Happy Anniversary, "Coming Out Crazy"...

We're two years old today. I cannot believe it and what an education writing this blog has been for me.

IN THE BEGINNING...

On April 9, 2008, I posted my first blog, called Welcome to Coming Out Crazy – and we weren't even live and on line, right at the beginning. (Now everything I've ever posted is archived and online.)

I was just beginning to toy with my own blog and didn't really have a clue about what blogging and the blogosphere was all about, when Brandie Weikle sent me an email asking me if I'd be interested in blogging about mental health for a then-new website The Toronto Star was building called Healthzone.ca.

I just reread that opening post. When I think back to what I thought I would be doing, I'm shocked at how much I've learned and how innocent I was.

As I mentioned, we were not interactive, like we are now. Any feedback came via email that went either to Brandie or directly to me. Our correspondence was strictly one-on-one and a ton of work. 

POSTS FROM THE FIRST FEW MONTHS AND OUR FIRST AWARD

At the beginning, it was just a trickle, but the initial reactions were positive and I kept plodding on writing about some of the topics I'm passionate about – like labeling, language, lessons we can learn from abroad, Recovery and Denial, mad pride, madness and more, "framing" or "the 'S' word", ECT and other current therapies, mental health in the workplace and suicide. 

I shared stories, like the challenges of living with my pregnant Dandie Dinmont terrier bitch, Lucy – who is not pregnant again, I'm sad to report. And this one I discovered on www.TED.com by Sir Ken Robinson. I called it Shall We Dance. 

On October 22, 2008, I turned 60 and that morning, we won our first award as one of the Best Bipolar Blog on the Web Award! We won another in 2009.

Most of all, I was learning how much I didn't know and how much more I wanted to know. I made some enemies, but more friends. I began to familiarize myself with the other mental health bloggers on the Internet – and there are millions of them all over the world – but mainly from the U.S., in England and Canada. 

I quickly discovered that there were very few newspaper mental health bloggers at that time – besides Liz Spikol in Philadelphia, who writes about her bipolar disorder. I've linked you to other bloggers who have intriguing ideas to share. The more we can share, the more we can learn from each other.

In Canada, to the best of my knowledge, I'm still the only person writing regularly and candidly in a major daily about my personal mental health issues, my recovery, and mental health and wellness in general. If not, please let me know who you are, where you are and join our conversation.

I wrote about one of the most remarkable psychiatrists I've ever known, about schizophrenia, about depression, about my teaching, how I came out in class to my students about my mental health issues, about my hearing loss, about how friendship heals, about "living out loud", about my ongoing battle with food and my moods, about letting go, about stress and about hope.

And I wrote about you. 

And Angela and her electroconvulsive therapy, which will be finishing very soon. And I'll be reporting on that, rest assured. Will she need maintenance ECT? I'll keep you informed.

Yet, I've just scratched the surface. There's so much more.

I answered your questions, or tried to, and I explored some of the issues in your comments. I've come to care about you, became acquainted personally with some of you, and even met and befriended some of you.

Now, because of this blog, I have new friends and I'm so grateful to you. This is a dialogue. I thrive on your input. Yes. I live for your comments.

I'VE LEARNED SO MUCH FROM YOU...

I learned so much about you and from you. 

How much you need to share, to speak about your personal pain, your traumas and psychic scars, your stresses and anxieties, your feelings of abandonment and loneliness, your fears and frustrations trying to find compassionate listeners who will help you develop the tools for living meaningfully, instead of or in addition to dispensing medications.

And I've made lots of mistakes. One worked out wonderfully. As a result, I met psychiatrist Ron Pies, a professor of psychiatry at Boston's Tufts University and the S.U.N.Y. Upstate Medical University in Albany, N.Y. He has generously helped me with much of my research and become our resident expert and my friend. 

From the beginning, and especially after we moved to Typepad in June of 2008, I began to dream of creating, here, a safe and supportive virtual community, where you can share your stories, perspectives, complaints and opinions openly with me and each other.

And once I began linking, I began to love sharing all I was learning with you, too, by giving you sources and seeking out the best references I can find for you. Dr. Pies calls me a "public educator" but we're all educating each other, contributing to a body of knowledge here that can help challenge discrimination and prejudice with information and discussion. Openness. Coming out and staying out comfortably. 

Changing the landscape about mental health. Though change doesn't come easily and there's always resistance. We must keep trying.

THANKS FOR THE MEMORIES

For the last few hours, I've been traveling back, touring the archives of this blog. I'm amazed at how much territory we've covered. 

And how much more we must cover.

As a little anniversary gift to you, the links above will take you back, too. To some posts that were never on line and are now available as well as others you may remember.

