All posts by mross109

Coming in January: Mind You The Realities of Mental Illness A Compilation of Articles from the Blog Mind You

We have decided to publish a book on the best of our mental illness blogs over the past 4 and a bit years. The book will be available in print and e-book formats everywhere in early 2019.

Below is the introduction:

We began this blog in October 2014 in order to provide commentary on the state of mental illness and its treatment for the lay public. What we provide is a viewpoint from that of a psychiatrist with many years of experience (David Laing Dawson) and a family member of someone who does have schizophrenia (Marvin Ross). Aside from his personal experience (or lived experience as it is commonly referred to), he is also a medical writer, advocate and publisher of books that take a unique look at mental illness.

To date, we have had close to 75,000 views and have been read in 151 different countries since 2014.

We also write on other topics but these are the ones on mental illness covering topics like recovery, treatments, suicide, addictions, and alternative treatments (or pseudo science).

When we began, we had this to say of our purpose:

 Welcome to the launch of Mind You. While we intend to post on mental illness,mental health and life, we decided on the name Mind You to reflect that not everything is black and white. There are ideas and opinions but then mind you, on the other hand, one can say…….

And that is what we would like to reflect. Ideas about mental illness,health and life that can be debated and discussed so that we can come to a higher understanding of the issues. And, we have separated out mental illness from mental health because, despite their often interchangeability, they are distinct.

The National Alliance on Mental Illness defines mental illness as a medical condition that disrupts a person’s thinking, feeling, mood, ability to relate to others and daily functioning. Just as diabetes is a disorder of the pancreas, mental illnesses are medical conditions that often result in a  diminished capacity for coping with the ordinary demands of life. Serious mental illnesses include major depression, schizophrenia, bipolar disorder, obsessive compulsive disorder (OCD), panic disorder, post traumatic stress disorder (PTSD) and borderline personality disorder.

On the other hand, the World Health Organization defines mental health as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community. That is quite different from mental illness.

Unfortunately there is a tendency to confuse these and organizations like the Mental Health Commission of Canada have a tendency to talk about mental health issues and problems which are not the same as mental illnesses.

 Both Dr David Laing Dawson and I (Marvin Ross) will be posting on a regular basis on a variety of topics.

The posts we have selected for this volume are the most widely read over the past 4 years.

Mind You, ISBN 978-1-927637-31-9, 193 pages distributed by Ingram

 

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Taking issue with “issue”, again.

By Dr David Laing Dawson

Poets choose words for their rhythm and sound as well as their meaning. And for a poet, that can be a meaning implied or suggested, with the rhythm, sound, and suggested meaning creating a whole that invokes a new thought and feeling, or an old thought expressed more cogently.

If a poet were to choose the word “issue” she might choose it for its vowels and sibilants and its suggestion of movement or controversy.

But when we are trying to convey information in an essay, a news article or a political statement the actual meaning of the word chosen is paramount. But that word can be chosen not as a poet might, but rather to obscure, to obfuscate, to euphemize, to negate, and even to simply shore up the speaker’s credentials.

Unfortunately words get used this way and somehow creep into our regular lexicon for decades at a time. And when used this way for a decade, by politicians, reporters and editors, we are all protected from the truth, from factual information about ourselves and others.

The word “issue” is just one of those words. I am tired of hearing it used to obscure or soften reality.

Recently,  two senior Canadian politicians resigned from their positions in order to seek treatment for “addiction issues.” It turns out that one of them may actually be addicted to alcohol or drugs, but even this was an obfuscation of the real problem of “inappropriate sexual activity”. Now even this is a silliness. “Inappropriate sexual activity” is the couple making out in the back seat of the bus from Toronto to Hamilton. But sexual harassment, intimidation, or assault are more than “inappropriate”.

The other, it turns out, has been sexting and sharing nude pics of himself over the internet and got caught in a blackmail scam.

In one of these cases the word “issue” obscures what might be alcoholism or drug addiction. In both of these cases “having issues” and “seeking treatment” obscures some stupid immature behaviour and does a disservice to people who “seek treatment” for actual illness.

We can forgive both of these men for acting in a stupid, immature fashion, but neither should ever be elected to office again. For both of these men there is no treatment beyond someone shouting at them, “For God’s sake, what were you thinking?”

