"Next to Normal" – Electrifyingly True!

I never felt so normal in the audience of a Broadway musical as I did on Wednesday sitting second row centre at The Booth Theatre on West 45th Street in New York watching the Tony Award-nominated Next to Normal with my husband.

Within the first 10 minutes, I felt like I was watching myself. 

It was a peculiar feeling. And I have to admit these feelings are really hard for me to process. Much more complicated than I thought they'd be because they resonated so deeply. It would be much easier to intellectualize about this electrifying show. As I've been struggling to write this post for the last 24 hours, I've found myself slipping into a different voice. My critical, reviewing voice. 

But I wasn't given two complimentary tickets to intellectualize or be a theatre critic and write a review. Next to Normal has received rave reviews. Critical acclaim. From the leading theatre critics in New York and Washington. For it's bravery, originality, spirit and sincerity.

I flew down to Manhattan on Wednesday morning – and was on the ground for all of nine hours – to see this show and react to it viscerally. Diana Goodman, the suburban housewife and central character in Next to Normal, and I share a very similar psychiatric diagnosis – bipolar disorder.

We're not identical – no two people with the same diagnosis ever are – but the way Diana is treated by her doctors, what she goes through on her odyssey to wellness is so close what I've gone through that it's almost uncanny. That's why I've been struggling and it's taken me so long to process my feelings. Her story cut me to the core.

Minutes after the curtain rises, sleep deprived and speedy, Diana is madly making her family's lunches. She covers the kitchen table, chairs and eventually the floor with slices of bread, lettuce and ham in a frantic attempt to get ahead. Until her husband stops her and they go back to her doctor, once again, for a readjustment to her psychopharmacological cocktail of drugs.

Diana is a victim of today's North American quick-fix, pill-popping, McDonaldization of psychiatry culture. Over a period of seven weeks, Dr. Fine, her psychopharmacologist, keeps readjusting her meds to gradually numb her symptoms, or rather the side-effects of all the powerful psychoactive pills she taking – until she admits "I don't feel like myself. I mean, I don't feel anything."

Finally, Dr. Fine is satisfied, as he pronounces, "Patient stable."

That was me 40 years ago, when there wasn't the same smorgasbord of psychopharmacological drugs available. The few that did exist – chlorpromazine and haldol, the "chemically-lobotomizing" antipsychotics – were primitive mind-bludgeoners compared today's offerings. I barely remember how I felt because I was knocked out, practically deadened by their force.

We've come a long way. Or have we?

It's just a question of degree. Diana Goodman's doctors approach her today in much the same way as my doctors approached me then. That's why this riveting rock musical is hard hitting. It hit me hard. Over the head.

Has nothing changed in all these years? Obviously not. 

Today, we're brainwashed into believing that we should be controlled. All be emotional "square pegs." Diana's profound emotional "differences" are harrowing for her family. Her husband is happier when she's more complacent and compliant. Calmer, more "normal" – even if she's dying inside.

I wasn't married when I was experiencing my most dramatic moodswings but my immediate family – my parents and sisters – mirrored exactly what The Goodman Family experienced. That was a revelation for me, watching this show.

My mother, like Diana's husband, Dan, was understandably happier when my manic episodes were tranquillized. The family functioned better, I guess. 

No one really knew how I felt inside except me. Years of my episodic emotional cycling must have been so emotionally trying, tiring and taxing on my family, I can understand why they were ecstatic when I met and married my husband almost nine years ago.

Ironically, one of my sister's said to me: "He perfect for you. He's a rock." 

I'm absolutely sure they're thrilled that he has taken me off their hands. More or less.

Watching the Goodman family dynamics play out in front me with its passionate and at times violent rock rhythms, for the first time I was able to empathize, not only with Diana and her family, but with my family, too. I've never been able to feel what they must have felt, until Wednesday afternoon. The process of writing this post has been cathartic for me. It's forced me to put into words a reality that I've never admitted before because I didn't have their point of view.

My relationships with members of family have been and, at times, can still be rocky. But until now I only perceived my own pain. Not theirs. I couldn't really empathize with them. I didn't have two-way vision. 

Diana's sixteen-year-old daughter, Natalie, could have been one of my sisters, when I was at the crest of one of my many emotionally and mentally turbulent times.

Like this beautiful, sensitive, searching young girl, they, too, must have felt invisible when one of my over-the-top outbursts overshadowed them and their lives. Or when my mother, like Diana's husband, Dan, was overwhelmed by a crazy-quilt of confusing feelings and guilt. They both navigated an arduous, uncompromising, and at times, horrifying medical system that can seem so cruel and inhumane.

There is no escaping collateral damage when one member of a family is struggling to live with a mental illness, especially given the still essentially regressive approach offered by mainstream medical practitioners. 

"Next to Normal" has nailed many of these truths in my consciousness for the first time. And, as a rock musical, it accomplishes this in a way that no straight play or movie ever can. The music is emotionally jarring, at times. Poignant and plaintive, at others. I bought the CD but it's hard for me to listen to because it's so provocative. Musically and lyrically, it's exploring a rugged emotional landscape that's been my experience. An experience no one wants to talk about. 

Diana decides to try a new psychiatrist. Dr. Madden, a psychotherapist, not just a psychopharmacologist. He explains that medication and psychotherapy work best in tandem. But when she hits a wall, he hypnotizes her, opening to her memory of the trauma she's buried for 16-years in order to survive. (It took me 14-years of psychotherapy to unearth the trauma of my adolescent sexual assault.)

Mind you, Diana's story is not exactly like mine. No two stories are. Nor is her diagnosis – Bipolar depressive with delusional episodes. Mine is Unipolar disorder with a vulnerability to mania. 

She misses the vibrancy of her emotions when she's medicated. The drugs mask the real reasons for her madness. She's wrestling with unresolved anger and grief. The pills aren't helping her with that. Pills don't unravel or clarify the causes of your psychiatric symptoms. All they do is fiddle with the chemistry of your brain. It's futile. Her depression would be considered "drug-resistant." 

And she knows it. So, understandably, courageously, she pours all her pills into the garbage. She's a brilliant, charming, vivacious and educated woman. Both she and her husband were architecture students when they met.

