Remembrance Day on the 100th Anniversary of Armistice – From the “War to End All Wars”

single_red_poppy

By Dr David Laing Dawson

WW1 was stupid, stupid, stupid, one of the great follies of humankind. And this is what we need to remember on November 11th while still honoring the soldiers who died in that war, or came home with minds and bodies shattered. And we need to do this without glorifying or even justifying war.
This week a classic FM station has been playing a new musical version of “In Flanders Fields”. The composer talks of noticing the last stanza in this poem and its importance and neglect. That’s the stanza that begins “Take up our quarrel with the foe”. She has added the ominous rhythm of marching boots to her score.
No. That “foe” was comprised of equally frightened boys and young men sent to war by the equally blind, heartless, stupid leaders, kings, emperors, Kaisers and politicians of the day. And when Dr. John McCrae wrote that poem, several million bodies of those “foes” were already strewn in the fields of Europe.

In the spring of 1916 my grandfather stood up from a soggy rat infested trench in Belgium at the call to charge. A bullet pierced his left arm and shrapnel from an exploding bomb gashed his face and stuck in the left side of his skull. He was carried to the field hospital for the third time that year and from there transported to a hospital in England and then a rehabilitation center.
A hundred years later I have his service and hospital records on my computer.
The bullet in his left upper arm was a through and through and the wound healed quickly. The Xray of his skull shows particles of shrapnel embedded in his frontal and parietal bones. The surgeons removed what they could but a few metal shards remain. He was then transferred to the rehabilitation center to be prepared to be sent back to the front. But my grandfather kept having dizzy spells and falling down. In the brief medical jargon of the day the doctors wondered if this was caused by concussion, or was it shell shock or might it be “functional”. Today the doctors would have used the words “post-concussion syndrome”, PTSD, and pondered the possibility of conversion reaction and/or malingering. But first they would send him for an MRI.
My grandfather spent the summer and autumn of 1916 in that rehab center and he kept having dizzy spells and falling down. Eventually he was given a medical discharge and sent home to Canada, to Victoria, to arrive there in the winter of 1917.
I have a few scattered memories of my grandfather from the late 40’s into the 50’s when, for the entertainment of his grandchildren, he might tap the metal in his head and imply his whole skull was steel. Otherwise, I know, he never talked of the war. He had enlisted in 1915 with the first Canadian Expeditionary Force, after the rule that wives had to agree was dropped. He trained in England in the summer of that year and then was deployed to the battlefields in the fall, the trenches of France and Belgium.
I had always assumed my grandfather was a veteran of Vimy Ridge and I visited the monument there and wrote in the guest book. But his war and hospital records show he was discharged home before the battle of Vimy Ridge. He was a veteran and survivor of lesser known and less successful battles.
In the language of medicine “functional” implies both “no physical/organic cause” and “the possibility of there being a purpose or goal involved in the loss of function”. “Conversion reaction” and “malingering” are two extremes of interpretation. The first implies that though the behaviour has a goal it is not a conscious goal, the second that it is a fully conscious goal. Of course, for much human behaviour the truth lies somewhere in between.
But there it is. In the hospital and rehabilitation center in England did my Grandfather decide he was not going back to that insane war, to the death trap of those trenches, to the whim of a general ordering a charge against machine guns? Did he decide to fake infirmity and return to his wife and three small children waiting in a farmhouse on Cedar Hill Crossroad?
I’m sure he suffered PTSD, and those dizzy spells may have been caused by concussion, by cerebral bruising.
But I like to think that he realized how stupid, stupid, stupid it was for young men to be sitting in rat infested soggy trenches through the night and day shooting at each other, and that he should go home to care for my grandmother, my uncle, my aunt and my father. (Another aunt arrived after the war).
If he consciously decided to go home on a medical discharge, even while feeling the guilt and humiliation of such a decision, well, here is what I have to say:
“Good on ya, Grandad. I’m proud of you.”

