Monthly Archives: March 2017

A Rose by any Other Name

Guest Post by Joseph Merlin Bowers from The Unashamed Schizophrenic

I have a friend who is a dedicated and effective advocate for people like me who have serious mental illnesses. Living in a politically correct world, she asked me once what term I would prefer when someone refers to the mentally ill. After all we are told that words matter. Perpetuating stereotypes is the cruel consequence of words like crazy, lunatic, nutcase and the like.

I spent some time trying to think of the perfect word that would be descriptive, non-derogatory and accurately portray one of us with a serious disease of the brain. After some time I came to realize that I just don’t care and I probably should not.Two quotes come to mind: Shakespeare-“A rose by any other name smells just as sweet.” Brene Brown-“Loving ourselves through the process of owning our story is the bravest thing we’ll ever do.”

Whatever word one uses to describe a serious brain disease, what matters is the image the word conveys to the listener and how that listener reacts to that image. I don’t care what you call me. I do care how you react to me and treat me.

I totally own my story. My story involves mental illness. When I went up the stairs in my house with a loaded shotgun intending to kill my grandmother, I was totally bat shit crazy. Sometime latter when in recovery, I apologized to my grandmother for scaring her badly. She said that the doctors told her that it wasn’t really me that assaulted her. That is only true in a sense. I would never have dreamed of harming  my beloved grandmother when my brain was healthy and operating normally. What I did had nothing to do with who or what I really am when healthy. But in another sense it was me. In the grip of insanity, I did what I did. It was me. It wasn’t anybody else. I can’t own my story without acknowledging that.

I belong to the biological explanation for most serious mental illnesses school of thought. I’ve seen brain scan and activity images showing physical differences in the brains of schizophrenics and people with bipolar disorders. When I first encountered this information I had two simultaneous reactions. My first was dismay. If my disease is a physical deformity what hope do I have of recovery. I can’t just change my behavior or my way of looking at things and reacting to events.

My other reaction was a feeling of liberation. My disease was not my fault. It was not my families fault. It was nobody’s fault!

I have friends whose stories are much harder to own than my own. Doing so requires much courage and strength. We have done things we will always regret. We wish to hell we could go back in time and undo what we did. To own our stories is necessary to put them behind us, get on with our lives and live in the now, looking to the future.We know the science of why we behaved in a manner uncharacteristic of who we really are.

We are ashamed of nothing. To react with shame to words like crazy, lunatic or nutcase is self stigmatizing. It involves buying into the fiction that having a mental illness is something to be ashamed of. What other disease of what other organ should one be ashamed of?

When I acted crazy it was because I was crazy. I would prefer to have you say I was crazy than something like “a soon to be consumer of mental health services”.

Canadian Families Coping With Schizophrenia Don’t Have a National Voice

This blog post was written by Susan Inman and appeared in the Huffington Post on March 21. It is a sad shame that there is no longer a viable voice to express the concerns of families with members who suffer from schizophrenia.

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Families who care for people with schizophrenia once had an organization that gave them a national voice. They no longer do. This lack of national representation impacts not just our own situations; it also hurts the people we support, because they are often unable to advocate on their own behalf.

Family caregivers, who had previously established provincial advocacy organizations, came together over 30 years ago to establish the Schizophrenia Society of Canada.

Certain core values originally united these organizations. These values included building close ties with the psychiatric and neuroscience communities which had come to see schizophrenia and bipolar illness as disorders of neural circuitry. These groups sought to provide the most up-to-date education about these illnesses to people with the disorders, to families, clinicians, police, and the public.

As well, these organizations have advocated for high quality supported education, housing, and psychosocial rehabilitation services.

These organizations have also worked to dispel the unjustified blaming of families for psychotic disorders that earlier theories about these illnesses had propagated. The legacy of these beliefs, which have faded from psychiatry, have persisted and negatively impacted other areas of clinical practice. Frequently clinicians are still training in the many credentialed programs that don’t require any science-based curriculum on psychotic disorders.

