And now for something different...

Today, I'm taking a break from Electroconvulsive Therapy. I need it.

A QUICK ANGELA UPDATE

The last time Angela and I spoke was on Monday, when she said, "I'm holding my own." 

She sounded calm and relaxed while watching the Olympics. On Sunday, she admitted she was feeling a little bored. She had wanted to go snowboarding, but those plans didn't work out.

Over the last few days, she has punctuated our conversations with short bursts of laughter. Giggles, really. Her voice is sounding buoyant. I can always tell how she's feeling by the way she answers the phone and over the weekend, her "Hello" sounded brighter to me than it had sounded in the months prior to her ECT treatments which began three and a half weeks ago.

So today, I'm going to break away from Angela and her ECT and discuss my mood and one way I stay anchored.

This method has nothing to do with pharmaceuticals or psychotherapy, though it's therapeutic – healing.

SHINING LIGHT ON MY PERSONAL LIFE AND HOW I COPE

Today, I'm going to shine a little light into my personal life. The last few months, for me, have been more stressful than usual with the ominous possibility of a strike looming for all 24 Ontario community colleges and no resolution in sight. I am not good at "not knowing" even though, believe me, I am growing increasingly adept at enduring stress.

Three years ago, I walked away from a full-time job with full benefits and 100% security into an occupational abyss. I felt something would come along, but I also felt, even more, that I had to leave to survive.

My job may have had all the financial rewards and benefits, but the work itself was killing me. Things had changed. For my health and well being, I had to leave after 30 years. It was a huge risk for me but it turned out to be the best career move of my life. 

All kinds of windows sprung open for me. Ten days after I walked out of The Toronto Sun newsroom, The Globe and Mail published an op-ed piece I wrote in its editorial section. Two months later, on March 8, 2007, International Women's Day, I was hired on the spot to teach Women's Studies in the School of English and Liberal Studies at Seneca College. I graduated from Seneca in 1971.

Today, I'm teaching a course I was asked to develop called Leadership in Society. Seneca literally saved my life. I went on to Queen's University, Ryerson University, though it was a Polytechnic when I attended, then my 30-year Toronto Sun newspaper career and now I'm here at The Toronto Star – and loving it.

I'm learning more than I ever dreamed possible every day, between teaching and writing here. I love my blog, though it can be emotionally taxing, as my friend, mentor and polymath Tufts University psychiatry professor, clinician, writer, poet and fellow blogger Ron Pies empathized the other day, “'fighting off the Mongol hordes' (if that is not offensive to Genghis Khan’s people)."

I have an endlessly fascinating and adventurous life with my husband, Marty, and our two dogs, Lucy and Riley. We rarely travel, but we are never bored. Ever.

OURS IS NOT ALWAYS AN EASY LIFE

Ours is not an easy life. Marriage is a PhD in living – compromise, communications, acceptance, open-mindedness and all the challenges of inclusivity that culminate when two people over 50 join together, with three previous marriages between them, not to mention his two daughters. (One was 12 when we met and 13 when we married. She lived with us because Marty was a widower. His older daughter is a successful film producer, independent and now happily married.)

Here's what's best about my life and why I can cope. I respect my husband's values more than you can imagine. He is highly principled, generous, caring and compassionate – about all people who are oppressed. He's also excitingly political. I never knew anything about politics until we met and now I'm learning. His humanity is colouring mine, I'm happy to report. Also, living with Marty, I like to say, is "like living with Google," to borrow from my friend, journalist Cheryl Hawkes who has said that about her late husband, the brilliant journalist Bill Cameron. 

Besides being a film historian and teaching the History of the Cinema to aspiring film and TV actors at Humber College, Marty is an actor, screenwriter, TV writer, playwright and baseball fan. He has an encyclopedic memory and does the New York Times crossword puzzle in ink every Sunday. Best of all, he's a humourist. Almost everything that flows from his fingers is funny.

Nothing thrills him more than making me laugh and he's on a constant quest to do so. We share a passion for The New Yorker magazine, The Sunday New York Times, good coffee, old movies, great books, spectacular art, our darling Dandie Dinmont Terriers, a small coterie of dear, faithful, fun loving friends, and our bright little yellow house in Toronto's suburbs.

We both work hard, but we thrive on our work, and it is our work and these three significant "others" (my husband and my two dogs) that anchor me day-by-day. Marty, it goes without saying, has transformed me in many other ways. He loves me unconditionally, as I feel no one else ever has. My confidence and self-esteem has grown, though I'm still plagued at times with insecurity. (My other significant other is my psychiatrist, Dr. Bob.) 

Marty is rock solid, with a kind and gentle temperament that complements my madness. I'm emotional. Histrionic. Larger than life. Impatient. He calms me, just with his touch.

Do we have lots of money? Not by a long shot. We have more. Each other. Our routine. Our health, at the moment. Plus, we're both card carrying members of Weight Watchers.

WE LIVE IN THE MOMENT AND THINGS ALWAYS LOOK BETTER IN THE MORNING

Here's the clincher. We know we have enough. More than enough. We live in the moment. Marty has taught me the futility of worrying and that guilt is a waste of time.

