One Last Comment on Guns

By Dr David Laing Dawson

We don’t really need another voice lecturing American politicians “It’s the guns, stupid.” But I can add a perspective to this issue:

For many years I have had a large caseload of troubled teenage boys. And always, always, on any given week at least one is exhibiting an obsession with weapons, and two others are espousing a code of honour and demanding they be respected, and justifying violence as a legitimate response to grievance, and at least three are behaving in a manner that would quash the love of anyone but their mother.

Can you imagine, because I can imagine, how sleepless my nights would be if I thought any one of them had access to a semi-automatic assault rifle? Fortunately these boys do not live in the USA.

There will always be troubled boys and young men, some with treatable illnesses. Better psychiatric services may catch many of them in time. But it is the loaded gun that differentiates a troubling altercation from a tragedy.

 

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Alternative Facts

By Dr David Laing Dawson

I was probably ten or twelve when I asked my Sunday school teacher if there was any archeological evidence supporting the parting of the Red Sea and its collapse back over all those chariots. And in grade 7 when our science teacher, Mr. Edmonds, asked the class which way the earth travels around the sun and I told him it depends where in the universe the observer is standing. We argued and he sent me to see the Vice Principal from whom I first heard the idea of ‘convention’.

And then we all run into professors in first and second year university who tell us of the social manufacture of reality, and those who tell us how our attitudes and perceptions are shaped by the power elite. And we run into G. E. Moore and Bertrand Russell and ponder the nature of truth. “Moore, are there apples in your basket?” And somewhere along the line a professor turns a chair upside down, places it on a table and asks the class, “What is this?” We tell him it is a chair, and he asks us how we know it is a chair. And someone else tells us that a light switch is neither on nor off, but in a position of relative on-ness, and that an electron might be in two places at once.

During his summer vacation between first and second year university, my grandson, in the comfort of his bedroom, day trades cryptocurrency on his new laptop. We discuss the nature of cryptocurrency, tulip bulbs, and “real” coinage, the very concept of money. I see that some articles on bitcoin are illustrated with a graphic of large, hard, embossed gold and silver coins. The irony is striking. The economists see bitcoin as a silly invented bubble; the bitcoin “experts” talk of cryptocurrency as being as big a social disrupter as the internet, liberating currency as the internet liberated information.

There are ads every night on CNN supporting legitimate journalism. They sometimes show an apple from first one angle and then a second and proclaim that it is still an apple. I think the ad writers missed the Beyond the Fringe parody of Russell and Moore, and Duchamp’s painting of a pipe titled, “This in not a pipe.”

“Moore, are there apples in your basket?”

And then we have Carter Page who apparently is referred to as a “Famous American Economist” when he gives talks in Russia, and Sean Hannity, and President Trump “totally vindicated” by the Nunes memo.

Many explanations for the rise of Donald Trump have been written, grounded in the history of the USA, the technological changes sweeping the world, the paranoia that accompanies mass migration, the always present racism, the forgotten but once privileged white working man, the attraction of populism and demagoguery….

And we are all fascinated by the extent this man can obfuscate, dissemble, lie, confabulate, and contradict himself without consequence.

But, pulling these random thoughts together, it seems to me that with Moore and Russell we left behind the certainty of 19th century truth, and with space travel, the origins of the universe, black holes, space time continuum, anti-matter, the digital revolution, the internet, robots doing our vacuuming and manufacturing, the democratization of information, the ubiquity of video illusion, virtual reality, artificial intelligence, and, perhaps most importantly, the development of every day tools that only a few really understand…..we are now a very bewildered species. We used to know where we were going. Now we don’t. We used to understand our tools; now we don’t. We are inundated with fiction; we binge watch Netflix. Many teen boys can recite the political intricacies of the Star Wars series much better than that of their own world. In our fictions there are an astonishing number of American Special forces whizzing around the world killing bad guys and keeping us safe. We find ourselves applying the expectations and conventions of fiction to reality. Conspiracies abound in fiction, though real humans are more prone to folly.

It has long been preached that truth will outlive a lie. But today that lie can be widely disseminated in seconds, with conviction and graphics, while the truth is often slow, difficult, and complex. Today the lie has done its job long before the truth emerges.

