Anti-Woke Rant

By Marvin Ross (he/him)

A letter to the editor written by a woke woman objected to an op ed I wrote. I’m used to criticisms as everyone who writes opinions is and I welcome them. As one of my editors years ago said, it proves someone is paying attention. This woman is entitled to her opinion of course but it was so silly, in my opinion, that I have to comment.

First, however, let me deal with my one time only use of the phrase “he/him” after my name. What does that mean? Why does it matter? I have no clue but I suspect it refers to the fact that I am a male and maybe that I am a straight male. Does that really matter? No. It is, I think woke or political correctness and serves no purpose but I see it all over the place.

I really don’t care what you call me and the anti-psych people have called me lots of names. I pointed out to one who lambasted me on social media that ad hominem arguments don’t cut it and she replied with I intended it to be ad hominem. So much for logic. I was influenced early on by the late Alan Borovoy who was head of the Canadian Civil Liberties Association for many years fighting discrimination in rental housing and work. He always said “I don’t care if you like me, I just insist that you treat me fairly”.

For the past few years, I’ve been writing op eds denouncing the Ontario Government for its failure to provide adequate financial supports for the disabled who cannot work because they are disabled. A significant number have serious mental illnesses. Almost 30 years ago, a right wing government won the Ontario election and introduced what they called the Common Sense Revolution which included slashing social assistance payments. When challenged, they produced a welfare diet which proved to be unhealthy and suggested people could buy dented tins of tuna cheap.

Subsequent governments failed to restore social assistance rates to where they were in 1995 and the plight of the disabled got worse and worse. Today, a single disabled person gets $1169 a month to cover all their costs. The average cost of a bachelor apartment in Toronto is $1225. When the current government was first elected in 2018, they cancelled a legislated increase for the disabled. They think the disabled should get jobs. For those who have to live in group settings (and I suspect they are mostly those with serious mental illnesses), the mostly private operator is paid according to the Ministry:

All ODSP applicants in a board and lodging situation will have their budgetary requirements calculated based on the maximum board and lodging rate. In the case of a single ODSP recipient it would be up to $825 a month.

And, being generous:

In addition, recipients in a board and lodge situation receive a special boarder allowance of $71 per benefit unit to help with additional personal need costs such as toiletries.

I did ask some follow up as I thought it was about $125 but they are ignoring me.

My latest op ed on the topic discussed all this under the head of “Compare disability benefits to corporate welfare to measure our disdain for the disabled”. The disabled get bupkis (literal translation from the Yiddish is goat shit) while 3 large corporations got government covid grants of $240 million to continue giving their shareholders increased dividends and the Auditor General reports that the Ontario government can’t find $4 billion of covid grants. Add to that the fact that the new government has the largest, highest paid cabinet in the history of the province.

The $1169 a month income translates into $14,028 a year while the low income cut off (LICO) for Ontario in 2022 is $26,426.00. LICO is an income thresholds below which a family will likely devote a larger share of its after-tax income on the necessities of food, shelter and clothing than the average family.

I had hoped that people reading all this would get angry and I know that many did. But not the woke letter writer. This bothered her:

while the debate continues about whether to use “people with disabilities,” or “disabled people,” the term “the disabled” is generally considered derogatory and a form of “othering.”

Call me what you want but don’t call me late for lunch or, as Borovoy always said, I don’t care just treat me fairly.

She also said

The experience of disability is diverse. For many people disability is an essential and fundamental part of their identity. Rather than “shedding” disability, research indicates that society must shed its disabling barriers and attitudes that prevent the full participation and flourishing of people with disabilities.

I don’t know any one who sees their disability as part of their identity but rather as a burden they must deal with every single day. As a compassionate, caring society, we must help people to cope and to flourish. That means providing them with a decent income so they do not have to decide between rent and food unless they were lucky enough to be born into a very wealthy family.

If the woke and the politically correct warriors have a social conscience, they will focus on what really matters and not this silliness.

Psychiatric Hospital Design and Security.

By Dr David Laing Dawson

My Quest to Answer Marvin’s Question

Part I

In July of 1968 I entered Crease Clinic, Riverview Hospital, British Columbia as a first year resident.

The completion of the mental health wing of the teaching hospital on the University of British Columbia (UBC) campus had been delayed, forcing the Department of Psychiatry to negotiate a deal with the Provincial Mental Hospital to take over one ward in Crease Clinic, the ward for acute admissions from Vancouver.

Originally opened in 1934 as a treatment centre for First World War veterans, the building underwent an expansion in 1945 and reopened in 1949 under a new name and motive – the Crease Clinic of Psychological Medicine, joining and fronting the other massive brick buildings that constituted the Provincial Psychiatric Hospital for all of B.C.

