All posts by mross109

Assisted Suicide and Mental Illness – Where Do You Stand?

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Image by Gerd Altmann from Pixabay

By Marvin Ross with commentary by Dr David Laing Dawson

Numerous countries throughout the world (including some US States) allow for medically assisted death for people who are suffering. The original Canadian legislation contained the caveat that the person requesting must have death as an imminent reality to qualify. The individual had to be competent, agreeable and have grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition. That left out those whose lives met all of those criteria save for imminent death and  those with mental illness.

This past September, the Quebec Superior Court struck down the imminent death section and gave the government six months to amend the law. Once the amendments are in place (consultation with the public are ongoing and government has requested an extension), assisted suicide will be open to all who meet the strict criteria including those with mental illness.

The inclusion of mental illness is causing considerable debate and there have already been cases where those with mental illness have taken their own lives in private because they could not be granted assistance. Andre Picard, in the Globe and Mail, cites a woman in Quebec suffering with intractable bipolar disorder who finally resorted to suicide by putting her head in a plastic bag and crawling into the trunk of her car.

In a letter sent to media just before she took her own life, she wrote “People with cancer can die with dignity and be comforted, surrounded by their loved ones. A person with mental illness must die alone, in the trunk of her car. I so badly wanted to be accompanied and helped.” As Picard wrote Véronique Dorval, a 38 year old biochemist, suffered from bipolar disorder, which she described as a “cancer of the soul.” Medication provided little relief from her suffering, and debilitating side effects.

In Windsor, Ontario, Adam Maier-Clayton attempted for quite some time to be given the right to die with dignity because of the terrible suffering he was experiencing as the result of :

generalized anxiety disorder, obsessive-compulsive disorder, major depressive disorder, depersonalization disorder and psychosomatic pain that was “just horrible,” a burning in his eyes, head, biceps, chest and elsewhere.He and his father said they tried everything —including medications, counselling and experimental treatments —but nothing worked.”

When he could not qualify for assisted suicide, he checked into a motel alone, and ended his life by overdose.

The arguments against allowing suicide for mental illness patients, according to Picard are that “It is impossible to determine if a mental illness is irremediable, and vulnerable patients will be encouraged to die because of a lack of mental health services or evil-doers who want to rid society of people with disabilities.” Both are not valid says Picard. In the Netherlands that has a very liberal law, fewer than 1% of patients who take this route suffer with mental illness.

Udo Schuklenk who holds the Ontario Research Chair in Bioethics at Queen’s University in Kingston, Ontario and who chaired the Royal Society of Canada International Expert Panel on End-of-Life Decision-Making, also wrote supporting assisted suicide in the Globe. He went through all the arguments used by the opponents and disproved them.

The point of view of a practicing psychiatrist in Dr David Laing Dawson is the following:

I think assisted suicide for refractory mental illness presents three very difficult issues to consider.

Most chronic and debilitating physical illnesses have been so well studied, researched and documented we, or experts in each field, know with a degree of certainty the inevitable course of the illness and whether or not all known effective treatments have been utilized.

For e.g. we know where ALS leads; we know there are no effective treatments beyond the palliative; we know and can see objectively, the suffering entailed in the progression of this disease.

But for bipolar disorder or schizophrenia, for example, the patterns of symptoms and the course of the illness, and the responsiveness to treatment, are almost as variable as the number of people with these illnesses. How do we ensure, when the request for Assisted Death is made, that the course of the illness from this point is predictable and that all known treatments have been tried and failed? And if resources are available to make such a determination and/or to carry out another new treatment plan?

The second problem is making a determination that the request for assisted death is not, in itself, a symptom of the illness. Or of a co-morbid untreated severe depression.

The third problem lies in the transactional nature of the request. That is, for all of us at times, and for some people with certain personality disorders all the time, any such demand or request or statement is driven by transactional needs, such as the need, at this moment in time, to be able to assume or fight for power/control in the current relationship.

A highly contentious topic and I would love to hear what readers of this blog have to say on the issue. Feel free to wade into the debate.

Post Democracy US

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Below is a column from David that we published in January, 2017. Who knew just how bad the US political system would get under the leadership of the American Ayatollah but it has become worse. With his impeachment acquittal, he is now being accused of another quid pro quo with New York State trying to stop investigations into his prior tax fraud. And of course, he is going after the dedicated public servants who blew the whistle and testified. As the Toronto Star Washington correspondent wrote Donald Trump is a law unto himself.

And, to remind all, there is a collection of  our posts on his mental state called Two Years of Trump on the Psychiatrist’s Couch with 5 stars on Amazon and available everywhere in print and various e-book formats.

By Dr David Laing Dawson

My optimism was short lived. After watching Trump’s speech at the CIA headquarters and Sean Spicer’s first press conference I wondered how one goes about dismantling a democracy. I assume there is no manual for this. So I thought I would create a Coles Notes version so we can all follow along:

1. Make frequent reference to the utter failure of all previous administrations. Take credit for anything good that happened during the most recent administration.

