Orthomolecular Medicine : Finding care for depression, mental episodes, and brain disorders by Robert Sealey 0968612741

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Finding Care For Depression, Mental Episodes and Brain Disorders READER COMMENTS “Most health books can be divided into two major types: 1. Where the writer is a victim of one or more illnesses and describes in detail what happened, both negative and positive. 2. When the author is a physician or healer who describes one or more different types of therapy. A few books fit into a third category: determined patients who keep searching until they find quality care and learn how to become therapists for their own conditions. In the field of orthomolecular therapy, there have been several books of this third type, but more are appearing. This is the type of book written by Mr. Sealey. He describes his chronic depression, the failure of standard psychiatric treatment to provide him with restorative care, and how he recovered after he undertook a major responsibility to heal himself. He became a serious student of the literature of mood disorders, starting with psychiatry and psychology. Eventually, he read about orthomolecular medicine, and worked hard to apply its principles and practices to his own condition. He is now well. After decades of problems, he vanquished his depression and began to rebuild his life. I ask readers to consider his account seriously because [the author’s] illness might have left the patient forever incapacitated and a charge on his family and community. His anecdote represents only one of thousands of stories about similar patients who recovered using orthomolecular treatment. The evidence has been published in many clinical accounts, standard and complementary journals and many books. The evidence is there. It needs only to be studied and applied. Sealey developed a practical guide for patients, family and caregivers. I think that this book could be a model for anyone who is ill, especially for people who cannot find quality care or orthomolecular therapy. I recommend this book, even to medical students and psychiatrists in training.” Dr. Abram Hoffer Victoria, BC, Canada

“Antidepressants and mood stabilizers only clouded Bob Sealey’s brain or gave him the type of nervous energy that made him want to jump out of his skin. Then there were the side effects. One professionally negligent psychiatrist did nothing as Bob’s condition deteriorated on the drug he prescribed. When Bob filed a complaint, the professional governing body refused to act (when have you ever heard of a psychiatrist being disciplined for misconduct or incompetence?). Talk therapies proved similarly disappointing. After 20 years of struggling with bipolar II, Bob decided to take a different approach. He researched natural therapies, and through trial and error under the guidance of doctor [authors] he restored his mental health using a combination of low-cost plan extracts and a regimen of nutrients and minerals. Bob describes his journey to recovery … it eventually dawned on him that there were four options for diagnosis and treatment, three of them not good. Even psychiatry at its best [too often] relies on labels rather than a true diagnosis and pills and talk therapies instead of real treatment. A restorative approach, by contrast, is based on accurate diagnosis of the root causes of the illness and corresponding treatment to recover normal health without adverse side effects. This means that if you have say a vitamin B6 deficiency, you will be treated with vitamin B6. A chapter written by Dr. Abram Hoffer, the father of orthomolecular medicine, describes how he and a colleague first got started by successfully treating a schizophrenic patient with vitamin B3 (niacin) and vitamin C. A subsequent small double-blind study found the two-year recovery rate for first-time mentally ill [schizophrenic] patients using the vitamins was 75 percent. All this whets one’s appetite for more [information about] natural supplements and how they work on the brain – but the book is content to provide a lengthy list of references … it’s as if the author knows you’re cheating yourself if you try to get all your information out of one book. With precious few doctors out there committed to restorative medicine, the onus is on us to learn everything we can, from as many references as we can get our hands on. One day, perhaps, we can place our trust in the hands of a new generation of practitioners. Hopefully, the wait won’t be long.” John McManamy McMan’s Depression and Bipolar Weekly, CT, US

“Your book is a beacon to those searching for an accurate diagnosis and appropriate care … I applaud you for having the courage to bare your soul as you took the reader through the “roller coaster years” …” PB, RN, Toronto, ON “Congratulations on a job well done!” DG, BSc, Welland, ON “The book is well written and easy to follow and understand, not technical … It gives a good outline of what one can go through when suffering from depression, of how one can feel. One could do a self analysis by using the book. It also details the problems encountered in finding good care and [explains] how to assess the care given. Plenty of reference books are [listed] … to further increase knowledge of the illness and its ramifications … very helpful reading for people with depression.” LS, PEng, Niagara Peninsula, ON “Your book is disturbing and reassuring at the same time. It is extremely informative to the person who hasn’t gone through what the rest of us have … 10 years of hit and miss treatment. I am a professional therapist [bipolar II] and so experienced far less damage than the average person and was far more fortunate than most in finding an excellent psychiatrist. However, I am interested in the alternative treatment of bipolar II disorder with vitamins and supplements specifically … You should be proud of your work, as it is so informative, a person can avoid all the pitfalls of bad and insufficient treatment no matter how shy you are about taking [the responsibility for finding effective] treatment into your own hands! Thank you!” DG, Therapist, NY, US

Review – Reference Copies Were Submitted to • • • • • • • • • • •

• • • • • •

Mood Disorders Assoc. of Ontario National Depression and Manic Depression Assoc., Chicago, US Canadian Naturopathic College Canadian Schizophrenia Foundation Journal of Orthomolecular Medicine Learning Disabilities Assoc. of Ontario McMan’s Depression and Bipolar Weekly, CT, US MindFreedom Journal (formerly Dendron News), OR, US Nutrition and Mental Health, Toronto, ON Open Minds Quarterly, Sudbury, ON Psychiatrists, physicians and other health professionals Centre for Addiction and Mental Health, Toronto Mt. Sinai Hospital, Toronto private practitioners, Toronto, ON and BC, US Sick Children’s Hospital, Toronto Sunnybrook and Women’s College Health Centre, North York Schizophrenia Digest, Ft. Erie, ON Toronto public library University of Toronto Vitality, Toronto, ON www.mentalhealthrecovery.com www.alternativementalhealth.com

Presented Canadian Authors Association, Toronto branch Word on the Street, Toronto, Sept. 2001 Canada’s National Book and Magazine Fair Canadian MoneySaver magazine conferences Burlington and North York, Oct. 2001 The book is available to mental health organizations. Contact SEAR Publications about possibilities for • • • • •

fund-raising: ongoing efforts and events, presentations educating consumers, survivors, callers and families supporting members, patients and readers attracting new members, donors and subscribers resale by health professionals, publications and web sites

Finding Care For Depression, Mental Episodes and Brain Disorders

A Layman’s Guide by Robert Sealey, BSc, CA With a Chapter by Dr. Abram Hoffer

How Orthomolecular Medicine Can Help

Copyright © Robert Sealey, 2001 All rights reserved Notice to Readers The authors and publisher do not advocate the use of any particular health program but believe patients and families, caregivers and health professionals can use the information in this book to find quality care. Restorative mental healthcare can help people with depression, mental episodes and brain disorders. This book is based on the personal and clinical experiences, education, training, reading and research of the authors. To the best of the authors’ knowledge, the information is true and complete. To protect privacy, names in the teaching tales were either changed or omitted. This book is intended only as an educational guide for people who want to find care for mental health problems. It is not intended to replace, countermand or interfere with the advice given by physicians or other health professionals. Since each person and each situation is unique, the authors and publisher encourage people with depression, mental episodes or brain disorders to consult with qualified health professionals and think about their options for effective care. Readers are encouraged to focus on accurate diagnosis and effective treatments. As there is always some risk involved, the authors and publisher are not responsible for any problems, negatives, downsides or consequences resulting from any use of the information, tips, traps, tools, tales, poems, reviews or references in this book. ISBN 0-9686127-4-1 paperback 1. Depression 2. Mental illness 3. Mental health care 4. Orthomolecular medicine II. Title Cover Design, Interior Design, and Page Layout by Keith Boa Printed and bound in Canada First printing: August 2001 10 9 8 7 6 5 4 3 2 1 Published by SEAR Publications 291 Princess Ave. North York, ON, Canada M2N 3S3 Internet web site: www.searpubl.ca

Contents Dedication

vi

Acknowledgements

vii

Preface

ix

How to Use This Book

x

Introduction

xi

How Orthomolecular Medicine Can Help by Dr. Abram Hoffer

xvii

Part 1: The Trusting Patient

1

Chapter 1: After Years of Symptoms – Is It a Mental Disorder?

2

Chapter 2: Bob, a Depressed Patient, Trusted Dr. T.T. ShorCu The Paradoxical Case of the Expert Psychiatrist The Patient’s Medical File: Notes and Omissions

12 22 17

Chapter 3: Independent Depression Project

23

Chapter 4: Finding Care for Refractory Depression Learning About and Following the Practice Guidelines of Psychiatry The Mental Status Examination Worksheet Ten Steps for Effective Mental Healthcare Worksheet

26

Chapter 5: A Patient Can Find Quality Care

44

32 34

Part 2: Exploring the Mental Healthcare Maze

47

Chapter 6: Introduction – Exploring the Mental Healthcare Maze

48

Chapter 7: Charting the Healthcare System Health System in Ontario, Canada

51 54

Chapter 8: Mapping the Maze of Depression Diagnoses and Treatments Mental Healthcare Reality Check The Maze of Depression Diagnoses and Treatments

56 59 60

Chapter 9: Investigating a Case of Care Gone Bad

62

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Chapter 10: Blowing the Whistle on Substandard Psychiatry Thirteen Standard of Care Procedures Were Omitted

67 69

Chapter 11: Suggestions for Mental Patients and Caregivers

76

Chapter 12: The Psychology of Whistle-Blowing

78

Chapter 13: Risk Management with Suicidal Patients – Review Negligence Checklists

80 83

Chapter 14: Psychiatric Survivors: Human Rights or a Reality of Wrongs?

86

Chapter 15: After Reviewing the System: Assessing the Mental Health Professional Health Professional Assessment and Rating Forms

89 94

Chapter 16: Hard Lessons Learned Well My Experience of Ontario’s Mental Health System Twists and Turns Around and Through the Mental Healthcare Maze

Part 3: Tools for Finding Care

98 102 101

105

Chapter 17: Introduction – Tools for Finding Care

106

Chapter 18: Developing a Mental Healthcare Compass Mental Healthcare Compass Illustrations by Charles Sucsan

107 113 114

Chapter 19: Using the Mental Healthcare Compass to Find Care for Depression

116

Chapter 20: Twelve Steps for Coping with a Mood Disorder

127

Chapter 21: TAYO – The Healthcare Planner Think About Your Options Introduction and How to Use the Planner TAYO – Planning Diagrams

129 130 136

Chapter 22: Finding Advice about Money Matters 138 Helping a Retired Client and his Family Cope with Depression 143 Chapter 23: Conclusion – Tools for Finding Care

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144

Part 4: References for Restoring Mental Health

147

Chapter 24: Introduction – References for Restoring Mental Health

148

Chapter 25: References, Snapshot Reviews, Notes and Quotes

154

Reviews Active Treatment of Depression Antidepressant Survival Program Anxiety and Depression – The Best Resources to Help You Cope Dealing with Depression Naturally Handbook of Psychotropic Herbs The Last Taboo The Noonday Demon Prozac Backlash Worry

162 155 157 171 177 184 190 196 211

Chapter 26: Quick Pick Reference Lists for Common Conditions Attention Deficit Disorder (ADHD) Autism Depression and Bipolar Disorder Dyslexia Epilepsy Obsessive-Compulsive Disorder (OCD) Schizophrenia Suicide

214 214 214 215 217 217 218 218 218

Chapter 27: Musings on the Curious Capabilities of the Disordered Brain

219

Chapter 28: Conclusion – Finding Care for Depression

223

Appendix:

Index

225

About the Authors

229

By the Authors

230

90 Day Plan For Finding Quality Care

233

Sear Publications Order Form

255

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Dedication

A

65-year-old chap called while I was writing this book. He was depressed. He had been depressed for many years. He remembered being well for one year after he consulted with an orthomolecular physician in Syracuse, NY. He was tested, diagnosed and advised. As instructed by the doctor, when the chap took his daily regimen of supplements: vitamins, minerals, amino acids and co-factors, his depression soon lifted. He remained well for the year he used restorative medicine. After stopping his regimen, he relapsed. Local doctors put him on prescription medications. During several interviews, he shared his treatments – prescription medications: barbiturates, benzodiazepines and antidepressants. He had 20 shock treatments. His depression resisted and he despaired about getting well. Sadly, he lost hope. He died in 1999, a suicide. A good friend ended her life at the age of 30, before she could try restorative care for her chronic degenerative condition. She also lost hope. A family friend ended her life at the age of 18. So young, so fun, and now she’s gone. Now that we know, you’re far away. We can remember you today.

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Acknowledgements

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o everyone who helped with this book, thank you. For decades, my family tolerated my moods, listened to my intense ideas, read my writing, and helped me financially. Depression buddies and over 150 interview subjects shared problems and progress, symptoms and side effects, struggles and stories. Their courage was inspiring. My book team was patiently supportive: contributor – Dr. Abram Hoffer designer – Keith Boa of Terrestrial Design, [email protected] editors – Ariadne Patsiopoulos and David Sealey editing course instructor – Jim Taylor illustrator – Charles Sucsan publishing consultant – Bruce Batchelor, www.trafford.com Editors and publishers accepted excerpts for first publication in: Canadian MoneySaver – Dale Ennis Depression Survivor’s Kit – SEAR Publications Fire and Reason – Ariadne Patsiopoulos Journal of Orthomolecular Medicine – Steven Carter, Dr. Abram Hoffer Masks of Madness: Science of Healing – Bob Hilderley, Quarry Press Open Minds Quarterly – Barbara Wilson, NISA Schizophrenia Digest – Bill MacPhee, Magpie Publishing Wordscape 7 – Canadian Authors Assoc. – Jennifer Footman, Bill Belfontaine My story and consulting work was reported by: CA Magazine – Up Front column – January 1998 CBC TV – The Health Show – February 1997 Masks of Madness: Science of Healing -TV – Margot Kidder, Dr. A. Hoffer - 1998 The Toronto Star newspaper – Ellen Roseman’s column – Sept. 27, 1999 Authors and healthcare professionals explained their work and encouraged me to learn about restorative healthcare, develop depression survival tips for laymen and write books for patients, survivors, family and caregivers. Special thanks to: Dr. Abram Hoffer, Dr. Priscilla Slagle, Mary Ellen Copeland, MS, MA, Dr. Al Siebert, Dr. Bryne Waern, Dr. Ken Shulman, Francis DeFeudis, PhD, Dr. Vince DeMarco, Dr. K. Drieu, Dr. J. Bradwejn, Dr. R. Cooke, Dr. D. Lonsdale, Dr. Miriam Kaufman. FINDING CARE FOR DEPRESSION

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Information, newsletters, references, books and encouragement: American Psychiatric Association – practice guidelines, DSM Bipolar Puzzle Solution (and other books) – cover quotes, review notes etc. Canadian Psychiatric Association – practice guidelines Canadian Schizophrenia Foundation – Toronto, CA For a list of books by mail order, write CSF, 16 Florence Ave., Toronto, ON, Canada, M2N 1E9 Humber College – summer writers’ workshop – Joe Kertes Mood Disorders Assoc. of Ontario – www.mooddisorders.on.ca monthly lectures, executive director – Neasa Martin McMan’s Depression Weekly – e-mail newsletter To subscribe, write to McMan’s Weekly, PO Box 331, Southington, CT, USA, 06489 For sample issue, e-mail to [email protected] Medscape Psychiatry Medpulse – weekly e-mail update psychiatry.medscape.com To subscribe, e-mail to www.medscape.com/profile Mindfreedom Journal (formerly Dendron) Support Coalition International – David Oaks www.mindfreedom.org NAMI – www.nami.org The National Alliance for Research on Schizophrenia and Depression www.narsad.org NARSAD Research Newsletter To subsribe, write to NARSAD Research Fund 60 Cutter Mill Rd., Ste. 404, Great Neck, NY, USA 11021 National DMDA (Depression and Manic Depression Assoc.) – US www.ndmda.org Safe Harbor – Dan Stradford www.alternativementalhealth.com The Way Up by Dr. Priscilla Slagle To subscribe, e-mail to www.thewayup.com/nwslttr.htm University of Toronto – Taddle Creek summer writers’ workshop – Steven Heighton viii

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Preface

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he author left home at the age of seventeen and set out to find his way in the world. A trusting young man, he did not know he had a mood disorder. He did not expect a chronic mental illness to darken his future, for decades. In 1995, he was no longer a young man. At his worst while under the care of an ‘expert’ psychiatrist, the forty-five-year-old author had involuntary symptoms of a bipolar II mood disorder, migraines and anxiety. Misdiagnosed and mistreated, he suffered negative effects of medications. Sick and tired, he faced the social stigma that made him all but invisible. He swallowed a powerful dose of reality. After his trust was betrayed by health professionals, he became fascinated with the dark side of the mental health system. He wondered why his medical advisors chose quick and easy shortcuts. Wanting to learn the standard of care procedures, he questioned incompetent alternatives, studied medical books and reviewed practice guidelines. For twenty-eight years, the author lived with his illness and explored the mental healthcare maze. In 1996, as a psychiatric outpatient, he learned about restorative mental healthcare. Using books to guide his recovery, he stabilized and learned to live well with his disordered but otherwise highly functional brain. Determined to help others, he started the Independent Depression Project (IDP), interviewed patients, found scientific and medical references, researched tips and traps, wrote tools and tales and reviewed references for patients, family and caregivers. He developed a mental healthcare compass and designed TAYO – The Healthcare Planner to help people think about their options and plan effective healthcare. He wrote articles, insider reports and teaching aids to guide psychiatric survivors who want to find quality care and cooperate with competent health professionals. If you or someone you love suffers from depression, mental episodes or brain disorders, this layman’s guide can help you explore the mental health system and benefit from restorative mental healthcare.

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How to Use This Book

T

his book was written for patients, caregivers, family, friends and health professionals. If you are not feeling well, you may prefer to scan for items of immediate interest and take a quick look at the references. Later, you can study the teaching tales, tips and tools. The Introduction There are four common patterns for diagnosis and treatment. Dr. Abram Hoffer, a practising psychiatrist, researcher and author, contributed a chapter called ‘‘How Orthomolecular Medicine Can Help’’ to explain how mental patients can recover and keep well. Part 1 – The Trusting Patient We learn what happened when Bob, a depressed patient, trusted Dr. T.T. ShorCu. It introduces an important tool for finding quality care. There is a layman’s outline of the practice guidelines of psychiatry and worksheets that you can use with your health professionals. Part 2 – Exploring the Mental Healthcare Maze Medical mistakes can lead to a bad outcome. A story about a case of “refractory” depression shows what can go wrong if a mental health professional is incompetent. Please do not repeat the author’s mistakes. There is a health professional assessment to guide the patient. Part 3 – Tools for Finding Care The mental healthcare compass and TAYO – The Healthcare Planner can help patients, family and caregivers think about their options and find effective care. There is advice about money matters. Part 4 – References for Restoring Mental Health The references are annotated with review comments, notes and quotes. Restorative references get four stars. These books can help patients and caregivers who want to learn about mental healthcare for depression, mental episodes and brain disorders.

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Introduction

I

t took me decades to find my way through the mental healthcare maze. For nearly ten years, I suffered with depression without knowing I was sick. For an entire decade I was not diagnosed or treated. For another twenty years I was laughed at, silenced, misdiagnosed, mistreated, found fault with, drugged into oblivion, rejected, excluded and abandoned – by eight health professionals, and other people. At the age of 46, I learned about restorative mental healthcare. It worked wonders for my bipolar II mood disorder, migraines and anxiety. When I wanted quality care for my recurring episodes of depression, I had problems finding competent medical advice. I mistakenly trusted doctors. My trust was betrayed not just once, but several times over twenty years. I believed that health professionals were well educated and carefully trained. I believed in their clinical experience. I assumed their methods were tested and proven by successful outcomes with other patients. Their professional manners and practice guidelines inspired my confidence. I trusted them too easily, one after the other. My professionals seemed competent; why would I question them about negligent short cuts? I learned about mood disorders by reading. After living for decades with depression, migraines and anxiety, I finally found competent care. Now I check reference books before accepting medical advice. By reading and research, I learn how restorative procedures can help and whether there are negative effects. When I couldn’t find layman’s tips for surviving and living well with a mood disorder, I wrote a Depression Survivor’s Kit. I wrote Finding Care For Depression after restoring normal mood and maintaining mental health for five years. I have been stable since 1996. I don’t know if a person with a bipolar mood disorder can ever be “normal” but I live well, work, consult with clients, research, write and provide for my family. I am still variable, volatile, vulnerable to episodes of depression (and high energy hypomanic times), reactive, intense, hypersensitive, periodically creative, surgingly energized and hypergraphic (I write a lot). I feel a lot better and am more stable than for years before. Even if you suffer with depression or anxiety for years, please do not give up hope. You can find quality care. You may feel lost when you start to explore the mental healthcare maze. Even when you feel well, it is not easy to find FINDING CARE FOR DEPRESSION

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your way through a maze; it is much harder if you are sick or depressed. You may expect proper care, but head down blind allies. You may be disappointed if you try shortcut alternatives (to accurate diagnosis and effective treatments). Depression is an intensely painful condition. It has a variety of causes and there are a number of “cures.” The typical mood disorder patient suffers with up to 15 involuntary symptoms, is labelled by healthcare professionals and can be stigmatized by polite society. Patients can be shunned if family and friends don’t understand what is wrong. I wrote Finding Care For Depression with tips and traps, tools and tales, reviews and references so people can find restorative healthcare. You can use this book if you are depressed or care for someone with a mood disorder, anxiety, dysthymia, bipolar disorder (also called manic depression), obsessive compulsive disorder, schizophrenia, autism, dyslexia, epilepsy, migraine, stroke, dementia, Alzheimer’s, Parkinson’s or any other chronic or episodic brain condition. People are using my ideas to find care for depression, mental episodes and brain disorders. This book is for laymen, caregivers and health professionals. The language is not technical. There are no DSM terms and no psycho babble. I have a BSc degree (with courses in biological and medical sciences and psychology) and a professional designation as an accountant. I have practical experience consulting with local clients since 1972. Thirty percent of my clients experience episodes of depression or other brain conditions (or care for affected family members). As an independent consultant and writer, my professional practice involves helping local clients deal with money matters. While living and working with my bipolar II mood disorder, I learned that many people have problems with chronic anxiety (for no obvious reasons) and depression (sucking the joy out of their lives). After years of problems, their hope runs low. Depression affects the brain by darkening perspective. Sick people may think they cannot find good information or their health professionals will refuse restorative methods. I learned to trust what works but if something doesn’t work, I was told to consider other possible solutions until the problem gets solved. I thank my father for that valuable lesson. He taught me to persist. I learned to read, research and write about restorative mental healthcare and depression survival. For medical care and therapy, I recommend qualified health professionals: doctors and therapists. I share reference books to help people learn about depression and find quality care. As a consultant, I give depressed people advice about money matters. As a depression survivor, I help clients cope with depression by coaching. I encourage people to find restorative care for depression and cooperate with competent health proxii

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fessionals. Even my mistakes can teach readers who not to trust, when to question short cuts and how to navigate the mental healthcare maze. You can learn from my tips, traps and tools. You can use my mental healthcare compass and you can use TAYO, The Healthcare Planner. You can find care for depression, mental episodes and brain conditions. While working on another book, Restoring Mental Health, I interviewed over 150 depressed people and family members. Many people trusted me with their stories. I expected to hear that depressed people get good medical care and restore normal health. I was surprised that few people shared happy endings to their depression stories. If they are not accurately diagnosed or effectively treated, they continue to suffer. As I listened to depressed people speak about their experiences, there seemed to be 4 patterns of care. The first three are are expedient short cuts, but they are not consistent with the practice guidelines of psychiatry. They are minimal, negligent and conservative patterns. 1. Find fault and do nothing (but deny, blame, argue, worry, delay and wait) = minimal; 2. Misdiagnose and mistreat (happens more often than expected) = negligent; 3. Label quickly and suggest easy treatments (pills, talks, or both) = conservative. The fourth pattern below is consistent with the practice guidelines: 4. Diagnose accurately (discover the root cause(s) or underlying medical illness(es)); and treat effectively (recover normal health without adverse effects) = restorative. These patterns inspired me to design a mental healthcare compass. I read many books about different kinds of care as I tried to find care. I learned that some mental health professionals recommend talk therapy for depression. Many books by professional psychologists and social workers report success using various talk therapies with mental patients. Empathy and counselling can help when people suffer with mental disorders. Articulate health professionals write about therapies. Their books outline the common practices and explain the range of techniques. Sadly, my experience with talk-talks didn’t help me recover from my mood disorder. Counselling was helpful after I restored normal brain function. Before then, I was told that my patterns of thinking, feeling and behaving during episodes of depression were skewed toward the negative. Those put-downs weren’t much help. I encourage you to read about therapies for depression and brain conditions. When a person struggles with involuntary mental health problems, there is much to be learned about the brain and FINDING CARE FOR DEPRESSION

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how patterns of thinking, feeling and behaving shift during episodes of depression. Therapy and counselling can help you understand the social and psychological issues involved with a mental illness. Some depressions have psychological or relationship triggers. If the cause of your depression is psychological or social, therapy can help you recover. Psychiatrists, physicians and other qualified medical professionals recommend pills (and more pills) for mood disorders. They claim success using one or more of the 20 or so antidepressants, mood stabilizers and antipsychotic medications (commonly prescribed for depressed people). Sadly, the usual antidepressant medications did not help me get well. It was educational to take medications, but the effects were mostly negative. In my case, side effects, adverse effects and toxic effects made me worse. I leave it to psychiatrists to explain their medical practices. If you are advised to take pills for depression, remember to ask for an accurate diagnosis and read about your medications so you will be informed about the range of effects: good and bad. An author has to read at least one book for every page he writes. I read many books about depression by mental healthcare professionals and survivors. Books by mental healthcare professionals such as psychiatrists and psychologists tend to explain a 2-step method: 1. label the patient’s mental illness, problem or condition; and 2. recommend easy treatments. The “easy” treatments tend to follow a 3-step pattern: 1. talk therapy; 2. pills (and more pills, by prescription); and 3. combinations of talks and medications. None of these books held the answers for me. I am curious about why these authors claim such methods are effective. I wanted restorative medical advice, with support, encouragement and respect. I hoped for better biological treatments than 2- and 3- step patterns. I wanted to know about the root causes of mood disorders. I wanted insights into the brain’s experience of depression as a low-fuel condition and a chemical imbalance. I hoped to understand why depression has so many symptoms. I wanted to restore normal mood and maintain good mental health. I didn’t want to mask symptoms of depression and anxiety while living with a lingering mood disorder. I didn’t want to be sick for decades. I wanted to get better, not be stuck with symptoms of a chronic mental illness. Too often, I thought death would be better than living with depression so I kept on reading, asking questions and searching for care. I learned that some great writers wrote insightful books about the painful experience of depression. I do not presume to write as eloquently as they do. The poignant words of brilliant writers describe the painful experience xiv

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of depression. Books about the history of psychiatry and the mental patients who suffered through early “cures” for depression do not help readers find effective care for their depressions but they are interesting, shocking and sad. You can learn about the experience of depression and the history of psychiatry, psychology and mental illness by reading these books. I encourage depressed people to read about mood disorders. There can be a problem with talk, pills and the 3-step approach to mental healthcare if the sick person doesn’t get better. If easy treatments don’t work, the depressed person may suffer for years. People can get stuck: sick of being tired and tired of being sick, alone and lonely, helpless and hopeless while struggling with “the common cold” of mental illness (as depression is often described). Patients wonder who they have to consult to get proper care, and what they have to do to restore mental health and maintain normal brain function. Just as colds are left to run their course, many sufferers of depression are left to survive as best they can until their conditions resolve, even though they are not diagnosed accurately or treated properly. I read many books before finding a scientifically valid and medically proven approach to effective mental healthcare (without adverse effects). This works well for me. While using this quality of care, I have been stable since 1996. While working on an independent depression project, I read books about restorative mental healthcare and interviewed depressed people. Many had never heard about restorative treatment for mood disorders and mental illnesses so I wrote a layman’s guide to mental healthcare references. I appeared in the TV documentary, “Masks of Madness: Science of Healing,’’ and met the founder of orthomolecular medicine, Dr. A. Hoffer, interviewed some of his patients and read several of his books. The word orthomolecular originated decades ago when biochemist Linus Pauling cooperated with Dr. Abram Hoffer to conceive a medical speciality based on human chemistry. Orthomolecular means to straighten the molecules in the brain and restore normal biochemistry. It is fascinating to read about the pioneering work of these health professionals and learn how well their methods work. Orthomolecular health professionals continue to research and develop new regimens as they care for thousands of patients worldwide. They do not claim to have all the answers. They have effective techniques for restorative mental healthcare. I read books by many doctors who use restorative methods to help mental patients recover and maintain normal brain function, to the extent practical in each case. Conventional doctors sometimes doubt the value of restorative methods FINDING CARE FOR DEPRESSION

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but orthomolecular doctors use accurate diagnosis and effective treatments, which is what the practice guidelines of psychiatry recommend. Their restorative approach applies the life science of biochemistry to the arts of medicine and psychiatry. Although orthomolecular medicine is not acknowledged as a conventional form of mental healthcare, its practitioners are credible scientists and caring health professionals If you are unwell with depression, mental episodes or a brain disorder, you can take responsibility for reading and learning about your condition. You can think about your options and pay attention when you trust your life to a health advisor. If you want to get well, you can ask for restorative care. Restorative mental healthcare has been used for more than fifty years. You may have to persevere until you find competent mental health professionals who will accurately diagnose the root cause(s) of your condition and recommend restorative treatments. You can recover. I hope the tips, traps, tools and references in this book will help you find effective care. You can use this layman’s guide to benefit from the practices and principles of restorative mental healthcare. I look forward to hearing how you find quality care for depression, mental episodes or brain disorders.

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HOW ORTHOMOLECULAR MEDICINE CAN HELP contributed by Dr. Abram Hoffer

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any people suffer depression so severe and for such a long time that it forces them to ask for medical care. Over fifty years ago, only people with severe cases of depression or melancholia sought help. They were often admitted to psychiatric hospitals where there was little help until the first effective treatment, called electroconvulsive therapy, was discovered. Psychotherapy and psychoanalysis were tried on a large scale but proved futile for most depressed patients, and their suicide rate remained high. There was little effective treatment for severe clinical depression until psychiatry entered its chemical age and the first antidepressant called imipramine was discovered in Europe. We are still in this chemical treatment era except that now we have dozens of different antidepressants. Each modern one is said to be better than the preceding ones. “Better” means fewer side effects, but on a comparative basis, there is little evidence that newer antidepressants are more effective in alleviating depression. Antidepressants work best when used together with a sympathetic form of medical guidance or psychotherapy. This approach to depression is used by many physicians. Because there are no laboratory diagnostic tests for depression, it is difficult to distinguish it from other medical conditions in which symptoms of depression are a major problem. Schizophrenic patients are invariably depressed, as are many patients with serious or debilitating physical diseases such as cancer, chronic fatigue and many more. Furthermore, the word depression is given too heavy a burden when it is used to describe conditions that have no similarity to each other. Thus if you fall and stub your toe, you may be momentarily depressed. If you fail an exam which meant something to you, you might become depressed for longer than that. If your spouse or parent or child dies, the experience of depression called mourning may last for several years. These “depressions” are different from each other and require different ways of being helped. Just as the Innu have many words to describe the different types of snow, we need many different words to correctly characterize the various conditions of depression. An expanded vocabulary for depression would remove from the word depression its heavy burden of describing every person who is medically unwell, sad, tired, clinically depressed, and so on. The main problem in treating depression has been, and still is, to diagnose FINDING CARE FOR DEPRESSION

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it properly so that each group of patients with depression is homogeneous, and to have treatments that are specific and effective for each type of depression. I do not know when modern psychiatry will improve the specificity and effectiveness of caregiving for depression, nor do we yet have restorative care for depression – except for the new upstart branch of medicine called orthomolecular medicine and psychiatry. What, then, is orthomolecular medicine, how did it get started, and why was it so helpful to Robert Sealey, who did not recover from his mood disorder until he began, mostly on his own, to practise its principles? Orthomolecular medicine started in Saskatchewan in 1952 when Dr. H. Osmond and I gave large amounts of niacin (vitamin B-3) and ascorbic acid (vitamin C) to a catatonic schizophrenia named “Ken” in the Saskatchewan Hospital in Weyburn. We had just received our supply of these vitamins from Merck and Company in order to try them as a treatment for schizophrenia. This was based upon our adrenochrome hypothesis in which we suggested that these patients were sick, not because they were bad or evil, or had bad or evil mothers, but because they produced chemicals or poisons in their bodies which caused perceptual distortions and other problems in their brains (like LSD or hallucinogenic drugs do). Ken, age 22, did not respond to insulin coma treatment or ECT (then typical treatments for catatonic schizophrenia) and he was dying in his coma. Since he could not swallow, Dr. Osmond and I used a tube to pour 10 grams of vitamin B-3 and 5 grams of vitamin C directly into Ken’s stomach. The second day he was able to sit up and drink a solution which had 3,000 mg of vitamin B-3 (niacin) and 3,000 mg of vitamin C (ascorbic acid). By the end of 30 days on the same daily dose, he was normal. We discharged him. This was the first clinical test of our therapeutic hypothesis that a patient’s schizophrenic brain disorder could be effectively treated by using supplements of two vitamins, normally vital amine nutrients for healthy human beings. Dr. Osmond and I believed that supplements of vitamins B-3 and C would reduce the hallucinogenic levels of adrenochrome which we believed accumulated in the brains of some schizophrenic patients. We were lucky that our hypothesis worked and Ken got well. Encouraged by this, we gave the same treatment to eight additional patients in two hospitals and they recovered. This is called a pilot trial. Such a small test is designed to measure the best dose range and look for any side effects. I was not very worried about side effects of niacin since I knew that water soluble vitamins were extraordinarily safe. Toxicity tests in dogs showed that 5 grams of niacin per kilogram of body weight would kill half of them. A test dog weighing 20 kg would get 100 grams of niacin. The xviii

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dose that kills 50% of the test animals is called the LD 50. That dose would be equivalent to giving a 30 kg child 150 grams of niacin and a 60 kg adult 300 grams (more than one half a pound) every day. Anyone who swallowed that much niacin would probably vomit it promptly back up. Our treatments typically use 3 to 6 gram doses of niacin. This is nowhere near the LD dose. One of my female patients took, as a suicide gesture, two hundred 1/2 gram (=500 mg) tablets of vitamin B-3. Before she began to take vitamin B-3 as directed – at the rate of 2 tablets, 3 times a day – she became angry at her mother and swallowed the whole bottleful. For the next three days, she complained of stomach ache but then had no further complaints. She eventually recovered from her schizophrenia. Dr. Osmond and I used our scientific knowledge of the life science of biochemistry to develop reasons why supplements might be effective treatments for schizophrenia. We began our search for a restorative treatment for schizophrenia by looking at 3 to 6 gram doses of vitamin B-3 and matching doses of vitamin C. We then applied to Ottawa for a research grant so that we could run a larger scale clinical study. We were advised that we must do the trial using a double dummy design. This was later called double blind. It meant that the patients to be tested would be divided by random selection into two groups: half would be given a placebo (an inert substance) and the other half, the vitamins being tested. These patients were not chronic mental hospital back ward patients. They were ill for the first time or had had several attacks with remissions. For this type of patient, the generally recognized recovery rate is about 35 percent. No one, including the patients involved in a double blind study, would know whether they were getting placebo or vitamins. We agreed to the conditions of this study and as a result, by 1960, we conducted the first six double blind controlled experiments in psychiatry. Since you cannot hide the effect of the niacin flush, we added a hidden group who were given a form of vitamin B-3 called niacinamide which does not cause any flush. We found that the twoyear recovery rate using the vitamin therapy was 75 percent compared to the 35 percent recovery using the placebo. These positive clinical trials and the experience gained by many hundreds of other patients treated outside of the controlled trails convinced me that the addition of this vitamin to the standard treatment of that day would markedly improve the therapeutic outcome. Based on our experiences, we asked my sister Fannie Kahan to rewrite the book, How to Live With Schizophrenia, which was based on the earlier drafts of this book that Humphry Osmond and I had written. We asked her to take our final manuscript and rewrite it into plain English comprehensible to the averFINDING CARE FOR DEPRESSION

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age twelve year old. This book helped our patients to understand their treatment. A few years later, the Committee on Therapy of the American Schizophrenia Association was established. It involved over a dozen physicians, mostly psychiatrists. They became the pioneer doctors who rapidly expanded the use of vitamin treatment. As the early pioneers of orthomolecular medicine, they trained many other doctors in North America. Dr. Linus Pauling, a PhD biochemist, happened to read How to Live With Schizophrenia one weekend while he was visiting friends. He was astonished by the fact that we were giving huge (megavitamin) doses of vitamins, up to 1000 times more than the RDA (recommended daily allowance). He soon gave up his plans to retire and accepted a position at the University of California in San Diego, California. He started receiving letters from patients after they were treated with vitamins and recovered. In 1968 Dr. Pauling published his important work, “Orthomolecular Psychiatry,” in Science magazine where he showed how large doses of vitamins could be helpful. Above all, he emphasized the importance of working with molecules – substances – that were normally present in the human body. Our work coincided with his earlier work with sickle cell anaemia which was the first molecular disease to be described. Dr. Pauling’s paper launched the orthomolecular medical movement and embroiled him in a major controversy for the next 30 years of his life. His credibility was attacked by every established health group including physicians, psychologists, nutritionists, social workers and even some government departments. The Committee of Therapy, after long discussions, decided to adopt his word orthomolecular as the one word which best described what we were doing. Now over thirty years later, the word is well established outside of the United States and Canada. In these two countries where the research was done, there is still major reluctance to use the word. Some orthomolecular medical practitioners in North America are still looked upon as strange or labelled as quacks. This does not make sense since these doctors are only applying the life science of biochemistry to the art of medicine. Internationally, orthomolecular medicine is spreading quickly. The International Society of Orthomolecular Medicine has seventeen member countries. It is expanding into Europe, South America, Japan and Korea. As defined by Linus Pauling, PhD, and accepted by the Committee on Therapy of the American Schizophrenia Association and later the Huxley Institute of Biosocial Research, orthomolecular medicine is a system of medicine which depends heavily on the therapeutic use of natural subxx

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stances which are normally present in the human body. These are the vitamins, minerals, essential fatty acids, enzymes, hormones such as insulin and melatonin, and other compounds. Note that hormone therapy has been used in general medicine for a long time. The main emphasis of orthomolecular medicine is on compounds that are present in our food but that can be reinforced by adding supplements until each person takes in optimum amounts of nutrients. Each patient benefits by getting what their biochemical systems need for them to be well. The advantage of using natural products is that they are safe. There have been no deaths in the past twenty-five years from vitamins. Each year in the United States alone there are over 100,000 deaths following the use of medical drugs in hospitals. It follows that prescribed drugs have to be used very carefully since the therapeutic index is so narrow. The TI (therapeutic index) is the ratio of the toxic dose compared to the effective dose. Thus for niacin to lower cholesterol levels, the effective dose is usually 1 gram after each of three meals (i.e., three grams daily). The toxic dose is about 300 grams. For niacin, the TI ratio is 300/3 = 100. There is no known toxic dose of vitamin C and therefore it is so safe that the therapeutic index for vitamin C is undetermined. In contrast, drugs have to be prescribed very carefully by physicians who must pay strict attention to side effects and toxic reactions; meanwhile, vitamins are safe. A physician may need to spend several years mastering the intricacies of drug therapy, whereas any intelligent person can master the intricacies of vitamin therapy in a much shorter time. Society has recognized this by insisting that drugs must be prescribed whereas vitamins are available over the counter. To me, it makes sense to depend more on nutrient supplements because they can help to restore defective chemical reactions in the body. Thus in pellagra there is a deficiency of NAD, the coenzyme made from niacin. Giving niacin to a person who is ill with pellagra allows that person’s body to synthesize enough NAD so that the symptoms of their disease vanish. On the other hand, drugs interfere with natural reactions. The most effective drugs are those that most closely resemble natural molecules and can be metabolized and excreted. Very dangerous drugs kill because they interfere with reactions in the body. They act as poisons. The ideal killing drug cannot be metabolized and therefore builds up in the body. The ideal therapeutic compound does not build up, but enhances the natural reactions of the body and any excess is excreted. Drugs fall somewhere in between. The closer they are to natural molecules, the more successful drugs can be as therapeutic agents. FINDING CARE FOR DEPRESSION

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Conditions Treatable by Orthomolecular Medicine Even after working in this field since the 1950s, I do not know all the conditions that will respond favourably. There has still not been enough research in this area. We started with schizophrenia and we had very good results. Almost 80 percent of the early pioneers of orthomolecular healthcare were psychiatrists. The members of the Committee on Therapy soon found that the principles that worked well with schizophrenia also worked well with other disorders such as depression and anxiety; for children with behavioral and learning disorders; and for reversing some of the ravages of aging. However, each condition benefits most from a specific and tailored regimen. When we saw Ken recover so quickly from catatonic schizophrenia, we did not think in terms of depression. In the first few years that we used vitamins, we excluded every non-schizophrenic patient. Diagnosis was very important and we wanted to work only with schizophrenic patients. Later on we found that kryptopyrole, which we found in the urine of most schizophrenic patients, was also present in other patients and they also responded well to orthomolecular treatment. We found some people who were very depressed and they had this compound in their urine, but they were not schizophrenic. They also got well on the same vitamin therapy. We know now that the vast majority of mental patients can be treated, but there are certain indications which determine the regimen of natural supplements which should be used in each case. I am convinced that every psychiatric patient should be treated with nutrition and nutrient supplements along with the standard drugs (but preferably without drugs whenever this is possible). No matter what the disease is, the body can cope better if it is as healthy as possible. We started with Ken, a catatonic schizophrenic. His response encouraged us to persevere; we treated thousands of mental patients under careful medical supervision and now we come to the case of Mr. Sealey who is not schizophrenic but suffered severe depression until he placed himself on the orthomolecular program. He also recovered. The Orthomolecular Program for Restorative Mental Healthcare NUTRITION – Individual nutrients singly or in combination cannot be used to replace food. The first principle is to examine the food – the patient’s diet. The relation between food and health is complex. This has been written about in dozens of books including a book that I wrote with Morton Walker, DPM, called Orthomolecular Nutrition (Keats Publishing, New Canaan, Connecticut, 1978) and another book of mine called Hoffer’s Laws of Natural Nutrition (Quarry Press, Kingston, ON, 1996). xxii

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The balance of optimal nutrition that was established during evolution between animals and their environment was so strong that most animals in the wild remained healthy without needing nutritional consultants to advise them. Animals remain healthy because they eat the foods their species has consumed for thousands of years. The best zoos follow the same principle. Humans have corrupted this relationship by altering food and creating artifacts that appear to be foods but are not very healthy. We have done this to the degree that the natural safeguards present in animals against eating foods which will make them sick are no longer operative. For example, in nature, foods which are bitter will not be eaten because animals do not like bitter-tasting foods. Bitter-tasting foods tend to be poisonous. However, poisons can be embedded in food artifacts which are every bit as dangerous, especially over the long haul, as preparations that have all the appearance and taste of healthy food. I find two simple rules provide a useful guide for a healthy diet. Most patients understand and they can work with these rules. The first is that all junk food must be removed from the diet. I define junk food as all food preparations containing added free sugars such as sucrose, glucose and lactose. If these are eliminated, about 90 percent of the common additives in our commercial foods will also be eliminated, and this is advantageous. The second rule is to avoid all foods to which you are allergic, even foods which are supposedly healthy for a “normal” person. Food allergies and sensitivities have to be determined by the patient and physician working together. Keeping in mind that the principle of biochemical individuality often applies, if a person is allergic to a common food such as wheat and continues to eat wheat, nutrients will not overcome the symptoms generated by that food allergy. THE SUPPLEMENTS – These are the vitamins, minerals, essential fatty acids and other natural compounds. They are used in optimum quantities. The problem here is that very few physicians understand what this means. Many doctors still follow the food guides provided by the government’s RDAs. The RDAs were developed to guide governments about the probable needs of a large majority of the community. The RDAs are only to be used for the healthy part of the population. Therefore, they do not apply to pregnant women, children, and anyone who is ill (i.e., about half the human population). We need recommended daily allowances for each different disease. So far the concept of taking optimal doses of supplements is still too new and frightening to the medical profession, even though they know that when using drugs, one must use the optimum dose to get the expected results and avoid toxic reactions. FINDING CARE FOR DEPRESSION

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The term megavitamin was created by Irwin Stone when he discussed vitamin C. It is not really a good word because it just means large dose. It has not been defined more precisely. Some patients have looked for “megavitamins” as if there were vitamins called megavitamins. The term refers to the size of the dose. This varies with each nutrient. The best dose of a nutrient depends on the state of each person’s health and that individual’s biochemical needs. I suspect that eventually every nutrient will find a role for some patients in optimum or orthomolecular doses. The first ones used were vitamins E, C, B-3, B-6 and more recently other vitamins such as folic acid. Folic acid was recently found to be helpful for the treatment of many cases of depression although as Mr. Sealey learned, this is not necessarily a helpful supplement in all cases of depression. Between 1950 and 1970, major interest evolved around the vitamins, over the next ten years minerals were added, and since then the essential fatty acids have been recognized as having great importance. Resistance to the use of vitamins in orthomolecular doses was very great but began to moderate after the term antioxidant came into use. Some of the same doctors who were opposed to using megavitamins later changed their minds and began to use antioxidants such as vitamin E and vitamin C. The discovery that niacin lowered cholesterol levels was published in 1955 marking the introduction of the new paradigm – the vitamins-as-treatment paradigm. A vitamin dependency is said to exist when a person cannot get well unless given mega doses of one nutrient. This was found to be the case with Canadian soldiers kept in Japanese prisoner of war camps for 44 months. I treated some camp survivors who were very ill but recovered when they were given large doses of niacin. A few diseases may be expressions of a double dependency (i.e., they need two or more nutrients in large doses). An example is Huntington’s Disease which requires large doses of vitamin E and niacin. I am positive that many more will be found when a proper search is undertaken. If a fraction of the money now being spent studying new drugs was applied toward orthomolecular research, an enormous amount of useful information could be gained in a few years. Recently, I received confirmation that trigeminal neuralgia will respond to the combination of vitamin B-12 injections, vitamin C and l-lysine. Shingles also appears to be a triple dependency on the same three nutrients. The number of permutations and combinations is immense. XENOBIOTICS – Drugs. These are molecules foreign to the body, but may have structural similarity to natural products or they would be too toxic to be used. Orthomolecular doctors also prescribe drugs, on the principle xxiv

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that one should recommend the best of modern medicine for every condition. A doctor should not be a bigot, either for or against any set of medical compounds. Orthomolecular physicians use nutrition and supplements as the main program and drugs as add-ons for certain indications, with the aim of getting patients off psychiatric drugs as soon as possible. Tranquilizer drugs can produce a number of negative effects in many patients which I have called the tranquilizer psychosis. Results Gained by Orthomolecular Treatment Evidence-based medicine has become the fashion at least in the medical journals and perhaps in the colleges of medicine. I find this ironic since physicians have used evidence-based medicine for thousands of years. The evidence was sometimes faulty and often biased, but at the times these practices were used, they were the best available. Modern evidence-based medicine is not what you might think. It is evidence that can be gained only from the double blind controlled randomized prospective therapeutic trial. My colleagues and I were the first psychiatrists to conduct this type of experiment; I was among the first to examine the method carefully and conclude that while useful, it was not the gold standard, but only one of several ways to research. For many types of disease, this type of experiment is totally unusable. Devotees of this approach will not take Mr. Sealey’s account of his illness and his recovery seriously, because they are blinded by the clothes fashioned by the double blind method, like the naked Emperor’s clothes. I ask readers to throw away their blindfolds and to read this account carefully and seriously, because it is one account of a serious illness which might have left the patient forever incapacitated and a charge on his family and community. His anecdote represents only one of thousands of similar cases which have recovered given orthomolecular treatment. The evidence has been published in many clinical accounts, in many standard and complementary journals, and in many books. The evidence is there. It needs only to be read and studied. So far, out of over fifty physicians who have spent a day or more in my office to observe my practice and talk to my patients, none have resumed their original way of practice. They all became orthomolecular physicians. Medical resistance remains high. Recently, I saw a chronic schizophrenic patient for the third time in 6 months. He was referred by his psychiatrist. After orthomolecular treatment, he was almost normal. The only residual symptom was that he still heard voices, but they were much quieter. He was looking forward to finding employment. For the previous three FINDING CARE FOR DEPRESSION