But the ward was as one would imagine: heavy locked door, large open day room, high ceiling, linoleum floor, communal showers and toilets, dormitories, a couple of seclusion rooms, large windows but separated into small panes with a metal grid, and a nursing station. The lino floor was scarred with years of ground-out cigarette butts.

Did I mention this was 1968 and I was fuelled by 1960’s idealism and perhaps a touch of arrogance? The docs at Riverview all wore white lab coats. I wore a jacket or sweater sans tie. I refused to carry keys and we soon unlocked the big door, at least through the daytime hours. We started a therapeutic community, which in practice means all staff and all patients meet in a large circle every morning and make as many decisions as possible by consensus. The discussions often focused on issues of food and activities but they did venture into medication and “privileges” and a weekend pass someone had requested.

No longer trapped in an entirely passive state the patients often proved more conservative, and more bluntly honest than the staff: “I don’t think you should go home on the weekend, Angela. You were talking of offing yourself just yesterday.” And “Go back on your meds Tony. You were talking crazy this morning.”

Almost all were Involuntary Patients with most referrals originating with the Vancouver General Emergency Department.

When the door is unlocked the urge to run, to escape, to seize control, diminishes. Lock the door and you increase the feeling of being trapped and the urge to get out, and the violence that follows.

But my patient, Willy, did elope one evening. I had been trying to get the staff to address this hapless man as Mr. Wilson, without success. I was home in Vancouver that evening when the hospital called to tell me that Willy had phoned them from a pub in Coquitlam to tell them he planned on killing himself.

I drove the 45 minutes to Coquitlam (my memory tells me it was raining) located the pub and went looking for Willy. I found him sitting at a beer-soaked table with a couple of new found friends. I joined them at their table, bought a round for the four of us and then drove Willy back to the hospital.

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The newly finished mental health section of the teaching hospital being built on the UBC Campus was designed with much input from the professor of psychiatry: three wards for 20 patients each, no locked doors, carpeted, single and double occupancy bedrooms; furniture was Teak Modern rather than hospital style (At that time a boat load of Danish Teak Modern Furniture was less costly than Hospital Furniture), walls were earth-tone coloured, some of them wood paneling, wide short corridor, even sliding doors to an outside balcony on the first floor, open nursing station, a fireplace in the inviting day room.

This hospital could not take involuntary patients but within psychiatric hospitalization few patients are entirely voluntary. All would rather be elsewhere. Spooky long white corridors, cold reflective floors, white walls, industrial furniture, a security guard and locked doors add an imperative to that wish to be elsewhere.

At Riverview I had complained to my supervisor about the intransigence of the institution, the total institution, its rigidity, its denigration of its own clients. He said, quite wisely, David, don’t get angry at it, study it. And so I did. This lead to my first published academic paper being titled: Institutional Change.

And to my search for a mental hospital that was both effective and humane, and that lead me to Fulbourn Hospital, Cambridge, England, which, under Dr. David Clark, had begun unlocking doors and instituting therapeutic community principals even before our effective medications became available.

To be continued.

Psychiatric Hospital Security

By Marvin Ross

The most read blog we’ve published since we began in 2014 is The Decline of Mental Illness Treatment From the 1980’s on by Dr David Laing Dawson. That appeared in 2017. I highly recommend people reread it or read it for the first time. There is a tremendous amount of truth in that from someone whose career covered that time period and an explanation of what we should return to if we want to restore effective humane treatment for people suffering with serious mental illness.

What twigged with me was his comment about “the dramatic growth of locked Forensic Psychiatry Units, and a sad return to locked doors for the rest of the hospital now dominated by the Forensic units.” That really struck because my son is currently back for a stay in our local psych hospital and I have been reminded of the absurd level of security that exists. It’s a bit like going to Guantanimo.

Is that level of security really necessary?

In psych wards in general hospitals, security consisted of an elderly south Asia gentlemen sitting on a chair at the entry door. I don’t think I ever saw him do anything. The specialized psych hospital that preceded this current brand new one was open. Some of the wards (and maybe all of them) might have had locked doors to enter, but the hospital was pretty open. This new hospital is lovely in that patients have their own rooms and private bathrooms but it is totally locked.

To get into the inpatient section, you go to security, give the guard the name of the patient you are visiting and your name and the information is entered into the computer. You then get a visitor badge which you use to scan the lock on the floor to ceiling gate so you can enter. When you leave, you scan your badge and then return it to the guard and the gates open. The patients also have badges and the amount of freedom they have is programmed. Some patients are restricted to their own ward, others can wander the hospital but not exit through security, and some have privileges to pass security and go outside to smoke or to buy drugs from the dealers who sometimes hang around.

