Epilogue

Last Friday, when my Anniversary post went up, I knew it would be my penultimate post, here, at Healthzone.

Minutes before, I learned that The Toronto Star has decided to discontinue "Coming Out Crazy" ~ but wait. Remember. We're more than a blog. We're a community.

IT'S ALL ABOUT RESILIENCE

So before you react, let me assure you, our community and the relationships that you and I have spent two years building, all the caring and candour we have here is not going to disappear because of an arbitrary decision. We're more resilient than that. Right? And if not, this is a great time to learn.

The last few days have taught me so much about positive attitudes as I've been churning out lemonade by the gallon.

And listen. Hasn't it been a great ride so far? 

Well, I've decided that we're staying the course. We're just changing, a bit. That's all. And I'm looking forward to it. Even though change isn't always easy. I've made up my mind that things are only going to get better, from now on.

You know my philosophy. I'm not about to cry in my coffee over what I've lost, because I've lost nothing. I've gained. Big time. I choose to celebrate all I've learned. And move on. No hard feelings. I'm not going to dwell on the past, because I cannot change it.

As I've said, I will always be grateful to my editor Brandie Weikle for taking a chance on me, a blogging neophyte, and giving me the opportunity to learn a slew of new skills. For her generous support and guidance. And for her friendship, which will not change. 

I'M NOT DWELLING ON THE PAST – I'M STAYING IN THE PRESENT

I've benefited in numerous ways personally and most of all, I've made so many friends in you.

None of that will change. Now, is where I am and where I intend to stay. With you. Focused. I believe by staying in the present, the future will take care of itself. 

So, we're going to make a few little geographic and environmental changes. Spruce up our look, though we're keeping it simple. Minimalist. Classic. Easy to navigate. With a blog roll – mine's called "The Honour Roll" – and an "About" page. Both will constantly be changing. As we change.

And believe me. Nothing, absolutely nothing whatsoever is going to shatter our spirit in this new incarnation of Coming Out Crazy. I promise.

Resilience is our middle name. We're moving, that's all.

WE'RE GOING TO CONTINUE OUR WORK TOGETHER – AS A COMMUNITY

We're still going to be the community we've become. We're going to continue the work we're doing together. We're going to keep on growing and learning and evolving and exploring anything that touches on emotional and mental health and well being. 

Most of all, we're going to continue communicating and sharing with each other. Educating and enlightening each other. Learning from each other.

I'll continue reporting on my friend Angela, who's in San Francisco right now. And bring you news. More often, too. Not just twice a week. Whenever I like. We're untethered, now. Free.

By the way, did you hear? This week, the Broadway musical I reviewed here, last June, Next to Normal won a Pulitzer Prize for best drama. After its shaky start, this groundbreaking Tony Award winning rock opera about the struggles of a suburban mother with bipolar disorder and the backlash on her family is the toast of the town. And a mainstream commercial hit, too. 

EVERYTHING IS CHANGING SO FAST

Who knows? We may find a new home. Or other new ways to communicate with each other. I'm hopeful. Everything is changing so fast. It's hard to keep up, but it's amazing how you can adapt. So, for now, we're on our own. 

I'm here for you and I hope you'll be here for me.

I send you all affection, gratitude and hugs, for now.

Speak soon.

You can now find Coming out Crazy here.

Happy Anniversary, "Coming Out Crazy"...

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

IN THE BEGINNING...

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

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

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

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

POSTS FROM THE FIRST FEW MONTHS AND OUR FIRST AWARD

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

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

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

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

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

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

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

And I wrote about you. 

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

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

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

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

I'VE LEARNED SO MUCH FROM YOU...

I learned so much about you and from you. 

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

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

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

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

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

THANKS FOR THE MEMORIES

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

And how much more we must cover.

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

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

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

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

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

With heartfelt thanks and gratitude to all of you.

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

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

Speak soon.

Hugs to you all!

The gifts of giving back...

