All posts by mross109

Health Canada: Two drinks per week?

By Dr David Laing Dawson

Evolution has endowed us with an impressive organ between our ears, an organ that allows us to do all the things mankind has contemplated and accomplished. It has also endowed us with self-awareness. Now it has been pointed out that even a lobster demonstrates a kind of self-awareness when it distinguishes its own claw from that of another lobster. But you can be pretty sure the lobster does not contemplate the meaning of its life and the certain end of its life, nor what other lobsters think of it.

This terrible awareness of our own existence and the inevitable pain, loss, suffering to come, and inevitable death, are the necessary consequences of such a wondrous cognitive capacity.

This level of self-awareness has spawned centuries of puzzlement, theorizing, university departments of philosophy, psychology, sociology and theology, countless religious and fantastical explanations, and a search by each one of us for something, some idea, some activity, some habit, some guru, some God, and/or some substance to dampen the horror of existence, at least in the evening, or once a week.

As Marx put it: “Religion is the sigh of the oppressed creature, the heart of a heartless world, and the soul of soulless conditions. It is the opium of the people.”

We have always needed something to dampen awareness, to allow us to relax, feel safe, forget, to smile, laugh loudly, speak without fear, and come away saying, “Well, that was a good time.” And then, perhaps, fall back into work and worry the next day.

And now it is 2023 and we live in a time when our awareness is heightened by a bombardment of information, a time when we know something of the beginning of both the universe and human existence and can foresee the end of both. A time when we no longer fully understand the tools we use, a time when an AI platform can write my essays for me, a time when poor souls exchange their money for a blockchain in the sky.

Substance abuse has dramatically increased, along with the industry that tries to help. Gurus thrive. Evangelical con men thrive. The snake oil business thrives. Every day Google offers me several 30 minute videos that will shrink my prostate, give me better sleep, clear out all toxins, prevent cancer, and grow my penis. None of this is surprising.

And this is the moment the Canadian Centre on Substance Use and Addiction decides to recommend zero consumption of alcohol, while Health Canada says we can have two drinks per week.

Let us get real, people. Grandmothers gave better advice. “Moderation in all things” they would tell us, but we do need some of those things, in moderation. And when we forbid one of those things, we humans will turn to others. And alcohol, for those of us with the genes that allow us to metabolize ethanol efficiently, is not one of the worse things to which we will turn. In moderation, of course.

Meanwhile Google tells me there are ten or twelve health benefits to drinking whisky. So I will continue to have my two or three drinks most evenings.

Only a decade ago the ruling was three or four per day for men and two or three for women, and red wine especially contained some good antioxidants.

Well, okay, I’m just rationalizing. But. That is also what we do, we humans. We find ways to dampen the anxiety of existence and we rationalize.

Apparently Donald Trump does not drink. Wish that he would. I’ll bet George Santos will claim he doesn’t drink if asked, but maybe if he did some veritas might emerge.

Cheers.

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Rethinking our Advocacy Strategies

By Marvin Ross

The front page headline in my local paper recently caught my eye and made me shudder. Blazoned across the front was If my neighbour can do this to my brother it can happen to anyone’: Man who gunned down neighbour not criminally responsible due to schizophrenia The subhead read “Friends and family of Nikko Sienna say court finding for Mark Duckett in 2019 shooting is an injustice.”

How often have we seen similar protests in various communities around North America? An innocent person (or more usually) a family member is killed by an untreated person with a serious mental illness and the rage is directed against the sick individual rather than the system that allows this? People want retribution and blood and begin to lobby against the judicial system for having a not criminally responsible disposition.

Ironically, there was supposed to be a solution to prevent this locally. In March 1997, a toddler was stabbed to death by his next door neighbour who thought he possessed the soul of her own son who had died of AIDS. Zachary Antidormi’s parents had called the police numerous times to complain of their neighbour, police took reports and that was as far as it got. Responding officers were unaware of previous calls and no treatment and/or hospitalizations was ever offered.

Out of the inquest that was held after the event, came the establishment of the Crisis Outreach and Support Team in Hamilton. This program pairs specially trained plain clothed police and mental health workers to attend crisis calls, defuse them and arrange long-term solutions. Sadly, from my own experiences and from what I’ve heard from others, they can take a couple of days to respond to calls.

Zachary’s mom, Lori Triano, was a psychology intern at the Hamilton Program for Schizophrenia and has dealt with her grief by devoting her practice to helping others grieving. She went on to become president of the Schizophrenia Society of Canada. She did not rail against the law that sent her neighbour to hospital but she used her energy to do good. Most people do not have her education or understanding so we, as advocates, need to address these events head on.