It is no wonder that many of us sitting in our puddle of bewilderment and angst are easily coaxed back to primitive religions, pre-enlightenment medicines, strong-men, demigods, and false prophets.

There is a heartening backlash to all this, symbolized in a small way by Georgian College throwing out its program in homeopathy. And in reality the economies of the world are all in better shape than they ever have been, fewer people starve, fewer people die of preventable and treatable illnesses (thanks to modern western medicine), more have access to clean water (modern medicine and science), fewer people are crippled or die from nutritional deficiencies (modern medical use of supplements and scientific dietary advice), fewer people are actually killing one another than ever before, fewer are enslaved, many with chronic illnesses have better lives….. We even have better and better treatments for mental illness…and I don’t mean pig pills, micro-nutrients, and mindfulness.

We are at a tipping point I think. Can sufficient numbers of us, members of this human race, accept the reality of uncertainty, live with the angst of self-aware existence, discard the need for Gods and demigods, accept the scientific manner of seeking truth as primary, accept our species and ecological scientific truths, and get down to the task of preserving and expanding our democratic institutions, accepting this small planet as home to us all, and recognize we face two daunting tasks if we are to survive, that we must deal with over-population and global warming?

And this does not mean we should be wasting time and money shooting large rockets and small roadsters into Asteroid belts.

PS – David Stephan who was mentioned at length in the previous blog, went on a Facebook live video rant earlier this week attacking everyone involved in the cancellation of his lectures including Marvin Ross and Dr Terry Polevoy.

I feel left out. You rant against Marvin Ross and Terry Polevoy. Please add Dr. David Dawson to your list of trolls.

Now, two things: You and your wife were very scientific. You conducted an N of one experiment using nutrition, Pig Pills and supplements on a very ill child rather than taking him to a doctor for appropriate examination, tests and the application of modern medicine. The legal aspects of this are complicated. What is clear is that your pig pills and supplements and “Truehope” failed, and the child died. Your child died.

At the end of your diatribe on Facebook you say the “saddest thing” is the cancellation of your promotional speaking gigs. I would have thought it was the death of your child. It should have been the death of your child.

 

 

 

 

 

 

Despite Science, Alternatives Flourish

By Marvin Ross

exorcism

Despite the tremendous advances that medical science has made over the past number of years, many persist in their unscientific beliefs about vitamins and alternative medicine. A few things cropped up in the last week to make my head hurt. First, the Journal of the American Medical Association released a report on vitamin and mineral supplements and their efficacy. They stated:

“most randomized clinical trials of vitamin and mineral supplements have not demonstrated clear benefits for primary or secondary prevention of chronic diseases not related to nutritional deficiency. Indeed, some trials suggest that micronutrient supplementation in amounts that exceed the recommended dietary allowance (RDA)—eg, high doses of beta carotene, folic acid, vitamin E, or selenium—may have harmful effects, including increased mortality, cancer, and hemorrhagic stroke”

They then go on to discuss what vitamins should be used for and that list is very specific.

At about the same time, it is revealed that Georgian College in Barrie Ontario is setting up a three year course in homeopathy. Dr Stephen Barrett of Quachwatch describes homeopathy as the ultimate fake. I remember an episode on Marketplace a few years ago where they tried to have people overdose on homeopathic medicines (distilled water) and no one could. The public outcry against Georgian College was so strong that they cancelled the program.

Next up was a notice that David Stephan was to be the keynote speaker at the Saskatoon Wellness Conference. Stephan is the man who, with his wife, was convicted for the death of their toddler who suffered from a very curable meningitis but was given vitamins and homeopathic potions instead. One of the products the child was given was EM Power Plus which is the product his father’s company manufactures and sells. More on that in a minute but the organizer of the event (and Stephan is to speak in other cities as well) is that “he judges his vendors based on their products, not on their personal lives.”

Nice but the two are intertwined. I’ve been writing about this product for years and the following is from an earlier Mind You blog:

The blog Neurocritic entitled one of its articles as EMPowered to Kill as one man with schizophrenia went off his meds to take EMP and brutally killed his father in a psychotic state. I have written on this case as well in Huffington Post. Health Canada has declared the product a health hazard on two occasions. I have written critical articles about this in various publications and an e-book with Dr Terry Polevoy and a former Health Canada investigator and now private detective in Calgary, Ron Reinold, called Pig Pills.