And this is the real problem with constant use of the term “mental health issues”, as in “has” or “is seeking treatment for”:

On one hand it manages to endlessly widen the scope of human follies, behaviours and struggles to which we do not assign personal responsibility, while at the same time obscuring and denying the existence of true, serious mental illness, and conversely and perversely assigning people who suffer from these illnesses personal responsibility for their illnesses.

Both Terry Fox and I have leg health issues. Mine are a problem of aging joints and lack of exercise. His was, of course, cancer.

The Ontario Ford Government – When Satire Becomes Reality

By Marvin Ross

In my wildest dreams I never would have expected to see a bit of satire that I wrote in the 1970s become reality in the latest policy announcement by the Ford Government. Let me explain. In 1977, my book Cover Your Ass or How to Survive in a Government Bureaucracy was published (still available in many libraries). One of my anecdotes was of the concern that a number of ruling politicians had over the fact that many of their elderly supporters were dying.

 They set up a task force to investigate. What they found was that the majority of people who died did so in hospital. The solution was simple. Close hospitals and fewer people will die.

Absurd, of course, but fast forward to 2018 and the Ford Government concern with reforming social assistance. First, you allow them to earn more money working so that they will eventually earn enough to get off assistance. Second, redefine what it is to be disabled so that fewer people will qualify. And then shift the blame to the Feds by using their definitions.

What is missing in all this, aside from humanity, is the realization that people with disabilities are disabled and cannot work or at least work full time. If they could work and live normal lives, they would not be disabled.

 I don’t disagree with letting them earn and keep more money if they are well enough to do some part time work which many are capable of doing. Depending on the nature of their disabilities, some can do a few hours here and there either regularly or when their conditions allow assuming there are employers willing to hire them.

 What I disagree with vehemently is redefining disability which will likely be more stringent than now and using the Federal guidelines. Under ODSP rules, a disability is a physical or mental impairment that is continuous or recurrent that impinges on their living and employment. This must be verified by a physician.

I wrote about the disability tax credit from CRA for those with mental disabilities in Huffington Post in 2016 and the rules are such that most with psychiatric disabilities have to appeal to the Federal Tax Court to obtain disability status. The form is highly complex and the requirements were changed by the Harper Government in 2006 to state activities markedly restricted at least 90% of the time. This resulted in many doctors refusing to fill out the forms.

Getting a disability tax exemption is so difficult that an entire industry has emerged of consultants to lobby on behalf of the disabled individual. The largest is the National Benefit Authority but there are numerous others all charging up to 30% of the benefit for their services.

In order to bring more equity to the process, an advocacy group called the Disability Tax Fairness Campaign was established recently headed up by Lembi Buchanan of Victoria. Ms Buchanan has been fighting CRA since 2001 and is responsible for a landmark case on behalf of those with mental illness that was upheld by the Federal Court of Appeal. In 2016 she was awarded the Meritorious Service Medal by the Governor General for her work.

And then there is the Canada Pension Plan Disability which is just as fraught with problems. The Globe and Mail reported earlier this year that 60% of claims are denied. Then most appeals are lost so that Canada has the highest rejection rate of all the OECD countries. There is also a very large backlog of cases to be heard and the cases are now heard by a single adjudicator. Previously there were three which usually included a medical professional, a lawyer and a lay person.

We have all seen the ads by lawyers and paralegals offering to fight for your disability rights under CPP. What Ford is doing is to increase the revenues for the lawyers and consultants who will be needed to fight for the rights of the disabled who will have their income eliminated. They will also lose their access to the medications they need and now get as recipients of the disability benefits.

And by pushing it all on to the Feds, Ford can sit back and say not my problem. So much for the premier for the people.


What to do at St. Michael’s College School

ownersmanualBy Dr David Laing Dawson

And for those not in Ontario, St Michael’s in Toronto is presently involved in police investigations where charges have been laid against students for bullying, assault and other charges pertaining to numerous incidents seen in videos spread on social media.St Michael’s is an all boys private Catholic secondary school

First we insist all schools be co-ed. We ban girls-only and boys-only schools. Then we stop overestimating the maturity and judgement of teenagers, especially when we find them in clusters, groups and herds.

