Transcript: Electroconvulsive Therapy | May 09, 2019

Steve sits in the studio. He's slim, clean-shaven, in his fifties, with short curly brown hair. He's wearing a black suit, white shirt, and spotted brown tie.

A caption on screen reads "Electroconvulsive therapy. @spaikin, @theagenda."

Steve says SEVERE DEPRESSION AND ITS
VARIOUS TREATMENTS - TALK
THERAPY, MULTIPLE MEDICATIONS,
AND ELECTRO-CONVULSIVE THERAPY -
MAY NOT BE THE MOST OBVIOUS
TOPIC FOR A MUSICAL.
HOWEVER, THE TONY AWARD WINNING
PLAY, "NEXT TO NORMAL,"
CURRENTLY ON STAGE IN THE
PROVINCIAL CAPITAL, DELIVERS
BOTH AS GREAT THEATRE AND AS A
WINDOW INTO THE MENTAL HEALTH
ISSUES FACED BY SUFFERERS AND
THEIR FAMILIES.
WITH US NOW FOR MORE, MA-ANNE
DIONISIO, WHO PLAYS THE MAIN
CHARACTER DIANA GOODMAN IN THE
MIRVISH PRODUCTION "NEXT TO NORMAL."

Ma-Anne is in her thirties, with long straight chestnut hair. She's wearing a printed blue blouse.

Steve continues DAPHNE VOINESKOS, STAFF
PSYCHIATRIST, TEMERTY CENTRE FOR
THERAPEUTIC BRAIN INTERVENTION
AT CAMH, THE CENTRE FOR
ADDICTION AND MENTAL HEALTH.

Daphne is in her late thirties, with long straight auburn hair. She's wearing a black blazer, burgundy blouse, and a golden pendant necklace.

Steve continues AND DR. PETER GIACOBBE, CLINICAL
HEAD OF THE HARQUAIL CENTRE FOR
NEURO-MODULATION AND A
PSYCHIATRIST AT SUNNYBROOK
HEALTH SCIENCES CENTRE.

Peter is in his late forties, clean-shaven, with short gray hair. He's wearing glasses, a gray suit, white shirt, and spotted black tie.

Steve continues AND IT IS SO GOOD TO WELCOME EVERYBODY TO THE PROGRAM, AND
YOU TWO ON THE ENDS, DON'T TAKE
THIS THE WRONG WAY, BUT I SAW
YOUR PLAY, MA-ANNE, YESTERDAY.
YOU ARE PHENOMENAL.
THE PLAY THE PHENOMENAL, AND I'M
SO GLAD THAT YOU'RE HERE AND
CAN'T WAIT TO TALK TO EVERYBODY,
BUT ESPECIALLY YOU ABOUT ALL THIS.

Ma-Anne says THANK YOU.

Steve says OKAY, HERE WE GO.
LET'S SET THIS UP.
THIS IS A PLAY ABOUT A WOMAN
WITH SEVERE DEPRESSION.
YOU PLAY THE LEAD.
SHE'S GOT A LOT OF MENTAL HEALTH
ISSUES.
AT SOME POINT HER PSYCHIATRIST
SAYS TO HER: ELECTRO-CONVULSIVE
THERAPY, ELECTRO SHOCK AS IT IS
MORE FAMILIARLY CALLED, IS
ADVISED.
SO LET'S START THERE.
WHAT IS ECT?

The caption changes to "Daphne Voineskos. Centre for Addiction and Mental Health."
Then, it changes again to "The mythology."

Daphne says ECT HAS BEEN AROUND FOR A
LONG TIME.
IT'S OUR MOST EFFECTIVE
PSYCHIATRIC TREATMENT FOR
TREATMENT-RESISTANT DEPRESSION,
SO FOR DEPRESSION THAT HAS NOT
RESPONDED TO MEDICATION OR TALK
THERAPY.
IT'S ONE OF OUR ONLY PROCEDURAL
TREATMENTS IN ECT.
IT'S QUITE A BIT MORE INVASIVE
THAN TAKING A PILL.
BUT IT'S VERY EFFECTIVE, UP TO
70 percent OF PEOPLE WITH
TREATMENT-RESISTANT DEPRESSION
WILL RESPOND TO ECT.

Steve says WHAT DO YOU ACTUALLY DO?

The caption changes to "Peter Giacobbe. Sunnybrook Health Sciences Centre."

Peter says SO ELECTRO-CONVULSIVE THERAPY
INVOLVES THE APPLICATION OF A
BRIEF SHORT ELECTRICAL STIMULUS
TO THE SCALP TO INDUCE A SEIZURE
UNDER GENERAL ANAESTHESIA.

Steve says DOES IT CAUSE MEMORY LOSS?

Peter says MOST OF THE DATA WOULD
SUGGEST THAT IMMEDIATELY AFTER
THE TREATMENT THERE IS SOME
DEGREE OF MEMORY IMPAIRMENT, AND
THAT MAY BE DUE TO THE
ANAESTHETIC, DUE TO THE
PROCEDURE ITSELF, BUT WHEN YOU
LOOK AT FOLLOW-UP THREE TO SIX
MONTHS LATER, IN GENERAL
PEOPLE'S MEMORY IMPROVE, AND
PART OF THE REASON FOR THAT IS
WHEN PEOPLE ARE DEPRESSED THEY
CAN HAVE A PROFOUND EFFECT ON
THEIR MEMORY, AND WHEN YOU
SUCCESSFULLY TREAT THEIR
DEPRESSION, THAT CAN IMPROVE.

Steve says WHAT DOES THE EVIDENCE
SAY ABOUT WHETHER OR NOT IT
CAUSES ANY DAMAGE TO THE BRAIN?

