Monthly Archives: May 2020

Group Dementia, Anti-Science, Anti-Vax and Anti-Psychiatry

By Marvin Ross

An individual I look after who has Alzheimer’s and is in a dementia care home called because he can no longer tolerate the Covid-19 restrictions. He has been locked in since the beginning and can no longer go for his daily walks (with his Personal Support Worker) to various coffee shops in the area. The arguments he used were quite similar to the arguments used by the anti-lock down people in the US. They were:

  • there is no pandemic
  • people die all the time so what’s the big deal
  • who are the public health officials and medical officers of health to tell me what I can and can’t do
  • my freedom is curtailed and it is my business

He can be excused because he has dementia which trumps (no pun intended) his doctoral degree and his knowledge of science and medicine. But how can we account for those views in people who do not have dementia? The answer, I think, is our anti-science views that are not restricted to just the groups mentioned in the title and the conspiracy theories they breed. For example, someone in Quebec is torching cell towers because they believe that 5G technology is spreading the virus. The towers do not have 5G technology.

A doctor in France, for some reason, decided to do a small study of a malaria treatment drug called Hydroxychloroquine to see if it might help with Covid-19. Why, no one seems to know since the drug is used to prevent malaria and to help with the symptoms of lupus and rheumatoid arthritis. The study has few people in it and is badly designed but he claims some efficacy. Trump latched on to it, Huffington Post suggested, when he was influenced by a “philosopher who tweets anti-semitism, two bitcoin bros and right wing media” Suddenly, numerous universities around the world decide to conduct full scale clinical trials. Right now, there are 199 trials of this drug listed with the clinical trials registry.

The rationale for conducting a clinical trial is that there is a viable hypothesis to suggest the drug might be efficacious. I do not think there is one in this case so why are we wasting our resources?. The clinical trial process is lengthy and takes years to complete before a drug is finally approved. The steps are laid out in this article from the American Council on Science and Health .

Remdesivir, an anti-viral agent, may show some promise but the one study found no reduction in mortality from its use and a reduction of time to cure reduced by about 4 days from 15 days. Production is being ramped up despite a marginally positive result in one small trial. The American Council suggested that the one study with results is no cause for celebration.

As for vaccines, the fastest a vaccine has ever been developed is 5 years and yet there is tremendous hype for a vaccine with one small trial involving only 8 patients. The stock market response to this one very small trial added $29 billion to the value of Moderna stock.

“Several vaccine experts asked by STAT concluded that, based on the information made available by the Cambridge, Mass.-based company, there’s really no way to know how impressive —or not — the vaccine may be.”

There were 45 subjects in this trial but the company only released data on 8. What were the results for the other 37 subjects? No one knows and that is just one problem with the data.

The anti-science attitude is not new nor is it confined to certain segments of society like the uneducated. This attitude is surprising given that the last 50 or so years has seen incredible scientific advances that have enhanced our lives and allowed us to live longer than before. The anti-vax movement is as unscientific and stupid as can be and is not confined to those with little education. The same goes for the anti-psychiatry group as I have been writing for a number of years.

I still cannot get over the scholarship for anti-psychiatry studies established at my alma mater the University of Toronto a few years ago. I wrote about it here and here.

Just recently, a long list of supposedly respected people and disability groups wrote an open letter to the Public Broadcasting System (PBS) in the US because they showed a documentary on serious mental illness called Bedlam done by a psychiatrist. Unfortunately, I did not see the film because my local PBS station across Lake Ontario in Buffalo, New York did not show it. The letter demands that PBS give them airtime and criticized what they think are the fallacies in the film.

Unfortunately, those who oppose modern psychiatry and the treatment of serious mental illnesses are either ignorant or unaware of the advances in the neurosciences and in the treatment of these illnesses. Their letter decries the lack of discussion of such treatments as Open Dialogue from Finland, the Hearing Voices movement and Sorteria. As I wrote a few years ago, Open Dialogue has yet to be proven to be efficacious. My blogging partner, Dr Dawson covered this in this blog. Hearing Voices was discounted by me in the Huffington Post and by Dr Dawson in this blog as well. Sorteria, a drug free program founded years ago and abandoned years ago is getting a bit of a resurgence in a drug free treatment program in Norway.

