One Last Appeal to the American Voters

By Dr David Laing Dawson

In 4 years 5 of my grandchildren will be in their teens, one turning six and another will be 21. For America and the world to be in a better place 4 years from now the following spheres of American reality must improve or, at at the very least, not get worse:

1. gun control

2. race relations

3. access to health care

4.  public education

5.  access to college and universities

6.  infrastructure

7. police practices re gun use

8.  reliance on Prisons

9.  access to mental health care

10.  a pathway to citizenship for current illegal immigrants.

11. treatment and rehabilitation response to addictions.

12.  the respect and trust of world leaders and the citizens of other countries.

13. Play a large and important role in all world organizations.

14. Participation in the containment and eventual elimination of ISIS/ISIL

15. Participation in the stabilization of unstable countries.

16. Help end the civil war in Syria.

17. Participation in finding solutions to current migrant/refugee problems facing much of the world.

18.  the use of renewable energy sources, reduce reliance on oil and coal, or invest heavily in the development of scalable technologies for the removal of CO2 from the atmosphere, or both.

19.  income equality. Improve minimum wage. Increase tax rates and tax recovery on the wealthy, individual and corporation. Recover tax from tax havens. Close loopholes that allow avoidance by the wealthy.

20. Work with international agencies to control nuclear proliferation and ultimately reduction and elimination of nuclear weapons.

***

Non-Americans are often appalled at the grandiosity and Jingoism voiced at times by American citizens. USA, USA, USA. But the truth is the entire world needs a good and healthy and influential United States of America. We need you to live up to your ideals.

We need you to be stable, and one of the adults in the room. I doubt the world could survive four years of deteriorating alliances, economic recession, more violence, an increasing gap between the 1% and the rest, policies built on ignorance and bluster, denial of global warming, and the angry impulsive use of nuclear weapons.

So read that list again, remove a few if you would like, add a couple more, and ask yourself which candidate for president, if elected, is most likely to improve most of those issues, or, at the very least, not make matters worse, far worse.

 

 

Conspiracy Theories, Big Pharma and Anti-psychiatry

By Marvin Ross

The world is full of conspiracy theories from President Obama was not born in the US and is a Muslim to vaccines cause autism, cancer could be cured but Big Pharma prevents the cure to make money and Big Pharma drugs people with mental illnesses to also make money.

The only truth in any of that is that Big Pharma’s goal is to make money. And that goal to make money is why they exist as they are private for profit companies in our capitalist society. TV networks, publishers, banks, retail outlets are all designed to make money by providing something that people either want or need.

What’s the big deal?

And if you are opposed to that concept, then join a political movement that advocates for socialism. However, bear in mind that only Big Pharmaceutical companies have the means and motive to invent, study, produce new and better treatments for our ailments. But they need to be monitored, regulated, and whatever research they sponsor that “proves” the safety and value of a new agent needs to be replicated by  independent studies.

Profit companies provide a service or a product that is needed in order to make money for their shareholders or owners. In the case of Big Pharma, it is medications that will help to ameliorate illness – probably not cure but reduce symptoms. They are the ones who do this because governments either can’t or won’t. History has shown that their products have dramatically improved our lives, or at least the levels of health and wealth and comfort that many of us maintain.

The role of governments is to provide a regulatory framework to ensure that these capitalist outfits do not ignore ethics in their pursuit of profits. Restaurants need to abide by rules of cleanliness for example so that their customers do not get ill and there are government inspectors to ensure that. In order to drive a car, you need a license as proof that you are capable.

The banking system requires very stringent regulations to ensure they do not run amok which is what happened to cause the recession in 2008. Many of the banking controls in the US had been removed and we saw what happened. Canada, which has always had a very tightly regulated banking system, was only mildly impacted by the 2008 crash.

And so too Big Pharma. In the US, Teddy Roosevelt brought in legislation creating the FDA in 1906 to regulate food and drug purity. At that time, many medicinal elixers contained opium, heroin and cocaine so regulation was implemented to make these products safer. Today, the FDA regulates drug development via a very stringent process to ensure that when a drug is made available to the public, it has proven to be efficacious for its intended purpose with side effects that do not outweigh its benefits. Absolutely we should not trust them or the doctors who shill their products for big paychecks. But without them there would be no pharmaceutical progress.

