Margot Kidder and Me

By Marvin Ross

Like so many of you, I was saddened by the passing of Canadian actress Margot Kidder. Aside from her acting, she was an advocate for those with serious mental illness and, as a celebrity, she was the recipient of unwanted publicity.

Regular readers of my material know that I have been writing and speaking about the vitamin “treatment” for mental illness called EM Power plus put out by the Southern Alberta company called Truehope. Early on in our investigation of this product and its claims, my colleagues and I came upon an article in the Calgary Sun dated September 19, 2001. The paper reported that Tony Stephan, one of the founders of the company, had been invited along with his partner, David Hardy, to an award ceremony in LA to honour Ms Kidder. The event was sponsored by a group called Safe Harbour.

The newspaper article stated that:

“Kidder who suffers from mental illness and has benefited from EM Power, made international headlines several years back when she was living in a cardboard box. For Kidder and thousands like her, Stephan has become her superman”.

I contacted her in Montana and this is her e-mail back to me:

In response to your questions, no I do not take Synergy or EMPower, whatever that is, and Tony Stephan is certainly not my superman as I have no idea who he is, nor do I know who David Hardy is. I have made a point of not endorsing any products at all. Where on earth did you read such a thing and how can I get hold of them to correct this misrepresentation? Thanks for bringing this to my attention.

best, Margot Kidder

See Pig Pills Inc, P 50

I’m not sure if Margot ever did contact the Calgary Sun but Tony Stephan’s son is in the news again now. David Stephan and his wife are the parents who fed their little boy various so called naturalistic remedies including EM Power. When he became far sicker, they called an ambulance but it was too late and he died of preventable meningitis.

The Stephans were convicted in a lengthy trial and they appealed that conviction all the way to the Supreme Court of Canada. In mid-May, the court found that the trial judge had made a number of errors in his charge to the jury and have ordered a new trial. While I am outraged at the court decision, in sober reflection the good judges were not commenting on what happened but on the actions of the trial judge. I have little doubt that the Stephans will be found guilty again.

Meanwhile, the Truehope saga gets even stranger. A few years ago, I received a call from someone in California wanting to disclose that there was a secret ingredient in EM Power + and it was that secret ingredient that made it so effective. This individual told me that law suits against the company were imminent. It turned out that he wanted my investigative colleagues and me to pay him for his information so that we could, in turn, make a lot of money selling this “expose” to papers and media around the world.

That was the last I heard until about a month ago when I received a friend request on Linkedin from a David Rowland of Guelph. I ignored that as I remember the guy from an article I did on alternative nonsense called “Also Good for Gout….” and reprinted here.

This is what I wrote about him:

Nutritionist David Rowland continued with that theme and claimed that 106,000 people are killed each year by drugs that are properly prescribed and taken.

U.S. psychiatrist and anti-quack advocate Dr. Stephen Barrett describes David Rowland on his website (www.quackwatch.org) as “one of Canada’s leading promoters of nutrition nonsense” and says “his writings and speeches advocate ‘freedom of choice’ and decreased government regulation of the health marketplace. His entrepreneurial activities have included practising as a ‘nutrition consultant,’ writing articles and booklets, publishing a magazine, operating a correspondence school, and issuing ‘credentials’ for ‘nutrition consultants’.”

David Rowland was referred to as a Ph.D, but this is what Dr. Barrett has to say about that: “His Ph.D. degree was obtained from Donsbach University, a non-accredited correspondence school operated by Kurt Donsbach, a chiropractor who has engaged in so many health schemes that nobody — including the man himself — can document all of them with certainty.”

David Rowland was also introduced to the audience as a member of the New York Academy of Sciences. The implication was that this membership gave greater credence to what he had to say. A call to the academy revealed that he is a member, but that members are not elected. Anyone can join. All that is required is payment of the membership fee. Membership does not mean that the work members do is endorsed by the academy, the public relations official stressed, although that is sometimes attempted. A recent example, he said, was the dictator of Turkmenistan, who joined and then claimed he was elected until the academy objected.

