By Dr David Laing Dawson Margaret is frugal. She takes great pride in this. In season she survives on the edible fruits, berries and mushrooms she finds in backyards and boulevards. She would like to teach her survival skills to mental patients. In the winter, she dresses in many layers and sleeps whenever and wherever she is taken in. She will not accept a boarding home, or psychiatric treatment. She defaces her disability benefit cheques and does not cash them. These represent charity and are abhorrent to her. She would like to see the Premier, "The Highly Placed One," who could, she is sure, correct certain past injustices, and then reissue her cheques as salary. She is a woman of great dignity to whom God delivers explicit instructions, which she is expected to follow and convey to others. On one of her attempts to gain direct audience with the Premier, she spent a full weekend hiding in a closet in the Ontario Legislative Building. When she tells me this she smiles and seems to recognize both the comedy and tragedy of her life. When, in the past, she was hospitalized and treated, treated against her will with neuroleptic injections, she spoke less of God, of herbs, elixirs, and the Premier of the Province, and her conversation became easier to follow. But the moment she left the hospital she stopped her treatment and recalled, bitterly, the receiving of The Needle, as a wrong and immoral act, an assault on her autonomy, her specialness, and her humanity. At times she visits with her mother, a short, stocky peasant woman now in her eighties living in a small house not far from the hospital. Old photos of a small German-speaking Romanian village sit on her mantle piece. She has little English but it is clear she is bewildered by our inability to make everything right. During a very cold January I give Margaret fifty dollars to buy a pair of winter boots. She speaks to God for a moment before accepting. Apparently, He tells her it is all right to take this money and go to the mall. When she returns she shows me the boots she has bought and she gives me twenty dollars in change, for she has found a bargain, which pleases her greatly. Another day she arrives looking ill and tired, emaciated. I can smell acetone on her breath. She has not eaten for days. She is capable of foraging for food but this is a hunger strike, which only a word, a concession, from the Premier, the "The Highly Placed One", will forestall. It is hopeless trying to convince her that I have no access to the Premier's ear. She has her own knowledge of how the world works. And in her world, within her reality, it is not so far-fetched that the Chief Psychiatrist of the Mental Hospital might stand very near "The Highly Placed One." Now Margaret drops in unannounced quite regularly. She usually stays a while and sings a hymn. Sometimes she babbles incoherently. Sometimes her ramblings are interrupted with asides to God. Upon His silent instructions she continues, or alters her current discourse. Sometimes she brings jars of liquid, which she claims she has distilled from berries and plants and herbs and which contain all the nutrients any human should need. She gave me a jar, which remains on a shelf unopened. She wants to teach the patients of the hospital her survival skills, her nutritional knowledge. Sometimes when she has sung loudly I realize she is drunk, and the ingredients in her jars are preserved in alcohol. I am always fascinated by the way she constructs a sentence. She uses some combination of Germanic inversion and schizophrenic association But this time she is dying. Or she will die within days if she does not start eating again. I take her to a hospital ward, escorted by nurses. I tell her I will be giving her a needle in the buttock and that she must start eating. She pauses for a moment, then looks at me, and shakes her finger at me, and says, "All right. You may give me the needle. But not as a husband to a wife." I can feel Freud smiling down upon me. She accepts the syringe of anti-psychotic medication. She begins to eat immediately. This is not the result of pharmacological treatment, but the product of some kind of detente. She stays a few weeks in the hospital, gaining strength and a modicum of sanity, and then she departs. It is another time, another year, and I find Margaret has been cut off from welfare. Her purse is full of defaced cheques, yet some she has cashed and put in her bank account, which now totals, to my amazement, eleven thousand dollars. With a bank account that large she can no longer receive benefits. But she has no money to use. She is destitute, again not eating. For, in her mind, the money in that bank account belongs to God. She cannot use it. She speaks to God for a moment and apparently He will not alter His policy. She cannot spend His money. On the telephone, I explain to the Welfare Officer that Margaret has no money, that she cannot access the account of eleven thousand dollars. It belongs to God, and God alone can release the funds, and He has chosen not to. The Welfare Officer, it seems, lacks the capacity to imagine parallel universes with different immutable