Band Aids are not a Solution to Homelessness

By Marvin Ross

It’s winter in Toronto and, as can be expected, there is a cold snap. Not surprising of course but with every serious drop in temperature, the medical officer of health announces a severe cold weather alert so that agencies can look after the homeless.

The city opens special shelters so those poor souls do not freeze to death as often happens in the winter. The number of homeless in Toronto and other Canadian cities is a blot on our supposed safety net. Our solutions to homelessness are totally inadequate.

This past week, a poor woman sleeping in an alley in an attempt to keep warm was run over and killed by a garbage truck backing into the alley as the driver did not see her. As a consequence, one charitable group is handing out visibility sashes to protect the sleeping souls from this happening to them as well.

https://globalnews.ca/video/embed/4865296/

Shortly before this event, another woman died when she was trapped in a charity box used to collect clothing items as she had presumably gotten into it to keep warm . I find it totally disgusting to see the numbers of homeless in downtown Toronto sleeping on sidewalk grates in the financial capital of the country (Bay St) with all their possessions piled around them. They are invisible as humans as the bankers, stock brokers and other business types walk around them failing to see the human beings hidden under the blankets.

One year, driving into Toronto for a meeting, I watched as I was stuck in the rush hour traffic as a van pulled up blocking the curb lane. The driver got out with breakfast for the just waking up homeless on the sidewalk.

It is nice to have breakfast in bed wherever you are but this was and is a totally useless exercise. In 2018, the number of homeless in Toronto was 6000 but today it is 9000. Project Winter Survival (one of the many aid groups in Toronto) has been besieged with requests for survival kits this year: homeless aid groups sought 21,000 kits, up 60 per cent from last year. Jody Steinhauer, the founder of Project Winter Survival was quoted in the Toronto Star stating that “we need to put the pressure on the city of Toronto: open up 1,000 shelter beds, get people into housing long-term with support solutions so that next year at this time, we can be indoors and being proud.”

According to the Homeless Hub at York University in Toronto, “30-35% of those experiencing homelessness, and up to 75% of women experiencing homelessness, have mental illnesses. 20-25% of people experiencing homelessness suffer from concurrent disorders (severe mental illness and addictions). People who have severe mental illnesses over-represent those experiencing homelessness, as they are often released from hospitals and jails without proper community supports in place.”

One study carried out by McGill University in Montreal, found that it is costing over $50,000 a year to provide support to one homeless person without resolving the problem. These costs were comprised of services such as supportive housing, treatment for substance use, emergency department visits, ambulance trips, hospital admissions, police and court appearances, social assistance and disability benefits, and incarceration.

Matthew Pearce, the head of Montreal’s Old Brewery Mission, told the CBC that “homelessness is not the problem. It’s a symptom of a problem” and that “It’s a symptom of inadequate services for people with mental illness. It’s a symptom of inadequate options for affordable housing for individuals.”

The researchers said that there is a “need for a comprehensive response” to the problem, and the importance of preventing vulnerable people from finding themselves in that situation in the first place.

Yes, the homeless need to be kept warm and safe but they also need to have treatment for the conditions that allow them to become homeless in the first place. Until we start to do that as a society, we will only be putting band-aids on the problem not solving it.

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Books Based on Mind You Blog Now Available

By Marvin Ross

We are pleased to report that you can now get Mind You the Realities of Mental Illness: A Compilation of Articles from the Blog Mind You and Two Years of Trump on the Psychiatrist’s Couch in either print, kindle or Kobo versions.

Both print editions are distributed by Ingram which supplies almost all bookstores everywhere. The print editions are listed in Amazon world wide, Barnes and Noble, Books a Million, Chapters/Indigo. Kindle editions are, of course, available in all Amazon websites internationally and Kobo is also sold internationally.

A tip for Canadian purchasers. Amazon is selling the books at the US price of around $17.95 whereas Chapters is charging $23.95 for each of the books.

All reviews welcome.

