All posts by mross109

Disasters

By Dr David Laing Dawson

In most unfolding human disasters, in my lifetime and historically, it is difficult to ascertain a time, a moment, a place, when the actions of one person could have made a difference, could have changed the course of an unfolding disaster.

But this is one of those rare moments. Simply put as a request:

“President Trump, please call President Erdogan and tell him to stop. Say it simply and firmly. Do it now before it is too late. Then quickly return two hundred or two thousand  American advisors, experts, medical personnel and soldiers to the border towns, encampments, prison camps of Northern Syria.”

You made a mistake giving Erdogan the green light, for reasons only you and Erdogan might understand. You can rectify this with a phone call.

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A Refreshing Moment of Sanity in an Insane World

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Image by OpenClipart-Vectors from Pixabay

By Dr David Laing Dawson

She asked what I was smiling about and I said, “I’ll tell you later.”

Earlier we had visited the Musee National des Beaux Arts du Quebec and spent some time in the contemporary art pavilion. The exhibition was titled in three lines, Where we came from, What we are, Where we are going.

It featured a grouping of several three foot eggs of ragged twine soaked in black paint or tar, the tar staining the white pedestals upon which they sat. And then a male mannequin dressed in jacket and tie, lifelike save for the brown paper bag serving as a head and lit from within. This mannequin was sitting but another standing had its head replaced by an explosion of LED filaments.

There was a placard of artspeak on the wall explaining these, sincere I’m sure, responses to the title. I didn’t read it.

Instead I walked to another Pavilion where I sat for a time looking at the stark and haunting landscapes of Jean Paul Lemieux. Almost always cold and always eternal whether he included a sister in her black habit or not. And always with just enough colour to give me hope that I will see another spring.

And now we were sitting in a small seafood restaurant watching the chef and sous chefs working with enthusiasm in the open kitchen, one shucking oysters, another searing scallops, a third plating with the eye of an artist.

The young couple behind me were earnestly discussing philosophies of literary criticism, I think, though more accurately he was loudly expounding on them while she listened.

I smiled and chuckled a little while I listened to their intense discourse and thought about the sincere artists in the contemporary exhibition and realized that at our table we had talked of nothing but the food for the past hour, the wine, the origin of the scallops and oysters, the pinot noir from France, the preparation of salmon and beef ribs in sous vide before the sear.

With our friendly waiter we had spoken an odd combination of English, French, Dutch and German and when we left he wished us a Guten Abend.

The rain had stopped when we stepped out onto the cobbled walk, and the clouds were lifting across the valley over the Laurentian hills revealing a final pink glow, a punctuation mark to our day.

Roof tops glistened, lights sparkled. We stepped around the puddles.

Trump and the Kurds

By Dr David Laing Dawson

Western powers meddling in, invading, colonizing, any of the middle east Nations has seldom if ever resulted in something good. I must leave this as “seldom if ever” because the history of such meddling, colonization, invasion, corruption is too long and complicated to review. Even the fact there is no Kurdistan but rather populations of Kurds in three adjacent countries is the product of Western meddling, of arbitrary boundaries drawn up after European wars.

But then we arrive rather suddenly in the last months of 2019 and even though, albeit through much tragedy and failed foreign policies, we are at a point of relative peace and success (defeating ISIS), and an opportunity for Western powers, this time mostly the US, at a relatively small cost, to stay with just enough presence to prevent more war and genocide, to provide the Kurds with some defacto autonomy, to prevent Erdogan’s Turkey from exercising its genocidal impulses, to prevent a resurgence of ISIS…. and now, with a rare chance of doing great good with minimal cost the US cuts and runs.

Not the US actually, but Donald Trump. Supposedly after a little quid pro quo phone call with Erdogan.

Such an irony. The most foolish inept corrupt president the US has ever suffered is given an opportunity to have success, and to save lives, and preserve peace by simply doing nothing and he blows it. Over the next few weeks and months we can all watch how this unfolds, causing more suffering and more de stabilization of the region.

But why is this happening? Even Trump’s acolytes know it is a bad move and are speaking out.

I think we are hostage now to Donald Trump’s rather severe personality flaw. As bombastic and ruthless as he appears to be with ordinary mortals he lapses into a craven sycophant seeking approval whenever one on one with a man who holds true life and death power over his own tribe.

