Angela's progress ...

Hi there.

I'm back! How are you?

You have no idea how much I've missed you. So much has happened over the last week – my Reading Week. There were times I ached to sit down here at my trusty iMac and write to you – what a relief it would have been to interrupt the monotony of "marking midterms," but I needed a break.

I've continued speaking with Angela daily over the last 13 days even though I've not been posting about her progress. I take notes. I have an Angela journal.

She's had a few little ups and downs but nothing dramatic – with one exception – and this would definitely qualify as an "up"... she's sleeping well. Better than she's slept in years. 

Angela is athletic. She loves to snowboard. Watching hockey is one of her passions. You know where she is every Saturday night and could safely bet money on it. It's a good thing she doesn't have her Electroconvulsive Therapy treatments on Saturdays.

On a few occasions, over the last week and during the Olympic Hockey matches, she slept through the games. 

And she wasn't upset about it.

Once, she said she went to sleep "to escape my mind," a curious phrase. When I asked her why, she mentioned some long running personal concerns, matters of everyday living that no ECT treatment can or ever has been able to resolve. The stuff that can turn a good day sour for anyone. The stresses that wear you down emotionally.

ECT IS GRADUALLY TRANSFORMING HER OUTLOOK ON LIFE

These issues are not the cause of her drug-resistant clinical depression. They could be filed in a drawer called "Life Sucks" and we all have those drawers. Sometimes, I think unhappiness is confused with depression. Both can be exhausting and stressful, but for Angela, her ECT is gradually transforming her outlook on life. Brightening it. Refreshing her mind. Buoying her on so she can better handle the real consequential issues in her life.

Not just those "Life Sucks" issues, but even tougher stuff. 

SLEEP HEALS

Sleep, as I've often said, heals. So it is, often, for Angela. She's an early riser and not only on the two days a week when she must awaken at 6 a.m. to be at the University Health Network at 7 a.m., hopefully to be the first in line to receive her ECT treatment, which she prefers.

Since she began her eight or possibly 12 weeks of bi-weekly ECT treatments on Monday, January 25, she's has changed dramatically, although it's a slow and steady transformation and she's not entirely aware of it. These posts have become a mirror for her.

It's blatantly obvious to me that she's joking and laughing more these days than I've ever known her to do – and we've known each other for years. When I called last night, she was watching the Toronto-Boston Hockey Game and not sleeping.

"It's tied right now," she said, sounding anxious to get off the phone. I let her go back to her passion. Three months ago, Angela felt no passion for anything. She complained constantly of feeling "flat" or "feeling nothing" or "being blah." She was immobilized by her severe depression.

Last night, her gusto for the game she loves seemed a significant benchmark in the headway she's making.

SUICIDAL THOUGHTS SEEM LIKE A THING OF THE PAST – FOR NOW

After 12 treatments, her suicidal thoughts seem a thing of the past. She hasn't mentioned them in several weeks. This doesn't mean she is perfectly recovered. ECT doesn't purport to solve all your problems and cannot. She knows this. She sees her psychiatrist twice a week. She takes all her medications.

She also knows that she may need follow-up weekly or semi-monthly treatments when this current treatment course finishes because ECT is not permanent. Depression can be cyclical. So she may need ECT on an ongoing basis or every three or four or more months. But it should keep her suicidal thoughts at bay and help her function better than she has in years.

ECT IS NO ONE SHOT DEAL

No responsible, knowledgeable and experienced psychiatrist who routinely administers ECT would ever suggest that ECT is a one-time only treatment course. For some people, not all, it's not. 

Like medication, it may have to be part of an ongoing treatment protocol for mood stability. (Like the Tegretol that I take twice a day for my mania. I've been taking it for 22 years. It's one of my major recovery tools.) Any follow-up ECT regime, its schedule, differs depending on each individual ~ as does everything in life, it seems. 

