Debunking Another Anti-Psychiatry Myth – A Review of The Great Pretender

alone-513525_640
Image by Gerd Altmann from Pixabay

Marvin Ross

One of the main beliefs of the anti-psychiatry advocates is that mental illness does not exist. They love to cite the fact that there are no objective tests for mental illness like blood work but that is also a feature of many conditions that they do not dispute exist – Alzheimers and other forms of dementia and Parkinson’s come to mind.

The other contention is that psychiatrists cannot differentiate between the sane and the insane. I have to admit that I was not aware that this belief came about as the result of a “study” done by psychologist David Rosenhan published in Science in 1973. Rosenhan got himself admitted to a psychiatric hospital where he was diagnosed with schizophrenia based on telling the doctors he heard voices.

He claimed that this was the only symptom he presented with and, once admitted, he began to act as he normally did and was soon discharged with the diagnosis of schizophrenia in remission. Rosenhan then recruited a number of other sane pseudopatients who got themselves admitted to various other hospitals around the US where they too were diagnosed with schizophrenia save for one who was diagnosed manic depressive.

This 2017 video explains how the experiment was conducted and the results:

The study made a huge impact at the time although Rosenhan quickly dropped the topic and went on to do other work. He was offered a book contract with a generous advance but he failed to finish the book and the publisher sued to recover the money.

Thanks to the incredible investigative work of Susanna Cahalan in her book The Great Pretender, proof is provided that the study was highly flawed. Ms Cahalan obtained Rosenhan’s notes and found them to be sloppy to the point of being unprofessional and even unethical. He made errors about the length of time spent in hospital and even the capacity of one hospital. He claimed a hospital had 8000 patients when it only had 1510.

The published study had very exact percentages for staff time spent in various activities with patients but one of the pseudopatients interviewed by Ms Cahalan told her that no data was collected. The data presented in the study contained such statements as attendants spent only an average of 11.3 % of their time outside the cage (staff desk) while doctors spent only 2% of their time where they paused and chatted with patients.

These are very specific figures and yet there was no explanation as to how they were derived and calculated.

Dr Rosenhan initially went undercover to Haverford Hospital in the Philadelphia area and claimed that his data was not used in the study but, in fact, it was. Cahalan was able to obtain the actual medical record for his time in hospital and discovered that the symptoms he complained of were far more extensive than simply saying he heard voices.

The actual record showed that he told the doctors that he was sensitive to radio signals, that he could hear what others were thinking and that he tried to drown out the noises by putting copper pots over his ears. The use of copper pots is similar to schizophrenic patients covering their heads with tinfoil to protect against the rays aimed at them from outer space. He also said that being in hospital could better insulate out the noises. He also confeseed to being suicidal.

Ms Cahalan concluded that Dr Rosenhan intentionally distorted the facts for his paper.

One of his critics at the time, Dr Robert Spitzer, corresponded at great length with Rosenham  and was so outraged that he was motivated to develop an updated version of the DSM (version III). Spitzer quoted another physician who stated that:

If I were to drink a quart of blood and, concealing what I had done, come to the emergency room of any hospital vomiting blood, the behavior of the staff would be quite predictable. If they labeled and treated me as having a bleeding peptic ulcer, I doubt that I could argue convincingly that medical science does not know how to diagnose that condition.”

If you describe symptoms that encompass all the markers of schizophrenia to a psychiatrist then you can expect them to diagnose you with schizophrenia.

There was a 9th psuedopatient in the research who wanted to emphasize the positive aspects of his 19 day stay in hospital but there is a footnote in the study saying that this data was excluded. Turns out that it was not excluded. The author found a draft paper of 9 pseudopatients and then the published paper with a footnote saying the 9th was removed.

Despite being removed, the numbers did not change. The average length of stay, the number of pills dispensed remained the same and the time that nurses spent with the patients did not change. If you remove one subject from a small sample size, the numbers will change but they did not in this case. Had the editors of Science been aware of these transgressions, Cahalan said, they would not have published the paper.

Research is essential for advancing our knowledge by investigating new areas or, and this is crucial as well, in replicating earlier studies to demonstrate their veracity. Studies that find negative results are also important but many have been suppressed. Since January 2018, those conducting clinical trials have been compelled by law to report all results even if negative. This was enacted to ensure that doctors and patients could determine if treatments were safe and effective and arose because it was not unusual for pharmaceutical companies to suppress data that did not support the efficacy of a drug under development.

But, as Science reported, many are not doing this and there has been no enforcement for their failure.

Research study results often involve a great deal of hype and publicity which is good for the researchers and their institutions. Promotions result and grant money flows so deception is common. The website, retraction watch, hosts a database of the flawed research that has had to be retracted and that is just the tip of the iceberg. I personally came across a research study from the Institute for Clinical Evaluative Science in Toronto which reported that doctors in Ontario were failing to abide by prescribing guidelines. The problem was that the guidelines came out after the research was complete. The researcher and the director refused to admit error but the editor of the journal it was to be published in made them add a correction. That correction was not conveyed to the many media outlets that reported on the flawed conclusion.

Cahalan does touch on these problems with research and cited the Reproducibility Project at the University of Virginia. An attempt was made to reproduce the results of 100 social psychology experiments and fewer than half could be replicated.

