Category Archives: Psychiatry

Pencil Pushers and Bureaucrats Should Have No Say in Mental Illness Treatment Strategy -Part Two

By Dr David Laing Dawson

I agree with everything Marvin has written but I don’t think the CEO of the Royal Ottawa Mental Health Centre has written her op ed with any serious thought, or consideration, or understanding of the public import of her words.

Her writing (and I have listened all too often over the years to similar expressions) is a nicely constructed assemblage of warm, fuzzy, good feeling words, meaning, ultimately, nothing. Nothing except self-congratulation and virtue signalling.

Nobody can argue with such feel-good words organized in any way on a page:

“patient centred, patient driven, patient choice, personal freedom, democracy, equality, fraternity, self-determination, team approach, holistic, wellness, life-style, autonomy, transformation, best outcome, radical change, given a voice, client-centred, gold standard, seamless, engagement, thriving, options, normalcy, convenience, independence……”

I think these kinds of writings or speeches are fairly harmless in the committee room, the board room, and within the task force designing the mission statement for the institution, (And they do continuously remind us of some ideals to pursue) but as an op-ed they contribute to the imprecision, the fuzziness of our thinking, the Orwellian world in which the words alone, no longer just signifiers, become realities, or are then treated as realities. It has been said and therefore it is. But not only are the words now a form of reality, they allow us to ignore, if you will pardon the redundancy, real reality. In this case the jails and prisons filling with the mentally ill, the burgeoning homeless population, and the horrific struggle families go through trying to get psychiatric treatment for a family member who is mentally ill.

And they obscure the very troubling, always difficult, always stressful, social, ethical, legal, medical, and often necessary choice to make a decision for someone else, to decide when someone else is incapable of making such a decision for themselves. Or, left to make such a decision for themselves, they will choose a course of action that predictably will end in poverty, homelessness, jail, or death.

These feel-good words are also an assault on medical and psychiatric treatment, and science, and paradoxically they increase the public stigma for those who suffer from severe and persistent mental illness.

The stigma and fear that added to the burden of those afflicted with cancer has been dramatically alleviated between 1960 and today. This was not accomplished by renaming cancer as “cell health issues”, calling cancer patients self-determining clients, and the institutions that serve them, The Princess Margaret Holistic Cell Health Centre and the Sloan Kettering Cellular and Substance Issue Center.

Terry Fox did not run halfway across the country to raise money for bone health issues but for bone cancer.

Calling severe mental illness a “mental health issue”, and addiction an “issue with substances” is ridiculous.

I have severe osteoarthritis in my deformed left knee (?knee health issues). The internet tells me I could choose (for a sum of money) a bunch of capsules that will magically transport new cartilage to my left knee, or (for a sum of money) a strange exercise program to strengthen my glutes to fix the problem in my knee, or attend a chiropractor who will charge me for weekly massage and stretching, or get some strange smelling medicine or a bunch of needles stuck in me by a naturopath or acupuncturist, or I could become a patient of an orthopaedic surgeon who will fulfill his or her role in the doctor-patient social contract by examining my knee, diagnosing the problem, and recommending the best and safest solution or help that science has demonstrated to date. I will be fully informed. I will make the decision, but my wife, who is tired of shoveling snow, will be there with me. And I trust the medical and surgical care will take place in a hospital and not at a “Client Driven Joint Health And Addiction Issue Holistic Centre”.

Pencil Pushers and Bureaucrats Should Have No Say in Mental Illness Treatment Strategy -Part One

Marvin Ross

I don’t believe I have ever seen the CEO of an oncology facility suggest how doctors should treat those with cancer but the CEO of the Royal Ottawa Mental Health Centre just did in an op ed in the Ottawa Citizen. If the CEO was a psychiatrist I would not object but the author, Joanne Bezzubetz, has an MBA and a PhD in Applied Management and Decision Sciences from Walden University. She has a history of admin positions in mental health but no education in mental health treatment.

She begins by saying that “It is time to put clients (patients) at the centre of their own care, to let them make choices about their therapies, and to give them the resources they need to lead independent and happy lives.”

She is clearly an advocate for patient centred care whereby the health care system puts the needs of the patients first. No one can disagree with that but my question is why is that such a big deal. Without patients, health care personnel have no jobs so what did they do before someone came up with this concept? I hope the system always put the needs of the sick up there at or near the top and always provided them with the treatment and resources they needed to overcome their illnesses, pain and suffering.

None of that should be radical. Where I have a problem is to allow them to make their own choices about treatment. Imagine going to the doctor with an infection and the doctor asking what would you like to do? That doesn’t happen. What the doc does is to present the patient with possible solutions, the pros, the cons, the side effects and then decide on a course with the patient. The choices might be wait and see if it resolves on its own or start antibiotics now.