2. Promote a cult of personality. Suggest the new leader has God-like powers, such as controlling the rain, and solving complex and intractable problems with forceful statements.

3. Paint a bleak picture of the current state of affairs and grossly exaggerate the risk, the dangers posed by outsiders and nonbelievers.

4. Promote law and order and military power as the only forces that can keep us safe.

5. Incrementally reduce voting rights by insisting on regulations that favor your supporters and disenfranchise others. Do this by claiming you are controlling corruption and fraud.

6. Choose an enemy or two, give them names, and promise to eradicate them. Use emotionally inspiring words such as evil, kill, wipe them out, get rid of them once and for all.

7. Exaggerate the size of your support and the crowds attending your rallies. Refer to this as a movement.

8. Lie frequently and often. Use big, bold lies. This is a form of desensitization. More and more will believe your lies. The remaining citizens will stop caring.

9. Undermine the Fourth Estate. Seed distrust of news and information. Call all reporters and truth tellers liars. It will be difficult to fully control the media (this is not Russia) but consider using licensing bodies, libel laws and the courts to tie their hands.

10. Promote the idea that the people of your nation, your followers, are superior human beings, exceptional, and deserve to live better than others. American Exceptionalism. Or is that “Uber Alles”?

11. You will need the armed forces and intelligence agencies so flatter them frequently, while you replace their leaders with your own men.

12. You will need cabinet members and spokespeople who will unabashedly promote you and your statements and policies no matter how unpalatable or ludicrous they become. Some will be willing to do this for money, others for power and glory of their own, and others because of their own anger and resentment from earlier grievances. Unfortunately such people abound. But remember, it is not loyalty that binds them to you, but self-interest. Reward them generously; always be prepared to kill them.

13. Quickly disparage and render impotent any leader who opposes you. Memorable name calling and disinformation will suffice.

14. Create a language of code words for anything that remains unacceptable for most citizens. For example: “alternative facts” for lies, “violence in the inner cities” for racial profiling.

15. Use hyperbole at all times. A person or event is either “great”, “fantastic”, “amazing”, or “a disaster”, “evil”, “total failure”. This fosters a dichotomous view of the world and will help dehumanize victims when the time comes to purge.

16. Find some allies in other countries by directly or tacitly supporting their extreme views. Examples might include Putin, Duterte, Boris Johnson, Marie Penn and Netanyahu. Be unpredictable for the others. Keep them on edge.

17. Finally, incrementally increase your power and authority until you can accurately call yourself “president-for-life” or “Supreme Leader”. This will take time. At some point you will need a crisis at home (Terrorist attack for e.g.) or you will need to provoke a crisis abroad and at home (Palestinian response to moving embassy to Jerusalem for e.g.). This will justify your transfer of a specific power from a democratic body (congress/senate/parliament) to your own office. This can be done on the grounds that only you know all the facts, and quick decisions are required. It is also more acceptable if the democratic bodies are perceived as ineffective or too partisan. Your people can ensure the latter condition is met.

18. In the meantime cater to the dominant political force in the democratic body by quickly implementing all their pet projects (e.g anti-abortion legislation), and by cancelling all the social and health initiatives of that upstart negro president.

19. Build monuments to yourself. Oops. I forgot. You already have. Good. Build more. Start with the Trump Great Southern Wall.

20. Throughout this process continue to emphasize that you are working for the people. Use the words “people”, “working people” and “democracy” frequently. As you usurp power explain that you are protecting democracy.

21. Have patience. Others may deliver you the crisis and fear that will allow an incremental or bold increase in power. When you assume new powers present yourself as reluctant to do so.

22. Use as much pomp and circumstance as possible. People love ceremonies. Emphasize the sacred trust your office embodies.

23. Visit a religious leader (televised of course). Ensure him and the American Public that you understand the enormity of your office and the need for God’s guidance. Try not to sneer or chuckle doing this. It is not wise to compare yourself to God, but you can hint that He favors you in some way.

24. Don’t worry about the physical quirks the cartoonists seize upon, the little black mustache for example, or the blonde comb over. Ultimately these will confer upon you icon status.

25. There will be protests and marches against you. Be gracious in your response to those that remain peaceful. Come down very hard on those that become violent. Emphasize these, and use them to accrue more power. But, be assured that any large gathering of people can become violent with a little help from your friends.

26. Toady up to the leaders of organized religion, the church.  With few exceptions these religious leaders will see you as a means of helping them achieve their long term goals. They will not stand against you for fear of losing their own power.

27. Allow others to live vicariously through you. This is a fine balance. While allowing the people to view your sumptuous life style use colloquial language, talk as they do. Remind them you work tirelessly for them. Pretend that one day they can all live as you do.