Stephan and his wife both worked at the Truehope website advising customers on their treatment. You can listen to some calls that were made to the call centre here.

One of the research gurus for Truehope is a psychologist at the University of Calgary, Bonnie Kaplan. Her research trial on EMP at the University of Calgary was shut down by Health Canada because it failed to meet the proper standards for a clinical trial but she now writes on mental health and vitamins for the Mad in America website. She also gives lectures where she tells the audience not to google her name (slide 3). She even went so far as to bring professional misconduct charges against Dr Terry Polevoy with the College of Physicians and Surgeons of Ontario because he criticized her work.

And yet, she was just named as one of the 150 Canadians who make a difference in mental health for the above work.

Meanwhile, the Schizophrenia Society of Canada states in its recent report on re-imagining itself that:

External stakeholders expressed concern that emphasis on a western medicine biological model of understanding of schizophrenia does not reflect the diversity of ways people from different cultural groups understand and explain mental illness.” (P13).

What can I say to this? OK some people do not agree with how science has tried to understand schizophrenia (and it has a long way to go), and would prefer to ignore treatments (again not perfect but reasonably effective) for their own folkways like exorcism to let the demons out as depicted in the graphic that goes with this.

How is that gonna work?

Probably as well as it did for a young Aboriginal girl from the Six Nations Reserve near me who decided to stop her chemo for what was first described as native healing. Her acute lymphoblastic leukemia was given a 75% probability of a cure with conventional medicine. The “traditional indigenous treatment” she sought out was at a vitamin cure spa in Florida called the Hippocrates Health Institute which is being sued by former staff who allege the company’s president Brian Clement is operating “a scam under Florida law” and practising medicine without a licence.

Sadly, Makala died.

PS I wrote this on Sunday morning and by late afternoon Sobey’s,  a grocery chain, had cancelled its sponsorship with the Wellness Expo and the organizers of the event had removed Stephan’s name from its list of speakers.

Ontario’s Flawed Mental Health System and the Failure of the Current Provincial Government

By Marvin Ross

stone of madness

I recently came across an excellent assessment of the very bad mental health system in Ontario that prefers to have people receive services in the forensic stream rather than before they get to that point. The assessment was not published but was obtained under Freedom of Information.

That led me to write this on Huffington Post – Ontario Has Failed to Provide Adequate Resources for Mental Illness. 

After that appeared, the Hamilton Spectator did a feature on a young man named Ross Biancale with the head I’ve already written his obituary: Mom struggles to save son from himself. This sad but true recounting of what it takes to get someone service in Ontario illustrated all the points that I made in my Huffington Post blog. Below is my explanation for this mess.

The reason that Ross Biancale and thousands like him are falling through the cracks of the mental health system (the Spectator, January 23) is easily explained and easily fixed. They have not been fixed because the Liberal government has no interest in doing so.

Justice Richard D Schneider ran the Toronto Mental Health Court for years and then completed a report for the Department of Justice called The Mentally Ill: How They Became Enmeshed in the Criminal Justice System and How We Might Get Them Out in 2015. That report only saw light of day because of a CBC Freedom of Information request.

Justice Schneider points out that the main fault is the Ontario Mental Health Act and the conditions required for an involuntary committal to hospital. Under the current legislation, someone who is exhibiting all the signs of illness, listening to the voices of Martians in his head while denying he is ill, cannot be hospitalized without consent. Neither the police nor the Justice of the Peace will help hospitalize that person if they do not believe there is “clear evidence that he is dangerous to himself or others”. And, even if he is admitted, he is “discharged before he is stable” and “his condition deteriorates”.

Justice Schneider said “if the individual is not seen as dangerous to himself or others he is free to roam the streets ‘madder than a hatter’” And, in many cases, the person will come into conflict with the law and wind up in the vastly more expensive forensic psychiatric system.

