A psychiatric chuckle...

As you know, on Wednesday, I attended a memorial celebration of the life of my husband's closest friend, film and television producer, director, screenwriter, and poet, Bill Davidson.

Actually, Marty was the M.C. I sat with about 40 of Bill's nearest and dearest, including his wife Mary, his two daughters, Wendy and Ann, and his granddaughter, Tabitha.

Tabby chose to read several of her grandfather's poems from a little collection called "A Baker's Dozen," that he sent to a very select group about eight years ago. As it happens, we were among them. 

I had read Bill's "things" as he called them at that time. They were enchanting, as I recall. Then Marty took them from me for safekeeping – I tend to misplace things – and stowed them in his office. I'd forgotten them, until Tabby started her charming recitation. One in particular stood out as being perfect for you. 

And as November is such a dreary month, especially for teachers overwhelmed with end-of-term marking, I thought we could all use a little chuckle from our darling friend Bill. 

Last evening I called Mary, and she gave me permission to post it.

I want you to know that Bill loved reading Coming Out Crazy, so I know he wouldn't mind my sharing one of his poems with you. He was a loyal member of our community.

First, these were written on a typewriter. A manual typewriter. You can tell, which makes them even more endearing. In his covering letter, he explained that he had written his poems at his cottage on Pig island near Whitefish Falls and Manitoulin Island, southwest of Sudbury. His motivation came from an old friend, retired Rutgers University psychology professor John L. Falk.

"We had been out of touch for over fifty years. To re-introduce himself, he sent me a classy, slim volume of poetry published here in Canada by Guernica Press.

"Apparently, during all his teaching years he had been writing poetry, over three thousand poems," Bill wrote in his covering letter, titled "Explanation" ... "For Sandy and Martin."

"I thought, why not just knock off some stuff that pops into my mind, for my own pleasure (and maybe for Mary, too) to entertain myself. 

"Now, I did something else to get myself kickstarted. I didn't want to poke fun of John's book, but I wanted to clearly establish my imposter credentials, my colossal conceit in pretending to write a short book of poems (things). So I claimed to have a publisher, Howler Monkey Press, and even wrote a series of reviews of my own work for the back cover."

Indeed, the return address on the manilla envelope that we received was "From the publisher's office: Howler Monkey Press, Port Hope, Ontario – no address, no phone, no email, no fax, no anything."

Imagine a big man, a commanding presence at 6-ft, 2-inches, with a broad smile and sparkly blue eyes, perched on a rock on his island, his typewriter on his lap, pounding away at his poetry. He was blissfully unwired up there.

His covering letter ended:

"I said, why not share this wacky stuff with my dear friends, Martin and Sandy, and maybe, just maybe, brighten up their day with a few twinkly chuckles. Enjoy!

"WARNING: If too painful, take this stuff with Celebrex!"

Tabitha read several of her grandfather's creations. Here's the one I think you'll appreciate most, including a few of his "advance reviews and comments"...

"A stunning disaster. A tribute to man's folly. Beats the Titantic. Sank immediately after launching." – Rear Admiral Ahab, retired skipper, Toronto Island Ferry.

"Highly recommended for infants and toddlers. From the Hickory-Dickory-dock school of poetry. Pablum for the masses." – The Brothers Grimm, professors of pornography, Humpty Dumpty Institute.

"The work of a buffoon. Forgettable, but not forgivable. His movies weren't so hot either." – Crusty McNasty, entertainment critic, The Toronto Star Weekly.

At the Annual Convention: The Return of the Fairytale Shamen. 

Based on an old English folk song.

These fellows, me thinks, 

are rinky dink shrinks, 

Willy Winky, Tom Cobly and all.

***

They're here to discuss

the probing of us, 

Uncle Siggy, Pope Carl and all.

***

They peddle their pills 

to cure all our ills,

Oedipus Rex, bad sex and all.

***

They stir up a gumbo

of cool mumbo jumbo,

bipolar, postpartum and all.

***

They unscramble our brains

for capital gains,

Lamberghinis, sunny condos and all.

***

It's buyer beware

at this sordid affair,

turkey niblits, juicy giblets and all.

