Hidden Homelessness: One woman's story...

I often say to my students that "teaching is learning" and the same is true of journalism and perhaps even more, of blogging. There is a visceral connection between you and me in the blogosphere, often it grows beyond a virtual connection, too. It's very affecting and inspiring. 

This is the story of one of those times.

On Saturday night, I had a tough time falling asleep. My mind was whizzing. 

The day before, on Friday, while achy, feverish and sleeping most of time, felled by some sort of bug, I received an email from a member of our community here at Coming Out Crazy named Sandra Dawson.

She was clearly upset and for good reason. Through a series of emails and then a five-hour telephone conversation on Saturday evening, I discovered that Sandra's recovery journey is nothing short of miraculous. 

"When I was eight, my depression started. For no reason. I became glum, sad, moody cranky, often during the fall and spring. It was biological. I wasn't diagnosed at all until years later," she said. 

Sandra grew up in a comfortable and "privileged" military family, and as she was moving all over the country growing up, her behaviour began changing along with her moods.

"When I was about 10, I wrote a Christmas play and my teacher decided that I could direct it, but she fired me as the director because I was too bossy," she said, laughing at the recollection, perhaps a harbinger of the more exuberant moods she would experience later.

Initially, her mood swings were characterized by short episodes of increasingly severe depression, and occasional suicidality – her first attempt was when she was 11 years old, in school, with a pair of blunt, round-edge scissors. "I just knew I wanted to die," she said. A schoolmate spotted her and called her "Freak!" Nothing else happened. 

"We didn't talk about it in my family," she said. "We were repressed and didn't discuss our feelings or our emotions."

By the time she was in her early 20s, she was beginning to experience wildly euphoric manic moments as well as depression. Sometimes the two extreme moods occurred coincidentally, with "mixed episodes of mania/depression and hypomanic/euphoria. Depression with spikes of mania," she said. 

Eventually, Sandra started seeing a counselor, to no avail, then a psychiatrist who prescribed medication. "I was misdiagnosed as being depressed," but because of her own ignorance and fears about mental illnesses, her prejudice and discrimination, her negative stereotypes, she wouldn't take those drugs, even though she was suicidal.

She never went back to that doctor.

Sandra is now 42. She has been hospitalized approximately 35 times, calling herself a classic 'revolving door.' Most of those hospital stays, she stresses, were for relatively short periods of time – from a few days to two months.

"There were many times when my doctors didn't know what to do with me," she said from her home in Vancouver. Sometimes, they still don't, she added. 

Between these episodes, she typically has much longer periods of independence, emotional stability and productivity. 

At 27, a GP misdiagnosed her again and prescribed Prozac. This time, Sandra decided to take the medication, but it was disastrous for her. "It made me more manic."

Coupled with the death of her father, insecure living arrangements, travel, and another serious manic episode, her life started spiraling out of control. Suffering from Post Traumatic Stress Disorder, unable to work, for the first time in her life, she experienced hidden homelessness.

Four out of five (80%) homeless people in Canada don't live on the street. Most are improperly housed or on the verge of eviction, far too many are children. Women who earn less than men are more vulnerable to homelessness. The hidden homeless live in cars, couch surf or find temporary shelter in church basements or abandoned factories. 

Over the decade between 1994 and 2004, Sandra became homeless – but only four times. Years apart. Those episodes were short. She stayed in shelters for abused women, hospitals, or on friend's couches. She also lived in marginal housing like rooming houses and Single Room Occupancy hotels.

"I've been lucky," she said. "I've never lived 'on the streets' as in the stereotypical sleeping bag on a sidewalk. I am considered high functioning by my psychiatrists. Although my disorder is severe, I can look after my basic needs. Low functioning people need more help, but high functioning people can and do fall through the cracks and become homeless or at risk." 

These experiences were so searing, they turned her into a crusader, a passionate advocate, working professionally and within the community as a volunteer to help to understand, enlighten and fight hidden homelessness, and to ensure that more supportive housing is available especially for people with mental health issues.