28. Women are tricky. Have one or two around you but not many. They tend to have empathy for others, children, small animals. They tend to prefer compromise and cooperation. Reference your own dear mother frequently, and say how much you respect women. But subtly denigrate them by your own actions, and limit their voices and rights through reproductive and child-care legislation.

29. Gain increasing control of your population. You can start this by controlling all immigration and visitation to your country. Then pick the minority group most feared or misunderstood by your followers and order a registration process. This will appear harmless, like getting a driver’s license. Then incrementally increase the strength of this process, include more identifiable groupings, until all citizens must carry “papers” with them and submit to police checks. This will instill fear.

Feb 16, 2020   Donald has been quite masterful making the Republican Party his own cult, and making truth a relative commodity. I thought undermining the independent judiciary would be difficult. (In Canada a politician publicly opining about any case before the court can cost their job). But it is now happening and happening quickly in the US, with Trump, emboldened by his acquittal,  stating publicly he “has every right to intervene”.

We are now in the top of the ninth with two runners on. Political control of the courts is the death knell of democracy.

 

Debunking Another Anti-Psych Myth and Worthwhile Anti-Stigma

 

By Marvin Ross

Another myth claimed by anti-psychiatry advocates is that people with serious mental illnesses like schizophrenia have significantly shortened lives because of the pharmaceutical treatment they get. There is no doubt that psychiatric medications have bad side effects that result in greater susceptibility to physical ailments like diabetes and cardiovascular disease but there is another explanation that is largely overlooked – stigma by medical professionals.

Over the years, there have been a number of studies demonstrating that those with serious mental illness do not receive adequate physical health care. A 2018 study pointed out that There is evidence of inequitable access to and/or uptake of physical and dental health care by those with schizophrenia”.

A 2011 study suggested that there is sufficient evidence that people with SMI are less likely to receive standard levels of care for most of these diseases (Nutritional and metabolic diseases, cardiovascular diseases, viral diseases, respiratory tract diseases, musculoskeletal diseases, sexual dysfunction, pregnancy complications, stomatognathic diseases, and possibly obesity-related cancers) .

A cross sectional survey in 27 countries found that More than 17% of patients experienced discrimination when treated for physical health care problems. More than 38% of participants felt disrespected by mental health staff.”

the latest study published in January comes from Sweden where there exists an impressive database of patients to draw upon. What researchers did was to compare 4536 patients (cases) and 44,949 controls. Cases included patients with reported preventable harm in primary health care and emergency departments from January 1st, 2011 until December 31st, 2016.

What they found was that Psychiatric disease, including all psychiatric diagnoses regardless of severity, nearly doubled the risk of being a reported case of preventable harm. The authors pointed out that a significant reason for this is what is called diagnostic overshadowing. This is a process whereby physical symptoms are misattributed to mental illness and therefore ignored.

Most of us (and I suspect mainly women) have been told that our complaints are all in our heads when doctors cannot find a cause for the symptoms. When someone with schizophrenia reports symptoms, they are often overlooked because of the schizophrenia.

The most egregious example of that took place at the ER at St Joseph’s Health Centre in Hamilton Ontario in 2002. Rusty Potter, a 40 year old man with schizophrenia and asthma was sent to the ER by his family doctor because he had pneumonia. Randy was known to the ER staff because he volunteered at the hospital and his address was a group home for people with schizophrenia. As a result, they assumed his problems were psychiatric despite what he told them. When he was having increased difficulty breathing, a nurse handed him a paper bag to breathe into assuming he was having a panic attack.

Randy arrested and died in the waiting room.

I wrote about this in my book Schizophrenia Medicine’s Mystery Society’s Shame and quoted one of the patient advisors who wrote to the local paper and said that:

persons with mental illness do not obtain appropriate medical treatment. All too often, our clients don’t get access to medical services or their concerns go unrecognized because the symptoms are viewed as part of their illness or they are attention seeking by asking for help.

Dr Miriam Schuchman wrote in another Canadian paper (The Globe and Mail), that medical staff in doctor’s offices or in ER’s may be uncomfortable treating these people.

There goes another anti-psychiatry myth and a stigma that does need to be corrected.

And on another note, the world recently lost one of its key anti-psychiatry advocates in Toronto’s Bonnie Burstow who began an anti-psychiatry scholarship. Ms Brstow received numerous obituaries including the New York Tines 

A Psychiatrist Comments on stigma

By Dr David Laing Dawson

Marvin is right about the limitations of the anti-stigma endeavours. In fact I would add that much of the movement downplays the seriousness of some mental illness, and creates a mush of euphemisms. Historically (my experience in the 60’s) the word cancer was not used in hospitals, at least not outside the Doctors’ lounge, the seminar room and the cafeteria. Real progress did not occur until the word Cancer became acceptable, with acknowledgement of the suffering and death it caused. Terry Fox did not run across Canada to raise awareness and money for Bone Health.

