Category Archives: Psychiatry

Mark Vonnegut, Schizophrenia and Mother Blaming

By Dr David Laing Dawson

Mark Vonnegut, the son of Kurt, had (has) a psychotic illness. In his autobiographical novel he explained delusions in this way: if you were being chased by a pack of wild dogs, wouldn’t you rather think that somewhere there was a hound master who could call them off if he chose to do so?

I have always thought he was right, at least with respect to delusions. They are explanations for experiences that, in the case of mania, cannot be explained within the accepted laws of physics; in the case of schizophrenia, cannot be explained by a diminished social perceptual and information processing system; and, in the case of dementia, cannot be explained by a diminished cognitive apparatus.

The invented explanations are usually quite simple and usually involve blame in either a positive sense (God has granted me…) or a negative sense (the CIA is…). The target for blame (or perceived source) in a delusion is always standard fare. The source of extraordinary power and well being is God; the causes of failure, constraint, weakness, control, are parents, the police, a disease, or Aliens. The methods are always contemporary:  in pre-industrial  cultures, by curses, spells, hexes, and evil eyes, through the 20th century by radar and radio waves, and now through a variety of electronic devices, bugs, and micro implants. And as per the topic of a recent blog, note that parents make that list.

But beyond an explanation of delusions, this wish for a hound master who could, if he chooses, call off the dogs of hell, is really quite universal. Historically we have used, or fallen into, just such an explanation for every sin, illness, climatic event, and tragedy that befell us. And, almost always, we have been wrong.

But this need, this psychological human brain imperative, continues. The value of this trait of the human brain (mapping, organizing, understanding) lies in the advancements of science. We want to understand why things happen as they happen. The downside to this need, this wish, is the continuing enthrall of astrology, a myriad other nonsense fads and conspiracy theories, and the wish to find someone to blame  for schizophrenia.

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More on Families, Privacy And Suicide

By Dr David Laing Dawson

Much of psychiatry is about convincing people to do things that will improve their mood, their health, and their lives. Exercise, better diet, overcoming fears, taking necessary medication, stop taking harmful substances, go to bed earlier, turn off electronics, find balance in your life, join something to overcome loneliness, stop procrastinating, call a relative, tell your husband, plan your day, stop worrying about things you cannot control, take baby steps, take medication regularly as prescribed, go for blood tests, enjoy small pleasures, scream at someone rather than cut yourself….

It is not in the DSM V (I think) but we know “no man is an island”. We are social beings. Maybe not to the extent of bees and ants, but no less than chimpanzees. We are never fully independent life forms. Even a hermit has a relationship (albeit a distorted and contrary one) with the community and family he or she is rejecting.

We also know that the quick impulse to say to the doctor, “Don’t tell my family.” or “I don’t want my family involved.” is often derived from shame, guilt, a sense of failure, and sometimes the opposite, a genuine wish to not burden the other. This is further complicated in the teen and youth years by an ongoing negotiation with respect to power, control, individuation, responsibility. We also know in these years the adolescent often says, in the same breath, “I hate you. Give me a hug.” “Get out of my life. Drive me to the mall.” “Don’t tell my dad. Please tell my dad so he can protect me.”

And we also know that persons suffering from severe anxiety and depression develop a sort of tunnel vision that excludes broad levels of social awareness and understanding. “Leave me alone.” And people suffering from a psychotic illness often harbour delusions about family members. “She’s controlling me.”

So, absolutely, when the young person says, “Don’t involve my family.” professionals should explore this, and then convince the patient otherwise unless there is good evidence that keeping the family (parents, sibs) away will be ultimately better for this patient.

Insane Consequences Review – Mandatory Reading for Students, Politicians and Health Care Bureaucrats

By Marvin Ross

Insane Consequences How the Mental Health Industry Fails the Mentally Ill by US advocate, DJ Jaffe is a tremendous resource for anyone wishing to understand the industry that has developed around mental illness. And that is an industry that ignores the most seriously ill in favour of promulgating programs that are not evidence based, that are grounded in social theory rather than scientific theory, and generate jobs for the professional carers.

