Category Archives: Schizophrenia

More on What Families Need and Don’t Get

By Marvin Ross

This original  blog post on what families need and don’t get seemed to have touched a nerve with many as it was shared far and wide and received a number of interesting comments. I thought I would reply to some of them.

The first comment stated that family involvement that I wrote about bears no resemblance in the US because of the privacy legislation under HIPPA. That very same situation exists in Canada as each province has its own privacy legislation. Doctors on both sides of the border hide behind that as an excuse to avoid dealing with families but, if they do, they should be challenged. Any good psychiatrist will ask if the family can be involved but the problem arises if the patient gives a blanket no.

The doctor should not leave it as no and the family should insist that further questions be asked of the patient. Quite often, there are issues like drug use or sexual activity that the patient does not want revealed but is willing to allow other information such as diagnosis or treatment options to be revealed. A doctor who refuses to include the family some way even when the patient says no is, if I may, an idiot and it should be challenged by the family.

We only went through this once and the reason for the no  was uncharacteristic. The patient feared that if the family had information, the government would find out and steal all his money. Had the doctor asked why, he would have realized that the paranoia was extreme. The damage caused by this was rectified and the doctor was reprimanded by the hospital.

A retired psychiatric nurse pointed out that nurses today are inundated with paper work and reports that take time away from their ability to interact with patients. Bureaucracies are in the cover your ass mode and require that all this be done in order to defend themselves from angry family when something goes wrong. Nurses spend too much time sitting in front of computer screens entering data or, as I’ve often seen, wandering the halls with a computer pad recording patient activity.

They do their best to interact with their patients but the system is designed against that. As an older retired psych nurse trained in the UK pointed out, nurses in the 1960’s engaged with patients far more than they do now. Talking to patients, having coffee with them and walking with them can have a beneficial effect but there is just not enough time for them to do that. Hospitals really need to reduce the cover your ass paper work and get back to basics.

Another comment pointed out the propaganda that many health professionals spout such as the mentally ill being the victims of violence rather than being violent themselves. That is true for those who are stabilized and not actively psychotic but it is not true for those who are psychotic. Families want to know the truth and deserve to be told the truth and not lied to as if they were little children. Mental health staff need to be more honest with families and so families should question and press the staff on what they are told. Demand evidence and sources from what they tell you.

Finally, it was suggested that the family meeting was deficient because there were no patients involved as required by the Strategy for Patient-Oriented Research (SPOR) policy of the Canadian government. That policy pertains to identifying “gaps in treatment and care, provide the best evidence to fill those gaps and conduct new research when existing knowledge is incomplete”. This meeting had nothing to do with research but I do agree that people who are “recovered” are a good source for families to see and hear.

Families of newly diagnosed are raw and hurting with little idea of what the future holds for them or for their relative. Being able to see someone who has done well with treatment can give them hope and allay their fears. The family education program that I referred to in the original blog did have one session with someone who was doing well. The most impressive example we saw was that of a young mother who was hospitalized. The woman had schizophrenia and was receiving ECT in hospital when we met her. Some time later, I was in line getting coffee in the hospital coffee shop when this attractive and well dressed woman said hello to me. She realized that I did not recognize her and introduced herself as the woman from the inpatient unit who was undergoing ECT. “This is the post ECT patient you met before” she explained.

At that same time, one of the patients on the unit who was in and out of the seclusion room was a professor emeritus at the medical school the hospital was affiliated with. He would send the nurses to his office to pick up his mail as the faculty was in the same building.

So yes, families do need to see some successful people and to realize that mental illness is an equal opportunity disease. It does not discriminate based on gender, income, education or race/ethnicity.

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What Families of Serious Mental Illness Need (and often don’t get)

By Marvin Ross

joanna cheung at panel event.
Joanna Cheung, art therapist giving presentation while Drs Lori Trianno and David Dawson look on.