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years, he could not work. He stopped seeing the psychiatrist who referred him to me because the psychiatrist would not agree he was better. They fought over his progress. The referring psychiatrist was so blinded by his belief that only drugs could help the patient that he could not see how the patient was making positive progress using orthomolecular methods. Dr. B. Rimland, founder of the Autism Research Institute, recently reviewed the efficacy of drugs compared to nutrients. He accumulated data from 18,500 parents of autistic children who had been treated. He compared the number of children who were better and the number who were made worse. He found the following ratios of “better over worse.” This might be called the EI (efficacy index). The most effective substances have high EI ratios and the least effective have low EI ratios. Here are comparative EI ratios for commonly used treatments for autistic disorders: Lower Efficacy Antipsychotics

Range from 0.5 to 4.1

SSRI antidepressants, lithium

Range from 1.2 to 3.0

Higher Efficacy Vitamin B-3 Vitamin B-6 and magnesium Vitamin C Zinc

8.6 10.9 15.3 14.8

The higher EIs for nutrients indicate that children with autistic disorders can benefit more if they take appropriate does of vitamin B-3, vitamin B-6, magnesium, vitamin C and zinc, than if they take commonly used psychiatric medications. Over the past 45 years, I have seen thousands of mental patients recover using orthomolecular medicine even though they previously failed to recover using orthodox clinical treatments. It is important that we no longer deprive our psychiatric patients of their chance to get well. To reach my definition of recovery, they must be free of signs and symptoms, they must get on well with their families and the community and they must be able to work enough to provide for their needs and pay income tax. It is interesting that after suffering for nearly thirty years (ten with undiagnosed and untreated symptoms of depression, and then twenty years with an apparently misdiagnosed and undertreated bipolar II mood disorder), Robert Sealey restored his mental health using orthomolecular methods. xxvi

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He read many medical reference books and fanned the spark of his desire to get well until it turned into a passion. He finally found restorative care for his mood disorder. Now he is using the story of his experiences to help other people. Readers will sense his frustration and disappointment when his mental health professionals did not follow their professional guidelines, did not offer competent care and did not help him get well. Even when he took the prescription medications that his doctors recommended, he did not restore normal brain function, but found his symptoms masked as he struggled with negative effects of antidepressants, mood stabilizing and benzodiazepine medications. Mr. Sealey learned that he could trust the logic of the practice guidelines of psychiatry. He kept searching for an accurate diagnosis. He used the guideline principles to get a proper diagnosis and he read reference books until he found and applied the restorative practices of orthomolecular medicine. He restored his mental health without negative effects. Today Robert Sealey can live well. He works as a self-employed professional in North York, Ontario. He consults with healthy clients and also with people who have episodes of depression and other brain disorders. He writes articles and guides for laymen and health professionals. He shares his experiences living with a bipolar II mood disorder and using restorative mental healthcare. Finding Care For Depression is written for patients and caregivers. Mr. Sealey’s success using orthomolecular methods for effective mental healthcare can inspire patients, consumers, survivors and caregivers to learn about, ask for and benefit from restorative mental healthcare. I encourage you to consider Mr. Sealey’s recovery story and refer to his helpful selection of tools and tales, tips and traps, reviews and references for laymen and caregivers. People who live with depression and other mental illnesses can use this book if they want to find care for depression, mental episodes and brain disorders. December 20, 2000 Abram Hoffer, MD, PhD, FRCP(C)

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P a r t

Exploring The Mental Healthcare Maze

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C h a p t e r

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EXPLORING THE MENTAL HEALTHCARE MAZE – INTRODUCTION

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f a fortune teller looked into a crystal ball when I was seventeen and foresaw decades of mental illness without diagnosis or treatment, I would have been shocked. If the visionary foretold that I would enter a health maze, investigate substandard care, research practice guidelines and explore restorative care, I would have said he was nuts. A future that dark and difficult didn’t seem like my destiny. As a child, I was hypersensitive and anxious. Migraines started when I was twelve. My mother, sister and son get them too. Obviously we inherited a neurological condition that affects our brains. To look on the bright side, these painful episodes ‘reset’ our brains about once a month. I learned to accept the resetting and take an extract of the feverfew plant to ease the pain. At seventeen, I was skinny, introverted, hypersensitive and anxious, younger than my peers. After my best friend moved away and my girlfriend dumped me, I felt lost and alone. Studying and thinking about going away to college, I did little but worry and mope around, in a black funk. No one said much and I didn’t think to ask for help. I didn’t recognize these bad moods as an episode of depression. During four years at university, my courses fascinated me but the workload was heavy. The depressions came and went; my memory didn’t work right and my marks were not good. Even while studying biological and medical sciences and psychology, I did not recognize the symptoms of mental illness. I did normal college stuff, made new friends and fell in love with the empathetic woman who is still my wife. I was moody: variable, volatile, vulnerable (to episodes of depression and angry irritable outbursts), reactive, intense, hypersensitive, periodically creative and surgingly energized. In retrospect, this is no surprise because I had a mood disorder as well as anxiety. With memory problems limiting my studies, I changed career plans. I took night courses in commerce and worked days in an accounting firm. Office work did not involve the life sciences but number problems and business logic appealed to me so I became a chartered accountant. At the age of twenty-six, I qualified for a CA designation after passing rigorous final examinations. Then, I went into a major depression. It made no sense to get so blue right after qualifying for a professional designation. What was depleting me? What was wrong with my brain? 48

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I consulted eight health professionals over twenty years. None diagnosed my bipolar II mood disorder or treated me restoratively. I got worse. While I was sick and getting sicker, my healthcare consisted of the following: 1. the silent treatment (by an older psychiatrist); 2. being laughed at (by a family doctor); and 3. being told that I was ignorant, negative and egocentric (by a psychologist who talked for hours about her problems). Professional caregivers gave me quick labels and tried easy treatments. They watched me get worse. There was a dark side to care involving silence, laughter, fault-finding, rejection and abandonment. I didn’t know that my symptoms were consistent with a bipolar II mood disorder. I didn’t know how this condition was diagnosed or treated. I didn’t know the chances for recovery. Therapy, insightful at times, did not resolve the episodes of depression or correct my biochemical disorder. I call this initial exploration of the mental healthcare maze my ‘in-the-dark’ phase. A National Depressive and Manic-Depressive Association (NDMDA) study indicates that many people who have bipolar mood disorders see several doctors before they are accurately diagnosed. Without a correct diagnosis of the root causes of a mental illness, problems can go on for years. It took twenty-eight years before I got an accurate diagnosis. Fortunately, I was not hospitalized, did not have ECT treatments and did not take antipsychotic medications. For decades, I endured the brain pains of an undiagnosed and untreated mood disorder. It is not surprising that an untreated illness will get worse. My family worried. In 1994, my wife insisted that I see a doctor. After reading that low brain fuels can cause symptoms of depression and anxiety, I politely asked my doctor about that possibility. When the doctor just laughed, I knew it was time to find another doctor. The second doctor did some tests and ruled out five of the fifty medical conditions which can cause or contribute to symptoms of depression. He concluded that I was depressed. He prescribed antidepressant medication, a selective serotonin re-uptake inhibitor (SSRI). The drug numbed the pain of my depression, dumbed my brain and stimulated my energy. It also caused negative effects such as akathesia (a state of restless aggressiveness) and constant sweating. The SSRI turned off my sexuality and chilled my marriage (lukewarm after years of mood disorder symptoms, episodes and outbursts). This medication was not an effective treatment for my condition. FINDING CARE FOR DEPRESSION

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When I asked if he was going to wait until I was dead before treating me properly, the doctor was blunt; he told me to see another physician. A friendly therapist encouraged me to see a psychiatrist. After a morning-long meeting and psychological testing (but no medical testing and minimal patient or family medical or mental history-taking), the psychiatrist diagnosed dysthymia. He prescribed an MAOI antidepressant. Initially, I was pleased to get a diagnosis (not knowing that ‘dysthymia’ means chronic depression). I followed his instructions but the MAOI was not the answer. For a short time after taking each pill, I felt a bit better; then I slowly slid back into depression. Until the next pill. Up and down, all day long. That psychiatrist did not see regular patients because of his medicallegal specialty. He was too busy writing reports. He referred me to the expert psychiatrist, Dr. T.T. ShorCu but I was not diagnosed properly or treated effectively. I kept on exploring the mental healthcare maze. After consulting with physicians, psychiatrists, psychologists and therapists, I knew something was wrong but I didn’t know what it was called or how to get well. When I was suicidally depressed, I decided to read medical books to learn how mood disorders are diagnosed and treated. Another depressive suggested orthomolecular medicine. It did not take long before the restorative approach worked. I have been stable since 1996. Not perfect, but much better. In 1996, I started an Independent Depression Project and interviewed 150 depressed people. Some were clients of my consulting practice; others called when they heard about the book. They were keen to share their experiences. Many of their stories were worse than mine. It surprised me to learn that so many depressed people do not get restorative care. I wondered what would happen if a recovered patient investigated a bad outcome and blew the whistle on substandard psychiatry. After working as a forensic and investigative accountant (i.e., a fraud investigator), I knew that a case can take a long time. Even if there is evidence, little happens until responsible people make the time to consider the problem and take action. “Surely, the authorities will do something if substandard psychiatry is risking lives,” I said to myself. Once again, I was heading off in the wrong direction.

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CHARTING THE HEALTHCARE SYSTEM

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never used to wonder how the healthcare system works or whether its checks and balances actually operate to protect patients. I never realized that the laws, offices, organizations and people are coordinated. I assumed that a doctor would help a sick patient. While suffering with a bipolar mood disorder, migraines and anxiety for thirty-three years, I learned that quality mental healthcare is hard to find. I charted the system for this book, outlining the healthcare laws. In Ontario, Canada, the Regulated Health Professions Act, 1991 (RHP Act) covers the provincial minister of health, a regulatory advisory council, a review board and twenty-one health professions, including physicians. The Act authorises health professional associations to investigate complaints of incompetence, incapacity or misconduct. The Act stipulates that The Medicine Act applies to physicians. The Criminal Code also has sections which apply to health professionals. Relevant sections of the RHP Act include the following: Incompetence – Section 52: “A panel [of the health professional’s association] shall find a member to be incompetent if the member’s professional care of a patient displays a lack of knowledge, skill or judgment or disregard for the welfare of the patient … ” Investigation of complaints – Section 25: “A complaint filed with the Registrar [of the health professionals’ association] shall be investigated by a panel … [of] the Complaints Committee …” Complaint in bad faith – Section 26(4): “if the panel considers a complaint to be frivolous … it shall give … notice that it intends to take no action … the complainant and the member [can] … make written submissions within 30 days …” Timely disposal – Section 28: “a panel [of the health professional’s peers] shall dispose of a complaint within 120 days after the filing of the complaint.” If the physicians’ association does not investigate a complaint properly or come to a reasonable decision, the patient can ask a review board to consider the matter. FINDING CARE FOR DEPRESSION

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Review by Board – Section 29: 1. “… the [review] board shall review a decision of a panel of the Complaints Committee if the board receives a request [from the complainant]”. Conduct of review – Section 33: 1. “In a review, the board shall consider either or both of, (a) the adequacy of the investigation conducted; or (b) the reasonableness of the decision.” These quotes indicate that a victim of medical incompetence can ask the physicians’ association to investigate a bad outcome and then consider whether there is enough evidence to discipline an incompetent doctor. A health professional’s peers may not believe that a complaint by a recovered patient is credible. Depending on the outcome of their investigation, the complaint committee may take action. If the panel deems a complaint to be ‘frivolous’, the committee can do nothing. “Frivolous” is not defined in the RHP Act. The Medicine Act is short and to the point. Section 3 defines “the practice of medicine [as] the assessment of the physical or mental condition of an individual and the diagnosis, treatment and prevention of any disease, disorder or dysfunction.” This law does not allow a physician to make a sick patient worse, misdiagnose or fail to treat. Since incompetence involving a physician is covered by the RHP Act, the Medicine Act does not deal with it. The Criminal Code has sections which apply to health professionals. For instance, S216 deals with “legal duty to use reasonable knowledge, skill and care in administering medical treatment that may endanger life.” The RHP Act, the Medicine Act and the Criminal Code can protect trusting patients from incompetence, incapacity and criminal misconduct by a physician. The diagram, “Health System in Ontario, Canada,” outlines the laws, the offices in the system and the people in the offices. It shows that a psychiatrist is highly qualified after years of education, study of professional references and clinical experience. The education of a doctor starts with a university degree in biological and medical sciences and continues with four years of medical school. A successful medical student graduates as a physician. After years of specialty education, a physician can take qualification exams and practise as a psychiatrist. A psychiatrist reads, studies, learns and understands books about life sciences, medical sciences, psychiatry and psychology. Further study covers professional journals which report medical research, clinical trials of 52

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psychiatric medications and current practices. The practice guidelines of national psychiatry associations (e.g., American and Canadian) outline and summarize the consensus of experts. The guidelines specify the standard of care procedures which a psychiatrist uses to diagnose a patient accurately and treat the patient effectively. Psychiatrists gain clinical experience during medical school. They work as resident doctors training in teaching hospitals. As graduate physicians, they work as staff doctors in hospitals. As staff psychiatrists, they work in hospitals, consult with other physicians and see patients in private offices. A psychiatrist sees hundreds, if not thousands of patients during the course of his medical education and clinical experience. After this much preparation, the trusting patient assumes that a psychiatrist will be ethical and use normal procedures to diagnose the root cause of the patient’s symptoms and help the patient recover. The trusting patient would not expect a psychiatrist to misdiagnose or mistreat. At this time, in Ontario, there is no assessment process to rate the ethics of health professionals. There is no public record of the performance of medical specialists. Although the RHP Act, the Medicine Act and the Criminal Code encourage competent healthcare, these laws are not rigorously enforced. Even though the health system has laws, offices and people responsible for monitoring and controlling healthcare, unethical doctors can practise without timely investigation or discipline of incompetence. In May 2001, The Toronto Star printed a series of articles that reported that 99% of patient complaints are routinely dismissed by the physicians’ association without proper investigation and without disciplining incompetent doctors. More than 300 victims of incompetence involving one specialist physician recently started legal action to resolve their concerns. At specified years, the RHP Act empowers a regulatory advisory council to review the effectiveness of the Act and recommend improvements. In 2001, the Minister of Health of Ontario received three reports. The results of their reports have not been released to the public after the council and consultants investigated cases of incompetence and considered weaknesses in healthcare quality controls. The consultants and the council may recommend improvements to the RHP Act. Changes may improve the quality of care and better protect trusting patients. These reports may be released later in 2001. Meanwhile, vulnerable patients can read about their illnesses and ask for competent healthcare. It is all right for the patient to ask if his doctor is following standard of care procedures for diagnosis and treatment. FINDING CARE FOR DEPRESSION

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HEALTH SYSTEM IN ONTARIO, CANADA Extracts – Canadian Legislation Regulated Health Professions, Act, 1991 S 52 … incompetent if the care of a patient displays a lack of knowledge, skill or judgment or disregard for the welfare of the patient … " S 25 "A complaint filed with the Registrar … shall be investigated by a panel … " S 25 (2) "after investigating and considering … all records and documents … relevant" S 28 "A panel shall dispose of a complaint within 120 days … " S 33 (1) "In a review, the Board shall consider either or both of (a) the adequancy of the investigation … (b) the reasonableness of the decision." Medicine Act, 1991 S3 "The practice of medicine is the assessment of the physical or mental condition of an individual and the diagnosis, treatment and prevention of any disease, disorder or dysfunction."

Offices in the System Provincial minister of health Regulatory advisory council Review board Health profession associations (21 in Ontario) Members National associations eg., psychiatry Hospital Inpatient care Outpatient clinics Health professionals

Criminal Code S 216 "legal duty to use reasonable knowledge, skill and care in administering medical treatment that may endanger life" 54

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Law enforcement

HEALTH SYSTEM IN ONTARIO, CANADA People in the offices

Psychiatrist

Minister Assistants

Education

Chair Board members

Professional References

Registrar Board members Registrar Complaint committee Discipline committee e.g., physicians

US – APA, CA – CPA

Chief psychiatrist Dept. heads, staff, residents Nurses and admin staff

University degree – pre-med. Medical School (4 yrs.) Specialty – psychiatry (4 yrs.)

Books – life sciences – medical sciences – psychiatry, psychology Articles in medical journals Practice guidelines Clinical experience Medical school training Hospital – residency Hospital – staff Consulting with physicians Private Practice A psychiatrist has professional education, references & experience Patient

e.g., psychiatrist Police officers Investigators e.g., OPP medical fraud squad

Excuse me, why short cuts? Why is incompetent care 'appropriate'? FINDING CARE FOR DEPRESSION

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C h a p t e r

8

MAPPING THE MAZE OF DEPRESSION DIAGNOSES AND TREATMENT

D

epression, anxiety, mental episodes and brain disorders can be difficult to diagnose and treat. There are many possible diagnoses and a range of treatments. Conventional health professionals use the Diagnostic and Statistical Manual (DSM) to label the patient. Then they may recommend medications or talk therapies – or a combination of the two. The standard of care procedures work well in many cases. Some patients find it difficult to get proper care. They may end up running around like mice trapped in a research maze. The diagram “The Maze of Depression Diagnoses and Treatments,” shows how this can happen. Even when health professionals intend to be helpful, patients may not be diagnosed accurately or treated effectively. The patient, family and caregivers can cooperate to monitor the quality of care and resolve problems. The family doctor is often the first health professional consulted when a patient becomes depressed or anxious. A competent physician will test for underlying medical conditions. Depending on the results of the tests, a doctor may offer counselling or antidepressant medications. If the patient does not recover, the physician may decide to refer the patient to specialists for in-depth diagnosis and treatments. In the case of mental illness, the specialist is a psychiatrist. The practice guidelines of psychiatry recommend a series of steps to accurately diagnose the root cause of the patient’s symptoms and treat the patient effectively until the patient recovers. The trusting patient assumes that a psychiatrist will follow his practice guidelines and use standard of care procedures. Other specialists may also be consulted. Neurologists or endocrinologists consider the patient’s symptoms and the severity of the patient’s problems. These specialists uses the standard of care procedures of their respective specialties to diagnose patients and offer appropriate treatments. Some conditions are difficult to diagnose and treat. By consulting with specialists, patients can get in-depth care. Medical professionals may learn that the patient is troubled by personal issues, family of origin difficulties or abusive relationships. A range of psychological and social problems can lead to symptoms of depression and anxiety. If there seem to be social or psychological issues, the patient may be referred to a psychologist, social worker, therapist or counsellor. Talk therapies can identify negative patterns of thinking, feeling and acting. 56

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Competent therapists can help the patient resolve certain types of issues and shift toward positive and productive patterns. In many cases, multiple factors strain the patient until there are symptoms of distress or illness. Patients who suffer with depression, mental episodes and brain disorders can have combinations of causes. They may have inherited biochemical vulnerabilities, underlying medical conditions or live in abusive homes. It may not be easy for a mental health professional to identify the root cause(s) of the patient’s discomfort or help the patient get an accurate diagnosis and find effective treatments. Mental patients can go back and forth, exploring the mental healthcare maze, trying therapy and taking medications, while underlying medical conditions are left undiagnosed and untreated. Meanwhile, they are expected to cope with the multiple involuntary symptoms of depression and anxiety, tolerate the negative effects of powerful psychiatric medications and continue living in difficult environments. Fortunately, the mental healthcare maze has restorative options. European health professionals, naturopaths, homeopaths and herbalists are trained to use plant extracts called phytopharmaceuticals in cases of mild to moderate depression and anxiety. These treatments have been developed over centuries of use. There are scientific methods to standardize, research and test the effectiveness of herbal medications for psychiatric conditions. Orthomolecular health professionals are medical doctors who combine the life science of biochemistry with the practice of medicine. After root cause diagnostic testing, they tailor regimens of supplements. Vital amines (vitamins), trace minerals, amino acids, energy, enzyme co-factors and essential fatty acids can help individual patients, depending on their biochemical needs. Nutritional supplements can restore patients and maintain their mental health without negative effects. Other methods may be effective treatments for depression and anxiety, depending on the root causes of the patient’s problems. Optimum doses of exercise, full spectrum light, rest, nature walks, pass times, meditation and yoga have helped people recover and keep well. Even if there an underlying medical condition, supportive methods can be a useful part of the patient’s overall program to maintain wellness. Electroconvulsive shock therapy (ECT) helped some patients recover from suicidal depressions after other treatments failed. Many patients report problems with memory loss and other difficulties. Current ECT treatments are less problematic than earlier methods which used higher voltages and bilateral shocks. FINDING CARE FOR DEPRESSION

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New treatments are being researched and developed for depression. Transcranial magnetic stimulation (TMS), vagal nerve stimulation and EEG neurofeedback are three promising possibilities. People who suffer with depression, mental episodes or brain disorders can find competent mental healthcare, get accurate diagnoses and benefit from effective treatments. If there is little or no progress exploring the mental healthcare maze, patients can do the “Mental Healthcare Reality Check” (see page 59). Patients getting poor care can ask for second opinions and negotiate for better care.

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MENTAL HEALTHCARE REALITY CHECK Substandard Care

Quality Care

Diagnosis

Diagnosis

❑ ❑

❑ ❑

• label • no histories, no tests

• mental status exam • histories, tests

Treatments

Treatments

❑ ❑ ❑

❑ ❑ ❑

• short cuts • unproven alternatives • masking, cover-up

• standard of care procedures • practice guidelines • restorative, healing

Medication

Medication

❑ ❑

❑ ❑

• negative effects • side or adverse effects

• positive response • improvement, side benefits

Communication – education

Communication – education

❑ ❑ ❑ ❑

❑ ❑ ❑ ❑

• withhold and deny • silence or put-down • reject, abandon • false and misleading

• share information and support • communicate and encourage • consider, cooperate • true and helpful

Results

Results

❑ ❑ ❑ ❑ ❑

❑ ❑ ❑ ❑ ❑

• misdiagnosis • mistreatment • minimalist • negligent • deterioration

• accurate diagnosis • effective treatment • conservative • competent • recovery FINDING CARE FOR DEPRESSION

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THE MAZE OF DEPRESSION DIAGNOSES AND TREATMENTS There are many possible diagnoses: 1. symptom, syndrome, sign of medical illness, a mental illness (e.g., a mood disorder, involuntary, kindled or learned illogic, anxiety or helplessness) 2. physical, medical, neurological, psychological, biological, metabolic, inherited condition, environmental, individual overload, unresolved transition, loss or grief (continued page 61)

There are many possible treatments: Conventional – medicate symptoms and talk i.e. counsel General practitioner or family doctor test for, treat related medical conditions e.g., hypothyroid

Psychiatrist

Psychologist, therapist social worker, counsellor

test for underlying medical conditions

refer to physician for medical testing

counselling

talk therapy

talk therapy

antidepressants

antidepressants

**watch for 'side' effects

**watch for 'side' effects

refer to specialists for indepth diagnosis-treatment

choices include: • SSRI, TCI, MAOI • antiseizure / sleeping • antianxiety (alone or combinations) • lithium (mega dose of a trace mineral that affects brain function)

• severe cases may mean • antipsychotic drugs • ECT • hospitalization

Focus of therapy • self, others and the world • shift from negative to positive • unrealistic expectations • contexts of therapy include: • overloads, depletions • self esteem, assertiveness • grief – unresolved • relationships, abuse • metaphors, issues • learned helplessness • cognitive restructuring • transitions • may recommend seeing physician for diagnosis of medical illness(es) and / or prescribing antidepressants

** Note – synthetic antidepressant medications are known to cause negative side effects in some people. Reprinted with permission of SEAR Publications from the Depression Survivor's Kit.

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THE MAZE OF DEPRESSION DIAGNOSES AND TREATMENTS There are many possible diagnoses: 3. neurotransmitters: genetic imbalance, depletion, interference with synthesis; metabolism; cellular energy; biological systems responding to ongoing distress 4. diet may lack nutrients, missing enzyme cofactors may imbalance or interfere with normal brain function, promote yeast; environment may be a factor (e.g., toxic metals / enzymes)

There are many possible treatments: Restorative European practitioners use phytopharmaceuticals test for, treat related physical illness e.g., hypothyroid

Orthomolecular medical professionals physicians / psychiatrists / other test for, treat related physical illness e.g., hypothyroid

talk therapy

talk therapy, counselling

antidepressants

antidepressants (nontoxic)

**watch for 'side' effects

**watch for 'side' effects

• may treat using natural medications i.e., phytopharmaceuticals

Extensive biological testing looking for root cause(s)

• less toxic than synthetics, possibly milder acting

Other approaches • exercise • light • rest, relaxation • art, beauty • nature walks • distractions, hobbies, passtimes • meditation

• may treat with • may consider natural supplements cellular energy Other to restore normal enzyme cofactors professionals brain function: e.g., Coenzyme Q10 • naturopath • vitamins e.g., B-6 • homeopath • trace minerals, • may consider • herbalist e.g., Zn, Mn stress hormone • accupuncturist • amino acids precursors • chiropractor e.g., l-taurine e.g., DHEA • precursors, cofactors • may consider: • metabolism • interference from: • yeast imbalance • toxic metals

• may consider diet: • may consider noninvasive • add nutrients nonsynthetic • avoid allergies • CES, EEG • food allergies • balance

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9

INVESTIGATING A CASE OF CARE GONE BAD

W

hen care goes bad, a sick patient can get worse or even be harmed. Every year there are medical errors and damage involving toxic medications, complications and drug interactions. A patient may not be accurately diagnosed or effectively treated. Bad care may be linked to inexperience, incompetence, malpractice or even negligence involving health professionals. In the case of depression, mental episodes and brain disorders, there is a risk of suicide. If a painful condition gets worse, a patient who feels helpless can give up hope and decide that death is the only way out. For instance, painful symptoms can worsen due to the negative effects of excessive doses of the wrong medications. If a despairing patient is impulsive, there can be a tragic loss of life. It is hard to believe that an expert psychiatrist would misdiagnose or mistreat any patient, knowing that a bad outcome could damage the patient. It is difficult for a patient to prove that his medical care was bad. A patient’s credibility is reduced by his mental disorder. People may suspect a whistle blower of paranoia. Meanwhile, a negligent health professional can continue using short cuts. While working on consulting projects and fraud investigations, I learned to study systems and monitor controls. I was trained to compare the facts of a situation with standard procedures. If a bad outcome is the result of incompetence or negligence, it makes sense to review what went wrong, starting with the written evidence in the medical file. A patient may assume that files prepared by a psychiatrist are not available to the patient. In Ontario, Canada, a mental patient can see the file. A polite request to the hospital and a small fee soon produced a copy of my file. During my illness, I kept a diary. I was upset and ashamed to have a mental illness. Even though my family cared, they were not familiar with the mental health system and they did not want to discuss many of my concerns. For a long time, I had no one to talk to about my difficulties. As my life deteriorated, I coped with episodes, symptoms and negative effects of medications. A journal became my faithful companion. I made regular notes. Without complaint, the diary recorded my symptoms and problems, fears and frustrations and the effects of medications. I compared the doctor’s file with my journal. A patient expects his psychiatrist to apply years of study, education, training, knowledge and experience in order to practise competently, according to the current standard of care It baffled me that the file was so skimpy. The doctor’s notes were

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either incomplete or not consistent with my experiences. Furthermore, the psychiatrist did not complete the documentation as recommended in medical books and practice guidelines. In view of my problems with his care, I wondered how my psychiatrist could possibly be an expert. When I read Risk Management of Suicidal Patients, I learned that negligent care may involve (1) improper procedures being done to a patient, or (2) standard of care procedures being omitted. The worst failures in care can result in a patient’s death. Court cases (after the suicide of a patient) focus on aspects of failed care. It was not hard for me to compare my medical file with negligence checklists. After listing thirteen failures, I began to understand why my care went bad. Thinking that my case was not typical, I learned about other cases by interviewing and studying reports of patients with depression, mental episodes and brain disorders. I read medical references, the practice guidelines of psychiatry, articles in professional journals and books by survivors and health professionals. When I was sick, bibliotherapy renewed my hope. I learned how other patients cope with substandard care. If their mood disorders, migraines and anxiety were not diagnosed accurately or treated effectively, other patients reported problems similar to mine. A 2001 issue of a physicians’ association newsletter reported a case of medical incompetence involving a physician. The association’s discipline committee decided that it was “unanimous in its decision that [the doctor] was guilty of professional misconduct in the care of his patients for failure to maintain appropriate standards of practice, and of incompetence in that he displayed a lack of knowledge, skill or judgment of the patient … the following reasons [were] the basis for this decision: 1. … failed to take a complete history and carry out a physical examination … 2. … did not consider a differential diagnosis nor did he order appropriate laboratory and clinical investigations to establish a specific diagnosis … 3. … did not meet any recognized standard (of care) … did not monitor his patients adequately … 4. … the standard of practice of the profession is determined by … (a) what is taught to medical students and residents (b) what is actually done in practice (c) what is known to be effective and safe in publications (peer reviewed) (d) what is accepted by competent and ethical physicians 5. … [failed] to monitor the liver or kidney function [of patients taking certain medications] …’’ FINDING CARE FOR DEPRESSION

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The committee concluded, based on “clear, convincing and cogent evidence that … guilty of professional misconduct … failed to maintain the standard of practice … was incompetent …” It is odd that no patients complained even though the physicians’ association decided that the doctor’s care was incompetent. My case included the five problems listed above and eight others. My medical file did not have enough documentation to suggest that the psychiatrist cared, diagnosed accurately or treated properly. At each visit, the doctor followed the same pattern. He made very brief notes: Mood was depressed. Assess – refractory depression Plan – [drug dose] … See in 2 weeks. By noting about twenty words after each visit, the psychiatrist made efficient use of his time, but his documentation was not consistent with the standard of care. Significance of the missing standard of care procedures 1. failed to diagnose Without an accurate diagnosis, I was not treated for bipolar II mood disorder, anxiety or migraines. The doctor’s assessment of “refractory depression” sounds like a diagnosis, but according to published sources, those words mean “[problems] with diagnostic-treatment variables.” By failing to diagnose, the psychiatrist could not recommend appropriate medications; give professional advice about restorative care; or use standard treatments. It is obvious that he could not treat health problems that he did not identify. As I deteriorated, he knew something was wrong because he continued to write “refractory depression” for eight months. 2. failed to take proper histories; never got files from previous doctors This meant that the doctor did not know there were mood disorder symptoms for twenty-eight years as well as migraines and anxiety. My defective brain is not the doctor’s fault, but without proper histories, the psychiatrist could not consider the symptoms, diagnose or treat any illnesses. Not taking histories means that the doctor was not aware of my family history of migraines, mood disorders, diabetes, diverticulitis, kidney dysfunction and prostate cancer. Without histories, he could not consider whether inherited health problems might be causing symptoms, affecting my ability to process medications or prolonging the symptoms. Not getting files from a previous family doctor meant that the psychiatrist had no knowledge that a previously prescribed SSRI medication caused 64

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negative effects. He prescribed another SSRI without considering or noting negative effects. Not having the file from a consulting psychiatrist meant that the psychiatrist did not consider the basis for any diagnosis. Without histories or prior files from other health professionals, the psychiatrist was working blind. 3. failed to do diagnostic tests This meant that the doctor had no objective test results for an accurate diagnosis. Even though his professional practice guidelines, medical books and his own articles (written for professional journals) recommend diagnostic testing, the psychiatrist did not test me for medical, mental or psychological problems. 4. failed to do mental status exams There are no detailed mental status exams in the medical file. The practice guidelines of psychiatry recommend a mental status examination as the first step with any new patient and every returning patient. The psychiatrist failed to do this procedure which is relevant to diagnosing the patient and assessing the effectiveness of ongoing treatments. 5. failed to monitor lithium levels, failed to test kidney function With family history of polycystic kidney disorder not known to the psychiatrist, he watched as I deteriorated while taking lithium. He knew, according to articles in his professional journals, that some patients do not respond well to lithium, particularly patients who have kidney problems. The doctor knew about this risk, and he saw deterioration. He failed to test lithium levels and kidney functions. He did not warn my family or me that lithium might cause problems. 6. failed to educate about condition, risks, options or prognosis As my life deteriorated, the skimpy medical file proves that I was never educated or informed of: 1. the diagnosis, 2. trigger factors, 3. the purpose of patient and family, medical and mental histories, 4. the need for testing, 5. the increasing risk of suicide, 6. options for combining medication with therapy, 7. orthomolecular medicine or 8. the prognosis. I was left to read, research, study, learn, call the drug company and get a list of SSRI effects from a dentist. The file proves that there was no effective treatment plan. 7. failed to document risk of suicide After years of mood disorder problems, I was thinking about ending my life. I am not proud to admit this. My suicidal thoughts darkened while taking medications which made me worse. I discussed dark thoughts with the doctor but he failed to note these discussions in the file. FINDING CARE FOR DEPRESSION

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8. failed to recommend therapy Psychiatrists know that many patients respond to a combination of medication and therapy. Medical books suggest this for quality care. Psychiatry texts and the practice guidelines of psychiatry recommend the same approach. The psychiatrist advised against therapy when my life was deteriorating. When I needed support, encouragement and help to cope with losses of personal functioning, business problems, family concerns and financial difficulties, he just smiled. 9. failed to note symptoms Neither my symptoms nor my deterioration were noted in the medical file. Three months after seeing him, his nurse noted that I was worse. Eight months after seeing him, a consulting psychiatrist noted that I was a lot worse. For eight months, the psychiatrist did not seem to notice or note that I deteriorated. The file has the evidence. 10. failed to warn about negative effects of medications Psychiatric medications have negative, adverse, side and toxic effects on some people, particularly people who are hypersensitive to medications, are misdiagnosed or have kidney problems. The psychiatrist did not warn me, monitor negative effects, take blood levels or test kidney functions. He did not obtain informed consent before prescribing medications. 11. failed to get informed consent before treatments, failed to explain to family My family could not understand what was going wrong. After all, the psychiatrist was a mood disorder expert. For months, neither my family or I knew there were problems with the treatments or a risk of suicide or that tests could have been done to make a diagnosis, develop a treatment plan and prescribe nontoxic medications or restorative supplements. The psychiatrist did not help me recover. He failed to get informed consent before treatments and he failed to explain to the family. When my wife attended one visit and said, “Bob is fading away,” the psychiatrist did not note her visit in the file. 12. failed to note problems tolerating prescription medications As the doctor increased the doses of prescription medications (one to more than twice the maximum recommended dose), problems with negative effects increased and symptoms continued. One drug caused daily migraines and precipitated a painful episode of hypomania. The doctor did not note that there were a number of problems tolerating prescription medications. 66

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13. failed to make arrangements for care when psychiatrist left the hospital While I was experiencing an episode of hypomania (likely caused by an SSRI medication), the psychiatrist stopped working at the hospital. A consulting psychiatrist noted in the file that I was to be seen by the regular psychiatrist. The expert psychiatrist left the hospital without calling, helping me cope, explaining the risks or making arrangements for continued care. The thirteen failures are obvious from the file. I could accept the doctor forgetting one or two steps and cutting corners to save time, but the picture painted by thirteen failures is consistent with a bad outcome. The psychiatrist ignored his professional practice guidelines, published articles and medical books, his education, training and clinical experience. I do not know why there were thirteen failures in my case. As I got worse, I could not work effectively and I could not maintain the mortgage on my home. I could not operate my business without hiring staff and borrowing money that I could not repay. I experienced financial, personal, family, client and staff losses. I nearly lost my family, my business, my home and my life. A peer psychiatrist could scan the file and see proof of short cuts. Any doctor could confirm that the psychiatrist failed to follow the thirteen steps outlined above. For months, the psychiatrist knew there were problems with diagnosis and problems with treatments. He cut corners and I got worse. The file proves that there were thirteen failures. Hoping to help other patients, I decided to blow the whistle on substandard psychiatry. C h a p t e r

1 0

BLOWING THE WHISTLE ON SUBSTANDARD PSYCHIATRY

Q

uestions remain unanswered after the physicians’ association (PA) dismissed my complaint – twice. Who monitors the quality of medical care? Can a patient trust a psychiatrist to use standard procedures and follow practice guidelines? Why doesn’t the PA investigate a credible complaint? The National Depression and Manic Depression Association (NDMDA) reports that a typical patient with a bipolar mood disorder consults more than five doctors and it may take over five years before he gets an accurate diagnosis and effective treatments. NDMDA 1992 and 2000 surveys found that even a psychiatrist can misdiagnose a bipolar patient. Misdiagnosed and mistreated, a sick patient gets worse. FINDING CARE FOR DEPRESSION

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On April 27, 2001, Dr. Kay Jamison, a psychologist from Johns Hopkins University, spoke at the University of Toronto. She told 250 supporters of the Arthur Sommer Rotenberg chair in suicide research that she was “appalled at the callousness and incompetence of [some] doctors” who treat patients with depression and manic depression. Her book, Night Falls Fast, reports that every year, misdiagnosed and mistreated patients take their own lives. I believe that ethical psychiatrists do help patients; but substandard care can cause damage. This report does not name any of the individuals involved in my case: the expert psychiatrist, the chief psychiatrist, the hospital, the physicians’ association, the committees, the review boards or the lawyers. They know who they are and they know the truth. For six years, they refused to investigate this case properly. Maybe they prefer the pleasure of a secret shared to the work of investigating and reprimanding. Maybe they have too many other priorities. The health system diagram in this book may suggest the names of people who are known as a matter of public record. They were not involved in my case. They are still not involved. In 1995, my psychiatrist omitted thirteen standard of care procedures For twenty-eight years, I suffered symptoms of a bipolar II mood disorder, migraines and anxiety. From time to time, I consulted with health professionals including family doctors, psychologists and psychiatrists. Sadly, I was misdiagnosed and mistreated. Without getting a proper diagnosis or effective treatments, I got worse. Early in 1995, I was referred to a mood disorder expert. I was encouraged when I visited the large hospital and saw the psychiatrist’s office and his medical diplomas. He was credible when he prescribed antidepressants and other medications but my symptoms worsened and I deteriorated. As I got sicker, the psychiatrist smiled and reassured me saying, “You will get well” or “Let’s increase your dose.” When I was ill, I trusted him. I did not know about the standard of care procedures. Two years later, I found proof that the expert cut corners. The medical file that the psychiatrist prepared had no personal, family, mental or medical histories. There were no mental status exams or diagnostic tests. There were only short cuts. No wonder I deteriorated for months. I trusted my psychiatrist. He was an experienced specialist. He ran a mood disorder clinic. I believed he was competent. After eight months, another psychiatrist told me that the medication was making me worse by causing hypomania and migraines. I felt betrayed. My regular psychiatrist did not tell me about the risks of medications, monitor my condition, document my problems, examine my mental status or get my informed consent. I was too sick to realize that the expert psychiatrist cut corners. 68

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Thirteen Standard of Care Procedures Were Omitted 1. Failed to diagnose accurately or treat effectively as per practice guidelines; wrote ‘refractory depression’ in the patient’s file for months knowing this meant [problems] “with diagnosis and treatment” 2. Failed to discuss, obtain or record patient, family, medical or mental histories (yet falsely claimed these were taken); failed to get patient’s file from a former doctor at the same hospital 3. Failed to do diagnostic tests (medical, biological, psychological or social); without testing, could not and did not make an accurate (differential) diagnosis 4. Failed to do mental status exams, or if any were done, none were documented in the patient’s file 5. Failed to monitor lithium blood levels; failed to test kidney functions, did not warn patient about the negative effects of lithium; failed to note negative effects while patient was taking lithium 6. Failed to educate patient about his condition; failed to develop a treatment plan, failed to discuss treatment options or prognosis with patient or family 7. Failed to document risk of suicide; failed to note worsening suicidal thoughts as patient’s condition deteriorated over eight months 8. Failed to listen or recommend therapy or counselling when patient tried to discuss problems and needed help with his deteriorating condition 9. Failed to note patient’s symptoms; watched patient get worse; failed to note in patient’s file that his wife, an RN, came in to report that the patient was worse 10. Failed to warn patient about known side effects, negative effects and adverse effects of prescription medications; failed to note negative effects of medications (MAOI, SSRI, lithium, and benzodiazepine) in the patient’s file (instead the doctor smiled and said “Let’s increase your dose.”) 11. Failed to get informed consent before drug treatments; failed to explain diagnosis, treatment plan, risks, options, condition and deterioration to family 12. Failed to note patient’s problems tolerating prescription medications; did not act after patient deteriorated to the point that patient nearly lost his business, his family, his home and his life; doctor just smiled and said, “You will get well.” 13. Failed to make arrangements for patient’s care after physician left the hospital (doctor later claimed patient had another doctor); failed to follow up or help patient after another psychiatrist noted an SSRI medication caused hypomania FINDING CARE FOR DEPRESSION

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In 1997, I complained to the physicians’ association (PA) Believing that the physician’s association would investigate substandard care, at first I reported my concerns without naming the doctor. The PA was not interested. I wrote a series of polite letters to the psychiatrist, asking for explanations. I wanted to meet the doctor and discuss the damaging effects of his short cuts: prolonged pain and suffering, worsening family and money problems. The psychiatrist did not respond until May 1997. He waited out the oneyear time limit for civil litigation, then reported me to the police, claiming that my letters constituted a threat. The police officer listened to me carefully. He advised me to complain to the association. So I did. Formally. Expecting nothing, but wanting to understand what went wrong with my care. Hoping for closure. The PA sent my complaint to the psychiatrist and the psychiatrist’s written reply to me. Without investigating the matter or evaluating the damage done by the thirteen short cuts, their in-house lawyer suggested dropping the matter. By that time, the psychiatrist had not seen my file for two years because he left the hospital and he had no access to the file. Nevertheless, he wrote to the PA that he took histories and treated me properly. The medical file proves that he didn’t. With my consent, the PA obtained the medical file from the hospital. The file was skimpy. Thirteen standard procedures were omitted. Even after seeing documentary evidence of substandard care, prepared by the psychiatrist and noted in the medical file, the PA refused to investigate. The complaint committee dismissed the matter, somehow deciding that the “care was appropriate.” The doctors on the committee were not psychiatrists and they did not ask a peer psychiatrist to review the file. They did not explain why standard procedures were omitted. They did not disclose other complaints. I followed through but the physicians’ association dismissed the matter From 1997 to 1999, I read medical books and learned about the standard of care procedures. As the law allows, I submitted extracts to the physicians’ association to support the complaint. According to expert opinions in the practice guidelines of psychiatry, reference books and journal articles, the standard of care for depression includes the following procedures: 1. 2. 3. 4. 70

mental status exams; patient, family, medical and mental histories; psychological, biological and medical testing; investigate symptoms, medicate after informed consent; FINDING CARE FOR DEPRESSION

5. accurate (differential) diagnosis of the root cause(s) of the patient’s symptoms; and 6. effective treatments which help the patient recover and keep well. The medical file proved that the psychiatrist did not discuss, do or note any of these procedures in my case. I know they were omitted because I paid $25 for a copy of the hospital file. I was shocked to learn that while I was trusting the psychiatrist, taking the pills he prescribed and hoping to recover, the expert noted in the file: “refractory depression,” drug doses and little else. The psychiatrist did not diagnose accurately or treat properly. He knew that “refractory depression” means [problems] “with diagnosis and treatment variables.” He wrote this in an article for a medical journal. Nevertheless, he repeatedly wrote “refractory depression” in my medical file, for eight months. He wrote an article about another patient who was also misdiagnosed and mistreated. That patient ended up dead, by suicide. His own articles prove that the psychiatrist knew about misdiagnosis and mistreatment and he knew about the risks of substandard care. He never even noted my deteriorating condition. A year later in 1996, I asked my family for medical history information.While I was sick, my father was suffering kidney failure and had a kidney removed due to a progressive condition called oncocytoma. I learned there was a family history of polycystic kidney disease, a possible explanation for my body’s intolerance of lithium. The psychiatrist never asked for family histories, monitored lithium levels or tested kidney functions. While I was taking lithium, I was melancholy, apathetic and had tremors – possibly toxic effects of too high a dose. Even though the medical file proves that the psychiatrist omitted standard of care procedures, the PA dismissed the case without a proper investigation. They wrote that the [missing] “care was appropriate,” but I could appeal to a review board. I thought there was a misunderstanding. In 1999, the review board heard the story and saw the evidence The review board held a public hearing in November 1999. It was difficult to tell the story to strangers. There were three board members, the PA’s representative, the doctor’s lawyer and several members of the public. I offered the medical file as proof and questioned the short cuts. I brought evidence: five copies of a 75-page document brief (one for each member of the board, the PA and the lawyer). There were copies of the medical file, a chronological summary and extracts from articles and reference books. In 2001, the board wrote that its three copies were gone. FINDING CARE FOR DEPRESSION

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The PA’s representative at the hearing was a part-time military chap. He politely admitted that the complaint committee ignored 87% of my submissions. He said there was no psychiatrist on the committee (that dismissed the case without investigating properly). The physicians’ association wrote that they ignored most of the evidence, including a list of the missing procedures. I showed the board how the psychiatrist, a recognized mood disorder expert, wrote “refractory depression” in the medical file for eight months but little else other than medication doses. The board saw the expert’s article which proved that the psychiatrist understood ‘refractory depression’ to mean [problems] “with diagnosis and treatment variables.” The psychiatrist did not come to the hearing. His lawyer claimed that the care was appropriate and histories were taken. The doctor’s lawyer did not explain why were there no history notes in the medical file, prepared over eight months, or why so many standard procedures were not done. The board wondered why the doctor did not come to the hearing to answer their questions or use the medical file to justify his methods. The doctor’s lawyer said that she advised him not to attend. After 90 days, the board decided that the evidence was credible. They asked the PA to investigate one of the thirteen missing procedures – patient and family, medical and mental histories. In 2000, the association dismissed the complaint again, without investigating In 2000, the PA contacted the large hospital and received a second copy of the medical file. They wrote to the psychiatrist again. He wrote back that the history notes were dictated but not typed. It seems odd that a file prepared by a health professional, over eight months, has no medical, mental, family or other histories and there is no history or file data from two previous doctors. The PA dismissed the complaint again, without investigating. The skimpy hospital file proved that the doctor omitted thirteen standard procedures. The association counselled the psychiatrist to type histories in future. They did not ask a peer psychiatrist to interview the patient or speak to the doctor. They did not compare the file with the practice guidelines for psychiatry. In Ontario, the physicians’ association is legally responsible for investigating a patient’s complaint. In minutes, a peer psychiatrist could scan the skimpy medical file and verify that thirteen standard of care procedures were omitted. 72

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In 2001, the review board heard the story again The second dismissal letter indicated that I could request another review board hearing. In May 2001, I appeared at the review board again, one day after The Toronto Star reported that the physicians’ association dismisses 99% of patients’ complaints without investigating properly. I was stuck in a catch-22 runaround. During the second hearing, I referred the board to the Regulated Health Professions Act, 1991 which allows the PA to investigate if a patient complains about incompetence. There were no medical professionals on the review board that heard my case in 1999; there were no medical professionals on the 2001 board either. I explained to the lawyer (chairman) and two board members that the psychiatrist did not follow the standard of care procedures. Using practice guidelines and reference books (about negligent psychiatry), I pointed out thirteen failures in the care. Neither the doctor nor his lawyer came to the second hearing but the lawyer wrote and claimed that histories were taken and the care was appropriate. The lawyer knew that the file has no proper history notes. The PA did not send a representative to the second hearing. The Board’s eight page decision, dated Nov. 2001, reviewed the 1997 complaint, noted the missing patient history and named the doctor. The Board did not require an investigation of the substandard care by a peer psychiatrist; the Board confirmed that the PA ‘counselled’ the doctor. According to the Regulated Health Professions Act, a board can take its own time to decide. The board can dismiss a matter. The Toronto Star reported that this happens in 90% of cases. The board can investigate a matter itself if the PA fails to act within six months but this case was still not investigated properly four years after the complaint was made. Since the board has no medical professionals, the law allows them to consult a health professional before deciding on a case of medical incompetence. I asked them to consult an expert but the board refused to consult with a health professional in my case. I interviewed the chief psychiatrist at the hospital where the care was substandard; he told me that the psychiatrists in his department were expected to study, learn, know and follow their practice guidelines. The chief did not attend the hearing. If the review board decides that a patient’s appeal is credible, it can return the case to the physicians’ association to investigate. If a case involves incompetence, the PA can discipline the physician. The outcome of a disciplinary proceeding is noted on the public record. The Toronto Star reports that these quality controls are rarely used. The President of the PA, quoted in The Medical Post, stated that less than 1% of more than 4,000 FINDING CARE FOR DEPRESSION

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patient complaints (in a prior year) led to discipline proceedings. Without followup, there is no public notice that a physician is incompetent. Should a patient’s complaint be investigated properly? When a credible patient complains about substandard care, the law allows the PA to investigate. If a victim is willing to appear at a public hearing; discuss the evidence; answer the board’s questions; and allow the case to become a matter of public record; surely the PA can investigate properly, not just dismiss the matter and leave other patients at risk. The evidence documented in the patient’s medical file can be considered carefully by the PA and the review board. Lax attitudes about substandard care leave trusting patients at risk. The law does not state that the PA can dismiss 99% of complaints. Presumably the law intends that substandard care will be investigated and action will be taken to protect vulnerable patients. Each case is different. Busy doctors cannot perform all possible diagnostic tests or offer a range of treatments to each patient. Cost cutting may restrict care to what is practical but, ethical physicians can still answer questions and follow practice guidelines. Patients should not assume that their physicians are using standard of care procedures (as outlined in practice guidelines and medical books). If a patient deteriorates while trusting a medical specialist, there may be something wrong with the quality of the care. If a doctor is unethical or incompetent, the PA can investigate the situation on a timely basis. Trust in Secrecy: trust betrayed The health system in Ontario was designed to protect sick people. There are quality controls, checks and balances. There are practice guidelines. The Regulated Health Professions Act, the Medicine Act and the Criminal Code have the power to identify incompetence and deal with medical perpetrators. If these laws are ignored, malpractice may not be discovered or investigated. In 2001, the Ontario minister of health received two reports on the Regulated Health Professions Act; the first by independent consultants and the second by a regulatory council. These reports were not released to the public at the time of writing. Maybe the reports will recommend tightening up the health system and investigating more cases of incompetence involving psychiatrists. The Toronto Star reported that the official motto of the physicians’ association is “Trust in Secrecy.” Concerns will continue as long as the PA dismisses complaints and trusts in secrecy. If substandard psychiatry is not investigated or dealt with, trusting patients can be betrayed and damaged. 74

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In Abigail Padgett’s mystery, The Last Blue Plate Special, the author writes, “Medical personnel make mistakes, but rarely does [a] medical practitioner deliberately inflict harm. It just doesn’t happen. And when it does, the perpetrator … reveals a darkness in the human soul.” I struggled with mental health problems for years. When my trust was betrayed, I was sick, angry, confused, frustrated and upset. Finally, I took responsibility for understanding my illness, researching the diagnosis, considering treatment options and finding restorative care. After coping with episodes of a mood disorder, migraines and anxiety for twenty-eight years, obviously I waited too long. Within months of making a commitment to find my way through of the mental healthcare maze, I used the suggestions, tools and references in this book to find quality care. Now I am much better. I have been stable since 1996, and remain so, as long as I use restorative methods. Reader guide to diagrams and checklists: Health System in Ontario – see page 54 Mental Healthcare Reality Check – see page 59 Maze of Depression Diagnoses and Treatments – see page 60 Suggestions for Patients and Caregivers – see page 76 Health Professional Assessment and Rating – see page 97 Author’s Experience of Mental Health System – see page 103 Addendum: In September 2001, the 180 page report of the Ontario Health Regulatory Advisory Council was released to the public. Adjusting the Balance: A Review of the Regulated Health Professions Act presents their findings. During its review of effectiveness, efficiency, flexibility and fairness, HPRAC considered 360 submissions from regulatory colleges, health practitioners, members of the public and others. The report makes 65 recommendations to better “protect the public from harm, promote quality care and make health professionals [more] accountable to the public”. Suggested changes would tighten the system by improving the procedures for complaints and discipline, creating an enforcement capability and allowing the public greater access to information. The report offered no timetable for legislative action. A revised Act could restrict incompetent practitioners who ignore practice guidelines, cause bad outcomes and damage vulnerable patients. FINDING CARE FOR DEPRESSION

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SUGGESTIONS FOR MENTAL PATIENTS AND CAREGIVERS

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atients and caregivers can monitor the quality of care, ask for standard of care procedures and request a second opinion. A patient or caregiver can read the practice guidelines and ask for accurate diagnosis and effective treatments. The guidelines of psychiatry are written clearly enough for laymen. Many of the patients I interviewed could not say whether their health professionals followed the standard of care procedures. These patients were not familiar with the practice guidelines of psychiatry. Few knew about the negative effects of their antidepressants and other medications. A health professional need not rely on short cuts. A differential (accurate) diagnosis requires a proper work-up. If a health professional uses a short intake interview to save time, he may label a patient rather than diagnose properly. A doctor may quickly prescribe antidepressants (or other powerful medications) and then increase doses without testing for any of the fifty medical conditions that are known to cause or contribute to symptoms of depression and other mental illnesses. No amount of antidepressant medication will heal a patient whose mental symptoms are caused by a thyroid dysfunction, hypoglycemia or a brain tumour. If a mental disorder is a chronic condition, I advise patients and caregivers to ask for standard of care procedures. Patients and family can review the practice guidelines, find competent health professionals and cooperate with restorative treatments. I suggest the following: 1. Patients can read reference books to learn about their conditions. There is nothing to be afraid of. Many books about mental illness are written by experienced health professionals. They have clear information, success stories, clinical cases and current research about restorative care. 2. Patients can complete consent forms and obtain copies of their medical files. If there are problems with the care, looking through

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the files can help patients understand what their health professionals consider, do, discuss and write. This can clarify diagnosis and treatments. 3. Patients can study the practice guidelines. These are available from American and Canadian psychiatric associations. Written by professionals for caregivers and laymen, they recommend standard of care procedures for accurate diagnosis and effective treatments. 4. Patients and caregivers can ask health professionals for information and references. Even if a doctor is too busy to teach Psychiatry 101, the patient can ask about basic books with helpful information. Informed patients find it easier to ask for help and cooperate with care. 5. Patients can read the practice guidelines and books about their condition, review diagnosis and treatment practices and ask their doctors to use standard procedures. Patients can request in writing that their care follow the practice guidelines for accurate diagnosis and effective treatment. 6. Patients can ask their health professionals (doctors, nurses, pharmacists and drug companies) to explain the range of effects of medications. It is upsetting if a sick patient gets worse without knowing that certain drugs can cause negative effects – in some people. The patient can make notes of his symptoms and side effects and give a copy of these notes to his doctor. 7. If there is little progress after a diagnostic work-up and treatments, patients can ask for specialist advice, medical testing or peer consultations. Patients can ask for second or third opinions. 8. Patients can ask other patients how they are diagnosed and treated. Local and national depression support groups offer opportunities for sharing personal experiences with survivors and consumers. Sick patients trust their lives to healthcare professionals; substandard short cuts are not acceptable alternatives to competent care.