In oncology, the same process would take place and if the patient decides to not accept conventional treatment but wants to go to Tijuana for alternative therapy, I would expect the doctor to have a long talk with the patient and try to dissuade them. If the patient is adamant then there is not much the doc can do. The patient has the capacity to make that decision and does so.

Under common law, as Justice Robins of the Ontario Court of Appeal explained:

“The right to determine what shall, or shall not, be done with one’s own body, and to be free from non-consensual medical treatment, is a right deeply rooted in our common law. This right underlines the doctrine of informed consent. With very limited exceptions, every person’s body is considered inviolate, and, accordingly, every competent adult has the right to be free from unwanted medical treatment. The fact that serious risks or consequences may result from a refusal of medical treatment does not vitiate the right of medical self-determination. The doctrine of informed consent ensures the freedom of individuals to make choices about their medical care. It is the patient, not the physician, who ultimately must decide if treatment — any treatment — is to be administered.”

What Ms Bezzubetz is espousing is something that already exists and is well entrenched in the legal statutes and in case law. I did highlight With very limited exceptions because it is those exceptions that she may be talking about and those are serious mental illnesses and dementia. It is not unusual for these two groups to be unable to understand that they are ill and to be able to make rational decisions about their care. When it comes to dementia, we mostly understand this and allow a substitute decision maker to make those care decision.

Granny has advanced Alzheimer’s and does not know what day it is, how to make a cup of tea safely but refuses care that will keep her safe. With compassion and understanding, we guide her into the care she needs which may be into a long term care facility where she can be looked after. We do not allow her to wander the streets and to live in the park or at a street corner.

In contrast, a young person with untreated schizophrenia is allowed to refuse treatment because he or she insists there is nothing wrong with them. And the longer their condition is untreated the worse it gets. Their family cannot cope and they end up living on the street, getting in trouble with the law and ending up in jail or dead. Society does not care and seemingly those like Ms Bezzubetz feel that is fine because they were “at the centre of their own care” and were allowed to “make choices about their therapies”.

In Ontario and most other jurisdictions, if these individuals become dangerous to themselves or others, they can be incarcerated in psychiatric facilities. Unfortunately, in Ontario they can still decide upon their treatment which usually is to refuse treatment. As a result, we have patients locked up for years who are dangerous but refuse treatment and the chance to recover and be released. How sensible is that?

If Ms Bezzubetz had more knowledge about psychiatry she would be aware that close to half of all patients with schizophrenia and bipolar disorder do not realize they are ill which is why they refuse treatment. The term is anosognosia and it is not just denial of being ill but a symptom of being ill whereby you are not capable of understanding. The following video by Xavier Amador is a perfect example of this condition.

In addition to or as an extension of this characteristic, people with schizophrenia “experience the world differently. And many have a relatively unique set of cognitive impairments, or problems with their intellectual functioning.” Those with schizophrenia have poor memories, trouble shifting between tasks, making bad judgement calls and failing to predict consequences.

None of this bodes well for them to be able to make rational decisions about treatment or no treatment or the best treatment. At least, of course, in the acute early phase of their illness. In that circumstance, consultation should involve family or those who are closest to the patient and know them best. Once treated and stable, the ill person is capable to discuss refinements in treatment. Physicians should pay attention to potential side effects and be willing to change medications to other drugs or to rationally discuss the choice between oral versus injectable forms of drugs.

Those providing treatment have to have the knowledge and the compassion to treat their patients with the appropriate respect and to act in their best interests.

What I’ve written reflects the frustration of a family member experiencing a health system governed by what I consider the harmful ideas expressed by Ms. Bezzubetz. Part Two tomorrow reflect the experiences of a psychiatrist working within that system.

What is a Disease – Advice for Anti-Psychiatry and Anti-Science Luddites

By Marvin Ross

Ancient treatment for mental illness and migraines

Schizophrenia and mental illnesses do not exist say the anti folks because we cannot see it, measure it, test it and whatever. To answer that, one of my favourite psychiatric writers, Dr. Ronald W Pies wrote a tongue in cheek article in Psychiatric Times entitled “Why Thomas Szasz Did Not Write the Myth of Migraine?

Dr Pies began his article with:

The next time one of psychiatry’s detractors tells you that psychiatrists do not treat real diseases because we have not identified the precise pathophysiology of schizophrenia, bipolar disorder, or other psychiatric illnesses, try this: Ask the skeptic to explain the precise pathophysiology of migraine or cluster headaches. Follow up by asking what laboratory test or neuroimaging study neurologists use to diagnose these devastating conditions. At that point, the critic should be either blushing or blanching.