I am absolutely amazed at the amount of work that has gone into this volume. If anyone doubts Jaffe’s conclusions or statements, his sources are well laid out so you can check on them for yourself. A great deal of the problems with mental illness treatment in the US is its totally absurd health care system which baffles those of us who live in countries with universal single payer health care.

A few years ago, the Bridgeross author, Erin Hawkes (When Quietness Came: A Neuroscientist’s Personal Journey with Schizophrenia), appeared on an NPR radio show in Ohio to talk about her book. The interviewer was amazed at how much care and treatment she received in both Halifax and then Vancouver. How much did it all cost, she was asked. She thought for quite  awhile and said, “I think I once paid for an ambulance ride”. The interviewer was stunned.

But then, we don’t have absurd rules like the Institute for Mental Disease (IMD) exclusion. Because of this rule, Jaffe points out, Medicaid will not reimburse states for psychiatric beds. When the states cannot get reimbursed, they close the hospitals.

However, despite the difference in how health care is funded, most of what Jaffe talks about is relevant for Canada and, I suspect, other western countries. The seriously mentally ill are ignored for the most part, make up a huge proportion of the homeless and of the prison population. The focus, as Jaffe discusses, in the US and in other countries is on stigma which helps no one, on denying the connection with violence for those who are untreated, and on the misguided concept that people are free to decide their own fate when they lack the capacity to do so and are thus left to fend for themselves when they need to be hospitalized.

While medication is the cornerstone of proper treatment, there are still non evidence based theories being flogged as replacements for the medications. We have Open Dialogue from Finland that lacks any proper evidence, Mental Health First Aid, prevention programs to prevent illnesses where the cause is not known, and to foster peers with so called lived experience to replace trained medical staff. All discussed in this book.

I should also mention that Jaffe talks about the problems that caregivers have dealing with the system because of privacy laws. I quoted him in my Huffington Post blog on the problems that caregivers have with a suggestion that we all deserve a hug.

All of the book is valuable as a resource but what I found most helpful was his Appendix on the studies of Assisted Outpatient Treatment (AOT). These orders compel a mentally ill individual to accept treatment in the community. If they refuse, then they can be hospitalized. Jaffe cites about 20 studies that demonstrate the effectiveness of this program to reduce homelessness, incarceration, violence, reduced hospitalizations, and emergency department visits to name a few.

This book should be mandatory reading for all students in mental health counselling programs, nursing, social work and medicine. It also needs to be read by government policy makers. Money can be thrown at a problem but unless that money is spent wisely on evidence based programs, it is wasted. And that is what happens today.

Finally, because Jaffe is donating all his royalties to  the Treatment Advocacy Center and to Mental Illness Policy Org, purchasing the book will help those groups better advocate for the seriously mentally ill.

Yes Virginia, Psychiatric Medication Does Work.

By Marvin Ross

As I’ve said so many times, anecdotes are not proof of anything but I am going to use one to demonstrate the efficacy of anti-depressants. The anti-medication people do nothing but give anecdotes of the dangers of psychiatric medications and the difficulties some have going off them. When research is cited, they usually attack it as being biased and/or funded by big pharma.

Research does show that for most and when prescribed properly, these pharmaceutical agents do help. As an example, I’m the power of attorney for someone with Alzheimer’s Disease. When he was first being assessed by a family doctor, he came out as being depressed on the Beck Depression Inventory. While he was under going evaluation, he was given anti-depressants which he only took rarely.

However, when he had his diagnosis confirmed by the geriatric psychiatrist, it was recommended that he go back on and stay on the anti-depressant to help with both his depression and his anxiety. In order to ensure compliance with that and the Alzheimer’s med, he was given a weekly blister pack. The pharmacist loaded the pills for each day and for the proper time.

He saw the psychiatrist a few months later and was assessed again on the Mini Mental Status Exam (MMSE). The psychiatrist noted that not only did he appear more relaxed and less anxious than at the previous session, but that his dementia score had improved slightly – not because his dementia was better but because he had less anxiety.

Then, a few months later, the home care co-ordinator showed up to do a reassessment. She called me amazed. My friend, she said, was far more relaxed and showed no signs of anxiety or agitation which were evident when she first assessed him. As she said, “he still does not know where he lives or what the date is, but he is very relaxed about everything”.

