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.

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."

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...

 

The way I see it ...

It's taken me a while to process my impressions and thoughts about Ethan Watters' provocative essay The Americanization of Mental Illness that ran in last Sunday's New York Times Magazine.

If you want to know the truth, I've been living with him – or it feels that way – all week. Initially, his article excited me, especially in its criticism of the way American psychiatry is "homogenizing the way the world goes mad."

Of course, this isn't entirely true. Nor is it new. Here's what I wrote in an article titled "My Life in Labels" in the Spring/Summer 2007 issue of the Canadian Mental Health Association magazine Network:

"Years ago, a diagnosis could depend on where you lived. In the 1970s, the joke among North American psychiatrists was that ''you could cure schizophrenia if you could fly to Europe,'" where psychiatrists there, using the tighter diagnostic criteria of the World Health Organization's International Classification of Diseases or ICD, would more likely diagnose you with bipolar disorder, which was more treatable. Here, where the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders or DSM is the standard reference, you would most likely get stuck with schizophrenia – then, much harder to treat and often considered hopeless. Now, such discrepancies are less likely as diagnostics have become more globally understood."

Watters essay was adapted from his brand new book Crazy Like Us: The Globalization of the American Psyche, which was published last Tuesday and which I haven't yet read. 

That, in itself, is a problem. 

Several writers have reacted to this story over the past week and there are links to their posts in the comments to my last post. I wanted to know how a Western-trained psychiatrist would react to Watters blistering critique of Western – read American – psychiatry and it's global reach. I fired off an email to my friend and mentor, Tufts University clinical psychiatrist and researcher Dr. Ron Pies.

A couple of points were of interest to me and Ron addressed them in a way that I found both wise and humane. After all, I take a holistic approach to health and well-being that encompasses mind, body, soul and spirit. The whole package. So does he. As does my psychiatrist.

"BRAIN DISEASE" VERSUS "MENTAL ILLNESS"

On the subject of "brain disease" vs. "mental illness" – here's what Dr. Pies wrote in his response to my email:

"I think this is a sterile debate that has plagued the field for decades, and is the baneful legacy of our friend Rene Descartes, with his mind/body dualism! My own view, which was anticipated by the late Robert Kendall, M.D., is that 'disease' is properly attributed to persons – not 'minds' or 'bodies.' As Kendall puts it in J. Schaler's book, Szasz Under Fire, p. 41)...

"Neither minds nor bodies suffer from diseases. Only people ... do so, and when they do both mind and body, psyche and soma, are usually involved."

Pies added, "The idea actually goes back to the great physician Maimonides, who said, "The physician does not cure a disease, but a diseased person." 

I am comfortable with the person I am, warts and all. Though I'm no cultural anthropologist, when it comes to psychiatry, in all honesty, I've been studying it from the inside for close to 50 years as a patient. No formal training, just one long extended, sometimes bumpy but endlessly fascinating field trip that began in 1960. 

In those days you rarely ever saw the word "psychiatry" in a daily newspaper or magazine. Psychiatry was almost unmentionable. It seemed to be more black magic than medicine. It was just a few years into its "chemical" age and just out of the age of the frontal lobotomy.

Also, I'm Canadian, with a slightly different take on some things, including psychiatry and medicine. I've grown up in a family of doctors, most of them specialists and academics. I've also learned that one's family culture, perhaps more than one's national, ethnic or even religious cultures, is astoundingly powerful in determining how you see yourself, your beliefs, your values and your personal outlook on life – especially if it is determined that you have a "mental illness."

Case in point. Until about four years ago, I really bought into the "Western Biomedical Model" of mental illnesses – hook, line and sinker. I was convinced that my mental illness was chronic, like diabetes (ugh!) and I was, indeed, deficient in some deep-seated way. I knew the chemical imbalance theory of the causes of mental illnesses is just that – a theory and unproven, according to Dr. Bob – still, I function best with a medication, one tool in many I use to stay as healthy as I can. (I have a large toolbox.)

Still, I believed that there was something wrong with my mind. This, despite a successful journalistic career, a wonderful new marriage and a good life. I believed that there was something terribly wrong with me but that through my therapy, I was righting it. 