Daphne says THERE'S NO EVIDENCE THAT
THERE'S DAMAGE TO THE BRAIN AS
FAR AS WE CAN TELL.
THERE IS MEMORY IMPAIRMENT, AND
THE PERIOD OF TIME AROUND ECT
AND INCLUDING THE TIME THAT YOU
HAVE ECT UP TO A FEW MONTHS ON
EITHER SIDE CAN REMAIN QUITE A
BIT FUZZY FOR PEOPLE IF THEY
HAVE MEMORY IMPAIRMENT.

Steve says I WANT TO KNOW HOW
MUCH YOU KNEW ABOUT ALL OF THIS
BEFORE YOU TOOK ON THIS ROLE.

The caption changes to "Ma-Anne Dionisio. Actor, 'Next to normal.'"

Ma-Anne says UMM, NOT VERY MUCH WHEN IT
COMES TO ECT.
IT'S JUST A VERY, VERY BASIC
KNOWLEDGE OR UNDERSTANDING.
ALSO, SHARED EXPERIENCES FROM
PEOPLE WHO HAVE ADMINISTERED ECT
AND WHO HAVE RECEIVED IT.
AND MY UNDERSTANDING IS IT
VARIES WITH EACH PERSON.
LIKE, THE DEGREE IN WHICH THIS
THERAPY AFFECTS THEM, OR IF IT
IS ACTUALLY EFFECTIVE FOR THEM.

Steve says BUT AS AN ACTOR, I
PRESUME YOU DO SOME RESEARCH IN
EVERY ROLE THAT YOU GET.
WHAT KIND OF RESEARCH WOULD YOU
HAVE DONE TO GET READY FOR THIS ONE?

Ma-Anne says WITH HER IN PARTICULAR, I
JUST EXPLORED HER CHARACTER, NOT
SO MUCH ON THE ECT LEVEL BUT ON
THE LEVEL OF HER GRIEF AND WHERE
IT COMES FROM, BECAUSE I THINK
SHE MAINLY DEALS WITH THE LOSS
OF HER CHILD AT A VERY YOUNG
AGE, AND BECAUSE IT WAS SUCH A
SUDDEN LOSS, WITHOUT HER
ACTUAL... ACTUALLY BEING ABLE TO
HAVE THE COPING MECHANISMS TO
DEAL WITH THAT LOSS, AND THEN I
GUESS AT THE TIME THAT SHE WAS
TRYING TO DEAL WITH HER GRIEF,
OTHER OPTIONS WERE PRESENTED TO
HER, AND WHETHER OR NOT THOSE
OPTIONS WERE THE ACTUALLY RIGHT
THING FOR HER, OR IF IT MADE THE
SITUATION WORSE, IS, I GUESS,
WHAT I HAD TO EXPLORE AS THE
CHARACTER.

Steve says NOW I PRESUME YOU
WANTED TO DO THIS SHOW
BECAUSE... I MEAN, A, IT'S A
GREAT SHOW, B, IT'S A GREAT
CHARACTER THAT YOU PLAY, BUT
SOMETIMES ACTORS HAVE AN ACTUAL
PERSONAL CONNECTION TO THE
SUBJECT MATTER.
DO YOU IN THIS CASE OR YOUR FAMILY?

The caption changes to "Ma-Anne Dionisio, @Mirvish."

Ma-Anne says ABSOLUTELY.
I THINK THAT ESPECIALLY IN
SOCIETY TODAY I THINK WE WOULD
BE HARD PRESSED TO NOT HAVE SOME
KIND OF RELATIONSHIP WITH A
MENTAL HEALTH ISSUE.
I THINK AS A SOCIETY IT'S
DEFINITELY SOMETHING THAT WE
NEED TO ADDRESS.
I'M GLAD THAT PEOPLE ARE
ACTUALLY TALKING MORE ABOUT IT,
SHEDDING LIGHT INTO THE SUBJECT,
BECAUSE THERE ARE SO MANY...
THERE ARE VARYING DEGREES OF
DEPRESSION AND MENTAL HEALTH
ISSUES.
THERE'S JUST TOO MANY TO EVEN
START.

The caption changes to "Connect with us: Twitter: @theagenda; Facebook, agendaconnect@tvo.org, Instagram."

Steve says THERE ARE SOME VERY
CLEVER LINES IN THIS PLAY.
I'M NOT GOING TO
SPOIL... I'M NO SOCIOPATH.
I'M NOT SYLVIA PLATH.
THAT'S A GREAT LYRIC.
LOVE THAT.
AND PETER, I WONDER IF YOU COULD
TELL ME IF THIS IS TRUE,
MA-ANNE'S GOT A LINE IN THE PLAY
THAT SAYS MOST PEOPLE WHO THINK
THEY'RE HAPPY ARE JUST STUPID.
[Laughter]
IS THAT THE CASE?

The caption changes to "Peter Giacobbe, @Sunnybrook."

Peter says WELL, I'M NOT SURE I'M
QUALIFIED TO ANSWER THAT
QUESTION.
BUT WE DO KNOW THAT ABOUT 10 percent OF
CANADIANS IN THEIR LIFETIME WILL
BE DIAGNOSED WITH A MAJOR
DEPRESSIVE DISORDER.
SO IT'S NOT UNCOMMON TO HAVE
DEPRESSION, AND WHEN YOU EXTEND
THAT TO OTHER MOOD DISORDERS,
INCLUDING BIPOLAR DISORDER,
MAYBE UPWARDS OF 15 percent OF PEOPLE.