Until recent years, the goals of these family groups had been represented by the Schizophrenia Society of Canada (SSC). However, while sitting on many national committees as the presumed voice of families, the SSC has failed to support the perspectives of the families who created it. It does not address the lack of appropriate curriculum in training many clinicians. Similarly, it does not work to provide basic information about schizophrenia in the annual national mental illness literacy campaign in which it plays a lead role.

These failures are occurring because its current leadership has given itself a different mandate. It has supported trends in the social sciences that seek to de-medicalize mental illnesses and advance the idea that all problems arise from social and personal adversity.

Instead of fighting against the stigma that too often interferes with the ability of family caregivers to develop collaborative relationship with clinicians, the SSC Executive Director, Chris Summerville, has actively promoted stigmatizing attitudes. For instance, he promotes the notion that families undermine the recovery of their family member by holding stigmatizing attitudes towards them.

Summerville has written that families block their family member’s access to treatment because they don’t want to expose their ‘family secret.’ At the same time he has failed to help people with illnesses, their families, and the public understand anosognosia, the brain based inability of many psychotic people to understand that they are ill. This is the symptom that families struggle with as they try to get an ill family member into treatment.

The SSC has also failed to promote the most progressive, evidence-based psychosocial treatments. In recent years there has been extensive research about the common cognitive losses that are associated with the illness. While most people’s psychotic symptoms can be controlled with anti-psychotic medications, the cognitive losses often persist. These include difficulties with concentration, short term and working memory, problem solving, and judgment. While BC’s Early Psychosis Intervention toolkit makes this information readily available and even educates people about useful cognitive adaptation strategies, the SSC ignores this issue in its educational programs.

Cognitive losses are widely understood to be the biggest factor in the extensive ongoing disability of this population. While espousing its commitment to the Recovery Model, the SSC has not only failed to provide education about cognitive problems. It has also failed to promote the evidence based cognitive remediation programs that can improve recovery; these programs have been expanding in other countries for the past 20 years.

While the SSC has failed to promote programs that are desperately needed, it has played a leadership role in the mis-education of the growing peer support work force. Many of us hoped that the new national guidelines for training peer support workers that the SSC helped create, would begin to provide peer workers with essential information about the illnesses of the people with whom they often work. The guidelines don’t require — or even recommend — that training programs offer any information about mental illnesses. Instead of informing peers about why people suffering from psychosis sometimes need involuntary treatment, peers are encouraged to oppose it.

Now the SSC leadership has taken an even more alarming step in securing its vision for this organization. It’s created a survey that has been designed to guide responders to provide the desired responses. The survey wants a mandate to move away for what it calls the “western medicine biomedical disease model” of schizophrenia.

The survey is also looking for support for getting rid of the term “schizophrenia.” However, schizophrenia has long been included in the Diagnostic and Statistical Manual that is used in mental health, criminal justice, education and social services. The diagnosis enables people to access disability payments and many other essential supports.

The SSC survey argues that we should substitute the term “psychotic spectrum disorder” for schizophrenia and points out that this term is used in early intervention programs. It doesn’t say that, when cognitive and other symptoms persist once psychosis is managed, people often receive more specific diagnoses like schizophrenia or schizoaffective disorder.

It’s convenient for national organizations to continue to use the SSC to ensure the presence of a family voice. However, the SSC doesn’t represent the perspectives of the vast majority of family caregivers I’ve met in the last seventeen years.

Maybe it’s time for the leadership of the SSC to create their own organization representing the conditions they consider significant and the alternative treatments they help popularize. They could return the SSC to the families of people with severe mental illnesses who created it.

Trump Speak

By Dr David Laing Dawson

The collection of laughable, inane, grossly inaccurate, and stupid things that Donald Trump says grows by the week. They have become the fodder of late night talk shows and the target of journalists’ disdain. Satirists don’t have to satirize; they merely repeat what he says.

On the internet one can also find several collections of odd, funny, nonsensical things that came out of George W. Bush’s mouth. George occasionally mangled syntax; he created the odd neologism, mixing two words to make a third; he put his adjectives in the wrong place; he stumbled over language and grammar. One could make the case that he is a little dyslexic, or simply not gifted in the spoken language department.

