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

Angela is a seven!

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

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

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

THE ITALIAN PIONEERS OF ECT

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

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

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

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

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

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

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

ECT TAKES TIMES

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

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

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

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

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

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

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

MY SIDE EFFECTS FROM ALL THIS "ECT"

This morning I slept in.

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

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

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

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

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

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

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

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

So, I hope you'll understand. 

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

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

Puppies. 

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

Have a great weekend.

Speak soon!

ECT on Angela's mind and mine...

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

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

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

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

"I hate this!"

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

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

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

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

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

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

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

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

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

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

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

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

Time will tell.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

"Hope you're having a good day!"

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

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

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

I suspect they'll have lots to discuss.

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

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

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

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

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

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

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

"NO SIDE EFFECTS AT ALL" 

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

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

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

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

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

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

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

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

I asked her about her appetite.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Let's see what happens.

THE ANTI-PSYCHIATRY MOVEMENT ATTACKS

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

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

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

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

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

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

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

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

If only more people did...

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Angela thought it tasted like gasoline.

"Then I was out," she said. 

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

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

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

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

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

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

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

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

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

I asked her how her memory was.

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

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

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

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

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

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

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

 

About "The Americanization of Mental Illness" and then some...

What a week! 

It began on Sunday when I read a fascinating and provocative critique of the global influences of Western psychiatry by Ethan Watters titled The Americanization of Mental Illness in the Sunday New York Times Magazine,. Great title.  

I went through that piece initially on Saturday night online, when my friend Susan, a New Jersey-based bipolar blogger emailed me about it thinking it might be a good story to write about here.

Her email arrived while I was madly preparing for my first classes at Seneca College that began this week, so I decided I'd read this lengthy feature more carefully in print with my hard-copy of The Sunday Times the next morning, which I did.

Still, it started percolating at the back of mind. Though I expected the blogosphere to light up with comments, it didn't, as far as I could tell. Only Gianna Kali at Beyond Meds mentioned it and linked to it.

Reading it on Sunday morning in print, I penciled it up like a student preparing for a class. I found myself feeling comfortable and at ease, repeatedly nodding in agreement. After all, many of the points Watters makes, I've made here numerous times. 

Then at 5:11 a.m. Monday morning, as I was getting ready to leave for my class, my niece who teaches philosophy at a northeastern university sent me a link to it.

"hi sandy," she wrote. She never capitalizes in her missives to me. "did you see this? i haven't finished it yet  but it is very interesting and i think i'm going to include it in my emotions class..."

Interesting. Then, a red light went on in my mind. 

I started asking myself questions. I was beginning to wonder if there was something missing in Watters approach to a series of highly complex issues. He's a San Francisco-based published author and journalist with interests in cross-cultural psychiatry, anthropology, globalization and psychology, according to his blog. 

Does he have a psychiatric diagnosis, I wondered? I couldn't find any evidence of it, but to be honest, I didn't spend a great deal of time looking. I didn't have the time. I was racing against the clock trying to finish my course prepping.

Since Watters was so critical of American psychiatry, I decided to ask an American psychiatrist what he thought of this essay and I whipped off a series of questions to my friend and muse, my font of knowledge and wisdom, Dr. Ron Pies, Tufts University clinical psychiatrist and researcher and Editor-in-Chief of Psychiatric Times, the largest international online psychiatric magazine on the planet. 

Ron also contributes to The New York Times, The Boston Globe and PsychCentral's World of Psychology as well as endless psychiatric journals. 

I've devoted a number of posts to him here, too.  

Then, at 6:45 a.m., nervously, I drove off to school for my first class of the term – an 8 a.m. Monday class – a students' favourite. 

This is the first of my two Seneca classes. Twenty-two out of 35 students showed up and they were jittery. Not only because of today's Ontario Community College OPSEU province-wide faculty strike vote (I'm not in the union as a part-time teacher, so I'm not voting, by the way) but because of my course and what its demands will mean for them.

