Monthly Archives: July 2020

Premiere – My Name is Walter James Cross and I Have Schizophrenia

By Marvin Ross

walter

Premiering on Youtube July 30, 2020 at 7:30 is the latest production of Dr David Laing Dawson’s powerful one act play on schizophrenia. My Name is Walter James Cross and I Have Schizophrenia was first written about 20 years ago based on David’s experiences treating people with schizophrenia. That version of the film has been played at various conferences including the Annual Meeting of the American Psychiatric Association in New York and has been broadcast on TV Ontario.

The current video premiering on July 30 is a new production that was produced by the Artword Theatre in Hamilton Ontario and performed this past March before it was forced to close because of the Covid-19 lockdown. The March 12 production was filmed using three cameras in a performance described by the producer as “flawless”.

One review described the impact of the play as

“it’s the power of “Walter” that still, long after I’ve left the theatre, the way he experiences the world is very much with me — to the extent that I can understand it, and the play enlarges that extent.”

He goes on to say

“the remarkable achievement is that he (the actor) lifts our engagement with Walter beyond the stare of curiosity, albeit sympathetic, into a trance in which we begin to identify with the struggle of his being”

I have to confess that I did not see this production simply because I’d seen it so many times before and the original actor who played Walter was brilliant. I cannot imagine anyone doing a better job than him but I can’t wait to see. Where this production differs is that the soundscape allows the audience to actually hear the voices in Walter’s head.

Another reviewer commented that the play

“is a theatrical vessel through which we can all better understand our personal interactions with the mentally vulnerable. It’s impossible not be emotionally touched by his presentation and each and every audience member will be remembering their own Walter as the stage lights go down.”

Walter is an opportunity to understand and to sympathize with the life and challenges of someone with schizophrenia. I can’t recommend it enough. This is the link to the youtube channel where Walter will be live Thursday July 30 at 7:30 and where it will remain in case you can’t make that time. https://youtu.be/_CQadomWvUA You can set a reminder for the premier on the site.

Inequity in Care – What Families Already Know Proven

By Marvin Ross

Every family of those with mental illness knows that health care for their relatives is deficient and now a new study confirms that. Researchers in Ontario set out to “assess the equity of distribution of new alternative payment models and teams introduced under primary care reform in Ontario for patients with mental health disorders.” The study looked at data on health care spending from 2002/03 to 2011/12.

Mental health and substance abuse impacts 33% of people in Ontario over the course of their lives and these individuals suffer from a mortality gap of 13-20 years compared to others. The goal of the health system is one of equitable care for all and, to achieve that, Ontario increased investments and brought in reforms to achieve that goal. This research aimed to asses how well equity was achieved.

At the end of 2012, there were 1,645,324 people identified as having a mental illness or 16.6% of the total population. 149,185 of them had a psychotic disorder and 127,820 had a substance abuse.Total per capita primary care spending grew by 88.3% over the study period but the growth for those with mental illness only grew by 62.0%. the growth for substance abuse increased by 142.7%

When the data was adjusted for age, sex, rurality, neighbourhood income quintile, immigrant status, comorbidity and primary care model, payments for people with a mental health disorder were 50% higher in 2002 but by 2012, they were only 35% higher – a relative reduction of 10%. Overall payments were reduced by 8% for psychotic disorders but increased by 141% for substance abuse disorders.

This increase for substance abuse users could be accounted for by urine drug testing for those on opioid substitution (methadone) which went from nothing in 2002 to $1140 in 2012.

The poor care for those with mental illness and particularly those with psychotic disorders is not unique to Ontario. The authors point out that in the US, payment systems are compartmentalized between primary care and behavioural health care resulting in fragmented and suboptimal care for both. Structural barriers in the US maintain the siloed nature of care. In the UK, the quality improvement incentive program has led to improved primary care consultation for those with serious mental illness but the imact on those with other mental illness problems is unknown.In Australia, the better access initiative has led to more frequent visits for depression but concerns continue for those with schizophrenia and bipolar disorder.

As I said, families are aware of this but it is nice to have it empirically demonstrated so that we can prove it to governments when we lobby for program improvements.

The World is Becoming Balkanized!