Steve says HMM.
IT'S ALMOST 45 YEARS AGO THAT
THE MOVIE "ONE FLEW OVER THE
KOEKKOEK'S NEST CAME OUT" AND
FOR A LOT OF PEOPLE THAT'S GOING
TO BE THEIR SOLE EXPOSURE TO
ELECTRO-CONVULSIVE THERAPY, AND
IT DOESN'T LOOK TOO GOOD IN THAT
MOVIE.
CAN YOU TALK ABOUT HOW ACCURATE
THAT PORTRAYAL OF ECT WAS?

The caption changes to "Daphne Voineskos, @CAMHnews."

Daphne says SURE.
SO THAT MOVIE IS REMARKABLY ONE
OF THE MOST COMMON IMAGES THAT
PEOPLE HAVE WHEN I TALK ABOUT
ECT, WHETHER IT'S GIVING A
LECTURE TO MEDICAL STUDENTS,
ALTHOUGH SOME OF THEM NOW ARE
TOO YOUNG FOR THAT MOVIE.
OR IN A CONFERENCE OR TO
PATIENTS, AND IT'S NOT VERY
ACCURATE.
THERE ARE SEVERAL PARTS OF THE
MOVIE THAT DO NOT REFLECT THE
WAY WE DELIVER PSYCHIATRIC
TREATMENT AT ALL, OR ECT TODAY.
FIRST OF ALL, ECT WAS DELIVERED
TO JACK NICHOLSON'S CHARACTER
AGAINST HIS WILL, AS A
PUNISHMENT.

Steve says THAT DOESN'T HAPPEN.

Daphne says NO, PATIENTS OR THEIR
SUBSTITUTE DECISION MAKERS WILL
CONSENT FOR ECT ALWAYS.
IT WAS TO SOMEONE REALLY WITHOUT
A PSYCHIATRIC DIAGNOSIS.
HE WAS FAKING IT IN THE MOVIE,
OR FOR HIS CHARACTER.
AND WITHOUT A GENERAL
ANAESTHETIC, WHICH WE WOULD NOT
DO TODAY.

Steve says YOU HAVE GENERAL
ANAESTHETIC WHEN YOU TAKE ECT?

Daphne says CORRECT.
IT'S A VERY HEAVY SEDATIVE,
SIMILAR TO A GENERAL ANAESTHETIC
OR SOMETHING YOU WOULD HAVE FOR
A VERY HEAVILY SEDATED COLONOSCOPY.

Steve says HAVE YOU SEEN THE MOVIE?
IT IS A GREAT MOVIEMOVIR, RIGHT?
IT MAY NOT BE ACCURATE, BUT
IT'S... HAVE YOU SEEN IT?

The caption changes to "Peter Giacobbe. Harquail Centre for Neuromodulation."

Peter says I HAVE.
I USE IT AS A CLIP WHEN WE'RE
SHOWING ECT TO STUDENTS.
WE HAVE A CLIP FROM THAT MOVIE
AND ALSO A MORE RECENT EXAMPLE
FROM HOUSE WHERE ECT IS ALSO
PORTRAYED IN AN INACCURATE FASHION.

Steve says HMM.
DO YOU HAVE... I KNOW I'M SO...
I WANT TO BE SO CAREFUL HERE
THAT I DON'T DO ANY OF THESE
PLOT SPOILERS BECAUSE I HATE IT
WHEN PEOPLE... HOWEVER.
WHEN YOU DO ECT IN THE PLAY,
IT'S VERY DRAMATIC.

Ma-Anne says IT IS.

Steve says THE... IS VERY
DRAMATIC.
WAS THERE EVER A DISCUSSION
ABOUT ANY QUALMS ABOUT
PORTRAYING IT IN THE WAY THAT
YOU DO?

Ma-Anne says ALWAYS.
THERE'S ALWAYS SOME, BUT AT THE
SAME TIME I GUESS YOU TAKE
LIBERTIES WHEN YOU'RE IN A
THEATRICAL ENVIRONMENT.
AND ALSO... I MEAN, THERE'S A
LINE THAT SHE DELIVERS ABOUT THE
ANAESTHETIC, RIGHT, ABOUT ME
COUNTING UNDER TO, AND THEN ONCE
I'M UNDER, WHAT YOU ACTUALLY SEE
AS A PORTRAYAL IS SORT OF WHAT
HAPPENS IN HER MIND.
I'M NOT ACTUALLY PHYSICALLY
AWAKE.
IT'S ONE OF THOSE THINGS.

Steve says SHOULD WE LET THE
PEOPLE SEE YOUR WORK?

Ma-Anne says PLEASE DO.

Steve says I THINK WE SHOULD.
OKAY.
LET'S ASK OUR DIRECTOR SHELDON
OSMOND IF HE WOULD TO...

Ma-Anne says OH, YOU MEAN RIGHT NOW?

Steve says YEAH, SURE, WE'RE
GOING TO SHOW A CLIP.
THAT'S OKAY, ISN'T IT?

Ma-Anne says YES, SURE.

Steve says MA-ANNE SAYS I'M
ALLOWED TO SHOW A CLIP.
SHELDON, GO AHEAD.

A clip plays on screen with the caption "Next to normal."
In the clip, Ma-Anne performs a dramatic song on stage in a theatre. Fast clips show doctors carrying her in a wheelchair.

She sings
YOU DON'T KNOW WHAT IT'S LIKE
TO FEEL THAT WAY
WANDERING THROUGH THE
WILDERNESS
AND SPENDING ALL MY TIME...

The clip ends.

Steve says DO YOU KNOW HOW I KNOW
THAT YOU'RE A GREAT ACTOR?

Ma-Anne says HOW.