The 1967 Ontario Mental Health Act allowed for someone to be admitted to hospital involuntarily if they were suffering from a mental disorder severe enough to warrant treatment in hospital for their own or others safety and they could be held for one month. That was changed in 1978 thanks to the civil libertarians to involuntary treatment only if the person had threatened or attempted to do harm to himself or others. The time held was lowered to 14 days.

Further, the 1967 Act considered that hospitalization meant treatment and people being held were treated. That changed in 1978 and someone could be held involuntarily but they did not have to agree to treatment.

Attempts have been made to change the Mental Health Act in Ontario and that was one of the recommendations of the 2008 all party Select Committee on Mental Health and Addictions. Recommendation 21 in that report states that the Ontario government should set up a task force within one year to “investigate and propose changes to Ontario’s mental health legislation and

policy pertaining to involuntary admission and treatment.”

That was 2008 and this is 2018 and the Liberal government still has not acted.

The other barrier to effective treatment mentioned in the Spectator article is our privacy legislation. If a person is over 18, they are an adult even if they live with their parents and are supported by them. Health care providers cannot talk to family without the permission of the ill person and, if they are paranoid, they may not grant permission.

The Select Committee also decided that the government should change the privacy legislation in recommendation 22. “The changes”, they said, “should ensure that family members and caregivers providing support to, and often living with, an individual with a mental illness or addiction have access to the personal health information necessary to provide that support, to prevent the further deterioration in the health of that individual, and to minimize the risk of serious psychological or physical harm.”

The 2013 Mental Health Commission of Canada report on caregivers made similar recommendations but, again, this is 2018 and Ontario has still done nothing.

These are issues that those of us with an interest in improved care for the mentally ill need to ask the candidates running in the upcoming provincial election.

 

Skeptical Musings on Mindfulness

By Marvin Ross with an Addendum by Dr David Laing Dawson

I am pleased to say that I now have something in common with an apologist for Catholicism when it comes to Mindfulness. Susan Brinkman warns Catholics about the dangers of this practice in her book A Catholic Guide to Mindfulness. We have some criticisms in common although part of her objection to this overly touted strategy is that it is too closely linked to Bhuddism. She is concerned that people will abandon prayer and move away from talking to God for the relaxation of the mindful strategies.

Where we do agree is that Mindfulness is oversold and not well researched with valid studies. As we all have likely seen, mindfulness is promoted for stress reduction, depression, anxiety, pain control and likely more. Ms Brinkman cites a metaanalysis from Johns Hopkins University from 2014 that looked at 18,000 studies and found that only 47 (or .0026%) were methodologically sound. Over 99% of the studies to evaluate efficacy were not sound.

Of those 47 studies, “the research found only ‘moderate evidence’ of decreased anxiety, depression and pain and ‘low evidence’ of improved mental health-related quality of life.” She also points out that there is a great deal of money to be made by practitioners.

The poor methodological quality of mindfulness studies mentioned by Ms Brinkman have not gone unnoticed in the field. This past October, a new study was published that set out to evaluate studies over the past 16 years for signs of improved methodological rigour. They found that of the 142 research projects they looked at, there was only a slight improvement in methodology and the studies still appeared to lack scientific validity.

In reporting on this latest study, psychologist James Coyne asks this:

Should we still take claims about mental health benefits of mindfulness with a grain of salt?

His answer:

“A systematic review by one of mindfulness training’s key promoters suggests maybe so.”

Addendum from Dr Dawson sent from Australia

Two popular contemporary forms of counselling can each be summed up in a simple piece of advice, and a piece of advice most of us have heard at least once from our parents and grandparents. “Look on the bright side.” (CBT) and “Stop and smell the roses.” (Mindfulness).

They do not speak to mental illness, suffering, disease, or much of reality. But they do address the existential problem of we humans being conscious life forms with an awareness of ourselves as vulnerable bags of mostly water with limited life spans.

We must anticipate danger and threat to survive, but failing a math test is not a terminal diagnosis. We must, as I must now, remember to look first to my right (Australia) before crossing the road. This is a moment when it is not wise to let the roses distract.

We know it is not good to be pessimistic and constantly worried, but there are moments when anxiety and worry are required. We know it is not good to miss the calm, the peace, the beauty of this world and always be distracted by the traffic but I still need to remember to look to my right and then my left before crossing the street.

