Category Archives: Schizophrenia

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

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

Below is the introduction:

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

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

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

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

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

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

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

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

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

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

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

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

 

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More on The Continuing Proof of the Efficacy of Anti-Psychotics

By Dr David Laing Dawson

The narratives from the proponents of Open Dialogue remind me of the narratives arising from the psychoanalysts working in private psychiatric hospitals in the United States in the 1950’s and 1960’s. Many case studies were available and even books written on the subject.

In the late 1960’s we were unlocking the doors of the mental hospital in Vancouver and applying therapeutic community principles. The principles and ideas of the therapeutic community can be found in the activities of the Open Dialogue program. And before that they can be found in the practices of small hospitals from the Moral Treatment Era of the 1850’s to 1890’s, and again, briefly, in some mental hospital reforms shortly after WW1 and before the Great Depression, albeit, in each case, within the language and pervasive philosophies of the time.

In the late 1960’s we had already discovered how wonderfully effective chlorpromazine could be in containing mania and reducing the psychotic symptoms of schizophrenia.

So in this context, knowing the evidence, the clear evidence of chlorpromazine being the first and only actually effective treatment for psychosis, and lithium for mania (beyond containment, sedation, shelter, kindness, protection, food, routine grounding activities, time and care) it behooved us to look closely at the claims of the psychotherapists who were writing such elegant and positive case studies from the American private hospitals.

So I read them.

They were interesting reading, detailing the relationship of therapist and psychotic patient, interpreting the content of the psychosis, and the painstaking time consuming process of building a relationship, working to help the patient view the world in a different manner, and always, through the pages of these reports, it was said great progress was being made. And they all ended with something like (this is the one I remember best) “Unfortunately, despite showing so much progress, patient X assaulted a nurse and had to be transferred to the State facility.” Curiously, as with many “studies” I read today, despite the obviously bad outcome, a paragraph is added at the end extolling the progress made (before the unfortunate outcome) and recommending we stay the course.

There are many interesting explanations for the continuing anti-medication (for mental illness) philosophies. (Note that almost nobody objects to taking medication for other kinds of suffering and illness). Marvin and I have written about a few – the preciousness of the sense of self, the wish that there be an immortal mind that can outlive a brain, the fear of being controlled, distrust of Big Pharma, professional jealousies, and turf wars. But writing the above reminds me of another reason this irrationality persists.

It was clearer to me then (1960’s/1970’s) than it is now, because we really wanted to find ways of helping without medication: It is much more ego gratifying to mental health workers of all stripes when our patients get better simply because of our presence, our words, our care, ourselves, than if we just happen to prescribe the right medication.

I remember well a patient, a professional, a few years ago, thanking me for helping him overcome a severe depression. “Nah,” I said, “I just managed to prescribe the right medication for you.” “No, no,” he said. “It was more than that.”

All right. There are a few moments when I can be attentive, thoughtful, kind, and even find the right words. But to try doing that alone while withholding medication for severe mental illness would be malpractice, cruel, egotistical, even sadistic.

 

The Continuing Proof of the Efficacy of Anti-Psychotics

By Marvin Ross

Despite the protestation from the anti-psychiatry advocates, medication for schizophrenia works and another study has just been published to support that position. A new study based on a nationwide data of all patients hospitalized for schizophrenia in Finland from 1972 to 2014 found that the lowest risk of rehospitalization or death was lowest for those who remained on medication for the full length of time.

The risk of death was 174% to 214% higher among patients who never started taking antipsychotics or stopped using them within one year of their first hospitalization in comparison with patients who consistently took medications for up to 16.4 years.

It should be pointed out that this is real life data rather than a clinical trial involving a total of 8,738 people.

What is particularly significant for me in this study is that it is from Finland which is the home in one isolated part of that country (Lapland) to the alternative Open Dialogue espoused by the anti-psychiatry folks including journalist Robert Whitaker of Mad In America fame. Whitaker claims that 80% of those treated with Open Dialogue are cured without need for drugs.

