All posts tagged depression

  • Guardian Australia story: ‘”His Death Still Hurts”: Pfizer anti-smoking drug Champix ruled to have contributed to suicide’, September 2017

    A feature story for Guardian Australia. Excerpt below.

    ‘His Death Still Hurts’: the Pfizer anti-smoking drug ruled to have contributed to suicide

    An Australian coroner says Champix had a role in Timothy John’s death, which occurred after only eight days on the drug

    '"His Death Still Hurts": the Pfizer anti-smoking drug ruled to have contributed to suicide" by Andrew McMillen on Guardian Australia, September 2017

    When the retired Queensland schoolteacher Phoebe Morwood-Oldham started an online petition following her son’s suicide in April 2013, she could not have known that her insistence on asking hard questions of one of the world’s largest pharmaceutical companies would lead to an Australian-first finding by a state coroner.

    On Thursday in Brisbane magistrates court, coroner John Hutton found that a commonly prescribed drug named Champix – manufactured by Pfizer and sold internationally under the name Chantix – contributed to the death of a 22-year-old Brisbane man, Timothy John, who died by suicide soon after he began taking a medication that he had hoped would cut his smoking habit from eight cigarettes a day down to zero.

    For Morwood-Oldham, the finding was a satisfying outcome for a lengthy process that began with a Change.org petition that she started four years ago, which asked for on-the-box warning labels on Champix packaging. It has been signed by 49,000 people. “His death still hurts so deep,” she wrote at the top of the petition. “After taking the anti-smoking drug marketed as ‘Champix’ for just 8 days, my beautiful boy hung himself. But despite reports of 25 suicides linked to Champix in seven years – there still aren’t proper side-effect warnings.”

    Every Sunday for four years Morwood-Oldham and her older son, Peter, have visited Timothy’s grave at Cleveland cemetery. The weekly routine involves the laying of lillies and turning their minds toward a young man who was, as his headstone says, “much wanted and loved”. Morwood-Oldham tells Guardian Australia that Timothy’s death “was so sudden” and it affected her deeply.

    “I lost the person I love the most in the world, in eight days. I never expected it.”

    Talking about Timothy, Morwood-Oldham warns that her emotions are “all over the place”. He is never far from his mother’s mind, nor her gaze: when she opens her laptop to share some photographs, there he is, her screensaver. A cute, blond boy aged six, aiming a cheeky smile at the lens.

    Timothy had suffered mental health issues, something his mother speaks of in terms of grades out of 10. He had for a time been a 4/10, then, after cognitive behaviour therapy, he was back to 9/10.

    “How did he go from a 9/10 to a 1/10 in eight days on Champix?” she said. “The autopsy showed there were no alcohol or drugs in his system other than Champix and Ibuprofen.”

    The inquest heard that, on a drive back from the Gold Coast just hours before his death, Timothy asked, “Mum, do you think I should give up the Champix? It’s making me feel strange.” Morwood-Oldham told the original two-day inquest in November last year: “I said to him, ‘Timothy, if it’s helping you to give up smoking maybe you keep it up’.” She had not been part of the consultations with her son’s GP when he was prescribed the drug and the Champix packaging did not contain warnings for any potential adverse effects.

    To read the full story, visit Guardian Australia.

    For help if you are in Australia: Suicide Call Back Service 1300 659 467; ­Lifeline 13 11 14, Survivors of Suicide Bereavement ­Support 1300 767 022. For help if you are outside of Australia, visit suicide.org’s list of international hotlines.

  • Backchannel story: ‘Wikipedia Is Not Therapy!’, August 2016

    A feature story for Backchannel. Excerpt below.

    Wikipedia Is Not Therapy!

    How the online encyclopedia manages mental illness and suicide threats in its volunteer community.

    'Wikipedia Is Not Therapy!' by Andrew McMillen for Backchannel, August 2016. Illustration by Laurent Hrybyk

    One recent Tuesday night in the suburbs of Sydney, Elliott* was sitting in front of his home computer, editing Wikipedia and debating with a fellow volunteer who was continually undoing his hard work. He was devoting his weeknight hours to developing an article about Salim Mehajer, a former deputy mayor of a Sydney city council who had attracted national headlines for a variety of indiscretions, including shutting down a public street without authorization in order to film his own wedding. But as Elliott typed, his eyes intent on the screen, his mental state was deteriorating.

    Elliott, 37, knew the inner workings of the online encyclopedia better than just about anyone. Since his first edit in 2004, he had invented the popular ‘citation needed’ tag, used by editors to indicate when a statement requires more evidence. He had started the administrator’s noticeboard,where the site’s volunteer leadership could discuss inflammatory incidents. And he wrote ‘exploding whale,’ a quirky article that remains emblematic of the sparkling brilliance for which the crowdsourced encyclopedia is widely beloved. For the latter creation, which summarized how the Oregon Highway Division attached half a ton of dynamite to a beached sperm whale carcass in 1970, he was awarded Wikipedia’s first ‘oddball barnstar,’ and so another user pinned a bright green badge to his userpage to acknowledge his enterprising work.

