Skeptical Musings on Mindfulness

By Marvin Ross with an Addendum by Dr David Laing Dawson

I am pleased to say that I now have something in common with an apologist for Catholicism when it comes to Mindfulness. Susan Brinkman warns Catholics about the dangers of this practice in her book A Catholic Guide to Mindfulness. We have some criticisms in common although part of her objection to this overly touted strategy is that it is too closely linked to Bhuddism. She is concerned that people will abandon prayer and move away from talking to God for the relaxation of the mindful strategies.

Where we do agree is that Mindfulness is oversold and not well researched with valid studies. As we all have likely seen, mindfulness is promoted for stress reduction, depression, anxiety, pain control and likely more. Ms Brinkman cites a metaanalysis from Johns Hopkins University from 2014 that looked at 18,000 studies and found that only 47 (or .0026%) were methodologically sound. Over 99% of the studies to evaluate efficacy were not sound.

Of those 47 studies, “the research found only ‘moderate evidence’ of decreased anxiety, depression and pain and ‘low evidence’ of improved mental health-related quality of life.” She also points out that there is a great deal of money to be made by practitioners.

The poor methodological quality of mindfulness studies mentioned by Ms Brinkman have not gone unnoticed in the field. This past October, a new study was published that set out to evaluate studies over the past 16 years for signs of improved methodological rigour. They found that of the 142 research projects they looked at, there was only a slight improvement in methodology and the studies still appeared to lack scientific validity.

In reporting on this latest study, psychologist James Coyne asks this:

Should we still take claims about mental health benefits of mindfulness with a grain of salt?

His answer:

“A systematic review by one of mindfulness training’s key promoters suggests maybe so.”

Addendum from Dr Dawson sent from Australia

Two popular contemporary forms of counselling can each be summed up in a simple piece of advice, and a piece of advice most of us have heard at least once from our parents and grandparents. “Look on the bright side.” (CBT) and “Stop and smell the roses.” (Mindfulness).

They do not speak to mental illness, suffering, disease, or much of reality. But they do address the existential problem of we humans being conscious life forms with an awareness of ourselves as vulnerable bags of mostly water with limited life spans.

We must anticipate danger and threat to survive, but failing a math test is not a terminal diagnosis. We must, as I must now, remember to look first to my right (Australia) before crossing the road. This is a moment when it is not wise to let the roses distract.

We know it is not good to be pessimistic and constantly worried, but there are moments when anxiety and worry are required. We know it is not good to miss the calm, the peace, the beauty of this world and always be distracted by the traffic but I still need to remember to look to my right and then my left before crossing the street.

The popularity of Mindfulness (and Buddhism for that matter) speaks to how hard it is to find that balance, how hard it is to be a sentient being not always terrified, worried, fearful, angry, jealous and preoccupied by the intricacies of life and the certainty of death.

Yesterday at The Rocks in Sydney among the tourists and locals we several times watched a man trudge by dressed in brown monk’s robes, a large hat and boots, wondering what he was up to. Then in a moment when I was distracted he approached my wife and slipped a cheap beaded bracelet on her wrist, and then another on the wrist of our granddaughter, and then said something about money and showed her a book of initials beside a list of sums. The figures were each between 20 and 50 dollars. I muttered “no, no, no” as my wife reached for her purse and came up with five dollars. I told him it was bad karma to con people. I’m not sure if he said, “f***k off” or “father” as he left us. He also gave her a gold (thin plastic) medallion with the words “Work Smoothly” and “Lifetime Peace” printed on it.

We had at least five dollar’s worth of laughter and chatter from this, before falling back to enjoying the warm sun, the pigeons and Rainbow Larakeets, the parade of old and young humans from several continents, the busker at the corner, and the delightful teasing inquisitive grandchild sitting between us. My daughter arrived 20 minutes late having been stuck in Sydney traffic and forced to park four blocks away in an expensive arcade. This put her in a foul mood, which was quickly alleviated by a bit of paternal mindfulness and CBT.

Looking At Trump and Thankful for a Constitutional Monarchy

By Dr David Laing Dawson With an Addendum by Marvin Ross

Mike Pence looks upon Donald Trump with besotted eyes. Six months after the election Trump can get a crowd chanting “Lock her up.” I watch Jeffrey Lord, once an acolyte of Ronald Reagan, crawl through semantic swamps to throw himself at the feet of The Donald.

I read many accounts of how and why Donald Trump won that election: The forgotten citizens of the rust belt, of coal country and small town America. The rise of a populist leader sewing division, preying on our instinctive distrust of the other tribes who may covet our watering hole.

But I am also aware of very many successful cult leaders, men who can grow a following of thousands (or millions) in order to steal all the gold and the young women. To say nothing of tin pot dictators, cruel despots, and other false prophets.