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Time to Relegate Anti-Stigma to the Garbage Heap – Part Two

By Dr David Laing Dawson

There is a moment for most of us sometime in second year University studying linguistics, humanities, philosophy, psychology when questions of truth, reality and delusions become quite interesting. Is there really a difference between the man who believes the CIA is watching him (assuming they are not) and the man who believes Jesus turned water into wine without the aid of grapes and fermentation.

Is what we call a delusion just a lived experience no different than a thousand other unfounded beliefs the rest of us live by? Is it just a social judgment by which we differentiate?

The answer is no. Though it may not be readily apparent to other than a family member or someone who has spent years treating schizophrenia.

First of all the delusion, the false belief of the schizophrenic is almost always tormenting: being watched, controlled, denigrated, persecuted. And when it is not that, when it endows the schizophrenic with a power to right these wrongs, it is dangerous.

And secondly, most clearly differentiating a delusion from an ordinary unfounded belief is the accompanying cognitive deficit.

This is not a cognitive deficit that shows up on an IQ test. This is rather a more subtle and complex social information processing deficit. It is a deficit in the ability to stay grounded in this social moment including having a governing awareness of the effect we are having on others and of the consequences of what we say and do. It is this deficit that differentiates the disheveled man ranting about God on the street corner and the Jehovah’s witness knocking politely on my door.

Schizophrenia is a brain illness for which we have effective treatment.

And as Marvin points out, stigma is not reduced by railing against it. When the subject of the stigma is a frightening illness, stigma is reduced by naming that illness, understanding that illness, and ensuring that it is treated.

Time to Relegate Anti-Stigma to the Garbage Heap

By Marvin Ross

I am so terribly tired of all the effort and money spent on fighting the stigma of mental illness. I don’t really think it is that much of a problem. What is a problem is discrimination – the fact that mental illness does not get the health funding that it should when compared to other illnesses. There is a lack of beds, a lack of community supports, a lack of support for family caregivers and I could go on.

I feel a bit like Howard Beal did in the classic 1976 film written by the brilliant Paddy Chayevski and I am mad as hell. His famous line can be seen here

A couple of things have set me off. The first was the appointment to the Order of Canada of Professor Heather Stuart who holds the Bell Mental Health and Anti-Stigma Chair, the world’s first anti-stigma research chair at Queen’s University in Kingston, Ontario. I’ve met Heather, have corresponded with her a number of times, and years ago I backed her getting a grant from the Schizophrenia Society of Ontario to conduct a study of stigma by health professionals against those with schizophrenia so I’m pleased for her to win recognition. Sadly, her efforts to promote anti-stigma do not improve the treatment for anyone.

As an advocate in Kingston Ontario continually tells me, the streets of downtown Kingston are filled with ever increasing numbers of obviously untreated mentally ill. Maybe Heather should get off her endowed chair and try to get them some help.

The other event this week was told to me by a Toronto advocate who notified me of a bioethics lecture at the University of Toronto entitled Reflection on Mental Health Stigma, Narrative, and the Lived Experience of Schizophrenia (you have to activate Adobe Connect to see it). The presenter was a PhD candidate in philosophy at York University in Toronto.

To his credit, the lecturer admits the existence of anasognosia and that people with schizophrenia do have cognitive deficits. However, he suggests that many people fear those with schizophrenia. I think many of us do if they are not treated and are in active psychotic states. He does seem to suggest that doctors should accept the delusions that people have and not ignore their lived experiences. He also suggests that people are told that there is no recovery.

What he did not seem to differentiate between was treated versus untreated and that is crucial. It is true that recovery to a totally healthy state is not normally possible but many people can and do recover to live as reasonable lives as possible. And some don’t. That is the reality.

The notion that people fear those with schizophrenia and distance themselves needs to be qualified. Maybe some do but they are not in the majority. Those people will also fear and distance themselves from people diagnosed with cancer or some other serious and chronic ailment. They are not in the majority. Most people are sympathetic and many will tell you of relatives or friends who also suffer. Despite some tragic examples involving the police, the majority are incredibly sympathetic and understanding.

I remember one case years ago when a man with schizophrenia took off (as often happens) and the police found him miles away from his home. As he was over 21 and not declared incompetent, the police could not take him back to his family but the officer phoned his father 3 hours away and told him he would keep an eye on his son till the father got there. He did, provided cell phone updates and kept it up even when his shift ended so the family could be reunited.