In my early adolescence, I remember struggling to learn to play George Gershwin's "Rhapsody in Blue" on the piano. How perfect for a budding manic-depressive, years before psychiatrists branded me that way. Back then, my diagnosis was schizophrenia, though I didn't know it. Nor did my family. 

OBSESSED WITH "RHAPSODY IN BLUE"

I was different. And difficult. Histrionic. My nickname was Sarah Bernhardt. I was also taking drama classes, then. My mother considered drama to be a "good outlet" for me, and those classes kindled a lifelong love of the theatre.

But at home, I was obsessed with "Rhapsody in Blue." Mysteriously it whispered to me, deep down. I couldn't explain it. I tingled with exhilaration. Its manic rhythms resonated emotionally. Not rationally or intellectually or verbally. It calmed and excited me simultaneously. Not only listening to our Oscar Levant recording with Paul Whiteman and His Orchestra – but attempting to play this complicated jazz concerto on the piano, myself. 

I have no musical talent whatsoever, but my persistent pounding on the keyboard of our baby grand demanded concentration and focus. It transported me far from my anxieties at that time. Was I making music? I wouldn't call it that, but whatever I was doing was transforming. Tranquilizing. For me.

I felt a little guilty about the way I was mangling Gershwin's masterpiece. He was probably twirling in his grave, but that didn't seem to matter because his music and my attempt at playing it were magical. It had to be therapeutic, though this was years before music therapy was as prevalent as it is today. It felt good. Liberating. It was a healthier emotional release than my acting out.

Until someone in my family, driven mad by my painful practising, demanded I stop. I did. My lessons were stopped, too, I'm sad to say, though I never lost my love of Gershwin and his music.

THE TRANSFORMATIVE POWER OF MUSIC AND THE ARTS

I was very lucky. My parents were vigilant. My mother could see early on that I was struggling in school and needed other more artistic outlets beyond what was offered there. Not all kids are so blessed.

That's why am I talking about the transformative power of music and the arts.

Last Thursday evening, I attended the Annual General Meeting of the Cabbagetown Community Arts Centre where I was elected to the volunteer board. I'm so excited about this. 

For me, helping this small, grassroots organization in any way I can, transports me back to my youth and, in a curious way, to my unfinished performance of Gershwin's piano concerto. 

The CCAC was founded in 1979 by a local Cabbagetown resident, the late David Blackmore, to offer arts programming to children in nearby Regent Park. In 1985, it became a registered charity and now serves all Toronto inner city children. 

"The bulk of our children come from single parent families earning incomes of less than $20,000 per year," CCAC Board President Peggy Weir said. "They have to register with us and we have a sliding scale of fees." 

Individual lessons are offered in instrumental music, and classes in vocal music, drama, visual arts, photography and karate. Homework tutouring is available, as well as pre-school art, reading circles and creative movement classes for moms and tots.

"We focus on individual music lessons and we have qualified teachers who are more than role models and mentors. For many of our children, meeting with their music teacher is the only chance they have each week to engage with an adult, one on one," Weir said. 

 AN OASIS OF LEARNING WHERE CHILDREN ACQUIRE AN EXTRAORDINARY SENSE OF SELF

"Our vision," according to a one-page overview of the CCAC's mandate, "is to be an oasis of learning where children acquire an extraordinary sense of self, of a world where all children and young people have a sense of belonging and are loved and valued. A world where they can fulfill their potential, shape their destiny and experience the joy of life."

Its mission is to do this by "providing them with arts and music lessons focused on building character, discipline and skill."

One woman at the meeting, clearly passionate about the work of the CCAC, sent her son there when he was a child. She talked about how she used to clean the Centre to earn extra money so she could take him to concerts to "see and hear" the music he was learning, being played by the Toronto Symphony or other professional musicians.

Though he's now 29, he did not follow his musical muse professionally, his mother reported. Instead, he became a medical doctor and he's now studying in Florida.