So, I'm wishing you a Happy Anniversary, too. Because without you, I simply couldn't do what I do.

Finally, I want to give special thanks to my editor Brandie Weikle. She not only edits me and all of HealthZone brilliantly, but also ParentCentral, where she writes a charming and informative blog about raising her two adorable young sons, Cameron and Alister. Their cute kid quotes of the day are guaranteed to give you a lift.

Her guidance is invaluable. She works like a trojan and she is endlessly patient with me and my occasional emotional outbursts. Brandie, you're a dream of an editor. I adore you!

I want to say a special thanks to the powers-that-be, and all the editors and moderators at thestar.com for having the wisdom and courage to launch a mental health blog. It's crucially important to give all health issues fair treatment, time and space ~ physical and emotional and mental. It's validating for us and empowering for everyone touched directly or indirectly by mental health issues. And we're all touched in some way, somehow. No one is immune.

With heartfelt thanks and gratitude to all of you.

So far, it's been a fascinating ride – not without a few bumps, mind you. I learn lots from those bumps.

So, here's to continuing on our journey of discovery and self-discovery together for another year ~ in health.

Speak soon.

Hugs to you all!

This & That...

It seems like ages since I last posted, or responded to your comments. I've been remiss. I apologize.

Please forgive me. I've missed you.

Although I hate it when people talk about how busy they are – because we're all busy – it seems that this is an uncommonly "wild and crazy" time.

Between Passover seders that fell this year on two of the three days I teach, plus all my marking, which is over for the time being, I have not watched any television, cracked open a book or even read the newspapers very carefully. To be honest, I don't miss the TV, but I'm feeling a little out of touch.

Except, I got a real kick out of a charming story in this past Sunday New York Times about U.S. President Barack Obama and this year's second White House seder. 

Most of all, I'm terribly sorry that I've had to neglect "Coming Out Crazy" – and you – for a few days.. So today, I'm going to play catch up and fill you in on what's happening with Angela and some other news and views. Plus, this is a short week, with Good Friday tomorrow and Easter Sunday. It's tax time, too. It means we're all working harder and faster than usual to accomplish more that needs to get done, in less time. 

Stressful, to be sure.

Next week, I plan to return to my regular schedule of two posts a week, plus commenting on your comments. Thank you for your understanding. 

ANGELA PLODS ON AS HER ECT TREATMENTS DRAW TO A CLOSE

Angela has about four or five more treatments left. Neither of us is sure if she'll be having ECT on Easter Monday, so we don't exactly know.

We speak almost daily. Yesterday morning, she was upset because there's been a hitch with her new motorcycle and she's anxious to get her hands on it and start biking the highways and byways of Ontario as spring temperatures are rising. I cannot believe it will be 24 degrees Celsius tomorrow, but that's what the weather man is telling us.

One recurring theme in our conversations is that ECT may do wonders for one's mood, but it doesn't solve all the problems in your life. And it can create others, like problems with memory – though Angela didn't complain about her memory at all yesterday.

I've been thinking about all the things that electroconvulsive therapy cannot do and was never intended to do.

Sometimes, Angela expects miracles but she's beginning to realize how much long term work she has to do with her psychiatrist in psychotherapy – in addition to the ECT. And she is willing to have maintenance ECT treatments if it is recommended.

ECT WORKS BEST IN COMBINATION WITH PSYCHOTHERAPY

"My way of thinking is messed-up," she admitted yesterday morning. "It's gonna take a while to fix. Still, I do think the ECT is beneficial. And I don't think it would be as beneficial unless it's combined with therapy."

This is true for all psychiatric treatments. And for emotional healing. Medications are much more effective in combination with psychotherapy. Ultimately, though, you have to do the work – and it IS work. Whether it's psychiatric therapy or peer support or any number of other approaches – any therapy. It's never easy and often painful. It's all about change. Transformation. I've been at it for close to 50 years and still counting. More than 20 years with Dr. Bob. Trust me, it's worth it.

Changing the way you think and perceive, changing your beliefs and your behaviour patterns is the toughest work in the world, but I wouldn't trade all those years of psychotherapy for the world. That's why I call it "my PhD in me" – though I'll never graduate with any degree. This is what recovery is all about. Those years have given me peace of mind – insight – as I hope they will Angela.

All that work is the only way to truly go into recovery. (As I've often said, you won't find insight in a bottle of pills.) It's a constant. Never ending. Because our lives are changing all the time – throwing us curves we have to deal with and adjust to. Dr. Bob and I often joke about how we'll be together until we die. "Whoever goes first." I don't view this as a weakness, either. It's a strength because change is so challenging and ultimately so rewarding. Builds resilience.

