Back in January – Our Final Blog of 2020

By Marvin Ross

This is our last blog for 2020 in what has been a horrible year . We will return in January when the roll out of vaccinations increases to slow the deaths from Covid-19. We can only hope that we can regain all that has been lost as we mourn the countless number of people who did not make it.

Science has shown that when it needs to, it can come up with a vaccine in less than a year in a process that normally takes 5-10 years if ever. There are still many infectious diseases that do not have a vaccine. Meanwhile, science is still a long way from unravelling the mysteries of serious mental illness let alone developing truly effective treatments.

We can all use a little laughter in our lives so I would like to present a one man show called Charly’s Piano for your entertainment. Charly Chiarelli is a retired social worker, and entertainer who plays a mean Blues harmonica. His show from 2019 which I saw live has just been made available on Youtube. As the description states, this is a “heartwarming true tale of how, in 1972, he was a young hippie looking for work in Toronto. He gets a job as a psychiatric assistant at the Clarke Institute of Psychiatry and organizes a fundraiser to buy a piano for the patients’ lounge. Some of his quirky patients help him….”

and “He returns years later with his daughter Selina, to find that things have changed in psychiatry.”

I knew the Clarke well as about that time, I had a friend who escaped from there regularly and showed up at my apartment not to far away. Charly is a graduate of McMaster University (and two others) and was inducted into the McMaster Hall of Fame along with its other grads – Martin Short, Dave Thomas and Eugene Levy.

Enjoy and have a safe and happy holiday. See you in January.

Guest Blog – Saved From Committing a Psychotic Murder

By Joseph Bowers

There was no one in this world I loved more than grandma when in my right mind so why did I try to kill her? By the time I turned 17 in 1964, I had become totally absorbed by psychotic delusional fantasies. I was living with my grandmother and she and my grandfather, who had died about ten months earlier, had raised me from the age of two. Also living with us was my Uncle Fred who was not home much.   

One evening shortly after my birthday, my brain became convinced that the devil had replaced my grandmother’s soul from her body with his own. He was doing this waiting for an opportunity to kill me. I don’t remember exactly who I believed I was: God or Jesus, a critical figure for good in the ongoing battle of good versus evil in any case.  

Alarmed as I was, my brain saw this as a great opportunity. I could kill my grandmother’s body whereupon the devil’s soul would be forced to vacate. At that point, my spirit friends would capture him and imprison him eternally. Without his leadership, the forces of evil would crumble and the battle of good versus evil would be over once and for all with good triumphant. I probably had a plan for restoring my grandmother’s body and reuniting body and soul. We would all live in peace happily ever after. 

Just after grandma went upstairs to bed that night, I took a single shot 16-gauge shotgun out of a closet, loaded it and started up the stairs toward her bedroom. As I reached the top of the stairs, looking in through her open bedroom door, I saw her kneeling by her bed praying. 

Confused, I hurried on down the hallway out of her line of sight. What was the devil doing kneeling in prayer? Surely, he had somehow become aware of what I was up to and was trying to fool me into thinking this was just my dear grandmother after all. 

Taking a deep breath. I went back down the hallway and entered her room. As she turned to me, I pressed the barrel of the shotgun against her chest and pulled the hammer back cocking the gun. At this point she reached out to me touching my arm and pleaded, “Joe don’t! You’ve never been mean to me!”  

Time seemed to stand still as I wrestled with my dilemma. Do I pull the trigger or not? 

I pointed the gun to the floor. With my thumb on the hammer, I pulled the trigger letting the hammer down gently harmlessly. Breaking the breach, I unloaded the gun, and we went downstairs to wait for Uncle Fred to come home. 

Nearly sixty years later, I still wonder what saved my grandmother that night. Was It the uncertainty caused by finding her in prayer? Did her reaching out and beseeching me somewhat reestablish our relationship and make it harder to believe her to be the devil? Did I have one of those brief lucid moments that sometimes come in the midst of psychosis? I just don’t know, but I’m thankful whatever it was. 

That night they took me to Middletown State Mental Hospital in lower New York State where I would stay for more than two months being treated for what they diagnosed as paranoid schizophrenia. 

At the hospital I received the best science-based treatment available in 1964. My family never got a bill. The state of New York paid for it. I was able to leave the hospital after about two and a half months reasonably stable. As a teenage boy from rural upstate New York and a family of limited financial resources, I didn’t realize how lucky I was to get this kind of treatment.  