***

They feed on our fear

they'll be back next year,

Goldilocks, Goosey Gander and all.

* FOOTNOTE: Proud to say, the fairytale shamen, good sports all, have asked Leonard Cohen to sing this rollicking folk song, during the opening banquet at next year's convention. If we wake him up in time. I need the royalties."

By the time Mary Davidson called me last night, I had already written another post. I'll save it for next week. It won't go stale. And I hope you don't mind this little detour from my usual harder focus on mental health and wellness.

Call it a "mental health day" post.  A break from the routine. A non-medicinal bromide. This has been a very difficult week for us. I'm glad that I was able to end it on a light note, and especially to be able to share with you the magic that was Bill Davidson. 

Speak soon and have a lovely and restful weekend. Be well and be good to yourselves. You deserve it!

Letting things go...

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

Nothing happens all by itself. Timing is everything. 

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

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

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

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

Process is the key word. 

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

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

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

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

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

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

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

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

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

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

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

The essence of leadership is change. 

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

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

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

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

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

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

Everybody wants to feel respected. 

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

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

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

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

Be well and thanks for listening.

Coming Out Crazy wins blog award

I was crying and shaking in Dr. Bob's office this morning after an overly long hiatus between psychotherapy sessions when an announcement went out onto the Internet and into my email mailbox.

Had I known at the time, I would have saved my psychiatrist half a box of Kleenex. 

But I didn't. Instead, I made a month's worth of standing appointments because I've been overly stressed out lately and then left his office, as always, feeling 100 lbs. lighter. That's the power of talking therapy with him for me.

My husband picked me up and while we were driving home, on a whim, I pulled my iPhone out of my purse to check my email ... and there it was – the annual Top Ten Bipolar Blogs 2009 from PsychCentral.

For the second consecutive year, Coming Out Crazy made the list. I was stunned. Last week, PsychCentral launched the new Journal of Participatory Medicine on his World of Psychology blog. I figured these awards were discontinued.

Not so.

Under an introduction stressing the growing number of entrants, Sandra Kiume noted the difficulty in narrowing this year's list to 10 plus several Honourable Mentions. As far as I'm concerned, all 18 blogs named are equally worthy of this honour.

Here is what Kiume, a Vancouver-based mental health advocate and editor of Channel N said about Coming Out Crazy. This is daunting. Humbling. Blatant self-promotion isn't really my style, but here goes:

Coming Out Crazy. Sandy Naiman is fierce and fabulous. With a background in print journalism, her blog was new to the net last year and it's been fun to see her adapt to the medium – and vice-versa. Some of the perennial trolls have been buzzing around her blog, smelling fresh blood, but she deftly slaps them down with precise words soaked in reality and wisdom. Sandy is a dynamo who is an offline mental health advocate and speaker. In Coming Out Crazy, she's making gorgeous jewelry from her goldmine of experience as a person living with bipolar.

I feel privileged to be in the company of the following fascinating bloggers who have far more experience in this medium than I do.

Congratulations to The Secret Life of a Manic Depressive – I look forward to becoming acquainted with Irish-born British blogger Seaneen. I'm particularly pleased that veteran blogger Liz Spikol and The Trouble With Spikol are honoured once again. I'm a longtime fan of this well-deserving, candid and incisive Philadelphia-based journalist and blogger.

I'm anxious to get to know Joel Sax and his Pax Nortana, Amy's humourous posts at All About Bipolar, Cristina Fender's Raw Writing for the Real World Bipolar, Crazy Tracy and Time for your Meds, and Crazy Black Woman.

Phil Dawdy's Furious Seasons and John McManamy's Knowledge is Necessity are "must-reads" for anyone who wants to be well-informed about the hijinx of Big Pharma and the complexities of mood disorders. Both are informed investigative writers. 

Huge kudos to Wellness Writer, If You're Going Through Hell Keep Going, Bipolar Happens, Crazy for Life, Gus Greeper, Bipolar: Crazy Mermaid's Blog and Patient Anonymous.

Last year, I telephoned PsychCentral CEO and Founder psychologist John M. Grohol to thank him personally for supporting Coming Out Crazy in his 2008 list. Grohol, who launched PsychCentral, his groundbreaking independent Internet mental health network in 1995, said that this was a great way to spread the word and draw more people to our blogs.