She has a steady part-time job on the Mental Health Commission of Canada as a consultant, a person with lived experience of hidden homelessness, working on its newly launched, national multi-city study called At Home/Chez Soi.

Sandra is also on the board of Vancouver's Marine View Housing Society, a licensed and supportive housing project that began in 1975 and owns residential buildings in Vancouver for people with mental health difficulties. For years, she has also volunteered with her local arts community in several capacities. 

"It's so important to me. It makes me feel useful," she said.

Her work with the Mental Health Commission of Canada is one of her passions. 

On Sunday, Sandra was a presenter at a major national Vancouver conference on homelessness called Into The Light, which winds up today. She participated on a National Consumer Panel of peers with lived experience of homelessness and/or mental health issues involved in the At Home/Chez Soi project. These panelists represented cities of all sizes and discussion focused on pressing local issues in their respective areas. 

So why was she so upset when she wrote to me last Friday? 

When this four-year Housing First study was launched at a media event last week, Sandra bravely spoke out, telling her story about her own experiences with homelessness. She gave an interview to the press. Somehow, she was misrepresented and her story was badly distorted, so much so that she feared her credibility would be damaged and her reputation besmirched.

So she reached out to me and I'm so glad she did. I knew virtually nothing about hidden homelessness. It wasn't on my radar screen. Indeed, it was hidden. Invisible. Buried under the stereotype of the homelessness we see. I have started to scratch the surface. I will keep digging. 

Best of all, I've become acquainted with Sandra Dawson, one of the most courageous, generous-hearted people I have ever had the honour to engage with... and I sense we are more than acquainted. We have made a connection. I hope it will continue. There is so much more to share about the nature of homelessness – visible and hidden – especially among children and youth.

I have so much to learn. 

Thank you, Sandra.

From my inbox... about suicide

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

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

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

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

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

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

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

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

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

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

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

"Best wishes – Dorothyanne."

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

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

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

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

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

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

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

This story didn't really address that. 

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

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

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

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

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

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

Yet, she, too, is frustrated. 

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

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

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

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

Pills are perceived as an easier solution.

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

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

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

Check out the World Health Organization's global picture.

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

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

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

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

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

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

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

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

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

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

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

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

What do you think?

Working Through It

Have I got a website for you!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Bravo! Let's spread the word. 

Edging a car out of my parking lot...

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

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

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

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

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

Saks is cited twice in The New York Times archives.

Jamison, 561 times.

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

Both are married. 

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

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

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

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

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

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

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

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

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

Speak soon. 

Malcolm, myths and a bit of holiday optimism...

First, I want to wish you a wonderful holiday. A warm, fun-filled, happy time surrounded by your friends and family and people you love and who love you.

Most of all, I hope you are not alone. I will repeat a value here, something I tell all my classes because I know it to be true, at least it is for me. It may sound corny, but I really believe it. People are the world's greatest resource. So I sincerely hope that during the next few days, you have one or two special people you love and trust close by and that you thoroughly revel in their camaraderie.

Now, for the "myths" of my headline. These first came to my attention last year when The New York Times Health writer Tara Parker-Pope listed the seven medical myths that even doctors believe reported in the British Medical Journal. In case you're curious, they are:

1. People should drink at least eight glasses of water a day. 2. We use only 10 percent of our brains. 3. Hair and fingernails continue to grow after death. 4. Shaving hair causes it to grow back faster, darker and courser. 5. Reading in dim light ruins your eyesight. 6. Eating turkey makes people especially drowsy.

This last one leads to my next list, again, thanks to Tara Parker-Pope, from a new study also published by the BMJ of Festive medical myths by the same researchers, Dr. Rachel Vreeman and Dr. Aaron Carroll of the Indiana University School of Medicine. They carefully scoured research in the medical literature but found no supportive evidence suggesting that any of these six "myths" for the holiday season are true.