Yes, this is an anecdote that and not a definitive study but it is an example of the benefit of this class of drugs. For a list of the meta analytic studies done for anti-depressants that do show efficacy, visit this webpage. Check out the home page on that site for other resources. Thanks to Robert Powitzky for pointing me to it.

The Brain, Cognition and Illness

By Dr David Laing Dawson

The aware, receiving, perceiving, organizing, planning brain.

Two recent writings got me thinking about this. The first was a comment from Mr. Summerville, in support of the absolute discharge of Mr. Vince Li, that Mr. Li showed “no signs of cognitive impairment”. The second was the raw honesty of Mr. Bowers when he writes that when he took a shotgun upstairs with the intention of killing his grandmother he was “bat shit crazy”.

I suffered one of those nasty strains of flu this winter. At the time it seemed to affect every organ in my body. Including my brain. That is my brain was aware this state of body sickness was impairing some of its functions as well.

I guess it’s tricky. We are aware when our stomachs aren’t working as we would wish them, when our prostates and kidneys are not quite right, when perhaps our livers are acting up, our eyes, our inner and middle ears, our calf muscles are balking. Well, really, it is our brain noticing these things. But when the brain is acting up, not quite functioning smoothly in one of its functions, there is no one left to tell us. That is, no other organ in the body is prepared to tell us that the brain is a little off. “Liver here. Brain, your thinking is off.” or “Brain, your medulla oblongata is a little sluggish this morning. Your perceptions are clouded.”

I have also suffered, by my own count, three depressions of clinical severity so far in my life. Perhaps the cause of these can be traced to my circumstances each time, perhaps my genetics, perhaps to my childhood, probably a combination of genetics and circumstances. But each time it happened I know my brain was impaired, not functioning well, not scanning, perceiving, reviewing, interpreting as it normally does.

You can find a list of the symptoms of “depression” in the DSM and on many a website not to mention TV advertisements for the latest antidepressant. But of course the organ experiencing these symptoms is the same one reading and hearing about them.

It is often family members and close friends who notice first. You are not yourself, they say. Or “the spark has gone from your eyes.” And always when I treat someone for depression and they improve, it is family members who notice the improvement first. The patient tells me they don’t notice any change, though I see his or her eyes are livelier, his face a little less strained, and the corners of his mouth more agile. And the mother or wife points out he came down for dinner, engaged in conversation, laughed at a joke. The brain of the patient hasn’t noticed these changes yet, because… well because its perceptual, interpreting, responding, scanning apparatus is still partially impaired.

Liver illness impairs the functioning of the liver. Mental illness impairs the functioning of the brain, and that can be some or many of its functions. Mental illness is a brain illness.

So let’s go back to Vince Li. His brain was absolutely definitely impaired at the time of his crime. And at this point if he is not terrified of relapsing, and thus wanting help for the rest of his life to keep himself from relapsing, if he does not himself (his brain) understand and want all safeguards in place to keep himself from relapsing, if he thinks he can just change his name and move on, then his brain is still impaired in some of its functions. If this is the case then his perceptual, cognitive, judgmental processes are still impaired.

Contrast that with the Blog written by Mr. Bowers. He has fully recovered from being “bat shit crazy” and he is fully aware he never wants to go there again, and he is fully aware (the perceptual, organizing, planning, monitoring, cognitive processes of his brain are functioning well) that he needs help and vigilance to never go back to that place again.

More on Vince Li and Absolute Discharge

By Dr David Laing Dawson

Let me give a little background to my previous blog on Vince Li.

I have had many patients over the years (50 years now, actually) who have done well with treatment, who recover, who have insight, who promise to stay on their medication. They are good people. I like them. We become friends. With some it can involve an ongoing dialogue about needing or not needing to stay on medication.

But at some point most of them stop their medication, at least once. Their lives have changed. They have been well for 20 years. They meet a family doc who doesn’t understand why they are still taking Olanzapine. They fall in love. They move. They get ill in some other way. The pharmacy changes hands. Their doctor moves. They come under the influence of one of any number of cults, including Scientology. They read the bullshit of the anti-psychiatry crowd, or the homeopaths. Someone offers them cocaine.