Since her first course of ECT treatments in 2001, Kitty Dukakis has follow-up "sets of ECT treatments," on average, every seven or eight months, when her depression returns. The wife of Michael Dukakis, former Massachusetts governor and 1988 Democratic Presidential candidate, bravely and with brutal, visceral honesty writes about her ECT experiences in Shock – The Healing Power of Electroconvulsive Therapy. It ended her lifelong struggle not only with severe drug-resistant depression, but with her alcohol and amphetamine addictions that masked it for years.

HER MEMORY HAS STAYED PERFECTLY INTACT

Angela is now in Week Seven of her treatment course. It may end next week or continue for four more weeks. She doesn't know. So far, her memory has stayed perfectly intact. Sometimes, like this past Monday morning, 90 minutes after treatment, when I called her from Seneca, she sounded groggy.

It was 10:30 a.m. "What day is it?" she asked.

She had been sleeping and my call woke her.

"It's Monday and I'll call you later."

Let's be honest. Don't you find that sometimes, it you take a nap in the late afternoon and wake up at 9 p.m. you feel a little disoriented. "Did I sleep through the night?" you ask yourself. You search for a clock wondering, "What time is it?"

By Monday night the disorientation Angela felt earlier in the day had disappeared. It always does within a few hours of her ECT treatments, always with healing sleep. To the best of her knowledge, she is experiencing no permanent or even temporary memory loss whatsoever, thus far.

Time will tell. And I'll tell you.

Now, then. Let me know how you're faring. Comment. Comment. Comment. 

I've missed your voices. Your ideas. Even your criticisms. You inspire and stimulate me.

It's great to be back.

Speak soon!

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!

Beginning MMX with Recovery...

Hello! I've missed you. I'm happy to report that during my break there was some action in the comments which always warms the cockles of my heart. Thank you. What a lovely gift they were and they kept me on my toes.

I hope you are well and thriving now that the 2009 holidays are history. I hope they were smooth and whizzed by without any major bumps. Now you can look forward to Family Day, our nice innocuous statutory holiday on Monday, February 15, the day after Valentine's Day this year. A real double-header. It coincides with Presidents' Day in the U.S.

For those who are given this day off, it will be a lovely mid-winter day to relax, recharge, go to a movie, ski, snowboard or simply snuggle up with a good book. 

I feel in my gut that MMX, as the Roman's would say, is going to be an exciting year. As soon as it starts for me. Gut is the operative word here. Mine is not in terrific shape at the moment.

You see, it's been a long, hot (as in high temperature, mine) holiday in our house, mainly because I've been sick. Still am. You don't want to know the details, but let us say that "rest" is what the doctor ordered and "rest" is not one of my strong suits. In school, I would fail "rest" and I would ace multitasking. 

Oh well. That's the story.

There is an interesting item in today's New York Times by one of my favourite mental health writers Benedict Carey. The headline says it all – Popular Drugs May Help Only Severe Depression. By no means a new story, it's based on a new report published today in The Journal of the American Medical Association. 

It certainly supports the strong contention I have about quick-fix, pill-popping approaches to mental health recovery. For cases of severe depression, this report finds quite conclusively that antidepressants are substantially more effective in cases of severe depression than in cases of mild or moderate depression.

This has been debated for some time and now a large and wide-ranging randomized study has come up with some conclusive findings. I have always sensed this to be true and further, than when antidepressants are prescribed, psychiatrists should be monitoring their patients closely and talk therapy should be part of the healing regimen. It is no secret that pills without therapy are never as effective as pills in combination with therapy. And that doesn't mean "a 15 minute appointment and prescription." That's not psychotherapy.

Carey sites Dr. Erick H. Turner, a psychiatrist at Oregon Health and Science University, who says, "I think the study could dampen enthusiasm for antidepressant medications a bit, and that may be a good thing. People's expectations for the drugs won't be so high, and doctors won't be surprised if they're not curing every patient they see with medications."

Dr. Turner adds, "The findings shouldn't dampen expectations so much that people refuse to even try medication."

Turner's last comment intrigues me. Mental health issues like depression are treatable, yes. But curable? Such a curious word for what most medical doctors consider mental illnesses to be – namely chronic, "like diabetes." Oh, how I hate that comparison.