"But he went through the University of Toronto," she said, stressing that the values, skills, disciplines of his musical training and the sense of community at the CCAC equipped him to carry on with his higher education. It changed the course of his life.

Other students have gone on to study music at the Royal Conservatory of Music and funds raised by the CCAC can cover the costs of their entrance examinations. 

MUSIC MAKES EVERYONE FEEL GOOD

"There are oodles of studies showing that studying the arts, particularly music, promotes learning," Weir said.

"Children who take music lessons often become quite enamoured and end up practicing. We give them instruments to take home – violins and keyboards. They have the responsibility of taking care of them. Also, if you're practicing, you're less likely to be hanging out at the corner with friends who may be offering you illegal substances."

Weir has been involved actively with the CCAC for six years and has lived in Cabbagetown for 25 years. 

"I know this community and through my personal experience, I know that music is the great leveler," she said. "It doesn't matter where you come from, it's the international language. I moved to Canada from Brussels. Listening to music or playing an instrument, it no longer matters what language you speak or what your dad does or where you live. It makes everyone feel good. It lifts you up and takes you out of whatever closet you find yourself in."

My music making days are long gone and with my hearing loss, even listening to music is not what it used to be, but I have another source of pleasure that's even more rewarding.

Volunteering. I grew up with a mother who was always active in the community and I've been volunteering for years.  

GETTING OUT INTO THE COMMUNITY AND GIVING A HELPING HAND

There's tons of research proving how volunteering is beneficial for your physical and mental health. I believe in preventative health. Who knows what problems the CCAC may be preventing down the road for its children?

And everybody has something to give. 

That's why I'm so thrilled about joining the CCAC board. Meetings take place in the centre, a newly renovated, brightly-lit space in an old red brick house on Parliament Street. During our meetings, which take place there, we can watch young people bustling to and from their classes. 

You have no idea how exciting it is to watch how your efforts are transforming lives right before your eyes. I can't wait for the Spring Recital.

Not long ago, I met a woman who was struggling with depression. She decided to drive patients to and from their chemotherapy treatments for the Canadian Cancer Society. Her mother had died of cancer and she found that a meaningful way to give back. She admitted that it made her feel better. 

"I still have my dark days, but it gets me out and out of myself," she said.

You cannot buy these gifts of time and care that you're giving. No store carries them. They are priceless. As priceless and rewarding as the way giving them makes you feel.

This & That...

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

Please forgive me. I've missed you.

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

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

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

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

Stressful, to be sure.

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

ANGELA PLODS ON AS HER ECT TREATMENTS DRAW TO A CLOSE

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

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

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

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

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

ECT WORKS BEST IN COMBINATION WITH PSYCHOTHERAPY

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

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

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

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

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

CHANGE IS NEVER EASY – THERE'S ALWAYS RESISTANCE

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

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

WHAT'S NORMAL? AM I NORMAL?

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

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

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

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

WE'RE ALL NEXT TO NORMAL

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

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

Do you?

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

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

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

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

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

Don't you?

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

Angela's news and "Words on the Wall"...

"I'm confused," Angela said at the outset of our conversation last evening at 7:56 p.m. "Really confused."

She sounded groggy and sluggish. I hadn't heard quite this sound before. Her affect wasn't flat. She did not sound in the least depressed, but she didn't have the bounce in her voice I have come to expect lately. 

Angela had her third bilateral electroconvulsive therapy treatment 12 hours earlier – her 15th over the last eight weeks. Her first 12 were unilateral. This coming Monday, she will begin the final stretch of her 12-week treatment course.

"I COULDN'T REMEMBER WHY I WAS HAVING ECT"

"I came out of the anesthesia this morning and I couldn't remember why I was having ECT and I'm still foggy," she said. "I had to do some stuff on the computer and I couldn't remember how. Eventually it came back though..."

"I bought a motorcycle today," she announced, voice sounding a little more cheery. She had been looking at one for over a week. Last summer, her motorcycle was stolen and she's wanted to replace it ever since, but she hasn't been able to move on that decision until now.