    But on this particular night, his virtual achievements were far from his mind. With his wife and two young children occupied in another room, Elliott was locked in what’s known as an edit war, while using a different account than the one that had earned him his earlier plaudits. Elliott was convinced that his detailed account of Salim Mehajer’s traffic violations, including an occasion in 2012 when he ran over two women in his car, belonged on the site. His interlocutor, another Australian editor of prominent standing within the community, remained unconvinced. “I don’t like the guy either, but Wikipedia’s policies on undue weight, original research and biographies of living people don’t not apply because you don’t like someone,” the second editor wrote, mistaking Elliott’s industrious research for bias against Mehajer. On several occasions, this second editor had reverted these lengthy additions, before using one particular adjective to describe Elliott’s work: obsessive.

    Their bickering had been brewing for several days. The pair went back and forth in the article’s ‘talk’ page, which is linked in the top left corner of every entry on the site. Elliott argued passionately for his cause, and at one point logged out of his account to back up his own argument anonymously; these contributions were tagged with his IP address. Two days earlier, he had responded anonymously to another editor, writing, “I fart in your general direction, which is a hell of a lot more pleasant than editing Wikipedia, I can tell you!” After reviewing the conflict, a site administrator decided to ban Elliott on that Tuesday night. “Given the seriousness of this conduct, I’ve set the block duration to indefinite,” noted the admin.

    Elliott’s mind was on fire. Already short-fused from several months of unemployment and recent health and financial woes, he felt overwhelmed with stress. As he sat fuming in front of the screen, his wife approached and asked him to help put their children to bed. The request startled him, and he reacted with a flash of fury. Elliott immediately regretted his anger. Stunned and embarrassed, he grabbed his phone and keys, hopped into a white Hyundai, and sped off.

    After driving for a while, he parked outside a local school and switched off the engine. He pulled out his iPhone and started typing a lengthy email. Titled “The End” and sent to a public Wikipedia mailing list watched by thousands of people around the world, late on the evening of Tuesday, May 17, Elliott’s email begins, “I’ve just been blocked forever. I’ve been bullied, and I’m having suicidal thoughts.”

    More than 2,000 words later, after recounting the events surrounding his ban in the exhaustive manner of a man well-versed in defending his position to nitpicking online strangers, he wrote, “I know I’m not well. I have fought this feeling for a decade.” Elliott ended with this: “I sit here in my car and contemplate suicide. My despair is total. There is not a kind one amongst you.You have taken my right of appeal, my ability to protest and my dignity. You have let others mock me, and I have failed to contribute to Wikipedia’s great mission—one I feel so keenly. I failed. I’m not sure what I’m going to do next. I will drive, I don’t know where. I pray my family forgives me.”

    To read the full story, visit Backchannel. Above illustration by Laurent Hrybyk.

  • GQ Australia story: ‘Shock To The System: Electroconvulsive therapy’, March 2012

    My first story for GQ Australia magazine: a 4,200 word feature about the psychiatric treatment electroconvulsive therapy, otherwise known as ECT or ‘electroshock’. This story appeared in the Feb-March 2012 issue of GQ.

    Click the below image to read the story in PDF form (link will open in a new window), or scroll down to read the article text underneath.

    Shock To The System

    Electroconvulsive therapy has long been the stuff of cinematic nightmares. But after nearly four decades since One Flew Over The Cuckoo’s Nest, many are arguing it does much more good than harm.

    Words: Andrew McMillen

    As the young man is led into the operating theatre, the smell of salt water and sterilisation fluid hangs in the air. The room is unremarkable; all greys, blues and whites, just like any other theatre in hospitals across the country, except for a couple of innocuous-looking machines stacked on a bench. Twenty-five-year-old John Vincent doesn’t know it yet, but those machines would soon change his life.

    Helped onto a gurney, Vincent lies flat on his back as a clamp is placed on his index finger to monitor his oxygen levels. He feels the cold wipe of saline solution on his collarbone, biceps and forehead, before a nurse applies several electroencephalography (EEG) electrodes to trace his brainwave activities. Moments later, a general anaesthetic makes its way up his arm, and he drifts out of consciousness.

    Having been sedated, he doesn’t remember what happened next, but it goes like this. A specialist affixes an electrode to the middle of his forehead, and another one above his left temple, then switches on the Thymatrons – those machines in the corner – sending a series of short electric shocks coursing through his brain, bringing on a grand mal seizure. Fifteen seconds later, it’s all over. The current is switched off, the electrodes removed, and Vincent is wheeled into an adjacent recovery room.

    It might sound like a scene from a ’70s movie, from the days of roguishly experimental medical procedures, but this was Boxing Day 2010, and Vincent had just received his first course of electroconvulsive therapy (ECT) at Toowong Private Hospital in Brisbane. A psychiatric treatment most commonly used on those with severe depression, ECT – better known by its outdated term, electroshock – is also called upon to treat patients suffering from acute mania or, in Vincent’s case, bipolar disorder. And despite the popular public perception of ECT as a barbaric, archaic practice, the treatment is administered on a daily basis at both public and private hospitals all over Australia.