INTERNALIZING YOUR DIAGNOSIS

Long ago, I internalized my diagnoses – and oh, what damage that does to one's psyche, let me tell you, especially when you're 18 and you discover have schizophrenia. It took another seven years to right that misdiagnosis. All this was part of my family's culture, too. After all, I am still seen as The Family's Resident Nut Case and recently, one of my relatives said, in a rather accusatory tone, "You've made a career out of your mental illness." 

Several things have happened to change that. Now, I know I'm okay. And I choose to believe that we're all "next to normal."

First, I was asked to speak to a group of psychosocial rehabilitation specialists and in doing my homework, I discovered the mental health recovery movement. 

This was an epiphany for me. A seismic shift in my consciousness. It was possible to be in recovery. I could recover. In fact, I already was in recovery. I didn't even know it. Can you believe how stupid I was?

I had known there were other non-psychiatric mental health models like Fountain House, which started the International Clubhouse Movement, but this time, the reality that you can recover from schizophrenia and bipolar disorder and other serious mental health problems and live a meaningful life – like mine – really sank in. 

So I started seriously researching.

Around the same time, my mother told me about a Benedict Carey story in the New York Times. "You must read it. It sounds just like you," she said. The headline – Hypomanic? Absolutely. But Oh So Productive! When I showed it to Dr. Bob, initially he resisted, but ultimately, he agreed and changed my diagnosis. After all, I've been manic, psychotic, but never depressed. I'm unipolar with a vulnerability to mania. Where's the bipolarity in that?

Though Dr. Bob wasn't enthusiastic about the idea of mental health recovery when we first discussed it, he's gradually changed his mind about its potential power and the way it transforms people's lives. I've grown increasingly recovery-oriented and also increasingly skeptical of the way the American biomedical model operates. For many reasons. Diagnosing young children with psychiatric conditions and prescribing powerful medications for them – medications untested for children – is criminal, as far as I'm concerned. There are other tools, other ways, other approaches. 

PEOPLE IN THE INTERNATIONAL RECOVERY MOVEMENT DEMANDING CHANGE

The point is, I started doing my own cross-cultural research about what was happening in other countries and cultures and I discovered that the American way is light years behind a significant majority of people in the recovery movement around the world demanding change.

Take Britain's Time to Change. Last week, this program to end discrimination "faced by people who experience mental health problems" (I love the language they use) announced another new ambitious community in Islington mounting a campaign to promote mental health equality. 

Community Mental Health and Recovery is a growing global movement in the world even though much of the medical establishment doesn't recognize it or simply pays lip service to it. Watters doesn't even mention recovery in his article, though he's right, according to Pies, "to call attention to the ways that culture and ethnicity can shape both diagnosis and expression of psychiatric symptoms." 

I guess the main problem I have with his essay is that I don't like generalizing about people and mental health and well being and diagnostics. Mental health is not a constant state for anyone, ever. Nor is having a mental health issue. We, individuals, are changing all the time. Our lives, our circumstances, our work environments, our relationships are in constant flux. We're all different, every day, and no diagnostic label is really 100% accurate. It's a ball park. A designation for a doctor to use. A place to start. Also, it's very useful for insurance companies. 

We're all unique, despite our diagnoses. As I've said for years, "I'm not my mental illness." Labels are for jars, not people.

MANY PROBLEMS PLAGUE MODERN PSYCHIATRY

There are many problems plaguing modern psychiatry. Every psychiatrist has his or her own approach. Even Watters' wife, who is a psychiatrist, and a very good psychiatrist, he says. There's the rocky modern landscape of psychiatry, influenced by new medications and new technologies. There's the pull of the neurosciences against and not always in concert with the healing powers of the psychotherapies. There's our quick fix, pill-popping culture. And there's the discrimination and negative stereotyping and prejudice that we must continue to fight with education. And open minds.

Lots to think about and to ponder. But I will add this. On his Psychiatric Times blog The Couch in Crisis Dr. Ron Pies posted about the Watters essay, too. It's worth a read.

I'm still processing. Today, I'm seeing Dr. Bob. We'll have lots to talk about.