1. Sugar makes kids hyperactive. 2. Suicide increases over the holidays. 3. Poinsettias are toxic. 4. You lose most of your body heat through your head. (Actually, you lost only about 10 percent.) 5. Night eating makes you fat. (Eating more calories than you burn at any time of the day or night causes weight gain.) 6. Hangovers can be cured. (The only way to avoid a hangover is to drink little or not at all. Sorry.)

Now that we've taken care of the "myths," let's move on to "Malcolm" as in Malcolm Gladwell, staff writer at The New Yorker, author of three best selling books, who also happens to be an optimist. And if ever we needed optimism, this is the year for it. 

You may be wondering why Malcolm Gladwell and why now? Well, I'll confess, that since September, I've read nothing but academic literature related to the courses I teach at Seneca College. Since my marks were submitted last Monday along with my addendum for next term and the promotion meetings were last Tuesday, for the first time in months, I've been thoroughly free for the last few days to luxuriate in some recreational reading. 

Namely, Malcolm Gladwell's latest book, Outliers: The Story of Success, and now his first, The Tipping Point: How Little Things Can Make a Big Difference. His second book, Blink: The Power of Thinking Without Thinking, is sitting next to my bed waiting anxiously to be opened. 

Why am I devouring Malcolm Gladwell with such voracity? 

I've always liked his writing in The New Yorker. He's fascinating to read. Thoroughly engaging. He hooks you in a split second. He's a masterful story teller, especially with a seemingly endless repository of short, riveting, anecdotal tales that he artfully integrates into his prose to illustrate his points. And these points, by the way, are based on his expert, exhaustive research which he translates, popularizes and organizes, so that everyone can easily understand and use ideas. They become part of our vernacular.

Gladwell has a nice voice, too. He's open and easy and charming and affable. I like him. Businesses also like him, though I wouldn't call his book "business" books. Nevertheless, Google and Microsoft, to name a few, love him so much, they pay him $40,000 a pop to hear him speak. He's become a pop culture phenom and his books take me into other worlds but keep me tethered tightly to this one at the same time, so I learn lots. And I love learning.

Most of all, Malcolm Gladwell is an optimist. In a February 5, 2006 profile by Rachel Donadio in The New York Times, he said, "I'm by nature an optimist. I can't remember the last time I wrote a story which could be described as despairing. I don't believe in character. I believe in the effect of the immediate impact of environment and situation on people's behaviour."

That's hopeful, isn't it. Change is possible. We can change. That's what he's saying. 

Because he's an optimist, and a great writer and journalist, I'm using Malcolm Gladwell as my holiday tonic, this year. He's good for holiday chitchat around the Christmas dinner table. That's why I read his most recent book, first. Obama's election certainly raised my spirits and now Gladwell is keeping them up there. 

I believe you have to work on your mind and mood, just like any other project. If you want to learn a sport, you have to get yourself in shape and learn the rules of the game. And practice. If you want to look nice, you take some time at it. Practice.

Your mind and mood are no different. I think we a have profound responsibility to ourselves. We have to do things to keep our minds in festive shape. Good shape every day.

So, thanks to Malcolm Gladwell's optimism coupled with my own – I've always considered myself a cockeyed optimist – I'm staying upbeat and buoyant this holiday. It's contagious. If you read The Tipping Point, you'll discover how trends, like viruses, are contagious. (Try yawning in a group and see what happens.) Trends start small and spread. Some become epidemic, like the flu, except they don't necessarily hurt you. They can make a difference. Sometimes huge differences. And I'll leave you with that, for now.

Stay warm. Button up. Be well. Have a Happy!

Down for the holidays...

This year, you may not be anticipating the holidays like you have in the past. Or, if you usually find them stressful, 2008 may feel like it's pushing you right off the stress scale.

Many of you probably and understandably feel a little depressed. The economy is gasping and rasping. Headlines are painful to read. There's no ho-ho-ho or good cheer in the news. How can you feel joy when so many people are losing their jobs, entire industries are tottering on the brink of bankruptcy and stores are empty. Rumour has it that even Santa is tightening his belt in his North Pole workshop and has laid off 10 percent of his elves. 