By Dr David Laing Dawson

:

“The center can not hold”

From the very beginning when each extended family was ruled by an alpha male and no language or symbols existed for that which was not immediately apparent, and all other tribes were “others” competing for the same watering hole and hunting ground, our tribes remained small. Our gradually increasing frontal lobes and imaginations, our developing ability to create and communicate with symbols, including our invention of Gods and tools, allowed us to dramatically increase the size of our tribes. The alpha male, (and occasionally female), needn’t be seen, might in fact only exist in our imagination, though we need to be regularly reminded of his existence through symbols and rituals. With both religious (imaginary) and secular alpha males and their acolytes and lieutenants and new weapons, our tribes could each expand through inclusion and conquest, and then fracture and start over again.

The periods of unrest between each new consolidation were long and unleashed famine and pestilence. But it was always clear that survival depended on size and power and alliances, so new tribes, then fiefdoms, city-states, kingdoms and then nations and empires with new alliances were formed, growing in size and power, through inclusion and conquest, increasing our Darwinian chance for survival (at least for a few more generations).

Our history has been one of tribal expansion by inclusion or conquest, followed by fragmentation, conflict, disintegration, and then consolidation and expansion again, with the secular kings and potentates finding an array of ways to incorporate the religious tribal formations, from a full embrace, to an uneasy truce, to self-serving accommodations, to a perennially argued separation of church and state.

Fast forward to the twentieth century with our sciences allowing, causing, a rapidly expanding population, along with increasingly fearsome weapons, and it begins to become apparent that for our survival we will need to expand our concept of our tribe to include at least half the world if not the whole world.

The first world war shatters alliances, empires, and nations, and leads to attempts to form new constructs, new alliances, new global arrangements. But they are for the most part poorly conceived, and lead directly to the second world war. And this time we have a documented, even filmed demonstration of how much damage our new weapons can cause, and how depraved we can all be when we revert to our primitive tribal yearnings.

And again we consolidate, grow more inclusive, form alliances. With some alliances we try to include half the world (NATO, The Soviet Union, European Union, Trade agreements), and with others we try to include the whole world: U.N., Nuclear weapon treaties, World Court, UNESCO and WHO.

And this gives us an unprecedented period, 75 years?, of prosperity and peace. (all relative of course). Fewer people without food and medicine, life span increases, fewer deaths in war, and those wars we have are, relatively again, contained. For the most part our new inclusiveness and our mechanisms to resolve tribal disputes work.

But again we find ourselves at a tipping point.

With our expanding populations and our technologies causing the existential threat of global warming, along with a brand new pestilence upon us (neither the first nor the last), many of our achievements over the past 75 years are under threat:

Russia is reverting to a Czarist totalitarian expansionist regime. Hungary is revisiting its fascist heritage. Austria is flirting with this as well. Turkey moves from a separation of church and state to a full embrace of Islam. There are reports of a rising far right in Germany. Great Britain leaves the European Union. America (Donald Trump) undermines NATO and the UN, and withdraws from nuclear treaties, WHO, and the World Court. China takes steps to absorb Hong Kong.

Within each country old religious/race based tribalism has arisen, in Europe provoked by Mid East and African immigration, in the U.S. from an unfinished, un-reconciled history of slavery, civil war, and a flirtation with fascism. Global alliances are giving way to nationalism.

We need global leaders at this time, men and women (maybe it should be all women), who understand the lessons of the past century, who understand that this time, if it all falls apart, it is unlikely that any of us will survive; we need leaders who understand that our tribe, our concept of us, must expand to include the whole world.

Human advancement is not inherent in our biological instincts. We are not born good and well-intentioned. We learn to share and trust and expand our consciousness of others. Those biological instincts that kept us from losing our watering hole to the other tribe some centuries ago no longer work in favour of our survival. Human survival now depends on our ability to overcome those instincts, to control them through human made social structures, organizations, laws, systems, that are inclusive, non-violent, always sharing. And at this time, for this century, for our survival, those social constructions need to be as big as, as inclusive as, the UN, WHO, and the World Court.

Time for a Guaranteed Annual Income

By Dr David Laing Dawson

A small note on Guaranteed basic income:

I would like to see a mathematically gifted person take a huge amount of data and derive an equation that would let us know what would happen if Canada moved to this. Most of what I read are naysayers forecasting huge debt, or proponents talking about the social value of doing this. But, but, when I do some simple mathematics it works like this:

$20,000 annually paid out to every Canadian adult.