So at some point most of them stop their medication at least once.

With psychotic illness the illness returns, and it always returns in the same way. With some my relationship is good enough that I can cajole them into going back on their medication. With some I have had to spend hours offering it while my patient tries to decide if I am a friend or the devil. With others it means a complete relapse and re-hospitalization.

And in most cases, the only ones hurt by this relapse are my patient and his or her family. That is no small thing though. The social, emotional, vocational, educational, and sense- of-self cost is huge. Often a year or more of progress is lost.

Lack of insight may be a good predictor of human behaviour, but insight itself is not. An equally poor predictor of future behaviour is remorse, or a display of remorse. “Good behaviour, model patient or prisoner” has also little to do with what will happen in a different context five years from now. I will agree, however, that a good support system is a good predictor, but we need that support system in place for 40 years.

We clinicians are further hampered by our natural empathy, our natural sympathy that flows toward anyone nearby. It is not special; it is just human. At least twice a week during commercials I see on the television screen an emaciated fly-covered child. I get up and refill my glass. But should that child and his mother be in the room with me, my response would be quite different. Hence, as I have seen many times with CCRB cases over the years, the staff actually caring for and treating the patient are very poor at predicting future behaviour.

Now, I have not examined Mr. Li. It is possible he had a psychotic episode that will never reoccur. In my 50 years experience I know this to be only possible if the initial psychosis was caused by a brain injury, a stroke, toxic substances, or withdrawal from toxic substances, or very severe acute trauma within the time-frame of the psychosis. But from what I have read Mr. Li developed a schizophrenic illness with hallucinations and the specific delusion that resulted in a very specific horrendous crime.

So, from my 50 years of experience, I would say the people who know Mr. Li, who have spent time with him, are the last people who should be making predictions of future behaviour. Secondly, insight, remorse, promises, even absolute statements of conviction are not good predictors of distant future behaviour.

We know this man, when well, is a very nice man, and could be a good citizen of any community. We also know when ill he is capable of committing a horrendous crime.

Would it not be reasonable to use the tools we have to keep him well for the next 40 plus years? To protect Mr. Li and any future community in which he resides? They are not overly constrictive or intrusive considering the possible consequences of a relapse.

By allowing even a remote chance of a repeated homicide by Mr. Li you are doing everyone else diagnosed with a psychotic illness a great disservice.

Anti-Psychiatry

By Marvin Ross

I really don’t get it – anti-psychiatry that is. I can understand that if someone has had a bad experience with a psychiatrist, they might be wary and hostile. After all, not all doctors are good and I have no doubt that most of us have run into a bad one over the course of our lives. I certainly have seen my share of rude, arrogant and stupid doctors from family practitioners to cardiologists but I do not condemn them all. I do not devote my energy to attacking emergency medicine because of a bad ER doc I’ve encountered.

A lot of the anti-psychiatrists I’ve encountered fall into this category. They’ve had a bad experience and generalize to all. But a lot of the others aren’t in this group. They are people who have decided that their time should be devoted to attacking psychiatry as their contribution to freedom of the individual or to the good of mankind. And, for the most part, they know very little of neuroscience, medicine or mental illness. If they truly want to make a difference, they should devote their time to advocating for better care and treatment for the seriously mentally ill or to help with the growing problem of refugees, world peace, homelessness, child poverty, and the list goes on.

For the most part, they are mistaken in their views of psychiatry as Mark Roseman pointed out so brilliantly in his review Deconstructing Psychiatry. I highly recommend that people read that. His analysis is far more detailed than mine but I would like to comment on a few of the common myths that he covers in more detail.

The one complaint that is common among the anti-psychiatry mob is that psychiatrists are controlling people who give an instant diagnosis and then force their patients to take toxic drugs.

People do not go to see psychiatrists by calling one up or walking into their offices. They need to be referred by a general practitioner or via a hospital like an emergency room. And they would only be referred to a psychiatrist if they had psychiatric problems that were beyond the expertise of the general practitioner. That referral would only be made after the general practitioner had ruled out non-psychiatric causes of the symptoms and behaviour.