    Growing up, Vincent was a happy kid. He had lots of friends, enjoyed playing soccer, and loved going fishing with his younger brother while on regular camping holidays with the family. Then, aged 17, in his final year of high school, Vincent was diagnosed with bipolar disorder.

    As he got older, his mental illness became harder to manage. “John was existing, but he wasn’t happy,” recalls his mother, Tina, a kind woman in her early fifties with a fair complexion and green eyes who runs a small business alongside her husband. “He wasn’t right, and at some stage he decided to go off his medication. Unfortunately, with his type of bipolar – type one – when he goes off medication, he goes into a state of catatonia. Everything shuts down; no communication, nothing happens.”

    Things worsened as the years passed, and by late 2010, Vincent was living a life of isolation in Townsville, north Queensland. He’d withdrawn from the people around him: friends, family, even the younger brother he lived with. “You know those wildlife documentaries on TV, where they record the animals’ every move, behaviours and moods, and all that?” he asks, his hazel eyes burning with intensity. “I felt like I was an animal; like I was being surveyed.”

    This was a dark time for Vincent, who says he spent a lot of time in his room “trying to hide away”. He constantly felt as though there was someone outside looking through the windows at him, recording his behaviour.

    One Friday in December, his parents went to Mackay for their first trip away together in a year. The next morning, Tina and her husband received a call from their youngest son. “He didn’t think John was all that well,” she says. “We jumped on the first plane and came home. We spent all Saturday with John. He continued to decline into a catatonic state; not eating, not talking. It was almost like he was in a coma.”

    By 5pm, Vincent’s movements had become “robot-like”, with his body barely responding to the signals sent by his brain, and the famil rushed him to the emergency ward at Townsville General Hospital, before he was transferred to the mental health hospital. “It’s pretty sad, because there just aren’t enough facilities,” says Tina, remembering how they how desperate they were for a solution to their son’s illness. “We turned to friends in the medical profession, who gave us a great deal of support and help.”

    A man named Dr Josh Geffen was mentioned, who specialised in ECT at Toowong Private Hospital. Vincent had never heard of ECT before his parents brought it up, but since he was in such a low mental state at the time, he didn’t argue. “I just went with it,” he shrugs. “I cooperated, and followed my parents’ advice. I did what I was told.”

    He hardly remembers a thing about the journey. His mother continues: “We got John down to Brisbane straightaway, and when Dr Geffen saw the state John was in, the first thing he recommended was ECT,” she says. “We were pretty horrified; we’d heard stories from the olden days of ‘shock treatment’ and that sort of stuff. We hadn’t really given ECT a lot of thought. It’s a little bit frightening, because you really don’t know what’s involved. But Dr Geffen explained everything to us, showed us a DVD, and put our minds at ease. We consented to John having the ECT, and he agreed to it, too.”

    They got to work immediately. Doctors warned Vincent that the muscles in his arms, legs and shoulders might feel sore once he came to, after receiving the electric shocks. And indeed, he did feel uncomfortable for a couple of hours – he likens the muscle soreness to the day after a big gym workout – but says, “Afterwards, I felt fine. It took a while for the anaesthetic to wear off, but after that I was OK.”

    Vincent’s story is more common than you might think. Statistics from the Australian Institute of Health and Welfare show that in the 2009-2010 financial year, 26,848 individual ECT sessions were administered throughout Australia – although the exact number of people treated is unclear, as patients tend to have multiple sessions. “A typical course of ECT involves between six and 12 treatments,” explains Dr Aaron Groves, the director of mental health in Queensland, adding that, while ECT can be used on people of all ages, since depression is more common in adults than in children, around 80 per cent of treatments are on patients aged 30 to 80.

    Based on those figures, on any given day here in Australia, 73 people get hooked up to a machine and jolted with electricity in the name of medicine. What’s more, far from being a curiosity from the past that hasn’t quite died out, it’s actually on the rise. Why? Well, because it works.

    ++

    Electroconvulsive therapy has its roots in early schizophrenia research. In 1934, Hungarian neuropsychiatrist Ladislas Meduna saw improvements in schizophrenic patients after seizures were induced with chemicals such as camphor and Metrazol. Three years later, Italian neuropsychiatrists Ugo Cerletti and Lucio Bini discovered that these seizures could be more easily induced by electricity. In a TED.com presentation uploaded in October 2007, an American surgeon and author named Dr Sherwin Nuland relayed an eyewitness account of the first time ECT was performed on a human in 1937.

    “They thought, ‘Well, we’ll try 55 volts, two-tenths of a second. That’s not going to do anything terrible to him.’ So they did that… This fellow – remember, he wasn’t even put to sleep – after this major grand mal convulsion, sat right up, looked at these three fellows and said, ‘What the fuck are you assholes trying to do?’ Well, they were happy as could be, because he hadn’t said a rational word in the weeks of observation. They plugged him in again, and this time they used 110 volts for half a second, and to their amazement, after it was over, he began speaking like he was perfectly well.”

