Will the Mental Health Commission Succeed?

The Mental Health Commission of Canada has the most inspiring vision and mission of any organization I have worked for in my long career. The Commission is all about leading transformative change. Its vision is a “society that values and promotes mental health and helps people who live with mental health problems and mental illness lead meaningful and productive lives.” Its mission is “to promote mental health in Canada, and work with stakeholders to change the attitudes of Canadians toward mental health problems, and to improve services and support.”



I am acquainted with many people who suffer from mental illnesses or mental health problems. Unfortunately, I have known about a dozen people who died by suicide. For all these people and because of my own mental health problems, the work of the Commission is of deep personal interest to me.

I believe the Mental Health Commission of Canada should succeed for the following seven reasons:

Timing

People who have a mental illness are the only remaining large group in Canadian society who are still inappropriately stigmatized, discriminated against and marginalized. Since the pivotal decade of the 1960s, Canada, along with many other countries, has made great progress building a society that is increasingly inclusive of everyone. Discrimination against visible minorities and immigrants, women, gays and lesbians and people with physical disabilities has significantly decreased over the past five decades. But people with mental illnesses have remained in the shadows.

However, the beginning of real change is now evident. The direction of societal development seems to demand that people with mental illnesses come “Out of the Shadows Forever” as the tag line of the Commission calls for. From a historical perspective, the Commission was launched at the right time.

Leadership

While many played a part, the driving force that brought the Mental Health Commission of Canada into existence was Mike Kirby. He led the Senate Committee which tabled the Out of the Shadows at Last report in May 2006, a report which continues to be referred to as the Kirby Report. In a rare, risky and courageous act of true leadership, Mike Kirby resigned his Senate seat to lobby for the creation of a mental health commission. His considerable efforts succeeded and the Mental Health Commission of Canada was launched in March 2007.

Mike Kirby is now in his second term as Chair of the Commission. He continues to be its leader as he impatiently pushes the organization to achieve its vision and mission.

Resources

There are many excellent organizations in Canada dedicated to the cause of helping people with mental illnesses. There are many people with many good ideas for positive change and progress has been achieved. The current situation is much improved compared to fifty years ago. But everyone would agree that the degree and pace of change falls far short of what was desired.

To effect change requires resources and a significant reason for the underachievement of progress has been the lack of resources brought to bear on this cause.

The Mental Health Commission of Canada has significant resources. A funding agreement with Health Canada provides $130 million to fund the Commission for ten years. A second funding agreement with Health Canada provides $110 million for a five year research project on the mentally ill homeless population. This magnitude of funding for this cause is unprecedented and is the result of the leadership of Mike Kirby.

Strategy

In several critical areas the Commission has the correct strategic approach necessary to succeed in its vision and mission. Again, Mike Kirby is the architect of these strategies. While he certainly has his shortcomings, when it comes to strategic thinking he shines brightly.

Mike Kirby is realistic about where the Commission should be positioned as a catalyst for change. “Just inside the outer edge of political feasibility,” he has said over and over again. To advocate for only modest systemic changes will not result in enough change to be meaningful. To advocate for radical change is to over-reach and fail. Achieving the correct balance between these two extremes must be determined by political feasibility, which is a continuously shifting target. Ultimately, it is the power of governments that must make the necessary changes.
Over the years, the lack of action on sound recommendations in excellent reports from fine organizations stems partly from a lack of political feasibility. The recommendations were overly idealistic and beyond what governments were willing to do at the time.

But Mike Kirby and the Commission also have the right strategy to push the limits of what is politically feasible. It is well understood that politicians respond to public pressure. From the very beginning of the Commission, Mike Kirby recognized the need to generate a big social movement to support the recommendations the Commission will be making. Such a social movement will push the point of political feasibility in the right direction.

A third strategy employed by the Commission also originated with its leader - the (obvious) need to involve the people who themselves have mental illnesses. People with lived experience with mental illnesses are prominent at every level of the Commission. They are on the Board of Directors, they are on Advisory Committees and they are on staff. They have a strong voice.

