Monthly Archives: June 2016

Privacy Laws Should Not Exclude Families

By Dr David Laing Dawson

“Frustration over mental health disclosure doesn’t trump privacy protection: experts” (CBC News, Halifax)

This story makes specific reference to a 21 year old who committed suicide after 3 trips to the University Health Services, only one of which her mother knew about.

Years ago, as a young psychiatrist with but one and then two very young children of my own, I am sure I “respected” the privacy of many of the teens I saw and treated. Usually our clinic staff saw them alone, and then invited the parent(s) in, and didn’t disclose anything the teen adamantly refused to share. I can’t remember the official age of consent at the time, but some years later it became 12. I remember this because a social agency asked me to see a 12 year old caught stealing. I said I would like to see his mother with him. They said, “We will have to ask his permission.” My mouth fell open. “What? You need to get permission from a 12 year old before you talk with his parents? That is nuts.”

Before that moment my thinking had evolved. Not least because I realized how outraged I would be if a doctor, counselor, psychiatrist did not tell me about important, serious things my daughter might disclose to her.

Working in a clinic that saw many teens, and consulting to local High Schools, I decided I could treat an 18 year old as an adult, and a 14 year old as a child. The child would always be seen with his or her parents. In between 14 and 18 the child had to prove he or she was “adult”, in order to be seen alone. And by adult I mean have at least a rudimentary sense of personal responsibility, at least a rudimentary sense of the consequences of certain behaviors, at least a rudimentary sense of not being the center of the universe, at least a lessening of that knee jerk oppositional response to parents and any other authority, and at least a small decay in that adolescent sense of omnipotence.

Of course, within the first half hour of any interview most teens demonstrate that they are not adult in the above sense and then I would say, “I will have to talk with your parents.”

They never fought me very hard on that because, really, they need and want their parents to know about their troubles. They want their parents to parent them. And that includes setting boundaries (protecting them) as well as loving and supporting them.

There was a time when I would ask a teenager something privately, working on the assumption that a.) In the presence of his parents he would not reveal the truth, and b.) His parents may not be ready to hear the answer. Sexual activity and orientation for example.

But my thinking evolved again. I concluded that, instead, a.) There is nothing I as counselor, physician, psychiatrist should know about a teen that his or her parents should not know and b.) Most family secrets are known or suspected by other family members already, and c.) If the parents have a bad, primitive, nasty reaction to the news, it would be better to have it in my presence.

So now I always see a child or teenager with his or her parent(s) and I ask whatever questions I need to ask. And I watch and I listen.

Occasionally I am talked into seeing a teen alone by a parent who insists I do so, and occasionally because the parent did not show up. It is always a futile exercise. It is not far off the metaphor of the blind man describing an elephant. There is one exception to this of course. Once in a while we run into a teenager who is more mature than either of her parents. In social work jargon, this is the ‘parentified’ teenager looking after the welfare and feelings of her parent(s).

I am talking about teenagers here, but it is not age that defines them. It is social, psychological, financial, emotional dependence on others. Their welfare depends on others.

But none of us is an island. Our health, our mental health, our welfare depends on others. So my policy of seeing teens with parent(s) has expanded to anyone who is financially, emotionally dependent on another. That includes college students, young “adults”.

I am seeing them because they are in trouble. If the trouble has to do with drugs, alcohol, relationships, money, failing – parents are in a better position to help than I am, or, at least, their support is necessary. If the young person suffers from a mental illness, then I may be able to treat that illness with or without the parents, but I want them informed and helping and supporting.

Health professionals put themselves in a bind when they see a young troubled person alone and he or she specifically says, “I don’t want my parents to know.”

To prevent that bind, privacy trumping parental concern and good care, we need merely see them together. The patient and his or her family. Together. In the same room at the same time.

So include them right from the beginning. Even bad parents, those who do all the wrong things (well-intentioned or not) should be included. For the child spends far more time with, is more dependent on, is more influenced by or reacting to, his parents than myself. Include them. Teach them if you can. Even if the teen objects before entering the interview room, persist, because he will change his mind very quickly once he understands he will be heard as well.

Don’t give up on parents, family, until you see with your own eyes that they are hopeless, unhelpful, or destructive. When that is the case, unfortunately, we must counsel, treat, care for, look after someone who is not yet an adult as if he or she is a responsible, self-sufficient adult.

