Monthly Archives: September 2017

Talk Therapy & Mental Illness

By Dr David Laing Dawson

In the years between 1965 and 1975 I would loved to have discovered that psychotherapy (talk therapy) worked for severe mental illness. I had read Freud (Sigmund and Anna), Jung, Adler, Sullivan and many others. I read all the detailed case studies available. I read all the theories.

We unlocked the door of the first mental hospital ward I worked on in 1968 and started group therapy and community meetings. I learned how to talk with people who are psychotic. I spent many hours trying to penetrate the mask of catatonia, the wall of stuporous depression, to calm the ravage of mania, and the erosion of anxiety. I saw the pain of what we then called agitated depression.

And I found that humanizing the environment and finding ways of relating to very ill people are good things, but they do not cure, treat, or ameliorate the actual illness. Talking alone does not work, though, as I have said before, it is always good to have someone in your corner.

I studied the history of Asylums and the treatment of the mentally ill pre-asylum, and before the application of, dare I say it, the disease model. I read all the analysts’ and other therapists’ case studies and discovered that though the writers developed an elegant understanding of each patient, their actual patients did not get better. Much like some of the data mining studies referred to recently in this blog, the results belied the conclusions.

So I am sometimes puzzled and sometimes angered by the periodic waves of anti-medication opinion that surface in all forms of media. Actually I am not very puzzled because one can usually detect the underlying ideology or motive. The motive is usually the preservation of status and/or ascendancy of the non-prescribing counseling professions. The ideology can be traced to some kind of belief in the perfection of the human mind, spirit, and soul, and a quite reasonable fear of us humans tampering with this.

I am not against psychotherapy and counseling at all. For mental illness the best results are always realized with a combination of medication and good counsel. And I say “good counsel” rather than naming a specific brand of psychotherapy, for despite the continuing attempts to rarefy (also own, patent, and make money from) one form over another, it is the common elements of good counsel that are ultimately helpful: a professional relationship that offers acceptance, empathy, dependability, understanding, support without moral judgment, and, sometimes, wise advice.

We also know people need decent housing, adequate diet, a meaningful activity, membership in some group providing a sense of identity, at least one good relationship, and a bit of exercise.

So why can’t we just get on with it and spend our time and money developing good services for the mentally ill which provide all of the above, rather than argue over the relative merits of each?

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Media Disservice to Public Understanding of Health and Medicine

By Marvin Ross

There exists an evil axis of reporters poorly trained in science and medicine, PR mavens and /researchers/universities/journals who feed off each other to present information to the public which can only be considered fake news. This article has been on my back burner for awhile but I’ve moved it up because of Dr Dawson’s last blog on the bad research and data mining on anti-depressants that he wrote about last.

I’m referring to the study that attempts to demonstrate that you are more likely to die if you take medication for your depression. Immediately after this appeared, we received an e-mail from a copy editor at a newspaper wishing that when papers write about stuff like this, they take the time to include comments from other experts who were not involved in the research. This is the report that we read although it has spread widely across North America. The lead author is not a psychiatric researcher but a professor of evolutionary psychology with an undergraduate degree in aerospace and then a legal degree.

What the copy editor suggested is what is supposed to happen but mostly does not. Anyone writing about current research should consult and quote someone not involved with the study in order to get a more objective view.

And the axis of evil is this. Researchers do their stuff and want to be recognized for their brilliance and their contributions to the good of society and (most important) to make it easier to get academic tenure and grants in the future. The PR people are anxious to get maximum press for their publication or university. In the case of universities, it looks good for their funding people and to show to alumni during fund raising. Reporters need a story and so often will simply reshape a press release into a news item.

