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.

Musings on schizophrenia...

On Monday, I had lunch with an old friend. It all started because of last week's newsmaking announcement about so-called new findings about the genetics of schizophrenia.

I sent my friend a piece in The New York Times by Nicholas Wade which seemed to me to put a sober perspective on all the hoopla that followed. Well worth reading. Rather than a major breakthrough – for nothing would delight psychiatric researchers more than finding a cause for a varied group of disorders described as schizophrenia – what was reported was a big deal about information that's been known for years.  At best, a tiny little piece of the puzzle was confirmed by three new studies. 

The mysterious causes of schizophrenia are linked to thousands of genes, not just a few. There's lots of work still to be done.

It was this study that reconnected me to my friend. He often remarks that the word "schizophrenia" really describes psychosis – or, to be more precise, a number of different psychosis with several widely varying classes of symptoms.

At 89 and utterly brilliant, he and I met while I was writing for The Toronto Sun on one of my extended forays into psychiatric research and we remain buddies, although I do not see him often enough.

Yesterday, we wandered along College Street until we could locate a Japanese restaurant to our mutual liking and had an enlightening and, as always, fascinating chat.

He is a rare bird in the realm of psychiatry. One of the only people I know who launched his career as a psychiatric social worker in 1948 – the year I was born – after graduating from the London School of Economics in Psychiatric Social Work and studying clinical psychiatry with William Mayer-Gross at the Crichton Royal Hospital in Dumfries, Scotland. Dr. Mayer-Gross authored a seminal text called Clinical Psychiatry published in 1954, before the advent of the earliest antipsychotic medications.

After finishing his training with Dr. Mayer-Gross at the Crichton Royal Hospital, my friend moved to Canada to become director of social work at the former Whitby Psychiatric Hospital. Then he was named advisor in social work in the mental health branch of the Toronto Department of Health before taking the post of Associate Director of Psychiatry at the Toronto Psychiatric Hospital, which became the Clarke Institute of Psychiatry in 1964 and part of the Centre for Addiction and Mental Health (CAMH) in 1998. He finished his career at McMaster University as a research scientist, Professor of Social Work and Associate Professor of Psychiatry before retiring in 1990. 

His professional career in psychiatry spans 42 years from the pre-Chlorpromazine Age to the age of the atypical antipsychotics. He is one of the most knowledgeable and reasoned professionals I have ever known and this week, schizophrenia was on our minds.

My very first psychiatric diagnosis was schizophrenia. A rather dotty and dusty old-maid psychiatrist named Margaret McQuaid gave me that diagnosis back in 1960 when I was barely into my teens. I didn't know it then, but ah, those labels. How they stick!

About six years later, I found out about it in a brutal way. Another mad shrink at The Clarke Institute of Psychiatry – I cannot name him as he's still kicking around – decided he had cured me, so one day, he put me in a glassed-in cubicle on the eighth floor and handed me my chart to read.

There, in correspondence and other documentation, I discovered I had schizophrenia and then, a few years later, the word "catatonic" was added. Scary words for an 18-year-old to absorb. I remember riding home on the subway shuddering. I ran up to my room where my 1966 edition of the Random House Dictionary of the English Language sat above my desk and looked those two words up. 

• "Schizophrenia – a psychosis marked by withdrawn, bizarre and somewhat delusional behaviour and by intellectual and emotional deterioration. Also called dementia praecox, which means premature dementia."

• "Catatonia – a syndrome seen most frequently in schizophrenia, with muscular rigidity and mental stupor."

I didn't recognize myself remotely. Why were these words applied to me, I remember wondering. Can you understand why I detest these psychiatric labels and why language is so important to me? Yet, for the next seven years, through Seneca College and Queen's University, in the back of my mind, that diagnosis was there, though never in my entire life have I ever been "withdrawn." 

In 1975, that diagnosis was changed to manic depression.

"You know, this is the 100th anniversary of the word schizophrenia," my friend announced as we perused the $5.99 specials. His first statement has been well documented. According to an article in the American Journal of Psychiatry Paul Eugen Bleuler and the Birth of Schizophrenia, on April 24, 1908, Swiss psychiatrist Bleuler first coined the term "schizophrenia" at a meeting of the German Psychiatric Association in Berlin – as opposed to the earlier label, dementia praecox.

Without recounting all this history of labels, let's just say that the term schizophrenia simplified what had been a grab-bag of other labels. Too bad. I've always thought that huge catch-all categories are more dehumanizing than specific ones.

According to former Boston Globe investigative reporter Robert Whitaker, in his book Mad in America – Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill, "Throughout the nineteenth century, physicians had conjured up a wild profusion of insanity types. Medical texts told of such ailments as "old maid's insanity," "erotomania," "masturbatory psychosis," "pauperism insanity," and "chronic delusional disorder."

Whitaker adds, "There was no rhyme or reason for these terms, and they provided little insight into what the future held for the patient." German psychiatrist Emil Kraepelin classified them into two streams – manic depression for those with psychosis and emotional disturbances, and dementia praecox for those with lack of emotion. The second group were given a less hopeful prognosis.

In 1908, Eugen Bleuler came up with the term "schizophrenia" which he viewed as a milder form of dementia praecox, according to my friend.   

Bleuler wrote a paper about his new term "schizophrenia" in 1911, so my friend considers 1909 – a point in between – as the true birth of the schizophrenia. 

Still, not much is really known about its causes today – probably because there are so many. I seriously doubt any one cause will ever be discovered. 

My friend announced that back in the 1940s and 1950s, close to 50% of patients who were diagnosed with schizophrenia went into spontaneous remission – complete recovery – with humane care and no medication. There were no antipsychotics back then.

