Angela is good...

THIS MORNING, FOR THE FIRST TIME, ANGELA SAID, "I FEEL GOOD." 

Her statement was spontaneous. Her voice sounded bright and buoyant. After her ninth Electroconvulsive Therapy treatment yesterday and a good sleep last night, this morning at 9:30 a.m. Angela said, and I quote, "I feel good."

This is a first. She's never sounded so emphatic. So vigorous. 

Yesterday, she mentioned that she couldn't remember much yesterday about "going under" with the anaesthesiology during her 7:30 a.m. session at Toronto's University Health Network, other than the fact that the doctor's resident administered the anaesthetic. 

"On Monday, the resident was there watching. Yesterday, he did it and the anaesthesiologist was observing. Afterwards, I couldn't remember very much about it, but now I do," she said.

Thus far, any memory loss she's experienced during her eight or possibly 12-week course of bi-weekly ECT treatments that began five weeks ago on Monday, January 25, has lasted no more than a few hours. Routinely she's described it as "a tiny bit of confusion" more than actual loss of memory.

A CURIOUS PATTERN

Earlier this week, Angela admitted that on the days of her bi-weekly ECT treatments, she's noticed a curious pattern. She has short, momentary flashes of suicidality. Only on those days. Only right after the treatment. It's minor, but definitely present, she said.

"Nothing serious, though. And usually, I just go to sleep. I'm really tired after each treatment," she said. "When I wake up, those suicidal flashes are gone completely."

She confided to me that she thought, perhaps, these short-term suicidal flashes might have more to do with the anaesthesia than with the ECT. "I'm going to talk to my psychiatrist about it," she said.

FLASHES OF SUICIDALITY CAUSED BY THE ANAESTHESIA – NOT THE ECT

When Angela did, her psychiatrist thought it might very well be possible. Why wouldn't this reaction might be caused by the way Angela's unique body chemistry or metabolism reacts to either the muscle relaxant succinylcholine and/or the Sodium Pentothal, the rapid-onset, short-acting general anaesthetic, or the combination of the two she receives intravenously every times she has an ECT treatment.

"I don't know if there's any validity to this," Angela admitted this morning.

"If it's valid for you, then it's valid," I countered.

I reminded her that we're all different and we all react to drugs and medical procedures in our own unique ways. That's why there is nothing purely objective about most of medicine, and especially psychiatry.

She admitted that she's getting a bit tired of waking up at 6 a.m. twice a week to get to the hospital at 7:15 a.m. Angela is always early. Whenever we've had a "date," she's always waiting for me when I arrive. 

ECT DOESN'T SOLVE PROBLEMS OF EVERYDAY LIFE – IT HELPS YOU COPE 

Although she knows that ECT doesn't solve marital problems or other varied vicissitudes of everyday living, "it helps you cope with them better," she's finding. "I'm not having suicidal ideation all the time, and that's a huge difference. And I'm not going to kill my cat for pissing all over the floor, though I have no idea why he's doing it and neither does the vet."

I suggested that maybe he (her cat) is reacting to her change of mood. She laughed.

She told me she's thinking of retraining. Of going back to school. Perhaps studying interior design. Angela has started painting, along with her sculpture. "But I'm having a hard time finding what I want to paint, right now. I find I'm pretty abstracty."

We signed off with a possible plan to meet this coming week for lunch.

I'M ON READING WEEK STARTING NOW!

I'm on Reading Week! Hurray! And there's no Community College Strike. 

This week, all I have to do is mark over 100 journal entries and 52 midterm exams. Plus finish the final editing of the book of my late father's war stories that Marty and I wrote and edited this summer.

And, surprise, surprise. Lucy's breeder decided at the 11th hour to breed her with my male Riley's son, Charlie.

SURPRISE! WE BRED LUCY THIS WEEK – AT THE 11TH HOUR

Last Sunday, at 2 p.m. whilst putting the finishing touches on my midterm examination, on 10 minutes notice, I sped up to Uxbridge so little Lucy could have her romantic tryst with this fabled stud. 

Charlie, who is just three weeks older than Lucy, is a Canadian and British Champion and the top sire in England last year. He's never been bred in Canada until now. We're crossing our fingers that this breeding will take. We repeated the process on Monday, right after my 8 a.m. class. 

After doing two "Olympic" Review Quizzes for Gold – I used two medals Lucy won in her obedience class – and two midterm examinations, my classes came to a close yesterday afternoon at 2:30 p.m. I'm off until Monday, March 8 at 8 a.m.