I really doubt if they will blush or blanch as the good doc is being kind. They will probably sputter more nonsense or refer to a psychologist or chiropractor or an alternative medicine guru. The fact is that despite all the research done into migraines (like serious mental illnesses), the exact pathophysiology of migraine is not known. There are also no medical tests or neuroimaging that will identify a migraine in someone. Migraines are diagnosed based on the reports of the patient and the elimination of other causes. Just like serious mental illnesses.

Despite our lack of knowledge on the causes of migraines, there actually are some very good treatments for them although far from perfect ones. And the same goes for schizophrenia, bipolar and severe depressions.

What the anti crowd fail to understand is how scientists come to determine if something is a disease. My colleague, Dr David Laing Dawson, covered this in a blog from a few years ago called Understanding the Disease Model. He stated that:

The disease model is founded on the idea that if a number of people suffer the same symptoms and signs, and if their affliction follows the same course with the same outcome then perhaps these people suffer from the same “thing”. This in turn raises the possibility that the cause is the same in all cases and that a treatment that works for one will work for the others. To study this we need to name (diagnose) the thing and describe it’s symptoms, signs, and natural course. Given that we are biological beings it is reasonable to think that some of the signs of these diseases will be biological, and that the causes might be as well. But first the chore is to observe, study, collate, find groupings and test this hypothesis.

The Consistency of Mental Disorders Over Time and Geography

By Dr David Laing Dawson

Recently a filmmaker from Nova Scotia, working on a project about “madness”, reminded me of The Stirling County Studies. These longitudinal studies found the incidence of Anxiety and Depressive Disorders (not angst or sadness, but defined disorders) to be 9 per 1000.

Which reminded me that we have been here before.

We have done the studies. We asked those questions last century. If the major mental illnesses are socially determined then we would find very different rates in very different cultures and socioeconomic conditions. This did not turn out to be the case. What we now call Major Depression, Bipolar Disorder, Anxiety Disorder, and Schizophrenia, occur in all cultures, countries, and socioeconomic classes in surprisingly consistent numbers. The names and the language used to describe these conditions are different, the understanding of them variable, but the actual numbers are very close. In fact the outliers tend to be exceptionally high incidences of bipolar disorder (manic depressive disorder) in a few tight knit and genetically isolated communities.

Of course the level of stigma, the treatment offered, and the course and outcome of these disorders are definitely profoundly affected by culture and multiple social factors.

We know schizophrenia afflicts the Inuit at the same rate as it does an English speaking middle class community in Toronto. They don’t (or didn’t) have the word schizophrenia, but they certainly have words meaning “not in his right mind.”

A late teenage boy may be developing a psychotic illness. He refuses to cooperate and refuses treatment. I tell the mother we have to watch this closely and I will take action when I can and should. She, a recent immigrant from a Middle Eastern Country, says to me, “Can’t you just hold him down and stick a needle in his bum like they do in the old country.”

An old classmate who became (as unlikely as it seemed) the Deputy Minister for Health for Papua New Guinea, talks of the natives of villages deep in the jungles tying to poles a newly psychotic citizen and carrying him through the forest for many miles to the nearest Medical Station for ECT treatment.

Working in a Psychiatric Hospital near Cambridge England in 1970 I found a surprising number of middle age Polish Men suffering from schizophrenia on the wards I attended. But it was only surprising until I learned of the history of the formation of a Polish Army in England in 1940. Then the numbers fell in line with exactly what we know about the incidence of schizophrenia in the age group of young recruits. And the later prevalence, for these are all chronic illnesses.

The diseases are the same. Quality and availability of treatment, course of illness, quality of life, outcome of illness and life expectancy are strongly culturally and socially determined. There is where we need to make a difference. But those factors are not amenable to diagnosis and treatment. We know what they are. And they can be improved through changes in attitude and through political action.

(I have a step granddaughter who has Cystic Fibrosis. We know the genetics of this illness with some exactitude. She is Canadian, living in a middle class family, and receiving Canadian medical care. Her life expectancy, with this illness, in Canada, is a little better than that of the average healthy Russian, and, strikingly, about 20 years better than that of a child born in the USA with this illness.)

There is much in this world that needs improvement. But denying the reality of these mind/brain illnesses would be big step backwards.

Three New Book Titles on Schizophrenia for 2021

By Marvin Ross

Since 2008, I’ve been publishing books mostly on schizophrenia via my company Bridgeross Communications. The current titles can be found on the books page on this blog and I’m pleased to say that they have been well received by readers and reviewers and are still selling. I had no intention of publishing anymore but circumstances changed and I’m pleased to announce that three new books are coming this Spring. Allow me to introduce them to you:

What’s So Funny? The Autobiography of a Professional Schizophrenian, Artist, Public Speaker and Singer

Jude Mersereau, the author, I have known for a number of years as we live in the same city where she is an amazing artist. She was one of three artists with schizophrenia that were the subjects of a documentary film that Dr Dawson and I did of the art program she was involved with. This is the trailer for that film which does feature Jude who is also the singer along with her husband, George on guitar.