There would be more than twenty years of struggling with recuring psychotic episodes. There would be more hospitalizations and a couple arrests. 

In time I was put on a medication that proved very effective without serious side effects, I’ve developed a solid support system of professionals, family and friends and I have learned effective coping skills. Working with a professional, my wife and I learned signs of impending illness which would alert us to take preventative action. I haven’t had a serious episode in more than thirty years now and have overall lived a reasonably normal and successful life. 

Never on any sort of disability insurance, I have held down many jobs. For two years I fought forest fires on a hotshot crew for the U.S.D.A. Forest Service, worked as a roughneck on oil rigs and retired from twenty-nine years helping produce low-cost electricity at a large power plant.  I’ve earned a B.S. degree from a major university and had a successful marriage. My wife and I have three grown children all healthy, doing well and contributing to society. 

I am truly one of the lucky ones. 

With the changes I’ve seen in mental health care in my lifetime, I can just imagine how things might go in this day and age. A teenage boy from the country and poorer parents developing serious mental illness would face a different scenario than what befell me in 1964. 

If he got a hospital bed at all, he would almost certainly be released way too soon and get little of the needed support on the outside. It’s not hard to imagine a life of homelessness on the streets in and out of jails and prisons. This happens all too often. 

The big paradox for me is that even as our ability to treat serious mental illness has increased a great deal in my lifetime, the likelihood that people will get the treatment that is available is much less.  

Joseph Bowers now lives in Colorado                

Will the Trump Star Fade After January?

By Dr David Laing Dawson

The question hinges on what is it that is perceived/projected into any cult leader, despot, dictator that allows the cultivation of such a mindless, unquestioning loyalty among his accrued followers.

As I have written before, this mindless human trait allowing for the unconditional surrender of self to a leader must have had, at least until democracy evolved, some survival value. Hence it continues, like many human traits, despite the fact it no longer confers tribal or personal or world survival value.

But will it fade for Trump after he is out of office?

My hopeful prediction is yes.

Trump does not have the gift of drama and theatrics of the evangelical leaders, cult leaders, who are successful despite having no actual power or control over life, death, illness or prosperity.

Out of office he does not have the mystique, the folk tales, and the fearsome band of warriors with which a Castro surrounds himself in the mountains.

He does have the gift of bringing out the worst of human nature – that sense of entitlement, a sense of unfairness, a sense of victim hood, the hatred of others who are impeding my success. He also has the gift of being able to take our very human existential anxiety and directing it at some specific other. The same gift Hitler and Stalin had, and Sean Hannity and Rush Limbaugh and Alex Jones.

But I do not think Trump has what it takes to be a king in waiting for four years, maintaining his following with an army in the mountains, with an underground press, with the sacrifice required to break bread with his troops around the campfire.

Without the oval office, without the mystique of a revolutionary leader, without any real, articulated way he might lead all to a better life, without any power, and actually being endlessly litigated instead, and without a wife who could now don peasant clothes and campaign beside him among the people, his star will fade.

I hope.

But America does astonish at times with its evangelical fervour, its Rambo proud boys, its racist scars, its celebrity culture, and its constant failure to join all other wealthy, advanced nations in the provision of health care for all, social security for all, reasonable gun control, and good public free education for all.

Toronto Van Attack Trial – Not Criminally Responsible?

By Dr David Laing Dawson

Reading the news reports of the ongoing Minassian trial I realize how much we humans fall back to centuries old, sometimes outdated, even meaningless concepts, when struggling to understand and decide a course of action.

At the time of the M’Naghten trial in 1843 the wording and concepts used to formulate a category of bad behaviour for which a person could and should not be held responsible (and punished) drew naturally from the world view of the time, Judeo Christian principles of the time, and the prevailing understanding of human behaviour of the time, within the specific context of 1843 England.

M’Naghten was found to suffer from “acute insanity” for which, at the time, and until the 1950’s, there was no effective treatment. His symptoms were that of Schizophrenia, or more specifically, of acute paranoid schizophrenia. Today we have effective treatments for this illness, and specific ways of monitoring the illness and compliance with treatment.