The popularity of Mindfulness (and Buddhism for that matter) speaks to how hard it is to find that balance, how hard it is to be a sentient being not always terrified, worried, fearful, angry, jealous and preoccupied by the intricacies of life and the certainty of death.

Yesterday at The Rocks in Sydney among the tourists and locals we several times watched a man trudge by dressed in brown monk’s robes, a large hat and boots, wondering what he was up to. Then in a moment when I was distracted he approached my wife and slipped a cheap beaded bracelet on her wrist, and then another on the wrist of our granddaughter, and then said something about money and showed her a book of initials beside a list of sums. The figures were each between 20 and 50 dollars. I muttered “no, no, no” as my wife reached for her purse and came up with five dollars. I told him it was bad karma to con people. I’m not sure if he said, “f***k off” or “father” as he left us. He also gave her a gold (thin plastic) medallion with the words “Work Smoothly” and “Lifetime Peace” printed on it.

We had at least five dollar’s worth of laughter and chatter from this, before falling back to enjoying the warm sun, the pigeons and Rainbow Larakeets, the parade of old and young humans from several continents, the busker at the corner, and the delightful teasing inquisitive grandchild sitting between us. My daughter arrived 20 minutes late having been stuck in Sydney traffic and forced to park four blocks away in an expensive arcade. This put her in a foul mood, which was quickly alleviated by a bit of paternal mindfulness and CBT.

Looking At Trump and Thankful for a Constitutional Monarchy

By Dr David Laing Dawson With an Addendum by Marvin Ross

Mike Pence looks upon Donald Trump with besotted eyes. Six months after the election Trump can get a crowd chanting “Lock her up.” I watch Jeffrey Lord, once an acolyte of Ronald Reagan, crawl through semantic swamps to throw himself at the feet of The Donald.

I read many accounts of how and why Donald Trump won that election: The forgotten citizens of the rust belt, of coal country and small town America. The rise of a populist leader sewing division, preying on our instinctive distrust of the other tribes who may covet our watering hole.

But I am also aware of very many successful cult leaders, men who can grow a following of thousands (or millions) in order to steal all the gold and the young women. To say nothing of tin pot dictators, cruel despots, and other false prophets.

It all speaks to a flaw in our human character, and a flaw, like many of our flaws, that once had survival value.

I’m sure when we lived in the jungles, even when we rode horseback on the prairies, and our tribes were beholden to a single alpha male, when we even sometimes thought of this alpha male king as a God king, we were stronger as a tribe when we offered blind allegiance, when we never questioned his decisions, and when we overlooked his indiscretions and malfeasance. Not that long ago we would shout “For King and country” as we rushed off to war.

This all implies an ability (a tendency) we have to project unto our leader, our king, the strongest of our desires and wishes, to assign to him the kinds of wisdom and compassion and strength that we would wish to see in our leaders, and in ourselves. We see such a leader, not as he really is, but as we would want him to be. Donald was right when he said his base would still vote for him if he shot someone on Fifth Avenue.

With the checks and balances of the American Constitution, with the equally powerful House, Senate, Judiciary, and with the fourth estate intact, America may survive this despot and our very human tendency to see someone as we wish to see ourselves.

But I write this really as a plea to keep our constitutional monarchy in Canada. We humans need a King or Queen and a Royal Family, as long as they have no legislative power. Then we can project into them all that we wish to. We can revere them, talk about them, read the gossip and inside dope, admire their wealth and stateliness. We can argue about their usefulness and cost. We can enjoy the pomp and circumstance. They can be our symbols of power and goodness. They can be the embodiment of our collective.

And as long as we have a monarchy it will let us see Justin Trudeau as a guy doing a half decent job as a member of parliament and, for now, our Prime Minister. Fully human, entirely replaceable. Even though he made the cover of Rolling Stone, we will still listen to what he says and watch what he does, and judge him accordingly. And we and our parliament will hold him accountable for all that he says and all that he does.

Addendum

Aside from the existence of the Electoral College, the biggest problem with the US system is the separation of powers. Because of that, the executive branch headed by the president is separated from Congress.  While the Vice President resides over the Senate, the president has the power to veto all bills passed while not sitting in either the Senate or the House.