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Flu Season is Coming

By Marvin Ross

Recently, a Facebook contact held a poll to determine if they should get a flu shot. Much to my surprise, 30% voted no with reasons like “it is better to build up your own immune system” to “the vaccine is not perfect”.

I was surprised but I guess I should not have been given the amount of anti-vax sentiment around. Building up your own immune system is stupid and it does not work. Polio, smallpox et al were eradicated not by having people build up their immune systems but by vaccinations. And yes, the flu vaccine is not perfect and its efficacy varies based on the best guess of epidemiologists but it does help to varying degrees.

What convinced me about 30 years ago was a study done by the National Hockey League. It may have just been the Toronto Maple Leafs but what they found was that the time off for players was greatly reduced  the year they got flu shots compared to the previous season. I’ve been getting it since and have never contracted the flu.

There is also an interesting difference between Canada and the US over flu shots. For many years, the flu shot in Ontario was only free to people with chronic diseases who were immune compromised. Then, it became available for free to everyone. In fact, only three provinces in Canada do not provide free vaccinations universally but they all do provide it for those with chronic illnesses. A few years ago, Ontario made it available in all pharmacies so people did not have to make a doctor’s appointment but could go into a pharmacy and get it from the pharmacist.

From what I gather, the flu vaccine in the US is only free to people who can satisfy certain conditions and who must apply for it. Otherwise, you pay. Now I don’t have stats on what percentages in each county do get the shot but the death statistics are telling. The World Health Organization says that up to 650,000 people die from influenza each year. In Canada, deaths from flu are about 3500 a year. As the US is about 10 times the Canadian population, that translates into 35,000 Americans. The actual death toll in the US in 2017/18 according to the CDC was 80,000. More that double the Canadian rate. This is an example of what the Spanish flu of 1918 to one city

An interesting commentary on the failure of the US to adopt universal health care was mentioned by the anthropologist, David Graeber. In his book Bull Shit Jobs, he quotes Obama who said:

“Everybody who supports single-payer health care says ‘look at all this money we would be saving from insurance and paperwork’. That represents one million, two million three million jobs (filled by) people who are working at Blue Cross Blue Shield or Kaiser or other places. What are we going to do with them? Where are we employing them?”

That quote came from an article in Nation, June 26, 2006 by David Sirota called “Mr Obama goes to Washington”.

When you don’t get a flu shot, you not only endanger yourself but those around you with compromised immune systems like the chronically ill and the elderly.

Go get a flu shot!

To US Citizens – Tuesday is Your Last Chance

By Dr David Laing Dawson

There must have been a moment, a day, sometime between 1927 and 1939 when it became too late to alter the course of world affairs as one Adolf Hitler rose to power and brought about the destruction of Europe.

The Austrian National Socialist party won only 779 votes in all of Austria in the general election of 1927. But their membership doubled each year after that and by the early 30’s one of their slogans was, “500,000 unemployed – 400,000 Jews – Simple way out; vote National Socialist”.

Historians can trace the seeds of WWII to WWI, but still there must have been a day when it was too late to stop WWII and the holocaust. Perhaps that day was the last opportunity to not vote for the National Socialists. Should not the slogan in the preceding paragraph been enough of a warning? Is not the code in “Simple way out” obvious? Or the juxtaposition of 500,000 unemployed to 400,000 Jews?

Apparently not.

I am writing this because I fear this Tuesday, the 6th of November, 2018, is the last day Americans can go to the polls and change the course of history.

I listened to some Trump supporters last night and I find they are just as deaf to the implications of the words of Donald Trump as the citizens of Europe were to that slogan:

“500,000 unemployed – 400,000 Jews – Simple way out; vote National Socialist”.

“I tell the truth when I can,” says Trump, without a flicker of irony. “Consider rocks as rifles if migrants throw them”. “…very bad thugs and gang members and middle ‘easterns’..”, “rapists and murderers..”, “Ìnvaders”.

Trump uses simpler code than the Nazi’s of the early 30’s. It should be easy to decipher, and then to grasp the full implications, and then to recoil from them.