The most famous of psychology experiments also conducted at Stanford, The Prison Experiment, has also been exposed as a sham in a very detailed expose in Medium.

Research is crucial but findings need to be replicated and the lay audiences should be wary of basing beliefs on the results of only one study particularly if there is a great deal of media hype surrounding it.

 

Climate Change Report From Australia

koala-4721677_640
Image by dayamay from Pixabay

By Dr David Laing Dawson

I am sitting inside under an air conditioner at this moment because the temperature outside in Willoughby just north of Sydney is 40 degrees centigrade and the air outside is humid and smoky. The bush fires rage up and down the coast and inland, some under control and some not.

And this decade, they say, may be the last chance to do something about climate change before a tipping point is reached, and that point is the moment a positive feedback loop engulfs us all – when it is too late to stop the destruction.

Australia contributes just over 1 percent of world carbon emissions, but combined with the emissions of similar small contributors like Canada this adds up to over 40%.

With the USA wallowing in some kind of self-destructive delusional state, leadership could fall to a new group of developed countries – a consortium say of Australia, Canada, the UK, France, Germany…. and so I will, at the start of this decade, pitch my idea again.

We need to bring together the people and the knowledge from all the pertinent fields to arrive at a doable plan. Not merely a plan to “reduce emissions”, or a target for global emissions, but a consideration of the roles and possibilities of other factors as well. These are:

  • Population control (and this should be high on the list)
  • Bypassing fossil fuel in developing countries. What can developed countries do to foster this?
  • Carbon Capture technology. Are any of these technologies viable and scalable?
  • Natural carbon capturing plants and trees. What role can reforestation play? New technologies to plant millions of trees?
  • Shifting all power plants to carbon neutral technologies. How and when and which ones?
  • The role that could be played by nuclear power.
  • Carbon neutral housing and building standards. What impact can this have?
  • Cycling and mass transit. Just how much of a difference can this make?
  • More plant based diets. Realistically what difference will this make?
  • How long to shift most land transportation to electrical or hydrogen based power?

What incentives are needed to do this?

  • Air transportation. Is there a viable technology to make carbon-neutral jet fuel? And how do we get there?

I’m sure this list could be longer, and each item have it’s own subheadings of viability, time, cost, contribution, technical, economic and political feasibility…but…

Justin, you could take the lead. A Manhattan project to save the world.

Setting this up will cost a lot but not nearly as much as all the fire fighting and disaster relief we will all be paying for in the coming years.

Twitter, Thomas Szasz and the Channukah Attack

menorah-157983_640
Image by OpenClipart-Vectors from Pixabay

By Marvin Ross

At the end of December US psychiatrist Allan Frances tweeted that in 1977 he had dinner with Thomas Szasz (The Myth of Mental Illness). Frances reported that he asked Szasz if he would intervene were his child suicidal because of psychosis. He smiled/answered: “I am a father first, a libertarian second”.

Dr Frances responded that “Szasz could hold extreme views re meds/commitment only because he never once treated a severely ill patient”.

Dr George Ikkos replied that “In 1994 Szasz insurance paid $650,000 for negligence to widow of patient with “manic depression” who committed suicide following his advice to stop lithium. The source is a book called Mad Muses by Jeffrey Berman (P110).” Dr Ikkos is an “elected Honorary Fellow of the Royal College of Psychiatrists. The Honorary Fellowship is the highest honour the College bestows” (from his website.)

Also chiming in to this interesting twitter exchange was Dr Mark Ruffalo who provided a link to an interview that Szasz did with Jonathan Miller in 1983. He summarizes:

Szasz concedes that society should treat the gravely disturbed (“mad” or psychotic) person in the same way it treats the person who has been rendered unconscious by an accident, implying support for involuntary treatment in these cases.

The entire interview can be seen below and these comments are made around the 34 minute mark. Prior to that, Szasz states that psychiatrists either lock up the innocent or free the guilty and that no mental illness existed prior to the advent of asylums in the mid 18th century.

I’m not sure what provoked the initial tweet by Dr Frances but a couple of comments before transitioning to Channuka. The initial question asked of Szasz is something that I always ask of doctors when they propose a certain course of treatment or a medication. If this was you (or a spouse or parent) would you still suggest that? We should all do that.

The other comment pertains to libertarianism. Szasz suggests that libertarians would always propose no involuntary action. I’m not sure that is a valid position for libertarians and it is definitely not for a psychiatrist I know who is one. This particular Toronto psychiatrist once told me that no one is as libertarian as he is and he firmly supports involuntary committal and treatment. People have an absolute right to decide their own fate but in the case of someone who is psychotic, he said, their mind is incapable of making rational decisions. It would be wrong to allow them to make those choices when so impaired.

While this twitter feed was happening, New York State and FBI officials were declaring the attack against a Channukah party in New York State to be an act of domestic terrorism and that the perpetrator, Grafton Thomas, would be charged with hate crimes. Of course, we all now know that Mr Thomas is a man with untreated schizophrenia.

It is not a hate crime nor is he a domestic terrorist.