None of these exquisitely performed scenes by the show's magnificent ensemble seemed to make anyone in the packed Booth Theatre squirm. We were enthralled. Fascinated. Fixated. Touched. The satire pinched and pricked us. We rode with the pulsating waves of the music and with each character. And surely, all of us identified with at least one character in the show.

Who has not known someone like Diana? Loved someone like Diana? Or been someone like Diana?

We weren't uncomfortable. I didn't sense that. We laughed and cried. We were moved because what was happening was so real. So genuine. I had no idea that it would resonate with me so deeply. 

It's 2009. Diana reluctantly consents to a course of ECT or electroconvulsive or "shock" therapy treatments. They destroy the last 16-years of her memory. Wipe it out. This was not my experience in 1965, or again in 1967, or again in 1975. I had three courses of ECT, but my memory is intact. If I've forgotten anything, I have no idea what it is.

Diana's experience is extremely rare. But, it's mind-blowing in a Broadway rock musical. 

My knee jerk reaction, however, was one of anger. At first. Why portray such a rare scenario in such an otherwise authentic production? I know that ECT can be helpful in cases of drug-resistant depression. Won't this reinforce old stereotypes?

Writing this post, I've been processing my feelings about "Next to Normal." My mind has flooded with painful memories and distressing emotions. Forcing me to relive my own past. It's no sentimental journey, I can tell you. But I realize how enlightened and enlightening this Broadway rock musical is. 

And one thing it is not – is docudrama or medical research.

So I'm not angry anymore. Experiencing "Next to Normal" – watching it live – is a journey in itself because it's so real. When you see Diana's tears streaming down her face. They're real.

And so is it's ending.

On her own, sad, but hopeful, Diana leaves her family and returns to her parent's home, a safe haven for her, to begin to heal and recover. To start to live with an awareness of the trauma she's experienced. Understanding will take time for her to process. That will be her recovery journey.

Her husband and daughter will survive and recover, too. There's no doubt they'll grow stronger. And as the stage went black, I felt inspired and hopeful. It won't be easy for Diana, but mental health recovery isn't easy. It, too, has it's ups and downs. It's all about finding a meaningful way to live. It's different for everyone. 

This is such a rich, multilayered musical. Utterly unique. There's not a derivative minute in it. It has many truths.

For me, Diana's odyssey keeps on resonating. I cannot get her out of my mind. We're all "next to normal" because, after all, what's normal?

As far as I'm concerned, this show is a clear-sighted, and at the same time, empathetic critique of today's biomedical neuroscientific approach to psychiatry. It shows how little many psychiatrists, especially psychopharmacologists, know about the workings of the human mind – which is far more complicated than the brain. How frustrated and impotent they must feel. 

Brian Yorkey, who wrote the book and lyrics for the "Next to Normal" defines the difference between "treatment" and "healing" – and far too many modern medical practitioners simply are not being taught the tools to heal the "whole" person. This is a real tragedy.

He certainly reinforces a fact I have learned – having lost a kidney to Lithium toxicity. There are no quick fixes for the devastations of emotional trauma, which invariably play a huge role for so many of us diagnosed with so-called "mental illnesses."

Diana's recovery begins when the show ends. Perhaps she'll begin to find a way to live a life that's meaningful for her. Whatever that may be. Recovery is different for all of us.

We all jumped spontaneously out of our seats at The Booth to give the six-character ensemble a standing ovation. How they deserved it. This is not an easy show to perform eight times a week. 

Alice Ripley was astonishing as Diana. I'd put money on her winning a Tony Award on Sunday night. Next to Normal deserves to win one for Best Musical. You can watch at 8 p.m. on CBS. The Tony's are by far the most intelligent and entertaining televised award shows.

I left the theatre inspired and uplifted. Not flying high. But proud. I sensed that everyone felt the same way. People were talking about the show, exploring their feelings and voicing them. 

And there's so much to talk about. 

Biologically speaking, how our pets heal us...

I cannot fathom the number of hours I spend here in my book-lined study in front of my iMac – writing for you! 

Under my desk, a simple pine Parsons table with no drawers, lies Riley, my five-and-a-half-year-old Dandie Dinmont Terrier. Always.

He makes all my work, which is also my passion, perfect. I love being here because he's always here with me, lying at my feet – a warm cuddly reminder of his loyalty and love for me. 

Sometimes he gives my toes a bath with his affectionate licks. Other times, he sleeps curled up, contentedly. If I get up, he raises his head. If I leave the room, he follows me. He is always with me, body and soul, wherever I am, whatever I do. Steadfast. My constant companion. Joined, latched on, like a baby. 

He loves me. Adores me. Not just because I feed him and groom him. He depends on me. And I adore him. I find holding him in my arms and stroking him the most relaxing activity in the world. We have the perfect bond. 

Right? Wrong!

It's all chemistry. Neurochemistry. Oxytocin. The hormone of love. 

I remember first reading about oxytocin and writing a story about it for The Toronto Sun in 1993, sparked by Pulitzer Prize-winning New York Times science writer Natalie Angier's November 2, 1993 story What Makes a Parent Put Up With It All?

Meg Daley Olmert read that same story – and it changed her life.

Back then, neuroscientists were on the threshold of their investigations into brain chemistry and, in this case, human parental-social bonding.

"Oxytocin is familiar to doctors as the hormone that spurs birth contractions and milk production in women... But lately scientists have realized that the power of the hormones extends far beyond physiology," Angier wrote.

"'Nature is conservative, and this a beautiful example of that... The same peptides that are important for things like uterine contradictions and feeding an infant are also important for monogamous social bonds and parental behaviour,'" Angier quoted National Institute of Mental Health (NIMI) neuroscientist, and now NIMI director Dr. Thomas Insel as saying.

Angier was reporting primarily on what scientists were beginning to discover about human-to-human bonding, through their studies of animals and in some cases, "measuring women's blood levels of oxytocin before and during pregnancy." 

But she concluded then, that many of these findings were still highly speculative.