Take care.

Speak soon!

'Tis the season to party. Aaaaargh!

Today, it's Erev Christmas Eve. The Hebrew word Erev means "the night before," and it's a succinct way to say "the night/day before the night/day before," if you get my gist. A nice cultural blending, too.

Still...

At 1:31 a.m. this morning, when I slipped into bed, it occurred to me I really have no idea what Christmas stress is, since I've never experienced it at full-tilt. 

The only day newspapers never publish is Christmas Day, so the only day each year, the only day news rooms are dark is Christmas Eve. That's changing as we go digital and the Internet never sleeps. Nevertheless, I've always been a Christmas orphan. I've always worked through the holidays so my non-Jewish colleagues could enjoy them without the added pressure of work. That's pretty traditional in the the newspaper business. Though that's changing in this digital age where the Internet never sleeps. To add to that, my family is never around. They're always "down south" or at a cottage, as they are this year.

So, for more than 20 years, when I was single, I celebrated the Christmas Social Season on my own or with friends. By proxy, I was privy to its stresses and some of its silliness

'Tis the season to party and socialize – except if you're not a party animal... then what?. 

With parties come a certain amount of anxiety. For me, anyway. I'm never terribly nervous speaking in front of audiences, of any size – from 12 to 1,200. On radio and television. It doesn't matter. I love it.

But invite me to a cocktail party, and do I ever get my knickers in a twist any season but especially this season when expectations are so high.

I'm a bit party-phobic. Maybe you are, too. Well, welcome to a safe place for party-phobes. The other name? Social Anxiety Disorder, but that doesn't need to apply if it only relates to social gatherings like cocktail parties at Christmas, so forget the label for now. You know I hate labels.

I used to dread parties. Now I don't in the same way. I've learned a few things. So today and tomorrow, I'm going to muse on the stresses of socializing, particularly at this time of year when the pressure's on to have a good time. Plus how and why I've been able to recover, somewhat. I'm no expert.

As the holiday season swings into high gear, as social gatherings loom on your calendar between Christmas and culminating on New Year's Eve, do you find your stress-o-meter rising?

If you haven't any plans, that may stress you out, too. You may be feeling isolated with an empty dance card. That's an awful feeling. I've been there, too. There was no happy medium. And there's nothing worse than being a "sympathy guest" – issued an invitation at the last minute simply because you ARE alone. 

This is a tricky season. Everyone is filled with good will and trying to be. There are so many types of events. Family gatherings. Social gatherings. Business parties. All with their own cultures and expectations. Their own peculiar politics and stresses.

One areligious synonym for the Christmas season is celebration. It means party-time and for too many of us caught up in today's consumer and commercialized lifestyles, with all its implicit and explicit expectations, "party time" can also mean "show time" – all razzle dazzle and bling bling.

Put on a happy face and gird your emotional loins for the onslaught. Some trick when you're not in a party mood, but you're obligated... how's that for pressure.

In one of last week's posts, this prescient comment came in, proof this subject is weighing heavily on people's minds. This comment says it all, eloquently:

"What is really going on with the holidays? 

"Have you ever not been able to breathe for whatever reason (running, stress, being underwater) and then come up for air and panicked? You're breathing but you're scared and it hurts. 

"This is what Christmas is. We're more busy, and then in a moment we breathe. We're scared to breathe and reflect upon what's going on in our lives. 

"Hell, we'll have to tell acquaintances and family we only see at holidays what's going on in our lives. It's stressful. 

"This is the first Christmas I'm experiencing without being manic or depressed. It doesn't feel like my first breath because I've taken three-day-weekends and breathers along the way. I'm nervous about the parties, etc., but I know I can handle it. Maybe if we are so go go go until Christmas it is a more enjoyable experience."

Social gatherings are supposed to be about fun (and family, if you have family in the vicinity), but everyone has a different idea of what fun is. Family and fun don't necessarily go hand in hand.

What if fun is close friends, small groups, conversations with no crosstalk and the security of knowing you're loved for who you are – no matter what you're wearing or how you look. Feeling loved. Feeling secure. 