When David Dawson was shooting his feature film on schizophrenia, Cutting For Stone, we needed a police cruiser in the middle of the night for one scene. Two cruisers showed up for us and one of the cops commented that if any group needed more exposure it was people with schizophrenia.They were happy to accommodate (available on Amazon for streaming) and I got a chance to ride in the front with the sirens blaring.

Many people with schizophrenia are willing to expose themselves to the public by telling their stories in books. Many of them I’ve published thanks to the willingness of people like Sandra Yuen MacKay, Erin Hawkes-Emiru, the late Dr Carolyn Dobbins, and Sakeena and Anika Francis. Others have done the same in books and blogs like Christina Bruni, The Unashamed Schizophrenic and others. Some have exposed themselves in documentaries like the ones in the film The Brush The Pen and Recovery directed by David Dawson (available on Amazon for streaming).

The same goes for those with bipolar disorder like Victoria Maxwell and many others including a new book called Mad Like Me. This one was originally submitted to me but I turned it down for a number of reasons. The author, however, did take some of my suggestions, rewrote it and had it published. Or, a book that I reviewed in these pages called Shatterdays Bipolar Lives

I often receive requests from people with schizophrenia offering to tell their stories as I did last night from a gentleman in California. His e-mail to me stated “I have been contemplating writing this manuscript for several years,and have decided to now ,because I feel there is no shame in having a mental illness, as it is no different than having a disease such as Epilepsy. I wrote this book to be in an advocate/activist position to be able to speak for those who cannot. If my book, my story, can help just one person, one family, it will have been more than worth the effort of writing it.”

I think it would be well worth it for mental health agencies to run writing workshops for people with mental illnesses.

But, let me circle back to the issue of stigma. Who in their right mind would not be fearful of a dishevelled ranting, untreated schizophrenic wandering down the street. I almost hit one the other day when he suddenly walked out into the traffic of a busy street impervious to the traffic.

The best solution to this stigma was offered by Dr Stuart’s partner, the psychiatrist Julio Arboleda-Flórez, He wrote:

The lesson to be drawn from these papers is simple: helping persons with mental illness to limit the possibilities that they may become violent, via proper and timely treatment and management of their symptoms and preventing social situations that might lead to contextual violence, could be the single most important way to combat the stigma that affects all those with mental illness. While most myths about mental illness can be traced to prejudice and ignorance of the condition, enlightened knowledge does not necessarily translate into less stigma unless both the tangible and symbolic threats that mental illness poses are also eradicated. This can only be done through better education of the public and of mental health service consumers about the facts of mental illness and violence, together with consistent and appropriate treatment to prevent violent reactions. Good medication management should also aim to decrease the visibility of symptoms among patients (that is, consumers) and to provide better public education programs on mental health promotion and prevention.

The Perils of Data Mining

By Dr David Laing Dawson

Allowing computers to search through large medical data bases may one day discover a link, an association of great importance and one that stands up as actually a causal link. It is really the headlines associated with the reporting of these studies with which I have a problem.

These headlines appear on Google searches, Google news, newspapers, and trade epublications such as Psychiatry Times. I suppose the purpose of a headline or lead is to make the reader want to read the article, or in these cases, the research findings and the methodology.

If I read that eating bacon is going to double my chance of a heart attack I am compelled to read the actual study. In that case (an example from a few years ago) I concluded, after reading the actual study and juggling statistics with reality, that I would have to increase my bacon consumption from occasional to every day to increase my chance of dying from cardiovascular disease within the next ten years from 14 percent to 16 percent.

You can’t make good carbonara without bacon or prosciutto.

Butter is good, butter is bad, and now butter is good again.

These data mining exercises can never account for all variables, and they certainly don’t prove cause. In fact they are quite dumb in the sense of ignoring the obvious, and they seem often to be initiated with a prejudice, with the prejudice informing the headline but belied by the actual results of the study.