Needless to say, David Rowland was totally opposed to regulation of the industry — but not, he said, because of the issue of increased cost for compliance with good manufacturing practices his company and others will be required to follow under the new legislation. “The issue,” he stressed, “is your lives and safety” and the “censorship” being applied by Health Canada in its rules against the making of unproven claims for products.

When I ignored his request, I got an e-mail from him with a sworn affidavit for a legal action he has commenced against Truehope. He is suing them because he claims that EM Power contains a secret ayurvedic ingredient called Shilajit and it is believed that shilajit in whole or in part is responsible for the remarkable recovery from mental illness claimed by the product. David Rowland states that he holds the patent for this product and that the Truehope people have violated his rights.

Shortly after I received this e-mail, mental health advocate Natasha Tracy got in touch with me because she received the same information. Natasha had written some very damning blogs about EM Power.

What can I say other than:

Pulling your Hair Out

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Turbans and Equality Before the Law

By Dr David Laing Dawson

Driving out of Hamilton this morning I observed a spectacular array of head coverings. Some had, I’m sure, religious significance; others were a celebration of a belated spring morning; some were to ward off the chill; one was a large colourful wrapping more at home in Kenya; some were statements of fashion, others were black flowing fabric extending to the ground, some were signs of teenage affiliation, a couple were those dark knobs of youthful sihkism, and some were that hallmark of anonymity and singularity, the hoodie.

This North America was once referred to as “the new world”, as opposed to the old world steeped in rules of deportment and dress, a hierarchy based on parentage, and years of bloody conflict.

We have done a fair to good job overcoming tribalism and fostering inclusion in Canada.

But that is only one of the significant advancements to which we aspire in this New World.

The others? Equality of opportunity, equality before the law, knowledge and science before superstition, limitations on if not full dissolution of privilege.

The priest sprinkles his (soon to be his or her) holy water on the head of my newest grandchild. But we all know it is just water, H2O, and I would not be allowed to carry a liter of it onto a plane in case it turns out to be flammable or toxic.

I also know I will have to remove my shoes and belt at airport security even though my pants will droop and reveal my SAXX underwear as I stumble through the scanner.

Which brings me to Navdeep Bains. My Google headline news this morning was all about Mr. Bains, a member of Trudeau’s cabinet, being asked to remove his turban before boarding an American plane. Bains reports that he felt “frustrated” and “awkward”. He complained. He also in his comments implied that a man of his position should not be treated this way. All this hit the headlines; the Americans apologized.

That Mr. Bains did not want to remove his turban, that he argued the point, is all well and good, and reasonable whether he won or lost the argument. The rest, the outrage, the apology, the fact it made news based on outrage, risks undermining those equally important aspirations of equality, sanity, and no one given special privilege.

If my SAXX underwear must be exposed so too should Mr. Bains’ hair.

At airport security I and my wife must remove our shoes because one sweaty suicidal young man managed to smuggle plastic explosives in his sneakers. I don’t like it. I am tempted to argue that no one in my demographic has ever been known to bring a bomb onto a plane. We comply and smile.

On the other hand, Mr. Bains, the worst terrorist act in Canadian history was perpetrated by people who wear the same tribal symbol as yourself. So get over it Mr. Bains. This inconvenience is a small price to pay for the privilege of living in a land of equality before the law.

Two Short Pieces – Trump Post Mother’s Day

By Dr David Laing Dawson

The United Banana Emirates

When Donald J. Trump brought his son-in-law and his daughter into the White House and gave young Jared something like 5 portfolios, 5 jobs to do, each requiring a full time employee with years of expertise and experience, pundits talked of despots, kingdoms, banana republics and nepotism.

Of course Jared could not do all those jobs, which may have been the point.

Then Mar a Lago became a “Southern White House”, which meant important meetings and government business was being conducted in the potentate’s country estate. There was surprisingly little outcry about this, but it struck me as an important step toward despotism. The president was no longer conducting business from the house of the people, but from his own castle. When the president of Japan visits it is not to the historic house of democracy, but to the wealth and splendour of the King’s castle.