    “It eventually became apparent that it was a much better treatment for depression than schizophrenia,” says Dr Jacinta Powell, clinical director of mental health at the Prince Charles Hospital in Brisbane. “This is how these things develop: psychiatrists make leaps of logic, they try them out, and see whether it works.”

    What they hope for with any treatment is remission. So, how does ECT stack up against other methods of treating depression?

    According to statistics presented in May 2011 at the American Psychiatric Association Conference in Hawaii, 34 per cent of ECT patients were in remission after two weeks of treatment. Four weeks later, that had risen to 65 per cent; and after a full course of ECT, that figure reached a 75 per cent remission rate. Those success rates aren’t just good; they’re remarkable.

    So, why are we still so scared? Perhaps Dr Geffen [pictured right] – the man who treated John Vincent – would have some answers. A stocky, silver-haired man in a dark suit, he leads me into the theatre where John was first treated on Boxing Day. He drags in a couple of chairs from the waiting room, which is adorned with intricate paintings of wildflowers and a poster entitled ‘Understanding Depression’. We sit in the middle of the theatre and begin talking ECT. “Intuitively, it does seem like a worrying thing to do,” he admits, “to pass a dose of electricity through somebody’s brain in order to treat them.”

    And he’s right. A seizure-inducing electrical current sent through the brain, where all our memories, emotions, likes, dislikes, fears and secrets are stored; where our very personality is kept? The mind recoils in horror at the thought alone.

    That’s partly because, for the majority of us, who haven’t had any first-hand experience of ECT, our knowledge is mostly based on what we’ve seen in movies. Take One Flew Over the Cuckoo’s Nest – the 1975 Miloš Forman adaption of Ken Kesey’s 1962 novel.

    You’ll remember the scene when the main character, Patrick McMurphy, played by Jack Nicholson, is judged to be so disruptive to the daily routine of his fellow psychiatric ward patients that doctors see no alternative but to treat him with ECT.

    McMurphy is led to a bed, his hairline coated with a conductive gel and a piece of leather placed between his teeth. Electrodes are applied to each temple, and his brain is exposed to a current of electricity. There’s no anaesthetic, nor is the patient forewarned of what’s about to happen. McMurphy appears to be in severe pain, with several men restraining his wildly convulsing body. It’s unclear whether McMurphy’s treatment is an attempt to ‘fix’ him psychologically, or simply to punish him for being a trouble-maker, but it was a very convincing performance that won Nicholson an Oscar, a Golden Globe, and a BAFTA for Best Actor.

    “It’s a great movie. I love Jack Nicholson; he’s fantastic,” says Dr Geffen, with a grin. “It’s also nothing like modern ECT. It was set during a time when anaesthesia was already involved, so a bit of creative licence has cost us quite a lot of bad press.” He continues with his list of ways the film misrepresents modern ECT. “No treatment electrodes are placed on people until they’re asleep, because it’s not a very pleasant feeling if you’re coming in for your first treatment,” he says. “It’s much kinder for the person who’s anxious about what’s going on.”

    It’s also worth noting that the vast majority of treatments do not induce enormous, full-body convulsions like the reaction portrayed by Nicholson. In most cases, the only physical sign of the electrical current is a slight twitching of the patients’ fingers and toes.

    At the Prince Charles Hospital, Dr Powell shows me a segment from the 1990s-era television program Good Medicine, in which a greying man in his mid-forties is treated with ECT. The footage of his treatment is so incredibly mundane and unremarkable that I can’t help wondering what all the fuss and controversy is about. Particularly given the guidelines adopted by the Royal Australian and New Zealand College of Psychiatrists in 1982, which note that it’s “among the least risky of medical procedures carried out under general anaesthesia, and substantially less risky than childbirth.”

    “It’s a very effective treatment for very ill people,” agrees Geffen. “It’s more likely to get you into remission than any other treatment.” Success rates with medication when used as a first-line therapy are only 30 per cent, he says. After a year of trying different strategies, this may rise to around 60 per cent in a best-case scenario.

    And what about therapy for depression – you know, the kind where you lay on a couch and talk things through?

    “The type of depression we see here, people are too sick to be having much talking therapy. Not that talking’s unimportant, but that’s part of the post-recovery.”

    Yet somehow, even though lying on the therapist’s couch isn’t the right thing, and months of antidepressants aren’t very effective, people are instinctively more keen to stick to those methods than to volunteer to be subjected to a series of electric shocks.

    “A few things soften that,” says Geffen, ever the salesman. “The dose of electricity is quite small; 0.8 to 1 amp. I was treating an electrician, and I asked him, ‘How can I explain it to people?’ He said, ‘Well, it’s about 10 per cent of what a toaster puts out.’ Now I always tell people, ‘Don’t stick forks in toasters, please!'”

    Geffen breaks into a wide smile and continues, “Another way to put it is that the current is enough to light up a 25 watt bulb for about one second. Once or twice in the process, I’ll pass the electricity across my hand, and feel a little jolt. But it doesn’t throw me to the ground.”

