Monthly Archives: July 2018

RIP Dr Fred Frese

By Marvin Ross

The world just lost another advocate for serious mental illness. Dr Fred Frese was a psychologist with schizophrenia and an active promoter of better care for the seriously mentally ill. He had been a board member of the National Alliance on Mental Illness and one of the founders (along with Dr E Fuller Torrey) of the Treatment Advocacy Center.

I met Fred, and his wife Penny, when they gave a talk at the Hamilton Program for Schizophrenia in the late 1990s and did a profile of them for one of the medical papers that I wrote for. Both of them were incredible speakers. Fred first got sick when he was an officer in the US Marine Corps guarding the largest repository of nuclear weapons in the US.

He became quite paranoid and was eventually transferred to Walter Reed Hospital in Washington where, he said, may of his fellow psychiatric inmates were high ranking officers. While a patient there and elsewhere, he pursued his education and obtained a PhD in psychology. He joked that he went from being an involuntary patient in one hospital in Ohio to becoming its chief psychologist years later.

He commented that he continued to study because people with mental illness simply cannot find work. His sense of humour was evident when he talked about dating his wife. They had gone for a long walk in the woods and it was then that he decided to tell her that he had paranoid schizophrenia. Not the best place to do that, he commented. She did not run off screaming, they married and had four children.

Dr Frese has always been a strong supporter of involuntary treatment when it is necessary (as it often is) and for the fair treatment of those who are ill.

He explains his position in this presentation below:

As he said in the video clip below, he refuses to be ashamed of his illness and that he is not recovered (despite all his credentials) but is in recovery.

I should also mention that Fred was very generous with his time and was an active supporter of the late Dr Carolyn Dobbins (another psychologist with schizophrenia) and was gracious enough to write a very good blurb for Katherine Flannery Dering’s book, Shot in the Head.

Those of us who advocate for improved services for the mentally ill will have to step up our efforts to make up for Fred’s loss.

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Trump-Speak explained

By Dr David Laing Dawson

Listening to Donald Trump at any time is not conducive to equanimity but I clicked on the link to his “take on Brexit”. He was asked about Brexit by a reporter as he stood behind a podium. At first, in a congenial way, he responded that he had been reading a lot about Brexit in anticipation of his upcoming visit to the UK. And then he elaborated in his usual style.

But I am writing about this because it was a clear demonstration of how Donald Trump’s mind works, and of the concept of “associations”.

When we listen to someone else, or to our own thoughts as we form sentences and speak words, each noun, verb, adverb and adjective can cause us to experience associations from other memories and experiences.

In a serious discussion about roses the word “pink” might be used, causing us to think of a “pink Cadillac” or the singer “Pink”, but being in the context of a serious discussion about horticulture we will not let our brains and mouths take us off the topic at hand.

Now people with Asperger’s or “on the ASD spectrum”, not being as keenly aware of the intent of the speaker as others usually are, will often go off on an extraneous tangent, caused by a word association. Often it is a metaphor or simile mistaken for a factual statement of equal or more importance than the original topic.

Someone in a state of disorganized psychosis may appear to go off on an irrelevant tangent linked to a single word, and in that tangent the unusual linkages can occur over and over and may cause a “word salad.”. “Word salad” being an extreme form of “loosened associations.” Of course some of the associations may be to unspoken thoughts and feelings, including delusions and hallucinations.

With the toxicity of drugs, alcohol, infections, chemicals, the fractured sentence structure can be further impaired by problems of working, immediate, and recent memory and the distractions of distorted perceptions.

In dementia, with impairment of recent memory, the brain may associate words spoken, not with the forgotten recent topic, but with other older memories.

And, of course, with some people, the assault on linear,  logical and cohesive sentence structure can come from word associations to an overwhelming theme, or trait, or need, or obsession. And here we have Donald Trump. Always, always to his own accomplishments, his self-aggrandizement, his prickly defensiveness, his greatness, his popularity, his wealth.

