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!

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!

Letting things go...

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

Nothing happens all by itself. Timing is everything. 

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

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

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

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

Process is the key word. 

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

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

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

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

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

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

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

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

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

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

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

The essence of leadership is change. 

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

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

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

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

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

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

Everybody wants to feel respected. 

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

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

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

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

Be well and thanks for listening.

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. 

Working Through It

Have I got a website for you!

Yesterday evening, an email arrived in my inbox from my longtime friend and mentor, Mary Ann Baynton – with this subject line: 

Finally! Here is the link to Working Through It. Please forward it to anyone who can use it or share it.

Mary Ann and I go back a long way, but that's another story.

For now, let me simply say that she has dedicated her life to changing the culture of Canadian workplaces – to help employees facing mental health issues and their employers. Most workplaces are pressure cookers of stress and anxiety, demands and deadlines. More so every day.

Some of us can be emotionally vulnerable to these tensions, triggers for our mental health problems. Some of us bring those issues with us, but secretly. Either way, the workplace can be daunting for everyone involved.

In Canada, that's been changing because of Mary Ann.

In 2001, she was developing an educational program to help equip employers with easy-to-learn skills and training strategies to appropriately accommodate their employees who may be facing mental health difficulties on the job. Touchy situations that Mary Ann, with her training and commitment knew could be successfully mediated. Especially if an employee can "coach up" and help a supervisor learn skills they've never been taught.

Through the Canadian Mental Health Association (Ontario) she launched Mental Health Works. Since then, this multi-faceted program has won awards and now is running in government, private companies and corporations in at least five provinces. It's a win-win-win. 

There is no question that healthier workplaces with mentally and emotionally healthier and more resilient employees improve a company's bottom line! This has been proven time and again. Education is the key and Mary Ann's Complex Issues. Clear Solutions training and tools enables management to function more effectively – to discuss sensitive issues, resolve conflicts, create accommodations and avoid discrimination and human rights violations in the workplace.

A few years ago, Mary Ann began branching out and consulting. Now, she's consulting with CMHA and Mental Health Works but she's moved on.

Her newest venture is far more ambitious and delves deeper into the collective consciousness of people living with and struggling with mental health issues. Last night, I managed to track Mary Ann down at her home, where she was busy entertaining her extended family. She explained that in 2003 or 2004, a woman named Mandi Luis approached her at her CHMA (Ontario) office. 

"She had to walk away from a 27-year banking career because of severe depression. No one was able to help her," and now she wanted to help prevent that happening for others who may find themselves in similar straits.

Mandi is now a peer support specialist – peer support could have helped her when she needed it most. 

Mary Ann suggested Mandi write an article for Mental Health Works, which she did, but there was a problem. 

"When I was really, really depressed, really sick, I wouldn't have been able to concentrate on an article like this. I couldn't focus," Mandi explained.

So what to do about Mandi's dilemma? How do you transmit information to people who are currently struggling and so mentally and emotionally stressed out they're not able to concentrate well enough to read? How do you reach them?

Mary Ann came up with a possible solution. How about short videos of people, real people, talking about their experiences? 

In collaboration with Mental Health Works and The Mood Disorders Association of Ontario (MDAO) with the funding of Great West Life, where Mary Ann is now consulting, a working group was formed and 10 people were carefully selected to share their experiences in front of a camera. 

That's how Working Through It came about. This is an encyclopedic resource. Amazing. In all 31 videos. Short, byte-sized, none are more than three or four minutes. Several are even shorter than that. You can come and go, visit for a few minutes and then come back. Easily digestible and extraordinarily engaging.

There are 15 major themes, featuring four or five different people comfortably sharing segments of their stories of how they have "reclaimed their well-being at work, off work and returning to work."

"We wanted to use broad language that was entirely inclusive," Mary Ann explained when I asked why the word "recovery" was not used.  

You'll meet and grow to know Gord Conley, Sean Miller, Phillipia Wright, Bonnie Pedota, Hazel Gabriel, Rose Pardham, Marvin Burr, Melonie Long, Donna Hardaker and Constantin Nastic as they open up their hearts and their hurts to you. Candidly, viscerally, they tell you about their lives with their mental health struggles and their triumphs.

Speaking out about tough stuff sometimes. But they are surprisingly comfortable in front of the camera. They talk about their deeply personal feelings, memories, insights and strategies. They share practical tidbits of life experience that they've developed in facing all kinds of challenges in getting well, staying well, and coping when they may not be well, all the time. Yes, they talk about what they do when things go wrong. 

They talk about how they wish they could turn the clock back. How they wish they had sought help sooner. How facing the reality of their issues earlier may have saved them years of emotional anguish. Implicit is a sense that they want to help you to be more open to yourself, more honest. To refrain from denial and speak out. Open up. Don't go it alone.  

"This can happen to anybody and it's very treatable if you recognize it," says Gord Conley. 

We're all changing all the time. Life happens. Nothing stays the same. We all have set backs and they talk about theirs, too. And how they cope. What they do to prevent serious setbacks from reoccurring. All their support systems and strategies, from exercise and watching what you eat to taking your medication or going to regular 12-step program meetings. Whatever it takes. It's up to you.  

