Monthly Archives: January 2020

The Red Herring of Anti-Stigma

By Marvin Ross

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Anti-stigma red herring Image by PublicDomainPictures from Pixabay

Many of us have spoken up against the very popular mental illness anti-stigma strategies that have proliferated over the past few years. The problem has never been stigma but the lack of resources needed to properly treat serious mental illness. Queen’s University psychiatrist, Dr Julio Arboleda-Florez once stated that

“helping persons with mental illness to limit the possibilities that they may become violent, via proper and timely treatment and management of their symptoms and preventing social situations that might lead to contextual violence, could be the single most important way to combat the stigma that affects all those with mental illness.”

Sadly, we are not capable of doing that because we just do not have the psychiatric resources as a recent analysis by the Globe and Mail just revealed. Our resources are strained but thanks to anti-stigma policies and work-place wellness initiatives that reduce stigma, more people are seeking help.

Journalist, Erin Anderrson reports that half of Canadians have too few local psychiatrists or none at all. The result is chocked emergency rooms, long wait lists to see psychiatrists, frustrated families and stressed out doctors. Most of the psychiatrists are located in the large urban areas like Toronto and Vancouver and many of them not only do not take on new patients but have few patients on their roster.

Dr Paul Kurdyak of the Centre for Addiction and Mental Health (CAMH) in Toronto pointed out that some get too much care when they may not need it and those who do need it get too little. He co-authored a study in Toronto and Ottawa that found that 40% of full time doctors saw less than 100 patients a year and 10% saw less than 40. Those patients are in high income areas and have usually never been hospitalized. A 2019 paper found that about one in three psychiatrists only see less than two new out patients a month. And those patients tend to be wealthier and healthier than those seen by busy psychiatrists.

The bottom line as those of us on the front lines as family and advocates know, is that the seriously ill are pretty much abandoned, left to fend for themselves, are cared for by families, wind up homeless or in jail.

Instead of campaigns focusing on anti-stigma, concerned citizens (and corporate citizens) should be lobbying to encourage more medical students to go into psychiatry. Bell Let’s Talk could spend their efforts on setting up scholarships for med students to study psychiatry rather than their Let’s Talk program.

Bell and others could invest in financing hospital beds and units for those with serious psychiatric illnesses. Encouraging people to get help when there is no help available and both cruel and stupid.

What about housing for those with serious mental illness? Let’s say they are lucky enough to get treatment in hospital and are stabilized. Where do they go to live after? Not all have parents who can help and parents get burned out.

How do they pay for housing when they can’t work and disability payments are so low? Increases in disability allowances and guaranteed minimum incomes are needed but, in Ontario anyway, the minimum income project was cancelled and we can expect the right wing Ford government to soon begin attacking disability payments. The disabled in Ontario have still not recovered from the hatchet job done by the last time we had a right wing government in the early 1990s.

It’s time to throw anti-stigma out and move on to more lucrative strategies to improve the lot of those among us with serious mental illnesses.

Debunking Another Anti-Psychiatry Myth – A Review of The Great Pretender

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Image by Gerd Altmann from Pixabay

Marvin Ross

One of the main beliefs of the anti-psychiatry advocates is that mental illness does not exist. They love to cite the fact that there are no objective tests for mental illness like blood work but that is also a feature of many conditions that they do not dispute exist – Alzheimers and other forms of dementia and Parkinson’s come to mind.

The other contention is that psychiatrists cannot differentiate between the sane and the insane. I have to admit that I was not aware that this belief came about as the result of a “study” done by psychologist David Rosenhan published in Science in 1973. Rosenhan got himself admitted to a psychiatric hospital where he was diagnosed with schizophrenia based on telling the doctors he heard voices.

He claimed that this was the only symptom he presented with and, once admitted, he began to act as he normally did and was soon discharged with the diagnosis of schizophrenia in remission. Rosenhan then recruited a number of other sane pseudopatients who got themselves admitted to various other hospitals around the US where they too were diagnosed with schizophrenia save for one who was diagnosed manic depressive.

This 2017 video explains how the experiment was conducted and the results:

The study made a huge impact at the time although Rosenhan quickly dropped the topic and went on to do other work. He was offered a book contract with a generous advance but he failed to finish the book and the publisher sued to recover the money.

Thanks to the incredible investigative work of Susanna Cahalan in her book The Great Pretender, proof is provided that the study was highly flawed. Ms Cahalan obtained Rosenhan’s notes and found them to be sloppy to the point of being unprofessional and even unethical. He made errors about the length of time spent in hospital and even the capacity of one hospital. He claimed a hospital had 8000 patients when it only had 1510.

The published study had very exact percentages for staff time spent in various activities with patients but one of the pseudopatients interviewed by Ms Cahalan told her that no data was collected. The data presented in the study contained such statements as attendants spent only an average of 11.3 % of their time outside the cage (staff desk) while doctors spent only 2% of their time where they paused and chatted with patients.

These are very specific figures and yet there was no explanation as to how they were derived and calculated.