One can go into recovery through medication, therapy, peer support, the process of self-actualization through meaningful and fulfilling work and having a stable family and home life. Recovery is a process. Not a pill. Not a cure. It's ongoing. It means many things, as I have often written. Have a look at The 10 Fundamental Components of Recovery from the U.S. National Consensus Statement on Mental Health Recovery. 

Among them: Self-Direction, Empowerment, Peer Support, Respect, Responsibility and Hope. Similar to those underlying fundamentals of recovery at The Krasman Centre in two locations just north of Toronto. These centres are staffed completely by people in recovery from mental health issues. 

As I reported last year in my story about mental health recovery in The Walrus magazine, "Today recovery is a fully realized and internationally recognized approach to attaining wellness... Still, it's hard to pin down an exact definition of recovery. 

"Tanya Shute, the executive director of Krasman and a survivor, describes it as 'a person's ability to self-actualize, with or despite one's mental health experience.' Elaine Amsterdam of Toronto's Gerstein Crisis Centres says, 'It's about living well,' adding, 'The meaning of that is different for everyone and can include a range of different approaches.' 

"But the whiteboard that hangs on the Krasman Centre's kitchen wall (in it's Richmond Hill location) notes five key concepts in indelible black ink: hope, personal responsibility, education, self-advocacy, and support."

We must all find our own way and it is that processing that we can begin experiencing recovery.

As Carey stresses, in some cases certain antidepressant are very helpful, in severe cases of depression. In his story today, he concludes with the words of one of the team of researchers in this study which included psychologists "who favour talk therapy and doctors who consult widely with drug makers."

On is Dr. Robert J. DeRubeis of the University of Pennsylvania, who stated, "The message of patients with mild to moderate depression is, 'Look, medications are always an option, but there's little evidence that they add to other efforts to shake the depression – whether it's exercise, seeing the doctor, reading about the disorder or going for psychotherapy."

This is such a positive message. Depression which isn't severe responds to many different and very accessible approaches, not the least of which is knowledge and understanding, learning about depression, facing it plus, peer support, doing things that make you feel better which can be anything from reaching out to an organization like the Mood Disorders Association of Ontario or joining your local community centre and signing up for Belly Dancing classes. Taking a class in Mindfulness Meditation, perhaps, or knowing when the best medicine is a lovely warm bubble bath or listening to your favourite music or a walk in the park with your dog or with a friend or with your thoughts. 

Recovery is within reach. As long as you're willing to reach out.

Isn't this going to be a good year? Full of hope.

Now, I'm back to my bed.

Speak soon and be well.

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?

 

On mothering and mental health...

Children of all ages often blame their mothers for all their problems. 

Today, I come not to blame my mother, but to honour her.

If you've ever wondered why I'm so comfortable talking openly about my mental health issues, my psychiatric history and any of my mental and emotional experiences, I credit my mother. 

She was and is very enlightened, considering she was only 21 when I was born in 1948 and her mother died when she was 28, at the age of 60. My mother was pretty well on her own with a child who didn't conform. (That was a buzzword back in the 1950s and 1960s – conformity.)

When I was a kid, and a very dramatic, theatrical, stagy and rather "unusual" one, my nickname around the house was Sarah Bernhardt. I was described as histrionic – not to be confused with hysteria.

One way my mother handled my early emotional "acting out" was to channel it. From the age of nine, she sent me to drama classes – not to be confused with drama therapy. In the 1950s, these classes were a wonderful outlet for me. I'll never forget the fun I had at the Jack Medhurst Acting Studio. His classes sparked a lifelong love of the theatre, many exciting and successful acting experiences in skits and plays at camp and school, and led to my graduating with a BA in Drama and English Literature from Queen's University.

In the early 1960s when I started seeing my first psychiatrist, my mother used to say: "If you break a leg, you go to a doctor who puts it in a cast so it can heal. If there's something wrong with your mind, you talk to a psychiatrist, so you'll feel better."

Of course, those were the days when children were never diagnosed with bipolar disorders or anxiety disorders or Attention Deficit Hyperactivity Disorder or any of the hundreds of disorders available today. Those disorders didn't exist. There was basically a "one-diagnosis-fits-all" for troubled children – schizophrenia.