The adolescent years are important. It is a time for these nascent humans to discover, navigate, as pioneers, the complexity of a sane, competitive yet compassionate society of human beings. They are discovering and forging boundaries, social contracts, the necessities of cohesion, cooperation. They are, at the best of times, overcoming fears and prejudices, and finding ways to satisfy their needs and desires while remaining kind and civil, building a unique sense of self while maintaining membership.

For this they need to be sitting in classrooms and walking the hallways with a full range of other human adolescents. Girls and boys of different sizes, shapes, abilities, and origins.

Putting all the boys in one school, and the girls in another, is a gross distortion of socialization during a very important developmental phase.

I could go on about this in abstract terms alluding to brain development, frontal lobe development, managing sexuality, gender identification, self awareness, expanding consciousness, and the need for all of this to happen within a good prototype, a good facsimile of the real world. But two small examples might paint the picture more vividly.

At the end of each Junior High School year my school held a convocation, an assembly, with the auditorium filled with students and parents. Besides speeches and singing, awards were presented. The three top students of each year had to go on stage to be presented a certificate. For three years I had to walk on stage and share these honours with a white girl and a Chinese girl. I remember fearing being teased by boys, my friends and buddies with their “manly” values, but I never was.

A generation later I have a photograph of a Student Council Meeting at M.M Robinson High. My daughter, Erin, is chairing that meeting. The members are sitting around the table. They appear to be listening intently as Erin points something out to them. They are all boys.

Contrast this with the current cover of The New Yorker. It depicts a room full of suited, older white men, all white, conferring with one another, and a door opening with a colourful array of women about to enter.

It is not at all hard to imagine, at an all boys school, with a tradition of manly muscular Christianity, how a gang culture develops with an emphasis on hierarchy, loyalty, dominance, and submission, with the infliction of pain confused with mirth, and the expression of sexuality becoming mixed with both.

We have a long way to go figuring out how to supervise our teens at home and at school now that their years of dependency stretch into their 20’s, unskilled but good jobs diminish, and these teens can now communicate with one another 24/7, and spend much of their time staring at screens, but closing the all boys and all girls schools would be one step in the right direction.

For more about raising adolescents, check out The Adolescent Owner’s Manual

A Cornered Narcissist is not a Pretty Sight

By Dr David Laing Dawson

Here is what to expect:

Increasing displays of petulance, irrational accusations, self-pity, rage, and depression, while he continues to seek out adoring crowds and fawning world leaders wherever he can find them.

This depression will take the form of blunt affect, self-imposed isolation, and paranoia.

I was struck by Trump’s demeanour right after the midterms. The news channels referred to it as upbeat, positive. His words (the actual words) started out upbeat, declaring the midterms a Republican “victory”, calling it “great”, before taking pot shots at all his favourite enemies and hinting at a democratic/deep state conspiracy against him, but his affect throughout this was flat, his pronunciation dull, his face blunted. even when using the words “great” and “victory” – at least until his petulant rage at Jim Acosta.

With the democrats now having the majority in the House, the republicans weakened in many State legislatures, the firing of Jeff Sessions, we are now into the endgame.

I don’t profess to feel any certainty how this will unfold. The possibilities include everything from impeachment to endless investigations to a thin gruel of feigned bipartisanship to more unrest, polarization, and violence.

But Donald Trump’s responses are predictable, and highly visible in his five tweets today attacking the press and the Mueller Investigation with even more recklessness and less attention to reality than we have seen before.

There was a time when a mad king could be isolated and the kingdom protected from his madness. Unfortunately we now have twitter and more than a few sycophants surrounding this president. And many more commentators still trying to shine a kind light on his outrageous words and notions.

Perhaps the world’s frightening march back to 1913 with the rise of nationalism, the erection of fences, the dissolution of agreements, and the rebirth of oligarchs will proceed without Trump. Or, or, or America might return to an improved version of itself as the beacon of successful liberal democracy, perhaps even with universal health care, gun control, less racism and a major role to play addressing climate change. I hope they try. Whatever poison flows below the 49th parallel tends to seep into Canada.

So, my American friends, it is now time for damage control and careful planning. If only you could promise him a statue bigger than Lincoln’s and the rating of “best president ever” in the history books in return for his retirement to Mar-a-Lago, quietly and permanently.