In Canada, that role is carried out by Health Canada and in the European Union, it is the European Medicines Agency. Each agency must approve any drug sold in that jurisdiction so that Big Pharma must gain the approval of the FDA, Health Canada and the European Agency to sell their product in those jurisdictions.

And drug development is expensive. It is estimated that for every 5-10,000 agents that begin preclinical testing, only one ends up approved for dispensing. The cost of developing that one prescription item is about $500 million and takes 8-12 years. That is a lot of money and time to get to market. Now I’m not justifying the price of drugs but the company does have to get its money back and show a profit.

The resources required to accomplish all of this are far greater than governments can afford. For those who think that drugs are mostly poisonous and are foisted upon unwitting patients by evil people to make money, this is the process to ensure that the drugs are as safe as possible.

Promising therapeutic agents are identified based on the latest understanding of a particular disease. That agent is then tested in lab animals to determine safety before an application is made to the regulatory body for an investigational new drug license. At this point, the testing involves 3 phases of study. The first involves giving a small amount of the agent to a small group of healthy volunteers to see if there are any adverse effects.

In the second phase, a small group of subjects with that disease are studied to see how effective the agent is. The third phase, if they get that far, can last for years and involve thousands of patients in various locations to test for efficacy compared to a placebo or an already approved drug and side effect profile.

Only then, years later, is the drug submitted for approval to the regulatory agency who then have their own scientists evaluate all the data. A drug approved by one regulatory agency for a particular country as I said earlier will also have to be approved the same way by the regulatory agency in those other countries.

This is a very long and costly process to ensure that the drugs doctors use for their patients are effective and have a side effect profile that is not greater than the benefit they have. And everything has a side effect including something as seemingly benign as water

Of course, it isn’t always possible to predict what will happen when patients begin taking medications in the real world and so regulatory agencies do have adverse event reporting systems in place to track and investigate these occurrences. In many cases, drugs are removed from the market for various reasons that became clear with widespread use over time. Wikipedia has a very long list of these agents, the countries where they were pulled and the reasons.

The system is not perfect but it works for the most part and people are able to have prescription products to help ameliorate their symptoms. To attack Big Pharma for developing these drugs and the doctors who prescribe them for their patients, is absurd. I am not defending Big Pharma or suggesting that they do not sometimes go to excess but simply describing what is and why.

Donald Trump vs Lincoln, FDR, Eisenhower and JFK

By Dr David Laing Dawson

A depressing explanation for the existence of Donald Trump as a viable candidate for a position held by Lincoln, Eisenhower, F.D. Roosevelt, and John F. Kennedy.

Disparate data supports this hypothesis:

  • I have some patients, teenagers, 20 somethings, who spend almost every waking hour in front of one or two or even three screens, absorbing Youtube Videos, Reality TV shows, and gaming. Some sleep at random times, and bathroom breaks and grabbing some food from the refrigerator are minimal, random, and treated as an interruption.
  • Some years ago mental health professionals were so influenced by film and television that “multiple personality disorder” migrated from being a theatrical device to a real syndrome.
  • One teenager I have seen told me she did not identify as specifically male or female. And then she went on to tell me that in fact she did not identify as human.

Two hundred years ago the average person lived within and experienced reality for 99% of his or her waking hours. Perhaps he or she listened to a storyteller once per week.

Books do transport us to imaginary places populated with imaginary people, but to make a book come alive, the writing must be clear and we must use our own imagination to visualize the pirate ship, the colony on Mars, the monster in the swamp. The boundaries between literary fiction and the reader’s reality remain reasonably intact at all times. At least after grade 6.

Perhaps our ancestors in the 18th and 19th century were transported to fictional experiences as often as once per week at a theater, and once per week at a church. But no more than that.