Steve says BECAUSE I'VE KNOWN YOU
NOW FOR FIVE MINUTES AND YOU ARE
SUCH A CALM MILD MANNERED
PERSON, AND YOU'RE ACTUALLY A
LITTLE BIT SHY AND A LITTLE BIT
NERVOUS RIGHT NOW, AND YOU ARE
SO OUT THERE IN THE PLAY.
I MEAN, YOU ARE... RIGHT?

The caption changes to "The reality."

Ma-Anne says I GIVE YOU MY HEART.

Steve says YOU SURE DO.
YOU SURE DO.

Ma-Anne says YES.

Steve says THAT CLIP JUST SHOWS
THE TIP OF THE ICEBERG OF I
THINK HOW INTENSE YOUR
PERFORMANCE HAS TO BE EIGHT
SHOWS A WEEK OVER AND OVER AND
OVER.
AND I WONDER WHETHER
OR NOT THIS ROLE TAKES ANY KIND
OF PSYCHOLOGICAL TOLL ON YOU.

Ma-Anne says ABSOLUTELY.

Steve says IT DOES.

Ma-Anne says YES.
I KIND OF LEARNED SORT OF THE
LONG AND HARD WAY THAT WHAT I DO
I HAVE TO BE ABLE TO... AT THE
END OF THE DAY, TELL MY BODY
THAT IT'S ACTUALLY NOT HAPPENING
TO ME.
YOU KNOW, WHEN IT COMES TO
MENTAL HEALTH, I DID MISS SAIGON
FOR ABOUT EIGHT AND A HALF YEARS
OF MY LIFE, SO MUCH SO THAT IF
YOU'RE DOING THAT SHOW EIGHT
TIMES A WEEK FOR THAT LONG, YOUR
BODY ACTUALLY THINKS YOU'RE
THERE OR IT'S HAPPENING TO YOU.
SO I LIKE TO... OR COMING FROM
THAT UNDERSTANDING, I NOW THEN
PHYSICALLY LITERALLY TELL MY
BRAIN THAT I'M OKAY, I'M SAFE,
THIS IS NOT HAPPENING TO ME.
BECAUSE THEN IT COUNTERS THE
CHEMICALS THAT WERE PRODUCED BY
YOUR BRAIN THAT IS BEING
PROCESSED IN YOUR BODY AS REAL,
BUT IF YOU SAY TO YOUR BRAIN
"IT'S NOT HAPPENING TO YOU" THEN
YOUR BRAIN IS ABLE TO PRODUCE
THOSE OTHER HAPPY CHEMICALS THAT
LET YOU KNOW THAT YOU'RE SAFE.
SO IT'S A BALANCE, AND I
WOULD... I HIGHLY ADVOCATE
MENTAL HEALTH AND MEDITATION.
LIKE, WITH MY COLLEAGUES,
BECAUSE IT'S VERY, VERY
IMPORTANT BECAUSE IT DOES... IT
WILL TAKE A TOLL IF YOU DON'T
HAVE THAT PRACTICE.

Steve says THIS OPENS UP A WHOLE
NEW REALM OF PRACTICE I THINK
FOR THE TWO OF YOU, AND THAT IS
IN SHOW BUSINESS.
REMINDING OR
CONVINCING ACTORS THAT THEY ARE
ACTUALLY NOT REALLY GOING
THROUGH WHAT THEY ARE KIND OF
REALLY GOING THROUGH AT THAT
MOMENT.
THERE'S A MOMENT IN THE PLAY
WHERE YOU ARE DIAGNOSED WI A
PSYCHIATRIST, AND PETER I'LL GET
YOU IN ON THIS, THE PSYCHIATRIST
SAYS ECT IS INDICATED.
AND MAYBE YOU COULD
HELP US UNDERSTAND WHAT
CONDITIONS SOMEONE WOULD NEED TO
PRESENT FOR ECT TO BE CONSIDERED.

Peter says RIGHT.
SO ECT IS AN IMPORTANT TREATMENT
THAT WE HAVE AVAILABLE TO US IN
PSYCHIATRY.
IT'S NOT FOR EVERY CONDITION.
MOST OF THE TREATMENTS ARE
PROVIDED IN THE PROVINCE ARE FOR
PEOPLE WITH SEVERE MOOD
DISORDERS, AND ALSO FOR PEOPLE
WITH PSYCHOTIC DISORDERS.
IN OUR CANADIAN GUIDELINES, IT
LISTS IT AS A SECOND LINE
TREATMENT BUT A FIRST LINE
TREATMENT FOR PEOPLE WITH
CERTAIN FEATURES, INCLUDING
PROMINENT SUICIDAL, PSYCHOTIC
FEATURES AND SEVERE TREATMENT
RESISTANCE.

Steve says PSYCHOTIC FEATURES
WOULD INVOLVE WHAT?

The caption changes to "Daphne Voineskos. Temerty Centre for Therapeutic Brain Intervention."

Daphne says IT CAN INVOLVE THINGS LIKE
AUDITORY HALLUCINATIONS,
DELUSIONAL BELIEFS THAT PEOPLE
ARE MONITORING YOU OR AFTER YOU
OR TARGETING YOU OR THAT
SOMETHING HAS GONE BAD OR ROTTEN
IN YOUR BODY, OR EVEN THE BELIEF
THAT YOU'RE DEAD ALREADY.
ALL OF THESE SORTS OF THINGS CAN
BE CLASSIFIED UNDER DELUSIONAL
BELIEFS AND PSYCHOTIC SYMPTOMS.

Steve says I HAVE TALKED PROBABLY
FOR 35 YEARS TO PEOPLE IN THE
ANTI-PSYCHIATRY MOVEMENT WHO
THINK THIS IS AWFUL, AND YOU
HAVE YOUR OWN EXPERIENCES WITH
OBVIOUSLY YOURSELF FROM A
PROFESSIONAL POINT OF VIEW.
HOW DO WE RESOLVE THAT DEBATE?