She informed me that she did not have her customary afternoon post-ECT nap yesterday, either. 

Instead, she spent the whole day "doing things I had to accomplish," which included spending $16,000 on this new 2009 motorcycle.

"I spent money I don't entirely have," she said. "My mother is lending me $5,000, but when I talked to her about it earlier today, I couldn't really have a conversation with her, I was so confused. This evening, we talked again and I was feeling a little better."

I cut our conversation short. Clearly, she needed sleep. I sensed it and we discussed it. She admitted she was tired and going to bed right after she hung up the phone.

THIS MORNING SHE SOUNDED REFRESHED

At 10:42 a.m. this morning, she sounded like a different person when she answered the phone – refreshed, alert and bright as the day. It's sunny and will reach 18 degrees Celsius. 

"I'm much less confused, though some things are not back yet," she admitted. "I've only been up for about an hour and a half."

We talked about how she learned an important lesson, yesterday, about her need for a nap after her ECT that seems to "scramble my brain." Sleeps seems to unscramble it. 

SLEEP UNSCRAMBLES HER BRAIN AFTER ECT

Sleep heals. We chatted about it and she admitted that having a nap when she can fall asleep on the afternoons after her ECT treatments "may be an answer." 

She was giggling and laughing a lot during our talk. She reported that she was feeling "not too bad" – generally "normal" about her mood and life in general, with "not a lot of plans for the day." 

Usually, Angela sees her psychiatrist on Friday mornings, but today, her psychiatrist is attending a conference.

"I'm not nearly as confused as I was last night, not by a long shot," she said. "I'm feeling much better and my memories are coming back. It just takes a little time, which can be frustrating."

*   *   *   *   *

HONOURING THE MEMORIES OF PSYCHIATRIC PATIENTS PAST

About four weeks ago, Geoffrey Reaume sent me a note about an upcoming, intriguing and creative-sounding artistic initiative called "Words on the Wall" ~ a fundraiser for plaques for the 19th Century Patient-Built Wall.

Geoff and I go back quite a few years. I've interviewed him several times on a variety of topics related to the history of psychiatric treatment of "inmates" at the former Provincial Lunatic Asylum, now the site of the Centre for Addiction and Mental Health (CAMH) at 1001 Queen Street West. 

He is not only a "psychiatric consumer survivor" himself – and flourishing in his recovery, I might add – but also he is the author of Remembrance of Patients Past: Patient Life at the Toronto Hospital for the Insane, 1870-1940. 

This is fascinating and at times alarming history. Geoff is a dedicated and passionate advocate of honouring the memories of the patients who built this wall. He is the driving force of The Psychiatric Survivor Archives who freely and quite regularly shares his expertise and the stories behind the bricks for for people who wish to tour the wall with him.

And finally, Geoff is a York University assistant professor who teaches and researches in the area of disability studies and one of his courses is called Mad People's History. 

BUILD A BRICK WORK OF ART AND HELP PUT "WORDS ON THE WALL"

Now that I've given you Geoffrey's history, here's why he contacted me. 

On April 21 at the Gladstone Hotel, this special "Words on the Wall" event will be held in conjunction with This is Not a Reading Series.

You can take part. The Psychiatric Survivor Archives of Toronto is giving out bricks to serve as the basis for a work of art – possibly yours. Artists and groups, anyone, really, can use a medium of their choice to decorate or create an original brick-based work of art that will be sold by silent auction that night. The evening will raise funds for historic plaques to commemorate the history of the patient-built wall.

That evening, Geoff will also lead one of his engaging tours of "the wall," followed by a relaunch of the 2nd edition of his book, Remembrance of Patients Past. This evening will wind up with the silent auction.

The deadline for submissions is Wednesday, April 7 and to request a brick or for more information, email psychsurvivorarchives@gmail.com or phone 416-661-9975 or 416-809-1013.