About 1.1 million Canadians are diagnosed with depression every year, and 35 per cent of those diagnoses are made in December, according to social psychologist Dr. Richard Earle, managing director of the Canadian Institute of Stress. 

But not all of these cases are serious, chronic, big "D" depression. Some are temporary. 

"We all slide in and out of depression and anxiety and other moods all the time. Much of this is caused by uncertainty in our lives and sometimes that uncertainty can even be energizing."

But at other times, it can be overwhelming, especially during the holidays when too many uncertainties collide, as they seem to be right now. When words like "Recession" and "Depression" have economic clout as well as emotional punch, what then?

"We're all on a stress roller coaster right now with all the pressures of shopping and preparing for the holidays, especially this year," Earle said. Living with so much uncertainty is becoming commonplace and it wears on your psyche after a while.

Add all your concerns about your family and how to handle gift-giving when money might be tight, entertaining and other holiday traditions that might not be quite as lavish as in the past. In the back of your mind, you may be feeling overwhelmed.

Earle has a few good, common-sense suggestions for ways to override some seasonal stresses by re-framing the way you choose to celebrate the holidays. 

"You can spend a lot less money and still make your gifts special by personalizing them," he said. "Be creative."

Make cards, design your own gifts, pay more attention to thoughtful gifts, and gear down your expectations of a "perfect" Christmas, he suggested. Be realistic and responsible. Focus on family, friends and the fun of getting together – not the presents – sharing time together. 

If you're going to give gifts, make them experiential. A movie or a play, a scheduled coffee or lunch date, a dinner party (and make it a potluck) in January and February, after the holidays, when there's nothing much happening.

Earle said that for some people, however, these uncertainties can be so overwhelming that certain behaviours may warrant a visit to your family doctor, especially if the following signals last for two weeks or more. It's a good idea to take stock and keep an eye on how you're feeling:

 

• having problems with sleep – either sleeping too much or not enough

• experiencing chronic aches and pains more frequently or severely

• muscle and joint pain

• feeling unable to enjoy everyday pleasures

• feeling unable to concentrate or focus as well as usual

• having fatalistic thoughts

One myth about the Christmas season is that suicides peak, but according to Tara Parker-Pope's Well blog at The New York Times, "suicides are more common during warm and sunny times of the years, studies show. There is no evidence of a holiday peak in suicides." 

If you're feeling depressed, Earle stresses that you don't need to see a psychiatrist.

"If someone has a panic attack, it doesn't mean they have an anxiety disorder. It means they've had an anxiety episode. There's no reason to catastrophize a feeling or experience that is stress-related," Earle said.

When you visit your family doctor, who has an overall picture of your physical and emotional health, he is far more likely to be able to spend some time with you, Earle said, "in talk therapy or cognitive behavioural therapy, and be able to help you in re-framing your situation so you can begin to feel better.

"As well, your family doctor may prescribe a medication, which I consider a tactile tool – not a life strategy. By staying in touch with your family doctor, there's a good chance you can get through any seasonal depression, and only take that medication temporarily."

Don't forget the special people in your life who can listen to you. Really listen. Make time to spend a few quiet moments with them. Be good to yourself. There are all kinds of strategies for weathering the holidays and spending quiet time with someone who cares about you and understands you is, perhaps, the best gift you can give yourself.

You deserve it.

A Recovery Story

A little while ago, while I was blogging about one of the most hotly contested issues in mental health – electroconvulsive or “shock” therapy or ECT – a friend called me for help.

This happens a lot. I’m no professional. Just a fellow traveller. Yet people come to me thinking I have magic answers.

In this case, his father was in serious trouble. He lives in another province and has a history of serious depressive illness. Nothing has worked for him and his doctors are recommending ECT. “What should he do,” my friend asked.

As far as I was concerned, there was no question. Depression can be lethal, if it’s ignored. People can become so severely depressed, sometimes end up killing themselves. I explained my experience of ECT which was benign. It was years ago. Methods have changed. It’s safer now. I made sure it was being administered by experts in a good teaching hospital. It was.