In the 1950s and 1960s, children were never prescribed powerful drug cocktails of anti-depressants, anti-psychotics, mood stabilizers and who knows what else. Many of those drugs didn't exist. Then and now, all drugs are tested on adults because it was and remains unethical to do drug testing on children whose brains and bodies are growing and developing. 

I have no regrets about this. If you want to understand what can happen when children are prescribed these powerful neuroleptic drugs, have a look at The Medicated Child. 

Back in my youth, psychiatrists knew almost nothing about childhood mental health or mental illnesses, but my mother did the best she could at the time. For this, I am enormously indebted to her. When I was a kid, it was relatively rare for a child to be seen by a psychiatrist. Childhood psychiatry was in its infancy. On the other hand, starting then probably helped me enormously. Early intervention often does.

As far as I'm concerned, today most psychiatrists still know very little about mental health in general and childhood mental health in particular. They know about serious mental illnesses because that's what they study and see. 

They know about symptom management and control. They know about creating square pegs with medications, which control symptoms. Without some form of psychotherapy, medications alone never impart insight or help people of any age to understand and overcome their emotional issues.

Also, and this is really a big issue for me – who advocates for children with mental health issues or psychiatric problems? They have tiny voices. They cannot speak up for themselves. If they try, they are rarely heard or listened to or taken seriously. 

There are no quick fixes in healing emotional and mental health disturbances, even though that's what many people demand. 

My mother has often said that all children are geniuses until they go to school. Today, what happens, especially in the public school system, when a child "acts out"? Often, not always, a teacher who is not trained as a psychologist, who has no mental health expertise of any kind and is ill-equipped to make any kind of psychiatric or psychological diagnosis, will make the first call. 

Parents will be called in and told that their child isn't like the other children, is disruptive, is acting out and that there's something wrong and the child should get help or be seen by a doctor, perhaps a psychiatrist.

Kids are not square pegs, yet too many teachers try to turn them into square pegs. 

A child is sensitive and emotionally fragile. 

There are other ways to help children who appear to be acting out or unhappy or troubled, other therapies that do not involve medications which are highly invasive and have often serious side-effects.

Trust me, I know of what I speak. I lost my only kidney to Lithium toxicity in 1991 and although I've received a kidney transplant, I will never be physically healthy. I survive on a diet of drugs all of which have side-effects, several of which are highly carcinogenic.

The word therapy means "to heal" and there are many non-medicinal, non-psychiatric therapeutic approaches that have proven to be remarkably helpful and healing in children – Theraplay, play therapy, art therapy, dance therapy, music therapy. Sports is a popular and very therapeutic activity – though few people think of "hockey" as a form of therapy. Physical activity is healthy and healing. Its benefits are widely accepted as teaching teamwork, imparting self-confidence, and numerous other emotional and physical benefits.

The advantages of keeping a child out of the mental health system are manifold. 

They avoid being labelled, perhaps the most emotionally deleterious consequence of going to a psychiatrist. Labels are internalized and take years to overcome. Some people never do. Adults often suffer from the aftershock of negative stereotyping, prejudice and discrimination if they are labelled with a psychiatric diagnosis. 

It's taken me 49-years of psychotherapy and I'm still struggling with feelings of inadequacy because I grew up in the mental health system – with the misdiagnosis of schizophrenia. Yes, psychiatrists make mistakes. Why chance that with your child. 

Labels have a habit of sticking. 

In the 1960s, after a nine-month hospitalization at The Clarke Institute of Psychiatry for psychosis, where I was given Chlorpromazine, the first anti-psychotic, known then as "the chemical lobotomy," a diagnosis of catatonic schizophrenia and my first course of ECT – my psychiatrists told my mother there was "no hope for me and that I would be a revolving door case. Sick for the rest of my life." 

My mother chose not to believe them. She chose to believe in me. She became my advocate and taught me how to advocate for myself. One of her greatest gifts to me.

I often say in my speeches and always in my classes where "celebrating difference and diversity" is our motto, that there is only one label that I will accept, if there must be labels. Human. If you must label me anything, label me human.