Properly applied pharmaceutical therapy for serious illness saves lives. To ignore this is folly.

Given the extent that scientific advances since the mid 1950s have enhanced lives, it is surprising that anti-scientific views attract so many people.

Guest Blog Will the New Federal COVID Mental Health Funds Help Those With Serious Mental Illness?

By Home on the Hill

Prime Minister Trudeau has announced an investment of $240.5 million to develop, expand, and launch virtual care and mental health tools to support Canadians during the COVID Crisis. This action is laudable, however, will people with serious mental illness be helped with this money?

Many have symptoms such as “anosognosia” or lack insight that they are ill and will not reach out and ask for the help that they need. Home on the Hill has heard from a family where the telephone crisis service asked that the family member with schizophrenia, and in crisis, make the telephone call himself which he did not do.  When things became overwhelming, the family called the police which they had done many times in the past.. While the police do treat families with respect, their actions are not subtle and five police cars can land on your street which causes consternation and suspicious questions from neighbours.

Kathy Mochnacki, a family caregiver and Chair of Home on the Hill, attempted to communicate that  “anosognosia” prevented people from accessing care at the Service Coordination Council on Mental Health and Addictions of the Central Local Health Integration Network (LHIN) and felt uncomfortable with the response of some members who did not appear to understand this symptom. Over the three year span of this Council, she repeatedly asked that a psychiatrist attend the meetings but this request was disallowed even though psychiatrists play a significant role in a family member’s care.  This Council was to embed the patient and family voice and an Interim Report from the Centre for Excellence in Economic Analysis Research (CLEAR) evaluation group of St. Michael’s Hospital in Toronto recommended  “meaningfully engaging people with lived experience and their family members”.

Despite this, the family voice was not heard. Until it is, scenarios like the above described example will continue to happen.

Education to service providers about the symptoms of psychotic illness would help them understand anosognosia and other symptoms of psychotic illness which prevent the individual from reaching out.  Service providers would then understand that by not asking for help, the individual  is not expressing a choice but demonstrating a symptom of his or her illness. And families are not left with the only option of calling costly emergency services such as the police. (please see a training opportunity about anosognosia education by Dr. Xavier Amador)

The above mentioned family are grandparents with their own health issues whose grandson was finally taken to hospital by the police but was shortly discharged.  He walked all the way home from one city to another and arrived at the family home around midnight.  When we last checked, the grandparents said they are “practicing deep breathing and are saying prayers” and desperately scrambling for emergency housing.

Is this how our society should treat its most ill citizens and their families?

Is there a way that this new funding could lessen the burden of this family when the reason for their distress is systemic?  

And why does the current COVID pandemic garner a response of mental health funds, when the ONGOING PANDEMIC OF UNTREATED PEOPLE WITH SERIOUS MENTAL ILLNESS who lie abandoned on our streets, and in our jails continues to be ignored? 

Five thousand citizens live with a serious mental illness in the city of Richmond Hill alone. These citizens deserve appropriate hospital stays, education for them and their families about the illness, a psychiatrist, a family doctor for the many physical issues that they experience, rehabilitative supports, appropriate supportive housing and a mental health system which listens to them and their families with respect.

The COVID pandemic is an opportunity to draw the curtains back, and ask some hard questions. The family home, out of necessity, has replaced the asylum and until we get adequate and appropriate supportive housing, this will always be. Family caregivers perform most of the care tasks and ask that this fact be appreciated.. It is not a role that they chose. While families are included in meetings with the doctor when the patient has cancer, they are so often excluded  from the discussion if their loved one has a mental illness even when the patient has given permission.

Is it not time for mental health professionals to help mitigate the myriad of barriers that families experience like the unrealistic Ontario Mental Health Act and entrenched attitudinal barriers. Can we not streamline, enhance (like increase hospital beds) and coordinate services that work to make it easier for patients and families?. Is there an opportunity to evaluate services and not depend solely upon inputs like the number of visits or the length of the wait lists but study outcomes such as whether the youth suicide rate has gone down?.