Like all doctors, the psychiatrist will take a detailed history from the patient, consider possible diagnoses and recommend appropriate treatment. The treatment recommended is based on the professional guidelines outlining evidence based strategies. These are the practice guidelines used by the American Psychiatric Association. Similar guidelines are used in different countries. The cornerstones of any medical practice are to do no harm and to relieve suffering.

I often hear comments and criticisms that a psychiatrist put someone on toxic drugs that they were then forced to take for eternity. A comment to my blog on the anti-psychiatry scholarship at the University of Toronto stated “based on the results of a positive diagnosis (from a 15 minute questionnaire score) a patient (including young children) may receive powerful psychoactive drugs for years, the long term effects of which are not yet known.”

As I said above, the diagnosis is not based on a 15 minute questionnaire but on an extensive evaluation. And, regardless of the medical area, drugs are always (or should be) prescribed in the lowest dose for a short period of time and the patient brought back in for evaluation of efficacy and side effects. The goal is to find the lowest dose that is effective with minimal side effects. This is a process called drug titration.

If the drug is not effective or if it causes too many unwanted side effects, it will be changed. No one is forced to take a drug that does them little good in any discipline of medicine. Surely, the patient does have choice to continue with that doctor or not and to take the advice that is offered. People who see psychiatrists are not held captive.

When it comes to children, they are not seen in isolation as the anti-psych criticism I quoted above implied. They are seen with their families who, understandably, do not want their kids on powerful drugs. There are long discussions with the psychiatrist where all less invasive means are explored. When pharmaceuticals are prescribed, the parents are at complete liberty to stop them if they do not work or if they cause troublesome side effects. The children are not held captive by the psychiatrist and force fed pills against the wishes of the parents.

When a child does continue to take the medication it is because it is having a benefit and there are no troublesome side effects. I remember a mother who resisted Ritalin for her hyperactive child for years telling me how well it worked once she decided to give it a try. “I wish I had tried it much earlier”, she told me. “It would have saved so much grief.”

The anti-psychiatry bunch also assert that mental illnesses do not exist and cite the lack of any one definitive test to prove bipolar disorder, schizophrenia or other afflictions. Quite true but the same can be said for many other maladies. How about Parkinson’s as but one example. Doctors cannot measure the amount of dopamine in the brain (which is depleted in Parkinson’s) to definitively say that the person has the condition. They determine the presence of this condition based upon observing the person and his or her movements.

Alzheimer’s is another. Like with schizophrenia, it is diagnosed by eliminating all possible other reasons for the observed dementia and when none can be found, the diagnosis of Alzheimer’s is made. On autopsy, there will be found specific markers but no one ever gets an autopsy to prove that the doctor was correct. And rarely is anyone with schizophrenia autopsied on death but this is a lengthy list of the abnormalities that demonstrate that it is a disorder of the brain.

The anti-psychiatry group should be looked upon with the same disdain that sensible people look upon the anti-vax faction.

Mental Illness and the Political Spectrum

By Marvin Ross

I have always been on the left of the political spectrum – more so in my student days – but I still consider myself left and vote for progressive ideas and progressive candidates. Progressive, of course, is a value laden term but what has baffled me has been the lack of progressive ideas by the left on mental illness.

I’ve just done a Huffington Post piece attacking the establishment of a scholarship in anti-psychiatry at the Ontario Institute for Studies in Education (OISE) at the University of Toronto. After it was penned but before it was published, I was sent a link to an article in Rabble.ca written by the founder of that scholarship, Bonnie Burstow, extolling the supremacy of Toronto academia in anti-psychiatry “scholarship”. She equates this anti attitude for the search for social justice and as diametrically opposed to Toronto’s Centre for Addiction and Mental Health.

Aside from caring for patients, CAMH has a research budget of $38 million a year, is a World Health Organization Collaborating Centre and home to the only brain imaging centre in Canada devoted entirely to the study of mental illness. Among the supporters and activists of anti-psychiatry, Burstow cites David Reville and Cheri DiNovo. Reville was a politician in the disastrous NDP government in Ontario headed by Bob Rae (1990-1995). DiNovo is also an NDP member of the Ontario Legislature.

For non-Canadian readers, the NDP is the Canadian version of a Labour Party.