As the drums of impeachment beat louder he will seek and need this kind of approval more and more, from both chanting crowds and one on one from those he perceives as powerful men.

Dual Citizenship

By Dr David Laing Dawson

Until the recent news cycle I did not know that in Canada we have no rules addressing dual citizenship and public office. A man or woman who is a citizen of both Canada and another country could become our Prime Minister.

I am once again roused from the suffocating vapours emanating from our neighbour to the south.

Dual citizenship is a way of hedging bets. It is an “If things go wrong I can always go back home.” kind of thing.

And I accept that it is a reasonable and logical state for many immigrants testing the waters in Canada, or someone born of Canadians in another country. But maybe there should be a time limit on that. Say 20 years to make up your mind and commit.

But dual citizenship does imply a divided allegiance, a back door to escape through. It also, in some cases, allows one to benefit from the best of both worlds, say peace, security, health care, good governance in Canada, and big money in the USA, or a life with longer summers, a good pension and free health care every six months.

But never, ever should we allow a person with dual citizenship, a sworn allegiance to two different countries, divided loyalties, an escape hatch, to become a sitting member of our Parliament, let alone the Prime Minister.

Mr. Scheer’s history with this smacks of arrogance, no real commitment, and a reluctance to sacrifice anything for the honour of being our Prime Minister.

While I am here I would like to propose another rule. And that is, No one should be allowed to run for public office, Municipal, Provincial, or Federal, until they have experienced at least, say, 15 years of adult life: job, career, community, workplace, partner, house, mortgage, rent, responsibilities……

Stepping out of college and taking one exam in insurance while working as a clerk does not cut it.

Treatment Resistant Schizophrenia and the Family – A Book Review

By Marvin Ross

book cover My Father Fortunetellers Me

My Father, Fortune Tellers and Me: A Memoir, is a book that should be mandatory reading for all counsellors in training, psychologists, social workers, psychiatrists and anyone who is working with or involved with families of those with schizophrenia – particularly untreated or treatment resistant schizophrenia.

Eufemia Fantetti, in telling the story of her family and her mother’s treatment resistant illness, has provided us with the full horrible extent of the complete destructive power of this illness. I can’t think of anything that depicts so vividly the impact on the family but the book also gives us more than that – family love and resilience. The book also demonstrates our total failure as a society to help care for people who are that sick.

Eufemia’s father had a pretty good life as a 30’s something Italian immigrant in Toronto – single, good job and living in a vibrant city with a large Italian subculture when he returned to his home town to take an arranged bride, a second cousin, years younger than him. Eufemia opens the book with a wedding photo of her parents in front of the statue of St Anthony of Padua holding the baby Jesus who, Eufemia says, is waving ciao to someone in the church.

Her father she describes as unsure of himself having only seen his bride twice before that day and he had never spoken to her. She points to her mother, Lucia, with Jordan almonds that symbolize health, wealth, happiness, fertility and longevity “My folks scored two out of five”. Married life continued in Toronto and soon Eufemia came along.

Lucia became increasingly more erratic as the years went on and so the family went for a long stay to Italy where it was hoped that she could get medical help. Once her treatment with an Italian doctor started, her father returned to Canada leaving Eufemia with Italian relatives. Lucia quickly stopped taking her medication and eventually, mother and daughter returned to Toronto.

Of course, the bizarre behaviour continued and often Eufemia was the brunt of the mother’s anger and physical abuse. At one point, a little girl in the neighbourhood had drowned in an accident and Lucia took Eufemia to the visitation against her father’s wishes. Visitations freak me out as they are not part of my cultural upbringing and I’ve never been comfortable standing around with a cup of tea making small talk while grandpa lies dead a few feet away. Imagine what it must be like for a young child especially when the departed is another child?

Lucia drags Eufemia to view the body and, if memory serves, makes her touch the little girl. She then gets in the line and introduces the grieving mother to her own daughter who she describes as the light of her life. This causes the departed’s mother to start howling in anguish and the two leave.

Later, Lucia goes to the factory where her husband works and takes his car in order to drive Eufemia to school. After dropping Eufemia off, she plows into the back of a truck and takes off, puts the car in the garage and says nothing. That evening, the damage is discovered and the father calls the police to report it. The police arrive quickly as they had been out looking for the hit and run driver but Lucia was in church so they come back later.