Are there innovative ways to engage vulnerable people at risk as 50% of people with schizophrenia have the symptom of “anosognosia”.  Could service providers look at less stressful ways to deliver care such as the practice of visiting nurses who give injections now practiced by St. Joseph’s Hospital in Hamilton. Finally, many families who look after a vulnerable relative with no help from the system are bewildered at the costly bureaucracy which appears detached and totally removed from what they are experiencing.  Is there a way, instead, to spend our precious financial resources on these aforementioned much needed determinants of health for people with serious mental illness?

Home on the Hill is a supportive housing initiative in Richmond Hill, Ontario. For more information, visit http://www.home-on-the-hill.ca/

Addendum

A recent editorial in the Lancet points out that the one group that is not getting any consideration during this pandemic are those with serious mental illness. The authors suggest that:

Those who wish to build fairer societies and health systems after the pandemic ends must learn about and prioritise the needs of people living with severe mental illness as a matter of urgency.

Assorted Comments on Depression, Schizophrenia and the White House Press Corps

By Marvin Ross

Mental illness is something that is found in many people in all walks of life and to varying degrees of seriousness. Unfortunately, society does not see examples of successful people who are struggling quietly. If we did, maybe more of us would have a greater compassion. I say this with the understanding that someone’s health condition is personal.

Baseball fans will be familiar with the late Roy (Doc) Halladay who died in a single plane crash a few years ago. Halladay was a brilliant pitcher during his time with the Toronto Blue Jays and he continued his brilliance when he went to Philadelphia when he qualified as a free agent. In 2010, he pitched a perfect game (no hits and no walks) and later that year, he pitched a second no hitter. He was only the fifth pitcher to throw two no hitters in one year.

Aside from his skill as a player, Roy showed a great deal of empathy towards kids with disabilities. While in Toronto, he and his wife outfitted a box at the ballpark for children from the local children’s hospital so they could enjoy a game with their families – “Doc’s Box”. Every year with the Jays, he donated $100,000 each year to the Blue Jay’s Charity.

According to a new book just being released, “Doc: The Life of Roy Halladay”, by Todd Zolecki the Philadelphia Phillies beat reporter for MLB.com,:

“He struggled a lot with depression,” Brandy (his wife) said. “He struggled a lot with anxiety. Social anxiety. He never felt like he was good enough or funny enough or liked. He was a sad spirit. But I don’t want that to overshadow all the great times.”

Depression and anxiety can impact anyone.

New Schizophrenia Research

Some new research suggests a reason for the sex disparity in schizophrenia. It is well known that schizophrenia tends to be less severe in females than in men and some have hypothesized that the reason is that the onset in females is later. By the time it raises its head in females, they have had more time to learn academically and social skills. A gene called C4 is more pronounced in men. This gene is protective against lupus and another auto immune disease called Sjogren’s Syndrome. Far more women get these two conditions then men so the suspicion is that it protects men from them but makes them more susceptible to schizophrenia..

Those carrying more of this gene were 7 times less likely to get Lupus and 16 times less likely to develop Sjogren’s. They were 1.6 times more likely to get schizophrenia. This research does suggest some new avenues for treatment of these conditions.

Another bit of research finds that people born blind do not develop schizophrenia. What is thought is that just might be something in the way the world is perceived that protects those who are congenitally blind from developing schizophrenia. If the way a person sees the world is off, it becomes harder to predict what is going to happen and the brain steps in to try to correct for this failure. Someone who is blind from birth, does not have this problem. An interesting observation that needs to be explored with the goal of finding new treatment modalities if this pans out.

Follow Up on the White House Press Corps.

The day after my blog on the failure of White House journalists to challenge Trump’s claims, someone did. Trump got quite upset and walked out. Congratulations to the young lady from CBS for doing that. It is a start but more need to start challenging him.

Intimations of Mortality

By Dr David Laing Dawson

I’m sure I have not used the word “intimation”, nor read it, since a High School Poetry class. And over the years Wordsworth’s phrase has changed in my memory from “Intimations of Immortality” to “Intimations of Mortality”, making it finally a word and a phrase that exactly suits the moment.