The book features a lot of her art in colour. Those who have read the draft are very impressed. Sandra Yuen Mackay who wrote My Schizophrenic Life which I published said:

“Schizophrenian Judy Mersereau writes with humour, poetic cleverness and lively originality. The book is beautifully illustrated with her art. The telling of her story winds and weaves with elements of joy in her memories. An entertaining read, written with honesty and insight, demonstrates Judy’s example of a full life despite diagnosis. She found ways to cope and give through her music, art and writing.”

Sandra is the recipient of the Courage to Come Back Award given by Vancouver’s Coastal Health and was named one of the five faces of mental illness in Canada to promote understanding of mental illness.

Kathy Mochnacki, chair of the board of Home on the Hill Supportive Housing commented that:

“Jude is a master at using literary tools. Her play on words can cause involuntary outbursts of laughter. But most striking is her use of juxtaposition which jars us into thinking from her perception of the world. Her artwork is original and enigmatic and is showcased throughout.”

Jude has spoken at Home on the Hill and she and her husband have performed for them.

When Neurons Tell Stories: A Layman’s Guide to the Neuroscience of Mental Illness and Health

By Erin Emiru (nee Hawkes) who is the author of When Quietness Came: A Neuroscientist’s Personal Journey with Schizophrenia. As the title of her first book states, Erin has schizophrenia and is a neuroscientist. She became ill while an undergraduate but managed to go on to complete a masters in neuroscience at the University of British Columbia and enrol in their PhD program while sick.

She managed to be the recipient of numerous prestigious awards and scholarships, including two Natural Science and Engineering Research Council’s (NSERC) grants and a Michael Smith award. Her papers were published in a variety of academic peer-reviewed journals in conjunction with her supervisors, colleagues, and fellow students. For several years, she attended and presented research at the massive (35,000+ attendees) Society for Neuroscience conferences.

It took years for Erin to find a medication that helped and, until then, had numerous forced hospitalizations where she was transported to hospital restrained by police. She has written a number of articles on how forced treatment saved her life. Unfortunately, Erin was not able to continue with her doctorate or to continue working in a neuroscience lab so became a peer support worker in addition to her many lectures to nurses, doctors and others on schizophrenia.

Her book takes you on a tour of the neuroscience of schizophrenia and other related topics. The subjects who will bring this neuroscience to life are her clients who experience mental health and addiction challenges. Their stories form the backbone of this book. She also describes her role as a peer support and how peer support should be done as part of a treatment team.

Her book will be an antidote to all the anti-psychiatry types who deny the existence of serious mental illness. Her definition of what recovery should be will be very enlightening. As a companion to that book is

Anti-psychiatry and the UN Assault on the Mentally Ill

This is my own foray back into book writing since my Schizophrenia Medicine’s Mystery Society’s Shame in 2008.

The book is an evidence based refutation of all the dribble spouted by the anti-psychiatry crowd which is becoming more entrenched. In my blog after the US election, I mentioned that I put anti-psychiatry in there with the anti-mask, anti-vax, alternative medicine proponents who are becoming more and more prevalent. Thanks to my friend Dr John Gray in Victoria, one of Canada’s leading experts in mental health legislation, I learned of their role with the UN.

This volume exposes the danger of the anti-psychiatry beliefs and their infiltration into the UN and that body’s Convention on the Rights of Disabled Persons. Many countries have signed on although a few like Canada and Australia refused to ratify the odious terms for psychiatry. The US has not signed but there is every indication that the Biden Presidency will sign it all.

This book and Erin’s book will provide the ammunition you need to counter anti-psychiatry’s arguments.

I will let everyone know when the books will become available and they will be available internationally in print and in e-book formats.

Guest Blog Mental Illness Left Out of BC Candidates Debate on Mental Health Services

By Susan Inman author of After Her Brain Broke Helping My Daughter Recover Her Sanity

Just before BC’s Oct. 24th election, candidates from the NDP, Liberal and Green parties participated in a debate on mental health services organized by the BC CMHA. Unfortunately, for people concerned about those living with severe mental illnesses like schizophrenia, during the entire two-hour event there was only one fleeting reference to “mental illness.”

There was no mention during this debate of what advocates for the needs of people with severe mental illnesses frequently call attention to such as the shortage of acute and tertiary psychiatric beds, the need for more supported housing, implementation of cognitive remediation programs and focused efforts to improve the ability of mental health staff to cooperate with families. The current BC Freedom of Information and Protection of Privacy Act (see Guide to the Mental Health Act Appendix 13) actually allows for communication between staff and families in order to provide continuity of care; too many staff either do not know about this provision or prefer not to abide by it. Promoting improvements in this cooperation would be an excellent and inexpensive policy position for a political party.