Meanwhile, Meg Daley Olmert, a native New Yorker, was always fascinated with animals. She was born with a natural way with them. She worked with veterinarians, and later with National Geographic Television, watching how people and wild animals interact. Endlessly fascinated.

In 1993, actress and conservationist Stephanie Powers hired her to develop a series on the history of animals and humans. Olmert's research led her to scientists who were studying the therapeutic healing effects of having people with heart disease and mental illnesses engage with animals.

She witnessed how young boys with Attention Deficit Hyperactivity Disorders were calmer and more attentive when paired with or even just in the company of rabbits, turtles, gerbils and doves. She started asking questions and discovered what we all now know and almost take for granted. 

That our interactions with animals can lower our heart rate and blood pressure. 

She started asking why? How did this biologically happen?

No one knew. Olmert, it seems, was the first person to seriously ask those questions and pursue the answers.

That's when she read Angier's 1993 New York Times story. 

Instead of following Angier's lead and tracing the scientists investigating human-to-human bonding, Olmert began her own personal odyssey – an investigation of the human-animal bond and the power of the hormone oxytocin in this immutable bond.

She contacted the same scientists Angier had interviewed, those working with animals who released oxytocin, but invariably got only so far, before hitting dead-ends. 

In 1993, research into neurochemistry and human behaviour was booming. (Today, it's booming even louder.)

More and more questions were haunting Olmert. 

Why did animals have this obvious calming effect on humans? How did it happen biologically? What was the history of this bond? How did humans first domesticate wild animals? 

Oxytocin, it would seem, was the key, she surmised, but no one was studying this particular phenomenon scientifically. 

It was years before she finally found the scientific hook she needed. 

In 2003, in South Africa, two researchers had actually measured blood pressure levels and chemistry in 18 humans and dogs before, during and after warm, friendly interactions.

They found that oxytocin in both humans and dogs practically doubled. That meant that pets are one of the most powerful triggers of oxytocin, this "hormone of love" in humans.

I've known that since I was 17 in the Spring 1966 – though I certainly had no idea why. Could barely think clearly about almost anything. My mother had bought me my first dog, a two-year-old retired Yorkshire Terrier show dog. Derry was the sweetest, gentlest, kindest little fellow I've ever known. She felt, instinctively, that having the responsibility of caring for him would help me recover – heal me – after seven tumultuous, mind-numbing months in The Clarke Institute of Psychiatry after my first and by-far worst-ever psychotic episode.

Mother knew best. 

Derry did. From then on, I was utterly smitten with dogs. I've had six, including Riley and his mischievous female companion, Lucy. 

Their amazing predecessor, Murphy the Wonder Dog, a poodle/shih-tzu cross was a St. John's Ambulance Therapy Dog. For several years, we went to the adolescent and adult psychiatric wards at Sunnybrook Health Sciences Centre – no one else had the nerve – where I witnessed first-hand how he calmed agitated and anxious patients by simply rolling over on his back and luxuriating as they rubbed his tummy.

I cannot live without a dog in my life.

For those of us living with psychiatric diagnoses, the repercussions of emotional trauma and mental health issues, our pets have long been our most loyal living companions. Stroking them calms us more easily and effortlessly – more safely – than any psychotropic drug. While mental illnesses have a sorry history of socially marginalizing us, our pets are oblivious to this discrimination and prejudice. It doesn't compute with them. 

All they want is to connect with us. Bond with us. To be touched and to touch us.

Animals, especially our pet dogs and cats, are often our significant others. They love us more divinely than any human possibly can. Without explanation. They understand us on a visceral level that cannot be matched by any psychiatrist or psychotherapist or even close relatives. Even, dare I say, a spouse. Without words. Babies. Like little children who never grow up. No wonder we anthropomorphize them.

Spell the word "dog" backwards and you have "god". The origin of the word "dog" remains one of the greatest etymological mysteries of the English language. I wonder why.

There's more to the animal-human bond than biology and neuroscience, I'm sure. Just as there's more to the human-human bond than biology and neuroscience. But, we are still on the threshold of our understanding of these complex, always unique relationships. Still learning. There's so much more to learn, with each new discovery. 

Our world of knowledge is expanding exponentially and it's often overwhelming for me. But I'm curious. That's why I keep an open mind.

The healing power of dogs has been studied and celebrated, but Meg Daley Olmert's landmark book, Made for Each Other (The Biology of the Human-Animal Bond) published in February 2009 (Da Capo Press,$30) is the first to seriously examine the biology and neuroscience in the manifold bonds between animals and us.

She will be giving an exclusive lecture about her research findings on Saturday, June 6 from 4:30 p.m. to 6 p.m. at the Pawsway Pet Discovery Centre near Toronto's Harbourfront Centre on the shore of Lake Ontario, at 245 Queen's Quay West. 

Tickets are $40 before June 5 and $45 at the door. Call (416) 360-PAWS (7297) to reserve. Seating is limited. 

Signed, specially discounted copies of her book will be there.

And so will I.

P.S. Good News: Commenting is fixed. I long to hear from you. All is well with the world! :–)

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?

 

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. 

The perfect pill ...

I'm exuberant. Can't help it. It's my nature. That's why I was first sent to a psychiatrist. Histrionic, they called it. Dramatic. Exaggerated. 

As a child, my nickname was Sarah Bernhardt.

Sadly, even 49 years of psychotherapy hasn't changed this in me.

It can and often is a real problem for a lot of people, especially those close to me. I've always been exuberant. Really irrepressibly animated. Upbeat. Bouncy. Larger than life. Fast thinking and faster talking. My husband says I never stop to breathe. He can't get a word in.

I'm a true extrovert who thinks and talks at the same time. And fast. I derive my energy from engaging with others.

I burst out of bed in the morning and instantly, I need to connect with people. I start making phone calls or if it's too early, I check my email – before I brush my teeth. I'm constantly checking, connecting. I thrive on connecting.

You cannot miss me at a dinner party. I have to rein myself in sometimes. I can become euphoric without any chemicals at all. High, on Perrier and lime. Happy, joyful, animated, lively. I can drive my family crazy.

Oh, I can listen, too. Really intensely. I'm an exuberant listener. 