He is a delusional soul who has not been provided with treatment as the mental health advocate DJ Jaffe pointed out in his excellent assessment in the New York Daily News. Jaffe points out that Thomas’ long term pastor could not understand why he had never been institutionalized stating “There hasn’t been anyone who has given a real solution to deal with a grown man who is dealing with schizophrenia, other than ‘Go home and call us if something happens.’ ”

Situations like this are not unique to New York State or to the United States but to Canada as well. Every one of those jurisdictions has examples of crimes committed with and without deaths due to the failure to treat people with serious illnesses.

Of course, one of the key reasons that people do not get proper treatment even if it requires involuntary hospitalization stems from the works of Szasz and all the others who deny the existence of serious mental illness.

What is also equally galling is the rise of anti-semitism and other forms of racism in the world today. While US officials were quick to jump on the Channukah attack as a hate crime, they have seemingly ignored others. In the week before the holidays, there were 4 attacks against Jews in the New York City area plus the assault in Jersey City of a Kosher supermarket according to Bernie Farber. Farber is the Chair of the Canadian Anti-hate Network.

Farber also reminded readers of Trump’s anti-semitic comments at a dinner for the Israel American Council. Faber neglected to mention Trump’s comments after the White Nationalist march in Charlottesville or Rudy Guliani’s anti-semitic tirade as reported by CNN.

Attributing the violent delusions of a man with schizophrenia as a hate crime when the villain is our failure to treat mental illness while ignoring real acts of hatred is a travesty.

I never thought I would ever applaud anything from Boris Johnson or from a Chasidic Rabbi but both got it right. Johnson delivered a very forceful speech on fighting anti-semitism while the Rabbi whose house was invaded spoke out about the need for greater understanding and support between minority communities. “The Hasidic Jews of Monsey must ignore the outsiders who want us to take up arms and politicize our tragedy.”

Happy Holidays – Back in 2020

By Marvin Ross

covermindyou

It has been an interesting year with far more going on than anyone would have expected so we’ve decided to take a short break over the Christmas season and return in early January 2020.

Since beginning this blog in October 2014, we have published 419 posts and had over 97,000 visitors. Our visitors are mostly from Canada and the US but visitors have come from a total of 163 different countries.

In the past week, there has been a considerable interest in a column that David Dawson did back in January 2015 on the Canadian murderer, Luke Magnotta. Turns out there is a Netflix docudrama on him which has resulted in new visitors finding us. Some of the most popular blogs, not surprising, have to do with David’s many evaluations of Donald Trump. They are available in our compilation Two Years of Trump on the Psychiatrist’s Couch which is available in print and in all e-book formats from whoever your favourite supplier is.

cover dawson trump

And don’t forget we also have a compilation of our other blogs in Mind You which is also available in print and e-book format.

Enjoy the holidays and we will be back next year

Understanding Bullying

By Dr David Laing Dawson

bullying-3362025_640
Image by Gerd Altmann from Pixabay

Rather than write about how bad it is and how something punitive must be done, I thought I would put some thoughts together that might help understand bullying and thus might lead to effective means of reducing it on our school yards.

1. We are (mostly) dealing with children and teenagers.


Recently I saw a nine year old boy with moderate to severe ADHD (emphasis on the H). This otherwise quite charming, bright, athletic boy was spinning, twisting in his chair, constantly moving his legs, his arms, his eyes. Whatever came to mind he said, blurted out in fact. He lacked an inhibitory filter. This caused him trouble at school. He could blurt out mean comments. His mother, with a worried look, said the boy’s teacher had wondered if he lacked empathy for others.

The connection with bullying in my mind is not this boy’s behaviour, but rather the teacher’s observation, which, along with many other comments I have heard (such as a current belief in some circles that a teacher should never say No to a child) suggests to me that part of the problem here is that collectively we do not understand the developmental limitations of the brains of children and teenagers. Or, for many, we are still stuck in that Victorian era when kids were thought of as little adults.

My point being that expecting this thing we call empathy from a 9 year old, or even a 15 year old for that matter, is premature. And this lack of understanding leads to the belief that children and teens, taught good moral reasoning, will behave well, will not hurt others, will not do bad things, will always choose the right thing to do.

They still teach Lord of the Flies in school I believe. Some teachers should read it themselves.

Empathy for others is something we develop gradually, slowly, through adolescence and adulthood, and even then, as adults, we can lose it in times of heat and stress.

Do not expect empathy for others from children and teens. An instinctive response to protect small furry creatures, yes. The learning of social etiquette in order to fit in, yes. Occasional heart warming displays of kindness, of sharing, yes. An instinctive response to defend or protect other members of the same group, yes. Marching for a good cause as a positive manner of expressing a natural oppositional attitude, yes. But not empathy. Not yet.

2. Membership, status, self-worth

We humans, as young primates, instinctively seek membership, and status within that membership. Or as many male teens would say, “respect.” And by membership I mean some form of peer membership. It has been fascinating to observe over the years just how strong that need is in young adolescents, the need to fit in, to be accepted, and the fear of being rejected by a peer group.

Membership implies some sort of inclusion and exclusion criteria, some sort of agreed set of values, some kind of guideline for acceptable behaviour. And that peer group can be a club, a sports team, the school band, or just a small amorphous group who hang out together. Today, of course, it can be a virtual peer group, present only on a screen.