So, that is how I live my life and how I can sit here and muse here about all aspects of emotional health and well being. I learn as I go and believe me, it's often really hard for me, like what went on last week. But I'm learning so much and ultimately, I know that we're all next to normal in varying degrees. I am stubbornly hopeful. I believe in recovery. It's hard work, but it's real. It happens. And it's different for all of us.

Feeling this way, knowing this, makes my life lovely to live, even when the living gets tough.

I have one little secret. Not a secret, really, but it helps me survive the rough times. 

Things always seem to look better in the morning.

Take care. Speak soon. Thanks for listening.

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!

ECT on Angela's mind and mine...

At 10:14 a.m. Saturday, Angela sent me the following email:

"I decided not to go away with Rob (her boyfriend) this weekend because I'm uncertain as to whether or not I can keep it together. Today, I am tearful, the feeling of sadness is overwhelming and often leads to suicidal thoughts.

"Maybe the ECT doesn't have the clout as yet to keep unwanted thoughts suppressed, and I sure as hell don't have the capacity to keep them at bay.

"I want it to be Monday so I can have another treatment. I want to know if the ECT is going to stick with me and work for me. My patience wears thin, my eyes tearful, and my heart has broken into millions of tiny pieces. 

"I hate this!"

I called her as soon as I read her message. She sounded more buoyant than I had expected. Her sinking mood admittedly was caused by other problems in her life that have nothing whatsoever to do with her psychiatric condition and the trauma that's the root cause of her depression and suicidal ideation.

"Life's complicated," she said, referring to these problems that seem to her to be insurmountable right now with all that's happening to her – all the unknowns and anxieties about her new electroconvulsive therapy protocol. 

She's concerned about her mother who isn't well and will be visiting her this weekend. Angela is terribly anxious about how her mother will react to her having ECT. She hasn't yet told her about it.

"And there's lots more," she added. "It's complicated."

She wanted to spend the weekend alone and I couldn't persuade her to meet me for lunch or to come and have dinner with Marty and me on Saturday night. She didn't seem open to company at all, insisting that she wanted to stay home, by herself, with her three cats – to watch the hockey game.

So, I signed off, reassuring her that I was here and at her beck and call if she wants to talk.

Meanwhile, to say I have ECT on my mind is an understatement.

Constantly, I was monitoring the comments to my Friday post. By Saturday night, there were 12, excluding my responses. (This morning, there are 18 in all.)

But one in particular that came in Saturday disturbed me and not because of its angry tone. I didn't know what to make of it, despite my attempts at researching it. 

I'm no scientist and ECT is a highly scientific, complex procedure with remarkable inconsistencies depending on widely specific variables. 

I was so confused that on Saturday at 6:23 p.m., reluctantly, I wrote to my friend, psychiatrist Ron Pies of Tufts University, who is as committed to public education as I am. We are communicating often these days as I dig deeper into the contentious realm of ECT.

He has introduced me online to psychiatrist Max Fink, a leading U.S. authority on ECT, who generously agreed to answer my questions if I email them to him. On the thorny question of "involuntary" ECT, Ron also consulted leading forensic psychiatry expert Professor Daniel W. Shurman, the M.D. Anderson Foundation Endowed Professor of Health Law, Dedman School of Law at Southern Methodist University. In the weeks to come, I will be sharing this and other information I'm uncovering as Angela continues with her eight-week course of twice weekly ECT treatments. Depending on her response, this course could be extended to 12-weeks.

Time will tell.

In my Saturday night email to Ron, I admitted: "I don't know how to respond to this comment," referring to a writer named Ginger who sited a 2007 study by Columbia University psychologist Harold Sackeim. "I've found Harold Sackeim's paper, but I'm not sure he's using the most up-to-date ECT methodology nor am I sure why he's reversed his opinion.

"Everybody has a story," I wrote. "A different story. I think that there must be variation in quality of equipment and methodology in different hospitals. Differences between outcomes in bilateral versus unilateral. I can't become an expert in ECT. I'm reading as fast as I can, I'm not really adept at interpreting scientific research papers. Perhaps I've opened a Pandora's box with this series and now I'm in real trouble."

Ron responded at 12:10 a.m. on Sunday morning. 

"Believe me, I sympathize. I waded through not only the 2007 paper by Dr. Sackeim's group, but also their 2008 follow-up study, which is of considerable importance, and which (I believe) clearly runs counter to the overblown claims by Linda Andre," of the The Committee for Truth in Psychiatry. 

"Even with my training, I had trouble teasing out the clinical significance of many of these findings, as contrasted with the statistical significance. There is a big difference. The bottom line: it's like in real estate, but instead of "Location, location, location," the slogan is "Technique, technique, technique!" 

"So much depends on using the newest and most "cognition-sparing" techniques. When you do so the results appear to be very good, without substantial cognitive loss in most individuals, and with substantial improvement in mood."

Ron signed off promising to find "a more definitive response" within a few days after getting "some consultation of my own."

Meanwhile, I found this TED.com talk by Sherwin Nuland on Electroshock Therapy. Nuland is an American surgeon, now retired, and prolific, award-winning author. He gave this stunning this talk in 2001 and it was first released in 2007. It's well worth 22 minutes of your time.