Dr Rosenhan initially went undercover to Haverford Hospital in the Philadelphia area and claimed that his data was not used in the study but, in fact, it was. Cahalan was able to obtain the actual medical record for his time in hospital and discovered that the symptoms he complained of were far more extensive than simply saying he heard voices.

The actual record showed that he told the doctors that he was sensitive to radio signals, that he could hear what others were thinking and that he tried to drown out the noises by putting copper pots over his ears. The use of copper pots is similar to schizophrenic patients covering their heads with tinfoil to protect against the rays aimed at them from outer space. He also said that being in hospital could better insulate out the noises. He also confeseed to being suicidal.

Ms Cahalan concluded that Dr Rosenhan intentionally distorted the facts for his paper.

One of his critics at the time, Dr Robert Spitzer, corresponded at great length with Rosenham  and was so outraged that he was motivated to develop an updated version of the DSM (version III). Spitzer quoted another physician who stated that:

If I were to drink a quart of blood and, concealing what I had done, come to the emergency room of any hospital vomiting blood, the behavior of the staff would be quite predictable. If they labeled and treated me as having a bleeding peptic ulcer, I doubt that I could argue convincingly that medical science does not know how to diagnose that condition.”

If you describe symptoms that encompass all the markers of schizophrenia to a psychiatrist then you can expect them to diagnose you with schizophrenia.

There was a 9th psuedopatient in the research who wanted to emphasize the positive aspects of his 19 day stay in hospital but there is a footnote in the study saying that this data was excluded. Turns out that it was not excluded. The author found a draft paper of 9 pseudopatients and then the published paper with a footnote saying the 9th was removed.

Despite being removed, the numbers did not change. The average length of stay, the number of pills dispensed remained the same and the time that nurses spent with the patients did not change. If you remove one subject from a small sample size, the numbers will change but they did not in this case. Had the editors of Science been aware of these transgressions, Cahalan said, they would not have published the paper.

Research is essential for advancing our knowledge by investigating new areas or, and this is crucial as well, in replicating earlier studies to demonstrate their veracity. Studies that find negative results are also important but many have been suppressed. Since January 2018, those conducting clinical trials have been compelled by law to report all results even if negative. This was enacted to ensure that doctors and patients could determine if treatments were safe and effective and arose because it was not unusual for pharmaceutical companies to suppress data that did not support the efficacy of a drug under development.

But, as Science reported, many are not doing this and there has been no enforcement for their failure.

Research study results often involve a great deal of hype and publicity which is good for the researchers and their institutions. Promotions result and grant money flows so deception is common. The website, retraction watch, hosts a database of the flawed research that has had to be retracted and that is just the tip of the iceberg. I personally came across a research study from the Institute for Clinical Evaluative Science in Toronto which reported that doctors in Ontario were failing to abide by prescribing guidelines. The problem was that the guidelines came out after the research was complete. The researcher and the director refused to admit error but the editor of the journal it was to be published in made them add a correction. That correction was not conveyed to the many media outlets that reported on the flawed conclusion.

Cahalan does touch on these problems with research and cited the Reproducibility Project at the University of Virginia. An attempt was made to reproduce the results of 100 social psychology experiments and fewer than half could be replicated.

The most famous of psychology experiments also conducted at Stanford, The Prison Experiment, has also been exposed as a sham in a very detailed expose in Medium.

Research is crucial but findings need to be replicated and the lay audiences should be wary of basing beliefs on the results of only one study particularly if there is a great deal of media hype surrounding it.

 

Climate Change Report From Australia

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Image by dayamay from Pixabay

By Dr David Laing Dawson

I am sitting inside under an air conditioner at this moment because the temperature outside in Willoughby just north of Sydney is 40 degrees centigrade and the air outside is humid and smoky. The bush fires rage up and down the coast and inland, some under control and some not.

And this decade, they say, may be the last chance to do something about climate change before a tipping point is reached, and that point is the moment a positive feedback loop engulfs us all – when it is too late to stop the destruction.

Australia contributes just over 1 percent of world carbon emissions, but combined with the emissions of similar small contributors like Canada this adds up to over 40%.

With the USA wallowing in some kind of self-destructive delusional state, leadership could fall to a new group of developed countries – a consortium say of Australia, Canada, the UK, France, Germany…. and so I will, at the start of this decade, pitch my idea again.

We need to bring together the people and the knowledge from all the pertinent fields to arrive at a doable plan. Not merely a plan to “reduce emissions”, or a target for global emissions, but a consideration of the roles and possibilities of other factors as well. These are:

  • Population control (and this should be high on the list)
  • Bypassing fossil fuel in developing countries. What can developed countries do to foster this?
  • Carbon Capture technology. Are any of these technologies viable and scalable?
  • Natural carbon capturing plants and trees. What role can reforestation play? New technologies to plant millions of trees?
  • Shifting all power plants to carbon neutral technologies. How and when and which ones?
  • The role that could be played by nuclear power.
  • Carbon neutral housing and building standards. What impact can this have?
  • Cycling and mass transit. Just how much of a difference can this make?
  • More plant based diets. Realistically what difference will this make?
  • How long to shift most land transportation to electrical or hydrogen based power?