Daphne says I THINK IT'S VERY DIFFICULT.
THERE'S BEEN A LOT OF STIGMA
AROUND PSYCHIATRY AS A WHOLE,
AROUND MENTAL HEALTH AND MENTAL
HEALTH DISORDERS, AND OF COURSE
AROUND ECT.
I THINK SOME OF THE MOST SEVERE
STIGMA HAS HIT ECT, AND WE
UNDERSTAND WHY.
IT SEEMS TO BE ONE OF THE
TREATMENTS THAT IS THE LEAST
UNDERSTOOD BY THE PUBLIC, AND I
THINK ONE OF THE THINGS WE CAN
DO IS TO CONTINUE TO DO WHAT
WE'VE BEEN DOING, TO JUST START
TALKING ABOUT MENTAL HEALTH,
ABOUT PEOPLE'S STRUGGLE WITH
MENTAL HEALTH, AND TO SEE HOW WE
CAN TRY TO DECREASE THE STIGMA.

The caption changes to "Connect with us: Twitter: @theagenda; Facebook, agendaconnect@tvo.org, Instagram."

Steve says PETER, LET ME GET YOU
TO WEIGH IN ON THAT.
HOW WOULD YOU CONVINCE THOSE WHO
THINK THAT NO GOOD CAN COME OF
THIS, THAT IT CAN?

Peter says SO ECT HAS BEEN AROUND FOR
ABOUT 80 YEARS.
I THINK IT'S SOMEWHAT
UNDERSTANDABLE THAT PEOPLE HAVE
AN OLDER WORKING MODEL OF WHAT
THIS TREATMENT IS.
IT'S A DYNAMIC PROCEDURE.
SO THE SCIENCE CONTINUES TO
EVOLVE WHEN IT COMES TO ECT, AND
THE PRACTICE HAS CHANGED FROM
ONE FLEW OVER THE KU KU'S NEST
IN THE '60S AND '70S.
PEOPLE COME TO A CLINICAL POINT
WHERE ECT IS TALKED ABOUT, THEY
MAY HAVE THOSE OLDER BELIEFS.
AND I THINK IT'S ABOUT SHARING
WITH THEM THE INFORMATION WE
HAVE, HELPING THEM TO MAKE AN
INFORMED CHOICE.
SO IT REALLY COMES DOWN TO
PRESENTING THE INFORMATION WE
GATHERED OVER THE LAST 80 YEARS
ON THIS PROCEDURE, ESPECIALLY IN
THE LAST 20 YEARS, THERE'S BEEN
A HUGE ACCELERATION IN OUR KNOWLEDGE.
AND THEN PRESENTING THAT TO THEM
AND HAVING THEM HAVE A
DISCUSSION WITH US.

Steve says OBVIOUSLY DON'T WANT
YOU TO VIOLATE ANY PATIENT
CONFIDENTIALITY HERE, BUT IF YOU
COULD GIVE US AN EXAMPLE OF
SOMEONE WHO PRESENTED, YOU KNOW,
THESE KINDS OF SYMPTOMS OR
PROBLEMS, WHAT YOU DID AND HOW
IT IMPROVED THEIR LIFE, THAT
WOULD BE HELPFUL.

Peter says ABSOLUTELY.
SO WHEN I WAS IN MEDICAL SCHOOL,
I SAW SOMEBODY WHO ACTUALLY WAS
VERY INFLUENTIAL IN TERMS OF
GUIDING ME TOWARDS LOOKING AT
INTERVENTIONS FOR PSYCHIATRY.
THIS WAS AN INDIVIDUAL... I'M
GOING TO CHANGE SOME DETAILS.
BUT THIS IS AN INDIVIDUAL THAT
HAD A SEVERE DEPRESSION WHO IS
NOT EATING AND WAS BASICALLY
TRYING OUT MEDICATIONS, WAS NOT
DOING WELL, AND WAS HEADING
TOWARDS A VERY DIRE PATHWAY.
ECT WAS OFFERED TO THIS PERSON,
AND THIS INDIVIDUAL STRUGGLED TO
MAKE THE DECISION FOR A LITTLE
WHILE.
ULTIMATELY GOT THE TREATMENT AND
WAS FULLY IN REMISSION, AND IT
WAS ONE OF THE THINGS THAT I'VE
SEEN AS A MEDICAL STUDENT, YOU
SEE A TREATMENT THAT, YOU KNOW,
HAS A BACKGROUND ASSOCIATED WITH
IT, AND THEN TO SEE AN AMAZING
RESULT STUCK WITH ME, AND IT
HELPED GUIDE ME TOWARDS WANTING
TO PURSUE THIS AS A CLINICAL AND
A RESEARCH CAREER.

Steve says WHEN YOU SAY FULLY IN
REMISSION, WHAT DOES THAT MEAN?

Peter says SO THIS IS AN INDIVIDUAL WHO
COULDN'T TAKE CARE OF
THEMSELVES, AND THEN WITHIN TWO
TO THREE WEEKS WAS COMPLETELY
SYMPTOM FREE, WAS ABLE TO GO
HOME, BASICALLY RESUME THEIR LIVES.

Steve says DO YOU KNOW FOR HOW LONG?