"The prospects of lasting spontaneous remission are greatest during the first two years of illness," my friend quoted in an email from page 267 of Clinical Psychiatry (Cassell, London, 1954), co-authored by Wilhelm Mayer-Gross, Slater and Roth. "After five years of continuous illness they become negligible. If a series of patients whose illness have lasted a year are followed up, about half are found eventually to remit; if the illness lasts two years, the proportion is still about 45%. Thereafter it quickly declines."

My friend notes that with "effective community support, many former patients with longstanding schizophrenia were able to live satisfactory lives without or later with medication." 

Having a diagnosis of schizophrenia is not an easy one to live with and today, what we know about psychosis, no matter what you call it, is that early intervention is the key – especially for young people.

This also explains why so many leaders in the modern recovery movement – psychologist Patricia Deegan, Dr. Daniel Fisher and British psychologist Rufus May are three examples of countless people who have fully recovered from serious cases of schizophrenia and now live meaningful lives without medication. Others have succeeded brilliantly with psychoanalysis and medication, like law professor Elyn R. Saks, PhD. 

The question is, what about the other 50% who don't spontaneously remit? Why? And what about the standard contemporary biomedical approach that involves prescriptions of newer, very powerful atypical antipsychotics? Do they promote spontaneous and permanent remission? Or are they harmful?

A great deal in psychiatry has changed in the last 40 or 50 years, but not a great deal more is known about the causes of schizophrenia. Genetic testing and brain imaging will be studied in about 100 people with schizophrenia, bipolar disorders and depression at CAMH, the first hospital in the world to explore these newer avenues of therapy. 

We should be able to use all possible tools available for recovery. And recovery should be the goal. Not a belief that this condition is chronic. 

The word "schizophrenia" carries enormous baggage. The media hasn't helped. But, I think it's interesting to learn from the past. If many people diagnosed with schizophrenia, experiencing abnormalities in perception, hallucinations, delusions and disorganized thinking have fully recovered with humane support and care – that, to me is a reason for hope. And an approach to be seriously considered. Not isolation, hospitalization, drugging and other inhumane treatments. Instead, inclusion, respect, education, accommodation, empowerment and nurturing. Give people a chance!

Schizophrenia is probably not chronic brain disease, as so many people would have you believe. It involves the mind and the soul, the whole of a human being. There is no scientific proof that it's a disease of the brain.

Trauma can play a part in the development of the symptoms that suggest a diagnosis of schizophrenia, as can genetics, intrauterine factors, early childhood environment, psychology, neurobiology, social and cultural influences – even drug abuse.

Until we have more information, the jury is out and anything is possible, including recovery! It's time to rethink our knee-jerk reactions to this condition. See it not just a medical context but in an historical context. In a post-psychiatric context, too, and in the context of the recovery movement. 

Madness, a word I prefer to all the others, has many meanings. Love. Anger. Insanity. 

Let's open our minds to all them.

What do you think about "Mental"?

I'm really thrilled that mental illnesses are finding their way into mainstream entertainment – Broadway Theatre and especially television.

Two examples are the rock musical Next to Normal – which won three Tony Awards last Sunday – and the new television series Mental.

Here are some random thoughts...

When Alice Ripley won the Tony Award for Best Actress in a Musical on Sunday night, I was over the moon with excitement.

Perhaps that means that "Next to Normal" will continue its Broadway run, at least until mid-September. On Tuesday, fresh from watching the Tonys on television, my psychiatrist Dr. Bob and I were discussing this groundbreaking rock musical about a suburban housewife with drug-resistant bipolar disorder attempting to cope with her life, family and hallucinations. It feels more like an opera with so many traumatic moments viscerally exposing how mental illness reverberates within a family and expressed in song. 

Ripley is in 24 of the show's 32 musical numbers.  

It wasn't hard to convince Dr. Bob to trip down to New York for an artistic weekend to see this show and the new Tony Award-winning Best Play, "God of Carnage".

Between those two corporeal crawls through the innards of contemporary coupledom – in Normal, the circle broadens to include kids – a psychiatrist, especially mine with his psychoanalytic bent, can't avoid having the time of his life.

He seemed convinced and I can't wait to discuss his take on these two plays.

According to a terrific story about Ripley in last Sunday's New York Times, after every performance, she is mobbed at the stage door by a gang of admirers, "and one out of five people ... is bipolar. I meet them every night," she said. 

In researching the role of Diana Goodman, Ripley read extensively about depression and psychopharmacology, she said in the New York Times interview. She also relied on a favourite uncle and her personal assistant as real-life resources. Both are diagnosed with bipolar disorders.

Ripley makes a striking and hopeful analysis of her onstage persona – which is why this show deserves to run for a very long time. Even Sir Elton John clearly stated this when accepting his Tony for "Billy Elliot" as Best Musical on Sunday night. 

"I started by thinking of Diana as someone with a disorder and I look at her now, and there's nothing wrong with her. I think that tells me I'm on the inside."

No matter how anyone reacts to this show, I think it's a healthy and hopeful portrayal of a woman realistically struggling with her bipolar disorder diagnosis as it's handled by mainstream medical approaches. It's controversial and gets people talking – gives them the freedom and the courage to open up more than they did before seeing the show, or reading about it. 

It's liberating. Those of us who have ever felt marginalized and negatively stereotyped can see ourselves in this character and in other characters in this show, indirectly affected when someone close to us is grappling with a serious and complicated psychiatric problem. 

This show is also contributing to the public discourse about emotional trauma as it relates to the development of a psychiatric illness. It calls into question the way we, in North America, perceive mental illnesses and/or mental disorders.

Are they "brain diseases" or "emotional disorders"? Or both? Are they chronic diseases or can you recover?

These are not yet mainstream ideas because a long-standing yet incorrect "assumption" – that mental illnesses are rooted in brain chemistry – is generally accepted as true in the medical mainstream. It is not. There is no scientific proof yet. This is an increasingly debated issue.