“What’s the alternative?”

I heard nothing more. For a couple of months. Then he called again. His father had been talked out of the ECT by frightened relatives and he had attempted suicide. Now he had no choice. I wished his father well.

The ECT went well, but the patient was slow to recover. He was still down, though not suicidal. You should know, he is a sad person – a man with no job, little if any income and an unfinished life. There seemed to be reasons for his depression.

When his son called a month or so ago, he wanted to know if I could help get his father into an Ontario psychiatric hospital, where he could be taken care of because his doctors had washed their hands of him. There was nothing more they could do.

Why should they do anything more, I thought.

People must take responsibility for their own personal health recovery – physical and mental. They have to want to get better and must work at it. Let’s say you break a leg. You need rehab. You have to work at exercising that leg back to full functionality. If you don’t, you have pain and you limp for the rest of your life. Maybe you never walk again. Your choice.

The mind is no different.

To recover, you have to own your recovery and work at it. No one ever said it’s easy. Pills aren’t always magic bullets. They numb symptoms, and that’s about it.

Do you think for one moment that without 48 years of a variety of different psychotherapies, including group work, peer support, and many other healing activities, I would be the same person I am today?

Yet this man and his family wanted his father put away and taken care of — so he wouldn’t hurt himself. And they could rest a little easier. At the expense of the Ontario tax payer. Where psychiatric hospital beds are at a premium for residents of Ontario.

While we were talking, I quickly located online a branch of the Canadian Mental Health Association in this man’s town and province.

I suggested his son encourage him to go. What did he have to lose?

Guess what? I ran into my friend this weekend. He couldn’t thank me enough. His father is much, much better. He’s found a community of people to connect with at the CMHA. Lots of support. Activities. New friends. People who understand him. He goes there at least three or four times a week. His life is beginning to have new meaning. His financial situation hasn’t changed. He’s had to sell his house and move in with relatives, but he’s happier.

In recovery.

Suicide

This summer two people died by suicide on my street.

The neighbourhood grapevine whispered, used the word “commit,” as if suicide is a crime. Once, tragically, it was considered murder, but that’s been off the books for years. Still, the word and the idea persists.

One of these suicides was understandable, but no less shocking.

A sweet, kind 57-year-old man hanged himself in his garage. He was very ill and lonely. He ached for a constant companion, but he never found her. He had lost the quality of his life to a form of brain cancer that was cured by surgery, but the cure left him with constant pain and an agonizing cacaphony in his head that wouldn’t be silenced. He couldn’t stand it anymore. He found his peace.

The other was less easy to reconcile. A 17-year-old boy hanged himself in his basement. I heard this but little else through whispers in the neighbourhood. Apparently his father discovered his son’s body.

No one dares speak out loud about suicide. It’s a taboo. Still.

Yet, among youth of both sexes between the ages of 10 and 19, suicide is the second leading cause of death in Canada and the U.S. It is a major public health issue, yet there are huge gaps of knowledge and far too little research devoted to understanding suicide and trying to prevent it.

There are a great number of assumptions made about people who die by suicide. The most prevalent is that they are depressed or have some form of mental illness – mainly depression. Were this true, then the suicide rates should have plummeted with the proliferation of dozens of different antidepressants that have flooded the market over the last few decades.

They haven’t.

There has been a slight decrease in suicide rates in youth between 15 and 19 years of age in recent years – from 13.8 per 100,000 to 12.9 per 100,000 – the use of antidepressants may account for a fraction of these.

Alcohol and substance abuse may have declined and there is a decreased availability of firearms.

As for the use of antidepressants, the relatively new SSRIs or Selective Serotonin Re-uptake Inhibitors in some rare cases may worsen suicidal tendencies. It’s still very controversial. No one knows if these powerful drugs developed for adult brains are safe and effective for young, developing, teenage brains.

To be perfectly honest with you, I don’t know if stamping a young person with the label of “Depression” – as in a mental illness – does much to brighten his or her mood.  Especially if this young soul is showing signs of angst and unhappiness that may appear more profound that what’s considered typical of the teenage mind and brain.