With radio in the 20th century this transportation increased, and the power of it is evident in the consequences of Orson Welles’ broadcast of War of the Worlds.

Still, absorption into a fictional universe occurred, at most, and for most, a few hours per week.

Then came television, and we couch potatoes expanded that to perhaps 20 hours per week.

And now new media, smart phones, tablets, internet, plus television and film, and a whole generation has grown up with their waking hours being divided evenly between a virtual reality (fiction and spectacle and gaming), and reality, and for some the balance has made a profound tilt toward fiction and virtual reality.

So I am wondering if Donald Trump owes his current success to a demographic that can no longer make, can no longer see clearly, the distinction between entertainment and reality, between spectacle and thought, between the absence of real consequences to bad ideas and decisions in virtual reality and the tragedies that bad decisions cause in the real world.

The proposed high wall between the US and Mexico may be a specific symptom of this confluence of reality and virtual reality. In a computer game such a wall can be built quickly and easily, the cost assigned to one’s opponents. It fulfills its purpose or not. It is breached or not. It can be torn down as easily as it was put up. Even if we go bankrupt and our warrior is killed, we simply push the reset button. That ain’t reality.

Donald Trump is a spectacle, a fiction, a celebrity. He is entertaining. He appeals to the petulant child in all of us. We don’t worry about the consequences of his leadership, his stupid statements, his endless lies, because this is just a TV show, a Youtube video, a game. He is a harmless Avatar, and a guilty pleasure. Vicariously we can be The Donald for a while, enjoying his billions, his jets, his mansions, his trophy wife, his freedom to say whatever comes to mind, his freedom from guilt, from anxiety, from empathy. We needn’t think about the real consequences of his candidacy because the season isn’t over yet. And it is just a game show after all.

Charter Challenge To B.C. Mental Health Act Is Misguided

By Marvin Ross

Two B.C. patients have just launched a Charter challenge to the province’s Mental Health Act. The last challenge to a Mental Health Act that I am aware of was in Ontario where expanded civil commitment rules and the provisions of Community Treatment Orders (CTOs) were challenged. That was unsuccessful. A CTO is an order mandating treatment in the community.

The case in B.C. is a bit unusual in that it opposes provisions in the B.C. Act that are unique in Canada. The two plaintiffs are opposed to the rules that allow a detained individual to receive treatment without consent. The concept of the Act is that if you need to be detained because you pose a danger to yourself and/or others yet lack the capacity to seek voluntary treatment, then you should also be treated as soon as you are detained. That provision is one that makes the Act in B.C., in my opinion, superior to other jurisdictions.

The claim suggests that this forced treatment violates a person’s rights and that the person being committed should be able to help decide on the treatment they wish to have. However, involuntary committal only occurs when someone with a mental illness poses a danger and refuses to accept treatment according to the guide to the Act. (P11). If they recognized they needed treatment and accepted it, they would not be detained.

The plaintiffs argue that with physical illnesses, patients are allowed to make bad health care decisions, which are denied to psychiatric patients. But — and they acknowledge this — if someone is taken to the emergency injured and unconscious, it is appropriate that they be treated. When someone’s brain is so injured and incapacitated by their mental illness, they can be considered to be in the same situation as someone unconscious from a physical trauma. It may take them longer through treatment to reach a level of consciousness where they can participate in their treatment options but providing that treatment is analogous to treating the unconscious victim.

Many will likely disagree with my statement above but B.C. civil libertarian, Herschel Hardin, writing in the Vancouver Sun in 1993, gave an excellent explanation of that when he said, “Here is the Kafkaesque irony: Far from respecting civil liberties, legal obstacles to treatment limit or destroy the liberty of the person.”

He went on to say:

The opposition to involuntary committal and treatment betrays a profound misunderstanding of the principle of civil liberties. Medication can free victims from their illness – free them from the Bastille of their psychoses – and restore their dignity, their free will and the meaningful exercise of their liberties.