No one knows for sure the causes of mental and/or emotional disorders. They are varied and differ with each individual. Causes can include genetic, intrauterine, biochemical, environmental, social, cultural, and psychological factors – or a combination of them.

And people do recover from severe mental illnesses. I'm one of them. 

Meanwhile, on the home entertainment front, my husband and I have been watching a new summer replacement every Tuesday night at 9 p.m. carried on Global and produced by Fox Telecolombia called Mental.

This show, shot in Bogota, Columbia is being vigourously debated among bloggers and others online and elsewhere, I'm sure. It's highly unrealistic, but dramatically intriguing. And also encourages people to start publicly discussing mental health issues more openly. In essence, it's helping to normalize mental illnesses and health issues, and it's broadening the public discourse. 

It has people talking.

Here's what I like about Mental.

It's lead psychiatrist – a terrifically appealing character named Dr. Jack Gallagher played by British-born actor Chris Vance – is highly unconventional. 

Gallagher is always getting himself into hot water in the mental ward of the L.A. general hospital where he's recently been hired.

He's obviously modelled on Dr. Gregory House played by Hugh Laurie in the multiple award-winning House, M.D., also carried on Fox – but with a more engaging personality. Gallagher is a creative and unorthodox problem-solver with a team of young shrinks-in-training assisting him with his bizarre cases.

Normal, run-of-the-mill people with diagnoses of psychosis, severe depression, bipolar disorders, anxiety or schizophrenia are rarely the focus of each weekly segment, which ends with a solution. How conveniently and conventionally "Hollywood"!

It would be nice if real-life patients received this supremely specialized care instead of the cookie-cutter treatment most of us receive when we're hospitalized and even as outpatients. In Canada, all-too-often, it's the proverbial "15-minute consult and a prescription."

Nevertheless, for once, psychiatric patients are not depicted as villains and murderers, but complex individuals, human beings, with reasons for why they may be acting out or catatonic and solutions for their potential recovery. This is a huge step forward for a mass-market television show. It's far from perfect, but it's hopeful.

And it's too early to tell. Next week's segment involves a young boy with bipolar disorder. 

Why not tune in and have a look. Give me your critique. Share your ideas and what you think. Do you hate this show like the very popular Philadelphia mental health blogger Liz Spikol? 

Or do you like it. Share your reasons.

Let's discuss it!

My adventures "across the pond" ... (part two)

This is the continuation of my post on Tuesday. It's about what happened as a result of my early morning curiosity getting the better of me and my overwhelming desire to broaden my perspectives on mental health and wellness... beyond North America.

You'll recall that I've been feeling claustrophobic. Itching to go beyond North America and join up with other non-profit agencies in Britain challenging mental health discrimination and "Working together to help everyone affected by severe mental illness recover a better quality of life."

Here, there are too many barriers to change, too many old stereotypes, too many unfounded fears. There is still too much discrimination and prejudice. It's time to start dismantling them in a way that's healthy and productive. To look beyond our own borders to other countries and learn from them. We can be a global community.

To be honest with you, I'm not convinced that turning mental illnesses and mental health issues into brain diseases is the way to go and that's the direction we're going here.  

You will remember, on Sunday morning, I awoke after a wonderful night's sleep. I typed "mental health recovery" in the BBC news search engine and found myself on BBC's Mental Health page.

I ended up on Skype, clad only in my pink nightie, talking to the renown social and business entrepreneur Robert Ashton. Let us say that when he appeared on my 24-inch iMac screen in full-colour, live and staring back at me, barely awake, and barely covered-up, my face blushed to matched the colour of my pink night gown. 

Here's Part two...

Robert Ashton and I had a good chat, despite my embarrassment. He smiled a lot, but he's going to help me to join Rethink, a 30-year-old charity dedicated to "working together to help everyone affected by severe mental illness recover a better quality of life."

He's also linking me up to other British mental health charities that for decades have been fighting discrimination and prejudice, fear and ignorance while helping the one in four of us who live with mental health issues every day.

I discovered that Rethink – one of the largest of these charities – only allows Brits to join. So, I'm hoping Robert will help me join, as a Canadian. That will give me and you, too, a totally different perspective on Mental Health and Recovery. Robert has important connections with the British mental health community because he's involved in "spreading the word" – one of his social entrepreneurial passions. He also lives with depression.

Robert's definition of "entrepreneurship" is very enlightened:

"I'm a business writer, speaker, broadcaster with a passion for all that enterprise can deliver," he wrote to me in a Facebook exchange. "You don't have to start a business to be entrepreneurial, just get it into your head that you are in control of your life and stop letting others lead you where you don't want to go!"

One of his connections is British mental health activist Dawn Willis, Vice Chair, Regional Committee, at Rethink, Mental Health Services.

Robert arranged for us to meet on Facebook and we've already become "friends" – we have 13 mutual Facebook "friends", I discovered. The international community of activists and advocates is remarkably small. I'm hoping Dawn will help me and perhaps, I can help her. We can help each other. Communicate and collaborate. Share our ideas and learn from each other.

Synergy. 1 + 1 = 3. You know. Two heads are better than one. 

We have to do something, here, on this side of the Atlantic. Talking Therapies are big in Britain. There's more to mental health there than PILLS. I'm getting very bored and increasingly upset with the neuroscientific approach that's overpowering psychiatry here in North America. 

ENOUGH! We've got to make some changes. How to go about that process? We have to voice our concerns. And if not us, who will? We have to raise our voices. Collectively. We have to start agitating for changes. Healthy changes that include all approaches to mental health, including group therapy and peer support. 

Like a thoughtful and careful and prolonged period of diagnosis and a 60-minute hour psychotherapy session instead of 15 minutes – The McDonaldization of Psychiatry, according to my friend, Tufts University author, poet and clinical psychiatrist and psychoanalyst Ron Pies. He's also Editor-in-Chief of Psychiatric Times, the world's largest online psychiatric journal with more than 41,000 readers worldwide.