It all speaks to a flaw in our human character, and a flaw, like many of our flaws, that once had survival value.

I’m sure when we lived in the jungles, even when we rode horseback on the prairies, and our tribes were beholden to a single alpha male, when we even sometimes thought of this alpha male king as a God king, we were stronger as a tribe when we offered blind allegiance, when we never questioned his decisions, and when we overlooked his indiscretions and malfeasance. Not that long ago we would shout “For King and country” as we rushed off to war.

This all implies an ability (a tendency) we have to project unto our leader, our king, the strongest of our desires and wishes, to assign to him the kinds of wisdom and compassion and strength that we would wish to see in our leaders, and in ourselves. We see such a leader, not as he really is, but as we would want him to be. Donald was right when he said his base would still vote for him if he shot someone on Fifth Avenue.

With the checks and balances of the American Constitution, with the equally powerful House, Senate, Judiciary, and with the fourth estate intact, America may survive this despot and our very human tendency to see someone as we wish to see ourselves.

But I write this really as a plea to keep our constitutional monarchy in Canada. We humans need a King or Queen and a Royal Family, as long as they have no legislative power. Then we can project into them all that we wish to. We can revere them, talk about them, read the gossip and inside dope, admire their wealth and stateliness. We can argue about their usefulness and cost. We can enjoy the pomp and circumstance. They can be our symbols of power and goodness. They can be the embodiment of our collective.

And as long as we have a monarchy it will let us see Justin Trudeau as a guy doing a half decent job as a member of parliament and, for now, our Prime Minister. Fully human, entirely replaceable. Even though he made the cover of Rolling Stone, we will still listen to what he says and watch what he does, and judge him accordingly. And we and our parliament will hold him accountable for all that he says and all that he does.

Addendum

Aside from the existence of the Electoral College, the biggest problem with the US system is the separation of powers. Because of that, the executive branch headed by the president is separated from Congress.  While the Vice President resides over the Senate, the president has the power to veto all bills passed while not sitting in either the Senate or the House.

In a Parliamentary System, the Prime Minister (PM) or the premier in Canadian provinces is an ordinary member of the legislature elected by his constituents in a local riding. He or she becomes the head person when elected by the party. As such, the PM sits in the legislature and is responsible to it, the local constituency and to the party. During question period, members of the opposition have the opportunity to ask questions of the PM and the cabinet in what is often a very heated exchange. That heated exchange is televised and often clips are on the nightly news.

If this institution was part of the US system, Mr Trump would have to sit in the legislative branch and be grilled on his policies. That would make for great TV.

 

How to Achieve Medication Compliance

By Dr David Laing Dawson

Anosognosia is an unwieldy word meaning lack of insight, or, literally in translation, `without- disease- knowledge`.  In the case of some brain injuries or stroke the brain may become quite specifically unaware of what is missing. The part of the brain that would perceive this is damaged. With mental illness, schizophrenia, bipolar, the apparent lack of insight  or denial of obvious impairment or implausible grandiosity may be more nuanced and variable. It may be part defensive in nature; it may be more a denial of the consequences imagined; it may be more about the power relationship at hand. Some of it may be merely human, the unwillingness to give up a longstanding belief, whether that be of the second coming,  CIA surveillance and persecution, or of being chosen, special, destined for greatness.  Some of it may be a distorted form of the normally complex parent – adult child relationship.

But almost every family with a severely mentally ill member must deal with, at least once, that time when the ill member claims to be fine when obviously not, and refuses to take medication or go for an appointment to the doctor.

How to approach this. What options do you have. Below is an outline for talks I have given on the subject:

Stage 1

• Calm and slow
• Non-threatening (posture, position (e.g. side by side), distance, tone, pace)
• Aim for a negotiated reality. (not the acceptance of your reality)

• i.e. He may not be willing to admit he is ill or delusional or needs medication but may be willing to agree that he is in trouble, anxious, not well, in pain, not sleeping, and that in the past the pills have helped with that. He may by his behavior be willing to take pills or come for an appointment as long as he doesn’t have to admit to need or illness.

• Gently find out what he or she fears.
• Gently find out what his objections are.

• Allay these objections and seek a “negotiated reality”.
• Stay away from labels, declarations, and you defining his reality.

• Offer pill with glass of water without saying anything.

Stage 2

Family intervention, same tactics as above but with whole family or available members, or a specific family member with influence.

Stage 3

Ultimatums. (You can`t live here unless…..)

But before doing this you should assess the level of risk (provoking violence, and/or leaving and putting self at risk). Discuss in family plus with a professional. Must also assess realistically your tolerance for confrontation, anxiety, worry, guilt. And ultimatums are only effective if truly meant, if you are truly willing to carry through with the ultimatum. If the ultimatum works, do not reiterate it unnecessarily.