For on another day the same as the last, checking the worldwide coronavirus numbers and then sitting by the window watching the leaves finally unfold in the colder than usual May, the word ‘intimation’ settles with full meaning in my mind. Not just a feeling; not just clues; not simple hints; not information exactly; not merely foreboding; not only an unsettling mood, but some combination of all these. Brought about I’m sure by the change in routine, the uncertainty, the threat of illness, the quiet in the streets, and the world encompassing information.

And there it sits; and I should allow it to sit; and I should live within it for a while to see what I learn.

But we run from it exchanging cartoons and memes and black humour with family and friends. We return to what we imagine was a simpler age and garden and bake and knit and build and paint and write. And we binge watch old series where people smoked and watched television in small boxes and phoned each other from heavy contraptions on a desk.

And I write a blog describing all the good things that might arise from this pandemic, the changes societies could make in response to the crisis. But there are other possibilities too: the rise of nationalism, polarization, a fatalistic view of climate change, the rise of tyrannies, a return to the status quo with more inequality, and less attention paid to the hidden population of mentally ill.

I watch CNN in the evening and ignore CBC though I am a fourth, maybe a fifth generation Canadian, and this because my intimations tell me to watch America. Canada is muddling through this without excess rancour and discord, as it is bound to, finding compromise where ever possible, its citizens obeying most cautions, laws and directives, sacrificing comfort and pleasure for the common good.

But the USA is where the action is, where the polarization increases under duress, where racism rears up, where the social contract is broken, where guns are carried to protests, where the selfish I openly struggles with the We, where each blames the other, where politicians regress to school yard taunts, where expedience trumps knowledge, and where this might all go the wrong way.

Intimations indeed.

Lessons Learned from Covid-19

By Dr David Laing Dawson

We humans seldom change our behaviour until and unless we have to. The counselling mantra is that we don’t change (go into rehab, drink less, exercise, stop smoking…) until we want to, decide to. But that’s not really true. We don’t do those things, that is make difficult changes in our routine behaviour, until we have to, as brought to us by a health scare, a threat from a loved one, an embarrassing experience, an overall shift in social attitude…

The same goes for corporate behaviour. Corporations don’t shift behaviour until they are fully in a crisis, or get caught.

So the good news about the current pandemic is that we are in a crisis and we did get caught.

So maybe, just maybe, some good things will come out of this. Here is my list:

1. True international cooperation and preparedness for the next virus, or bacterium that emerges.

2. Some measures taken to prevent the jump of pathogens from animals to humans.

3. Improving our long term care facilities and procedures. (It has always been known that influenzas and pneumonias, viral and bacterial, carry off this vulnerable population each season, but COVID- 19 is a wake up call)

4. Hospitals are paying some attention to antibiotic resistant bacteria but they are really Petrie dishes for these new evolving pathogens. Time to take it really seriously.

5. An overall increase in the awareness and acceptance of actual scientific medical information. e.g. vaccines

6. Improvement in our health care systems, COVID 19 having shown us the different gaps and problems and inequalities in each nation’s system.

7. I have always expected to acquire a minor virus or two when travelling any distance by air. Perhaps this crisis will show us how to travel by air/train without such an expectation.

8. This awakening to a problem that is world wide, that has an impact on every human on the planet, may help us expand our consciousness to the plight of all, and specifically to the developing crisis of climate change and global warming.

9. And finally, this may bring about a new understanding of what is referred to as “the economy”.

I was struck by the television reporting the past couple of nights of people in the USA lined up for food banks. “Not since the great depression” was the tag line, with some black and white images of long lines of unemployed and hungry families in the 1930’s. They are standing, clustered in threes and fours, in quarter mile lines, appearing gaunt, dressed in drab clothes, waiting their turn for the soup kitchen. In contrast the lines today were of cars and SUV’s lined up for blocks to enter the drive-through food bank, with boxes of food stuffs being loaded into the cargo space.

The great depression was preceded by the roaring twenties, with excess, excess in expectations, borrowing, crime, growth, debt, leading to a collapse of banks and the stock market.

It wasn’t until Roosevelt’s New Deal that it occurred to government that this man-made problem could have a man-made solution, that the problem of no jobs could be overcome by creating jobs, by getting money into the hands of ordinary people, that as much as jobs create money, money creates jobs. And money can be printed.