They have a voice but they do not have the final, deciding voice. There are those in the mental health community who believe that people with lived experience should have the final say on all matters. I have heard expressed publically by leaders in this community that they should have control of the organizations that serve their needs through majorities on Boards of Directors. Were this to occur, I believe this would eventually move such organizations beyond what is politically feasible. There is a lot of anger amongst people with lived experience because their needs have not been adequately met and they have suffered greatly for a long time. But when this anger pushes for radical change beyond what governments can realistically deliver, the result is only token change rather than real progress. The Commission has wisely avoided this trap.

The Mental Health Commission of Canada listens to all voices – the established system, various professional associations, social service organizations, employers, governments and people with lived experience and their families. No one voice dominates nor should this be otherwise.

Of course there is little hope of complete agreement amongst widely different interest groups. Mike Kirby and the Commission have no such expectations and this is where the principle of equalized unhappiness comes in. If everyone likes 75% of what the Commission promotes, dislikes 25% and what is disliked is different for different groups, all will unite to achieve “their” 75%. This strategy should be a unifying force and should prevent the paralysis which would result from any misguided attempt to achieve a higher level of consensus.

Structure

The structure of the Mental Health Commission of Canada is important and has not received the attention it deserves. It is a non-profit corporation funded by the federal Government through Health Canada but independent from government. The Federal Government and Provincial Governments have seats on the Board of Directors but only a minority. Other Board seats are filled from the mental health community across Canada.

This structure is more conducive to achieving the Commission’s vision and mission than attempting to achieve system reform through the federal bureaucracy. A crown corporation or any type of entity controlled by governments would not be effective. No other existing organization in Canada could have successfully delivered on the vision and mission given to the Commission.

People

By being a new entity independent of governments, the Commission has been able to attract a wide variety of individuals with energy and passion for the cause.

The significant resources and bold strategies organized in an effective structure under the charismatic leadership of Mike Kirby have enabled the Commission to engage many talented and passionate individuals. Amongst the Board of Directors, Advisory Committees, Executive Leadership Team and staff are many people with high levels of skill, knowledge, experience, intelligence, energy and passion.

Momentum

The Commission has momentum and has quickly emerged as a leader in the mental health community. After its first couple of years, Mike Kirby remarked with great pride that the Commission “took off like a rocket.”

The Commission should succeed. It is now four years into its ten year mandate and its influence is continuing to grow. Major systemic change is not easy to accomplish and takes time. It will be several more years before it will be appropriate to evaluate the Commission’s impact. It may never be possible to determine what positive changes would have happened even without its existence. But that doesn’t matter because, as Mike Kirby says, it’s about the cause, not the organization.

The Mental Health Commission of Canada has many strengths which justify optimism. But it is a far from perfect organization and there are areas which should cause concern. As a former member of the Executive Leadership Team for almost three years, I was privileged to play a part in its formative phase. I will provide my perspectives on some of its initiatives, projects, accomplishments and shortcomings in the near future.

Inside the Commission

On January 28, 2011 my employment with the Mental Health Commission of Canada ended on mutually agreed to terms. My three years with the Commission was in many ways the highlight of my career. From start to finish it was an intense experience and a rare opportunity to be on the inside of an important, new organization.



As a Board Member of the Canadian Mental Health Association, I had been well aware of the launch of the Commission in March 2007. But I was taken by surprise, as was the whole country, when the Commission announced that the head office would be located in Calgary where I lived. The instant I heard the news I knew I wanted to work for the Commission.

I was further pleasantly surprised when Glenn Thompson was appointed Interim President. We knew each other from our time together at CMHA National – Glenn as Acting Chief Executive Officer and I as a Board Member and National Treasurer. I phoned Glenn and expressed my interest in joining the Commission as Chief Financial Officer and he invited me to apply.

On a Saturday morning in September 2007 I received a phone call from Glenn who was in Calgary for the Commission’s first Board meeting. Would I like to meet with Mike Kirby, he asked.