Peter says SO IN THAT CASE I DON'T KNOW
BECAUSE THIS WAS SOMEBODY WHO
WAS ON IN-PATIENT ROTATION.
WE KNOW THAT ONE OF THE FEATURES
OF ECT IS THAT IT IS OUR BEST
ACUTE ANTIDEPRESSANT.
SO IF YOU CAN GET PEOPLE WELL IN
TWO TO THREE WEEKS, WHEREAS MOST
MEDICATIONS TAKE TWO TO THREE
MONTHS TO SHOW THEIR EFFECTS.
THERE NEEDS TO BE SOME SORT OF
MAINTENANCE ECT TO KEEP THE
EFFECT GOING, AND WE KNOW THAT
WITHOUT ANY MAINTENANCE,
RELAPSES CAN OCCUR.
SO THERE'S BEEN A HUGE GROWTH IN
THE LAST 10 YEARS ABOUT
DIFFERENT WAYS TO MAINTAIN THE
RESPONSE, AND WHEN DOING THAT
ECT, MOST PEOPLE WILL OVER 80 percent
OF THE PEOPLE WELL IN SOME STUDIES.

Steve says MAINTENANCE MEANS
REPEAT TREATMENT HOW OFTEN?

Peter says WELL, THAT VARIES.
THERE WAS A LARGE STUDY
PUBLISHED A COUPLE YEARS AGO
WHICH SUGGESTED THAT THE FIRST
MONTH AFTER SUCCESSFUL ECT, IF
PEOPLE RECEIVED WEEKLY ECT, AND
THEN AS NEEDED ECT FOR THE NEXT
SIX MONTHS WHERE IT COULD BE
ZERO PER WEEK OR ONE OR TWO, IT
CAN KEEP PEOPLE WELL.

Steve says DO YOU THINK MORE
PEOPLE SHOULD BE TRYING THIS?

Daphne says THAT CAN BE A TOUGH QUESTION.
I THINK IT SHOULD BE PRESENTED
MORE AS AN OPTION FOR PEOPLE
WHERE MEDICATIONS HAVE NOT
WORKED.
BOTH PETER'S CENTRE AND OUR
CENTRE ARE ALSO WORKING ON SOME
SLIGHTLY LESS INVASIVE
ALTERNATIVES TO TRY BEFORE ECT,
THINGS LIKE FOCUSED ULTRASOUND,
LIKE RTMS,.
I THINK THE GOVERNMENT CAN DO A
LOT BY HELPING US TO OFFER THESE
TREATMENTS UNDER OHIP, THE NEWER
TREATMENTS, TO TRY AND DECREASE
THE STIGMA AROUND BRAIN
STIMULATION AS A WHOLE.

Steve says MA-ANNE, THERE'S A
SONG THAT YOU SING... AFTER YOU
HAVE BEEN THROUGH HELL IN THIS
PLAY, AND YOUR FAMILY HAS BEEN
THROUGH HELL IN THIS PLAY, THERE
IS A SONG CALLED "THERE WILL BE LIGHT."
WHAT DO YOU INFER FROM THAT?

Ma-Anne says WELL, FROM MY CHARACTER'S
STANDPOINT IS THAT AFTER SHE'S
GONE THROUGH ALL THE
POSSIBILITIES FOR GETTING
BETTER, FOR WELLNESS, FOR
THERAPY AND NONE OF IT WAS
WORKING, IT'S THE ACCEPTANCE
FINALLY OF, WELL, WHAT HAD
HAPPENED TO HER, THE GRIEF, AND
THAT IT'S OKAY TO LIVE WITH THAT
PAIN, AND THERE ARE WAYS TO FIND
JOY IN OTHER THINGS DESPITE THE
PAIN.
AND YEAH, AND SO THAT THERE WILL
BE LIGHT IN TERMS OF OTHER...
FOR ME, THE THEATRE IS SUCH A...
IT'S A PLACE FOR HEALING, OR IT
PROVIDES AN OPPORTUNITY FOR
HEALING, NOT JUST FOR THE PEOPLE
THAT ARE ON STAGE BUT FOR THOSE
THAT WITNESS WHAT'S ON STAGE.
SO I THINK AT THE END OF THE
DAY, IT'S THAT CONNECTION WITH
ANOTHER HUMAN BEING THAT IS THE
MOST POWERFUL WAY TO HEAL
WHATEVER IS GOING ON IN YOUR
HEART, IN YOUR MIND, BECAUSE I
THINK AT THE END OF THE DAY
THAT'S WHERE IT ALL STEMS FROM,
LIKE A NOT HAVING BEEN
UNDERSTOOD OR BEING HEARD OR NOT
BEING ABLE TO EXPRESS WHAT IT IS
THAT THEY'RE FEELING AS A HUMAN,
AND NOT HAVING THOSE NEEDS MET
AS A HUMAN I THINK IS
ESSENTIALLY WHERE OUR DISEASE OR
DISEASE COMES FROM.

Steve says THERE IS I GUESS A
DISAGREEMENT IN THE PLAY, WITHIN
THE PLAY, ABOUT WHAT YOUR
CHARACTER SUFFERS FROM.
WE HAVE THE DIAGNOSIS
FROM THE PSYCHIATRIST IN THE
PLAY, BUT I DON'T KNOW, DOES
YOUR CHARACTER AGREE WITH WHAT
YOU'VE BEEN DIAGNOSED TO BE
SUFFERING FROM?

Ma-Anne says I THINK THAT... LIKE I SAID,
BECAUSE SHE... BECAUSE THE LOSS
HAPPENED AT SUCH AN EARLY AGE,
THE FACILITY WAS NEEDED TO GO
AND HER HUSBAND AND THEN BEING,
YOU KNOW, OH, WE NEED HELP,
LET'S DO THIS, LET'S DO THIS, SO
AS OPPOSED TO ACTUALLY DEALING
WITH THE PAIN THAT HAS OCCURRED,
IN HER CASE, ANYWAY, I FEEL LIKE
IT WAS BLANKETED BY ALL SORTS OF
OTHER IMMEDIATE SOLUTIONS
WITHOUT ACTUALLY ADDRESSING THE
REAL PROBLEM.