laws. I then appeal to common sense and economic reason. I explain that unless her office releases Margaret's welfare money, Margaret will not eat, I will have to put her in hospital, and this will cost the taxpayer seven hundred dollars a day rather than seven hundred a month. But the welfare officer is adamant. She will not release funds until Margaret spends the eleven thousand dollars in her bank account. Margaret returns to a diet of boulevard berries and the discarded foods she finds in bins behind grocery stores. Another year and it is the dead of winter once again; the temperature has dropped to 35 below zero, record lows. It is even colder than that, they say, when the wind chill has been factored in. Margaret is living on the street. She makes her way through the city to the hospital and then to my office and spends the day in a chair in the corridor keeping warm. The deep freeze is not letting up. Non-essential employees are allowed to leave their work an hour early. We worry that our cars won't start, that pipes will freeze and burst, that black ice will make the roads impassable. A storm is coming. At the end of the day, Margaret is still sitting in the corridor, bundled in her coats. I offer to admit her to the hospital so she might spend the night in a warm bed after an adequate meal. She refuses. She will not allow me to assign her patient-hood. She is not mental she tells me several times. But when I broach the idea of sleeping at the hospital as a guest, rather than as a patient, she accepts, after her usual aside with God. The wards are full though, and the best we can do is offer her a mattress on the floor in an empty room. The institution sputters here. On the ward that I have chosen as the most suitable, the nurse in charge tells me that moving mattresses is the job of Housekeeping, not Nursing, and the Housekeepers have left for the day to avoid the coming storm. On the telephone I tell the nurse in charge that I will come over and place the mattress myself if I have to, and this appears to motivate a temporary change in job description. They agree, reluctantly, after first warning me of various legal consequences should anything go wrong during the night, conjuring images of Margaret attacking somebody, running amok, or simply dying. The mattress and blankets are placed in a side room on the ward. Margaret finds her way there. She stays a few days, behaving well. She remains quiet, polite. She tidies up after herself. When the cold spell dissipates and a thaw is in the air, she puts on her coats and leaves.A month passes before I receive a formal letter from the president of the union, copy to the Ministry of Health, demanding that I write a letter absolving the nurses of any responsibility for allowing a non-patient to sleep on one of the wards. I had some sympathy for their concerns before the events in question, but now it is over, without tragedy, without incident, without lawsuits, I have trouble understanding the motivation for their request. For a few moments I contemplate their attachment to specific words and how these word symbols can accrue more substance than the physical reality to which they refer. Much like Margaret. As Margaret will only accept my help as long as it is not called `treatment', or `counsel', or `charity', and as long as we don't call her `mental', or `patient', with the same rigid eye on symbol and definition, the nurses, or their union, can only offer help and charity to someone called, officially documented that is, `patient'. I write the letter they have requested. It is not hard to do. In fact, I find myself taking some perverse pleasure typing in bold, "I and I alone take full responsibility for allowing a homeless woman to sleep in the hospital when the temperature was 35 degrees below zero, Celsius. Margaret disappears for months at a time. Occasionally I might see her bent against the wind in her kerchief and multilayered coats, making her way along an urban street. And then she would appear again, in my office, asking again if I would put her in touch with The Highly placed One I have been calling her Margaret in this writing, but my secretary and I never addressed her as Margaret. She would correct us. It must be `Ms.' followed by her last name. Ms. Rossel. With emphasis on the second syllable. Ms. Rossel is here to see you. Ms. Rossel is singing in the corridor. In turn, she always addressed me as Chief Psychiatrist Dawson. Sometimes she added the modifier, a highly placed one. Not The Highly Place One, a title she reserved for the Premier of the Province. When I left the hospital I had not seen her for some time, and I have not seen her since. It is pleasant to think of her camped out somewhere, cooking her herbs and roots and fruits over an open fire, distilling her elixirs, singing her hymns, communing with God. Or it would be nice to think she found a way of accepting patienthood, organized housing, welfare cheques, food banks, and social workers as highly placed ones who might direct her life in a less eccentric manner. But between these two hypothetical outcomes, I must confess, I am most fond of the first.