Tuesday, November 6, 2018 may be that last day, my American friends, when you can stop this malignant rush to tribal warfare and the destruction of democracy.

Vote.
Continue reading To US Citizens – Tuesday is Your Last Chance

Trump Trashes the Veneer of Civilization.

By Dr David Laing Dawson

Just as we humans always overestimate our memories and find ourselves regretting we didn’t commit to paper or snapshot yesterday or last week, we also overestimate the extent to which our actions are guided by thoughtful consideration and choice.

We are easily influenced, especially if the influence is playing to our rat brain, to centuries of old survival coding.

The crowd of ordinary people chant in unison, “Lock her up. Lock her up.” It is, of course, entirely irrational, a bit nasty, and quite contrary to all due processes of judgment and punishment that have developed within western civilization over the past 100 years. I scan the part of the crowd shown on my monitor and I can’t find one person who has chosen not to chant.

But then we already know this about humans within crowds and mobs and humans under the influence of a charismatic authority, even when that authority is self-proclaimed. It is a small percent that can resist at that moment, that can buck the trend, be contrary, who can ask themselves, “Is this right?”

We know this from history. We know this from the Nuremberg Trials, from human behaviour in times of armed conflict and occupation. And we know this from some simple experiments in social psychology.

And we also know that among us are a few who respond eagerly to license and sanction, the go ahead to unleash the beast within, to act on a simmering hatred. Again we know this from history and contemporary observation.

Though the assumption of free will and personal responsibility is a cornerstone of human society, it does not negate the reality of what is written above.

We know these things about human behaviour. All our leaders should know these things.

So, yes, when Donald Trump’s crowds chant “Lock her up.” and “CNN sucks.” and when he tells his people they should fear the caravan of “invaders”, and when he fails to condemn the Alt-right extremists or other tyrants, he is culpable.

The Culpability of a President

By Dr David Laing Dawson

There are always men around, men from age 18 to 70, who are capable of committing hate crimes. These are boys and men who always blame others for their failures, infirmities, losses, inadequacies, and perceived slights. They harbour resentments. Their thinking is delusional or just this side of delusional. They may fantasize revenge, the settling of scores, the righting of wrongs. This particular disorder of personality will usually preclude successful intimate relationships, long term employment and even good friends – the very antidotes to distorted and paranoid thinking.

Isolated it festers, grows and deepens. “They are to blame.”

But usually such men don’t act on their convictions, their fantasies. At least they don’t act on them without some kind of encouragement, support, and sanction.

Unfortunately such encouragement is now readily available on internet sites. This was probably the source of encouragement that set the man off to driving his van into pedestrians (women) on Yonge street.

But for the man who sent pipe bombs in the mail last week, his move from anger, conspiracy theory and threats to action, the encouragement undoubtedly came from the President of the United States. In fact the word “sanction” fits in this case because the encouragement came from authority.

The call has been to “tone down the rhetoric”. That is too weak. Men and women in power need to know their words can foster peace and cooperation or they can incite violence. There are always some men who are waiting for just such encouragement, just such permission.

Donald Trump is not personally and specifically responsible for those pipe bombs, but he is culpable.

He needn’t “tone down the rhetoric”, he needs to “stop inciting violence”.

As I was writing this another delusional man committed multiple murders in a synagogue. His encouragement to act on his antisemitic delusion seems to have come from a social media site called Gab and alt-right conspiracy theorists, but the caravan of “invaders” moving through Mexico may have been the final trigger, and we all know how much Trump has hyped that fear, and, for that matter, threatened to send in a platoon of men with guns. “Screw the optics,” wrote this killer, “I’m going in.”

Trump’s remedy for this was more guns, armed security within houses of worship, before he was distracted by a baseball game and tweeting out a criticism of the manager for pulling the successful pitcher in the last innings of the game.

Nero came to mind.