Others have pointed out that there is a very strong correlation between the presence of an ambulance and a road side accident. My satire on the subject would compare the rate of death from cancer in people who have taken anti cancer drugs with people who never have.

But I am writing this because of a Psychiatric Times headline that implied a causal relationship in the elderly between antidepressant treatment and hip fractures. Forcing me to read at least the synopsis of the study.

Comparing the elderly population (mean age 80) who were not taking antidepressants with those that were found that more of those taking antidepressants had suffered hip fractures. In the details of the study they found peak incidences of hip fracture 30 and 90 days before the initiation of antidepressants. Yes, before the initiation of antidepressants.

This throws the notion of antidepressants causing hip fractures out the window and hints at a much more complicated relationship between hip fractures, falls, osteoporosis, and depression. Depression is, after all, an illness that affects the body as well as the mind: (diet, life style, exercise, concentration, isolation, sleep, carelessness, memory, awareness, along with low mood).

Of course with the elderly all drugs need to be prescribed with added caution, often lower doses, and closely monitored. But if not newspaper editors at least the medical and science writers should refrain from writing headlines that are actually not supported by these data mining exercises.

But more often today all the other interpretations of the data, the cautions, the caveats, the list of missing variables, and the call for more research is added at the end. But few readers today, as we know, read more than the headlines and first paragraph.

Reinventing the Wheel – More on Health Standards Organization

By Marvin Ross

Back in November, I wrote a very critical blog about the Health Standards Organizations and their attempt to find a psychiatrist to finish a draft standard on mental health services in Canada. Their efforts had previously been criticized by Susan Inman in the Huffington Post. She then wrote in the Tyee that with these new standards, those with severe mental illness will wind up getting even worse care than they do now.

The president of the Canadian Psychiatric Association (CPA) also complained to them as did another psychiatrist in a blog on the CPA site. All the criticisms are linked in my blog.

That blog did get a number of comments that were also critical of them. One reader in the US stated:

“I got a headache trying to understand what the HSO was, what is it’s authority, and what is it’s driving source of funding and philosophy. Standards of care and accreditation should be a governmental or professional organizational function. The HSO is an enigma.”

Another Canadian reader stated:

Unfortunately, Accreditation Canada https://accreditation.ca/ appears to have SUBCONTRACTED the development of new standards to HSO — which appears to be part of some larger, multinational organization of mysterious origins. In any case, their shoddy work and obvious ignorance is astounding. (When I completed HSO feedback form on draft mental health standards, it asked for my zip code)

 

There was also a reply from Health Standards which can also be seen at the end of that original blog. I did not think it made much sense so I attempted to find their media person but got caught in their voice mail hell and hung up when I could find no human operator. I still have no idea who that person is but I did send an e-mail to them November 17. They responded via twitter on November 19 that they had my e-mail and were preparing answers. On December 12, I reminded them that they had not responded This is what I asked below in bold marked with a Q, their responses sent to me on December 17 marked with an R. My editorial comments to their answers are in italics starting with My comment. Despite my correspondence with them, no one has ever given me their name. The e-mail was not signed and came from “communications”. A robot? A secretary? The person who delivers coffee? I have no idea.

Q. What are the requirements for your committees?

R. The Mental Health and Addiction Technical Committee is made up of 16 voting members and three advisors and will soon include a psychiatrist as a voting member.

Worth highlighting are the two co-chairs of the committee:

Rita Notarandrea, MHSc, CHE, is currently the CEO of the Canadian Centre on Substance Abuse and Addiction and has held several roles during the 21 years she worked at the Royal Ottawa Hospital (Mental Health Care & Research), including 13 years as the COO.

Ed Mantler, Registered Psychiatric Nurse, MSC, is the Vice President of Programs and Priorities at the Mental Health Commission of Canada.

You can see the rest of the committee members on page II of the draft standard at http://healthstandards.org/files/Mental-Health-EN-PR-2018.pdf.

My Comment: Ms Notarandrea has been with substance abuse for many years and when she was with the Royal Ottawa Hospital (a psychiatric facility) she was the chief operating officer and left in 2005. Not, in my opinion, sterling qualities for this role as it does not appear that she has clinical experience.