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Omar Mateen and the Orlando Shooting

By Dr David Laing Dawson

I will try to do something I shouldn’t do with so little information. Understand Omar Mateen. I will try to do this in an attempt to counter the glib labels, the quick rhetoric based on anger and political need.

Here is what we know:

Omar was raised by an Afghan immigrant family. His father was grandiose and homophobic, a Mujaheen fighter who promoted himself to general years later. Omar had a troubled childhood and adolescence according to school records. He was identified early on as an angry and violent troublemaker. But he married, had a child, beat his wife regularly. Her family rescued her from him. He acquired another, second young wife of Palestinian origin, again through an internet connection. He was not particularly devout. He drank a fair bit. He worked as a security guard and wanted to be a police officer. He took selfies that display an excessive narcissism and attention to appearance.

He became a patron of a gay club, attended drag shows, he may have been a regular. He may or may not have expressed disgust to his father about homosexuality.

Lately, at least, he attended a mosque several times a week. He spent enough time looking at radical Islamic websites and talking about this to alert the FBI twice. He had easy access to serious weapons.

He was a confused, lost, angry man. He was probably gay or had homosexual yearnings that would have disgusted his father and perhaps himself.

He was a man seeking answers or an answer for his self-loathing, his anger, his failures. Unfortunately he found a single answer and acted upon it.

We don’t know if he had a treatable mental illness. We do know he was a Muslim who had, at least, gay yearnings, violent tendencies, excess narcissism, drank alcohol, failed in his relationships, had easy access to weapons, and access to toxic websites proposing violence and martyrdom.

  • Probably loathed himself for his homosexual yearnings.
  • Angry and lost, narcissistic.
  • Found an answer in martyrdom.
  • Easy access to automatic weapons.
  • On the FBI watch list.
  • Chose a target in line with his own self-loathing and extreme Islamic teaching.

Are there lessons in any of this? How do we prevent a re-occurrence?

  • Continue to try to eliminate homophobia by education, demonstration.
  • Ensure effective mental health services are available for children and teens.
  • Muslim leaders must be as clear as possible that these kinds of actions are abhorrent. They should be specifically clear they don’t believe in martyrdom or rewards for such in the afterlife. Rather than vague statements about Islam being a religion of peace they need to specifically denounce those passages of the Koran that appear to sanction violence.
  • The FBI needs to look for any red flags they might have missed.
  • The world needs to isolate and defeat ISIS but in doing so not create fertile ground once again for an angry radical group to emerge.
  • We need to look at counter measures to fight their slick impressive videos and calls to arms.
  • But, again, in this list there is but one action that could specifically reduce killings in relatively short order. And that is GUN CONTROL. There is no reason on earth a civilian should own a combat weapon. I don’t think there is any reason a civilian should own a gun period. But at least let’s start with eliminating those weapons that can kill so many people so easily and quickly.

It is not a matter of good gun owners or bad gun owners. Any owner of an automatic weapon, if not intent on using it some day, fantasizes about using it. Let’s get rid of them.

On Adolescent Suicide

By Dr David Laing Dawson

Adolescent suicide is a tragic event. It can have a devastating and life long impact on others: parents, siblings, teachers, relatives, counselors, friends.

Five Woodstock, Ontario  teens have taken their own lives since January this year. A very high number for a small community.

If this were a cluster of deaths from respiratory causes we would surely investigate with a team comprised of a respirologist, an epidemiologist, and the public health officer.

Thus our first step here should logically be an investigation by an epidemiologist, a  psychiatrist, and the public health department. Let us first see if these deaths are a result of undetected, untreated mental illness, if the teens know one another in real life or through social media, if they are all browsing the same toxic websites, or if each has been the target of bullying or something worse, or a combination of these. Let us try to understand before rushing into awareness programs, school assemblies, more crisis lines.

There are several good reasons to not rush to “talking about it” as the answer. These are teenagers, not adults. We know from anti-smoking programs, when we gathered our high school students into the auditorium to talk to them about the horrors of smoking and showed them videos of cancer-ridden lungs and COPD sufferers gasping for breath, the number of teens taking illicit puffs at the local smoking pit increased. Increased. Not decreased, increased.

