Dr. David Laing Dawson and Marvin Ross
Hard to believe that another year has passed and we’ve somehow managed to generate at least one post a week throughout 2022. We’re going to take a bit of time off until early January but we wanted to wish all of our readers the very best for the holiday season and a safe and happy new year.
David and Marvin
By Dr David Laing Dawson
Earlier this month, Marvin e-mailed me with:
Maybe I’m becoming a crotchety old man but I think all is lost and worse than it has ever been. Look at the Georgia Senate race. The democrats won but the ex football player still got 48% of the vote. Alberta, as suggested by the Globe and Mail, is now run by the truckers. Hospitals are overflowing with sick kids and yet less than 25% of kids have been vaccinated for the flu. The Hamilton school board debated masking for schools and the gallery had to be cleared because of the howling anti-vaxers.
Doug Ford is ending development fees for new housing subdivisions which will bankrupt cities who will have to pay for roads, sewers, etc and he has given dictatorship status to Toronto’s mayor who can push through whatever he wants with only 1/3 of the vote.
The Globe wonders if it is worth putting the sick mentally ill wandering the streets into hospital as that will just cause other problems.
We should just keep drinking
My reply:
Overall the world is in a better place than it was 50 and 60 years ago by most metrics.
So why the conflict, the unrest, the craziness, the threat of far right groups, the anti-vaxxers, the election deniers, the rise of anti-semitism, the heightened ideological divisions, anti-psychiatry, homelessness, increase in addictions, death from addictions and overdose, mentally ill on the streets, a surprising daily display of delusional beliefs, and a surprising growth of bogus cures and snake oil salesmen?
Fifty years ago, or so, I had a rudimentary understanding of the tools I used, how they worked, and a passing acquaintance of quantum physics, and the construction of the universe, some understanding of physiology, then anatomy, of immune systems, genetics, evolution, and ecology.
Today I am typing this on a machine I barely understand, then sending it to Marvin in packages of digital machine code, through the air and thin strands of glass and copper wire, at speeds I cannot imagine, to appear on his screen via mechanisms of electricity and light I do not fathom. Some time ago I asked a grandchild where the photo went when she swiped the screen on her phone from left to right. Down there, she said, pointing to the side of the phone. I realized I would be hard pressed to explain the right answer to that question.
For generations most of us understood the tools we used, from the kitchen to the farm and factory. Even the internal combustion engine on wheels. This is certainly no longer true.
I was not religious then or now but those who did attend churches and mosques and synagogues 60 years ago were not constantly assailed by alternate beliefs, the corruption in their own institutions, and the eroding effect of science.
The peoples of the world as a whole may be better off but the roles, and tasks, and purpose, and memberships of many men in the developed world have been usurped by machines.
Science, modern medicine, and social attitudes have undermined age old certainties of gender, racial identity, cultural identity, and purpose. It is a quaint yet hopeful comment when someone says, “Everything happens for a reason.”
Science has not brought us understanding and certainty. It has brought us an awareness of how little we understand, how ultimately unknowable it all is. Yet today we are assailed by information, some based in reality, some fake, the trivial mixed in with the salient. On my Google feed I find Amanda Holden in another see-through dress, next to scientists creating a black hole in the lab, what actor was not cast in a decades old film, and how many children were killed in missile strikes last night.
And yet we crave certainty, predictability, organization, cause and effect. Unique among creatures on this planet, we need to know. Ah, think of life as a cobbler in a village pre-Gutenberg. Harsh but simple.
And then we build the internet and social media, where anybody can have a voice, a voice without responsibility or accountability. The very technology that allows me to have the British Museum, the Oxford English Dictionary, the Smithsonian, and the lectures of Bertrand Russell in my home also brings me Alex Jones, Donald Trump, a bevy of self-proclaimed influencers, and every malfeasance by Pfizer.
No rules, no limitations, no boundaries, no separation of fact and fiction. Therein lies the road to madness.
We should not be surprised to read a couple in New Zealand refuse a life-saving operation for their child unless the blood on hand for transfusion comes from an unvaccinated person.
Well, messenger RNA vaccines; these are something like manufacturing a clone of Paul Revere in the laboratory of a big (for profit) corporation and sending it out six months before the British arrive.