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THE PSYCHOLOGY OF WHISTLE-BLOWING Protection Of The Status Quo, Even Substandard Psychiatry

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t takes time and effort for a patient to report substandard psychiatry (e.g., short cuts); it was harder than I expected. A “maintainthe-status-quo” psychology protects substandard psychiatry: 1. While working hard to maintain stability during recovery, it takes lots of energy to come forward. Even though the whistle-blowing patient intends to protect other patients, the patient risks social stigma. Telling tales is not socially acceptable; giving up social support is difficult for a recovering patient. This protects the substandard psychiatrist and exposes the whistle blower to destabilization and depletion. 2. To be heard as a former patient, lacking credibility, silenced and invisible after years of illness, a person has to work hard to overcome society’s automatic discounting. Former patients have to reach a higher level credibility than is required for reporting other life-threatening conditions such as a traffic hazard or a fire. 3. Reports of substandard healthcare involving short cuts and damage to patients may not be taken seriously by medical regulatory bodies – especially if the report comes from a mental patient. They may dismiss the patient’s complaint rather than have an independent health professional interview the patient, review the medical file and seriously consider the evidence of substandard psychiatry. 4. When medical regulatory bodies discount, dismiss, find fault and do nothing, a victim can revictimize himself by documenting the case in detail, providing references, reviewing short cuts and reliving details, only to be sloughed off. 5. The people responsible for investigating complaints either cannot cope with the volume or do not pay attention when a damaged patient comes forward. A matter can be reported again and again, with little or no response; each report requires the victim to recall the details and revictimize himself while the perpetrator can continue using short cuts. An unethical psychiatrist can practise negligently for years.

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6. The patient risks a double social stigma: first by declaring episodes of mental illness; second by reporting the perpetrator of medical short cuts. Two levels of discounting seem to apply when the victim of substandard psychiatry comes forward. (1) A recovered mental patient is not often credible. (2) An individual is not likely to be accepted as a credible reporter of substandard care involving a health professional. 7. It appears that no one cares if a former patient reports misdiagnosis and mistreatment. There is no sense of urgency to check the facts and assess the extent of substandard psychiatry or medical malpractice. Society seems to distance itself from victims and leave other patients at risk. 8. Administrative doctors are not likely to believe a mental patient. It is easier for colleagues of the perpetrator to believe in his medical degrees rather than pay attention to the evidence. Even when there is evidence of substandard care, the physicians’ association dismisses many complaints without investigating, resolving concerns or protecting patients. 9. Hospital supervisors are not likely to question the ethics of present or former employees. A supervisor who knows about the mistreatment of a patient by a psychiatrist cannot easily report that it happened in his department. Such a supervisor would have to admit to inadequate supervision. Summary There appears to be a bias toward maintaining the status quo, protecting the perpetrator of substandard psychiatry and turning a blind eye to the use of short-cut alternatives to standard of care procedures. Even though the RPA Act allows a patient to report substandard care, by law, healthcare regulators can accept short-cuts without checking for incompetence, investigating or maintaining the quality of care. If you or people you care about have mental health problems and if a patient gets worse as a result of substandard psychiatry, think carefully before you report the offender. Do not expect the process to be quick or easy. If you have concerns about your legal rights, you can consult a lawyer.

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RISK MANAGEMENT WITH SUICIDAL PATIENTS – REVIEW *Edited By Bruce Bongar, PhD et al, The Guilford Press, New York, 1998

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any mental patients live in despair. A shocking number kill themselves. Two people I knew took their lives while I was researching and writing this book. I write this review with respect for my dead friends and their families. Risk Management with Suicidal Patients encourages mental patients to find competent care. Rather than watch patients deteriorate, the authors propose a sensible action plan. For healthcare to be effective, patients have to search for practitioners who follow practice guidelines carefully and consistently. Competent professionals diagnose the root cause(s) of medical and psychological conditions and treat patients effectively. Finding quality mental healthcare may not be easy. Too many mental patients are misdiagnosed and mistreated. Mental patients struggle with interrelated difficulties including: a) multiple involuntary symptoms, b) effects of medications, (positive and negative), c) the stigma of being rejected, excluded, found fault with and distanced, d) low self esteem, e) restricted careers and limited employment opportunities, f) minimal finances and g) family problems. Having experienced many of these difficulties myself for over thirty years, it is hard for me to write about them calmly. Since I only have a bipolar II mood disorder, anxiety and migraines, I am lucky to be functional. For many years, I was not ’restored’. After lengthy episodes of depression, I understand the despair of patients who are misdiagnosed and mistreated; I can see why some take their own lives rather than continue living with the brain pains of major depression, psychosis, mania, schizophrenia and other serious brain disorders. Such sad passings are less likely if mental healthcare is competent. Most mental health professionals know that the Diagnostic and Statistical Manual (DSM) is used for diagnosing mental illnesses. Psychiatrists in North America know that American and Canadian psychiatric associations publish practice guidelines of psychiatry. Risk Management with Suicidal Patients explains how care can go wrong and how a psychiatrist can be negligent. Ten mental health professionals cooperated to write the book, psychiatrists and psychologists. The editor, Bruce Bongar, PhD, introduces the book. Chapter 1 “is a reprint of a widely cited paper on general outpatient standards of care, which includes an analysis of common failure scenarios.” The authors do not link their recommendations to the practice guidelines of psychiatry. 80

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The definition of negligence is given “as doing something which he … should not have done (commission) or omitting … something which he … should have done (omission).” Although it is obvious, “… the best solution to the spectre of liability following a patient’s suicide is for the clinician to have provided good clinical care that followed acceptable standards of practice” and “… appropriate risk management is the core of a preventative approach to the unfortunate possibility of liability after the suicide of a patient.” Even though few legal claims involving negligence proceed to trial (and even if there is a trial, most cases are won by physicians), it makes sense for health professionals and patients to learn, discuss and focus on standard of care procedures. They can cooperate to follow practice guideline recommendations for accurate diagnosis and appropriate care. The standard of care is defined as “that degree of care which a reasonably prudent … professional should exercise in the same or similar circumstances,” and therefore “deviations from the standard of care are usually referred to as negligence.” The definition itself does not outline the steps involved in competent mental health care. Fortunately the book explains effective inpatient and outpatient care. It indicates how allegations can result from failed care and it offers risk management procedures to minimize liability. I compared the negligence checklists with the practice guidelines of psychiatry and had no problem understanding the steps for proper care. It is easy to see how concerns can arise if standard of care procedures are not followed. The book was written for mental health professionals. A sobering quote from John Maltsberger, MD on the back cover explains its goals and objectives: “One-third of the psychologists and half the psychiatrists in this country (US) will find themselves snared in malpractice actions in the course of their careers. These … usually drag on [for] several years; practitioners pay a heavy price and at best can expect a searing emotional experience before such a case is concluded … knowing what is in this book is the practitioner’s best prophylaxis for safe practice.” Dr. Maltsberger could expanded his target readership by suggesting that knowing what is in this book is the mental patient’s best way of avoiding negligence and getting proper care. Thinking about the sobering impact after a misdiagnosed and mistreated patient dies by suicide made me realize that suicide sears the lives of family and friends with far more heat than the lives of health professionals who were negligent. FINDING CARE FOR DEPRESSION

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Steps can be taken to reduce the risk of misdiagnosis and mistreatment of vulnerable patients. Patients and family can cooperate and ask practitioners to explain which standard of care procedures are appropriate. I included sample checklists from Risk Management of Suicidal Patients so readers can assess care, identify problems and resolve concerns. For instance, health practitioners can recommend a short reading list to educate patients and significant others about patients’ illness and treatments. Many books are written for laymen. Taking an adequate history is easier if the practitioner explains to the patient and family what this involves and asks them to note details of medical and mental histories. Histories can offer valuable clues about inherited tendencies, the diagnoses of relatives and treatments which worked well for them. A busy mental health practitioner can ask the patient and family members to help by asking for treatment records. I tested two former doctors by writing for copies of my files. Their paperwork came in two weeks. One doctor works at a hospital. He asked for a modest payment. I was comfortable with the fee, knowing that hospital staff had to take time to find the file, make copies and mail them. The other doctor, a private practitioner, also responded promptly. He provided his file with a brief letter wishing me well. My former psychiatrist never asked for these past files. When I was ill, I did not know that he was not using the files that his colleagues prepared. After I learned that histories could help, it was easy for me to obtain information which the psychiatrist could have used to diagnose me accurately and treat me effectively. When I was his patient, I remember feeling sick and upset. I worried as my condition deteriorated. I was too sick to question the quality of care. I was stupid to trust my life to short cuts. Now I know what to expect when my bipolar II mood disorder flares up. After finding restorative mental healthcare, I have been stable since 1996. I learned about the practice guidelines of psychiatry, obtained past files and noted medical and mental histories. I am ready cooperate with a competent psychiatrist if I get sick again. There is no point waiting until a patient dies by suicide before learning about standard of care procedures. Rather than trusting the lives of vulnerable patients to negligent health professionals, patients, family and caregivers can cooperate. Risk Management with Suicidal Patients is a helpful antidote to negligent psychiatry. It encourages cooperation among health professionals, patients, family and friends of people who suffer with depression, mental episodes or brain disorders. 82

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A MENTAL HEALTH PROFESSIONAL CAN AVOID ALLEGATIONS OF NEGLIGENCE (A Mental Patient Can Monitor The Quality Of Care) 13 Essential Elements of (Effective) Outpatient Care by A.E. Slaby, MD, PhD, MPH Department of Psychiatry, NYU

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1.

Conduct evaluations for suicidal ideation.

2.

Estimate risk based on factors.

3.

Determine need for hospitalization.

4.

Evaluate and instigate medications to treat the (right) disorder & diminish impulsivity.

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5.

Enhance social support: directly, indirectly.

6.

Provide individual and family therapy.

7.

Provide concurrent substance (advice).

8.

Provide medical consultation.

9.

Provide ECT, if needed.

10.(a) Educate patient & significant others about signs of deterioration and need for intensive treatment.

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10.(b) Plan to provide what is needed. 11.

Arrange access to therapist and other caregivers if need for intervention arises.

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12.

Help patient, family and friends understand that goals must be realistic.

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13.

Keep careful records.

Extracts from Risk Management of Suicidal Patients, edited by Bongar et al, Guilford Press, 1998 FINDING CARE FOR DEPRESSION

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A MENTAL HEALTH PROFESSIONAL CAN AVOID ALLEGATIONS OF NEGLIGENCE (A Mental Patient Can Monitor The Quality Of Care) 8 Most Common Allegations for Malpractice after a patient's suicide by J.D. Robertson, Psychiatric Malpractice, Wiley, New York

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1. Failure to predict or diagnose suicide.

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4. Failure to medicate properly.

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8. Failure to place the patient in a secure room.

2. Failure to control, supervise, restrain. 3. Failure to take proper tests and failure to evaluate patient to establish suicidal intent.

5. Failure to observe patient on a frequent enough basis. 6. Failure to take an adequate history. 7. Inadequate supervision or failure to remove dangerous objects.

Extracts from Risk Management of Suicidal Patients, edited by Bongar et al, Guilford Press, 1998

Author's addition Failure to follow the Practice Guidelines of Psychiatry (APA, CPA) which suggest:

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1. Procedures for accurate diagnosis of the root cause(s) of the patient's symptoms.

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2. Effective treatments to help the patient restore and maintain good mental health.

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A MENTAL HEALTH PROFESSIONAL CAN AVOID ALLEGATIONS OF NEGLIGENCE (A Mental Patient Can Monitor The Quality Of Care) 15 Risk Management Procedures to Minimize Liability by A. Berman, PhD, and B. Bongar, PhD Extracts from Appendix 7.1

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1. Inform patient of confidentiality limits. 2. Use informed consent. 3. Stay current with developments in the field. 4. Know community resources, referral sources. 5. Evaluate suicide risk. 6. Secure past treatment records. 7. Assure clinical competence. 8. Provide adequate documentation. 9. Consult professional colleagues. 10. Maintain quality of patient care. 11. Discuss the benefits and limits of short-term care. 12. Patients in crisis should never be terminated. 13. Clearly document decision to terminate. 14. The more insurance coverage the better. 15. Retain a lawyer.

Extracts from Risk Management of Suicidal Patients, edited by Bongar et al, Guilford Press, 1998 FINDING CARE FOR DEPRESSION

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PSYCHIATIC SURVIVORS: MEDICAL RIGHTS OR A REALITY OF WRONGS

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f psychiatric survivors speak up about their illnesses, they may not be heard. They may not get good medical care for their involuntary symptoms. They may suffer in silence. If they get upset once too often, they may be drugged into oblivion, shocked into memory loss, hospitalized unwillingly, shunned and stigmatized. Compare the rights of people who are reasonably healthy, ‘normals’, with people who have a mental illness (e.g., depression). Depressives don’t always get their medical rights. Depressives are expected to ignore their symptoms, see through their darkness, accept platitudes and use their anguished brains to cope. Depressives may live in a reality where medical rights are wrong, but substandard alternatives are ‘right’. 1. Right to a standard of care which is consistent with professional practice guidelines. When ‘normals’ get hurt or sick, their rights include accurate root-cause diagnosis and restorative treatments. Medical care for ‘normals’ is based on finding the causes of their painful symptoms and treating their illnesses. Depressives can suffer quick and easy ‘care’, labelling and drugging. Minimalist medical effort may involve finding fault and doing nothing or misdiagnosing and mistreating. The brain pain of depressives may be numbed and their cognitions dumbed by powerful drugs. Synthetic medications can, and often do, make depressives worse. The ill-being of depressives may be multiplied by negative effects which they are told will go away. Meanwhile doses may be increased until side effects turn into adverse effects. Doctors, pharmacists, drug companies and regulatory bodies know that drugs for depressives can cause a range of problems, including toxic effects. The right medications, in the right doses, can help depressives if the pills are prescribed by competent health professionals who have taken careful histories and done medical and mental tests to determine the underlying illness. Therapy can help depressives cope with troubling symptoms, chronic illness and daily distress. 2. Right to R.A.I.S.E. ‘Normals’ expect to be treated with respect, approval, interest, support and encouragement.

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Depressives often get D.D.E.D.D.: disrespect, disapproval, exclusion, discounting and discouragement. 3. Right to medical care. ‘Normals’ assume they will be tolerated with patience, comfort, consideration and compassion. Depressives may experience intolerance, impatience, abuse, discomfort, cruelty or shunning. 4. Right to peace of mind and a place in society. ‘Normals’ take this for granted. Depressives live with involuntary symptoms, as well as the negative effects of powerful medications, often suffering in isolation. Depressives may be shunned by polite society, family and friends during, after or because of episodes, moods and outbursts. Depressives can become social lepers. Some people treat their dogs better than relatives who periodically or regularly experience episodes of mental illness. 5. Right to be believed. Reasonable comments by ‘normals’ are listened to, learned from, believed in and trusted. They usually get ethical healthcare. Depressives may not be credible. People may not listen, learn, believe or trust them but distrust, dismiss, discount and dispute them. Depressives may not be good enough for people to listen to their words, learn from their symptoms, believe their truths or trust their requests for standard of care procedures. 6. Right to have complaints about neglect, negligence or substandard care taken seriously, investigated, verified and resolved. ‘Normals’ count on being taken seriously if they are abused or victimized by unethical health professionals. Depressives are easy victims for unethical, incompetent, inexperienced or predatory psychiatrists. Depressives may be dismissed, discounted, or ignored if they report short cuts, substandard care or incompetence by health professionals. Credible complaints by depressives may not be investigated. 7. Right to justice. In the ‘normal’ world, people who break the law are subject to investigations, charges and prosecutions. If found guilty, they face serious penalties. Depressives may be victims of negligent short cuts if careless or unethical doctors prescribe powerful pills which are noxious at FINDING CARE FOR DEPRESSION

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high doses. This can harm or even ‘torture’ depressives. Unethical predators can abuse patients with drugs and shocks, ignore their suicidal thoughts and watch them deteriorate until they take their lives. It is difficult to prove that harm was done to depressives by substandard care. 8. Right to workplace equity. ‘Normals’ count on protected career opportunities and disability insurance if they suffer from an illness lasting for months or years. Psychiatric survivors whose brains don’t function properly during depressions, mental episodes or brain disorders cannot prove their disabilities by blood tests, fluid losses, X-rays, scans or lumps. Mental illness is an invisible disability. Repeated episodes of depression reduce people’s rights to be treated fairly by employers and coworkers. Depressives can keep silent about their symptoms, diagnosis, treatment and prognosis. Keeping quiet about their dark reality means they do not qualify for anything other than negative performance reviews. Speaking up about their illnesses may mean that depressives are disqualified from promotions, sidetracked from career opportunities or shown out the door. Mental illness is a disabling condition but it does not stop depressives from wanting to work, advance their careers, make money, live independently and support families. Depressives may not be able to claim financial support from the insurance companies to which they pay disability premiums. Disability due to moderate physical illness is often covered by insurance, but chronic mental illness is not often covered. 9. Right to be fallible human beings. ‘Normals’ take it for granted that their flaws, faults, frustrations and failures will be accepted as part of the human experience. Depressives may find that no matter what they do, it is not good enough to be accepted. They may be stigmatized and dehumanized, tainted and distanced. 10. Right to life, liberty and the pursuit of happiness. The North American dream is the expected right of ‘normals’. Depressives find these dreams much harder to achieve. Psychiatric survivors may exist as the living dead: people with few rights, restricted freedoms and lost opportunities. Without full medical rights, psychiatric survivors live in a topsy-turvy reality of wrongs. 88

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AFTER REVIEWING THE SYSTEM: ASSESSING THE MENTAL HEALTH PROFESSIONAL

M

y exploration of the mental health maze was circular. After investigating, I ended up back where I started, sadder but wiser. I learned that there are laws to protect patients. There are complaint committees and professional associations to consider reports of incompetence, incapacity or misconduct involving physicians. There is a review board to hear matters which are not disposed of properly. There is a regulatory council to review the healthcare legislation. There is an office at the minister of health to oversee the health system as the representative of the elected government. On the plus side, it is obvious that the health system was designed to help sick people. On the minus side, little or no action is taken after a whistle blower reports substandard care. In Ontario, Canada, the procedures for investigating bad outcomes and resolving patient complaints are very slow. If complaints are dismissed, there is no incentive for patients to report cases of care gone bad and there is no way for physicians and patients to learn what happened or make sure that similar problems do not recur. If a credible patient complains about substandard care and questions the competence of a physician, the dismissal of the patient’s report by the physicians’ association does not maintain the quality of medical care or protect other vulnerable patients from damage due to medical incompetence, inexperience, negligence or shortcuts. The psychiatrist chose not to tell the truth about my bad outcome. The lawyer who represented the psychiatrist was convincing. Even after seeing evidence of substandard psychiatry, the physician’s association protected the doctor. The complaint committee dismissed the case without investigating properly. The review board heard the story and saw evidence of substandard care but seemed powerless to do more than refer the matter back to the physicians’ association. The office of the minister of health acknowledged the case and passed the buck to the physicians’ association. The regulatory council included me in a focus group discussion and thanked me for sending extracts from this book (to consider when they drafted their report on the RHP Act). There was a polite but firm bias against following up the evidence of incompetence by the psychiatrist. The medical file had clear evidence, written by the psychiatrist himself, but everyone involved gave him the benefit of the doubt; as if they could not bring themselves to believe a former mental patient. This seems paradoxical. With evidence of incompetence, laws empowering action and responsible people authorized to investigate, it seems odd that FINDING CARE FOR DEPRESSION

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nothing was done to resolve the matter and protect other patients. I did not expect the psychiatrist would admit his short cuts but I did think the evidence in the medical file would be taken seriously. I did not expect the physicians’ association to believe the story without investigating but I did think they would ask a health professional to compare the file with the practice guidelines. I did not expect they would trust my analysis but I did think the review board would ask an expert psychiatrist to consider the evidence of incompetence. Given the skimpy file, an investigation would have taken less than one hour. The matter could have been wrapped up within the six month time limit provided for the the RHP Act. The psychiatrist could have been disciplined and re-educated. His patients could have been protected from the damage done to me. Six years after the matter came to light, there is no progress to report. After blowing the whistle on substandard psychiatry, I pondered the lack of response. I wondered how a mental patient could improve his chances of getting quality care. If the patient is deteriorating and doubting the competence of a psychiatrist, surely something can be done to help the patient. As I was exploring the system, reading about depression and interviewing survivors, I met other patients who had similar problems finding competent care for depression, mental episodes and brain disorders. I read medical books, studied the practice guidelines of psychiatry and looked at the legislation. It was encouraging to learn about the systems and procedures for diagnosing and treating mental illness. There is information about psychiatric, psychological and medical causes of depression, mental episodes and brain disorders. Health professionals, hospitals, organizations and support personnel can provide competent care, monitor standards and protect patients. In theory, standard of care procedures help to maintain the quality of medical care. In practice, things are different. Although there are health professionals, thoughtful systems and careful controls, there are no teeth in the system. Unethical health professionals can cut corners and damage patients. Exploiting sick people by misdiagnosing and mistreating them is not acceptable, especially if the predator is a psychiatrist If health systems and quality controls do not always work effectively, perhaps some problems can be related to overzealous cost cutting and staff terminations not to mention reducing the number of beds, closing hospitals and pruning mental wards. Saving money by thinning staff, combining facilities and cutting costs may strengthen the bottom line of hospitals but the health system is weakened if things go too far. With healthcare costs spiralling out of control, it is reasonable to monitor expenditures and 90

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improve efficiencies, but it is not fair to eliminate standard procedures and reduce the quality of care until sick patients suffer. When quality controls are weak, unethical psychiatrists can cut corners, take advantage of loopholes and escape reprimands. If too few resources are available for detection, investigation and follow-up, unscrupulous professionals are not identified or punished. Even though my test case of substandard care was reported from 1995 to 2001, the psychiatrist never explained his short cuts. There was no requirement that he improve his practise. His association counselled him to note patient histories but missed the truth – he did not take patient or family, medical or mental histories. Nothing was done to assess whether other patients had similar problems. At this time in Ontario, Canada, there is no public record of complaints about physicians. Some American states have rules for reporting concerns if a physician is incompetent. Formal systems for reporting bad outcomes allow physicians, patients and family to monitor and maintain the quality of care. Until such systems are implemented more widely, it is up to patients, family and caregivers to monitor each case informally and discuss bad outcomes. A psychiatrist knows that a patient needs help if there are ongoing problems. Caregivers can watch for: • multiple involuntary symptoms of depression and / or hypomania; plus co-morbid conditions (such as anxiety, migraines, hypoglycemia or other medical conditions) • negative effects of powerful psychiatric medications (which help many people but they can, and often do, cause side, adverse and toxic effects) • personal problems: without education and information, sick people worry about their diagnosis and prognosis; being brushed off is little comfort when patients’ lives are coming apart • rejection and exclusion by health professionals, family, friends, clients and other people who don’t understand or think the sick person should pull up their socks (when socks aren’t down) • social deficits; after losing credibility; mental patients are relegated to social leper status; and • limited financial resources; after years of illness, career derailments, business problems, difficulty paying for food and shelter and problems maintaining financial commitments during episodes. If a sick patient does not get better, the patient can ask for tests, request an accurate diagnosis, read books to understand his illness and search for competent care. For a long time, I did not take these steps. It seems obvious FINDING CARE FOR DEPRESSION

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to me now that a patient can ask for quality care. Although my psychiatrist said, “You will get well,” I didn’t realize that his encouragement was not backed up by proper procedures; he didn’t bother make an accurate diagnosis and the treatments he recommended were not restorative. The drugs he prescribed were not helpful. In hindsight, it is not surprising that the wrong medications made me worse. The psychiatrist could not feel my pain. As I got worse, it was wrong for me to trust my life to substandard psychiatry. You may question how a mental patient or family could benefit by reading the patient’s medical file. You may wonder if you have the resilience to present a bad outcome at a hearing. I did. It was unfortunate that I could not afford to hire a lawyer to represent me at the hearings but I wanted the case to be heard. After decades of health problems, many patients have limited resources and little motivation to understand files or present evidence. Even though my exploration of the mental healthcare maze was circular, I still believe that the RHP Act can protect patients. The physicians’ association and the review board can cooperate to maintain quality care. They can take timely action when standard of care procedures are not used. There are systems and procedures, checks and balances. Responsible people can do as the law allows and investigate incompetent physicians. The patient, his family and caregivers can overcome problems with substandard psychiatry by assessing the mental health professional before and during treatments. They can notice if progress is being made and think whether to keep on trusting the practitioner. Like everything else connected with the mental health system, it is not easy for a sick patient to determine if a health professional is competent. A patient may be too sick to assess the quality of care but family and other caregivers can pay attention to what is going on. They can ask the psychiatrist for his track record helping mental patients. A patient can ask to meet some of the doctor’s other patients who have been helped. Caregivers can ask for references, testimonials and success stories. Patients, family, friends and caregivers can use the “Health Professional Assessment and Rating Checklist” to monitor each health professional for quality of care, competence, communication and cooperation. At the start of each visit, when the health professional examines the patient, the patient can use the checklist to assess the health professional. Together patient and doctor can monitor progress. Many patients have enough common sense to use a checklist. Rather than continue if a relationship is not working, the patient can ask questions and discuss concerns. A psychiatrist who does not want feedback from a patient can refer the patient to another doctor, counsellor or support worker. 92

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When they are not well, mental patients can be upset and upsetting. Many struggle to cope with involuntary symptoms of depressions, mental episodes and brain disorders; a good percentage of patients have negative effects when taking medications; they experience career set-backs and job discrimination. They can feel helpless and hopeless, alone and lonely, sick and tired, stigmatized and shunned. Mental patients may feel like society’s rejects, the bottom class of patients in the health system. Ontario laws such as the Regulated Health Professions Act, the Medicine Act, the Criminal Code and the practice guidelines of health professionals do not discriminate against mental patients. These laws give health professionals, hospitals, professional associations, review boards and law enforcement officers the legal authority to help mental patients just the same as any other patients. The laws, checks and balances of the health system are designed to help patients recover. My experience taught me that there are difficulties getting the proper authorities to investigate a case of substandard psychiatry. After going around in circles, I cannot advise patients, family or caregivers to report substandard care if it is only going to waste time. Rather than trust the lives of sick patients to unethical professionals who are using ineffective methods, I recommend assessing each professional for quality of care, competence, communication and cooperation. Patients, family and caregivers can use the “Health Professional Assessment Checklist and Rating Scale”. Patients are likely to get quality care if their health professionals score in the range of 3 to 5 on the R.A.I.S.E. rating scale. If a health professional scores -3 to -5 on the D.D.E.D.D. rating scale, there may be problems. The health professional may not be competent or he may not be using his education, training, references and experience. Patients, family and caregivers can watch for health professionals who seem sincere but do not care about their patients. Rather than debate matters, patients can ask for another opinion. When a patient gets worse, some hospitals have a policy of assigning a ‘refractory’ patient to a second psychiatrist for a consult. Before trusting the lives of sick people to mental health professionals who may be unethical, inexperienced or incompetent, a patient can assess the health practitioner. The assessment can be updated at each meeting. The patient’s goal is to find and cooperate with competent mental health professionals who score well on the R.A.I.S.E. rating scale. These practitioners are likely to follow their professional practice guidelines, use standard of care procedures, diagnose accurately and treat effectively. R.A.I.S.E. practitioners know how to help mental patients restore their mental health. D.D.E.D.D. practitioners may have medical degrees, years of clinical experience, FINDING CARE FOR DEPRESSION

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HEALTH PROFESSIONAL ASSESSMENT A patient can see, ask, listen and learn. Does the caregiver – 1. Respect patient and family?

R

❑

A

❑

I

❑

S

❑

E

❑

I respect depressed patients. They have involuntary symptoms and want to get well. Mental patients have the right to quality care involving standard procedures. 2. Approve? Follow practice guidelines? Mental patients deserve competent care. If we follow practice guidelines, we can find the root causes and help each patient get well. 3. Include? Educate? It is good to include the patient in the process of diagnosis and treatment. Mental patients can hear, see, talk, read and learn. We explain that there are causes and triggers. After we diagnose patients accurately, we can help them recover and keep well. 4. Support patient and family? We support research and medical practices. We help mental patients recover by treating underlying conditions and recommending restorative mental healthcare. 5. Encourage quality care? Professional practice guidelines recommend accurate diagnosis and effective treatments to help mental patients recover. In our clinical experience, mental patients can restore mental health and live well. 94

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HEALTH PROFESSIONAL ASSESSMENT A patient can see, ask, listen and learn. Does the caregiver – 1. Disrespect? Upset?

D

❑

D

❑

E

❑

D

❑

D

❑

A mental patient is sick. We can't do much. There is little hope of recovery. Mental patients can't be helped. It is wrong for mentals to hope for the impossible. 2. Disapprove? Deny? Mental patients aren't like normal people. We don't look for causes. We talk to mentals. We use medications to quiet them. 3. Exclude? Silence? Mental patients are upset and upsetting. Their brains don't work right. They can't understand. Their capabilities are limited. We do our best to cope with mental cases. We smile silently as patients struggle to cope in the real world. 4. Discount? Dismiss? There is no such thing as restorative mental healthcare. Only quacks would make such claims. The scientific research, clinical protocols and recovery stories are unproven. 5. Discourage standard of care practices? Guidelines exist but they aren't standards of care. Nice in theory, but not much use in practice. Mental patients don't often recover. We can't do much to help most mental patients. We discourage false hope. FINDING CARE FOR DEPRESSION

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HEALTH PROFESSIONAL RATING (For use by patient, family and caregivers) Assessment

Respects

R

❑ 1

Approves

A

❑ 1

Includes

I

❑ 1

Supports

S

❑ 1

Encourages

E

❑ 1

R.A.I.S.E. Total

❑

Profile of a R.A.I.S.E. Practitioner (Scores between 3 and 5) • focus is guideline quality of care, sincere communication, cooperation and competence • follows professional practice guidelines for accurate diagnosis and effective treatment • cooperates to help the patient restore mental health, maintain high functioning • encourages recovered patient to live well

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HEALTH PROFESSIONAL RATING (For use by patient, family and caregivers) Assessment

Disrespects

D

❑ -1

Disapproves

D

❑ -1

Excludes

E

❑ -1

Discounts

D

❑ -1

Discourages

D

❑ -1

D.D.E.D.D. Total

❑

Profile of a D.D.E.D.D. Practitioner (Scores between -3 and -5) • seems sincere but there are problems with poor care, shortcuts, non-communication and incompetence • fails to diagnose accurately or treat effectively, watches sick patient get worse • if mental patient is misdiagnosed and mistreated, not concerned as the patient deteriorates • knows worsening illness increases risk of suicide.

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and promote their expertise by writing articles in professional journals but their preference for substandard short cuts can harm a vulnerable patient. Incompetence and negligence can prove deadly. Even though a mental patient may be unwell with depression, mental episodes or brain disorders, the patient can assess the quality of care, find ethical psychiatrists and cooperate with R.A.I.S.E. practitioners. Instead of giving up, readers can use the tools and references in this book to search for competent care and avoid the traps of misdiagnosis and mistreatment. Patients, family and caregivers can use the mental healthcare compass to discuss the practice guidelines and find quality care. They can use TAYO, the healthcare planner, to cooperate, get accurate diagnoses and effective treatment. You can read about these tools in Part Three. C h a p t e r

1 6

HARD LESSONS LEARNED WELL

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f you think I am bitter about the bad outcome of my mental healthcare, let me reassure you. The substandard care and my travels through the mental healthcare maze taught me about the dark side of the system. I learned valuable lessons from the expert psychiatrist, the medical file, the chief psychiatrist, the hospital clinic, the physicians’ association, the review boards, the administrators of healthcare associations, the authors of reference books and other survivors. I appreciate their patience. Maybe short cuts are helpful if a busy physician gets overloaded. Too many cuts can lead to incompetent care which can make a sick patient worse and risk the patient’s life. After my care went bad, it was foolish for me to keep trusting Dr. T.T. ShortCu and his short cuts. His smiles and substandard care taught me that a psychiatrist may not always diagnose his patient accurately or treat the patient effectively. A callous doctor can write “refractory depression” in a patient’s file and prescribe medications which make the sick patient worse. The trusting patient does not expect a doctor to ignore his practice guidelines or take short cuts. Even while coping with symptoms and side effects, a mental patient has to monitor his care. The chief psychiatrist at the large hospital taught me that psychiatrists are supposed to study, learn and apply proven techniques for accurate diagnosis and effective treatment, according to their practice guidelines. The chief encouraged me to introduce the guidelines to readers of this book. He made time in his busy schedule for an interview. I asked why my 98

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problems with substandard psychiatry happened at his hospital (where his residents, staff and expert psychiatrists are supposed to follow the standard of care). Tactfully, the chief declined to discuss the bad outcome. The review board heard my story and saw evidence of substandard care. The board listened to the doctor’s lawyer. She claimed that the doctor took histories. The board saw that there were no proper history notes in the medical file, prepared over eight months. With no physician at the hearing, it was unlikely that the board could identify substandard care or evaluate incompetence. The 1999 board understood enough to ask the physicians’ association to investigate why there were no history notes in the file. The board did not consult with a health professional, as they might have done. The physicians’ association got a second copy of the file from the hospital. The histories (patient, family, medical and mental) were still missing. There were no diagnostic tests either. The physicians’ association saw evidence of substandard care in the skimpy medical file, in the doctor’s handwriting. They counselled the psychiatrist to follow up history-taking in future. Effectively, they let him off scot-free. The association also taught me about short cuts. With thousands of cases every year, many complaints by credible patients are dismissed. Otherwise, the association physicians would have no time for their medical work. It would make sense for the association to use eight steps to investigate and process patient complaints which involve incompetence: 1. 2. 3. 4. 5. 6. 7. 8.

assign each case to a peer physician interview the patient study the medical evidence verify the complaint compare the file with the practice guidelines ask the doctor to justify short cuts check a sample of patient files explain substandard care to patients and their families

If a pattern of substandard care is detected, medical associations should follow the provisions of the RHP Act and protect patients from incompetent, unethical, inexperienced or negligent doctors. Timely follow-up could resolve misunderstandings, maintain the quality of healthcare and save time and money. The hearings were embarrassing but educational. Presenting my case and showing the evidence was not easy. It was humiliating to disclose my mental health problems, put the case on the public record and ask the FINDING CARE FOR DEPRESSION

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physicians’ association to investigate Dr. T.T. ShorCu. By reporting substandard care, I did what the law allowed. Even though another patient died (after a case of misdiagnosis and mistreatment involving the same psychiatrist), my complaint was not taken seriously. It was upsetting that the system did not follow up or find out what went wrong with my care. My experience of Ontario’s mental health system (refer to diagram) taught me that there are laws, offices, people and procedures. My perception of short cuts at all levels is not consistent with the practice guidelines of psychiatry or the RHP Act. According to the RHP Act (in Ontario, Canada), if a credible patient suffers a bad outcome and suspects incompetent care by a physician, a patient can report the doctor. If a physician relies on short cuts rather than standard of care procedures, the law allows the physicians’ association to investigate. The law does not encourage the association to put off the victim, ignore the evidence, dismiss the complaint or allow the physician to continue using negligent short cuts. An investigation might discover good reasons for substandard care (unlikely). The people responsible for monitoring medicine can act to maintain the quality of care and protect patients from incompetence. Since the hearings were public, I can write about the bad outcome, the dismissals and the process, without being sued. If it was not for the bad outcome of substandard psychiatry, I would not have gotten upset about short cuts and incompetent healthcare. I would not have read so many books. I would not have learned my correct diagnosis or found restorative care. Fortunately, I recovered. Bibliotherapy is a good strategy. You can learn from my experience that patients can read and find effective care for depressions, mental episodes and brain disorders. Hard lessons, learned well.