WE MUST KEEP CHALLENGING DISCRIMINATION THOUGH EDUCATION

This is a universally significant event, I think, because we must never forget where we've come from, how important and vital our history is and how much work needs to be done to publicly educate everyone, young and old, about psychiatric issues past and present.

Without emotional health and well-being, we have nothing. 

We must challenge and keep challenging discrimination – through education.

We are the best experts. We all can raise our voices. We need to be heard. 

Angela goes bilateral...

Wednesday, March 10 at 4:45 p.m. The phone rings.

"What do you think of the idea of me trying bilateral?" Angela asked.

Her psychiatrist in charge of her current course of Electroconvulsive Therapy had raised the issue in a telephone conversation earlier that day. 

WE DISCUSSED MAKING THE SWITCH

For about 15 minutes we discussed her concerns about making the switch, much in the way we had when she called and asked me, "What do you think of ECT?" back in early January. 

Angela explained that her doctor had made the suggestion because was she might progress more quickly with bilateral versus unilateral ECT. She has had 12 unilateral ECT treatments over the last six and a half weeks. 

"I'm definitely going for the extra four weeks," she said, referring to the option she was given when she first discussed her treatment course and the study on memory loss in which she's involved. "But I'm worried about changing things mid-stream." 

Ultimately, I suggested she speak to her outpatient psychiatrist, who knows more about her psychiatric history and about the differences between unilateral and bilateral ECT than I do. 

She agreed and signed off.

In the meantime, I started nosing around the Internet for a good, reliable distinction between the two variations on ECT administration, without much luck. Most sources were dated in the last century and not very reliable, as far as I could tell.

Within 10 minutes, Angela called again.

"I'm having my first bilateral ECT treatment tomorrow," she said. "I'm going to try it. I discussed it with my psychiatrist and she thinks is a good idea. If I find it's too hard on me, I can always go back to unilateral."

UNILATERAL VERSUS BILATERAL ECT

Wednesday, March 10, 5:41 p.m. 

I fired off a note to my mentor and friend, fellow blogger and sage, Tufts University clinical professor of psychiatry Ronald Pies, MD. 

"I have a question for you. Angela has decided on her doctors' recommendations to try bilateral ECT. She's not progressing fast enough, I guess. She's going to have her first bilateral treatment tomorrow. I want to post about it on Friday. Although, I see an impressive improvement. It's not enough. She's in week seven and has decided to go for 12 weeks. 

"If I could quote you and link to a good article that describes the pros and cons of bilateral versus unilateral ECT, something recent, in this century, that would be perfect. I've looked and I cannot find anything. Am I missing something? Is there something in the archives of Psychiatric Times that I cannot see? I'd rather quote you and link to an article on this ultra controversial subject, but I'm a little stumped." 

At 8:07, Ron's email arrived:

"Given that these are very technical matters, I thought the comments from the Royal College of Psychiatrists, 2008, would be more helpful than a journal paper," he wrote. "I think this really summarizes the situation, as I understand it, quite well. It comes down to a trade-off between very high efficacy, significant cognitive side effects [bilateral ECT] and high efficacy, mild-to-moderate cognitive side effects [unilateral, non-dominant ECT]. There really is no “right” or “wrong” decision."

NO "RIGHT" OR "WRONG" DECISION 

"In bilateral ECT, the electrical current is passed across the whole brain; in unilateral ECT, it is just passed across one side. Both of them cause a seizure in the whole of the brain. Although there is a lot of research being done, it's still not clear which type of ECT is 'best'. 

"Bilateral ECT seems to work more quickly and effectively and it's probably the most widely used in Britain; however bilateral ECT seems to cause more side effects. Unilateral ECT has fewer side effects, but may not be as effective; unilateral ECT is also more difficult to do properly. 

"Sometimes ECT clinics will start a course of treatment with bilateral ECT and switch to unilateral if the patient experiences side effects. Alternatively they may start with unilateral and switch to bilateral if recovery isn't happening. The choice of bilateral or unilateral ECT will depend on the needs and wishes of the patient, the opinion of their doctor and the skills of the ECT team." 