That disastrous government in Ontario brought in legislation to establish an Advocacy Commission to protect vulnerable people and to promote respect for their rights. That, of course, is laudable but the bill was so flawed and cumbersome that it was immediately repealed by the Conservative government that replaced them in power.

The Ontario Friends of Schizophrenics (now the Schizophrenia Society of Ontario), told the committee that:

Ontario Friends of Schizophrenics has had dialogue with officials because we have been persistent and because we have done our homework in making some solid proposals for improvements in the legislation. We have been unable to meet with a single minister of the three ministries concerned, despite repeated requests and despite the fact that people with schizophrenia are one of the largest groups in the vulnerable population that will be affected by these bills.”

They then pointed out that the bill excluded families; that it gave more power to the commission to enter someone’s home than the police have; that the test of capacity was ability to perform personal care rather than understanding; the low standard of capacity; no provisions for emergency treatment; and too much power to the Consent and Capacity Board.

The Alzheimer’s Society of Metropolitan Toronto was equally critical arguing that the new act penalized the family. Their presenter told the committee that:

“I have serious concerns about the prevailing use of unknown professional advocates with sweeping powers, heavy demands on their time, unclear qualifications and little accountability.”

In Ontario, the only improvement to the Mental Health Act was brought in by the extreme right wing at the time Conservative government under Mike Harris. They have not always been that extreme and the word Progressive precedes Conservative in the name of the party. That improvement to the Mental Health Act was Brian’s Law which enabled those with serious mental illness to be hospitalized if they posed a danger (not imminent as previously) and to be discharged from hospital under a community treatment order. They could live in the community provided that they were treated.

Only 10 members voted against the bill, 6 of whom were members of the NDP. The Health Minister after this was passed was Tony Clement who showed his support for those afflicted with schizophrenia by attending the banquet at the Schizophrenia Society of Canada annual conference when it was held in Toronto. As mentioned above, the schizophrenia group complained that no elected official would meet with them to discuss the flawed bill they were implementing. I have always had respect for Tony while detesting his ultra right policies further honed in the Federal Harper government.

The one member of the legislature who has done the most, in my opinion, to improve services for the mentally ill and the disabled was Conservative Christine Elliott. It was her pressure that resulted in the Liberal Government establishing an all party select committee to look at possible reforms. Despite an excellent report agreed to by members of all three political parties, nothing has been done. Sadly, she left politics after not winning the party leadership but she is the first ever patient ombudsman in Ontario.

And this regressive attitude on mental illness by the left is not unique to Canada. My advocacy friend, DJ Jaffe of the Mental Illness Policy organization in New York often comments that even though he is a Democrat, the most progressive people advocating for improvements in the US are Republicans. He is referring to a bill by Republican Congressman, Dr Tim Murphy called the Helping Families in a Mental Health Crisis Act. I suggested that Canada could use help in mental illness reform from a Republican back in 2013. In 2014 I wrote about how little we could hope for reform in Ontario.

To demonstrate further the left attitude to mental illness, you just have to look at the critical comments that my most recent blog on the anti-psychiatry scholarship garnered. One woman who is doing her PhD in Disability Studies at OISE claimed that I could not criticize because I am a white male member of the bourgeoisie. My proletarian father who worked in a garment factory on piece work and was a member of the Amalgamated Clothing Workers, would cringe in his grave located in the Independent Friendly Workers’ section of the cemetary.

That criticism goes on, quoting Barstow, that all that is needed to cure mental illness is that those with the illness know “we are cared for and that we are in control of our own lives.” Another critic said people “get better because they get free from psychiatry, find peers, get in touch with their inner experience, connect with and rely on others.” That same person also said “Psychiatry was invented by the privileged to dehumanise (sic) women, the neurodiverse, gay and lesbian and transgendered people, the poor, the Indigenous, and never-to-be-heard survivors of child abuse.”

I wonder how the scientists in the Faculty of Medicine or at the Centre For Addiction and Mental Health with their budget of $38 million a year feel about being told they are oppressors?

