More on Stress and Psychotic illness.

By Dr David Laing Dawson

We humans were not designed for stress free environments, with the exception of a few stolen days luxuriating in the tropical breezes on a beach in Costa Rica. And we know we will enjoy it all the more if we had a difficult time getting there.

As someone else expressed it, we humans will quickly perish if the hardest thing we have to do is get into our SUV’s to drive to the nearest Pizza Parlour.

We all need a little stress.

And then we have human variation. Some people thrive on challenge and stress. The more, the harder, the better. Others don’t. A little is enough. Too much and those well-known physiological symptoms emerge: anxiety, panic, exhaustion, headache, nausea, stomach cramps, sweating, sleeplessness, irritability.

Paradoxically, experience and research tell us that most of us cope quite well with flood, fire, disaster, famine, and pestilence. The stress seekers and the stress averse alike. These are singular calls to action that focus the brain and our survival instincts. And that includes those of us vulnerable to psychotic illness.

But those of us who have or are vulnerable to psychotic illness are susceptible to specific kinds of stress.

Two of those stresses can cause psychosis in anyone, eventually: sleep deprivation and sensory deprivation. But sooner and worse with someone prone to a psychotic illness. Sleep is important. Without sleep – that regular period in our day when the organizers, sweepers, and cleaners take over our bodies and prepare our filing cabinets, our energy panels, and our sensory apparatus for the next day –  we will go off the rails. And our complex information processing system known as the brain craves input. Without input or very limited and distorted input it will also go off the rails.

We can, in simplified terms, consider some psychotic illnesses as originating in a vulnerability to disordered mood control and others in a  vulnerability in our interpretive mechanisms. The first is a problem with that apparatus in our brain that normally allows us to experience pleasure, excitement, fear, sadness, anger and then return to a neutral state. This vulnerability, the vulnerability to run-away emotional states, makes us vulnerable to situations of prolonged and extreme excitement: religious rallies, political conventions, parties, alcohol, fan conventions, intense conflicted relationships, long winters.….

Someone with, or vulnerable to, bipolar disorder, needs regular sleep, social involvement, but should limit exposure to prolonged and emotional human gatherings, and, of course, avoid alcohol and stimulant drugs (e.g. cocaine)

The second form of psychotic illness (schizophrenic disorders) may originate in an inability, or loss of ability, to take in, engage with, and correctly interpret all those social cues around us that help us make sense of where we are, who we are, what is happening, and what is expected of us. This person is vulnerable to the stress of large unruly classrooms, going away to university, taking on a new job, meeting new people, courting, having a baby, migrating to a new culture, even attending a singles dance. And, of course, to any substance that alters perception.

On the Sad State of Mental Illness Knowledge in Britain

by Marvin Ross

What is it with the Brits, or maybe just some of them, that they promote strange theories of mental illness and, in particular, schizophrenia? First we had the very controversial British Psychological Society report Called Understanding Psychosis and Schizophrenia that generated a great deal of controversy. See the summary of it by James Coyne. Now we have a course being offered by King’s College London for caregivers of people with schizophrenia.

This sounds like a very worthwhile course given by a university that claims to be “one of the world’s leading research and teaching universities based in the heart of London”. I was encouraged to sign up for it and did so much to my chagrin. After the introductory explanations of what schizophrenia is, they tell us that trauma is an important cause of this ailment and that this concept is gaining greater interest. The traumatic event they mention first is the loss of a parent either through death or separation. They then suggest that trauma may be associated with the hearing of voices and that the symptoms of schizophrenia may actually be Post Traumatic Stress Disorder (PTSD).

I looked for references but could find none. As a medical writer I’ve been involved in producing learning materials for doctors and other health care providers and the first rule is that whatever you write has to be evidence based and the evidence must be cited. I recall once being told to find references to prove a statement in a document I was writing on blood pressure that exercise is beneficial.

I left a comment in the King’s College course asking for references but received no reply.