Steve says HMM.
BECAUSE THE SUGGESTION IN THE
PLAY IS THAT YOUR CHARACTER IS
BIPOLAR.

Ma-Anne says YES.
OR WAS DIAGNOSED.

Steve says OR WAS DIAGNOSED THAT WAY.
DO YOU THINK YOUR CHARACTER IS BIPOLAR?

Ma-Anne says I HONESTLY THINK THAT SHE WAS DEALING WITH GRIEF AND...

Steve says OVER THE LOSS OF A CHILD.

Ma-Anne says YES, AND WASN'T ABLE TO
PROCESS THAT GRIEF PROPERLY.

Steve says HMM.
HERE ARE... THESE ARE SOME OF
THE LYRICS THAT YOU HAVE TO SING.
I'M NOT GOING TO MAKE YOU SING
THEM HERE, ALTHOUGH I'D LOVE TO.
BUT YOU KNOW, YOU GOT TO DO IT
EIGHT TIMES A WEEK ALREADY.

Ma-Anne says COME TO THE SHOW.

The caption changes to "The future."

Steve says YEAH, EXACTLY.
BUT I WILL ASK THE TWO
PROFESSIONALS HERE ON THE SET,
HERE'S THE LYRIC FROM ONE OF
MA-ANNE'S SONGS.
YOU WAKE UP IN THE MORNING AND
NEED HELP TO LIFT YOUR HEAD.
DO YOU READ OBITUARIES AND FEEL
CLIFFSIDEJEALOUS OF THE DEAD?
IT'S LIKE LIVING ON A CLIFFSIDE
NOT KNOWING WHEN YOU'LL DIVE.
DO YOU KNOW, DO YOU KNOW WHAT
IT'S LIKE TO DIE ALIVE?
AND I WANT TO KNOW WHETHER
THAT'S... HOW GOOD A DEFINITION
OF MENTAL ILLNESS IS THAT?

Daphne says I THINK THAT'S SOMETHING THAT
PEOPLE CAN DEFINITELY EXPERIENCE.
I THINK THAT WOULD RESONATE WITH
A LOT OF PEOPLE WHO HAVE
DEPRESSION OR SEVERE DEPRESSION.

Steve says PETER?

Peter says ABSOLUTELY.
SO SUICIDAL THOUGHTS, IF I CAN
INFER THAT FROM THE LYRICS, CAN
BE PART AND PARCEL OF YOUR
MENTAL ILLNESS.
WE KNOW ECT ACTUALLY IS
SOMETHING THAT CAN IMPROVE
SUICIDAL IDEATION QUITE QUICKLY.
SO THERE'S A CONNECTION THERE
BETWEEN THE LYRIC AND WHAT
HAPPENED IN THE PLAY.

Steve says WHAT ARE YOU DOING IN
SUNNYBROOK IN TERMS OF VIRTUAL
REALITY TO HELP WITH ALL OF THIS?

Peter says WELL, ONE OF THE THINGS THAT
IS PERHAPS LIMITING THE USE OF
ECT IS, AS WE TALKED ABOUT,
STIGMA, AND PART OF THAT COULD
BE PATIENTS AND THEIR FAMILY
DON'T KNOW WHAT TO EXPECT WITH
THE PROCEDURE.
THEY GO INTO A ROOM, AND THEN
WHAT HAPPENS NEXT MAY BE A
MYSTERY.
SO WE'VE STARTED A VIRTUAL
REALITY STUDY WHERE WE HAVE THE
ENTIRE PROCEDURE AT SUNNYBROOK
RECORDED IN 360 degrees, AND AN
INDIVIDUAL PUTS ON THE VR
GOGGLES AND CAN LOOK AROUND AND
SEE THE ENTIRE PROCEDURE FROM
THE NURSE COMING TO THEM AND
GREETING THEM TO THE EXPLANATION
THAT THE IV IS GOING TO GO IN
NEXT, TAKING THEM LITERALLY DOWN
THE HALLWAY SO THEY CAN LOOK
AROUND, SEEING THE
ANAESTHESIOLOGIST, SEEING THE
PSYCHIATRIST, SEEING THE
MACHINE.
BASICALLY TO BREAK DOWN THE
MECHANICS OF THE PROCEDURE, AND
THAT WE THINK CAN ALLEVIATE A
SIGNIFICANT DEGREE OF ANXIETY
AND MAY HELP PEOPLE TO DECIDE
THAT THIS IS SOMETHING FOR THEM.

Steve says HOW LONG DO YOU THINK
IT WILL TAKE BEFORE ECT IS NOT
AS STIGMATIZED AS CUCKOO'S NEST
HAS APPARENTLY MADE IT.

Daphne says WHEN I TAUGHT MEDICAL
STUDENTS THIS YEAR, THEY HAD NOT
SEEN CUCKOO'S NEST.
IT WAS OUT A WHILE AGO, 1975, I
THINK, AND SO THEIR IMAGE OF ECT
WAS FROM SOMETHING MORE RECENT,
FROM HOMELAND.
IT'S A LITTLE MORE WELL PORTRAYED.

Steve says HOMELAND THE TV SHOW?

Daphne says CORRECT.
I THINK WE'RE WORKING ON IT AND
I THINK THE MORE WE TALK ABOUT
IT, JUST LIKE MENTAL HEALTH, THE
BETTER, THE BETTER WE CAN DO.