And now two more revelations about the drift to banana status: The President’s personal lawyer, a Michael Cohen, has been selling access to the president for hundreds of thousands of dollars, and the very agencies established to protect the citizens and the planet from the excesses, from the greed and corruption of various industries, are now firmly under the control of those industries. That’s Banana Republic 101.

Donald and the ethics of a psychiatric diagnosis

As a physician I should not diagnose, or label, a set of personality traits unless I do it to benefit my patient, to help him or her in some way. But Donald, you do have a narcissistic personality disorder. And knowing this can help you in the following way: You want to be revered, liked, loved at all times, congratulated, fawned over. You love to take credit for all good things that happen. You must undercut all competition for  affection of others. Because of this disorder you can never be fully content. Your ego must be fed again and again.

And there are many who do express their love for you, who will applaud you, defend you, do your bidding without question, fawn over you. And you in turn will shower them with praise, affection, opportunity and money. But Donald, they don’t love you, not really. They are almost as narcissistic as you are. They are just men (and a few women) who will sell their souls for a little second hand limelight, celebrity status, money, and the illusion of power.

You’ve given Giuliani, like an old opera star, a second chance on the stage. You’ve given Pruitt an opportunity to hob nob with the hoi polloi and get rich in the process. For Bannon and Putin you have been a useful idiot. You have given Cohen a chance to smoke cigars, swagger, make deals and get rich without doing much work. And the list goes on.

The point is, Donald, they don’t really love you. Your narcissism renders you vulnerable to praise. And when your ship is sinking they will not be sharing their life vests with you.

Yonge St. and Ready-Made Delusions

By Dr David Laing Dawson

In the early seventies a friend and colleague commented upon a popular piece of literature of the day being almost a manual for psychosis. I don’t remember if he was speaking about Timothy Leary or Carlos Casteneda or any number of other subversive ideas of the day. And his comment may have been both premature and prescient.

Our brains are organizing machines. They seek explanations, schemata, to provide satisfying linkages between our feelings and our observations, our expectations and our situations. Not about trivial matters. About these we can accept the influence of chance, leaky memory, luck, coincidence, and magic. But about the degree to which we have power, control, worth, status with others, and the vectors of threat, support, intimacy and sexuality between us.

The tools we use to do this include all our perceptual apparatuses and social information processing abilities. And when these are impaired our brains and our rising anxiety continue to demand answers, explanations.

A young man developing a psychotic illness in the 1960’s might conclude that he is being controlled with Radio Waves, or that he should don robe and guitar and preach love as a messenger of God. Delusional means of being controlled or controlling evolved through the years from the invisible hand of God or Devil, to possession, hypnotism, Xrays, radar, magnetic fields, radio waves, television, particle fields, and on to implanted microchips.

When we don’t have the tools to formulate a reasonable and acceptable schemata (usually by life engagement, communication with others, real others, understanding both textual information and contextual information, being sufficiently flexible to adjust from being an egocentric child and entitled adolescent to a simple mortal adult of the species) – when we don’t have these tools the brain still demands a schemata, a cause and effect, a satisfying sense of self in a sometimes hostile environment.

We then search. It used to be through books, song lyrics, common knowledge of the day, and imagination. Now this includes the internet. And one can find on our internet ready-made delusions and truly fake news: whole schemata already worked out for the person seeking – schemata and explanations for why he (or she) is failing, feeling despair, unloved, unsuccessful, without power, struggling, confused – schemata and cause and effect that blame others for all of our troubles.

And these ready-made schemata come with communities. Virtual reality communities in effect.

When we communicate face to face in real time and real place the ideas we share are always governed by the impact we see we are having on the other. We feel responsible for what we say, how we say it, and how it might affect the other. (with a few sociopathic and narcissistic exceptions)

Not so on many internet sites and forums. Text is spewed without the instant feedback from the face of the receiver and thus without any sense of social responsibility.

