Monthly Archives: October 2014

Alternative To What?

stone of madnessBy Marvin Ross

Two interesting events this past week. Scientists at Northwestern University in Chicago announced a major breakthrough in the cause of ALS which may lead to an effective treatment. It has taken a team of researchers studying one family who are genetically prone to this disease to uncover what they believe is a cause using, of course, the scientific method.

In Orlando in contrast, we had the 28th annual Alternatives Conference put on by the National Mental Health Consumers’ Self-Help Clearinghouse and funded by the US Government. Their theme was Creating the Future: Change, Challenge, Opportunity and that “Learning from each other is a clear example of self-help, mutual support, and the principles of recovery in action!”

Looking through their program, I don’t see anything that in any way suggests that they are going to come up with solutions to the cause or effective treatment of mental illnesses. And effective treatment (recovery) does require an understanding of why and how these conditions afflict us. We are nowhere near that. What I do see is a lot of talk about peers helping peers and concepts like Emotional CPR.

I’ve always had a problem with the term alternative. It is as irritating as political correctness but on two occasions I did attend alternative conferences – the Total Health Expo Billed as “North America’s premier natural health show”. The event has been held every year since 1977 by the Toronto-based Consumer Health Organization of Canada. Both times I attended, it was with physicians and I described that visit for a magazine.  

The one person there who talked about mental illness (depression) was Carolyn Dean who claimed that 784,000 people are killed annually by doctors in the U.S., but thought that the true number might be five times greater. Dean is a popular speaker who recommends magnesium for many ailments and currently lives in Hawaii. She is a medical graduate of Dalhousie University in Halifax and then had her medical license revoked in Ontario in 1995 for “incompetence and professional misconduct.

She claimed in her talk that when she appears on TV in the U.S., she is not allowed to talk about depression and St. John’s Wort. She told the assembled faithful that the networks tell her the subject is too heavy for the audience. But she says that is not the real reason. She believes that pharmaceutical advertisers probably have a clause in their contracts with networks preventing them from mentioning anything other than prescription drug treatments.

Now I don’t know how far out the Alternatives delegates in Florida are as I was not there but I have to wonder at their use of the term alternative. I agree with Montreal scientist Jonathan Jarry who said in his Cracked Science Video on homeopathy that there is no shame in looking after our health if we feel underwhelmed by the medical system. It’s natural to look for alternatives (as the folks in Orlando are doing) but these substitutes are often not based on scientific evidence.

I’ll go even farther and support the  definition put forth in an editorial in the New England Journal of Medicine by two of its editors. In 1998, Marcia Angell and Jerome Kassirer said:

It is time for the scientific community to stop giving alternative medicine a free ride… There cannot be two kinds of medicine — conventional and alternative. There is only medicine that has been adequately tested and medicine that has not, medicine that works and medicine that may or may not work. Once a treatment has been tested rigorously, it no longer matters whether it was considered alternative at the outset. If it is found to be reasonably safe and effective, it will be accepted.”

So, if the Orlando alternative folks want to support each other as is indicated in their tag line that’s great. But they need to realize that all pills, substances, medicines are placebos. All have the potential to make us feel better, at least for a while. But some of these placebos also have scientifically proven pharmacological effect, proven help beyond that of a placebo. Those are true medicines. The others are not. But as long as the others make us feel better, give us hope, do not bankrupt us, do not cause harm, and do not prevent us from seeking real medicine, they are fine. The last two phrases being the most important: if they do not harm, and they do not prevent us from seeking real, scientifically proven, medicine.

And the drawing at the beginning of this blog is of an old treatment for mental illness – drilling a hole in the skull or trepanation. It was mainstream for a large part of history and, according to Wikipedia, “In 2000, two men from Cedar City, Utah were prosecuted for practicing medicine without a license after they performed a trepanation on an English woman to treat her chronic fatigue syndrome and depression.”

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On the Radicalization of Youth – Written Before the Ottawa Events

benchDr David Laing Dawson

Why on earth would a young man, for even an hour of madness at four A.M., come to the conclusion that the way of ISIL/ISIS/IS is better than living peacefully in a liberal and secular Canadian democracy, no matter his ethnic and religious background?

When confronted by inexplicable outrageous behavior both writers and psychiatrists search within themselves for minor echoes, for nascent experiences that might shed at least a little light on the conundrum.