Currently each province begins to charge income tax at a taxable income of approximately $11,000.

If I consider a recouped amount of 15% (average, GST, PST, HST, fuel tax, alcohol tax, cannabis tax, Income tax) with each transaction, and if I consider that $20,000 moving through one transaction per week, exchanging hands as it were, then in 52 weeks the governments have recouped close to $14000 of the $20,000. (I can use the series function on a spread sheet)

The remaining $6000 could be recouped by an increase in tax on the higher brackets or not buying an antiquated submarine.

Clearly this is simplistic and assumes everybody pays all taxes and there is no fraud, and that the whole $20000 circulates during the year, and is not hidden from Federal or Provincial taxes.

So there is the challenge: Some individual or group needs to acquire real data from many sources and design some complex mathematical formulae, but this could give us, I think, solid ground for making such a far reaching decision.

I believe a complex mathematical formula written in computer code is what they call an algorithm today, so, a shout out to my grandson who can do this stuff: stop trying to beat the stock market and apply those skills to a bit of social activism.

More Misguided Anti Racism Zeal

By Marvin Ross

Dr Marion J Simms (1813–1883 ) is considered to be the father of modern gynecology but he is now getting a great deal of bad press on Facebook and elsewhere for allegedly operating on slaves without anaesthesia.

Unfortunately, this is likely another example of the failure of many in their zeal to expose racism in our society to mistake what actually happened. Thanks to my medical writing colleague, Bruce Wilson, for bringing this to my attention. Simms developed surgical techniques for Vesicovaginal fistula which:

“was a common and catastrophic consequence of birth in which a hole develops between a woman’s bladder and her vagina and leads to constant, unremitting, and uncontrollable urinary incontinence. Attempts to cure this condition had eluded many previous generations of surgeons who had tried to repair these devastating injuries time and again, but without significant success.”

Simms set up a hospital behind his home in Montgomery, Alabama in order to try to develop a treatment for this condition. The reality of this condition was described by Dr P M Kollock at the annual meeting of the Georgia State Medical Society in April, 1857:

The poor woman [with a vesicovaginal fistula] is now reduced to a condition of the most piteous description, compared with which, most of the other physical evils of life sink into utter insignificance. The urine passing into the vagina as soon as it is secreted, inflames and excoriates its mucous lining, covering it with calcareous depositions, and causing great suffering. It trickles constantly down her thighs, irritates the integument with its acrid qualities, keeps her clothing constantly soaked, and exhales without cessation its peculiar odour, insupportable to herself and those all around her. In cases where the sloughing has been extensive, and the loss of substance of the tissues great, and where neither palliative nor curable means have availed for the relief of the sufferer, she has been compelled to sit constantly on a chair, or stool, with a hole in the seat, through which the urine descends into a vessel beneath.

Given this reality, it is not surprising that many women, in their desperation, were willing to try anything to get relief.

As for consent,Simms stated:

For this purpose [therapeutic surgical experimentation] I was fortunate in having three young healthy colored girls given to me by their owners in Alabama, I agreeing to perform no operation without the full consent of the patients, and never to perform any that would, in my judgment, jeopard life, or produce greater mischief on the injured organs—the owners agreeing to let me keep them (at my own expense) till I was thoroughly convinced whether the affection could be cured or not

It has also been said the Simms operated without anaesthesia but again it is not quite that simple. Simms first surgery was done in 1845 which predated the use of chloroform as an anaesthetic. Even after it was introduced, many doctors were cautious in its use. The view was that:

humane, conscientious, highly reputable practitioners and ordinary lay people held many misgivings about the new discovery. Neither sadists nor fools, these critics alleged a variety of rational drawbacks to the use of anaesthesia.

Sir James Young Simpson who discovered chloroform did not feel that it was necessary in this type of surgery. He stated:

“The mere amount of pain endured by the patient is perhaps less than in most surgical operations, as the walls of the vesicovaginal septum are far less sensitive than you would a priori imagine”.