If it is a breakthrough discovery in a laboratory petrie dish or mouse model, it gets hailed as “a new treatment is coming” and those with that disease become hopeful only to discover there is no new treatment. In the case of this particular study, all those who are anti-psychiatry will have more ammunition. I can’t find the figure but it is something like 20,000 promising therapeutic agents investigated to get one that is actually used and is on your pharmacy shelf. Those are the odds. We have all seen over the years the announced breakthroughs in Alzheimer’s Disease. In the mid 1980s, I wrote a book on Alzheimer’s called the Silent Epidemic and, for the most part, it is still relevant today. That is how many miraculous discoveries have appeared in that time.

Data mining is a common activity for some so that they can churn out papers. When I used to cover medical conferences, there was always at least one study by a Veterans Administration doctor who had culled through their huge store of medical records on mostly older male veterans and would manage to present their paper at the conference. The medical writers rarely took this work seriously.

Sadly, the public is inundated with stories which do nothing but raise false hope for sick people and cause many to rush out and waste money and endanger their lives. Think of the liberation theory for MS which turned out to be false but desperate people spent money and some died in pursuit of ridding themselves of their disease. For the most part, journalists do not specialize in a beat like medicine and health. Those who do  have a good grasp of science and knowledge of their subject matter. The others do not and  also do not have time to properly research.

I still laugh at this but a number of years ago, I started to freelance for a newspaper for doctors that had just launched. Their goal was to inform docs and sell advertising geared at doctors. One of the articles I wrote mentioned medical imaging and the editor called to ask me to define that. She was worried that doctors would not know what that meant but I told her that if they didn’t, they should not have a medical license. It means x-rays, CAT scans, etc. I gave up and told the publisher that his paper would not last. It lasted longer that I thought it would but it soon went out of business.

Take what you read on medicine in your local papers or media with a grain of salt.

Lies, damned lies, and statistics

by David Laing Dawson

Mark Twain said that long before we had computers and a few dozen algorithms we could apply to random numbers to find ‘meaningful’ patterns.

Data mining and scientific studies that find nothing or negative results seldom get published. So it behooves all academics to find something. To find at least an association that can be inflated by the manner the data is reported. Then it will get published, and the press might even pick it up if it is startling enough.

I am writing this because an article on the front page of our local paper tells us that people who take antidepressants are at risk of premature death. This is based on a local academic’s data mining and meta-analysis. The figure quoted is 33% higher risk of premature death and 14% more likelihood of death from cardiovascular disease. They also have to explain away the fact that if you have previous cardiovascular disease the use of antidepressants does not increase risk.

First, these are associations, not cause and effect. Secondly the variables are numerous. And the first variable that comes to mind is that the people who take antidepressants probably suffered from anxiety and depression, undoubtedly felt unwell, and did ask their physicians for help. The people who never took antidepressants did not. The only way these figures can be clarified would be to take 10,000 people who attend doctors complaining of anxiety, OCD, and depression and give antidepressants to 5000, and nothing to the other 5000, (randomly selected) and follow over 20 or 30 or 50 years.

Then we have the startling 33%. Well, if 3 people out of 1000 die in one group and 4 in the second group, that is a 33% increase, looking at it one way, but really a 0.1% difference looking at it in a real life way. These kinds of statistics are often misused in the press. When the actual risk (sorry, not actually RISK, just different finding) of contracting something increases from 1 in a million in one study to 2 in a million in another study that can be reported as a 100% increase.

I am sure antidepressants are both underused and overused. Underused in the rush of clinical practice when severe depression is not recognized or not reported, underused when the person is already self-medicating with marijuana, alcohol or opioids, underused when the dosages used are too small for severe depression – and overused as the go-to-drug for angst and unhappiness.

I am also sure any drug should be avoided if it can be. That goes for anti-hypertensives, statins, antibiotics, and aspirin.