Most of the plans that were presented focused on promotion of mental health especially among children and youth. These were discussed as ways to prevent future mental health problems. The debate’s moderator, Tyee health reporter Moira Wyton, firmly declared that “root causes” of these future problems are abuse and trauma and the evening’s discussion was shaped around these beliefs. Wyton promoted the popular but erroneous notion that mental health problems should be understood as arising from adverse social determinants of health. No-one mentioned the existence of schizophrenia or bipolar disorder or appeared to know that neither of these medical disorders, impacting about 4% of the population, can be prevented.

While there was no acknowledgement of the existence of or the needs of people with severe mental illnesses, threats to the basic safety of this population were actually omnipresent in much of the debate. These threats relate to support for the current vigorous efforts from some advocacy groups to cut off access to involuntary treatment.

Schizophrenia and bipolar disorder frequently involve episodes of psychosis accompanied by anosognosia, a brain based inability for people to understand that they are ill and need treatment. Without this treatment, people are left trapped in psychosis and frequently become homeless, victimized, addicted and, increasingly, incarcerated. Although the streets and shelters of cities and towns across the province are full of these people, no-one during the two hour debate took notice of them.

Wyton’s beliefs shaped the discussion of involuntary treatment; early in the debate Wyton declared that evidence shows that involuntary treatment doesn’t work.

This was an alarming moment for people familiar with the dangers of living with psychotic illnesses. It doesn’t take much research to find substantial evidence that involuntary treatment does very often not only get people out of psychosis, but allows them to live more stable and longer lives.

The evidence supporting the use of involuntary treatment is why in recent years the US has brought in numerous Assisted Outpatient Treatment (AOT) programs. BC’s extended leave outpatient programs are similar to these. Research on AOT programs have demonstrated dramatic reductions in homelessness, hospitalization, arrests, and incarceration.

Involuntary treatment for psychotic disorders relies on the use of medications. A recently released long and large (62,000 people) study coming from Scandinavia demonstrates that people diagnosed with schizophrenia who stayed on antipsychotic medication were twice as likely to be alive after 20 years in contrast to those who didn’t.

Wyton and the Green Party candidate advocated for a review of and changes to BC’s Mental Health Act; groups pursuing this effort want to eliminate involuntary treatment. The Green candidate also advocated for the elimination of Canada’s reservation to the UN Convention on the Rights of People with Disabilities (CRPD); he sees it as essential in ensuring human rights. Canada’s reservation to the controversial CRPD ensures that people have access to involuntary treatment when they need it.

Wyton writes that mental health advocates want to ‘overhaul” what she calls an outdated Mental Health Act. Her questions during the debate assumed that the value of the review of the Mental Health Act isn’t to be questioned. She seems unaware that advocates in my community of families of people with the most severe mental illnesses are very concerned about these efforts; we know that if the goals of the groups pushing for the review are realized, access to involuntary treatment will disappear.

Wyton references a report from the BC Ombudsperson which has led to more careful completion of necessary forms used in involuntary treatment. The Ombudsperson report relies on a document, Operating in Darkness, released by the Community Legal Assistance Society (CLAS), an organization pushing for a review of BC’s Mental Health Act; the Ombudsperson did not recommend this review or any significant changes to the Mental Health Act. Lead author Laura Johnson is representing the plaintiffs in the current attack on BC’s Mental Health Act which would eliminate access to involuntary treatment. Johnson’s perspectives on psychotic illnesses and treatments relied on the beliefs of the fringe group Mad in America (MIA), not the knowledge of contemporary psychiatry. Johnson quotes a MIA psychiatrist who believes anti-psychotic medications don’t actually get and keep people out of psychosis. This is a common belief in the influential psychiatric survivor/alternative movement made up of people who believe they were harmed by psychiatrists and medications that they didn’t need for their problems.

Wyton’s article supports Johnson’s and the BC Ombudsperson’s recommendations for “independent” rights advice. However, the core issue in this change wasn’t acknowledged. As Johnson wishes, the report suggested a change in the way legal rights are explained to involuntary patients. Currently, legal rights, including the request for a review panel, are explained by psychiatric nurses and social workers who see and work with the patients. The Ombudsperson recommended that an outside legal agency, like the Community Legal Assistance Society (CLAS) with which Johnson is affiliated, take over supplying legal advice. If this were to happen, then millions of dollars in the vastly underfunded mental health system would now be going to lawyers. And if CLAS supplies these lawyers, these lawyers will be working to get people out of the hospital, regardless of how severely ill they may be.

The debate would have been the perfect opportunity for an impartial moderator to ask the Green candidate, who called for the elimination of Canada’s CRPD reservation, to discuss the consequences of this action.