In a Parliamentary System, the Prime Minister (PM) or the premier in Canadian provinces is an ordinary member of the legislature elected by his constituents in a local riding. He or she becomes the head person when elected by the party. As such, the PM sits in the legislature and is responsible to it, the local constituency and to the party. During question period, members of the opposition have the opportunity to ask questions of the PM and the cabinet in what is often a very heated exchange. That heated exchange is televised and often clips are on the nightly news.

If this institution was part of the US system, Mr Trump would have to sit in the legislative branch and be grilled on his policies. That would make for great TV.

 

How to Achieve Medication Compliance

By Dr David Laing Dawson

Anosognosia is an unwieldy word meaning lack of insight, or, literally in translation, `without- disease- knowledge`.  In the case of some brain injuries or stroke the brain may become quite specifically unaware of what is missing. The part of the brain that would perceive this is damaged. With mental illness, schizophrenia, bipolar, the apparent lack of insight  or denial of obvious impairment or implausible grandiosity may be more nuanced and variable. It may be part defensive in nature; it may be more a denial of the consequences imagined; it may be more about the power relationship at hand. Some of it may be merely human, the unwillingness to give up a longstanding belief, whether that be of the second coming,  CIA surveillance and persecution, or of being chosen, special, destined for greatness.  Some of it may be a distorted form of the normally complex parent – adult child relationship.

But almost every family with a severely mentally ill member must deal with, at least once, that time when the ill member claims to be fine when obviously not, and refuses to take medication or go for an appointment to the doctor.

How to approach this. What options do you have. Below is an outline for talks I have given on the subject:

Stage 1

  • Calm and slow
  • Non-threatening (posture, position (e.g. side by side), distance, tone, pace)
  • Aim for a negotiated reality. (not the acceptance of your reality)
  • i.e. He may not be willing to admit he is ill or delusional or needs medication but may be willing to agree that he is in trouble, anxious, not well, in pain, not sleeping, and that in the past the pills have helped with that. He may by his behavior be willing to take pills or come for an appointment as long as he doesn’t have to admit to need or illness.
  • Gently find out what he or she fears.
  • Gently find out what his objections are.
  • Allay these objections and seek a “negotiated reality”.
  • Stay away from labels, declarations, and you defining his reality.
  • Offer pill with glass of water without saying anything.

Stage 2

Family intervention, same tactics as above but with whole family or available members, or a specific family member with influence.

Stage 3

Ultimatums. (You can`t live here unless…..)

But before doing this you should assess the level of risk (provoking violence, and/or leaving and putting self at risk). Discuss in family plus with a professional. Must also assess realistically your tolerance for confrontation, anxiety, worry, guilt. And ultimatums are only effective if truly meant, if you are truly willing to carry through with the ultimatum. If the ultimatum works, do not reiterate it unnecessarily.

Stage 4.

Form 1, J.P., Court order, Police intervention.

Before doing this decide on desired outcome, assess odds of achieving this desired outcome as best as possible (i.e. is there a treatment that works? Will they keep him or her long enough? Does the trauma of this kind of intervention justify the long-term outcome?)

Having decided on desired outcome, use all resources to achieve this. Learn the wording of the Mental Health act to get desired outcome. Use this wording to your advantage. Find family mental health friendly lawyer. Discuss with the health professionals who will be receiving the family member.

Family Doctors and Psychiatric Medication

By Marvin Ross

I’ve heard this more than once but family doctors who wonder why their patient with a serious mental illness is on the psychiatric medication they are on when they seem to be fine.

And so, they suggest that the patient either go off the meds or start to taper them with, of course, disastrous outcomes. The latest case I heard was of a woman I know with stable schizophrenia who has been stable for many years. This is a woman for whom it took years to stabilize and get her to the level she is now.

The patient in question is so in favour of medication that she has been active giving lectures to health care students and other professionals on the importance of them for stability.

But then, her family doctor wondered why she was on the dose she was on. He told her that as you get older, your metabolism slows and you do not need as much medication as before. She agreed to start lowering her dose with the expected result. She slowly became more psychotic to the point where her family had to to go to court to have her hospitalized and forced back on medication.

She is now back to normal stabilized on her meds but considerable time and anguish was wasted on something that did not need to happen.