Mr Mantler is with the Mental Health Commission of Canada which is an organization that I have severely criticized for years. His main focus, it seems, is on reducing stigma and promoting mental health first aid. Again, efforts that I have written critically about for a number of years. Prior to that, he was CEO of physician recruitment in Saskatchewan and senior operating officer at the University of Alberta Hospital. Physician recruitment and operations of a hospital are not clinical roles in mental health.

Both of those agencies were part of an extensive re-evaluation on the usefulness of their role by Health Canada and both were deemed to be expendable. The Globe and Mail reported that “it is also clear that, in all the scenarios, three organizations come out big losers: the Mental Health Commission of Canada, the Canadian Partnership Against Cancer and the Canadian Centre on Substance Abuse and Addiction.”

Q Who are the general interest members and what committee criteria do they posses.

R You can find information on HSO Technical Committees here: https://healthstandards.org/standards/technical-committees/. There is an infographic about halfway down the page that explains the composition and defines each group. If you haven’t already, you can also learn more about the standards development process on this page: https://healthstandards.org/standards/development-process/.

Technical Committee Requirements

Technical Committee members apply on our website at www.healthstandards.org. They find out about us through social media, our partners, existing relationships, conferences, and targeted outreach that we conduct.

We take the following into account when selecting Technical Committee members:

1.Professional/clinical experience as it relates to the scope of the standard

2 Acceptance of agreement with of the role of the patient as a partner in care and a member of the care team

3.Knowledge of standards and familiarity with accreditation

4.Relevant committee/extracurricular participation

5.Unique experience/perspective or contribution that relates to the standard’s topic

6.Commitment and anticipated level of engagement in the technical committee

7.A balance of positions within the health system (for example national versus provincial, acute care, and primary/community-based services)

  1. Balanced representation from a geographic perspective (remote, rural, and urban)

Q Who are the policy makers, how big is the committee and how were they solicited and/or accepted?

My comment:  This does not seem to have been answered unless it is part of the answer to the previous question

Q What is a product user?

My comment: This also does not seem to be answered

Q. You statedUnlike clinical practice guidelines, our standards follow the patient journey through the system by including elements of population health to plan services and identify health inequities, chronic disease prevention and management”

What does this mean? How do you prevent chronic diseases like schizophrenia or bipolar disorder?

My comment  Not answered

Q. You are a not for profit so could you send me your last financial statement?

R Our financial information is made available to the public on Canada Revenue Agency’s website: https://apps.cra-arc.gc.ca/ebci/haip/srch/t3010form23-eng.action?b=852490200RR0001&fpe=2017-12-31.

Unlike many other non-profits, HSO do not receive funds from public entities outside of fees for services performed.

My Comment The stated aim of HSO from their financial reporting is the promotion and protection of health. I am not sure what that means other than maybe they are protecting our health and promoting it. How do they do that?

Their main activity is to provide the international health sector community with leading edge accreditation, education and advisory services to improve health care and patient safety. I am not sure how that translates into programs

To accomplish all this, HSO has 10 full time employees all earning over $120,000 a year and one earning over $350,000. There are also 13 part time employees earning a total of about $142,000. Total salaries comes to a little over $2 million. Total revenue is $4.8 million with Total non tax-receipted revenue from all sources outside Canada (government and non-government) of $1.4 million. Total revenue from sale of goods and services (except to any level of government in Canada) is $3.4 million. Total expenditures are $5.6 million with $1.3 million going to professional and consulting fees.

Q Why do you charge $100 for standards?

R Except in the rare case when another organization works with us to sponsor a standard, we cover 100% of the cost of developing our standards. This cost is recuperated through the sale and licensing of our standards. This model is used by many other Canadian and International Standards Development Organizations, including the CSA Group and ISO.

Q Health Quality Ontario just brought out guidelines/standards for the treatment of schizophrenia and they list all members of the committee. Many of them I know either personally or by reputation and it is a very competent group. Why are your standards needed?

R Clinical practice guidelines focus on a specific illness – for example, schizophrenia – and recommend things like assessment tools, medications, and treatment options. HQO standards provide clinical practice guidelines, specific to Ontario.