Reinventing the Wheel -The Health Standards Organization

By Marvin Ross

In mid October, Bridgeross author Susan Inman (After Her Brain Broke), did a piece in Huffington Post about standards for mental health services in Canada being developed by an organization in Ottawa called Health Services Organization (HSO). Susan pointed out that “HSO minimizes the impact of severe illnesses and then fails to suggest needed services. It’s important to note that the committee creating these standards did not include any psychiatrists

In the Tyee, Susan pointed out that with these new standards, those with severe mental illness will wind up getting even worse care than they do now. I agree with Susan on the absolute stupidity of developing guidelines on an illness while not consulting doctors who treat people with those illnesses. That’s like developing standards of care for those who have heart attacks and neglecting to include cardiologists in the development.

Their draft standards were open for consultation till the end of October and I gather they are still considering the comments that they received.

My blogging partner, Dr David Laing Dawson, summed up the gist of their standards into one sentence:

“We should all treat each other nicely and kindly and use as many euphemisms as possible.”

One of my readers complained to them as well about the lack of psychiatric input and was asked if she could recommend a shrink. My only reaction to that is to quote Little Richard and “good golly miss molly”. This is an organization “formed in February 2017, to unleash the power and potential of people around the world who share our passion for achieving quality health services for all. We are a registered non-profit headquartered in Ottawa, Canada.”

Are they not capable of finding psychiatrists?

The Canadian Psychiatric Association (CPA and also in Ottawa) is only 4 miles away from them in the same city. A short cab ride (Uber if you prefer) or they could meet in the middle. But then, when the CPA found out about what they were doing, they sent them a letter. On October 26, the president of the CPA told them that “I am writing today to express the CPA’s concerns about the proposed standard, and in particular, about the composition of the advisory committee, which did not include any psychiatrists.” You can read the full letter here.

On November 3, psychiatrist Nachiketa Sinha wrote a blog on the CPA site suggesting that the disregard for experts in mental health is a symptom of the stigma that mental illness faces. Dr Sinha added “How can I possibly trust that the care I am receiving is appropriate for my illness if the policy and programs have been created by laypeople, administrators, and NO EXPERTS on my mental illness and the care I need?”

And while I used the example of heart disease standards needing cardiologists to develop them, Dr Sinha wondered if anyone would trust a bridge built by people with no engineers involved.

On twitter, HSO commented to Dr Sinha that they are “trying identify a psychiatrist to join this committee.” Again, “good golly” how hard can it be to find experts to work on this? And I should point out that the CPA along with similar organizations in other countries, does produce clinical practice guidelines that detail how various diseases should be best treated based on all of the current evidence. CPA has guidelines on the treatment of anxiety disorders, depressive disorders and schizophrenia. And, of course, so does the American Psychiatric Association. And we should not forget all of the reports (over the course of 11 years) developed by the Mental Health Commission of Canada.

Do we really need someone else to reinvent the wheel at considerable cost? The money wasted could be well spent on funding more beds which are desperately needed.

Remembrance Day on the 100th Anniversary of Armistice – From the “War to End All Wars”

single_red_poppy

By Dr David Laing Dawson

WW1 was stupid, stupid, stupid, one of the great follies of humankind. And this is what we need to remember on November 11th while still honoring the soldiers who died in that war, or came home with minds and bodies shattered. And we need to do this without glorifying or even justifying war.
This week a classic FM station has been playing a new musical version of “In Flanders Fields”. The composer talks of noticing the last stanza in this poem and its importance and neglect. That’s the stanza that begins “Take up our quarrel with the foe”. She has added the ominous rhythm of marching boots to her score.
No. That “foe” was comprised of equally frightened boys and young men sent to war by the equally blind, heartless, stupid leaders, kings, emperors, Kaisers and politicians of the day. And when Dr. John McCrae wrote that poem, several million bodies of those “foes” were already strewn in the fields of Europe.