Over the years I have spoken with hundreds of young men (and women) developing psychosis, working through fractured ideas of persecution and grandiosity, seeking an ultimate answer. I hope the pills and support I give them will allow them to be satisfied with a good cup of coffee and a community of family and friends.

But now I know they may be up all night engrossed in the community of lies, blame and false hope that the internet can provide. “Incel”, ISIS, “Alt-right”, “white supremacy”…..”Flat Earth”, “conspiracy theories”…

Some of these are harmless but others may provide a ready-made delusion and a call to action for the man (or woman) whose social ability to formulate a healthy sense of reality is impaired, and who is desperately seeking relief.

Homeopathy and Rabid Dogs

By Dr David Laing Dawson

I grew up in Victoria, B.C. It was then a sleepy mostly white collar town, home to the B.C. Legislative Buildings, the Empress Hotel, a strong English heritage, and excellent educational institutions.

It is now 2018, and I read that a Victoria Homeopath/Naturopath, one Anke Zimmermann has prescribed for a child some derivative of the saliva from a rabid dog. This hit the news because of the “saliva from a Rabid Dog” part, although, like all homeopathic “remedies” it is unlikely to have anything in it that is either harmful or helpful. And like many homeopathic remedies it is based on some cockamamie theory of memory. That is that water that once had a particular substance in it, but no longer does, retains a “memory” of that substance. (Pity the tub of water that was once my bath. Come to think of it, given that those water molecules have existed for eons, sometimes as vapour, sometimes as liquid, sometimes as ice, they could have an encyclopaedia of memories). The theory continues that the memory that resides in that small vial of water, when ingested by a sufferer would….. but then I get lost with the impossibility of their reasoning.

How can this be happening in 2018?

But I visited a Family Health Team recently. The waiting area was simple and clean. Nothing was promised, but a few posters and a couple of screens promoted some very basic ideas about keeping healthy. My name was called and I met the young doctor who led me through the rabbitwarren corridor to a tiny office. He said to just call him Michael. The minuscule examining room was filled with a partial desk with keyboard and computer screen, a stool for him and a stool for me and one examining table covered with white paper. The walls were bare save for the blood pressure and eye, ear instruments. A little cupboard held a few medical tools such as the rubber headed reflex hammer.

There was NO magic to be found. No mystery, no history, no spooky artifacts. No body diagrams, graphics of the actual physiology of the human body, no skeletons in the corner. The doc wasn’t even wearing a lab coat.

No magic. Just evidence based medicine. All scientific, except for the clear evidence that we all crave magic, hope, reassurance, belief.

2018. My patient tells me his homeopath put him on lithium. I am about to say, “What?” with incredulity, when I remember that this means he was prescribed water that remembered it once contained lithium or a tablet that contains less lithium than your average radish.

And another tells me his acupuncturist stuck needles in his right knee to help the osteoarthritis in his left knee. “I guess it’s all connected,” he says.

My impression is that more people are turning to various kinds of fraudulent health care, to ideas formulated three hundred and even 1300 years ago than did in the years I grew up in Victoria. And again more than I remember in 1980 or 1990.

So either our educational systems have failed to produce a population that understands, at least in a rudimentary sense, why we can now prevent measles, treat cancer and survive AIDS, or doctors of real medicine have underestimated our human need for magic, false hope, easy solutions.

And now Michael will send me for Xrays and remind me that some regular back and leg exercise, some weight loss, and taking some ibuprophen now and then is the best treatment for the osteoarthritis in my knees, short of titanium replacements.

Both my knees are in bad shape. I wonder if I could have the acupuncturist stick needles in my left knee to help my right knee and vice versa, or maybe if I bathed in water that remembers the knees of a young athlete….Maybe if I had saved my bathwater from 1960….But would I have to drink it for the full effect?

The Failure in Police Reactions to Emergencies – Amended After Toronto

By Dr David Laing Dawson

Within the span of a few days the Hamilton Police demonstrated good judgment and remarkable restraint keeping two unruly mobs apart on Locke Street, saved a little girl’s life with quick compassionate action, and killed a teenager, a boy obviously in the throes of some kind of psychotic episode.