Despite the fact that we resist change, which is natural, I suppose.

CHANGE IS NEVER EASY – THERE'S ALWAYS RESISTANCE

Just look at what's happening in the U.S. and all the resistance to the new Health Reform Bill and its amendments that were passed over the last two weeks. Surgeon and journalist Atul Gawande puts this revolutionary change (for the U.S.) and the resistance Health Reform is facing into perspective in a fascinating commentary in this week's New Yorker titled Now What? 

When it comes to change, some things never change, I guess...

WHAT'S NORMAL? AM I NORMAL?

Whenever anyone, I mean ANYONE, starts talking about being normal or not being normal, I jump in and say, "What's normal? There is no normal."

Psychologist John Grohol had a nice little post about that this week on his PsychCentral blog World of Psychology that explores the question we all ask ourselves at one time or another: Am I Normal?

I don't ever ask it anymore. Instead, I view everyone as "Next to Normal" which nicely encompasses all manner of quirkiness and eccentricity and even outlandish behaviour. Extreme behaviours.

I picked up that handy little phrase after flying down to Manhattan last June for a mid-week matinee of a then-new Broadway rock musical/operetta about a suburban family coping with a mother who has serious and seemingly drug-resistant bipolar disorder.

WE'RE ALL NEXT TO NORMAL

This show is called Next to Normal and I will be forever grateful because of its integrity, honesty and respect for the complexities of psychiatric conditions and their impact on everyone they touch directly and indirectly. (We're all touched in some way.) More important to me is that it puts into perspective this rather absurd notion of "normal" – which applies perhaps to body temperature – 98.6 degrees Fahrenheit. That's about it.

When it comes to people and their personalities and behaviours and experiences, I have no idea what "normal" means. 

Do you?

Three days later, this stunningly authentic show picked up three Tony Awards, including Best Actress in a Musical for the wildly talented and irrepressible Alice Ripley, who plays the mother, Diana Goodman and sings most of the songs.

This show was slated to close in August 2009, prior to its Tony wins. It wasn't drawing great crowds. That's why I was invited to attend and comped two tickets. Instead – three days later, after scoring big at The Tony's, it started picking up steam and has continued to resonate with its audiences. The wildly spontaneous standing ovation as the curtain goes down is testimony to that. Its run has been extended repeatedly.  

Last Saturday, March 27, marked the first anniversary of Next to Normal's Broadway run. This little show that almost didn't make it has turned a profit, both signs that it's a legitimate Broadway hit.

Here's the clincher. It's an artistic and commercial hit about a most unlikely subject for a rock musical – a serious mental illness – bipolar disorder. There's even a scene during which Diana undergoes ECT, and as a result loses her memory.

I think this is revolutionary. Think of it. A major mental illness goes musical and mainstream. It's not depressing, but inspiring and uplifting. A national tour is planned for the fall. I think this is the best news of all. 

Don't you?

Have a good weekend and speak soon. I feel so happy to be back.

"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 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"

 

The way I see it ...

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

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

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

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

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

That, in itself, is a problem. 

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

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

"BRAIN DISEASE" VERSUS "MENTAL ILLNESS"

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

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

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

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

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

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

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

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

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

INTERNALIZING YOUR DIAGNOSIS

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

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

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

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

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

So I started seriously researching.

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

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

PEOPLE IN THE INTERNATIONAL RECOVERY MOVEMENT DEMANDING CHANGE

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

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

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

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

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

MANY PROBLEMS PLAGUE MODERN PSYCHIATRY

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

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

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

Take care.

Speak soon!

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.

Hidden Homelessness: One woman's story...

I often say to my students that "teaching is learning" and the same is true of journalism and perhaps even more, of blogging. There is a visceral connection between you and me in the blogosphere, often it grows beyond a virtual connection, too. It's very affecting and inspiring. 

This is the story of one of those times.

On Saturday night, I had a tough time falling asleep. My mind was whizzing. 

The day before, on Friday, while achy, feverish and sleeping most of time, felled by some sort of bug, I received an email from a member of our community here at Coming Out Crazy named Sandra Dawson.

She was clearly upset and for good reason. Through a series of emails and then a five-hour telephone conversation on Saturday evening, I discovered that Sandra's recovery journey is nothing short of miraculous. 

"When I was eight, my depression started. For no reason. I became glum, sad, moody cranky, often during the fall and spring. It was biological. I wasn't diagnosed at all until years later," she said. 

Sandra grew up in a comfortable and "privileged" military family, and as she was moving all over the country growing up, her behaviour began changing along with her moods.