By Jude Mersereau
So I’ve been asked to elaborate on Schizophrenia and those waxing Schizophrenian. Keep in mind that this illness can be worldwide in scope whilst remaining comfy in somebody’s compact personal brain. A city within itself. Those who have been granted this unfortunate citizenship are members of an elite yet most misunderstood club in their cranium. This particular metropolis is uniformly a run-down unkempt ghetto with unseen stagnant thought poverty. Even if a schizophrenian is adept at expression, the echo sounds like “poor me” instead of “understand me”, and so all is interpreted as a climate of destitution. We just cannot win. Common belief concludes that we barely are able to scrape two thoughts together, and if we can…we are rendered delusional.
So what keeps us going? In one simple statement, “we exist”. It’s more akin to starting out by saying ”I AM” and then immediately shuddering with the stark conclusion “I am SCHIZOPHRENIAN” Pretty bleak. A lifetime of poverty: poverty monetarily, poverty of diet, poverty of living arrangements, abundance of rejection, poverty of thought and conversation, regulated supplies of cigarettes (up to 90% of us smoke) But in our hearts there is soaring of the mind with stubborn rejection of this outer world’s down pressing of the disabled.
We dream big. And since this wry condition cannot be pried away without medication, psychotherapy, and familial intervention, for example, since it cannot return to a happier past and still calmly reject the hopes permanently left behind, Schizophrenian becomes an elephant in the room. But there is hope for the burgeoning Schizophrenian. It does take something with the force of another elephant to clear the room of its elephant in the room(get it?) The problem is that all too often the second elephant is more resistant to vacate than the first. And so on. Perpetual perception problems. The elephant-filled room.
And what is this room?
It is a box where we exist. It is usually closed to the public until one of us citizens discovers a secret ceiling and escapes upwards for a time. When those guarding the box see this freed “clown” happy and bouncy, they frantically stifle and smother said clown down into the box. Again. Then, their particular job resumes, mindlessly cranking through life like a mass-lever round and redundantly round expecting no surprises. Alas.
Another nut gets out.
Okay. That actually is a Jack-in-the-box memory from my childhood.
Here is the precise allusion. Many of us earthlings can relate to this world as containing three “worlds”.
The first…that’s the number-one best… is specially for the rich, overdeveloped, overweight “countries” Although some patriots are not habitually fat during their daily skinny-money marathons.
The second world, sadly enslaved by chaotic hellish communism is poor but maintains the capacity to incinerate the entire planet several times over.
The third: world music, lots of love, and no money at all in their perpetual paradise. Yay
But wait—could it be??? A fourth world? A fourth one not made up of psychiatric patients, but maybe revering them in a way. You see, the Indigenous people worldwide: the first nations…and therefore the last, hold ownership of an invisible clime, unseen by those blinded by self. No wonder it is considered magical. Anyway, these natives hold mental types as harbingers of danger, sentinels to the wind’s whispers, and special with their unique gifts, even more completely unseen by other money chasers or nuclear bomb happy power mongers. But maybe observed by chance by those poor enough to relate in that third world aforementioned as poor.
And so…the Schizophrenian seen in greater accuracy by first nation ones, do really have a place to thrive and therefore are citizens by right on this orb called earth. Care to vacation in our “land?”
What so Funny? An Autobiography of a Professional Schizophrenian, Artist, Singer and Public Singer, 2021, Published by Bridgeross Communications, ISBN 978-1-927637-37-1, $19.95 print, $9.95 e-book, distributed by Ingram and available from most retailers.