The teen girl lies in bed at night pinging/texting inanities back and forth with her BFFs, and then checks the number of Likes she gets on her Snapchat upload, before being confident enough to go to school the next day. The teen boy expresses his expectations of the members of his group in gang and prison talk, absorbed from television and Youtube: respect, loyalty, and harsh punishment.

Membership implies exclusion, the exclusion of those not worthy of membership. In fact exclusion of others clarifies one’s membership.

Many teen memberships/groupings are healthy: music groups, dance, sports teams, chess club…..supervised, skill and confidence building activities. Some teen groupings are informal, the crowd they hang out with for example, and the rules of membership and the expectations are unspoken but do exist, and can easily become distorted.

Some teen memberships are mostly imaginary. And today some can be part imaginary and part virtual.

What I am trying to point out here is that the act of discriminating against, of actively excluding someone is part of the way adolescents instinctively demonstrate membership. This membership can be simply member of the soccer team while others don’t make the cut. But it can also be a mostly imaginary membership in a “tough guys club” requiring, to reinforce this membership, the active exclusion of others.

I suppose one could go on with this line of thought, and propose that the need for this membership plus the need for status within this membership, is the foundation for racism and white supremacy groups.

But for this topic, it is sufficient, I think, to point out that the seeking of, the need for membership is instinctive. And such membership requires exclusion of others. And the active exclusion of others can enhance a feeling of membership/status. And the simplest way of excluding others from one’s imagined group of superior beings is to label them, call them names, tease and taunt them. A certain president (mental age about 14) does this every day.

3. Cruelty

In the late 1960’s I participated in group exercises that were a mild version of the Stanford guard/prisoner experiments. In an ordinary training space we were paired off for role playing in which one of the pair would be a guard with absolute power, the other a prisoner who badly wanted something. There were too many variables to draw any scientific conclusions, but… But what I think was the most telling result of this role playing was that each “guard” found within him or herself, a capacity for cruelty. As the prisoner grovelled and begged, the participant playing guard experienced a growing disdain that began to evolve into disgust. We did not continue the experiment long enough to find if any of us were capable of acts of actual cruelty, but we each found within ourselves the potential for just that.

It is also pretty clear from observation that bullies choose victims from whom they get a response, a reaction, a reaction of anger, hurt, fear, tears, perhaps pleading. And then they may re-enact the taunting from an increasing feeling of disdain, disgust, and then from the immediate satisfaction of excluding this victim from the imagined group the teen boy belongs to. (men among men, tough guys club, gang…..) And as teenage girls and boys without supervision they can quickly find their potential for cruelty.

So we needn’t be horrified to find a certain lack of empathy in our teenagers, and we shouldn’t be horrified to discover these human children and teenagers have the capacity for cruelty.

All teenagers need to find, to develop, membership in a peer group. If they don’t find such membership in healthy real supervised groupings they may find it in informal groups brought together by an unhealthy interest, and/or in imaginary groups and/or part imaginary and part virtual membership, or groups simply defined by their exclusiveness.

So this means adults, parents, teachers, and the school system should work hard to ensure each and every teenager feels they are members of some real and healthy grouping. And this means that we need to spend money and resources in extra curricular activity, and that having a Pokemon or Dr. Who club is as important as having a soccer team or school band. Every teen needs to be able to define him or herself as a member of, and having status within, a club, team, pro-social grouping without resorting to imaginary membership in a tough guys club or a master race.

There will always be kids that have something about them that sets them apart from their peers, and who also react badly to teasing and taunting. They are natural targets of bullying. (I am not blaming the victim here, just analyzing the reality) Their reactions can unleash the nascent cruelty of their attackers. (see guard/prisoner experiments)

In the best of teen worlds these kids are protected by peers who are stronger, and more secure in themselves and their memberships.

So, to reduce bullying, apart from surveillance, alertness, sanctions and punishment, we need to:

1. Ensure every teenager achieves some form of membership in some kind of pro-social real group, preferably supervised.

2. Make, however laws and regulations and common sense allow, successful teenagers within the school system responsible for the protection of the vulnerable.

Years ago a deaf boy joined my son’s hockey team. My son was assigned the task of looking after him on the ice, partnering him, guiding and protecting. This left him little chance of showing off to the (imagined) NHL scouts.

I was very proud.

Pets, Mental Illness and Lived Experience

By Marvin Ross

sophie
Sophie Ross

And I don’t mean pets as service animals although they can be very helpful. I’m talking about trauma as a purported cause of mental illness, addiction and all other negative things. Dogs and cats can teach us.

It suddenly dawned on me that our latest dog, a rescue, and her rescue friends can provide an example. Sophie was adopted 8 years ago when she was three. I don’t know all that she went through in her traumatic early years as she is reluctant to talk about it but she was so matted and her hair so long that she could not lift her tail to pee. She had to be shaved and one of her toenails had to be surgically removed from neglect. It had curled into her paw.

She does not like the noise that equipment trailers hooked onto cars and trucks make but, other than that, she is fine. She is an extrovert who loves people and especially kids and babies. She exhibits no signs of her early life and the trauma and abuse she suffered.