Ontario is a good example of the downside of committing someone involuntarily because they pose a risk of danger to themselves and then allowing them to refuse the treatment that is deemed necessary. This issue was discussed in a 2008 article in the Canadian Bar Review called Treatment Delayed – Liberty Denied . The authors demonstrate that attempts to safeguard autonomy by allowing involuntary patients to then refuse treatment has the opposite effect. It: “often results in subjecting them to prolonged detention, mental anguish, physical and chemical restraint, and solitary confinement.”

The most famous Ontario case is that of Professor Starson as he called himself as he believed he was a son of the stars (starson) and a professor. In 2003, the Supreme Court of Canada upheld his right to refuse treatment that had been proposed in 1998 (P 680 in Bar Review Article). After that decision, Starson’s delusion led him to refuse to either eat or drink for fear that his imaginary son would be tortured. By 2005, his health had deteriorated to such an extent that, fearing death, his doctors appealed to the Consent and Capacity Board who ruled that he could be treated. He began on the anti-psychotic medication that he was offered in 1998 and he improved dramatically. He lost seven years of his life as the result of his refusal to accept treatment [P 680-681 in article].

Three other patients like Starson were incarcerated from 5 1/2 years to over 10 with long stretches in solitary until they became so ill without treatment that they had to be treated to prevent death [P 713]. As with Starson, the three of them improved dramatically once they began treatment. One person who continued to refuse, Paul Conway, has been locked up for 25 years and, without treatment, he is unlikely to ever be discharged P 714].

The choice is agreeing to treatment when voluntary or putting up with it when involuntary and getting better in both instances versus being locked up indefinitely. I think the rational decision is treatment.

And, it should also be pointed out that there are protections for the involuntary patient at every step of the procedure. Those opposed to involuntary treatment imply by omission that once someone is locked up they remain so and lose all their rights. That is not the case in any jurisdiction.

Section 7.1 of the B.C. Guide lays out all the rights that the involuntary patient has upon being hospitalized. These range from the right to consult with a lawyer or advocate, the right to a second medical opinion, to a hearing by a review board, regular reviews of the committal orders and the right to apply for habeus corpus.

Involuntary committal and treatment is not something that is taken lightly by anyone or used frivolously but is only done in extreme circumstances in the best interests of the patient.

The Excited States of America

By Dr David Laing Dawson

I am of an age when I might sit on the back porch and grouse about the sorry state of the world. Either that or stop watching the news. Two items disturbed me last night. They were two rather inconsequential items amidst the horrors of the Fentanyl epidemic, the disaster of Aleppo, and a Canadian company selling war machines to South Sudan. But these two items spoke of a mind set more far reaching in its possibilities than the others.

The first was the CNN report of the Iranian warning to a US plane. I listened to the warning. It was standard fare. A radar ground crewman warning a war plane that it was currently in international air space but drifting toward Iranian air space and if it entered it would be “targeted”. An Iranian radar guy doing his job.

But then we have Wolf Blitzer announcing in that voice of his that I suspect could not order a cup of coffee without it sounding like Armageddon is the next customer in line, and then commentary by experts and generals and an old CIA guy. Wow. I could hear the war drums, the pounding of chests, the sirens in the missile silos.

I hope this is a matter of ratings, of audience appeal, the need to grip the audience with drama and threat and suspense. I hope the American ego is not that fragile. For if it is, and if Donald is commander-in-chief, a raised middle finger could trigger a nuclear disaster.

The second item was our Peter Mansbridge interviewing a debating expert from one of our Universities. I have no doubt there is technique involved in a good debate. And I am sure technique is everything in one of those sporting debates with an audience of students and profs scoring the event.

But the examples used were clips from the Lauer interviews of Trump and Clinton. The clip of Trump had him first stating a lie, then quickly following this with two simple truths, and then diverting to an attack on Obama. The expert pointed out the form of this technique and rated it a good one that she herself has used a couple of times. Start with a lie but cover it quickly with a two indisputable truths. Mansbridge did not question this.

The boundary between entertainment and reality has disintegrated. This is a candidate for President of the United States lying, not a clever sophomore convincing us that angels do dance on the head of pins. Not a reality TV show where the only stakes are ratings and advertising dollars.

