Monthly Archives: October 2016

Understanding Youth “Suicide”

By Dr David Laing Dawson

Our assumptions and the language we use, that we so quickly use, often hinder a fresh and more useful way of viewing a problem. The word “suicide” and the phrase “attempted suicide” are examples of such assumptions and language.

This word and this phrase carry assumptions of intent, a formed intention, an intention to engage in an action that will achieve a goal. With the word “suicide” we imply that the goal is death, the ending of a life.

In the newspaper, and equally in medical charts, the phrase “attempted suicide” is poorly applied to many behaviours that were not “attempted suicide”. For many “attempted suicides” by teens, and some adults, the goal is not death, but …. Well, many things: payback, “they’ll be sorry”, negotiating power and control, making a point, taking a break, sleeping for a while, avoiding, revenge, punishment, getting someone to care, stopping the emotional pain…. Even when the goal is “death”, for a teenager, this can be a very ill-formed concept of death (complete with the idea of being around later to watch other peoples’ reactions), or a very drastic solution to a relatively small and temporary problem.

When the goal is not “death” and yet we call it “attempted suicide”, our interventions will be ill formed and misguided. In fact, I will make the case that when we mistake a teenager’s “getting someone to care”, or “punishing a boyfriend” for a “suicide attempt”, we mental health professionals find ourselves ratifying self harm as a legitimate tool of social discourse and problem solving.

But what is “death” to a ten year old, to a 14 year old? What is “death” to a Catholic or a Moslem?

Some years ago the uncle of a young boy killed himself by hanging. The boy was taken to the funeral of his uncle; he was privy to the conversation and distress of his own parents. And then the boy hung himself.

The community was understandably distraught. His teachers, family, friends, and the social workers working for the school board.

I was asked why an 11 year old would commit suicide? Was it a suicide? Could they have prevented it? I gave it some thought and reassured them that it was “an accident”, a tragic accident, not suicide.

For is it possible for an 11 year old to formulate a goal of being dead? Meaning “dead, dying, and death” as adults mean these words? No. For the boy in question we can never know how much was curiosity, imitation, how much distress, how much distracted parents, what he imagined he was actually doing. I am sure, that at 11 years of age, he did not have in his mind a clear and mature sense of the finality of death.

I am writing about this because of recent news reports of deaths of children age 10 to 14 in two northern Saskatchewan Communities. The reports are labeling these deaths “suicides”. They are also saying many other youth have “attempted suicide.” The responses have apparently been to send in mental health counselors, and to fly one or two out for psychiatric assessment. And these responses go along with the assumption that these children did in fact “commit suicide” and are in fact “attempting suicide.”

Now no doubt they are engaging in behaviours that have the potential to kill them, and that did so in four cases, including the most recent 10 year old. But that is what they are actually doing, these children; they are engaging in behaviours that can result in death. They are too young to know what that actually means for themselves, and for their families.

We do need to send a team in to investigate, but without the assumption that these behaviours constitute either “suicide attempts” or “suicide”, in an adult sense. We should investigate without the assumptions carried by those words.

Exactly what behaviours are these children engaging in, where, how, and why? And then, how can it be stopped. Or what needs to be done to change these patterns of behaviour?

 

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Dangers of Chiropractic Neck Manipulations

By Dr David Laing Dawson

Some years ago my father, then in his 80’s, suffered dizziness and syncope following a visit to his chiropractor. Now, I didn’t know he went to a chiropractor, or I would have been all over him before this. But this time, he had a neck adjustment and I found out because of the symptoms it caused afterward.

I made him promise to never visit a chiropractor again. I explained the anatomy of the neck to him, and the fragility of his arteries, cartilage and bones at his age.

When patients tell me they go to chiropractors I tell them, okay, but do not let them “adjust” you. Go for the massage, the muscle stretching. No adjustments. Especially the neck. Do not let them go near your neck. There are rather important things running up and down your neck.

Had my father died from his neck adjustment it would not have made the news. Because of his age we may never have known the cause. He lived till the age of 95 and died of cancer surrounded by his children and grandchildren.

