If there is such a thing as the opposite of a holiday, then April 15th
must qualify. I tend to think of it as the day I go to work for the
federal and state governments (or, at least, the day my money does). It
would be interesting to run a clinical study to see if mood disorders
peak around Tax Day (funded, of course, by our taxes...).
On a more positive note, welcome to Issue #5 of MentalMeds news, which
contains two featured articles. The first one is a first-person account
of the onset of bipolar disorder, followed by an ultimately
successful struggle to overcome it. The second is on the
of electoconvulsive therapy, or "shock therapy" as it has often been
called. Few subject evoke as much heated discussion as this one, fueled
as much by the technique's checkered past as by reasonable
disagreement. Is ECT a good idea, or a bad one? Read on.
Kevin Thompson, Ph.D.
P.S. As always, if you do not wish to receive email from me, please let
know, and I will remove your name from my list.
Do you have experiences you would like to share about how you have
coped with mental illness? Uplifting stories? Educational stories?
Email me with your idea, and if it makes sense, I will be happy to
include it in a future issue.
Funny stuff from around the Internet.
A Night at the Asylum
Late one night at the insane asylum one inmate shouted, "I am Napoleon!"
Another one said, "How do you know?"
First inmate answers, "Winston Churchill told me!"
Just then, a voice from another room shouted, "I did NOT!"
Jean-Paul Sartre is sitting at a French cafe, revising his draft of Being and Nothingness
He says to the waitress, "I'd like a cup of coffee, please, with no
cream." The waitress replies, "I'm sorry, monsieur, but we're out of
cream. How about with no milk?"
The City Boys and the Black Sheep
is one of my all-time favorite jokes (which tells you a lot about me).
This is also from Philosopher
, where I have spent too much time recently.
An engineer, an experimental physicist, a theoretical
a philosopher were hiking through the hills of Scotland. Cresting the
top of one hill, they see, on top of the next, a black sheep.
The engineer says: "What do you know,
the sheep in Scotland are black."
"Well, *some* of the sheep in Scotland
are black," replies the experimental physicist.
The theoretical physicist considers this
moment and says "Well, at least one of the sheep in Scotland is black."
"Well," the philosopher responds, "on
one side, anyway."
- William Knorpp
Doctor's stories-You can't make this stuff up. (Sometimes the
truth is funnier than fiction!)
A man comes into the ER and yells, "My wife's going to have her baby in
the cab!" I grabbed my stuff, rushed out to the cab, lifted the lady's
dress, and began to take off her underwear. Suddenly I noticed that
there are several cabs, and I was in the wrong one!
At the beginning of my shift I placed a stethoscope on an elderly and
slightly deaf female patient's anterior chest wall. "Big breaths," I
instructed. "Yes, they used to be," remorsed the patient.
One day I had to be the bearer of bad news when I told a wife
her husband had died of a massive myocardial infarct. Not more than
five minutes later, I heard her reporting to the rest of the family
that he had died of a "massive internal fart."
I was performing a complete physical, including the visual acuity test.
I placed the patient twenty feet from the chart and began, "Cover your
right eye with your hand." He read the 20/20 line perfectly.
"Now your left." Again, a flawless read.
"Now both," I requested.
There was silence. He couldn't even read
the large E
on the top line. I turned and discovered that he had done exactly what
I had asked; he was standing there with BOTH his eyes covered. I was
laughing too hard to finish the exam.
And of course, the best is saved for last.... I was caring for a woman
from Kentucky and asked, "So how's your breakfast this morning?"
"It's very good, except for the Kentucky
Jelly. I can't seem to get used to the taste," the patient replied.
I then asked to see the jelly and the
woman produced a foil packet labeled "KY Jelly!"
, also from
(Hmm. Would this work for depression?)
A man goes to the doctor with a long history of migraine headaches.
When the doctor does his history and physical, he discovers that the
poor guy has tried practically every therapy known to man for his
migraines and STILL no improvement.
"Listen," says the doc, "I have
migraines, too and
the advice I'm going to give you isn't really anything I learned in
medical school, but it's advice that I've gotten from my own
experience. When I have a migraine, I go home, get in a nice hot
bathtub, and soak for a while. Then I have my wife sponge me off with
the hottest water I can stand, especially around the forehead. This
helps a little. Then I get out of the tub, take her into the bedroom,
and even if my head is killing me, I force myself to have sex with her.
Almost always, the headache is immediately gone. Now, give it a try,
and come back and see me in six weeks."