I hated medical school, at least until I discovered or developed some skill and competence. During that first year the faculty took us on a retreat, which meant sitting in small groups to air our grievances, and share our hopes. The question was asked of our group, “What had we given up to enter Medical School”. I don’t remember in detail what I said when my turn came, but I do remember being surprised by the extent of my anger and my grief. I was 23 at the time. Three of us were sharing a two-bedroom apartment. We lived on Kraft dinners at nine cents per serving, and augmented this on weekends with something we found in the grocery store labeled, enigmatically, “neck bones”. But what we had really given up was childhood: the sports, the comradery, the bands, the jam sessions, the Sundays at the beach, the parties, the security, flirtations, seductions – the endless summers.

Though always a small particle of courage away from dropping out and pursuing an alternative dream (which for me would have been notebook and canvas and a one-way ticket to Paris), I channeled my anger into making sure I got a passing grade.

Young men. Still angry at the end of childhood. Craving a life of significance with insignificance beckoning. Craving some security no longer provided by a family home, and only available through grinding work. Craving some certainty not provided by a liberal education, a multicultural society, and a profoundly complicated set of laws and rules to live by. Saddled with a set of aggressive and competitive instincts, no longer having an outlet on the soccer field. Craving a father, an elder, who will show us the way. Craving a good woman without all the trouble of seeking and impressing one. Craving some control over our lives, our future.

Most of us get through this, find our communities, discover love and the small pleasures, come to terms with being, more or less, insignificant within a vast mysterious universe, take pleasure and pride in working, in creating, in helping, and occasionally going on vacation.

But think what IS has to offer: a life of absolute certainty, a promise of profound significance, a very simple set of rules to live by and die by, no ambiguities, all the big questions answered with certainty, brotherhood, a father, adoring women, sex slaves, eternal life, and, people you can righteously kill.

The last phrase may be the most significant. The propaganda of IS taps into the rage and the primitive instincts of the young man on the sidelines facing a life of insignificance.

Magic, Shamanism and Modern Science

stone of madnessBy Dr David Laing Dawson

This was in the news today:

“The judge deciding whether an aboriginal girl can forgo conventional cancer treatment for traditional healing questioned whether forcing chemotherapy would be “imposing our world view on First Nations.” ”

This child has an acute form of Leukemia that is known to be 100% fatal untreated, but, unlike most cancers, has a 90 to 95% chance of remission and cure if treated. That is the science of it. The western medical science.

The judge’s use of the term “world view” struck a cord with me, but rather than wading into this mine-field of misperception, mistrust, and down right denial of science, I will relate a story much closer to the reality of human behavior and human motivation.

Some years ago I was consulting in Northern Ontario when I found I had an appointment with an Ojibway medicine man in the town of Kenora. He was something of an itinerant medicine man, healer, shaman, traveling to reserves in Manitoba and Ontario as needed. He was a tall man, quite imposing, with dark eyes and a charismatic intensity. He introduced himself and told his story. He was scheduled (now “scheduled” is not quite the right word here, because it certainly was our Industrial Revolution that imposed scheduling) to perform, in the near future, a second try at exorcising a powerful and evil spirit that had invaded a woman’s body. He had performed one ceremony and failed, he explained. The beast was still within this woman and destroying her and making her behave in a psychotic manner. This invading spirit, this evil, was particularly pernicious (my word), and, once out of the suffering patient, was apt to invade an onlooker.

He invited me to attend the ceremony.

“But”, he said, “You should bring some holy water to protect yourself.” He said this with such conviction that I was quite prepared to visit the Catholic Church to ask the priest if I might borrow a little from the chalice.

We talked some more, and I explored and asked what I could about the nature of the ceremony and the woman’s symptoms, and I agreed to come when summoned. But as he got up to leave I was still puzzled by something. So I asked, hesitatingly, “But really, why would you want to have me at this ceremony?”

He looked at me and said, “You might bring some of those pills of yours.”

And then he left.

And I thought, a smart man, covering all his bases. Native spiritualism, Catholic magic, and Western Medicine. And also, I thought, a true reflection of where we really are: hankering for the magic world of the spirit, the certainty and comfort of religion, but relying on the wisdom of enlightenment and science. I would take some fast-acting anti-psychotic medication with me when called.

Naming

By Dr. David Laing Dawson

exorcism Part 1 of a few.

Disease, illness, affliction, problem, atypical neurological development, eccentricity, issue, alternate reality, way of life, gift? There is no shortage of words and phrases to name and describe the nature of our struggles to cope, to live and survive in our social world. But each word conveys implications of value, worth, status, promise, expectation, and responsibility. Often these implications themselves determine which word is chosen. About once a month I am told I am about to see (in consultation) a child who has been labeled “gifted”. Whereupon I must try to find a delicate way of asking if “gifted” means Carnegie Hall by the age of 13, or brilliant at quantum mechanics but can’t relate to people, or simply learning disordered, or, careful with these words now, mentally handicapped.