Of course, my anti-psychiatry critics will suggest that she was addicted to the medications and that her descent back into psychosis could be predicted by her body reacting to the poison that was cut off. That, of course, is nonsense. She needed the medication and when it was taken away, her illness returned. In one of his earlier blogs, Dr Dawson mentioned that when psychosis returns, the individual develops the same delusional thoughts as they originally had. That happened in this case.

Regardless of the illness, if you are on medication, you are doing well, and there are no side effects, then why mess with it. One psychiatrist I quoted in one of my writings pointed out that it is so difficult and time consuming to find the right medication at the proper dose to help a patient, why mess with it when it is found.

Unless there is a really good reason to do so, continue with your dose.

Reminiscences of Hockey and Schizophrenia

By Marvin Ross

This past week Johnny Bower, the 93 year old former great goalie for the Toronto Maple Leafs, passed away. One of the comments made of him was his charitable work along with the fact that he was goalie the last time the Leafs won the Stanley Cup. I’m old enough to remember that it was so long ago.

His passing twigged my memory of the time that the Hamilton Chapter of the Schizophrenia Society of Ontario were the recipients of the charity of old hockey players. I’m not sure when this began but I became involved in the chapter in the late 1990s and was chair for a few years. The largest and most successful fund raising event was the annual National Hockey League (NHL) Alumni Association golf tournament put on for us at a course north of Toronto.

The moving forces were our executive director at the time and Keith McCreary who was one of the founders of the NHL Alumni. Sadly, both are no longer with us. I attended two of the golf tournaments in 2000 and 2001 and Johnny Bower was there along with many of the hockey greats from my childhood. I certainly remember Red Kelly, Dennis Hull, Eddie Shack, at least one of the famed French Connection line for the Buffalo Sabres, and numerous others.

What struck me was their incredible generosity. Some donated memorabilia to be auctioned off and all of them were more than happy to peel off $50 and $100 bills to enter the many raffles that were held. Hockey players of that era did not make the big bucks that they do today as Dennis Hull mentioned in his after dinner stand up comedy routine. He commented that today’s players earn more in a day than most of the guys in that room made in their entire careers. But their generosity to a disease that most of them probably knew very little about was remarkable.

Another guest who was much beloved by the hockey crowd was Michael Burgess who often sang the national anthem at Leaf games and who played Jean Valjean in Les Mis. The players all loved his rendition of Danny Boy which he did that evening. The link above is to his singing on Youtube.

Also incredible was one mother who positioned herself on the first tee and subjected each and every foursome before they teed off with her lecture on the horrors of schizophrenia and the need for more treatment, family support and research. She was not a young woman but stood in the sun and heat for hours without either a pee break or a drink break so that she would no golfer would forget what they were supporting.

That night, I drove home with our executive director and what was left over from the day along with about $10,000 in cash for the bank when I was stopped in a police road block looking for impaired drivers. Fortunately, I had cut myself off early in the evening.

That was September 10, 2001 and we all know what happened the next day 9/11 that changed the world forever.

But, the moral of the story is that there are good people out there who can understand serious mental illness and do their bit to make the lives of those who suffer just a tiny bit better.

schizcover  For more on schizophrenia, see Schizophrenia Medicine’s Mystery Society’s Shame and other Bridgeross titles

The Decline of Mental Illness Treatment from the 1980s On

By Dr David Laing Dawson

Through the 1970’s into the 1980’s I ran what we called Community Psychiatry Services. They were General Hospital based and consisted of teams of psychiatrists, nurses, social workers and psychologists. We used what we called an “Active Intake” process that ensured that the severely ill received appointments very quickly and the worried well were rerouted to other agencies. The “active” part of the intake process was a pre-appointment engagement of the patient, the family, the other caregivers. Doing this required that the clinic not become specialized, and that it did not have exclusionary criteria.

The second component necessary for this is a true team, with each member involved, the care plan decided by the team led by a psychiatrist, and that the nurses and social workers be willing to function as case managers. It also required that each member of the team be prepared to help with medication compliance and monitoring, medical care, budgeting, finding bus passes, talking to families, giving shopping lessons, helping with all activities of daily living and also counseling.