Six weeks later, the patient returns
with a big
grin. "Doc! I took your advice and it works! It REALLY WORKS! I've had
migraines for 17 years and this is the FIRST time anyone has ever
"Well," says the physician, "I'm glad I
"By the way, Doc," the patient adds,
"You have a REALLY nice house."
Send me your
favorite joke, funny story, or amusing picture, as long as
it is related to mental illness. Keep it upbeat, please! Jokes
involving mental illness are welcome, but jokes that demean mental
illness are not. If it's appropriate, I'll put it up on the humor page.
Psychedelia: A Bipolar Journey
It was easy and human to understand the emotional highs and lows when
you were an adolescent growing up in the 60s and 70s. The
exuberance and social revolution of those times seemed right and
healthy. We were on the edge of creating a new society, new
values, new music, and new, altered states of consciousness.
Conventional thinking and expectations were regarded as restraints on
creativity and the potential for individual freedom to experience
So, it was a great time to go through fluctuations in moods and even
mental alterations without considering them as abnormal. Infact, they
were seen as a sign of the kaleidoscopic possibilities of a free mind.
I grew up in that age. And I think that this special period
our culture, with its optimism, hedonistic values, and intellectual
rapture, may have blinded me to the ominous signs of psychologial
trouble ahead. Wild parties at college, with the typical
the time, like concert speakers, strobe lights, smoking paraphernalia,
and deep conversations into the night about the infinite number of
states of consciousness, felt like an induction into a new esoteric
world, closed to the mundane majority.
If I felt ecstatically happy, dancing down the street of a small
university town with my friends, it was because we were young and
happy. If I fell into the depths of depression, it was
parents couldn't appreciate and accept my cool boyfriend. If
talked too much in class, it was because I was so bright and had so
many pertinent things to say. If I went to the library to
a book, and came out with a dozen hard-cover texts that I could breeze
through over the weekend, it was because I wanted to do a good job on
my project. And I did do a lot in my teens. My
impressed at the amount of energy I had. I would get up at
a.m., exercise, then go to my job downtown, and at the end of the day,
would take night classes, arriving back at home around 1:00 a.m. every
day. Having finished college, I then entered university
and finished an Honours B.A. in two and a half years. I then
immediately entered the M.A., which I completed in two years.
this, while having a whirling social life and getting married on the
same summer I completed my Masters thesis.
The marriage was a very elaborate and joyful affair as I am an
only child and my parents went out of their way to make it
special. My husband was a college sweetheart in the same
and attending some of the same classes. Everything looked
fairy tale during that year. He too had finished his degree
was accepted into law school. It was as if, life was a
for me to see how much I could accomplish in how little time.
didn't care how exhausted I had become. The race gave me a
high. The future looked wide open with opportunity and
seemed inevitable in every endeavour.
It was a strange and unexpected surprise to find out that the harder
they come the harder they fall. I had continued my
agenda, working at the Computer Sciece Department of my university, and
other departments, when the idea struck me. I was
enough. I thought I could accomplish more: the final degree
could become a professor. I applied and and was accepted to one of the
top universities in Canada.
The work was demanding, and within one and a half years, I finished all
the course requirements, the Comprehensives, four Teaching
Assistantships, and had begun the dissertation. A fellow
with possible mental problems had begun to harrass me and my husband
while we were at the university, and the Department tried to accelerate
the completion of my degree as fast as possible-- hence the one and a
half years covering so much work.
The congruence between a possible underlying affective disorder, and
the impetus that that may give to ambitions and plans in your life, is
often overlooked. The gathering conflicts and
easily blamed on the sheer amount of work that had to be
Mental illness is not perceived as such when it drives your emotions
without any perceptible cognitive disorders. If it has not crossed the
barrier between normal and abnormal experiences you are familiar with,
it is easily overlooked. Paradoxically, that can also apply
people close to you, as they live with you and travel the same pace,
developing familiarity with your habits.
There were some prodromal signs that could have rung an alarm bell to
someone experienced with the development of mental illness-- the
depressions, insomnias, elations, wild parties, numerous love affairs,
intense and sometimes brilliant intellectual work. But all these could
be accounted for within the normal scope of human experience in the
life of a university student. If it was the beginning of
hypomania, it was certainly pleasant enough to accept as living life to
The crash came as suddenly as a tornado hitting the hot
spot. It was preceded by some strange mental states
then, attributed to fatigue, Valium, and disappointments.
were states not experienced before: panic attacks, flatness of
emotion, depression, changes in libido, and something like a
of emotional equilibrium, akin to vertigo. Ultimately, these
states progressed to severe insomnia, lasting about five days, and a
full-blown breakdown to what old Psychiatry might call, regression
first, doctors guessed that I may have had
depression, and was given imipramine. This drug only made me
anxious, sleepless, and also gave me hives. Perhaps, the
were a blessing in disguise, as I asked to be taken off it, preferring
the depression. I think the doctor did not like the hives,
About half a year elapsed, and I continued to struggle through the
doctorate, feeling very ill at ease, but pushing on to the finish line.