It was a good class. When I got home, I continued my correspondence with Ron. What a wild few days.

Yesterday at another Seneca campus at 1:30 p.m. I went through the same nerve-wracking experience with another 35 students.

Why nerve-wracking, you ask? 

Because I teach an elective course, required of all Seneca students who wish to graduate, no matter what program they are in, and I have a very diverse groups of students. Lots of business students of every stripe from administration and financial management to marketing and accounting, plus fire protection technology, early childhood education, library technology, fashion and any other of the dozens of programs Seneca offers. 

My classrooms look like a mini-United Nations. It's extraordinary. Teaching is learning, and I swear, teaching an elective at Seneca is a post-graduate degree in itself.

My course is called Leadership in Society and it is for college students who want to make a difference – more than money. It's what I do here. It defines my life today.

This course has become a life-changing experience for many of my students. It combines leadership training and Community Service-based learning, a growing movement in North American colleges and universities. In my course, 30% of their final mark is based on a major Community Service Project requiring each student to do a minimum of 20-hours of community service over a period of three to five consecutive weeks with a non-profit organization – in addition to their full academic load. 

They learn to write reflectively, keeping weekly journals. They must go out and find and interview a community leader. I teach them how to conduct an interview.

It's a major commitment. The subtextual prerequisite is that they care about making changes for the greater good of the community or society. Many students do. Others don't but learn to care, and often they continue their community service long after the course ends.

This is my course. I was asked to develop it in the Fall of 2007 while teaching Women Studies and I've been teaching two classes every Fall and Winter term since. It's a work in progress. In constant development. I've made a lot of mistakes but I've learned more than I could ever imagine.

I love teaching this course. It's my passion because, like creating and writing Coming Out Crazy here at HealthZone and exchanging ideas and community-building with you, teaching and learning are what I love to do most. I'm happier with these two part-time jobs, than I ever was in my full-time journalistic career. I make less money. I have no benefits. My life is rich, rewarding, meaningful and endlessly challenging and exciting. 

Proof that making a difference and having true meaning in your life is more rewarding than a huge bank balance. All you need is enough. Thank you, Daniel H. Pink! He happens to be one of my resources for my course.

Yet this course is often a very tough sell to the students. Yesterday, in one of my classes, I had 35 students registered. They arrived late. They didn't want to do Community Service and were very vocal about it. They were also so disruptive during that class, I came home with a backache, a headache and a stomachache. Thoroughly spent. No energy to write this post. 

I've learned that disruption in a classroom is contagious. A few can destroy the class culture for everyone. I was so stressed out, I had a snack and went to sleep at 5:30 p.m. worrying about how I would be able to manage this group for the next three months.

I felt awful, even though Ron Pies had blogged about the Watters piece himself and cited me and another doctor as having inspired it.

"Thanks for providing the 'spark'! --- Best, Ron," he wrote in an email at 4:45 p.m. yesterday.

I was a mess.

Sometimes I think the ongoing stresses of everyday life are insidious and potentially dangerous. Their relentless pressures hammer away at you, again and again, week-in and week-out. They're cumulative and more difficult to live with and manage that annual stresses like Christmas or peak stresses like having to move to a new home or the shock of losing your job or even experiencing the death of someone dear to you.

Their repetitive onslaught on our minds, spirits and bodies is doggedly destructive and distressing. 

Yesterday night, I was devastated. Then, just before I went to sleep, I checked my class lists. All those disruptive students had dropped my course. My class list was down to 29. 

So, on Friday, I will share with you my concerns and what I've learned about "The Americanization of Mental Illness..." I promise. I'll share some of the correspondence I had with Ron Pies, with whom I do not always agree, by the way. How could we? I have a 49-year psychiatric history. I'm Canadian. He was a toddler when I went to see my first psychiatrist in 1960. He's also a polymath with interests in philosophy, Talmudic studies, poetry and ethics. He's published widely and not just psychiatric texts but a wonderful book I give as a gift called Everything Has Two Handles – The Stoic Guide to the Art of Living (Hamilton Books, 2008). He's one of the wisest people I know, but we come from very different places. Yet we respect each other. I adore him.