Why do they perform so well, even heroically, in some circumstances, and so poorly, tragically, in others?

I am not asking the question rhetorically, for the question may be worth serious consideration.

The first of these three situations was the most dangerous. It could easily have erupted into violence followed by five years of lawsuits.

The second required quick, focused action despite the horrifying sight of a child being caught under a moving train.

The third required a calm assessment of imminent danger (there was none) and then a calm slow approach.

In the rush to arrive at an unfolding situation each officer will develop heightened arousal. Stress hormones, adrenalin, breathing pattern, heart rate, blood pressure will all be aroused. This is commonly called the fight / flight response, but it is a complex system of brain/body arousal that allows for increased awareness of danger, heightened ability to focus, increased startle response, decreased pain sensation, decreased attention to ‘unimportant’ internal and external stimuli (e.g. time, hunger, thirst, chirping birds, other people), and heightened reflexes.

For the little girl with the severed limb this served her well. The officer reacted quickly and with full focus and efficiency without external distraction.

For the containment of the two mobs there had been enough planning, preparation, structure, and organization that each officer was able to quell or override their fight/flight response and diffuse the potential for violence.

Not so in the third example. The officers arrived in fully aroused state and entered the situation with heightened reflexes and heightened fear. Guns were drawn, triggers pulled.

Each circumstance is different. But in all the unnecessary police shootings of the past few years there has been one consistency: Police arrive in a rush on a call labeled as dangerous in some way. They are in a state of heightened arousal. They do not pause. They do not collect their thoughts or information. They do not pause in safety to slow heart rate, breathing, to scan the environment. They are hyper focused. They push forward. There is no thought of backing up.

In this state a cell phone can be seen as a gun. Awkward movements and slow response to commands can feel dangerous and threatening. The fact that no third party is at imminent risk does not register.

In a recent police shooting in the U.S. you can hear the heightened arousal, the full fight/flight response in the voices and breathing of the officers.

I have to conclude that some things are missing from police training. The first would be a pause upon arrival at the scene to determine if there is indeed a truly imminent threat to a third party. (Not a suicide threat, refusals, waving of arms, bizarre behavior, bad language, verbal threats – but a truly imminent threat to a third party. Is there anyone else on the street car, in the back yard, nearby in the field, nearby in the park, in the arrival lounge?). The second is the option to hold, rest, backup, breathe, take the time to dampen the state of arousal one is in at that moment, and then and only then proceed in a sane, calm, safe fashion.

And all that I suggest was done by the Toronto police officer when he confronted the driver of the van that had just wreaked havoc on Yonge St killing 10 and injuring many others. When the officer arrived, no one was in imminent danger. He even had the presence of mind to return to his cruiser and turn off the siren as it was distracting and preventing the officer and the subject from hearing one another. That also gave  him time to calm his nerves. At times, he backed away and, presumably when he realized that he was not in danger himself, he advanced and the suspect gave up.

We can only hope that this incident will serve as a training tool for others who might find themselves in a similar situation.

The Disease Model Simplified

By Dr David Laing Dawson

“I’m still coughing and sneezing,” one person says. “I caught what’s going around this winter.”

“Yeah,” replies the other. “Everybody in the office got it. And it lingers and lingers.”

It has been a long winter and I have overheard variations of that conversation a dozen times. And I wonder if they know they are applying both the disease model or concept plus some simple epidemiology to their observations of dis-ease, ailment, illness.

Disease model:

Symptoms: “coughing and sneezing”

Natural course: “lingers and lingers”

Same symptoms and course for many leading to assumption of this being the same thing: “I caught what’s going around this winter.”

And probably having the same necessary etiology. “I caught what’s going around.”

And epidemiology:

“Everybody in the office got it.”

It is the same reasoning that John Snow used when he traced the outbreak of Cholera to the Broad Street Pump in Soho, London, in 1854.