Later that day in the lounge of the Hyatt, I met with Mike Kirby, John Service, Howard Chodos and Glenn Thompson. During this “interview,” I deliberately tested the Commission by being quite open about my personal mental health problems. I have struggled with bouts of depression and anxiety since teenage. In many other organizations my disclosures would have ended any hope of employment on a senior management team. But after due process, I joined the Mental Health Commission of Canada in January 2008 as CFO.

The atmosphere at the January 2008 Board meeting was electric, full of anticipation. The number of attendees was quite large because Advisory Committee members were included. Together with Board and staff, this group became aptly known as the Commission Family.

My first six months with the Commission was the best period of my long career. I was highly motivated and full of energy. There were considerable challenges because this was a start-up situation and I literally began work on my kitchen table. I rose to the occasion with great productivity and accomplishment.

The Executive Leadership Team bonded almost instantly. Working with John Service, Howard Chodos, Mike Pietrus and Jayne Barker seemed almost effortless from a team dynamics perspective. Everyone was completely focused on whatever needed to be done. All of us were excited by the opportunity to really make a difference in a cause important to each of us.

But it certainly wasn’t perfect. Michael Howlett joined the Commission as Chief Executive Officer and he did not make a good first impression on me when we first met in Calgary in April. Something doesn’t feel right, I remarked to my wife after that first meeting. I quickly began having difficulty working with the new CEO and we disagreed on several significant matters. Fortunately he worked out of an office in Toronto where he lived and we saw little of him in Calgary.

The six month high I had been on ended abruptly with the first major negative event in the Commission’s history. In September 2008 Michael Howlett brutally terminated without cause the employment of John Service, Chief Operating Officer. I was further dismayed that the Board of Directors did not intervene. This unjustified act violated my core values and upset me deeply. For a couple of weeks my productivity plummeted and I considered resigning. Thankfully, I was encouraged to stay by Jayne Barker and I am glad I took her advice.

Naively, I had thought that the Mental Health Commission of Canada would be a special place to work both in terms of what the organization did as well as how the work was done. The work of the Commission was indeed special and the rapid start up and accomplishments of 2008 and 2009 was impressive. I found my job a CFO very challenging and stressful but also very rewarding. All things considered, there was no other place I would rather have been.

The challenges of a start-up, the extremely fast pace, the inevitable continuous change, the enormous expectations and trying to work with Michael Howlett added up to a very stressful situation for me, but I coped. Looking back, I am proud of my contribution.

But in July 2009 I had a serious mental health problem which I described in my blog entry Who gets Depressed on Vacation. I began to think about what changes I needed to make for the sake of my mental health. I also received some excellent advice from a psychologist who I see from time to time.

In January, 2010 Michael Howlett informed the Executive Leadership Team that he had resigned and would be leaving the organization at the end of March. Figuratively speaking, I leapt from my chair in pure joy. My two years of trying to work with him was the worst inter-personal experience in my forty year career.

Louise Bradley accepted the offer to move up to Chief Executive Officer. In a private meeting with Louise in March, she expressed her confidence in me and her intention for me to continue as CFO. However, I surprised her and replied that for the sake of my mental health, I wished to semi-retire and step down. Over the next few months we worked out a plan for a smooth transition for both me and the organization.

In September 2010 I left my position as CFO and joined the Commission’s Mental Health First Aid program, working in a part-time, non-management role. I thought we had arrived at a win, win and was pleased to remain with the Commission. However, on December 22, 2010, which by coincidence was the date of my wedding anniversary, I was placed on leave with pay. On January 28, 2011, my employment with the Mental Health Commission of Canada ended on mutually agreed to terms.

SNAKES IN SUITS

While on vacation a couple of months ago I read SNAKES IN SUITS When Psychopaths go to Work by Paul Babiak, Ph.D. and Robert D. Hare, Ph.D. This book is about the presence and behavior of psychopaths high in the ranks of management. The thoughts expressed by the authors are chilling.