So, today, I'm decompressing and planning my classes for tomorrow. I teach at two campuses every Thursday. I have 100 minutes to get from one campus to another. It's tough, when your students need you and want talk to you!

I pray that it does not snow on Thursdays this winter.

Be well. Stay warm. Speak soon.

You...

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

WITHOUT YOU, I WOULDN'T BE HERE

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

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

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

I REMEMBER HOW ANXIOUS I WAS COMMENTING FOR THE FIRST TIME

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

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

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

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

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

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

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

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

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

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

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

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

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

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

And ponder, I did. I love pondering.

YOU GIVE ME SUCH RICHES

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

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

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

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

Be good to yourselves and speak soon.

Beginning MMX with Recovery...

Hello! I've missed you. I'm happy to report that during my break there was some action in the comments which always warms the cockles of my heart. Thank you. What a lovely gift they were and they kept me on my toes.

I hope you are well and thriving now that the 2009 holidays are history. I hope they were smooth and whizzed by without any major bumps. Now you can look forward to Family Day, our nice innocuous statutory holiday on Monday, February 15, the day after Valentine's Day this year. A real double-header. It coincides with Presidents' Day in the U.S.

For those who are given this day off, it will be a lovely mid-winter day to relax, recharge, go to a movie, ski, snowboard or simply snuggle up with a good book. 

I feel in my gut that MMX, as the Roman's would say, is going to be an exciting year. As soon as it starts for me. Gut is the operative word here. Mine is not in terrific shape at the moment.

You see, it's been a long, hot (as in high temperature, mine) holiday in our house, mainly because I've been sick. Still am. You don't want to know the details, but let us say that "rest" is what the doctor ordered and "rest" is not one of my strong suits. In school, I would fail "rest" and I would ace multitasking. 

Oh well. That's the story.

There is an interesting item in today's New York Times by one of my favourite mental health writers Benedict Carey. The headline says it all – Popular Drugs May Help Only Severe Depression. By no means a new story, it's based on a new report published today in The Journal of the American Medical Association. 

It certainly supports the strong contention I have about quick-fix, pill-popping approaches to mental health recovery. For cases of severe depression, this report finds quite conclusively that antidepressants are substantially more effective in cases of severe depression than in cases of mild or moderate depression.

This has been debated for some time and now a large and wide-ranging randomized study has come up with some conclusive findings. I have always sensed this to be true and further, than when antidepressants are prescribed, psychiatrists should be monitoring their patients closely and talk therapy should be part of the healing regimen. It is no secret that pills without therapy are never as effective as pills in combination with therapy. And that doesn't mean "a 15 minute appointment and prescription." That's not psychotherapy.

Carey sites Dr. Erick H. Turner, a psychiatrist at Oregon Health and Science University, who says, "I think the study could dampen enthusiasm for antidepressant medications a bit, and that may be a good thing. People's expectations for the drugs won't be so high, and doctors won't be surprised if they're not curing every patient they see with medications."

Dr. Turner adds, "The findings shouldn't dampen expectations so much that people refuse to even try medication."

Turner's last comment intrigues me. Mental health issues like depression are treatable, yes. But curable? Such a curious word for what most medical doctors consider mental illnesses to be – namely chronic, "like diabetes." Oh, how I hate that comparison.

One can go into recovery through medication, therapy, peer support, the process of self-actualization through meaningful and fulfilling work and having a stable family and home life. Recovery is a process. Not a pill. Not a cure. It's ongoing. It means many things, as I have often written. Have a look at The 10 Fundamental Components of Recovery from the U.S. National Consensus Statement on Mental Health Recovery. 