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Twists and Turns Around and Through The Mental Healthcare Maze There are hidden truths and obvious lies about mental illness. It is hard to see sense through the darkness of depression. While exploring the mental healthcare maze, twists and turns, lies and silences, stigmas and defences, illusions and shadows, ignorance and fear, frustration and pain can conspire to hide the truth. The persistent patient gets the prize: restorative mental healthcare. (Extract from poem in Wordscape Seven, an anthology published by the Canadian Authors Association, 2000)

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MY EXPERIENCE OF ONTARIO'S MENTAL HEALTH SYSTEM 1995 TO 2001 The watchdogs were toothless. The system protected incompetence. Short cut alternatives to standard of care procedures cut costs and reduced the quality of mental healthcare. Physicians' association – generalist and specialist doctors The system receives patient complaints • investigators include a lawyer, a part-time military man, nurses • website reports 4,000 patient complaints a year, few results are reported • physicians' association can dismiss complaints, counsel or discipline doctors • complaint committee has physicians, specialists and layman members Short cuts expedite • of 7 complaint outcomes, 6 dismiss and/or leave patients at risk • less than1% of patient complaints are referred for discipline hearings Doctors – family physicians and mental health professionals psychiatrists have specialist education, training and experience The system educates doctors and practises on mental patients • educated, trained, experienced, clinicians and researchers are trusted • an expert can write articles for medical journals to gain credibility • the practice guidelines of psychiatry recommend proven procedures • a patient expects quality care ie. proper diagnosis and effective treatment • a mental patient has involuntary symptoms, may be sensitive to pills Short cut alternatives = quick and easy $$$$, save time • a doctor can write "refractory" and raise doses of powerful medications which are known to make sick people worse, efficient but careless • a psychiatrist can smile and watch a sick patient get sicker, deteriorating for months. The specialist gets paid. No one seems to care if medical short cuts, incompetence or negligence damage a sick patient. Practice guidelines of psychiatry – Cdn. and US The guidelines are comprehensive • consensus of expert opinions, based on articles from 1971 to 1991 • explain how a patient can be properly diagnosed and effectively treated • mental status examination is the first step in assessing the patient • histories are the next step – patient and family, medical and mental • can test for over 50 medication conditions known to cause depression • advise combinations of medications and counselling to help patients • if a patient doesn't get well, can review and re-do diagnostic workup, re-diagnose, then adjust treatments to help the patient get well Short cuts • psychiatric guidelines exist but doctors don't have to follow them • practice guidelines are not considered standards of care for practitioners 102

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MY EXPERIENCE OF ONTARIO'S MENTAL HEALTH SYSTEM 1995 TO 2001 Review board can hear health matters The system outlined • non-medical board hears matters in public • sees evidence of medical incompetence • the health professional need not attend • the patient's credibility is questioned • the board can appoint an investigator Short cut outcomes • can: (1) dismiss or (2) refer the matter back to the physicians' association Regulatory council • notes matters to report • covers 21 health colleges • no power to investigate

• reviews RHP Act • reports to the ministry • public can submit reports Ministry of health

• receives patient complaints about cases of incompetence • may refer voters to the physicians' association • can ask OPP to investigate if there are multiple victims or fraudulent schemes Hospital – department of psychiatry The system outlined • employs psychiatrists to research and staff inpatient wards & outpatient clinics • chief psychiatrist supervises the department • department trains new doctors, residents Short cuts • some doctors may not follow guidelines • some supervisors may not report short cuts Civil litigation • patient can sue a negligent physician for malpractice • the cost is prohibitive • experts disagree on care • after one year, a patient cannot take civil action (in Ontario, Canada) Criminal code and the police The system can protect victims • sections of the criminal code apply to health professionals • police will listen but, if only one victim, refer victim to the physicians' association • limited resources, have to prioritize Some medical schemes are investigated • OPP medical fraud squad can investigate schemes, e.g., if deceit is used to make money at the expense of the public health system FINDING CARE FOR DEPRESSION

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3

P a r t

To o l s For Finding Care

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C h a p t e r

1 7

TOOLS FOR FINDING CARE – INTRODUCTION

I

f people suffer for years with misdiagnosed or untreated depressions, mental episodes or brain disorders, their lives deteriorate. Mental conditions are difficult for patients, family, friends and caregivers to understand. Healthy people may not put up with mental patients who are upset and upsetting. To recover and keep well, sick people need to find proper care. During episodes of depression, patients cannot always think clearly, react logically or behave consistently because their brains are dulled, their feelings are numbed and their capabilities are reduced by involuntary symptoms and negative effects of medications. They are not helpless. They can still read, listen, learn and discuss their symptoms, share their issues, explain their worries and outline their problems. It is hard to keep hope alive if episodes of a chronic condition recur or worsen. Many patients need restorative healthcare. It makes sense to ask for quality care but the mental health system is overloaded and complicated. Catch-22s can distract patients who explore the twists and turns of the mental healthcare maze. An experienced guide would be handy, I thought to myself, after wandering around in the maze for nearly thirty years, feeling depressed for months at a time and coping with episodes, anxiety and migraines. Although I consulted with physicians, psychiatrists and psychologists, I did not have a guide to competent care. During lucid periods, I wondered about developing tools to focus my energy, navigate the maze and find quality care. A good set of tools would help, I pondered, wondering what they might be like and where to get them. As a consultant to healthcare professionals and mental patients, I studied the principles of psychology. People tend to repeat patterns of thinking, feeling and acting. With income reduced (when not well), I needed work to maintain my home, provide for my family and operate my business. Eventually, my parents understood and they helped me keep my home, research and write. I read many books about mental illnesses before finding references for restoring mental health. I mapped out twelve steps for coping with a mood disorder, developed a mental healthcare compass and designed a healthcare planner. If you want to find care for depression, mental episodes and brain 106

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disorders, you can use these tools: introduction to practice guidelines, practitioner assessment, annotated references, book reviews, negligence checklists, coping tips, healthcare compass, financial advice and TAYO – The Healthcare Planner. After you recover, you can live well. C h a p t e r

1 8

DEVELOPING A MENTAL HEALTHCARE COMPASS

I

developed a mental healthcare compass after suffering with a mood disorder for many years. After problems finding care, I felt lost and alone. I ran low on hope and wondered if I would ever be diagnosed or treated. I was disappointed that my care involved short cuts. Experienced health professionals labelled my depressions, but they don’t do enough medical or psychological testing to find the root causes of my problems. Misdiagnosis was superficial and not useful. After quick labels, the typical response was silence, antidepressant pills or talk therapies. I only seemed to get worse, even when cooperating with health professionals. I was not a bad patient; I was cooperative. I wanted to get well. I believed the professionals would help me recover. As the years passed with no accurate diagnosis or restorative treatment, my trust eroded. When I was sick, an expert psychiatrist told me not to read. At a low point in 1995, I started to read about mental illnesses, their diagnosis and treatment. Even through the darkness of depression, I could read and understand. I wanted competent help. I developed a clear goal but I needed a direction-finder to navigate the mental healthcare maze. My objective was to restore normal mood without negative effects. Before that, I was found fault with, watched deteriorating, given the ‘silent’ treatment, laughed at, labelled, drugged (with antidepressants and mood stabilizers which made me worse) and talked at (about dark thoughts, numb feelings and illogical behaviors). No health professional explained the involuntary symptoms or the cognitive effects of depression. A mood disorder affects thoughts, feelings and behaviors. I was rejected, excluded, disrespected and discounted – by health professionals. I was victimized by medical incompetence. Without proper care, I deteriorated. As the years passed, my undiagnosed and mistreated bipolar mood disorder got worse. I became anxious and upset, frustrated and angry. That seemed to encourage my caregivers to distance themselves while smiling blandly and saying things like, “You will get well,” “Pull up your socks” or “You seem a bit down.” To test the “sock” theory, I experienced depression with thick socks, thin FINDING CARE FOR DEPRESSION

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socks, white socks, black socks, coloured socks, mismatched socks, socks hanging down and socks pulled up. I took my socks off and left my socks on. After my careful sock experiments, I can assure you that depression has nothing to do with socks. Socks don’t make depression better and they don’t make it worse. To test the “down” theory (which I did while doing the sock tests) I tried lying down, standing up, sitting down and walking up and down. When I felt bad, it was a comfort to lie down. Lying down at night when I could not sleep was a torment. At night, restful sleep was elusive. Between “sock” experiments and “down” tests, I designed a compass to explore the mental healthcare maze. A compass has to be clear and easy to use. When a traveller gets lost, he needs help to find his way home. A compass can help people head in the right direction and reach their destination. If people get lost in the mental healthcare maze, they can use a compass to find their way to quality care. I reasoned that a healthcare compass would help patients, family, friends and caregivers cooperate and find effective care. A good compass would point the way forward and help patients renew their hope. The typical compass has four directions – N, S, E and W. Within each direction, there are degrees to guide an explorer. I set out four directions for a mental healthcare compass. As I explored, I felt like a failure when I got worse. I could not explain symptoms to family, friends or caregivers. I had no language to describe the pain of depression. I had no sense of direction. I felt lost and alone. During interviews with more than 150 other depression survivors, I expected to hear that they were properly diagnosed and effectively treated, but their experiences sounded like mine. Few were better, even after treatments. Some liked their doctors and took medications but their results were mixed. Others, after counselling, just accepted their conditions. A desperate few chose to end their lives rather than continue living with the painful torment of untreated or mistreated depression. I wanted to survive depression, find quality care and restore mental health. Even though I studied life sciences and psychology at university and read about clinical cases of mental illnesses, I did not understand how health professionals did their work. Even after doctors, psychiatrists and psychologists practiced on me, I still had no idea that the health system was testing my persistence and resilience. I wandered around and through a maze of paradoxes and blind alleys. As I listed symptoms and problems and noted possible solutions, I found a combination of positive words to focus my energy and renew my hope. The concept of a mental healthcare compass came to mind, I used it to find 108

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care and recover! Let me explain how it worked for me so it can work for you! There are four directions for diagnosis. Until a depressed person learns that they have a mood disorder and finds out what is making them sick, the person cannot understand their experience. Diagnosis involves finding out the name of an illness. Four Directions for Diagnosis 1. Finding fault With a mental illness, I was moody. To be more specific, I was variable, volatile and vulnerable (to repeated episodes of depression and rare times of hypomania). I was reactive, intense, hypersensitive, periodically creative, surgingly energized and hypergraphic (I wrote a lot). Intensity seemed to be built into my brain’s design. When I was unwell with depression, my family tended to find fault with me. It makes sense that they would. After all, the fifteen characteristic and involuntary symptoms of depression are faults. A sick person has many symptoms and feels faulty. For instance, too much variability, volatility and vulnerability are faults. Reactivity, intensity, hypersensitivity, periodic creativity and surging energy can be exhausting for patients, family and caregivers. Too much writing annoys slow readers. The profile of a person with a mood disorder involves characteristic patterns of human fallibilities, skewed toward the negative. Healthy people like to point out the faults of mental patients. It must make them feel good. Unfortunately finding fault is not the best way to make an accurate medical diagnosis of an illness. 2. Quick labels Several mental healthcare professionals gave me quick labels like ‘depression’ or ‘dysthymia’ but without explaining. Maybe they assumed that I knew that depression was a medical condition and a mental disorder. They didn’t outline the involuntary symptoms. Maybe they were too busy labelling to teach. One doctor did a handful of medical tests before deciding, after returning from his holiday a month later, that I was depressed. A quick label is not an accurate medical diagnosis. 3. Mistaken diagnosis The mistaken diagnosis involved not being treated for anything or being treated for depression without any workup to determine whether I might have a bipolar mood disorder or any other problems. The result of a mistaken diagnosis was mistaken treatment. One antidepressant caused me to experience hypomania. That might have accelerated into mania except I FINDING CARE FOR DEPRESSION

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stopped taking the medication. I do not recommend that anyone should stop taking their medication. If you have experienced the painful torment of hypomania, you know that it can spiral out of control. If you get worse after treatment, you can question whether there was a mistake in your diagnosis. 4. Accurate diagnosis The benefits of an accurate diagnosis became clear when I read the practice guidelines of psychiatry. Diagnostic decision trees explain that there are many causes of depression, mental episodes and brain disorders. Health professionals can run detailed tests to diagnose a patient accurately. Patient histories can offer clues about genetic factors, family of origin issues, and medications which can cause or contribute to symptoms. Medical tests can verify whether there are co-morbid conditions (e.g., a thyroid dysfunction). A mental status exam involves easy questions and careful observations. A competent health professional does a number of diagnostic tests before deciding what is wrong with the patient. When an accurate diagnosis is noted in the patient’s file, it lets the patient and health professionals know what is causing the symptoms. Making a correct diagnosis helps a health professional develop a treatment plan with standard of care procedures. The four directions of diagnosis gave me hope. After decades searching for care, I reviewed the directions. My experiences came into perspective. I decided to head in the right direction and search for care that would help me get well. Along with four directions for diagnosis, the compass needed directions for treatment. I thought about my experiences and developed those directions. Four Directions for Treatment 1. Do nothing For decades, my family and I did nothing about my disordered brain. When I was depressed, we either kept quiet or found fault. When I was upset, unwell, anxious, frustrated, irritable or angry, they knew something was wrong. My faults convinced me that the do-nothing approach was what I deserved. My sister summed up the do-nothing direction when she was in her twenties. By then, I had been depressed, off and on, for twenty five years. She pronounced me negative, argumentative and defensive and said she would exclude me from her life. Her rejection was painful. While I was struggling to cope with symptoms and searching for care, her dismissal came as a shock. I know now that her decision was right for her. She had her own problems and she had no time to help me with mine. 110

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It is harder to explain why doctors, psychiatrists and psychologists did nothing to help me get well. Maybe they were too busy. Maybe I wasn’t sick enough. Maybe cutbacks stretched their resources too thin. Maybe they just didn’t care. 2. Easy treatments I tried two easy treatments. The first was the talk-about-it approach. My counsellors used calming generalities and reassuring platitudes. Therapists seem to know how to talk to depressed people without explaining that the patient has a mental illness which can be treated restoratively. If a depressed person shares dark-sided ideas or angry outbursts, therapists know how to explore those negative feelings, for months. My therapists likely knew that if they tell a sick person he seems angry, it can make the depressed person express more anger, fear and frustration. Therapists could offer supportive information along with their counselling, consideration and concern. As mental health professionals, they always knew best. Their nimble minds ran rings around my dark and depressed brain. After reading that therapists have four hundred therapies in their therapeutic arsenals, I began to sympathize with them. They have so many sick patients and so many choices. It must overwhelm them. The other ‘easy’ treatment involved prescription antidepressants. I trusted the doctors who prescribed them. Fortunately, I only spent a year in the drug-induced haze that these medications produced while I was already unwell with depression. I hoped that the pills would help. I believed that antidepressants, antianxiety and mood stabilizing medications would work, but my body does not tolerate them. I am hypersensitive to medications, hypersensitive to rejection and hypersensitive to just about everything. Bloody annoying. I felt like a failure when the pills added negative, side, adverse and toxic effects to my symptoms. It seemed easy for mental health professionals to prescribe antidepressants and increase the doses even though these pills made me worse. The doctors hinted that the medications might have good effects but they did not warn me about the range of negative effects. It was scary to get worse while I was taking prescription medications. Maybe the doctors were too busy to explain the effects of medications. Soon after my mood shifted to an uncomfortable level of high energy called hypomania, a consulting psychiatrist, seeing me for the first time, told me an SSRI antidepressant was the cause. I was upset that pills could make a sick person worse. A call to the drug company confirmed that their antidepressant is known to cause this problem in some people. Their neuropsychopharmacologist was sorry. He seemed sincere, encouraging and supportive. FINDING CARE FOR DEPRESSION

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He recommended seeing the psychiatrist and asking for a lower dose. I was pleased that the drug company’s spokesperson was sympathetic but I could not bring myself to return to the psychiatrist for more mind-numbing drugs. While trying one of that doctor’s prescriptions for sleeping problems, I had a paradoxical reaction: I did not sleep for two days and had an explosion of suicidal thoughts. So much for the easy treatments. 3. Mistreatments My experiences with mistreatments involved being ‘treated’ with silence, laughed at, put-down and found fault with. I was discounted and distanced, rejected and excluded. I took medications that made me worse (by causing negative, side, adverse and toxic effects and triggering hypomania). The mistreatments were practiced by eight healthcare professionals. The worst practitioner used to just smile and say, “You will get well!” I understand health professionals trying quick and easy methods and hoping they might help. They seemed friendly when they smiled benignly. They experimented with pills, talked at me and worked through their repertoires. No matter how sick I was, they always got paid, either by me or by the public health system, even for mistreatments! 4. Restorative treatments If you think restorative treatment is the impossible dream of a delusional mental patient, it may interest you to know that I found restorative care. I have been stable, relatively well, and nearly ‘normal’ since 1996. I recovered using orthomolecular medicine. The reference section of this book has many books that explain the restorative approach to mental healthcare. There are a range of restorative treatments. You might wonder if this was a placebo effect. After living with a deteriorating mood disorder from the age of seventeen to the age of forty-five, when I first heard about orthomolecular medicine, I was skeptical. I was pleasantly surprised that it worked quickly and helped me get well, without negative effects. After extensive reading, I learned that orthomolecular doctors combine the life science of biochemistry with the arts of medicine and psychiatry. They help patients restore and maintain mental health. Their books share clinical success stories, scientific research and medical information. They know how to help patients recover and keep well. Directions for the Mental Healthcare Compass During three decades of mental problems, I experienced all the directions of diagnosis and treatment. These directions fit nicely into a mental healthcare 112

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MENTAL HEALTHCARE COMPASS Directions for Diagnosis and Treatment

FF • DN

QL • ET

find fault do nothing

quick label easy treatments

Minimalist

Conservative

Negligent

Restorative

MD • MT

AD • RT

misdiagnosis mistreatment

accurate diagnosis restorative treatments

Who cares if patients get worse? Which caregivers make the most money? How? Is there bias against restorative care? Why? FINDING CARE FOR DEPRESSION

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With The Dark Pain Of Depression, It Is Human To Seem Stuck

Where is the light?

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compass design. I encourage you to use the compass when you are exploring the mental healthcare maze. It can guide your search for accurate diagnosis and restorative treatments. It occurred to me to match each diagnosis direction with a corresponding treatment direction. A patient usually gets one or more treatments to go with each diagnosis. Any treatment can go with any diagnosis, but interviews with 150 depressed people taught me the four common combinations of diagnosis and treatment. 1. 2. 3. 4.

Diagnosis

Treatment

Direction

find fault quick label mistaken accurate

do nothing easy treatment mistreatment restorative

FF • QL • MD • AD •

DN ET MT RT

Laying out these words in a compass design made me realize that I had risked my life for years by exploring the healthcare maze in the wrong directions. The compass helped me see that I could restore and maintain mental health if I followed the directions for accurate diagnosis and restorative treatments. The practice guidelines of psychiatry encourage this approach. The guidelines were developed by a consensus of health professionals. After practising on thousands of patients from 1971 to 1991, they developed effective procedures for diagnosing and treating mental conditions. Ethical health experts recommend accurate diagnosis and effective treatments. Looking at the mental healthcare compass helped me see that my chances of restoring mental health were best if I searched for an accurate diagnosis of my condition and then found restorative treatments. It is no surprise that the practice guidelines recommend this quality of care. Sick patients need good directions to explore the mental healthcare maze. The mental healthcare compass can help. Testing the mental healthcare compass proceeded steadily. The typical response from test subjects was, “Aha, now I see which way to to go!” or “What a relief to learn where to look for care!” People say the same things when they use the compass design with TAYO – The Healthcare Planner (more about this later). It makes sense that mental patients can get better if they search for quality care, just as the practice guidelines of psychiatry recommend. Patients can use the compass to cooperate with competent health professionals, get an accurate diagnosis and focus on restorative treatments. If you are unwell with depression, mental episodes or a brain disorder, I encourage you to use the healthcare compass as you explore the mental healthcare maze. It can guide you toward restorative care. FINDING CARE FOR DEPRESSION

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About the Sucsan illustrations The illustrations of the depression survivor’s journey were provided by Charles Sucsan, a Quebec-based artist. You can walk with our depressed cartoon friend as he struggles through the darkness of depression, and uses the healthcare compass to explore the mental healthcare maze, find the light and get well. C h a p t e r

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USING THE MENTAL HEALTHCARE COMPASS TO FIND CARE FOR DEPRESSION

I

used the mental healthcare compass to find care for depression and other problems. After consulting with eight health professionals over twenty years, I felt helpless and hopeless because their advice did not work. I just got sicker. The compass helped me find quality care. Eventually, I was diagnosed accurately and recovered using restorative care for episodes of depression, hypomania and anxiety. I wonder how patients can be restored by insightless talks, synthetic medications (with negative effects), silence, laughter, rejection, exclusion, faultfinding and other shortcuts. Surely most mental health professionals would diagnose patients accurately and care for them effectively. Why not me? As I pondered failed relationships with health professionals, I thought, Enough already! I want to restore normal mood without adverse effects. It was time to learn about mental illness and understand what was happening in my brain. I needed a strategy to identify ineffective shortcuts and head toward recovery. If consultations with health professionals weren’t helping, I could read their books! I silently repeated my mental healthcare mantra, over and over again. Restore normal mood without adverse effects. I used the healthcare compass to consider the four directions for diagnosis: find fault, misdiagnosis, quick label and accurate diagnosis. Then I pondered the four treatment directions: do nothing, mistreatment, easy treatments and restorative treatments. It was obvious that each diagnostic direction fit with a corresponding treatment direction. One day something clicked. It was not in my best interests to explore the ‘find fault’ and ‘do nothing’ directions. Misdiagnosis and mistreatments didn’t work. Quick diagnosis and easy treatments made quick and easy money for health professionals but their methods did not help me. 116

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SHORT CUT MENTAL HEALTHCARE • Biased Toward Minimalist Effort • Assumes Patients Are Incurable

FF • DN

QL • ET

find fault do nothing

label and pills or talks

Minimalist

Conservative

Negligent

Restorative

MD • MT

AD • RT

misdiagnosis mistreatment

accurate diagnosis restorative treatments

Don’t discuss, do or document

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Expect Depression To Worsen With Misdiagnosis And Mistreatment

How did I get stuck down here?

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After twenty-eight years, I decided to explore the fourth direction of the mental healthcare maze. I wanted an accurate diagnosis and restorative treatments. The practice guidelines of psychiatry explain how ethical psychiatrists use differential diagnostic testing to determine the root cause(s) of each patient’s symptoms. A psychiatrist becomes a sleuth as he gathers clues and figures out what is making each patient sick. The workups involve patient histories, medical tests, mental status exams and interviewing patients to assess why depression is happening (e.g., asking about transitions, abuses, losses, grief or depressogenic, social or psychological factors). An accurate diagnosis is possible after analyzing the patient’s life and considering history, biology, medical, social and psychological problems, lifestyle, environment and any other factors which are known to cause or contribute to symptoms of depression, mental episodes or brain disorders. To get an accurate diagnosis, I reviewed my medical and mental histories – mood disorder symptoms since the age of seventeen – lengthy episodes of depression and rare hypomanias, monthly migraines and daily anxiety. High energy phases seemed to occur more often after an episode of hypomania that started when I was taking an SSRI antidepressant. Overall, my thinking was clear, logical and coherent. Even while suffering from depression, I could think and perceive accurately, albeit darkly. With no distortions of perception, hallucinations or psychosis, I did not have a thought disorder. Repeated episodes of depression with rare hypomanias, suggested that I might have a bipolar mood disorder, a form of manic depression. I read that there are mild to moderate forms of this condition, ranging from bipolar I, II and III, depending on how deeply and how often the patient has symptoms. My history and symptoms fit into the bipolar II category. However, the diagnosis was not complete without considering histories and medical factors. My mental status did not suggest schizophrenia, autism or epilepsy, although periodic migraines were seizurelike in their sudden presentation. Medically, I had back problems in my 20s but flareups of back pain were rare after that. An infected prostate did not recur after treatment. Medically, there was nothing obvious. Two relevant conditions came to light after I reviewed the family medical history. I learned that several family members had episodes of depression. My father’s cousin, on dialysis for a polycystic kidney condition, wrote that she had dreadful depressions. My mother and sister get migraines. My father also has a kidney condition. He had a kidney removed after an oncocytoma. FINDING CARE FOR DEPRESSION

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My mother developed adult-onset type II diabetes. My sister was diagnosed with celiac disease. My grandfather was intense, moody and volatile. One of his daughters, my half aunt, had an eating disorder. A second cousin had episodes of depression. The family history suggested possible causes of my symptoms. For instance, the difficulties suffered by my mother’s side of the family, my mother’s blood sugar disorder and my father’s kidney disorder might suggest genetic factors affecting brain fuels and neurotransmitter levels. If my kidneys were not working correctly, maybe they could not clear psychiatric medications. Even low doses might cause side effects. That might explain why modest doses of lithium caused me to suffer tremors and slip into an apathetic state, suggesting possible lithium toxicity. If my ability to process and metabolize medication was limited, that might explain why I was hypersensitive to antidepressant medications. I needed to find a nontoxic antidepressant which was tolerable for people with borderline kidney dysfunction. My mother’s diabetes made me wonder if I might have symptoms of hypoglycemia. My sister’s diagnosis made me wonder if the wheat in certain foods might trigger problems. Maybe it would help to balance my diet, by reducing sugar and cutting out foods with gluten. Repeating my mantra, I kept reading, hoping to find a medication with few side effects. An extract of the world’s oldest living plant, gingko biloba, turned out to be an effective antidepressant and it reduced my anxiety. I sent away for European medical books about scientific research, clinical trials and success stories of patients whose brain problems resolved after they took extracts of gingko biloba leaves. Gingko is also used by patients who have certain kidney problems. I was skeptical but a few days after I started taking gingko biloba, I was surprised to get significant relief from symptoms of depression and anxiety. A mild GI discomfort went away after I added garlic to help with digestion. Not every case of depression responds so well to gingko. I have been taking gingko biloba since 1995 with odourless garlic as a digestive aid and valerian at night for sleeping. In my case, these plant extracts do not cause problems or negative effects. I learned which doses work, considered the half life and planned the timing. I researched how quality phytopharmaceuticals (plant extracts) are standardized during manufacture. I learned that a person’s diet and nutrition can affect their mood and brain function. It seems obvious that the body makes brain fuels from nutrient building blocks. Changing my diet to eliminate milk, cut down on white sugar and avoid white flour and wheat products seemed to help. I read that kidney patients, not yet on dialysis, can benefit from a regimen 120

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MENTAL HEALTHCARE COMPASS Directions for Diagnosis and Treatment (Consider the practice guidelines of psychiatry)

FF • DN

QL • ET

find fault do nothing

quick label easy treatments

Minimalist

Conservative

Negligent

Restorative

MD • MT

AD • RT

misdiagnosis mistreatment

accurate diagnosis restorative treatments

Symptoms worsen. Sick person deteriorates.

Find root cause(s). Help patient recover.

Which directions are best for patients? Doctors? Which approaches diagnose correctly and treat effectively? FINDING CARE FOR DEPRESSION

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With A Quick Label – Easy Care Or Is It An Easy Label – Quick Care? Can a Good Outcome Happen? Can Depression Clear Up on Its Own? Can Any Illness Get Better by Magic?

Aha, I see some light!!

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of vitamins, minerals and amino acids. I experimented with supplements which are known to be safe and effective. I read that orthomolecular doctors recommend natural supplements for patients who have depression, mental episodes or brain disorders. Slowly, I developed a regimen that works for me however I had to learn the hard way that some supplements are not good for my brain. It is interesting that some supplements work better than others but not surprising. Dr. Roger Williams, a PhD biochemist, explains this in his book Biochemical Individuality. Although they are known to help some depressed people, these do not help me: 1. Folic acid triggers hypomania within 1/2 hour. My antidote is GABA. 2. Vitamin B-3 triggers a flush and a brain fog. I only take small doses. 3. SAMe seems to over-rev me. It has this effect on some bipolars. I do not take it. 4. Glutamic acid unsettles me but GABA is calming. 5. L-tryptophan can unsettle me. 6. Too much l-carnitine can be overly energizing. 7. Too much coenzyme Q10 can be overstimulating. Small amounts maintain energy. Information that a high histamine condition called histadelia can trigger episodes of depression came from the work of Dr. C. Pfeiffer. Recommendations in his book, Nutrition and Mental Illness, encouraged me to (1) take supplements of methionine (which come with choline and inositol), (2) take calcium and magnesium, (3) avoid folic acid and (4) take vitamin B-6 with zinc and manganese. Dr. Pfeiffer recommends increasing vitamin B-6 doses until the patient can recall dreams. I had not remembered dreams for decades, until the vitamin B-6 supplements restored my dream recall. Other suggestions came from The Way Up From Down, by Dr. Priscilla Slagle, a California psychiatrist whose own depression responded well to nontoxic orthomolecular supplements. She recommends vitamins, minerals and amino acids (such as l-tryptophan, l-taurine and GABA). Her book explains how to take supplements, starting with small doses, slowly and learn which ones help. The goal is to restore normal brain function without negative effects. Using my medical and mental history, family medical and mental history and books about restorative mental healthcare, I tried various supplements and developed the following regimen to restore and maintain mental health without adverse effects: FINDING CARE FOR DEPRESSION

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• moderate doses of plant extracts of gingko biloba, odourless garlic and valerian, as psychiatric phytopharmaceuticals; • nontoxic supplements of vitamins, trace minerals, amino acids, energy and enzyme cofactors and antioxidants (trials with essential fatty acids were unclear) Working slowly, over two years I learned to • identify and avoid trigger supplements like folic acid, SAMe, glutamic acid and B-3 • change my diet to cut out milk and reduce intake of sugar and white flour products. I slowly developed a restorative regimen by adding small doses of each supplement. I started with the lowest possible dose and learned, by trial and error, which ones work for me. Monitoring the effects of diet took time and I stopped eating foods which trigger depression episodes or brain fogs. As my depression cleared up, I began to have calm afternoons, then normal days and my sleep regularized. Recovery was uneven but I gradually improved until I had a normal week. When I had my first stable month for decades, I knew I was on the right track. I expected episodes of depression to recur but as long as I take the regimen of plant extracts and supplements, avoid trigger factors and watch the diet, there are no prolonged depressions. Now and then, there is a bad afternoon if I eat the wrong things or forget to take the regimen of brain fuel cofactors. After several normal months, I started to rebuild my life by shifting patterns of thinking, feeling and behaving toward the positive. This was easier when my brain was restored. I remembered therapy years before. With a stable brain, the advice of psychologists finally made sense. For instance, one psychologist recommended a daily journal to process personal issues. It helps to write goals and priorities, consider relationship possibilities and clear out personal garbage by writing in a daily journal. I still monitor my mental health and take the daily regimen. Brain restoration and maintenance worked. I have been stable since 1996. Although I do not advise other people to take supplements without supervision, I suggest that they read and learn. The mental healthcare compass can help them search for competent health professionals and cooperate with accurate diagnoses and restorative treatments. The standard of care procedures, the recommendations in the practice guidelines of psychiatry and restorative mental healthcare using orthomolecular medicine can help many patients recover from depression, mental episodes and brain disorders. Each patient has to take responsibility for finding competent health 124

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QUALITY MENTAL HEALTHCARE • Accurate Diagnostic Testing • Leading to Restorative Treatments

FF • DN

QL • ET

find fault do nothing

quick label easy treatments

Minimalist

Conservative

Negligent

Restorative

MD • MT

AD • RT

misdiagnosis mistreatment

accurate diagnosis restorative treatments Follows practice guidelines. Uses standard of care procedures.

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With An Accurate Diagnosis And Restorative Treatments Depression Lifts, the Outlook Brightens with Recovery and Restoration of Mental Health

I feel happy! I see the light!

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professionals, cooperating with good advice, noting medical and mental histories, asking for accurate diagnosis and using effective treatments. In my case, it was helpful to take regimens of nontoxic supplements, plantbased extracts of botanical medications which mankind has used for centuries and eat a diet which is nutritious and works for mood disorders, migraines, kidney dysfunction and hypoglycemia. Other patients may not find my regimen helpful. As unique biochemical individuals, each person can benefit by taking medications and a regimen of supplements which are customized for their brain biochemistry. Orthomolecular psychiatrists smile when I report my progress. They use the same approach with their patients. They do testing before they make a diagnosis. Then they design a program of restorative treatments for each patient. Their goal is to help each patient restore and maintain mental health by normalizing brain chemistry. I used the mental healthcare compass to restore my mental health. Based on my success and after reading that research scientists and medical professionals developed restorative methods and after interviewing other patients who have been helped, I am pleased to recommend the mental healthcare compass as a tool for finding care. I encourage people who suffer with depression, mental episodes or brain disorders to use the compass to explore the mental healthcare maze, consult with competent health professionals and cooperate with restorative care. C h a p t e r

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TWELVE STEPS FOR COPING WITH A MOOD DISORDER 1. Learn the facts about mood disorders and the reality of mental illness. Accept the symptoms, diagnosis, treatment, progress and prognosis; monitor self-esteem. 2. Ask doctors to follow practice guidelines and use standard of care procedures. Cooperate with competent doctors; avoid careless doctors who can make a sick patient worse. Do not trust short-cut alternatives; consider how healthcare laws focus on competent care. 3. Select a treatment objective (e.g., restoring health without adverse effects): Consider the variety of causes of mood disorders: genetic, medical, social and psychological. Explore restorative possibilities; medications, therapy, orthomolecular medicine and nutrition. Ask for help to recognize and reframe patterns of thinking, feeling, acting and reacting. FINDING CARE FOR DEPRESSION

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4. Learn about positive practices for mental healthcare; practice mental self care. Drug companies, doctors and pharmacists know about the negative effects of medications. Take responsibility for your illness; be kind to yourself; encourage other depressed people. Learn about quality care for mood disorders; connect, cooperate and ask for support. 5. Manage relationships with family of origin, wife, children and friends. Tolerate people who do nothing but find fault; accept contrarian views. Ask for RAISE: respect, approval, interest, support and encouragement. Watch for putdowns, negative judgements, rejection, exclusion and perfectionism. 6. Grieve mental illness. Work through losses and dark times. Shift to positive. Stages, struggles and stigma: fear, denial, anger, education, acceptance, peace and self-esteem. Effects on well-being: relationships, earnings, career, business, status and finances. 7. Monitor mood continuums and use capabilities. Every fallible human being can be productive; enhance your capabilities for positive purposes. Use restorative care to get well, live well, maintain normal brain function and recover zest. 8. See through the glass darkly. The world of mental patients can be paradoxical. Where rights are wrong and wrongs are right; long dark days; work to keep hope alive. 9. Encourage yourself and others to get competent care. Keep your life light on. To live well with a mood disorder; get depression coaching; find depression survivor buddies. Meet and learn from people who have mental conditions, caregivers and health professionals. Write a daily journal; respect the survivor’s perspective; share information and help others. 10. Integrate restorative biological and medical sciences with work and career. Restore and maintain mental health and self-esteem; network with psychiatric survivors. Believe in capability instead of disability; use intense moods productively. 11. Create symbols to help yourself, read and write, listen and learn. Read and write to heal; share tips and traps; find articles; encourage restorative care. Meet writers, take courses, interview survivors, attend support groups, read and learn. 12. Integrate mood disorder with a career. Find support services. Network. Research, develop and apply tips and tools to live well, share and find work. Maintain contact with local professionals, family and survivors; build a self-help network. Encourage self and others to live well with a mood disorder; consider on-line resources

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T A Y O

Think About Yo u r Options

The Healthcare Planner for Patients, Health Professionals, Family and Caregivers Focus on accurate diagnosis and effective treatments. Cooperate with standard of care procedures. Monitor quality of care; negotiate improvements. Target successful outcomes; avoid bad results.

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C h a p t e r

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TAYO – THE HEALTHCARE PLANNER: INTRODUCTION

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AYO – The Healthcare Planner was designed to help patients, health professionals, family and caregivers cooperate to find quality care. It encourages each patient and caregiver to Think About Your Options for diagnosis and treatment. TAYO, The Healthcare Planner, directs patients, health professionals, family and caregivers to focus on accurate diagnosis and effective treatments and help the patient restore mental health and keep well. If depression, mental episodes and brain disorders are not diagnosed accurately or treated effectively, patients tend to get worse. Many patients gamble with their health by not getting quality care. TAYO can help people discuss their options, make better choices, plan for recovery and coordinate care. With a good plan, a successful outcome is more likely! TAYO – The Healthcare Planner TAYO uses three planning diagrams. Depression survivors and patients can do TAYO plans on their own or work with health professionals, family and caregivers. TAYO uses the mental healthcare compass for exploring the mental healthcare maze. There are four directions for planning healthcare: 1. 2. 3. 4.

Minimalist = FF & DN = find fault and do nothing Negligent = MD & MT = misdiagnosis and mistreatment Conservative = QL & ET = quick label and easy treatments Restorative = AD & RT = accurate diagnosis and restorative treatment

There are Two TAYO Planners for Diagnosis and Treatment The first planner is for diagnosis. Each participant can mark their choices. After each person notes their preferences, it will be obvious whether they are working together to obtain an accurate diagnosis. The second planner is for treatment. Each participant can mark their choices. After each person notes their preferences, it will be obvious whether they are cooperating for restorative treatments. The Third TAYO Planner Uses the Mental Healthcare Compass The third planner combines the options for diagnosis and treatment with the mental healthcare compass. Each of the four directions has one diagnosis square and one treatment square. After using the diagnostic and treatment planners, people can mark their choices on the third planner. Each person involved with the patient and his care can explore the mental healthcare maze by choosing diagnosis and treatment options. The goal of 130

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TAYO – THE HEALTHCARE PLANNER Think About Your Options

T A Y O P

D

F

C

Options For Diagnosis FF

Find fault

MD

Misdiagnosis

QL

Quick label

AD

Accurate diagnosis (1)

Note (1) – differential or root-cause.

T A Y O P

D

F

C

Options For Treatment DN

Do nothing

MT

Mistreatment

ET

Easy treatments

RT

Restorative treatments

The Planners

The Plan

P D F C

T A Y O

= = = =

patient doctor family caregiver

= = = =

Think About Your Options

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healthcare planning is for participants to explore in the same direction. The object is for the patient to get well, the family and caregivers to get their friend back in good health, restored with zest for life. How can People Use the TAYO Planners? The patient uses the ‘p’ squares. The doctor uses the ‘d’ squares. The family uses the ‘f’ squares. Other caregivers use the ‘c’ squares. People can discuss their choices and consider all the options. Number of Plans TAYO healthcare plans can be updated every day or whenever people say “TAYO – Think About Your Options!” The plans can be used for as long as it takes to f ind quality healthcare. Each person can copy the planning diagrams, review the choices and consider the options. People can compare their plans and discuss possibilities. Each participant can change his preferences and adjust his plan for a positive outcome. Results of Healthcare Planning There are many possible outcomes when patients, health professionals, family and caregivers use TAYO – The Healthcare Planner. Two outcomes are outlined: A Bad Outcome Is Likely After Substandard Care

The Planners

The Plan

P D F C

T = A= Y= O=

= = = =

patient doctor family caregiver

With poor healthcare, what can happen? Who gets better? Who gets paid? 132

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Think About Your Options

The patient may want an accurate diagnosis and effective treatment but if no one else explores that direction, the patient is not likely to get well. Health professionals know all the options. If a sick patient deteriorates, the doctor can revise the diagnosis and plan new treatments. If a patient gets worse, the family loses, and caregivers lose. Whatever happens, health professionals still get paid. If the patient wants restorative care, he will focus on the AD and RT squares and ask for quality care. If health professionals head off in other directions, the result is not going to be good. If there is poor care, the mental patient will stay sick – a bad outcome. This will lead to more patient visits and unnecessary suffering. A Good Outcome Is Likely Using Quality Care

The Planners

The Plan

P D F C

T = A= Y= O=

= = = =

patient doctor family caregiver

Think About Your Options

With an accurate diagnosis and restorative treatment the patient can recover and keep well!

If the patient finds a competent doctor who is willing to accurately diagnose the root cause of the patient’s symptoms and recommend effective treatments to help the patient get well, the patient can explore the restorative direction, cooperate with the doctor and make positive progress. With brief explanations, the doctor can explain the standard of care procedures for AD diagnosis and RT treatments. Family and other caregivers can be informed. Quality care is most likely to produce a successful outcome. The patient gets well, the doctor gets paid, qualifies for referrals and builds his FINDING CARE FOR DEPRESSION

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professional practise based on success stories. The family has peace and caregivers see the patient recover and maintain mental health. To enjoy a good outcome, participants can focus on the AD and RT squares. They can cooperate and explore the same directions until they discover the of the root cause(s) of the patient’s depression, mental episodes and brain disorders (i.e., get an accurate diagnosis). Keeping in mind that over 50 medical conditions can cause or contribute to symptoms of depression and other brain disorders, it is important for each patient to be diagnosed accurately. After making an accurate diagnosis, a competent health professional can usually recommend effective treatments. If a patient receives restorative care, the patient is likely to recover and keep well. Overview of TAYO – The Healthcare Planner TAYO comes with three planning diagrams. The first is for diagnosis; the second is for treatment and the third uses the mental healthcare compass. People can update TAYO – The Healthcare Planner every day or as convenient. Each planner can focus on any of the options for diagnosis and treatment. People can explore any direction, compare notes and discuss choices. If patients, health professionals, family and other caregivers cooperate to head in the same direction, there will likely be quality care and a good result. If they explore in different directions, there will likely be poor care and a bad outcome. TAYO – The Healthcare Planner can help people cooperate with accurate diagnosis and effective treatment of depression, mental episodes and brain disorders.

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TAYO – THINK ABOUT YOUR OPTIONS – HEALTHCARE PLANNER The Planners, their Options, and Hints for a Successful Health Plan The Planners and their squares P = patient (uses P1 to P8) D = doctor, health professional (uses D1 to D8) F = family (uses F1 to F8) C = caregiver (uses C1 to C8) The Options Four Options for Diagnosis F F = find fault MD = mistaken diagnosis Q L = chat and a quick label AD = tests and an accurate diagnosis • to find the root causes

The TAYO Planning Guide 1. The patient uses the 'P' squares to consider the options and plan for diagnosis and treatment. 2. The doctor uses the 'D' squares to consider the options and plan for diagnosis and treatment. 3. Family members use the 'F' squares. 4. Caregivers use the 'C' squares. 5. Planners can compare and discuss. 6. All planners win if the patient gets well!

Four Options for Treatment DN = do nothing MT = mistaken treatment E T = easy treatments eg. pills and more pills and / or talks and more talks RT = restorative treatments • To resolve underyling medical, mental, metabolic, biochemical psychological or social problems. • To restore normal brain function without causing negative effects, (to the extent possible in each case). A Riddle Which of the 64 outcomes is best? 4 planners x 4 diagnoses x 4 treatments = 64 possibilities.

Hints for a successful outcome 1. Restoring mental health is more likely after an accurate diagnosis and effective treatments. 2. People can discuss, compare and cooperate. 3. Planners can agree to explore the same directions and coordinate their plans for positive progress. 4. Health professionals can plan to follow professional practice guidelines for accurate diagnosis and use standard of care procedures. 5. Health professionals can plan to use proven, safe, effective and restorative treatments.

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TAYO – THINK ABOUT YOUR OPTIONS – HEALTHCARE PLANNER For Patients, Survivors, Health Professionals, Family and Caregivers: Planners can note their preferences for diagnosis and treatment monitor quality of care, explore the mental healthcare maze

Find Fault

Do Nothing

P1

D1

P2

D2

F1

C1

F2

C2

FF • Find Fault Discount Discourage Disapprove

DN • Do Nothing No treatment No therapy No care

Minimalist Negligent

Misdiagnosis P5

D5

P6

D6

F5

C5

F6

C6

MD • Misdiagnosis No history No testing, prior files No mental status exams 136

Mistreatment

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MT • Mistreatment Sick person gets worse Negative or toxic effects Incompetence, negligence

TAYO – THINK ABOUT YOUR OPTIONS – HEALTHCARE PLANNER Patients use squares P1 – P8, Health Professionals D1 – D8, Family F1 – F8, Caregivers C1 – C8

Quick Label

Easy Treatment

P3

D3

P4

D4

F3

C3

F4

C4

QL • Quick Label A short chat A DSM label A disorder

ET • Easy Treatment Medications Talk therapy Shock therapy

Conservative Restorative

Accurate Diagnosis

Restorative Treatment

P7

D7

P8

D8

F7

C7

F8

C8

AD • Accurate Diagnosis Mental status exams Take histories Diagnostic tests

RT • Restorative treatment Effective care Treats root causes Helps patient recover

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C h a p t e r

2 2

FINDING ADVICE ABOUT MONEY MATTERS

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s an independent consultant, I work with local clients. About 30% suffer with depression, mental episodes or brain disorders. Since I have a bipolar II mood disorder and migraines, I understand how involuntary brain conditions can affect daily life. Every person wants to live well in spite of their symptoms and episodes. I encourage people to search for competent advice about medical and money matters. It helps to find professionals who understand mental illnesses, brain conditions and psychiatric guidelines. The best advisors know that distresses, strains and illnesses can affect education opportunities, job performance and career prospects not to mention earning capacity, investment capabilities and financial decisions. Consultations with financial advisors can help sick people manage their money. Before advising, I learn about each client’s comfort zone. When clients have business worries or tax tangles, they move out of their comfort zones. They appreciate care, concern, timely solutions and practical advice. There is a circularity to the psychology of money. When a person feels well, he works hard, spends wisely, invests carefully and saves consistently. He is relaxed and motivated to perform well. He can work, earn and invest. He tends to make good money decisions. He lives well and adds to his savings. He provides for his family and plans for the future. When he gets sick, these things can shift to the negative. Money patterns learned in childhood may be illogical or irrational but people tend to repeat familiar thoughts and feelings about money. Their spending habits are usually careful and consistent. However, when people get sick, their money perceptions shift toward the dark side. Their behaviors change as they struggle to keep up with their bills. Mental distress can skew people’s money patterns toward the negative. When people are unwell with depression, they can get stuck or spiral downward. They may feel helpless and hopeless. Their thoughts, feelings and actions may become unstable. They may take time off work and use their savings to pay for living costs, medications and therapy. If their conditions worsen, depressed people can lose hope and self-confidence. As their incomes decline, investments may destabilize and their decisions may become subjective. Depressed people feel the painful symptoms of their illness when they are thinking badly about their lives and feeling unsettled about their prospects. They can become anxious 138

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or fear the worst. When their judgement is not normal, people can panic, act rashly or even harm themselves. Sick people may have a good net worth but feel uncomfortable about their financial position. When depressed, people tend to recall their problems, ruminate about losses and worry about investments. When their perceptions are gloomy, they may focus on their fears or unstable situations. Things can shift from negative to overly positive if a mood-disordered person experiences high energy states known as hypomania (mild) or full blown manias (severe). During up and down mood disorder episodes, distressed people may dwell on past mistakes, obsess about illogical investments or spend money unwisely on grandiose schemes. They may not be predictable. People with mood disorders use variable psychologies of money, depending on the status of their condition. When they are well and stable, they use their normal patterns. When depressed, their money patterns may become negative; when hypomanic, their money patterns can seem overly ambitious. Two of these patterns may not be realistic. Before a crisis develops, it can help to consult with a financial advisor who can review a financial plan and give independent advice. Paradoxically, during high energy episodes of hypomania, people may focus more intensively, work harder, think faster, surge creatively and generate new ideas. It may be hard for them to listen when their energy is highly charged and they are overly optimistic. When clients are distressed, they appreciate supportive advice. They may have money worries while they are having symptoms of brain disorders. A depression episode can involve up to fifteen characteristic symptoms and there are opposite symptoms for hypomania. If a client has troubling symptoms, recurring episodes and chronic mental conditions for years, his mental condition can become a significant handicap. An untreated or lingering illness will affect job performance, career prospects, earning power, financial perceptions and money decisions. A consultation between a financial advisor and a depressed client starts with an interview and focuses on making effective use of the client’s capabilities and resources. An accountant normally helps a client prepare reports of their net worth and business operations, fill in tax returns and update career and personal plans. Clients want answers to money and investment questions, tax tips, and solutions to problems as they work to build their businesses, develop careers, maintain financial positions, increase their net worth or enjoy their retirement years. FINDING CARE FOR DEPRESSION

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During the first meeting with a new client, I listen carefully. Sometimes I wonder what is not being said. If a client seems depressed or has an involuntary condition, I try to understand his point of view. I draw on my own experience of living and working with a bipolar mood disorder for decades. I encourage each client to explore his capabilities, outline his mental and medical histories, ask family for background information and consult with health professionals to assess the genetic, medical, social and psychological causes of his condition. If a client has a mood disorder, I explain that a depressed person can restore normal mood without adverse effects by finding competent medical advice and asking for restorative treatment. This involves searching for health professionals who have proper credentials and relevant experience. It is important to find caregivers who know about restorative mental healthcare. The best professionals do medical testing before making a diagnosis. They recommend nontoxic medications and they offer proven therapies which helped other patients recover and keep well. Since 1996, I interviewed and worked with many people who have involuntary brain conditions such as depression, bipolar disorder, manic depression, dysthymia, anxiety, obsessive-compulsive disorder, post traumatic stress disorder, attention deficit hyperactivity disorder, autism, epilepsy, stroke, migraines, Menieres, dementia or cancer. They are fascinating people. Their most common complaint is depression. I wrote a composite case based on consultations with several depressed clients. The story started when a local chap called for information about mental accounting services. During our first session, he reported suffering for decades with episodes of depression. He consulted with several healthcare professionals: a psychiatrist for medications and a psychologist for therapy. When he does not feel well, he constantly worries about his financial situation. Before we discussed the details, he asked if his personal, medical, psychological and financial information would remain confidential. Although an accountant does not have client-solicitor privilege, client information is confidential. His diagnosis was not clear to him. He described being depressed but not manic. His doctor was treating him for unipolar depression, which usually involves black and blue moods. He was taking several medications but did not understand their potential for causing negative effects. At times he was talkative, but he did not seem to be excessive or inappropriate. Patient 140

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education about mood disorders could teach him about his diagnosis, medications, therapy, treatments, options and prognosis. He could ask for a second opinion about his condition, testing, diagnosis and drugs. He was taking several medications: antidepressant, antiseizure, antianxiety and sleeping pills. He could not concentrate, his mind seemed foggy, his memory was poor and he was unhappy. We discussed how a medication like lithium can stabilize a depressed person’s mood, sometimes below his comfort level. Antidepressants and other medications often help but they can make a depressed person seem worse if there are negative effects. Apparently his doctor had not explained these risks and was not monitoring his blood levels of medications. A patient can ask his pharmacist for reports which outline the negative effects of prescription medications, check off side effects and discuss problems with his doctor. Adjustments in the dose, timing and type of medication can be made until the patient gets the most benefit possible with the fewest negative effects. If side effects worsen, a patient can ask his doctor to investigate drug reactions, monitor blood levels, change medications or reduce doses. Before giving money advice, I ask each client to consider his treatment objective and let his doctors know his preferences. When people are not aware of the facts, I explain that antidepressants can numb the pain of depression, dull cognitive function and stimulate energy. Short-term depression is sometimes treated with this “numb-dumb-stim” approach. Chronic depression can be treated effectively using restorative methods. If effort is made to determine the root cause of the patient’s symptoms, a good doctor can recommend effective treatments and help the patient get well. I ask each client if he wants to restore mental health without adverse effects and whether he has explained his healthcare goals and objectives to his health professionals. If a client wants to get better, I suggest getting opinions from their local specialists. An orthomolecular psychiatrist, an internist, a neurologist, an endocrinologist or a naturopath can help. The field of orthomolecular psychiatry applies the life science of biochemistry to the art of medicine. These health professionals use detailed biological and medical tests and other diagnostic procedures to determine the root cause of each patient’s chronic health problem. An orthomolecular doctor is trained to assess brain functions, identify biochemical imbalances and recommend supplements of vitamins, trace minerals, amino acids, energy and enzyme co-factors, essential fatty acids, antioxidants and other FINDING CARE FOR DEPRESSION

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nontoxic nutrients. They may recommend low doses of prescription medications. The restorative approach can help a depressed person recover normal brain function. With medical supervision, some patients can gradually reduce their antidepressant medications until there are fewer negative effects. The typical depressed client usually thinks that his financial situation is in a dreadful state. Darksided ruminations are common during episodes of depression. A client may worry that he made bad investment decisions when he was sick. Even though I surprise the client by reviewing his mental status, symptoms, history, diagnosis and treatments before discussing money matters, we review his net worth, work, income, financial position, tax status and business issues. I explain that with proper medical advice, many patients can recover, adjust their medications, take nontoxic brain ‘fuel’ supplements and restore normal mood without adverse effects. When a client feels better, his dark and negative view of himself and his money slowly resolves. He realizes that his financial picture is brighter than he thought. Many chronically depressed people have not worked to their full potential for years. They have painful memories of episodes and outbursts, medication effects and failed treatments, relationship problems and career setbacks. As a client gets better, I suggest that he plan to resume the work he enjoys, rebuild his career and reactivate his network of friends and contacts. This cannot happen overnight, but progress is possible after effective mental healthcare. Financial consultants can help when clients are experiencing episodes of depression or a mental illness. The advice varies depending on each client’s brain disorder. Adjustments in the nature and frequency of consultations depend on the stage of the illness and the severity of each client’s problems. If a client is unhealthy when evaluating new investments, he may need advice before taking big steps, making unusual choices, planning large expenditures or considering major decisions. I encourage each client to take responsibility for his illness, find restorative treatment, maintain his brain and cooperate with competent mental health professionals. I do not offer medical advice or therapy. If a client has a dark-sided focus, money worries or lingering doubts about restoring mental health, he can ask his accountant, banker, investment advisor, financial planner, lawyer or consultant for advice about personal and business planning, money matters and financial problems. 142

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HELPING A RETIRED CLIENT AND HIS FAMILY COPE WITH DEPRESSION Arthur, a 69-year-old retired professional, was worried, confused and upset. His cash position was tight after he withdrew $50,000 from his savings account, bought a new car and booked a six week cruise. He berated himself for overspending. Lately, he had trouble concentrating and difficulty sleeping. He was forgetful, lost his appetite, drove erratically and had blue moods. After his last episode of depression, Arthur stopped taking his antidepressant and sleeping medications. He was fed up with their side effects. Now he was dispirited and anxious about getting sick again. This time he felt a lot worse. His wife was concerned and his adult children were worried. They wondered what was wrong and whether they should do something to help Arthur. “Do money problems cause depression?” Arthur asked Bob, his accountant. After a sigh, Arthur added, “Or, does depression cause money problems? “Neither,” said Bob. “But people worry about money when they don’t feel well. “Should we sell our home?” fretted Arthur “I don’t think my wife can manage with me sick and the house to look after.” “Before we chat about such a big change to your lifestyle, let’s discuss how you can get proper medical care.” said Bob. “If you can stabilize and maintain good health, you will be more comfortable. Then we can update your financial plan for retirement.” When a retired client suffers with a brain disorder and has money worries, it can challenge family and financial advisors who are not familiar with mental illness. Should they ignore medical matters? When concerns multiply, how can caregivers help? Without giving medical advice, an advisor can suggest that the client see his doctor, have a mental status exam, get an accurate diagnosis and cooperate with effective treatments. There is no need to panic. After the client’s medical situation is clarified, an advisor can discuss money matters and update financial plans. Quick tips for coping with episodes of depression 1. Brain disorders like depression and anxiety have a number of possible causes. These chronic but treatable conditions can be diagnosed accurately and treated effectively. If there is an uncharacteristic episode or any unusual behavior involving money, the family can call their doctor and schedule a check-up. After the client gets a diagnosis, the advisor can listen as the client or family members explain the ongoing treatments. A financial advisor can encourage the client and his family to monitor the progress of treatments and budget for healthcare costs. 2. Doctors can easily prescribe medications for depression and anxiety. If an episode continues or worsens, the client will need follow-up care to discover the root cause of the symptoms and get restorative treatments. A financial advisor whose client is deteriorating can encourage the client to ask for a second medical opinion. FINDING CARE FOR DEPRESSION

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3. Before stopping any medications, the client should consult with his physician. The doctor will explain how long to continue taking each one. An advisor can suggest that the client discuss concerns about medications with qualified health professionals. If the client has negative effects when taking prescribed pills, the patient and family can ask about adjusting doses. His doctor can see the client more often during transition periods and monitor the patient more closely. His pharmacist can discuss side effects. The client and family members can note the effects of pills, provide documentation and coordinate consultations with health professionals. A financial advisor can advise the client to make notes about ongoing difficulties. 4. Before making major decisions or spending money impulsively, the client can call a financial consultant. If the client reviews the situation with his accountant, banker, investment advisor, lawyer, planner or insurance agent, the client can get objective advice. An independent advisor can help the family recognize when to call for advice, help the client adjust his financial goals and offer objective advice about investments. When the client’s diagnosis and treatments are known, a financial adviser can consider how healthcare costs will affect the client’s financial and retirement plans. 5. After a spending spree, it will take time for the client to replenish his savings. An advisor can reassure a despondent client so he does not sink into despair while ruminating about money. With patience and persistence, the client’s situation can improve. An advisor can do a financial check-up and encourage the client as he adjusts to his diagnosis and treatments. An advisor can help the client monitor expenditures, modify financial plans, rebuild his savings and adjust his lifestyle. If a client gets sick with depression, a mental episode or a brain disorder, it takes time for the client, family and caregivers to understand what is happening, accept the involuntary symptoms, find competent care, learn about medications, monitor treatments and regain perspective. The client’s family can help. A financial advisor can encourage a sick client to get medical advice, see his doctor and call his therapist. When the client is comfortable, the advisor can discuss money problems, resolve financial concerns, update financial plans and coach decision-making.