We are also living with the paradox of contemporary times when kids are inundated with suicide awareness programs, when every school counselor and nurse asks every troubled kid the question, when each community has an advertised crisis line, when the question “do you ever think of harming yourself?” is asked on countless questionnaires and surveys, when our teens are communicating with each other around the clock, when information on any and every subject is as available as the nearest smartphone, and when we are in the midst of public discourse about assisted suicide. It is in these times, not in the 50’s, 60’s, or 70’s ( when the word suicide would only be said in the same whisper as syphilis), that clusters of teens are committing suicide.

Or so it seems.

But what I am trying to say is that we should investigate these phenomena before we rush to “solutions”, especially with teenagers. They are not adults. They often do things just because they have recently learned those things are possible to do. They are often more intrigued when adults bend over backwards to warn them of danger.

The adolescent brain has lost some of the intuitive avoidance and fear of the child’s brain. It is developing some reasoning and analytic processes to replace these. But it does not have the breadth and depth of experience of the adult brain, nor the ability to consider the distant future and the effect on others. The adolescent brain tends to live entirely within its present context.

“Would you swim with sharks?” When a child is asked this question he or she will answer with an emphatic NO. An adult will also offer a very quick negative, though with some adults and a few adolescents the questioner may need to add that ‘sharks’ is meant in a literal sense. But the teenager. Ah, the teenager. He or she asked that same question will ponder it. You can see and sometimes hear the analytic reasoning kicking in: “Well, humans are not the sharks’ natural prey, so….and though I am not a good swimmer….and depending on…”

So far, with teens, my own informal survey has resulted in answers of “yes or maybe or I’d consider it” 100 percent of the time.

I am not saying we should downplay suicide and it’s tragic consequences. I am saying that we should treat an increase, a cluster of suicides like any other serious outbreak of illness. We should study it without pre-judging. And when teens are involved we should take into account their contrary minds.

The Woodstock cluster may be a problem of inadequate resources; there may be a contagion factor at work;  there may be a local stigma about seeking help; there may be some cyber bullying occurring; the means to kill oneself may be too readily available; there may be untreated mental illness involved; they may all have been fans of the same toxic Web site; they may know one another, or not; they may be using or misusing the same drugs; they may be all attending the same counselor; or this cluster might be simply a statistical anomaly…

We should help family and friends cope with these tragedies, but we should investigate before we plan a preventive intervention.

 

Harambe the Gorilla and Mental Illness

By Marvin Ross

Like many, I was saddened to see Harambe shot. Was he helping the toddler as the initial photo may have suggested or was the toddler in danger as the subsequent video suggested? I have no idea! But I am astounded that there are seven petitions out there for people to express their dismay. One petition is approaching 500,000 signatures as I write this while another is getting close to 200,000 signatures.

That’s a lot of people who want justice for the gorilla.

Sadly, there is far less of an outcry when someone with untreated mental illness gets shot by the police. According to the Washington Post, a quarter of those shot by the police in the US were mentally ill. In Canada, according to a recent documentary on police shootings, 40% of those shot by the police are in a mental health crisis.

Here is one example of Toronto Police shooting a poor man in his hospital gown after he ran out of hospital https://www.youtube.com/watch?v=RbWUnzvAgb4

Shootings of those with untreated mental illness is only one small part of the injustices suffered by those who develop a mental illness in our society. In Canada, 38% of incoming prisoners suffer with a mental illness. Their offences often result from a lack of proper treatment. In Ontario, 40% of prisoners in solitary were locked away for 30 or more straight days. This is twice the limit permitted by the UN in its Nelson Mandela Rules. The main reason for the solitary was mental health or special needs.

Homelessness in Canada is accounted for by mental illness or addiction in between 23 and 67%.

In the US, a recent report found that there are 10 times the number of mentally ill in prison than in hospital. The consequences of not treatment, according to the Treatment Advocacy Center is homelessness, incarceration and violence.

And so few people care about any of this! Instead, we angst over one shot and killed gorilla.

To paraphrase Stalin one dead gorilla is a tragedy, a million maltreated and ignored mentally ill is a statistic.

Isn’t it time we showed some compassion for the mentally ill and gave them appropriate treatment and support?