But I see in the news a beautiful woman and mother (Katie May)  just died from a neck adjustment. She developed what she called a “pinched nerve” in her neck on a photo shoot and went to see her chiropractor who “adjusted” her neck. The adjustment tore an artery and she died.

Do not let chiropractors go near your neck.

Adjustments are nonsense procedures of course. And when it involves the neck, also dangerous.

What chiropractors tell you they are doing when they “adjust” your spine, they are not doing. In fact, they cannot do it. Or to put it another way, if they actually had the strength to force a shift in the alignment of your vertebrae, this procedure would be even more dangerous. It would risk the integrity of the spinal cord. But they don’t have  the strength to do that, except when the cartilage is brittle, the ligaments are old and infirm, the muscle wasted, and the bone is porous – as in aging. (Although I must admit there is a moment in many violent thrillers when one character breaks the neck of another in what looks suspiciously like a “cervical spine adjustment”.)

Those “pinched nerves” we talk about are seldom pinched nerves. They are inflamed ligaments and muscles from acute or chronic stress. The muscle may be in spasm. An acute muscle spasm can be stretched out as I do with my calf when I awaken in the night with a cramp, and trainers do on the football field. Other than that the inflamed, sore muscle or ligament responds to heat and rest, and, when persistent, anti-inflammatories.

That crick in the neck we get from sleeping awkwardly? Same thing. And left alone it will heal. There is no need for serious intervention. Especially interventions that are

1. Entirely bogus and 2. Very dangerous.

Mental Illness and the Political Spectrum

By Marvin Ross

I have always been on the left of the political spectrum – more so in my student days – but I still consider myself left and vote for progressive ideas and progressive candidates. Progressive, of course, is a value laden term but what has baffled me has been the lack of progressive ideas by the left on mental illness.

I’ve just done a Huffington Post piece attacking the establishment of a scholarship in anti-psychiatry at the Ontario Institute for Studies in Education (OISE) at the University of Toronto. After it was penned but before it was published, I was sent a link to an article in Rabble.ca written by the founder of that scholarship, Bonnie Burstow, extolling the supremacy of Toronto academia in anti-psychiatry “scholarship”. She equates this anti attitude for the search for social justice and as diametrically opposed to Toronto’s Centre for Addiction and Mental Health.

Aside from caring for patients, CAMH has a research budget of $38 million a year, is a World Health Organization Collaborating Centre and home to the only brain imaging centre in Canada devoted entirely to the study of mental illness. Among the supporters and activists of anti-psychiatry, Burstow cites David Reville and Cheri DiNovo. Reville was a politician in the disastrous NDP government in Ontario headed by Bob Rae (1990-1995). DiNovo is also an NDP member of the Ontario Legislature.

For non-Canadian readers, the NDP is the Canadian version of a Labour Party.

That disastrous government in Ontario brought in legislation to establish an Advocacy Commission to protect vulnerable people and to promote respect for their rights. That, of course, is laudable but the bill was so flawed and cumbersome that it was immediately repealed by the Conservative government that replaced them in power.

The Ontario Friends of Schizophrenics (now the Schizophrenia Society of Ontario), told the committee that:

Ontario Friends of Schizophrenics has had dialogue with officials because we have been persistent and because we have done our homework in making some solid proposals for improvements in the legislation. We have been unable to meet with a single minister of the three ministries concerned, despite repeated requests and despite the fact that people with schizophrenia are one of the largest groups in the vulnerable population that will be affected by these bills.”

They then pointed out that the bill excluded families; that it gave more power to the commission to enter someone’s home than the police have; that the test of capacity was ability to perform personal care rather than understanding; the low standard of capacity; no provisions for emergency treatment; and too much power to the Consent and Capacity Board.

The Alzheimer’s Society of Metropolitan Toronto was equally critical arguing that the new act penalized the family. Their presenter told the committee that:

“I have serious concerns about the prevailing use of unknown professional advocates with sweeping powers, heavy demands on their time, unclear qualifications and little accountability.”