Leprosy, the very disease that gave us the term leper, did not lose its stigma when it was renamed Hansen’s Disease, but when it became both understood and medically treatable.

One day we may be able to divide Schizophrenia into several specific forms, each linked to specific genes, as we can now do with several types of cancer, but for now lets just accept the name schizophrenia and use the effective treatments we have. But let’s not confuse this illness with work stress or remorse or insecurity.

And let’s accept that physicians and physician specialists comprise the only professional group that can actually employ a methodology and tools to investigate, diagnose, and treat serious mental illness, with the assistance of several other kinds of “mental health professionals”. I state this bluntly because the anti-stigma movements usually refer to “mental health professionals” as a somehow unified body of equally qualified and knowledgeable helpers.  As I think about this more I wonder if the anti-stigma movement is further stigmatizing mental illness and by extension psychiatry by using such terms as mental health and mental health professionals, making it, I’m sure, far more acceptable to be seeing a counselor for mental health than a psychiatrist for a mental illness.  Which might be contributing, ultimately, through similar prejudices within the medical community, to the diminution of medical graduates entering psychiatry.

And…

I know statistically people suffering from mental illness are more likely to be victims of violence than perpetrators of violence but it is also true that the most gruesome and apparently inexplicable of crimes making the headlines of our newspapers are usually committed by people suffering from severe and untreated mental illness. Emphasis here on the word ‘untreated’.

The Red Herring of Anti-Stigma

By Marvin Ross

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Anti-stigma red herring Image by PublicDomainPictures from Pixabay

Many of us have spoken up against the very popular mental illness anti-stigma strategies that have proliferated over the past few years. The problem has never been stigma but the lack of resources needed to properly treat serious mental illness. Queen’s University psychiatrist, Dr Julio Arboleda-Florez once stated that

“helping persons with mental illness to limit the possibilities that they may become violent, via proper and timely treatment and management of their symptoms and preventing social situations that might lead to contextual violence, could be the single most important way to combat the stigma that affects all those with mental illness.”

Sadly, we are not capable of doing that because we just do not have the psychiatric resources as a recent analysis by the Globe and Mail just revealed. Our resources are strained but thanks to anti-stigma policies and work-place wellness initiatives that reduce stigma, more people are seeking help.

Journalist, Erin Anderrson reports that half of Canadians have too few local psychiatrists or none at all. The result is chocked emergency rooms, long wait lists to see psychiatrists, frustrated families and stressed out doctors. Most of the psychiatrists are located in the large urban areas like Toronto and Vancouver and many of them not only do not take on new patients but have few patients on their roster.

Dr Paul Kurdyak of the Centre for Addiction and Mental Health (CAMH) in Toronto pointed out that some get too much care when they may not need it and those who do need it get too little. He co-authored a study in Toronto and Ottawa that found that 40% of full time doctors saw less than 100 patients a year and 10% saw less than 40. Those patients are in high income areas and have usually never been hospitalized. A 2019 paper found that about one in three psychiatrists only see less than two new out patients a month. And those patients tend to be wealthier and healthier than those seen by busy psychiatrists.

The bottom line as those of us on the front lines as family and advocates know, is that the seriously ill are pretty much abandoned, left to fend for themselves, are cared for by families, wind up homeless or in jail.

Instead of campaigns focusing on anti-stigma, concerned citizens (and corporate citizens) should be lobbying to encourage more medical students to go into psychiatry. Bell Let’s Talk could spend their efforts on setting up scholarships for med students to study psychiatry rather than their Let’s Talk program.

Bell and others could invest in financing hospital beds and units for those with serious psychiatric illnesses. Encouraging people to get help when there is no help available and both cruel and stupid.

What about housing for those with serious mental illness? Let’s say they are lucky enough to get treatment in hospital and are stabilized. Where do they go to live after? Not all have parents who can help and parents get burned out.

How do they pay for housing when they can’t work and disability payments are so low? Increases in disability allowances and guaranteed minimum incomes are needed but, in Ontario anyway, the minimum income project was cancelled and we can expect the right wing Ford government to soon begin attacking disability payments. The disabled in Ontario have still not recovered from the hatchet job done by the last time we had a right wing government in the early 1990s.

It’s time to throw anti-stigma out and move on to more lucrative strategies to improve the lot of those among us with serious mental illnesses.

Debunking Another Anti-Psychiatry Myth – A Review of The Great Pretender

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Image by Gerd Altmann from Pixabay

Marvin Ross

One of the main beliefs of the anti-psychiatry advocates is that mental illness does not exist. They love to cite the fact that there are no objective tests for mental illness like blood work but that is also a feature of many conditions that they do not dispute exist – Alzheimers and other forms of dementia and Parkinson’s come to mind.