Stage 4.

Form 1, J.P., Court order, Police intervention.

Before doing this decide on desired outcome, assess odds of achieving this desired outcome as best as possible (i.e. is there a treatment that works? Will they keep him or her long enough? Does the trauma of this kind of intervention justify the long-term outcome?)

Having decided on desired outcome, use all resources to achieve this. Learn the wording of the Mental Health act to get desired outcome. Use this wording to your advantage. Find family mental health friendly lawyer. Discuss with the health professionals who will be receiving the family member.

Family Doctors and Psychiatric Medication

By Marvin Ross

I’ve heard this more than once but family doctors who wonder why their patient with a serious mental illness is on the psychiatric medication they are on when they seem to be fine.

And so, they suggest that the patient either go off the meds or start to taper them with, of course, disastrous outcomes. The latest case I heard was of a woman I know with stable schizophrenia who has been stable for many years. This is a woman for whom it took years to stabilize and get her to the level she is now.

The patient in question is so in favour of medication that she has been active giving lectures to health care students and other professionals on the importance of them for stability.

But then, her family doctor wondered why she was on the dose she was on. He told her that as you get older, your metabolism slows and you do not need as much medication as before. She agreed to start lowering her dose with the expected result. She slowly became more psychotic to the point where her family had to to go to court to have her hospitalized and forced back on medication.

She is now back to normal stabilized on her meds but considerable time and anguish was wasted on something that did not need to happen.

Of course, my anti-psychiatry critics will suggest that she was addicted to the medications and that her descent back into psychosis could be predicted by her body reacting to the poison that was cut off. That, of course, is nonsense. She needed the medication and when it was taken away, her illness returned. In one of his earlier blogs, Dr Dawson mentioned that when psychosis returns, the individual develops the same delusional thoughts as they originally had. That happened in this case.

Regardless of the illness, if you are on medication, you are doing well, and there are no side effects, then why mess with it. One psychiatrist I quoted in one of my writings pointed out that it is so difficult and time consuming to find the right medication at the proper dose to help a patient, why mess with it when it is found.

Unless there is a really good reason to do so, continue with your dose.

Reminiscences of Hockey and Schizophrenia

By Marvin Ross

This past week Johnny Bower, the 93 year old former great goalie for the Toronto Maple Leafs, passed away. One of the comments made of him was his charitable work along with the fact that he was goalie the last time the Leafs won the Stanley Cup. I’m old enough to remember that it was so long ago.

His passing twigged my memory of the time that the Hamilton Chapter of the Schizophrenia Society of Ontario were the recipients of the charity of old hockey players. I’m not sure when this began but I became involved in the chapter in the late 1990s and was chair for a few years. The largest and most successful fund raising event was the annual National Hockey League (NHL) Alumni Association golf tournament put on for us at a course north of Toronto.

The moving forces were our executive director at the time and Keith McCreary who was one of the founders of the NHL Alumni. Sadly, both are no longer with us. I attended two of the golf tournaments in 2000 and 2001 and Johnny Bower was there along with many of the hockey greats from my childhood. I certainly remember Red Kelly, Dennis Hull, Eddie Shack, at least one of the famed French Connection line for the Buffalo Sabres, and numerous others.

What struck me was their incredible generosity. Some donated memorabilia to be auctioned off and all of them were more than happy to peel off $50 and $100 bills to enter the many raffles that were held. Hockey players of that era did not make the big bucks that they do today as Dennis Hull mentioned in his after dinner stand up comedy routine. He commented that today’s players earn more in a day than most of the guys in that room made in their entire careers. But their generosity to a disease that most of them probably knew very little about was remarkable.

Another guest who was much beloved by the hockey crowd was Michael Burgess who often sang the national anthem at Leaf games and who played Jean Valjean in Les Mis. The players all loved his rendition of Danny Boy which he did that evening. The link above is to his singing on Youtube.

Also incredible was one mother who positioned herself on the first tee and subjected each and every foursome before they teed off with her lecture on the horrors of schizophrenia and the need for more treatment, family support and research. She was not a young woman but stood in the sun and heat for hours without either a pee break or a drink break so that she would no golfer would forget what they were supporting.

That night, I drove home with our executive director and what was left over from the day along with about $10,000 in cash for the bank when I was stopped in a police road block looking for impaired drivers. Fortunately, I had cut myself off early in the evening.

That was September 10, 2001 and we all know what happened the next day 9/11 that changed the world forever.

But, the moral of the story is that there are good people out there who can understand serious mental illness and do their bit to make the lives of those who suffer just a tiny bit better.

  For more on schizophrenia, see Schizophrenia Medicine’s Mystery Society’s Shame and other Bridgeross titles