Labels stick. Do you want to put your kid “into the mental health system?”

What’s typical, anyway? I don’t know if the experts know. Psychiatrists take one point of view. That you’re sick. Some psychologists do, too. A psychologist who saw my 13-year-old stepdaughter for a few sessions was convinced she was severely troubled and needed long term care. It’s to their advantage. They get paid $150 per hour.

There are other strategies. Other therapies that are proving promising. Cognitive Behavioural Therapy, for one.

When we took a different approach, and her father and I went to weekly groups sessions with other parents of difficult children with Parents for Youth we found that my stepdaughter responded beautifully to the changes in our behaviour and the strategies that we learned. From other parents.

Today, at 21, she's perfectly fine.

Peer support for parents and kids can be very powerful and very healing.

People, young and old, internalize the psychiatric labels tossed around so easily, these days. Even though “depression” and “anxiety” are so ubiquitous, they’re considered almost normal.

Furthermore, what might “depression,” feelings of despondency and dejection and hopelessness be caused by? A chemical imbalance in the brain? (No proof of that, yet.) Perhaps emotional, physical, sexual abuse at home. Perhaps bullying at school. Perhaps overwhelming academic demands. Perhaps an undetected learning disability. Perhaps parental neglect. Perhaps a sense of disconnect between a young person and parents who are obsessed with their work and their obsessions for acquiring “stuff.”

I think that feelings of hopelessness can come from many external sources (and have nothing to do with a “mental illness"). Maybe it’s the inability of parents and teachers to cope. Their lack of strategies that can be learned. Perhaps it’s the school system and kids who simply learn differently. Who have artistic talents that aren’t valued academically at school. Perhaps it’s peer pressure.

There can be any number of situations that can cause a young person to feel a sense of despondency.

If ignored, that despondency can spiral out of control.

Surely, when a family doctor prescribes a medication that has to be monitored regularly, perhaps just having to see a doctor on a weekly basis, someone who has the time to listen and show sincere interest, might help. Is it the regular human contact, the sympathetic ear? Or the chemicals that might prevent a suicide?

Listening. Actively. Just being there to listen, I think, is healthier than a psychiatric label and a prescription for a young person who seems to show warning signs of trouble beyond the typical teenage angst.

Recognize the warning signals.

When a kid comes home exhausted from school. Won’t go to sleep at a reasonable hour and then cannot sleep. Isn’t communicating. With parents. Siblings. Friends. When there seems to be a disconnect, don’t just chalk it up to adolescent angst. Look at the big picture and seek help.

There are many different strategies. Possibilities for Recovery that don't involve psychiatry. Do your homework. Seek ways to help your child without branding him or her with a “mental illness.” Look for holistic ways that will encompass the family, school and other influences in your child’s world.

Don’t go looking for a quick fix and a pill to make your child right. There are many different holistic approaches to help families in crisis. And, if a child is in crisis, perhaps it’s a family issue.

Just don’t wait. Don’t ignore the signals. It may not be a phase. Do something.

School Daze and other stuff!

Happy New School Year! It’s been quite a week.

I’m back at school, teaching at Seneca College. Ten hours a week – two classes each of two courses. One, I’ve never taught. The other one, I developed last winter, and continue developing.

If you have children or you’re a student yourself, you know how stressful these days can be, for teachers, students, parents, not to mention everyone working in education.

Students face major problems, trying to arrange their timetables, not to mention arranging any special accommodations they made need.

In the comments to my last post, a lively discussion played out about accommodation and how asking for it on the job in “the real world” too often leads to being let go.

It breaks my heart because, besides the obvious injustice, these stories speak of discrimination and prejudice and ignorance.

Employers desperately need help.

They need it more than people with diagnoses of mental illnesses – or madness.

Far too many people in powerful positions will accommodate someone with a physical illness or condition – I don’t like the word “dis-ability” – yet dismiss people with mental illnesses or “mental health issues,” or more accurately, madness.