On Sunday morning, Angela and I spoke on the phone three or four times.

"I can't wait until Monday," she said anxiously and often. "I can't wait for my next treatment. I want it to kick in. It seems to take so long. I don't want to wait. I want to be cured now. "

She's also anxious because her current psychiatrist who is administering her ECT treatments is only going to continue for this week and next week, she'll have another doctor, a doctor she hasn't yet met. "I wish there was more consistency," she said.

I reminded her that the University Health Network is a teaching hospital and this is a standard practice in teaching hospitals. That wasn't what she wanted to hear.  

Her despondency continued later Sunday evening. It was mild. She would giggle from time to time and joke with me, even though the word she tended to use to describe how she felt was "glum." When I asked her about her suicidal thoughts, she said she kept thinking, "What's the point of all this?" 

I sent her the link to Nuland's talk and another 12-minute talk he gave in 2003 that was posted last month, On Hope. She said she'd have a look.

Yesterday morning, her third ECT treatment went without a hitch. When I called her at 9:45 a.m., she didn't answer the phone. At 10:43 a.m., she sent me the following note:

"Just checking in post ECT... Have a little confusion but nothing serious. I don't feel well today... suicidal thoughts and just glum. Wish this treatment will hurry up and work!!!

"Hope you're having a good day!"

We spoke a few hours later and her confusion was gone. She couldn't understand why she wasn't having three treatments a week, the way ECT is typically administered in the U.S. and in the U.K. She said she'd prefer that.

This morning, still "glum," she said a few hours ago. "I remember absolutely everything now and the suicidal thoughts are gone completely. No side effects. But why does this take so long to kick in." 

Later today she'll be seeing her psychiatrist. I sense from what she says and even more, from some of her silences, that she doesn't realize just how much she needs this therapeutic support right now.

I suspect they'll have lots to discuss.

ECT is "like abortion" & Angela's 2nd treatment...

Yesterday morning at 11:55 a.m., I spoke to Angela briefly several hours after she had her second ECT treatment at the University Health Network – Toronto General site. She sounded sleepy, so tired, we agreed to connect later.

I called at about 9:30 p.m. and there was no answer. I sent her an email and at 6:51 a.m. this morning, she wrote:

"I spent most of the day and evening sleeping. Sorry I missed your call. All is well. I was tired yesterday. Had a tiny bit of confusion after the treatment but it cleared up quite quickly. I'm awake at the moment but will likely have a nap..."

At 8:30 a.m. Angela called to give me a more detailed report.

First, I asked her about her muscles and the aching she felt after her first ECT treatment on Monday. 

"It's all gone and this time, it wasn't a problem. I had a little headache, but I took two regular Tylenols and they took it away," she said.

"NO SIDE EFFECTS AT ALL" 

I asked her about her "tiny bit of confusion."

She said, "It was really mild. It was like, I knew what I wanted to say but I couldn't find the words. It was like, if I got up to go the kitchen to get something, when I got there I couldn't remember what I wanted. But then, I'd think about it and I'd remember. It lasted for about two hours, but it wasn't at all debilitating. It was very transient and extremely mild and it went away."

Her ECT treatment experience yesterday mirrored her Monday treatment, "except I was first and I had a different anesthesiologist. I liked the first one better," she said. "The first one explained everything he was doing and this one didn't talk to me. And yesterday, there were students there. Nursing students. But it's a teaching hospital. I don't mind."

I wanted to be sure about the side effects, so I said, "So this time, would you say that two hours after your second ECT treatment, you had no side-effects?"

Angela said, "That's right. No side effects at all."

Again, she said she came out of the anesthetic quickly and easily and was back home at about 9:30 a.m.

Since starting her ECT treatments on Monday, Angela also reported that she hasn't had any suicidal thoughts. 

"There's a difference," she said. "I'm still emotional about things, certain things still upset me, but they're not as upsetting. The 'upset' isn't as prominent. But it could be a placebo effect."

I asked her about her appetite.

"It's extremely poor, but that's been 'my normal' for several months. Me and appetite is a funny thing," she added. "I was anorexic when I was younger. Now, I tend to forget about eating. I think it's because of the medication. It has a lot of anorexic properties."

I suggested she might monitor that a bit and we signed off. She sounded positive and during our conversation she giggled more than I had remembered in recent months. Monday, she'll have her third ECT treatment and this weekend, she's going away with her man.

"ECT IS LIKE ABORTION – IT'S A RED-FLAG"

Meanwhile, your silence is deafening. There have been no comments here for close to a week. Only a couple on my Networked blog on Facebook, questioning my sanity in pursuing this coverage.

You're probably wondering why I'm spending so much time on ECT, a hot-button issue in the world of mental health that fires up emotions of anger, fear and irrationality. 

Dr. Bob and I have often discussed electroconvulsive therapy. He compares it to abortion because it's so hotly-debated and emotionally-driven. "It's a red flag. I don't think it will ever come to any resolution," he has often said.