In Ontario, the only improvement to the Mental Health Act was brought in by the extreme right wing at the time Conservative government under Mike Harris. They have not always been that extreme and the word Progressive precedes Conservative in the name of the party. That improvement to the Mental Health Act was Brian’s Law which enabled those with serious mental illness to be hospitalized if they posed a danger (not imminent as previously) and to be discharged from hospital under a community treatment order. They could live in the community provided that they were treated.

Only 10 members voted against the bill, 6 of whom were members of the NDP. The Health Minister after this was passed was Tony Clement who showed his support for those afflicted with schizophrenia by attending the banquet at the Schizophrenia Society of Canada annual conference when it was held in Toronto. As mentioned above, the schizophrenia group complained that no elected official would meet with them to discuss the flawed bill they were implementing. I have always had respect for Tony while detesting his ultra right policies further honed in the Federal Harper government.

The one member of the legislature who has done the most, in my opinion, to improve services for the mentally ill and the disabled was Conservative Christine Elliott. It was her pressure that resulted in the Liberal Government establishing an all party select committee to look at possible reforms. Despite an excellent report agreed to by members of all three political parties, nothing has been done. Sadly, she left politics after not winning the party leadership but she is the first ever patient ombudsman in Ontario.

And this regressive attitude on mental illness by the left is not unique to Canada. My advocacy friend, DJ Jaffe of the Mental Illness Policy organization in New York often comments that even though he is a Democrat, the most progressive people advocating for improvements in the US are Republicans. He is referring to a bill by Republican Congressman, Dr Tim Murphy called the Helping Families in a Mental Health Crisis Act. I suggested that Canada could use help in mental illness reform from a Republican back in 2013. In 2014 I wrote about how little we could hope for reform in Ontario.

To demonstrate further the left attitude to mental illness, you just have to look at the critical comments that my most recent blog on the anti-psychiatry scholarship garnered. One woman who is doing her PhD in Disability Studies at OISE claimed that I could not criticize because I am a white male member of the bourgeoisie. My proletarian father who worked in a garment factory on piece work and was a member of the Amalgamated Clothing Workers, would cringe in his grave located in the Independent Friendly Workers’ section of the cemetary.

That criticism goes on, quoting Barstow, that all that is needed to cure mental illness is that those with the illness know “we are cared for and that we are in control of our own lives.” Another critic said people “get better because they get free from psychiatry, find peers, get in touch with their inner experience, connect with and rely on others.” That same person also said “Psychiatry was invented by the privileged to dehumanise (sic) women, the neurodiverse, gay and lesbian and transgendered people, the poor, the Indigenous, and never-to-be-heard survivors of child abuse.”

I wonder how the scientists in the Faculty of Medicine or at the Centre For Addiction and Mental Health with their budget of $38 million a year feel about being told they are oppressors?

I haven’t heard such rhetoric since the days of Trotskyites on university campuses in the 1960’s but would love to see these critics spend some time in a psychiatric hospital ward with unmedicated schizophrenics, those experiencing the mania of bipolar disorder, or in a severe depressed state. I’m sure they would find some way to rationalize why their attempts to free them from “dehumanizing” psychiatry did not work.

Donald Trump and the Mind of an Adolescent

By Dr David Laing Dawson

ownersmanualThe friends and family of Donald Trump should have intervened a year ago, as I hope my friends and family will do if I ever decide to try something for which I do not have the skills, knowledge, history or temperament. He has made a fool of himself. And at some point, that is going to really hurt.

It is sadly remarkable how far he has come in this race while being a clown, shouting slogans, inanities, lies, slander, and incomprehensible half-sentences. Let us pray he inflicts no lasting damage to American democracy when he loses in November.

The third debate is being picked apart by pundits both professional and amateur. I have little to add, except …

Once again Trump has demonstrated that he has the temperament, language skills and emotional age of a teenager.

“No one respects women more than I do.” This is a particular and entirely unnecessary hyperbole one hears from adolescents. “No one likes pizza more than I do.” It is, on face value, a ridiculous claim, and the kind of hyperbole that only rolls off the tongue of someone whose awareness of others (and himself) is very limited.