This would have allowed everyone to learn that the consequences include elimination of all involuntary inpatient and outpatient mental health treatment and eliminating the not criminally responsible on account of mental disorder defence. The effect would be that the more than 15,000 people a year in BC, whose illness is so severe that they are likely to harm themselves or others or deteriorate, would be turned away from hospitals.

Currently, people who are found to have committed their crimes because of their mental illness are sent to forensic hospitals. These hospitals allow people whose mental illnesses are understood to have caused their crimes to receive treatment and regain their freedom. Instead, if Canada’s reservation to the CRPS is removed, anyone convicted of a crime, no matter how mentally ill they were at the time, will serve their sentence in the regular prison population. People with mental illnesses in the regular prison system often cannot follow rules and end up with longer sentences. Some of us would have appreciated a moderator asking a human rights lawyer, like the Green candidate, to explain how these changes further the human rights of this population.

It’s common for human and disability rights groups to avoid acknowledging the negative consequences of their positions. In fact, these groups often actively undermine efforts by journalists and filmmakers to draw attention to the suffering of people with untreated mental illnesses.

The psychiatric survivors, whom these groups rely on to support their positions, maintain that attention should not be given to those with untreated psychotic disorders who cycle in and out of homelessness, ER’s and incarceration. They argue that this attention promotes stigma against people like them whom they say are people with mental health challenges. In fact, just the use of the term “mental illnesses” is seen as offensive and this might explain its basic absence in the recent debate.

Human and disability rights advocates must look beyond the perspectives of the psychiatric survivor movement if they want to authentically represent the rights of people with severe mental illnesses.

People like my daughter and her friends who live with schizophrenia have had access to involuntary treatment when they needed it. Although they aren’t able to participate in contentious meetings or write about their opinions, they don’t want to be left in untreated psychosis in the future.

If rights groups wanted to truly represent the people they are assumed to represent, they could easily access the perspectives of people with severe illnesses who publicly support access to involuntary treatment.

Julia Fast blogs about living with her bipolar disorder in Psychology Today. She supports involuntary treatment and writes:

“The concept of individual rights doesn’t apply to someone who is not in his or her right mind. We are not in our right minds when we are sick.”

Joseph Bowers, who has lived a long life with schizophrenia writes:

“I’m near seventy, healthy, a husband and father who is retired with enough money coming in. None of this could have happened without involuntary treatment. My civil liberties were not taken away when force medicated and treated. I was instead liberated from the tyranny of serious psychosis.”

Eric Smith, who lives with bipolar disorder, endured 15 years of chaos before he got access to involuntary Assisted Outpatient Treatment (AOT) services. He writes,

“AOT saved me from the criminal justice system and from insanity.”

Erin Hawkes, a Vancouver based peer support worker on an Assertive Community Treatment, makes clear her support for involuntary treatment in her National Post article (#19), “Forced Medication Saved My Life.”

The absence of the perspectives of people like these writers living with psychotic disorders was very evident in this debate. Alternative groups and their allies in academia want to de-medicalize all ‘mental health problems.’ They promote the notion that all people impacted by ‘mental health challenges’ object to involuntary care. They have been aided in these efforts in the unwillingness of national and provincial governments to provide adequate public mental illness literacy campaigns. Until they are exposed to essential information, the public won’t increase its support for the policies and programs that actually help, not harm, people with severe mental illnesses.

The lack of basic public mental illness literacy hurts people with psychotic disorders. This lack leads to family and friends not looking for medically based advice and this leads to prolonged duration of untreated psychosis (DUP). Long DUP is strongly linked to worse outcomes.

Now that BC has held its election, the Green Party is limited to three representatives; their perspectives won’t be receiving the same kind of attention as they did during this debate. Hopefully, journalists covering the ongoing efforts of groups like them that are fighting to stop access to involuntary treatment will become more able to inform the public of what the consequences of these changes would mean.

The lack of acknowledgement of severe mental illnesses in this debate is not unique to BC or Canada. These are problems arising from trends in the social sciences, divorced from scientific and evidence-based approaches, that got out of control. Those pushing for a review of BC’s Mental Health Act want us to see it as “outdated.” In fact, it’s a tribute to more rational voices that managed to prevail. People in other parts of Canada, whose family members have been left to flounder in untreated psychosis, look to BC as a model for a more humane response to people trapped in psychosis.

The inadequate funding of services for people with severe mental illnesses will continue to confront the newly re-elected NDP government. However, not providing these services leads to homelessness, recurring use of ambulances and ER’s, the development of concurrent disorders, and involvement in the criminal justice system. These are very expensive consequences for taxpayers.

The profound economic impact of CODID 19 may make it even more difficult to get the necessary supports for this population and the family caregivers they often rely on. Families like mine can only hope that, at least, legal decisions won’t be made that will make life even harder and more dangerous through misguided interpretations of human rights.