But Snow didn’t know much about bacteria let alone viruses, so he would not have said, “I caught what’s going around.” Instead, observing the distribution of the illness, reasoning out the source, all he could conclude was that the cause (hypothesized from this scientific approach to be the same for all sufferers) behaved as if it were a living thing in the water from the Broad Street Pump.

And there we have it. The modern western scientific medical concept of disease. If the symptoms are the same; if the natural course of the illness is the same; if the demographics are similar, then perhaps the cause is the same for each person afflicted. And while we look for that cause, can we see if there is some definable treatment that works for all or most?

It is instructive to know that we can be as ignorant as John Snow was about bacteria and still, applying the disease concept and basic epidemiology, come up with treatments that work ninety percent of the time. For cholera it is sanitation, basic public health measures, clean water, re-hydration and replenishing electrolytes.

Of course to complete the modern medical disease concept, we must then ask the most scientific question of all: “How do we know that to be true?” In the case of treatment this question is framed as “How do we know that it works?” That is, we must test the hypothesis and our otherwise very subjective observations.

For one hundred years psychiatrists have argued about the relevance of the disease model (described above as succinctly as I can) to mental illness. It doesn’t seem to work well with, or help our understanding of, day to day woes on one hand and major social upheavals on the other. But when applied to serious mental illness it is the only concept so far that has lead to treatments that work, and that have been scientifically shown to work.

We are all different. We have different experiences, levels of well-being, social support, education, intelligence, occupations, relationships, resilience. Some, without treatment, quickly die from cholera. Others survive. Yet we know it is the same disease afflicting each and every sufferer.

Same with mental illness. There are hundreds of factors apart from the disease itself, its causes, and our scientific treatment, that affect outcome.

But today, in 2018, why in God’s name would anybody want to throw away the western medical scientific disease concept? It is the one and only concept/model of severe mental illness that has lead to treatment that has been scientifically, objectively, proven to work.

More on The Continuing Proof of the Efficacy of Anti-Psychotics

By Dr David Laing Dawson

The narratives from the proponents of Open Dialogue remind me of the narratives arising from the psychoanalysts working in private psychiatric hospitals in the United States in the 1950’s and 1960’s. Many case studies were available and even books written on the subject.

In the late 1960’s we were unlocking the doors of the mental hospital in Vancouver and applying therapeutic community principles. The principles and ideas of the therapeutic community can be found in the activities of the Open Dialogue program. And before that they can be found in the practices of small hospitals from the Moral Treatment Era of the 1850’s to 1890’s, and again, briefly, in some mental hospital reforms shortly after WW1 and before the Great Depression, albeit, in each case, within the language and pervasive philosophies of the time.

In the late 1960’s we had already discovered how wonderfully effective chlorpromazine could be in containing mania and reducing the psychotic symptoms of schizophrenia.

So in this context, knowing the evidence, the clear evidence of chlorpromazine being the first and only actually effective treatment for psychosis, and lithium for mania (beyond containment, sedation, shelter, kindness, protection, food, routine grounding activities, time and care) it behooved us to look closely at the claims of the psychotherapists who were writing such elegant and positive case studies from the American private hospitals.

So I read them.

They were interesting reading, detailing the relationship of therapist and psychotic patient, interpreting the content of the psychosis, and the painstaking time consuming process of building a relationship, working to help the patient view the world in a different manner, and always, through the pages of these reports, it was said great progress was being made. And they all ended with something like (this is the one I remember best) “Unfortunately, despite showing so much progress, patient X assaulted a nurse and had to be transferred to the State facility.” Curiously, as with many “studies” I read today, despite the obviously bad outcome, a paragraph is added at the end extolling the progress made (before the unfortunate outcome) and recommending we stay the course.

There are many interesting explanations for the continuing anti-medication (for mental illness) philosophies. (Note that almost nobody objects to taking medication for other kinds of suffering and illness). Marvin and I have written about a few – the preciousness of the sense of self, the wish that there be an immortal mind that can outlive a brain, the fear of being controlled, distrust of Big Pharma, professional jealousies, and turf wars. But writing the above reminds me of another reason this irrationality persists.