There is no doubt Alek Minassian did commit this particularly horrific act. And now great amounts of money are being spent, and hours and hours of testimony and argument fill the air as we struggle with his “capacity to distinguish right from wrong”, evidence of a “conscience and a moment of moral struggle”, or not. All of course in service to the question “Should this man be punished?”. And, from what I am reading, the conceptual underpinnings of the legal arguments have not changed since the early 19th century, and have little to do with what we now understand are the determinants of individual and group behaviour. (I do not mean to imply that we have solved the puzzle, just that we have come a long way since 1843)

A combination of Minassian’s Autism, his social isolation, his sense of social failure, plus the depth of his submersion in the nasty online subcultures of Incel and other extremist sites, resulted, tragically, in the deaths of 10 people and injury to 16 others.

While today we do have an effective treatment for M’Naghten’s condition, we do not have specific, effective, and easily monitored treatment for any of the three elements contributing to Minassian’s Van Attack (autism/social isolation-failure, online cults).

Today one of the newspaper reports was of Minassian saying something like, “Honestly, I don’t think I did have a mental illness at the time.” Now what fascinates me about this comment is that it is exactly what I would expect. Minassian does not accurately read the context, the social context of his situation, and the goals and intentions of those around him. He responds as if he is having this discussion over a coffee with a friend. This is autism.

But if we are going to spend incredible amounts of money asking and debating complex questions, why not ask pertinent questions?

1. Do we have effective and easily monitored tools (treatment) that will reduce the chances of Minassian re-offending to nil, short of some form of incarceration and life time surveillance? The answer is no.

2. Would this legal process, plus a finding of guilt and a severe punishment for Minassian, deter others in the future? Again, the answer is no. In fact, with these kinds of crime, the notoriety and the press and social media exposure are more apt to increase the likelihood of someone else doing the same.

3. Can our understanding of Minassian and the three main elements underlying his crime help us in any way to prevent such actions by others in the future.

And here the answer is yes. Or at least possibly.

The first: His autism: The treatment: early diagnosis, early remediation, medical treatment as needed, socialization and corrective experiences as thoroughly as possible, and continuing these well into adulthood. We all need to fit in somehow.

Social isolation: This plays a major role in coming to these kinds of conclusions and formulations in Alek’s mind/brain. Ordinarily, such, essentially delusional ideas, forming to explain ones inadequacies and failures, are quickly countered by real social experiences in face to face real life. We all need at least one real friend (or family member) who will tell us when we are full of shit, or blaming the wrong people. (Surely the guy who took an automatic weapon to a pizza parlor to root out Hilary Clinton’s pedophile ring, would not have done so had he shared his plans with his buddies down at the local. Or maybe I am over-estimating the intelligence of the guys down at the local)

Online Cults: Now we are treading in very new and complex territory. Just how much should the internet and social media be policed? All these particular kinds of sites and forums are very dangerous for socially isolated men and women searching for meaning, connection, purpose and understanding – especially if they are unable to find these meanings, structures, and purpose in the real world.

But, in a way, the Incel culture is to women, all women, what an anti-semitic, holocaust denying website is to Jews. And likely to set a Minassian, somewhere, sometime, on a path of violence.

The Need for Science Teaching

By Dr David Laing Dawson

Anti-vaxxers, anti-psychiatry, anti-science, anti-disease model, deniers of neurological differences, deniers of actual brain problems. Where are these people coming from? And why in such numbers in the enlightened year of 2020?

We need to teach history, real history, in schools and colleges. Not just great leaders, conquests, kings and countries, disasters, but the lives of real people through the ages, prevalent diseases, child and maternal death rates, life expectancy, how people actually lived and died.

When I was in second year medicine attending a lecture by the Professor of Psychiatry, with 60 other students in a small amphitheatre classroom at UBC, one of the yahoos in my class, when the professor had barely begun, asked or stated quite loudly, “This psychiatry stuff is not really scientific, is it?”

The professor paused for a second, adjusted his glasses, and then asked the student if he would mind explaining to the class what science is, what it means, the philosophy and underlying principles of a scientific way of thinking? The student fell silent. Then our professor put down his notes and proceeded to do just that. He delivered an hour lecture on the philosophy, history and meaning of science. And at the time I realized that I had studied high school and undergraduate biology, physics, philosophy, chemistry, and then physiology, anatomy, bio-chemistry, and even some preliminary medical subjects but in all that time I had never before attended a lecture on what science actually is, the philosophy and meaning of science. Many of my courses and subjects were “sciences” but what (historically revolutionary), principles and concepts underlay them?