Pies is sounding a call for the survival of his profession. In Great Britain, there's a strong post-psychiatry movement afoot with psychiatrist Philip Thomas at the helm. I attended several sessions with Dr. Thomas last June at a Toronto International Alternatives to Recovery Conference.

Even my York University "friend" Julie Gazzola is excited about this prospect of my linking up with the British Rethink movement and other British organizations committed to change through education and communication.

Here's her reaction via Facebook – "Good for you, that's great! I worked as a social worker on a children-with-disabilities team. I loved my time in England. And yes, talking therapies are much bigger there. It's an interesting place."

So, I await word of my pending membership in Rethink. In the meantime, let's move forward. Let's branch out and expand our community here at Coming Out Crazy. Let's see what's happening 'across the pond'. Let's go global. Isn't that what blogging is all about? Social Media for Social Change to benefit the greater good of society. Community.

We can learn so much from each other. It's about time. Don't you think? Let me know! Comment, please! 

(In all honesty, I cannot answer all your personal emails, though I'm thrilled to receive them. I wish I could. That's what the comments on this blog are for. If you wish to remain anonymous – and I understand why – create a special email address, or a different username or identity. But, please, comment and keep on commenting.)

I want to hear your voices! Your ideas and perspectives. How else can we become a strong community and a force for change? That's what must happen. That's my vision for this blog! 

Change through the exchange of information, ideas, suggestions, experiences. All are valid when it comes to healthy recovery and healing. It's called "talking therapy"!

Thanks so much, in advance, for your support.

Speak soon!

sln

My adventures "across the pond" ... (part one)

This past Sunday morning, after a really good, long, healing night's sleep, I awoke, walked into my office and logged onto BBC News. I've just started to subscribe. 

I've been feeling a bit claustrophobic lately. All this neuroscience for mental health is beginning to get to me. I'm itching for new perspectives. Fresh ideas. The North American biomedical approach to mental health is beginning to seem oppressive to me.

Out of curiosity, I decided to explore, so I typed "mental health recovery" into the BBC search engine, where I easily found a link to its bright purple and white Mental Health page with a big picture of a dozen or so people of diverse ages and races, smiling, plus dozens the following (unsponsored) section and links:

1. Emotional health 
2. Disorders and conditions 
3. Coping Techniques 
4. Supporting and caring 
5. Therapy and therapists
6. Understanding drugs 
7. See also (This page is filled with all kinds Useful Contacts.)

(I tried this with CBC News and one unsponsored story appeared. Dated May 23, 2008. The headline? More education needed about schizophrenia in teens years: experts.) 

I clicked on every link and my mouth was watering. I knew Britain took a different, more enlightened stand on mental health, but I had no idea it was so dramatically different than what's going on here in North America. Neurosciences and drugs therapies are practically the only option available to people seeking help. No wonder 75% of Canadians who could be helped by some form of therapeutic treatment never seek it. That daunting statistic used to be 66% about 10 years ago. Now it's up 11%. Something is drastically wrong here.

But what really caught my eye on the main BBC.news Mental Health page, right at the top, was this main message. You couldn't miss it:

Maintaining a balance. 

One in four of us will have some sort of mental health problem in our life. This means there are millions of people in Britain who are either encountering problems themselves or know someone else who is experiencing them.

Here's what jumped out at me. The first five words. "One in four of us..." 

Not one in four people. One in four of us.

Now that's inclusive. I love inclusive – it's one of my guiding principles. This message was so humane and inviting. 

I started exploring this front page, clicking on all the links and eventually found myself at Rethink. This national British charity, founded 30 years ago, to give a voice to people affected with severe mental illnesses, now has more than 8,300 members and helps more than 48,000 people every year through a variety of services, support groups and the dissemination of helpful information. 

This enlightened initiative has this mission:

"Working together to help everyone affected by severe mental illness recover a better quality of life."

(Rethink is only one of several large and longstanding Mental Health charities that are "challenging discrimination" and helping and celebrating people with mental health issues. Among them, Time to Change –  Let's End Mental Health Discrimination and Mind for Better Mental Health., which gives out an annual award for Journalist of the Year.

"For excellence in reporting mental health issues in the media... high quality, informed reporting on these issues goes a long way to increase public understanding about mental health. People with mental health problems consistently tell us that negative media coverage only adds to the challenges they face. We hope that this award paves the way to breaking down any remaning taboos around mental health reporting."

I was drooling. Wow, do we have a lot to learn from the Brits.

May I remind you that Canada is still the only G8 country without a national mental health strategy. That, finally, is in the works, thanks to the work of the Canadian Mental Health Commission.

But it's very slow. I'm impatient. My concern is that with several senior psychiatrists there, wedded to the traditional biomedical approaches to mental illnesses, there's an innate bias. I could be wrong.

Back to Rethink, which I first heard about from a British gent named Robert Ashton. He is a veritable "one-man industry" with his own blog, Robert Ashton Unlimited and he's all over YouTube. He accurately describes himself on his website as an established author, broadcaster, experienced social and business entrepreneur, and an engaging speaker. Somewhat unconventional. 

He lives with depression.

Let me scroll back for a moment...

Back on February 18, 2008, I received an email from a man named Robert Ashton. I didn't know him. Never heard of him. It was a few months before I had started blogging here for Healthzone.ca at The Toronto Star. I was teaching part-time at Seneca College. And I was dabbling in blogging and had just launched my own personal blog. Perhaps four people had found it. One of them was Robert Ashton. He had emailed me and said that his Google-Alert on "anti-stigma" had picked me up along with my Groucho Marx quote. That's how we met – through Groucho. 