What could go wrong? Purdue Pharmaceutical? Boy Scout leaders and Priests taking my child on a camping trip? Hershel Walker? Anti-vaxxers disrupt a School Board meeting? A convoy of truckers takes over Ottawa. Putin decides he wants to be Emperor of a nineteenth century expanded Russia? Fourteen year old boy geniuses become billionaires? One of them misplaces a few billion? Fascism is resurrected all over the world? Deep fakes mean I can’t even trust my own eyes? Donald Trump leaves the old school scams of phony university degrees, signature steaks, and real estate tax fraud behind, and gets modern with an NFT scam. Jordan Peterson says Canada is about to collapse. Keven O’Leary is paid millions to promote worthless cryptocurrency and is paid in cryptocurrency. (At least I get to smile at the irony of that).
I think I shall have to invent my own reality and give it a test drive.
By Dr. David Laing Dawson
One of the self-appointed political commentators with his own podcast, after interviewing Trump supporters, asked if some of these people were mentally ill. He was referring to a surprisingly large number of people who hold obviously erroneous beliefs (or delusions) about such things as voting machines, pedophile rings, and the resurrection of JFK junior.
Is the debacle of Kanye West flowing from a mental illness or that not uncommon human trait of generalizing from a single experience and converting his own sense of failure or disappointment into hatred of some imagined enemy?
As I write this slowly and carefully I am aware part of this problem is the very contemporary phenomenon of people with less than stellar knowledge, wisdom, and judgement being able and willing to share their random thoughts with very large audiences.
I did, I confess, watch the Tim Pool interview of Kanye West. Kanye was mildly hypomanic; in fact he did admit at one point that his brain was generating seven thoughts at the same time. There was often no link between one thought and the preceding thought he shared, and with the slightest pushback he abruptly left the studio.
One hallmark of delusions generated by psychotic illness is that they are usually, if not quite always, self-referential. That is they do not declare that the FBI is controlling people; they declare that the FBI is controlling me, my thoughts, or watching me, looking in my windows. They don’t say song lyrics are about my neighbours; they say the song lyric is about me, written for me. They don’t say the television is sending messages to other people; the television is sending messages to me. They don’t say there will be a second coming; they say I am the second coming.
The brain is an organizing machine. It constantly seeks meaning. And by “meaning” I mean organizing principles that offer some degree of predictability. What might happen next? What are the reasons I feel this way? Who is mine enemy? Who is my friend? Where lies safety? Where lies danger? What control do I have? What power? What or who is causing my limitations? Where might I find love?
At its best the brain contains sufficient information, filtered knowledge, wisdom, well-functioning cognitive processes and well-functioning sensory, perceptual processes to arrive at some, at least satisfying and pro-social, organizing principles. At best it is also flexible enough to alter some of those ideas according to new information. Three very specific skills in this process are: noticing patterns without inventing them, ignoring irrelevant information, and accurately reading non-textual interpersonal communication.
When the brain itself is impaired, be it by schizophrenia, mood disorder, cognitive impairment, or dementia, the need to answer the questions in the bolded paragraph remains. The impaired brain still seeks answers even when over-alert to patterns, unable to read the intent of others, unable to sort the wheat from the abundance of chafe, unable to link one thought with the next, or overwhelmed with emotions of elation or depression. The organizing principles this impaired brain arrives at may be drawn from recent news, new technologies (a common delusion of yesteryear was of being controlled by xrays – today it is implanted microchips), religion and various real and perceived power structures. (Being Queen Victoria is passe, but being a messenger of God is still with us.) These delusions are the product of brain impairment from illness (also injury and toxicity) and are self-referential.
Intelligence and education play a role here: The delusions of a mentally ill but highly educated and intelligent person can be complex, subtle and well defended. The delusion of the not-so-smart ill person is usually blunt and straight forward.
And once any of us answer those existential questions we proceed to seek evidence to support our conclusion and ignore or avoid evidence that might refute it.
But of course even with a fully functioning brain it is quite possible to become deluded.
We are social creatures. We depend on others for information and understanding. We instinctively look to leaders to provide this. Some of us look to these leaders more fully and willingly than others. Hence the power of a cult leader, be he a true believer or a psychopath.
We need social information to inform our organizing principles. Hence social isolation breeds delusions, or, at least, strange and eccentric ways of understanding the world.
Information silos and social media algorithms control the information we receive and thus reinforce specific patterns we rely on for meaning.