With all the times that Lucia spent in church, I have to wonder why no priest ever realized she was in need of medical help and suggested it. It was mainly the police who did and, after taking their report from Lucia, the officers parting advice to the family was to take her for medical help. It was because of that suggestion that Lucia was diagnosed with schizophrenia.

The diagnosis did not lead to any improvement and Lucia continued to terrorize the family often smashing the house and inflicting abuse on Eufemia. There were countless encounters with the police, charges, restraining orders and, at one point, a police officer arrived and gave Eufemia’s father the business card of an Italian social worker so that he could get help. The cop said “sir, you cannot continue to live like this”.

Eufemia regularly saw a counsellor to help her through and the best advice she was given was to graduate from high school and to go to university as far away from Toronto as possible. Eufemia moved to Victoria, BC and lived on the west coast for many years while trying to help her father as best she could. Eufemia’s father endured until the stress of his life took its own toll on him and he had his own mental collapse.

It eventually took him four years to divorce his wife in a proceeding that his lawyer told him was the most complex of his 30 years practice as a lawyer. Ten years ago, Eufemia moved back to Toronto and she and I  were introduced by our mutual friend, Susan Inman (and Bridgeross author of After Her Brain Broke). I was somewhat familiar with the story in the book but not the full details and always hoped that she would write of her experiences.  I’m delighted she has and the book exceeds all expectations I had for it.

Eufemia often posts conversations with her father whom she calls Pappy on Facebook and the love and affection shines through along with Pappy’s optimism and good sense:

My dad insists that the Lord watched out for him – is certain the biblical sky dignitary dealt the cards for the game of Scopa my father played throughout his life.

“And if I didn’t marry the woman who ruined my life” she quotes her father saying, “I wouldn’t have you. I got what I wanted in this world: someone I could talk to. I prayed for someone reasonable and I got you.”

Words escape me!

Going back to the police, Eufemia states that “in a fair and kind society, police wouldn’t be tasked with the role of front-line mental health workers. We wouldn’t close our hearts to the suffering of others. We wouldn’t blame people for their illnesses…..”

At one point after her return to Toronto, Eufemia goes to visit her mom who is under the care of the Provincial Public Guardian and Trustee housed in a nice one bedroom apartment. Eufemia notices that all her blister packs of pills are months out of date and so decided to take Lucia to the doctor’s office for her monthly anti-psychotic injection.

The pleasant nurse points out that “we have not seen you for awhile Lucia”. And my reply is why do they not ensure that she does get her monthly shot and make sure that she is taking the meds in her blister pack? Should their job not also be to ensure that the vulnerable patients under their care at least get the medication they are supposed to?

And a final word about Eufemia. Her story collection, A Recipe for Disaster & Other Unlikely Tales of Love (Mother Tongue Publishing) was runner up for the Danuta Gleed Literary Award and won the F.G. Bressani Prize for short fiction. A recipient of the Commonwealth Broadcasting Award, she is a graduate of The Writer’s Studio and holds an MFA in Creative Writing from the University of Guelph. Her work has appeared in the Globe and Mail, Event Magazine, and The New Quarterly. She teaches at Humber College and lives in Toronto.

I cannot recommend her book strongly enough.

My Father, fortune-Tellers, & Me By Eufemia Fantetti, Mother Tongue Press ISBN-13: 978-1896949758

Vaping, E-Cigarettes and Schizophrenia

by Marvin Ross

A number of times over the past few years, I’ve written about the need for people with schizophrenia to smoke. Yes, it is dangerous to their physical health but it does help calm their brains. I’ve also written about the cruelty of hospitals that do not accommodate smokers with serious mental illness. It would not be that difficult but they refuse and, in one case, patients cannot even possess tobacco.

As a healthier alternative, I’ve suggested e-cigarettes that provide the needed nicotine but by the safer alternative of vaping. E-cigarettes enables  smokers to get their nicotine fix without the dangerous chemical byproducts of burning tobacco. Now, thanks to the FDA and the CDC, that option appears to be on the way out. Fortunately, Health Canada is reserving judgment and I hope that good sense and science will prevail.