HSO quality and safety standards can be applied across Canada and, in many cases, internationally. They focus on providing the best possible patient journey rather than focusing on how to treat a specific illness. This includes topics such as: accessibility and safety of services; health promotion and disease prevention; awareness and early detection of illnesses, including initiation of treatment and continuity of care during transitions in service; and engaging clients and families in service design. HSO standards are based on the HSO Quality Framework, which consists of eight quality dimensions that all play a part in providing safe, high quality care. For more information on the HSO Quality Framework, see page XII of the draft standard.

Both types of documents have a place in the health system. HSO quality and safety standards are intended to be used along with clinical practice guidelines and health care providers’ professional and regulatory requirements; they do not replace or duplicate them.

My Comment I do have to say that in my opinion their rationale for what they are doing is gibberish. When you suffer from an illness, you want the best possible treatment developed using appropriate evidence and recommended by those who actually treat. Those are what clinical practice guidelines are whether we are talking about schizophrenia, hypertension, stroke or whatever. Those are guidelines that apply to everyone everywhere.

The Health Quality Ontario guidelines which they dismiss as being relevant only for Ontario is an absurd contention. Clinical practice guidelines do not know geographic or political boundaries and should not.

Health Standards focuses on “best possible patient journey”. Well, if you or a loved one face a health problem, the best patient journey is to receive timely diagnosis and timely treatment using the best modalities that we have. What else is there or am I missing something?

As always they mention disease prevention and would that not be wonderful if we could prevent many of the illnesses that plague us – cancer, mental illness, whatever. But the truth of the matter is that we cannot prevent unless we know what the cause is. That is certainly the case with most serious mental illnesses. How will their efforts prevent someone from developing schizophrenia or bipolar disorder?

As my US colleague, DJ Jaffe, wrote recently, Serious mental illness is about biology and it CAN NOT be prevented.

If Health Standards is serious about improving the patient experience then all the money they have for staff would be well used in providing more psychiatric hospital beds for those in acute phases, more community programs for those stabilized and more affordable supported housing for those trying to survive in the community. Neither the streets nor jail are suitable therapeutic venues.

 

 

Guest Blog What Goes Through My Head When I Diagnose A Child With Schizophrenia

By  Dr Jennifer Russel, Child and Adolescent Psychiatrist, Vancouver, BC

Reposted from Huffington Post with permission from Dr Russel and for the parents of those with schizophrenia for the Christmas Season.

I know what it’s like for people and families facing harrowing, life-altering illnesses to receive the nourishing support they need from those around them. My husband survived pediatric cancer. At age 14, he developed chest pain, a cough and was eventually diagnosed with Hodgkin’s Disease. After surgery, chemotherapy and radiation, he achieved remission and has been well ever since.

The psychological effects of his cancer still haunt us. His mother has made me promise to call her and wake her up if he is ever in an Emergency Department — she still lives with fear to hear those words again, “Your son has cancer.”

My husband often speaks of the support he received from family, friends and his school during this very difficult time. Unfortunately, these helpful responses aren’t what the families of my patients receive.

As an adolescent psychiatrist, I have spent the last 10 years working on inpatient psychiatric units, where I have diagnosed and treated adolescents with what was initially psychosis, and later diagnosed as schizophrenia. I have had to sit face to face with mothers, fathers, aunts, grannies, brothers and sisters, and tell them that their teenager — the same one that cuddled up to them at night, baked cookies and scored the winning goal in soccer — has schizophrenia, a lifelong chronic condition which has robbed their child of their mind, their ability to differentiate what is real and what is fantasy.

Even once we have treated the frightening positive symptoms (hallucinations and delusions) the vast majority of patients are left with lifelong negative symptoms (apathy, inability to experience pleasure, lack of motivation, decreased or blunted emotion and decreased speech) in addition to significant cognitive decline. By the time these parents have come to me, their child has often been ill for some time. Despite this, for many this diagnosis comes as a surprise.

No one wants to hear, “Your child has schizophrenia.”