Among them: Self-Direction, Empowerment, Peer Support, Respect, Responsibility and Hope. Similar to those underlying fundamentals of recovery at The Krasman Centre in two locations just north of Toronto. These centres are staffed completely by people in recovery from mental health issues. 

As I reported last year in my story about mental health recovery in The Walrus magazine, "Today recovery is a fully realized and internationally recognized approach to attaining wellness... Still, it's hard to pin down an exact definition of recovery. 

"Tanya Shute, the executive director of Krasman and a survivor, describes it as 'a person's ability to self-actualize, with or despite one's mental health experience.' Elaine Amsterdam of Toronto's Gerstein Crisis Centres says, 'It's about living well,' adding, 'The meaning of that is different for everyone and can include a range of different approaches.' 

"But the whiteboard that hangs on the Krasman Centre's kitchen wall (in it's Richmond Hill location) notes five key concepts in indelible black ink: hope, personal responsibility, education, self-advocacy, and support."

We must all find our own way and it is that processing that we can begin experiencing recovery.

As Carey stresses, in some cases certain antidepressant are very helpful, in severe cases of depression. In his story today, he concludes with the words of one of the team of researchers in this study which included psychologists "who favour talk therapy and doctors who consult widely with drug makers."

On is Dr. Robert J. DeRubeis of the University of Pennsylvania, who stated, "The message of patients with mild to moderate depression is, 'Look, medications are always an option, but there's little evidence that they add to other efforts to shake the depression – whether it's exercise, seeing the doctor, reading about the disorder or going for psychotherapy."

This is such a positive message. Depression which isn't severe responds to many different and very accessible approaches, not the least of which is knowledge and understanding, learning about depression, facing it plus, peer support, doing things that make you feel better which can be anything from reaching out to an organization like the Mood Disorders Association of Ontario or joining your local community centre and signing up for Belly Dancing classes. Taking a class in Mindfulness Meditation, perhaps, or knowing when the best medicine is a lovely warm bubble bath or listening to your favourite music or a walk in the park with your dog or with a friend or with your thoughts. 

Recovery is within reach. As long as you're willing to reach out.

Isn't this going to be a good year? Full of hope.

Now, I'm back to my bed.

Speak soon and be well.

Focus on family and friends this Christmas...

Welcome back to our Coming Out Crazy Christmas stress coverage to help you through this 2009 holiday season and ease you into a New Year and a New Decade!

Yesterday I mused about Christmas partying and social stresses and I hope you'll contribute by adding your thoughts in the comments. Remember, I'm a bit of a novice in all of this, being Jewish.

Today, on Christmas Eve, I'm focusing on family and friends.

If you have lost a close member of your family this year, all your family Christmas traditions will seem tinged with memories and a subtext of sadness. It's natural, but poignant and very difficult the first year. My heart goes out to you. 

Then, there are the family gatherings. If they're few and far between, only a couple of times of year, they can have their challenges, too.

Compared to Christmas cocktail parties, family Christmas parties pack special stresses. 

Consider this comparison. Venue is everything. Christmas cocktail parties are not for serious conversations. Dinner parties often are.

Christmas cocktail parties are often all about superficials. Appearances. Especially crowded house parties where no one can move or carry on a meaningful conversation. Or where everyone's drinking, as they are wont to do at this time of year and trying hard to have a grand old time. Maybe even drinking to mask their anxieties about seeing people they haven't seen for a long time. It's always a little nerve wracking.

A trick I've learned is to focus outward, instead of inward. Ask questions. Be curious. Interested. This is very flattering and puts anyone in a good frame of mind.

As a teetotaller, parties at this time of year make for entertaining but socially isolating party viewing. There's not much significant social interaction. But most people go to Christmas parties to relax and "let go" – not for "significant" social intercourse. "Insignificant" intercourse, perhaps.