Unfortunately, the focus of a lot of established mental health groups is to deny this violence reality and to point out that the majority of the mentally ill are victims rather than aggressors. True enough, but each event of violence nullifies all that good work and puts us back to square one. Let’s be realistic, a young untreated often homeless individual with schizophrenia can be very scary. Despite that, much of the advocacy focus has been to try to eliminate the stigma surrounding mental illness while ignoring the untreated.

It may be possible to generate sympathy for a depressed, quiet, reclusive group of people but not for the dishevelled homeless wandering the streets pan handling. Yes, they are someone’s child but the fear of them and the periodic violence that occurs generates very little sympathy.

The late Dr Julio Arboleda-Florez of Queen’s University in Kingston, Ontario was involved with the Open Doors Anti-Stigma Project begun by the World Psychiatric Association in 1998. In an editorial that he wrote in the November, 2003 issue of the Canadian Journal of Psychiatry, he made the following comment based on those results.

He said “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.”

He added:

while most myths about mental illness can be traced to prejudice and ignorance of the condition, enlightened knowledge does not necessarily translate into less stigma unless both the tangible and symbolic threats that mental illness poses are also eradicated. This can only be done through better education of the public and of mental health service consumers about the facts of mental illness and violence, together with consistent and appropriate treatment to prevent violent reactions. Good medication management should also aim to decrease the visibility of symptoms among patients (that is, consumers) and to provide better public education programs on mental health promotion and prevention.”

Dr E Fuller Torrey made similar comments in an article that he wrote in Schizophrenia Bulletin in June 2011 called “Stigma and Violence: Isn’t It Time to Connect the Dots?” He points out that despite increased understanding of what causes mental illness, stigma has increased. And he says that the reason for this is that violence by those with serious mental illness has increased which increases stigma. Like Dr Arboledo-Florez, he sees the solution in reducing the violence with proper treatment. Numerous studies have demonstrated that treatment will reduce violence in those who might become violent.

As advocates we must own up to this violence and push the fact that treatment is needed to help both the ill person and society. Everyone should have the right to be we as well as modern medicine can accomplish.

Schizophrenia Treatment Past and Future

By Marvin Ross

Those of us with lived family experience of schizophrenia are well aware of the complexity of the condition. Listening to the “woke folk” who posit causes of familial dysfunction, trauma, and/or social determinants as causes tend to infuriate us. What infuriates us further is their lack of understanding of the need for medication (imperfect as they may be) and their often very simplistic solutions. Those beliefs often tend to be on the same level as those who blamed the Buffalo Bills cardiac arrest as having resulted from covid vaccinations.

The true complexity of schizophrenia and the efforts to help ameliorate the symptoms was just outlined in an excellent article in Psychiatric Times by Dr. John J Miller. His essay called the RX Evolution: Pharmacological Paradigms for the Treatment of Schizophrenia reminds us that schizophrenia is not just the positive psychotic symptoms of delusions which are easier to control but the more debilitating, intractable negative and cognitive symptoms. These are the symptoms that previously resulted in lifelong institutionalization and led to the historical term of dementia praecox or early onset dementia for the disease.

Prior to the accidental discovery of chlorpromazine in the 1950’s, patients would be hospitalized for life or, in third world countries, locked in cages or chained to things. Chlorpromazine was a dirty molecule that acted on a wide range of dopamine receptors but quieted psychosis. Haldol and Prolixin which followed were cleaner but led to movement disorders and  hyperprolactinemia. These drugs helped with the positive symptoms but made the negative and cognitive symptoms worse.

Over enthusiasm about their efficacy coupled with a desire to save money led to the closing of psychiatric hospitals and the mass exodus of patients to the streets, shelters and jails of North American cities. The money saved was to be transferred from the institutions to community resources but never was.

Clozapine appeared next targeting two of the serotonin receptors rather than dopamine and proved to be very effective save for one serious side effect. In some patients (about 1%) it resulted in destroying the white blood cells. Today, it is mostly used for treatment resistant schizophrenia but with regular blood checks. In order to overcome the white blood cell problem but preserve the clozapine efficacy, scientists developed what Miller called the apines – olanzapine, quetiapine, and asenapine – and the odones – risperidone, ziprasidone, paliperidone, iloperidone, and lurasidone.

This class of drugs operated at the dopamine and serotonin receptors but still resulted in movement disorders but not as frequently. They also resulted in  weight gain, hyperglycemia or increased insulin levels, elevated lipids, sedation, and elevated prolactin.