I wrote about Open Dialogue very critically back in 2013 in Huffington Post and pointed out that there is very little research to demonstrate its efficacy. I actually asked a Finish psychiatrist, Kristian Wahlbeck who is a Research Professor at the National Institute for Health and Welfare, Mental Health and Substance Abuse Services, in Helsinki about Open Dialogue.

This was his answer:

“I am familiar with the Open Dialogue programme. It is an attractive approach, but regrettably there has been virtually no high-quality evaluation of the programme. Figures like “80 per cent do well without antipsychotics” are derived from studies which lack control group, blinding and independent assessment of outcomes.”

He went on to say that:

“most mental health professionals in Finland would agree with your view that Open Dialogue has not been proven to be better than standard treatment for schizophrenia. However, it is also a widespread view that the programme is attractive due to its client-centredness and empowerment of the service user, and that good studies are urgently needed to establish the effectiveness of the programme. Before it has been established to be effective, it should be seen as an experimental treatment that should not (yet?) be clinical practise.”

As for the claim that psychiatric hospital beds in Finland have been emptied, he said “in our official statistics, the use of hospital beds for schizophrenia do not differ between the area with the Open Dialogue approach and the rest of the country.”

My blogging associate, Dr David Laing Dawson also wrote about Open Dialogue in this forum with very skeptical view. He stated that the director of the program admitted that about 30% of the patients in Open Dialogue are prescribed medication so arguing that medication is not used is not correct.

At the time my article appeared in Huffington Post, someone on Mad In America agreed with me that there was insufficient evidence on the efficacy of Open Dialogue and said that a US study was set to begin in, I think, Boston. I did find a completed study on Open Dialogue done by Dr Christopher Gordon. His study involved 16 patients and he states at the outset that

“Since this was not a randomized clinical trial and there was no control group, we cannot say that these outcomes were better than standard care, but we can assert that they were solidly in line with what is hoped for and expected in standard care.”

In the paper that is in a legitimate psychiatric publication, he states that of the 16, two dropped out and a further 3 had disappeared at the end of the study so no data is available for them. This is a study of 11 people who completed the one year term.

He then points out that:

“Of note, four individuals had six short-term psychiatric hospitalizations (two involuntary).”

and that:

“three of the six individuals who were not on antipsychotics at program entry started antipsychotics. Of the eight already on antipsychotics, four had no change in their medication, and four elected to stop during the year. Both groups of four had similar outcomes and continued to be followed in treatment. Shared decision making and toleration of uncertainty contributed to these choices.

Hardly the success he suggests if the goal was to help them get well without medication.

But, coming up at the end of May in Toronto we have a conference with Robert Whitaker and others on Shifting the Narrative on Mental Health from the psychiatric disease model to the relational/recovery model, and on the challenges that are stacked against that eventuality.

Now I would say that the challenges against that shift are science but they define it as “The challenges and resistances to progressive change are of an ideological, macro-economic nature guaranteeing a protracted and difficult struggle for recovery advocates.”

Reminiscences of Hockey and Schizophrenia

By Marvin Ross

This past week Johnny Bower, the 93 year old former great goalie for the Toronto Maple Leafs, passed away. One of the comments made of him was his charitable work along with the fact that he was goalie the last time the Leafs won the Stanley Cup. I’m old enough to remember that it was so long ago.

His passing twigged my memory of the time that the Hamilton Chapter of the Schizophrenia Society of Ontario were the recipients of the charity of old hockey players. I’m not sure when this began but I became involved in the chapter in the late 1990s and was chair for a few years. The largest and most successful fund raising event was the annual National Hockey League (NHL) Alumni Association golf tournament put on for us at a course north of Toronto.

The moving forces were our executive director at the time and Keith McCreary who was one of the founders of the NHL Alumni. Sadly, both are no longer with us. I attended two of the golf tournaments in 2000 and 2001 and Johnny Bower was there along with many of the hockey greats from my childhood. I certainly remember Red Kelly, Dennis Hull, Eddie Shack, at least one of the famed French Connection line for the Buffalo Sabres, and numerous others.