I wasn't spending much time blogging back then – mostly developing and teaching my then-new Leadership in Society course. I knew how to do it – but hadn't a clue how to teach it. Also, I was far less cyber-savvy. I'm no great shakes, now, but I'm learning fast. So, I confess, I didn't do much homework on Robert. 

However, all that changed on Sunday morning, sitting here in my nightie, my blogging uniform, fresh out of bed at 6:15 a.m. That's when my Dandie Dinmont Terriers wake me up. After taking them out and feeding them, I decided to check out BBC news, re-discovered Rethink and tried to join.

But I couldn't. Only Brits allowed. 

I knew that mental health recovery, rarely discussed here in the North America mainstream media, is big in England. I could see, judging by the BBC Mental Health page, that Talking Therapies are big there, too. Much bigger than Drug Therapies. You know, I'm a strong advocate for "talking therapies" to mental health recovery and very concerned about the pervasive emphasis on drug treatments here in North America.

So, since I have Robert's Skype address, I decided to ring him up and ask him if he could help me join Rethink. 

I never, for a moment expected him to answer. Sometimes I forget about time zones. Timing is Everything, I know, but timing has never been my strong suit!

Anyway... rrrriiiinggggg... and there Robert was – live and in full colour! All dressed and respectable, in his charming brick-walled office, wearing his pale blue Rethink T-Shirt. It was about noon in England. It was 6:15 a.m. here. Oh, dear. He could see me, too, in my pink nightie, my hair unbrushed, barely awake. I forget that I have a camera on my iMac and I don't Skype very often, either.

Oops! I was caught, unawares. Oh, well. What the hell....

But I've gone on too long, so this is going to be a two-instalment post. I know, I'm leaving you here, hanging. I promise on Thursday, I'll continue my story of my conversation with Robert Ashton and my adventures "across the pond..." in Part Two. 

Thanks for your patience. Stay tuned.

A concerned mother responds...

On Saturday, May 9, the day before Mother's Day, I received the following personal email in response to my Friday post on Mothering and mental health... I responded immediately and the writer gave me permission to publish it anonymously. 

It's been on my mind ever since. The links, by the way, are mine.

Hi Sandy,

Thank you for your article today. Certainly you raise the red flag for children who are funnelled through the mental health system, but what do we do with highly anxious children who simply cannot fit into a mainstream environment?

Increasingly there is reduced emphasis on play in childhood. The Junior Kindergarten and Senior Kindergarten environment both my children are in right now focuses on benchmarks of school readiness, even when my five-year-old daughter (already labelled with ADHD and a severe anxiety disorder) is clearly in need of play and relationship skills.

For our part we are lucky enough to have the financial resources so that my daughter will switch from the current system into a private Montessori school. But what of the other families? And what of families like us, who despite having the financial and educational resources lack the emotional ones?

For example, while university educated and from a middle class background, I was diagnosed with ADHD at 37 after a lifetime of failures at school and career, which brought on depression after depression. My coping skills are substandard to say the least, and I know now that I lack the higher level processing required to keep myself organized and calm without lots of self-prompting built into my day.

I openly admit that my difficulties related to my child might well be a contributor to her current behaviour. I learned TOO LATE of the role that interactive play and engaged relationships have in healthy brain development – she's only five-and-a-half!

Evidence supports the growing school of thought that stressors in a child's environment – be they inadequate relationship support, inadequate nutrition, inadequate stimulation – before the age of six (or even three) create an overdeveloped limbic centre in the brain and thus literally create a "stressed" brain which is then much less responsive to cognitive interventions.

Is there any way we can create a formalized network of wellness and relationship-based initiatives based in play, sport, the arts and nutrition which might support healthy brains by identifying the science and getting this info out to the community?

I'm game to support this as a parent and as an employee in the childcare system. Any chance you could write a blog as an informal tool to gauge public interest? I know many academics in Canada including child and adolescent psychiatrist Jean Clinton of The Offord Centre – and the mother of five children –and her colleagues (associated with McMaster University and McMaster Children's Hospital in Hamilton, Ontario) might be willing to support an application to get this kind of network going in communities across Canada.

Looking forward to seeing your thoughts in blog format or by reply to this email. 

What an intriguing synthesis of neuroscience sounding a call to turn back the clock for the sake of our youngest children.

And talk about red flags! This email raised dozens for me. Alarms went off. Bells started ringing. Whistles began blowing. Mind-blowing sounds.

I had hoped the comments to this blog would erupt with these concerns, but alas, this didn't happen, proving my point. Young children do not and cannot speak up for themselves. They desperately need advocates who can listen to them actively and empathetically – listen with their eyes, their ears and their hearts.

Especially very young children, most vulnerable to their emotional and physical environments – their relationships, their mental, emotional and physical stimulation, their nutrition – as their young minds and brains, as well as their bodies, are rapidly growing, developing and changing. 

I just watched Dr. Jean Clinton's PowerPoint presentation. Have a look. It's based on a broad variety of sources – medical, scientific and other researched-based programs that will give you a quick overview of the complexities of the developing brain – from conception to age 12. Yes, the pre-natal brain/mind. It includes the ground-breaking work of Toronto-based children's advocate Mary Gordon, founder of Roots of Empathy, a program with which I am most familiar. 

There is a great deal of "evidence" suggesting many things in our information-driven technological age. But what do we really know for sure about the workings of the brain, especially the childhood brain? 

Terms like neuroscience and neuroplasticity are transforming our understanding of how the brain works, but for young children upon whom studies are never performed, the first three to six years of life are and should be sacrosanct. 

That's why I think "gauging public interest" across Canada about the level of concern for the mental health of our very young, even unborn children, as this young mother suggests, is so crucial. Why not mounting a movement to reclaim play in childhood, especially in junior and senior kindergarten.

Why are we rushing childhood? Why tamper with kindergarten? Very young children are not mentally and emotionally equipped to learn numbers and the alphabet at the ages of three or four or five. It's too stressful for them. 