My mood stabilizer prevents me from becoming so manic I become psychotic. But for the normal everyday hypomanic moments, for the little madnesses that I bring to everyday activities from teaching to grocery shopping to walking my dogs – yes, I'm an exuberant dog walker, too – what to do?

(This term, one of my students actually told me I was too charismatic to be a teacher!)

Well, at last, a new pill has been developed and it's just received FDA approval – a prescription depressant called Despondex.

This may be my salvation. 

Have a look.

Peace, at last.

I'm not God! You're not God! We all make mistakes!

We're human. Not perfect. We make mistakes. 

Even doctors aren't God. Though some think they are, or second to God. Take the infamous Dr. Joseph Biederman, the Massachusetts General Hospital child psychiatrist currently the focus of a congressional investigation into conflict of interest charges, known as the Godfather of the Bipolar Child Theory – for more on him and his "mistakes" read Furious Seasons. 

Philip Dawdy has been on Biederman's case for ages, scooping the mainstream press until quite recently, when Congress started its investigations. If you can believe it, this all-too-influential shrink recently went on the record as saying that if you're a full professor at Harvard, you rank above God! 

Yup. Medical doctors, some, can begin to believe they're God or close to it because they deal with life and death all the time. They don't yet create life – but they're working on it – and they can certainly save lives. They can also, however, make mistakes, errors in judgement, all kinds of mistakes, that can cost people their lives.

Psychiatrists are especially good at making mistakes. It's part of their stock-in-trade. How many psychiatric diagnoses have you been given? Count 'em. On the average most of us have at least four. Just because people don't admit to making mistakes, doesn't mean they don't make them. Or they don't exist. Or they didn't happen.

It's not like a mistake is "the tree that falls in the forest" when no one sees it fall or hears the crash. Does that mean the tree didn't fall? Does that mean the mistake didn't happen?

No way. Especially because mistakes usually ripple. Like a pond, when you throw a stone into it. Someone will hear the echo, feel the tremor, sense the backlash. Remember Newton's Third Law: "For every action, there is an equal and opposite reaction."

Doctors and lawyers and all "experts" and "super-specialists" and even "judges" make mistakes. They're human. We're all human.

Yesterday morning, my husband and I were talking about this over our 8 a.m. coffee. We were reading in print our two favourite Sunday New York Times columnists – Frank Rich is Marty's and Maureen Dowd is mine. 

They were both writing about Barack Obama and the political crisis of his presidency right now. We were talking about Obama and some of the mistakes he's made. 

That "Special Olympics" joke was a big one for me. Huge. It didn't bother Marty as much, but he doesn't have any kind of disability whatsoever. I wear hearing aids and I'm in recovery. I have a psychiatric diagnosis. In my world, people see what they believe instead of believing what they see. Many people are blinded by their beliefs. Blinkered. 

It's not always easy. So that joke really disturbed me. 

Yes, Obama was quick to apologize. 

As the late Carnegie Mellon University computer science professor Randy Pausch said in his Last Lecture, apologies must have three parts:

"What I did was wrong. I feel badly that I hurt you. How do I make this better?" 

Obama learned an important lesson about his "slip of the tongue." Something we all do! They're thoughtless. And sometimes not so innocent. They can be cruel. They cut deep.

Tim Shriver, Chairman of the Special Olympics in his gracious televised reaction to Obama's "sincere" apology for the joke he made on "The Tonight Show with Jay Leno" at the expense of people with special needs said, "Words hurt. Words do matter... and this is a teachable moment." 

Let us all learn from the U.S. President's mistake.

Think about that much misinterpreted, misused, misunderstood word, stigma. You know I find it foul and confusing. Hurtful. Let this teachable moment be a wake-up call for all of us to be more respectful with the language we use when talking about people with psychiatric, mental and emotionally traumatic problems, conditions, disorders, difficulties, addictions and troubles.

Sadly, you cannot take back hurtful words once you've said them or they've slipped out. I detested that joke, but I still believe Obama is a brilliant man with enormous empathy, the potential to be a great president and to make positive changes for the greater good. Even to help repair a very badly broken economy. 

I also believe that the other half of mistake-making is to be forgiving. 

At 9 a.m., Marty turned on our favourite TV show – CBS Sunday Morning and guess what! 

Host Charles Osgood, the epitome of his name, announced "this week's cover story" – headlined "Ooops" – Make No Mistake: To Err IS Human" – all about the human bent for "getting it wrong," for "misconstruing and misinterpreting," for "misreading and confusing," for "mixing things up and miscalculating," for "assuming and blundering and omitting and miscalculating."

And why. Based on a new book, Why We Make Mistakes: How We Look Without Seeing, Forget Things in Seconds and Are All Pretty Sure We Are Way Above Average by Joseph T. Hallinan, former writer for The Wall Street Journal, Pulitzer Prize winner and past Nieman Fellow at Harvard University.

I take a different approach to mistakes. Hallinan can tell you why we all make them. A good night's sleep can help you avoid them, but we all know that sleep heals.

I'm going to muse on why we should celebrate them. 

Look up human in the dictionary. As an adjective, it means mortal, fallible, weak, frail, imperfect, vulnerable, susceptible, erring, error-prone as well as compassionate, kind, understanding, sympathetic and approachable.

Some coincidence, eh? I didn't even watch the whole segment. I'll catch it later. I just ran up here to my iMac and started writing. There is method to my madness for wanting to write about not being God and mistakes. I've made so many, lately.

At the same time, I love mistakes, even though I feel awful when I make them. I take them very seriously. I want to disappear off the face of the earth. They have enormous impact on me and on others. I try very hard to right my wrongs. I try even harder not to make the same mistake twice. 

They are the best learning tools we have. When I tell my students that, they think I'm crazy. (Of course, we know, they're right! ;-)

God doesn't make mistakes. God is perfect. That's why God is God. We cannot understand God, because that's what makes God, God. If we could understand God, we'd be God, too.

In our house, we view God in several ways. Among them, as "Good Old Dad" and as "DOG" spelled backwards.

Religion has nothing to do with it. Nada. I learned this from one of my students recently.

As for mistakes, as I mentioned, I'm an expert at mistake-making! A veritable genius at it. I have made so many mistakes, I could write an encyclopedia of mistakes.