In 2002, a third generation of anti-psychotics appeared which Miller calls the ABC class – aripiprazole (Abilify), brexpiprazole (Rexulti), and  cariprazine (Vraylar). It had been hoped that these agents would not produce movement disorders or the risk of tardive dyskinesia but that has not happened. The other drug newly approved in 2019 called  lumateperone (Caplyta) is in a class of its own. Miller says very little about its efficacy or side effects but it has “extremely potent 5HT2A antagonism and modest D2 antagonism, serotonin reuptake inhibition, and D1 receptor modulation.”

He sums up all these treatments with:

Despite an impressive and heroic progression of research into the pathophysiology of schizophrenia, development of novel agents, and improvements in developing and delivering an accompanying essential array of biopsychosocial treatments and supports, the lifetime prognosis for many individuals with schizophrenia remains poor. Epidemiological data indicate that an individual with schizophrenia will die on average 20 years earlier than age-matched healthy individuals. Looking at the 1 dimension in which pharmacotherapy has had the greatest treatment results, psychotic symptoms, a staggering one-third of individuals with schizophrenia remain psychotic despite aggressive treatment. Another third continue with intermittent relapses of positive symptoms combined with progressive negative symptoms and cognitive decline. Currently there are no FDA-approved treatments to treat the negative and cognitive symptoms, which ultimately cause the greatest lifetime functional impairment.

Despite these modest gains, scientists continue to explore other viable treatments that do not rely on dopamine. These avenues involve serotonin activity, Muscarinic Cholinergic Agonism and Trace Amine–Associated Receptor 1. Scientific progress is slow and science has been at this since the early 1950s with the discovery of chlorpromazine. I doubt most of us will see real progress in our lifetimes as nothing is more complex than the brain. Miller points out that “Significant progress has been made in the understanding of the interplay of numerous risk factors through wide-ranging research, from genetics and epigenetics to developmental and environmental factors, neuroimaging, and more”.

He concludes with  “as is the case with many chronic disorders such as cardiovascular disease and diabetes, we remain challenged to improve our treatments and outcomes. Treating all 3 domains of schizophrenia—positive, negative, and cognitive symptoms—continues to be a high priority and significant unmet need.”

Neuroscientists world-wide have been working on this complex puzzle for years and continue to do so. Why do those “woke folks” think the answer lies in trauma, social dysfunction or social determinants or that those with schizophrenia should be allowed to determine what treatment they want or need when their brains are so impacted that they become delusional, have the negative symptoms of lack of motivation and pleasure and cognitive losses?

It’s nice that they care but first they should get more information before they start telling us what should be done. I wonder if they realize that the poor souls they see pushing their shopping carts full of junk while mumbling to themselves could be helped or the increasing number of pan handlers at traffic lights also do not need to be there.

I’m not being paternalistic but compassionate in suggesting that they need help and understanding – the help of the best medication and supports that science has developed to date. We give that to Alzheimer’s patients – a disease not dissimilar to schizophrenia. In fact, more progress has been made in pharmaceutical agents for schizophrenia than has been made for Alzheimer’s. In 1987, I wrote a book on Alzheimer’s and nothing much has changed since then. One drug that slows the cognitive decline but does not alter the eventual outcome has been around for a few years. Recently, a very expensive new drug was approved by the FDA but that is mired in controversy. Turns out it does nothing and the FDA has been implicated in encouraging its approval despite negative results in trials. Just Friday, another new drug was approved that only moderately slows cognitive decline in very early stages at an estimated cost of $25,000 a year.

If the “woke folks” were to do with Alzheimer’s what they do with schizophrenia, they would be telling families to allow their cognitively impaired relatives to live like they wish and to decide what if any treatment they want. Imagine if demented grandma was allowed to retain her basic human rights to refuse living in a dementia home and could simply wander the streets and potentially freeze to death as some who have wandered off have done.

Where is the freedom in that?

The Preventable Killing of Teenage Head Guitarist Gord Lewis

Marvin Ross

My friends at the Treatment Advocacy Center (TAC) in the US would classify the death of Teenage Head guitarist Gord Lewis and the not criminally responsible (NCR) verdict for his son Jonathon as a preventable tragedy. Jonathon has untreated schizoaffective disorder but now that he has been declared NCR, he will get the treatment he should have had. For years, TAC has maintained a database of these preventable occurrences.

This death in Hamilton. ON and the many other similar deaths did not need to happen if we had a proper system of mental health care. According to the Lewis family, Jonathon had been involved with repeat hospitalizations, outpatient visits and trips to the ER. He was diagnosed in 2019 at the local psychiatric hospital in Hamilton and prescribed medication but he relapsed and was rehospitalized a number of times. Between July 28 and August 4, Jonathon went to the ER in Hamilton, Toronto and Brampton ten times. He would tell the staff he was being poisoned by his father but would leave without being seen by a doctor.