C h a p t e r 2 3 CONCLUSION TO TOOLS FOR FINDING CARE

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atients and family can use the tools in Part Three to explore the mental healthcare maze and find restorative care for depression, mental episodes and brain disorders. The tools can help psychiatric survivors and caregivers who want to find competent care.

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Mental patients can use these tools even when they are sick and tired of being sick. Patients may feel helpless and hopeless but they can still ask for restorative care. Patients can cooperate with competent health professionals. Many patients can get well, even those who suffer with multiple involuntary symptoms as well as negative effects of powerful medications. Trusting patients may be vulnerable. Mental patients may be stigmatized, laughed at, treated unkindly, shunned, discounted or silenced but they are worth caring about. They just want to get well. Psychiatrists can follow their professional practice guidelines and use standard of care procedures for diagnosing accurately and treating effectively. If professionals do not have the time to explain the guidelines to patients, family and caregivers, they can recommend reference books. Patients trust doctors to use professional judgement when they apply guideline recommendations. Hospitals may not monitor the quality of care or report doctors who rely on short cuts. Patients, family and caregivers can review progress and ask for proper care. They can look for competent health professionals and cooperate with physicians who care enough to use practice guidelines consistently. With four hundred or more talk therapies, there are no consistent standards for therapy. Research studies are analyzing the effectiveness of counselling. Even though therapy is an important part of the mental health system, there is little monitoring of the quality of counselling. With cost-cutting, closure of hospital beds and a staff shortage, there are fewer resources for teaching patients about their conditions, diagnosis, treatment and prognosis. Some patients have to find their own way through a dark and painful maze of fallibility, fear, frustration and failure. Patients, family and caregivers should not give up hope. They can use the tools in this book to search for care. After an accurate diagnosis and effective treatments, many patients can recover and keep well. Patients who are misdiagnosed and mistreated can document their concerns and ask their doctors to apply standard of care procedures for restoring their health and keeping them well. This book has practical tools for patients, family, and caregivers who want to explore the mental healthcare maze. There is a layman’s introduction to the practice guidelines of psychiatry; tips and traps, tools and tales; mental healthcare reality check; health professional assessment and negligence checklists, a mental healthcare compass, TAYO – The Healthcare Planner and advice about money matters. Part Four has references for restoring mental health. FINDING CARE FOR DEPRESSION

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4

P a r t

References for Restoring Mental Health

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INTRODUCTION TO REFERENCES FOR RESTORING MENTAL HEALTH

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t took me decades to find quality care for depression and other problems. Bibliotherapy got me well. When I was sick, I wanted help. The up and down phases of my bipolar condition affected me but for years, I didn’t know I had a mood disorder. In my 20s, I sought medical advice. This was nine years after my first episode of major depression. The psychiatrist used a silent treatment. That didn’t help. When I sought medical advice again, the family doctor laughed. That didn’t help either. After 28 years of problems, misdiagnosis and substandard care, I was sick and discouraged. I had two labels for my condition: depression and dysthymia (chronic depression). While it was good to have names for the symptoms, they were wrong. Eventually, I learned that without a correct diagnosis, a patient doesn’t get quality care. I don’t have plain depression; I have a form of manic depression, a bipolar II mood disorder. Since the age of 17, I have been moody and anxious, intense and variable. Long episodes of depression came between normal periods. There were rare hypomanias. As the years passed, the episodes of depression deepened and lasted longer. It was uncomfortable to feel so dark and defective, helpless and hopeless. I wanted to restore normal mood but I was too confused and upset to achieve that goal on my own. In 1996, a depression survivor suggested orthomolecular medicine. Even though I have a degree in biological and medical sciences and psychology, orthomolecular was a puzzling word. My psychiatrist told me not to read, but I began to look for information about restorative mental healthcare. Episodes of dysthymia and major depression did not stop me from reading. By distracting me from the dark side of depression, the helplessness and the hopelessness, reading was an effective therapy technique. I learned the truth about mental illness. Insightful writers introduced me to other patients with the same problems and competent doctors who knew how to help. The first books were clear and well-written but they offered no hope of restoring normal health. Many books later, I realized that conventional mental healthcare was not working. I wanted to restore and maintain normal mood without negative effects. By the end of 1995, I had deteriorated. Years of depression and problems with synthetic antidepressants had taken their toll. I was worse and often thought about suicide. Most days it was painful to go on but my family was depending on me. It was frustrating to 148

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be so sick. I trusted health experts but only received substandard care. I do not suggest that any mental patient should stop taking their medications without supervision, but my SSRI medication was causing me to experience daily migraines, hypomania and other unwanted effects. I was only taking a medium dose but my system could not tolerate this type of medication without a number of negative effects. After prescribing antidepressants, my doctor, a conventional psychiatrist and a mood disorder expert, knew that I was experiencing hypomania. Knowing that I was suicidal, he let me sweat it out at home. He did not reconsider his diagnosis or offer support. His substandard care was not restorative. Desperate for help, I decided to stop taking a benzodiazepine medication. After reading that three plant extracts (phytopharmaceuticals) gingko biloba, odourless garlic and valerian – are commonly used in Europe and the Far East, I decided to try them. Highly skeptical, I started to take a simple regimen of these three extracts. Even though I doubted that they would work, these traditional medications quickly helped me feel better. Then I weaned myself off the SSRI antidepressant. My psychiatrist did not explain my condition so I kept reading. I learned: (1) how depression is supposed to be diagnosed and treated, (2) how mental status exams are done, (3) how over fifty medical conditions can cause or contribute to symptoms of depression, (4) how medical testing can check for biological factors, (5) how mood disorders run in families, (suggesting genetic factors as well as other vulnerabilities), (6) how psychologists use talk therapies to help depressed patients, (7) how conventional psychiatrists often prescribe antidepressants (alone or in combinations using an arsenal of over 20 psychiatric medications. If depressed patients do not respond to single treatments, they may be given two or more pills.), (8) that combinations of therapy and pills can help depressed people and (9) that practice guidelines were developed by psychiatric associations (which compiled the expert opinions of mental health professional members into a consensus series: one guideline for each mental illness. These inform clinicians and help patients). It was fascinating to read. The more I learned, the less I had to be afraid of. I began to focus on recovery. Before stopping the prescription medications (which were making me worse by adding negative effects to my symptoms), I learned about restorative care. Some nutritional supplements help my bipolar brain so its intensity does not delplete fuels and lead to depression. Others calm me down. Any changes in medications should be supervised by health professionals. When I stopped taking my pills, I did not know the risks. After horrible experiences with hypomania induced by the SSRI antidepressant and a difficult FINDING CARE FOR DEPRESSION

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time stopping the medication, I learned that the proper procedure involves weaning a patient slowly off each pill while monitoring for problems such as withdrawal or rebound insomnia. The worst cases may need supportive hospital care. My psychiatrist did not explain risks or offer support. He just let me suffer: sick, alone and suicidal. I am NOT suggesting that you should replace your medication with any old supplements. To repeat, and to warn readers, I am NOT recommending that you stop taking any prescription pills. That could be disastrous. Knowing that your doctor is busy and that you want help (or you would not be reading this book), I advise you to read and (1) learn about your condition, (2) educate yourself about the treatments which are known to be restorative, (3) understand the practice guidelines of psychiatry and (4) find quality care for your depression, mental episodes and brain disorders. Qualified health professionals can help you recover by using standard of care procedures and following their practice guidelines. Short cut alternatives are not likely to help you; incompetence or negligence can damage your life. By studying, I learned that since the 1950s, orthomolecular doctors have been combining the life science of biochemistry with the art of medicine. They offer hope for restorative mental healthcare. I read books by doctors who (1) recovered from their own depressions, (2) eliminated their brain allergies, (3) reduced their intake of sweets after refined sugars caused hypoglycemia, (4) cleared up their brain fogs, (5) identified their food sensitivities and (6) took supplements of vital amines, trace minerals, amino acids, antioxidants, energy and enzyme co-factors and essential fatty acids. These doctors documented how they learned which supplements can restore brain chemistry and how they developed protocols to help patients recover and keep well. I read that some depressed people respond well to simple regimens of natural supplements while other patients need complex regimens. The best books explained how orthomolecular psychiatrists and naturopaths are trained to identify imbalances in brain chemistry and care for patients until they can live independently, work productively, make money and pay taxes! Those books renewed my hope. The promise of restorative mental healthcare sounded too good to be true. I started to take brain ‘fuel’ supplements in small doses – worrying that they might make me worse. That was a sensible precaution. While I was taking synthetic antidepressants which caused me to experience ‘side’ effects, I learned what a negative effect felt like. When three supplements turned out to be unwise choices, I knew enough to stop taking them right away. There were only a few problems as I gradually tested a series of supplements and learned which ones balance my brain ‘fuels’. 150

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Fortunately, the negative effects of natural supplements did not last long. For instance, when I took supplements of a vitamin called folic acid, which is known to help many depressed people, it caused me to experience hypomania. I found a reference book which explained that my type of brain imbalance does not respond well to folic acid. Fortunately, GABA proved to be a quick antidote to hypomania. When vitamin B-3 caused me to experience an uncomfortable flush and an episode of brain fog, Dr. Abram Hoffer wrote to encourage me not to give up. He learned from schizophrenic patients that vitamin B-3 (also called niacin) has restorative capabilities. Dr. Hoffer patiently explained that my reaction to vitamin B-3 proves the principle of biochemical individuality – each patient’s brain works best with the right biochemical supplements in the right quantities. After taking three phytopharmaceuticals and a few supplements, I read Nutrition and Mental Illness by the late Karl Pfeiffer, PhD, MD. That book explained how supplements of vitamin B-6 work with small doses of zinc and manganese to help brain enzymes and other processes. When I tried taking them separately, nothing happened and I got discouraged. When I took them together, they worked. Now I take them as a team of three – the vitamin is balanced with two complementary trace minerals. Just as Dr. Pfeiffer predicted in his book. Slowly and steadily, I added other supplements and learned which ones help my brain. I have been stable since 1996. I feel much better now. Orthomolecular medicine helps me maintain normal brain function without negative effects. I know there are other treatments for depression because I tried them – talk therapy and synthetic medications. The restorative approach consistently gives me better results. If you wonder whether a person with a bipolar disorder can ever be ‘normal’, maybe you will accept that I am better. I may not be perfect, but I am perfectly good enough to live well and work productively. I hardly ever get depressed or hypomanic (then only briefly). I still tend to be VVV-RISCE-H – variable, volatile, vulnerable (to depression and hypomania), reactive, intense, hypersensitive, periodically creative, surgingly energized and hypergraphic (I write a lot). This curious profile is typical of people with mood disorders. We are an intense and moody bunch. Several years before I recovered, I started writing a journal. When I was depressed, a psychologist suggested that regular writing might help me connect confused feelings, vent painful issues and safely express fears, frustrations and failures. I noted patterns of thinking, feeling and behaving and identified stuck places. Without expressing moody outbursts inappropriately, writing helps me focus and live well with a chronic disorder. FINDING CARE FOR DEPRESSION

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Writing is a productive use of my brain’s capabilities. This is a good example of how a patient can reframe and transform characteristic symptoms into productive capabilities. In theory, every person who has a brain disorder is also gifted with a brain energy profile which they can learn about and apply productively. No, it isn’t quick or easy to reframe and reapply unusual brain ‘energy’ patterns, especially during dark depressions or delusional schizophrenias, but it can be done. Even normal people have to learn about their strengths and weaknesses, faults and fallibilities. Everyone learns from experience as they search for their positive purpose in life. Mental patients are no different except that our brains are vulnerable to episodes involving low brain ‘fuels’. Shadow Syndromes by Dr. John Ratey and Catherine Johnson, PhD can “identify the hidden time bombs in your personality … [and suggest] proven treatments and strategies [to] … change your life.” Finding Care For Depression has over 250 references for readers and caregivers who want to learn about depression, mental episodes and brain disorders. There are many books about restorative mental healthcare with success stories and current resources. Quality references can help people cope with chronic conditions or understand family members, friends or acquaintances who live with depression, mental episodes or brain disorders. There are four types of books about mental illness. It is useful to read at least one book from each category. You can learn the truth about mental illness: accurate diagnosis and restorative treatments. Standard, survivor, health profession survivor and restorative 1. Books by psychiatrists and psychologists who describe symptoms, label mental conditions and recommend talk-talks, synthetic medications or combination treatments. Sadly, when I tried those methods, they weren’t enough to help me get well. 2. Books by people who live with disorders of mood, thought, attention or other brain problems. Survivor stories connect us with people who suffer as we do. They validate our experiences with involuntary symptoms of depression, mental episodes and brain disorders. 3. Books by health professionals with mental disorders. These offer insider insights into the reality of the mental healthcare maze. These are informative, encouraging and inspiring, especially those by gifted writers or doctors who learned how to restore and maintain their own mental health. 4. Books by scientific researchers and medical clinicians explain how they combine the life sciences (e.g., biochemistry) with the art of medicine. 152

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They use orthomolecular medicine or other restorative methods to help patients recover normal brain function and maintain mental health. Part Four references have snap-shots, cover quotes and longer reviews. Readers can prepare a short reading list and study books from each category. It does not take long to learn that patients can renew their hope, restore their wellbeing, recover their zest for life and maintain their health. There is a quick-pick reference section to guide your search for books which are relevant to common mental illnesses. Readers can learn how other people experience brain disorders, how mental illnesses are diagnosed and treated, how to navigate through the mental healthcare maze and how to find restorative care for mood, thought, attention and other brain disorders. Laymen, caregivers, family and professionals can find helpful books and develop peace of mind about mental illness. Finding Care For Depression has a mental healthcare compass to guide you as you explore the mental healthcare maze, ask for helpful information and qualify for restorative care. TAYO – The Healthcare Planner uses the compass model to encourage patients, health professionals, family and friends to focus on restorative mental healthcare. Patients and caregivers can use these tools with the references as they search for competent caregivers, ask for standard of care procedures and cooperate with health professionals to learn, cope, recover, reframe and live well. You can use Finding Care For Depression to find restorative healthcare for depressions, mental episodes and brain disorders. If you or someone you know has a mental problem, don’t despair; restorative mental healthcare is available for many common brain conditions. Please be encouraged as you study the tips and tools, tales and references. Remember, if I could find quality care, stabilize, restore my health and feel well after twentyeight years of migraines, depression episodes and bipolar II mood disorder problems, you can get better too!

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REFERENCES FOR RESTORING MENTAL HEALTH The stars indicate four levels of references for laymen, caregivers and health professionals. ★ Standard – Books by psychiatrists and psychologists describe symptoms, label mental conditions by type and recommend talk-talks, synthetic medications or combination treatments. Informative. ★★ Survivor – Books by people who live with disorders of mood, thought, attention and other brain conditions. Survivor stories connect us with people who can cope and validate our experiences. ★★★ Health Professional Survivor – Books by health professionals who live and work with mental disorders. These have insider tips about the reality of the mental healthcare maze. Insightful. ★★★★ Restorative – Books by scientific researchers and / or medical clinicians who explain how they combine life sciences with arts of medicine to help patients restore normal brain function and keep well. • Bullets indicates Notes and Quotes. ★★★★ Acidophilus and Colon Health: The Natural Way to Prevent Disease by David Webster, foreward by R. Renn, DO, Kensington Books, New York, 1999 About: Focus: With: Author:

colon health, colon flora: our protective shield, the toxic colon restoring colon health by using nutrition and supplements microbiological facts, principles of colon health, resources, references health researcher and writer

★★★★ A Dose of Sanity: Mind, Medicine and Misdiagnosis by Sidney Walker, MD, John Wiley & Sons, New York, 1996 About: thousands of patients with medical conditions such as thyroid imbalance, Lyme disease and even poor nutrition are misdiagnosed with psychiatric disorders Focus: the dangers of misdiagnosis, a DSM label is not a proper diagnosis With: cases, 24-hour-day checklist to note your symptoms, references Author: neurologist, psychiatrist, neurosurgeon, degrees in physiology, pharmacology Books: Psychiatric Signs and Symptoms Due to Medical Problems

★★ Addiction by Prescription: OneWoman’sTriumph and Fight for Change by Joan Gadsby, Key Porter Books, Toronto, 2000 About: benzodiazepines, (commonly used for sleeping problems, anxiety) Focus: her life deteriorated while taking anti-anxiety pills, tips, traps & cautions With: personal experiences, interviews, references, survivor resource group, 154

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The Antidepressant Survival Program ★★★★ Robert Hedaya, MD, Crown Publishers, New York, 2000 Review by A. Hoffer, MD, PhD, FRCP(C) I like this book on depression and how to become well with minimal side effects when antidepressants are needed. For decades I have been convinced that to treat depression adequately (i.e., to full recovery) one must pay attention to a large number of nutritional, physiological and medical problems, and that one cannot depend only on drugs even though they are very helpful. There are many good books that describe which antidepressants to use, how to use them, what are their side effects, but these books ignore the nutritional and other factors. Most of these are written by orthodox physicians. There are also many good books written about the nutritional, physiological and biochemical components of depression. Many ignore the value of the xenobiotic antidepressants. Most of these are written by non-medical writers. I have often wished that the whole spectrum of treatment would be described in one book where the proper use of antidepressants is dealt with, the side effects and toxic properties described, advice given how to minimize them, and where proper attention is given to food, to allergies, to digestion, to the hormones such as thyroid, and to the vitamins and other nutrients that do play a significant role. At last we have it; this book by Dr. Hedaya fulfills my wish. In brief, his prescription for health, for a condition free of depression, includes a balanced diet (which he defines as free of junk food and which I call orthomolecular), a balanced fitness or exercise program, a balanced psychological program including stress reduction, spiritual development, pleasure in life and normal sexual responsivity. From the medical point of view he discusses the major hormones which influence mood and energy, thyroid and adrenal glands. In his discussion of thyroid he points out that the balance between T4 and T3 is important, something overlooked by many authors. He also discusses the vitamins and minerals and other nutrient factors that play a role. He finds that hair analysis for minerals is very helpful. Omega-3 essential fatty acids are recognized to help control mood and even in stabilizing bipolar mood disorders. Folic acid and vitamin B12 are recognized as very important in dealing with depression. In this Dr. Hedaya anticipates some of the work which is emerging such as the recent study showing that large doses of folic acid (up to 50 mg) daily are very effective and for many, may be much more effective than the standard antidepressant xenobiotic [medications]. Dr. Hedaya points out the importance of the doctor-patient relationship and urges patients to take a much more active role. Dr. Hedaya bases his conclusions on many years of clinical experience treating depression. Every orthomolecular psychiatrist will attest to the value of this kind of a program. I am grateful for this book which puts it all together so easily and so well. Both orthodox and orthomolecular therapists will find this book very helpful in their practice.

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(Addiction by Prescription … continued)

Author: journalist was treated for her ‘life’ with tranquilizers that made her worse; her doctor denied responsibility; as she researched, she was surprised and then shocked to learn that many other people have similar problems; she suffered withdrawal symptoms but stopped the drugs and got well. She felt betrayed by a healthcare system that recommends strong drugs to vulnerable patients without explaining the risks.

★★★★ The Antidepressant Survival Program by Robert Hedaya, MD, Crown Publishers, New York, 2000 About: Focus: With: Author: Books:

how to beat the side effects and enhance the benefits of your medication restore using vitamins, minerals and hormones needed to maintain health balance of nutrition and exercise, supplement considerations, references clinical professor of psychiatry, clinical pharmacologist Understanding Biological Psychiatry

★★★★ The Antioxidant Miracle by Lester Packer, PhD and Carol Colman, J. Wiley & Sons, New York, 1999 About: putting lipoic acid, pycnogenol and vitamins E and C to work for you Focus: the benefits of antioxidants, using a regimen of antioxidant supplements With: clinical applications, references, clear scientific explanations Authors: scientific professional – antioxidant researcher, bestselling co-author Books: The Melatonin Miracle, Stop Depression Now, Shed 10 Yrs in 10 Wks

★★ Alternative Treatments for Children Within the Autistic Spectrum by Deborah Alecson, Keats Publishing, Los Angeles, 1999 About: Focus: With: Author: Books:

the experience of autism, overview of autistic spectrum disorders, treatments layman’s guide: outlines the variations of autism and helpful treatments cases, references, practical information clearly explained master’s degree in special education, practices as a behavioral therapist Lost Lullaby

★★ Alzheimer’s: Finding the Words: A Communication Guide for Those Who Care by Harriet Hodgson, Chronimed Publishing, Minneapolis, MN, 1995 • Author’s mother has had Alzheimer’s for 12 years

★★★★ Anxiety & Depression: A Natural Approach by Shirley Trickett, foreward by Dr. J. McDonald, Ulysses Press, Berkeley, CA, 1997 Author: nurse, counselor and teacher Books: Free Yourself From Tranquilizers and Sleeping Pills Headaches Migraine, Panic Attacks: The Natural Approach

★, ★★, ★★★ Anxiety and Depression: The Best Resources to Help You Cope edited by Rich Wemhoff, PhD, Resource Pathways, Issaquah, WA, 1999 Review follows 156

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ANXIETY AND DEPRESSION: THE BEST RESOURCES TO HELP YOU COPE I recommend this book as a key tool in your search for information, books, references and resources about depression, bipolar disorder and anxiety. While it does not have all my favourites and it does not cover other mental disorders, it has many excellent books about mood disorders. A list follows of about one third of the books which are presented in this superb resource guide and depression reference directory for laymen. It includes books by psychiatrists, psychologists, other health professionals, depression survivors, and professional writers. You can select excellent books from this directory and find a wealth of information about mood disorders. The 1999 edition does not mention books about restorative orthomolecular medicine but it reviews many good books about traditional depression medications, even some prepared from plant extracts, herbs. Consider these 40 books: 1. ★★★ Anxiety and Depression: A Natural Approach by Shirley Trickett, nurse, counsellor, teacher, author, Ulysses, 1997 2. ★★ The Beast: A Journey Through Depression by Tracy Thompson, newspaper writer and depression survivor, Plume, 1996 3. ★★★★ Beat Depression With St. John’s Wort by Steven Bratman, MD, physician, Prima, 1997 4. ★★ Bipolar Puzzle Solution: A Mental Health Client’s Perspective by B. Court (engineer & survivor) & G. Nelson, MD, Accelerated Development, 1996 5. ★★ A Brilliant Madness: Living With Manic Depression by Patty Duke & Gloria Hochman, Bantam, 1993 6. ★★★ Coping With Depression: Self-Help strategies by Mary Ellen Copeland, MS, MA, a survivor of manic depression, New Harbinger, 1994 7. ★★ Darkness Visible, A Memoir of Madness by William Styron, Pulitzer Prize winning author, depression survivor, Vintage, 1992 8. ★★★★ Dealing With Depression Naturally The Drugless Approach to the Condition that Darkens Millions of Lives by Syd Baumel, depression survivor who used natural antidepressants, Keats, 1995

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9. ★ Depression: How it Happens, How It’s Healed by John Medina, PhD, molecular biologist, New Harbinger, 1998 10. ★★★ The Depression Workbook A Guide to Living With Depression and Manic Depression by Mary Ellen Copeland, MS, MA, a survivor of manic depression, New Harbinger, 1992 11. ★ Depression Resource List: web site of links to depression resources online www.execpc.com/~corbeau, by Dennis Taylor, depression survivor 12. ★ Essential Guide to Depression by American Medical Association, large US physicians’ assoc., 1998 13. ★ The Essential Guide to Psychiatric Drugs by Jack Gorman, MD, psychiatrist, St. Martin’s 1997 14. ★ Feeling Good: The New Mood Therapy by David Burns, MD, teaches psychotherapy and drug therapy at university, Avon, 1992 15. ★★★★ Healing Anxiety With Herbs by Harold Bloomfield, MD, psychiatrist, Harper Collins, 1998 16. ★ Listening to Prozac by Peter Kramer, MD, psychiatrist, Penguin, 1997 – an optimistic look at the properties of an ideal antidepressant (prozac benefits some cases of depression; this best selling book does not claim that prozac is a cure-all) 17. ★★★ Living Without Depression and Manic Depression A Workbook for Maintaining Stability by Mary Ellen Copeland, MS, MA, psychologist who recovered from manic depression, New Harbinger, 1994 18. ★ A Mood Apart The Thinker’s Guide to Emotion and Its Disorders by Peter Whybrow, MD, psychiatrist, Harper Collins, 1997 19. ★ National Depressive and Manic Depressive Association www.ndmda.org - web site promotes NDMDA a non-profit mental health advocacy and support organization, info. on depression and suicide, support groups 20. ★★ No One Saw My Pain: Why Teens Kill Themselves by Andrew Slaby, MD and Lili Garfinkel, psychiatrist and parent educator, W.W. Norton, 1994 – profiles of 8 suicidal teens, guidance for helping 158

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21. ★ Overcoming Depression: The Definitive Resource for Patients and Families who Live With Depression by D Papolos, MD and J Papolos, psychiatrist and writer, Harper Collins, 1997 22. ★★ Overcoming Postpartum Depression & Anxiety by Linda Sebastian, nurse practitioner and therapist, personal experience, Addicus, 1998 23. ★ Postpartum Survival Guide by A Dunnewold PhD and Diane Sanford, PhD, psychologists, New Harbinger, 1994 24. ★★ Prozac Nation: Young and Depressed in America: A Memoir by Elizabeth Wurtzel, journalist and author, depression survivor, Riverhead, 1997 25. ★ The Relaxation and Stress Reduction Workbook Cure Yourself of Worry, Depression, Chronic Anxiety and Fear by Martha Davis, PhD. et al, psychologist, social worker, New Harbinger, 1998 26. ★ The Secret Strength of Depression by Frederich Flach, MD, psychiatrist, Hatherleigh, 1995 27. ★★ Speaking of Sadness Depression, Disconnection and the Meanings of Illness by David Karp, PhD, sociologist and depression survivor, Oxford Univ. Press, 1996 – personal experience of depression and interviews with 50 depression survivors 28. ★★★★ St. John’s Wort: Nature’s Blues Buster by Hyla Cass, MD, psychiatrist who uses nutritional medicine, Avery, 1998 29. ★ Suicide: Read This First www.metanoia.org/suicide – web site by Martha Ainsorth, works in crisis intervention, 1996 30. ★ Talking Back to Prozac What Doctor’s Aren’t Telling You About Today’s Most Controversial Drug by Peter Breggin, MD and Ginger Breggin, psychiatrist and educator, St. Martin’s, 1994 – outlines how the FDA approved prozac, with cautions and concerns

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31. ★★★ Undercurrents: A Life Beneath the Surface by Martha Manning, PhD, psychologist and depression survivor, Harper Collins, 1994 32. ★ Understanding Depression A Complete Guide to its Diagnosis and Treatment by Donald Klein, MD and Paul Wender, MD, psychiatrists, Oxford University Press, 1993 33. ★ Undoing Depression What Therapy Doesn’t Teach You and Medication Can’t Give You by Richard O'Connor, PhD, director of a mental health centre, Berkley, 1997 34. ★ Understanding Your Teenager’s Depression Issues, Insights & Practical Guidance For Parents by Kathleen McCoy, PhD, psychologist and counsellor, Perigee, 1994 35. ★★★ An Unquiet Mind: A Memoir of Moods and Madness by Kay Redfield Jamison, PhD, psychologist survivor of manic depression, Vintage, 1995 36. ★ You Can Feel Good Again by Richard Carlson, PhD, psychologist, Penguin, 1993 37. ★★ You Mean I Don’t Have to Feel This Way New Help for Depression, Anxiety and Addiction by Collette Dowling, writer, depression in family members, Bantam, 1993 38. ★★ We Heard the Angels of Madness A Family Guide to Coping with Manic Depression by Diane and Lisa Berger, mother and sister of a bipolar chap, Quill, 1991 39. ★ Waking Up Alive The Descent, The Suicide Attempt, and The Return to Life by Richard Heckler, PhD, psychologist, Ballantine, 1996 40. ★ Winter Blues: Seasonal Affective Disorder, What It Is and How To Overcome It by Normal Rosenthal, MD, psychiatrist and researcher, Guilford, 1998

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★★★★ The Arginine Solution: The First Guide to America’s New Cardio-Enhancing Supplement by Robert Fried, PhD and Woodson Merrell, MD, Warner Books, New York, 1999 About: using a natural supplement to open clogged arteries, boost potency Focus: adding l-arginine to nutritional sources to restore biochemistry With: research, case histories, clinical experience and references Authors: prof. of biopsychology and clinical prof. at Columbia University Medical School

★ Asperger Syndrome edited by Ami Klin, PhD, Fred Volkar, PhD, Sara Sparrow, PhD, The Guilford Press, New York, 2000 About: Focus: With: Editors: Other:

behavioral aspects, family genetics and neurobiology, diagnosis, treatment increasing awareness of AS and related conditions perspectives on research and clinical practice, parent essays, references professors of child psychology and psychiatry at Yale University Child Centre Journal of Autism & Developmental Disorders, Journal of Child Psychology & Psychiatry

★ Asperger’s Syndrome: A Guide for Parents and Professionals by Tony Attwood, forward by Lorna Wing, Jessica Kingsley Publishers, London and Philadelphia, 1998 About: empathetic information for patients, parents and professionals Focus: description and analysis of unusual characteristics of Asperger’s syndrome, social behavior, language, interests, routines, cognitions, sensitivities. With: resources, diagnostic criteria, web sites, related book list, references Author: clinical psychologist who specialises in AS for >25 years Other: 1988 article in the Journal of Autism and Developmental Disorders

★★ Attention Deficit Disorder: A Different Perception by Thom Hartmann, intro. by E. Hallowell, MD, Underwood Books, Grass Valley, CA, 1997 About: Focus: With: Author: Books:

ADD – “Hunter(s) in a Farmer’s World”, how people can understand ADD capabilities of the ADD brain, author’s story, tips & traps practical ideas, clear language, interviews, references former director of residential treatment facility for children, he has ADD Think Fast – the ADD Experience, ADD Success Stories: A Guide to Fulfilment for Families with ADD, Beyond ADD: Hunting for Reasons in the Past & Present

★★★★ A Beginner’s Introduction to Vitamins by Richard A. Passwater, PhD, Keats Publishing, Inc., New Canaan, CT., 1983 • • • •

identifies what vitamins are and how they work indicates recommended daily adult vitamin intakes sources & functions of specific vitamins vitamin deficiencies are linked to health problems FINDING CARE FOR DEPRESSION

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A REVIEW:

ACTIVE TREATMENT OF DEPRESSION *★★★ by Richard O’Connor, W.W. Norton & Co., New York, 2001 (cover quote) “Active Treatment Of Depression skillfully highlights the fact that there are many paths into and out of depression. Each of the ways out requires a willingness to take sensible action on one’s own behalf. It is to Richard O’Connor’s credit that he is able to capture and articulate the complexity of depression, and that he can model through his style of writing, the flexibility and skill needed to manage the disorder intelligently. He provides an appropriate skepticism about what we think we know from depression research, and a healthy optimism that depression can be defeated.” by Michael Yapko, PhD, author of Breaking the Patterns of Depression. Richard O’Connor, a PhD psychologist, has suffered with depression himself. His book, Undoing Depression, shared his personal experiences and offered general readers suggestions for coping. Active Treatment of Depression is is an in-depth guide, targeted for professional readers. The author proposes that client and clinician both need to take an active part in depression treatment. John Grohol, PhD says that the book offers “thoughtful commentary, researched explanations and illustrative case studies … and provides realistic hope in the treatment and recovery from depression.” O’Connor proposes a common sense model of depression. He observes that some individuals are vulnerable to depression because of such varied factors as “genetic predispositions, history of noncontingent punishment, unstable self-esteem, early loss, poor interpersonal skills, pessimistic thinking and lack of social supports”. Rather than proposing a narrow theory about what causes depression, O’Connor suggests that there can be multiple causes. He observes that when the vulnerability factors combine with current stresses such as ”failure, illness, loss of role status, narcissistic injury or relationship loss,” vulnerable people can be pushed past their comfort threshold until they experience the vicious circle of depression with its interlocking problems such as brain “neurochemical changes, physiological symptoms, sleep, appetite and sexual disturbance, discrimination and stigma, preoccupation with the self, depressed thinking, behavioral symptoms, guilt, shame and diminished self-esteem, (and suffer) impaired 162

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functioning in their stable, dysfunctional interpersonal world.” He quotes references such as the 1997 National Depressive and Manic-Depressive Association consensus statement on the undertreatment of depression by Hirschfeld et al which was published in the Journal of the American Medical Association as follows: “Depression is a pernicious illness associated with episodes of long duration, high rates of chronicity, relapse, and recurrence, psychosocial and physical impairment, and mortality and morbidity – with a 15% risk of death from suicide in patients with more severe forms of depression. Despite these facts … patients with depression are being seriously undertreated, even though effective treatments have been available for more than 35 years … the vast majority of patients with chronic depression are misdiagnosed, receive inappropriate or inadequate treatment, or are given no treatment at all.” Although this suggests a bleak outcome for many sufferers of depression, O’Connor does not shirk the difficult task of offering practical help. He proposes active treatment for depression organized around eleven principles which he explains in considerable depth. It is clear that the author is familiar with the experience of depression as a patient himself and it is soon becomes clear that he also knows, from clinical successes, how to help patients recover and keep well. Each principle is explained. The eleven principles are as follows. 1. Conduct a thorough biopsychosocial assessment to determine what maintains depression in the patient’s world. 2. Engage the patient’s emotions. 3. Pay attention to feelings of grief, entitlement, rage and hope. 4. Use medications appropriately. 5. Use yourself wisely (addressed to clinicians). 6. Maintain a therapeutic focus. 7. Address the patient’s social and interpersonal world. 8. Challenge depressed thinking (using a cognitive-behavioral model for therapy). 9. Teach self-care so patients can treat themselves with respect and care. 10. Practice new skills rather than repeating acquired habits of depression. 11. Prepare for termination of the therapeutic alliance (by educating the patient about the disease and the need for continuing selfcare, recognize when to get help and know how to get it). FINDING CARE FOR DEPRESSION

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He recommends an accurate differential diagnosis and medical treatment but leaves these topics to other writers. Instead, he focuses on counselling and coping strategies. To illustrate the depth of O’Connor’s insights, the chapter about assessment concludes with “There is a great deal to be done in the assessment phase with a depressed individual. We (clinicians) need to begin to determine the interplay between biological, psychological and social factors in the current illness. We need to make sure the patient is safe. We need to take steps to alleviate acute distress. We need to begin to develop a therapeutic focus. We need to begin to strategize about what points in the vicious cycle of depression may be the best targets for intervention. We need to begin to educate the patient about how we work, and we need to begin to learn about how the patient’s mind works. And although we have to do a lot, we also have to begin to get the patient actively invested in the process of helping himself.“ Although this book was written for health professionals, I had no problem reading it. There were valuable insights, and a wealth of detailed advice, encouragement and support. O’Connor uses clear language to tackle a range of issues that popular books about depression seem to gloss over. There are tips for patients and caregivers who want to understand depression triggers and make positive progress, cope with distressing situations in life, recover from depression and keep well. My own case of depression required biological treatment to restore my mental health before I could benefit from therapy. O’Connor’s Active Treatment Of Depression offers hope for cooperating with mental health professionals who can actively help with the prevention of depression relapse and the maintenance of normal mood.

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★ Benzo Blues: Overcoming Anxiety without Tranquilizers by Edward Drummond, MD, Plume – Penguin, New York, 1998 About: prescription benzodiazepines can prolong and exacerbate symptoms resulting in the “benzo blues,” without treating the underlying problems that cause the anxiety in the first place, reliance on them can grow

★★ Beyond ADD: Hunting for Reasons in the Past & Present by Thom Hartmann, Underwood Books, Grass Valley, Calif., 1996 About: people with ADD have hunters’ capabilities but live in a world of farmers

★★★★ Biochemical Individuality: The Basis for the Genetotrophic Concept by Roger Williams PhD, Keats Publishing, New Canaan, 1998 About: Focus: With: Author: Other:

understanding what shapes your health, useful for depression + linking diversity in our anatomy and body chemistry to nutritional needs concepts and examples of individuality in nutrition, references scientific professional – PhD biochemist, discovered some vitamins author also wrote articles for scientific journals

★★★★ Biological Treatments for Autism and PDD by William Shaw, PhD, with contributions by Bernard Rimland, PhD, L. Lewis, PhD, Karyn Seroussi, Bruce Semon, MD, PhD, and Pamela Scott, The Great Plains Laboratory, Overland Park, KS, 1998, www.greatplainslaboratory.com About: Focus: With: Author: Other:

range of effective treatments that have been useful for autism and PDD restorative approaches based on scientific and medical knowledge clear info. about biochemical factors, testing, supplements, references PhD biochemist, clinical chemist, toxicologist, organic testing for metabolic diseases author of many scientific papers, two book chapters

★ Bipolar Disorder: A Guide For Patients and Families by Francis Mondimore, MD, Johns Hopkins University Press, Baltimore, 1999 About: Focus: With: Author: Books:

symptoms, syndromes, diagnosis, treatment, variations, connections comprehensive, practical, compassionate guide to manic depression info. to help patients make informed choices, cases, history, references psychiatrist, faculty of Johns Hopkins Univ. School of Medicine Depression: The Mood Disease

★★ Bipolar Puzzle Solution: A Mental Health Client’s Perspective 187 Answers to questions asked by support group members by B. Court and G. Nelson, MD, Accelerated Development, Philadelphia, 1996 About: Focus: With: Author: Books:

the experience of bipolar disorder, tips and traps for coping and living well practical information for patients and caregivers personal insights, questions, clear answers, references engineer, who lives with a bipolar disorder, co-author physician A Passion for Science, The Triumph of the Embryo, Passionate Minds FINDING CARE FOR DEPRESSION

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★★ Bitter Pills: Inside the Hazardous World of Legal Drugs by Stephen Fried, Bantam Books, New York, 1998 About: Focus: With: Author: Books:

a husband’s story of his wife’s problems with negative effects of a NSAID how a person suffers when their system can’t tolerate a ‘safe’ medication personal observations, investigative insights of the FDA process, references investigative journalist Thing of Beauty: The Tragedy of Supermodel Gia

★★★★ The Body Ecology Diet: Recovering Your Health & Rebuilding Your Immunity by Donna Gates, BS, MEd, B.E.D. Publications, Atlanta, 1996 About: Focus: With: Author: Books:

principles of human body ecology, description of body ecology diet restoring your body ecology by managing your diet, creating a bright future clear tips, examples, menus, references nutritional consultant and lecturer on candiasis and immune disorders The Magic of Kefir, The Stevia Story, The Stevia Cookbook

★★★★ Brain Allergies by W. H. Philpott, MD & D. K. Kalita, PhD, Keats Publishing Inc., New Canaan, Connecticut, 1980 • a change in behaviour and in mental health can result from the changing concentrations of essential nutrients in the brain, or from reaction with an allergen • discusses nutritional and orthomolecular approaches to well-being • investigates drug-induced illnesses and the healing powers of vitamin C • “behaviour is determined by the functioning of the brain … is dependent on its composition and its structure” • “proper functioning of the brain is known to require the presence in the brain of molecules of many different substances,” “mental disease usually associated with physical disease, results from a low concentration in the brain of any one of a number of vitamins” Linus Pauling, PhD

★★★★ Brain Builders: A lifelong guide to sharper thinking, better memory, and an age-proof mind by Richard Leviton: Parker Publishing Company, Inc., West Nyack, NY, 1995 • use nutrition, diet, herbs, and supplements to boost mental powers • benefit from the brain’s natural rhythms of activity and rest • free the brain from potentially harmful environmental and lifestyle inhibitors that could be preventing it from reaching maximum efficiency • achieve enhanced learning and memory abilities through music, meditation, brain aerobics, and breathing secrets • develop “brain fitness” and prevent mental sluggishness and lazy mental habits through scores of “brain trainers” 166

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★★★★ Breaking the Vicious Cycle: Intestinal health through diet by Elaine Gottschall, MSc, The Kirkton Press, Baltimore, ON, Canada, 1994 • (cover) “The relationship between food and intestinal disorders such as Crohn’s disease, ulcerative colitis, diverticulitis, celiac disease, cystic fibrosis of the pancreas, and other forms of chronic diarrhoea. • “A discussion of the cycle of events occurring in the intestine of those with (such) problems and how the Specific Carbohydrate Diet can break this cycle and permit the body to regain normal functioning. • “A complete recipe section offers an assortment of simple, quick, as well as gourmet-type recipes, based on the scientific principle underlying the specific Carbohydrate Diet.” • a clear and well written account of GI system function, carbohydrate digestion, brain connection and more!