So, lets look at some of the evidence. According to Dr Cheryl Corcoran, a psychiatrist at Columbia University Medical School, chronic stress may lead to psychotic symptoms (hallucinations, delusions) in the context of PTSD or depression. However, she points out that schizophrenia is more than just those symptoms. Schizophrenia, she says “also includes problems in thinking (concentration, planning, memory, etc.) as well as what are called “negative” symptoms (low motivation, difficulty enjoying things, lack of strong feelings, little emotional expression). Schizophrenia can also include odd and disorganized thinking and behavior.” She concludes that there doesn’t seem to be any evidence that stress leads to these other symptoms of schizophrenia.

The National Health Service in the UK also disagrees. They say “some people may be prone to schizophrenia, and a stressful or emotional life event might trigger a psychotic episode. However, it’s not known why some people develop symptoms while others don’t.” They point to a variety of possible causes including genetics, brain development, neurotransmitters, pregnancy and birth complications.

According to the Australians “Any evidence that childhood trauma directly causes psychosis or schizophrenia is controversial. Psychotic disorders may be secondary to co-morbid affective ilness, substance use, personality, or post-traumatic stress disorders, all of which have been linked to early trauma and all of which are common in those with a psychotic mental illness. Another difficulty for reporting childhood trauma in adulthood is accurately recalling events, and for some people memory is affected by the psychotic disorder. In other areas of research, such as depression, instruments have been developed which employ strategies to overcome recall problems such as the use of multiple sources of information. To date, these strategies have not been employed in most studies of schizophrenia.”

The number one cause of trauma that the King’s College Course cites is coming from a one parent family. Well, as I’m sure that most people know, this is a growing phenomenon. According to the Child Trend’s Database in the US, the proportion of children living with both parents has been in decline since 1970 and reached 64% in 2014. That means that in the US, 36% of children are in one parent families. This is a trend that is universal in the developed world and yet there is no increase in the number of people who develop schizophrenia. One study conducted in England over the period of 1960 to 2009 concluded that “We found no evidence to support an overall change in the incidence of psychotic disorder over time, though diagnostic shifts (away from schizophrenia) were reported.”

This course also suggests treatment modalities such as Cognitive Behavioural Training for Trauma and Eye Movement Desensitization and Reprocessing (EMDR). Both are tried as treatments for PTSD and may or may not be effective but they are not a first line for schizophrenia. The other risk factor that is talked about is marijuana use but I suggest taking the course and deciding for yourself how relevant it is.

One psychiatrist to whom I mentioned the emphasis on trauma as a cause of schizophrenia commented that this is both insulting to the families and potentially dangerous. But, let me end by quoting my blogging colleague, Dr David Laing Dawson from his blog called As For Trauma Causing Schizophrenia: No! No! No!

“People with psychotic illness do not need someone probing the wells of their psychic discomfort; they do not need (no matter how well-intended) a therapist scouring their childhood memories in search of an unhealed wound. They need support, safety, security, grounding,  and satisfying routine before they can get better. And good medical treatment.”

Of Course Guns are the Problem.

By Dr David Laing Dawson

No doubt the perpetrators of recent mass shootings in schools, churches and university campuses were troubled young men. They may or may not have each suffered from a treatable psychiatric illness. They did nurse grievances. Their solutions for those grievances were at the least misguided, and at the most delusional. They were also  suicidal, though possibly young enough and deranged enough to not really grasp the finality of death.

In each case the impetus for their actions was partly internal, partly fueled by internet propaganda and hate.

And they were each able to acquire an arsenal of weapons, openly, not secretly – proudly, not furtively.

In another time and place each of these young men may have come to grief, may have hurt someone, may have been brought to good counsel and treatment, or simply continued to fantasize an end game without acting on it.

But in this time and place, in the United States of America, each was able with credit card and basic computer skills to fill their shopping carts with lethal weapons. They can be delivered to your door without much more fanfare than a medium pizza.

Unlike all other personal weapons the gun is fast; it can respond to an impulse and the movement of a finger; it is immediate; it can be instantly lethal, and it permits some distance, some emotional and physical distance. It allows the user, the killer, to depersonalize the victims.

In Canada, over the years, I have seen many young men who fit the description in that first paragraph. Some responding to terrible childhoods; some to persistent social and academic failure; others to developing psychotic illnesses; some whose grievances were clearly delusional.