They're tremendous likable people and I was overwhelmed by their generosity, bravery, sincerity and courage.

Why? Because they've been through it. They tell you about how they've worked through it, how painful at times this process it. 

Most of all, they tell you and show you how you can feel better. How there is help out there. 

They are the faces of hope. There are lots of different ways to get help and stay healthy. And most of all, they show you that you're not alone.

To be honest, when I first entered the sight, I didn't know where to begin. It's so comprehensive. Initially, you see a selection of titles including What is happening? Why is it such a struggle? and What should I say? and How can I manage financially? and How do I stay well? and more.

I've never been one to begin at the beginning of anything. Being perpetually backward, I chose to bypass the Introduction and instead, headed to the end, to the penultimate section called Never Give Up. That title spoke to me.

I pressed the little orange arrow. A screen popped up and a lovely, pleasant-looking gentleman started talking, followed by another, and then two women. They weren't edited. They were extraordinarily comfortable and easy to listen to as they talked their mental health problems. They looked and sounded liberated. Alive. Free. 

I urge you to click onto Working Through It to see for yourself. No matter how you're feeling. There's so much information for you. Not only from these exceptional people, but specialists. Psychiatrists, leaders in the community who work to provide access to all kinds of support systems.

There's something for everybody here. Whether you are experiencing a mental health problem right now or you know or work with someone who is. University of Toronto Professor of Psychiatry Dr. Anthony Levitt talks about some startling statistics about how many people find the "right" help.

If you take 100 people with depression or anxiety, only 50 of them will recognize that they need help. Only 25 of them will look for that help. They may be prescribed one of 22 different medications or perhaps be offered one of five or six different kinds of talking therapy. That's 25%.

But here's what shocked me. Of that 25%, only 10% will follow through and receive the right treatment. 

You have to work through it. And it's not always easy.

These videos are powerful gems of hope and inspiration. Melonie Long talking about how she cannot believe what would have happened "had I been successful in my suicide attempt..." and now "knowing what joy feels like," brought tears to my eyes.   

You will be able to identify with these people. And there are loads of other resources embedded in this website. It's extremely user-friendly. One of the most exciting online mental health initiatives I've ever seen and experienced, anywhere.

This is another beginning for Mary Ann. "Next, we want to find out how we can help people get the right treatment, the help and support they really need, the first time – whatever it is." 

Think of how revolutionary that will be. And how much needless suffering will come to an end.

Think of how healthy our society as a whole could be. Negative stereotypes will be smashed. Workplaces with thrive. More people will live meaningful productive lives.  

Because we'll all feel more safe and secure Working Through It ourselves, with our families, our friends, our colleagues, our doctors. Everywhere. We'll be more comfortable with ourselves. 

Bravo! Let's spread the word. 

Grading...

Right now, today, I'm living in a nightmare. My own personal trial by fire. It's an ordeal. A struggle. I agonize over it every time I am faced with it. It never gets any easier. I think it becomes more difficult. Maybe it's character-building. I don't know. But it's unquestionably one of the most challenging tasks I ever have to face. 

I'm grading my students. I genuinely like my students. As I grow to know them, more and more. My job is to help them succeed. I tell them that. Again and again. Grading them seems counterproductive to me.

I do not like assigning "final grades" to people. Period. Isn't that what a eulogy is for? Or an obituary? 

How can you put a final grade on a work in progress – a student. I can't pin them down with a final grade and I don't want to. What if I'm wrong? It's possible. I'm human.

My mostly young college students are very vulnerable. They take their marks terribly seriously. They do not yet have the life experience to realize that it's not the mark that really counts, but what they've learned. What they take away with them. What they can apply in their lives – at work, at play, in their personal relationships with the people they know and meet.

"You know, in 20 years you probably won't remember the mark you receive in this course," I always tell my new classes of students in an attempt to defuse their initial concerns about a new course and a new teacher. "But I bet you'll remember what you've learned." 

(I can attest to this. I have no idea what my transcript looked like when I graduated from Seneca in 1971, but I have full recall of what I learned. I can visualize my most outstanding professors and the important lessons they taught are still with me.)

My students look at me incredulously. They don't buy it.

Sadly, for too many of them, marks determine their future. And they're so arbitrary.

A single mark never seems entirely right. It never seems to say enough. It seems unfair.

Do we assign a letter or numerical grades to our sisters, brothers, parents, friends, colleagues, employers and acquaintances? 

"I have an A++++ boss. What about you?" 

"Oh, mine only rates a C+/B-. But she's improving. Maybe next term. We'll see."

Take our politicians. Voting is grading I suppose. Winning or losing is a mark of success or failure. But what does a winning number of votes say about an individual? Other than more people voted for him/her than the other person in the race? I'm a little naive when it comes to politics, I know. But I'm very nervous when I have to apply either a number or a letter grade to a human being. I can't help it.

I don't like competition. Never have. Not when it comes to human beings. (I'm not a sports-buff, so I'm not referring here to games people play. That's different. That can be character-building, depending on the sport. Boxing doesn't fly with me, though. I prefer team sports. But not violent ones. Or golf. Or tennis. I like baseball, too.)