In the spirit of sharing intriguing new ideas and perspectives about Bipolar Disorders, I want to thank him and Sandra Kiume for drawing to my attention many of these new voices and including mine. I look forward to reading them and referring to them in my future posts, linking to them and learning from them.

I am thrilled to be in this remarkable company, as is my editor at The Toronto Star, Brandie Weikle. It was her vision to have a Mental Health and Wellness blog on Healthzone.ca when it launched on April 8, 2008. She invited me to write it. We work as a team. And the rest is history.

Take care and speak soon!

Hope and Recovery...

Tomorrow I have a 9:30 appointment with my psychiatrist Dr. Bob. It's been too long.

The last time I saw him was on Monday, September 1, almost two months ago. Before school started. Everything was going tickety-boo. 

Since then, it's been a rather rocky ride. Up and down. I'm overdue for a 60-minute session with him and I always feel 100 lbs. lighter when I leave his office. I'm counting the hours. He's been out of town and my killing teaching timetable this term at Seneca has taken its toll.

In exactly 24 hours, I'll be sitting in his plant-filled office across his desk, eye-to-eye pouring my heart out. Crying, too. That's how I feel right now. Fragile. 

Did I ever promise you that recovery was going to be a rose garden? Well, it's not. Mental Health Recovery has many meanings, depending on where you live on this planet.

For me, it's lifelong learning. Growing pain. The more I learn, the less I know. Wonderful.

For Elly Litvak "recovery is a self-directed journey, process of healing, growth and self-discovery that has its ups and downs while striving toward balance and enriched quality of life." 

For Priscilla Ridgway and her former University of Kansas team, it's a Strengths Recovery Self-Help Workbook called Pathways to Recovery.

For Mary Ellen Copeland it's a Wellness Recovery Action Plan called WRAP.

For psychiatrist Daniel B. Fisher, in recovery from schizophrenia, it's his National Empowerment Center.

That's just the tip of the iceberg. 

For everyone, anywhere on earth Mental Health Recovery is an individual journey. Unique. Your personal story. We all have our own recovery stories. They're ongoing. All different. So perhaps it's healthy to start talking, because as you talk, you learn as you go.

That's what happens to me in Dr. Bob's office.

Mental health recovery is ever changing and evolving. Everybody defines it differently. For me, it's sleep, psychotherapy and gaining insight. 

What is it for you? Let me know. Let's share our definitions here!

I haven't been sleeping well lately. So my mind isn't clicking along as it usually does. 

I cannot focus. All I did yesterday was walk my dogs. Riley and Lucy and I went for a 90-minute walk to check out the Halloween decorations in the neighbourhood. It felt good until the guilt set in because I knew I should be doing other things. 

Recovery is hard work. It demands one thing. HOPE. Without it, we cannot heal! 

Despite what one of my favourite writers Barbara Ehrenreich asserts in her latest book – Bright-Sided – How the Relentless Promotion of Positive Thinking has Undermined America – which I have not yet read, only read about, I still can't help being a cockeyed optimist – "stuck like a dope with a thing called hope and I can't get it out of my heart."

Does that mean I wander about in a golden haze of mindless bliss? Please. I'm too passionate, too driven, too obsessed to see a better world. To help make it happen. I'm too impatient.

I'm sure my positive outlook would make Ehrenreich cringe. I consider my psychiatric history a gift. It's given me a raison d'etre. A passion. A cause. You. Coming Out Crazy. My craze for change. It hasn't really stopped me.

I'm innately positive. Resilient. I've learned to be. Without optimism or hopefulness, the foundation of mental health recovery – not anger, which I think is too toxic an emotion – there can be no recovery, no healing.

Without anticipation for a better tomorrow, without believing there is a chance for a better life, I wouldn't be here.

Why else get out of bed every morning?

The promise of a little more learning, new experiences, meeting new people – even if all this knowledge is acquired through my genius for making mistakes – I learn from everything and everyone. 

It's exciting. Painful sometimes. With indelible lessons.