In the spring of 1916 my grandfather stood up from a soggy rat infested trench in Belgium at the call to charge. A bullet pierced his left arm and shrapnel from an exploding bomb gashed his face and stuck in the left side of his skull. He was carried to the field hospital for the third time that year and from there transported to a hospital in England and then a rehabilitation center.
A hundred years later I have his service and hospital records on my computer.
The bullet in his left upper arm was a through and through and the wound healed quickly. The Xray of his skull shows particles of shrapnel embedded in his frontal and parietal bones. The surgeons removed what they could but a few metal shards remain. He was then transferred to the rehabilitation center to be prepared to be sent back to the front. But my grandfather kept having dizzy spells and falling down. In the brief medical jargon of the day the doctors wondered if this was caused by concussion, or was it shell shock or might it be “functional”. Today the doctors would have used the words “post-concussion syndrome”, PTSD, and pondered the possibility of conversion reaction and/or malingering. But first they would send him for an MRI.
My grandfather spent the summer and autumn of 1916 in that rehab center and he kept having dizzy spells and falling down. Eventually he was given a medical discharge and sent home to Canada, to Victoria, to arrive there in the winter of 1917.
I have a few scattered memories of my grandfather from the late 40’s into the 50’s when, for the entertainment of his grandchildren, he might tap the metal in his head and imply his whole skull was steel. Otherwise, I know, he never talked of the war. He had enlisted in 1915 with the first Canadian Expeditionary Force, after the rule that wives had to agree was dropped. He trained in England in the summer of that year and then was deployed to the battlefields in the fall, the trenches of France and Belgium.
I had always assumed my grandfather was a veteran of Vimy Ridge and I visited the monument there and wrote in the guest book. But his war and hospital records show he was discharged home before the battle of Vimy Ridge. He was a veteran and survivor of lesser known and less successful battles.
In the language of medicine “functional” implies both “no physical/organic cause” and “the possibility of there being a purpose or goal involved in the loss of function”. “Conversion reaction” and “malingering” are two extremes of interpretation. The first implies that though the behaviour has a goal it is not a conscious goal, the second that it is a fully conscious goal. Of course, for much human behaviour the truth lies somewhere in between.
But there it is. In the hospital and rehabilitation center in England did my Grandfather decide he was not going back to that insane war, to the death trap of those trenches, to the whim of a general ordering a charge against machine guns? Did he decide to fake infirmity and return to his wife and three small children waiting in a farmhouse on Cedar Hill Crossroad?
I’m sure he suffered PTSD, and those dizzy spells may have been caused by concussion, by cerebral bruising.
But I like to think that he realized how stupid, stupid, stupid it was for young men to be sitting in rat infested soggy trenches through the night and day shooting at each other, and that he should go home to care for my grandmother, my uncle, my aunt and my father. (Another aunt arrived after the war).
If he consciously decided to go home on a medical discharge, even while feeling the guilt and humiliation of such a decision, well, here is what I have to say:
“Good on ya, Grandad. I’m proud of you.”

Flu Season is Coming

By Marvin Ross

Recently, a Facebook contact held a poll to determine if they should get a flu shot. Much to my surprise, 30% voted no with reasons like “it is better to build up your own immune system” to “the vaccine is not perfect”.

I was surprised but I guess I should not have been given the amount of anti-vax sentiment around. Building up your own immune system is stupid and it does not work. Polio, smallpox et al were eradicated not by having people build up their immune systems but by vaccinations. And yes, the flu vaccine is not perfect and its efficacy varies based on the best guess of epidemiologists but it does help to varying degrees.

What convinced me about 30 years ago was a study done by the National Hockey League. It may have just been the Toronto Maple Leafs but what they found was that the time off for players was greatly reduced  the year they got flu shots compared to the previous season. I’ve been getting it since and have never contracted the flu.

There is also an interesting difference between Canada and the US over flu shots. For many years, the flu shot in Ontario was only free to people with chronic diseases who were immune compromised. Then, it became available for free to everyone. In fact, only three provinces in Canada do not provide free vaccinations universally but they all do provide it for those with chronic illnesses. A few years ago, Ontario made it available in all pharmacies so people did not have to make a doctor’s appointment but could go into a pharmacy and get it from the pharmacist.