He was on the Ellen DeGeneres show recently and he said, “…I’m going to use a big word now – symbiotic…” Ellen said, “Wow, four syllables..” The audience laughed, George smiled. And I rather liked him for a moment.

These days the journalists, the pundits, the comedians, the talk show hosts, pounce on the words of Donald J. Trump and point out their inanity, their inaccuracies, their wrongheadedness, and their untruthfulness. But beyond what he says and tweets, a true revelation of the depth of trouble we are in can be found in the way he says what he says. That is, not so much in the simple meaning to be found in his tweets and statements but the meaning hidden in the structure and form of his sentences (or lack thereof).

Whatever the subject, the reference point is himself. Whatever the subject, no matter the population actually affected, how it affects Donald is supreme. Whatever the subject, his words imply that he is supreme; they always imply that he is supreme.

Below is a list of things Donald J. Trump has tweeted or said. Let me point out what is happening in the first two. These two statements followed briefings by experts on the two subjects at hand. In them Trump indirectly admits that perhaps he didn’t fully understand the complex subject before, but then he quickly points out that “nobody” does. He has to say this to retain the fiction in his own mind that he is brilliant, superior, supreme, that he knows all there is to know, and all that anybody can know.

This is a very dangerous level of narcissism.

“It’s an unbelievably complex subject, nobody knew that health care could be so complicated.” (Health Care Policy)

“It’s a very complex subject. I’m not sure anybody is ever going to really know.” (climate change)

“I know words; I have the best words.”

“I will build a great wall — and nobody builds walls better than me, believe me –and I’ll build them very inexpensively. I will build a great, great wall on our southern border”

“I’ve never had any trouble in bed, but if I’d had affairs with half the starlets and female athletes the newspapers linked me with, I’d have no time to breathe.”

“I love the poorly educated.”

“He was a war hero because he was captured. I like people who weren’t captured.”

“All of the women on The Apprentice flirted with me – consciously or unconsciously. That’s to be expected.”

“I am totally in favor of vaccines. But I want smaller doses over a longer period of time.”

“Sorry losers and haters, but my I.Q. is one of the highest -and you all know it! Please don’t feel so stupid or insecure, it’s not your fault.”

“Cher is somewhat of a loser. She’s lonely. She’s unhappy. She’s very miserable. And her sound-enhanced and computer-enhanced music doesn’t do it for me.”

When was the last time anybody saw us beating, let’s say China, in a trade deal? I beat China all the time. All the time.”

“I think the only difference between me and the other candidates is that I’m more honest and my women are more beautiful.”

“Part of the beauty of me is that I am very rich.”

“I dealt with Qaddafi. I rented him a piece of land. He paid me more for one night than the land was worth for two years, and then I didn’t let him use the land.”

“Number one, I have great respect for women. I was the one that really broke the glass ceiling on behalf of women”

These quotes (and much of what he says and writes in tweets) boldly display:

  1. An appalling lack of understanding of issues/technologies/events/history/the world…
  2. An appalling lack of awareness of his own shortcomings and deficits.
  3. An appalling (and child-like) lack of awareness of a world beyond himself.

He could do great damage to the world within four years if he stays energetic, active, engaged, provocative and disruptive.

But clearly he has a short attention span and he doesn’t particularly like to read, work, study, or listen. So while he is watching cable news, golfing and dining at Mar a Lago, some contemporary Rasputins (Bannon for one) will be able to do great damage to the world.

We are about to find out just how solid and resilient and principled American Democracy really is.

 

 

 

 

Please, America, Please

By Dr David Laing Dawson

I have always looked to our south, like many Canadians, with a little disdain, a smidgen of envy, a touch of awe, and no small sense of superiority. When you repeat over and over again, ad nauseum, that America is the Greatest country on earth, I want to politely shout, “No, you are not.” Perhaps by one measure out of twenty you are, but that’s it. One out of twenty. Maybe two. Military force and entertainment. Maybe three: military force, entertainment, and some of the sciences.

You got the atomic bomb first, with the help of a few imported scientists, but Canada was second in having the knowledge and technology to build one, and it did not. Perhaps this was a much more significant accomplishment.

You can see our relationship has been complicated.

Traveling in Europe we quickly identify ourselves as Canadian, not American. I know some Americans who do as well.