    And of course, ECT isn’t the only instance of doctors using electricity to reset an organ that’s not operating properly; cardioversion, for example, applies the same theory to correct a malunctioning heart. “I do wonder, sometimes, why the person who cardioversed Tony Blair is the ‘cardiologist hero’,” Geffen says, “but I can be painted as a ghoul for trying to treat people’s depression.”

    ++

    Part of our reluctance to embrace ECT, though, may well be because, despite years of research, it’s still a bit of a mystery. We know it works best when used to treat severe depression, but when it comes down to it, we don’t really know why. “At one level, that’s true,” agrees Geffen. “We don’t fully understand all of the mechanisms of its action. However, that’s true of many treatments in medicine. We do know how damaging severe depression is to people’s brains and their lives. At another level, we’re understanding a lot more about how it works, as well as the key chemicals involved in depression: serotonin, adrenaline, dopamine, and this – being a powerful treatment – influences all of them. Most antidepressants work on one, or – at most – two of those. ECT is a potent stimulus for brain cell growth.”

    His sentiments are echoed by Dr Daniel Varghese, a Brisbane-based psychiatrist in both the private and public health fields. “I think it’s true to say we don’t really know why or how it works,” Dr Varghese says.

    “But then again, we don’t know why or how people get severe mental illness either, because the brain is clearly an inherently complex thing. That’s something that psychiatrists and people with mental illness have to deal with in a range of illnesses: we don’t really know why, but we do know some strategies and treatments that we’ve found to be helpful.”

    ++

    Of course, it’s important to make it clear that ECT is not a catch-all miracle cure for depression, and some of the fears surrounding its usage are real. It certainly has its fair share of detractors.

    On a chilly morning in the Brisbane suburb of Highgate Hill, I meet with Brenda McLaren, a spritely woman who loves to talk. Her face is riddled with deep wrinkles, which make her appear far older than her 57 years. Her memory is shot, however, and she has prepared notes in an A5 notebook ahead of my visit. Her relationship with ECT has not been an altogether pleasant one. She was first treated in 1988, as a severely depressed 34-year-old. At first she consented, as she wanted to get better and believed that the doctors at Prince Charles Hospital were acting in her best interests. Over 20 years later, she’s not so sure.

    Brenda smokes a cigarette on the sun-soaked front balcony of the Brook Red Community Centre where she works as a peer support worker, and reads her handwritten notes. In 1988, her youngest son was six. “I can’t remember him between the ages of six to 15,” she says. “In some ways, [ECT] must cause some sort of brain injury for that to occur. He talks to me about things, and I honestly don’t remember.”

    “My other children would come up to visit me at that time,” she says, “and I wouldn’t know who they were. This would happen quite regularly after ECT. This made them hate the whole system, which is still a big thing with them. It created relationship problems within the family. I’m not saying there weren’t already problems, but it didn’t help. Because… how can a mother forget her children?”

    She looks up with sadness in her eyes, and it’s clear the memory loss still hits her hard. “It made me feel very guilty. When you really think about it, in some ways you lose your identity,” she says. “You lose who you are.”

    “I would be the most forgetful person here,” she says of her peers at the Centre, which supports people living with mental illness. “I put things down constantly, and never know where they are. I lose things. I believe it’s affected that part of the brain that makes you remember things, long-term. I find it hard to retain information. I find it hard to bring information out. That’s why I’m reading this.” She points at her notebook.

    McLaren says she received “dozens” of courses of ECT in her life, the last of which took place around 13 years ago. “I know they do it as humanely as possible,” she says, “but I think it’s barbaric, and in some ways, it’s a form of torture. If I was told I needed ECT today, they would have to take me screaming. Because I will never sign to have ECT again. Ever.”

    ++

    In an adjoining room to the ECT theatre at Toowong Private Hospital, Dr Geffen and his colleagues have written some literary quotes on a whiteboard to keep them focused on the job at hand. “Diseases desperate grown by desperate appliance are relieved, or not at all” – William Shakespeare. “Diseases of the mind impair the bodily powers” – Ovid. “When you treat a disease, first treat the mind” – Chen Jen.

    I tell Brenda McLaren’s story to Geffen, interested to hear his thoughts. “I feel sorry for her,” he says, after listening carefully. “I believe her when she says that ECT has damaged her memory, and that this affects her sense of identity. Recurrent ECT of this nature is a difficult scenario; if she was severely suicidal or malnourished from depression it may have saved her life, although obviously at some cost.”

    What Brenda described is, he says, a mixture of the common side effect of peri-treatment amnesia – loss of memory of the period around treatment – as well as the rarer retrograde amnesia, which is the loss of memory for “weeks, months, even years” before being treated. “With modern techniques, the peri-treatment amnesia is less severe and retrograde amnesia is even rarer,” he says.

    That’s partly thanks to the more recent side-lining of a variation of the treatment, called bitemporal ECT, in which an electrode is placed above each temple (as seen in One Flew Over the Cuckoo’s Nest). ECT guidelines note that “bitemporal ECT is associated with greater cognitive impairment, but these effects vary from patient to patient. Any memory impairment is usually resolved by 4-6 weeks following ECT, but a number of patients report persistent difficulty with retrograde memory.” The other, now more popular, method is unilateral ECT, where one electrode goes above the temple on the non-dominant side of the brain, while the other sits in the middle of the forehead.