Most mothers and fathers do the best "mothering" they can. Everyone makes mistakes. Our mothers were mothered, too. Their mothers made mistakes. The knowledge about and norms of parenting have evolved over the years. Sometimes for better, sometimes not.

I have never given birth to a child – not unusual for many mothers today – however, I have two stepdaughters. The youngest was 12 when I met her father and 13 when we were married. The eldest is 20 years older, from a previous marriage, and is a happily married professional.

My youngest stepdaughter's mother died when she was eight, so you can imagine how she felt with me intruding on her exclusive relationship with her father. 

There were fireworks, but on the advice of my psychiatrist, we did not send her for help – her father and I went for help. Weekly group sessions with other parents of difficult children, facilitated by a noted child psychiatrist in a group called Parents for Youth. (Now, sadly defunct.)

We learned how to stay on the same page, how to give our daughter appropriate opportunities to prove she could be responsible and that grounding and curfews simply didn't work for her. This year of "therapy" for us was the best investment in her happiness and in the health of our marriage. Today, she is a lively, independent, self-sufficient young woman finishing her BA in drama.

All I know is that my mother did the best she could for me at the time. 

And who can ask for anything more?

Mum, Happy Mother's Day! 

Being loopy in the first snow!

Why is it that every one goes loopy in their cars with the first snow of the season?

Here's what happened yesterday after the virgin snowflakes of 2008 began falling at 3:30 p.m.

I was in my office Seneca's Newnham Campus at the northeast end of Toronto. I had arrived at 6:30 a.m. My husband Marty dropped me off on his way to Humber College, at the opposite end of town about 50 miles away.

Wednesday is the only day we both teach. We have only one car, so this our deal. Marty's class ends at 1:00 p.m. and mine at 2:30 p.m., so he picks me up at about 3 p.m. and all's well.

Except yesterday was different. He had a meeting at 2:30 p.m.

And the first snowflakes of 2008 fell down from the sky.

Everyone in a car on a road in Toronto went loopy.

Me, too. And I wasn't even driving.

I was bone, blood and brain-tired. To get to Seneca by 6:30 p.m. we awaken at 4:30 a.m. I had prepared my classes until 1:30 a.m., so I was "going" on three hours of sleep.

Yesterday, because it was snowing, by 4:30 p.m. Marty wasn't even heading north. He was caught downtown because a truck had overturned on the Don Valley Parkway.

Maybe the truck driver was a little loopy, too.

I decided to take a cab – not happy about the $20 fare.

It took forever for the taxi to arrive because, after all, it was snowing and no one could remember how to drive.

Why does this happen every year? From March, sometimes April, to November — just six months — everyone forgets how to drive in a little snow. It's just frozen, not freezing, rain. What's the big deal?

It's not as if it doesn't snow EVERY year here it Toronto.

I would say, with absolute certainty, there has NEVER, EVER, been a year since the beginning of time when it didn't snow in Toronto in the winter.

So, call me a liar. It's still autumn. Late November. But last November it snowed here big time. Even earlier, I think.

Yesterday, November 19, we were long overdue for snow. We were living on borrowed time in the snow department.

I went outside to wait for the taxi. I wasn't covered in snow when it finally arrived. It looked pretty outside. The roads were fine. It wasn't that slippery. No one was sliding off the road. But it was slow. About 25 minutes later, after a drive that routinely takes 10 minutes, we arrived my house.

Except I couldn't find my keys. Anywhere. The dogs were barking. They hadn't been outside to pee or poop since 6:25 a.m. It was now 5:15 p.m.

I couldn't get in. I started to cry. I said I'd wait for my husband outside. This taxi driver was very kind. And very smart.

"I won't let you wait outside in the dark in the cold. It's dangerous," he said.

He lent me his cell phone and told me he would take me to a coffee shop so my husband could pick me up.

I called Marty. We only have one cell phone, too. He had it. He said he was driving north on Bayview. At Sheppard. Usually about 15 minutes away. He said it would take an hour. We couldn't decide where he would pick me up. I started screaming at him. He got a little upset.