I would actually like to believe that when Trump lies it is a clever strategy he is employing. Unfortunately I think it comes naturally to him, easily, just as it does to a child.

Follow Up Donald Trump and the Nature of Thought

By Dr David Laing Dawson

My Monday blog may have leapt too quickly from pondering on the nature of thought to Donald Trump. Let me try to clarify.

This is a unique situation. We have a candidate for the highest office in the land who has no track record in public service, elected office or governance. We cannot look at his record of speeches, policies, and voting to make any decision about how he might continue to perform, what his core values are, how he thinks about issues both large and small. We do not have a record of principles and problem solving to consider – at least not outside his reality TV personae, and the wild west of High Finance.

We can only look at what he says and how he says it now, during this election season. As everyone points out what he says is entirely inconsistent when substantive, often outrageous, sometimes simply untrue. Only his hollow slogans are consistent: “Make America Great Again”.

So we need to ask, “How does he think? Does he have a keen penetrating mind? Can he ponder the evidence, consider long term outcome, consider consequences to people other than himself? Can he dispassionately apply deductive reasoning to the questions that will confront him. Can he look beyond his very human emotional reactions to slurs, to impasses, to challenges, to disappointments and to sycophantic praise?”

Now I must admit I think we are all a little limited in this attribute. Hence the first half of Monday’s missive. What usually follows the phrase “I think…” is a rationalization. Much of what we think and say is really a defense of what we did or said yesterday or of a rigid belief we happen to hold.

Seldom do any of us apply that other kind of thought to an issue: look at the evidence with an open mind, apply logic and reasoning, consider the short and long term consequences to ourselves and others, and formulate a sensitive and considerate answer.

But that is the kind of thinking I want our leaders to have, especially those who may be called upon to make momentous decisions. We can only see evidence of this through our candidates’ track records or implied by their off-the-teleprompter speech.

And I see no evidence of this kind of thinking in Donald Trump’s speech pattern – in his off-the-cuff speech. In fact I see only the rationalizations, evasions, repetitions, accusations, partial sentences of a 14 year old boy with ADD. (or a ten year old without ADD)

I used the pronoun ‘we’ in this essay though I am Canadian and do not get to vote. Like it or not we are all affected by some of the decisions made in the White House. We are all affected by how well the President of the United States comports him or herself at home and abroad.

Especially with the darkening clouds of CO2 emissions, refugees from war and famine, and unrest from inequality and deprivation looming on the horizon. We need a President who will put some real thought into these matters, who will listen to experts, and consider the long term consequences of any decision he or she may be called to make.

We need a President who understands it is not wise to either taunt or cozy up to a bear. We need a President who knows something of the history of Walls. We need a President who relies not on economic theory but on the evidence of what has worked for all in the past in some countries and states and what is working now. We need a President who genuinely understands the increasing importance of a very good public education system. We need a President who won’t bankrupt the country or blow it up.

Donald Trump, The Nature of Thought And an Appeal to American Voters

By Dr David Laing Dawson

It is very difficult to pinpoint the nature of thought.

We like to believe that our cognitive processes, our internal ruminations, our ability to formulate abstractly in metaphor and in simile, our ability to induce and deduce, to follow a train of argument to a logical conclusion – we like to believe that all this is inherently human and that most of us use these abilities to modify our words and guide our behaviours.

But it is pretty clear after we have spent some time on this earth, that much thinking is a form of after-the-fact rationalization. That is we have already acted or spoken, and now we must think of ways of supporting, explaining or justifying what we just said or did or “believe”. We remain, primarily, biological and social animals, responding to the dictates of our instincts and our social imperatives. And by social imperatives I mean those social initiatives and responses driven by our biology. The same biology that drove our social behaviour in the jungles, in the forests, in the deserts.

Our biological instincts and our social biology care little for truth, for compassion, for consideration, for nuance, for complexity. They care little for members of another tribe. They care little for the distant future.

We start this way as children. As children what we say and do is driven by biology and social imperative. Our behaviour as children is not driven by thought or careful formulation.