★★★ The Burden of Sympathy: How Families Cope With Mental Illness by David Karp, Oxford University Press, New York, 2001 About: a sociology professor writes about his interviews with 60 families similarities in feelings of shame, fear, guide and powerlessness in the face of socially stigmatized mental illnesses Wrote: Speaking of Sadness: Depression, Disconnection & the Meanings of Illness

★★★★ The Carnitine Miracle: Supernutrient Program that Promises Brain Wellness by Robert Crayhon, MS, foreward by Dr Jeffrey Moss, M Evans & Co., New York, 1998 About: l-carnitine for energy, brain wellness, fat burning, heart health, longevity Focus: nutrition and supplement regimens for restoring good health With: cases, regimens, carnitine programs, references Authors: nutrition clinician, researcher and educator Books: R Crayhon’s Nutrition Made Simple, assoc. editor of Total Health

★★★★ The Canary and Chronic Fatigue by Majid, Ali, MD, Life Span Press, 1995 • ‘‘… chronic fatigue sufferers are human canaries – unique people who tolerate poorly the biologic oxidative stressors of the late 20th century. They are genetically predisposed to injury to their energy and detoxification enzymes by agents in their internal and external environments. Their molecular defences are damaged by undiagnosed and unmanaged allergies, chemical sensitivities, environmental pollutants, microbes, sugarinsulin-adrenalin roller coasters, stress and hostility of sped-up lives.” • “… information about non drug therapies that work for the chronic fatigue sufferer" • supplement protocols for people who want to restore normal function without adverse effects • unique teaching tales that explain biochemical factors (without using chemical terms)

★ Choosing to Live: How to Defeat Suicide Through Cognitive Therapy by T. Ellis, PsyD, C. Newman, PhD, forward by Aaron Beck, MD, New Harbinger Publications Inc., Oakland, CA, 1996 FINDING CARE FOR DEPRESSION

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★★★★ Chronic Fatigue, Fibromyalgia & Environmental Illness by Burton Goldberg and editors of Alternative Medicine Digest, Future Medicine Publishing, Tiburon, California, 1998 About: 26 doctors show how they reverse these conditions with alternative therapies Focus: understanding causes, using nutritional supplements, restoring vitality With: articles, advice, quick definitions, references Authors: doctors who apply biochemistry to the art of medicine Books: Alternative Medicine Magazine

★ Clinical Interviewing by Rita and John Sommers-Flanagan PhD’s, J Wiley & Sons, New York, 1999 About: scientific and interpersonal aspects of mental health interviewing With: issues, explanations, checklists, examples, references Book: Tough Kids: Cool Counselling

★★★★ The Coenzyme Q10 Phenomenon by Stephen Sinatra, MD, FACC, Keats, Lowell House, Los Angeles, 1998 About: Focus: With: Author: Books:

CoQ10 breakthrough nutrient that helps combat heart disease, aging + more scientific studies and clinical applications show medical benefits of CoQ10 medical applications of CoQ10, a cellular energy co-factor, references clinical cardiologist at a US university, thousands of patients taking CoQ10 A Cardiologist’s Guide to Weight Loss and Nutritional Healing, A Cardiologist’s Guide to Optimum Health

★ Cognitive Behavior Therapy of DSM-IV Personality Disorders Highly Effective Interventions for the Most Common Personality Disorders by Len Sperry, MD, PhD, Brunner/Mazel, Philadelphia, 1999 About: Focus: With: Author: Books:

specific treatment strategies for avoidant, borderline & narcissistic disorders potent interventions: cognitive and behavioral therapy and strategies explanations of paradigm shift, treatment intervention charts, references prof. of psychiatry and behavioral medicine, psychiatrist and neurologist Handbook: Diagnosis and Treatment of DSM-IV Personality Disorders

★ Cognitive-Behavioral Therapy for Bipolar Disorder by Monica Basco PhD and John Rush, MD, The Guilford Press, New York, 1996 About: cognitive-behavioral techniques for managing bipolar disorder Focus: monitoring symptoms, cognitive changes, psychosocial problems, coping With: complementing medication, monitoring forms, resources, references Authors: clinical psychologist and a clinical researcher in mood disorders Articles: eg. neurobiological bases for psychiatric disorders in Comp. Neurology 168

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★ Comparative Treatment for Relationship Dysfunction, edited by Frank Dattilio & Louis Bevilacqua, Springer Publishing Co., New York, 2000 About: Focus: With: Editors: Books:

18 theories for couples therapy, fascinatingly applied to the same case story illustrating how couples can find effective help for their interpersonal issues theories applied in practice, goals, tips, pitfalls, limits, guidelines, references psychologist trained in behavior therapy and clinical psychologist Cognitive Therapy for Couples, Panic Disorder: Assessment & Treatment Through a Wide Angle Lens, The Family Psychotherapy Treatment Planner

★ The Complete Guide to Psychiatric Drugs: Straight Talk for Best Results by Edward Drummond, MD, John Wiley & Sons, New York, 2000 About: synthetic medications for depression, bipolar disorder, anxiety and other Focus: understand psychiatric medications, side effects, how to get good results With: medications with precautions, interactions, dose, monitoring, references, some information about plant extracts and vitamins Author: psychiatrist, medical director of a mental health centre in the US

★ Consumer’s Guide to Psychiatric Drugs by J. Preston, Psy.D. J, O’Neal, MD, and M. Talaga, R.Ph, MA, New Harbinger Publications, Oakland, California, 1999 About: comprehensive overview of current treatments for mood disorders Focus: diagnostic issues, biology of mental illness, drug-drug interactions and more With: clear language, dosage, side effects, directions for proper use, references Authors: psychologist, psychiatrist, pharmacist Books: You Can Beat Depression, Growing Beyond Pain

★ Coping With Schizophrenia: Guide for Families by Kim Mueser, PhD and Susan Gingerich, MSW, New Harbinger Publications, Inc., Oakland, CA, 1994 About: Focus: With: Authors: Books:

persistent symptoms: positive & negative, diagnosis, treatments clear information for family caregivers: illness reviewed, treatment choices common problems, tips, crisis and stress checklists, resources, references assoc. professor of psychiatry and schizophrenia research associate Social Skills Training for Psychiatric Patients, Workbook for Behavioral Family Therapy

★ Current Psychotherapeutic Drugs by Donald Klein, MD and Lewis Rowland, MD, Brunner/Mazel, New York, 1996 • About: medications: dosage, indications, adverse effects, half lives FINDING CARE FOR DEPRESSION

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★★★★ Dealing with Depression Naturally The Drugless approach to the condition that darkens millions of lives by Syd Baumel, Keats Publishing, Inc., New Canaan, Connecticut, 1995 • how orthomolecular psychiatry evolved & uses nutritional supplements if depressed patient has a subclinical nutritional deficiency, depressive may need certain nutrients in larger quantities than a normal diet can provide – supplements can make up for nutrient losses brought on by depression-related distress – supplements may improve the function of defective or deficient enzymes – large doses of some nutrients can have antidepressant effects, above and beyond their normal physiological effects, eg. #1 – large doses of vitamin B3 (niacinamide) may have a valium-like effect eg. #2 – large doses of vitamin B1 may act like an antidepressant drug • certain medical conditions may promote depression, eg. – Candida imbalance, mercury from poor dental work

★ Defeating Depression by Sidney Kennedy, MD, FRCPC, Sagar Parikh, MD, FRCPC, Colin Shapiro, PhD, Joli Joco Publications, Thornhill, ON, 1998 ★★★★ Depression and Natural Medicine by Rita Elkins, Woodland Publishing Inc., Utah, 1995 • discusses the connection between depression and diet, environmental factors, herbal treatments, vitamins and minerals, meditation, exercise, thyroid, light, food allergies, bowel disorders, hormones • certain naturally occurring substances can stimulate the process in the brain which is affected by antidepressant drugs

★★★★ Depression: Cured At Last by Dr. Sherry Rogers, SK Publishing, 1996, Box 40101, Sarasota, FL, USA 34242 • environmental, nutritional, metabolic factors involved in some cases of mood disorder • suggests treatment using nutritional supplements, vitamins, minerals and amino acids • author is a physician who used this information to resolve her own depression and now she helps patients this way • depression is not a deficiency of Prozac or antidepressant medication

★★★★ Depression-Free for Life: All-Natural 5-Step Plan to Reclaim Your Zest for Living by Gabriel Cousens, MD with Mark Mayell, William Morrow, New York, 2000 About: Focus: With: Authors: Books: 170

optimizing your personal biochemistry, using diet and supplements non-toxic methods of coping with depression range of 5-step plans for different individuals, case studies, references health professional – psychiatrist, medical writer Conscious Eating, Spiritual Nutrition and the Rainbow Diet

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A REVIEW:

Dealing with Depression Naturally Complementary & Alternative Therapies for Restoring Emotional Health ★★ and ★★★★ by Syd Baumel, Keats Publishing, Los Angeles, 2000 – 2nd edition (cover quotes) “A very good book. I wish every therapist, every medical columnist, and every expert in this field would read this and take to heart the important messages contained herein.” – Abram Hoffer, MD, PhD, orthomolecular psychiatrist “An outstanding compilation of drug-free treatments for most depressions.” – Townsend Letter for Doctors & Patients. (cover blurb) “Syd Baumel is a writer, editor, artist whose articles have appeared in Health, Alive and Natural Life. He is the author of Serotonin and Natural Antidepressants. For information about his work, visit his Web site at www.escape.ca/~sgb. The author takes an even-handed and compassionate look at depression, its symptoms, its causes, and the many options – both natural and pharmacological – available for treatment. Including extensive information on nutrition, holistic medicine, bodywork, exercise, psychotherapy, and many other nontraditional approaches to mental health, this invaluable guide will arm you with the knowledge you need to restore emotional well-being.” Some cover blurbs are overblown but I agree with this one. Syd Baumel, himself a survivor of depression, thoroughly explored the mental healthcare maze before writing this superb book for laymen and caregivers. Too many books about depression, even those written by mental health professionals, are superficial in the sense that they resort to quick labels and easy treatments - either medications or talk-talks. Mr. Baumel looks deeper. He considers the range of factors which can cause or contribute to the patient’s symptoms of depression and then he explains how nontoxic natural methods can restore mental health. He writes so clearly that any reader, whether depressive or health professional, can use this book to their advantage. The orthomolecular approach to depression is introduced and then the author explains how nutritional supplements can help some people recover. The book details the potential benefits of vital amines (i.e., vitamins), trace minerals, good fats, helpful aminos and other supplements. The book recommends healing herbs for some cases of depression and an interesting and insightful range of subtler therapies such as aromatherapy. The author encourages depressed patients to “journey out of stress” and restore emotional health. Definitely a four-star book - highly recommended. FINDING CARE FOR DEPRESSION

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★ Depression: How it happens; How it’s healed by John Medina, PhD, foreward by John Schwartz, MD, CME Inc and New Harbinger Publications, Irvine, California, 1998 About: Focus: With: Author: Books:

depression – the basis, in words and pictures clarifying how depression occurs and resolves pictures, clear explanations for laymen, insights, references molecular biologist and writer The Outer Limits of Life, Uncovering the Mystery of AIDS

★★ Depression Survivor’s Kit by Robert Sealey, BSc, CA, SEAR Publications, Toronto, 1999 About: surviving depression: episodes of unipolar, bipolar, dysthymia, anxiety Focus: tips & traps, survival insights, coping strategies With: success story, references for laymen, writer-tested original ideas Author: personal experience of depression, bipolar II mood disorder, migraines Books: SEAR Guide Series: eg. Mental Healthcare References – Layman’s Guide Web site: www.searpubl.ca

★★ Desperate Disguises: Living in the Shadow of Psychiatric Illness by Jo Clancy, LMSW-ACP, LCDC, Psychosocial Press, Madison, Conn., 1998 About: how people who struggle with mental illnesses walk among us undetected, often wearing ‘masks’ to be ‘normal’. Author: personal and professional accounts of the emotional pain experienced by mental patients and the people who love them

★★★★ DHEA: A Practical Guide The Natural hormone that helps fight disease, improves mood and energy, boosts your sex drive, influences longevity by Ray Sahelian, MD, Avery Publishing Group, Garden City Park, New York, 1996 • (cover) “Dr. Sahelian discusses the safety of DHEA (dehydroepiandrosterone), how DHEA affects the brain, heart, and immune system, DHEA levels throughout life, and what is known about DHEA’s anti-aging potential. He covers … the practical aspects of how much to take and when, and … includes personal stories of DHEA users … provides straight forward answers regarding the benefits and limitations of this vital and important supplement.”

★★★★ DHEA: The Youth and Health Hormone by C. Norman Shealy, MD, PhD, Keats Publishing, Inc., New Canaan, Connecticut, 1996 • shows promise as an antidote to diseases of aging and as a rejuvenator

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★★★★ Digestive Wellness by E. Lipski, Keats Publishing Inc., 1996 • chemical environment in our digestive tract is the medium from which we obtain our essential nutrients, except oxygen, and where we deposit most of our wastes. If the chemicals within that environment are wrong for the individual, if the system is not able to absorb or use them properly, and if waste products are not properly eliminated, it is impossible for that individual to be well. • health of the individual depends on the integrity and functional capacity of the digestive tract. This book describes what a healthy tract should do, what can happen to it and how to correct problems.

★★★★ Distinguishing Psychological From Organic Disorders: Screening for Psychological Masquerade, by Robert Taylor, MD, Springer Publishing Co., New York, 2000 About: Focus: With: Author: Books:

appearances can be deceiving, clinical traps, recognizing brain syndromes cases where mental symptoms reflect biological problems in the brain analysis of masqueraders, drug induced mental disorders, cases, references consulting psychiatrist and lecturer Mind or Body (1982), Health Fact, Health Fiction (1990)

★★★ Do One Thing Different by Bill O’Hanlon, MS, W. Morrow & So., New York, 1999 About: resolving depression, shifting toward the positive Focus: solution oriented therapy, tips & traps, possibility and inclusive therapy With: success stories, cases for laymen, writer-tested ideas Author: marriage and family therapist, personal experience of depression Books: Stop Blaming, Start Loving; Rewriting Love Stories, 15 other books Web site: www.doonethingdifferent.com

★★★★ Dr. Hoffer’s ABC of Natural Nutrition for Children by Abram Hoffer, MD, PhD, FRCP(C), Quarry Health Books, Kingston, 1999 About: Focus: With: Author: Books:

diagnosis and treatment of children with learning and behavior disorders orthomolecular nutrition to restore deficiencies in essential nutrients research, cases, references biochemist, orthomolecular psychiatrist and author Vitamin B3 and Schizophrenia: Discovery, Recovery, Controversy

★★★ Driven to Distraction Recognizing and Coping with ADD from Childhood through Adulthood by Edward. Hallowell, MD and John Ratney, MD, Touchstone, New York, 1994 About: Focus: With: Authors: Books:

ADD – reality, risks and benefits, diagnosis and treatment insights, strategies, tips & traps, life with the condition, family coping success stories, references, research reports, cases, resources healthcare professionals, psychiatrists who both have ADD What Are You Worth?; Finding the Heart of the Child: Essays FINDING CARE FOR DEPRESSION

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★ DSM-IV Internet Companion by M. Robert Morrison, PhD & Robert Stamps, MA, MAC, W.H. Norton & Co., New York, 1998 About: Focus: With: Authors: Books:

a guide to 1,500 web sites with information about mental illness wealth of web sites keyed to the DSM-IV; info. for laymen and clinicians web sites, resources, mailing lists, overview of DSM disorders psychologist and professor; addictions counsellor and journalist The Video Improvement Program

★ DSM-IV Made Easy: The Clinician’s Guide to Diagnosis by James Morrison, MD, The Guilford Press, New York, 1995 About: Focus: With: Author:

quick guides for applying DSM criteria when diagnosing mental patients understanding APA’s diagnostic and statistical manual of mental disorders for each category – cases, evaluations, symptoms, criteria, references chief of psychiatry and professor of psychiatry

★★★★ Eat Smart, Think Smart How to use nutrients and supplements to achieve maximum mental and physical performance by Robert Haas, HarperCollins Publishers, Inc., NY, 1994 • how to use nutrient programs to: boost mental energy, increase memory, fight depression; burn off excess body fat; promote anti-aging strategies for the brain; enhance sex drive; get a good night’s sleep; build muscle with alternatives to synthetic medications

★ Effective Treatments for PTSD: Practice Guidelines from Intl. Society for Traumatic Stress Studies edited by Edna Foa, PhD, T. Keane, PhD, M Friedman, MD, PhD, The Guilford Press, New York, 2000 About: Focus: With: Editors: Books:

treatment approaches based on literature reviews, treatment guidelines variety of expert opinions on diagnosis, assessment, therapy theories outlined, practices, clinical studies, references professors of psychology and psychiatry, director of PTSD centre Treating the Trauma of Rape, Assessing Psychological Trauma & PTSD

★★ Emergence: Labelled Autistic by Temple Grandin & Margaret Scariano, Warner Books, New York, NY, 1996 • (cover) “Temple tells the story of … how she went from a fear-gripped, autistic childhood to become a successful professional, a world leader in her field. An astonishing true story, a chronicle of perseverance, courage, and the loving wisdom of a few adults who saw in Temple what others couldn’t, Emergence will give new hope and new insight into the tragedy of autism and the vast potential of the human spirit.” • (cover) “This is the story of a frightening journey which provides the reader with … the sense of isolation, hopelessness, and anxiety suffered by autistics and their families.” • explains how tests indicated the nature and extent of affected brain function, practical advice for autism caregivers • mentions how Dr. A. Cott’s regimen of supplemental vitamin B-6 and magnesium helps 174

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★★★★ Enzymes & Enzyme Therapy: How to Jump Start your way to Lifelong Good Health by Anthony Cichoke, DC, Keats Publishing Inc., New Canaan, Conn., 1994 About: five step program to identify and restore enzyme imbalances to control the fuel and energy output of each cell in the body, reports of positive effects

★★ Facing Autism: Giving Parents Reasons for Hope and Guidance for Help by Lynn Hamilton, fwd by Dr. Bernard Rimland, Waterbrook Press, Colorado Springs, 2000 About: Focus: With: Authors: Books:

a mother who found quality care for her autistic child understanding autism, finding help, integrating psychology and biology practical tips for laymen, resources, web sites, references a mother and a healthcare professional – PhD psychologist, autistic children Infantile Autism, by Dr. Bernard Rimland

★★★★ Fats that Heal – Fats that Kill by Udo Erasmus, BSc, MA, PhD, Alive Books, Burnaby, BC, 1993 About: Focus: With: Author: Books:

how healing fats can prevent and reverse ‘incurable’ degenerative diseases healing properties of essential fatty acids, biochemistry explained information on orthomolecular nutrition, biochemical individuality, references graduate studies in genetics and biochemistry, PhD in nutrition, psychologist MegaNutrition and The Listen to Your Body Diet, by Richard Kinin

★★★★ Foundations of Nutritional Medicine by M.R. Werbach, MD, Third Line Press Inc., 1996 • 5th in a series of additions to the scientific development of orthomolecular medicine, evaluates orthomolecular literature • details disorders due to abnormal nutrition, common deficiencies, bioavailability of supplements, interaction between supplements and between supplements and drugs • considers pathology of heavy metal intoxication and interactions of metals with supplements • useful for looking at relationships between essential reactions to hone in on biochemical faults, or missing nutrients

★★ The Gift of Dyslexia: Why Some of the Smartest People Can’t Read … and How They Can Learn by Ronald Davis, Berkley Publishing, New York, 1994 dyslexia, how people can resolve its problems by reorienting capabilities of the dyslexic brain, underlying talent, tips & traps workable solution, practical program, clearly explained, references has dyslexia, gifted with creativity and imagination but labelled ‘retarded’ after failures and setbacks, he became an engineer, businessman, and sculptor – at age 38, a startling discovery enabled him to read better, founded the Davis Dyslexia Assoc. Intnl. in 1995 Other: quarterly newsletter – The Dyslexic Reader

About: Focus: With: Author:

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★★★★ Ginkgo: Elixir of Youth by Christopher Hobbs, Botanica Press, Santa Cruz, Ca, 1991 • explains how ginkgo can improve memory and brain function, protect the heart and restore blood circulation, heal hearing and vision problems, fight common allergic reactions, help preserve general health and vitality • includes notes on the chemistry and pharmacology of ginkgo

★★★★ Gingko: A Practical Guide Nature’s Effective Herb that improves memory, enhances concentration, increases circulation by Georges Halpern, Md, PhD, Avery Publishing, Garden City, NY, 1998 About: gingko extract, used by mankind for thousands of years, to improve brain function Focus: history, cultivation, beneficial effects for a variety of health problems

★ Guidelines for Diagnosis & Pharmacological Treatment of Depression by Depression Working Group, Chair Sidney Kennedy, MD, CANMAT, Toronto 1999 About: making the diagnosis, managing depressive disorders, pharmacology Focus: using antidepressant medications to help patients recover With: charts, medication information, dose ranges, references Contributors: mental health professionals – psychiatrists from major hospitals

★★★★ Healing Anxiety with Herbs by Harold Bloomfield, MD, HarperCollins Publishers, New York, NY, 1998 Featuring a natural self-healing program to relieve stress, promote sleep & maximize performance • herbal remedies with Kava, Valerian, Hypericum or St. John’s Wort, ginseng, ginkgo, milk thistle, licorice root, traditional Chinese Medicine and aryuvedic herbs for anxiety and ADD, reishi mushroom, etc • natural self-healing program of practical, powerful exercises to relieve anxiety and sleep well • (cover) “H. Bloomfield, MD is a Yale-trained psychiatrist and a respected leader in … integrative psychiatry … he has been at the forefront of a number of worldwide self-help movements for more than two decades.”

★★★★ The Healing Nutrients Within by E. R. Braverman, MD with Carl Pfeiffer, MD, PhD, K. Blum, PhD and R. Smayda, DO, Keats Publishing, Inc., New Canaan, CT, 1997 How to use amino acids to achieve optimum health; new research on their beneficial roles in cancer, Alzheimer’s disease, depression, heart condition and more • (cover) “This update and revision of the landmark book on amino acids covers the exciting discoveries of the last decade and shows how to use them in your personal health management program.” • discusses amino acid function and therapeutic supplementation to help various conditions • extensive reference section 176

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A REVIEW:

Handbook of Psychotropic Herbs: A Scientific Analysis of Herbal Remedies for Psychiatric Conditions ★★ by Ethan Russo, MD, The Hawthorn Press, New York, 2001 (cover quote) “Sound advice on the rational use of safe and effective herbs to help alleviate a wide range of … [mental] disorders. An authoritative guide in an area where solid, reliable information is often difficult to obtain.” – Mark Blumenthal, Executive Director of American Botanical Council, Editor of HerbalGram Dr. Ethan Russo, MD is a neurologist at Montana Neurobehavioral Specialists, an adjunct associate professor at the University of Montana, Department of Pharmaceutical Sciences and a clinical associate professor in the Department of Medicine at the University of Washington. With a lifetime interest in medicinal plants, he lectures on a variety of topics and researches the serotonin receptor activity of natural products, especially for migraine treatment. He also treats patients. It is unusual for such a highly qualified North American medical specialist to use herbal extracts in clinical practice. Readers will learn how a doctor who has as many qualifications as Dr. Russo came to use phytomedicines and how research studies encouraged him to apply these methods to neurology patients. The author warns readers that this book was “not designed to be a self-help manual … it cannot replace consultation with a properly trained herbalist, naturopath, or open-minded physician … [It] was designed to introduce the … herbal treatment of mental or nervous conditions, and … a reference of current research on such agents. The book’s audience … psychologists, social workers, pharmacists and other counsellors in a position to advise patients about psychotropic herbal remedies. It may attract … psychiatrists, other physicians, medical students … and laypersons … ” The book offers a wealth of information about the safe and effective use of herbal medications for depression, mental episodes and brain disorders. While not claiming these are panaceas, the author explains how botanical medications are regulated in the US, how plant extracts were researched and how they have been clinically proven to help people with mild to moderate cases of depression, insomnia, cognitive impairment, anxiety and other conditions. Part III has eight detailed case studies of patients with depression, anxiety, dementia, head injuries and other mental disorders. These cases explain how carefully a neurologist examines each patient, taking histories and assessing mental status before making a diagnosis and prescribing treatments. Each patient’s clinical outcome is provided. The cases show how a competent medical specialist uses standard of care procedures to diagnose and treat. The book is enlightening and informative. FINDING CARE FOR DEPRESSION

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★★★★ The Healing Power of Herbs The enlightened person’s guide to the wonders of medicinal plants by Michael T. Murray, ND, Prima Publishing, Rocklin, CA, 1995 • gives description, chemical composition (incl. chemical formulae), pharmacology, clinical applications, medicinal effects, dosages, and toxicity for many herbs • recommends herbs for specific health conditions

★★★, ★★★★ Healing the Hyperactive Brain: Through the New Science of Functional Medicine by Michael Lyon, BSc, MD, Focused Publishing, 2000 About: physician, medical researcher and ADHD sufferer shares his success using natural and nutritional medicine

★★★★ Healing the Mind the Natural Way by Pat Lazarus, Nutritional Solutions to Psychological Problems G.P. Putnam’s Sons, New York, NY, 1995 • introduces orthomolecular psychiatry and presents nutritional solutions for common psychological problems • leading-edge research by orthomolecular physicians offers new hope for people suffering from psychosomatic problems, depression, eating disorders, addictions, anxiety, learning disorders, hyperactivity, Alzheimer’s, etc.

★★★ Healing the Trauma of Abuse: a women’s workbook by Mary Ellen Copeland, MA, MS and M. Harris, PhD, New Harbinger Publications Inc., Oakland, CA, 2000 About: rebuilding self esteem after suffering abuse, your healing journey Focus: practical, step-by-step guide through recovery and healing With: warning signs, practical tips, checklists, references Authors: psychologist who lives with manic depression, co-author psychotherapist in private practice, codirects nonprofit mental health agency, writes on violence Books: Trauma Recovery and Empowerment

★★★★ Heinerman’s Encyclopedia of Nuts, Berries and Seeds by John Heinerman, Parker Publishing Company, Inc., West Nyack, NY, 1995 • nature’s remedies for common health problems from a medical anthropologist’s files • “our ancestors learned by trial and error which natural foods were good for our bodies” • plant knowledge became the basis for many medical remedies we take in pill or powder form

★ Helping Your Teen Overcome Depression: A Guide For Parents by Miriam Kaufman, BScN, MD, FRCP, Key Porter Books, Toronto, 2000 About: Focus: With: Author: Books: 178

types of depression and anxiety, medication and therapy treatments helping teens cope with depression and anxiety, preventing suicide signs & symptoms, practical information clearly explained, cases, references staff physician in adolescent medicine, assoc. professor pediatrics Easy For You to Say: Q&A for Teens Living With Chronic Illness

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★★★★ Herbal Medicine: Expanded Commission E Monographs editor Mark Blumenthal, American Botanical Council, Austin Tx, 2000 About: translated from German, authoritative information for medical use of herbs includes description, chemistry and pharmacology, uses, contraindications, side effects, interactions, dosage and administration and references

★★★★ Herbal Medicine for Sleep and Relaxation by Dr. Desmond Corrigan, Amberwood Publishing Ltd., London, 1996 • history and science of several herbs commonly used to resolve sleeping problems • helpful information about valerian, Passion Flower, hops (humulus lupulus) and more • “All those with an interest in the simple and safe induction of restful sleep will be amply rewarded with new ideas and agreeable and effectual remedies.” Adrian Williams

★★★★ Herbs for the Mind: What science tells us about nature’s remedies for depression, stress, memory loss, and insomnia by Jon Davidson, MD and Kathryn Connor, MD, The Guilford Press, New York, 2000 About: Focus: With: Authors: Other:

use of St John’s wort, Kava, Gingko biloba and valerian for mental conditions scientific & medical information about herbs used for anxiety & depression scientific evidence, essential facts, uses, side effects, references professors of psychiatry at a US university Dr. Davidson is main investigator of NIH study of St John’s wort and depression

★★★★ Herbs that Heal Rx: Prescription for herbal healing by Michael A. Weiner, PhD & Janet A. Weiner, Quantum Books, Mill Valley, CA, 1994 • traditional uses of, and recent scientific findings for over 220 medicinally active herbs

★★ His Bright Light: The Story of Nick Traina by Danielle Steel, Delacorte Press, New York, 1998 About: Danielle Steel’s powerful personal story of the son she lost and his courageous battle with manic depression

★ A History of Psychiatry by Edward Shorter, PhD, John Wiley & Sons, Toronto, 1997 About: Focus: With: Author: Books:

psychiatry from the era of the asylum to the age of prozac how psychiatry evolved to science and medical profession history, references, little about the latest in restorative mental healthcare professor in the history of medicine, University of Toronto The Making of the Modern Family

★★★★ Hoffer’s Laws of Natural Nutrition: A Guide to eating well for pure health by Abram Hoffer, MD, Quarry Press, Inc., Kingston, ON, 1996 • recognizing connection between proper nutrition and health FINDING CARE FOR DEPRESSION

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• processed diets appear to lead to various diseases • food allergies may cause certain people to experience psychiatric symptoms • describes positive effects of specific vitamins and minerals when the need exists, supported by case studies

★★★★ How to Get Well: Dr. Airola’s Handbook of Natural Healing by Paavo Airola, ND, PhD, Health Plus, Sherwood, Oregon, 1974 • (cover) “Learn how foods, vitamins, supplements, herbs, juices, baths, fasting, and other ancient and modern, harmless natural remedies can help to restore health, prevent premature aging, and prolong life.” • (cover) “an authoritative and practical manual on the most common ailments – and what you can do about them – by a world-famous authority on nutrition and natural healing.” • series of chronic conditions such as colitis are linked to dietary considerations, biological treatments, vitamins and supplements, juices, herbs, specifics and referential reading • how to protect yourself against common poisons in food, water, air and environment • why and how to use vitamins and supplements • “vitamin guide – common vitamins, their functions, deficiency symptoms, natural sources, recommended dietary allowances (RDA) and usual therapeutic doses”

★★★★ How To Live Longer and Feel Better by Linus Pauling, PhD, Avon Books, New York, 1987 About: Focus: With: Author: Other:

a simple and inexpensive plan for health longevity which vitamins your body needs on a daily basis, immune system explanations of how vitamins help various body systems, references scientist, chemist, physicist, crystallographer, molecular biologist, researcher Vitamin C and the Common Cold, article about orthomolecular psychiatry

★ How to Save Your Own Life The Savard System for Managing and Controlling Your Health Care by Marie Savard, MD with Sondra Forsyth, Warner Books, New York, 2000 About: Focus: With: Author: Other:

how the patient can become an active partner with his doctor learning about your condition, seeing your records, getting information practical tips that can save your life, 8 step action plan, cases health professional – physician The Savard Health Record, host of radio show Medical Frontiers

★★★★ 5-HTP: Nature’s Serotonin Solution – 5-hydroxytryptophan by Ray Sahelian, MD, Avery Publishing, Garden City Park, New York, 1998 About: how supplementation with 5-HTP can raise serotonin levels naturally and help to reduce depression and anxiety and improve sleep; author explains his views on the intelligent use of nutrients, amino acids, herbs and hormones in combination with medicines. With: advice on dosages, complementary therapies, cautions and side effects 180

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★★★★ The Hyperactivity Hoax: How to Stop Drugging Your Child & Find Real Medical Help by Sydney Walker, MD, St. Martin’s Press, New York, 1998 About: Focus: With: Author: Books:

how to determine if your child needs medical help, find a good doctor many children with medical conditions are misdiagnosed & mistreated cases, diagnostic criteria, 24-hour-day checklist, references neurologist, psychiatrist, neurosurgeon, degrees in physiology, pharmacology Help for the Hyperactive Child

★★★★ Hypericum & Depression by H. H. Bloomfield, MD & M, Nordfors, MD & P. McWilliams, Prelude Press, California, 1996 • according to the British Medical Journal, “ St. John’s plant (flower) is a promising treatment for depression … hypericum extracts were significantly superior to placebo and similarly effective as standard antidepressants … The herb may offer an advantage, however, in terms of relative safety and tolerability, which might improve patient compliance.” • Dr. Bloomfield is a world-renowned Yale-trained psychiatrist who has 25 years of clinical practice specializing in the treatment of depression. He has written several other best-selling books about coping with depression. • information to consult with healthcare professionals and make an informed choice about whether you need treatment for depression and what that treatment might be • medicinal effects of hypericum on depression (includes clinical studies) • hypericum is widely used for depression in Germany where hypericum products account for 50% of the German antidepressant market, compared to prozac which has 2%

★ I’ll Take Care of You: A Practical Guide for Family Caregivers by J. Ilardo, PhD, LCSW and C Rothman, PhD, New Harbinger Publications, Oakland, 1999 About: Focus: With: Authors: Books:

caregiving: the dynamics, self-care, when recipient has a mental disorder practical guidance for caregivers tips and traps, charts, cases, advice for laymen, references psychotherapist, professor, clinical psychologist Father-Son Healing, Risk Taking for Personal Growth, As Parents Age

★★★★ The Ion Effect by Fred Soyka with Alan Edmonds, Alpine Industries, Minneapolis, MN, 1991 Revolutionary discoveries reveal electrically charged particles in the air may control your moods, health, & sense of well-being • (cover) “Tiny electric particles flowing in the air – negative and positive ions – may increase your sense of well-being or make you feel terrible… scientific findings about these mood-changing ‘vitamins of the air.’”

★★★★ Journal of Orthomolecular Medicine Sr. Editor: Abram Hoffer, MD, PhD, 16 Florence Ave. North York, ON M2N 1E9, 416-733-2117 FINDING CARE FOR DEPRESSION

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• quarterly journal, information about current orthomolecular practices, procedures, research articles by health professionals • publications are available by mail order, call for list.

★★★★ Kava: Nature’s Answer to Stress, Anxiety, and Insomnia by Hyla Cass, MD & Terrence McNally, Prima Publishing, Rocklin, CA, 1998 • (cover) “Kava has been used ritually and medicinally in the islands of the South Pacific for centuries. Widely used in Europe, [kava] has been shown to relieve tension and anxiety while maintaining alertness. In larger doses, kava promotes deep, restful sleep. Safe, natural, and inexpensive … alternative to drugs such as Valium.” • author, is assistant clinical professor of psychiatry at the UCLA School of Medicine

★★★★ The Ketogenic Diet: A Treatment For Epilepsy by John Freeman, MD, Jennifer Freeman, and Millicent Kelly RD, LD Demos Medical Publishing, NY, 2000 About: Focus: With: Authors: Books:

controlling seizures using biochemistry, useful for people with epilepsy nutritional control of epilepsy, diet developed at Johns Hopkins Hospital serious science, clear language, case studies, references health professional – physician, supported by a sick child’s father Seizures and Epilepsy in Childhood: A Guide for Parents Tough Decisions: A Casebook in Medical Ethics

★★★★ L-Carnitine: The Energy Nutrient by Brian Leibovitz, PhD, Keats Publishing, Los Angeles, 1998 About: Focus: With: Author: Books:

natural food factor that promotes cardiovascular health and burns fat nutritional and biological aspects, medical applications clinical effects, explains biochemistry and metabolism, references scientific professional – zoologist and physiologist, worked with L. Pauling Carnitine: The Vitamin Bt Phenomenon, Journal of Optimal Nutrition

★★★ Learning to Live With a Stroke: Can You Hear the Clapping of One Hand? by Liza Veith, Jason Aronson Inc., New Jersey, 1997 About: author, a physician who suffered a stroke, shares her story of recovery Focus: combining the insights of patient and physician, path to recovery Author: physician, noted historian of health sciences and psychiatry

★ Life After Trauma by Dena Rosenbloom, PhD & Mary Beth Williams, PhD, LCSW, CTS foreword by Laurie Pearlman, PhD, The Guilford Press, New York, 1999 About: coping after trauma, feeling safe, rebuilding trust, regaining control Focus: reactions to trauma, re-working beliefs, restoring self-esteem With: clear text, perspectives on trauma, workbook exercises, references Authors: clinical psychologist and social worker who work with trauma victims Books: The Revised E.I. Syndrome, Wellness Against All Odds, Tired or Toxic? 182

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★★ Like Colour to the Blind by Donna Williams, Doubleday Canada Ltd.,Toronto, 1996 • living well with autism

★ Living Well With Epilepsy by Robert J. Gumnit, MD, Demos Vermande (Medical Publishing), NY, 1997 About: Focus: With: Author: Other:

living well with a seizure disorder practical tips for living well information for finding quality care healthcare professional – physician First Aid for Epilepsy – information card for patients and caregivers

★★ and ★★★★ Living Well With Hypothyroidism What Your Doctor Doesn’t Tell You … That You Need to Know by Mary J. Shomon, Avon Books, New York, 2000 About: Focus: With: Author: Other:

thyroid dysfunction, how people can get proper diagnosis and treatment symptoms, author’s recovery story, tips & traps, risks & challenges practical help, patient stories, interviews, references, resources professional writer, a thyroid patient herself monthly newsletter Sticking Out Our Necks; www.thyroid-info.com

★ Living With Grief After Sudden Loss – Suicide, Homicide, Accident, Heart Attack, Stroke edited by Kenneth J. Doka, PhD, Taylor & Francis, Bristol, PA, 1996 About: Focus: With: Authors: Other:

coping with the complications of grieving and mourning after sudden death responding and helping survivors journey through grief and reinvest in life insights, cases, resources, support, references 21 health professionals, counsellors, survivors The Hospice Foundation of America

★★ Living With Prozac & other SSRI’s: Life on Antidepressants, edited by D Elfenbein, fwd. by P. Kramer, MD, Harper San Francisco, 1995 About: first person stories of depressed people who take prozac, paxil or zoloft, some do well, others experience negative effects.

★★★ The Loneliness Workbook: A Guide to Developing & Maintaining Lasting Connections by Mary Ellen Copeland, MS, MA, New Harbinger Publications, Oakland, CA, 2000 About: Focus: With: Author: Books:

loneliness, useful for people with mood disorders, mental illness insights, relieving loneliness, developing relationships, tips & traps practical ideas for coping, interviews with sufferers, references, resources health professional – psychologist, has manic depression, thyroid condition series of books for laymen e.g., Living Without Depression and Manic Depression FINDING CARE FOR DEPRESSION

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THE LAST TABOO A SURVIVAL GUIDE TO MENTAL HEALTH CARE IN CANADA ★★ by Scott Simmie and Julia Nunes, McClelland & Stewart, Toronto, 2001 (cover quote) ‘‘The Last Taboo will do more than any previous publication to break down the fear and stigma surrounding people with psychiatric disabilities … ” Ed Pennington, director of the Canadian Mental Health Association, writes in the foreward that ’‘The Last Taboo is a practical road map for people … looking for paths to hope and recovery.” Author Scott Simmie is an experienced journalist. He lives with a bipolar mood disorder. His wife and co-author Julia Nunes is also a journalist. Together they map out the mental health system in Canada, selecting their words with care and compassion, and explaining how the system can help sick people. Believing that “mental disorder, remains … the last taboo, [they] work to break that taboo. One story at a time.” The book starts with Scott’s story. Overseas on assignment, he experienced an episode of deep depression. Then he suffered the perplexing over-excitement of an episode of mania. As his mental health deteriorated and his world fell apart, Scott struggled to maintain his career and his self-esteem. For a long time, he did not know that he had a bipolar mood disorder. His wife cared enough to stay with him and they worked on his recovery. They became fascinated with mental illness: the people who have it and the people who care for them, how the mental health system works and how to renew hope for mental health. Julia writes about her reaction to Scott’s experience. Rarely do we get the chance to learn how hard it is for a close family member to understand what is happening to a sick mate. Julia was puzzled, concerned and upset, at times coping with her own health problems. Together they explored the mental health system and Scott found competent care. With Julia’s help and his family’s support, he recovered. We expect experienced journalists to do extensive research. Scott and Julia do not disappoint us. They interviewed many people: patients, family, researchers and health professionals. They read about psychiatry and psychology. They share the good news: a lot is known about mental illnesses: how to diagnose disorders and how some patients recover. There is bad news too: some patients do not 184

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recover normal brain function, even though they cooperate, take conventional psychiatric medications and have the usual talk therapies. Scott and Julia explain that a person with a mental disorder is temporarily unwell and not an ogre to be feared or excluded. In addition to their own poignant story, they introduce us to a succession of fascinating people who live with a variety of mental illnesses such as manic-depression, depression, schizophrenia, and obsessive-compulsive disorder. We learn that mental patients want to get well and live with dignity. They have the same dreams and aspirations as normal human beings. Statistics indicate that 20% of the general population suffer with episodes of depression, anxiety, substance abuse and other conditions. Psychiatrists and psychologists use a diagnostic manual to label the symptoms. The causes can be explored. Scientific knowledge has advanced but mental disorders are complex. Vulnerable people seem to have a susceptibility built into their genetic inheritance. Biological, psychological, social and environmental factors can overload peoples’ coping capabilities until they experience the symptoms of a mental illness. There is help. Scott explains the formal mental health system in Canada. We would like to believe that the system is working well but the authors report that there are major problems. Informal systems support people who are willing to learn from survivors. The benefits of conventional medications and therapy are outlined. Proven alternatives are also mentioned. Patients are advised to help themselves by reading, organizing peer support and using the formal and the informal systems to find care. Patients are encouraged to take responsibility for their progress. It is sad that 15% of mental patients slip into despair and die by suicide. This horrifying reality is presented with tact and compassion. The issue of stigma is addressed and there is a conclusion: stigma isn’t the patient’s fault, it is a problem created by uninformed people who react inappropriately when they meet a mental patient. In the end, there is only one explanation “ … folks [who live with mental disorders] are just like everyone else. Just like you. Recovery … needs nurturing. Care. Love.” While keeping Scott’s story in their hearts, Scott Simmie and Julia Nunes wrote this book gently but firmly. They teach us that mental patients are people who are unwell not sub-human beings to shun. They paint a clear picture of the mental health system in Canada. They warn us about the problems but encourage patients and their families to explore the mental health system and hope for recovery. FINDING CARE FOR DEPRESSION

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★★★★ Lifting the Bull: Overcoming chronic back pain, fibromyalgia & environmental illness by Diane Dawber, Quarry Press Inc., Kingston, ON, 1997 • (cover) “Dawber builds her book on fibromyalgia – a chronically painful and disabling muscular syndrome – … telling how she was able to defeat her pain and regain her strength through a regimen of orthomolecular nutrition or nutrient supplements, bodywork exercise, and cleansing of her environment. The title also alludes to the other kind of ‘bull’ – the various medical myths, useless diagnoses, and ineffective pharmaceutical and surgical treatments involved with chronic pain syndromes like fibromyalgia …” • (cover) “Told in a personal journal form … a moving story of human suffering and recovery, full of the anecdotal appeal missing from other clinical treatments of this syndrome, as well as a practical guide to recovery. The recovery regimen the author recommends has been endorsed by medical doctors, physiotherapists and kinesiologists.” • a rare account of the practical application of orthomolecular medicine by a patient who took the time to research her options, and persist as trial after trial of assorted treatments by a variety of medical professionals did not cure, she persisted until she found competent health professionals who diagnosed accurately and helped her recover

★ Making Hope Happen: A Workbook for Turning Possibilities into Reality by D. McDermott, PhD & C.R. Snyder, PhD, New Harbinger Publications, Oakland, CA, 1999 About: Focus: With: Authors: Books:

exploring and rebuilding hope, useful for people with mental illness insights, your story, your hope patterns, renewing your hope, tips & traps practical ideas, clear language, interviews, references health professionals – psychologists The Psychology of Hope: You Can Get There From Here, Hope for the Journey: Helping your Children Through Good Times and Bad

★★ and ★★★ Malignant Sadness: The Anatomy of Depression by Lewis Wolpert, Faber and Faber Limited, London, 1999 About: Focus: With: Author: Books:

the experience of depression, psychology, biology, treatments how the condition feels, what treatments work personal insights, historical notes, clear explanations, references science professional – research biologist, who experienced depression A Passion for Science, The Triumph of the Embryo, Passionate Minds, The Unnatural Nature of Science

★★★★ Managing Menopause with Diet, Vitamins and Herbs by Leslie Beck, RD, Prentice Hall Canada, Toronto, 2000, www.lesliebeck.com About: Focus: With: Author: Books: 186

easing symptoms of perimenopause including mood swings using natural supplements to restore and maintain good health benefits of diet, herbs and supplements, references registered dietitian, integrative nutritional practitioner The Complete Idiot’s Guide to Total Nutrition for Canadians

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★★★ Margin: Restoring Emotional, Physical, Financial and Time Reserves to Overloaded Lives by Richard Swenson, MD, Navpress, Colorado Springs, 1992 About: Focus: With: Author: Books:

pain of problems, stress, overloads – restoring margin through balance restoring depleted energy and personal resources, tips & traps practical ideas for coping, interviews with sufferers, references health professional – physician who experienced depletion The Overload Syndrome

★★★★ Masks of Madness: Science of Healing by Dr. Abram Hoffer, introduction by Margot Kidder, TV documentry (1998), available from Quarry Press, Cdn. Schizophrenia Foundation • 8 mental patients report progress – orthomolecular care for schizophrenia, mood disorders • 6 doctors share their clinical success using orthomolecular medicine – Abram Hoffer, Patrick Holford, Hugh Riordan, Hyla Cass, Bradford Weeks, Michael Janson

★★★★ Mental and Elemental Nutrients: A Physician’s guide to nutrition and health care by Carl C. Pfeiffer, PhD, MD, Keats Publishing, Inc., New Canaan, Connecticut, 1975 • during Dr. Pfeiffer’s research, practice and experience as director of Princeton’s Brain Bio Center, he learned that many mental conditions are caused by the absence of vital nutrients. This may relate to abnormal loss of trace mineral(s), a blood sugar imbalance, toxic pollutants or modern diet of adulterated empty-calorie processed foods • role and function of nutrients including protein and vitamins as well as trace minerals which can make the difference between sickness and health, sanity and mental illness • presents his program and philosophy for optimum mental and physical well-being

★★★★ Mental Health: The Nutrition Connection by Patrick Holford, ION Press, 1996, 34 Wadham Rd., London, UK SW15 2LR • consists of two back-to-back volumes: (1) How to Beat Depression, Anxiety and Schizophrenia by Carl Pfeiffer (2) How to Enhance Your Mental Performance and Emotional Well Being by Patrick Holford • Pfeiffer established a scientific nomenclature, a diagnosis which is causal not merely descriptive, and methods one can use to repair damage and restore mental and physical health eg. method for dividing the schizophrenias into three sub groups • Holford enlarges the value of nutritional treatment by discussing conditions such as sugar blues (depression caused by too much sugar in the diet), the role played by stress and allergies

★★ Mental Illness: Survival and Beyond: A Practical Guide to the Inpatient Psychiatric Experience by Virginia Wilson, Trafford Publishing, Victoria, 1998, www.trafford.com About: Focus: With: Author:

reality of being hospitalized for a psychiatric illness practical experience of the psych ward, cooperating with treatment personal observations, clear insights, legal rights, references articulate and empathetic psychiatric survivor, experienced depression FINDING CARE FOR DEPRESSION

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★★★★ Methyl Magic: Maximum Health through Methylation by Craig Cooney PhD & Bill Lawren, Andrews McMeel Publishing, Kansas City, 1999 About: Focus: With: Authors: Books:

methylation aspects of human biochemistry, useful for depression + the methyl magic program for health conditions, explained for laymen methylating supplements, programs for using them, references healthcare professional – PhD biochemist, medical writer authors have written for scientific journals and national magazines

★★★★ Migraine by Oliver Sacks, University of California Press, Los Angeles, 1992 About: Focus: With: Author: Books:

understanding migraines, the biological basis, treatment advances migraines as an involuntary brain condition, possible reset function case histories, new findings, practical information on treatment, references professor of neurology The Man Who Mistook His Wife For A Hat, Awakenings, Seeing Voices

★★ Migraine by Edda Hannington, MD, Priory Press Ltd., 1974 ★★★★ Minerals, Supplements and Vitamins: The Essential Guide by H. Winter Griffith, MD, Fisher Books, Tucson, Arizona, 2000 About: Focus: With: Author: Other:

vitamins, minerals, amino acids and other supplements basic information, benefits, deficiency symptoms, usage, interactions warnings and precautions, overdose/toxicity, references physician, professor of medicine, writer of medical-info. books for laymen The Complete Guide to the Anti-Aging Nutrients by Saul Hendler, MD, PhD

★★★★ The Miracle Nutrient: Coenzyme Q10 by Emile G. Bliznakov, MD & Gerald L. Hunt, Bantam Books, 1986 • scientific and medical researchers learned that coQ10 is in every cell of the human body • well known that oxygen, water, vitamins, proteins, carbohydrates and fats are essential to life; it is also true that the body cannot survive without coenzyme Q10 • as humans age, the body may not manufacture coQ10 from precursors efficiently enough for optimum health and this can lead to a deficiency throughout the body • supplements can help to bolster brain and body energy systems including the immune system, protect against aging, lose weight, reduce high blood pressure, strengthen the heart or cure periodontal disease

★★★★ The Miracle of MSM: The Natural Solution for Pain by Stanley Jacob, MD & Ronald Lawrence, MD, PhD & Martin Zucker G.P. Putnam’s Sons, New York, NY, 1999 • (cover) “… a nutritional supplement that is establishing a reputation as a safe, natural, and effective solution for many types of pain and inflammatory conditions, including: degenerative arthritis, chronic back pain, chronic headache, muscle pain, fibromyalgia, tendinitis and bursitis, carpal tunnel syndrome, TMJ, post-traumatic pain and inflammation, allergies. 188

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• “a natural substance present in food and in the human body … the end result is relief, with none of the troubling side effects frequently caused by prescriptive pain medication.” • “Drs. Jacob and Lawrence explain the myriad benefits of MSM and share their wealth of experience in the successful treatment of thousands of patients for pain and allergies.”

★★★★ NADH The Energizing Coenzyme by George Birkmayer, MD, PhD, Keats Publishing, New Canaan, CT, 1998 About: how an important, little-known coenzyme can enhance brain function Focus: effects of NADH on cellular metabolism, medical applications – Depression, Dementia, Alzheimers, Chronic Fatigue Syndrome With: success stories, references, research reports suitable for laymen Author: health professional, physician, biochemical researcher Other: 150 research papers, 100 scientific articles

★★★★ Natural Alternatives to Over-the-Counter and Prescription Drugs by Michael T. Murray, ND, William Morrow and Company, Inc., 1994 • safe, natural alternatives to prescription drugs like Tagamet, Prednisone, Seldane, Zantac • natural alternatives to over-the-counter drugs used to treat acne, high cholesterol, heartburn, the common cold, insomnia, arthritis, headache, hay fever, etc. • suggestions for using medicinal herbs, nutrient therapy, dietary changes, etc.

★★★★ Natural Alternatives to Prozac by Michael T. Murray, ND, William Morrow and Company, Inc., New York, 1996 • • • •

discusses possible adverse effects of synthetic antidepressant medications like Prozac identifies causes and symptoms of depression, natural treatment alternatives lifestyle and nutritional factors which may be associated with depression (cover) “In a straightforward … style … offers natural remedies for people who want to alleviate depression without pharmaceutical drugs. Outlining some of the consequences involved with taking Prozac, naturopathic physician Michael Murray provides a comprehensive look at depression’s damaging effects on quality of life and includes tests that readers can take to help determine if they are suffering from depression. Chapters about lifestyle and nutrition examine how food allergies, heavy metals, and vitamin deficiency can contribute to a depressed state of mind. Murray shows which herbs, extracts, vitamins, and minerals can provide the same benefits as Prozac – without the side effects. With detailed, information, this guide will help readers live fuller, healthier lives.”