But I was in Paris when the twin towers came down, and we spent four days there watching the news. And I found, out on the street, that suddenly I too was American, North American.

How dare these primitives, these semi-civilized thirteenth century people, attack the greatest city on earth, the showpiece of my America? How dare such primitives, such pre-enlightenment Neanderthals attack this beacon of light, this democracy, our democracy?

At that moment the civilized enlightened world was with you, America. You had a free hand to go hard after Osama Bin Laden. Instead you invaded Iraq. And as the war drums grew I found myself saying, “No. They won’t do that. Nobody could be that stupid.”

But you were. And then you did it badly, ignoring history and everything we know about collective human behaviour, about what happens when you take away stability, structure, organization.

And once again I became a disdainful Canadian watching you torture yourselves (and others).

Of course, with your own disdain of regulations and oversight, you also allowed a financial crisis to assail the world, and for the gap in wealth to grow to outrageous proportions. The very rich got richer, the poor got poorer.

And then we had 8 years of Obama, a man who proved to be, if a little indecisive, at least sane, intelligent, kind, thoughtful, knowledgeable and responsible. It looked like America had a chance again and might one-day regain a fourth or even fifth category of greatness.

Four or five out of twenty wouldn’t be all that bad. Education? Health care? Quality of Life? Women’s rights? Racial equality? Literacy? Scientific literacy? Standard of living? Clean air? Clean water? Mental health care? Less primitive corrections system? Modern transportation system? Banking regulations? Maybe you would even direct that famous American energy and ingenuity toward preventing the calamity of climate change?

But no.

Instead you took a mighty step backwards. You elected a child as president and a raft of 19th century idealogues to Congress. The arguments I hear on CNN about that whole list one paragraph above are silly, stupid, primitive, ill informed. With each of them the push is backwards: women’s rights, health care, EPA, great lakes, mental health care, climate change, education, science, corrections, regulations, wealth equality, race relations.

Please, America, Please. Those of you who are enlightened, educated, worldly, kind, sane, responsible – those of you who have empathy for others, who have outgrown or at least come to terms with your past – those of you who care about the real future – the future for yourselves, your children, your grandchildren, and the rest of the world for that matter – you need to resist; you need to turn the tables.

I could simply go on feeling superior and disdainful, but America is too important, even the idea of America is too important. We, the whole world, need a sane, stable, educated, advanced, involved, compassionate America.

And now I shall watch CNN again and cross my fingers.

Popular TV and Mental Illness Misrepresentation

By Dr David Laing Dawson

Currently two serial TV shows of the thriller/spy genre feature major characters who suffer from bipolar illness. Both usually take their medication and acknowledge that it keeps them stable. So far so good. They are successful likable characters and thus could be seen as antidotes to stigma, to the usual poor representation of mental illness by film and television. But in both story lines the characters go off their medication in order to decipher a complex conspiracy. They become manic, paper the walls of their rooms with clippings, photos, lists, time lines, arrows, connecting lines, question marks.

Voila. The unlikely pattern becomes clear to them. And once again the myth of madness and genius being one and the same is exploited for entertainment.

Our brains are organizing machines. They are always looking for patterns, recognizable and logical patterns. In a state of mania and hypomania, aroused, alert and scanning for such patterns, the brain does indeed find them more readily, that is, the brain invents them. The manic person sees connections and patterns where none exist, and to make this connection the manic brain often invents forces, and powers and conspiracies that are pure fictions. This might result in an interesting piece of art, a fascinating stream of consciousness, or even an entertaining performance, but it is a dysfunctional state and it does not result in valuable insight. The usual result is loss of employment, loss of community, loss of reputation, and eventually loss of freedom.

To portray mania as a form of genius does great disservice to those who actually suffer from this illness.

Of course mental illness does not discriminate so we are as likely to find that it strikes a brilliant mind as often as that of an oaf. And that is not a pattern either. Just statistical probability.