At issue is the increase in the number of young people vaping who are developing serious lung problems resulting in seven cases, at time of writing, of death. We are now looking at a ban on e-cigarettes which would be throwing the baby out with the bathwater.

Vaping nicotine should not be done by young people who do not smoke cigarettes nor should they be vaping coloured, flavoured products as it can lead to smoking. But, vaping nicotine may either help people who want to quit or be a healthier substitute for smoking cigarettes. An English study from 2018 found that “e-cigarettes may be a unique harm reduction innovation for smoking relapse prevention. E-cigarettes meet the needs of some ex-smokers by substituting physical, psychological, social, cultural and identity-related aspects of tobacco addiction.”

The National Health Service (NHS) in the UK found “E-cigarettes are 95% less harmful than tobacco and could be prescribed on the NHS in future to help smokers quit,” But what about the lung damage and deaths? According to Alex Bezerow, vice president of scientific affairs for the American Council on Science and Health (ACSH), the damages and deaths caused by vaping were the result of people vaping THC infused oil that they got from the street. “THC is not soluble in water, so it has to be dissolved in oil. The oil of choice is vitamin E acetate” and “Inhaled oil can trigger lipoid pneumonia.”

As these products are purchased from the black market, they may contain other impurities. The FDA and the CDC, he suggests, are allowing myths and fear-mongering to govern their policies. If you are interested in the chemistry of how this damage and deaths is coming about, then Dr Josh Bloom with ACSH provides a simple explanation of the process. If nothing else, Bloom explains how PEZ was initially developed as a means to help people quit smoking.

Why ban e-cigarettes after 6 people died from using the device improperly according to the evidence available now when so many in the US are dying from gun attacks? Guns have killed far more than 6 people and yet the US refuses to do what every other civilized country has done.

Where is the logic?

Universal Health Care and Mental Health Care

By Marvin  Ross

Canadians will be going to the polls in about a month and one of the top issues for every election be it federal or provincial is the state of health care. And the presidential election in the US for later next year has already begun with numerous Democrats fighting for the right to try to take down the Trumpster. Universal health care is another issue that is high on the list of US voters.

Every country in the world with an advanced economy provides some form of universal coverage for its citizens except for the US. Why, I will never really understand but I do hear comments that our system is inefficient, has long wait times, and could benefit from a dose of privatization. An American I know on Facebook recently posted that their insurance premiums come to $730 a month but they have not received any payments from the insurance company despite paying out about $1500 for medical treatment since the beginning of the year.

In this country, right wing politicians and many doctors are trying to bring in some degree of privatization to improve our efficiency – or so they claim. Recently, Dr Bob Bell, an orthopaedic surgeon, former heard of the University Health Network in Toronto and former Deputy Minister of Health in Ontario, discussed his research on the Canadian system versus others with some elements of privatization.

His findings are that there is:

“much evidence to support the argument that private insurance exacerbates problems rather than solves them. Healthcare becomes more expensive, and care for public patients deteriorates when private care is introduced.”

You can read his reasons for that conclusion in the link above where he does state that the British system performs better in mental health than Canada. That is something that I will pursue in the near future.

The US, in 1965, passed the Institutes for Mental Disease  exclusion (IMD) which forbids Medicaid funding for institutes with more than 16 beds that provide residential mental health care. This was an attempt to leave mental health funding to the states but it resulted in many of those facilities shutting down. Consequently, almost half those with mental illnesses in 2013 received no treatment. In contrast, while treatment for the mentally ill in Canada could be  better than it is, we do have free standing hospitals dedicated to treating patients with mental illness and psychiatric wards within general hospitals. Treatment is covered the same as it is for any other disease and social assistance covers medication.