Doing this work requires a high tolerance for chaos, uncertainty, anxiety, and insanity.

What happened?

Several things I think, though it is difficult to see the forces of change while living within them.

1. The length of stay in hospitals for the mentally ill became shorter and shorter, driven at least in part by spurious management and budget ideals.

2. The mental hospitals continued to downsize, in some part as a naive ideal, but mostly as a means of shifting cost (and responsibility) from Province and State to Community and Federal Governments. (Note the stats of the Chicago area show an exact mirror image between the declining numbers in hospitals, and the inclining numbers in jails and prisons from 1970 to 2010)

3. The general Community Psychiatry Service is not a good academic career choice. Academics need to specialize for teaching and research opportunities. Hence the development of Anxiety Disorder and Bipolar Clinics. This doesn’t work for the severely mentally ill because to satisfy all the research and protocol needs the waiting list is long, the assessment phase onerous.

4. Again, based on naive idealism, many community services shifted location from the hospital to the community. But once a clinic is moved away from the hospital (geographically and managerially) several things happen:

a. They can no longer risk taking disorganized, chaotic and potentially dangerous patients and

b. Non-medical and non-psychiatric philosophies start to dominate, and the severely ill are excluded. And

c. (at least in my experience) away from the stable budget and managerial practices of a hospital, strange things happen, all the way from pop psychology to fraud.

5. I suppose it was inevitable that each discipline develop more of a sense of autonomy and independence. Social workers and other mental health professionals are no longer case managers working with psychiatrists. They are independent counselors. The development of simplistic models of counseling (CBT and DBT) which can be applied once per week for ten weeks helped this along. This has also contributed to something of an anti-pharmaceutical attitude. (By the way, there is no evidence that CBT is any more helpful than any other professional counseling relationship, but being a rigid simplistic set of responses it is easier to study)

6. I am also convinced that by putting addictions and mental health (illness) under the same umbrella, we diluted what sympathy and empathy the community was developing for the seriously mentally ill.

7. This was compounded by the so-called recovery model, which at its heart, really means (and this may be appropriate for addicts) that if you really try hard enough and think only good thoughts (CBT), and are sufficiently “supported”, you can get well and recover fully.

8. The corollary of this being that if a person with a psychotic illness is not recovering it just means he is not trying hard enough.

9. De-stigmatization. I just happened to watch “Big” the other night and noticed that the actor who played a walk through part, non speaking, looking homeless and mumbling to himself in downtown New York, was listed in the credits as playing “Schizo”. The real way to de-stigmatize any illness is not by feel good infomercials, but by providing adequate and successful treatment. Think Leprosy, AIDS, cancer.

10. Without a team to work with, to case manage, to field crisis calls, to make home visits, to check on progress more frequently, a lone psychiatrist will find it difficult to treat the severely ill.

11. The tightening of the mental health acts and processes in each state and province,  the protection of individual rights and the provision of due process (as defined by lawyers), again based on a sort of naive idealism, resulted in four unintended consequences: thousands of people suffering from untreated psychotic illnesses in the streets and shelters, a burgeoning population of mentally ill in the prisons, the dramatic growth of locked Forensic Psychiatry Units, and a sad return to locked doors for the rest of the hospital now dominated by the Forensic units.

Between 1900 and 1960 the severely mentally ill were mostly institutionalized, treated in mental hospitals for long lengths of stay, by doctors who were often imported and/or had limited licenses. Then as now, the Academic and North American trained psychiatrists worked in private offices treating a small number of patients over many years. These patients could be counted on to be articulate, educated, and at least middle class.

Between about 1960 and 1990, with new effective medications and the move to de-institutionalize, community clinics like the ones I worked in developed in many parts of North America; the General Hospitals developed psychiatric programs, and for at least two decades, perhaps three, we seemed to be moving in the right direction. In parts of Canada incentives were developed to keep psychiatrists working in hospitals with the severely ill or as they were called then, the seriously and persistently ill. And the University Departments of Psychiatry finally took an interest in the medical treatment of the severely mentally ill.

We were going in the right direction.

And now it seems we must re-invent the wheel.

For more information on schizophrenia, check out the documentary Schizophrenia in Focus