What struck me was their incredible generosity. Some donated memorabilia to be auctioned off and all of them were more than happy to peel off $50 and $100 bills to enter the many raffles that were held. Hockey players of that era did not make the big bucks that they do today as Dennis Hull mentioned in his after dinner stand up comedy routine. He commented that today’s players earn more in a day than most of the guys in that room made in their entire careers. But their generosity to a disease that most of them probably knew very little about was remarkable.

Another guest who was much beloved by the hockey crowd was Michael Burgess who often sang the national anthem at Leaf games and who played Jean Valjean in Les Mis. The players all loved his rendition of Danny Boy which he did that evening. The link above is to his singing on Youtube.

Also incredible was one mother who positioned herself on the first tee and subjected each and every foursome before they teed off with her lecture on the horrors of schizophrenia and the need for more treatment, family support and research. She was not a young woman but stood in the sun and heat for hours without either a pee break or a drink break so that she would no golfer would forget what they were supporting.

That night, I drove home with our executive director and what was left over from the day along with about $10,000 in cash for the bank when I was stopped in a police road block looking for impaired drivers. Fortunately, I had cut myself off early in the evening.

That was September 10, 2001 and we all know what happened the next day 9/11 that changed the world forever.

But, the moral of the story is that there are good people out there who can understand serious mental illness and do their bit to make the lives of those who suffer just a tiny bit better.

schizcover  For more on schizophrenia, see Schizophrenia Medicine’s Mystery Society’s Shame and other Bridgeross titles

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.

More on Trauma in Youth and Schizophrenia

By David Laing Dawson

This blog is in response to a comment made on an earlier blog called As For Trauma Causing Schizophrenia: No! No! No! 

The comment was how do you account for this study? And how can you claim that trauma cannot be causative of schizophrenia? https://www.sciencedaily.com/releases/2012/04/120419102440.htm

This is the answer:

There is no doubt severe trauma in childhood can have long lasting effects. But can trauma be a specifically causative element in the development of the full illness schizophrenia? And is it either a necessary causative element or a contributing factor?

Data mining and surveys come up with many associations, some weak, some strong. Fair enough. But we have to examine the definitions of each and every term and understand that association is not necessarily causative. And in this situation we must be very careful what we publicize because any association between trauma and schizophrenia provides support for parent blaming.

I am back to eating butter after something like 20 years of favouring margarine. This because for many years data mining found associations with butter and other animal fats and cardiovascular disease, and only recently further data mining and studies have shown that, au contraire, we need fat, and margarine may be worse than butter. Now I slather butter on my corn and biscuits without guilt. As someone else has pointed out, there is a very strong association between major road accidents and the presence of ambulances.

The word paranoia is used in many of those studies. I don’t know how they define it or determine it. Adolescents suffering from anxiety often experience what they call ‘paranoia’ but we refer to as ‘ideas of reference’. They feel their peers are always talking about them, judging them. Some avoid school because of this. Sometimes this feeling becomes a conviction and then it may be prodromal of a psychotic illness.

Bullying is interesting. I have 30 years of experience dealing with families in which a child is reported as being bullied by his peers. There are some distinct subcategories in this: In one subset, when the details are elicited, it turns out the boy in question is as much a perpetrator as a recipient. They taunt one another. But this particular boy tells his mother that Jason called him a “…..” in order to get a reaction from his mother, or to avoid something, or simply to get in front of the call that is going to come from Jason’s mother or the school.

A second subset is the Asperger/ASD child. They are common targets for bullying, precisely because of the way they react to unfairness, teasing, slights, and taunts. It is not kind and it is not good but they have become targets for bullying precisely because of the social deficits they already exhibit. My own survey reported on this site indicates that at least a third to a half of people diagnosed with schizophrenia have had autistic symptoms since infancy. So I would definitely expect a higher proportion of bullied children to develop a psychotic illness. The bullying is not causative, but the prodromal symptoms of the illness “invite” bullying.

Auditory hallucinations are not, in and of themselves, schizophrenia. People, girls, who have suffered prolonged sexual abuse report a higher incidence of auditory hallucinations. This certainly could be understood as persistent trauma of a particularly disorienting kind causing impairment in the brain’s otherwise quite miraculous ability to (usually) locate the locus of a thought or feeling, as well as causing all the other symptoms of PTSD as well.