We've talked about it because of my own relatively benign experience with it more than 40 years ago and more recently because of the rabid reaction I received the last time I posted about it. I was raked over the coals in several personal email messages from David W. Oaks of MindFreedom International which is leading a zealous campaign against "forced" or "involuntary" ECT treatments, apparently administered in the U.S. and other countries.

Over the weekend, I received this message on my Facebook account from a leading U.S. mental health advocate:

Darby Penney wrote, "Sandy, you say you 'know a lot' about ECT, but it doesn't sound like you advised your friend about the very real risks of permanent memory loss and brain damage from ECT. Or the fact that recent peer-reviewed research found that there's no basis to psychiatry's oft-repeated opinion that ECT is effective in preventing suicide. I'll bet her psychiatrists didn't tell her about these things either..."

(I value peer-reviewed research, but I also value scientific studies like the multi-site neuropsychological study that Angela is involved in. The principal investigator is psychologist and senior scientist Brian Levine of Toronto's Rotman Research Institute at Baycrest that is investigating memory loss at a cellular level will be completed in about one year. I'll keep you posted.)

As for the issue of "forced" ECT, it's a huge hornet's nest and I'm not going into it right now (but I will), except to say that MindFreedom International is essentially an anti-psychiatry, consumer-survivor and psychiatric-survivor-driven organization.

To clarify... you know that I am not anti-psychiatry. Nor do I identify with any political anti-psychiatry movement, or any movement. I'm not anti-anything. I am pro-Recovery. I am pro-open mindedness. I'm interested in learning as much as I can about everything related to mental health and wellness. I value individual experiences as well as academic research. I listen to everyone.

I detest labels of any kind. If you're going to label me anything, label me "human."

I am interested in history. I am interested in truths. I accept that there is no absolute truth, except that one. There are many truths. We all have our own truths. That said, in this series, I am simply following the experiences of a 36-year-old Toronto-born woman suffering with severe drug-resistant depression and suicidal ideation through a course of electroconvulsive therapy – which she decided to have one her own without any prompting or even suggestion from her psychiatrist.

Let's see what happens.

THE ANTI-PSYCHIATRY MOVEMENT ATTACKS

Historically, the anti-psychiatry movement has been attacking ECT for hundreds of years and it includes "writers, former patients (not all of whom have fully recovered), physicians, legislators and several prominent anti-psychiatry psychiatrists, most notably Thomas Szasz and R. D. Laing," according to Zigmond M. Lebensohn, MD., Chief-Emeritus, Department of Psychiatry, Sibley Memorial Hospital, Washington, in his article "The History of Electroconvulsive Therapy in the United States and Its Place in American Psychiatry: A Personal Memoir," from the May/June 1999 (Vol. 40, No. 3) issue of Comprehensive Psychiatry.

Tufts University clinical psychiatrist Ron Pies, MD (who kindly and generously takes the time to answer any question I ask him) adds this: "The general mistrust of institutional psychiatry in the U.S. (and elsewhere) is often fostered (ironically) by some in the mental health field, including several well-known psychiatrists who have written influential (if misguided) books. 

"Unfortunately, the association of institutional psychiatry with involuntary commitment raises fears about psychiatric treatments in general, including but not limited to ECT. (By the way, most people in the U.S. are not aware that it is a judge, not a psychiatrist or other physician, that "commits" a patient to long-term, involuntary hospitalization, which varies from state to state in the U.S.)."

Today, from what Angela is reporting, ECT bears no resemblance to the way it is often portrayed sensationally by Hollywood – cruelly, as a form of social control. These images have polluted our perceptions of this treatment used primarily in cases where patients have intractable depression and in some cases (like Angela's) may be dangerous to themselves because of their suicidal thoughts. 

In "earlier ECT procedures – 'bilateral' involving both sides of the brain – significant memory problems were more common," reports Pies. "With the newest ECT techniques most studies using neuropsychological testing have shown no significant residual memory problems six months after ECT. But, there are isolated cases in which substantial memory problems may be reported for unclear reasons. These are often the cases that get written up or circulated on the Internet anti-psychiatry websites." (See the Ray Sandford case.)

"Much less publicized are reports of the many thousands of highly successful cases of ECT use, without any substantial or pervasive memory impairment, using the most modern ECT techniques."

And doesn't this make sense, when you think about it?

After all, how many of us are running around trumpeting to the world our psychiatric histories and all the therapeutic tools of all kinds that have helped us to live meaningful, productive and successful lives.

If only more people did...

 

ECT: Up close and personal – the first treatment ...

At 7 a.m. this past Monday morning, my friend Angela (not her real name) walked into the University Health Network on University Avenue in Toronto and took the elevator up to the second floor surgical admissions desk, where she was registered for her first Electroconvulsive Therapy treatment.

Because she has joined a long-term, multi-site Toronto study to examine the hotly debated issue of memory loss and ECT, last week she signed consent papers (routine for anyone choosing to have ECT), had blood work, four hours of tests, including a two-hour MRI of her brain, and a consultation with an anesthesiologist.

She also met with the doctor who will administer her treatments that will be unilateral, twice weekly and last between eight and 12 weeks.