Can you understand why I'm exhausted? 

So, all this to explain that I'm taking next week off here, too. I will continue monitoring Angela and her ECT treatments. I want to be able to see her if I can, between all my marking and editing. I feel I need a little holiday. Because of a possible strike hanging over our heads until Wednesday, this has been the most stressful term for both students and faculty.

Now it's resolved and I can relax, a bit.

THIS WAS A WEEK OF PURE MADNESS!

What a wild week I've had. So, I'm off. I've been binging on chocolate. Eating badly. Sleeping sporadically. My entire system is off. It's 11:45 a.m. and I haven't even eaten breakfast yet. Or taken all my pills. My darling, overworked, endlessly supportive editor Brandie Weikle is off next week, too.

So, have a great week. I'll see you after Monday, March 1st, with Spring just three weeks away!

Comments to Coming Out Crazy are always open to you, and you're welcome to carry on a free-form dialogue. I love them and live for them.

You don't need me, though I'll probably be watching, maybe even contributing. Or not. Depends on how I feel.

Truly, I am bone-tired. I need to rest. This has been a trying time. 

I long to read for fun. 

My breeder was clearing out her library and she gave me free rein, so I've come home with a potentially pregnant Dandie Dinmont Terrier. (This is a seriously endangered species and there are several wonderful families anxious for puppies. So keep your fingers crossed and send positive thoughts, please.) 

I've also brought a shopping bag full of old-or-precious-or-new-to-me books, including a yellowed, 1937 edition of Gone With The Wind, the first-ever adult novel I read in grade five, after everything L. M. Montgomery ever wrote. 

Also, I have a slender volume published 1968 and titled "The Last Will and Testament of ..." an intriguing selection of 27 celebrated men and only one woman from John F. Kennedy to Marilyn Monroe to Albert Einstein to Ernest Hemingway to Shakespeare to Hitler to Pope John XXIII and on and on. 

Can't wait to dig into them! And not one of these books concerns Electroconvulsive Therapy. Yipppppeeeeeeeee!

Be well. Take care. Spring is closing in on us, despite the snow.

xox

s

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

I am no expert on Attention Deficit Hyperactivity Disorder. 

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

• trouble maintaining focus or often being distracted

• lots on the go but nothing ever finished

• perpetual financial problems

• piles of paperwork scattered around home and office

• poor listening skills and talking excessively

• impulsive behaviours

• impatience

• frequent traffic accidents or routine speeding

• difficulty maintaining friendships or romantic relationships

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

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

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

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

ADULT ADHD IS REAL AND NOT JUST FOR KIDS

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

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

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

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

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

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

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

WITH TREATMENT FOR ADHD HIS LIFE IMPROVED DRAMATICALLY

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

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

ADHD IS MUCH MISUNDERSTOOD AND MALIGNED

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

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

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

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

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

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

THE NEW ADD WEBSITE IS FUNNY. ENGAGING. TERRIFIC.

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

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

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

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

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

UNDERSTAND YOUR STRENGTHS AND WEAKNESSES

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

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

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

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

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

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

*   *   *   *   *

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

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

How my dogs safeguard my emotional health...

In May of 1966, when I was 18, my mother decided having a dog would be good for me. 

I had just been discharged from Toronto's Clarke Institute of Psychiatry (now the College Street site of the Centre for Addiction and Mental Health known as CAMH) after a seven-month hospitalization. 

Around Halloween of the previous year, I had become psychotic for the first time in my life. My diagnosis was schizophrenia, though I was unaware of this, as was my family. I have very vivid, colourful memories of my behaviour at that time, what I was doing and saying, and why I was admitted, but I'm not going to describe them right now. It would take too long. Another time. 

After all, this is a dog story.

HOW DOGS HAVE HELPED TO KEEP ME EMOTIONALLY AND MENTALLY STABLE

More importantly, it's a story about how dogs have helped to keep me emotionally and mentally stable for many years. Still do.

Around Christmas of that seven-month hospitalization – my longest ever – I became catatonic. I have no recollection of anything from one evening, when I was supposed to go on a tour of the Christmas lights with a group of patients until Easter of the following year. Four months are gone. Blank! 

During March and early April of that blank period caused initially by the catatonia, I had my first course of Electroconvulsive Therapy. It snapped me right out of my catatonic state and brought me back to life. I recovered quite quickly, and in May, I went home – but I was very emotionally fragile.