Stigma, The Brain And Brain Illnesses

By Dr David Laing Dawson

Every day the news contains at least one item describing our struggle to understand a difficult or troublesome or tragic human behaviour. As I write this there is an ongoing trial of a man accused of killing, dismembering, and then burning a Calgary man and woman and their grandson who happened to be on a sleep over with his grandparents. It is reported that the accused held a grudge against this grandfather because of a failed business arrangement years ago. The grudge “grew in his mind” until….

Then I read of a woman who committed suicide two months after the birth of a child. The grieving husband wants to shed light on post-partum depression but the emphasis in the article was about trying to alleviate the shame some women feel because they cannot breast feed.

This is the article that stuck in my mind because it emphasized the problem of stigma, the need for awareness, and the “let’s talk about it” approach to “mental health”. All well and good. But it continued the trend of trying to understand these tragic behaviours as the consequence of some kind of rational, all-be-it extreme, thought processes.

I understand this. When confronted by any odd human behaviour we try to “understand” it by applying two mechanisms: a logical sequence of cause and effect and empathy (how would I behave in similar circumstances?).

We live our lives believing in the supremacy of mind; we organize socially and act independently within an assumption of “mind”, of “free will”, of “choice” and consequences and personal responsibility. We are very reluctant to accept the fact that the brain can hijack this process, that the brain is the primary organ dictating human behaviour, that the brain, this biological computer system of cells and neurohomones and fragile connections, can go wrong. This reluctance has extreme advocates such as Bonnie Burstow who thinks…. or who’s brain leads her to think…

Actually I have no idea what she really thinks and why she thinks  it.

But phrases like “mental health issues”, euphemisms for mental illness, and much anti-stigma publicity continue to support the primacy of mind and downplay the role of brain. They continue to support the notion that all troubles, with a little support, acceptance and understanding, can get better, be overcome.

This does a tremendous disservice to those who suffer from true, serious mental illness.

From her culture, her family, and perhaps from all the current pop cultural emphasis on breast feeding, the new mother in question probably felt some degree of disappointment that she could not breast feed. But this was not an experience that propelled her, through a logical sequence of thought processes, to suicide.

No. Serious postpartum depression, and postpartum psychosis is as clearly as any serious mental illness, a brain problem. The brain has hijacked the thinking process. It is no longer rational. This is a brain illness.

Prevention of the tragic consequences of this illness requires knowing which women who have given birth are at risk, screening for and identifying this illness, recognizing it as a brain illness, and treating it vigorously as one would treat any serious and life-threatening illness.

Sure, let’s talk about it and de-stigmatize it, but we also need to recognize that it is an illness, a brain illness, and offer, make available, medical/psychiatric treatment, and occasionally protect by holding the sufferer in a safe environment while waiting for treatment to take effect.

And, contrary to what Bonnie Burstow and the anti-psychiatry people say, we now have effective treatment for depression and psychosis.

We are Now in Big Trouble

by Dr David Laing Dawson

The other evening Mr. Tapper of CNN came out directly and asked the following question: Does Mr. Trump know the difference between the truth and a lie? Does he say these things as strategic gambits, all the while knowing they are falsehoods, in some cases outrageous falsehoods, or is he incapable of knowing the difference? This dichotomy suggests either he lies nastily and without regard for any semblance of truth as a political strategy, a gimmick, a distraction, or he is incapacitated.

Neither answer is very reassuring. And if this is an incapacity what is the nature of it?

There is a simple and consistent answer to this question. Pathological narcissism.

Trump’s lies are responses to that which his inflated ego cannot accept. All information, evidence, facts that suggest Trump is not supreme, the best, the most popular is unacceptable to him and therefore must be denied or rebuffed with “alternative facts”. Any successes or glory he does achieve must be revisited, replayed, exaggerated over and over again.

The fact Donald Trump’s narcissism is extreme enough to require this level of denial of reality (the size of the crowds, the “3 – 5 million illegal votes”, murder rate, wire taps) means it is incapacitating. He is incapacitated.

His lies, his tweets, are not even bounded by plausibility. They will continue, grow more outrageous, and dissolve in a wild lashing out.

Unfortunately Kim Jong Un and the excited commentary on American television may be providing Mr. Trump a way to lash out and destroy. And then, which I am sure aligns with an image in his head, he can stand akimbo in his great black coat upon the scorched battlefield like a Vulcan God.