★★★★ Natural Energy: From Tired to Terrific in 10 Days by Erika Schwartz, MD and Carol Colman, Berkley Books, New York, 1998 About: Focus: With: Author: Books:

simple rules to help repair, recharge and revive your life if you are tired benefit from the right diet, exercise and nutritional supplements information about carnitine, Co Q10 and other supplements, references physician who combines alternative and conventional medicine The Melatonin Miracle, The Superhormone Promise FINDING CARE FOR DEPRESSION

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The Noonday Demon An Atlas of Depression ★★ by Andrew Solomon, Scribner, Toronto, 2001 (cover quote) “An amazingly rich and absorbing work … In its flow of insights and its scope – encompassing not only the author’s own ordeal but also keen inquiries into the biological, social, and political aspects of the illness – The Noonday Demon has achieved a level of authority that should assure its place among the few indispensable works on depression.” – William Styron, author of Darkness Visible Andrew Solomon is an American magazine writer and book author. He confesses that he is a mood disorder survivor with a vulnerability to depression and anxiety. The title of this book suggests that the book can be a map to guide readers. Indeed, this book covers the geography, history, psychology, biology and sociology of depression - from the author’s perspective, as well as the perspectives of other patients, health professionals and authors. The author’s exquisite writing, personal awareness and prolific coverage of the depth and breadth of depression could justify the sub-title of An Encyclopaedia of Depression. Using his firsthand experiences and interviews with other patients, the author writes about depression, breakdowns, treatments (conventional and alternative), addiction, suicide, history, poverty, politics, evolution and hope. The author shares voluminous research, detailed notes and an extensive bibliography. Rather than waffling about difficult topics, the author takes a definitive stand. He shares what he learned during repeated episodes of depression. He compares his experiences with other patients. He interviews experts and outlines the literature in the field of mental health. The author tells it like it is and clearly outlines what is known and has yet to be discovered. He shares helpful information without offering false hope. The author reports that various factors can cause depression. Some people succumb when there are multiple causes. Depending on their triggers, individual patients often benefit from appropriate treatments, competently applied. Incompetently applied, sick patients risk deterioration. The 190

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author investigated a variety of treatments. Antidepressant medications and talk therapies are two conventional approaches which help him. He also investigated a range of alternative treatments and he enjoyed some benefit from EMDR and social rituals. The author’s story is fascinating. Few writers describe the painful experience of depression and anxiety as vividly or accurately. Few deal with the paradoxical effects of antidepressant medications which can numb the pain of depression but often cause negative effects. Few share the painful loss of a family member to suicide. Not content with sharing his own experiences, Andrew Solomon interviewed other patients: some from his country and some from abroad, some with his background and some from other cultures. Each story is fascinating in its own right. These accounts broaden the readers’ understanding of the fallible human beings who are vulnerable to episodes of depression. Once kindled, episodes of depression can recur with successively weaker triggers. Readers learn that depression is a universal human condition but there is hope for recovery. The author suggests that a person who is vulnerable to depression would be wise to learn about their fallibilities and develop a mental health maintenance program of medications, therapy and support from family and friends.

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★★★★ Natural Healing for Schizophrenia:A Compendium of nutritional methods by Eva Edelman, Borage Books, Oregon, 1996 • imbalanced brain biochemicals are linked with schizophrenia, nutritive treatments can alleviate imbalances and lead to recovery • nutritional therapies have helped a large number of patients recover from schizophrenia and other mental illnesses • unique style presents a wealth of helpful information about orthomolecular psychiatry • major biotypes of schizophrenic vulnerabilities. Appropriate helpful nutritional supplements are indicated. • focus is schizophrenia but also covers other brain imbalances such as hypoglycemia and depression with symptom checklists and suggestions for natural supplements.

★★★★ Natural Nutrition for Children, Dr. Hoffer’s ABC of by Abram Hoffer, MD, PhD, Quarry Press Inc., Kingston, ON, 1999 • (cover) “Following on the success of his previous books on natural nutrition for adults, including Smart Nutrients, Dr. A. Hoffer, a founding father of [orthomolecular medicine] … has written the definitive book on natural nutrition for children. He examines chronic illnesses suffered by 2,000 children in his practice, with special attention to learning and behaviour disorders, and discovers that nutrient deficiency is the predominant cause. He recommends against pharmaceutical, psychotherapeutic, and surgical intervention in favour of orthomolecular or nutritional therapy … Nutritional therapy of physical and mental illnesses uses a combination of optimum nutrition from common foods with vitamin and mineral supplements. The book features chapters on diagnosis and treatment, and case studies, in which many parents will find their children’s illnesses diagnosed; a table of the nutrient content of common foods which a parent can follow in developing an optimum diet; and a guide to vitamin and mineral supplements for children, with recommended dosages.”

★★★★ The Natural Pharmacy Covers all major ailments and conditions; includes herbs, nutritional supplements, and homeopathy by Skye Kininger, DC, Editor-in-Chief, Prima Publishing, Rocklin, CA, 1998 • (cover) “… complete coverage of the most common conditions, together with useful guidance on how to treat them. In addition, … gives you up-to-date, fully referenced, reliable information of a world of supplements that can improve your health … guide to conditions, supplements, herbs, and homeopathic remedies.” • considers nutrients, herbs and supplements that may be helpful … side effects and interactions • herb section has names, conditions that might be supportive, historical use, active constituents, doses, side effects

★★★ Night Falls Fast by Kay Redfield Jamison, PhD, Knopf, New York, 1999 About: Focus: With: Author: Books: 192

suicide and people with mood disorders, schizophrenia, family issues insights, survival strategies, tips & traps coping stories, references, research reports health professional – psychologist, has manic depression An Unquiet Mind; Touched with Fire; Manic-Depressive Illness

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★★ Nobody Nowhere: The Extraordinary Autobiography of an Autistic by Donna Williams, Doubleday Canada Ltd.,Toronto, 1992 ★★★★ Nutrition and Behaviour by Alexander Schauss, MA Keats Publishing, Inc., New Canaan, Connecticut, 1985 • what you eat affects what you do – and can prevent or promote delinquency & antisocial acts • identifies food intolerances and allergies • links iron, zinc, refined carbohydrate and megavitamin deficiencies with behavioural disorders

★★★★ Nutrition and Mental Illness: An orthomolecular approach to balancing body chemistry by Carl Pfeiffer, PhD, MD, Healing Arts Press, Vermont, 1987 • (from the forward) “Dr. Pfeiffer decided to examine the biochemistry of his psychotic patients. He found high or low levels of nutrients and other body chemicals and where possible, he learned how patients could normalize them using non-toxic supplements. He tested for food sensitivities and blood sugar levels. He measured histamine levels and urine pyrrole levels. He observed his patients, asked them about themselves, learned about their problems and grouped them into (often overlapping) groups according to symptomology. He devised nutritional therapies for them according to observation and biochemical profile.” • ‘‘Orthomolecular medicine today is primarily used in the treatment of psychiatric disorders, and orthomolecular psychiatrists make up approx. 1% of the 30,000 practicing psychiatrists in North America … the scope of treatable disorders has continually broadened since the initial treatment of schizophrenia to include epilepsy, autism, senility, childhood hyperactivity, arthritis, colds, herpes simplex virus infections and allergic and digestive problems … the nutritionally-oriented medical professional is a rare bird. The type of treatment offered by orthomolecular doctors varies, but the mainstream of work focuses on meganutrient therapy. After careful diagnostic testing … trained doctors interpreting these tests recognize the biochemical individuality of each patient. That is, each patient may have very different nutrient requirements from those of other patients.”

★ Nutritional Herbology: A reference guide to herbs by Mark Pedersen, Wendell W. Whitman Company, Warsaw, IN, 1994 • how and why herbs work, nutritional analysis of scores of herbs • scientific analysis that authenticates historical usage • detailed description of active principles in each herb, how to decipher each herb’s herbal properties • acupressure and iridology points correlated to herbal combinations, information about individual herbs

★★★★ Nutritional Influences on Mental Illness by M.R. Werbach, MD, Third Line Press Inc., 1992 • information about the scientific development of orthomolecular medicine • common mental health conditions are analyzed with an overview of nutritional causes, FINDING CARE FOR DEPRESSION

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(Nutritional Influences on Mental Illness … continued)

nutritional supplements and diet • with supporting studies both observational and experimental • reviews articles and case reports for each of several supplements

★ Obsessive-Compulsive Disorders: Complete Guide to Getting Well & Staying Well, by Fred Penzel, PhD, Oxford University Press, New York, 2000 About: Focus: With: Author: Other:

the most effective therapies, how to avoid relapse, help for loved ones getting proper treatment, recovery and acceptance, different forms information explanations, checklists, references psychologist who treats people with OCD contributor to the newsletter of the Obsessive-Compulsive Foundation

★ Of Two Minds – The Growing Disorder in American Psychiatry by T.M. Luhrmann, Knopf, New York, 2000 About: psychiatry at a cross-roads – inconsistent methods, questionable results, caring young psychiatrists see mental illness exploding but cost-cutting reduces quality of care in many cases, leaving doubts about their work Focus: insights into two methods of psychiatry which are at odds, perceptions about the ‘culture’ of mental healthcare professionals and patients With: interviews, references, research reports Author: academic professional – anthropologist Books: Persuasions of the Witch’s Craft; The Good Parsi

★★★★ Orthomolecular Nutrition: New lifestyle for super good health by Abram Hoffer, PhD, MD & Morton Walker, DPM, Keats Publishing, Inc., Connecticut, 1978 • explains the importance of orthomolecular nutrition (ingesting appropriate amounts of appropriate vitamins and nutrients to create an optimum molecular environment in the body) to maintain and recover mental and physical health, examples and cases including relative hypoglycemia, schizophrenia, etc. • clear, easy to read

★★★★ Orthomolecular Treatment for Schizophrenia by A. Hoffer, MD, PhD, FRCP(C), Keats Publishing, Los Angeles, 1999 About: Focus: With: Author: Books:

using orthomolecular medicine, normalizing biochemistry of schizophrenia taking natural supplements like vitamin B3 and C to restore mental health information about accurate diagnosis and effective treatments, references health professional - psychiatrist, PhD biochemist and medical writer Vitamin B3 and Schizophrenia: Discovery, Recovery, Controversy Vitamin C and Cancer: Discovery, Recovery, Controversy

★ Phantoms in the Brain: Probing the Mysteries of the Human Mind by V.S. Ramachandran, MD, PhD and S. Blakesless, foreward by Oliver Sacks, MD 194

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About: “Sherlock Holmes” of neuroscience reveals his strangest cases Focus: insights about human nature and the mind from cases in neurology With: cases to illustrate the functions and dysfunctions of the brain, references Authors: neurologist, professor and director of Centre for Brain and Cognition; writer Books: Second Chances, The Good Marriage

★ Practice Guidelines of the American Psychiatric Association steering committee chair John McIntyre, MD, APA, New York, 1996 psychiatric evaluation of patients with mood, eating and substance disorders disease definition, treatment principles & alternatives, recommendations studies from 1971-1991, consensus of experts, references to improve patient care by educating psychiatrists, other mental health professionals, and the general public about appropriate treatments Contributors: mental health professionals Other: There are APA guidelines for a range of mental illnesses.

About: Focus: With: Purpose:

★ Practitioner’s Guide to Empirically Based Measures of Depression edited by A. Nezu, G. Ronan, E. Meadows, K McClure, Kluwer Academic/Publishers, New York, 2000 About: Focus: With: Editors:

90 instruments that measure depression, written for health practitioners clinical tools for depression assessment, intervention and / or research reviews of depression measures, symptoms, scales, constructs, references psychologists at four US universities

★★★★ Prescription for Nutritional Healing by James F. Balch, MD & Phyllis A. Balch, CNC, Avery Publishing Group, Garden City Park, NY, 1997 • reference to drug-free remedies using vitamins, minerals, herbs and food supplements

★ A Primer of Drug Action: A Concise, Nontechnical Guide to The Actions, Uses & Side Effects of Psychoactive Drugs by Robert Julien, MD, PhD, W.H. Freeman & Co., New York, 1998 ★★★★ Probiotics: Nature’s Internal Healers by Natasha Trenev, Avery Publishing Group, New York, 1998 your diet and friendly bacteria, how people can benefit from supplements how gut flora and fauna can help you recover from various conditions recommended probiotic regimens, references worked in a family yogurt business, began studying the health benefits of probiotic cultures, established a standard for the Natural Products Quality Assurance Alliance (NPQAA), researched probiotics Other: articles on probiotics for medical journals www.natren.com

About: Focus: With: Author:

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A REVIEW:

PROZAC BACKLASH ★ by Dr. Joseph Glenmullen, MD Simon and Schuster, New York, 2000 The front page of the August 13, 2000 Toronto Star newspaper reported the case of a depressed 37-year-old mother, physician and therapist who tried to take her own life by jumping in front of a subway train with her baby in her arms. Sadly, they both died. The headline describes the case as a ‘puzzle’. Until we know what caused this tragedy, we can wonder why up to 15% of depression sufferers take their own lives. Caregivers can read books like Prozac Backlash to learn how we can cooperate to help depressed people before they suicide. As a result of my book research and writing, study of reference books about mental illness, consulting with local clients, and experiencing my own bipolar II mood disorder, I know something about depression and how despair can lead to suicidal thoughts. When I was being treated for depression, I took two SSRI antidepressants in succession. I was troubled, both times for months, with negative effects, side effects and adverse effects. I felt like a bad person and a bad patient when I was following my doctor’s orders and taking these prescription medications which only made me worse. At one point, while I was also taking a ‘sleeping’ medication which my psychiatrist prescribed, I experienced a paradoxical inability to sleep. I was in so much pain that I wanted to end my life rather than continue living in such torment. Fortunately, relief of the episode of sleeplessness came soon after I stopped taking the new medication. I wondered if a book might help to explain my experiences or solve the ‘puzzle’ of sudden suicides. Prozac Backlash, written by Dr. Joseph Glenmullen, clinical instructor of psychiatry at Harvard Medical School, explains matters in fascinating detail. Its complete title is Prozac Backlash: Overcoming the Dangers of Prozac, Zoloft, Paxil and Other Antidepressants with Safe, Effective Alternatives. Unlike other books with similar sounding titles, this book is thoughtful, balanced, clear and logical. It does not make wild accusations or grandiose claims. It focuses on the facts and outlines unsettling information about SSRI medications. Some of these disturbing patterns also happened years ago when patients took older psychiatric medications. 196

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I am not against psychiatry and I am not against antidepressant medications. Thousands of people are helped by pills which ease the dreadful pains of their depressions and give them a welcome respite, renew their sense of peace, bolster their self-confidence and give them windows in time to address painful losses, cope with transitions and deal with other depressogenic life situations. Antidepressants, anti-anxiety and mood stabilizing medications have their place in psychiatry. How do people cope if their medications have multiple side effects or cause adverse effects, while they are already sick with depression? Studies and anecdotes are reporting that many people who need help for depression, anxiety (and other mental health problems, distresses, strains and overloads) hope and trust that quick and easy one or two pill prescriptions will solve their problems. If only life’s problems and medical conditions could be fixed by taking a few pills. Dr. Glenmullen’s book presents many patients who suffer with depression for a variety of reasons. He explains what happened when they took SSRI antidepressants. He notes a pattern: new psychiatric drugs are lauded as definitive answers to serious mental problems. Some are prescribed widely BEFORE extensive testing is done but AFTER the medications have been tested enough to qualify for prescription drug status. There are 3 stages: 1. some patients report negative effects; 2. more testing is done; and 3. results lead to reduced medical applications of troublesome drugs. Stage #1: For about ten years, a large number of patients seem to be helped by the new medications but a growing number report multiple problems. When mental patients complain, their difficulties may be dismissed, discounted or ignored. Stage # 2: For another ten years, scientific studies are reviewed, questions are asked and tests are redone to systematically check thousands of patients and document the relative frequency of mild side effects, moderate adverse effects and serious complications connected to the medications (which by then are 10 to 20 years old and have been used by millions of patients). Stage #3: By about the thirty year mark, medications which are proven to cause serious complications are then limited to restricted use. The experience of human use unfolds differently for each prescription drug; eventually the drug patents expire. Manufacturers can make millions of dollars if their drugs are widely used. Effective medications help hundreds of thousands of patients who respond FINDING CARE FOR DEPRESSION

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favourably. Responsive patients are happy to feel better; bad responders are upset. There is confusion about the differences. Noting that this cycle of concerns and restrictions happened before with amphetamines and benzodiazepines, Dr. Glenmullen’s book raises questions about whether the same pattern is repeating with SSRI antidepressants. With millions of people taking these medications every day and depending on them for effective care for depression and other mental problems, we can hope that Dr. Glenmullen is wrong. Surely drug companies invested enough time and money to design, develop, produce and market only the best SSRI antidepressants. They must have done testing to be certain that their pills are safe and effective for human use. We cannot be repeating the same patterns and problems that happened with other drugs in the past. Or can we? Several SSRI antidepressant medications are at the 10 year mark. A few have been under development and used for nearly 20 years. Concerns about side effects, adverse effects and serious complications are being written about more often. Some people suffer worse than others. Clinical trials have been reviewed, questions asked and new studies started. Dr. Glenmullen writes at length about the concerns that some patients report while taking SSRI’s and he notes the responses of pharmaceutical companies. He seems to be objective and independent of SSRI drug companies, unlike other psychiatrists who encourage the use of medications without disclosing financial connections to the drug company manufacturers. Among Dr. Glenmullen’s concerns are: 1. SSRI antidepressant manufacturers claim that sexual dysfuntion is only experienced by 2 – 5% of the patients who use these medications; current studies report that up to 60% of patients suffer sexual dysfunction while taking SSRI’s for depression and other indications. 2. Chapter 4, titled “Bones Rattling Like Tuning Forks: Startling New Information on Suicide and Violence”, may offer clues to puzzling cases of sudden suicide attempts by depression patients. On page 155, Dr. Glenmullen writes “in early 1990, two Harvard Medical School psychiatrists … reported in the AJP that … (one SSRI antidepressant) could induce ‘intense, violent suicidal preoccupation’.” The chapter presents patients who experienced paradoxically suicidal thoughts while taking 198

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SSRI medications. The worst case involved a chap who, soon after starting to take an SSRI, went berserk, killed several people and took his own life. The jury’s verdict vindicated the drug manufacturer, however questions and concerns linger after the legal settlements. We are left with unanswered questions about the possible connection between SSRI medications, suicidal thoughts and impulsive behaviors in some people who don’t seem able to tolerate these pills. It is common knowledge that psychiatric medications can make some patients worse. Sometimes the effects clear up. It appears that psychiatrists cannot predict who will be good responders and who will suffer from side effects, adverse effects or serious complications. We cannot assume that an attempted suicide was caused by an antidepressant medication leading to overwhelming suicidal impulses, however that risk may apply to a small percentage of patients. Doctors may be overloaded and overworked with depression cases because they face severe cost-cutting while caring for a virtual epidemic of patients with depression. Who could blame doctors for using quick and easy methods or prescribing the newest antidepressants? If an individual turns out to be one of the estimated 3.5% of patients who experience an unexpected, surprising or ‘paradoxical’ suicidal reaction to an antidepressant, that might explain some of the reports of unexpected self-harming behaviors. If a patient’s antidepressant is a factor in impulsive behavior or a suicide attempt, that might leave the drug manufacturer with some ‘splaining to do. We cannot assume that medication is the only possible culprit. If violence involves impulsivity or criminal behavior, it is up to the patient’s doctor, the family, the medical review boards, lawyers and the police to investigate and take appropriate legal action. If an inappropriate medication can be linked to suicidal behavior, only a careful forensic investigation will yield the proof needed to prosecute the responsible parties. Meanwhile, readers who are taking antidepressants (and coping with side effects and adverse effects as well as involuntary symptoms of conditions like depression and anxiety or bipolar disorder) can read Prozac Backlash by Dr. Glenmullen to learn more about the touted benefits, success claims and valid concerns involving SSRI antidepressant medications. FINDING CARE FOR DEPRESSION

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★ Prozac Backlash: Overcoming the Dangers of SSRI’s and other Antidepressants With Safe, Effective Alternatives by Joseph Glenmullen, MD, Simon and Schuster, New York, 2000 About: risks and benefits of SSRI antidepressants, surprises about these pills, unravelling depression, surmounting anxiety, conquering addictions Focus: tips & traps about antidepressants, why they aren’t panacea’s With: practical, timely, clear warnings, clinical cases, research, references Author: health professional – psychiatrist, instructor at Harvard Medical School Books: Sexual Mysteries: Tales of Psychotherapy www.glenmullen.com

★ The Psychiatric Interview: A Practical Guide by Daniel Carlat, MD, Lippincott Williams & Wilkins, New York, 1999 About: Focus: With: Author:

obtaining a reliable history from a mental patient, form a therapeutic alliance quick concise information for professionals in the mental health system questions for diagnostic interviews, sample forms, references psychiatrist, section chief, dept of psychiatry, US hospital

★ Psychiatric Malpractice: Stories of Patients, Psychiatrists and the Law by James Kelley, Rutgers University Press, New Jersey, 1996 About: true stories: patients who sought help from psychiatrists, sued for malpractice Focus: four kinds of malpractice – patient suicide, patient violence, sexual misconduct by psychotherapist and use of unconventional treatments With: psychiatry – an uncertain branch of medicine, case reports, references Author: lawyer and writer who has personal experience of manic depression Other: author questions whether there is a consistent standard of care in psychiatry

★★★★ Pycnogenol: The Super “Protector” Nutrient by Richard A. Passwater, PhD & Chithan Kandaswami, PhD Keats Publishing, Inc., New Canaan, Connecticut, 1994 • an antioxidant that can help fight arthritis, diabetes, stroke, heart disease & cancer

★★★★ RDA: Rats, Drugs and Assumptions A book about one physician’s search for the cause of disease and the truth in medicine by Majid Ali, MD, Life Span Press, Denville, NJ, 1995 • challenges assumptions of drug medicine • clarifies medical statistics and shows how … medical research can be distorted to promote long-term use of drugs • exposes the deep prejudice of practitioners of drug medicine against natural nontoxic therapies • promotes restoration of enzymes by using appropriate nutrition, environmental and physical fitness approaches

★★★★ Reading by the Colours: Overcoming Dyslexia and Other Reading Disabilities Through the Irlen Method by Helen Irlen, Avery Publ. Group, Garden City, NY, 1991. About: scotopic sensitivity syndrome, using chronotherapy to improve reading 200

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★★★★ Reading to Heal: A Guide to the Best Nutritional Health Books for Indiv. & Groups by Diane Dawber, Quarry Press, Kingston, 1999 About: Focus: With: Author: Books:

alternative and complimentary books for laymen, setting up a reading group healthy book choices, using books to learn what doctors don’t explain 60 book cover images, snapshot reviews, references writer who found books to solve her fibromyalgia and depression mysteries Lifting the Bull: Overcoming Chronic Back Pain, Fibromyalgia etc.

★★★★ The Rebellious Body: Reclaim your life from environmental illness or chronic fatigue syndrome by Janice Strubbe Wittenberg, RN, Plenum Press, New York, NY, 1996 • (cover) “If you want to make sense out of the broad spectrum of disparate information, this practical, self-help book engages you in your own recovery, and assists you in customizing healing options. [Janice], a registered nurse and health educator, herself afflicted since 1982 with both illnesses, combines personal experience and scientific research to help you: identify sources of allergic reactivity …; discover how to avoid harm from toxins and detoxify from damaging substances; learn specific dietary interventions and supplements that support and boost immune function; strengthen certain organs and body systems in what which support recovery; examine deeper causes of illness that may inhibit health.” • author is a mental health crisis specialist, health educator and freelance writer who worked at the Menninger Fndn. and now teaches classes in management of chronic pain, suicide prevention and self-directed healing from environmental illness and chronic fatigue syndrome

★ Refractory Depression: Current Strategies and Future Directions edited by W. Nolen, J. Zohar, S. Roose, J. Amsterdam, J Wiley & Sons, New York, 1995 About: Focus: With: Editors: Books: Clues:

depressed patients who do not respond to standard treatments standard treatments, adding lithium, psychosocial factors, bipolar disorder 21 chapters by a variety of mental health professionals, references mental health professionals from US and European psychiatric centres previous books on the same topic – 1987, 1990, 1991 Ch. 20 Assessment – explains the value of physical exams, medical tests to detect conditions which might predispose patients to treatment resistance

★★★★ Return to the Joy of Health Natural medicine & alternative treatments for all your health complaints by Zoltan P. Rona, MD, MSc, Alive Books, Burnaby, BC, 1995 • various disciplines of health care (eg: medical, nutrition, chiropractic, naturopathy, etc.) may be appropriate • the medical approach may not provide the best solution for every (chronic health) problem, but it is the best route when it comes to diagnosis, surgery, emergency and trauma • “a nutritional assessment can help determine whether or not there is a need for [supplementing] vitamins, minerals, essential fatty acids, digestive enzymes [or] amino acids” FINDING CARE FOR DEPRESSION

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★★ Riding the Roller Coaster: Living With Mood Disorders by Marga Bergen, Northstone Publishing, Kelowna, BC, 1999 About: Focus: With: Author: Other:

first person account of living with a bipolar disorder practical tips, encouragement for managing mood disorders understanding, insight, tangible strategies, resources, web sites photographer, freelance writer, lives with manic depression articles for The Vancouver Sun, Fellowship Magazine, editing Moments

★ Risk Management with Suicidal Patients edited by B. Bongar, PhD and A Berman, PhD, The Guilford Press, N Y, 1998 About: standards of mental healthcare and management of suicidal patients; for outpatients and hospital patients, with legal issues and risk management, checklists

★★★★ The Roots of Orthomolecular Medicine: A Tribute to Linus Pauling edited by Richard Huemer, MD, W.H. Freeman & Co., New York, 1986 About: the biochemistry of various diseases, Ch. 12 – orthomolecular psychiatry Ch. 17 – the future of orthomolecular medicine by L. Pauling Focus: collection of papers presented at an orthomolecular medical society meeting With: papers about molecular biology of various illnesses, references Editor: physician, lecturer in genetics, director of clinical and research lab, Other: editorial board of Mechanisms of Aging and Development

★★★ Running on Empty: The Complete Guide to Chronic Fatigue Syndrome by Katrina Berne, PhD foreward by Daniel Peterson, MD, Hunter House Inc., Alameda, CA, 1995 About: Focus: With: Author:

diagnosis and treatment of CFIDS the person who suffers with chronic fatigue, a misunderstood illness personal observations case stories, resources, references clinical psychologist who has CIFDS and treats patients since 1985

★★★★ The SAM-E Solution: The Essential Guide to the Revolutionary Antidepression Supplement by Deborah Mitchell, foreword by Steven Bock, MD, Warner Books, N Y, 1999 clearly written and helpful information explains how SAM-E can work faster than prescription antidepressants in some people with no negative side effects, relieve pain from arthritis, fibromyalgia, and more

With:

★★★ Scattered Minds: A New Look at the Origins & Healing of Attention Deficit Disorder by Gabor Mate, MD, Knopf Canada, Toronto, 1999 About: Focus: With: Author: Other: 202

ADD – the experience insights, author’s story, tips & traps helpful ideas, clear language, interviews, references health professional, a physician, therapist and writer; he has ADD long time medical columnist for The Globe and Mail, Vancouver Sun

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★★, ★★★★ Schizophrenia Cured: A Case History and a Look at Orthomolecular Therapy by Terra Ford, Canadian Schizophrenia Foundation Publications, Toronto, Ontario, 1994 • (cover) “ Sister Theresa works at the Morris Centre, an orthomolecular treatment home in Winnipeg, Manitoba … would like the whole world to know the good news that schizophrenia is an illness as physical as a broken leg … believes that thousands of people with schizophrenia suffer unnecessarily and she hopes her wonderful story of recovery will help to reduce that number. Her interest is not limited to schizophrenia; orthomolecular treatment, which involves the optimum balance of nutrients for an individual, is also used successfully for arthritis, allergies, hypoglycemia, senility, coronary disease, learning disabilities and cancer.” • two books in one: (1) first person account of suffering with schizophrenia and recovering using orthomolecular methods (2) questions and answers about schizophrenia by health professionals, including biochemistry of the condition and using orthomolecular supplements to restore and maintain normal brain function without adverse effects

★★★★ The Scientific Validation of Herbal Medicine by Daniel B. Mowrey, PhD, Keats Publishing, Inc., New Canaan, Connecticut, 1986 • “comprehensive and highly referenced scientific approach to the science, history, pharmacology and clinical applications of herbal materials.” • ‘‘Mowrey weaved a subtle balance between the clinical anecdote, the history of natural botanicals, and the science which underlies their efficacy.” • “enlightened style flowed and inspired reader to read on” • “the field of green medicine began when pharmacological evaluations of indigenous Aztec medicines yielded agents with important implications in the treatment of modern disease. Since then, medicinal plants have provided the foundation of the modern pharmaceutical industry. Certainly, natural products may suffer from a lack of defined dose and potency data, but they benefit from the virtue of containing many specific molecular principles in their natural state possessing a variety of influences upon human physiology, as opposed to the purified synthetic drugs which are based on just a single specific molecular substance derived from the natural product. Dr. Mowrey has described these differences very nicely in this book and I believe this volume should benefit any individual who is concerned about natural healing and its clinical applications.”

★★★★ Smart Nutrients: A Guide to Nutrients that can Prevent and Reverse Senility by Dr. A. Hoffer, PhD, MD & M. Walker, DPM, Avery Publishing Group, Garden City Park, New York, 1994 • • • •

senility is not inevitable, even if the first symptoms have occurred aging changes are caused gradually by the stresses of our industrialized society hypotheses to describe the aging process, senility can be a form of chronic malnutrition vitamins, minerals, physical fitness can help to prevent senility FINDING CARE FOR DEPRESSION

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★★★★ Stop Depression Now: SAM-e the Breakthrough Supplement that Works as Well as Prescription Drugs in Half the Time … with No Side Effects by Richard Brown, MD, T. Bottiglieri, PhD, & Carol Colman, Putnam & Sons, NY, 1999 About: Focus: With: Authors: Books:

normalizing biochemistry of mood by using SAMe for depression how SAMe works, supplements can help some depressions, for laymen practical information about taking a natural substance, references healthcare professionals – physician, PhD biochemist, medical writer co-authored by C. Colman: Natural Energy, The Lupus Handbook for Women, The Melatonin Miracle: Nature’s Age-Reversing, Disease-Fighting, Sex-Enhancing Hormone The Female Heart: The Truth About Women and Coronary Artery Disease

★ Straight Talk about Psychiatric Medications for Kids by Timothy Wilens, MD, The Guilford Press, New York, 1999 About: psychotropic medications for common childhood psychiatric disorders Author: professor of psychiatry at Harvard Medical School

★★★★ Stress, Anxiety and Insomnia: How you can benefit from diet, vitamins, minerals, herbs & exercise by Michael T. Murray, ND, Prima Publishing, Rocklin, CA, 1995 • recognizing, understanding & managing stress, insomnia & anxiety • dietary, exercise, nutrition and herbal guidelines

★★★★ The Super Anti-Oxidants: Why they will change the face of healthcare in the 21st century by James F. Balch, MD, M. Evans and Co. Inc., New York, NY, 1998 • (cover) “Includes the most up-to-date information on … super antioxidants such as Vitamins A,C,E, lycopene from tomatoes, quertcetin found in zucchini, squash and green tea, herbs like gingko biloba and garlic, selinium and germanium, and proanthocyanidins, in grape seeds • “… food sources for phytonutrient power, techniques to decrease stress, anti-aging answers, dosage information on the powerful antioxidants …’’ • “… how and why free radicals attack cells and how the antioxidant system works to counteract this attack; the crucial link between free radical activity and health and physical problems associated with aging.” • (cover) “Dr. Balch’s medical journey began as a traditional physician, a urological surgeon. As he began complementing traditional surgical and treatment methods with nutritional supplementation and dietary change, [he] discovered that [his] patients were not only improving, many of them were being healed in an almost miraculous fashion … leading authority on nutrient healing.”

★ Surviving the Crisis of Depression and Bipolar Illness: Layperson’s Guide to Coping with Mental Illness Beyond the Crisis and Outside the Hospital by Mark Halebsky, BA, MPA, Personal & Prof. Growth Organization, 1997 204

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★ A Symphony in the Brain:The Evolution of the New Brain Wave Biofeedback by Jim Robbins, Atlantic Monthly Press, New York, 2000 About: healthcare professionals who continued to believe in the therapeutic possibilities for neurofeedback, developing clinical protocols to help people with mood disorders, addiction, ADD, autism Focus: how neurofeedback offers hope for restoring mental health With: success stories, references, research reports, therapeutic discoveries Author: freelance journalist writes for the science section of The New York Times Books: Last Refuge: The Environmental Showdown in the American West

★★ Thinking in Pictures and Other Reports from my Life with Autism by Temple Grandin, foreward by Oliver Sacks, Vintage Books, Random Hse, NY, 1996 About: how a little girl with autism became a gifted animal scientist with a PhD Focus: first person account; dual perspectives of a scientist and an autistic person

★ Tangled Minds: Understanding Alzheimer’s Disease and other Dementias by Muriel Gillick, MD, Plume and the Penguin Group, New York, 1999 About: Focus: With: Author:

eye-opening journey through the stages of Alzheimer’s disease history, research, treatments to lessen symptoms story of a composite patient, references physician who cares for elderly, professor in Harvard Medical School

★★★★ The Testosterone Solution What Men – and the Women Who Love Them – Need to Know Increase your energy and vigor with male hormone therapy by Aubrey Hill, MD, Prima Publishing, Rocklin, CA, 1997 • testosterone production gradually decreases as men age • (cover) “Dr. Hill explains how men can recapture their youthful vigor through testosterone replacement therapy. As we age, our body’s production of testosterone declines. Now there are safe and effective ways to boost our natural supplies. The positive impact may [include]: boost energy, enthusiasm, and self confidence; raise libido, strengthen muscles and build body mass, lower risk of heart disease, bone deterioration, etc; increase memory and mental acuity; enhance sense of well-being” • author is a family physician and counsellor on personal, marital and sexual difficulties

★★★★ Textbook of Advanced Herbology, Textbook of Modern Herbology by Terry Willard, PhD, Wild Rose College of Natural Healing, Ltd., Calgary, Alta, 1992 Quotes from the foreward and the preface • “For centuries, three traditional systems of medical care relied on the plant-human healing connection – Traditional Chinese Medicine, traditional European medicine and Aryuveda. Terry Willard’s text is part of work which is combining the ‘soul’ of traditional FINDING CARE FOR DEPRESSION

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(Textbook of Advanced Herbolgy … continued)

medicine with the ‘mind’ of scientific understanding to produce a ‘New World’ herbalism. • understanding plant constituent biochemistry with personal clinical experience and traditional medical thought • over 50 years, a huge body of scientific research on botanical constituents has been assembled. This text presents a relevant summary of this research with key applications. Balance between pharmacology of botanical medicines and the centuries-old traditions of herbalism. Effort to integrate tradition with scientific underpinnings of herbal practice. • reviews how herbal products are manufactured and how the quality should be evaluated. • Advanced Herbology has the biochemistry of healing plant categories like glycosides, lipids and the names of commonly-used herbs which share those biochemical characteristics • Modern Herbology outlines problems in brain and body systems with the names of healing herbs.

★★★★ Thorson's Guide to Amino Acids by Leon Chaitow, ND, DO, Thorsons, Hammersmith, London, 1991 • • • •

amino acids: what they are, what they can do, and how to use them why each person has individual requirements for 20 amino acids therapeutic roles of individual amino acids certain types of depression can improve using appropriate amino acids supplements

★★★★ TMS: Transcranial Magnetic Stimulation in Neuropsychiatry edited by Mark George, MD and Robert Belmaker, MD, American Psychiatric Press, Washington, 2000 About: Focus: With: Authors:

TMS as a brain mapping tool, application to major depression and bipolar how TMS can be used to show how the brain works and malfunctions brain scans, research reports, extensive references professor of psychiatry, radiology and neurology; professor of psychiatry

★★★★ Today’s Herbal Health by Louise Tenny, MD, Woodland Books, Pleasant Grove, UT, 1992 • herbs supply the body with essential nutrients that a healthy body and mind need • the vitamins and minerals found in herbs have curative effects when used properly, herbs can remedy diseases • natural therapy can activate the body’s natural healing powers • why herbs, vitamins, minerals and natural foods work

★★★ Tormenting Thoughts and Secret Rituals: The Hidden Epidemic of OCD by Ian Osborn, MD, Dell Publishing, New York, 1998 About: Focus: With: Author: 206

diagnosis and treatment of obsessive-compulsive disorder making sense of senseless symptoms, OCD – a brain disorder, finding help diagnostic criteria, cases, OCD scale, resources, references, internet sites psychiatrist who specializes in treating OCD, personal experience

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★★ and ★★★ The Toxic Labyrinth: by M Millar, BEd, MBA, H. Millar BSN, RN, foreward by Sherry Rogers, MD, Nico Professional Services, Vancouver, 1995 About: Focus: With: Authors: Books:

a family’s successful battle against environmental illness the biographical account of the stages of environmental illness personal observations, diary format, references mother and daughter (nurse and the patient) The Revised E.I. Syndrome, Wellness Against All Odds, Tired or Toxic?

★★★★ Toxic Metal Syndrome by Dr. Richard Casdorph and Dr. M. Walker, Avery Publishing, New York, 1995 About: Focus: With: Author: Books:

connections between brain conditions and aluminum and heavy metals conditions like Alzheimers may be affected by trace metals information about treatment with chelation therapy, brain boosters, references physicians – one practices in internal medicine, other a prof. medical writer Smart Nutrients, The Chelation Way, orthomolecular education

★ Transforming Depression: Healing the Soul Through Creativity by David Rosen, MD, Penguin – Arkana, New York, 1996 About: applying C Jung’s method of active imagination to depression, suicide

★ Treating Difficult Personality Disorders edited by Michael Rosenbluth, MD & Irvin Yalom, MD, Jossey-Bass Inc., San Francisco, 1997 About: Focus: With: Editors: Books:

personality disorders: borderline, narcissistic, antisocial guidance for clinicians: assessment and treatment, esp. psychotherapy therapy journeys, flexible treatment options, cases, concerns, references psychiatrists The Handbook of Borderline Disorders, Love’s Executioner

★ Treating Mental Disorders: A Guide to What Works by Peter Nathan, Jack Gorman, Neil Salkind, Oxford University Press, NewYork, 1999 About: Focus: With: Authors: Books:

helping people with mental disorders and their caregivers practical information, clearly presented questions, answers, web sites, references professors of psychology and psychiatry, education and research The Essential Guide to Psychiatric Drugs

★ Treating Suicidal Behavior: An Effective Time-Limited Approach by M. David Rudd, PhD, ABPP, T. Joiner, PhD, M. Hasan Rajab, PhD, The Guilford Press, New York, 2001 About: Focus: With: Authors: Other:

assessing suicide risk, crisis intervention, cognitive restructuring structured yet flexible approach in time-limited settings, skill building literature review, illustrations, outlines, forms, charts, references professors of psychology, psychiatry and behavioral science articles and book chapters about depression, eating disorders, suicidality FINDING CARE FOR DEPRESSION

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★ Treatment of Bipolar Disorder: The Expert Consensus Guideline Series Steering committee: A Frances, MD, J. Docherty, MD, D. Kahn, MD, Ross Editorial Services, Expert Knowledge Systems, LD, Independence, VA, 1996 About: treatment of bipolar disorder Focus: medications, psychosocial intervention, medical evaluation, monitoring With: expert consensus panel of 60 MD’s, mental health professionals, references Steering committee members: professors of psychiatry Books: There are other expert guidelines.

★ The Treatment of Bipolar Disorder: Review of the Literature, Guidelines, Options editors: Quentin Rae-Grant, MD, Paul Grof, MD, Mary Seeman, MD et al by The Canadian Journal of Psychiatry, Vo. 42, supp. 2, Cdn. Psychiatric Assoc., 1997 About: bipolar mood disorders: diagnosis, treatment and management Focus: summarizing evidence and recommendations for effective treatment With: assessment, medical evaluation of new patients, references Contributors: mental health professionals

★ Treatment Plans and Interventions for Depression and Anxiety Disorders by Robert Leahy, PhD and Stephen Holland, PsyD, The Guilford Press, NY, 2000 About: Focus: With: Authors:

facilitating effective treatment in typical outpatient settings enabling clinicians to quickly generate invidualized treatment plans patient monitoring forms on CD, references assoc. prof. of psychology in psychiatry and private practitioner

★★★★ The Ultimate Nutrient Glutamine: The Essential Nonessential Amino Acid by J. Shabert, MD, RD & N. Ehrlich, Avery Publishing Group, New York, 1994 About: Focus: With: Authors:

glutamine supplements to help with liver function, immune system, depression how glutamine can help some people with a variety of health problems clear explanations of research results, success stories, definitions, references obstetrician/gynaecologist, registered dietitian, husband is a pioneer in parenteral nutrition at a US university where he researches glutamine

★★★★ Unravelling the Mystery of Autism and PDD: A Mother’s Story of Research & Recovery, by Karyn Seroussi fwd by B. Rimland PhD, Simon & Schuster, New York, 2000 About: Focus: With: Author: Books: 208

“a mother’s successful struggle to rescue her child from a hopeless disease” two parents cooperate to learn how a child can get well from autism personal experiences, menus, scientific and medical information, references freelance writer, cofounder of ANDI – Autism Network for Dietary Intervention ANDI News, www.AutismNDI.com

FINDING CARE FOR DEPRESSION

★★★★ Vitamin B-3 & Schizophrenia: Discovery, recovery, controversy New hope for schizophrenics, their families & friends by Abram Hoffer, MD, PhD, Quarry Press Inc., Kingston, ON, 1998 • (cover) “Dr. A. Hoffer is a founding father of the alternative health movement whose pioneering research in nutritional therapy has become legendary. While he was director of psychiatric research for the Province of Saskatchewan during the 1950s, he developed Vitamin B-3 (niacin) treatments for schizophrenia. Although demonstrably effective for recovery from various forms of this illness, Dr. Hoffer’s use of Vitamin B-3 became highly controversial among the medical profession, especially within the American Psychiatric Association … story of Dr. Hoffer’s quest to provide natural, effective treatment for [schizophrenics using vitamin B-3] and the story of his patients who have been healed by his efforts. This story is also a central chapter in the history of nutritional medicine and vitamin therapy.”

★★★★ Vitamin B6 Therapy: Nature’s Versatile Healer by John Ellis, MD and Jean Pamplin, Avery Publishing, Garden City, NY, 1999 About: Focus: With: Author:

how vitamin B6 works, history, activates over 100 enzymes, 19 amino acids chronic conditions benefit from vitamin B6 supplements, inclu. brain function nutritional program, research, cases, success stories, references physician and medical director who does clinical research with vitamin B6

★★★★ Vitamin Bible by Earl Mindell, Warner Books, Inc., NY, 1991 • in-depth look at vitamins, minerals, amino acids, fats, carbohydrates, herbs

★★★★ Vitamin C & Cancer: Discovery, Recovery, Controversy by Abram Hoffer, MD, PhD, FRCP(C), Quarry Health Books, Kingston, 2000 About: Focus: With: Author: Books:

vitamin C-as-treatment paradigm developed with biochemist L. Pauling, PhD cancer patients who lived longer than expected while taking supplements cases, survival extension success stories, regimens, references biochemist, physician, orthomolecular psychiatrist, writer Vitamin B-3 & Schizophrenia, Hoffer’s Laws of Natural Nutrition

★ Waking Up,Alive:The Descent,The Suicide Attempt, and the Return to Life by Richard Heckler, PhD, Ballantine Books, New York, 1994 About: Focus: With: Author: Other:

the experience of the desire to die; the resilience of the human spirit 50 startling interviews with suicide survivors of all ages case stories, insights, suicide facts, resources, references psychologist – prof. of counselling psychology American Association of Suicidology

★★★★ Was It Something You Ate? – Food Intolerance: What Causes It, How to Avoid It by John Emsley and Peter Fell, Oxford University Press, Oxford, 1999 About: identifying non-nutrients that provoke a toxic response and make us ill Focus: food intolerance results if our body gets overloaded with a toxin FINDING CARE FOR DEPRESSION

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(Was It Something You Ate? … continued)

With: examples of ‘natural’ toxins, additives, contaminants, reactions, references Authors: Peter Fell is a physician in general practice, director of Oxford Allergy Centre. John Emsley lectured in chemistry for 25 years – U of London, writer Books: The Consumer’s Good Chemical Guide, Molecules at an Exhibition

★★★ and ★★★★ The Way Up From Down by Dr. Priscilla Slagle, St. Martin's Press, New York, 1992 • author is a psychiatrist who used orthomolecular methods to restore normal mood without adverse effects after she spent many years suffering with depression. Antidepressant medications did not help and therapy did not help her to resolve her depression. • her application of orthomolecular medicine worked for her and she wrote this easy-tofollow drug-free program of B vitamins and amino acids which may help depressed people restore normal mood without adverse effects

★★★ Wellness Recovery Action Plan (W.R.A.P.) A System for monitoring, reducing and eliminating uncomfortable or dangerous physical symptoms and emotional feelings by Mary Ellen Copeland, MS, MA, Peach Press, W. Dummerston, VT, 1997 About: Focus: With: Author: Books:

learning self-help skills for dealing with physical and emotional symptoms activities for everyday wellbeing, track triggering events, prepare, plan info. for developing a support system, focusing, tips, self-help references psychologist – teacher, writer and lecturer, survivor of manic depression A Guide to Living With Depression and Manic Depression

★★★★ What Do Lions Know About Stress? by Majid Ali, MD, Life Span Press, Denville, New Jersey, 1996 • Dr. Ali spent many years as a pathologist, looking at the causes of death for people • considers not just the obvious labels, like heart disease, but the underlying causes of health problems • this book has many tales which teach people how to manage stress; a sort of Aesop of medicine • Dr. Ali reports scientific studies that validate some ancient healing arts and philosophies

★ What to Do When Someone You Love is Depressed: A Compassionate Guide by Mitch Golant, PhD and S. Golant, H Holt & Co., New York, 1996 ★★★★ What Your Doctor Won’t Tell You The Complete guide to the latest in alternative medicine including: mega-nutrients, chelation therapy, energy medicine, therapeutic diets by Jane Heimlich, HarperCollins Publishers, New York, NY, 1990 • (cover) “… surveys the latest nonconventional medical treatments for prevalent diseases. • “… sourcebook on the most significant alternative approaches to health, including: antioxidants, Bach flower remedies, biomagnetism, colon detoxification, electrodiagnosis, fish oils, homeopathy, kinesiology, live cell therapy, macrobiotics, orthomolecular medicine, ozone therapy, vitamin C infusion, etc 210

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A REVIEW:

Worry Controlling it and using it wisely ★★★ by Edward Hallowell, MD, Ballantine Books, New York, 1997 (inside quotes) “Dr. Hallowell explains the universal problem of worry in its normal and abnormal forms. His book will be helpful for anyone who has experienced unnecessary worry – and who hasn’t? It is eminently readable and spiced with informative case examples. He offers sage advice about what to do about worries.” – Aaron T. Beck, MD, author of Anxiety Disorders & Phobias: A Cognitive Perspective “In a voice both authoritative and compassionate, Hallowell thoroughly explores a topic that touches nearly everyone in this age of anxiety … [and] provides abundant information on a wide variety of alleviating treatments.” – Publishers Weekly Dr. Hallowell hooks our interest as soon as he explains that he is a master worrier himself. We know that his empathy for patients and readers is based on firsthand experience. His book is divided into three parts: 1. The World of Worry; 2. Toxic Types of Worry and 3. Remedies that Work. Every normal human being gets anxious from time to time. Dr. Hallowell explains how we have a built-in danger detection system. Some people are so acutely sensitive that their excessive or inappropriate worry can become toxic. In the same way that the clanging of a fire alarm keeps us motivated to put out the fire, the human alarm system can motivate us to steer clear of danger. If the alarm stays on after the danger is long gone, we pay a price for our hypervigilance. Dr. Hallowell explains that worry can be adaptive but anxiety can escalate out of control. High on the anxiety scale, we find “maladaptive [or] unwise worry that serves no useful purpose and can hamper your life.” Looking at the root causes of worry, Dr. Hallowell outlines three categories. Underlying medical conditions, which may be inherited, can lead to toxic worry. Tragedy or trauma can add a second layer. Habitual worriers worry all the time about everything. By using examples from his own experience and stories involving patients, we learn how anxiety can be diagnosed accurately and treated effectively. His cases indicate that Dr. Hallowell’s combination treatments work. He listens, observes, gives rational assurances and encourages cognitive restructuring. He prescribes exercise and advises reorganizing. Practical treatments for coping with excessive worry also include medication (as-needed), meditation and relaxation until the patient moderates the intensity and duration of his worrying. The goal is to achieve “rebalancing, restoration of perspective and reassurance” that lasts. Psychiatrists give diagnostic labels when patients suffer from excessive anxiety. Conditions like generalized anxiety disorder, depression, panic disorder and social phobias, obsessive-compulsive disorder and paranoia are known to many mental patients and family caregivers. Dr. Hallowell’s book explains how to “turn chronic worry into a positive force.” His information is helpful and hopeful.

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(What Your Doctor Won’t Tell You … continued)

• “introduces you to a new world of medical doctors training in nutrition and preventative medicine … objective appraisals of dozens of mainstream medical treatments, from chemotherapy to bypass surgery and describes why the medical establishment continues to rely on toxic drugs and ineffective treatments owing to its ties with big business and government … in-depth overview of the best that alternative medicine has to offer.”