Unfortunately many of the words we use, benign and descriptive at first, over time accrue negative value like small crusty accretions. There wasn’t anything wrong with “retarded” (slowed, behind) until it became an epithet in the schoolyard.

To prevent misunderstanding, but inevitably to obscure, we often fall back on what an editor friend of mine calls “weasel words”, benign enough to not offend, but careless and unhelpful. “Issue” is one of those words, as in “addiction issues”, and “mental health issues.” I don’t know why anyone would say, “He has addiction issues.” rather than, “He is addicted to heroin.” But they do. The use of “mental health issue” is easier to understand, though equally unhelpful. The speaker or journalist is trying to avoid the word “illness”, as in “He suffers from a mental illness.”

A Monty Python skit comes to mind, in which the doctor hesitates while telling his patient that he has, or suffers from, Syphilis. He gets to the word and, instead of speaking it, bends and whispers it into the open drawer of his desk. The patient doesn’t hear the word and asks the doctor to say again. In Monty Python fashion this repeats over and over until….

Actually I don’t remember the ending and I cannot find it on Youtube. But I imagine Michael Palin finally screaming the word, and a few others, at John Cleese.

We avoid the word because of the stigma attached to it, thus increasing the stigma. It was not until we openly used the word “cancer”, that we didn’t run from it, euphemize it, hide it, that it began to lose its stigma. Once free of its stigma the doors opened, research money poured in; clinics, wards, whole hospitals were devoted to helping those who suffer from cancer. The illness cancer, the disease cancer. Not the “cancer issue”.

Terry Fox did not run across Canada with a leg amputated to raise money and awareness for Bone Health Issues.

About That Ladder of Scientific Progress – Reminscences of a Psychiatrist

By Dr David Laing Dawson

stone of madnessIn 1971, before my own son was born, a seventeen year old boy left his family home in Ontario, and traveled to the southern United States with his guitar and little else. This young man, Derek, dressed in a robe and sought out an audience for his message of peace and love. He was hospitalized there, his parents contacted, and they drove down to bring him home. Back in Ontario they brought him to the new Community Psychiatry Program at the Medical Center. This was the Thursday before the Easter Holiday weekend. The young man, fully alert and full of energy, was convinced that he had been appointed by God to deliver these messages. But he didn’t want my medication, and he did not want to be admitted to hospital. His parents agreed to take him home and bring him back for a second visit the following week.

This family went to church on Easter Sunday, and to everybody’s dismay, the young man jumped to his feet, interrupted the Priest, and began a loud, rambling sermon of his own. An ambulance was called and he was taken to hospital. His response to medication was good, and when well, he proved to be a bright, engaging, sensitive, smart young man, capable of succeeding in College and life. But he did not like taking the medication. He preferred, quite understandably, the sensation of invulnerability, of energy, of warmth and possibility, of certainty, that accompanies a state of hypomania and delusions of grandeur. He remained my patient for five years, and I struggled with him to find a pharmacology that would keep him sane without taking away his enthusiasm. He often stopped the pills, became ill, and then reluctantly agreed to try again.

After five years I moved to head a different clinic in another part of town, and then out of town, and then five years later, back to town. I had lost track of Derek, and now my own son was that age, seventeen, and I was driving him to something. I think it was October and the leaves were changing on Aberdeen, a wide road of old and stately houses, some of which had been converted to group homes. We slowed at a busy corner, and on that corner a bearded man with unruly hair and disheveled clothing stood, paced, gesticulated and shouted at imagined specters or people in the street, in the clouds, and in the trees. It was unmistakably Derek, now in his mid 30’s.

“Shit.” I said.

“What’s wrong?” asked my son.

“That man,” I explained. “He was my patient years ago, when he was your age.”

He looked at the psychotic man raving at invisible targets. “Dad,” he said, “It’s not your fault.”

Ahh, yes. I remember that moment because of the heart-warming display of empathy and understanding coming from my teenage son.

But really, we did fail Derek, didn’t we?

Thoughts on Schizophrenia Awareness Day – The Courgage of Those Who Suffer and Their Families

schizcover

By Marvin Ross

Every year, the World Health Organization celebrates October 10 as World Mental Health Day to raise awareness and this year their theme is living with schizophrenia. I think we should all pause for a moment and consider just how hard it is for those with this terrible affliction to cope and to commend them for how many of them do cope.

Imagine being a teen just starting out in the world and learning how to cope when gradually you start to become withdrawn, you likely hear strange voices insulting you and telling you to do various things, your reality becomes altered and you’re not sure who your friends are and you begin to misinterpret their intentions and the intentions of your own family.