It is difficult to discern from his answer how much he actually knows about Brexit (probably very little). But the word “Ireland” took him to the properties he owns in Ireland, to how much they love him there, and on to the “magical” property he owns in Scotland, the birthplace of his mother, and the fact he owns properties “all over”, but the people voted to leave the EU, and there will be protests, there will always be protests, and the word protests took him to his own experience of protests during his election (actually switching to the American election without naming it) and how many electoral votes he got, and the words won and election, took him to Wisconsin which he won and Ronald Reagan didn’t win even when Reagan “swept the board”.

There was nothing new here, but a clear demonstration of how much Donald Trump’s narcissism intrudes and distracts from any cohesive linear thought about something other than himself.

In a similar vein, if one listens carefully to Trump’s semantics, his choice of references, his associative processes, when he talks about the upcoming meeting with Putin, his narcissism prevents him from seeing himself as anything but himself, not as a representative of a country. His mind loops within the small circle of how he personally will be perceived and received by Putin (compared to all the lesser presidents who came before him of course).

In a sane world this man would now be making decisions about nothing more than the hair and tanning products he applies each morning. And perhaps what club to use on the dogleg seventh.

 

Advice to the Donald on How to Keep Track of Seized Kids

By Dr David Laing Dawson

Dear Donald,

It has come to my attention that you are having trouble reuniting the 2000 to 3000 apprehended children with their parents. It seems you may have to resort to DNA testing to determine who belongs with whom. (By the way, if you are worried that some might have been brought to the USA by sex traffickers you could simply ask them.)

Meanwhile, should you institute another roundup of children in the future might I recommend that you use a highly successful method of keeping track of them once used in an earlier roundup:

Simply tattoo a unique number on the arm of each child. Enter this number in a ledger along with the name and age of the child and the name of his or her parent. The forearm is a logical body part for such tattoos because it could accommodate a long number without resorting to an alphanumeric system. I will include a photo as a visual aid.

Please do not hesitate to call for further advice.

Sincerely,

numbers

Blue Dreams – the Story of Psychiatric Drugs

By Marvin Ross

I’ve just finished reading Blue Dreams The Science and the Story of the Drugs That Changed Our Minds and it is the most balanced accounting of psychiatric meds that I’ve ever read. Lauren Slater is a psychologist and someone who has taken psychotropic medication for bipolar depression for most of her life. She has been in and out of hospitals many times so she speaks from both experience and academic awareness.

She starts out with a very detailed account of how chlorpromazine, the first anti-psychotic, came to be and gradually made inroads against the psychoanalysis that was prevalent at the time. What surprised me was that there were psychoanalytic neurologists who considered Parkinson’s to be the result of psychology and not brain chemistry. She then moves on to give the history of the first anti-depressant, imipramine.

As a political aside, both of those drugs were first used in North America by Dr Heinz Lehmann in Quebec. He came to Canada as a refugee fleeing Hitler. His colleagues arranged a ski vacation for him to Quebec as a ruse so he left Germany with his skis and all his luggage. A lesson for the Donald on the value of refugees.

Her discussion of lithium is quite interesting as its use goes back many years for all manner of ailments but it was slow to be accepted by medicine for psychiatry because there cannot be a patent on a naturally occurring substance. No money can be made and so, to this day, no one has ever bothered to try to find out what it does to the brain or how it works. A sad condemnation of science and of the profit motive in drug development.

Ms Slater began suffering depression at quite a young age and was eventually sent to see a psychiatrist in her early teens. She saw the doctor three times per week. After about 6 years of no progress, her doctor put her on imipramine which had recently become available but it did not help and gave her terrible side effects. When Prozac became available, she was switched to that and she spent 17 years taking it.

This is what she had to say:

“Both before and while I was on imipramine, my emotions were wild and I was whipped between states of utter despair, whirling anxiety and unstable ecstacy that allowed me to pull all-nighters writing lengthy tomes that later, in the sober light of another day, lacked what I felt at the time of composition had been a poetic essence. I was also a revolving-door mental patient in and out of the hospital admitted and discharged five times between the ages of thirteen and twenty-four, with not much hope for a full future……”

“Prozac turned my life around and did it fast, one two.”

“On SSRIs, however, I have been able to stay out of mental hospitals, to write nine books, to bear two babies who are now adolescents with their own keen interests and proclivities to manage with their own interests, to manage a marriage and then a divorce, and, just as important, to nurture a circle of friends.”