I haven’t heard such rhetoric since the days of Trotskyites on university campuses in the 1960’s but would love to see these critics spend some time in a psychiatric hospital ward with unmedicated schizophrenics, those experiencing the mania of bipolar disorder, or in a severe depressed state. I’m sure they would find some way to rationalize why their attempts to free them from “dehumanizing” psychiatry did not work.

Anti-Psychiatry Bold and Profane

By Dr David Laing Dawson

Let me make a simple bold and somewhat profane statement about anti-psychiatry. Which I take to mean, really, anti-medical-pharmaceutical-psychiatry.

When I entered medical school and later psychiatry, I would have been content to believe that all these psychiatric illnesses were entirely “psychological” in origin and form. It was the 1960’s so I was even quite ready to believe that all this insanity was really a sane response to an insane world.

Insanity is fascinating. I have spent hours talking with, listening to people who believe the CIA is watching them, their phones are bugged, the television sends them messages, they are emissaries of God, the voices tell them they must kill someone, they are controlled by radar, Xrays, Radio waves, microchips, which in turn are controlled by the police, shadowy evil figures, particular races, the CIA, the Mafia, Martians and Venusians. The devil has figured in many of these conversations. God in many others.

I have talked with people who fear to leave the house, who keep the blinds down lest the watchers watch them, people who can’t cross an open patch of land, people who must count the ceiling tiles, who must pray every time they think a bad thought, people who must have every sequence of action and thought end in an even number.

I have talked with people too depressed to talk, to move, to shit, to piss. I have talked with people too agitated, too distraught, too full of dread to sit. I have talked to people who assumed I came from either God or The Devil or both or either. I have talked to people who could not complete a single sentence without it wandering elsewhere. I have written questions on paper for people who feared to talk at all. I have talked with people who keep their eyes on the door, or on the ground.

I write fiction and plays. Dreaming up historic, family, life event, and even intrauterine causes for mental illness is fascinating. I have entered a patient’s delusions. I have explained to a woman who thought her self to be Queen that I was the Prime Minister and therefore, in our parliamentary democracy, someone she could listen to. I have talked to “the illegitimate son of Adolf Hitler”, to a man who could “whistle up the wind”, and to women who set themselves on fire. I have talked with a man who killed two children and then their mother.

I would actually be content (but for the suffering from depression of my own mother) to have these people in humane mental hospitals, fed and clothed and active and cared for and available for me to talk with, explore, dialogue with, interpret, help to find a psychological cause, a trauma, a series of adverse childhood experiences that might explain their perceptions of reality. In fact I have done all of these. I have sat next to a manic with arm on her chair to comfort without touching, on a mattress on the floor with a man wanting to kill somebody, in parking lots and back porches. I have talked with a “King of Kings.”

It is fascinating. It is human. It is dramatic. It is sometimes comedic. It can provide me with wonderful fodder for my fiction, my plays.

But I am also a doctor. And as much as I romantically like the idea of being an Alienist, living in the manor house of the large Asylum and dining with the “lunatics”, or setting them free to roam a Grecian Isle, I must try my best to relieve their suffering. And, it seems, that from the mid 1960’s, just when I entered this field of psychiatry, we began to develop pharmaceutical agents that actually work, that relieve suffering, that restore functioning, that control these terrible illnesses.

My patients want their suffering relieved. They want their function restored. They want their illnesses controlled.

So, my anti-psychiatry friends, I must continue to prescribe drugs, relieve suffering, help restore functioning, and forgo the psychoanalytic pleasures, the philosophical, poetic explorations, the mad interpretations, just as I must insist on vaccinations for all children, and forgo all the wonderful and fanciful spiritual and moral interpretations of spots, and fevers, and delirium of the early 19th century.

The “Logic” of Anti-Psychiatry

by Marvin Ross

Our last couple of blogs have generated considerable criticism from the anti-psychiatry folks on Facebook. Not unexpected, of course, and I do enjoy (to a point) debating with them. I know that nothing that I or others say will sway them but it is important to expose them. If left unchallenged, they may influence some who are not as well educated in the realities of serious mental illness. And, for far too long, those shrill and hostile voices have made politicians cautious to implement reforms.

My blog on belief systems and anti-psychiatry I modified slightly and redid on Huffington Post. They gave the headline as Anti-Psychiatry Folks Cannot Ignore That Medication Saves Lives A much better head than mine.