As children when we behave badly and are questioned about it we launch into the kinds of rationalizations and evasions that only a child could and might consider within the limits of his or her vocabulary.

But we progress. As teenagers we develop some basic reasoning power, some thoughtful reasoning power. This can lead to the marvelous idealism of youth, and/or stupid behaviour founded on inexperienced reasoning. (If I jump off this roof into the swimming pool there is only a 5% chance that I will kill myself or break my neck) An experienced adult would know that a 5% chance of dying is a risk only worth taking when being treated for cancer or escaping from Syria. Not so the teenager or inexperienced youth.

Some adults give extensive “thought” to actions, to words, weighing the evidence and considering the complexities and nuances.

We want our leaders to do this, our mayors, our governors, our premiers, our presidents.

For some adults “thought” is seldom more than after-the-fact rationalization.

In a previous blog I wrote that Donald Trump’s speech and thought patterns are those of a 14 year-old boy or girl. I have since listened to more of his off-the-cuff palaver. Now I don’t think it reaches the level of a 14 year-old still attending school. Much of it is pre-teen. Much of what he says is of the moment, an impulse, usually no more profound than “I want cookie.” “I hate my sister” or “Criminals are bad people.”

When questioned about any of this he remains pre-teens, child-like, simply repeating himself, or offering a contradictory statement, or switching topics and going on the offensive. I detect no thinking whatsoever.

He does have one bit of commercial sophistication, though. He knows to repeat a descriptor several times, till it replaces our thinking with an echo. As in, “She’s corrupt, folks. Corrupt, corrupt, corrupt.”

We are all mesmerized by this phenomenon.

But please, my American friends, if you want to continue to live at least as well as you do now, if you want a country for your children and grandchildren to inherit, please do not let this man-child take the reigns of power.

Anti-Psychiatry Bold and Profane

By Dr David Laing Dawson

Let me make a simple bold and somewhat profane statement about anti-psychiatry. Which I take to mean, really, anti-medical-pharmaceutical-psychiatry.

When I entered medical school and later psychiatry, I would have been content to believe that all these psychiatric illnesses were entirely “psychological” in origin and form. It was the 1960’s so I was even quite ready to believe that all this insanity was really a sane response to an insane world.

Insanity is fascinating. I have spent hours talking with, listening to people who believe the CIA is watching them, their phones are bugged, the television sends them messages, they are emissaries of God, the voices tell them they must kill someone, they are controlled by radar, Xrays, Radio waves, microchips, which in turn are controlled by the police, shadowy evil figures, particular races, the CIA, the Mafia, Martians and Venusians. The devil has figured in many of these conversations. God in many others.

I have talked with people who fear to leave the house, who keep the blinds down lest the watchers watch them, people who can’t cross an open patch of land, people who must count the ceiling tiles, who must pray every time they think a bad thought, people who must have every sequence of action and thought end in an even number.

I have talked with people too depressed to talk, to move, to shit, to piss. I have talked with people too agitated, too distraught, too full of dread to sit. I have talked to people who assumed I came from either God or The Devil or both or either. I have talked to people who could not complete a single sentence without it wandering elsewhere. I have written questions on paper for people who feared to talk at all. I have talked with people who keep their eyes on the door, or on the ground.

I write fiction and plays. Dreaming up historic, family, life event, and even intrauterine causes for mental illness is fascinating. I have entered a patient’s delusions. I have explained to a woman who thought her self to be Queen that I was the Prime Minister and therefore, in our parliamentary democracy, someone she could listen to. I have talked to “the illegitimate son of Adolf Hitler”, to a man who could “whistle up the wind”, and to women who set themselves on fire. I have talked with a man who killed two children and then their mother.

I would actually be content (but for the suffering from depression of my own mother) to have these people in humane mental hospitals, fed and clothed and active and cared for and available for me to talk with, explore, dialogue with, interpret, help to find a psychological cause, a trauma, a series of adverse childhood experiences that might explain their perceptions of reality. In fact I have done all of these. I have sat next to a manic with arm on her chair to comfort without touching, on a mattress on the floor with a man wanting to kill somebody, in parking lots and back porches. I have talked with a “King of Kings.”