On the other hand preteen and teen girls with ASD or prodromal symptoms of schizophrenia are vulnerable to predators within a family and neighborhood.

In sum, there are weak associations, though all suffer from our poor definitions and lack of clarity of diagnosis. None are strong enough to be considered causative. And if this were an association between salt intake and hypertension, to publish early causes little harm. (although even here we now have the problem of some people having too little salt in their diet, and other studies showing high salt intake may have nothing to do with hypertension).

But because this overall weak association with all its definition and cause/effect problems could support the existing serious prejudice of parent blaming for schizophrenia, I have to stick with my simple, “No. Neither psychological trauma nor poor parenting cause the serious illness we call schizophrenia.”

Though, of course, either could make it worse.

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.

Canadian Families Coping With Schizophrenia Don’t Have a National Voice

This blog post was written by Susan Inman and appeared in the Huffington Post on March 21. It is a sad shame that there is no longer a viable voice to express the concerns of families with members who suffer from schizophrenia.

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Families who care for people with schizophrenia once had an organization that gave them a national voice. They no longer do. This lack of national representation impacts not just our own situations; it also hurts the people we support, because they are often unable to advocate on their own behalf.

Family caregivers, who had previously established provincial advocacy organizations, came together over 30 years ago to establish the Schizophrenia Society of Canada.

Certain core values originally united these organizations. These values included building close ties with the psychiatric and neuroscience communities which had come to see schizophrenia and bipolar illness as disorders of neural circuitry. These groups sought to provide the most up-to-date education about these illnesses to people with the disorders, to families, clinicians, police, and the public.

As well, these organizations have advocated for high quality supported education, housing, and psychosocial rehabilitation services.

These organizations have also worked to dispel the unjustified blaming of families for psychotic disorders that earlier theories about these illnesses had propagated. The legacy of these beliefs, which have faded from psychiatry, have persisted and negatively impacted other areas of clinical practice. Frequently clinicians are still training in the many credentialed programs that don’t require any science-based curriculum on psychotic disorders.

Until recent years, the goals of these family groups had been represented by the Schizophrenia Society of Canada (SSC). However, while sitting on many national committees as the presumed voice of families, the SSC has failed to support the perspectives of the families who created it. It does not address the lack of appropriate curriculum in training many clinicians. Similarly, it does not work to provide basic information about schizophrenia in the annual national mental illness literacy campaign in which it plays a lead role.

These failures are occurring because its current leadership has given itself a different mandate. It has supported trends in the social sciences that seek to de-medicalize mental illnesses and advance the idea that all problems arise from social and personal adversity.

Instead of fighting against the stigma that too often interferes with the ability of family caregivers to develop collaborative relationship with clinicians, the SSC Executive Director, Chris Summerville, has actively promoted stigmatizing attitudes. For instance, he promotes the notion that families undermine the recovery of their family member by holding stigmatizing attitudes towards them.

Summerville has written that families block their family member’s access to treatment because they don’t want to expose their ‘family secret.’ At the same time he has failed to help people with illnesses, their families, and the public understand anosognosia, the brain based inability of many psychotic people to understand that they are ill. This is the symptom that families struggle with as they try to get an ill family member into treatment.

The SSC has also failed to promote the most progressive, evidence-based psychosocial treatments. In recent years there has been extensive research about the common cognitive losses that are associated with the illness. While most people’s psychotic symptoms can be controlled with anti-psychotic medications, the cognitive losses often persist. These include difficulties with concentration, short term and working memory, problem solving, and judgment. While BC’s Early Psychosis Intervention toolkit makes this information readily available and even educates people about useful cognitive adaptation strategies, the SSC ignores this issue in its educational programs.

Cognitive losses are widely understood to be the biggest factor in the extensive ongoing disability of this population. While espousing its commitment to the Recovery Model, the SSC has not only failed to provide education about cognitive problems. It has also failed to promote the evidence based cognitive remediation programs that can improve recovery; these programs have been expanding in other countries for the past 20 years.