One comment this received on Facebook included this:

How many people have you treated, Marvin, that your blogging is somehow more accurate than Robert Whitaker’s journalism? He spoke with psychiatrists and other mental health professionals too, many of which (sic) prescribe medications and are involved in Mad in America.

My reply:

Neither Mr Whitaker nor I have treated anyone as neither of us are doctors. I’m a simple medical journalist like he is but I also have a family member with schizophrenia so I have first hand experience into what the disease is like when it is not treated and the difference that properly prescribed medication makes. I too have talked to many psychiatrists.

The reply

Having a family member who is diagnosed with schizophrenia is not first-hand experience. It is second-hand perception, at best, depending on how much one is trusted. The person with the diagnosis is the only person with first-hand experience…not doctors, not family members.

Now I do agree that those of us who have never experienced a disease do not know exactly what it is like. But that does not mean that medical specialists do not know how best to treat based on the currently available research and the guidelines established by experts in the field. That goes for psychiatric diseases, cancer and all other diseases humans contract. And Robert Whitaker is not in step with mainstream medicine given how many have criticized him.

I don’t know all the people involved in Mad in America but I do know one – Dr Bonnie Kaplan. She is a psychologist at the University of Calgary and the leading “researcher” on The Truehope product called EM Power +. She gives a continuing education course on Mad in America on Nutrition and Mental Health where the value of EM Power + (EMP) is talked about.

To one person who posted in the discussion to her program, Dr Kaplan had this to say:

I do not see why people should not take one of the mineral/vitamin supplements that emanate from the two Alberta companies, but I cannot figure out the context for your question. If you want to discuss offline, my email is kaplan@XXXX. The appropriateness and the dose of these formulas can vary with the individual.

The two companies are Truehope and the offshoot Hardy Nutritional which was formed when the two founding partners – Tony Stephan and David Hardy – dissolved their partnership.

In 2002, Dr Kaplan’s research trial on EMP at the University of Calgary was shut down by Health Canada because it failed to meet the proper standards for a clinical trial.

The blog Neurocritic entitled one of its articles as EMPowered to Kill as one man with schizophrenia went off his meds to take EMP and brutally killed his father in a psychotic state. I have written on this case as well in Huffington Post. Health Canada has declared the product a health hazard on two occasions. I have written critical article about this in various publications and an e-book with Dr Terry Polevoy and a former Health Canada investigator and now private detective in Calgary, Ron Reinold, called Pig Pills.

The vice-president of Truehope is David Stephan who made headlines around the globe when he and his wife were convicted in the death of their toddler from untreated meningitis by a jury in Lethbridge Alberta. Both had worked as well at the Truehope call centre advising customers on their treatment. You can listen to some calls that were made to the call centre here

Dr Kaplan gives lectures where she tells the audience not to google her name (slide 3). She even went so far as to bring professional misconduct charges against Dr Terry Polevoy with the College of Physicians and Surgeons of Ontario because he criticized her work.

She is one of the people involved with Mr Whitaker on Mad in America.

Dr Dawson’s last blog on anti- depressants and benzodiazapines also received a great deal of criticism. A favourite is:

Yeah, I like to get all of my information about psych drugs, withdrawal, discontinuation, and side effects from someone’s hypothetical idea of what it should look like without their having any clue at all what actually happens when people stop or start psych drugs.

And

who wrote this drivel? – It’s not even remotely accurate

I suggested to this last person that they look at the byline to see who wrote it and then look at his bio which is on the blog. I also suggested that they state what specific statement he made that they considered wrong and to provide me with evidence from research to back it up. Nothing. And Dr Dawson has worked in psychiatric hospitals in three Canadian provinces, in the UK, was chief of psychiatry in one and has been treating patients for close to 50 years.

When I suggested to someone that prescription drugs are monitored by regulatory bodies and removed from the market if their are problems, I was met with disbelief that anything is monitored. After I posted the link to the 35 drugs removed from the market by the FDA, there was no comment. Some are psychiatric drugs and two were drugs that I took for arthritis that I had no problem with and were very effective. No comment.

And no one commented when I posted this video of the author of My Schizophrenic Life.