 

Last year, I taught four classes in one day, pinch-hitting for a professor who was having surgery for cancer. I was teaching her classes – and a subject I had never taught. On the first day, I taught from 8 a.m. until after 5 p.m. My two classes and her two classes. Eight hours of teaching in one day. A first for me.

I was so exhausted at the end of the day I was a little wound up. That's my nature. I'm intense. I stormed into my Chair office. Paula Gouveia hired me – knowing all about my hypomanic "nature." I announced, "This is the worst teaching day of my entire life."

Without hesitation, she said, "No, this is the best teaching day of your entire life because you'll never forget this feeling and you've learned so much. You've learned that you can do it."

She was right. I've never forgotten that moment, that day and those feelings. Maybe I am a better teacher because of it. I'm still learning.

Paula is now Dean of Arts and Sciences at Humber College.

All I can say is, thank God for mistakes.

–––

P.S. I haven't forgotten my promise to review  Elyn R. Saks' best selling memoir The Center Cannot Hold, My Journey Through Madness (Hyperion, 2007) but as I am hardwired into news, I wanted to pick up on the timeliness of today's subject. I hope you don't think I've erred in so doing.

The Mood Disorders Association of Ontario is another great place for Peer Support. Thank you, Leslie, for Sharing the Health.

Have a great week. Speak soon!

The Family's Resident Nut Case

Last night, I was talking to one of my cousins. I'm the eldest of three girls. As far as I'm concerned, he's as close as any man I've ever known to being my brother. We're just a year or so apart – I'm older – and we grew up together every summer at The Family Cottage. He is one of only three people who gets away with calling me by my real name – Sandra Lee. The other two are my sister, Glorianne, and his sister, Linda Sue. Don't get me started.

Anyway, in the context of a conversation about our family, I told him that "I know I'm the family's resident nut case." He laughed and said, "The whole family's filled with nut cases." 

Very sweet and kind of him. But, in truth, it's quite true. This role belongs solely to me, and always will. I can't seem to stop that particular old record from playing. Currently, I lead the pack. Others may have preceded me. Others may come along. Right now, however, this is my starring role in my family. Nothing else I do ever seems to dull my glow in the family constellation. 

Later that evening, I sent him an email and signed it, "The Family's Resident Nut Case," and boy, did that feel good.

That's the power of "Coming Out Crazy" – as far as I'm concerned. I shared a little laugh with my closest cousin. I didn't take myself too seriously. (Rare, trust me.) In fact, I joked about myself. And guess what? It felt fantastic.

Try it sometime. You might like it.

*   *   *

Now, on to bigger and better things.

The print edition of The Toronto Star is to be congratulated for brilliantly deciding to enlist the genius, wisdom, knowledge, humour, medical expertise and humanity of Dr. Rob Buckman as a regular Friday Living section columnist.

Bravo, Toronto Star! With this kind of decision, your print edition will last forever!

Rob and I are long time friends. We've known each other since 1986, when I profiled him for The Toronto Sun. He is a leading oncologist at Princess Margaret Hospital/University Hospital Network, with professorships at the department of medicine at the University of Toronto and the M.D. Anderson Cancer Center, University of Texas. He has an ecclectic list if outstanding accomplishments and he authored a long list of books.

He is also my "spirit doctor" – but that's another story. 

Read him. I promise you that he will not disappoint you.

Today, his column is called Of bats and balls and baptisms and the first line is amazing, especially for me, as I teach a Community Service course at Seneca.

"Nothing provides a sense of community better than a community." 

That's Rob. Concise. A man for all seasons and reasons. A Humanist. A master of language. An original thinker. A true Renaissance man. We just spoke on the phone for about a half an hour and I am promoting him because I know how much integrity he has. I cannot recommend him highly enough. Aside from the fact that I absolutely adore him!

He's soul tonic.

• • •

I found an interesting blog, The Healthy Skeptic. 

I found it from my sweet, literary, New Jersey friend Susan Schechter, on her fine, often funny bipolar blog – If You're Going Through Hell Keep Going.

This blog is "published" – his word, not mine – by a fresh-faced and fascinating fellow named Chris Kresser. Right now, he's studying at the Acupuncture & Integrative Medicine College in Berkeley, California. 

I respect Kresser's goals for writing his blog and the way he expresses them. Particularly in terms of psychiatry, which needs to be held in check, I believe, for its unbalanced emphasis right now on the neurosciences. I find this is very problematic. 

"I launched The Healthy Skeptic last year to help others see through the common myths and misdirections peddled by the media and medical establishment. It is my sincere hope that the information on this blog will lead to greater health and well-being for you and those you love."

I love his last three words – "and those you love."

You should know where Kresser is coming from.

He is well-travelled, well-informed, well-read and passionate. Personal experience with a serious illness will do this every time. In his case, a mysterious tropical illness he contracted turned chronic. Twenty doctors around the world and thousands of dollars later, still sick, he decided to heal himself. Not by becoming a doctor, though he considered it, but by studying Chinese medicine, "which has been successfully used for over 2,000 years to promote health and longevity in addition to treating disease," he explains.

Our conventional, mainstream Western biomedical model cannot always make that claim.

This is a definition of Integrative Medicine. It's more than allopathic, alternative and complementary. Its synergistic. The whole is greater than the sum of its individual parts. I attended a conference on Complementary and Integrative Medicine in Mental Health in Toronto last June. Every presenter had an M.D. from a leading university medical school – like Harvard – but sadly, few medical doctors touch these methods and I didn't meet any at that conference. Most tend stick with what they know. What they've learned and how they've been taught. More invasive treatments. Surgery. Radiation. Side-effect causing drugs and chemicals. Often good. But not always. Why not use every tool in the world's biggest international tool box?

(Again, Dr. Rob Buckman – a researcher and clinician – thinks outside the box. In 2005, he launched a low-dose chemotherapy with no side-effects that, in some cases extends the lives of breast cancer, ovarian cancer and vulva Squamous cell cancer patients. He is about to introduce it in melanoma patients. It's called DalCM-P.)