Too many mental health professionals deny their patients hope by doling out dire prognoses and prescriptions. Not much opportunity for talking. "You'll have to take this medication for the rest of your life because you have a chronic mental illness, a disease – like diabetes."

Talk about dashing hopes. People report this all the time and it infuriates me. It's not necessarily true.

We deserve the right to choose our own pathways to recovery. It's tough but hope paves the way.

Recovery means hope! Hope leads to mental health recovery.

So here's to hope for a better day. Do a little something for yourself to make it happen.

Speak soon!

What "Mental Illness Awareness Week" means

This is Mental Illness Awareness Week.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Honestly. Candidly. Without arrogance. With humility.

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

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

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

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

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

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

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

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

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

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

As for labels, I accept only two for myself. 

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

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

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

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

Speak soon!

From my inbox... about suicide

Many of you regularly write to me personally and I really value the stories you share, so much so that often I wish they were more available to everyone who drops by Coming Out Crazy. 

The other day, Dorothyanne Brown, a nurse from Ottawa sent an extremely poignant and provocative note. Not only did she give me permission to publish it here, she said I could "bounce people to her blog" – which focuses on living with multiple sclerosis.

Here's what Dorothyanne said on Sunday, September 20, in response to my Friday post On Denial...

"I, like you, have been an advocate for those living silently with depression since I was diagnosed some years ago. I've since been diagnosed with MS and am working with the mood swings thought to be caused by the electrical warfare between the shredded neurons in my brain. Of course, as with depression, MS symptoms remain largely unexplained. Would that we could understand the brain just a wee bit better!

"I'm a nurse and former primary health care manager who had to quit work because of my cognitive lapses and moods – despite medication, everything remains uneven.

"But enough about me. What I wanted to mention to you was the denial other health care professionals show with regard to suicide. At several points in my first year with MS, I've felt suicidal. I made a plan, I gathered the necessaries, I plotted the time of day. Then I called in my helpers.

"No one listened to me. No one took me seriously. Even now, since I moved to a new community, when I reach out for help with these mood things, nothing helps.

"My MS doc listened to my plan and said, 'Well, yes, that'd work.'

"Fortunately, I stepped back from the brink, or have until now. But it does make me wonder how others, less articulate, less well-supported, might manage. It seems to me that unless you show up at the office with a gun or rope, people are not likely to take claims of suicidality seriously. No one seems interested in discussing it, even those at the MS society – despite the high rate of suicide in MS patients.

"What's your experience with this? Depression and depression medications and suicide are closely linked... and yet it still seems to be a hidden subject. Discussing it might help those with these feelings step back, reconsider. The feeling of aloneness in depression is such a high risk factor.

"Good on you to come out and be counted. I've always felt that is the best way to proceed.

"Best wishes – Dorothyanne."

When I responded, I had to confess that I have no personal experience with major depression or suicidal intent. Mania is my madness and I have lived with its psychotic features since my mid-teens. Since I found the right medication – for me – in 1988 at the age of 40, I've been reasonably fine, thanks to my twice-daily doses of Tegretol and especially the support, psychotherapy and constant emotional processing I've been doing with my psychiatrist Dr. Bob for close to 20 years and still counting.

Dorothyanne, you touched a real chord, however, when you stressed how medical professionals are reluctant and uncomfortable discussing suicide with suicidal people. 

Everyone is uncomfortable talking about suicide. It is a taboo subject for many complex reasons. I don't think this is because it is often thought to be caused by depression and too many people are uncomfortable talking about mental illnesses. It goes much deeper than that and I am no expert. I don't know if there really can be real expertise on suicide.

Last year, a neighbour of mine died by hanging himself in his garage on the Monday morning of the Victoria Day weekend. After a phalanx of police cars, fire trucks and paramedic vans pulled away from our dear little dead-end street in the suburbs, after his sheathed body was removed in a red van (not black or bearing any resemblance to a hearse) my neighbours quietly clustered together, whispering. 

Would they have whispered if this kind, gentle man who was suffering with the terminal side-effects of brain cancer treatments had died of his illness, rather than by his own hand? He was depressed because he couldn't envision life – he was divorced and living alone – in constant pain, a close friend of his told me. 