The other contention is that psychiatrists cannot differentiate between the sane and the insane. I have to admit that I was not aware that this belief came about as the result of a “study” done by psychologist David Rosenhan published in Science in 1973. Rosenhan got himself admitted to a psychiatric hospital where he was diagnosed with schizophrenia based on telling the doctors he heard voices.

He claimed that this was the only symptom he presented with and, once admitted, he began to act as he normally did and was soon discharged with the diagnosis of schizophrenia in remission. Rosenhan then recruited a number of other sane pseudopatients who got themselves admitted to various other hospitals around the US where they too were diagnosed with schizophrenia save for one who was diagnosed manic depressive.

This 2017 video explains how the experiment was conducted and the results:

The study made a huge impact at the time although Rosenhan quickly dropped the topic and went on to do other work. He was offered a book contract with a generous advance but he failed to finish the book and the publisher sued to recover the money.

Thanks to the incredible investigative work of Susanna Cahalan in her book The Great Pretender, proof is provided that the study was highly flawed. Ms Cahalan obtained Rosenhan’s notes and found them to be sloppy to the point of being unprofessional and even unethical. He made errors about the length of time spent in hospital and even the capacity of one hospital. He claimed a hospital had 8000 patients when it only had 1510.

The published study had very exact percentages for staff time spent in various activities with patients but one of the pseudopatients interviewed by Ms Cahalan told her that no data was collected. The data presented in the study contained such statements as attendants spent only an average of 11.3 % of their time outside the cage (staff desk) while doctors spent only 2% of their time where they paused and chatted with patients.

These are very specific figures and yet there was no explanation as to how they were derived and calculated.

Dr Rosenhan initially went undercover to Haverford Hospital in the Philadelphia area and claimed that his data was not used in the study but, in fact, it was. Cahalan was able to obtain the actual medical record for his time in hospital and discovered that the symptoms he complained of were far more extensive than simply saying he heard voices.

The actual record showed that he told the doctors that he was sensitive to radio signals, that he could hear what others were thinking and that he tried to drown out the noises by putting copper pots over his ears. The use of copper pots is similar to schizophrenic patients covering their heads with tinfoil to protect against the rays aimed at them from outer space. He also said that being in hospital could better insulate out the noises. He also confeseed to being suicidal.

Ms Cahalan concluded that Dr Rosenhan intentionally distorted the facts for his paper.

One of his critics at the time, Dr Robert Spitzer, corresponded at great length with Rosenham  and was so outraged that he was motivated to develop an updated version of the DSM (version III). Spitzer quoted another physician who stated that:

If I were to drink a quart of blood and, concealing what I had done, come to the emergency room of any hospital vomiting blood, the behavior of the staff would be quite predictable. If they labeled and treated me as having a bleeding peptic ulcer, I doubt that I could argue convincingly that medical science does not know how to diagnose that condition.”

If you describe symptoms that encompass all the markers of schizophrenia to a psychiatrist then you can expect them to diagnose you with schizophrenia.

There was a 9th psuedopatient in the research who wanted to emphasize the positive aspects of his 19 day stay in hospital but there is a footnote in the study saying that this data was excluded. Turns out that it was not excluded. The author found a draft paper of 9 pseudopatients and then the published paper with a footnote saying the 9th was removed.

Despite being removed, the numbers did not change. The average length of stay, the number of pills dispensed remained the same and the time that nurses spent with the patients did not change. If you remove one subject from a small sample size, the numbers will change but they did not in this case. Had the editors of Science been aware of these transgressions, Cahalan said, they would not have published the paper.

Research is essential for advancing our knowledge by investigating new areas or, and this is crucial as well, in replicating earlier studies to demonstrate their veracity. Studies that find negative results are also important but many have been suppressed. Since January 2018, those conducting clinical trials have been compelled by law to report all results even if negative. This was enacted to ensure that doctors and patients could determine if treatments were safe and effective and arose because it was not unusual for pharmaceutical companies to suppress data that did not support the efficacy of a drug under development.

But, as Science reported, many are not doing this and there has been no enforcement for their failure.

Research study results often involve a great deal of hype and publicity which is good for the researchers and their institutions. Promotions result and grant money flows so deception is common. The website, retraction watch, hosts a database of the flawed research that has had to be retracted and that is just the tip of the iceberg. I personally came across a research study from the Institute for Clinical Evaluative Science in Toronto which reported that doctors in Ontario were failing to abide by prescribing guidelines. The problem was that the guidelines came out after the research was complete. The researcher and the director refused to admit error but the editor of the journal it was to be published in made them add a correction. That correction was not conveyed to the many media outlets that reported on the flawed conclusion.

Cahalan does touch on these problems with research and cited the Reproducibility Project at the University of Virginia. An attempt was made to reproduce the results of 100 social psychology experiments and fewer than half could be replicated.