Then I hung up and started sobbing because he wasn't closer.

We were both loopy.

The only person who wasn't loopy was the sweet, kind, wise taxi driver. He suggested I wait at the Thornhill Public Library around the corner.

I called Marty back. He agreed. On the typical two minute drive to the library – which took 10 minutes because everyone EVERYWHERE had forgotten how to drive and was loopy – I was hysterical.

"Try to stay calm when your husband picks you up. Being calm helps," the brilliant and angelic driver suggested, gently.

He was about 22 years old with the wisdom of Job.

How could he possibly know he had a deranged woman with 49-year history of mania in the back seat of his cab?

Calm is never my thing!

At the taxi driver refused to accept any fee for the extra mileage and time I had cost him. He wished me well and off he went after settling me, safely, at the Library.

I waited quietly on a bench outside watching happy little children carrying hockey sticks and skates slither into the arena attached to the Thornhill Library – all part of the Thornhill Community Centre.

"Nice weather, we're having," a lovely Thornhill gentleman said smiling at me as he walked into the Library.

Everyone on foot seemed happy. Snow was falling. There was jolliness in the air. Santa Claus came to town last weekend.

Then I saw our dark green snow-covered 1999 Accord pull up.

Suddenly Marty was there. We slip-slided home and let our loopy dogs burst outside to cavort and do other things in the backyard.

Dandie Dinmont Terriers adore snow.

But then, neither of them knows how to drive.

Jumping for Joy

For as long as I can remember, I’ve been guilty of two of the seven deadly sins.

Gluttony and Sloth.

Well, I guess that’s exaggerating a bit. I just love to eat and I hate to exercise. Deadly combination.

This is typical of me. I’m an all-or-nothing-kinda-gal. I’m either losing weight, at which I am very good, or gaining it back, at which I am even better. And lightning fast. I’m a Lifetime member of Weight Watchers, with about 80 lb. to lose. I have never, ever maintained a weight loss for more than a weekend.

I’ve run a 10 K though I came in seventh from last. I’ve pumped all kinds of iron. Walked and run on treadmills and elliptical machines. I’ve boxed. Stretched. Skipped. Power-walked. With trainers and without trainers. I've lapped 44 lengths of an Olympic pool every morning at 5 a.m. before work. My wardrobe spans size six to infinity.

I’ve also wasted more money than I care to imagine on lapsed, unused gym memberships.

Conservatively, I’ve gained and lost at least 2,000 lb. in my lifetime. More than 907 kilograms.

If Yo-Yo dieting was an Olympic Sport, I’d be a multiple Gold Medalist.

So, why am I telling you this? Why am I jumping for joy?

This week, Liz Spikol, Philadelphia Weekly senior editor and one of my favourite bloggers, alerted her readers to a Vital Signs item in the Health section of The New York Times.

Exercise, it seems, isn’t all its cracked up to be when it comes to alleviating the symptoms of depression.

Now, you know, depression isn’t one of my problems. Mania is.

So this shouldn’t matter to me, but I’ll tell you why it does.

In my addled mind, it simply proves that the medical establishment doesn’t really know what causes depression or how brain chemistry really works.

It shows me the brain is not necessarily where the mind is located or vice versa.

Psychiatrists hate it when I suggest this. But, since I've been in psychiatry longer than my psychiatrist – Dr. Bob was finishing Grade 13 when I was first sent to a psychiatrist in 1960 – I figure my close to 48-years of experience has validity.

Psychiatry has been the through-line of my life. I have my ideas. And I try to follow the research, but at the same time, keep my eye firmly in the Recovery camp, too.

I do not believe psychiatric diagnoses equal Brain Disease! I do believe the mind is a holistic concept that encompasses all one's life experiences, feelings, traumas, perceptions, emotions, education. Everything.

I do not believe psychiatry is very scientific. Psychiatrists would love this to be so, but it really isn't. Yet. At one time, psychiatry and neurology were one branch of medicine — neuropsychiatry. Then, in 1948, that specialty was split into neurology, the science. And psychiatry, black magic, I like to call it.