Unfortunately, over the years she has had to increase the dose until Prozac became ineffective and she had to switch to other medications. And, the drugs had a severe impact on her health causing her to gain weight and to develop diabetes. But, she said, that was the price she had to pay for sanity.

While she has been helped by pharmaceuticals as have many people, she is very critical of psychiatry and its theories which are quite simplistic. I was surprised to learn that despite the dopamine theory of schizophrenia, it turns out that those with this disease can have a wide range of dopamine levels and the levels are not related to the presence of the disease or its severity. The same applies to serotonin in the case of those with depression. Prescribing is a guessing game and there are doctors who prefer certain drugs and that is what they prescribe based simply on their preferences and not the science of why a certain drug works. However, drugs that dampen or increase levels of these neurotansmitters do help with the symptoms but psychiatry still has no clue about etiology.

This ideological adherence to certain drugs is one that I encountered a number of years ago. I pitched a story to a psychiatry/neurology newspaper on research done comparing the side effect profile of the older anti-psychotics with the new atypicals. The pitch was accepted and I submitted the story which showed that the newer drugs had just as many side effects as the older ones. The editor called and told me the research was preposterous and should never have been accepted as a presentation at a psychiatry conference. They refused to run the story but paid me anyway because they had accepted my pitch (in error I was told).

Of course, we all now know that the research was correct.

One interesting fact she mentions is that even with drugs like Prozac, the rates of depression are increasing. The reported incidences of depression have increased a thousandfold since the introduction of anti-depressants. She suggests that this might be the result of an American society that emphasizes individualism and has very few safety nets like universal health care. Sociological studies have shown that depression increases with isolative societies.

It would be interesting to compare rates of depression over time between the US and other western countries that are less individualistic like Canada and Western Europe.

I was pleased to see that while she references my old opponent, Robert Whitaker, she discounts his views. Yes, anti-depressants do cause changes in the brain as he points out but then, untreated depression (and schizophrenia) cause changes in the brain and the patient when untreated, is not able to manage.

Psychiatry and our knowledge of the brain is still in its infancy and we can only hope that greater progress is coming.

When is it Too Late? Or is it?

By Dr David Laing Dawson

When the steps are incremental and desensitizing, inuring, it is difficult to know when we have moved beyond the point of no return. Many of us thought the separation of children from their parents and the incarceration of over two thousand children in cages all over the country might be a step too far and too fast. But even this is being obscured and overwhelmed with rhetoric and confusion, with Orwellian language.

And speaking of Orwellian language I notice that Trump is not bothering to use a full phrase in his accusations, such as accusing any number of democrats of being “soft on crime” or wanting “weak immigration policies”. He has taken the next step in simplifying and labeling: The Democrats are “for crime”, they are “for gangs”, and they want “no borders.”

“Power corrupts” is not an empty phrase. It is an observation of all human behaviour. From studies of our history to the guard/prisoner experiments of the 1960’s. The gentlest person can find his or her inner tyrant when placed in the social context of supervising the weak and helpless. A few will wrestle with these unwanted impulses. Many will give into them.

I mention this because I detect a subtle shift in tone coming from the President of the United States. He is still prickly and defensive. He still manages to bring every issue back to himself and his greatness. He still denigrates Obama and all previous leaders to enhance his own reputation. (and to fuel the racism of his base)

But now his rallies and tweets have adopted a demagogic tone more directly and specifically. More and more his words place him above the law. More and more his words place him as the only important decision maker. More and more he ignores ethics and due process. More and more he aligns with tyrants and disparages the leaders of the democracies of this world with the worst derogatory word a mob boss can muster: “weak”.

His over-the-top rhetoric about the “Witch Hunt” is working. He is swaying public opinion. Most Republican politicians are falling in line. He may know little of history, compassion, governance, but he sure knows Goebbels (“If you tell a lie often enough…”) and the principles of modern marketing.

He once added qualifiers to his outrageous lies and hyperbole. “They are rapists and murderers – though some I suppose are good people.” He doesn’t bother now. Immigrants are “invaders” and “infections”.  One step away from vermin and cockroaches.

Increasingly he directly threatens individuals and corporations in his tweets.

If we are not at the tipping point, my American friends, we are close.