It is also an example of the Big Lie, when the hole is too gaping to be bridged with a small lie.

The leaders of ISIS may have fled Mosul in anticipation of the Kurdish and Iraqi forces attacking. Donald tells us MacArthur, and Patton would be embarrassed by the lack of secrecy in planning this operation. “How stupid can they be.” He went on in this vein. And what I heard was the experience, the knowledge, the strategic thinking about warfare of a teenage boy. A knowledge based on movies set in the old west and before the telegraph. Electing Trump really would be giving the role of Commander-in-Chief to an impulsive teenager who watched George C. Scott play Patton and learned all the wrong lessons.

“She’s a nasty woman.” Point at her, make a face of distaste. Put it on Facebook; start a, well, “nasty” rumour in High School.

Then there is blaming Hillary for not creating a tax code that could prevent him from avoiding paying taxes. That was a good one. And it did remind me of teenagers who steal. I have heard them say that it was really the store’s fault for not having sufficient security. “If they leave it out like that, what do you expect?”

Deny saying what millions of people heard you say just a few days ago. Again, who but an adolescent can convince himself of this kind of revision of reality?

And finally, the horrifying statement that he may or may not accept the outcome of the election. There it is. That alone should disqualify this man from running for office in a democracy. Self aggrandizement, putting himself, and the welfare of his ego, above the democratic process, with a hint of blackmail. It is the hint of blackmail that reminded me once again of the teenage brain. “I’ll only go to school if…”

That’s it. No more. Let us pray Donald J. Trump slips into oblivion and we can all recover from the obsession he has created. And let us pray that democracy and civilization can survive him.

Donald Trump’s Mental and Emotional Age?

By Dr David Laing Dawson

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The recent revelations about Donald Trump, especially his barging into the dressing room of pageant contestants, left me wondering about emotional and mental age; specifically, at what age in a boy’s development would we find some of Trump’s behaviour, if still not laudable, at least common?

1. Peeking in the dressing room to get a glimpse of girls in partial dress: age 13 to 15

2. Complaining that the moderators are unfair and gave Hillary more time: 6 to 12 (preteen sibling rivalry)

3. Name calling repeatedly: age 6 to 12 (the school yard taunt)

4. Use of single word hyperbole to describe something: Age 14 to 16 (“It was like horrible, horrible.”)

5. Lying even when it is not necessary: 14 to 17 (Some teens get so used to shading their responses to questioning by parents that they lie even when the truth would get them kudos). Donald could have said, truthfully, that he decided, within a year or so of its onset, that the invasion of Iraq was a mistake, and he would have sounded thoughtful and mature.

6. Never taking responsibility; it is always the fault of someone else: age 10 to 15. (“The teacher hates me, I wasn’t doing nothing when…”.)

7. Boasting about sexual prowess: 16-18 (Actually at that age males usually boast about sexual prowess to an audience of peers who know the story is fiction. It’s more of an in-joke than a real boast. We all understand the deep level of insecurity that lies behind a real boast.)

8. Groping or kissing women without consent. Perhaps 15 to 25 but only if the young man is brain damaged, severely inebriated, or mentally handicapped.

9. Denying the obvious truth. Perhaps 13 to 16. (“The marijuana you found in my sock drawer – it’s not mine. I have no idea how it got there.”)

10. Broadly lashing out at unfairness when challenged. Perhaps age 3 to 10, and beyond that into teens when the boy has Fetal Alcohol Syndrome (FASD) or Autism Spectrum Disorder.

11. Just a few days ago, Mr. Trump said something I haven’t heard since I was privy to post football game teenage drunken banter:  “Look at her.” he said, implying clearly that he would only consider assaulting a more attractive woman.

12. And he keeps giving us fodder to think about. The latest: “I think she’s actually getting pumped up, you want to know the truth.” Now beside the bizarre accusation (he’s referring to Hillary) he uses one of his favourite phrases, “you want to know the truth.” There are many variants to this: “To tell the truth.” “I have to be honest.” “If you want to know the truth.” “Gotta be honest with you folks.” Now these kinds of qualifiers are not limited to adolescents, but they are precisely the phrases boys between the age of 14 and 19 use just before they lie. And addicts of all ages.