Christmas dinners are different. They're either tonight or tomorrow. Perhaps all weekend. They're potent and concentrated. Even if there's a general feeling of goodwill in the air and most of the time, people are happy to see each other.

Except if you have family issues – old hurts that haven't yet healed. Or if all the "old records" play. You know what happens when you return to the family roost. You may be 35, but somehow you start behaving with your siblings like you're 14. Old rivalries die hard when you're back in the nest. 

Then, even a Christmas dinner can be an emotional minefield.

How can your gird your emotional loins for this stuff?

All I can suggest is to keep smiling, be polite, stay closer to the mistletoe than the bar and beware of the eggnog. Alcohol lowers inhibitions and loosens tongues. I've learned the hard way that at family functions of any kind, often I have to walk on eggshells. It's not always easy, rarely fun, but it's safe. 

Keep in mind that Christmas is just for one day a year.

Finally, there's always the food. Food is a great help. Keeping your mouth full prevents you from saying things you may regret or that may be misinterpreted. (Unless you tend to talk with your mouthful. This is not recommended. Family lore will dine out on you for years if you do.)

At Christmas Dinners, whether sit down or buffet, it's all about the food and trust me, I know about food-oriented fetes. Every Jewish Holiday is really all about the food, except Yom Kippur. That's about fasting. But Erev Yom Kippur and Breaking the Fast are all about food. Passover Seders are all about foods without flour. (Fluffy matzoh balls, for example. God help you if they're like little golf balls. The family will never forget it.) 

If you are spending Christmas Day with friends, that might prove a little easier.

For me, sit-down Christmas dinners are a breeze compared cocktail parties and buffets, no matter what's on the menu. Seat me at an exquisitely set table with my name on a little card and nine others around me, even if they're people I don't know well, I'm happy. I'm temporarily at home. I can easily engage, converse and find emotional and gastronomic fulfillment. I become rooted for the evening and that's good for me.

Everything tastes good at Christmas, too!

Especially the meaningful conversation that can be sampled around the Christmas table. This is my kind of fun. Not cocktail talk. I have no skills at small talk. I'm a big talker. You can discuss the issues of the day at a Christmas dinner. You can be clever and quippy if you wish. You can celebrate the growth and development of the resident children and watch them mature with each passing year. After all, isn't Christmas all about the children? They're wonder. They're joy.

In the back of your mind you know that much of the world is taking a short, 24-hour Christmas break. (Except for people who work in essential services working for double time and a half, if they're lucky. And soldiers, who never can relax.)

It's a comforting feeling. I have attended the same Christmas dinner for the last 26 years with my closest friend, her family and friends. All the same usual suspects, year after year. Children who were six and eight are now married young professionals. I love seeing them at Christmas.

In 1999, when I met and and then a year later married Marty, he was instantly included and adored. Christmas night is the one night every year we always anticipate with relish. I enjoy having someone to hold my hand on the icy streets, though we're rarely seated together at this beautiful meal. It's always lovely to have a partner at a party and for me, this is a very new experience. It only took me 50 years. 

These days, I have other social issues. Because of my serious hearing loss, my two behind-the-ear hearing aids are problematic at parties of any kind. They amplify everything, so a social gathering of more than 10 becomes isolating. I hear only noise. But, I'm a great listener and I lip read brilliantly. So, life is good.

Give me a Christmas party any day over sitting at home or in a psychiatric hospital room, alone. I've done that, too. Health really is the greatest of all gifts. I choose to minimize the importance of stress. To focus on the positives. It's all in the attitude.

Ultimately, I am very grateful for all I have. For my family, Marty's grown daughters, my relative health and most of all, for you. What a gift you are in my life. What a gift this blog is. A whole new world has opened up to me. The Toronto Star and my new friend and fine editor Brandie Weikle who has offered to publish my posts all through the holidays, while she's off work and at home with her young boys.

How lucky can you get!