What incentives are needed to do this?

  • Air transportation. Is there a viable technology to make carbon-neutral jet fuel? And how do we get there?

I’m sure this list could be longer, and each item have it’s own subheadings of viability, time, cost, contribution, technical, economic and political feasibility…but…

Justin, you could take the lead. A Manhattan project to save the world.

Setting this up will cost a lot but not nearly as much as all the fire fighting and disaster relief we will all be paying for in the coming years.

Twitter, Thomas Szasz and the Channukah Attack

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Image by OpenClipart-Vectors from Pixabay

By Marvin Ross

At the end of December US psychiatrist Allan Frances tweeted that in 1977 he had dinner with Thomas Szasz (The Myth of Mental Illness). Frances reported that he asked Szasz if he would intervene were his child suicidal because of psychosis. He smiled/answered: “I am a father first, a libertarian second”.

Dr Frances responded that “Szasz could hold extreme views re meds/commitment only because he never once treated a severely ill patient”.

Dr George Ikkos replied that “In 1994 Szasz insurance paid $650,000 for negligence to widow of patient with “manic depression” who committed suicide following his advice to stop lithium. The source is a book called Mad Muses by Jeffrey Berman (P110).” Dr Ikkos is an “elected Honorary Fellow of the Royal College of Psychiatrists. The Honorary Fellowship is the highest honour the College bestows” (from his website.)

Also chiming in to this interesting twitter exchange was Dr Mark Ruffalo who provided a link to an interview that Szasz did with Jonathan Miller in 1983. He summarizes:

Szasz concedes that society should treat the gravely disturbed (“mad” or psychotic) person in the same way it treats the person who has been rendered unconscious by an accident, implying support for involuntary treatment in these cases.

The entire interview can be seen below and these comments are made around the 34 minute mark. Prior to that, Szasz states that psychiatrists either lock up the innocent or free the guilty and that no mental illness existed prior to the advent of asylums in the mid 18th century.

I’m not sure what provoked the initial tweet by Dr Frances but a couple of comments before transitioning to Channuka. The initial question asked of Szasz is something that I always ask of doctors when they propose a certain course of treatment or a medication. If this was you (or a spouse or parent) would you still suggest that? We should all do that.

The other comment pertains to libertarianism. Szasz suggests that libertarians would always propose no involuntary action. I’m not sure that is a valid position for libertarians and it is definitely not for a psychiatrist I know who is one. This particular Toronto psychiatrist once told me that no one is as libertarian as he is and he firmly supports involuntary committal and treatment. People have an absolute right to decide their own fate but in the case of someone who is psychotic, he said, their mind is incapable of making rational decisions. It would be wrong to allow them to make those choices when so impaired.

While this twitter feed was happening, New York State and FBI officials were declaring the attack against a Channukah party in New York State to be an act of domestic terrorism and that the perpetrator, Grafton Thomas, would be charged with hate crimes. Of course, we all now know that Mr Thomas is a man with untreated schizophrenia.

It is not a hate crime nor is he a domestic terrorist.

He is a delusional soul who has not been provided with treatment as the mental health advocate DJ Jaffe pointed out in his excellent assessment in the New York Daily News. Jaffe points out that Thomas’ long term pastor could not understand why he had never been institutionalized stating “There hasn’t been anyone who has given a real solution to deal with a grown man who is dealing with schizophrenia, other than ‘Go home and call us if something happens.’ ”

Situations like this are not unique to New York State or to the United States but to Canada as well. Every one of those jurisdictions has examples of crimes committed with and without deaths due to the failure to treat people with serious illnesses.

Of course, one of the key reasons that people do not get proper treatment even if it requires involuntary hospitalization stems from the works of Szasz and all the others who deny the existence of serious mental illness.

What is also equally galling is the rise of anti-semitism and other forms of racism in the world today. While US officials were quick to jump on the Channukah attack as a hate crime, they have seemingly ignored others. In the week before the holidays, there were 4 attacks against Jews in the New York City area plus the assault in Jersey City of a Kosher supermarket according to Bernie Farber. Farber is the Chair of the Canadian Anti-hate Network.

Farber also reminded readers of Trump’s anti-semitic comments at a dinner for the Israel American Council. Faber neglected to mention Trump’s comments after the White Nationalist march in Charlottesville or Rudy Guliani’s anti-semitic tirade as reported by CNN.

Attributing the violent delusions of a man with schizophrenia as a hate crime when the villain is our failure to treat mental illness while ignoring real acts of hatred is a travesty.

I never thought I would ever applaud anything from Boris Johnson or from a Chasidic Rabbi but both got it right. Johnson delivered a very forceful speech on fighting anti-semitism while the Rabbi whose house was invaded spoke out about the need for greater understanding and support between minority communities. “The Hasidic Jews of Monsey must ignore the outsiders who want us to take up arms and politicize our tragedy.”