I have spent considerable time reflecting on how to deliver this news. Is there a right or best way to tell a parent about their child’s schizophrenia? How can I be supportive, empathic and hopeful, yet honest and direct? I try to imagine — how would I want to be told the news?

What continues to shock and sadden me is what happens after parents leave my office. Too often when they call their families and friends, they discover that they, particularly the mothers, are blamed for their child’s schizophrenia or other psychotic disorder.

All of the mothers of my patients have been blamed (at some time or another) for their child’s illness by people they encounter, and even by health care workers. Yes, this still goes on. It is time that we stop Mother Blaming, and we focus on what we know is true about schizophrenia — that it is a brain disorder, where there is too much dopamine active in the brain.

Although we don’t know the exact cause, scientific evidence does tell us that parenting, even bad parenting, does not cause schizophrenia. We all (myself included) have parenting moments that we would like to take back or “do over.” Although we should take the time to reflect on these moments, and work to do better, we should do so with the knowledge that they do not cause schizophrenia.

I say this because the holidays are coming up. When a child gets diagnosed with cancer, which often has better outcomes than schizophrenia, the family is embraced with love. They are showered with care packages, hampers, food delivery schedules and spa gift cards. Go Fund Me campaigns are even started. When a young person is diagnosed with schizophrenia, the family is often isolated, shamed, ignored and silently shut out of the community. Sometimes I wonder if people think that psychosis is contagious.

What these families need is to be embraced, loved and cared for in the same way we care for parents whose children have other serious illnesses. It’s time to stop blaming, and start caring. This holiday season, as you prepare to celebrate, please take a moment to think about how you can support a loved one who is or has a family member suffering from a serious mental illness. Think about what that parent could be going through, and care in the best way you know how.

 

 

 

 

Baby It’s Cold Outside – Political Correctness Gone too Far

By Dr David Laing Dawson

Like many others (according to Google) I had to check the lyrics to see what the fuss was about.

The male lyrics in this duet are a little 1950’s pushy. It is easy to see Frank Sinatra or Dean Martin in the role.

But there is nothing in the female lyrics that indicate she does not want to stay. Rather she wrestles with what her father, her mother, her brother, the neighbour, and even her stern maiden aunt will say. She is conflicted. She wants to stay but what will people think? He, on the other hand, seems to have no qualms, no conflicts. But then, presumably, he is single; it is his apartment she is visiting; he is not worried about what his mother, father, brother, the neighbours, or a maiden aunt might say. This male may even boast about his conquest with his buddies the next day. But there is no indication from the lyrics that he holds some sort of economic or employment power over her.

So, in some ways, this song is a nice bit of sociological observation of the times. A casual sexual encounter puts the woman at far more social risk than it does the man.

And she wrestles with this. She is portrayed as an adult woman tying to thread her way between her needs and wants and societal values of the time.

To ban this song is not only silly it is very regressive. Banning the song infantilises women. It does imply (not the song, the ban) that adult women are so fragile that they should never be put in a position to decide on their own to stay or not to stay. Such a ban, trying to avoid one denigrating stereotype, promotes an equally denigrating stereotype.

Also Coming in January – Two Years of Trump on the Psychiatrist’s Couch

By Dr David Laing Dawson

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To be released January 15, this is a collection of the blogs written in the past two years and a bit about Donald Trump and American politics. The excerpt below is from the introduction.

It is perilous for a psychiatrist to write about a political figure. First it is unethical to analyze or diagnose someone without actually examining that person within the social contract of a doctor/patient relationship. And to make those findings public one needs the consent of the patient.

And our analyses, formulations or diagnoses are context dependent. That is, the purpose of these labels and interpretations is to help (alleviate suffering first) someone who is a patient.

No matter how much science lies behind these formulations and diagnoses they are still words, words that carry implications, much baggage, and interpretation is required.

Let’s take the word “narcissism” for example. We all know what it means, roughly, and how it is derived from a Greek Myth of a beautiful hunter who had so much self-regard that he fell in love with his reflection in a pool and could not leave the pool. Eventually his passion for himself and his reflection consumed him and he turned into a flower.

Curiously that myth also includes devoted followers who commit suicide for him.