The book was mentioned to me by my psychologist last year during a therapy session. It is her view that the impact of psychopaths is a big problem that is getting very little attention. She suspects that a number of her clients may be victims of psychopaths and that her experience may be widespread.

Psychopathy is classified in the DSM-IV as an Antisocial Personality Disorder and the proposed revision for the forthcoming DSM-V is Antisocial/Psychopathic Type. The American Psychiatric Association describes this disorder as follows:

Individuals who match this personality disorder type are arrogant and self-centered, and feel privileged and entitled. They have a grandiose, exaggerated sense of self-importance and they are primarily motivated by self-serving goals. They seek power over others and will manipulate, exploit, deceive, con, or otherwise take advantage of others, in order to inflict harm or to achieve their goals. They are callous and have little empathy for others’ needs or feelings unless they coincide with their own. They show disregard for the rights, property, or safety of others and experience little or no remorse or guilt if they cause any harm or injury to others. They may act aggressively or sadistically toward others in pursuit of their personal agendas and appear to derive pleasure or satisfaction from humiliating, demeaning, dominating, or hurting others. They also have the capacity for superficial charm and ingratiation when it suits their purposes. They profess and demonstrate minimal investment in conventional moral principles and they tend to disavow responsibility for their actions and to blame others for their own failures and shortcomings.

Those of us who have long been active in the field of mental health and mental illness know only too well how such difficulties often marginalize people. But knowing that individuals with very serious personality disorders can thrive in society and appear to be very successful paints a different picture indeed. It will be extremely challenging, probably impossible, to make psychopathy part of the conversation on mental health reform in Canada at this time.

Research on prison populations has shown that psychopaths may constitute 10 to 15 percent of criminals, significantly higher rates than their representation in general society, which is estimated to be about 1 percent. But psychopaths do not necessarily become criminals. Research by the authors of SNAKES IN SUITS found that about 3.5 percent of executives fit the profile of a psychopath. These executives cause problems, hurt people and often contribute very little real benefit to the organizations that employ them.

SNAKES IN SUITS provides the following list of behaviors that may be manifested by psychopaths in a business setting:

• Inability to form a team
• Inability to share
• Disparate treatment of staff
• Inability to tell the truth
• Inability to be modest
• Inability to accept blame
• Inability to act predictably
• Inability to react calmly
• Inability to act without aggression.

SNAKES IN SUITS also provides strategies for defending against psychopaths in the hiring and selection process. This is particularly important because such individuals are masters at presenting themselves as exactly what an organization may be looking for. Typically psychopaths have a well-crafted, impressive narrative about themselves and they often have a powerful, well-positioned patron who has bought their story.

Of course only qualified psychologists or psychiatrists can diagnose a personality disorder. Even for a trained professional, psychopathy is not an easy diagnosis to make. The advice of SNAKES IN SUITS to anyone encountering a suspected psychopath is to stay as far away from them as possible. Any attempt by an ordinary person to engage with a psychopath will almost always make a bad situation worse. I suspect that I have worked with more than one psychopath during my many years in management and in every case the dynamics closely followed the script presented in this most helpful book.

Men's Mental Health Matters

To say that men and women are different is to state the obvious. It may even provoke a chuckle. But there is also a very serious aspect to gender differences for people living with a mental illness or a mental health problem.



It is time to re-emphasize gender differences when the evidence supports doing so because there are benefits to be gained.

Western culture has been heavily influenced during the past fifty years by the feminist movement which sought to minimize gender differences in an effort to achieve greater equality for women. The objective was correct, but there have been unintended consequences. It has not been politically correct to emphasize gender differences and the potential of a gender specific understanding of mental illness and mental health has not been realized.

Soon after conception, males and females embark on different developmental paths. There are significant hormonal differences with male development influenced by testosterone and female development influenced by estrogen-type hormones. But the chemical differences go further and include some which are more closely linked to mental health. Males and females have different levels of serotonin, dopamine and oxytocin. These physical differences drive behavioral differences which play out in every aspect of life.