So now it has become common practice to spend our way out of recessions and depressions, to create or “borrow” money and “stimulate” the economy. Still we stumble from the good times to the bad and never learn.

While we are busy flattening the curve of COVID – 19, might we learn how to flatten the roller coaster ride of our “economy”?

Simple steps I think learned from 100 years of experience:

a. Bank, lending and market regulation and oversight. Corporations and people cannot be trusted.

b. Much more equitable distribution of wealth achieved through higher taxes on all forms of excess income.

c. Guaranteed annual income of at least, say, $20,000.

d. Simplify this by giving the annual income automatically to every adult, and have it replace unemployment insurance, welfare and disability pensions, old age pensions and all the bureaucracy that goes with these.

The time has come for this last idea. All it requires is a different way of thinking about “the economy” and about money itself.

The Trump Propaganda Machine Just Keeps Rolling Along

By Marvin Ross

Internationally syndicated columnist, Gwynne Dyer, recently wrote a column on how, during this pandemic, every country gets the government it deserves. He was specifically referring to the UK and to the US as both have severely botched their responses to this crisis. About the same time, Irish Times columnist, Fintan O’Toole, wrote that the attitude in the world today is to pity the United States.

“Trump’s mixed messaging and lack of leadership has made the U.S. the epicenter of the pandemic: “I don’t think we’ve ever seen… a leader who has been active spreading a deadly virus, which is really what Trump has been doing.”

And while all this is true, a great deal of the blame must go to the scientists as David Dawson wrote earlier,for not exposing his lies and BS. Yes, they are protecting their jobs and their asses but at the cost of tens of thousands of lives. Sure he can fire them but maybe, just maybe, the mass firings would get Americans to stop and think for a minute.

The other group that is enabling this BS are the journalists attending the White House press briefings. The role of the media in a democracy is to inform the public and to “act as watchdogs checking government actions.” That watchdog role should involve taking the statements that Trump and his press secretary make and doing some basic fact checking. Some US media groups are doing some of this but often not the ones sitting in DC listening to the press briefings.

The other day, I caught the new press secretary giving her briefing to the press. She was pointing out that because of all the hard work that had been done by the administration and by others, the US had one of the lowest rates of covid-19 and Covid-19 deaths in the world. So, as a result, we are now able to relax the lockdown rules and reopen the economy.

That is actually the opposite of what is happening. The US has one of the worst rates of infection and mortality in the world as can be seen here. With that as a response to a question, the proper response is for the journalist or others to ask a supplementary question. What evidence do you have for asserting that? No one did.

At that same press conference, she dismissed the need to mass test people and called it useless. However, it is reported that she, herself, and the inner White House Circle get tested twice a week.

By not challenging it, it then is considered to be fact. Now I realize that journalists might lose their accreditation to appear at the briefings but so what. If enough ask difficult questions and challenge the BS, most will be kicked out. And if they are, then the networks can refuse to broadcast it. By not going that route, they are simply enabling the lies and propaganda.

Trump’s newest press secretary is 32 year old, Harvard Law School grad Kayleigh McEnany. She is a life long Republican and an early supporter of Trump. In 2012 during the birther attack against Obama, she posted this on twitterHow I Met Your Brother — Never mind, forgot he’s still in that hut in Kenya.” Obama’s half brother, Malik, lives in Kenya and is a graduate in Accounting from the University of Nairobi.

The Trump propaganda machine has been busy and working from the very beginning. In 2017, Jeff Nesbit writing in the US News and World Report, compared Trump’s media policies to that of Joseph Goebbels and Hitler. He wrote:

“State-sanctioned propaganda – which works by destroying independent media credibility while simultaneously disseminating lies – is now lurking around every corner in America, and in the press briefing room at the White House itself, where the press secretary and administration officials offer demonstrably false statements as truth or “alternative facts.”

He ended with “The power of state-sanctioned propaganda, and its ability to destroy the credibility of independent media, is timeless for a simple reason: It works.”

It is time for the US media to stop enabling Trump and to take a stand.

A Dose Of Reality Is Needed For Mental Health Week

By Marvin Ross

In Canada, the first week in May is designated “Mental Health Week,” and according to the Canadian Mental Health Association, the purpose is “to encourage people from all walks of life to learn, talk, reflect and engage with others on all issues relating to mental health”. We are encouraged to #getloud for mental health.