So my mother decided that it would be therapeutic for me to have the responsibility of taking care of a dog. We had never had a dog in our family. I am the eldest of three girls, but my father wasn't very fond of dogs. Somehow my mother convinced him that the care and feeding of a dog would be a positive focus for me. I had lost a year of school. I remember feeling lost and out of sync with the world. Reluctantly, my dad agreed, as long as this dog was small.

We didn't know very much about dogs. My mother had grown up with them. That's all. My sisters were not terribly interested. So, my mother and I went to a dog show to case out different breeds. I remember that show well. It was northeast of the city in a huge arena. We didn't watch the show. Instead, we wandered about the huge area where all the breeders were set up to groom and ready their dogs for their individual competitions.

I FELL IN LOVE WITH A ONE-YEAR-OLD MALE YORKSHIRE TERRIER

After much browsing and chatting with dozens of breeders, we decided upon the breed for us – the Yorkshire terrier. One breeder's Yorkies seemed more beautiful than all the others. I can't remember the breeder's name, but I'll never forget her helmet of wild, frizzy, bright red hair. She seemed a little odd, a little eccentric, a little obsessive (as I've learned all good breeders usually are) but she took time to talk to us, while brushing and combing her exquisite little wards. She gave us her card, inviting us to visit her kennel in Oshawa. 

Within a week, we were there. First, we noticed how immaculate it was. Then, I fell in love with a one-year-old show dog. He weighed about seven pounds. He was perfectly sweet. Gentle. A darling little toy. Reluctantly she sold him to us. 

We called him Derrier because he had a silky, tan and black coat made his front look like his behind, but he was always called Derry. He was my first dog and my mother's instincts proved right. I researched the breed and learned to bathe him and groom him. I walked him and fed him. Most of all I adored him. 

Fast forward a bit. We thought Derry would enjoy a companion, so we bought another Yorkie from the Frizzy-Red-Haired breeder. A puppy. He was tinier than Derry and quite assertive. My father named him Fang. After that, we bought a third, Yorkie, a darling and quite daring little female. We named her Kismet, but she was known as Kissy.

Caring and loving these dogs had done its magic with me. I returned to school the following September and stayed relatively healthy for a number of years. Eventually, I went Seneca College, then Queen's University in Kingston, Ontario, and finally Ryerson, excelling all the way.

By 1977, my parents decided to move from our house to a condo. I was still living at home, but had just been hired by The Toronto Sun, so I was ready to move out on my own. Luckily we found a retired couple who doted on our little Yorkies and spoiled them unceasingly. 

I missed having a dog to care for and love. Living on my own, I felt it unfair to leave a dog alone for eight hours a day while I was at work, so I repressed the craving. 

From 1977 until 1988, I was hospitalized 11 times, often in the month of February, for between one and three months at a time. In 1989, I broke down and bought an eight-week-old male Shih Tzu-Poodle-cross, a Shih-Poo. I named him after my favourite journalist, Murphy Brown.

Murphy was the most remarkable dog I've ever known. My "significant other" for 10 years, sharing my bed, until I met my husband, when we became a crowded ménagerie à trois in my double bed. 

MY LITTLE DOG MURPHY NURSED ME THROUGH ALL MY ILLNESSES

He nursed me through all my years of iatrogenic endstage kidney disease (caused by Lithium toxicity), dialysis and transplant. He needed me to walk him and care for him. The routine kept me going. He was also a St. John's Ambulance Therapy Dog, the tiniest in his class and for years, we visited the adolescent and adult psychiatric wards at Sunnybrook Health Sciences Centre. No one else wanted this assignment, but it was perfect for us. Murphy looked forward to our visits and loved nothing more than to lie down on the floor to have his tummy rubbed or to be cuddled in anyone's arms. He seemed to know he could calm and brighten the spirits of those he served.

When I had to put him down at 13 years of age on December 8, 2003, I thought I would die. He was suffering from lymphoma –  losing weigh, not eating and his gums were bleeding. 

After three months of grieving, on February 13, 2004, we brought home our first Dandie Dinmont Terrier puppy, 13-week-old Riley. I adore the terrier breed, always have, but this particular terrier breed is like no other – and it's endangered. 

Riley is every inch a terrier – gorgeous, mischievous, playful – but he's also deliciously sweet and cuddles like a baby for hours, with his head on my shoulder making soft contented little sounds. He is gentle and loyal, with an immaculate pedigree. He became a Canadian Champion in 2005, the fourth top Dandie in Canada that year.