Most of her friends in the building we moved into are rescues as well. Reggie, for example, is a large and not cute dog with many scars. Reggie was rescued from a dog fighting ring thus the scars but he is a very calm, placid and friendly dog.

I have no doubt that there are rescued dogs and cats who do exhibit strange behaviour as a result of their maltreatment but they are the exceptions. Most people who have rescued cats and dogs report no problems. And dogs and cats do remember.

Now this may not be scientific in the true sense of scientific proof but a great deal of the tripe that I see is not either. The American Council on Science and Health just published a delightful essay on the anti-medical rant that Scientific American  published against Dr Jennifer Gunter which Scientific American had to delete. Seems that this is the third unscientific article they published in the past little while.

Dr Gunter is a gynecologist and the author of the Vagina Bible. The op ed attack against her took the position that

“women don’t need medical doctors because the lessons learned from staring at each others’ vulvas while sharing anecdotes about herbal remedies is every bit as legitimate as the lessons doctors learn in medical school.”

The author of the op ed critique went on to say that she:

goes on to denounce “authority” (which apparently means anyone with an evidence-based opinion) because it ignores “people’s lived experiences.”Lived experience is simply a different way of saying “anecdote.” Block clearly believes that scientific research is just one opinion among many. Sure, doctors might believe one thing, but Karen on Facebook disagrees. And her opinion counts too.”

And I love what he says about lived experience which I put in bold. That is the argument that we hear so frequently in mental illness. We must listen to those with lived experience even though they have no training. Now don’t get me wrong. I’m not saying that everything a doctor tells us is written in stone and we can’t discuss treatment strategies because we can. But there is a huge pile of evidence out there (or should be) telling us what the best strategies are.

Our failure to listen to evidence over anecdote is the cause of so many kids dying from the very preventable measles. So far 53 kids in Samoa have died from measles (Since writing this, the number of deaths has gone up). One of many such outbreaks in the world. Measles, a very preventable disease has increased  1100% in the Americas since 2000. Its vaccine has saved more than 20 million lives since 2000.

And, for psychosis, one comment on David Dawson’s blog on the topic suggested that “As for Robert Whitaker, he is one of the many experts on mental illness who have (sic) researched psychiatric drugs and found them to be harmful.”

Wonderful! That man is a journalist as I pointed out a few years ago in Huffington Post, journalists are not medical experts.  Let’s all look to journalism for our evaluations of diseases and their treatment. Who needs doctors and scientists?

Fascism of the Left

By Marvin Ross

word-cloud-3269303_640
Image by Mary Pahlke from Pixabay

Freedom of speech/free expression is a bed rock of democracy but it is being eroded by those on the left. There are, of course, limits to expression such as not inciting to violence or spewing hate crime which are covered in the Canadian Criminal Code, and not defaming people which can be remedied by civil action. Other than those examples, we are all entitled to express our opinions and no one should be blocked for doing so.

Three recent events I find very concerning because they do not seem isolated but appear to be a growing trend. The first took place in Hamilton just prior to the federal election. Maxime Bernier, the former Conservative member of parliament founded a new political party called the People’s Party – a right wing group that is anti-immigration (although he denies that). They have official party status, fielded candidates in all or most constituencies in Canada and participated in the TV debates.

Bernier is a controversial character. He was kicked out of the cabinet when the Conservatives were in power for leaving a briefcase full of classified documents at his girlfriend’s place. His girlfriend had ties to organized crime characters. As part of his campaign, he spoke at Mohawk College in Hamilton but not only did protesters show up (which is legitimate) but some of them wore masks to cover their faces and blocked people from entering the auditorium. One of those blocked was an elderly lady pushing a walker.

Those individuals were eventually found and arrested and, during the election, the People’s Party did not elect a single person and only got 1.64% of the popular vote. In my opinion, a testament to the intelligence of the electorate who heard what he had to say and rejected it. There was no need to prevent people from hearing him talk. People can decide and did decide.

Next up was a talk by a feminist writer (Megan Murphy) at a Toronto library branch who happens to hold contrary views on transgenders. Her talk was entitled “Gender Identity: What Does It Mean For Society, The Law and Women?” It was hosted by Radical Feminists Unite. She believes that allowing men to identify as women endangers women’s rights. OK. So what? She is entitled to her opinion and to argue that. She is entitled to speak.

Not so according to LGBTQ activists, a writers group and even the mayor of Toronto. All of them implored the library to cancel her talk and not allow her to use of the library. Writers should know better particularly given the history of authoritarian regimes that have banned books and burned them. The mayor of Toronto also disappointed but the librarians held their ground and refused to budge. The demonstration against her the night she spoke was peaceful but the constabulary was out in force to ensure it remained so. Police did have to escort those in attendance out of the building.

Finally, York University in Toronto where a talk put on by a Jewish group was violently disrupted by protesters shouting pro-intifada slogans. The speakers were Israeli Defence Force Reservists and the protesters pounded on the doors of the meeting room. Violence was kept to a minimum by a large contingent of Toronto police and university security staff.