In the US, the entire month of May is devoted to “mental health”.

However, I have to say that I am perplexed about the reason we “celebrate” mental health in both Canada and the US. I assume we are celebrating, but I’m not really sure what we are celebrating or what we are doing.

What is not “celebrated” is our abysmal record on providing treatment and resources to those who suffer from serious mental illnesses like schizophrenia, bipolar disorder, severe depression and other illnesses. And note, I said illness not health. There is a difference. A poster circulating on the internet expresses the problem extremely well. It says:

Saying “Mental Health” for schizophrenia is like saying “Physical Health” for cancer

You can substitute serious mental illness for schizophrenia above.

Justin Trudeau had this to say at the start of the week a few years ago, “Let us use our voices this week to help change the way society views mental health issues and those living with them. Now is the time to GET LOUD for mental health.”

And of course, he uses the word issue as in mental health issues. Mind You blogger, Dr. David Laing Dawson, discussed the use of the word issue in an earlier  blog and commented that “by calling mental illness an issue we are placating the deniers of mental illness and we are reducing it to an abstraction, a topic for discussion and debate, rather than a reality in our midst….”

And he ended his blog by stating “But let’s stop with the “issue” when we are naming or describing a painful reality.”

The painful reality of mental illness in both the US and Canada is that we do not have enough resources like hospital beds, community treatment, housing, etc to provide the proper treatment that is currently available for these who suffer.

Readers of my blogs on Huffington Post know that many of them deal with the inadequate services that those with the most serious mental illnesses receive in Canada. It is hard to pick out one as so many of them deal with this problem. If we were to have a realistic group of people representing the faces of mental illness in Canada, we would have someone who is in solitary confinement in a prison and someone who is homeless.

One of Correction Services Canada’s top priorities is to deal with the mental health needs of its population. They estimate that 38% of incoming prisoners suffer with a mental illness. In his June 2015 report, the Correctional Investigator of Canada, Harold Sapers, found that “mental health issues are two to three times more common in prison than in the general community”.

In Ontario, the Globe and Mail recently analyzed the long-term solitary confinement of prisoners in Ontario and found that 40% were locked away for more than 30 or more straight days. This is twice the limit permitted by the UN in its Nelson Mandela Rules.

The Globe reported that:

On 40 per cent of the files, staff gave mental health or special needs as part of the justification for their prolonged segregation, a figure that seems to clash with provincial policy stating that segregation should never be used for inmates with mental illness until all other housing alternatives have been considered and documented.

In the US, a recent report disclosed that there are 10 times the number of mentally ill in prison than in state psychiatric hospitals. Most of them, the report states, would have been in psychiatric hospitals before they began to be closed. The largest mental hospital in the US is Cook County Jail in Chicago.

And what about homelessness? According to the Centre For Addiction and Mental Health in Toronto, surveys of various Canadian cities put the percentage of homeless who suffer from mental illness at between 23 and 67 per cent. Furthermore, “While mental illness accounts for about 10% of the burden of disease in Ontario, it receives just 7 per cent of health care dollars. Relative to this burden, mental health care in Ontario is underfunded by about $1.5 billion”.

Again, in the US, about one third of the homeless are people who suffer from untreated mental illness

In a 2015 survey done by the Mood Disorders Society of Canada, the top priority for the respondents (91 per cent) was the need to have greater access to professionals. Over one third (38 per cent) said that the wait for diagnosis was over 12 months. In the most recent tragedy that took place in the middle of Mental Health Awareness Week, a 38 year old man was released from Burnaby, BC General Hospital where he had resided for three days due to suicidal thoughts. His mother had asked hospital staff to release him to her care but they did not do that. They gave him a bus ticket and sent him on his own. He committed suicide shortly after.

 

Clearly, as a society, we need more than simply being aware of mental health once or twice a year. We need a time when we can reflect collectively on how inadequately we treat those among us who have a brain illness. And we need to lobby to right that wrong. The money spent on these awareness campaigns could be put to better use providing more services for those who desperately need them.

NOTE: THIS BLOG FIRST APPEARED IN HUFFINGTON POST IN 2017