My failure to meet the grades of two more courses required for the
Ph.D., gave the department the opportunity to kick me out.
may have enabled them to avoid the bothersome conflict that had stirred
up divisions and trouble in the department. I did not take it
well, but it was an opportune break from overwork.
the Rabbit Hole
I experienced the critical breaking point of my mental and emotional
stability in my bedroom one day after returning from a class.
What was vaguely familiar in the past as a kind of vertigo, turned into
a vortex of blackness and despair. Physically, I suddenly
if some great magnetic force was pulling me into a hole.
anxiety, and depression alarmed me. I felt as if I was being moved by
some invisible force into an abyss and had no control to pull myself
out of it. I exerienced a sadness and despair
unknown to me
in even my darkest and most traumatic events of my life. It
like the exctinction of the flame of life, as if the very essence of
volition, and existence was smothered--a death in life.
My instinct told me to escape, and I ran outside the door, looking for
the next coming car on our street to step in front of--anything to
escape that terrifying sinking feeling like Alice falling into the
rabbit hole. The emotional part of the experience must have
far greater than the cognitive self-awareness. I think that
me from suicide, as I made quick turn from the middle of the road. For
at the time, our hospital was only a block away and instead of
following the impulse to terminate my life, I made a conscious decision
to run to the hospital for help. How many decisions do people
make in their life that determine what their next year, their
next, month, even their next minute will be. The nearby
which two years later was closed by the government, was a fateful
moment in time.
I was seen by two doctors, one of them a psychiatrist and the other one
who has been my personal doctor through most of my life, and the same
one who had removed me from imipramine about a year before.
interview was quite lengthy and this time, some new incidents made them
suspect that depression was not the correct diagnosis. One
incident in particular, was an irrepressible urge to walk for hours all
over the mountain of the city. I had an incredible amount of
energy which I felt I had to dispense somehow, through physical
exertion. Another, was a surge in libido and the delusion that I was in
love with someone whom I had only briefly met in the library.
the most disturbing one of all, was the outburst of tears and exquisite
sensitivity at the slightest sad event or idea, such as a scene of two
elderly ladies crying over their dead cats during my summer work at the
SPCA. Such incidents, led the doctors to suspect
I was put through a number of both physical and psychological tests for
two-three days. I confess to not remembering everything that
happened at that time, as I was quite a mess emotionally. If
recall correctly, it was the psychiatrist who recommended a list of
possible medications: lithium, carbamazepine, Valproate, and three
others which I cannot recall. His first choice was lithium,
he wanted me to try it first. I had a very vague idea of
psychiatric medications then, and one drug was as good as the other for
me; anything was good as the other, if only to escape the distress I
My family was on vacation at the time. I learned later that
doctors had contacted them and told them of my diagnosis. It
have disturbed them immensely and been a great disappointment, as they
never spoke of it to me personally. My husband himself, could
believe it, and thought like them, that there must have been a mistake.
I felt as if I had somehow come of age. It was a strange
of initiation into a different social status.
was glad. I think I felt that now, I could rest. I must have
to the pharmacy with my prescription and picked up the medication --
lithium carbonate. They looked like innocuous vitamin
was desperately unhappy and felt helpless and forlorn. I did not think
there was much left in my life, having let everyone down and lost my
emotional stability. I can't recall which capsule was the one
that switched the neurochemistry from misery to happiness, but the one
that did, was like a switch. I compared it to the immediate
transition of the ON/OFF change when rebooting a computer or turning on
a light. You could only have one state but not
If you had a euthymic state, then you could not have a depressed
state. Some sort of therapeutic level must have
reached, changing the brain chemistry from one state to another. It was
nothing short of miraculous. If I were a religious person, I
would say that at that moment, I had left the crypt and been born again.
This miracle did not come without a price. The side effects
were--especially in the beginning-- an adventure in psychopharmacology.