At an August 1 visit to Sunnybrook Hospital in Toronto, he told the doctors about being poisoned by his father but was discharged with an appointment for August 11. On August 7, police found Gord Lewis dead in his apartment at the hands of his son.

We don’t know just how much follow up he had after his initial diagnosis in 2019 but Jonathon did not appear to reach stabilization. We do know that patients are often discharged well before they attain stability and there are insufficient community resources for them .Clearly, Jonathon should have had more follow up and resources than he received but this is typical.

The best known example of a preventable tragedy was Vince Li who murdered and beheaded his seatmate on a Greyhound Bus in Manitoba in 2008. Li began to develop schizophrenia in 2004 and his condition deteriorated. In 2005, Li was found by police disoriented wandering along Highway 427 in Toronto and was taken to a local hospital. He was not detained, diagnosed or treated even though patients who are potentially dangerous to themselves or others can be held for a certain amount of time involuntarily. Doctors are often reluctant to do so and many in our society including the United Nations are totally opposed to this and demand the practice be ended.

While involuntary committal may be an extreme tool, it can be very effective and does come with numerous safeguards built in to prevent abuse. Li was found NCR and committed to a secure psychiatric facility for treatment. Today, he is living as normal a life as possible back in the community. Unfortunately, he has to live with the knowledge of what he did while his victim’s life was ended and that family must live with the aftermath.

While many branches of medicine are making progress, treatment for serious mental disorders is deteriorating. My blogging partner, psychiatrist David Laing Dawson, recently wrote about the decline in mental illness treatment from the 1980s on here.  Previously, he said, teams of psychiatrists, nurses, social workers and psychologists ensured that the severely ill received appointments very quickly. Each member of the team was prepared to help with medication compliance and monitoring, medical care, budgeting, finding bus passes, talking to families, giving shopping lessons, helping with all activities of daily living and also counselling.

Then, the situation changed and hospital stays got shorter and they downsized services for the seriously mentally ill to save money. What had been done in hospitals shifted to the community which lacked the ability to take on difficult, seriously ill patients. That shift also resulted in social workers and mental health professionals no longer working in teams with psychiatrists but as independent professionals. Their independence often came with a shift away from medical models to counselling theories such as cognitive behavioural therapy (CBT) and other concepts which were of no value for those with serious mental illnesses.

This was compounded by the so-called recovery model, which really means that if you try hard enough and think good thoughts (CBT), and are sufficiently “supported”, you can recover fully. If you don’t, its your fault. Added to that is a naivete among lawyers and civil libertarians believing they are protecting individual rights by having patients released from hospitals. That often results in what doctors call being allowed to die in alleys homeless and untreated with their rights intact, increased mentally ill in the prisons, the growth of locked Forensic Psychiatry Units, and a sad return to locked doors for the rest of the hospital now dominated by the Forensic units.

As a society, we need to do better!

Post Script:

The blog post that David wrote, The Decline of Mental Illness Treatment from the 1980’s on, is quoted above. It first appeared in 2017 but continues to be one of the most read posts and, sadly, becomes more and more relevant as time goes on. It is worth reading again.

What the Hell is Going on?

By Dr David Laing Dawson

Earlier this month, Marvin e-mailed me with:

Maybe I’m becoming a crotchety old man but I think all is lost and worse than it has ever been. Look at the Georgia Senate race. The democrats won but the ex football player still got 48% of the vote. Alberta, as suggested by the Globe and Mail, is now run by the truckers. Hospitals are overflowing with sick kids and yet less than 25% of kids have been vaccinated for the flu. The Hamilton school board debated masking for schools and the gallery had to be cleared because of the howling anti-vaxers.
Doug Ford is ending development fees for new housing subdivisions which will bankrupt cities who will have to pay for roads, sewers, etc and he has given dictatorship status to Toronto’s mayor who can push through whatever he wants with only 1/3 of the vote.
The Globe wonders if it is worth putting the sick mentally ill wandering the streets into hospital as that will just cause other problems.
We should just keep drinking

My reply:

Overall the world is in a better place than it was 50 and 60 years ago by most metrics.

So why the conflict, the unrest, the craziness, the threat of far right groups, the anti-vaxxers, the election deniers, the rise of anti-semitism, the heightened ideological divisions, anti-psychiatry, homelessness, increase in addictions, death from addictions and overdose, mentally ill on the streets, a surprising daily display of delusional beliefs, and a surprising growth of bogus cures and snake oil salesmen?