Two years ago, I had what I call a near death experience and wrote about the efficiency of the Canadian system that saved my life in the Huffington Post. This is what I wrote at the time:

For the past number of years, right-wing Americans have continually criticized the Canadian universal health-care system. Sometimes, they are joined by Canadians of similar political leanings who want to see privatization. A couple of years ago, Dr. Danielle Martin, a physician at Women’s College Hospital in Toronto, made a big splash when she appeared before a Congressional committee defending us and, in the process, poking holes in the States’ lack of universality and emphasis on profits. That video has been promoted by U.S. Senator Bernie Sanders

The other week, Canada’s system very efficiently saved my life so that I was released from hospital after only about five days. My experiences should convince skeptics, but first this — for years, I’ve been telling this story to doubting Yanks. It was probably the 1980s when my mother, who suffered from dementia, broke her leg in her nursing home. She was old, she was poor and she was demented, but she was taken by ambulance to one of the major University of Toronto teaching hospitals. The U of T ranks in the top 10 medical schools in the world, and my mother was operated on within 12 hours by the chief of orthopaedic surgery.

I was impressed. But then, to my surprise, the surgeon apologized to me for the 12-hour delay. He said they had major traumas come in that night, and my mother was made to wait under sedation, resting without pain.

Now for my own recent trauma. I had a routine colonoscopy, of which I’ve had many before (but this will be my last one). I had some unusual pain during the procedure, likely due to the air they inject to open up the colon for exploration. That evening I wasn’t feeling well and by morning I was sick and could barely walk. My wife called 911 and within about five minutes, the fire department was standing over me, quickly followed by the paramedics. It pays to live near a fire station.

I had no blood pressure so they got me into the ambulance and tried to find a vein to give me saline but they were unable to. I could hear them talking to the hospital and we quickly took off with lights and sirens. My arrival was like a TV medical show as I was raced into a trauma bay that was waiting for me and fully staffed with doctors and nurses jumping in to do their bit.

I won’t go into the gory details, but at one point I heard a doctor ask if I had family nearby and my wife was told that I was critical. By early evening, I was stable enough to not have to go to intensive care as planned, but to one level down called the medical step down unit. By the next afternoon, I was able to be moved to a regular ward. What exactly happened, no one is sure, but something from the colonoscopy (a common and usually safe procedure) triggered something that put me into organ failure and showed up on the CAT scan as a totally involved inflamed colon.

I was discharged five days later. The competence, dedication and compassion of all the staff amazed me. So, what did it cost? I’ve heard Americans say that nothing is free, so why should free health care be free? It isn’t and it’s not. I will get a bill for the ambulance for $45 — it’s something I’d object to, but I do know that if I were on social assistance, it would be waved. The flat screen TV with cable in the step-down unit was part of the service — no charge. I did have to pay for a personal TV in the other unit and picked the $15-per-day premium package so I could watch the Blue Jays continue to disappoint. My compensation was free WiFi.

My taxes and the taxes of my fellow citizens paid for all else. The 911 line, fire department and probably the paramedics were part of my municipal taxes. All else came out of the Ontario government with infusions from the Canadian government.

But here is another key difference that matters. Our hospitals, unlike in the U.S., are not private corporations intent on making a profit, but are not-for-profit institutions. They are lucky to break even, let alone make money. Here is a question for Americans to mull over: why should a corporation try to make a profit on someone’s misery and misfortune? Making a profit and money is a powerful motivator, but there are some things that should be done for the good of all in society.

The hospital that I was at is part of the Sisters of St. Joseph movement, so their reward is that of serving others, which they consider an honour. However, none of this means that our system and this hospital are not rife with wait times, inefficiencies and overpaid bloated bureaucracies. The health-care system is run by bureaucrats and politicians so the stupid is expected. But at least they are not trying to make a buck on my illness. That can and does compromise service.

In another place I actually was very critical of this hospital for its bureaucrats and their big bucks. The CEO makes about $750,000 a year which, frankly, is way too much. He could reduce his salary significantly so they could hire a few more of the competent nurses I had. They were willing to get down into the muck and bodily fluids which would have ruined the CEO’s fancy suits. He would still make a damn good salary.

If I may, some advice to the United States — Kiefer Sutherland. Let him restructure your health system. Besides saving the American Empire so many times on 24 and now as the Designated Survivor, his maternal grandfather was socialist Tommy Douglas who brought us universal health care. In 2004, almost 18 years after his death, he was voted the Greatest Canadian.

Kiefer, along with his mother, is an active supporter of universal health care, as he pointed out in this message from a few years ago. You may also be interested in a very passionate presentation (Part One) his mother gave on the struggle for and the origins of the Canadian health system. I’m sure, as a tribute to his grandfather, he would be happy to help.