A recent Syrian refugee to Canada (Aboud Danachi) attended the event and was so shocked by what he saw that he wrote an op ed in the Canadian Jewish News. His words should be taken to heart by those who oppose free speech. He wrote:

“I was always interested in meeting former soldiers of the IDF. Back in Syria, socializing with any Israeli whatsoever was the ultimate taboo. But I was in Canada now, browsing through the York University student cafeteria. Syrian President Bashar Assad could take his taboos and shove it. In Toronto, I was like anyone else. I could go where I pleased, when I pleased. And meet whom I pleased.

Or so I thought”

A Pakistani Canadian Muslim journalist also expressed disgust of how the Jewish group was treated at York. Raheel Raza, speaking on the Roy Green Show, was not surprised by what happened at York as she stated that it has a long history of anti-semitism and intolerance. She said her niece went to York and had threatening notes put on her door because she did not cover her hair.

We cannot afford to lose freedom of speech in this country but I am heartened by the fact that those who are new to this country are stepping up to defend it.

 

Psychosis is Not Normal – A Psychiatrist Responds

By Dr David Laing Dawson

This morning I witnessed a taxi pull up to a doctor’s office stopping as close to the entrance as possible. The cabby got out, went around to the passenger side and gently helped an older woman ease her way to the pavement. He then took her by the arm and slowly helped her up six stairs to the front door. He opened the door for her and only left when he was sure she was safely inside. All of this in a cold rain with remnants of snow and ice on the blacktop.

My despair for humanity is momentarily lessened.

But I must go back to a brief history of mental illness treatment as a response to Ms Nanos’ guest blog and some of the comments that it received.

When Medicine had only a few potions and surgeries that actually worked on any illnesses (let’s start somewhere in the early 1800’s) the severely and persistently mentally ill were hidden by their families, left to die in the streets, jailed, banished, punished, or they found their way to Asylums created by religious groups (Quakers, Sisters, Brothers).

Though Medicine had little to offer at the time, doctors were invited into the Asylums to help. These doctors became known as Alienists. (I’m not sure if it was a term of endearment or prejudice)

Fast forward through revolutions, civil wars, the industrial revolution, urbanization, massive population growth, the State taking over the Asylums, and the age of science. Scientific medical advances (the disease model) eventually led to the successful treatment (more importantly the prevention) of many things, of many illnesses other than mental illness, though a scientific approach did lead to a delineation of specific mental illnesses still quite valid today. And of course the Asylums grew along with the urban populations.

All that was tried to treat severe mental illness (from rotating chairs and cold baths to insulin coma and numerous varieties of work, rehab and talking) failed. Though at least through this time (about 1870 to 1950) there were some kinder periods when the Asylums lived up to the meaning of the word, and other less kind periods (wars, economic depressions) when the Asylums (evolving through titles of Asylum, Hospital for the insane, Provincial or State Hospital, to Mental Hospital and Psychiatric Hospital) at least provided three square meals and a bed to sleep in for many who would not otherwise survive.

With so many advances in scientific medical treatment developing, academic medicine (with some exceptions) lost interest in the untreatable population inhabiting the mental hospitals. Religious explanations for their existence (demonic possession for example) no longer sufficed, so it is no wonder, through the 1930’s, 40’s, 50’s, and 60’s, a plethora of psychological, sociological, familial, genetic, and conspiracy theories developed to explain psychosis, mania, depression and insanity. The new Medical specialty, Psychiatry, remained aloof. Academic and private practice psychiatry focused on the worried well, the neurotic, the anxious, the despairing and moderately depressed. They stayed clear of the mental hospitals, with a few exceptions when they brought and applied a variety of psychological and psychoanalytic theories to some wards of these Asylums and failed dismally to make a difference in actual outcome of illness, though probably bringing some improvement to many lives.

But then quite suddenly (1950’s and 1960’s), and mostly accidentally, medications were discovered that actually work: Medications that calm severe anxiety, obsessions and compulsions, that overcome severe depression, that level the profound mood swings of manic depression, that quell delusional grandiosity, and that actually work for the most puzzling and debilitating mental illness of all, schizophrenia.

The second world war was over, good economic times had arrived, our medications worked and we all looked forward to an era when mental hospitals would no longer be needed.

Paradoxically as the medications worked, and many people who otherwise would be living within the shrouds of psychotic illnesses were now functioning as independent citizens, the causality conflict between nature and nurture intensified, as did the calls to abandon the disease model.

Now I should note that Medicine (Doctors) have always over reached. When we have something that works on one problem we try it on another. At least we do this until the studies prove that it doesn’t work for the second problem.

But I think the real reason for this intense anti-psychiatry movement is two-fold: on one hand pharmaceuticals that work to change mood and thought, plus more and more sophisticated ways of watching the brain do what the brain does, undermine that last vestige of hope and desire that each of us is more than “a sloppy bag of mostly water with a limited life span”.

And professional aspirations and jealousies of status and turf.

Fast forward again (2000 to 2020) and we find our fear of psychiatry, plus the aspirations of growing numbers of psychologists, plus politicians jumping on ways to save money, (or shift costs to other jurisdictions), plus identity politics, plus changes in societal attitudes that are hard to fully understand from inside…..have left us in the disheartening position of having a mental illness treatment system worse than it was 40 years ago.