When I was in kindergarten, in the early 1950s, all we did, was play. Socialize. Eat snacks of cookies and milk. Rest on mats. Cut paper and paste it (with that icky flour and water kind of paste) and play – with wooden blocks, in sand boxes. Simple toys. We learned to share. We ran around outside or we sat in circles and sang sweet simple funny songs with rhymes and riddles. We did all kinds of art like finger-painting and water colours on big easels. Kindergarten was engaging and playful. Our minds were free to explore and develop. It was creative. We learned to relate to other little kids. That's what it was all about.

Building relationships.

I'm sure there was more to it than that, but I know we never had to learn to the alphabet or count. Homework? You must be kidding. That wouldn't have been healthy for our little developing brains. That was for the big kids in Grade One.

Sometimes, old traditions stand up better than all the new fangled ideas. Kindergarten was created in 1840 in Germany so children could learn to communicate, play and interact appropriately with each other. 

Today, kids learn to interact more through technology, computers, television, in a virtual world. How can these cool media be healthy for developing brains? 

Consider The Mothercraft Movement. 

It was started 1907 by a New Zealand doctor Truby King who pioneered a system of early childhood care for new mothers in a bid to combat high infant mortality rates. He published a Mothercraft Manual and mothercraft nurses, specially trained in his methods, were dispatched all over the country to teach new mothers.

King prescribed "Twelve Essentials" for the raising of healthy infants. At that time, they were considered revolutionary, but they're still relevant today and worth revisiting: air and sunshine, water, food, clothing, bathing, muscular exercise and sensory stimulation, warmth, regularity, cleanliness, mothering, management and, rest and sleep.

How many of you fit all 12 "essentials" into your daily routine – especially "muscular exercise" and "rest and sleep" with "regularity"? I know I don't!

By 1923, New Zealand had the world's lowest infant mortality rate, and two years later, Dr. Truby King was knighted for his vision of standardized "mothercraft" care and the way it was universally administered. His methods were adopted throughout the British Commonwealth.

One mothercraft nurse, Barbara Mackenzie, moved to Toronto in 1931 and married Irving Robinson, the president of the board of the Hospital for Sick Children. Together, they founded the Canadian Mothercraft Society.

There have been other experts. Dr. Benjamin Spock, the renown pediatrician and psychoanalyst published his landmark book, The Common Sense Book of Baby and Child Care in 1946. It's still in print today.

I'm hoping my HealthZone.ca editor Brandie Weikle, who also edits and blogs at ParentCentral.ca along with Ann Douglas who writes The Mother of All Parenting Blogs will have a look at this email and consider raising these concerns with their online communities.

Perhaps all three of us can raise these questions and help to create a groundswell of interest in a proposed pan-Canadian "network" of individuals and childcare experts with a variety of resources to consider the issues raised so passionately by this young mother.

Healthy children have a much better chance of growing into healthy adults. Isn't health the best legacy you can give your child?

What do you think? How do you feel about this? We were all children. I'm inviting you to share your ideas, your memories of your childhood. How were you mothered? Schooled? Raised? How has it affected you? What are your concerns about your children, nieces, nephews, grandchildren, friends' children? How do these questions resonate with you?

Let us put our heads together. We may not all be "mothers" or "fathers" but we're all sons and daughters. Let's empathize with today's children and help them reclaim their childhood.

Don't you think they deserve it?

 

Yesterday, I lost my mind ...

Yesterday, I woke up exhausted. I neglected to take care of number one. Me! 

So here's what happened.

I forgot to take my medication until 2:50 p.m. I neglected to brush my teeth all day. I didn't get dressed. I didn't brush my hair. I grabbed unhealthy food and gobbled it down without tasting it. Like a robot. Just to fill a void caused by frustration.

I was struggling with a post for this blog. Inspired by you. It was driving me crazy.

Ideas were flooding into my mind. All day. I had trouble focusing. I was hitting dead ends and desperately turning around re-routing my thinking.

This went on and on and on until 12:14 a.m. this morning, when I gave up and went to bed with a couple of 0.5 mg tablets of clonazepam – which I take only when needed. It helps calm my mind and turn off my thoughts when they're running wild.

No. I do not get depressed. I get the opposite. I get revved up. I cannot turn off my brain. I cannot stop my thoughts. Ideas in words and pictures flood my consciousness. Crazy quilts of ideas. Conflicting ideas. Picture fragments. Images. Blasting away the cerebral quiet needed to fall into sleep.

I don't have the switch that most people have when they get overtired. That's what's wrong with me. That's the root of my "mental illness" and there really isn't a name for it, other than chronic hypomania with a vulnerability to full blown mania if I don't ensure that I sleep.

Sleep is the antidote for my sanity. Everyone's really. But I cannot do it without a little help. Maybe I should learn to meditate, mindfully. But I don't have time. 

That's why I'm better on medication. Including my mood stabilizer. 

That's what I've learned.

I slept, dreamlessly. Deeply.

At 6:15 a.m. I was awoken by my dogs nipping at my side of the bed and wanting to be let out.

This morning, after five and a half hours of sound, deep, fast sleep, I woke up and guess what...

My mind was back.

Miraculous.

Anyway, that's the miracle, the blessing, the healing of sleep!

Go figure.

Anyway, I want you to know that I'm working on a couple of amazing posts for you. Inspired, as always, by you. 

However, I need a break. So today, as it happens, while my husband is having a colonoscopy, I'm going to be spending a long overdue hour with... guess who?

DOCTOR BOB! My wondrous shrink. After spending an hour with him, always, without exception, I leave magically transformed. Always better, more calm, more at peace with myself, than when I did at the beginning of that hour.

Feeling better than when I did.

So, I'll be back tomorrow. With the post I wanted to finish and see up today. I need a break. I need to take care of myself. We all do! 