His funeral was in no way "traditional" and he was buried against a fence in the cemetery, separated, removed from other plots, alone in death as he no doubt felt in life. People still say "commit" suicide, though it is no longer considered a crime. So much mystery and mythology still cloaks suicide.

A month later, the New York Times published a cover story in its Sunday Magazine titled The Urge To End It – Understanding Suicide. Two survivors of highly lethal suicide attempts – one by firearms and another by jumping – were interviewed. They were happy to be alive, despite permanent injury and disfigurement. The article was one of the most compelling I've ever read and it certainly furthers the discourse on the impulsivity of suicide. But what of those who are less impulsive and suffer suicidal intent and thoughts, without this impulsivity to act? 

This story didn't really address that. 

It wouldn't really be helpful for you, Dorothyanne, if you want to talk about your suicidal feelings.

Nor would it empower health professionals in their ability to help you, I suspect.

For some personal perspectives on feeling suicidal, you can go through the short engaging videos on the excellent new and undeniably easy to navigate website Working Through It where several people talk candidly about their suicidal feelings. And how happy they are they got help and don't feel suicidal anymore.

That might help you to seek help, but what if you cannot find the help your really need? The right fit for you? Then what? 

A hug and an ear from one of your helpers perhaps can prove better. You were cogent enough to be able to reach out. Feeling loved and wanted and cared about and valued by other people is decidedly more useful. But what if you don't feel that love, even if it's there. Then, what?

In her extraordinary book, Night Falls Fast – Understanding Suicide, (Vintage Books, 1999) one of the only serious studies of the subject, clinical psychologist and Johns Hopkins Hospital psychiatry professor Kay Jamison writes eloquently, perceptively and passionately about suicide. She knows her subject. She was diagnosed with manic depression/bipolar disorder as a university student and years ago, in graduate school, struggling with an episode of depression, she overdosed on her Lithium and almost did kill herself. 

Yet, she, too, is frustrated. 

In her epilogue, Jamison writes: "Like many of my colleagues who study suicide, I have seen time and again the limitations of our science, been privileged to see how good some doctors are and appalled by the callousness and incompetence of others. Mostly, I have been impressed by how little value our society puts on saving the lives of those who are in such despair as to want to end them. It is a societal illusion that suicide is rare. It is not. Certainly the mental illnesses most closely tied to suicide are not rare. They are common conditions, and, unlike cancer and heart disease, they disproportionately affect and kill the young."

But if you're suicidal, reading that book would be impossible. You probably wouldn't be able to focus. 

Dorothyanne, I don't know why some doctors and health care professionals don't take their suicidal patients seriously. Or cannot. Lack the ability. Maybe it's that old and perhaps mythic rubric – "if someone talks about killing themselves, they'll never do it"?

More likely, part of the reason, as Jamison states in her book, is that doctors, themselves, are twice as likely to kill themselves than other people, especially psychiatrists and psychologists – women more than men. And doctors tend to carry their emotional burdens along with the burdens of their patients, working independently and not seeking help or even recognizing that they need it.

Pills are perceived as an easier solution.

Last week, psychologist John M. Grohol on his PsychCentral blog World of Psychology mused about suicide rates in 2006 remaining virtually the same as in 2004 and 2005 – despite antidepressant use on the rise and a dramatic decline in talking therapies. Check it out. 

He also points out a new American National Drug Use and Health report on "Suicidal Thoughts and Behaviours among Adults". For the first time, all adults in this survey of 46,190 Americans 18 year of age and older were asked about suicidal thoughts. In the past, they were only asked about clinical depression. Check it out, too. 

Philip Dawdy at Furious Seasons posted about this, too, and his take is well-worth reading. 

Check out the World Health Organization's global picture.

There's an important clue in all of this, I think. It's found in an August 2009 post by Grohol about the fact that pill use is up (antidepressants) and psychotherapy use is down. People are demanding quick-fix – pills as their primary avenue to mental health and well-being. Maybe because they just can't connect with the right psychotherapist for them. Or the waiting list is too long. Or it's too expensive.

But, as I've said again and again, the answer is not in pills alone. 