Here's one of my favourite Kresser posts, which starts with this quote: "A theory that is wrong is considered preferable to admitting our ignorance." – Elliot Vallenstein, Ph.D.

The "chemical imbalance" myth. 

By the way, Vallenstein is a professor emeritus of psychology and neuroscience at the University of Michigan and the author of Blaming the Brain and about four or five other books on this subject. This is a man who knows of what he speaks. 

Kresser adds: "Even the most prestigious medical journals (dealing with mental health issues and psychiatric issues) have become nothing more than sales brochures for the pharmaceutical industry."  

Philip Dawdy on his award-winning, often-quoted-and-rarely-credited blog Furious Seasons, is consumed with posts supporting what Kresser goes on to observe: "I saw massive conflicts of interest between drug companies, doctors and researchers every I looked. I learned that errors in medical care are the third leading cause of death in the U.S. each year."

One more thing...

As you know, I'm a print journalist at heart. Can't help it. Old habits die hard. I love research. So, it seems, does Kresser. Sources are very important to me and to him. At the bottom of each post, he lists his recommended resources – not websites – books.

For The "chemical imbalance" myth, one book is by Vallenstein. Another – The Myth of the Chemical Cure: A Critique of Psychiatric Drug Treatment by J. Mondrieff, a medical doctor herself, recently received rave reviews in the British press. I really wanted to add it to my library, but it costs $75.96  at Amazon – a little too rich for my blood. 

The point is, Kresser does his homework and I like that about him.

So, have a look. Let me know what you think. I may muse more on The Healthy Skeptic sometime myself, but now here, not now.

Though I am going to review a book. Another book. 

Believe it or not, for about two years, I reviewed books full-time for The Sunday Sun. It was the toughest beat of my entire journalistic career. No one knows how hard it is to review a book, until you are told you're expected to deliver a book review a week, at least, one ... in no more than 800 words and preferably less. It almost killed me, but I loved it because it was so challenging. And for the first time in 35 years, I put the English Literature half of my Queen's University B.A. to good use. (The other half is drama.)

Except I just did a word count, so I'm not going to review this book right now. But I'm going to tease you and recommend it now. Review it next time. By then, perhaps you'll have read about it and we can discuss it. Have a little "Coming Out Crazy" book club chat.

The book I was going to review is called The Center Does Not Hold – My Journey Through Madness by Elyn R. Saks. 

She has "battled" – her word, not mine – schizophrenia all her life. And is in remarkable recovery. Primarily through psychoanalysis and medication, which she fought taking for years. Also, she is in recovery because of the love of her husband, which I completely understand. Her sheer will. And her beautiful mind.

My psychiatrist, Dr. Bob, recommended this book to me. Something he rarely does. I cannot recommend it enough. And you'll find out why. Here's a sneak preview and a riveting YouTube speech of University of Southern California Gould Law Professor Elyn R. Saks, talking and reading from her book.

Now, it's Spring and I'm going to take my dogs for a well-deserved walk.

This is the perfect day for Resident Nut Cases like me to be legitimately a little nutty! And that's how I feel. And I'm allowed. That's my role. One of them, anyway!

Enjoy your weekend.

Educating the Educators...

Last week, for the first time ever, I went to Kingston to speak to about 100 Queen's University first year medical students, the Class of 2012, during their Mental Health Awareness Week.

I was invited because of a question one of these students posed here about my ongoing campaign against the use of the word stigma. As I'm a Queen's alumna, Class of '74, she asked me to speak and I was happy to accept.

I was pretty nervous. I've never spoken to medical students before. I'm no scientist nor was I prepared to lecture. I wanted to initiate a dialogue. Engage these students. Challenge them. Get them asking questions.

After all, they're the next generation of doctors, perhaps psychiatrists. I was told that they hadn't heard one word in their classes about mental health/illnesses/psychiatry until the four 50-minute lunch time presentations last week. Mine was the last. 

It went very well. I had a full house and 95 per cent of them were medical students, along with a few psychology and occupational therapy students.

My introductory remarks were short – a quick overview of my mental health history, all my different diagnoses, my subsequent kidney problems caused by 16-years of badly monitored Lithium and the fact that despite "overcoming every psychiatric indignity short of a lobotomy, I'm still here."

I was hoping they'd be open to thinking about mental health outside the medical model. Consider the recovery model. I assured them that I was not anti-psychiatry but I wanted them to hear about the possibility of change. Desperately needed change in the way medical doctors are trained. So I chose to speak briefly about recovery, the power of language and mental health and why I detest the word "stigma" – and then open the floor up to them. They asked a steady stream of good, intelligent questions, especially about labelling.

"Isn't calling yourself crazy a label?"

Sure, but I asked, "What do you think crazy means?"

"Being out of control."

Don't you get out of control sometimes?

"Yes."

So, we're all capable of being crazy sometimes. That's one word I think we all use. I happen to like it. In the same way the many people who are gay, lesbian, bisexual and transgendered like to call themselves queer.

I told them that I also love the word "mad" – because madness has always been part of the human condition. Long before it was pathologized into the sphere of medical/mental illnesses. Since biblical times, people who behaved irrationally or too differently were seen to have what are today considered mental or psychiatric problems.

Invariably, though, people perceived as mad were, and still are, dismissed and disregarded. Marginalized. Perceived as less than human. With no voice. And because we have no voice, change is slow to happen. No one wants to listen to us or take us seriously.

I cannot remember many other specifics about my talk – I don't use a script – my presentations are spontaneous. The students were very attentive and according to the feedback I received they found me refreshing. They were very surprised that I was so open about my psychiatric history.

This always amazes me. I have no reason to feel anything but proud of my life. With all its ups and downs.

Before my presentation, I met with Heather Stuart, a Queen's professor of community health and epidemiology. She gave a very informative and thoughtful lecture a few days before mine on "Mental Health Stigma and Health Care Delivery."

Stuart is a world leader in the field of "stigma" as it is associated with mental illnesses. She told me that only three medical students attended her talk, which is too bad because they would have benefitted enormously from her research and experience, her empathetic approach and her wisdom. She is a scientist, yet she is as passionate as I am about changing the public perception of people with mental health difficulties, their treatment and maltreatment 

One statement shocked me. She said that people are afraid to come to seek treatment for their mental health problems, because of the negative stereotyping of and discrimination against people with mental illnesses.