So I did a little data mining of my own. It turns out that the people of Australia, Iceland, and Sweden rank in longevity 2, 3, and 4 in the world. Canada and New Zealand follow closely. Japan holds the number one spot but antidepressant data (for interesting cultural reasons) can’t be found so I have excluded Japan. On average the people in spots numbers 2,3, and 4 live between 82.4 and 82.8 years. Let’s average that to 82.6 years of life expectancy. Iceland, Australia, and Sweden also rank as the highest antidepressant users, ranking one, two, and four. (Denmark is number three)

Among the lowest antidepressant users (where data for life expectancy and antidepressant use can be accurately determined) are Estonia, Turkey and Slovakia.The life expectancy for the people of those countries averages 76. So by simple association we find that the longest lived people in the world consume the greatest number of antidepressant pills per person.

Applying my own meta analysis to this data I can arrive at the conclusion that high average consumption of antidepressants prolongs (oops, is associated with an increase in) life expectancy by 6.6 years, or almost 9%. The headline this could generate would be: Prozac increases life expectancy by 9%

But, academics have an ethical duty to explain the limitations of associations found in population studies and meta-analysis, and the true meaning of various statistical analyses in real life terms.

Reporters should have an ethical duty to avoid golly gee whiz headlines in health matters. (probably in a few other matters as well)

And medical historians should point out the dramatic change in the number of home and hospital beds utilized by moribund patients suffering from severe depression pre 1960 and today.

A curious side note: On the same Google page for Health news there is a report of a British teen dying from “eating her own hair”. They go on to discuss Rapunzel syndrome, and trichophagia. But such a compulsive behaviour is just that. A compulsion. A serious symptom of OCD. And easily treated today with one of those antidepressants maligned in the other article, along with some counseling of course.

 

Some Thoughts on Parenting and Parent Blaming.

By Dr David Laing Dawson

I read R. D. Laing years ago. He was a good writer, a poet, and unfortunately good writing can hide a bad argument. At the time I thought there was one glaring problem with his thesis, and that was, that if we are to believe that the parenting style, the behaviour of the parents, especially the mother, was entirely to blame for the child’s woes, or even schizophrenia, and therefore was BAD, as in “she is a bad mother”, then logically we could trace her badness to the behaviour of her parents, and then to their parents and on through the lineage.

So with that logic, if it were true that all of one generation’s woes can be traced to the behaviour of the parents, there was no blame to be assigned, except perhaps to Adam and Eve. And as I recall, with every theory of motherly behaviour causing schizophrenia being discussed in our study groups, (Laing’s conspiracies, double bind, skew and schism, the schizophrenogenic mother) someone would say, “Don’t all mothers do that?” And we would laugh at this obvious truth. For to be a parent means to be sometimes overprotective, sometimes a bit neglectful, sometimes too preoccupied, sometimes angry, sometimes demanding, sometimes in disagreement, sometimes short tempered, sometimes too tolerant, sometimes offering conflicting advice, sometimes playing on guilt, sometimes encouraging, sometimes discouraging, sometimes right and sometimes wrong.

On the other hand there is nothing to stop brutal, immature, even sociopathic teens and adults from having children. Some terrible things do happen to children. In this part of the world we have imperfect systems in place to discover this, to intervene, and to apprehend if necessary. The worst of these situations often go undetected for years, for by their very nature, they are secretive, antisocial, and sometimes very mobile. And the children who suffer through this are often scarred for life.

The systems to protect children will continue to be imperfect, for to perfect them would require a level of state surveillance and interference our society would not tolerate. But we can continue to do our best, discuss it, adjust our laws and processes, rescue many, and try to help others recover.

Professional Parenting advice changes with every decade, as often as other fads and fancies. It often follows the zeitgeist of the time, and usually echoes the current advice or wisdom found within other human endeavours, such as best management practices in the new information industries. Fortunately most parents ignore this formal advice and seek the guidance of their own common sense, knowledge of child and teen behaviour and development, and the wisdom of their own parents, aunts and uncles. And most parents struggle to find the right balance, the right expectations, the right levels of support, love, acceptance, control and discipline.