    We return to Brenda McLaren’s experiences. “The issue of difficulty learning new information some 13 years later is more problematic,” says Dr Geffen. “It’s not generally described in the literature, and may be contributed to by age, depression, and the impact of lifestyle factors like smoking. But,” he admits, “it is hard to rule out ECT as a factor.”

    Geffen has been immersed in this world of ECT for more than 15 years. “We start at 6.30am every Monday, Wednesday and Friday, and we’re done by 9am; 10am if we’ve got a long list,” he says. “It’s generally done in the morning; it’s a lot kinder to do it then, as our patients fast from midnight.”

    As he said earlier, it’s a treatment for the very ill, and here in this room, Geffen only sees those closest to the brink. I wonder whether the constant exposure to the severely depressed takes a mental toll on him. “When you see patients who are distressed coming in, or patients who have a really good response, you take that home with you and think about it a little bit,” he says, and then smiles. “My wife works in mental health, so it allows for a bit of pillow talk. She’s very familiar with all of this.”

    What does he say when asked what he does for a living? “I talk quite openly and freely to my children about what my job is, and explain to them about this,” he says, gesturing at his workspace, with a hint of pride. “Although it’s a stigmatised area, there’s nothing terrible that we do here. We help people who haven’t done anything wrong; they have a brain illness. In that sense, in my social life, I do carry on that view that you can de-stigmatise this.”

    ++

    John Vincent isn’t sure whether he received eight or nine treatments of ECT in total, as he, too, experienced peri-treatment amnesia. “I can’t remember a lot of things that happened when we were back at school,” he says with a shrug. “Birthdays, big events, I can’t remember so much. Things close to me I still remember, though.” Childhood camping and fishing trips, for example, take a while to recall, but his foggy mind does eventually reach back to find the details.

    It can be difficult, but he’s philosophical. “I’d rather feel happy, and more myself, than have memories,” he says with a tone of finality. “My health is worth more than having memories.”

    Vincent says his course of ECT made him feel more lively. “I’m not so anxious anymore. I’m not short-fused or jumpy. Now I feel more cooperative; I get along a lot more with people.” Not that ECT was a quick fix. “It was a gradual recovery. It wasn’t as though, when I got out, I was right as rain again. It took a while to slowly get to that stage where I felt comfortable.”

    His parents stayed at John’s bedside for 12 hours a day through his month-long stay at Toowong Private Hospital. His mother remembers that, within 24 hours of John receiving his first treatment of ECT, she and her husband could see a “definite improvement”.

    “John’s had very good results with it. It’s been really quite incredible,” she says. “It’s almost like having a flat battery in a car. You put the jumper leads on and give it a bit of a boost, and it comes back again.”

    She doesn’t really understand how it works, and she doesn’t care: she’s just glad to have her eldest son back again. It’s been two months since his last treatment. “He’s on track, and everything is going well. Geffen says, ‘If you go for three months and you don’t need any more ECT, and the drugs are keeping you level, everything’s good,'” Tina says.

    “We had no knowledge about ECT until John went into this meltdown and went into hospital,” she continues. “I think the more people talk about it, the better it’ll be. The more I can tell people, and the more open you are about it, the more it will become accepted.”

    As for Vincent, now that things are on the up, he’s looking forward to returning to work at his parents’ small business in Townsville. He’d like to settle down with a girl and he can see himself – one day – getting married and having kids, “but they’re a while away yet,” he says with a grin. Vincent isn’t sure what career path he’ll take – something to do with machinery, perhaps, as he’s always had an interest in that area – but he knows that, thanks to ECT, he’s in a better mental state to confront the future than ever before.

    *Names have been changed.

    Note: due to an error in the production process, a photograph of Dr Josh Geffen’s father, Laurence, appeared in the original article, rather than Josh himself. This error has been corrected in this blog entry.

    For more on electroconvulsive therapy, visit Wikipedia. If you are feeling depressed or suicidal, please contact Lifeline on 13 11 14, which is available 24 hours a day.

  • Australian Penthouse story: ‘The Low Down: male mental health and Soften The Fuck Up’, March 2012

    A story published in the February 2012 issue of Australian Penthouse.

    Click the below image to read as a PDF in a new window, or scroll down to read the article text.

    The Low Down

    Feelings. We don’t like them – they’re awkward and can suck the joy out of a night on the town with the boys. But can deliberately avoiding our emotions be killing us? New website campaign Soften The Fuck Up believes so, and with youth suicide statistics showing a disproportionate number of men are killing themselves, they might just have a point.

    Story: Andrew McMillen

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    Ehon Chan, 24

    I grew up in Malaysia. When I was 16, my best friend died in a drowning accident. For three months, I went through a period where I was, in some sense, questioning what life was all about. I asked myself, “If everyone lives to die, why do we all live?” I found it really hard to understand that we all could die tomorrow. I did what every man does at that time; the whole “suck it up, just move on,” kind of thing. I kept thinking, “I have to be strong for everyone else”. I kept a very strong face; on the outside I was normal, I was happy. When I’d get home and be in my bedroom at night, all these self-reflective questions would come up.