 

Bipolar Stories

By Dr David Laing Dawson

Some years ago, having published my fourth novel, I was asked by a local writers group to be guest speaker at their monthly meeting. I accepted, and when the date arrived I found a group of about twelve people sitting around a large table. The first half of the session went as expected as I discussed my approach to writing, and novel writing in particular, and they joined in, asking questions, sharing thoughts. Then we broke for coffee. A few left immediately to fill their cups but the majority remained with me at the table. They knew of my other profession and started asking me questions about mood stabilizers and anti-depressants, and sharing their own experiences with these medications. And suddenly, rather than being speaker at a writers’ meeting, I became a psychiatrist in a Mood Disorders Support Group.

It is not all that surprising, I think, that bipolar disorder is over-represented among writers, and that within this demographic it has been estimated that half of all poets might be so afflicted.

It has been said as well that depression fuels the furnace of creativity, providing the writer with anguish, with despair, with glimpses of hopelessness, and a wealth of existential questions, while mania, or at least hypomania, provides both the energy and the optimism to put pen to paper, or fingers to keyboard.

And for a psychiatrist, or anyone else who likes stories, bipolar disorder, among the mental illnesses, provides the best, though not always with happy endings. Here are a few:

In the winter of 1968 a tall man was brought to the emergency of a big city hospital. In my memory he towers over me though that may have been his mania rather than his height. I was an intern that year, and this man who would become my patient for a few hours, was the chief librarian of a major institution and held PhDs in English and Library Science. And he was indeed manic. His eyes were alight as they always are in a state of mania, seeming to see in more dimensions than I. Of course he could not stop moving or talking and so I walked beside him and listened as we made the full U shaped journey through the Emergency Ward several times that evening.

He had a revelation to share and this revelation was literary for within his excited stream of consciousness he sprinkled a hodge podge of quotes from poems and literature spanning more than a few centuries. He spoke too quickly and with an excess of erudition for me to follow and at the time I wished I had a tape recorder for his revelation may have been significant, but surely forgotten by tomorrow.

Now and again he paused in his stride, not so much to catch his breath as to see if his amanuensis was keeping up. And each time he paused I would reach into my white jacket and offer him a small tablet of chlorpromazine with a Dixie cup of water and most times he would take it before he was off in full flight again.

Eventually he slowed, both in movement and in speech, and eventually he sat. And then I was able to convince him to walk with me across the hospital and up an elevator to be admitted to the psychiatry ward. This he did, quietly now, a little wary and vigilant, and I handed him over to a nurse and wrote the admission orders.

I don’t know what became of this man of letters but I hope he stayed on his lithium and I hope any future bouts of depression or mania did no irreparable damage.

****

I had treated this young man in the big mental hospital outside Vancouver B.C. though he was from an Alberta ranch and wore the requisite Stetson and boots. He had driven straight through the Rockies and the Fraser Valley without stopping on his way to Vancouver. He managed this he said by holding his foot to the pedal while pissing in a bottle and dumping it out the window. He repeated this. “Piss in a bottle, dump it out the window. Whooee.”

I don’t remember what had attracted him to Vancouver in the first place; the rumoured nude beach? The hippie scene on Fourth Avenue? But I do know that at some point the Vancouver City Police found him encamped on the roof of their headquarters unfurling a banner over the side.

He didn’t think much of taking medication and he thought even less of the nurses telling him to stay away from the vulnerable female patients, but eventually we got him settled enough to send him home to Alberta and the family ranch.

A year went by and I was now working at the brand spanking new psychiatric hospital on the UBC campus in Vancouver. These were very optimistic days in psychiatry with both new and effective medications plus the idealism of the sixties. This unit, which would eventually become part of a neuroscience section and one program in a Health Sciences Center, had no locked doors, beyond the pharmacy. Earth toned colour scheme, carpeted floors, single rooms, wide short corridors, teak furniture, comfortable beds, nurses in civilian clothing, Docs shedding their white coats, all patients voluntary, community meetings every morning, even a fireplace in the lounge area, and a very nice, well appointed auditorium on the main floor.

There’s a call from Alberta they told me. “Will you accept the charges?”