Fifty years ago, or so, I had a rudimentary understanding of the tools I used, how they worked, and a passing acquaintance of quantum physics, and the construction of the universe, some understanding of physiology, then anatomy, of immune systems, genetics, evolution, and ecology.

Today I am typing this on a machine I barely understand, then sending it to Marvin in packages of digital machine code, through the air and thin strands of glass and copper wire, at speeds I cannot imagine, to appear on his screen via mechanisms of electricity and light I do not fathom. Some time ago I asked a grandchild where the photo went when she swiped the screen on her phone from left to right. Down there, she said, pointing to the side of the phone. I realized I would be hard pressed to explain the right answer to that question.

For generations most of us understood the tools we used, from the kitchen to the farm and factory. Even the internal combustion engine on wheels. This is certainly no longer true.

I was not religious then or now but those who did attend churches and mosques and synagogues 60 years ago were not constantly assailed by alternate beliefs, the corruption in their own institutions, and the eroding effect of science.

The peoples of the world as a whole may be better off but the roles, and tasks, and purpose, and memberships of many men in the developed world have been usurped by machines.

Science, modern medicine, and social attitudes have undermined age old certainties of gender, racial identity, cultural identity, and purpose. It is a quaint yet hopeful comment when someone says, “Everything happens for a reason.”

Science has not brought us understanding and certainty. It has brought us an awareness of how little we understand, how ultimately unknowable it all is. Yet today we are assailed by information, some based in reality, some fake, the trivial mixed in with the salient. On my Google feed I find Amanda Holden in another see-through dress, next to scientists creating a black hole in the lab, what actor was not cast in a decades old film, and how many children were killed in missile strikes last night.

And yet we crave certainty, predictability, organization, cause and effect. Unique among creatures on this planet, we need to know. Ah, think of life as a cobbler in a village pre-Gutenberg. Harsh but simple.

And then we build the internet and social media, where anybody can have a voice, a voice without responsibility or accountability. The very technology that allows me to have the British Museum, the Oxford English Dictionary, the Smithsonian, and the lectures of Bertrand Russell in my home also brings me Alex Jones, Donald Trump, a bevy of self-proclaimed influencers, and every malfeasance by Pfizer.

No rules, no limitations, no boundaries, no separation of fact and fiction. Therein lies the road to madness.

We should not be surprised to read a couple in New Zealand refuse a life-saving operation for their child unless the blood on hand for transfusion comes from an unvaccinated person.

Well, messenger RNA vaccines; these are something like manufacturing a clone of Paul Revere in the laboratory of a big (for profit) corporation and sending it out six months before the British arrive.

What could go wrong? Purdue Pharmaceutical? Boy Scout leaders and Priests taking my child on a camping trip? Hershel Walker? Anti-vaxxers disrupt a School Board meeting? A convoy of truckers takes over Ottawa. Putin decides he wants to be Emperor of a nineteenth century expanded Russia? Fourteen year old boy geniuses become billionaires? One of them misplaces a few billion? Fascism is resurrected all over the world? Deep fakes mean I can’t even trust my own eyes? Donald Trump leaves the old school scams of phony university degrees, signature steaks, and real estate tax fraud behind, and gets modern with an NFT scam. Jordan Peterson says Canada is about to collapse. Keven O’Leary is paid millions to promote worthless cryptocurrency and is paid in cryptocurrency. (At least I get to smile at the irony of that).

I think I shall have to invent my own reality and give it a test drive.

Making Sense of Kanye West

By Dr. David Laing Dawson

One of the self-appointed political commentators with his own podcast, after interviewing Trump supporters, asked if some of these people were mentally ill. He was referring to a surprisingly large number of people who hold obviously erroneous beliefs (or delusions) about such things as voting machines, pedophile rings, and the resurrection of JFK junior.

Is the debacle of Kanye West flowing from a mental illness or that not uncommon human trait of generalizing from a single experience and converting his own sense of failure or disappointment into hatred of some imagined enemy?

As I write this slowly and carefully I am aware part of this problem is the very contemporary phenomenon of people with less than stellar knowledge, wisdom, and judgement being able and willing to share their random thoughts with very large audiences.

I did, I confess, watch the Tim Pool interview of Kanye West. Kanye was mildly hypomanic; in fact he did admit at one point that his brain was generating seven thoughts at the same time. There was often no link between one thought and the preceding thought he shared, and with the slightest pushback he abruptly left the studio.

One hallmark of delusions generated by psychotic illness is that they are usually, if not quite always, self-referential. That is they do not declare that the FBI is controlling people; they declare that the FBI is controlling me, my thoughts, or watching me, looking in my windows. They don’t say song lyrics are about my neighbours; they say the song lyric is about me, written for me. They don’t say the television is sending messages to other people; the television is sending messages to me. They don’t say there will be a second coming; they say I am the second coming.