Fortunately Donald Trump’s candidacy is foundering on his behaviour and attitude toward women. The threat of having him in the White House is diminishing. But really, by my calculations, if Donald Trump were to be elected, we would be giving an immense amount of power to someone with the judgment and emotional age of a 7 to 15 year old boy, and not a sober, stable, empathic, conscientious 7 to 15 year old at that.

Psychiatric Refugees? Give me a Break!

By Marvin Ross

For years, we’ve had a small group of very vocal people who call themselves psychiatric survivors — people who have had psychiatric treatment, do not agree with it and consider that they have survived it. Now, thanks to CBC radio, we have someone dubbed a psychiatric refugee — a woman who fled British Columbia for Ontario to escape her involuntary status in a B.C. hospital. And, it was said, she is not the only so-called refugee.

Comparing yourself to people who survived a genocide like the Holocaust or saying that you are comparable to Syrians and others fleeing in leaky, dangerous boats from war is absurd. But what is also absurd is the story that this anonymous person called Sarah by the CBC told. It is just not logical but it is being used to justify the Charter challenge to the B.C. Mental Health Act that I suggested was misguided.

People deserve to know and to understand what the Mental Health Act is about. They deserve to know the processes that are in place to commit someone against their will and to treat them. And they need to know the safeguards that are in place to prevent excesses and protect the rights of the individual. These are never explained.

First, I encourage you to listen to the interview. To begin with, Sarah said that she went to the emergency at a hospital with her mother because of troubling life events and she wanted help. She was admitted, she said, voluntarily but then her status was changed to involuntary.

Now, for her to have been declared involuntary, she would have had to have satisfied all four of these criteria (page 18 of the guide):

  • Is suffering from a mental disorder that seriously impairs her ability to react appropriately to her environment or to associate with others;
  • Requires psychiatric treatment in or through a designated facility;
  • Requires care, supervision and control in or through a designated facility to prevent her substantial mental or physical deterioration or for her own protection or the protection of others; and
  • Is not suitable as a voluntary patient.

If she was involuntary, a licensed physician must have assessed her and certified that she met the criteria. Then, another independent physician conducted an examination with the same criteria to extend the stay beyond 48 hours.

( See form 4 where the reasons for the involuntary decision must be listed.)

At the end of one month, she would be examined again to determine if she still met the involuntary admission criteria and the proper form would be filled out to extend her stay a further month (page 20 of the guide). If she no longer needed to be involuntary during this period, the doctor can cancel it and she can always appeal her status to a review board at any time.

Once a patient has been deemed involuntary, they are given a form 5 (consent to treatment) (page 173), which explains to them what treatment is being given. Note that Sarah told the CBC that no one ever discussed treatment with her. They had to.

In addition, Sarah’s rights would have been explained to her and she would be given a form 13 to sign (page 182). She did say she had to sign something but she was not sure what it was. The person having her sign would have told her that she had a right to a lawyer, that she would be regularly examined by a doctor to ensure she was being held appropriately, informed that she could apply to a review board to assess her capacity, go to court to challenge the doctor’s decision and/or request a second opinion from a different doctor.

Next, she would be given a form 15 (page 186) to fill out so that she could nominate a near relative to be informed of her status. She did say that her mother went to the emergency with her so I have to ask where her mother was in all this. Surely she would have been liaising with the hospital staff over diagnoses and treatments. While her mother would have no authority under the act, most doctors do encourage family participation. During the CBC interview, Sarah said that she wished her mother could be involved in her treatment and there is nothing in the act that says she can’t be.

Sarah told the CBC that she absconded during a smoke break and that a form 21 (page 193) had been filled out. That form obligates a peace officer to return her to hospital. Sarah said she went to police in Calgary and told them, and that they called her psychiatrist but they did not hold her for return. The form 21 is only valid within British Columbia, but if 60 days had expired, it would not be valid and she would be deemed discharged.