    When I moved Australia in 2006, I discovered that there is a really low level of mental health literacy in this country; for men, even moreso. Australian men generally can’t pick up mental health signs and symptoms. They don’t know where to get help. A lot of people don’t know that their first point of call could be their GP, or they could call Lifeline. I decided to start something to challenge that knowledge gap. What’s the most common thing that Australian men get when they talk about any kind of weaknesses? The response is generally, “Harden the fuck up.” There’s no equivalent phrase for that in Malaysian!

    My friend said, “why don’t we call it Soften The Fuck Up?” Initially it was a joke; we all laughed at it. It’s currently an online campaign (softenthefckup.com.au, launched in July 2011), but we also want to make it an offline conversation. We want to take the conversation to the next level, so it’s not just about having a conversation with your mates, but equipping young people – in particular, men – with an idea of how to recognise signs and symptoms of mental health issues. And also, when someone comes up to you and says “I’ve got depression”, or “I haven’t been feeling well for the past five days”, what do you tell that person? What are the things you can and can’t say? Where do I get help?

    I was hesitant when the name was first suggested, because the word ‘fuck’ was in there. I wasn’t comfortable going ahead with it, but the more we thought about it, the more we decided, “you know what? That’s the whole point of this campaign”. We want to be unapologetic, we want to be in your face, and we want to push the extreme because we really want to change the culture. The more extreme we go, the more conversation it’s going to generate.

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    Paul Klotz, 51

    At the age of 13, I suffered sexual and physical abuse at the hands of the Catholic boarding system in Brisbane. After many months of being abused in every form you could imagine, I was then beaten with a leather strap for being a ‘bad boy’. After 36 years of hiding in a false existence and having to support a facade of a personality, I finally collapsed, and all of my defences began to crumble. I told a very select group; immediate family, my psychiatrist, and a few other friends. They were shocked, angry, and frustrated in terms of not knowing all these years. It’s not something that was easy to talk about.

    I’ve spent most of my life under the influence of drugs or alcohol to pretend that I was a normal, sane person. Despite that, I was extremely successful throughout my business career. But I’ve always lived with that self-destructive path. Once I achieved, I didn’t feel worthy. Because of this lack of self-esteem and self-belief, I was just continually and totally despising myself. Two years ago, I was able to look in the rear vision mirror, look at all those demons that had been there for the last 35-plus years and say, “enough’s enough; I need to deal with this”.

    This decision came at a huge cost. It’s doubtful if I’ll work again in anything near the capacity that I was before, because I’ve withdrawn from society. I feel uncomfortable around people, moreso than I ever did. It’s great to finally confront those demons and understand and recognise that I’ve suffered from severe depression, and severe post-traumatic stress disorder. I see a psychiatrist. I’m on all sorts of drugs and pills to try and keep that balance of life.

    In the last eight months I’ve been through five suicide attempts, and I’ve had to resign from the last two jobs because of the impact that my mental condition was having, and the episodes of depression, and being put into hospital. That started a period of living on the streets. I have nothing to hide. I’m quite comfortable in saying that if it wasn’t for my four beautiful boys, I wouldn’t be here. I have no doubt about that. During the last few suicide attempts, when I was fading away, it was the image of those guys that allowed me to get some strength, and fight back.

    If I get through all of this, my burning ambition is to assist other males out there. I want to let other males know that it is okay to put your hand up, it is okay to cry. It is okay to say, “I have been abused”, as difficult as that is. It is okay to say, “I’m suffering from depression”. It is okay to say, “I feel suicidal”. I live with the thoughts of suicide every single day of my life. We need to break down all these stereotypes that my generation – and I suppose it continues on, of – “Harden up son. Big boys don’t cry. You’ve just gotta suck it in, and move on,” because that’s such a narrow-minded, dead-end approach. Those feelings of discomfort, unhappiness, pain, guilt, shame; if they’re left inside, they do fester, and fester badly.

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    Nick Backo, 23

    I’ve lived in the same house in Parramatta all my life. I’m a social worker for child protection services, as well as studying post-graduate psychology and refereeing soccer. When I was 15, my Dad died. There was a lot of shock initially, because his death was unexpected. I became the eldest male in the house. I felt that I had to be strong, and look after my family. I saw a counsellor for two years, on and off, which was really useful for just talking with someone who was neutral, and who could give me some strategies around managing grief. I had a lot of support from friends, who gave me someone to talk to, even if it was just, “hey, I’m feeling shit”.

    It was hard to talk about. It brought up a lot of my own emotions, and you feel vulnerable sharing that sort of experience with people. It was also hard because a lot of people wouldn’t know what to say, or how to manage it. They were generally lost for words, so it was an awkward experience for me in bringing that up with them. To an extent, it’s something that you’ve got to live to understand. It would be beneficial for others to learn about grief, though. More broadly, it’s about educating people on supporting their mates, and being open to those types of conversations. Even if you don’t know what to say, just being there to listen and saying how you feel during those conversations is helpful.

