decision on behalf of the patient, my psychiatrist explained. First, a spouse or partner, then a parent or child who must be age 16 or over, then a sibling, and then any other relative. If none of these people is available, then the Public Guardian is consulted.

This decision is based on one of two criteria. If the patient made it known that s/he wishes not to have ECT, for example, that wish must be respected by law. If there is no prior known wish, then a decision must be made on the "Best Interests Principle" which is defined in The Health Care Consent Act. 

In Ontario, this is true for any medical procedure. Yesterday, I had to sign a consent form to have my dog Lucy's teeth cleaned. She had to be anesthetized. Last year, I had to sign a consent form to have periodontal surgery, though I did not have any anesthesia.

I had planned to tackle controversy swirling around the Newsweek cover story on antidepressants this morning, but as you can see, things sometimes derail my best-laid plans. I'll try to get to it next week.

HAVE A WARM AND RELAXING "FAMILY DAY"!

On Monday, Angela's regularly scheduled ECT treatment is cancelled because in Ontario, it's Family Day – a three-year-old and much-needed, mid-Winter holiday. It's also my stepdaughter's birthday, so we'll be celebrating that, too. If anyone has helped to support me and safeguard my sanity over the last 11 years, it's been my new immediate family. My darling husband, Marty, and his youngest and most spirited daughter, Maya, who will be turning 23 on Monday and grows sweeter and more adorable with each year. His older daughter, Rebecca, doesn't live with us, yet, she, too, is extraordinarily kind and considerate of me, always caring and compassionate. We're hoping she will celebrate with us.

I hope you have a family to celebrate on Monday, family in the broadest sense. Whether it's your father or mother (mine is extraordinary) or siblings (also pretty special to me) or your extended family, and your "chosen family" of friends.

Here's to a great weekend and a lovely, warm and relaxing Family Day!

"It's Complicated" – ECT and more...

A lot is going on today.

Benedict Carey reported in the New York Times the latest intriguing and provocative news in the ongoing and contentious debate over the DSM-V. I'm not going to weigh in on all this, but here are a couple of interesting preliminary analyses from two bloggers I respect though they don't always agree – psychologist John M. Grohol of PsychCentral and Philip Dawdy of Furious Seasons. 

Trust me, there will be tons of people, professionals, bloggers, patients, parents, anyone who has ever been diagnosed or misdiagnosed will discussing this crucial publication when it's released, and Carey explains why:

"The eagerly awaited revisions — to be published, if adopted, in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, due in 2013 — would be the first in a decade.

"For months they have been the subject of intense speculation and lobbying by advocacy groups, and some proposed changes have already been widely discussed — including folding the diagnosis of Asperger’s syndrome into a broader category, autism spectrum disorder.

"But others, including a proposed alternative for bipolar disorder in many children, were unveiled on Tuesday. Experts said the recommendations, posted online at DSM5.org for public comment, could bring rapid change in several areas.

“'Anything you put in that book, any little change you make, has huge implications not only for psychiatry but for pharmaceutical marketing, research, for the legal system, for who’s considered to be normal or not, for who’s considered disabled,” said Dr. Michael First, a professor of psychiatry at Columbia University who edited the fourth edition of the manual but is not involved in the fifth.

“And it has huge implications for stigma,” Dr. First continued, “because the more disorders you put in, the more people get labels, and the higher the risk that some get inappropriate treatment.”

You can be sure, I'll be watching and commenting, too. But not today.

Finally, I've spent too much time corresponding on Facebook with someone who's very critical of my perspectives on ECT and who commented on my last post, which I linked to Facebook.

Darby Penney is a well-known anti-psychiatry activist who vehemently opposes ECT. Among her accusations against me is that I have a "bias toward this brain-damaging treatment." (Darby, you'll be happy to learn that Linda Andre's book finally arrived in the mail this morning, so I'll be adding it to my list of resources.) 

ANTI-PSYCHIATRY ACTIVIST CONTENDS THAT ECT CAUSES "BRAIN DAMAGE"

Penney contends that ECT causes "brain damage" and supports her statement with three clearly "anti-ECT" perspectives. 

Nevertheless, this statement, in spite of her supporters, appears to have no bearing whatsoever on the way Angela is responding to her ECT treatments. 

My question is, "Is memory loss brain damage?" But that's another story.

The point is, I'm trying to be as fair and balanced as I can be. Follow the comments to this series and you'll see all kinds of reactions. They're not edited in any way. I invite all of you with strong feelings about ECT to weigh in. This is a public forum. It's too bad Penney chose to express her opinions on my Facebook page instead of here, but that was her choice. 

Now then...

This is Week Three of Angela's eight-week course of ECT treatments – that could possibly stretch to 12 weeks, depending on her progress and her results. She is also participating in a long-term Toronto-based study involving four University of Toronto-affiliated teaching hospitals that is investigating ECT and the nature of its possible resultant memory loss at a cellular level. This study is in its fourth year and the results will be available in 2011. Although she wanted to increase the frequency of her biweekly treatments to three times a week, because of the design of the study, her psychiatrist told her that wasn't possible.

Since Monday, when Angela had her fifth treatment at 7 a.m., she's been perkier than I've heard her sound in ages. We speak every day. At least once. Often more.

During our conversations this week, we've been carefully distinguishing between how she perceives her mood as compared to how she's feeling about other issues in her life which are problematic, but have nothing to do with her psychiatric condition – her intractable depression with suicidal ideation.

"I'D RATHER HAVE MEMORY PROBLEMS OR BE A BIT CONFUSED THAN BE DEPRESSED"

On Monday, following her treatment, Angela said she was feeling "a little depressed but not suicidal," stressing that she had no memory problems at all. "To be honest, I'd rather have memory problems or be a bit confused, than be depressed," she admitted.

It was her 37th birthday, but she wasn't celebrating in any dramatic way. "We're ordering in Chinese food and watching the hockey game," she said, adding, "and my mother made me fudge, but she overcooked it. It's hard fudge." 

Angela was laughing during this conversation. I could hear her mother joking with her in the background. She was having fun. It was wonderful to hear.

On Tuesday, admittedly less depressed, Angela was annoyed because one of her cats was "misbehaving" – missing the litter box. "But I'm not feeling unhappy," she said.

This morning, she said, "Monday's ECT treatment was the best one I've had so far as far as side effects because there was a minimum memory loss," she said. "And you know, I feel like the treatments are definitely making an improvement over where I was. My affect is not nearly as flat and I'm handling my emotions better."

She said her mother's visit "went really well. I told her about my ECT and I was worried about how she'd react, but essentially she's quite supportive and just wants me to be healthy."

There are other personal issues that are bothering her, but Angela admitted, "I'm handing them better than I know I would have before the treatment."

THIS MORNING, SHE'S A GOOD SEVEN AND A HALF

On our scale of one to 10, she says she's a good seven and a half – a slight improvement over how she was feeling last week.

"If ECT allows you to be better prepared to handle those adversities, then it's worth its weight in gold," she said. 

Angela has a small studio in her home where she enjoys sculpting. When she's depressed, she never feels like working with her clay, but when we ended our conversation this morning, she signed off saying, "I feel like sculpting... and I think I'm going to go back to it."

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!