“How do we know something to be true?”

In Victoria BC, a boy of seven or eight died of diphtheria in the early 1900’s. Had he lived he would have been one of my uncles. And I would estimate that at least 50% of the vocal anti-vaxxers would not have reached adulthood if it were not for vaccinations. And if they were not vaccinated, they are alive today because most of their school classmates were. This is one of the histories that should be taught before College.

———-

Sometime in the late 1970’s, as I remember, a colleague teacher remarked to me that he could no longer take medical students to the psychiatric hospital to see patients suffering from florid mania, acute schizophrenic psychosis, catatonia, and vegetative or agitated depression. And he couldn’t do this because these patients were all now receiving treatment and were recovering. The place, he said, to observe someone in an acute manic state, was at the jail.

And on a visit to the jail not long after, I did indeed observe a manic man on the crowded range behind bars, rapidly pacing, talking, shouting incessantly, gesticulating in fearful agitation. I asked the jail nurse why he wasn’t being treated for his mania. He refuses treatment, was her simple answer.

Kraeplin and Bleuler were observing untreated schizophrenia among patients residing in the asylums and mental hospitals of the time (late 1800’s to early 1900’s). Kraeplin applied, to his observations, the first principles of science: objective observation, description and categorization, in a way that might prove to distinguish one thing from another. Most of his observations remain valid today. Bleuler later observed the same population and tried to find some organizing principles, core symptoms and signs differentiated from secondary signs and symptoms. He concluded that with some of these patients suffering from what he then called the schizophrenias, the core deficit, from which secondary symptoms and behaviours flowed, was that of the unusual and sometimes contradictory, loosened, or autistic way the brain/mind of his patients associated thoughts and feelings.

People with untreated “schizophrenia”, before the days of religious retreats, asylums, and the state mental hospitals, existed in each and every society, and were treated in a variety of ways: from temporary veneration, to punishment, to being put to death, tied to trees in the bush, or simply banished from the village to wander and die. More wealthy families hid their afflicted members. Only with the development of asylums and the enlightenment and the notions of science, could many people with untreated schizophrenia be found in the same place and studied.

And, we need to remember, the patients studied by Kraeplin and Bleuler had not ever received effective treatment and had been suffering from this illness for several and often many years.

Fast forward:

Effective treatment was not discovered until the 1950’s. It was one of those rare instances in modern medicine when blind trials (in this case antipsychotic medication, chlorpromazine) were halted early because the positive results were so dramatic that it would be clearly unethical to withhold treatment from the placebo group.

I join this history in the late 1960’s. We still had large mental hospitals but these were being augmented by psychiatric wards in general hospitals for acute treatment. And we now had a couple of other agents related to chlorpromazine for the treatment of schizophrenia and of mania. But, every practitioner was still reluctant to make the diagnosis of schizophrenia and institute treatment early and keep on treatment for years (stigma and the pessimism inherited from Kraeplin), so at that time, the starting point of diagnosis and treatment of schizophrenia usually occurred upon the second or third or even fourth admission to hospital following a year or more of increasing illness, or relapse after the medication was discontinued.

Over the next, now 50 years, the mental hospitals have been reduced and in many cases have disappeared, and treatment of psychotic illness with anti-psychotic medication begins much earlier, in most cases. A great many of the people Kraeplin and Bleuler were studying, would, today, be found as functioning adults in our communities, regularly attending clinics and regularly taking their medication.

Unfortunately, the places today to see people with untreated florid schizophrenia are in our jails, prisons, in shelters, and on the street. Both Kraeplin and Bleuler would be hard pressed to find a cohort of this illness, whatever you wish to name it, untreated and available for study.

Covid – 19 and Anti-psychiatry

By Marvin Ross

The current pandemic is bringing out all the anti-science mayvens including those in the anti-psychiatry faction. Covid is having a major impact on our anxiety and depression thanks to the isolation we must endure, the economic impact and the very real fear of contracting the virus and dying. Mind you, I do have to wonder how people coped during the depression and the second world war. Those periods were longer than what we’ve endured to date. In fact, the best comment I heard was from General Rick Hillier, the former Chief of the Canadian Defence Staff and NATO Commander in Afghanistan, who has been put in charge of Ontario’s Covid vaccine distribution. He said if Canadians could storm the beaches of Normandy, why can people not sit on their own couches and go nowhere to defeat this.