The most famous of psychology experiments also conducted at Stanford, The Prison Experiment, has also been exposed as a sham in a very detailed expose in Medium.

Research is crucial but findings need to be replicated and the lay audiences should be wary of basing beliefs on the results of only one study particularly if there is a great deal of media hype surrounding it.

 

Climate Change Report From Australia

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Image by dayamay from Pixabay

By Dr David Laing Dawson

I am sitting inside under an air conditioner at this moment because the temperature outside in Willoughby just north of Sydney is 40 degrees centigrade and the air outside is humid and smoky. The bush fires rage up and down the coast and inland, some under control and some not.

And this decade, they say, may be the last chance to do something about climate change before a tipping point is reached, and that point is the moment a positive feedback loop engulfs us all – when it is too late to stop the destruction.

Australia contributes just over 1 percent of world carbon emissions, but combined with the emissions of similar small contributors like Canada this adds up to over 40%.

With the USA wallowing in some kind of self-destructive delusional state, leadership could fall to a new group of developed countries – a consortium say of Australia, Canada, the UK, France, Germany…. and so I will, at the start of this decade, pitch my idea again.

We need to bring together the people and the knowledge from all the pertinent fields to arrive at a doable plan. Not merely a plan to “reduce emissions”, or a target for global emissions, but a consideration of the roles and possibilities of other factors as well. These are:

  • Population control (and this should be high on the list)
  • Bypassing fossil fuel in developing countries. What can developed countries do to foster this?
  • Carbon Capture technology. Are any of these technologies viable and scalable?
  • Natural carbon capturing plants and trees. What role can reforestation play? New technologies to plant millions of trees?
  • Shifting all power plants to carbon neutral technologies. How and when and which ones?
  • The role that could be played by nuclear power.
  • Carbon neutral housing and building standards. What impact can this have?
  • Cycling and mass transit. Just how much of a difference can this make?
  • More plant based diets. Realistically what difference will this make?
  • How long to shift most land transportation to electrical or hydrogen based power?

What incentives are needed to do this?

  • Air transportation. Is there a viable technology to make carbon-neutral jet fuel? And how do we get there?

I’m sure this list could be longer, and each item have it’s own subheadings of viability, time, cost, contribution, technical, economic and political feasibility…but…

Justin, you could take the lead. A Manhattan project to save the world.

Setting this up will cost a lot but not nearly as much as all the fire fighting and disaster relief we will all be paying for in the coming years.

Twitter, Thomas Szasz and the Channukah Attack

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Image by OpenClipart-Vectors from Pixabay

By Marvin Ross

At the end of December US psychiatrist Allan Frances tweeted that in 1977 he had dinner with Thomas Szasz (The Myth of Mental Illness). Frances reported that he asked Szasz if he would intervene were his child suicidal because of psychosis. He smiled/answered: “I am a father first, a libertarian second”.

Dr Frances responded that “Szasz could hold extreme views re meds/commitment only because he never once treated a severely ill patient”.

Dr George Ikkos replied that “In 1994 Szasz insurance paid $650,000 for negligence to widow of patient with “manic depression” who committed suicide following his advice to stop lithium. The source is a book called Mad Muses by Jeffrey Berman (P110).” Dr Ikkos is an “elected Honorary Fellow of the Royal College of Psychiatrists. The Honorary Fellowship is the highest honour the College bestows” (from his website.)

Also chiming in to this interesting twitter exchange was Dr Mark Ruffalo who provided a link to an interview that Szasz did with Jonathan Miller in 1983. He summarizes:

Szasz concedes that society should treat the gravely disturbed (“mad” or psychotic) person in the same way it treats the person who has been rendered unconscious by an accident, implying support for involuntary treatment in these cases.

The entire interview can be seen below and these comments are made around the 34 minute mark. Prior to that, Szasz states that psychiatrists either lock up the innocent or free the guilty and that no mental illness existed prior to the advent of asylums in the mid 18th century.

I’m not sure what provoked the initial tweet by Dr Frances but a couple of comments before transitioning to Channuka. The initial question asked of Szasz is something that I always ask of doctors when they propose a certain course of treatment or a medication. If this was you (or a spouse or parent) would you still suggest that? We should all do that.

The other comment pertains to libertarianism. Szasz suggests that libertarians would always propose no involuntary action. I’m not sure that is a valid position for libertarians and it is definitely not for a psychiatrist I know who is one. This particular Toronto psychiatrist once told me that no one is as libertarian as he is and he firmly supports involuntary committal and treatment. People have an absolute right to decide their own fate but in the case of someone who is psychotic, he said, their mind is incapable of making rational decisions. It would be wrong to allow them to make those choices when so impaired.

While this twitter feed was happening, New York State and FBI officials were declaring the attack against a Channukah party in New York State to be an act of domestic terrorism and that the perpetrator, Grafton Thomas, would be charged with hate crimes. Of course, we all now know that Mr Thomas is a man with untreated schizophrenia.