"Three quarters of people in Canada and worldwide who meet criteria for mental health diagnoses do not receive care," she said.

In 1998, when I first started publicly presenting my story, putting these issues of stereotyping and discrimination out in the open, that figure was 66 per cent. Now, it's 75 per cent. What's happened?

That's the subject for another post.

Stuart was very receptive to my ideas about problematic use of the word stigma. As I see it, that word is part of the problem.

As well, she said that in terms of change, "We know contact counts. When we put people with mental health problems with those that don’t and allow positive interaction, we can see the difference that it makes. We need to do that. More contact. And we need to focus. We shouldn’t be going about spraying the public population. We need to target groups. Here are some groups that can be targeted ... worthy of targeting. Understanding what they need is the important way to proceed: School, police, health care workers."

I say, start with the health care workers, especially the doctors.

Especially the doctors who are training doctors in medical schools.

Medical school curricula must be revamped so that health is considered. Physical, mental, emotional, spiritual, social. Holistically. Surely health is more than absence of disease. Yet, healing and doctoring by today's standards are very different.

Today, we are a series of body parts and systems. Medicine is so specialized and technological that the essence of the person seems lost. That's where complementary medicine, and other schools and approaches to health have so much to share.

Not in today's medical schools, where one model is taught. The biomedical model. Not the recovery model. Doctors are scientists. Psychiatrists are neuroscientists.

What about our minds?

Nothing in medicine is purely objective – writes psychiatrist Ron Pies in his fascinating essay "Psychiatry Clearly Meets the 'Objectivity' Test." According to Dr. Emmanuel Persad, psychiatry can be an intellectually vigorous and rich specialty if talking therapies are a mainstay of its practice. If they aren't, I would think psychiatry must be boring as hell.

How can the neurosciences – biochemistry, pharmacology of the brain and nervous system – help people with issues that relate to their life experiences? Their traumas? Their minds?

Brain disease? No way.

Drugging people is a quick fix that doesn't always work well. It can help, but pharmaceuticals can also have serious side effects. Without the insight that can only come, in tandem, with psychotherapy, the neurosciences are only a partial fix. They're only one set of tools in a therapeutic tool box filled with many other potentially more effective tools. Certainly, handing out drugs without any human, therapeutic support isn't the only answer.

You need to have an open mind. That was my parting shot to these future medical doctors.

An open mind.

No answers. Just some soup to stew on. Part Two

I'm afraid I cannot easily answer the questions I posed last week. I promised but I cannot. I'm overwhelmed.

I've dug myself into a deep dark philosophical/medical/epistemological hole out of which I feel unable to tunnel my way out.

I'm just a humble scribe. I find the answers from wise people. I research and read and ask questions and think and try to assimilate. Then I write. Sometimes I like to think I also right, but that's when I'm a little high, exuberant.

This happens, mostly, when I'm exhausted. Often in November. Never a good month for me. And never  sweet for teachers or their students. Buried under mountains of marking, classes are interrupted by the sounds of students snoring — suffering from burnout after pulling too many all-nighters.

So, today, I'm throwing a whole slew of ingredients into my little soup pot here at Coming Out Crazy, so you can inhale their aroma and let your native wisdom draw you to your own conclusions.

First Ingredient: This from Benedict Carey of  The New York Times, courtesy of BipolarConnection.com on a novel new theory about the origins of mental disorders. Competition from the male and female genes. Think of it.

Carey reports on the theories of Bernard Crespi, a biologist at Simon Fraser University and Christopher Badcock, a sociologist at the London School of Economics. Both are outsiders in the field of behaviour genetics yet they've published their findings in several journals.

According to their intriguing research, Carey wrote: "An evolutionary tug of war between genes from the father’s sperm and the mother’s egg can, in effect, tip brain development in one of two ways. A strong bias toward the father pushes a developing brain along the autistic spectrum, toward a fascination with objects, patterns, mechanical systems, at the expense of social development. A bias toward the mother moves the growing brain along what the researchers call the psychotic spectrum, toward hypersensitivity to mood, their own and others’. This, according to the theory, increases a child’s risk of developing schizophrenia later on, as well as mood problems like bipolar disorder and depression."

That's just the beginning. There are mind-boggling implications for mental health in Crespi and Badcock's inventive and groundbreaking genetic research. It's firing the imaginations of clinicians, researchers and scientists everywhere.

“I think this work is often brilliant,” said Dr. Stephen Scherer, of the University of Toronto and the Hospital for Sick Children, by e-mail of Dr. Crespi. Still, Scherer added, “For autism there will not be one unifying theory but perhaps for a proportion of families there are underlying common variants” of genes that together cause the disorder."

Second Ingredient: Thanks to Dr. Ronald Pies and my friend and mentor, professor Harold A. Maio when it comes to talking about "mental" issues, specificity is the key.

"Be Specific," Harold said. "We don't talk about having 'physical illness,' so why do we talk about having  "mental illness?"

Good point. Dr. Pies agrees. "As for how people diagnosed with so-called mental disorders ought to refer to their conditions, I think it's often best to name the specific condition, such as "I have an anxiety disorder" or "I have bouts of depression."

Third Ingredient: a tantalizing item from the multiple award winning Furious Seasons and the ethical, Seattle-based journalist Philip Dawdy, a Herculean Sherlock on mental health matters pertaining to the nefarious shenanigans of Big Pharma and other dubious psychiatric types.

Watch out for some "goofy" new disorders you may be diagnosed with when the new and improved, revised DSM-V is published in 2011, as reported yesterday by Northwestern University English professor Christopher Lane in the L.A. Times, writes Dawdy.

• Apathy Disorder
• Parental Alienation Syndrome
• Premenstrual Dysphoric Disorder
• Compulsive Buying Disorder
• Internet Addiction
• Relational Disorder (Aren't all human beings relational? I teach a course on the Relational Model of Leadership. I'd love to know what this one means. If we're not Relational, I wonder what we are?)