But I don’t think we are biologically programmed to thrive, at least after age 3 or 4, within a cocoon of family perfection and complete safety. We need some challenge and adversity; we need some things to overcome, some fears to conquer, some skills to acquire. We need some adversity in our childhoods and adolescence. We need to experience failure, at least once or twice. We need to experience the death of a pet, perhaps a grandparent. We need to skin our knees, get lost and find our way home. We need to do some things that cause us anxiety. We need to experience disappointment. We do not need perfect parents.

But one child’s adversity may leave scars while another child’s proves to be the cauldron for a very successful life. Barack Obama is only one of several US presidents who lost their fathers by death or abandonment in childhood.

To paraphrase an actor/comedian who gave the Commencement address at his Alma Mater, The University of Western Australia: “You are all very lucky to be here. Some of you because you were lucky enough to have stable, wealthy parents, who guided you, inspired you, and paid your tuition. The rest of you because you were born with the genetic makeup to overcome whatever obstacles were in your way and get here on your own.”

Mark Vonnegut, Schizophrenia and Mother Blaming

By Dr David Laing Dawson

Mark Vonnegut, the son of Kurt, had (has) a psychotic illness. In his autobiographical novel he explained delusions in this way: if you were being chased by a pack of wild dogs, wouldn’t you rather think that somewhere there was a hound master who could call them off if he chose to do so?

I have always thought he was right, at least with respect to delusions. They are explanations for experiences that, in the case of mania, cannot be explained within the accepted laws of physics; in the case of schizophrenia, cannot be explained by a diminished social perceptual and information processing system; and, in the case of dementia, cannot be explained by a diminished cognitive apparatus.

The invented explanations are usually quite simple and usually involve blame in either a positive sense (God has granted me…) or a negative sense (the CIA is…). The target for blame (or perceived source) in a delusion is always standard fare. The source of extraordinary power and well being is God; the causes of failure, constraint, weakness, control, are parents, the police, a disease, or Aliens. The methods are always contemporary:  in pre-industrial  cultures, by curses, spells, hexes, and evil eyes, through the 20th century by radar and radio waves, and now through a variety of electronic devices, bugs, and micro implants. And as per the topic of a recent blog, note that parents make that list.

But beyond an explanation of delusions, this wish for a hound master who could, if he chooses, call off the dogs of hell, is really quite universal. Historically we have used, or fallen into, just such an explanation for every sin, illness, climatic event, and tragedy that befell us. And, almost always, we have been wrong.

But this need, this psychological human brain imperative, continues. The value of this trait of the human brain (mapping, organizing, understanding) lies in the advancements of science. We want to understand why things happen as they happen. The downside to this need, this wish, is the continuing enthrall of astrology, a myriad other nonsense fads and conspiracy theories, and the wish to find someone to blame  for schizophrenia.

More on Trauma in Youth and Schizophrenia

By David Laing Dawson

This blog is in response to a comment made on an earlier blog called As For Trauma Causing Schizophrenia: No! No! No! 

The comment was how do you account for this study? And how can you claim that trauma cannot be causative of schizophrenia? https://www.sciencedaily.com/releases/2012/04/120419102440.htm

This is the answer:

There is no doubt severe trauma in childhood can have long lasting effects. But can trauma be a specifically causative element in the development of the full illness schizophrenia? And is it either a necessary causative element or a contributing factor?

Data mining and surveys come up with many associations, some weak, some strong. Fair enough. But we have to examine the definitions of each and every term and understand that association is not necessarily causative. And in this situation we must be very careful what we publicize because any association between trauma and schizophrenia provides support for parent blaming.

I am back to eating butter after something like 20 years of favouring margarine. This because for many years data mining found associations with butter and other animal fats and cardiovascular disease, and only recently further data mining and studies have shown that, au contraire, we need fat, and margarine may be worse than butter. Now I slather butter on my corn and biscuits without guilt. As someone else has pointed out, there is a very strong association between major road accidents and the presence of ambulances.