It is fascinating. It is human. It is dramatic. It is sometimes comedic. It can provide me with wonderful fodder for my fiction, my plays.

But I am also a doctor. And as much as I romantically like the idea of being an Alienist, living in the manor house of the large Asylum and dining with the “lunatics”, or setting them free to roam a Grecian Isle, I must try my best to relieve their suffering. And, it seems, that from the mid 1960’s, just when I entered this field of psychiatry, we began to develop pharmaceutical agents that actually work, that relieve suffering, that restore functioning, that control these terrible illnesses.

My patients want their suffering relieved. They want their function restored. They want their illnesses controlled.

So, my anti-psychiatry friends, I must continue to prescribe drugs, relieve suffering, help restore functioning, and forgo the psychoanalytic pleasures, the philosophical, poetic explorations, the mad interpretations, just as I must insist on vaccinations for all children, and forgo all the wonderful and fanciful spiritual and moral interpretations of spots, and fevers, and delirium of the early 19th century.

The “Logic” of Anti-Psychiatry

by Marvin Ross

Our last couple of blogs have generated considerable criticism from the anti-psychiatry folks on Facebook. Not unexpected, of course, and I do enjoy (to a point) debating with them. I know that nothing that I or others say will sway them but it is important to expose them. If left unchallenged, they may influence some who are not as well educated in the realities of serious mental illness. And, for far too long, those shrill and hostile voices have made politicians cautious to implement reforms.

My blog on belief systems and anti-psychiatry I modified slightly and redid on Huffington Post. They gave the headline as Anti-Psychiatry Folks Cannot Ignore That Medication Saves Lives A much better head than mine.

One comment this received on Facebook included this:

How many people have you treated, Marvin, that your blogging is somehow more accurate than Robert Whitaker’s journalism? He spoke with psychiatrists and other mental health professionals too, many of which (sic) prescribe medications and are involved in Mad in America.

My reply:

Neither Mr Whitaker nor I have treated anyone as neither of us are doctors. I’m a simple medical journalist like he is but I also have a family member with schizophrenia so I have first hand experience into what the disease is like when it is not treated and the difference that properly prescribed medication makes. I too have talked to many psychiatrists.

The reply

Having a family member who is diagnosed with schizophrenia is not first-hand experience. It is second-hand perception, at best, depending on how much one is trusted. The person with the diagnosis is the only person with first-hand experience…not doctors, not family members.

Now I do agree that those of us who have never experienced a disease do not know exactly what it is like. But that does not mean that medical specialists do not know how best to treat based on the currently available research and the guidelines established by experts in the field. That goes for psychiatric diseases, cancer and all other diseases humans contract. And Robert Whitaker is not in step with mainstream medicine given how many have criticized him.

I don’t know all the people involved in Mad in America but I do know one – Dr Bonnie Kaplan. She is a psychologist at the University of Calgary and the leading “researcher” on The Truehope product called EM Power +. She gives a continuing education course on Mad in America on Nutrition and Mental Health where the value of EM Power + (EMP) is talked about.

To one person who posted in the discussion to her program, Dr Kaplan had this to say:

I do not see why people should not take one of the mineral/vitamin supplements that emanate from the two Alberta companies, but I cannot figure out the context for your question. If you want to discuss offline, my email is kaplan@XXXX. The appropriateness and the dose of these formulas can vary with the individual.

The two companies are Truehope and the offshoot Hardy Nutritional which was formed when the two founding partners – Tony Stephan and David Hardy – dissolved their partnership.

In 2002, Dr Kaplan’s 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.

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 article 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.

The vice-president of Truehope is David Stephan who made headlines around the globe when he and his wife were convicted in the death of their toddler from untreated meningitis by a jury in Lethbridge Alberta. Both had worked as well at the Truehope call centre advising customers on their treatment. You can listen to some calls that were made to the call centre here

Dr Kaplan 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.