There has been progress, and I'm not an anti-psychiatry advocate. I do not believe in throwing the baby out with the bath water. Freud introduced the practice of talk therapy.

I am critical. And I have an open mind.

Also, I know that prescribing of drugs to control behavioural symptoms proves nothing about the cause of these symptoms. It just controls behaviour.

Tylenol can soothe the pain of a headache, but does it tell you what the cause of that headache is?

The other reason I'm jumping for joy is that it seems what I've always believed is actually true.

Being fat doesn't necessarily mean you're unhealthy.

And being thin doesn't always mean you're healthy.

This week, this is big news everywhere, but Liz Spikol's blog The Trouble With Spikol, about mental health links to another of my favourite bloggers, Well, also from New York Times health writer Tara Parker-Hope. Liz posts a great picture, so have a look.

We're all different. I think that psychiatrists are desperately afraid of difference. They read it as "abnormal," which means nothing to me. I've never conformed.

I wish everyone could celebrate their "specialness," instead of trying to "cure" it. Forget what the psychiatrists tell you and their gobbledygook labels and language.

It's all madness. I like Shakespeare's take on it. All his Fools were mad and spoke the truth in his plays.

Be yourself. Try to find something that makes you feel good. Even if it's a walk in the park in the sunshine.

Licking an ice cream cone.

Simplify. Simplify. Simplify.

My Write Hand

Two weeks ago, I tripped and broke my fall with my right hand.

Instantly, it swelled up. I iced it and carried on. Nothing, short of death, can propel me to an Emergency Room. Not even a ballooning right hand. My knuckles disappeared. My palm and fingers turned black.

I was in pain, but I have a very high pain threshold.

I taught my Seneca classes. Gave a speech at the University of Western Ontario. Lived on Extra-strength Tylenol.

People started noticing my hand. “What happened,” they’d ask.

“I just fell,” I’d say. “Broke my fall with my hand. Stupid me.”

They started urging me to see a doctor. I resisted.

“It’s just a bad bruise,” I’d say. “There’s nothing they can do about it.”

It didn’t improve.

On the sixth day, my husband had a dentist appointment downtown, so I asked him to drop me off at Mount Sinai’s ER.

There, in remarkably shot order, my hand was x-rayed.

It was broken and put into a plaster cast up to my elbow. I was told to see a hand specialist ASAP.

Suddenly, I was incapacitated.

I'm right-handed. My left hand is useless.

I couldn’t type. Do you know the “return” button on my iMac is on the right side. You push it with your right baby finger. Mine is out of commission.

I couldn’t drive. I couldn’t grip the steering wheel. I couldn’t open the door of the car. I couldn’t turn the key to lock the front door. I couldn’t hold a pen. I couldn’t easily shower or shampoo. Or brush my teeth or my hair.

The pain worsened. Sharp shooting pains pulsed up my arm.

Physical injuries are emotionally draining and mentally depressing. I don’t easily depress, but being unable to type – which is why I appear to have abandoned you here, at “Coming Out Crazy” – started getting me down.

Powerful painkillers don’t agree with me. I started sleeping to numb the pain. Napping far too much. A sure sign of depression. 

Finally, six days later, a perky plastic surgeon who specializes in hands came to my rescue. Dr. Nancy McKee removed the dreadful cast, informing me that I had “royally” broken my fifth metacarpal close to the wrist. A charming occupational therapist named Julie fashioned a customized rubber and plastic splint.

Bright cherry red with sky blue Velcro straps. Happy colours. No boring flesh tones for me!

“You cannot drive for four weeks,” she sternly instructed.

But I can type! With eight fingers. Shower and shampoo. AND REMOVE THE SPLINT!

Gripping a pen is still a no-no. My students’ essays and exams won’t easily be marked, but they’ll understand.

I’m feeling much better.

Physical pain is emotionally upsetting. Mentally stressful.

Our minds are so vulnerable. They don’t heal like broken hands. In six weeks. You can’t see the breaks on an x-ray.

So, take care this summer. Don’t break a fall with your right hand, if you’re right-handed. Or vice versa.

Be careful. Be well.

Speak soon!