If I had been Icarus, my wings were certainly clipped. I felt as if I
had been grounded by some lead weight. I recall
downstairs and feeling like a hippopotamus-- heavy and lumbering and
careful not to lose my balance. I slept every afternoon for a
couple of hours, and my mouth felt metallic and dry as the Sahara
desert. Lethargy, frequent voiding, spaced-out concentration,
thirst, and sleepiness..... but Peace at last. It was a
drug, but I was no longer unhappy. Gone were the
swings and the wild temperament, the hellish depression and the
exhausting willpower . It was a
I was finally, a Stoic. almost. :-)
The Method of Last Resort
by Kevin Thompson, Ph.D.
is Electroconvulsive Therapy?
Electroconvulsive Therapy (ECT) is an electrical-stimulation technique
used to treat severe depression, bipolar disorder, schizophrenia and
psychosis, and catatonia. It is a remarkable fact that ECT is an
effective treatment for so many apparently unrelated types of mental
illness. It is perhaps equally remarkable that so little is known about
why it works, beyond the consensus that it is the seizure induced by
ECT that leads to the benefits.
During an ECT session, the patient is given a general anesthetic to
induce brief unconsciousness, and then a voltage is applied to cause an
electric current to flow through one (right lateral) or both
(bilateral) sides of the brain, inducing a seizure. For reasons that
are not well understood, this electrically-induced seizure can
dramatically alleviate depression.
Bilateral treament acts more rapidly than unilateral treatment, but has
more severe side effects. Right unilateral treatment produces less
severe memory loss, and is preferred for depression. Bilateral
treatment is generally restricted to emergency situations involving
severe depression with psychosis, severe manic episodes, severe
psychotic episodes, and catatonia.
is ECT Used?
ECT is typically used in these circumstances:
- When it is essential to provide the fastest-possible relief
for depression, mania, or psychosis (for example, in the case of
someone who is suicidal).
- When medications have proven ineffective, and symptoms
- For patients with bipolar disorder who need immediate
stabilization of their condition, or who are experiencing severe manic
episodes. ECT helps both the manic and depressive aspects of this
disorder, something that is not normally true for individual
- For patients with catatonia, a dangerous condition that is
often resistant to medication.
ECT is a proven technique. It does not always work, but it works more
often than medication for severe depression, and generally as well as
medications for bipolar disorder and schizophrenia. It often is the
only treatment that works for catatonia.
are the Drawbacks?
There are a number of drawbacks to ECT, including
- Practical Difficulties. Access to ECT may be difficult, as
it is not a common treatment. Also, the expense, and the overhead in
terms of time and care that the treatment entails, make it burdensome.
Finally, when used to treat depression, a course of 10-20 treatments
must be followed by maintenance therapy (medication or monthly ECT
treatments), or the benefits will not persist.
- Short-term memory loss. ECT typically causes short-term
memory loss, and possibly some temporary impairment of ability to think
- Possible long-term deficits. There are many anecdotal
accounts of long-term, even permanent, impairment of memory, ability to
think, and ability to experience the normal range of human emotion.
These claims have not been confirmed by clinical studies to date. Those
who assert the truth of these claims explain this discrepancy by saying
that the studies do not measure these types of deficits. As of this
writing, no conclusive evidence exists to settle the debate.
The Picture is Mixed
It should also be said that some people not only respond well to ECT,
but do so without experiencing significant deficits. For these people,
most of whom have exhausted the set of available medications, ECT is
very much a life saver.
The drawbacks, plus a somewhat sensational and checkered history of
past abuse, has led physicians and possible candidates to shy away from
ECT. However, ECT should be considered for the circumstances described
Ph.D. is the author of Medicines for Mental Health: The
Ultimate Guide to Psychiatric Medication
You can find information about treatments for depression, bipolar
disorder, schizophrenia, and sexual problems on his Web site at
on Resources: Mental Help Net
Mental Help Net
in its own
is a a Web site "dedicated to educating the public about mental health,
wellness, and family and relationship issues and concerns." Run by a
panel of mental health experts, Mental Help Net supplies
- Articles on virtually every mental-health issue known
- Advice on life issues
- General information about healthcare
- Overviews of medications commonly used to treat mental
- Discussion forums
- A Web log
The site is visually appealing, and the material well-organized and
comprehensive. Check it out.
You Looking for Writers?
If you are looking for articles on mental-health and medication issues,
for an online or printed publication, send me a note. I write for
various publications, and may be able to help.
MentalMeds News --
Copyright © 2008 by Kevin Thompson
May be freely distributed in whole or in part, provided material is
attributed to Kevin Thompson, Ph.D. at www.MentalMeds.org