While the SSC has failed to promote programs that are desperately needed, it has played a leadership role in the mis-education of the growing peer support work force. Many of us hoped that the new national guidelines for training peer support workers that the SSC helped create, would begin to provide peer workers with essential information about the illnesses of the people with whom they often work. The guidelines don’t require — or even recommend — that training programs offer any information about mental illnesses. Instead of informing peers about why people suffering from psychosis sometimes need involuntary treatment, peers are encouraged to oppose it.

Now the SSC leadership has taken an even more alarming step in securing its vision for this organization. It’s created a survey that has been designed to guide responders to provide the desired responses. The survey wants a mandate to move away for what it calls the “western medicine biomedical disease model” of schizophrenia.

The survey is also looking for support for getting rid of the term “schizophrenia.” However, schizophrenia has long been included in the Diagnostic and Statistical Manual that is used in mental health, criminal justice, education and social services. The diagnosis enables people to access disability payments and many other essential supports.

The SSC survey argues that we should substitute the term “psychotic spectrum disorder” for schizophrenia and points out that this term is used in early intervention programs. It doesn’t say that, when cognitive and other symptoms persist once psychosis is managed, people often receive more specific diagnoses like schizophrenia or schizoaffective disorder.

It’s convenient for national organizations to continue to use the SSC to ensure the presence of a family voice. However, the SSC doesn’t represent the perspectives of the vast majority of family caregivers I’ve met in the last seventeen years.

Maybe it’s time for the leadership of the SSC to create their own organization representing the conditions they consider significant and the alternative treatments they help popularize. They could return the SSC to the families of people with severe mental illnesses who created it.

The Absolute Discharge for Vince Li was wrong

By Dr David Laing Dawson

Vince Li has been treated now, for his schizophrenia, for 8 years. He has been living in the community and attending classes. The Review Board has given him an “absolute discharge”. He is, we are told, recovered, insightful, remorseful, and willing to take his medication regularly. Thus he is not a threat and qualified for absolute discharge.

He may well remain healthy and compliant with his medication for the rest of his life.

Perhaps the odds are slight that he will stop his medication and become ill again.

But, here are two realities about psychotic illnesses, schizophrenia in particular:It is hard to catch a relapse.

  1. When a patient stops his medication he will feel fine for a while. And when the relapse begins the first thing to become impaired is insight. One can monitor mood, but not one’s own cognitive processes. So very few people with schizophrenia who stop medication and feel good for a while, are then able to detect, on their own, the early signs of cognitive changes. As the illness worsens the prospect of insight lessens. It is the nature of schizophrenia. It affects thinking.
  2. When relapses of psychotic illnesses occur, the original delusion returns, if not exactly word for word, almost word for word. Thus if the original delusion was relatively harmless, in a relapse the patient’s returning delusion will be relatively harmless. “They are listening to my thoughts from the TV so I don’t ever turn it on.” “It is happening again.” But if the original delusion was dangerous: “I must kill to rid the world of the devil”, then when the relapse occurs the person in question will once again become dangerous.

Thus, even if the possibility of a relapse of illness for Mr. Li is small, such a relapse would be far more dangerous than for most people with this illness.

And if this occurs, if Mr. Li relapses and hurts or kills someone else, the cost will be much wider than Mr. Li and his victim. “Let’s talk about it” will certainly not be enough to reduce stigma then.

Such an occurrence will undermine the compassion and civility of the “not criminally responsible” finding.

The average citizen has trouble buying this defense now, for various reasons, especially when the crime is horrifying. If Mr. Li relapses and commits a crime, the community outcry will be very strong. A relapse and repeat by Mr. Li could thus do great harm to all mentally ill in Canada.

This could have been remedied simply: a discharge (though not absolute) that continued a lifetime of monitoring compliance with treatment. Not overly intrusive or restrictive. Simply making sure that Mr. Li continues his treatment, that he continue to take his pills every day or his injections every two weeks.

If Mr. Li stops taking his anti-psychotic medication, one year or ten years from now, the illness will relapse. And the delusions of this illness always return in the same form.

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.