From what I gather, the flu vaccine in the US is only free to people who can satisfy certain conditions and who must apply for it. Otherwise, you pay. Now I don’t have stats on what percentages in each county do get the shot but the death statistics are telling. The World Health Organization says that up to 650,000 people die from influenza each year. In Canada, deaths from flu are about 3500 a year. As the US is about 10 times the Canadian population, that translates into 35,000 Americans. The actual death toll in the US in 2017/18 according to the CDC was 80,000. More that double the Canadian rate. This is an example of what the Spanish flu of 1918 to one city

An interesting commentary on the failure of the US to adopt universal health care was mentioned by the anthropologist, David Graeber. In his book Bull Shit Jobs, he quotes Obama who said:

“Everybody who supports single-payer health care says ‘look at all this money we would be saving from insurance and paperwork’. That represents one million, two million three million jobs (filled by) people who are working at Blue Cross Blue Shield or Kaiser or other places. What are we going to do with them? Where are we employing them?”

That quote came from an article in Nation, June 26, 2006 by David Sirota called “Mr Obama goes to Washington”.

When you don’t get a flu shot, you not only endanger yourself but those around you with compromised immune systems like the chronically ill and the elderly.

Go get a flu shot!

To US Citizens – Tuesday is Your Last Chance

By Dr David Laing Dawson

There must have been a moment, a day, sometime between 1927 and 1939 when it became too late to alter the course of world affairs as one Adolf Hitler rose to power and brought about the destruction of Europe.

The Austrian National Socialist party won only 779 votes in all of Austria in the general election of 1927. But their membership doubled each year after that and by the early 30’s one of their slogans was, “500,000 unemployed – 400,000 Jews – Simple way out; vote National Socialist”.

Historians can trace the seeds of WWII to WWI, but still there must have been a day when it was too late to stop WWII and the holocaust. Perhaps that day was the last opportunity to not vote for the National Socialists. Should not the slogan in the preceding paragraph been enough of a warning? Is not the code in “Simple way out” obvious? Or the juxtaposition of 500,000 unemployed to 400,000 Jews?

Apparently not.

I am writing this because I fear this Tuesday, the 6th of November, 2018, is the last day Americans can go to the polls and change the course of history.

I listened to some Trump supporters last night and I find they are just as deaf to the implications of the words of Donald Trump as the citizens of Europe were to that slogan:

“500,000 unemployed – 400,000 Jews – Simple way out; vote National Socialist”.

“I tell the truth when I can,” says Trump, without a flicker of irony. “Consider rocks as rifles if migrants throw them”. “…very bad thugs and gang members and middle ‘easterns’..”, “rapists and murderers..”, “Ìnvaders”.

Trump uses simpler code than the Nazi’s of the early 30’s. It should be easy to decipher, and then to grasp the full implications, and then to recoil from them.

Tuesday, November 6, 2018 may be that last day, my American friends, when you can stop this malignant rush to tribal warfare and the destruction of democracy.

Vote.
Continue reading To US Citizens – Tuesday is Your Last Chance

Trump Trashes the Veneer of Civilization.

By Dr David Laing Dawson

Just as we humans always overestimate our memories and find ourselves regretting we didn’t commit to paper or snapshot yesterday or last week, we also overestimate the extent to which our actions are guided by thoughtful consideration and choice.

We are easily influenced, especially if the influence is playing to our rat brain, to centuries of old survival coding.

The crowd of ordinary people chant in unison, “Lock her up. Lock her up.” It is, of course, entirely irrational, a bit nasty, and quite contrary to all due processes of judgment and punishment that have developed within western civilization over the past 100 years. I scan the part of the crowd shown on my monitor and I can’t find one person who has chosen not to chant.

But then we already know this about humans within crowds and mobs and humans under the influence of a charismatic authority, even when that authority is self-proclaimed. It is a small percent that can resist at that moment, that can buck the trend, be contrary, who can ask themselves, “Is this right?”

We know this from history. We know this from the Nuremberg Trials, from human behaviour in times of armed conflict and occupation. And we know this from some simple experiments in social psychology.

And we also know that among us are a few who respond eagerly to license and sanction, the go ahead to unleash the beast within, to act on a simmering hatred. Again we know this from history and contemporary observation.

Though the assumption of free will and personal responsibility is a cornerstone of human society, it does not negate the reality of what is written above.

We know these things about human behaviour. All our leaders should know these things.

So, yes, when Donald Trump’s crowds chant “Lock her up.” and “CNN sucks.” and when he tells his people they should fear the caravan of “invaders”, and when he fails to condemn the Alt-right extremists or other tyrants, he is culpable.