By Dr. David Laing Dawson
Some years ago I wrote and produced a play and then a video depicting a young woman suffering from schizophrenia, eventually hospitalized, and then appearing before a Review Board Hearing. She and her lawyer claim at this hearing that she should be allowed to leave the hospital and not receive treatment. The psychiatrist and her parents plead to keep her in and give her treatment.
The girl says, “I can look after myself.”
And her lawyer adds, “And if she can’t, her parents will take her in.”
I think the Review Board Chair then asks the parents if they would take her in if she can’t cope on her own. After a tiny hesitation the mother says, “Of course we will. She’s our daughter.”
The play and video end when the findings of the Review Board are being delivered to the young woman. We don’t see them.
Not long after this my son, clever but a tad lazy in his last year of High School, had been procrastinating on a major assignment. He decided to show my video to his class and after they had watched it, hand out a simple questionnaire. Randomly half the questionnaires asked simply if the viewer thought the young woman with schizophrenia should be held in hospital and treated, or released.
The other half asked the same question but added: “She is your sister.”
This is a particular demographic, 17 to 19 years of age, known for their idealism but not necessarily their empathy for others.
Still the half who were given the simple question voted approximately 40/60 favouring release.
The other half, told simply, “She is your sister” voted overwhelmingly to keep and treat.
And there you have the dilemma. In the abstract, absolute freedom of choice and movement is ideal. In the abstract, a long, drawn out, multi-layered careful, expensive process to decide if and when we should override a person’s freedom of choice and movement is admirable. In reality the numbers of untreated mentally ill homeless grow. They are nameless and faceless and not members of our family. They often live short and brutal lives.
Ontario’s mental health act, in an abstract paper form, makes some sense and provides enormous safeguards against “wrongful” incarceration and involuntary treatment. But in human practice it leads to such absurdities as the Supreme Court of Canada in formal documentation calling someone “Professor Starson”, a man who believed he was a University professor (though he was not) and born of the stars, and another, at one time my patient, formally recognized by the Courts of Canada as “Joseph Pergalian, King of Kings”. It leads to the absurdity of someone being held indefinitely in the hospital because they meet the criteria of “imminent danger to self or others”, but untreated because they are deemed capable of making treatment decisions.
In human practice it means that after a long shift in the emergency ward the doctor will parse the word “imminent” to mean “during the next 24 hours” and the word “danger” to mean “death”.
Perhaps it would work better if all the forms ended with the phrase, “She is your sister.”
By Marvin Ross
I’ve written about this numerous times before but the cops do a great job with the mentally ill while many so called mental health professionals should be fired. My latest crisis explains. Over the years, we have come into contact with police and have always been amazed at their compassion, professionalism and concern for the ill person. I know, I know that there are some horrendous screw ups but they make the news and the good works do not. Dog bites man is not news but man bites dog is.
We have dealt with the Toronto Police Service, the Peel Regional Police and the Hamilton Police. The Toronto cops showed empathy and counselled our son. In the one experience with Peel Region, the cop bought my son a coffee. The Hamilton police have been amazing, understanding and have shown good humour. They have defused difficult situations and transported to hospital after convincing of the need to tweak medication.
On two occasions over the years, I’ve had the hospital call to ask where my son was when he was in their care. The first time, many years ago, my son got up and left and walked home about 20 miles so while I was on the phone with the hospital wondering where he was, he walked in the front door. The second time was when the hospital would not talk to me or even to my son’s case manager in the same building. He was gone for days and found by the police 60 miles away.
Due to a move he made and some other stressful issues, my son was experiencing periodic paranoia and was in and out of psychosis. His doctor planned to switch him back to an injectible and was in the process of making the arrangements but for the second time in 6 days, my son felt sufficiently unwell to call an ambulance and go to the psych ER. At the first visit, both the psych nurse and then the resident called, got my input as I am my son’s substitute decision maker and were quite competent and concerned. The resident felt that this was a case of a few missed days of meds combined with stress and discharged him but arranged for a pharmacy to deliver a week long blister pack of pills to him.