My friend, Dr. Ron Pies, Tufts University professor and clinical psychiatrist addressed the issue of medication use in effectively helping people with mental health issues recently, when I asked him about it. He wasn't referring specifically to suicide or even depression, but talking more generally. His remarks, however, are important:

"I think so much depends on what the 'issues' are; how serious and impairing the problems are; and how skilled the clinician is who prescribes the medication – and how closely he or she monitors the patient's response... medication alone is virtually never 'the answer' for those who experience serious emotional or behavioral problems. I continue to believe that, in carefully selected instances, it is often a part of the answer." 

That's vital. I wasn't kidding when I suggested a hug might be better. If not a hug, at least some kind of human engagement. Part of the answer lies outside the realm of strict medical science and in human and humane interaction and communication. 

Yesterday, I discovered this right here at Healthzone in a Toronto Star story recently written by Health Reporter Joseph Hall.

In this story, Hall quotes Karen Letofsky, the executive director of Toronto's Distress Centres, who says: "If you are concerned an individual is at risk (of suicide) then the first thing you would do ... is approach that individual...." and this approach "should be couched as an invitation for this person to share their feelings, while asking directly about thoughts of suicide."

Maybe you don't need a health care professional, Dorothyanne. This is such a crucial question.

Maybe you need a human being who knows how to listen to you. Who can feel with you and for you. Even a stranger on the other end of a Distress Centre phone line.

Or one of us, here, in this online community at Coming Out Crazy. Maybe we can harness the power of the internet to help out. Reach out to you. To each other. We've done it before. Why not with suicide?

I'm throwing this out to everyone reading this post. 

What are your thoughts? If you can talk about suicidal thinking, share your feelings about suicide here, where it's safe, then perhaps it won't seem so difficult, so frightening to face. Perhaps you'll be able to reach out when and if you need support – to the right people for you.

What do you think?

Working Through It

Have I got a website for you!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Bravo! Let's spread the word. 

Say "Yes" to Mental Health Recovery...

Yesterday a gentleman named Stephen Batson sent me an email. 

The subject line? "another country heard from" ...

It turns out that Mr. Batson is the Project Coordinator of the Michigan Recovery Center of Excellence, where "Recovery is the foundation of service delivery in the Michigan community mental health system," it states under Welcome to Michigan Recovery" on this website.

"The Michigan Department of Community Health (MDCH) has charged mental health providers, consumer leaders and other community stakeholders to work together to promote recovery-based service delivery models."

Stephen wrote to me because he liked my last post on – Coming Out In Class. 

(By the way, I'm happy to report that 15 students showed up in my class this morning. Earlier this week, I had seven students attend with nine registered. This morning, I had 15 attend with 20 registered. This, after I shared with them the fact that my community service is mental health advocacy and I have a long history of mental health problems. I even told them about this blog. Things are looking up.)

Stephen told me in his note that he found me on a blog that's been running since 2006 called The Recovering Life with the tagline – Observations on a Cultural Phenomenon – written by his friend Norm DeLisle.

Norman G. DeLisle runs a small, non-profit organization called the Michigan Disability Rights Coalition and blogs like a house on fire, posting five or six times a day. He's worked in disability advocacy for 37 years, has background in education, Montessori, and psychology. He seems to me to be a powerhouse who works tirelessly to raise awareness and make a difference. He doesn't miss a trick and his blog is well worth investigating.

It seems he posted my Wednesday entry on his blog and that's where Stephen Batson comes in. "Every story makes us feel good about our decision to live real and open ourselves to others," he wrote, inviting me to check out his site. I did. It's amazing.

Then he invited me to a Recovery Conference in Detroit on October 6, sponsored by the Detroit-Wayne County Community Mental Health Agency, a real going-concern when it comes to recovery judging by its publication, The Advocate News, which is devoted entirely to mental health recovery and hope. 

Stephen asked me if I knew Dr. Daniel Fisher of the National Empowerment Center, which he founded in Lawrence, Massachusetts, near Boston. "Talk about leadership," Stephen said. 

As a matter of fact, I do. Though I've never met him. I know Dr. Fisher's remarkable recovery story and his spiritual and healing approach to severe emotional trauma, often the root cause of mental disorders. Having hope is crucial.