(The boldface is Ron's – not mine.)

Thursday, March 11 at 4:05 p.m.

When I get home from Seneca, I pick up a voicemail message Angela left on my home phone at 1:13 p.m. 

"Hi. It's me. Just checking in. Call me."

HER VOICE SOUNDED COMPLETELY DIFFERENT...  NEW

It doesn't sound like her. At all. I barely recognize her voice, but from the log on my telephone screen, I know it is.

Instantly, I call her back. 

"How are you?" I ask.

There's a liveliness in her voice I've never heard before. Ever. We met in 2006, on the phone. She called me when I was still working at The Toronto Sun. I knew nothing, then, of her psychiatric history or her depression.

"I feel good, but confused," she says.

I can't get over her tone. It's sharper. Stronger.

"Can you describe your confusion?" 

"It's a little bit of confusion, like I can't remember everything I'm supposed to remember," she says.

"What do you mean?"

"Well... it like my thoughts are dull," she says. "I guess I'd call it mild confusion, but it's more pronounced than before."

She said she slept most of the afternoon, following her first bilateral ECT treatment at 7:15 a.m. that morning.

"I just got up," she said. 

I couldn't believe the way she sounded. 

"Maybe I'm spunky. The bilateral treatment was great!" she said. "There were three medical students with the psychiatrist and so she explained everything she was doing very carefully to them, and to me. She told them that I had been having unilateral and that now I'm having bilateral. And so far, I think I can handle it, so I'm going to continue with it." 

Then she started chatting about how much money she had spent that day on new brakes and tires for her car.

"It needed to be done, so we finally got our act together and did it," she said.

TODAY, SHE'S COMING UP HERE AND WE'RE CELEBRATING!

This was the most proactive thing she had done in months. Two weeks ago, she couldn't get it together to get out of her apartment and go for a walk on a sunny day. 

"Oh, and you know what? I had a good time with my anaesthesiologist today," she said. "When he gave me my drugs, he said, 'Have a good sleep.' And you know what I said to him?"

"No, Angela. Tell me."

"I said, 'Night, night!'" 

She was laughing. Really laughing. 

So, today we're celebrating. Right after she sees her psychiatrist this morning at 10 a.m. she's driving up here and we're going out for lunch. 

And I can't wait to see her!

 

Angela is good...

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

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

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

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

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

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

A CURIOUS PATTERN

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

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

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

FLASHES OF SUICIDALITY CAUSED BY THE ANAESTHESIA – NOT THE ECT

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

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

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

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

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

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

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

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

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

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

I'M ON READING WEEK STARTING NOW!

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

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

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

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

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

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

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

Can you understand why I'm exhausted? 

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

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

THIS WAS A WEEK OF PURE MADNESS!

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

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

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

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

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

I long to read for fun. 

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

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

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

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

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

xox

s

And now for something different...

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

A QUICK ANGELA UPDATE

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

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

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

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

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

SHINING LIGHT ON MY PERSONAL LIFE AND HOW I COPE

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

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

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

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

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

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

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

OURS IS NOT ALWAYS AN EASY LIFE

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

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

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

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

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

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

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

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

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

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

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

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

Things always seem to look better in the morning.

Take care. Speak soon. Thanks for listening.

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

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

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

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

THE LANGUAGE OF RESPECT 

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

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

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

"COERCIVE PSYCHIATRY"

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

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

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

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

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

"WE DON'T HAVE INVOLUNTARY ECT IN ONTARIO" 

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

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

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

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

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

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

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

HAVE A WARM AND RELAXING "FAMILY DAY"!

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

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

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

ECT on Angela's mind and mine...

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

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

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

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

"I hate this!"

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

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

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

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

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

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

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

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

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

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

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

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

Time will tell.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

"Hope you're having a good day!"

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

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

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

I suspect they'll have lots to discuss.