Does any of this do any good? I have no idea but patients can always escape. One day as I exited through “Checkpoint Charlie”, an alarm went off briefly. I looked around but did not see anything. As I was heading to the exit, I heard an unintelligible announcement over the PA system. While paying for my parking tag at the machine near the exit, I saw a young man racing down the corridor, pass the staff member sitting near the outside door and wave to her as he went by. A few minutes later, three security guards came racing after him followed a few minutes later by an over weight woman huffing and puffing – a nurse I suppose.

Not sure if he was caught but you have to give him credit for his style and his effort. If he wasn’t a forensic patient, what was the big deal? He would likely be back.

Patients have always done walk-abouts. I had friends in the 70’s who had a brother with schizophrenia who escaped regularly. The first time, he showed up at my apartment when I lived a mile or so north of the Clarke Institute of Psychiatry in Toronto. I asked him how he got out and he told me he simply ran past the elderly South Asian gent at the door and came to see me. He was quite agitated and insisted that I take him to the other psych hospital known by its address 999 Queen St W. This was before they merged.

Not having a car at that time, I had to take him in a cab and he was so agitated that the cab driver kept glancing nervously at us in the rear view mirror. The hospital refused to take him because he was a patient elsewhere and even though he kept bouncing up and down and insisting that he would not go back to the Clarke, they offered nothing. I took him by another cab and dropped him off at his sister’s place.

He did get his wish and got admitted to that hospital where, again, he escaped regularly and either visited me or phoned. My point, however, is this. Unless the patient is dangerous and/or criminal, is the high level of security of any value? The presence of uniformed young guards, locked doors, and electronic passes conveys a negative message to the patient, family and visitors.

Is it all necessary? And that is something I can’t answer. How do others feel?

Psychiatry Then and Now – Two Views

The first view by, Dr David Laing Dawson, looks at the growth of Deinstitutionalization and its impact on the care of those with both acute and chronic mental illnesses. Dawson watched it all happen and this is his story.

In my corner of the world we were making slow but steady and successful progress reducing institutionalization and transferring some money and programs to community services. People with severe and persistent mental illnesses were treated in the community within specialized programs with fluid and easy access to re-hospitalization if necessary. When hospitalized they would be kept long enough to stabilize and have a good chance at a successful life beyond the hospital. This was in the years between 1970 and 1990.

New and effective medications were a large part of this success. As was a willingness to put money into housing and psychosocial rehabilitation programs. And when someone did become psychotic and dangerous or unable to care for themselves, they could be easily admitted to hospital and treated. New programs and support systems were being developed every year.

And then Government got involved.

I remember the meeting in Toronto in which the Ministry of Health presented to us new targets for the reduction of beds for both acute and chronic mental illness and exhorted us to continue to reduce the number of beds available. I remember well because I pointed out that in our jurisdiction we had already reached those numbers. Doesn’t matter, they said, you must continue to reduce beds. The year before this, at another meeting, we were presented with a model of service delivery gleaned from a summer student’s study of the mental health services of Georgia. Georgia, a state in the Southern U.S., not in the Soviet Union, but almost as ridiculous a place to look for a good model of universal psychiatric care.

The governments of Canadian Provinces and American States rode on the era’s wave of optimism and attention to civil rights, along with the idealism of many mental health care workers, to get rid of a major budgetary irritant, and a source of political problems.

In the US the States saw a way of unloading the mental health (really the treatment of mental illness) budget onto the Federal Government. In Canada the Provincial Governments saw a way to unload the political problems that arose from direct ownership of those big old mental hospitals by transferring care and money to the General Hospitals and thus distancing themselves from any problems that arose.

The US fared even worse than Canada. The homeless population exploded along with the numbers of mentally ill in jails and prisons. In fact the statistics show the growing numbers of incarcerated inmates in the prisons around Chicago, exactly mirrors the decrease in numbers of patients in the mental hospital. Institutional care for the mentally ill was transferred from hospitals to jails.

The outcome in Canada was just a little better, but not much.

The second view is by Charlie Chiarelli, a retired social worker, from his one man show called Charly’s Piano about his work as a psychiatric assistant at the world renowned Clarke Institute of Psychiatry in Toronto before it morphed in the Centre for Addiction and Mental Health (CAMH)

Charlie had a long career in the mental health field but he is also a vey talented musician with a number of successful one man shows. I saw this a few years ago and just discovered that it is on youtube in its entirety.

This is the description:

Charly’s Piano is storyteller Charly Chiarelli’s 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: the wise “Magic of Cats” girl, Phillip who shows him the blues, and “the Duchess” who plays the piano. He returns years later with his daughter Selina, to find that things have changed in psychiatry.