Mental Illness in the Third World – More Refutation of Anti-Psychiatry

By Marvin Ross

A recent BBC report describes the horrific conditions for those living with serious mental illness in Nigeria. The article begins with

“Some adults, said to be mentally ill, were found with iron chains around their ankles, and forced to eat, sleep and defecate within the same confined place.

In one case, a 32-year-old man was chained up for at least seven years in his parents’ garage in north-western Kano state.”

and “The 30-year-old rescued from his parents’ garage in Kano, where neighbours said he had been locked up for seven years for allegedly being mentally ill, could barely walk when he was found”

Sadly, this is not that unusual. Part of the problem is a basic lack of psychiatric services but a bigger reason is the stigma associated with mental illness. Nigeria is not the only place where this happens to the mentally ill. Human rights Watch just issued a report on people with metal illnesses being kept in chains in many parts of the world.

The report points out that “Many are forced to eat, sleep, urinate, and defecate in the same tiny area. In state-run or private institutions, as well as traditional or religious healing centers, they are often forced to fast, take medications or herbal concoctions, and face physical and sexual violence.”

these reports do not surprise me but it brought back memories of my many fights with the anti-psychiatry zealots who used to and probably still do argue that psychiatric medication makes people sick while those in the third world focus on helping the mentally ill to recover. This is the view put forth by my old nemesis Robert Whitaker of Mad in America infamy. It was 8 years ago that I wrote that Anti-Psychotics aren’t the Anti-Hero.

Whitaker believed and probably still does that anti-psychotics are bad and that recovery has worsened with their introduction. He then went on to suggest that outcomes are better in developing countries than they are in our society. The shackles mentioned above are not new and have been going on for years but maybe he thinks that is better than taking medications. Regardless, the two studies that Whitaker cited as his proof are two studies by the World Health Organization (WHO) that were heavily criticized when they were published.

Of Course, the Donald down in DC would reject anything done by the WHO but Fuller Torrey wrote an extensive critique of Whitaker and explained what was wrong with his reliance on those two studies. I highly recommend that you read his paper.

And I have to wonder if those opposed to medications for mental illness wear masks.

The Eight Commandments for Successful Mental Illness Advocacy

By Dr David Laing Dawson

Serious mental illness requires:

  1. Treatment. That treatment is primarily pharmacological. Treatment controls symptoms and prevents relapse. But as human beings people with mental illness also need:
  2. Adequate stable housing
  3. Adequate nutrition
  4.  Regular activity that provides a sense of purpose and value
  5.  At least one relationship that approaches intimacy
  6. Membership in a group providing a sense of belonging/acceptance
  7. Currency (money, skill, knowledge, literacy…)
  8.  Meaning (a way of thinking about existence/purpose/being/self/others)

Having an untreated mental illness puts all other seven of those essential needs at risk.

Without treatment it is almost impossible to regain even one of them.

There are many good people and organizations in this world that would like to improve the lives of the mentally ill. Please stop the nonsense of opposing pharmacological treatment and replacing it with big words and false promises drawn from current new age and corporate lexicon.

Instead pick one or more on my list  and work on it, as an individual, an advocate, a service provider, a fund raiser, an organization, a politician…….

The categories in my list are not in precise order but achievement of each is generally dependent on achievement of the ones above.

(note: large artistic installations of solar spectrum light in urban malls is not on the list, apart from satisfying numbers 4,6,7 and 8 for the artist himself)

How Do You Find a Good Psychiatrist?

By Marvin Ross

Home on the Hill
From left to right Jude Mersereau, Dr David Dawson, Lindsay Thompson, Kathy Mochnacki (chair) Along with a police officer from the York Regional Police Force who often come to learn about mental illness

And that is a rhetorical question as I have no idea. It was a question raised the other evening at a presentation I was at with fellow blogger Dr Dawson. The presentation was put on by the group Home on the Hill Supportive Housing in Richmond Hill Ontario as part of their ongoing Robert Veltheer Lecture Series.

At this presentation, two women with schizophrenia talked about their experiences with the disease and how they coped. Dr Dawson answered questions about the nature of schizophrenia and the video will be available soon which I will post. Both women received standing ovations from the audience when they finished describing their struggles and their successes. I have to admit that I was very moved.

The question of a good shrink was raised and people struggled to answer it so I would be most interested in how the readers of this blog might answer that question.

Dr Dawson, if I remember correctly, talked about the need for all doctors to focus on their patients. Evidence based plus Electronic Medical Records (EMR) allows for the efficient input of great quantities of data gleaned from a q and a with the patient. But, while inputting, so much if not all of the appointment is spent with the doctor staring at the monitor or back and forth between patient and monitor. This strict adherence to evidence based medicine is unsatisfying for the sufferer and thus probably a reason more and more, in this era of science and information, are turning to acupuncture, naturopathy, chiropractors all of whom provide some comforting magic and the promises we all want to hear.