I groomed him, walked him daily and lost my heart to him. He is my dog. My constant companion. And my hobby, too,

In the summer of 2005, a little over a year later, my breeder gave us eight-week-old Lucy. We agreed to give her two litters. Lucy rules this house, though I'm utterly enchanted with her, as is Marty. She's the Alpha Male and a typical younger sibling, although these two dogs are actually cousins. 

She is the friendliest dog I've ever known and having two dogs is a part-time job, but I find the grooming calming and bonding, as I did with my first dog, Derry and every dog since. I had no idea what it was like living with a "bitch" who goes "into heat" every six months. She drives poor little Riley mad with desire. 

MY DOGS ARE A LINCHPIN OF MY EMOTIONAL HEALTH

For about 14 days of her 28-day cycle, Lucy and Riley must be kept separate at all times, a real challenge in our open-concept house. This will be her last season. The market for purebred dogs is shrinking. After one litter in August 2008 – remember little Auggie, – we haven't been able to breed Lucy and this spring, I am planning to have her spayed with my breeder's blessings, as the market for purebred dogs is shrinking.

Still, as always, the routine of all my dog-related activities and care, plus all the love I receive in return, keeps me emotionally anchored. I love holding a dog in my arms. I always will.

Marty helps enormously with our routine, but I do all the grooming and daily tooth brushing, much of the feeding, organizing and health care. With the dogs, I'm essentially in charge. 

They're a linchpin of my emotional health, in addition, of course, to my husband – the heart of my life. 

Since 1988, I've never had a major manic episode. 

I cannot imagine living without my dogs. They keep me in recovery. They keep me sane.

ANGELA UPDATE – "I SLEPT THROUGH THE HOCKEY GAME!"

Today, Angela is having a very good day following her seventh ECT treatment yesterday.

"Oh, I think there has been progress," she said, with a spring in her voice. "Last night I fell asleep and missed the (Olympic) hockey game!" She's a fanatical hockey fan. "Without my sleeping pills. And I slept through the night until 6:30 this morning. I haven't done that in, oh, at least two years. Maybe more."

A note from a friend made her feel even better. She read it to me on the phone. 

"I just happened upon Sandy Naiman's blog... and I have even more respect for you now than before," her friend wrote in an email. "I'm really wishing for great breakthroughs for you."

I think we all are!

And now for something different...

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

A QUICK ANGELA UPDATE

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

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

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

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

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

SHINING LIGHT ON MY PERSONAL LIFE AND HOW I COPE

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

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

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

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

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

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

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

OURS IS NOT ALWAYS AN EASY LIFE

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

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

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

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

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

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

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

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

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

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

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

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

Things always seem to look better in the morning.

Take care. Speak soon. Thanks for listening.

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

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

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

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

THE LANGUAGE OF RESPECT 

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

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

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

"COERCIVE PSYCHIATRY"

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

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

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

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

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

"WE DON'T HAVE INVOLUNTARY ECT IN ONTARIO" 

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

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

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

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

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

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

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

HAVE A WARM AND RELAXING "FAMILY DAY"!

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

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

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

"It's Complicated" – ECT and more...

A lot is going on today.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Now then...

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Angela is a seven!

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

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

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

THE ITALIAN PIONEERS OF ECT

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

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

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

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

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

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

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

ECT TAKES TIMES

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

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

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

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

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

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

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

MY SIDE EFFECTS FROM ALL THIS "ECT"

This morning I slept in.

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

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

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

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

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

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

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

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

So, I hope you'll understand. 

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

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

Puppies. 

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

Have a great weekend.

Speak soon!

ECT on Angela's mind and mine...

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

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

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

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

"I hate this!"

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

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

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

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

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

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

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

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

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

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

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

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

Time will tell.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

"Hope you're having a good day!"

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

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

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

I suspect they'll have lots to discuss.

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

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

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

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

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

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

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

"NO SIDE EFFECTS AT ALL" 

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

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

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

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

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

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

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

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

I asked her about her appetite.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Let's see what happens.

THE ANTI-PSYCHIATRY MOVEMENT ATTACKS

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

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

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

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

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

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

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

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

If only more people did...

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Angela thought it tasted like gasoline.

"Then I was out," she said. 

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

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

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

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

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

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

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

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

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

I asked her how her memory was.

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

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

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

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

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

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

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