It was the young man I had treated a year before. He had stayed on the family ranch for a while, attended a clinic in Lethbridge, but now he was off his meds and his father had sent him as a buyer to a cattle auction in Calgary, with money in his pocket. But some guys were looking at him, and talking about him, and calling him “queer and shit like that”, and he was getting paranoid. He couldn’t stay at the auction but he was supposed to stay and to bid on some good breeders, he said.

I spoke with him for awhile ignoring the long distance charges. I’m sure I asked him to go back on his meds and/or take himself to the nearest hospital emergency. I do remember feeling some relief after he hung up, knowing that he was currently in Alberta and 600 miles away from being my responsibility.

My day passed uneventfully, with patient meetings, conferences, team meetings, until mid afternoon when the front desk receptionist at the main entrance paged me to tell me that “Your patient is here asking for you. He’s wearing a cowboy hat.”

And there he was, as big as life, as loud as life. He had used the cash in his pocket not to buy a heifer but a one way plane ticket from Calgary to Vancouver. And I calculated in my mind, belatedly, that 600 miles is not a long distance when you are manic, impulsive and have some cash in your pocket.

He didn’t want to come up to my office. He needed open space, he said. No walls, man, no walls.

That well appointed auditorium was behind the main reception desk so I took him there. He chose a theater chair in the very middle beneath the high ceiling and I sat beside him. He was okay with the space of the auditorium though it wasn’t t like the open prairies of Alberta where he could see forever and didn’t have to watch his back.

Once more he became my patient and again I took on the task of getting him on and keeping him on the right medication. One day, as an outpatient, he expressed his disdain for medication quite dramatically. In my office he took a vial of pills from his pocket and placed it on a solid wood coffee table. Then he drew a hunting knife from his other pocket and said, while repeatedly stabbing at the now scattered pills and the table, “This is what I think of your God damn pills.”

“I hear you, I hear you.” I said.

But eventually, again, he became well enough to long for the open sky. His parents sent money and he flew home to the family ranch near Lethbridge.

****

Five years ago the secretary/receptionist for the mental health clinic of a town 100 miles from Toronto came to interrupt me in my office. “There’s a call from Toronto,” she said. “A Doctor Philpott. He insists on talking with you and he says it’s urgent. Do you want me to put it through?”

“I don’t know any Dr. Philpotts, but sure, why not.”

When I picked up, the voice on the phone said, “Hi, Dr. D. It’s Frank Rivers. Remember me?”

Twelve years before this, when in his late teens, Frank had become my patient after admission to hospital in an acute manic episode. And for the following 6 years he took his lithium diligently and remained well and successful. But neither Frank nor I were ever sure this episode had not been a one-off, a manic episode fueled by, or triggered by, some party drugs he had used. So we discussed the pros and cons, the risks associated with staying on the lithium indefinitely and the risks of going off it. He opted to stop the lithium and soon I lost him as a patient.

I know in the ensuing years he became a star salesman for a major telecommunications company, his hypomania being a source of his success, and he was sometimes in trouble. But because he was now an adult he was not referred back to me.

And now, that is five years ago, he was calling from the Sutton Place, a not inexpensive hotel in Toronto. He had eloped from Toronto’s CAMH Mood Disorders Program and booked into a Penthouse Suite. His employer had put him on sick leave and he wanted to come back to see me. Would I take him on again?

Of course I did, and he has been stable now for these five years, and we have had the time and space to discuss all the problems, and the nuances of having bipolar disorder. On the edge of mania he has the gift of reading people and persuading them to buy, to sell, to make a deal. When a little depressed he feels guilty about this. When thinking clearly and calmly he is embarrassed by some of his antics when manic, and then anxious about meeting colleagues who have encountered him in that state. And stigma is a constant worry for him. Should he hide his illness or wear it like a prize?

He is aware of the harm, embarrassment he has caused others when manic, and he suffers some symptoms of PTSD from his hospital admissions, which sometimes included seclusion rooms and forced injections. How much of his current lack of ambition is his fear of relapse, he wonders. And we discuss all the stresses and situations that might put him at risk: Parties? Travel? Late nights? Drinking? Affairs? The corporate life? And for him, what are the warning signs, and can he recognize them when he is having a good time? We talk of the necessity of sleep, exercise, routine, and solid relationships, to maintain a stable mood.