It is not a hate crime nor is he a domestic terrorist.

He is a delusional soul who has not been provided with treatment as the mental health advocate DJ Jaffe pointed out in his excellent assessment in the New York Daily News. Jaffe points out that Thomas’ long term pastor could not understand why he had never been institutionalized stating “There hasn’t been anyone who has given a real solution to deal with a grown man who is dealing with schizophrenia, other than ‘Go home and call us if something happens.’ ”

Situations like this are not unique to New York State or to the United States but to Canada as well. Every one of those jurisdictions has examples of crimes committed with and without deaths due to the failure to treat people with serious illnesses.

Of course, one of the key reasons that people do not get proper treatment even if it requires involuntary hospitalization stems from the works of Szasz and all the others who deny the existence of serious mental illness.

What is also equally galling is the rise of anti-semitism and other forms of racism in the world today. While US officials were quick to jump on the Channukah attack as a hate crime, they have seemingly ignored others. In the week before the holidays, there were 4 attacks against Jews in the New York City area plus the assault in Jersey City of a Kosher supermarket according to Bernie Farber. Farber is the Chair of the Canadian Anti-hate Network.

Farber also reminded readers of Trump’s anti-semitic comments at a dinner for the Israel American Council. Faber neglected to mention Trump’s comments after the White Nationalist march in Charlottesville or Rudy Guliani’s anti-semitic tirade as reported by CNN.

Attributing the violent delusions of a man with schizophrenia as a hate crime when the villain is our failure to treat mental illness while ignoring real acts of hatred is a travesty.

I never thought I would ever applaud anything from Boris Johnson or from a Chasidic Rabbi but both got it right. Johnson delivered a very forceful speech on fighting anti-semitism while the Rabbi whose house was invaded spoke out about the need for greater understanding and support between minority communities. “The Hasidic Jews of Monsey must ignore the outsiders who want us to take up arms and politicize our tragedy.”

Happy Holidays – Back in 2020

By Marvin Ross

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It has been an interesting year with far more going on than anyone would have expected so we’ve decided to take a short break over the Christmas season and return in early January 2020.

Since beginning this blog in October 2014, we have published 419 posts and had over 97,000 visitors. Our visitors are mostly from Canada and the US but visitors have come from a total of 163 different countries.

In the past week, there has been a considerable interest in a column that David Dawson did back in January 2015 on the Canadian murderer, Luke Magnotta. Turns out there is a Netflix docudrama on him which has resulted in new visitors finding us. Some of the most popular blogs, not surprising, have to do with David’s many evaluations of Donald Trump. They are available in our compilation Two Years of Trump on the Psychiatrist’s Couch which is available in print and in all e-book formats from whoever your favourite supplier is.

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And don’t forget we also have a compilation of our other blogs in Mind You which is also available in print and e-book format.

Enjoy the holidays and we will be back next year

Understanding Bullying

By Dr David Laing Dawson

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Image by Gerd Altmann from Pixabay

Rather than write about how bad it is and how something punitive must be done, I thought I would put some thoughts together that might help understand bullying and thus might lead to effective means of reducing it on our school yards.

1. We are (mostly) dealing with children and teenagers.


Recently I saw a nine year old boy with moderate to severe ADHD (emphasis on the H). This otherwise quite charming, bright, athletic boy was spinning, twisting in his chair, constantly moving his legs, his arms, his eyes. Whatever came to mind he said, blurted out in fact. He lacked an inhibitory filter. This caused him trouble at school. He could blurt out mean comments. His mother, with a worried look, said the boy’s teacher had wondered if he lacked empathy for others.

The connection with bullying in my mind is not this boy’s behaviour, but rather the teacher’s observation, which, along with many other comments I have heard (such as a current belief in some circles that a teacher should never say No to a child) suggests to me that part of the problem here is that collectively we do not understand the developmental limitations of the brains of children and teenagers. Or, for many, we are still stuck in that Victorian era when kids were thought of as little adults.

My point being that expecting this thing we call empathy from a 9 year old, or even a 15 year old for that matter, is premature. And this lack of understanding leads to the belief that children and teens, taught good moral reasoning, will behave well, will not hurt others, will not do bad things, will always choose the right thing to do.

They still teach Lord of the Flies in school I believe. Some teachers should read it themselves.

Empathy for others is something we develop gradually, slowly, through adolescence and adulthood, and even then, as adults, we can lose it in times of heat and stress.

Do not expect empathy for others from children and teens. An instinctive response to protect small furry creatures, yes. The learning of social etiquette in order to fit in, yes. Occasional heart warming displays of kindness, of sharing, yes. An instinctive response to defend or protect other members of the same group, yes. Marching for a good cause as a positive manner of expressing a natural oppositional attitude, yes. But not empathy. Not yet.