I've read several of his books including "One Vision of Recovery" – his personal story – and "A PACE/Recovery Reader" – an excellent historical anthology of writings about psychiatry, mental illnesses and recovery. 

My psychiatrist, Dr. Bob, was the first person to enlighten me years ago about the bogus claims that mental illnesses are caused by chemical imbalances in the brain – a theory that has never been proven. Fisher elaborates in his writings. I'm reading stories from substantial sources that corroborate this all the time, but still, especially here in Canada, the biomedical model which is grounded on this theory seems to stand firm. Psychiatrists prescribe cocktails of drugs and insist on diagnoses that rarely fit the individual. And people are getting sicker all the time, when they could, indeed, recover and live meaningful lives. 

We have universal health care here in Canada, but we're in the dark ages when it comes to mental health recovery. We're the only country in the G8 with no national mental health strategy.

Dr. Fisher subscribes to "recovery at your own pace." When I interviewed him several years ago, he stressed that medications can be helpful but only as tools, in the short term. There are other tools. Toolboxes full of them. He stated that he has not taken any psychoactive medication for more than 30 years. Community, inclusiveness, helping people to feel that they are not alone, that there is hope are among his prescriptions for recovery.

His story is recovery story remarkable. 

Years ago, as a PhD student, Fisher became delusional, ironically while researching the biochemistry of the brain in schizophrenia. He was hospitalized several times, treated like an animal, shut away and ignored. His psychiatric diagnosis? Schizophrenia.

So demoralized, appalled and angry at how he was treated as a psychiatric patient, Fisher vowed, then, that if he ever recovered, he would become a psychiatrist to ensure that people with psychiatric diagnoses would be treated with dignity and humanity. 

He finished his PhD, went on to complete his MD at Georgetown University and his psychiatry residency at Harvard. He has become a leading Recovery advocate, as well as a clinical psychiatrist – one of a tiny handful of psychiatrists who "are out" and openly discuss their psychiatric histories.

His interview on January 20, 2005 in Medscape is fascinating. Fisher is the featured keynote speaker at the Detroit conference, called Redefining Our Roles in Recovery: It's Everybody's Business. Sadly, my teaching schedule prevents me from attending, though I'd do anything if I could, I told Stephen.

But I'm following the activities of the Michigan Recovery Center for Excellence and Norm DeLisle's blog.

Then, this morning, when I came home after my class, there was another email from Stephen Batson.

"Hi again. I was thinking, on the way home last night, that we have recovery stories on this site. In fact, I will be spending the next seven days in Michigan's upper peninsula visiting drop-in and Clubhouses. While up there I will be video recording more stories to post on the site.

"I'm writing to you today because your article IS a recovery story. Perhaps not like the life stories many others have told, but yours talks about an important aspect of a person's recovery ... relationships' socially valued roles. So, I'm asking for your permission to include your story among the collection we have gathered."

Of course, Stephen. It would be an honour. My story is yours. As I tell my students, I have a mantra, one of several. "I live my life out loud. No secrets. No lies."

It's one way to find peace of mind.

Have a great weekend. I wish you the best, always.

Speak soon.

Rosemary on my mind...

I'm in a quandary. I didn't sleep well last night. 

In the wake of Senator Edward Kennedy's death the other day, and all the news and documentary footage I've been watching about this storied family, I cannot help but think about only one particular Kennedy.

Rose Marie Kennedy. Rosemary. Rosie, to her family.

I will admit off the top, I do not know a great deal about the Kennedy family. I am no expert. But I loved the Kennedy dreams and hopes and, in the case of Teddy, all the good he did for the American people. Yes, those three "boys" – Jack, Bobby and Teddy – had their faults. They made mistakes. (Who hasn't?) They were exuberantly human. Brilliantly so. I don't know why that should be such an issue, when you consider the big picture and all they accomplished and the hope they embodied.

But their sister Rosemary's life was a tragedy that didn't have to happen. Today, it never would.

Rose Marie Kennedy, born on Friday, September 13, 1918 in Brookline, Massachusetts, was the third of the Kennedy children – the first daughter of Rose Fitzgerald and Joseph P. Kennedy.

I don't know for sure all that much about Rosemary because there are too many conflicting accounts of her life and too many questions that remain unanswered. 