One of the best depictions of what it is like to have these delusions was by Erin Hawkes who described them to a conference on psychosis at the University of British Columbia in Vancouver last year.

http://www.bcss.org/recordings-project/2013-clinical-neurosciences-recordings/erin-hawkes-die-girl-die-my-psychosis-and-its-treatment/

But if the symptoms are not bad enough, those who suffer have to contend with the lack of understanding that so many have of schizophrenia. It is not a moral failure. It is not the result of bad parenting. It is an illness like so many other illnesses and those who suffer deserve to be treated with the respect accorded anyone else who suffers.

And they deserve to get a quality of treatment that others who are ill receive and that includes hospital beds when they need them, proper medical care, psychiatric care, support services like counseling, housing and vocational help.

The bravery of those who cope is exemplified here https://www.youtube.com/watch?v=4loR-bAKbuQ

And, we cannot forget to mention the family. It is devastating to any parent to watch the potential that their teen posses shattered by a horrific brain disease and the lack of sympathy that they often receive from those around them. As Katherine Flannery Dering put it “My younger brother Paul was more than a ‘schizophrenic’.  He was a brother, a son, and above all, a person that my eight siblings and I loved.”

So, the next time you see a disheveled street person mumbling away to no one, remember that they are someone’s child and they are likely sick and in need of help.

Youth Violence

Dr David Laing Dawson

Four teenage boys were murdered in Toronto in the last few days. One was killed inside his school with a knife. An eighteen year-old was killed by gun(s) in a back alley, possibly by a group of four other young men. And two boys lost their lives by gunshot while either observing or participating in a large social-media planned fight between rival schools.

Each of the candidates for mayor of Toronto has been pushed to address the problem of youth violence. Each has tried in their own way. Mr. Ford by talking about all he has done for youth in the past. Mr. Tory by promising money and programs. Ms. Chow by talking about poverty.

CBC interviewed youth workers and counselors. Each promoted an expansion of what they are doing now. Each was understandably distraught and a little angry about these killings. As we all are.

But before we throw money at the problem, or promote our favored panaceas, or recommend the unlikely and impossible, might it not be wise to study these cases? Let the police do their job and then look closely at each event (and possibly a few others). Hire two social scientists to cull the information, interview people, and come to an understanding of each story. Give them a deadline and task them with finding any elements in the chain of events that led to these deaths that could have been interrupted. And do we have the tools and means to do so?

There may be no commonalities to these deaths. The stabbing inside the school is inexplicable so far (untreated mental illness?). The back alley killing smells of gangs and drugs and retribution. The killings in the park sound like a group beef between teenage boys (over a girl, some disrespect, a perceived slight, a territorial infringement?). This last would not be a new phenomenon, but today fueled and expanded by Twitter and Facebook, and at least one boy brought a gun to what should have been a taunting stand-off, words and puffery, or, at worst, a fist fight.

But lets look at these events closely, study them. Are there any common elements? Are there preventable elements? And only then ask the question: What tools and programs and incentives are needed to bring about this prevention?

Dr Dawson is a child and adolescent psychiatrist and author of The Adolescent Owners’ Manual

 

The Launch of a New Blog

Welcome to the launch of Mind You. While we intend to post on mental illness, mental health and life, we decided on the name Mind You to reflect that not everything is black and white. There are ideas and opinions but then mind you, on the other hand, one can say…….

And that is what we would like to reflect. Ideas about mental illness, health and life that can be debated and discussed so that we can come to a higher understanding of the issues. And, we have separated out mental illness from mental health because, despite their often interchangeability, they are distinct.

The National Alliance on Mental Illness defines mental illness as a medical condition that disrupts a person’s thinking, feeling, mood, ability to relate to others and daily functioning. Just as diabetes is a disorder of the pancreas, mental illnesses are medical conditions that often result in a diminished capacity for coping with the ordinary demands of life. Serious mental illnesses include major depression, schizophrenia, bipolar disorder, obsessive compulsive disorder (OCD), panic disorder, post traumatic stress disorder (PTSD) and borderline personality disorder.

On the other hand, the World Health Organization defines mental health as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community. That is quite different from mental illness.

Unfortunately there is a tendency to confuse these and organizations like the Mental Health Commission of Canada have a tendency to talk about mental health issues and problems which are not the same as mental illnesses.

Both Dr David Laing Dawson and I (Marvin Ross) will be posting on a regular basis on a variety of topics. As murders of teens in Toronto has been in the news this week and as Dr Dawson practices child and adolescent psychiatry and is the author on a book on raising teens, we decided to kick off with his views on those murders.