The brain is an organizing machine. It constantly seeks meaning. And by “meaning” I mean organizing principles that offer some degree of predictability. What might happen next? What are the reasons I feel this way? Who is mine enemy? Who is my friend? Where lies safety? Where lies danger? What control do I have? What power? What or who is causing my limitations? Where might I find love?

At its best the brain contains sufficient information, filtered knowledge, wisdom, well-functioning cognitive processes and well-functioning sensory, perceptual processes to arrive at some, at least satisfying and pro-social, organizing principles. At best it is also flexible enough to alter some of those ideas according to new information. Three very specific skills in this process are: noticing patterns without inventing them, ignoring irrelevant information, and accurately reading non-textual interpersonal communication.

When the brain itself is impaired, be it by schizophrenia, mood disorder, cognitive impairment, or dementia, the need to answer the questions in the bolded paragraph remains. The impaired brain still seeks answers even when over-alert to patterns, unable to read the intent of others, unable to sort the wheat from the abundance of chafe, unable to link one thought with the next, or overwhelmed with emotions of elation or depression. The organizing principles this impaired brain arrives at may be drawn from recent news, new technologies (a common delusion of yesteryear was of being controlled by xrays – today it is implanted microchips), religion and various real and perceived power structures. (Being Queen Victoria is passe, but being a messenger of God is still with us.) These delusions are the product of brain impairment from illness (also injury and toxicity) and are self-referential.

Intelligence and education play a role here: The delusions of a mentally ill but highly educated and intelligent person can be complex, subtle and well defended. The delusion of the not-so-smart ill person is usually blunt and straight forward.

And once any of us answer those existential questions we proceed to seek evidence to support our conclusion and ignore or avoid evidence that might refute it.

But of course even with a fully functioning brain it is quite possible to become deluded.

We are social creatures. We depend on others for information and understanding. We instinctively look to leaders to provide this. Some of us look to these leaders more fully and willingly than others. Hence the power of a cult leader, be he a true believer or a psychopath.

We need social information to inform our organizing principles. Hence social isolation breeds delusions, or, at least, strange and eccentric ways of understanding the world.

Information silos and social media algorithms control the information we receive and thus reinforce specific patterns we rely on for meaning.

And to find equanimity (and not resort to a delusional explanation) in a world without absolutes, a world and universe in which nothing is fully understood or explainable (time, black holes, infinity, what did exist before the big bang, spooky action at a distance, death, consciousness, human behaviour…..) we each need a degree of security, social membership, purpose, trust, flexibility, and an acceptance of our own limitations.

When delusions arise from factors apart from mental illness they are not usually self-referential: “Hilary Clinton runs a pedophile ring.” “God talks directly to my cult leader.” “Jewish space lasers started the forest fires.” “Trump will be reinstated as president in August”.

And then we have moments when the two collide: the non self-referential religious/political delusion and the mental illness derived self-referential delusion.

“Hilary Clinton runs a pedophile ring in a pizza place.” “God has assigned me the task of righting this wrong.” “Jews, Arabs, Mexicans are replacing us.” “It is my mission from God to kill some of them.”

For what it’s worth, Kanye West appears to suffer from a self-referential bipolar mania- induced delusion and the other kind as well.

Is it Deja Vu All Over Again for the Mayor of New York City?

By Marvin Ross

Baseball great Yogi Berra had a way with words and the deja vu quote is one of his best. Will his words predict the coming fight between the “woke crowd” and civil libertarians versus the current mayor of New York City, Eric Adams?

Mayor Adams is trying to do the sane, compassionate thing “by ordering police and emergency services to more aggressively hospitalize those with mental illness who are on the streets, even if the hospitalization is involuntary and they pose no threat to other people.” Adams has rightly argued that these citizens are in desperate need of treatment but often refuse treatment because of the nature of their illness. They do not realize they are sick.

Needless to say, he is being opposed by the usual civil libertarians and the champions for the homeless. I suspect that his humane efforts will be defeated as were the efforts by his predecessor, Mayor Koch. At that time, the late DJ Jaffe who was a spokesperson for the New York City Friends and Advocates of the Mentally Ill as quoted in the New York magazine “Manhattan Spirit” stated that it was easier to get into Harvard Law School than Bellevue Psychiatric if you were mentally ill. He was referring to the case of a New York homeless person Joyce Brown.

This is what happened in that case as described in my 2008 book Schizophrenia Medicine’s Mystery Society’s Shame (and still available).