"When I was about 10, I wrote a Christmas play and my teacher decided that I could direct it, but she fired me as the director because I was too bossy," she said, laughing at the recollection, perhaps a harbinger of the more exuberant moods she would experience later.

Initially, her mood swings were characterized by short episodes of increasingly severe depression, and occasional suicidality – her first attempt was when she was 11 years old, in school, with a pair of blunt, round-edge scissors. "I just knew I wanted to die," she said. A schoolmate spotted her and called her "Freak!" Nothing else happened. 

"We didn't talk about it in my family," she said. "We were repressed and didn't discuss our feelings or our emotions."

By the time she was in her early 20s, she was beginning to experience wildly euphoric manic moments as well as depression. Sometimes the two extreme moods occurred coincidentally, with "mixed episodes of mania/depression and hypomanic/euphoria. Depression with spikes of mania," she said. 

Eventually, Sandra started seeing a counselor, to no avail, then a psychiatrist who prescribed medication. "I was misdiagnosed as being depressed," but because of her own ignorance and fears about mental illnesses, her prejudice and discrimination, her negative stereotypes, she wouldn't take those drugs, even though she was suicidal.

She never went back to that doctor.

Sandra is now 42. She has been hospitalized approximately 35 times, calling herself a classic 'revolving door.' Most of those hospital stays, she stresses, were for relatively short periods of time – from a few days to two months.

"There were many times when my doctors didn't know what to do with me," she said from her home in Vancouver. Sometimes, they still don't, she added. 

Between these episodes, she typically has much longer periods of independence, emotional stability and productivity. 

At 27, a GP misdiagnosed her again and prescribed Prozac. This time, Sandra decided to take the medication, but it was disastrous for her. "It made me more manic."

Coupled with the death of her father, insecure living arrangements, travel, and another serious manic episode, her life started spiraling out of control. Suffering from Post Traumatic Stress Disorder, unable to work, for the first time in her life, she experienced hidden homelessness.

Four out of five (80%) homeless people in Canada don't live on the street. Most are improperly housed or on the verge of eviction, far too many are children. Women who earn less than men are more vulnerable to homelessness. The hidden homeless live in cars, couch surf or find temporary shelter in church basements or abandoned factories. 

Over the decade between 1994 and 2004, Sandra became homeless – but only four times. Years apart. Those episodes were short. She stayed in shelters for abused women, hospitals, or on friend's couches. She also lived in marginal housing like rooming houses and Single Room Occupancy hotels.

"I've been lucky," she said. "I've never lived 'on the streets' as in the stereotypical sleeping bag on a sidewalk. I am considered high functioning by my psychiatrists. Although my disorder is severe, I can look after my basic needs. Low functioning people need more help, but high functioning people can and do fall through the cracks and become homeless or at risk." 

These experiences were so searing, they turned her into a crusader, a passionate advocate, working professionally and within the community as a volunteer to help to understand, enlighten and fight hidden homelessness, and to ensure that more supportive housing is available especially for people with mental health issues.

She has a steady part-time job on the Mental Health Commission of Canada as a consultant, a person with lived experience of hidden homelessness, working on its newly launched, national multi-city study called At Home/Chez Soi.

Sandra is also on the board of Vancouver's Marine View Housing Society, a licensed and supportive housing project that began in 1975 and owns residential buildings in Vancouver for people with mental health difficulties. For years, she has also volunteered with her local arts community in several capacities. 

"It's so important to me. It makes me feel useful," she said.

Her work with the Mental Health Commission of Canada is one of her passions. 

On Sunday, Sandra was a presenter at a major national Vancouver conference on homelessness called Into The Light, which winds up today. She participated on a National Consumer Panel of peers with lived experience of homelessness and/or mental health issues involved in the At Home/Chez Soi project. These panelists represented cities of all sizes and discussion focused on pressing local issues in their respective areas. 

So why was she so upset when she wrote to me last Friday? 

When this four-year Housing First study was launched at a media event last week, Sandra bravely spoke out, telling her story about her own experiences with homelessness. She gave an interview to the press. Somehow, she was misrepresented and her story was badly distorted, so much so that she feared her credibility would be damaged and her reputation besmirched.

So she reached out to me and I'm so glad she did. I knew virtually nothing about hidden homelessness. It wasn't on my radar screen. Indeed, it was hidden. Invisible. Buried under the stereotype of the homelessness we see. I have started to scratch the surface. I will keep digging. 

Best of all, I've become acquainted with Sandra Dawson, one of the most courageous, generous-hearted people I have ever had the honour to engage with... and I sense we are more than acquainted. We have made a connection. I hope it will continue. There is so much more to share about the nature of homelessness – visible and hidden – especially among children and youth.

I have so much to learn. 

Thank you, Sandra.