And we have also talked about the benefits of being bipolar: the bouts of high energy and accomplishment, fearlessness, creativity, and persuasive powers.

Today he takes his medication religiously and he seeks, as I suppose we all must, the right balance in his life, which means to some extent, knowing when to avoid the party and when to leave the party, go home, take your medications and go to bed.

The Continuing Rorschach of Donald Trump

By David Laing Dawson

back cover
Back Cover of Two Years of Trump on the Psychiatrist’s Couch

Most politicians are quite adept at concealing the inner workings of their minds, their unguarded thoughts: “That is a very important question you’re asking. I thank you for asking that and giving me a chance to respond to such an important question. Now when I was a young boy growing up in (Idaho, Winnipeg) in a working class neighbourhood, and I watched my father go off to work each morning…..”

But Donald, ahh Donald. Every day he tweets and talks he exposes something about himself, not necessarily in the content of his half sentences, but in their form and style and context.

I am writing this because of two compelling moments last week. The first of these was his inclusion of Alabama as a target of Hurricane Dorian, which was quickly refuted by Alabama officials and his following press conferences and tweets in which he compulsively went to great lengths, including the notorious addition of a sharpie curve, to claim he was right, not wrong, to include Alabama.

It was a very small, entirely forgivable mistake to include Alabama in the first place but he was officially corrected. And herein lies the problem. He could not admit to even such a small, understandable, inconsequential error. And this, unfortunately, is evidence of a very fragile narcissism, one that cannot accept any correction lest it topple the whole edifice.

The second was his use of phrases such as, “Who ever heard of a category 5?” The news and late night hosts were quick to find and air five or six times in the last three years Donald has used very similar phrases when talking about hurricanes. “I don’t think I’ve ever heard of a category 5”. “I’m not sure I’ve even heard of a category 5.”

It has been pointed out the second to sixth time he said this it was a lie. But I think it is more Rorschach evidence of something else. Whenever he is over his head, when he doesn’t know any details, when he doesn’t really understand, he resorts to a set form of linguistic grandiosity: “Bigger than you’ve ever seen before.” “Who knew health care was so complicated?” “Like you’ve never seen before.” or simply, “It will be big, very big.”

And these phrases cover for the fact he doesn’t know the details, he doesn’t comprehend or understand, while at the same time implying that if he doesn’t know something it is beyond the comprehension of mortal man. And, as always with Donald, truth is inconsequential in his self serving performances.

Not news, but just more Rorschach evidence.

On the other hand, is there any point trying to determine the working principals of this man’s brain/mind? Or as others have pointed out, might we be simply watching “Reality TV”? Was there really a plan in place to fly Taliban leaders and the President of Afghanistan to Camp David for a secret meeting with Donald scheduled for today, Sunday? That he then cancels publicly with a tweet? Boggles the mind, it does.

Well, either way we are living in a world where the man with the biggest voice plays always to the camera seeking immediate glory, attention, or revenge, using, just as “Reality TV” does, fictional contrivances masquerading as truth.

 

It’s Not Mental Illness Stupid. It’s Guns!

By Dr David Laing Dawson

Each day the newspapers, CNN, Google, these last few days, headline the question of motive for the most recent mass shooting in Texas. Little has been released save the man’s name and a bit of background, presumably because there are multiple “crime scenes” to be investigated first.

But what struck me was this hunger for motive, for reasons and explanations. We need the reassurance of specificity, of explanation, of cause and effect. We need to understand. And we want to understand in a manner that will reassure us that we are not vulnerable; that we will not find ourselves at either end of that rifle.

But it is also a way of deflecting from some uncomfortable answers, some simpler explanations. So I thought I would take it upon myself to spell those out once again.

This man was angry and depressed and he had a loaded gun in his car. Obviously he was angry, and depressed because he would know as we do that taking that action is suicidal.

Why angry and depressed?

Does it matter? Lost a job? Lost a partner? Developing mental illness? Years of grievances? Broke? Friendless? Paranoid?

There are many people driving around or sitting in chairs angry and depressed.

It’s the loaded gun that makes the difference between getting a ticket, having your car impounded and taking a taxi, breaking down and crying at the side of the road, railing at the cops, being reminded of the unfairness of life, and what actually transpired that morning in Texas.