What was truly an assault on African Americans was the Tuskeegee experiments performed on many with venereal disease. This video explains what happens and begins with an apology from President Clinton

Of course, today we have the very negative impact that Covid-19 is having on African Americans for many reasons and the failure of the US to have universal healthcare for its citizens. So despicable is the concept of making profits in exchange for health and that impact on the poor and marginalized, that a former health industry executive apologized for the lies he helped to spread about universal healthcare and the attacks on the Canadian system.

Those seeking justice and equity for minorities would be better off fighting for those injustices.

Forget Statues and Name Changes – Teach History

By Marvin Ross

There is a growing move to rid our cities of statues of historical figures whose views, while common when they lived, are not supported by today’s standards. Parallel to this is the demand to change place names. With the exception of the Confederacy, these attempts are ludicrous.

The confederate states seceded from the Union and precipitated a bloody war that lasted for years and killed and maimed thousands. That act of secession was treasoness and largely based on the desire to continue to own and exploit slaves. Symbols of that defeat simply perpetuate the failed goals of that failed state. Having monuments to defeated generals is about as logical as Germany erecting statues after the war to Rommel and naming military camps after him and the other German Generals. Flying the Swastika would not be allowed and yet many Americans fly the Confederate flag.

Canada is toying with the idea of ridding our cities of statues of Sir John A MacDonald (our first Prime Minister and a father of confederation) because he supported residential schools for indigenous children. Dr. Dawson wrote about this a few years ago when it first cropped up. Boarding schools for the English upper crust were common then and even now so sending Indigenous kids off to learn was not an unusual idea. The intention was positive but the brutal discipline, pedophilia, and snatching kids away from their parents was not. Those who established these schools made their mistake by allowing the clergy to run them.

Edgerton Ryerson is another historical figure that many want to see banished. Ryerson was the architect of residential schools and what I said about Sir John A applies to him. Ryerson  also promoted and developed our free educational system in Ontario and that should be celebrated. Rather than removing his statue, Ryerson University added this plaque to it:

“This plaque serves as a reminder of Ryerson University’s commitment to moving forward in the spirit of truth and reconciliation. Egerton Ryerson is widely known for his contributions to Ontario’s public educational system. As Chief Superintendent of Education, Ryerson’s recommendations were instrumental in the design and implementation of the Indian Residential School System. In 2015, the Truth and Reconciliation Commission reported that children in the schools were subjected to unthinkable abuse and neglect, to medical experimentation, punishment for the practice of cultures or languages and death. The aim of the Residential School System was cultural genocide.”

Beneath this text are the following two quotes:

“Let us put our minds together to see what kind of lives we can create for our children” – Chief Sitting Bull

“For the child taken, for the parent left behind” – Truth and Reconciliation Commission of Canada

Murray Sinclair, an Indigenous member of the Canadian Senate,  declared that “Ryerson University has shown leadership in its commitment to equity and diversity and is clearly dedicated to righting the wrongs of the past.”

This is a much more mature way of dealing with statues.

What, for me and striking close to home, is a movement to rename Dundas as I live in Dundas, Ontario. The demands first appeared in Toronto because of the name Dundas St which is actually highway 5 and is called Dundas because it leads to Dundas, Ontario. Henry Dundas was the 1st Viscount Melville which is my double whammy because for over 20 years, we lived on Melville St in Dundas.

The concern that people have with Dundas is that he allegedly delayed the emancipation of slaves by about 10 to 15 years. This may be simplistic. In 1776, he represented a Jamaican slave (Joseph Knight) who was seeking his freedom in Scotland. At the trial, Dundas stated that:

‪“Human nature, my Lords, spurns at the thought of slavery among any part of our species.”‬ His pleading in Scotland’s highest court was successful, and the Court ruled: “the dominion assumed over this Negro, under the law of Jamaica, being unjust, could not be supported in this country to any extent”.

During a debate in the House of Commons to abolish slavery in 1792, Dundas supported the motion. But, fearful that the bill would be defeated as it had been earlier, he suggested inserting the word gradually into the bill. The House of Commons had already defeated an abolition bill earlier and the same politicians were present. They would have defeated this bill too but it passed. Emancipation did not come to Britain until 1807 but it is a stretch to blame Henry for the delay.

History is not black and white but those arguing for the removal of statues and the change of place names only see in black and white. Their simplistic understanding of history and politics do all a disservice.