So, tonight, Christmas Eve, I wish you all well. I wish you health and friendship and companionship. I wish you the most important life force I can think of – the gift of hope and recovery.

Merry Christmas and don't forget to click on the official NORAD Santa Tracker. Your children will love it and the child in you will love it, too. 

Think fun. It's only one day a year. You'll be fine. I know it.

Tomorrow always comes. See you next week!

Smile. It helps. Smiling is contagious.

With affection and gratitude and all the best for the season,

sln

Sleeping throughout the holidays...

For the last few days, I've been feverish. About 100 degrees Fahrenheit. Nothing serious.

I'm just not feeling my best. Maybe it's cabin fever since I've been stuck here with all my papers to grade and my final marks to compute. (Every mark represents a student. If they don't pass my course, they may not be able to graduate when they expect. So it's not just numbers, I'm playing with people lives and it's stressful, trust me.)

I've been here for four days straight. Other than a 7 a.m. dentist appointment Wednesday morning, which wasn't exactly a "ringy" dingy time, I haven't felt well enough to run over to my community centre gym to work out. Not once. And I not only feel guilty about that, I feel sluggish. On top of feeling stressed out.

So, in Part Three of our series on How to handle holiday stress – a short post because I'm not feeling up to scratch and still marking papers – I want to remind you to take care of yourself during the holidays.

It's easy to get run down and to forgo sleep. Don't. You'll enjoy your merrymaking more when you're well rested, so click here for some helpful tips. Understand sleep and why it's so crucial to your overall mental health and well-being. When you're well rested, you make wiser decisions and you tend to be in a healthier mood. So, make an effort to sleep and recharge. Here are some more tips for a Good Night's Sleep.

Stress doesn't help and there are stresses we haven't yet touched on, like the stress of family gatherings during the holidays and how all those "old records" always seem to play when you're back in the family fold, with sisters and brothers, in-laws, and all their progeny. Big gatherings. It's so easy to fall into old patterns of behaviour. Sibling rivalries sometimes flair.

We'll tackle that one next week.

Now, I'm going back to my marking. I'm putting the holidays on hold until all this work is behind me. My deadline is looming.

*    *    *    *    *

Just a quick reminder... please send in your memories, comments and concerns. 

Share with us. 

Perhaps this Christmas is going to be especially difficult because you've lost someone you love during the last year. Share your thoughts here. 

Perhaps you have some special tips for lessening your feelings of harassment during the final days before Christmas. 

Perhaps the let-down following Christmas is particularly challenging for you.

Share those feelings. Chances are, if you feel them, lots of us feel them.

Here is the place to let it all hang out.

I'm not taking any time off. I'll be here. So talk to me – to us. To the whole community. 

We're listening. We can help each other. That's why Coming Out Crazy exists. To be here for you.

Take care.

And sleep tight!

When holiday and employment stress collide

This weekend we went to a suburban Cineplex Odeon Silver City for a late-Sunday afternoon screening of the multi-award nominated new movie Up in the Air, an up-to-the-minute recession-era story, if ever there was one.

The theatre was packed.  

So, you must be wondering ...

In a post dealing with holiday stress, why am I musing about a George Clooney star-turn in Jason Reitman's latest Oscar–buzzing Hollywood film?

How does this sardonic slice of a professional downsizer's life relate to the stresses of the season? Where's the "holiday" message in this sharp-edged portrait of a self-described shark in constant flight around the country firing people for profit and for corporate execs who haven't the guts to do it themselves?

If you've read anything about this movie – it world premiered at the Toronto International Film Festival this past September – you know it's somewhat docu-dramatic. Bookended by clips of "talking heads" reacting to the news of their professional demise, you can't help feel for them – and for good reason.

They're not actors. They're for real. 

Last January, Reitman interviewed these freshly "terminated" workers in St. Louis and Detroit, on location. I knew this backstory going into the theatre on Sunday afternoon, but it delivered an unexpected emotional double whammy for me.