I'm no party-animal. During all my single years – my first fifty – I was your classic wallflower. Never the type of person people were drawn to at parties. I was the girl standing alone on the periphery watching and trying to smile. (Or in a little gathering of wallflowers.) Clutching my club soda and lime, I felt intensely awkward, yet wanted to look like I was having a good time. 

All I really wanted to do was go home.

Surprised? Don't be. I spent my adolescence and much my young adulthood in residence at what was formerly The Clarke Institute of Psychiatry, now the College Street site of The Centre for Addiction and Mental Health, or other psychiatric wards about town. Never learned to flirt. I felt like an oddball in social settings. Especially where alcohol was featured.

Did I mention that I'm a teetotaller? Never developed much of a taste for alcohol. It tastes like medicine and I've taken my fill. (Still do.) Furthermore, I don't need drugs to get high. I can do that all by myself. No artificial stimulation needed. Then, up, up and away I go, off to a mental ward, again.

So parties worried me. There's nothing more isolating than watching a group of people getting looped when you're stone-cold sober. 

I'm not thin. I never felt I ever looked "hot" – just out of sync with my generation – an old soul. 

Add all this up and you can imagine how social gatherings, especially at this time of year, were always preceded by major cases of the jitters. Sometimes, I'll confess, I'd call the host at the last minute and say I couldn't come because I wasn't feeling well. Terribly bad form, but that's how frightening parties were for me. I couldn't face walking alone into a room filled with smoke (back then) and boozing. I couldn't face being ignored for a whole evening by everyone other than my coupled friends and their kindhearted other halves. 

Men didn't notice me. No matter what I wore or how thin or not I was or even if I smiled. 

I wasn't confident in those situations. I felt I wouldn't fit in and that became my self-fulfilling prophecy.

To be continued tomorrow...

Remember, Coming Out Crazy is not planning on taking a break this Christmas – though one never knows. I want to be up and running twice a week, as usual, so you can stop by, comment, share, muse, celebrate or vent. You don't have to feel alone or abandoned. I'll be checking in regularly and doing my best to keep up with your comments – I know I'm still a bit behind, but I'm catching up slowly. 

Cheers and sweet dreams tonight. Oh, one more thing. Tomorrow night click onto NORAD's Official Santa Tracker and follow "the big guy's" global journey. The countdown has already started. This is one of my favourite Christmas activities. 

See you anon...

Be well. Take it easy. And breathe.

What "Mental Illness Awareness Week" means

This is Mental Illness Awareness Week.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Honestly. Candidly. Without arrogance. With humility.

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

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

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

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

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

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

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

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

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

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

As for labels, I accept only two for myself. 

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

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

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

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

Speak soon!

On Denial ...

Last week, I was in touch with my friend and mentor, Tufts University professor of psychiatry Dr. Ron Pies after the summer break. He mentioned that Elyn R. Saks had written a commentary called "Some Thoughts on Denial of Mental Illness" for the September 2009 issue of The American Journal of Psychiatry.

I can't download this journal article without paying a fee, so Ron kindly offered to mail me the piece, which arrived yesterday. As you may recall, I wrote a lengthy post about University of Southern California Associate Dean and Professor of Law, Psychology and Psychiatry Saks and her "memoir of madness" The Center Cannot Hold – back in April. 

What I didn't mention then was that I detested her use of language. It made me cringe. Saks is a fine writer, but her language screams with embarrassment, shame and for the most part, exposes her chronic denial of her florid psychoses and her lifelong battle with schizophrenia.

It took Saks years and years, far too many years, to be able to admit to herself that she had a mental illness. It was and is still clear in the way she writes that she's ill at ease and grappling with her diagnosis of schizophrenia. 

Her commentary is rational. Emotions are irrational. 

It seems to me that she is actually in recovery, but doesn't know it or doesn't want to know it – despite her extraordinary academic accomplishments and her meaningful and rich life. She's happily married and a highly respected academic.

Right now, I'm not going to challenge her rationale simply because I don't have time. Saks has degrees in literature and philosophy besides law. She is a brilliant woman, an excellent writer, and her "thoughts" are argued with the precision of a closing argument in a murder trial. 