And to find equanimity (and not resort to a delusional explanation) in a world without absolutes, a world and universe in which nothing is fully understood or explainable (time, black holes, infinity, what did exist before the big bang, spooky action at a distance, death, consciousness, human behaviour…..) we each need a degree of security, social membership, purpose, trust, flexibility, and an acceptance of our own limitations.
When delusions arise from factors apart from mental illness they are not usually self-referential: “Hilary Clinton runs a pedophile ring.” “God talks directly to my cult leader.” “Jewish space lasers started the forest fires.” “Trump will be reinstated as president in August”.
And then we have moments when the two collide: the non self-referential religious/political delusion and the mental illness derived self-referential delusion.
“Hilary Clinton runs a pedophile ring in a pizza place.” “God has assigned me the task of righting this wrong.” “Jews, Arabs, Mexicans are replacing us.” “It is my mission from God to kill some of them.”
For what it’s worth, Kanye West appears to suffer from a self-referential bipolar mania- induced delusion and the other kind as well.
By Marvin Ross
Baseball great Yogi Berra had a way with words and the deja vu quote is one of his best. Will his words predict the coming fight between the “woke crowd” and civil libertarians versus the current mayor of New York City, Eric Adams?
Mayor Adams is trying to do the sane, compassionate thing “by ordering police and emergency services to more aggressively hospitalize those with mental illness who are on the streets, even if the hospitalization is involuntary and they pose no threat to other people.” Adams has rightly argued that these citizens are in desperate need of treatment but often refuse treatment because of the nature of their illness. They do not realize they are sick.
Needless to say, he is being opposed by the usual civil libertarians and the champions for the homeless. I suspect that his humane efforts will be defeated as were the efforts by his predecessor, Mayor Koch. At that time, the late DJ Jaffe who was a spokesperson for the New York City Friends and Advocates of the Mentally Ill as quoted in the New York magazine “Manhattan Spirit” stated that it was easier to get into Harvard Law School than Bellevue Psychiatric if you were mentally ill. He was referring to the case of a New York homeless person Joyce Brown.
This is what happened in that case as described in my 2008 book Schizophrenia Medicine’s Mystery Society’s Shame (and still available).
Ms. Brown was a mentally ill homeless woman who resided on a steam grate at E 65th Street and Second Ave in Manhattan. She urinated on the sidewalk and defecated in the gutter or on herself. At times, she tore up money passersby gave her, ran out into traffic and shouted obscenities. Many times, she was not properly dressed for the cold weather. Five times psychiatric outreach teams took her to hospital but each time she was released by psychiatrists who deemed that she was not a danger to either herself or others.
On the Diane Rehm National Public Radio show after the Virginia Tech shootings by a mentally ill man who had fallen through the cracks and should have been hospitalized before he engaged in his murderous rampage, Torrey stated somewhat sarcastically that in order to be deemed a danger to yourself or others, you have to either try to kill yourself in front of the psychiatrist or try to kill the psychiatrist.
Ed Koch, the mayor at that time, saw the women and tried to have mental health professionals get her treatment. He was told that she was not deemed to be in danger or dangerous. Koch proposed new and less restrictive legislation that would make it easier to hospitalize someone. Koch referred to the civil libertarians who opposed hospitalizations as the crazies who deny people the right to treatment.
Under his new legislation, Ms. Brown was hospitalized but the New York Civil Liberties Union challenged that in court. In claiming that Ms Brown was not a threat they argued the following in her defense:
Other New Yorkers also urinated on the sidewalk
Defecating on oneself is not really a threat to one’s health
Running into traffic was no different than jay walking
Tearing up money was a symbolic example of the woman’s independence
Her obscene language was no worse than what is commonly seen in movies
Judge Robert Lippman found for the Civil Liberties Union and stated that “the sight of her may improve us”. By being an offense to aesthetic senses, she may spur the community to action. Upon her release, Ms. Brown was invited to appear on the Phil Donahue Show and to address a forum at Harvard Law School.
She denied any mental illness and claimed that her homelessness resulted from her not having a proper place to live. She was given a home and a temporary job. Within weeks, she was back on the streets untreated and unwell.
I wish Mayor Adams luck and he will need it.
Time for some deja vu all over again
Mind You Reflections on mental illness, mental health and life 