★ When Perfect Isn’t Good Enough by M. Antony, PhD and R. Swinson, MD, New Harbinger Publication, Oakland, 1998 About: Focus: With: Authors: Books:

understanding and overcoming perfectionism, working with problems practical guidance for laymen, links with depression in some people advice, explanations, charts, references psychologist and psychiatrist Obsessive-Compulsive Disorder: Theory, Research and Treatment

★★★★ Dr. Whitaker’s Guide to Natural Healing by Julian Whitaker, MD, Prima Health, Rocklin, CA, 1996 About: wellness programs (e.g., to help people end depression without drugs comprehensive approach to natural healing)

★★★★ Why I Left Orthodox Medicine by Derrick Lonsdale, MD, Hampton Roads Publishing Company Inc., Norfolk, VA, 1994 • author “… nutritional medicine is extremely effective, particularly in the early stages of disease where modern orthodoxy fails miserably. Its preventive approach is a guaranteed benefit; and it is economically effective … though the developing science of nutritional treatment may appear, at first sight, to be an oversimplification, it actually influences body repair at the cellular level. Nutrition works, and this book provides a foundation for understanding why.” • interesting chapters include inborn errors of metabolism, intermittent and vitamin-responsive disorders, adaptive mechanisms and what happens when they fail, how oxygen drives the adaptive machinery and the three circles of health (genetics, stress and fuel) • “It is worth remembering that the ancient Chinese paid their physicians only when they were well. The moment that they became sick they stopped paying. It was an advantage to both physician and patient to remain well.”

★★★★ The Wild Rose Scientific Herbal by Terry Willard, PhD, Wild Rose College of Natural Healing, Ltd., Calgary, Alta, 1991 • complements the Textbooks of Modern Herbology and Advanced Herbology • commonly used herbs – biochemistry of selected active ingredients, description of the plant, constituents, mode of action, clinical studies, conditions which are helped, energetics, dosage and toxicity • scientific and medical references are provided for each herb 212

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★★★ Winning Against Relapse: A Workbook of Action Plans for Recurring Health and Emotional Problems, by Mary Ellen Copeland, MS, MA, New Harbinger Publications, Oakland, CA, 1999 About: Focus: With: Author: Books:

self-help system for monitoring symptoms and responding to reduce relapse identifying daily activities to maintain an optimum level of wellness tips for developing a personal crisis plan, forms, resources, references psychologist – teacher, writer and lecturer, survivor of manic depression Living Without Depression and Manic Depression

★★★ The Worry Control Workbook by Mary Ellen Copeland, MS, MA, New Harbinger Publications, Oakland, CA, 1999 About: Focus: With: Author: Books:

learning to reduce anxiety and deal with worry supportive and comprehensive guide for coping with excessive concerns techniques for identifying sources and reducing worry, forms, references psychologist – teacher, writer and lecturer, survivor of manic depression Fibromyalgia & Chronic Myofascial Pain Syndrome

★★★★ Zinc and Other Nutrients by Dr. Carl C. Pfeiffer, PhD, MD, Keats Publishing, Inc., New Canaan, Connecticut, 1978 • Dr. Pfeiffer was the director of the famed Brain Bio Center and author of Mental and Elemental Nutrients • presents the facts about findings on twenty essential trace minerals, how they can help, heal or even harm (e.g., zinc) – important in many biochemical processes throughout the body and brain, signs of deficiency, illnesses related to zinc deficiency includes depression, food sources, benefits of dietary supplement, toxicity, references Another reference (adding to the 250)

★★ and ★★★★ Healing Depression A Guide to Making Intelligent Choices about Treating Depression by Catherine Carrigan, fwd. by Abram Hoffer, MD, PhD, FRCP(C) Heartsfire Books, Santa Fe, NM, 1997 • Survivor Carrigan offers care, help and hope. Using 38 questions to focus attention, she explains how she struggled with a misdiagnosed bipolar disorder and recovered. She gently prompts depressed readers to get started by considering medical factors, stress and nutrition, connections, natural supplements and habits of mind. • (cover) “Catherine Carrigan explores the causes of depression, understanding that it has different origins in different people and that multiple aspects must be explored to uncover those factors needed for recovery. Her book stands as a holistic self-help manual that the reader can use to begin to understand the chemical origins of depression … Ms. Carrigan has been through the fires … Her experiences, both her triumphs and her failures … finding her way back to health are enlightening and encouraging for weary travellers with depression [who can] use [her] ray of sunshine as a guide in their own quests.” Paul Goldberg, MHH, DC, Professor of Clinical Nutrition and Gastroenterology FINDING CARE FOR DEPRESSION

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QUICK PICK REFERENCE LISTS Star ratings: give the level of information and the writer ★ Standard Information – written by a health professional ★★ Validation Of The Experience – written by a psychiatric survivor ★★★ Insights – written by a working health professional survivor ★★★★ Hope For Restoring Mental Health And Living Well

– health professional writers Attention Deficit Disorder (ADHD) ★★ Attention Deficit Disorder, A Different Perception

New Ways to Work with ADD at Home, Work and School by Thom Hartman, Underwood Books, CA, 1997 ★★★★ Dr. Hoffer’s ABC of Natural Nutrition for Children with Learning Disabilities, Behavioral Disorders, and Mental State Dysfunctions by Abram Hoffer, MD, PhD, FRCP(C), Quarry Press, Kingston, 1999 ★★★ Driven to Distraction

Recognizing and Coping with ADD from Childhood through Adulthood by Edward Hallowell, MD and John Ratney, MD, Touchstone, NY, 1994 ★★★ Scattered Minds

A New Look at the Origins & Healing of Attention Deficit Disorder by Gabor Mate, MD, Knopf Canada, Toronto, 1999 ★★★, ★★★★ Healing the Hyperactive Brain

Through the New Science of Functional Medicine by Michael Lyon, MD, Focused Publishing, Calgary, 2000 ★★★★ The Hyperactivity Hoax How to Stop Drugging Your Child and Find Real Medical Help by Sydney Walker, MD, St. Martin’s Press, New York, 1998

Autism ★ Asperger’s Syndrome: A Guide for Parents and Professionals by T. Attwood, fwd. by Lorna Wing, Jessica Kingsley Publishers, London, 1998 214

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★★★★ Biological Treatments for Autism and PDD What’s going on? What can you do about it? by William Shaw, PhD, with contributions by B. Rimland, PhD, L. Lewis, PhD, Karyn Seroussi, Bruce Semon, MD, PhD, and Pamela Scott, The Great Plains Laboratory, Overland Park, KS, 1998 ★★★★ Facing Autism: Giving Parents Reasons for Hope and Guidance for Help by L. Hamilton, foreward by Dr. B. Rimland, Waterbrook Press, Colorado, 2000 ★ Alternative Treatments for Children Within the Autistic Spectrum

by Deborah Alecson, Keats Publishing, Los Angeles, 1999 ★★★★ Unravelling the Mystery of Autism and PDD: A Mother’s Story of Research & Recovery by Karyn Seroussi, fwd by B. Rimland PhD, Simon & Schuster, NY, 2000

Depression and Bipolar Disorder ★ The Antidepressant Era

by David Healy, MD, Harvard University Press, London, 1997 ★★★★ The Antidepressant Survival Program

by Robert Hedaya, MD, Crown Publishers, New York, 2000 ★, ★★ Anxiety and Depression:

200 References and Resources to Help You Cope edited by Rich Wemhoff, PhD, Resource Pathways, Issaquah, WA, 1999 ★★ Bipolar Puzzle Solution: A Mental Health Client’s Perspective 187 Answers to Questions Asked by Support Group Members about Living with Manic-Depressive Illness by B. Court and G. Nelson, MD, Accelerated Development, Philadelphia, 1996 ★ The Complete Guide to Psychiatric Drugs:

Straight Talk for Best Results by Edward Drummond, MD, John Wiley & Sons, New York, 2000 ★★★★ Dealing With Depression Naturally

Complementary and Alternative Therapies for Restoring Emotional Health by Syd Baumel, Keats Publishing, Los Angeles, 2nd edition, 2000 FINDING CARE FOR DEPRESSION

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★★★★ Depression-Free for Life: All-Natural 5-Step Plan to Reclaim Your Zest for Living by Gabriel Cousens, MD with Mark Mayell, William Morrow, NY, 2000 ★ Depression: How it Happens; How it’s Healed

by John Medina, PhD, foreward by John Schwartz, MD, CME Inc and New Harbinger Publications, Irvine, California, 1998 ★★ Depression Survivor’s Kit

by Robert Sealey, BSc, CA, SEAR Publications, Toronto, 1999 ★★★ The Depression Workbook

A Guide for Living With Depression and Manic Depression by Mary Ellen Copeland, MS, New Harbinger Publications, 1992 ★ Fight the Winter Blues: Don’t Be Sad

Your Guide to conquering Seasonal Affective Disorder by C. Peters, fwd. by C. Gorman, MD, Good Health Books, Calgary, 1994 ★★ The Gift of Depression

Twenty-One inspirational stories sharing experience, strength and hope compiled by John Brown, Inspire Hope Publishing Corporation, Koloa, HI, 2001 ★ Guidelines for Diagnosis & Pharmacological Treatment of Depression by Depression Working Group, Chair Sidney Kennedy, MD, CANMAT, Toronto 1999 ★★ The Last Taboo:

A Survival Guide to Mental Health Care in Canada by S. Simmie and J. Nunes, McLelland & Stewart Ltd., Toronto, 2001 ★★ Mental Illness: Survival and Beyond

A Practical Guide to the Inpatient Psychiatric Experience by Virginia Wilson, Trafford Publishing, Victoria, 1998 ★★★★ Mind Boosters A Guide to Natural Supplements That Enhance Your Mind, Memory & Mood by Ray Sahelian, MD, St. Martin’s Griffin, New York, 2000 ★★ The Noonday Demon

An Atlas of Depression by Andrew Solomon, Scribner, New York, 2001 216

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★★★★ The Omega-3 Connection The Groundbreaking Omega-3 Antidepression Diet and Brain Program by Andrew Stoll, Simon & Schuster, New York, 2001 ★ Prozac Backlash: Overcoming the Dangers of SSRI’s and Other

Antidepressants With Safe, Effective Alternatives by Joseph Glenmullen, MD, Simon and Schuster, New York, 2000 ★★★★ Solving the Depression Puzzle

The Ultimate Investigative Guide to the Complex Causes of Depression, and How to Overcome It Using Holistic Approaches by Rita Elkins, MH, Woodland Publishing, 2001 ★ Understanding Depression

A Complete Guide to Its Diagnosis & Treatment by Donald Klein, MD & P. Wender, MD, Oxford University Press, NY, 1993 ★★★ The Unquiet Mind

A Memoir of Moods and Madness by Kay Redfield Jamison, PhD, Knoff, New York, 1995 Dyslexia ★★ The Gift of Dyslexia The Revolutionary New Method of Correcting Dyslexia and Other Learning Disorders by Ronald Davis, The Berkeley Publishing Group, New York, 1997

Epilepsy ★ Epilepsy: a new approach

What Medicine Can Do; What You Can Do For Yourself by Adrienne Richard & Joel Reiter, MD, Walker & Company, NY, 1995 ★★★★ The Ketogenic Diet

A Treatment for Epilepsy by John Freeman, MD, Demos Medical Publishing, NY, 2000 ★ Living Well With Epilepsy

by Robert Gumnit, MD, Demos Medical Publishing, New York, 1997

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Obsessive-Compulsive Disorder (OCD) ★ The Imp of the Mind

Exploring the Silent Epidemic of Obsessive Bad Thoughts by Lee Bauer, PhD, Penguin Putnam Inc., New York, 2001 ★★★ Tormenting Thoughts and Secret Rituals

The Hidden Epidemic of Obsessive-Compulsive Disorder by Ian Osborn, MD, Dell Publishing, New York, 1998 Schizophrenia ★ The Complete Guide to Psychiatric Drugs: Straight Talk for Best Results by Edward Drummond, MD, John Wiley & Sons, New York, 2000 ★ Coping With Schizophrenia: A Guide for Families by K. Mueser, PhD & S. Gingerich, MSW, New Harbinger Publ. Inc., Oakland, 1994 ★★★★ Natural Healing for Schizophrenia A Compendium of Nutritional Methods by Eva Edelman, Borage Books, 1996 ★★★★ Nutrition and Mental Illness An Orthomolecular Approach to Balancing Body Chemistry by Carl Pfeiffer, PhD, MD, Healing Arts Press, Rochester, VT, 1987 ★★★★ Schizophrenia Cured A Case History and a Look at Orthomolecular Therapy by Terra Ford, CSF Publications, Toronto, 1994 ★★★★ Vitamin B3 & Schizophrenia: Discovery, Recovery, Controversy by Abram Hoffer, MD, PhD, FRCP(C), Quarry Health Books, Kingston, 1998

Suicide ★ Living With Grief After Sudden Loss Suicide, Homicide, Accident, Heart Attack, Stroke edited by Kenneth J. Doka, PhD, Taylor & Francis, Bristol, PA, 1996 ★★★ Night Falls Fast

by Kay Redfield Jamison, PhD, Knopf, New York, 1999 ★ Waking Up, Alive The Descent, The Suicide Attempt, and the Return to Life by Richard Heckler, PhD, Ballantine Books, New York, 1994

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MUSINGS ON THE CURIOUS CAPABILITIES OF THE DISORDERED BRAIN

P

sychiatrists and other mental health professionals use their Diagnostic and Statistical Manuals to assign labels to a range of behaviors involved with bad moods, mental episodes and brain disorders. Getting a disorder label can clarify the patient’s perceptions - apparently he has a mental illness. Clarity is useful but living with a stigmatized condition can leave the disordered person feeling defective. Negative self-esteem becomes self-limiting. It is possible to reframe one’s self-concept by focusing on the positive power of his brain. Self-acceptance can renew hope and encourage progress. “Mood-disorder” might seem to imply that the patient’s moods are always in disorder. This is not the case. A mood-disordered brain can be described as VVV-RISCE-H. This acronym stands for Variable, Volatile, Vulnerable (to episodes of depression and / or hypomania), Reactive, Intense, hyperSensitive, periodically Creative, surgingly Energized and Hypergraphic. Even normal people have moods. One can learn to identify their characteristics as capabilities and learn to focus them selectively and apply them productively in a range of activities, jobs and even professions. Consider writing. A writer can use variability to approach a topic from different angles, and revise writing by testing new words and reorganizing a succession of drafts to suit different readers. The spark of volatility can ignite new ideas or take existing ideas off in new directions. Reactivity to feedback, sensations and perceptions can be useful to spur a quick reply or re-focus writing. When combined with variability and volatility, reactivity can lead to all sorts of interesting reactions, comments, objections, arguments - any of which can be helpful, useful, practical or insightful. Intensity is easily applied to writing. Thoughts and feelings can quickly be translated into a stream of words by using intensity. Hypersensitivity is another useful dimension of the mood-disordered brain. It allows a writer to detect opportunities, start new trains of thought, develop subtleties and distinguish shades of meaning. Surges of energy help to maintain an intense flow of writing. Periodic bursts of creativity can generate new ideas or express existing ideas differently or more effectively. Hypergraphic means that a lot of writing can be generated by a mood disordered brain. It is best to focus this output productively. The variability, volatility, reactivity, intensity, hypersensitivity, creativity FINDING CARE FOR DEPRESSION

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and energy characteristics of the VVV-RISCE-H brain can open doors to many positive possibilities. However, along with the concept comes a caution about the third ‘V’, the characteristic vulnerability to depression and / or hypomania. The mood-disordered person must take care to manage their episodes of depletion or depression carefully and be alert for the characteristic fifteen or so involuntary symptoms during episodes of low energy or depression and also during times of high energy or hypomania. It takes effort to monitor one’s moods and decide if refueling is required to restore normal mood before experiencing negative effects of low brain fuel conditions. Self-control is needed to control, channel or contain temporary outbursts. It is advisable to limit the expression of moods in social situations to avoid being branded as too unstable, difficult or eccentric to tolerate. Ongoing mood swings are not always socially acceptable. The mixed blessings of mental disorders are identified by John Ratey, MD in Shadow Syndromes: The Mild Forms of Major Mental Disorders (Bantam Books, 1997). The author lives and works with ADD. He describes the characteristic profiles of mild forms of mood disorders, schizophrenia, autism, ADD and OCD and other conditions that can be mildly annoying but can also give people a range of productive capabilities. He explains that people can learn to identify the degree of their disorders and focus on its positive aspects. Vulnerable people can reframe from disabled to enabled and make the most of their opportunities for living well. Touched With Fire by Kay Redfield Jamison, PhD also offers hope for using the characteristics of the mood-disordered brain productively. The author, a health professional psychologist with a bipolar disorder, learned about well known artists, writers and poets who had similar tendencies. It takes many trial and error experiences to appreciate the capabilities of a disordered brain, monitor one’s mental status and express one’s characteristics positively and productively. After living with my bipolar II mood disorder, migraines and anxiety for the past thirty-three years, at age 50, using restorative mental healthcare, I am finally making positive progress with my VVV-RISCE-H brain.

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Turning 50 This 2000 Year After years of fear, frustration and failure, INTJ preferences and a VVV-RISCE-H brain, Thirty eight years of migraine resets, Thirty three years of bipolar moods Depressions, worries and hypomanic times, set-backs, symptoms and stigma mimes, disapproval, disrespect and discouragement, rejection, exclusion and distance sent, put-downs, fault-finding and denials, isolation, shunning and lonely trials, problems, pains and paradoxical perceptions whispers, wimpers and negative reactions Involuntary symptoms, Recurring episodes Hopeful expectations, misplaced trust Minimalist doctors, mental telepathy Short-cut alternatives, incompetent negligence Misdiagnosis, mistreatment, laughing slough-offs Careless care, deceitful cover-ups Public hearings, interview-free investigations Silent communications, penniless support

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Distressing strains, social failures What have I learned? All these failures were my fault I’m pragmatic enough to see reality, and resilient enough to take it So many questions, so few answers The relentless dark side lingers set how much blacker can it get? Is it grey before the dawn? looking for the sun, the light turns on So many problems, so little time, can I love my half a lime? Can I reframe and recover, stay alive and make me over? Writing, working the way ahead, going slowly, still not dead How long will the struggle last? Should I be happy to get this past? The truth comes clear, through the facts and the fear All this trouble, toil and strife, when will peace come to my life? Restorative healthcare keeps me bright, live quite well and see the light.

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CONCLUSION TO FINDING CARE FOR DEPRESSION

D

epression is sometimes called the common cold of mental illness. It isn’t clear why people describe depression that way. Many people know it is a common experience because ten to fifteen percent of the population suffer with depression and one to two percent have a bipolar mood disorder. Many have anxiety. Maybe people think depression is like a cold. Could it be caused by a mystery virus. Does it come and go when the weather is cold or wet? Not likely. Depression is a serious illness and a life threatening disorder. Finding care for depression can be a life saver. You might think it is easy to get good care for common mental illnesses but it can be difficult. If you trust your health professionals and your depression still doesn’t get better after treatments, you may get discouraged. The last thing a depressed person needs is to feel more hopeless and helpless after asking for care, cooperating with the advice and taking the treatments recommended. Obviously no ethical health professional would make sick people worse but quick and easy care for depression isn’t always effective. More than fifty medical conditions can cause or contribute to symptoms of depression and there are genetic, environmental, biochemical, metabolic, relationship, lifestyle and many other aspects to a person’s vulnerability to episodes of depression and other brain disorders. It is important that you get a proper diagnosis of the root cause(s) of your condition. Based on an accurate diagnosis, you can find effective treatments which are designed to help without causing negative effects (when you are already suffering with symptoms of depression and anxiety). If you are determined to restore normal mood and recover brain function without adverse effects, you can use this book to find restorative care. You can find and cooperate with ethical health professionals who know when and how to recommend nontoxic methods for common mental illnesses. If you or affected family members are depressed, I caution you not to trust anyone’s life to incompetent care. Think carefully about what can go wrong. You will find it a fearful, frustrating, time-consuming, humiliating, costly and futile experience to be treated negligently, have your concerns dismissed and be laughed at by so-called experts who are too busy to bother with proper care. If your goal is to restore and maintain mental health without adverse effects, I encourage you to think about my explorations of the mental healthcare maze. Be skeptical about my story but please do not repeat my mistakes. You can use restorative methods. You can get well. FINDING CARE FOR DEPRESSION

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You can use the mental healthcare compass to guide your search for restorative care. You can use TAYO, The Healthcare Planner, to cooperate with health professionals, family, and other caregivers. You can use the annotated references to find books about restorative mental healthcare. Dr. Abram Hoffer’s introduction to orthomolecular medicine explains how that can help. There are nontoxic methods to help patients get well. You can try quick and easy approaches to finding care for depression or you can consider restorative healthcare. Either way, take care when you trust your life to any health professional. Ask questions, read and learn. I wish you well finding care for depression, mental episodes and brain disorders.

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Index

Compass – mental healthcare, 113 Complaining to physicians' association, 70 Complaints committee, 20

10 Steps for effective care, 28-31 worksheet, 34-43

Consulting specialists, 56 Copeland, Mary Ellen, MS, MA, 231

12 Steps for coping, 127

Coping with a mood disorder, 127

13 Standards of care were omitted, 69

Criminal code, 21, 52, 54, 93

significance, 64

A

D D.D.E.D.E., 87, 93, 97

Acknowledgements, vii

Dealing with Depression Naturally, review, 171

Active Treatment of Depression, review, 162 A Dose of Sanity, 27

Dedication, vi

ADHD – quick pick references, 214

Depression maze of diagnoses, treatments, 60-61

Adrenochrome hypothesis, xviii Allegations for malpractice, 84

Depression – quick pick references, 215

American Jnl of Psychiatry, 27

Depression, symptoms, 3

American Psychiatric Association, 27

Depression Survivor's Kit, xi

Antidepressant Survival Program,

Diagnosis, 2

review, 155

Diagnose accurately, treat restoratively worksheet, 34-43

Antioxidant, xxiv Anxiety and Depression – Resources, review, 157

Diagnostic and Statistical Manual (DSM), 56 Differential diagnosis, 29

Assessing a health professional, 89, 94-95

Dyslexia, quick pick references, 217

Autism – quick pick references, 214

DSM IV, 2, 56

orthomolecular care, xxvi

B

E ECT, 57

Biochemical individuality, 123

EEG neurofeedback, 58

Bipolar disorder, symptoms, 2

Efficacy index, xxvi

DSM criteria, 3

Epilepsy, quick pick references, 217

Quick pick references, 215

Exploring mental healthcare maze, 47

Bipolar puzzle solution, 3, 8

Expert psychiatrist, paradoxical case, 22

Blowing the Whistle, 67

Exploring the mental health maze, 47

Bob, a depressed patient, 12

F

Bradwejn, Dr. J., 25

C

Failed to diagnose, 64 Failed to take histories, 64

Caregivers can watch for, 91

Failed to monitor lithium levels, 65

Checks and balances, 21

Financial advice, 138 FINDING CARE FOR DEPRESSION

225

Finding care for refractory depression, 26 Folic acid, xxiv

M Masks of Madness, Science of Healing, xv, 25 Maze – depression, 60

G GABA, 123 Gingko biloba, 25, 120 Grof, Dr. P., 27 Guidelines for psychiatry, 27

H

Maze – mental healthcare, 55 McMan's Depression Weekly, viii The Medical Post, 73 Medical rights or reality of wrongs, 86 Medications, 9 Medicine Act, 52, 54, 93

Handbook of Psychotropic Herbs, review, 177

Mental accounting and consulting, 140 Mental healthcare compass, 113, 117, 121, 125

Hard lessons learned well, 98

developing, 107

Health profession associations, 54

directions for diagnosis, 109

Health system, 54, 55

directions for treatment, 110 quality care, 125

checks and balances, 21

short cut care, 117

Health professional assessment, 94-95

using compass to find care, 116

Health professional rating, 96-97 Hearing at review board, 71, 73

Mental healthcare reality check, 58 checklist, 59

Histadelia, 123 Histories, patient and family – missing, 64

Mental healthcare maze, 55

Hoffer, Dr. A, xv, xvii

Mental health system, overloaded?, 8 author's experience of short cuts, 102-103

How to use this book, ix Huntington's disease, xxiv

Mental status exam, 32

Hypomania, symptoms, 4

Methionine, 123 MindFreedom Journal, viii

I Illustrations, 114, 118, 122, 126 Incompetence, 51, 63 Increase the dose, 68 Independent Depression Project, 23, 50 Investigating a patient's comlaint, 74

Missing standard of care procedures, 69 significance, 64 Money matters, 138 Mood disorders – see references, 215 Multiple factors strain patient, 57

Investigating a bad outcome, 62

N

Introduction, xi

NARSAD, viii

J

National DMDA, viii, 8, 49, 67

Jamison, Kay Redfield, 7, 68

Negligence, defined, 81 Negligence checklists, 83-85

K

Niacin, vitamin B-3, xxi

Kidder, Margot, 25

The Noonday Demon, review, 190

L

O

The Last Taboo, review, 184

OCD, quick pick references, 218

Lithium, side effects, 9

Open Minds Quarterly, 25

226

FINDING CARE FOR DEPRESSION

Optimal nutrition, xxiii Orthomolecular, defined, xv Orthomolecular medicine, xvii

R R.A.I.S.E., 86, 93, 96 Rating a health professional, 96-97

autism, xxvi

Reality check, mental healthcare, 58, 59

depression and bipolar disorder, xxv

References for restoring mental health, 147

restorative mental healthcare, xxii

Refractory depression, 17, 18, 26

schiziphrenia, xix

worksheet, 42

Osmond, Dr. H, xviii

Regulatory advisory council, 53, 54

P

Regulated Health Professions Act, 51, 93

Patient history, 28 Padgett, A, 75 Paradoxical ideas, 23 Paradoxical case of expert psychiatrist, 22

excerpts, 51, 54 Restorative care, 11, 57, 61 Retired client, 143 Review board, 54, 71 hearings, 71, 73

Patient's notes, 45 Patient's medical file, 17 Patients' rights, 86

short cuts, 103 Reviews: Active Treatment of Depression, 162

Patterns of psychiatry, xiii

Antidepressant Survival Program, 155

Pauling, L, xx

Anxiety and Depression –

Pellagra, xxi

The Best Resources, 157

Pfeiffer, Dr. C., 123

Dealing with Depression Naturally, 171

Nutrition and Mental Illness, 123

Handbook of Psychotropic Herbs, 177

Physicians' association, 19

The Noonday Demon, 190

case of incompetence, 63

Risk Management with Suicidal Patients, 80

health system maze, 54

The Last Taboo, 184

short cuts, 102

Prozac Backlash, 196

suggestions for investigating, 99

Worry, 211

Practice guidelines, 27 patients and caregivers can use, 77

Rights of mental patients, 86-88 Rimland, Dr. B., xxvi

Prescription medications, effects, 14

Risk management procedures, 85

Practice guidelines, xiii, 27, 44

Risk management with suicidal patients, 80

Preface, ix

S

Prozac Backlash – review, 196 Psychiatric survivors' rights, 86 Psychiatric guidelines, 27 Psychiatrist, education, training, 52-53, 55 Psychiatry, patterns of care, xiii Psychology of Whistle Blowing, 78

Q

Safe Harbor, viii Schizophrenia – quick pick references, 218 SEAR Publications, 229 Searing experience, 81 Shadow Syndromes, 152, 220 Shingles, xxiv ShorCu, Dr.T.T., 12

Quick pick reference list, 214

Short cut system, 102

Quick tips for coping, 143

Short cuts, author's experience, 102 FINDING CARE FOR DEPRESSION

227

Shulman, Dr. K., vii Simmie, Scott, 184 Slagle, Dr. P., 123 The Way Up From Down, 123

V Vagal nerve stimulation, 58 Vitamin dependency, xxiv VVV-RISCE-H, 5, 48, 109, 151, 219

SSRI – effects on author, 49

adaptive value, 6, 7

hypomania, 119

how people react, 6, 10

Standard of care, defined, 81

useful characteristics, 6, 7

Standard of care procedures – omitted, 69

Vitamin B-3, xviii, xix

Substandard psychiatry,

Vitamin B-6, 123

blowing the whistle, 67 Sucsan illustrations, 114, 118, 122, 126 Suggestions for patients, 76 Suicide, vi, 11, 20, 68, 80 Night Falls Fast, 68

Vitamin C, xviii, xix Vitamins-as-treatment paradigm, xxiv

W Walker, Dr. S., 27 Dose of Sanity, 27, 154

quick pick references, 218 research, 68

Whistle blowing psychology, 77 Williams, Dr. R., 123

T

Biochemical Individuality, 123

TAYO – Healthcare Planner, 129

Wolkoff, Dr. I., 26

a bad outcome, 132

Worry, review, 211

a good outcome, 133

Writing a journal, 151

options for diagnosis, 131 options for treatment, 131

X

planning outlined, 135

Xenobiotics, xxiv

planning worksheet, 136-137 The Toronto Star, 53, 73, 74 The Trusting Patient, 1 The Way Up, viii The Way Up From Down, 123 Therapeutic index, xxi Therapy, 145 Think About Your Options – TAYO, 129 TMS, 58 Tools for finding care, 105, 145 Touched With Fire, 7, 220 Trial and Error, 8 Trigeminal neuralgia, xxiv Trust in secrecy, 74 Trust in secrecy, trust betrayed, 74 Trusting patient, 1, 12, 145 Turning 50 – poem, 221 Twists and turns – poem, 101

228

FINDING CARE FOR DEPRESSION

ABOUT THE AUTHORS Dr. Abram Hoffer is a founding father of orthomolecular medicine. He studied chemistry, medicine and psychiatry at the University of Saskatchewan (MSA), University of Minnesota (PhD) and the University of Toronto (MD). During the 1950s as Director of Psychiatric Research in the Province of Saskatchewan, Dr. Hoffer researched and developed orthomolecular treatments for schizophrenia, depression and other mental disorders. He pioneered research in nutritional therapy and developed protocols to optimize brain biochemistry. Treatment regimens combine healthy foods with natural supplements. If patients also require medications, Dr. Hoffer prescribes them in modest doses, as needed. Readers can learn, by studying his books and the Journal of Orthomolecular Medicine, how Dr. Hoffer and his colleagues diagnose and treat patients. Over his long medical career, Dr. Abram Hoffer helped thousands of patients to restore and maintain their mental health. At the age of eightysomething, he still practises psychiatry in Victoria, British Columbia, Canada. He has published nearly five hundred research articles as well as ten books, including the following: How to Live with Schizophrenia Vitamin B-3 & Schizophrenia: Discovery, Recovery, Controversy Vitamin C & Cancer: Discovery, Recovery, Controversy Hoffer’s Laws of Natural Nutrition Dr. Hoffer’s ABC of Natural Nutrition for Children Smart Nutrients: A Guide to Nutrients That Can Prevent and Reverse Senility Robert Sealey, BSc, CA is a consultant and writer in North York, Ontario, Canada. His brain has faults and fallibilities. He is variable, volatile and vulnerable to episodes of depression and hypomania. Reactive, intense, hypersensitive, periodically creative and surgingly energized, he is bipolar, migrainous and anxiety-ridden. Bob advises local clients about accounting, auditing, tax, business operations and financial planning. He has worked on fraud investigations. Thirty percent of his clients have depressions, mental episodes or brain disorders. From the age of seventeen, Bob suffered prolonged episodes of depression. Eight health professionals failed to ‘cure’ him. After decades of misdiagnosis and mistreatment, incompetence and short cuts, Bob learned how to restore and maintain his mental health. Damaged as a victim of psychiatric malpractice, Bob set up IDP, an Independent Depression Project, to explore the mental healthcare maze, research, FINDING CARE FOR DEPRESSION

229

develop and write a series of articles and layman’s guides including the following: Depression Survivor’s Kit Living with Depression: The Bad Mood Disorder – A Survivor’s Guide Orthomolecular and Mental Healthcare References – Layman’s Guides We might expect helpful guides from a chap with a Bachelor of Science degree with courses in biological and medical sciences and psychology. We wonder what would motivate Bob to study so many books about conventional psychiatry and restorative biochemistry. What could he learn by probing the healthcare system while living and working with a mooddisordered brain? Bob writes clearly enough for anyone to learn that restorative mental healthcare is not an impossible dream. He encourages patients, family and caregivers to hope, learn, cooperate and benefit. He reminds us that many people have mental conditions. We all know some of these poor souls: silenced, stigmatized, marginalized, shunned as if they were lepers. We recognize the urgent need for carefully designed tools to help vulnerable patients find effective care for depression, mental episodes and brain disorders. By writing about quality mental healthcare in a direct and uncompromising manner, Bob questions the status quo of psychiatric minimalism, offers tips, tools and teaching tales and links the practice guidelines of psychiatry with restorative methods suitable for patients and caregivers. BY THE SAME AUTHORS Dr. Abram Hoffer Publication list available from Journal of Orthomolecular Medicine 16 Florence Ave., Toronto, ON, Canada M2N 1E9 Tel 416-733-2117 www.orthomed.org Journal of Orthomolecular Medicine, senior editor quarterly Vitamin B-3 & Schizophrenia: Discovery, Recovery, Controversy, 1998 Dr. Hoffer’s ABC’s of Nutrition for Children: With Learning Disabilities, Behavioral Disorders And Mental State Dysfunctions, 1999 Hoffer’s Laws of Natural Nutrition: A Guide to Eating Well for Pure Health, 1996 230

FINDING CARE FOR DEPRESSION

Dr. Abram Hoffer with Linus Pauling, PhD Vitamin C & Cancer: Discovery, Recovery, Controversy, 2000 Dr. Abram Hoffer with Dr. Morton Walker Putting It All Together: The New Orthomolecular Nutrition, 1996 Smart Nutrients: A Guide to Nutrients that can Prevent and Reverse Senility, 1994 Orthomolecular Nutrition: New Lifestyle for Super Good Health, 1978 Dr. Abram Hoffer with Margot Kidder Masks of Madness: Science of Healing, TV documentary, 1998 Robert Sealey, BSc, CA SEAR Guide Series, available from SEAR Publications www.searpubl.ca Living With Depression – The Bad Mood Disorder, 1995 Depression Survivor’s Kit: A Layman’s Guide for Survivors and Caregivers, 1996 Mental and Orthomolecular Healthcare References: Laymans’ Guides to New Hope for Mental Health, 1997 & 1998 Articles about the psychology of money – Cdn. Moneysaver, 1998 - 2001 Articles, poems – Open Minds Quarterly, Fire & Reason, Wordscape 6&7, 1999 - 2000 BY OTHER AUTHORS Mary Ellen Copeland, MS, MA available on the Internet www.mentalhealthrecovery.com or by mail, write to PO Box 301, West Dummerston, VT, USA 05357-0301 The Depression Workbook: A Guide to Living with Depression and Manic Depression Healing the Trauma of Abuse: A Women’s Workbook Living Without Depression and Manic Depression: A Guide to Maintaining Mood Stability The Loneliness Workbook FINDING CARE FOR DEPRESSION

231

Winning Against Relapse: A Workbook of Action Plans for Recurring Health and Emotional Problems WRAP: Wellness Recovery Action Plan The Worry Control Workbook Also available – seminars, audio tapes, video, e-mail newsletter Gayle Grass with illustrations by Coral Nault available from: Iris The Dragon Inc. www.iristhedragon.com PO Box 923, Smith Falls, ON, Canada, K7A 4W7 [email protected] Catch a Falling Star information for children and families of children with mental illness Planned – newsletter, series of Iris the Dragon books Priscilla Slagle, MD e-mail newsletter available from www.thewayup.com The Way Up From Down John Brown Inspire Hope Publishing Corp., 2721 Poipu Rd. Ste. 533, Koloa, HI, USA 96756 www.findfun.org The Gift of Depression

232

FINDING CARE FOR DEPRESSION

Appendix 90 Day Plan for Finding Quality Care Personal Progress Report of Index: Notes and Forms: ASTER, Compass, TAYO Mental healthcare compass

234

The patient, doctor, family, and caregivers can ask for quality care at the start of the 90 day period. Consider all the choices. Discuss. 1st Month of

Year

Patient can outline visits with health professionals – Overview. Patient can note ASTER details – Assessment, Treatment, Effects, Results. Health professional rating – at the start of the 90 day period. TAYO chart for the month. Mental healthcare compass – Mark your heading at the end of the month. 2nd Month of

Year

Patient can outline visits with health professionals – Overview. Patient can note ASTER details – Assessment, Treatment, Effects, Results. TAYO chart for the month. Mental healthcare compass – Mark your heading at the end of the month. 3rd Month of

235 236 238 240 242

243 244 246 248

Year

Patient can outline visits with health professionals – Overview. Patient can note ASTER details – Assessment, Treatment, Effects, Results. TAYO chart for the month. Mental healthcare compass – Mark your heading at the end of the month.

249 250 252 254

After three months After 90 days of cooperating and monitoring care, if there are problems with diagnosis and / or problems with treatments, a patient or family can ask the health professional to discuss the medical file and review the practice guidelines. Refer to pages 32 to 42.

FINDING CARE FOR DEPRESSION

233

MENTAL HEALTHCARE COMPASS Directions for Diagnosis and Treatment

FF • DN

QL • ET

find fault do nothing

quick label easy treatments

Minimalist

Conservative

Negligent

Restorative

MD • MT

AD • RT

misdiagnosis mistreatment

accurate diagnosis restorative treatments

Consider which direction is likely to lead to quality care. 234

FINDING CARE FOR DEPRESSION

Notes:

Notes:

1st Month of

Ye a r

PATIENT NOTES (VISITS WITH HEALTH PROFESSIONALS): Date:_______________________________________ Name of professional:________________________ Discussion:_________________________________ Recommendations:___________________________ Results:______________________________________ Date:_______________________________________ Name of professional:________________________ Discussion:_________________________________ Recommendations:___________________________ Results:______________________________________ Date:_______________________________________ Name of professional:________________________ Discussion:_________________________________ Recommendations:___________________________ Results:______________________________________ Date:_______________________________________ Name of professional:________________________ Discussion:_________________________________ Recommendations:___________________________ Results:______________________________________ Date:_______________________________________ Name of professional:________________________ Discussion:_________________________________ Recommendations:___________________________ Results:______________________________________ FINDING CARE FOR DEPRESSION

235

Personal Progress Report of

ASTER DETAILS Assessment Symptoms

Diagnosis

Questions

236

FINDING CARE FOR DEPRESSION

Treatments • Medications • Supplements

• Therapy • Counselling

Questions

Month of

Year

ASTER DETAILS Effects Positive

Results Negative

Questions

Progress

Problems

Questions

FINDING CARE FOR DEPRESSION

237

HEALTH PROFESSIONAL RATING (For use by patient, family and caregivers) Assessment

Respects

R

❑ 1

Approves

A

❑ 1

Includes

I

❑ 1

Supports

S

❑ 1

Encourages

E

❑ 1

R.A.I.S.E. Total

❑

Profile of a R.A.I.S.E. Practitioner (Scores between 3 and 5) • focus is guideline quality of care, sincere communication, cooperation and competence • follows professional practice guidelines for accurate diagnosis and effective treatment • cooperates to help the patient restore mental health, maintain high functioning • encourages recovered patient to live well 238

FINDING CARE FOR DEPRESSION

Notes:

Notes:

HEALTH PROFESSIONAL RATING (For use by patient, family and caregivers) Assessment

Disrespects

D

❑ -1

Disapproves

D

❑ -1

Excludes

E

❑ -1

Discounts

D

❑ -1

Discourages

D

❑ -1

D.D.E.D.D. Total

❑

Profile of a D.D.E.D.D. Practitioner (Scores between -3 and -5) • seems sincere but there are problems with poor care, shortcuts, non-communication and incompetence • fails to diagnose accurately or treat effectively, watches sick patient get worse • if mental patient is misdiagnosed and mistreated, not concerned as the patient deteriorates • knows worsening illness increases risk of suicide. FINDING CARE FOR DEPRESSION

239

1st Month of

Ye a r

TAYO – THINK ABOUT YOUR OPTIONS HEALTHCARE PLANNER Patients, Professionals, Family and Caregivers: Planners can note their preferences for diagnosis and treatment. Find Fault

Do Nothing

P1

D1

P2

D2

F1

C1

F2

C2

FF Find Fault Discount Discourage Disapprove

DN Do Nothing No treatment No therapy No care

Minimalist Negligent Misdiagnosis

Mistreatment

P5

D5

P6

D6

F5

C5

F6

C6

MD Misdiagnosis No history No testing, prior files No mental status exams 240

MT Mistreatment Sick person gets worse Negative or toxic effects Incompetence, negligence

FINDING CARE FOR DEPRESSION

Notes:

Notes:

1st Month of

Ye a r

TAYO – THINK ABOUT YOUR OPTIONS HEALTHCARE PLANNER Patients use squares P1 – P8, Health Professionals D1 – D8, Family F1 – F8, Caregivers C1 – C8 Quick Label

Easy Treatment

P3

D3

P4

D4

F3

C3

F4

C4

QL Quick Label A short chat A DSM label A disorder

ET Easy Treatment Medications Talk therapy Shock therapy

Conservative Restorative Accurate Diagnosis

Restorative Treatment

P7

D7

P8

D8

F7

C7

F8

C8

AD Accurate Diagnosis Mental status exams Take histories Diagnostic tests

RT Restorative treatment Effective care Treats root causes Helps patient recover

FINDING CARE FOR DEPRESSION

241

MENTAL HEALTHCARE COMPASS Directions for Diagnosis and Treatment (Consider the practice guidelines of psychiatry)

FF • DN

QL • ET

find fault do nothing

quick label easy treatments

Minimalist

Conservative

Negligent

Restorative

MD • MT

AD • RT

misdiagnosis mistreatment

accurate diagnosis restorative treatments

Symptoms worsen. Sick person deteriorates.

Find root cause(s). Help patient recover.

After one month: is there a diagnosis? Are treatments helping? 242

FINDING CARE FOR DEPRESSION

Notes:

Notes:

2nd Month of

Ye a r

PATIENT NOTES (VISITS WITH HEALTH PROFESSIONALS): Date:_______________________________________ Name of professional:________________________ Discussion:_________________________________ Recommendations:___________________________ Results:______________________________________ Date:_______________________________________ Name of professional:________________________ Discussion:_________________________________ Recommendations:___________________________ Results:______________________________________ Date:_______________________________________ Name of professional:________________________ Discussion:_________________________________ Recommendations:___________________________ Results:______________________________________ Date:_______________________________________ Name of professional:________________________ Discussion:_________________________________ Recommendations:___________________________ Results:______________________________________ Date:_______________________________________ Name of professional:________________________ Discussion:_________________________________ Recommendations:___________________________ Results:______________________________________ FINDING CARE FOR DEPRESSION

243

Personal Progress Report of

ASTER DETAILS Assessment Symptoms

Diagnosis

Questions

244

FINDING CARE FOR DEPRESSION

Treatments • Medications • Supplements

• Therapy • Counselling

Questions

Month of

Year

ASTER DETAILS Effects Positive

Results Negative

Questions

Progress

Problems

Questions

FINDING CARE FOR DEPRESSION

245

2nd Month of

Ye a r

TAYO – THINK ABOUT YOUR OPTIONS HEALTHCARE PLANNER Patients, Professionals, Family and Caregivers: Planners can note their preferences for diagnosis and treatment. Find Fault

Do Nothing

P1

D1

P2

D2

F1

C1

F2

C2

FF Find Fault Discount Discourage Disapprove

DN Do Nothing No treatment No therapy No care

Minimalist Negligent Misdiagnosis

Mistreatment

P5

D5

P6

D6

F5

C5

F6

C6

MD Misdiagnosis No history No testing, prior files No mental status exams 246

MT Mistreatment Sick person gets worse Negative or toxic effects Incompetence, negligence

FINDING CARE FOR DEPRESSION

Notes:

Notes:

2nd Month of

Ye a r

TAYO – THINK ABOUT YOUR OPTIONS HEALTHCARE PLANNER Patients use squares P1 – P8, Health Professionals D1 – D8, Family F1 – F8, Caregivers C1 – C8 Quick Label

Easy Treatment

P3

D3

P4

D4

F3

C3

F4

C4

QL Quick Label A short chat A DSM label A disorder

ET Easy Treatment Medications Talk therapy Shock therapy

Conservative Restorative Accurate Diagnosis

Restorative Treatment

P7

D7

P8

D8

F7

C7

F8

C8

AD Accurate Diagnosis Mental status exams Take histories Diagnostic tests

RT Restorative treatment Effective care Treats root causes Helps patient recover

FINDING CARE FOR DEPRESSION

247

MENTAL HEALTHCARE COMPASS Directions for Diagnosis and Treatment (Consider the practice guidelines of psychiatry)

FF • DN

QL • ET

find fault do nothing

quick label easy treatments

Minimalist

Conservative

Negligent

Restorative

MD • MT

AD • RT

misdiagnosis mistreatment

accurate diagnosis restorative treatments

Symptoms worsen. Sick person deteriorates.

Find root cause(s). Help patient recover.

After two months: is there an accurate diagnosis? Are treatments working? 248

FINDING CARE FOR DEPRESSION

Notes:

Notes:

3rd Month of

Ye a r

PATIENT NOTES (VISITS WITH HEALTH PROFESSIONALS): Date:_______________________________________ Name of professional:________________________ Discussion:_________________________________ Recommendations:___________________________ Results:______________________________________ Date:_______________________________________ Name of professional:________________________ Discussion:_________________________________ Recommendations:___________________________ Results:______________________________________ Date:_______________________________________ Name of professional:________________________ Discussion:_________________________________ Recommendations:___________________________ Results:______________________________________ Date:_______________________________________ Name of professional:________________________ Discussion:_________________________________ Recommendations:___________________________ Results:______________________________________ Date:_______________________________________ Name of professional:________________________ Discussion:_________________________________ Recommendations:___________________________ Results:______________________________________ FINDING CARE FOR DEPRESSION

249

Personal Progress Report of

ASTER DETAILS Assessment Symptoms

Diagnosis

Questions

250

FINDING CARE FOR DEPRESSION

Treatments • Medications • Supplements

• Therapy • Counselling

Questions

Month of

Year

ASTER DETAILS Effects Positive

Results Negative

Questions

Progress

Problems

Questions

FINDING CARE FOR DEPRESSION

251

3rd Month of

Ye a r

TAYO – THINK ABOUT YOUR OPTIONS HEALTHCARE PLANNER Patients, Professionals, Family and Caregivers: Planners can note their preferences for diagnosis and treatment. Find Fault

Do Nothing

P1

D1

P2

D2

F1

C1

F2

C2

FF Find Fault Discount Discourage Disapprove

DN Do Nothing No treatment No therapy No care

Minimalist Negligent Misdiagnosis

Mistreatment

P5

D5

P6

D6

F5

C5

F6

C6

MD Misdiagnosis No history No testing, prior files No mental status exams 252

MT Mistreatment Sick person gets worse Negative or toxic effects Incompetence, negligence

FINDING CARE FOR DEPRESSION

Notes:

Notes:

3rd Month of

Ye a r

TAYO – THINK ABOUT YOUR OPTIONS HEALTHCARE PLANNER Patients use squares P1 – P8, Health Professionals D1 – D8, Family F1 – F8, Caregivers C1 – C8 Quick Label

Easy Treatment

P3

D3

P4

D4

F3

C3

F4

C4

QL Quick Label A short chat A DSM label A disorder

ET Easy Treatment Medications Talk therapy Shock therapy

Conservative Restorative Accurate Diagnosis

Restorative Treatment

P7

D7

P8

D8

F7

C7

F8

C8

AD Accurate Diagnosis Mental status exams Take histories Diagnostic tests

RT Restorative treatment Effective care Treats root causes Helps patient recover

FINDING CARE FOR DEPRESSION

253

MENTAL HEALTHCARE COMPASS Directions for Diagnosis and Treatment (Consider the practice guidelines of psychiatry)

FF • DN

QL • ET

find fault do nothing

quick label easy treatments

Minimalist

Conservative

Negligent

Restorative

MD • MT

AD • RT

misdiagnosis mistreatment

accurate diagnosis restorative treatments

Symptoms worsen. Sick person deteriorates.

Find root cause(s). Help patient recover.

After three months: differential diagnosis should be accurate; treatments should be appropriate. If not, see pages 32 to 42. 254

FINDING CARE FOR DEPRESSION

Notes:

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