Grading what students learn when they've just finished a course seems rather premature. They should be graded when they've been able to put what they've learned into practice in the real world. A year or two or three later. After they've graduated. And worked for a while. A job is the acid test. A profession.

It would be nice if students could receive a grade of "complete" or "incomplete." But that wouldn't help them in the big picture of their lives – if they want to continue with their education. The post-secondary education system simply doesn't work that way. Too bad. Ultimately grades are for administrators.

So I'm left with my trial by fire every term. I agonize over my eternal conundrum. Is it possible to appropriately and accurately grade or categorize or classify or place a value on a person you see only three hours a week for 14 weeks? Especially the students I teach. Often they're 17 years old and from other countries. International Students. This past term 99% of my Women in Canada students spoke English as a second language. Only one other person besides me in my classroom spoke English as a First Language.

Bear with me for a minute and imagine this. You're going to study at Peking Community College. It doesn't exist, but for the sake of argument, let's assume it does. 

You walk in on your first day and everything is printed in Chinese. Every sign. Everyone speaks Chinese. You are automatically enrolled in a 14-week term of "Chinese as a Second Language" and for 12-hours a week, that's all you do. Study Chinese. 

Then, Bingo. You begin classes where Chinese is spoken and written and everyone around you either speaks Chinese as a First Language, or another language that you don't speak as a First Language – a language other than English.

That's how my students from China, Japan, Pakistan, Russia, Iran, Iraq, India and many other countries feel. My heart goes out to them. You wouldn't believe how hard most of them work and how well they manage to do.

Grading students who are just forming and developing and learning about life seems almost immoral. Unfair. Meaningless. It's a form of pigeonholing that can really be damaging, depending on the individual student.

Isn't that one of the major issues around mental health and psychiatric labels? 

Bipolar Disorder. Anxiety Disorder. Schizophrenia. Hypomania. Depression. 

If I tell you my psychiatric diagnosis is Hypomania, and that's all I tell you about me, what do you really know? About me? Other than the fact that I have no trouble telling you about my psychiatric diagnosis.

A grade is a rating, a classification. A pigeonhole of sorts. Can't the same be said for a psychiatric label or disorder? Yet with psychiatry, where so much is still unknown, the label can be very damaging.

And in psychiatry, once you're pigeonholed or labeled, that's it. Labels stick. You're in the system. Someone may give you another label, too. You'll believe it. You'll internalize it. And that can be very damaging, especially if you begin taking medication. Too often, even the medication may not work for you, because you are unique. Special. An individual with your own experiences, your own body chemistry, your own uniquenesses.

And ultimately, psychiatric labels are for insurance companies, I suppose. Administrators. 

By definition, a label or classification is restrictive. But labels are often inaccurate, and in psychiatry, this is all too commonplace. How many of us have had multiple diagnoses? After all, you're dealing with diagnostics in an imprecise science. They're far more imprecise than a grade in college which sums up a student's classroom performances and behaviour over more than three months. Their assignments, class activities, interactions, attendance and punctuality, questions, concern, tests, exams.

As well as, you can learn a great deal about a student's individual complexities, their extraordinarily diverse cultural and personal perspectives and their backgrounds in the learning laboratory of a classroom.

Why, compared to giving a human being a psychiatric diagnosis, grading a college student seems like a walk in the park.

In school, you can at least change your Grade Point Average or your letter grade with hard work, if you really apply yourself. You can raise it. Improve your prospects. Often there's lots of help available to you.

"I've got a 3.5," one of my former students told me the other day. "Not very good," he said, sounding dejected. Confused. Lost.

Like someone who says, "I have bipolar disorder."

Whether it's a grade or B+ or C+ or a label like bipolar disorder or depression. What does it tell you about an individual? I ask you.

Does that tell you what this person has learned about life or a particular subject? What this person loves to read? Does it reveal their personal ethics and morals? Does it tell you who this person loves and cares about and cherishes? What this person likes to do in his or her spare time? What she or he wants to accomplish in life? What his dreams are? What her hopes are?

If you have a GPA of 3.9 it means you're a good student in a specific course. You write exams well and know all about how to do academic research papers. You have a set of skills at which you can perform in a classroom. 

But what about meeting deadlines in the real world? About respecting your co-workers and their concerns? About being a good citizen?

Does a 3.9 GPA indicate you'll be successful in life? Read Malcolm Gladwell's Outliers for an intriguing perspective on that question.

The same goes for a psychiatric label. It's a pinpoint on the course of life, a judgment made by an individual psychiatrist based on a collection of criteria – the DSM-IV and soon the DSM-V. People write the DSM criteria. Psychiatrists may have their own agendas. 

We are all human. We make mistakes. We're always changing. Evolving. Growing. Learning. And surprising ourselves and others. I'm always curious about people, waiting hopefully to be pleasantly surprised. Often I am.

Our outside appearances may not change all that much. But our minds are constantly in flux. Like kaleidoscopes. Beautiful fleeting refracted images of coloured glass that are never, ever repeated. Never the same. Unique. Like us.

That's why grading is so painful for me.