Ms. Brown was a mentally ill homeless woman who resided on a steam grate at E 65th Street and Second Ave in Manhattan. She urinated on the sidewalk and defecated in the gutter or on herself. At times, she tore up money passersby gave her, ran out into traffic and shouted obscenities. Many times, she was not properly dressed for the cold weather. Five times psychiatric outreach teams took her to hospital but each time she was released by psychiatrists who deemed that she was not a danger to either herself or others.

On the Diane Rehm National Public Radio show after the Virginia Tech shootings by a mentally ill man who had fallen through the cracks and should have been hospitalized before he engaged in his murderous rampage, Torrey stated somewhat sarcastically that in order to be deemed a danger to yourself or others, you have to either try to kill yourself in front of the psychiatrist or try to kill the psychiatrist.

Ed Koch, the mayor at that time, saw the women and tried to have mental health professionals get her treatment. He was told that she was not deemed to be in danger or dangerous. Koch proposed new and less restrictive legislation that would make it easier to hospitalize someone. Koch referred to the civil libertarians who opposed hospitalizations as the crazies who deny people the right to treatment.

Under his new legislation, Ms. Brown was hospitalized but the New York Civil Liberties Union challenged that in court. In claiming that Ms Brown was not a threat they argued the following in her defense:

􀁺 Other New Yorkers also urinated on the sidewalk

􀁺 Defecating on oneself is not really a threat to one’s health

􀁺 Running into traffic was no different than jay walking

􀁺 Tearing up money was a symbolic example of the woman’s independence

􀁺 Her obscene language was no worse than what is commonly seen in movies

Judge Robert Lippman found for the Civil Liberties Union and stated that “the sight of her may improve us”. By being an offense to aesthetic senses, she may spur the community to action. Upon her release, Ms. Brown was invited to appear on the Phil Donahue Show and to address a forum at Harvard Law School.

She denied any mental illness and claimed that her homelessness resulted from her not having a proper place to live. She was given a home and a temporary job. Within weeks, she was back on the streets untreated and unwell.

I wish Mayor Adams luck and he will need it.

Time for some deja vu all over again

Privatizing Canadian Healthcare is not an option.

By Marvin Ross

Covid and staff shortages in healthcare has led the right wing Ontario government to hint that drastic innovations like privatizing may be required to give health care a new life. Sadly, they are blinded by their own ideology and a lack of understanding of the issues. That may sway some to agree with them.

I for one am impressed with how well the system actually works despite the problems but more of that in a minute. Ontario already has parts of its health system privatized and it is a disaster. Since the election of an earlier right wing government under Mike Harris and his Common Sense Revolution, long term care has allowed for profit homes. Harris would become chair of the Chartwell Chain of residences and Wikipedia estimates he received $3.5 million for his services.

During Covid, it was discovered that the private long term care homes had the worst outcomes with far more elderly dying in their care than in the not for profit or municipal homes. The situation was so dire that the military was called in to help and the troops were shocked at what they found.

In October, I wrote about a private chain that provides so called supportive housing to adults with disabilities and the conditions were barbaric. The Global TV news has just done a multi -part expose on a private chain that provides housing and supports for vulnerable kids. The series outlines the findings of possible human trafficking and mistreatment, over medication, and possible deaths which the government has ignored. In fact, the office that provided oversight was disbanded in 2018 as a cost saving measure by the incoming Ford government. The report on the chain was never completed as a result.

I cannot imagine anyone wanting that type of care throughout the rest of the health system. If we consider what is often put forth for a dual system, that makes no sense. The argument is to allow private care for those who can afford it and keep the public system. The problem is that we only have a limited number of doctors, nurses and other professionals. With a private system, many would migrate to there where they could earn a lot more money leaving very few staff for a public system.

As it is now, nurses are fleeing hospitals because they are overworked and undervalued. The government has capped their salaries to no more than a 1% increase. In order to fill in for vacancies, hospitals and long term care facilities are forced to bring in nurses from agencies at $120 an hour. Why not pay nurses what they are worth. The government categorically refuses to rescind the bill that restricts their pay.

The biggest problem with health care in Ontario is the stupidity of how it is run. As I explained in one of my op eds in the local paper, the problem is a rapidly expanding bureaucracy which has no value added component. Today, the Ministry of Health and Long-Term Care has two ministers and an associate minister devoted to mental health and addictions. In 2005, there was just one minister. All those chiefs need staff so that today we have one deputy minister assisted by three associate deputy ministers. In 2005, it was one deputy and one associate deputy.