2. Membership, status, self-worth

We humans, as young primates, instinctively seek membership, and status within that membership. Or as many male teens would say, “respect.” And by membership I mean some form of peer membership. It has been fascinating to observe over the years just how strong that need is in young adolescents, the need to fit in, to be accepted, and the fear of being rejected by a peer group.

Membership implies some sort of inclusion and exclusion criteria, some sort of agreed set of values, some kind of guideline for acceptable behaviour. And that peer group can be a club, a sports team, the school band, or just a small amorphous group who hang out together. Today, of course, it can be a virtual peer group, present only on a screen.

The teen girl lies in bed at night pinging/texting inanities back and forth with her BFFs, and then checks the number of Likes she gets on her Snapchat upload, before being confident enough to go to school the next day. The teen boy expresses his expectations of the members of his group in gang and prison talk, absorbed from television and Youtube: respect, loyalty, and harsh punishment.

Membership implies exclusion, the exclusion of those not worthy of membership. In fact exclusion of others clarifies one’s membership.

Many teen memberships/groupings are healthy: music groups, dance, sports teams, chess club…..supervised, skill and confidence building activities. Some teen groupings are informal, the crowd they hang out with for example, and the rules of membership and the expectations are unspoken but do exist, and can easily become distorted.

Some teen memberships are mostly imaginary. And today some can be part imaginary and part virtual.

What I am trying to point out here is that the act of discriminating against, of actively excluding someone is part of the way adolescents instinctively demonstrate membership. This membership can be simply member of the soccer team while others don’t make the cut. But it can also be a mostly imaginary membership in a “tough guys club” requiring, to reinforce this membership, the active exclusion of others.

I suppose one could go on with this line of thought, and propose that the need for this membership plus the need for status within this membership, is the foundation for racism and white supremacy groups.

But for this topic, it is sufficient, I think, to point out that the seeking of, the need for membership is instinctive. And such membership requires exclusion of others. And the active exclusion of others can enhance a feeling of membership/status. And the simplest way of excluding others from one’s imagined group of superior beings is to label them, call them names, tease and taunt them. A certain president (mental age about 14) does this every day.

3. Cruelty

In the late 1960’s I participated in group exercises that were a mild version of the Stanford guard/prisoner experiments. In an ordinary training space we were paired off for role playing in which one of the pair would be a guard with absolute power, the other a prisoner who badly wanted something. There were too many variables to draw any scientific conclusions, but… But what I think was the most telling result of this role playing was that each “guard” found within him or herself, a capacity for cruelty. As the prisoner grovelled and begged, the participant playing guard experienced a growing disdain that began to evolve into disgust. We did not continue the experiment long enough to find if any of us were capable of acts of actual cruelty, but we each found within ourselves the potential for just that.

It is also pretty clear from observation that bullies choose victims from whom they get a response, a reaction, a reaction of anger, hurt, fear, tears, perhaps pleading. And then they may re-enact the taunting from an increasing feeling of disdain, disgust, and then from the immediate satisfaction of excluding this victim from the imagined group the teen boy belongs to. (men among men, tough guys club, gang…..) And as teenage girls and boys without supervision they can quickly find their potential for cruelty.

So we needn’t be horrified to find a certain lack of empathy in our teenagers, and we shouldn’t be horrified to discover these human children and teenagers have the capacity for cruelty.

All teenagers need to find, to develop, membership in a peer group. If they don’t find such membership in healthy real supervised groupings they may find it in informal groups brought together by an unhealthy interest, and/or in imaginary groups and/or part imaginary and part virtual membership, or groups simply defined by their exclusiveness.

So this means adults, parents, teachers, and the school system should work hard to ensure each and every teenager feels they are members of some real and healthy grouping. And this means that we need to spend money and resources in extra curricular activity, and that having a Pokemon or Dr. Who club is as important as having a soccer team or school band. Every teen needs to be able to define him or herself as a member of, and having status within, a club, team, pro-social grouping without resorting to imaginary membership in a tough guys club or a master race.

There will always be kids that have something about them that sets them apart from their peers, and who also react badly to teasing and taunting. They are natural targets of bullying. (I am not blaming the victim here, just analyzing the reality) Their reactions can unleash the nascent cruelty of their attackers. (see guard/prisoner experiments)

In the best of teen worlds these kids are protected by peers who are stronger, and more secure in themselves and their memberships.

So, to reduce bullying, apart from surveillance, alertness, sanctions and punishment, we need to:

1. Ensure every teenager achieves some form of membership in some kind of pro-social real group, preferably supervised.

2. Make, however laws and regulations and common sense allow, successful teenagers within the school system responsible for the protection of the vulnerable.

Years ago a deaf boy joined my son’s hockey team. My son was assigned the task of looking after him on the ice, partnering him, guiding and protecting. This left him little chance of showing off to the (imagined) NHL scouts.

I was very proud.