"They'll all be considered full-fledged psychiatric illnesses," writes Lane in his Op-Ed, Wrangling over psychiatry's bible.

Better start looking for a psychiatrist now because we're ALL going to have "mental health issues" or "mental disorders" or "mental illnesses" or "diseased minds."

Which brings me to my Fourth and Final Ingredient in today's soup! From Dr. Pies on the difference between illnesses, disorders, diseases, "You are raising extremely complex questions — we are all in 'over our head'! In brief, I believe that 'disease' [etymologically, dis-ease] is a pre-biological concept that has its roots in suffering and incapacity — not in demonstrating biochemical or anatomical lesions. The distinction with disorder is very confused in medical history. I also believe — along with psychiatrist Robert Kendall (former president of the Royal College of Psychiatrists) — that 'disease' ought to be predicated of persons, not 'minds' or 'brains' or 'bodies'."

Hence — specificity and how you feel, your level of suffering and incapacity determine whether you have a disease, a disorder, an illness, a condition. Whatever. This is the bare bones of it. Just a taste of a very complex issue. But perhaps it will be thought provoking. 

Have a gander at Objectivity in Mental Health: Who Has a Real Disease? — this is a most entertaining and informative talk Dr. Pies gave at the Cambridge Saloon Salon on March 2006.

I hope you enjoy my soup. I hope it's soul soothing and stimulating. If you have any other ingredients or seasonings that may improve it, please share them.

Have a good meantime. Keep warm and stay cool!

On a New Reader's fascinating question. Part One.

A New Reader posed a fascinating question, based on yesterday’s post.

“I guess I would like to ask you (and I am highly interested in your answer as someone with so much experience), what other term would you use instead (of 'mental')? Madness doesn't apply to all mental disorders, e.g. anxiety, depression. And yes there are grey areas and people diagnose everything under the sun now as mental disorders, but how about the real, palpable issue of mental health in Canada or world for that matter?

“I just think we can make the word ‘mental’ become a neutral word, like sinusitis, or myocardial infarction, etc., so that when someone says I have a mental disorder, we can understand that they are not to be discriminated against or treated as 'abnormal' just by the virtue of having a disease.

“Or if they are to be treated as ‘abnormal,’ it should be a part of a treatment protocol so this becomes routine and we recognize that we are treating them differently, and not ignoring the elephant in the room.”

Great question. I’m glad you asked it and I hope you don’t mind if I share it here.

I‘ll do my best to live up to your expectations and share some thoughts with you, but I don’t think there is any ONE answer. This is really a book!

It’s going to be in two parts. And if you don’t mind, I’m going to consult two far more experienced people than I, Tufts University psychiatrist and professor Dr. Ronald Pies and Harold A. Maio, another one of my sages.

In the meantime, here goes:

If you believe "mental illnesses" are diseases, you could use the word "psychiatric," instead of "mental."

But that’s not a very good solution because “psychiatry” is not seen in the world of medical science as real “science” since so much of psychiatry, like diagnostics, is very subjective.

No blood tests, X-rays, scans, urinalyses, or other concrete tests can yet definitively confirm a psychiatric diagnosis.

Many psychiatric patients, myself included, have had several different diagnoses, depending on who makes the diagnosis, when it was made and what the so-called “condition” is.

This can be true in physical medicine, too, but not to the same degree.

And that’s the point.

It’s “mental” versus “physical” medicine.

I do not believe that "mental illnesses" are caused only by "malfunctions of the brain structures/molecules."

What about emotional trauma? Childhood sexual, emotional and physical abuse? They can cause what look like “mental illnesses,” too. Can’t they?

What about genetics? What about other environmental issues? And personal experiences?

Cannot they also cause mental distress?

Also, I don't see mental illnesses as "diseases."

Are disorders and illnesses the same as diseases? Are they interchangeable? If so, then why aren't Bipolar Disorders — and there are several types — called Bipolar Disease? Or even Bipolar Disorders?

Cancer is Cancer, but any doctor will tell you that Cancer is 20,000 different diseases.

It's just not that simple.

Our minds are not organs, like hearts or kidneys. If they were, I'd ask for a transplant! Just kidding. I’ve grown accustomed to my mind. I rather like it, despite its “issues.” It’s mine and there’s no other quite like it. And isn’t that the point?

Is a broken leg like a broken mind?

Is a mental illness a brain disease? That’s an ongoing debate.

My psychiatrist, Dr. Bob, says neuropsychiatry may be making a comeback. It existed until 1948, when it was split into two different specialties —neurology and psychiatry. Organic and inorganic or ... ethereal?

Medicine and Psychoanalysis.

And where does Psychology fit into all this?

Some might say we’ve come a long way, but I’m not so sure.

I think this is not only a philosophical question but also a political one. The American Psychiatric Association, which is currently revising the Diagnostic and Statistical Manual of Mental Disorders, is a highly political organization.

Disorders and Diseases are not exactly the same. Would you say you have a "diseased mind?" I don’t think so.

Mental isn't really a noun. It just feels that way when someone says, "You're mental." Like you're a "Diabetic."

And that’s the classic comparison. But it doesn’t hold because the mind is a different paradigm than the physical body.

Like Mac computers that are on a different platform than PC's and rarely if ever catch “viruses.”

I believe this. And I don’t know if anyone can prove me wrong.

Mental Illnesses are not the same as Physical Illnesses.

I am not my mental illness. I do not believe that "mental illnesses" will be seen as neutral as long as universities teach doctors that there is a "stigma" around them that we have to get rid of because no one will ever take responsibility for any “stigma.”

The word "stigma" is a problem. It reinforces "stigma" and it's a linguistic problem.

Language is very powerful in creating and perpetuating our beliefs.

If people would erase the word "stigma" from our lexicon and instead talk about ignorance, fear, prejudice and discrimination, then society might take responsibility for its systemic ignorance, fears, prejudices and discrimination.

And do something about it. Using education. But first, people must be aware of their own fear and ignorance, discrimination and prejudice.

The answer is in education.

But the same old problem arises. People don’t know what they don’t know. So they blindly accept what they think is true.

And there are no absolute truths. Except that one!

I’ll stop here and continue next week!