This is the first and most important lesson of a life lived well. 

Have a great day!

Speak soon!

sln

"The Center Cannot Hold" – a riveting memoir of madness

First, thank you for letting me know that length matters less than content to you – and that you like variety – in my "Coming Out Crazy" posts. My poll was minuscule, but I am very grateful for your feedback.  

I'm happy to hear it. It's much harder to write short than long – trust me on this. I worked for a tabloid – which refers to size more than content, or used to – so from now on, I will not waste endless amounts of time trying to "trim" my posts to fit an arbitrary word count. I'll say what I want to say.

To be honest, I've never cared much for numbers. Ever.

"Enough" is my favourite number.

Particularly ...  number of pounds one weighs. Number of years one lives. Number of dollars one has or does not have – or one "makes" per number of hours, days, weeks, months or years one is lucky enough to be able to work.

You see? Lucky enough. Good enough. I love "enough." Enough has no measure and cannot be quantified. It's just "enough." 

My mantra these days is – "To know you have enough is to be rich."

Those are the measures I love. Measures than are immeasurable! I don't like the word "priceless" – I prefer "incalculable." 

If you must know, and I'm confessing this here for the first time – I'm truly afflicted with numerophobia and arithmaphobia. I need a calculator to add 2 + 2 to get the right answer. And for me, the right answer is rarely 4, but a greater number, like 5 or 10 or 27 or 13,753. That's synergistic – another story!

You wouldn't want to see my bank book! 

Now then, on to bigger and better things – like moving one car out of my parking lot, for good.

Elyn R. Saks, author of "The Center Cannot Hold," was born in Miami, Florida to a comfortable family. In her memoir, she writes about living with schizophrenia, although she always refers to "battling" or "fighting" it. Language aside – and hers is not particularly positive – there are some problems in what I found an utterly fascinating narrative.

First – and this really bothered me – Saks and her editors neglected to credit Irish-born poet and playwright William Butler Yeats – winner of the 1923 Nobel Prize for Literature – for the title of her book. Maybe it's so obvious, they didn't think Yeats needed the credit. Maybe I missed it. Either way, it's relevant.

In his 1919 post-WWI poem, The Second Coming, Yeats describes the chaos of trench warfare. It perfectly mirrors the chaos Saks describes in her mind as her psychosis progressively shatters her sense of reality.

 

Here, in the first of Yeat's two-stanza poem, he powerfully evokes the madness of The Great War:

Turning and turning in the widening gyre

The falcon cannot hear the falconer;

Things fall apart; the centre cannot hold;

Mere anarchy is loosed upon the world,

The blood-dimmed tide is loosed, and everywhere

The ceremony of innocence is drowned;

The best lack all conviction, while the worst 

Are full of passionate intensity.

(Bold face is mine, not the author's.)

No mention of Yeats or his poem is made in the Saks' book. It's a small thing, but it bothered me.

More interestingly, my episodes of manic psychosis never felt remotely like her psychosis, which was more constant and with variances in intensity. 

(Perhaps her diagnosis should be schizoaffective disorder, if she must have a diagnosis. Frankly, I just prefer to think of Elyn as now in recovery from her "madness" – as I am from mine.)

When I'm psychotic, my reality shifts dramatically. I've had delusions of grandeur and believed I was God. I felt once like my car was a magic carpet flying down Bayview. Quite joyful, actually.

Yet, for Saks, her delusions are the opposite. Evil. Frightening. Monstrous. Horrifying. She believes she's the devil, that she's killing thousands of people with her thoughts.

Her wild hallucinations are often self-destructive and suicidal, too. Her vivid descriptions cut to the bone. Compared to hers, my psychotic trips were like a visit to Oz. Colourful, bright, exciting, adventurous and exhilarating.

I've read many articles and several memoirs by people with other mental disorders – mainly anxiety, manic depression or one of the bipolar spectrum of disorders. This is the first by someone who endured and remembered years of wildly "florid" psychoses in remarkable detail – all the while fighting the idea of her schizophrenia diagnosis or any need for medication.

Saks is clearly and exquisitely brilliant. She managed to complete her MA and PhD in philosophy at Oxford University primarily because of the therapy she received with a psychoanalyst. Drug free. She completed her law degree at Yale, with another psychoanalyst. Today, she continues her recovery with psychoanalysis. 

Medications play an important and necessary, but secondary role in her recovery. For Saks, it is the regular and rhythmic daily hour spent voicing freely and frankly whatever crosses her mind – and analysing the meanings behind those thoughts and words. This is the process that gives her insight. It's painstaking hard work. A lifelong process.

Why did she become psychotic? Who knows? That's debatable. At the age of eight, she remembers experiencing night terrors, fierce compulsions and feeling that her mind was crumbling like a sand castle.

After discovering an adolescent flirtation with recreational drugs, her parents, overreacting I think, enrolled her in a brutal rehab program that instilled in her an irrational fear and repulsion at the idea of taking drugs of any kind, including prescription drugs. This phobia plagued her for years.

After that, her family seemed relatively absent, according to her. Saks writes of constantly protecting them by masking her mental problems. 

The story of her struggle to survive and graduate from three universities on two continents – always far from her home and family – is riveting. She attended the best schools – Vanderbilt, Oxford and Yale – all on scholarship, desperately clinging to some semblance of sanity to prove that nothing was wrong with her mind. Her life then was an astonishing roller coaster ride starkly contrasting British and American approaches to psychiatric treatment. (The Brits were much more humane and liberal.)

Most of all, her passion and unquenchable thirst for knowledge buoyed her on and kept her focused despite long periods of psychosis and several hospitalizations. 

In the academic world, Saks found emotional and intellectual solace and sustenance. She could breathe and flourish. Outside that world, in "the real world," she was and is lost and feels threatened. Her routine breaks.