After years of fighting simply to get up in the morning with her deadening depression, unable to work and struggling against constant suicidal thoughts, Angela had concluded that ECT was her last chance. Her doctors have prescribed eight different antidepressants, alone and in combination with a number of anti-psychotics. To sleep, she needs sleeping pills. 

None of these medications have helped her. Her melancholy persists. She feels desolate, as if a psychic blankness is blanketing her and killing her spirit. Now, working with her psychiatrist who agreed that ECT was a viable option, when Angela suggested it, she was feeling more upbeat in anticipation of her first treatment.

She had researched ECT meticulously, besides discussing it with her psychiatrist and with me. She knew that I had had several courses of bilateral ECT in the 1960s and 1970s with no memory loss or any other side effect. I told her that it had helped me when I was psychotic. So now, with more optimism than she's felt in years, Angela was looking forward to the relief of this storied, controversial, much maligned and misunderstood procedure with its long and curious history.

"I read so many reports about its effectiveness," she told me last week. "I'm not worried."

After registering, she was taken to a small waiting room, called after a few minutes, and taken to another room where she was instructed to change into two hospital gowns and slippers. Then, Angela was led to a larger room where she laid on a bed and was covered with warm flannel blankets. A nurse attached three small electrodes to her upper right and left chest and lower down over her left rib cage for an electrocardiogram. She was then hooked up to a machine that monitored all her vital signs – blood pressure, heart rate, oxygen saturation, respiratory rate, temperature and pulse.

Her anesthesiologist came by to check her weight and told her that he was preparing two medications that would be infused intravenously – a short-acting anesthetic called sodium pentathol and a muscle relaxant called succinylcholine.

These medications were not used in the early days of modern ECT, and certainly not in the most iconic of Hollywood's depictions of ECT – the 1975 Milos Forman film One Flew Over The Cuckoo's Nest adapted from Ken Kesey's 1962 novel. In that film, a drama, ECT appears to be cruelly administered for social control without anesthetics and muscle relaxants. 

The methodology has "absolutely" changed since then, said my friend and mentor Dr. Ron Pies, clinical professor of psychiatry at Boston's Tufts University and psychiatry professor and lecturer on Bioethics and Humanities at SUNY Upstate Medical University in Syracuse. He is also author of Everything Has Two Handles: The Stoic's Guide to the Art of Living as well as a book of poetry, a play and several psychiatric texts.

"In the early days of ECT, it was given without benefit of anesthetics or muscle relaxants – this is the origin of the horror-movie scenes often still shown in popular depictions of ECT," he explained. "The role of ECT is often confused with psychiatry's record of frankly unethical and deplorable treatment (during the 1930's-1960's) known as lobotomy which many people confuse with ECT. For example, here's a quote from a review of the movie One Flew Over the Cuckoo's Nest:

"Seeing people taken from the ward to another place and only returning to be even less than what they were when they left caused McMurphy to want to play hero. They were being taken to a room and being given electroshock therapy. In others words, lobotomy."

Pies added, "Of course, lobotomy has absolutely nothing to do with ECT, and is no longer performed in the U.S. or other advanced countries. This began to change in the 1950s and 1960s, at least in the west. In more recent years, refinements in electrode placement and in the amount and nature of the electrical stimulus have led to a procedure with far fewer side effects than in the early days. The actual medical risks of the ECT procedure itself acutely are comparable to those involved in having your tonsils taken out."

Angela admitted that nothing hurt her in the least. Even when the anesthesiologist inserted the IV needle into the left radical vein of her left hand, "down the line of my thumb," she said. A few minutes later, an oxygen mask was placed on her face and the doctor who was going to administer the ECT came in wheeling the ECT machine with her on a cart. She introduced herself and said she would be giving her the ECT treatments for the next two weeks.

"Like everyone else there, she was very nice and respectful," Angela said.

While the psychiatrist was getting the equipment ready, a nurse put gel on Angela's head and right temple and she was hooked up to an electroencephalogram machine to monitor her brain waves.

When the anesthesiologist announced he was ready to give her the medications, Angela remembers saying to the psychiatrist, "While you're in there, can you help me with my math skills."

The doctor laughed and said, "I don't know. I think I'll have to have a consult with your psychiatrist."

When the medications were started, the anethesiologist said, "Try to keep your eyes open. Most people say the medication tastes like garlic."

Angela thought it tasted like gasoline.

"Then I was out," she said. 

Her next memory was waking up in the recovery room. The nurse told her she came out of the anesthetic very quickly and offered her more warm flannel blankets. 

"I was monitored the whole time, from the moment I woke up from the anesthesia," Angela said.

After a while, she was wheeled into the Medical Day Unit. 

"A nurse asked me how I felt," Angela said. "I told her I had a headache and they gave me something for the pain through the IV."

After another assessment of my vital signs, the nurses asked her if she wanted anything to drink. (She hadn't eaten or drank anything since 12 midnight the night before the procedure.)

"I said, 'No, I feel ready to leave.' But they kept me for another 15 minutes. Finally, I left at 9:15 a.m."

We spoke on Monday afternoon at 12:55 p.m.

Angela said she felt like she had had dental surgery and it was hard for her to open her jaw.