She is one of the people involved with Mr Whitaker on Mad in America.

Dr Dawson’s last blog on anti- depressants and benzodiazapines also received a great deal of criticism. A favourite is:

Yeah, I like to get all of my information about psych drugs, withdrawal, discontinuation, and side effects from someone’s hypothetical idea of what it should look like without their having any clue at all what actually happens when people stop or start psych drugs.

And

who wrote this drivel? – It’s not even remotely accurate

I suggested to this last person that they look at the byline to see who wrote it and then look at his bio which is on the blog. I also suggested that they state what specific statement he made that they considered wrong and to provide me with evidence from research to back it up. Nothing. And Dr Dawson has worked in psychiatric hospitals in three Canadian provinces, in the UK, was chief of psychiatry in one and has been treating patients for close to 50 years.

When I suggested to someone that prescription drugs are monitored by regulatory bodies and removed from the market if their are problems, I was met with disbelief that anything is monitored. After I posted the link to the 35 drugs removed from the market by the FDA, there was no comment. Some are psychiatric drugs and two were drugs that I took for arthritis that I had no problem with and were very effective. No comment.

And no one commented when I posted this video of the author of My Schizophrenic Life.

Psychotropic Medication, Addiction, Withdrawal, Discontinuation, Relapse

By Dr David Laing Dawson

I can offer some thoughts on this from many years of observation.

Addiction is addiction. Defined as the development of tolerance (requiring more and more of the drug for the same effect) and physiological withdrawal symptoms upon stopping the drug.

Benzodiazepine drugs are addictive. The “pam” drugs. They are safest prescribed for short periods or for intermittent use. But most of us struggle with this because they offer instant relief and there are few alternatives. (this deserves a longer discussion at another time)

SSRI and NSRI antidepressant medications are not (by definition) addictive. We do not develop tolerance and require higher and higher doses. But when they are stopped abruptly patients often suffer “discontinuation” symptoms. Perhaps this is a euphemism for withdrawal symptoms but usually they are not severe, and some people come off SSRI medication without any such symptoms at all.

Usually these symptoms are unlike a true relapse and are short lived. They are described many ways by people using such words and phrases as “not like myself, foggy headed, pinging, buzzing or electric shocks in my head”.

Some of the SSRI and NSRI medications have worse discontinuation symptoms than others. Perhaps Paxil and Effexor XR are the worst offenders. But again, some patients go on and off these medications without any ill effects. Strategies to ameliorate withdrawal effects include very very slow weaning and switching to an SSRI with a longer half-life.

And it is usually not difficult to distinguish these withdrawal symptoms from a relapse of the original illness being treated with these drugs. The withdrawal symptoms are almost immediate, depending on the half-life of the medication; they are odd feelings rather than the slow return of the depression or anxiety disorder they were treating.

A true relapse of the illness may occur months or even years after discontinuation. And usually the discontinuation symptoms last a few days to a couple of weeks. When these illnesses relapse (depression, anxiety, OCD) the symptoms are usually identical to those of the first episode. This fact is one of the reasons it is reasonable to call Depression, Anxiety, and OCD illnesses.

Anxiety disorders and depressions can be chronic persistent disorders or relapsing and remitting disorders. They can be seasonal or more closely associated with events and transitions in life.

Usually these medications work. And the more severe the illness the more dramatically effective they can be.

Do these drugs actually cause a later vulnerability to depression? I think the short answer is “no”. Impossible to prove of course but I have not seen it. But I have seen much relief from suffering and dramatic improvement in function.

With all that, the SSRI’s are undoubtedly over prescribed for less serious mood problems, unhappiness, and disappointment.

Of course if non-pharmacological means of alleviating mood problems do so for you on their own, then by all means use these instead: exercise, meditation, yoga, SADS lamp, counseling and therapies of any kind, better diet and sleep, better balance in life……

But I must admit that in 40 plus years of prescribing life-balance, exercise, meditation and yoga, my patient compliance rate is running roughly 5 percent. It is very hard to initiate any of these activities if you are house bound with anxiety or morbidly depressed.