My psychiatrist recommended this memoir to me, I'm sure, because his approach to psychotherapy is psychoanalytic, which as Saks explains, is not always Freudian. There were many approaches.

Her first experience with psychoanalysis was in Oxford with a "Kleinian" therapist, who was not a medical doctor. 

Melanie Klein was "an Austrian psychoanalyst who immigrated to London in the late 1920s," Saks writes. "Unlike Freud (and later his daughter Anna), Klein believed that people with psychosis could benefit from analysis and that the necessary transference could develop. It was her theory that psychotic individuals are filled with (even driven by) great anxiety, and that the way to provide relief is to focus directly on the deepest sources of that anxiety."

I remember being told years ago, when my diagnosis was schizophrenia, that I would never be a candidate for psychoanalysis. Dr. Bob says that's ridiculous. "You never had schizophrenia," he said when we discussed this. He's been my therapeutic lifeline since 1991.

Besides her personal journey, the psychoanalytic process is central in this memoir. It strongly suggests that the bio-medical model driven by the excessive use of antipsychotic medications for psychosis – rarely psychotherapy of any kind – is not be the only route to recovery.

Once Elyn, as a young Oxford student, begins her psychoanalysis, she also begins to develop the insight that allows her eventually to begin to unravel the complexities at the base of her psychosis. This is where her healing begins.

I strongly recommend this memoir – warts and all. I don't know why it wasn't widely reviewed, but I suspect that's because it defies the mandate of Big Pharma. She was mentioned in a landmark Sunday, May 11, 2008 New York Times story in the "Style" section about Mad Pride. 

Next week is Mental Health Awareness Week, BTW!

Today, Saks is a University of Southern California professor of law. Mental health law is her area of expertise. She's well-published and openly advocates by telling her story, though reluctantly. She's never liked lecturing. She's also an adjunct professor of psychiatry at the University of California in San Diego and a research clinical associate at the New Center for Psychoanalysis in Los Angeles, where she lives.

She's still in analysis, and she's finally accepted her diagnosis and that her medication helps and not hurts her. Perhaps, one day, she will take her recovery beyond her diagnosis and stop labelling herself as "schizophrenic" – because she is so much more. Like so many others who live with and manage their psychoses, she has "a beautiful mind" but it appears that she's veering in the direction of the neurosciences. She is an academic, first. And is or plans to participate as subject and investigator in psychiatric and neuropsychological study of the brain – "and given brain scans," she reports at the end of her book. "The hope is that maybe then we can learn things that will help others."

She's now happily married to a good, kind, wise rock of man. 

I am, too. Her marriage, like mine, appears to be the wellspring of balance in her life and mind. It inspires in her a sense of security and hope.

We're both very lucky women – with more than enough.

Edging a car out of my parking lot...

Last summer, my psychiatrist Dr. Bob recommended I read The Center Cannot Hold – My Journey Through Madness by Elyn R. Saks.

This was a first. We've been together since 1991.

The only other book we ever discuss is the Diagnostic and Statistical Manual of Mental Disorders. He even gave me a little pocket edition called Quick Reference to the Diagnostic Criteria from DSM-IV – published in 1994. I treasure it.

Back to the Saks memoir. I've discovered a number of peculiarities about it. Though it was number 34 in the "Also Selling" section on the New York Times best seller non-fiction list in September  2007 – it was never reviewed and its author is mentioned only once. Saks is briefly quoted, but not about her book or herself.

Compared to the other notable psychiatric memoir I've read – An Unquiet Mind, A Memoir of Moods and Mania – published 10 years earlier by Kay Redfield Jamison, there are stunning differences.

Saks is cited twice in The New York Times archives.

Jamison, 561 times.

Saks has schizophrenia diagnosis. Jamison, bipolar disorder. Or manic depression, the term she prefers.

Both are married. 

Saks to a good, kind, supportive, rock-solid man – Will.

Jamison, to a Richard J. Wyatt, a renowned schizophrenia scientist about whom she has written her sixth book – Nothing Was The Same, a memoir – to be published in September 2009. For Jamison, a brilliant writer with an M.A. in English Literature, her second memoir is an elegy on her 20-year marriage that ended when Wyatt died of cancer in 2002 at age 65. 

Saks is a PhD in philosophy, a professor of law at the University of California, an adjunct professor of psychiatry at the University of California, and a research clinical associate at the New Center for Psychoanalysis. She prefers research. Dislikes lecturing. She's had a number of important scholarly books and papers published about her area of expertise – mental health law.

Jamison is a PhD in psychology, a professor of psychiatry at the Johns Hopkins School of Medicine, a clinician/researcher and one the leading authorities on bipolar spectrum disorders. She's written several medical texts, plus five books for non-clinical audiences. All about mood disorders. All wildly popular.

Among them – Exuberance – about hypomania. Touched With Fire examines manic depression and the artistic temperament. Night Falls Fast – about suicide – is still the first of its kind. Meticulously researched and breathtakingly written by a clinical psychologist who came perilously close to dying by suicide before being prescribed Lithium Carbonate in the mid-1970s. (Then a revolutionary pharmacological treatment for manic depression, it saved her life and successfully stabilizes her mood swings.) 

Saks' book is barely discussed. Rarely reviewed. Problematic, perhaps, it is extraordinarily compelling – the only memoir I've ever read by anyone with wildly delusional and psychotic episodes of schizophrenia yet her primary treatment was and remains psychoanalysis. She takes medication now, but for years she fought her diagnosis and often refused to stay on it.

Here, I stop. The rest of this post goes back into the parking lot. To be continued next time. 

You'll notice my posts are shorter, as they should be. This one is 561 words. I've written 1,500 word posts. Too long. I'm not writing for a magazine here. You should be able to read these on Kindle or an iPhone.

Let me know your thoughts on this. Does "length" matter?

Speak soon.