It was clearer to me then (1960’s/1970’s) than it is now, because we really wanted to find ways of helping without medication: It is much more ego gratifying to mental health workers of all stripes when our patients get better simply because of our presence, our words, our care, ourselves, than if we just happen to prescribe the right medication.

I remember well a patient, a professional, a few years ago, thanking me for helping him overcome a severe depression. “Nah,” I said, “I just managed to prescribe the right medication for you.” “No, no,” he said. “It was more than that.”

All right. There are a few moments when I can be attentive, thoughtful, kind, and even find the right words. But to try doing that alone while withholding medication for severe mental illness would be malpractice, cruel, egotistical, even sadistic.

 

The Continuing Proof of the Efficacy of Anti-Psychotics

By Marvin Ross

Despite the protestation from the anti-psychiatry advocates, medication for schizophrenia works and another study has just been published to support that position. A new study based on a nationwide data of all patients hospitalized for schizophrenia in Finland from 1972 to 2014 found that the lowest risk of rehospitalization or death was lowest for those who remained on medication for the full length of time.

The risk of death was 174% to 214% higher among patients who never started taking antipsychotics or stopped using them within one year of their first hospitalization in comparison with patients who consistently took medications for up to 16.4 years.

It should be pointed out that this is real life data rather than a clinical trial involving a total of 8,738 people.

What is particularly significant for me in this study is that it is from Finland which is the home in one isolated part of that country (Lapland) to the alternative Open Dialogue espoused by the anti-psychiatry folks including journalist Robert Whitaker of Mad In America fame. Whitaker claims that 80% of those treated with Open Dialogue are cured without need for drugs.

I wrote about Open Dialogue very critically back in 2013 in Huffington Post and pointed out that there is very little research to demonstrate its efficacy. I actually asked a Finish psychiatrist, Kristian Wahlbeck who is a Research Professor at the National Institute for Health and Welfare, Mental Health and Substance Abuse Services, in Helsinki about Open Dialogue.

This was his answer:

“I am familiar with the Open Dialogue programme. It is an attractive approach, but regrettably there has been virtually no high-quality evaluation of the programme. Figures like “80 per cent do well without antipsychotics” are derived from studies which lack control group, blinding and independent assessment of outcomes.”

He went on to say that:

“most mental health professionals in Finland would agree with your view that Open Dialogue has not been proven to be better than standard treatment for schizophrenia. However, it is also a widespread view that the programme is attractive due to its client-centredness and empowerment of the service user, and that good studies are urgently needed to establish the effectiveness of the programme. Before it has been established to be effective, it should be seen as an experimental treatment that should not (yet?) be clinical practise.”

As for the claim that psychiatric hospital beds in Finland have been emptied, he said “in our official statistics, the use of hospital beds for schizophrenia do not differ between the area with the Open Dialogue approach and the rest of the country.”

My blogging associate, Dr David Laing Dawson also wrote about Open Dialogue in this forum with very skeptical view. He stated that the director of the program admitted that about 30% of the patients in Open Dialogue are prescribed medication so arguing that medication is not used is not correct.

At the time my article appeared in Huffington Post, someone on Mad In America agreed with me that there was insufficient evidence on the efficacy of Open Dialogue and said that a US study was set to begin in, I think, Boston. I did find a completed study on Open Dialogue done by Dr Christopher Gordon. His study involved 16 patients and he states at the outset that

“Since this was not a randomized clinical trial and there was no control group, we cannot say that these outcomes were better than standard care, but we can assert that they were solidly in line with what is hoped for and expected in standard care.”

In the paper that is in a legitimate psychiatric publication, he states that of the 16, two dropped out and a further 3 had disappeared at the end of the study so no data is available for them. This is a study of 11 people who completed the one year term.