Follow Up – Education More Important Than Ever

By Marvin Ross

I’ve been contemplating a personal follow up to David’s blog on the importance of public education but I’ve been procrastinating. I decided to write it after having lunch with someone who was complaining that a grandchild was being sent to a private school at a cost of $25,000. His argument was that the local school the child goes to is quite good and he will have to be driven to the new school where he will lose contact with all his friends in the area.

The ability to play with other kids on the block, walk to and from school with them, and to hang out is an invaluable educational tool. I grew up in a Toronto that was just starting to break free of the grip of the Loyal Orange Order – a Protestant fraternal group that celebrated the defeat of the Catholics at the Battle of the Boyne in 1690. Most important jobs were reserved for Orangemen who proudly marched on Yonge St every July 12 behind someone outfitted on a white steed playing King Billy to celebrate the victory of William of Orange over Catholics.

Toronto was just beginning to see an influx of immigrants from all over the world at that time. Up to then, the main immigrants were Jews and Italians. The elementary schools were becoming mix of ethnicities and we all mingled and played together (with the occasional fights that were settled easily). As English Protestants ruled, classes began with the Lord’s Prayer and the singing of God Save the Queen. Once a week, some kindly minister conducted a class on religion.

Jews could be excused but I stayed as did most of the others as I recall. This invariably led to our existence being recognized by the holy man who talked about religion in general rather than his own denomination. We learned about and from each other. Groups of kids from different backgrounds would share experiences outside of class. I can still remember our comparing what we ate for Christmas dinner (which I didn’t have) and being intrigued because my best friend was Japanese and they ate octopus.

As I progressed through the years, more diverse people began showing up in class. At this time, most Blacks were descendants of those who came via the underground railroad but we were soon joined by people from the Caribbean. In elementary school, I went to a drop in centre across the street from our house run by the African Episcopal Methodist Church. One year, I was one of the three wise men in their Christmas pageant. Of new arrivals at that time, the most exotic was a new Algebra teacher called Mr Gupta. No one had ever seen a South Asian before but what was most remarkable was that his two sons were in his class. They were math whizzes much to our disgust.

I don’t want to give the impression that there was no racism as there was but it was slowly beginning to break down thanks to the children from large groups of people from diverse places. We mingled together in school, played and fought together on the playgrounds in the neighborhood and began to develop understandings of each other. In her book on growing up in Toronto as a child of Holocaust survivors (When Their Memories Became Mine: Moving Beyond My Parents’ Past), Pearl Goodman describes how playing with the neighbourhood kids and dealing with them in the local school, helped her contend with the views and trauma her parents had from their experiences.   The outliers were Jewish kids in the area who were sent to Jewish parochial schools rather than the public schools. They were quite different from us and even talked differently with the sing song accents so familiar to those whose first language was Yiddish.

During that time, there was even a radio program hosted by the Minister of Citizenship, Jack Pickersgill, who gave his audience information about the various immigrant groups (called New Canadians), who were flooding into the country. The Governments attempt to help them gain acceptance

Education was a prime reason that fear and distrust of others began to break down. Aside from the fact that most kids in my high school could swear in Yiddish (as Jews were the largest group), tolerance and understanding was starting to emerge in all areas. A holdover from the War was the fact that high schools in those days all had cadet corps affiliated with various regiments and often our teachers were called by their military rank. My history teacher was a major.

My school was affiliated with the Queen’s Own Rifles, an old and respected regiment that landed at Normandy on D-Day and fought its way north to help in the liberation of Belgium and The Netherlands. We had to go on a Church Parade one Sunday to the regimental church and when we got there, the Sgt had us all lined up. His command was Jews and Catholics, fall out and we did and spent the church service in the basement playing foot hockey while the poor Protestants had to endure a religious service.

Education helped us integrate and learn to understand and tolerate each other and is very crucial today more than ever. And it is this understanding and respect for each other that results in US Muslim Vets offering to stand guard to protect Jewish cemeteries from vandals or Toronto Jews standing guard at Mosques to show solidarity.

It has always been important for us to learn about and accept others as equals and that process flourishes when we all go to school together.