Or, as a colleague warned 30 years ago, we are heading for a time “when the good schizophrenics will get good treatment and the bad ones get none”. By that he meant, if I must translate his words into today’s reality, people with mental illnesses that respond to medication and who remain compliant with treatment and develop enough stability and insight, and have sufficient family and community support will get good treatment and helpful counseling and rehabilitation services, while those who don’t will be left to the streets and the jails.

And he wasn’t even considering the “Recovery Movement” and the plague of euphemisms that give cover for this disgrace.

The other night we had an Opening at the gallery: Live music, glasses of wine, a table of food and a growing crowd of art lovers. Then two young men wandered in. The leader was bundled in bulky parka over a hoody, drooping pants, multiple sweaters of varying length, with wild hair flailing beyond his parka. He was also carrying a very large rock partially wrapped in plastic. The second young man was gaunt, undernourished, stiff in his movements and vacant of eye.

They gravitated to a sitting area and a small bowl of chocolate bars. Others left the area and I got them sitting on a couch and I sat with them, between them. They quickly demolished the chocolate bars, dropping the wrappings on the floor. The thin young man slipped in and out of a catatonic state staring blindly and hearing nothing, unaware his nose was dripping, his face immobile, flat and blunted. He did tell me when I asked that he lived on this same street many blocks away. The other man babbled nonsense, making connections between the glass shards embedded in his rock and insects, spirits, goddesses and aliens. I offered him ten dollars for his rock but he said he wanted a quarter million. He said he has a house in Kingston, another in Mississauga, and a car somewhere in Hamilton. And his grandmother’s name is Olanzapine.

I took them to the food table but the lean one stood immobile over the cheese tray dribbling from his nose and the other bypassed the toothpicks and forks to stick his hands in the pickle bowl so I sat them down on a bench and brought them a plate of cupcakes.

And then I saw them on their way. The gaunt one headed for the door but the other held him back to choose a coat off the rack. I was satisfied the coat they chose was theirs and not that of a guest because it exuded the same odour that they did. And I wished them a good night.

But, ahh I thought, how much they would benefit from a month or two at the old Hamilton Psychiatric Hospital, or any other 1985 psychiatric hospital, with a warm bed, food, shower, activities, routine, the right medication, good counsel, and seamless follow up with regular outpatient care.

And here are two women with schizophrenia who talk about their difficult journey

And these are families asking how to help their ill relatives

Donald Trump and Marshal McLuhan

By Dr David Laing Dawson

Marshall McLuhan’s phrase “The medium is the message.” is often quoted glibly. I am sure I have done this myself. It means, I think, that the medium through which we receive messages alters, itself, the way we view the world, the way we receive these messages and understand them.

I think we quote Marshall glibly because as white rats in the experimental lab we are not often able to see how the medium, or media, are changing our perceptions. And Marshall said this before the internet arrived, and certainly before Twitter.

I have never thought of Donald Trump as a clever man, a man of deep thought and consideration, but damned if he doesn’t appear to understand Marshall better than the rest of us. I assume this understanding comes from being a creature of the media, a man without an inner life of doubt and shame and empathy and consideration.

And within all the noise in the past few weeks and months about Trump, Zelensky, the phone call, the quid pro quo, one minor point seemed to go unnoticed. Trump asked Zelensky to open an investigation into the Bidens, father and son, and to announce this “in a public box”. He didn’t say “invent some dirt on the Bidens”, or “charge them with something”, he asked that an investigation be announced in a public forum. He knew that such an announcement on TV, cable news, Facebook, Google, and Twitter can, in and of itself, blossom into a fixed perception of guilt. It is the world we live in today.

Trump has also intuitively understood that the medium of Twitter and its daily onslaught can make the unacceptable acceptable, can deodorize something putrid, can make the irrational seem rational, and a lie seem plausible, through copy, assertion, and repetition.

Evidence that he intuits this rather than fully grasping it lies in the letter he sent Erdogan. As a series of tweets this might have passed. As a letter, the ignorance, grandiosity, and adolescence of the message was clear.

Then Trump goes back to his favourite medium and he tweets a bizarre accusation and clear intimidation while the witness, Yovanovich, is testifying in the impeachment hearing. And we find ourselves again pondering Marshall’s words.

Written on paper and delivered as a letter, or overheard and recorded on a wire tap, Trump’s words would be perceived and understood as clear evidence of witness tampering. The same message in the medium of a Tweet? Is it just Trump being Trump?

And where on earth are Twitter, Snap Chat, Whatsapp, Tumblr, Instagram, Facebook, internet forums, texting, and blogging for that matter, taking us?

Psychosis is Not Normal – A Guest Blog

By Lynn Nanos author of Breakdown: A Clinician’s Experience in a Broken System of Emergency Psychiatry

brain-3446307_640
Image by 3D Animation Production Company from Pixabay

As I was selling copies of my book, Breakdown: A Clinician’s Experience in a Broken System of Emergency Psychiatry, at a National Alliance on Mental Illness (NAMI) conference in Albany, NY last month, I had an interesting conversation with someone which reminded me of the dangers of the antipsychiatry movement, which promotes the notion that mental illness doesn’t exist.

A man approached me at my booth and asked me about Breakdown and then shared his experience with bipolar disorder with psychotic features. He emphasized that he’s recovered.