It's Friday afternoon. I've just returned from teaching one of my classes. It's been a long week. My editor is leaving in an hour and a half, and I need to digest what Saks has written to challenge her ideas. But I will. 

For now, I will muse a bit about denial and mental illnesses on my own. This is a rich subject. I will leave my journalistic jousting with Ms. Saks for another day.

First, as you know, I am not in denial of my mental health issues or my mental illness – I always feel a little odd using the term "illness" when discussing the mind. I do not believe the much-hyped theory that mental illnesses are brain diseases caused by chemical imbalances in the brain. That's simply not been proven and it's too simplistic, as far as I'm concerned. 

I've never been in denial. I grew up believing, naively perhaps, that going to a psychiatrist to talk once a week was healthy and smart – like going to an allergist once a week to have allergy shots.

As an adolescent, I used to complain to my mother, "Why do I have to go to see Dr. McQuaid every week?" She would simply say, "If you had a broken leg, you'd go to a doctor who would put it in a cast to heal. Well, if there's something wrong with your mind, you go and talk to a psychiatrist every week and you feel better."

Coming from a predominantly medical family where everyone was either a doctor or a psychiatric social worker, I was socialized to believe that going to a psychiatrist was de rigueur even though I was the only kid I knew who did, back in the early 1960s.

I live my life out loud today because it never occurred to me that there was anything wrong with having a mental illness. I consider myself lucky. 

Over the years, people have always confided in me, but always in whispers. 

Several years ago, I was invited to speak to a group of women at the Ontario Ministry of Government Services. The event, which celebrates Women of Influence and Inspiration, took place during Mental Health Awareness Week in May. Linda Lane, the creator of the event who asked me to speak, selected me as one of that year's Women of Influence and Inspiration, but asked me to stay clear of anything that smacked of mental health. Instead, she wanted me to focus on my journalistic career and women's issues. 

When I arrived, there were more than 250 women seated in a large conference room. I started listening to the other speakers, all extremely successful, high-ranking women in government who had clearly broken through the glass ceiling. (I've always thought that glass ceiling was really a layer of men, but that's another story.)

As I listened, clearly, I knew I couldn't stick to my script. After all, I'm an advocate. Place me in front of an audience and I can't resist, especially during Mental Health Awareness Week. When my turn came, I started talking and slipping references to my mental illness into my speech. Funny references. Self-deprecating quips to show that having a mental illness doesn't mean you can't have a good life and a great career. It's all about having a positive attitude. 

The audience laughed in all the right places and seemed relieved that I wasn't talking about government business. Clearly, they were enjoying themselves. You could hear a pin drop.

After I finished to a resounding round of applause, there was a break. I had to leave and go right back to my office. As I slipped out of the room, a woman approached me. I'll never forget her. She was slightly hunched over. Her body language screamed out "Denial" – I knew what she was going to say. And I was right.

In a barely audible whisper, she said, "I have the same problem as you, but I would never tell anyone. I've had it for 16 years."

I listened to her as she told her story of loneliness and isolation. She spoke about how she kept it a secret. How she was afraid she would lose her job if anyone "knew"... and how hard it is not to be able to talk to anyone at work about it, especially when "I'm not feeling at my best."

You have no idea how many times I've heard this. And worse. Parents in denial for their children. Rather that seek the appropriate help, they take their troubled adolescents to every specialist in the world, except a psychiatrist or psychologist. In one case, when no "physical" problem could be found, a young boy of 15 was kept at home, out of school, far from friends, cloistered, and hidden away because his parents couldn't accept that perhaps he had an emotional or mental health issue.

That's one reason why the new website Working Through It so powerfully mitigates denial by showing that mental health issues are not only prevalent but treatable in a wide variety of ways and real people are doing the talking. 

Often, I'm told that I'm very open. This surprises people, this openness of mine. But I also find that when I'm open, others open up to me. They share the burden of their denial. And they feel better.

I'm convinced that there is no normal. That we're all "next to normal" and diagnoses can and often do more harm than good. Even in cases of psychosis and schizophrenia, there are so many people finding ways to recover.

And in recovery, they overcome their denial.