Seeing these people gigantically magnified on the big screen, smashing away at desktops, breaking down in tears, I kept thinking about them now. Today. Eleven months later. In the back of my mind, while their lives were really disintegrating in front of us, I kept wondering about them and the thousands of people like them, right now, all around us. Everywhere.

Not just statistics. Real people. Really laid-off. What are the stresses they're feeling this holiday season?

This was the movie's subtext, for me. 

Are they struggling to hold onto their homes? How are their families managing? Their kids? How is their mental and emotional health this Christmas 2009? 

When you lose a job, you lose your identity, your confidence, your self-esteem, your daily routine, your purpose, your raison d'etre.

"It's like a death," as one man in the movie describes how being downsized feels.

Losing your job, after 10 or 20 or 30 years, is like losing your family, another man said, obviously in shock. 

Isn't this season all about family? Friends? How can you celebrate when you've lost a huge chunk of your life, not to mention, your livelihood?

I thought about that, when I left my secure, full-time job after 30 years, on January 26, 2007. It was my choice, but still, I had nowhere to go. I felt rudderless, alone, isolated. Out of sight. Out of my work family's minds.

You spend five days a week working with your workmates and colleagues, more time awake at work over a lifetime than you do with your children, your spouse, your parents, your siblings and your friends.

It can be treacherous putting your life back together after it's been ripped away from you, any time of year, but especially at this time of year. 

You have to keep reaching out. Even if you'd rather wrap yourself up in your flannels and bury yourself under the covers 'til Spring.

Yesterday afternoon, I called one of my dearest friends, to say hello. 

"Oh, my daughter and I are in the middle of baking," she said sounding slightly breathless and quite stressed. "I'll call you later."

She didn't. That's okay. I'll call back. She bakes for her church. She gives of herself all the time. Her time. She's widowed. She takes anti-depressants and she has a strain of leukemia she has to keep an eye on, but she keeps on going and keeps on giving.

That's one way to manage holiday stress. Concentrate on giving your time to people who may benefit from your care and compassion. 

Instead of sending an email, pick up the phone and call someone. There's nothing like the touch of your voice.

Smile as you run about doing all the things you're stressing out to do. There's nothing like the warmth of your smile. That warmth is contagious. Strangers smile often back.

Life is for the living and the giving. Right now.

That's one way to deal with holiday stress. Turn your energies around a bit, if you can. All the experts on coping with stress say the same things.

Don't wait to do what you really want to do for someone else. One of the best ways to deal with stress any time of year is to plan, be realistic, give of yourself and take care of yourself, so you can take care of all the things you want to do for the people in your life.

Simplify.

"The holidays and Christmas are a time to take a good look around you," psychologist John H. Grohol wrote on his World of Psychology blog on December 13, 2003. His message is universal and timeless. Wise.

"The holidays are about finding something spiritual and wonderful about yourself, your life, and the people who fill it and make it special. Not to just give thanks or show appreciation through some materialistic and commercial sense, but to understand that you have a lot. Despite everything, you are alive, relatively well, and have a life filled with people that love you. 

"Yes, you may not realize it or even believe it to be true, but it is nonetheless. You may feel unlovable, unloved, unhappy, stressed out. But those are the simply untruths we tell ourselves every day. The frequency of the telling doesn't make them come true."

*      *      *   

"Just writing this helps," wrote Carole in her comment on this special series we're running here for the next few weeks on How to handle holiday stress – to help ease you through "the season." 

So, keep your comments coming. Share your memories, your concerns. Give a little. Anything that's on your mind. You'll feel good. It's therapeutic. Cathartic. Generous.

I'll respond. It may take me some time – I'm madly stressing out over my end of term marking – but I won't forget.

I'm here and we're all in this together.

Cheers.

---

More reading:

Part 1: Dealing with holiday stress 

Our round-up of stress-management tips for the holidays