Unfortunately, six days later, he became very paranoid again and I advised him to call 911 and go back to the ER. No one called to get my interpretation of events as they did the previous week but I was called by the psychiatrist with her intended outcome. She was discharging him even though she admitted he was psychotic. Her rationale was that there are lots of people wandering the streets who are psychotic. I pointed out that my son was being switched to an injectible decided upon the day before by his treatment team and they were in the process of arranging that. It will be in his computerized notes, I told her.
She told me that the hospital does not give injections which rather floored me. You are in a hospital, I said, so I would suspect you have access to syringes. You also have a pharmacy where you can order drugs so what is the big deal?
We don’t give injections she said and I’m discharging him with a prescription to hold him over till Monday and she hung up. I tracked my son down at home, took him to the pharmacy where the prescription was sent and got him sorted out. He has stabilized and is fine and received his injection a few days later. To the credit of the hospital, since covid, they have nurses drive around the city in mini-buses giving their injections so patients do not have to expose themselves getting to the hospital.
Meanwhile, the doctor is being investigated by her higher ups who responded very quickly to my complaint. But then they do know me. I’m a frequent flyer and they know I write stuff in the local paper about them. Why is it that we family members have to be such insistent pests in order to get competent service? What other disability area requires this level of attention?
A few years ago, my late wealthy philanthropist friend wondered what he could make a donation to at the hospital and I suggested a family resource centre. We put a proposal together and submitted it but got a very cool reception. Being wealthy has its privilege so my friend arranged a secret meeting with one of the vice presidents of the hospital to put our plan forward. We were able to meet with a few psychiatrists who supported us and eventually the chief of psychiatry. At the same time, I wrote an article critical of the hospital’s lack of response to the needs of the community compared to the other hospital in town.
It took a few years but they finally accepted his money, established a resource centre for families and it is very successful. The hospital is happy with the success and no one knows what we had to go through to get them to take a family member’s money (his son has schizophrenia) to benefit other families.
As a result of this, one of the psychiatrists who helped us with the lobbying, let me know that the hospital was planning to secretly close a satellite out patient office and fold it into the main hospital building. This satellite had been set up initially to bring services closer to patients so they did not have to take a number of buses to get to the hospital.
I called the media relations people to ask about this and they were shocked that I knew as they had no plans to let anyone know. Who told you, they demanded and, of course, I refused to reveal my sources. Again, I ended up exposing this in the local paper. My article elicited a response from the husband of the head of media relations at the hospital. He pointed out that the clinic was not being disbanded but moved and it was only being moved 4 1/2 Km.
According to google maps, it’s about 12 km and will take 18 minutes by car which these patients do not possess. Depending on where they live, it would take a couple of buses and likely an extra hour and a half each way. The doc who tipped me off let me know that the hospital administration confronted her and she received a considerable dressing down from the hospital president. I told her she did not have to admit she told me as I would not have revealed my source but she said she did not care and had left the hospital to return to private practice.
It wasn’t till a few years later when I discovered that the clinic had not been moved after all. The unfavourable publicity I hope helped force the hospital to do the right thing. There are many excellent front line staff doing an excellent job and showing compassion for their clients and families. The problem, as is often the case, is the bureaucracy. In one of my 2015 articles about the hospital, I pointed out that for its 786 beds (for all medical conditions), there were 31 directors including two executive directors. Their average salary was $139,000 and there was one director for every 25.4 beds.
In addition, there were 6 vice presidents earning a total of $1.5 million. At that time the president of the hospital’s salary was $509,779.11 a year and the CEO got $724,741.30. More recently, the CEO of the hospital took a lengthy trip to a Caribbean Island where he has a home in the middle of the pandemic at a time when officials were told not to take non essential foreign travel. Front line hospital staff were working overtime in danger as they sought to control covid cases. The day before he left, the hospital appealed to the government for help as infections and hospitalizations were rising rapidly. As the result of a public outcry, he either resigned or was terminated and walked away with over $1 million in severance because he was terminated without cause.