I empathized with his experience and happened to mention “illness.”

Immediately upon hearing this, he interrupted me mid-sentence with “I do not have an illness. I don’t like the use of that word so please don’t use it. I have a condition. I’m not defined by my condition. We need to stop stigmatizing this.”

I thought, “I’m not sure how this conversation will end, but I have to educate this guy. Otherwise, he’ll continue to spread the façade that stigma is an enormous issue and the only way to mitigate it is by not accurately describing what he really has – an illness.”

So, I said to him, “According to several dictionaries, ‘condition’ means ‘illness.’”

His eyes and mouth widened with “What? That can’t be true. Are you sure?”

I’m sure. Check it out yourself. I’m sure you’re a lot more than your bipolar disorder, but not accurately defining what you have is stigmatizing, not the other way around.”

After a few more minutes of him working through his shock about my challenging him, he eventually said “Thank you for pressing me to change for the better. I’ll look this up.” Smiles and relief.

∞∞∞

Earlier this year, I attended the National Alliance on Mental Illness’ national convention in Seattle, WA. The event was kicked off with pomp and circumstance involving a ceremonial military march beside the United States flag on stage before me. As I looked around at a sea of thousands of guests, I couldn’t help but think, “NAMI is huge, important, and powerful.”

Most of the week was filled with lectures and workshops. The “Cognitive Behavioral Therapy (CBT) for Psychosis” workshop I attended reminded me of the benefits of this therapeutic modality for a variety of mental illnesses, but also left me alarmed at some of the messages NAMI has been sending to mostly family members of those with mental illness and some professionals. CBT teaches people to think about, describe, and respond to the environment accurately. It persuades people to behave in healthy ways in response to thoughts. The underlying presumption of CBT is that when either one’s thought, emotion, or behavior changes, the other mental components change.

As I vigorously took notes in the workshop led by psychologists Kate Hardy and Sarah Kopelovich, my review was mixed. Should CBT for psychosis be completely disregarded? No. I’m grateful to the late forensic psychologist Robert Powitzky who extensively directed services for prison inmates, for his educational reminders. He wrote to me, “CBT can have several benefits other than making observable changes in positive and negative symptoms…is often effective for patients with schizophrenia who are stabilized on medication in conjunction with supportive housing.” 

CBT for psychosis can be useful, especially once the psychosis has been stabilized and well-managed. The psychologists said that CBT has shown moderate effectiveness in reducing the negative symptoms of schizophrenia – social withdrawal, poverty of speech and thought, apathy, anhedonia, loss of motivation, and inattention to social or cognitive input. I credit the psychologists for pointing out, albeit briefly, that per psychologist Xavior Amador, one of the greatest predictors of successful treatment is awareness into illness. But this was as far as they got regarding insight.

On another note, I confirmed that NAMI was doing two dangerous things: marginalizing those whose psychosis interferes with the ability to engage or benefit from CBT and minimizing mental illness.  A mother stood up and said to the psychologists, “All I could think of while watching this was ‘bullshit!’ Employing these techniques was impossible when my son was too agitated and unable to listen because of his psychosis.” 

Below is a detailed account of exactly what these psychologists said in the “CBT for Psychosis” workshop accompanied by my impressions.

  • Psychosis is a temporary condition. It is usually permanent.
  • Everyone is susceptible to psychosis. Not quite. An extremely small percentage of the population is far more susceptible to developing psychosis than others.
  • Trauma and stressors make someone more susceptible to becoming psychotic than genetics. False.
  • There’s a correlation between creativity and psychosis. I don’t know whether this is true, but I’m not compelled to research it because it seems mostly irrelevant to treatment goals. Even if it were true, how could this possibly be used to help people with psychosis? Should psychiatrists and social workers offer painting materials instead of medication and psychosocial rehabilitation to people suffering from psychosis? Yes, this is a rhetorical question.
  • Psychosis is often part of PTSD and can be part of borderline personality disorder. Untrue.
  • It’s not helpful to tell the person with schizophrenia, “You need specialized treatment.” Psychosis is a special illness requiring specialized treatment. Treatment providers help their patients by telling them the truth.
  • Expect recovery. If you get good treatment, recovery is the norm. Hundreds of NAMI blogs are ridden with happy endings, but everyone with psychosis does not recover. Telling families that recovery is the norm inappropriately sets them up for huge disappointment when good treatment does not work. There are many factors that can interfere with recovery even when the best treatments are tried.
  • Intrusive thoughts, which everyone has, can be compared to delusions and hallucinations. Are you stating that psychosis is normal? It sure seems like it.
  • CBT inherently normalizes psychosis, because we all have negative thoughts, engage in unhelpful behaviors, and use unhealthy coping strategies. Thus, CBT normalizes psychotic symptoms. Psychosis is normal. The psychologists asked the audience, “How many of you ever felt others were trying to harm you?” There is nothing normal about psychosis!

With all of NAMI’s grandeur and influence, speaking out against its marginalizing those who are most ill and spreading the notion that mental illness is less than important is paramount if we want to alter the status quo. Let’s destigmatize mental illness by defining it accurately. It’s a condition, but more accurately, it’s a brain disease.