Another important component of psychiatric support is ongoing support for the patient at fairly frequent and regular intervals. This can actually be done (and is often done in good programs) by case managers. The case manager will meet with the patient and discuss successes, failures and activities. If there are problems, then the psychiatrist can be brought in.

Most of the time, we do not get to chose the psychiatrist but have one assigned to us by the hospital or agency based on who is available. There is little room for choice given the shortage of those in this specialty. If I get referred to a cardiologist by my family doc and I do not like that person, I can always go back to the family doc and request a referral to someone else. This is not a luxury open to psychiatric patients.

Another problem, in Ontario at least, is that if you are hospitalized, the treating outpatient psychiatrist is replaced by whichever psychiatrist is responsible for that unit. Most of the time, the in patient doc will consult the chart and talk to the regular psychiatrist and caseworker but not always. I’ve seen that happen with disastrous results. And, like a crap shoot, you may actually get an exceptional psychiatrist which, thankfully, I’ve also experienced.

So from my perspective, a good psychiatrist is one who understands the disease and its treatment, listens to the patient and interacts with them, the family and provides regular and frequent support from a qualified and empathetic case worker.

I’d love to hear what you think.

From Asylums to Recovery -A Critique of a Mental Health America Documentary

By Marvin Ross

I just recently came across a documentary on Youtube put out by Mental Health America called From Asylums to Recovery – a celebration of the so called consumer survivor, anti-psychiatry movement in the US and beyond. After showing some images of the horrific conditions that people were forced to live in in asylums, we are greeted with the statement that in the late 1950’s and early 1960’s, there were 550,000 people locked up in asylums. Many, the documentary goes on to say, were locked up by their families and the courts because no one believed that those with mental illness could recover.

Horrific conditions did exist and no one can deny that but people were in the institutions because they could not usually recover in those days. Recover isn’t even the right word which really should be that their symptoms could not be dealt with appropriately. Recover really means to be cured and that is not possible for illnesses like schizophrenia and bipolar disorder.

The doc then states that today there are about 50,000 people in psychiatric facilities and that the system has improved. This reduction, they claim, is the result of 100 years of patient/consumer/survivor advocacy. The documentary then goes on to try to explain how this reduction in patients and improvement came about by interviewing many of those who were involved in the consumer/survivor movement.

What is missing, of course, is that from the early 1960’s on, new medications came along that, for the first time, could treat the worst of the symptoms of schizophrenia, bipolar disorder and major depression. In fact, the first anti-psychotic, chlopromazine, was discovered in the 1950’s and its first North American use was in Montreal in 1954.

That was the beginning and over the years, more anti--psychotics were developed so that doctors now can experiment to find the one that works best for a particular patient.

Lithium, the gold standard treatment for bipolar was first used in 1954 but not introduced into the US until the 1970’s. The US was late to the game as it was the 50th country to start using this agent to treat bipolar disorder.

Anti-depressant drugs to treat major depressive disorder began about 1957 with the appearance of the MAO inhibitors. This class of drugs had their problems with interactions with some food products such as cheese. However, other classes of drugs such as the tricyclic antidepressants, the SSRI’s and now other agents like ketamine are in use.

Those in asylums were able to have the worst of their symptoms treated successfully and to be released from hospital. Mental Health America fails to mention any of this and attributes the emptying of hospitals to the works of the consumer survivors and anti-psychiatry advocates. The problem, however, was that governments were too anxious to release people without first setting up proper community resources to aid and assist those being discharged.

Known as deinstitutionalization, the process has resulted in sick people being left in the community to fare for themselves. As a result, many of the homeless and those incarcerated are suffering from untreated mental illness. Is being homeless or in jail an improvement on the asylums of old? I think not!

All of this (drug development and deinstitutionalization) is ignored in this documentary designed to celebrate the 100+ years that MHA has existed. It began life in 1909 as the National Committee for Mental Hygiene. An organization that has been around for that long I would hope would have more understanding of mental illness than displayed in this documentary. The popular media, in my opinion, displays a greater understanding.

If you are a fan of the TV series Homeland, and have not seen season 7 then stop here unless you want the ending. The protagonist, Carrie Mathison, is a CIA agent with bipolar disorder. In this season, she is captured by the Russians and held prisoner before eventually being exchanged for a Russian spy held by the Americans.

As part of her torture, the Russians withhold her bipolar meds. After a significant time without medication, Carrie is returned to the US in the state that anyone who understands mental illness and the role of medications would understand. She is an incoherent mess and basket case. If Hollywood can understand this, why can an agency involved in the mental health field not understand it?