Researchers are continuing to discover identifiable differences in male and female brain structure. Specific areas of the brain linked to how information is processed differ by gender. Males and females even differ in how they use their brains (no jokes please). Right-hemisphere preference is more common in males and left-hemisphere preference is more common in females.

The nature-nurture debate is also relevant, of course. Boys and girls are raised differently, but probably much less so than fifty years ago. The feminist movement emphasized nurture as it wisely sought to expand opportunities for women. But the direction of scientific research today appears to be shifting the focus to nature.

Yes, but…

There is immense overlap between the genders. Of course the individual is more important than the gender. But this does not mean that gender is not significant. All differences between men and women should be viewed in the same way as obvious physical differences. Some women are taller than some men. But on average, men are taller than women. Gender is significant.

Yet it was in this century that speaking about gender differences landed Larry Summers in deep trouble while still President of Harvard University. He dared to link lower rates of female enrollment in sciences and engineering to gender. One woman was so offended that she walked out of the conference at which he was speaking. But he did not say that women were not capable of becoming very good engineers. Hopefully no one will be offended by those advocating for a gender specific approach to mental health and mental illness in areas where this approach is useful.

So far this is merely pre-amble before stating that almost four times as many men as women die from suicide. Yet women are more often diagnosed with depression. Why? We must find the reasons for these strikingly different outcomes. And we must understand what role gender plays.

Do men suffer less from depression or are men simply more reluctant to admit it? Does depression manifest differently in men, perhaps as mis-diagnosed physical symptoms? Do the causes of stress in the workplace differ for men and women and, if so, what gender specific coping mechanisms are most helpful?

Being a male can be bad for your health. Men have higher rates of heart disease and cancer. In fact, men lead women in all of the top ten causes of death. The life expectancy of men is significantly less than women and along the way men live sicker. This is less surprising when seen in light of women visiting doctors almost twice as often as men. Behavior is strongly linked to health outcomes. When it comes to health, both physical and mental, men behave badly. Gender ranks high as a determinant of health.

My Masculinity

About fifteen years ago I bought my first purse. The traditional male wallet no longer met my needs, being too small to hold all the items I wanted to carry and too uncomfortable in a back pocket. I have no need to refer to my purse as a “man bag”.

I have long realized that I do not fit the profile of a typical man. Of course, that very concept is highly problematic. Fortunately for me the society I live in has made significant progress in understanding the complexity of true masculinity. So have I.

The Bem Sex-Role Inventory was developed by Sandra Bem in 1974 and was the first test designed to objectively assess an individual’s masculinity and femininity. The BSRI has been both widely used and widely criticized for decades. Gradually society is moving away from stereotyping but there is still considerable room for more progress.

On the BSRI I score 60 out of 100 masculine points and 55 out of 100 feminine points. I wonder how many men would be uncomfortable with such scores? Why can’t all of us, both men and women, be completely comfortable with the way we are? That is not as easy as it sounds because understanding the self takes much effort, much struggle. The family and societal expectations we internalize are major barriers, insurmountable for some.

I would describe myself as often being moody, loyal, sensitive to others’ needs, tactful and gentle. I am not often competitive, assertive or ambitious. And I like who I am.

More than once in my career I have received feedback during a workplace performance appraisal that I am not tough enough as a manager. In my experience, managerial toughness is overrated and too often used as justification for unnecessary insensitivity to employees, particularly those at lower levels in organizations. Also, not enough credit is given to the tender for the ability of the head to rule the heart. A tender individual can make tough decisions and I have made my fair share during my career.

Compared to many men, I am quite emotional. While on far too many days I battle to keep my emotions under control, I find my emotional reactions very helpful and usually vindicated by subsequent events. Often when something doesn’t feel right, as time passes specific reasons emerge that confirm my original gut reaction. This can be a powerful advantage for a manager and I sometimes marvel at how slow executives can be to see the “obvious”. Perhaps I have a healthy amount of what gets mislabeled as women’s intuition!

Gender also plays out in significant ways in mental health and mental illness and that will be the topic of my next post.