"It's probably because my muscles were clenched," she said. "But really, it was nothing. The whole procedure was nothing."

I asked her how her memory was.

"No problem," she said. "I remember everything, except I feel like I was hit on the side of the head with a baseball bat. But you know what? I would have done this two years ago, if I had had a psychiatrist. I've had more memory loss from smoking pot. I just feel a little tired."

At 8:43 p.m. Monday evening, she reported that her headache was much better. She had taken some Advil. 

"My body feels a little achy, like I'd just done a work out. But I don't feel suicidal. I know that. And the repetitive thoughts about my childhood trauma seem dulled." 

On Tuesday afternoon, she said her headache was gone, though she still felt a little achy. 

"I think I'm going to give sculpting a try," she said. She hadn't sculpted in months. 

"I feel a little guarded because I want this to work, but I slept well with my sleeping medication, though I was up too early, at 5:30 a.m. At least, I had no dreams."

She added, "I feel not bad at all. So far. So good"

 

ECT: Up close and personal...

She called me about two weeks ago. Her voice was almost inaudible. Robotic-sounding. All she said was, "What do you know about ECT?"

As it happens, I know a lot. And we discussed it. Or rather, I discussed it. She listened so intently, it felt as if there was physical tension on my land-line.

She said, at one point, "I can't turn off the suicidal thoughts. And nothing is working." 

She has been struggling, no, suffering with fierce, deep and intractable depression for several years, as long as I've known her. About three years ago, she became so immobilized by her depression, she had to leave a senior position with a marketing firm. 

"My mind wasn't working any more. I had tip-of-the-finger syndrome. I couldn't quite come up with the right words."

That's when the suicidal thoughts started, though she didn't tell me at the time.

Last spring, for the first time, she called me one night, threatening to kill herself. As soon as I got off the phone with her, I called her partner and he told me she'd been threatening for days. "She's been calling several people. She's done this before." This time, he sounded worried.

For years, a series of family doctors had been prescribing anti-depressants. None of them worked. She had spent a fortune seeing psychologists and other counsellors because she hadn't been able to find a psychiatrist she felt she could work with. 

She couldn't sleep, so her GP added sleeping pills to the mix. They didn't help. She would fall asleep and awaken at 3 a.m. They fogged her up so much, one night she accidentally overdosed and ended up in Emergency having her stomach pumped. Although she was feeling suicidal, she swore at that the time, "that was no attempt." 

Five months ago, finally, she was able to start seeing a very good psychiatrist at a Toronto teaching hospital, with an expertise in women's issues, depression and psychopharmacology, who reassessed her medications and started her on a new regime. 

"They make me feel like I have no personality," she would say.

I told her to give it time. It takes time. I was wrong.

"I feel monochrome. I'm still not sleeping. I feel flat."

When I saw her, she tried her best to rally for me. She did everything she could to try to break through the haze. She took up sculpture. She dragged herself to her local gym. But most of the time, she stayed at home and thought about what a relief it would be to "not exist anymore." 

Over the holidays, she and her man went up north for a few days, but her depression and her suicidal thoughts travelled with her. Then, on Thursday, January 7, at about 6:30 p.m. she called and asked me about ECT.

I told her about my experiences in the 1960s and 1970s. I told her about several people I know personally who have had remarkable success with ECT. I sent her the two links to the July 2008 posts I wrote here about ECT and other "current" therapies. I told her that it's definitely something to consider.

On January 11, she called sounding more lively than she had in months. "I told my psychiatrist I'm thinking about ECT and she said 'it's certainly something we can explore.' I've decided I want to do it."

She had done her research. 

"Where did you get the idea to even consider it," I asked.

"It came to me out of the blue," she said. "I think I was watching something on TV. I can't remember. I just know nothing is working and this is a chance."

A few days later, she received a call from the psychiatrist who will administer her ECT treatments. Her psychiatrist had made the connection.

"I wasn't expecting him to call me," she told me. "It was a real surprise. He was great. So encouraging and informative. He had already spoken with my psychiatrist and he knew all about me. He said he thought it would be best for me to have two sessions a week of unilateral ECT for between eight and 12 weeks. Early morning sessions. He asked me to join a study and I said I would."

I couldn't remember her sounding so positive.

"Do you think I could follow your experiences while you're going through it?" I asked. "Since you're in this study, you're helping to further scientific research. My writing about your entire experience might help people see ECT as it really is and how it really works. It might clear up some misconceptions."

She said, "Yes, of course. That would be a good idea. It might really help. But please don't use my real name, okay?"

"Okay," I said. "Thank you."

Coming Out Crazy wins blog award

I was crying and shaking in Dr. Bob's office this morning after an overly long hiatus between psychotherapy sessions when an announcement went out onto the Internet and into my email mailbox.

Had I known at the time, I would have saved my psychiatrist half a box of Kleenex. 

But I didn't. Instead, I made a month's worth of standing appointments because I've been overly stressed out lately and then left his office, as always, feeling 100 lbs. lighter. That's the power of talking therapy with him for me.

My husband picked me up and while we were driving home, on a whim, I pulled my iPhone out of my purse to check my email ... and there it was – the annual Top Ten Bipolar Blogs 2009 from PsychCentral.