 

Fear and Loathing from Washington

By Dr David Laing Dawson

Some years ago driving from New Orleans to Ontario I was cruising through the bucolic landscape of Kentucky when a talk radio show asked callers about guns. The first caller suggested buying many guns before the government undermined the second amendment. The second caller disagreed. It was ammunition they needed to buy before the government controlled the amount one could purchase. That’s what they would control, he asserted, not guns. And he was ready with his multiple guns and his great store of ammunition. He would be armed and ready on his roof top when those “terr’rists come over the hills.”

It wasn’t the American obsession with guns that struck me so much as the fear and insecurity. I tried to imagine a full company of Islamic terrorists crawling through the blue grass and over the rolling hills of Kentucky. Fear, insecurity, and a total lack of perspective.

More recently I watched some white suburban American women being interviewed. I think three were leaning toward the democrats in this coming midterm, while at least one was a Trump supporter. This was shortly after his “Horseface” comment. When asked why she supported Trump and by extension the Republicans, this woman’s answer was simple and heart felt: “He has kept us safe.” She didn’t say safe from what. Islamic terrorists, hordes of illegal immigrants, North Korean missiles, socialism?

Though I have compared Donald Trump’s brain to that of the less-than-average 14 year-old, there is some evil genius in this mix. Fear, insecurity, and a lack of perspective, perspectives of time, history, impact, and size. These are the characteristics of a population ready to give up on democracy and welcome a tyrant, and Donald Trump is feeding these insecurities on a Paleo diet.

A caravan of Hondurans approaches from the south, and Trump hypes them into a plague of biblical proportions and threatens to send troops to close the border. If you stand in the middle of them, he says, and look around you will see “Middle Easterns” and criminals. Asked for proof of this he boldly says, “There is no proof of anything.” – an ironic admission that he can say and proclaim whatever comes to his mind.

And then he says he is withdrawing from the nuclear arms control deal with Russia.

Now he is scaring me.

So the democrats need to develop some effective counter punching, rather than the platitudes I’ve been hearing. Here are a few:

“Only a horse’s ass would call a woman a horseface.”

“A few hundred or even a few thousand women, children and men from Honduras are not a threat to the American Way of Life. But putting troops on the border and children in cages is.”

“For God’s sake, any control over nuclear proliferation is better than none.”

”Stop dismantling the international agreements that have kept the world from total destruction since 1945.”

“Your anxieties are misplaced. It is not a few Hondurans that will destroy the US of A but climate change, income inequality, racism, isolationism, criminalization of the poor and mentally ill, and unwarranted trust in the Plutocracy of Donald Trump.”

See David Laing Dawson’s latest play on the moral dilemma of resistence

 

Interesting Times

By Dr David Laing Dawson

“May you live in interesting times.” is an old Chinese curse that places an interesting twist on the word interesting.

And these be they I think. And not just because the world’s most powerful nation has the world’s dumbest president, not because the digital revolution allows me to write this and send it to your phones, tablets and computers, and not because a space station orbits up above us, and not because we now understand there is really no “up” within our space time continuum and expanding universe.

But because the generations alive today can be consciously aware of both the beginning and end of our existence. And by beginning I mean the enlightenment, the industrial revolution, and the birth of science, public health and medicine, and by “end” I mean the ravages of global warming and nuclear conflagration.

My generation had grandparents who moved from horse drawn buggies to motor cars, and they had grandparents of their own who left the farms and migrated to the cities for jobs in the new factories.

Up until then the human population was rather stable, despite pestilence, tribal and religious wars, famine and hardship. For thousands of years and thousands of migrations the ecosystem sustained, and life went on. Short and brutal though it was for most. And then suddenly (a mere blink in the life of our galaxy) we find we have 7 billion people on earth, insufficient forests to absorb the carbon we emit, all 7 billion gasping for breath on a wee polluted globe with a rising temperature.

I now have grandchildren who will experience the true disasters of global warming and over population, and they may have children and grandchildren who will witness the end of times.

From start to finish a mere 10 generations or so. And we, I think, live within that unique middle space of being able to imagine, experience, hear about and read about the beginning, and being able to see and imagine the inexorable movement toward the end. Interesting times indeed.