There are so many holes in what she told the CBC that cast doubt on all she said. It is important for people to understand, particularly in light of the court challenge, what protections there are for an individual who is involuntary. This is not something that anyone takes lightly and is done for the best interest of the patient and for society.

The infamous Vince Li, who beheaded Tim McLean on a Greyhound bus, was initially picked up by Toronto Police in 2004 and taken to hospital. He left hospital against medical advice as there was no mechanism with which to keep him.

Imagine what would have happened if he had been treated initially? Tim McLean would be alive, his family would not have suffered the pain and anguish they did, and the first Mountie on scene might not have developed severe PTSD and eventually taken his own life.

As for Vince Li, he has done so well on treatment that he is now living in a halfway house. I can only guess at the pain he must feel knowing what he did while psychotic and that he would not likely have done if he had been properly treated at the outset.

Vancouver resident Erin Hawkes has written extensively on how the so-called forced treatment had saved her life. She has written in the National Post, numerous times in the Huffington Post and in the Tyee.

The CBC should interview her as well on the court challenge and they should do better fact-checking. If the plaintiffs in this Charter challenge call Sarah as a witness, we will see how well her story holds up to cross-examination.

Note: this first appeared in the Huffington Post on September 26. One person criticized me for attacking mothers which is not what I intended. I pointed out that Sarah’s mother has gone to the ER with her and I likely had input. When I asked where she was, it was a comment directed towards Sarah who said that she wished her mother could have been involved and I suspect she was. I realize that not all doctors and mental health staff are open to families but enough are. My own experience as a family member is that I have always been involved.

Global Warming and CO2

By Dr David Laing Dawson

I am an amateur in these matters. I don’t really know the science of Global Warming. But boiled down it seems we have to either stop pouring CO2 into our atmosphere or find a way of taking it out of the atmosphere as fast as we put it in.

Okay. We have two choices. Stop using fossil fuels or find a way of taking CO2 out of the atmosphere. Or we perish. Slowly but surely. The most vulnerable and the poorest first. And not without a lot of chaos.

Every few months I read a small article on technologies that might be able to take CO2 out of the atmosphere. There are two problems remaining to be solved with this approach: scale/cost (whatever technology does this better must be distributed world wide) and what to safely do with the CO2 once it is captured. (stick it in the ground, turn it into something useful).

But every day I read about green energy, solar power, wind power, electric vehicles, reducing carbon emissions. Hours of talk. Hours of energy used. Billions of dollars spent. Alliances, declarations, conventions, plans, agreements.

Maybe Norway will get there. Having made a great deal of money exporting oil, having been fiscally prudent (unlike Alberta), and having a small post industrial contained population, all doing well with education, employment, health and social services – maybe they can get there. They are talking now about prohibiting the sale of gas or diesel vehicles after 2025. That one small country may soon enough get to the point of neutrality. Emitting no more CO2 than their forests can absorb.

No one else will.

It is time to get realistic. I may be an amateur in the science of global warming and the consequences of this, but I am not an amateur in the observation of human behaviour, singularly and in groups.

We will not get there simply talking about and trying to reduce CO2 emissions. It won’t happen. Even today the burning of coal is dramatically increasing in China and India. The USA produces 40% of its electricity burning coal. We will make a dent here and there. We can feel good about all those wind turbines despoiling the landscape, driving our expensive electric cars, buying efficient refrigerators, using LED lighting. Maybe a few more small countries like Norway will reach neutrality. But not the others. All the others are striving to achieve just a little of the safety, mobility, security, comfort and luxury of the developed world. They will use cheap energy to get there.

So. I want to be reading  less about green technology and more and more about capturing and using CO2. And that is where we need to put our billions of research money, our best scientists and engineers. That should be the focus.  I want to be reading about billions and billions of dollars spent researching and developing methods to remove and reuse CO2 around the globe. It is time for a Manhattan project to develop scalable ways of removing, safely sequestering, and/or reusing CO2.