Steve says MA-ANNE, I... YOU
KNOW, OBVIOUSLY PEOPLE GO TO THE
THEATRE BECAUSE THEY WANT TO BE
ENTERTAINED, BUT THE ADDED
ADVANTAGE I THINK OF YOUR SHOW
IS THAT, BOY, DOES IT GIVE YOU A
LOT TO THINK ABOUT AS WELL AT
THE SAME TIME.
AND I'D LIKE TO KNOW WHAT YOU
HOPE PEOPLE ARE THINKING ABOUT
AS THEY WALK OUT OF THE THEATRE
AFTER WATCHING YOUR SHOW.

Ma-Anne says THAT THEY ARE NOT ALONE IN
THEIR ALONENESS.

Steve says HMM.
THAT'S A BEAUTIFUL WAY TO PUT IT.
BECAUSE YOU SEE A LOT
OF THAT OUT THERE, EH?
A LOT OF LONELINESS.

Ma-Anne says MM-HM.
I THINK ESPECIALLY NOWADAYS, I
THINK WE'RE SO DISCONNECTED THAT
I THINK IT'S IMPORTANT.
THEATRE ALLOWS US OR GIVES US
PERMISSION TO... FOR THAT MOMENT
OR FOR THAT BRIEF THREE HOURS,
JUST TO AT LEAST OPEN YOURSELVES
UP TO... IT'S LIKE IT'S
LISTENING, YOU'RE ACTIVELY
LISTENING TO ONE ANOTHER.
LIKE, EVEN ME ON STAGE, I CAN
FEEL YOU LISTENING TO ME, AND SO
IT'S A VERY POWERFUL TOOL.

Steve says I DON'T KNOW IF YOU DO
THIS AFTER EVERY SHOW, BUT AFTER
THE ONE I SAW THERE WAS A Q and A
WITH THE AUDIENCE.
DO YOU DO THAT AFTER EVERY SHOW?

Ma-Anne says NO, NOT EVERY SHOW.
NOT EVERY SHOW.
AS YOU KNOW, IT'S A VERY
DRAINING SHOW, ESPECIALLY WHEN I
HAVE ANOTHER ONE FOLLOWING UP,
AND ALSO I GO HOME IN-BETWEEN TO
FEED THE KIDS DINNER, SO THERE'S
ALSO THAT ASPECT IN MY LIFE.
LIKE, THE THEATRE IS JUST LIKE
THIS TINY LITTLE BIT OF WHO I
AM, BUT YES, THE TALKBACKS ARE
VERY INFORMATIVE, AND ALSO AN
EXTENDED WAY OF, AGAIN, REACHING
PEOPLE.
I THINK AT THE END OF THE DAY,
THAT'S WHAT WE'RE HERE FOR.
IT'S... IT'S MORE IMPORTANT TO
BE THE HUMAN BEING THAN IT IS
REALLY TO BE THE ARTIST.
YOU'RE AN ARTIST IN EFFECT TO
EFFECT PEOPLE IN THAT WAY.

Steve says YOU HAVE THREE KIDS, RIGHT?

Ma-Anne says I DO.

Steve says WHAT DAYS DO YOU DO
TWO SHOWS?

Ma-Anne says WEDNESDAYS AND SATURDAYS.

Steve says YOU'RE GOING TO GO IN
AND DO A MATINEE, COME HOME AND
FEED THE KIDS AND THEN GO BACK
IN AND DO ANOTHER SHOW.

Ma-Anne says EXACTLY THAT.

Steve says OKAY, AM I ALLOWED TO
SAY THIS HERE?
YOUR LIFE IS CRAZY.
THAT'S QUITE A LOAD.

Ma-Anne says YES.

Steve says DO YOU LOVE IT?

Ma-Anne says MOST PEOPLE HAVE THAT MUCH OF A LOAD, I BELIEVE.
IT DOESN'T MAKE ME ANY MORE
SPECIAL THAN THEM.
YES, IT IS QUITE THE LOAD.
ONE DAY AT A TIME.

Steve says WELL, LET ME SAY, IT'S
A LITTLE MORE SPECIAL BECAUSE
YOU'VE GOT A ROOMFUL OF PEOPLE
WHO ARE WATCHING YOU DO WHAT YOU
DO AND KIND OF, YOU KNOW,
SITTING IN JUDGMENT ABOUT
WHETHER OR NOT THEY LIKE WHAT
YOU DO.
AND AT THE PERFORMANCE I WENT
TO, THEY WERE ALL ON THEIR FEET
WITHIN HALF A SECOND OF THE
LIGHTS GOING DOWN.
SO CONGRATULATIONS.

Ma-Anne says THANK YOU SO MUCH.
I APPRECIATE THAT.

The caption changes to "Producer: Liane Kotler, @LianeKotler."

Steve says" NEXT TO NORMAL," IT'S
A GREAT SHOW, IT'S AT THE CAA
THEATRE IN DOWNTOWN TORONTO
THROUGH THE 19TH OF MAY.
RUN, DON'T WALK, TO SEE IT.
THANKS TO MA-ANNE DIONISIO AND
PETER GIACOBBE FOR BEING ON THAT
SIDE OF THE DESK AND DAPHNE
VOINESKOS FROM THE TEMERTY
CENTRE ON THE OTHER SIDE OF THE
DESK.
REALLY APPRECIATE ALL OF YOU
COMING IN TONIGHT, AND GOOD LUCK
WITH THE REST OF YOUR RUN.

The caption changes to "Subscribe to The Agenda Podcast: tvo.org/theagenda."

Ma-Anne says THANK YOU VERY MUCH.
THANKS FOR HAVING ME.

Daphne and Peter say THANK YOU.

Watch: Electroconvulsive Therapy