I ask you: Who’s mad here? A well-qualified human being who experiences very real stresses and anxieties or depression at work, for good reason, and asks for a bit of accommodation? Or a boss, who gives this person a few days off, and then gives them the boot – under the guise that they’re redundant or their job is redundant, or some other madness.

Name game

One anonymous reader commented that he or she was utterly offended by the name of this blog, “Coming Out Crazy.”

In 1998, Chatelaine magazine invited me to write a major first person feature about my life with my mental illness. The headline was Coming Out Crazy. I happily approved it then because it felt right. It still feels right.

“I find (the title) offensive in the extreme," Anonymous wrote. "In no way does such a stance lessen fear or avoidance. Worse, it implies that everyone, even those with occasional attacks of anxiety or depression, is somehow in the same boat as an individual with paranoid delusions and a history of bizarre behaviour. It's not the case.”

The opposite is true. The name may shock people into thinking about what's called "crazy." Think about being open and up front about it. That's the idea. A little shock is a good thing.

You know what? We’re all capable of craziness and “bizarre behaviour.” If you think otherwise, I believe you’re kidding yourself.

A Couple of Announcements...

My friend Krista MacKinnon, a wonderful and creative woman, a survivor and a dedicated, tireless worker at Toronto’s Family Outreach & Response Program (FOR) is looking for “Recovery Stories” for the organization's website.

A few weeks ago, Krista reminded me that I had promised her mine, but I haven’t had time to write it.

“I only have one so far. It's lonely. Won't you help me populate my website with more and more stories of hope? Even solicit some stories from your readers? See, it's so lonely."

Share Your Recovery Story

So, why not your story of recovery at FOR? It’s an amazing agency that  “supports and educates families and friends during the recovery process.” Krista and the other staff at FOR “build on the strengths and resilience of families to enhance their lives. FOR strives to work with a diverse group of families and especially with those who cannot readily access support.”

In the meantime, I’m going to work on my Recovery Story, Krista! Promise.

Finally, one of my favourite blogs is written by a fabulous woman, a gifted New Jersey writer named Susan. On her newly redesigned blog, If you’re going through hell keep going,  besides her own colourful and impassioned writing, you’ll find many links to other blogs by writers exploring  important, often touching, mental health issues. I am especially impressed with Susan's section called “Suicide is not painless.”

She has included “Coming Out Crazy” on her blogroll. Here's what Susan says about her choices: "Every one of those links have been picked by me, there is something in each and every blog that has moved me, touched me, touched my soul. I don't agree with everything on them, but I admire these writers and enjoy reading what they have to say and hope you will too."

Thank you, Susan! I’m thrilled and honoured to be on your site and in such good company.

I urge you to have a look. You’ll be amazed at the world Susan opens up for you.

School Daze! Take it easy! It's a journey of new beginnings!

ECT vs. TMS. VNS vs. DBS. Huh? (Part Two)

I had no idea I was wading into a mysterious minefield of acronyms when I started comparing ECT and DBS last week.

All weekend, I mulled over this "charged" debate between Electroconvulsive “Shock” Therapy (ECT) versus Deep Brain Stimulation (DBS).

The more I thought about it, this more this “either/or” proposition bothered me.

CHARGED, CONTROVERSIAL, CONTENTIOUS

It's charged, all right. Very controversial and political. Consider the history of ECT.

Add all the agitprop Hollywood and other moviemakers have infused into the emotional discourse that swirls around ECT, morphing a psychiatric treatment into an instrument of cinematic horror – and no wonder ECT is so contentious.

Finally, a 20-minute phone-chat with my psychiatrist, Dr. Bob, cleared things up.

You'll see what I mean when I spell out the following acronyms of four approaches that all play a part in this "charged" debate.

ECT AND DBS AND VNS AND rTMS for TRD

ECT is Electroconvulsive "Shock" Therapy – for years it's been proven to work in many cases.
rTMS is repetitive Transcranial Magnetic Stimulation – similar to ECT, but less invasive, does not cause a seizure, but is still experimental.
VNS is Vagus Nerve Stimulation – newest of these procedures, surgical, not as invasive as DBS, but similar. Doesn't involve drilling holes into the brain. Not yet widely available.
DBS is Deep Brain Stimulation – most invasive surgical procedure, considered the last resort. ECT is a prerequisite. Still undergoing trials.