That was built into his contract. As far as I’m concerned, the members of the board who negotiated his hire should be made to pay that money our of their own pockets. What’s even worse is that the man they hired to run the show had been kicked out of a Toronto Hospital in 2013 when it was found that he paid another doctor $256,000 in public money to be a consultant with no proof the work was done. The doc he paid the money to also paid him $436,000 over the course of a few years. That other doc, Chris Mazza, had been hired to set up the air ambulance service which made him $9.3 million over the course of 9 years.
Imagine what all that money could buy in services for people. A lot of homeless and those with serious mental illnesses could get affordable housing for that money.
By Marvin Ross
An obscure Zoom video presentation given to interested members of his Synagogue Congregation in Toronto reveals why Ontario has what is considered to be the worst Mental Health Act in Canada. The presentation was by the lawyer who developed the Act.
Gilbert Sharpe , according to the Faculty of Law at the University of Toronto, “has influenced some of the most important legal issues and policy matters affecting modern health care. This includes the development of legislation and policies to improve the Ontario and Canadian health care system. This context is invaluable for those who seek to impact change in healthcare.”
The stupidity of the Ontario act allows someone who has been declared mentally ill and a danger to self or others and is detained for those reasons to then refuse treatment and to remain in hospital, ill, for years.
As John Gray, one of Canada’s leading experts on Mental Health Law, said in a presentation he gave to an Ontario committee in 2009 studying this:
Treatment refusal leads to unnecessary loss of liberty, continued suffering, unnecessary health costs and harm to others (e.g. assaults on nurses).
In his talk to his fellow congregants, Sharpe explains the rationale for this. He said that the Act only talked about detention and not treatment. So, “from my perspective” he said, he thought that common law should apply. Over and above detention, he felt that consent would have to be sought from the patient because suffering from a mental disorder and posing a safety risk does not mean you aren’t capable of making a treatment decision. You will find these comments about 12 minutes in on the video.
I have to wonder if Sharpe ever talked to anyone who was mentally ill and detained. If they are in such a state as to be a potential danger, it is hard to believe that they could put that paranoia, anger, delusion, fear, etc aside and then rationally weigh the pro’s and con’s of various treatment options.
It does not make sense!
In my blog on the efforts to change the BC Act to be like Ontario’s Act, I said:
Gray pointed out that on average, people can be discharged after about a month with treatment but refusal to allow treatment can result in years and years in hospital. He and two others wrote a paper called Treatment Delayed – Liberty Denied. In one case, Professor Starson was held untreated for 5 years in an Ontario hospital while his case made its way up to the Supreme Court. And those people who appealed a Review Board finding waited 253 days until the courts dismissed their appeals and the doctors could treat. The courts uphold the Review Boards so the patients wasted 253 days.
But what is worse are the examples given in that particular study. There were people being detained for 5, 10 and even 25 years because they refused treatment and so remained a danger to themselves or others. At $600 per day, or $219,000 for 1 wasted year and 4.38 million for 20 years that is a lot of taxpayer’s money not to treat people and to also deny them their liberty. That is the Province of Ontario but that is not something that could happen in BC with its mental health act which these anti-psychiatry types want to abandon in favour of Ontario’s flawed legislation.
Sadly, Mr Sharpe is still in the game and is now helping Ontario’s Associate Minister for Mental Health and Addictions, Michael Tibollo, “improve” mental health care in Ontario. According to Tibollo’s legal practice website, Gilbert is working in his legal practice. .
Last March, before it was cancelled due to the Covid lockdowns, Home on the Hill was to put on a presentation by Dr. Thomas Ungar, chief of psychiatry at St Michael’s Hospital in Toronto, on the Mental health Act. Home on the Hill attempted to get the Health Minister or the Associate Minister to come with no luck. Dr. Ungar suggested that Gilbert Sharpe could attend, present the Act and then Dr Ungar could critique it from the point of reality. Tibollo’s chief of staff thought that was a good idea and went to discuss it with Sharpe. Nothing further was heard as I wrote in the Hamilton Spectator.