For the second consecutive year, Coming Out Crazy made the list. I was stunned. Last week, PsychCentral launched the new Journal of Participatory Medicine on his World of Psychology blog. I figured these awards were discontinued.

Not so.

Under an introduction stressing the growing number of entrants, Sandra Kiume noted the difficulty in narrowing this year's list to 10 plus several Honourable Mentions. As far as I'm concerned, all 18 blogs named are equally worthy of this honour.

Here is what Kiume, a Vancouver-based mental health advocate and editor of Channel N said about Coming Out Crazy. This is daunting. Humbling. Blatant self-promotion isn't really my style, but here goes:

Coming Out Crazy. Sandy Naiman is fierce and fabulous. With a background in print journalism, her blog was new to the net last year and it's been fun to see her adapt to the medium – and vice-versa. Some of the perennial trolls have been buzzing around her blog, smelling fresh blood, but she deftly slaps them down with precise words soaked in reality and wisdom. Sandy is a dynamo who is an offline mental health advocate and speaker. In Coming Out Crazy, she's making gorgeous jewelry from her goldmine of experience as a person living with bipolar.

I feel privileged to be in the company of the following fascinating bloggers who have far more experience in this medium than I do.

Congratulations to The Secret Life of a Manic Depressive – I look forward to becoming acquainted with Irish-born British blogger Seaneen. I'm particularly pleased that veteran blogger Liz Spikol and The Trouble With Spikol are honoured once again. I'm a longtime fan of this well-deserving, candid and incisive Philadelphia-based journalist and blogger.

I'm anxious to get to know Joel Sax and his Pax Nortana, Amy's humourous posts at All About Bipolar, Cristina Fender's Raw Writing for the Real World Bipolar, Crazy Tracy and Time for your Meds, and Crazy Black Woman.

Phil Dawdy's Furious Seasons and John McManamy's Knowledge is Necessity are "must-reads" for anyone who wants to be well-informed about the hijinx of Big Pharma and the complexities of mood disorders. Both are informed investigative writers. 

Huge kudos to Wellness Writer, If You're Going Through Hell Keep Going, Bipolar Happens, Crazy for Life, Gus Greeper, Bipolar: Crazy Mermaid's Blog and Patient Anonymous.

Last year, I telephoned PsychCentral CEO and Founder psychologist John M. Grohol to thank him personally for supporting Coming Out Crazy in his 2008 list. Grohol, who launched PsychCentral, his groundbreaking independent Internet mental health network in 1995, said that this was a great way to spread the word and draw more people to our blogs.

In the spirit of sharing intriguing new ideas and perspectives about Bipolar Disorders, I want to thank him and Sandra Kiume for drawing to my attention many of these new voices and including mine. I look forward to reading them and referring to them in my future posts, linking to them and learning from them.

I am thrilled to be in this remarkable company, as is my editor at The Toronto Star, Brandie Weikle. It was her vision to have a Mental Health and Wellness blog on Healthzone.ca when it launched on April 8, 2008. She invited me to write it. We work as a team. And the rest is history.

Take care and speak soon!

"Hello from CBC Thunder Bay..."

I receive a number of emails each week from people who choose not to comment. Anonymity is the most common reason, but this week, anonymity was clearly not why Lisa Laco wrote to me.

The subject line of her message was "Hello from CBC Thunder Bay" and what followed was a touching and, at times, a rousing, even funny account of how she's learned to live with and decidedly not suffer from ... depression. 

"Let's get some facts straight," she wrote. "No, I've never been locked away. I don't think people tip-toe around me, afraid of my reactions. I haven't wandered the streets, mumbling to myself. These are just some of the images that accompany mental illness. But it's not that way. At least it hasn't been for me, or any of my family. And I have quite a family history of depression."

Lisa vividly recounted her mother's endless struggles with depression and all the painful treatments she had to endure, including ECT. Lisa comes by her depression "honestly," she stated. "Her mother, her aunts, her sisters have all been diagnosed with depression or manic depression. At one time, the accepted treatment included amphetamines. My mother, grandmother and great aunt were all at our house, remodelling. I think they managed to tear down walls, repaint and re-paper an entire house within a week. 'Speed' lets you do that!"

At the bottom of her long, bold face declaration, for that is how it felt as I read it, Lisa stated this:

"I'm the host of the morning show at CBC Radio in Thunder Bay ... I speak regularly here about the joy of living with mental illness ... thought I'd share a recent speech with you ... just to let you know you're not alone ... never alone."

The first thing I did was look up Lisa Laco on the CBC website. Her show is called The Great Northwest

and she's been at CBC in Thunder Bay since 1992. Her picture is on the website along with her bio.

I quickly sent her an email, asking if she would mind if I wrote about her. She responded quickly. "I would be thrilled as it might help someone somewhere look for help."

Then she called me a few hours later and left a message. When we finally touched base and spoke 24 hours later, she was more than happy to elaborate on her own story. 