Unless we somehow control population growth, ease it back to a sustainable 4 or 5 billion, find a way of reducing and absorbing carbon, and sweep Donald Trump into the dustbin of history.

But, speaking of Donald, I must check out those Cohen tapes about the payoffs to Stormy and that other playmate.

A Theory of Addiction

By Dr David Laing Dawson

My new theory about addictions, at least about the explosive increase in serious opioid addictions in the last few years:

I am well aware of the culpability of Purdue Pharma promoting Oxycodone, Oxycontin as “non-addictive”, coupled with an “academic” push to have doctors pay more attention to chronic pain, and then some sloppy prescription practices after acute injuries. And I am well aware that some addictions begin as self-medicating, usually self-medicating a mood or anxiety disorder.

I understand how hooked they are. How, once addicted, consciousness is reduced to getting that fix. Empathy is lost along with any ability to think beyond the fix and the avoidance of withdrawal. By that point there are brain changes and it is a disease.

And pockets of addiction can be found alongside unemployment, poverty and despair.

But this is 2018. Not 1932. There really is no shortage of easily acquired food, and despite the cries for more affordable housing for families, there really is no shortage of basic shelter for single men.

So why now are so many men sleeping on benches and on the hustle for drugs around the Sally Ann in my neighbourhood? And why is the otherwise fit looking man with his German Shepard dog willing to stand for hours in a cold drizzle at a busy intersection collecting coins from every tenth car that stops? And why on earth does anyone ever inject a substance into his vein that has a ?10, ?20 percent chance of killing him?

I have also had many clinical experiences of addicts, vague, unhappy, scattered in thought, pathetic in actions, but laser focused and energetic when it comes down to the moment of trying to persuade me to write a prescription. Tenacious, persistent, with far more stamina than I.

And here are two more seemingly unrelated bits of information: When we go on holiday our sense of well being peaks on day 8. It is downhill after that. Time to go back to work, we say, by day 12. And some zoos have learned that making the carnivorous animals hunt for their food, rather than just giving it to them, makes them happier and healthier. And the retired couple, free now of children, mortgage and job, free to roam in an RV. What do they always do? They get a dog, or two dogs to fuss over, look after.

We humans were not made for leisure. Our DNA tells us we need to hustle. We need to hunt for food, check the barricades, repair the roof, fashion the spear, dig the trenches, work for ten hours in the mine, or kitchen. We are programmed to be busy. And our busy-ness rewards us with food, safety, or some small achievement. (I am quite amazed how delighted I am when I manage to complete a New York Times Crossword puzzle and then cast it aside to look for a new one.)

Challenge, occupation, risk, reward, repeat. (note that this is the same sequence video games provide)

Our focus has been on the reward, the drug, swallowed, snorted or injected. We can make that safer with safe injection sites. We can eliminate the need for the hustle if we provide the drug. But what of the challenge, the occupation, the risk and the repeat? What of the need for the hustle?

My new theory is that these last few decades have removed the natural life challenges and occupations for more and more men, and that drug addiction provides just that. That is, it provides not just the reward (the drug) but also the challenge and occupation, the risk and repeat.

As do video games for the young man in his parents’ basement.

We can “treat” addiction, try to eliminate drugs, or provide the drugs legally, but how do we replace challenge, occupation, risk, reward, repeat as the robots take over all the work?

The Art of Psychiatry

By Dr David Laing Dawson

The Eyes, ahh, the Eyes.

Some years ago a psychiatrist asked me to see one of his patients on the ward of the mental hospital. She had been admitted in a state of psychosis; he had prescribed appropriate medication, and then later increased that medication, and now she sat alone all day, communicating with no one. Was the dose too high? Had he made her toxic? Should he stop the medication?

In her room the woman sat fully clothed on the side of her bed staring straight ahead. I introduced myself and talked with her. I sat beside her on the bed and talked to her. I received no answer, verbal or non-verbal. I looked closely at her eyes.

I left her room and talked with her doctor. Increase her medication I told him. He raised his eyebrows. No, I said, I’m sure.