Each of the above needs a fairly large staff to report to them to rationalize their existence. The more senior staff you have, the more juniors are needed. Going down one level we have the assistant deputy ministers who, today, number 14. Again, an entire bureaucracy is required beneath them to justify their existence. In 2005, there were only seven assistant deputies or one half as many as today. Has there been any improvement in care and delivery between 2005 and today as the result of this growth in bureaucracy?

No but there is a new organization called Ontario Health which has, I’m told, 30 Vice Presidents.

The provincial premiers are all demanding that Ottawa fork over more money but Ottawa rightly refuses unless their is accountability from the provinces on how the money is to be spent and how it was spent. Ottawa did give Ontario $450 million to improve the wait list for kids seeking mental health care. As a result, the wait list went from 18 months to 40 months and the money was used to develop a Centre of Excellence for mental health – more bureaucrats.

Despite this mess in health care and the delayed surgeries and long wait times, the system is working thanks to the dedication of the staff. At the height of covid, someone with Alzheimers in a good care facility for whom I was power of attorney, wound up in hospital. He was found one morning sitting on the floor at the foot of his bed and staff sent him to the ER at the University Health Network in Toronto.

He was suffering delirium from extreme constipation and was kept for months as he recovered. By this point, he needed long term care but his dementia had deteriorated to violent outbursts and he had to be watched by a staff person all the time. Staff were excellent, caring and compassionate and finally decided to refer him to the Toronto Rehab Hospital across the street where the psychogeriatric unit might have some success with his aggression. That would have made it easier to find him a placement.

Regrettably, he managed to escape from his wheelchair restraint, fall and fracture his hip. He was then moved next door to the ER at the Mt Sinai Hospital where the fracture was repaired. Sadly, and not unusual, he developed a pulmonary embolism and was moved into palliative care. Staff were kind, attentive and kept me updated on a regular basis so I could provide reports to his family in the US, the UK and Australia.

His passing was a tragedy but the care he received and the human contact and consideration was what we would all like. And this was at the height of the pandemic when staff were overworked and stressed.

I have other stories in a similar vein but it all illustrates how well served we are by a very dedicated, compassionate group of professionals.

They and the rest of us do not deserve the idiocy we see from our ideologue politicians.

Chronic Homelessness – A Trip to Finland for Trudeau

By Marvin Ross

Most of us, on our regular ramblings around whatever city we live in, can’t help noticing the increase in panhandling and tents pitched discretely in public parks. Signs of increasing homelessness are everywhere. Most readers of this blog also know that one significant reason for that homelessness is untreated mental illness. The solution is pretty straight forward.

Thanks to the Auditor General of Canada in her latest report, government efforts in this area have been an expensive waste.

Infrastructure Canada spent a total of $1.36 Billion between 2019 and 2021 on preventing and reducing homelessness without ever knowing if the money had any impact. That sum accounted for 40% of all the money spent on the housing initiative. Canada Mortgage and Housing spent an additional $4.5 billion without knowing who actually benefited from that spending. Rental housing units under the National Housing Co-Investment Fund was to be for affordable rental properties for low-income people but, in fact, many of the homes were not affordable.

Very disappointing but frankly not surprising. Governments give money for projects and groups not with the hope that some good will come of it but to be able to say “we’ve funded that project” now go away and leave us alone. If they truly cared about change, they would give more rationally and they would evaluate the outcomes of what they are doing. Instead, as the Toronto Star asked in its editorial, who is in charge? And then concluded no one!

Contrast what our government has not done with Scandinavia and, in particular, Finland where homelessness is declining. The Finnish solution is simple – give people housing. Not only do they give people homes but they provide services. “Services have been crucial,” says Jan Vapaavuori, who was housing minister when the original scheme was launched. “Many long-term homeless people have addictions, mental health issues, medical conditions that need ongoing care. The support has to be there.”

In one housing building as an example, the 21 residents are supported by 7 staff. That’s a strategy that is not cheap but it pays all sorts of dividends in cost savings and in generating improvements in human dignity. Finland spent 250 million Euros developing housing and hiring 300 support staff but saved an annual 15,000 Euros per homeless persons in emergency medical care, social services and the justice system.

I would like to make a suggestion for Mr Trudeau. I’ve lost track of just how much travel he’s done in the past few months between the Queen’s funeral in England, NATO, the G20 and a few other conferences in places like Thailand and Cambodia but winter is a lovely time to visit Finland. He could relax in a sauna while discussing how to move our Canadian homeless out of parks, ravines and from under bridges and over sidewalk grates into properly supported homes.

How about it Justin? And, before you go, take a look at this one hour long documentary on the absurdity of what is happening in BC. Treatment is ignored in favour of harm reduction in the case of addictions – a government sponsored drug distribution program. Well worth the time spent watching it despite the ads interspersed throughout.