He then points out that:

“Of note, four individuals had six short-term psychiatric hospitalizations (two involuntary).”

and that:

“three of the six individuals who were not on antipsychotics at program entry started antipsychotics. Of the eight already on antipsychotics, four had no change in their medication, and four elected to stop during the year. Both groups of four had similar outcomes and continued to be followed in treatment. Shared decision making and toleration of uncertainty contributed to these choices.

Hardly the success he suggests if the goal was to help them get well without medication.

But, coming up at the end of May in Toronto we have a conference with Robert Whitaker and others on Shifting the Narrative on Mental Health from the psychiatric disease model to the relational/recovery model, and on the challenges that are stacked against that eventuality.

Now I would say that the challenges against that shift are science but they define it as “The challenges and resistances to progressive change are of an ideological, macro-economic nature guaranteeing a protracted and difficult struggle for recovery advocates.”

Dwayne Johnson and Heroic Narratives

By Dr David Laing Dawson

Within the same time frame I was reading Marvin’s blog on the Mental Health Commission and the associated commentary, Dwayne Johnson’s story of depression popped up on multiple news sites. None of the sites gave much detail and I remain unsure if he suffered bouts of what we used to call “clinical depression”, and before that “endogenous depression” or if he simply suffered some difficult discouraging periods in life when his football career and a relationship ended.

In these brief news items Dwayne’s story is shaped as the narrative of an “heroic struggle”.

And I realized that most such stories are shaped and told in that form. It is a classic narrative form, and one we all want to hear.

Facing great odds, our hero, perhaps after learning some life lesson (humility, confession, love, trust, openness) battles his way through to success, health, and happiness. His weapons are will power, strength, hope, perseverance, and a little help from his friends.

It is the narrative form in the story of A Beautiful Mind’s John Nash. And it is the narrative form when the story is told about a victim of cancer.

The difference is that when we read the story and see the pictures of someone’s struggle with cancer, we know he or she has undergone one or many courses of radiation or chemotherapy, that he or she is still undergoing treatment.

The focus of the story may be on the courage and optimism of the patient, their loving  family, a special group of supportive friends, a cancer support group, or all that the patient is able to accomplish despite their illness – but we never lose sight of the fact of medical treatment for cancer.

It is good to bring mental illness out of the shadows. It is good to tell our stories. But we need to drop the euphemisms of mental health issues, and (a new one for me) mental health “situations”, and we need to include the fact of medical treatment for serious mental illness, because we don’t assume it as we do with cancer narratives. In fact, a very popular heroic struggle narrative is “I overcame my (illness, depression) without resorting to medication.”

This heroic struggle narrative has shaped the recovery movement; it has clearly influenced members of the mental health commission.

And who would bother watching a show, or reading a story with a tagline of: “A man develops depression, goes to his doctor; the doctor treats his depression and he gets better.”

This is not to denigrate the role of courage, optimism, hope, and support required to live with a chronic illness, or recover from an acute illness. But…

Update:

Another day, April 5 to be exact, and it seems it is OCD Day with several news items and videos appearing. Much is shared in these articles and videos, distinguishing crippling OCD symptoms from mild everyday forms of compulsions and obsessions. Psychological treatment is also explained, exposure and desensitization therapy. But not once, not once in the articles and videos I watched was it explained that there are medical pharmacological treatments that work with great success for about 90% of sufferers. Not once is this mentioned.

One of these medications has been around since the 1960’s, though at the time we didn’t know how effective it was for OCD and psychological/psychoanalytic thinking about the illness dominated.

I am not sure who or what is to blame for this. But for the psychologists who were interviewed to not mention this readily available medical treatment is akin to naturopaths not mentioning antibiotics when discussing the treatment of pneumonia.

Paradoxically, Jack Nicholson starred as a novelist with OCD in “As Good as it Gets” 20 years ago. At the end of the movie Nicholson’s character decides to be a better man and go back on his medication. Critics were not happy with that ending, and it did ruin the “heroic struggle” narrative. It was, as the third act of a story, very unsatisfying. “What? To quell his OCD all he had to do was take his medication?”  Well, yes.