He did so and the patient recovered, first in small ways, acknowledging the presence of others, and then talking, engaging, and plans for discharge were made.

Her eyes told me she was in a state of high arousal, not drugged at all, but rather in turmoil, flooded by fears and anxieties to the point of immobility. Her eyes were alive but focused internally.

It is easier to be a poet than a scientist when it comes to eyes. A nurse might say to me about a patient, “The lights are on but nobody’s home.” It is an apt phrase, so accurately describing a state of dementia. In early dementia the right image, phrase or music might bring that person back home for a while, but then she will leave home again, and, eventually, not return.

And then there is the stare of the true believer, aroused and focused, all knowing, all seeing. They are the same eyes one sees in delusional states. Perhaps they are daring one to challenge them. They send no signal of welcome, no invitation for discourse, no flicker of doubt. They are the easiest to imitate.

Boys on the ASD spectrum avoid eye contact, and when they are coaxed into making such “contact”, the eyes quickly touch and then slip away, as we do when we glance at the sun.

The girls, the ASD girls sometimes stare fixedly, unblinking. They make “good” eye contact we notice, but the dance is wrong, the movement static, the intent unreadable; my smile goes unanswered by her eyes.

The eyes of the man with schizophrenia are similar, but often flit from certainty to perplexity and back again, as if they are trying to decipher a very difficult passage in an ancient text.

Depression is always present in the eyes. The light is dimmed, the person home, but slow to answer the door. Sometimes they are hooded and dull, but other times, in agitated depression, fearful and searching.

And then mania. If it is an angry mania I sit low in my chair and make only fleeting eye contact, for fear of adding fuel to the blazing fire within my patient’s eyes. If it is a grandiose mania, I watch the eyes of delusion and true belief and wait for a moment of doubt, a shadow to cross those eyes, before I offer a comforting smile and some medication.

Smart Phones and Mental Health

By Marvin Ross

Can your smartphone usage predict your mental health? Silicon Valley seems to think so and millions are pouring into a start up called Mindstrong. The concept is that its “app, based on cognitive functioning research, can help detect troubling mental health patterns by collecting data on a person’s smartphone usage — how quickly they type or scroll, for instance.”

The app has generated tens of millions of dollars in investments from people like Jeff Bezos of Amazon and one of the company’s executives in Dr Tom Insell the former head of the National Institute on Mental Health. He acknowledged that the app isn’t perfect but the CEO told STAT that it “could provide unprecedented insight into conditions like depression”. They also told STAT that it “can even predict how a person will feel next week, or at least how a person will perform on the Hamilton Rating Scale for depression — kind of like a weather app for your mood.”

There is one little problem with the hype for this company. The program has never been validated by independent scientists and none of the results from 5 clinical trials have been released. They did publish a pilot study of 27 subjects and presented a poster of that which states that this is feasible.

This project came to my attention while I was reading Bad Blood Secrets and Lies in a Silicon Valley Startup by John Carreyrou of the Wall Street Journal. The book deals with a long standing health startup begun by a 19 year old Stanford dropout. Elizabeth Holmes was afraid of needles and decided that it would be possible to perform all blood testing with just a small finger stick as is done with blood sugar levels. Her idea was that the testing could be done instantaneously and people could even have these units in their homes.

She patented the idea, set up a company and managed to raise sufficient funds to value her company at $9 billion. Members of her board included former US Secretaries of State George Schultz and Henry Kissinger as well as General Mad Dog Mattis who went on to become Secretary of Defence under the Trumpster and Rupert Murdoch. Along the way, she managed to get testing done with the US Military and two pharmaceutical companies but those efforts failed. She also had arrangements with Safeway and Walgreens Pharmacy chain.

Investors have lost over $600 million in the venture including over $100 million by US Secretary of Education, Betsy Devos, and the heirs to the Walmart fortune. The founder was recently charged with criminal fraud.

So, if I’m a tad skeptical about using smartphones to measure mental illness, there is a reason. First, let’s have the data subjected to peer review in reputable journals.