Of course narcissism is not a thing. It is a spectrum of implied inner traits (implied by others from observations of behaviour) of self-regard. How much is too little? How much is too much? How much is extreme? We all need a little just to get out of bed in the morning.

Within the social contract of a doctor/patient relationship, this idea of narcissism only arises when we see these implied traits limiting or hurting our patient. When they seem to be the central problem, limiting relationships, limiting vocations, causing harm to self and others, then we might add the words Narcissistic Personality Disorder.

Even then we might argue whether it is a bona fide fixed trait, or an extreme overcompensation for its opposite. And what is an appropriate (or good, functional) level of self-regard for a child, a teenager, a young person, a mature person, especially in an age of “identity politics” and “being the best self you can be.”? At what point for a political leader does narcissism contribute to success, or make someone a wonderful subject for satire, or be dangerous for others?

And when we colloquially call someone “narcissistic” it is never meant as a compliment.

So many caveats.

But, but, we live in a moment of history when the leader of the free world (as the president of the United States is so often called) may hold in his hands the future path of democracy, the fate of millions all over the world, and, ultimately, the fate of our planet.

And that fact, I think, trumps (sorry) all the caveats. It is a time that anyone who can see the dangers posed by this man has a duty to speak up.

I started these blogs before Donald J. Trump was improbably elected. The most popular among them has been my assessment of Donald J. Trump’s mental and emotional age. I arrived at an age simply from observations of his behaviour and his statements, while asking the question, “At what age in development would one expect, or not be too shocked, to observe this behaviour?” I came up with an average of 14. Though occasionally his displays of sibling rivalry and his assessment of his own greatness are definitely pre-pubescent.

We become easily inured, desensitized. The outrageous and abnormal can be made to feel normal. A step at a time. The German government enacted something like 50 laws over a short historical period, starting with restricting Jews from Union Leadership.

Some of the political pundits on television comment regularly on the “abnormal” becoming “normal”. But the very presentation on TV contributes to the desensitization.

These blogs constitute my interpretation of the journey we are on with the Presidency of one Donald J. Trump as it is happening.

 Two Years of Trump on the Psychiatrist’s Couch will be released on January 15 in print and in e-book formats. It is available now for pre-order at Amazon for the kindle version. Visit https://www.amazon.com/dp/B07LCSWKNF

Mind You: The Realities of Mental Illness by Dawson and Ross will also be released on January 15 in print and e-book formats. It is available now for pre-order at Amazon for the kindle version. Please visit https://www.amazon.com/dp/B07LCT2V4V

Dumb as a Rock

By Dr David Laing Dawson

Having lost the centrality and privilege of childhood and now struggling with their own insecurities there is a moment some teens decide, and announce to me, that ALL their peers are stupid, dumb as rocks, and lying. Usually for teens trapped in this moment of narcissistic injury they make one exception. For boys it may be an online friend supporting his complaints in a gaming forum, for girls it is a best friend who goes to a different school.

Usually they grow past this period of developmental disappointment: A combination of time, some success at something, some judicious counselling, the love of a parent, finding a boyfriend or girlfriend, and sometimes taking the right medication for excess anxiety.

The analogy with Donald J. Trump is imperfect. For the teenagers their “dumb as rocks” peers comprise a classroom of 30 or a school of 1000. It is the limit of their experience at this age. New acceptable friends are hard to find.

But Donald, for every friend, associate and peer he decides is “dumb as a rock” there are two new friends waiting in the wings for a role in the play, and a chance to be best of buddies.

But the language he uses is the same:the playground accusations, the remarkable hyperbole, the name calling, the self reference, the projections, and the underlying insecurities.

I suspect the only reason Donald’s tweets sometimes sound more sophisticated than a 15 year old complaining to me is that he is quoting some words and numbers from Fox & Friends, as in “the 245 times James Comey told the investigators he didn’t know.”.

As this drama unfolds over the next few months I hope the adults in the room remember we are dealing with a very narcissistic 14 year old with the moral compass of a peanut.

Perhaps we can resurrect Donald’s parents and have Mueller and Congress hand the whole thing off to family court.