A valid point but in response to the mental distress all this is causing, psychologist John Read has used that to attack the validity of schizophrenia in Psychology Today. He begins his article with:

During the pandemic, increased incidences of distress can be portrayed as proliferations of mental illnesses such as ‘Depressive Disorder’ and ‘Anxiety Disorder.’ Alternatively, we can talk about our fears, worries, grief, pessimism, and despondency as understandable reactions to the general crisis and to our personal losses, actual and anticipated.

I have to agree with him when he says he prefers the second explanation that these feelings are reactions to the reality we all face. Some, he suggests, are claiming that these reactions are diagnoses based upon the medical model. But, then, he veers off into revisiting the work of Emil Kraepelin and Eugen Bleuler who first described schizophrenia. From their perspective, he says, they discovered schizophrenia whereas, in reality, they invented it.

The problem Kraepelin faced, he said, was that some people actually got better when he argued that the condition was incurable. Bleuler, however, went on to suggest that Kraepelin had grouped together a number of very different conditions so Bleuler began using the term the schizophrenias. Unfortunately, the plural has been forgotten as it does account for why the outcomes and severity of the condition vary.

As for the symptoms listed by these two, Read states that they “read rather like a list of broken social norms.” Read then concludes that there is no evidence to suggest that any of this is a biological disease. Kraepelin was unable, in 1913, to find any abnormalities in the brain but who is surprised by that? He then asserts that this absence of any biological proof continues today. The hyperlink he provides as proof of that does not work but the footnotes go to one of his own writings and to that of another of the anti-psychiatry psychologists. He ignores a great deal of current evidence.

The only thing someone diagnosed today with schizophrenia gets is a great deal of medication and stigma. Of course, he ignores how many people have had their lives improved by the use of these pharmaceutical agents. He ends by stating that:

Today, when we experience severe levels of distress and grief, whether or not it is related to the pandemic, we deserve better than scientifically meaningless, medical-sounding labels that wrongly imply there is something biologically defective about us as individuals, which in itself is depressing, and that run the risk of unnecessary medical interventions.

Of course, the reference to unnecessary interventions is one of his own negative articles about the role of anti-depressants.

Not Criminally Responsible and the Toronto Van Attack Trial

By Dr David Laing Dawson

The question of free will and choice, and do we humans, in our behaviour, actually have this, is worth at least one semester in a Philosophy 202 class. And don’t get me wrong here, it is easy to argue that of course we do not have free will, for the choices we make are determined by our feelings, our instincts, our particular life experiences, our ability, or lack thereof, to foresee consequences, our empathy for others, our ambitions, and our capacity for guilt and shame.

But we have long decided it is in our interest, as a society, to assume the presence of free will and choice. This assumption may be a strong determinant of behaviour in and of itself. And we also decided as a society to be very stringent in any decision to exempt anyone from this assumption of free will and choice.

And this brings me to Alek Minassian. In his defence his lawyers raised the issue of his Autism as a factor in support of a “not criminally responsible” conclusion to his trial on 10 counts of murder. The association of this level of violence and autism made many people angry. But of course his autism did make him vulnerable to the cult philosophy of Incel, and did contribute to his own autistic assumptions of his place and role in this world, and did contribute to his lack of empathy, his inability to experience the pain he would be causing many others.

Enter Dr. Bradford, who, according to the press, agreed Mr. Minassian is autistic but not psychotic, that he showed no signs of psychosis. By this I am sure he meant Mr. Minassian did not show any signs or symptoms of overt thought disorder, hallucinations, or delusions that would constitute a treatable psychotic illness such as schizophrenia.

These arguments will continue in court and among advocacy groups and the public as a whole, all naturally horrified by the actions and thought patterns of Mr. Minassian.

But the important question here now is not really that of free will, determinism, guilt, capacity to distinguish right from wrong and comprehend the consequences of one’s actions. It is rather this:

Do we have the tools, short of life long incarceration, to prevent a re-occurrence of Mr. Minassian’s behaviour.

And the answer, in this case, is NO.