My article gets published!

For me to write an article and get it published is a thrill!The following article was published in the October 2009 issue of CMA MANAGEMENT, a magazine which goes to all Certified Management Accountants in Canada. Hiring the mentally ill by John Stokdijk, CMA Would you knowingly hire someone with a mental illness? The Mental Health Commission of Canada, launched by the Government of Canada in 2007, faced this question in its early days of organizational life. The Commission is “a non-profit organization created to focus national attention on mental health issues and to work to improve the health and social outcomes of people living with mental illness”. My colleagues on the senior management team and I quickly agreed that it was important for the credibility of the Commission to “walk the talk.” Of course all potential employees must demonstrate that they have the skills, knowledge and experience to successfully perform the tasks which will be assigned to them. Organizations cannot afford to accept employee performance that does not meet expectations. But is there any other valid reason why someone with a mental illness should be excluded from consideration? The Commission believes the answer is an emphatic no and that all too often those with a mental illness are inappropriately discriminated against. To counter the many myths and misconceptions that abound about the mentally ill, the Commission is embarking on a multi-year anti-stigmatization, anti-discrimination campaign. When I hired my administrative assistant, I selected a candidate with bipolar disorder who had been out of the work force for twelve years. However, people do recover from mental illness. Given an opportunity, skills can quickly return as they did in this case. Most of the time, my administrative assistant performs at a level that exceeds expectations. But this story is about more than my staff. It is also about me. For the first time in my career, during my first interview with former Senator Michael Kirby, now Chair of the Mental Health Commission of Canada, and his team, I felt comfortable disclosing that I have experienced significant mental health problems. During my teen years I suffered from serious bouts of depression which continued throughout my adult life. Twice I have needed professional help because I was no longer able to function effectively in the workplace. Nevertheless, I was hired as the Chief Financial Officer of the Commission and am greatly energized by our organization’s motto “Out of the Shadows Forever”. Where is the leading edge of change in the workplace today? In recent decades, much improvement has been seen in how women are accepted and how motherhood is supported. Visible minorities are now part of the workforce everywhere. Employers have learned to make accommodations for the physically disabled. But people living with mental health problems or mental illnesses remain largely invisible. A new dimension in occupational health and safety is emerging in Canada – the idea that employers have a duty to provide a psychologically safe workplace. Earlier this year the Commission released a discussion paper, Stress at Work, Mental Injury and the Law in Canada by Martin Shain S.J.D., which will undoubtedly generate much discussion. The report describes a rapidly changing legal landscape and the implications for management. Organizations may be faced with an expanding duty to provide “a psychologically safe workplace... that permits no harm to employee mental health in negligent, reckless or intentional ways”. Stress in the workplace can sometimes reach unbearable levels and can lead to depression. Yet it can be difficult to successfully assert a short term or long term disability claim in such circumstances. Too often employers still expect employees to “suck it up and get on with it”. Is it really acceptable that employees have no option but to quit a job when they find themselves in these circumstances? Should the employer not bear some responsibility for mitigating workplace stress? Interestingly, employees with mental health problems or mental illness may have some advantage over other employees when it comes to coping with stress. Many of these employees have learned the hard way the importance of maintaining work-life balance and maintaining good physical health through proper eating, sleeping and exercising. In addition, many, like my administrative assistant and myself, are not reluctant to reach out for professional help when necessary. Employers may believe that they have fulfilled their obligations to employees by providing workplace wellness programs and employee assistance programs. Such programs have certainly made a significant contribution. However, the negative aspects of some organizational cultures too often still subtly overpower positive programs and policies. The need for organizational success and the need for containment of employee benefit costs are powerful forces which constrain the degree of employee support that is possible. But the direction of change must be to do more. The concept of comprehensive support for employees with mental health problems or mental illness has the potential to contribute to organizational success while reducing the costs for society as a whole. October 4 – 10, 2009 is Mental Illness Awareness Week. My challenge to my fellow CMAs across Canada is to consider hiring someone with a mental illness. Done properly, this can be a win, win, win for the organization, the employee and the country.