The word paranoia is used in many of those studies. I don’t know how they define it or determine it. Adolescents suffering from anxiety often experience what they call ‘paranoia’ but we refer to as ‘ideas of reference’. They feel their peers are always talking about them, judging them. Some avoid school because of this. Sometimes this feeling becomes a conviction and then it may be prodromal of a psychotic illness.

Bullying is interesting. I have 30 years of experience dealing with families in which a child is reported as being bullied by his peers. There are some distinct subcategories in this: In one subset, when the details are elicited, it turns out the boy in question is as much a perpetrator as a recipient. They taunt one another. But this particular boy tells his mother that Jason called him a “…..” in order to get a reaction from his mother, or to avoid something, or simply to get in front of the call that is going to come from Jason’s mother or the school.

A second subset is the Asperger/ASD child. They are common targets for bullying, precisely because of the way they react to unfairness, teasing, slights, and taunts. It is not kind and it is not good but they have become targets for bullying precisely because of the social deficits they already exhibit. My own survey reported on this site indicates that at least a third to a half of people diagnosed with schizophrenia have had autistic symptoms since infancy. So I would definitely expect a higher proportion of bullied children to develop a psychotic illness. The bullying is not causative, but the prodromal symptoms of the illness “invite” bullying.

Auditory hallucinations are not, in and of themselves, schizophrenia. People, girls, who have suffered prolonged sexual abuse report a higher incidence of auditory hallucinations. This certainly could be understood as persistent trauma of a particularly disorienting kind causing impairment in the brain’s otherwise quite miraculous ability to (usually) locate the locus of a thought or feeling, as well as causing all the other symptoms of PTSD as well.

On the other hand preteen and teen girls with ASD or prodromal symptoms of schizophrenia are vulnerable to predators within a family and neighborhood.

In sum, there are weak associations, though all suffer from our poor definitions and lack of clarity of diagnosis. None are strong enough to be considered causative. And if this were an association between salt intake and hypertension, to publish early causes little harm. (although even here we now have the problem of some people having too little salt in their diet, and other studies showing high salt intake may have nothing to do with hypertension).

But because this overall weak association with all its definition and cause/effect problems could support the existing serious prejudice of parent blaming for schizophrenia, I have to stick with my simple, “No. Neither psychological trauma nor poor parenting cause the serious illness we call schizophrenia.”

Though, of course, either could make it worse.

The Women on the Right

By Dr David Laing Dawson

I am not puzzled by the heavy-set blowhard males who espouse the views of Briebart, Fox News, and the Alt right. I know them. I remember them. They were always loud, obnoxious, dripping with hostility, overcompensating for something: Didn’t make the cut for the football team, passed over for Prom king, snubbed by the prettiest girl in the school, not dumb but certainly not first in the class, never cast in the lead of the school play.

But I have been puzzled by the females espousing the same views. The Ann Coulters of our television. But then I think, maybe I’m being sexist. Maybe I expect women to all be kind, empathetic, generous, inclusive, self-effacing. There is no reason a woman cannot be as selfish and short sighted and loud as a man. After all, their bible was written by a woman, one Ayn Rand.

Okay, adjust your thinking David. A woman has just as much right as a man to be a Roger Ailes, a Sean Hannity, a Glenn Beck, a Bill O’Reilly. Women can be loud, obnoxious, and right wing too.

But my puzzlement has returned, for yet another Fox News commentator has been suspended for “lewd photos sent to female colleagues.”

My puzzlement is not about these men behaving socially and sexually as if their development was arrested at age 14. That goes with the territory. That is where they are.

It is all one and the same. Their sense of white male privilege extends to being lord of the jungle, having ownership of all they survey, and that includes the women folk. And their notion of courtship has always been to display plumage and induce fear.

But why don’t the women recognize this? They are not and will never be equal partners in this right wing endeavor. Hand maids, concubines, and incubators, yes. But not equals.

So I remain puzzled by the women. Unless, of course, they have a plan to get rid of all the blowhard males and take over themselves.