    It’s important to embrace the characteristics of masculinity. One of those is ‘being strong’, and it’s not necessarily a bad thing. It’s also really important to talk about how you’re feeling, and your experiences. When Dad died, I was at that ‘coming of age’ stage in life. A lot of people were saying to me, “make sure you look after your Mum”, or “you’re the man of the house now”. I don’t think they were meaning it to put pressure on me. I guess it’s just what people say.

    For people currently experiencing grief, I’d tell them that it’s OK to feel however you’re feeling. If you’re angry or upset, or if you’re feeling okay or happy, that’s all part of the experience of grief. It’s fine to have those emotions. I’d really encourage them to talk to people that they feel comfortable with, and to talk about their grief and the person who has died. Even if it seems a bit crazy or unusual, that’s OK, because it’s an unusual experience to go through. I think about Dad every day, but as I’ve gotten older, I’ve learned how to manage my grief better. I took away a lot of positives from it, as well. I think I’m a better person because of that experience. On the same hand, if I could change that and have Dad back, I would in a second.

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    Ben Pobjie, 32

    I only recognised this year that I am suffering an illness. Since I was a teenager I’ve suffered periodical depression; I’d sink into a deep low for no particular reason. In the past I’ve been advised by people close to me that I should seek counselling. I’d shrug it off, saying “no, no, I’m just sad. Just going through a bad patch.” Which is not the right thing to do, really. You try and fight through it, because I didn’t want to appear weak or like I was making a big fuss over nothing. It builds up and gets worse and worse, and you have to admit that it’s not nothing. I broke down early this year, then realised that it’s not normal. I generally write jokes, and comedy. I’ve been writing more serious reflective things, having admitted to this. It’s possibly made me a little bit more honest as a writer. I’m on medication now, and I’m seeing a therapist.

    When I’ve been at my worst, I’ve self-harmed. I’ve cut myself. It’s hard to explain after the event, when you’re not in that headspace, exactly why you did something like that. It’s a culmination of trying to distract yourself from an emotional pain by giving yourself some physical pain. It’s a confusing time because when you go through those episodes, because obviously you’re not thinking rationally, and you don’t react to your own feelings rationally.

    When you’re depressed, you feel ashamed of yourself. It feels like something that you shouldn’t talk about. But I came to the realisation that if I didn’t tell people about it, then this can’t really be recognised as an illness. It couldn’t just be a secret that I kept. It takes courage to admit that you have a weakness. Everyone has weaknesses. It’s gutsy to own up to that. Most people are very willing to understand, and to show sympathy and support if it’s brought out into the open. That’s what I’ve found.

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    William Wander, 24

    I’m Brisbane born and bred. I went through various Catholic schools, though I’m definitely not Catholic. I work in sales for a software company. By night, I’m a writer and blogger. I’m that guy in their group of friends who always says the things that nobody really wants to hear. I’m a little bit too honest. I’ve always had something to do with depression, even from the age of 11 or 12. I had a very rough childhood; I had an abusive father, and was quite sick as well, while growing up. From the age of 13 or 14, I was on anti-depressants. For me, having depression is like having asthma; it’s just part of your genetic makeup, and you learn how to appropriately deal with it.

    I hadn’t been on anti-depressants for years until the GFC hit. I lost my job, I was unemployed for the first time in my life. I applied for 250 jobs and couldn’t get a single one. I hit rock bottom. The thing about depression is: it’s a hole that you can’t get out yourself. I’ve spoken to a lot of people about depression, and I’ve never met anybody that’s got out of it by themselves. I don’t think it can happen, honestly. You need to have somebody else, or some other group that helps you get out. You can take the first step, obviously, and say “I need help”. But in the end, it’s the support of other people that helps you to get out of that, and start to feel better.

    Depression is a disease that you can’t see. If you get hit by a car and your leg is twisted, that’s very visible and we can understand that. When people talk about depression, they feel weird about it for one of two reasons: they’re experienced it and they’re embarrassed about it and don’t know how to talk about it, or they have never experienced it and they can’t conceptualise it in their own head.

    I don’t care who you are, or how in touch with your emotions you are; it’s never easy to admit that you’re depressed. It’s always difficult, because the nature of depression is that you don’t want to acknowledge it. It’s easy to talk about it now, but when I am actually depressed, it is hard to acknowledge that, even to myself. I’m a very emotional guy. At the same time, I’m a fairly typical Aussie bloke, but I’ve always thought it’s ridiculous how closed-up guys are in general in Australia. Let’s not skirt around the issue. Let’s be men about it. Which, ironically, means approaching something, rather than just avoiding it.

    An enormous thanks to the brave men I interviewed for this story, and to Australian Penthouse for publishing.

    For more on Soften The Fuck Up, watch the below video and visit their website.

    For more about depression, visit Beyond Blue.

    If you are distressed after reading this story, please call Lifeline immediately on 13 11 14 (free call from all telephones in Australia).