Who gets depressed on vacation?

As it turns out, I do. Recently I had the worst episode of depression and anxiety I’ve had in the past three years. Because it happened while I was on vacation, the experience was very discouraging and troubling. I have been struggling to understand why it occurred and what I can do better.


The pace at work is very fast and there is a great deal of activity but by the last Friday in July, I had my work sufficiently organized and I was looking forward to a week off.

On Saturday my wife Pat and I were on a short flight to Victoria. After settling into our hotel, we went for a long walk in this beautiful city, enjoying the scenery and the great weather. On Sunday, Pat decided to go shopping and I went for another long walk. I was thrilled with all the beautiful flowers everywhere, the hot sunshine and the relief of being away from the pressures of work. In hindsight, I was probably much too high that day but failed to pick up on this warning sign.

Later that evening, consistent with my pattern over the years, in an instant my mood changed. I remember thinking how silly it was not to be happy on vacation, but the avalanche of negative thoughts was unstoppable. Every flaw in my wife became enormously magnified. I was angry at myself for feeling this way while on vacation. If this could happen on vacation, I thought, it could happen during retirement. And if I was going to be miserable in retirement, what was the point of living? For the next four days I thought there was no hope of ever being happy and that I might as well put a gun to my head to end my misery.

I was functional for those four days. Pat and I did the things we had planned but I was living on two levels. I was merely going through the motions of doing what was planned but mentally I was miserable. We went to the Butchart Gardens, which are incredibly beautiful, but that did not lift my mood. We visited friends we had not seen in many years, but I was very much faking my mood. Each day I hoped to awaken feeling normal only to be disappointed.

When I am depressed I become very introverted. It is more than not feeling like talking, it is being in a state where talking would take great effort, more effort than I can muster. Needless to say, silence while on vacation is not conducive to positive interaction between a husband and wife. Unfortunately we feed off each others’ negativity and the cycle is hard to break.

But as always, after a few days, four in this case, the dense fog I was in lifted and my mood changed. I was again capable of talking. Life returned to normal and Pat and I enjoyed the remaining days of our vacation.

This episode shocked me because it was severe and I had not had such depression for several years. What just happened? Why?

For the first six months after joining the Mental Health Commission of Canada as Chief Financial Officer, I was on a constant high. I was excited about having a great job with a great organization. Life was very, very good.

After about six months an incident occurred which upset me and brought me back down to earth. It did not trigger depression or anxiety, but it did end the period of a prolonged high. The stress of a demanding job built up over time but I seemed to be handling the challenge well. I was exercising regularly and eating well. But over the year and a half in my current position, sleeping well became more difficult. There was always so much to think about and it was hard to relax. When I started this job I would take Amitriptyline as a sleep aid , but only weekends. Over time, my usage increased to every night, although at a very low dose.

Then early in July, while on a thirty-minute run and hoping for a fast finish, I pulled a leg muscle and limped home. As a result of the injury I had to stop running and this has always been one of the best ways I manage stress. I tried to stay active but walking and gardening are just not the same. I had lost my best means of coping with stress and relaxing.

On my first day back in the office after vacation I was pleasantly surprised to learn that my colleague and friend, Phil Upshall, was in the office. I shared my experience with him and, of course, he was understanding and empathetic. He had a number of helpful suggestions including journaling but I am choosing to blog instead. He also suggested I reconnect with the psychologist I had been seeing a few years ago. He urged me to develop a preventive plan for future vacations. It felt very good to talk with Phil.

Pat and I have been talking a lot about this episode as well. I fear I would be lost without her yet when I need her most, my behavior drives her far away. We are going to try to address this unhealthy dynamic in our relationship.
A week after vacation I went on a trip to Nova Scotia for a family wedding and had an inspiring visit with my mother. At 89, she is mentally completely sound and continues to enjoy a long, healthy retirement. Following in her footsteps is what I really want to do. I know I have much to live for.