About "the joy of living with mental illness," Lisa said, "How about acceptance and perhaps a joyful acceptance by knowing who I am – foibles and accomplishments – and accepting who I am. It's brought a certain joy, a peace, a calmness. I'm glad I have depression because it explains so much of my life. As a little girl, I always felt guilty, inadequate. I didn't deserve to be happy. Underneath, I was a failure, just waiting to be caught out. I thought this was a normal way of thinking." 

She was the eldest of six children, all under the age of 10. "I vaguely remember my grandparents saying that part of my mother's problem was her children – us, too many of us – and I think this could have been the genesis of my guilt, that just by being alive, around, I was a problem for my mom," Lisa said. 

Despite having these feelings, Lisa, now 52, was able to follow her dream of being in radio, like her uncle CBC's Harry Brown, one of the original co-hosts with Barbara Frum of the groundbreaking CBC radio show As It Happens. She started in private radio and ultimately ending up with CBC in Thunder Bay, where she's happily married a second time and has raised her two sons. About 12 years ago at a family reunion with her five siblings, she discovered that two of her four sisters were also struggling with depression.

Until then, she had never told a soul about her feelings of guilt and inadequacy. "That would not make me 'cool' and I was terrified of being found out as weird. I don't confide in friends easily. I'm more of a listener," she said.

"That conversation at a downtown bar in St. John's was a revelation. Of course, I had depression as well. Wow! What an emotional moment! It explained so much. I literally felt exuberant. What I had always been feeling was not a normal way to feel." 

Back in Thunder Bay, she immediately told her doctor that she needed help and she start taking "good old Paxil." It took a few years, but what a difference. "Night and Day. I could cope." Two years ago, she spent a year in Cognitive Behavioural Therapy with a psychiatrist developing additional coping "tools" to deal with her depression, in addition to her medication. 

Her therapist, Dr. Paul Mulzer of Lakehead Psychiatric Hospital, "once told me that it's okay to talk about any illness that affects you from the 'neck down' but from the 'neck up' makes people uncomfortable." But nevertheless, about six years ago, she felt confident enough to let some of her co-workers know about her depression. 

"I'd even joke about taking my 'happy pill' and no one seemed shocked. It was all matter of fact," Lisa said. "At that point, I realized I didn't care who knew and that's when I must have made a subconscious decision to go public. I remember talking to my boss at the time, and saying, 'I'm going to do this on air. I'm not going to be exploitive or maudlin. I'm going to be matter of fact. So it began."

She did a two-part interview with her Dr. Mulzer focusing on depression and the negative stereotypes, discrimination and prejudices too many people have about mental illnesses. 

"I'm known as an upbeat host. I have fun at my job. I'm energetic and I believe strongly that it's important for people to know that you can have a mental illness and function every day in society. Hold down a job and not a menial job, but a job with substance," Lisa said.

"Most importantly, to not be afraid of being known as the crazy lady down the street. I've participated in a public awareness campaign here in Northwestern Ontario. My face is on billboards. I've spoken at numerous events about this. I've never, ever had a negative reaction. I think honestly that people would be afraid to react negatively because I'm so positive about life. I'm happy. I sound happy. I can survive, but I never mention my own battle with depression when the occasion warrants it. If I'm doing an interview about this, I always make sure it's part of the interview, on air."

Lisa stresses that she talks quite freely about her depression. "I don't really care who knows. My family, my husband and two sons, know this about me and I think it helps them to hear me talk about it. The more I talk, the more they realize that they are not the cause. They are not the problem. It's 'my' illness. It's not their fault. That's my greatest concern. I don't want my children to experience what I did, spending years and years thinking it was all my fault."

Recently, Lisa has taken up running. "It's fabulous therapy. You cleanse your mind when you're running. It's just one foot in front of another," she said.

"When you run, you concentrate on nothing but your next step. You're semi-focused and it's simple. That's the joy of life, of living with a mental illness or living in any other way. Life can be complicated or it can be simple. It depends on how you deal with it. I now know I can simplify a lot of my emotions and feelings by asking the pertinent questions, questions from my therapist. Like, 'Where's the evidence of that?" or 'Why are you a failure? Where the evidence?'

"Break things down to their basic fears – emotions – and analyse where it comes from. One step at a time. One foot in front of the other. You can figure it out."

Lisa, thank you for so generously sharing these lessons for living and the story of your life. It certainly resonates with me and I'm sure they'll resonate for everyone who reads them. It's an uplifting story of recovery. Your recovery. 

I want to end this post with a quote from a book by my friend, Dr. Ron Pies, clinical professor of psychiatry at Tufts University in Boston at S.U.N.Y. Upstate Medical University in Syracuse N.Y. He sent me this book, one of many he's written, but this one is very special. It's called Everything Has Two Handles – A Stoic's Guide to the Art of Living (Hamilton Books). I keep it beside my bed and read it before turning out the light. Since I started this little ritual, I've been sleeping more easily and more soundly every night. Waking up more refreshed.

From his chapter on "Living in the Here and Now," Pies writes:"One of the great liberating ideas of Stoic philosophy is the concept of 'present contentment.' In effect, the Stoic says, 'I can't change the past; I can't really determine or control the future; so the best I can do is live a life of decency and integrity – right here , right now."