At no time have I feared them. Because they did not have access to guns. If there is a gun in the home I insist it be removed from the home.

Some I have been able to help, to treat, along with social workers, nurses, psychologists, alternative educational programs, family support.

I would fear them if I knew they could proudly or secretly collect an arsenal of handguns and assault rifles in their bedrooms.

Eggs break when you drop them on the kitchen floor.  We could spend an enormous amount of time and money looking for a bio-engineering solution, some genetic splicing, to create a breed of chicken that will lay eggs with resilient shells.

We could spend an enormous amount of time and money trying (and probably failing) to engineer a foolproof assessment system and an implementation program that might keep guns out of the wrong hands without interfering with those cherished second amendment rights.

Or we could stop dropping the eggs.

Boilerplate Apologies for Canadian Politicians When Caught Doing or Saying Something Stupid.

By Dr David Laing Dawson

In our world there are people (I’m not saying which people) who do bad things like treat women badly. This is a bad thing. I’m against treating women badly. It’s not nice. They should stop. And there are even some extreme religions that treat women badly. Well, it’s not the religion itself. Faith is a good thing. It is some people’s interpretation of religion that can be bad. Which can happen anywhere. Even Alberta.

And I’m not making any comparisons. I mean like Adolf Hitler and Joseph Goebbels are simply incomparable. Like Sidney Crosby, but in a bad way. Oh, you know what I mean.

Yes, well, when I compared the holocaust to abortion I was simply comparing numbers. You know, like in there are 253 people on death row in Texas, which is 43 more than the first year class of the University of Toronto Law School. And, you know, some less mature person might make a joke about that but it is bound to offend the relatives of the death row inmates. So I will not do that.

I don’t tell jokes. When I was a kid I told jokes. But I matured. Everything is serious now. That’s no joke. The only joke is Mr. Harper wanting to be Prime Minister again. Ha Ha. LOL. Wait a minute, let me  check with Mr. Mulcair if he thinks that’s  in bad taste before you write it down.

I know a lot of stuff but I’m not saying what I know or don’t know because someone will get upset about what I don’t know and someone else will dispute what I know. Just believe me when I say I know a lot of stuff. And if there is something I don’t know that I should know it’s because I missed that class while looking after my sick grandmother and learning family values.

I don’t recall ever saying anything in the past, actually. I was a very quiet person. A Commodore 64 kind of person. But if I did say anything or write anything I am sure I intended no malice. I’m not a malice kind of person. Like I mean this sincerely, without malice, and it’s not like I wrote software to cheat on emission tests or something. I mean whether I’m standing still and being tested by the EPA or driving to San Francisco I only emit hot air.

Oh, sorry, I misspoke. It happens to everyone.

Yes, our armed forces are wonderful courageous people, but they shouldn’t have to go around the world killing people. Killing people is probably wrong. It should be avoided wherever possible. But if our armed forces have to go and kill people (and I’m not saying I am for that) then they should be armed to the teeth with the best instruments of death available. Assembled in Canada of course. And for their protection, not for killing other people.

Veterans? Let’s face it if you have armed forces you’re going to have veterans. I’m all for veterans. Especially their mental health. I love veterans.

No, I don’t often pee in coffee cups. But that was a special case. I was being paid by the hour and I wanted to keep working and save my customer money. I’m all for keeping costs down. I’m a fiscal conservative. Besides, I saved about two gallons of fresh water doing it that way. Good for the environment. You notice I didn’t even waste any water washing the cup?

That video, me, in a hoodie? I don’t know who that was, really, but you have to admit making the customer relations guys at the 407 look good was a minor miracle. They offered to pay me for that video to use as a commercial but I turned them down because though I am sure it would have been entirely ethical, moral and legal to accept their offer, it might be construed as a technical conflict of interest by a politically motivated auditor. The rules about that are really vague. I mean like what’s a legitimate expense and what isn’t? And it’s not like if I get into a big doodoo Nigel Wright is going to come along and cut me a check for ninety thousand. What a guy, eh? I mean what a guy!