Was she brain damaged at birth? Was she slightly mentally retarded? Was she simply not as brilliant and naturally athletic as her extraordinary siblings? Was she more high spirited and exuberant and moody than her brothers and sisters? Was she just a little too different for her controlling father to bear?

What is known for sure is that in 1941 on the recommendation of his doctors, Joseph P. Kennedy insisted that his 23-year-old daughter be given a pre-frontal lobotomy. At that time, Rosemary was the 65th American and according to some reports the only patient with a diagnosis of "mental retardation" to be subjected to this then-radical and experimental treatment.

It was a disaster. This beautiful young woman with a glorious smile who loved attending the opera and tea dances and writing in her diaries, following the surgery, became an incontinent, blubbering child-like soul who stared into space for hours. Her mother was devastated and considered this the first of the calamities that became known as "the Kennedy curse."

In 1949, Rosemary Kennedy was sent to the St. Colletta School for Exceptional Children where she remained for 56 years until her death at the age of 86 of natural causes on January 7, 2005. Her sister, the late Eunice Kennedy Shriver and her brother Teddy Kennedy were at her bedside. In the Kennedy lore, Rosemary is considered the inspiration for the Special Olympics, which the Shrivers initiated and championed.

Two biographies of the Kennedys published in the mid-1990s have different accounts of young Rosemary Kennedy and what led to her lobotomy.

Laurence Leamer, considered an expert on the Kennedys, in his 1994 biography The Kennedy Women: A Saga of an American Family suggests that Rosemary was "mildly mentally retarded" – the most widely accepted story – and a potential problem expecially for her father who feared she may do something to disgrace the family. She may have been brain damaged at birth, but no one knows for sure. Apparently placid and easy going as a child, in her adolescence she developed "violent mood swings" and tended to sneak out of her convent dormitory in the middle of the night, according to Leamer.

On the other hand, conservative journalist and biographer Ronald Kessler in his 1996 biography The Sins of the Father: Joseph P. Kennedy and the Dynasty He Founded, presents another picture. Rosemary, he suggests based on research he conducted, had a mental illness, depression perhaps. 

I don't know what to believe. 

All this petrifies me. Insisting that a 23-year-old woman have a pre-frontal lobotomy because she was considered "mildly mentally retarded" and might be a source of family embarrassment is abhorrent to me. I was sleepless last night. It all harkens back to my concerns about diagnostics and treatments. About what is considered "acceptable behaviour." To whom? 

Rosemary Kennedy never to my knowledge ever hurt a soul. Kessler suggests her story "is the biggest mental health cover-up story in history. Since the public story is still that Rosemary was retarded, the lack of support for mental illness is part of a total lifelong family denial of what was really so." 

Back in the 1940s, the mental illnesses were hugely feared. Enormously mythologized. Ignorance abounded. Along with hideous prejudice and discrimination. Secrecy. No one talked about mental illnesses or wrote about mental health in newspapers or magazines. No one knew anything, compared to what we are beginning to understand about the brain and the mind, today. Including psychiatrists.

Pre-frontal lobotomies were put out to pasture in the 1950s. Dr. Walter Freeman, known as "The Lobotomist" because he was running around the countryside performing thousands of these Draconian procedures, eventually lost his medical licence when one of his patients died.

Finally, pre-frontal and ice-pick lobotomies were replaced by the first antipsychotic medication Chlorpromazine – known as "the chemical lobotomy." That drug was given to me in the early 1960s when I was first hospitalized for mania with a diagnosis of schizophrenia. I remember very little of the experience. It hit me like a sledgehammer and turned me into a "zombie" – I slept for days, I'm told.

Pre-frontal lobotomies were used primarily in cases of schizophrenia back in the 1940s and 1950s. 

That's why the story of Rosemary Kennedy haunts me still. She was never diagnosed with schizophrenia. I'm sure she was well-treated in her Wisconsin institution and cared for with compassion.  

Still, she should never, ever have been given a lobotomy. Poor, dear girl. Now, she would have so many other options, I like to believe. 

I know this. She was born at the wrong time. And perhaps into the wrong family.

Speak soon.

Grading...

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

That's why grading is so painful for me.