ECT, TMS, VNS and DBS all fall under the general category of Psychiatric Neuromodulation – procedures that use either electrical or magnetic currents on the brain to treat debilitating psychiatric conditions – mainly treatment resistant depression TMR – long term, chronic depression or constantly recurring depression which does not respond to standard treatments like medication or psychotherapy.

Dr. Bob explained that ECT and DBS are like apples and oranges. They don't compare as well as ECT vs. rTMS. And VNS vs. DBS.

NOBODY UNDERSTANDS WHY OR HOW "PSYCHIATRIC NEUROMODULATION" WORKS

Nobody really understands how and why these procedures work and the only one with any real track record is ECT.

Veteran CBC and CTV radio and television broadcaster Helen Hutchinson calls ECT her "ace-in-the-hole."

In 1994, after years of numbing, debilitating depression, and more than five years of psychotherapy, a series of antidepressants, four hospitalizations and two suicide attempts, Hutchinson agreed to try ECT. One course. Six treatments.

"I welcomed it when I finally decided to have it," she told me in January 1995, during a Toronto Sun interview. "After all, what can I lose – a few brain cells?"

After her first ECT treatment, "It was like the light went on, like a blind suddenly flapped open. Instead of being in a tunnel with just a tunnel at the end, I was released," she said.

Earlier this week, Hutchinson, now-73, sounded vibrant and excited to hear my voice after 13 years when she picked up her phone.

SHE NEEDED ONE COURSE. SIX TREATMENTS. NO MORE.

"I'm just fine," she said. That one course of ECT did the trick.

Hutchinson still sees her psychiatrist regularly, takes an antidepressant and knows if ever her depression threatens, ECT is available on an outpatient basis.

“That’s never been necessary,” she said.

For Deanna Cole-Benjamin, more than 80 ECT treatments did nothing for her devastating depression.

"For a short time, there seemed to be a glimmer of hope that it would work, but it never did," the Kingston, Ontario public health nurse said recently on the phone – happy to interrupt a quiet summer evening in her backyard with her husband and four children.

In April 2006, Cole-Benjamin, a public health nurse, now 44, was the subject of a riveting Sunday New York Times Magazine feature called A Depression Switch?

ECT IS A PREREQUISITE FOR DBS

Her depression seemed to come out of nowhere and for no reason in late 2000. Antidepressants were useless. Eventually, she had to stop working and was hospitalized for 10 months. Her depression proved completely resistant to all drugs, psychotherapy and all that ECT. For the next four years, she was in and out of hospital many times and often contemplated suicide.

In 2004, she was asked to participate in the first clinical trial of Deep Brain Stimulation, radical new brain surgery for treatment resistant depression. It was developed in Toronto by neurologist Dr. Helen Mayberg and her neurosurgeon collaborator Dr. Andres Lozano whose small DBS trial at the Toronto Western Hospital was recently published in the journal Biological Psychiatry.

"I feel very well," Cole-Benjamin told me.

The battery in the neurotransmitter in her chest (a pacemaker-like devise) needed to be replaced once, "but that's just day-surgery. Now I just go to Toronto periodically for check-ups," she said.

DBS – VERY, VERY INVASIVE SURGERY

“The initial surgery was very, very invasive," she recalls. It involved drilling holes into her skull and then deep inside her brain, so two electrodes could be inserted into Section 25, a procedure that has already been performed on 30,000 people with Parkinson's Disease.

She was awake during this two hour operation, under a local anaesthetic so she could report any changes she felt.

Today, Cole-Benjamin jokes about her brain bionics.

"My head's a little bumpy from all the electrodes," she said, laughing. "My hairdresser always says that – and when I'm travelling, I can't go through airport security scanners."

A small price to pay to have your life back.