I decided to write this after the feedback from an event in Richmond Hill, Ontario put on by Home on the Hill, an organization which serves families and loved ones affected by serious mental illness. On May 10, this agency north of Toronto held a luncheon in honour of Mental Health Week. In the words of the president, Kathy Mochnacki, “This event featured a panel consisting of a psychologist, psychiatrist and a social worker/art therapist and the goal was to give families information about schizophrenia and psychotic illness. Our panel was stellar with psychologist, Dr. Lori Triano (president of the Schizophrenia Society of Canada), psychiatrist, Dr. David Dawson and Certified Art Therapist/Social Worker, Joanna Cheung from Markham Stouffville Hospital’s mental health system. Our local MP Majid Jowhari (member of Parliament in Ottawa) was there as were Richmond Hill Councillors, Karen Cilevitz, Godwin Chan, and Tom Muench from our municipal council, the York Regional Police,” and various mental health agencies.

Both David and I have spoken to this organization on a number of occasions and David commented to me after that the families just could not get enough information.

Talking to Kathy after, I was surprised to discover that most if not all the families received nothing like the support my family has received over the years. I thought I would share what I think would be an ideal situation for a family learning that their loved one has schizophrenia, bipolar or some serious mental illness.

When the person is diagnosed and that is usually in a hospital setting, the family should be told in a meeting with the staff who have cared for and diagnosed the person. You should be given information about the condition, an idea of treatments, prognosis, and what to expect down the road. You should also be provided with resources like books, pamphlets, courses and whatever might be of value. We got most of this.

Discharge should involve housing if that is needed and referrals for follow up care to doctors and agencies that will continue with the care and the road back to what may be a new normal. Of course families should be involved with the follow up care. In my family’s case, appointments not only initially involved the psychiatrist but a nurse educator and referral to an excellent program called Family Education and Training.

I am not sure if that still runs but there are considerable resources for families at my local hospital. This is a link to those In addition to a library, there are programs such as family peer support.

Families should always be involved on any ongoing care and treatment unless there are unique circumstances that prevent that. We have almost always been involved and able to talk to doctors or others. There was one time during a crisis where this did not happen and the result almost led to a very disastrous outcome. Fortunately, this was overcome much to everyone’s surprise and relief.

The doctor and the staff whose stupidity caused that problem were all reprimanded by the hospital and I was told that the incident was recorded on their personnel file.

The young psychiatrist who was left to pick up the pieces and put them back as well (along with a young social worker) said that there are better outcomes when families are involved. He also added that he has many patients with no family involvement and that makes recovery far more difficult.

What I have described here are things that those with problems like cancer, diabetes, MS, and on and on mostly already receive now. There is no reason that psychiatric illnesses do not get those too. I can only suggest that all of you make those demands of your health care providers and be as insistent as you have to be. Don’t be afraid to threaten legal action or of notifying the press.  Never worry about what they may think of you but just do all you can to make them do the right thing. What do you care if they may not like you and not want to go have a coffee with you.

While I may be painting my own local hospital in a favourable light, it gets there partly because they get pressure from the community. A few years ago, one of the doctors leaked that there were plans to move a satellite unit servicing an area with limited resources to the main hospital. I wrote about it and others complained and the unit is still there today.

In April this year, three psychiatrists quit the local psychiatric ER and the medical school pulled their residents out. Four days later, the hospital announced major changes. The safety problems were pointed out to the hospital a few years ago but suddenly, they had a solution.

As the result of the overcrowding at the ER, Arthur Gallant was made to sit in the general waiting area, hands cuffed behind his back with a police officer on either side of him, He is suing the hospital for $25,000. I’ve corresponded with Mr Gallant over the years as he used to write a regular blog on mental illness for Huffington Post. Arthur was 1 of 5 Canadians named as a Face of Mental Illness by the Canadian Alliance on Mental Illness and Mental Health which is an initiative of Bell Let’s Talk. Arthur has been featured several times on TVO’s The Agenda with Steve Paikin and in The Toronto Star, CBC’s The National , CTV News Channel, The Globe and Mail, CHCH’s Square Off, and an educational video for the Canadian Mental Health Association (Ontario Chapter).

And I should mention that he was a member of an Ontario Government advisory panel on mental health.

If you want improvements, fight for them!

An Addendum by Kathy Mochnacki MSW RSW of Home on the Hill

I did attempt recently to have coffee with the President of the Board of an organization which appears to be positioning itself as being an example of “evidenced based community treatment” for mental illnesses.  I had hoped to make him aware of the 50%  of people with schizophrenia and the 40% of people with bipolar who have the symptom of “anosognosia” and therefore lack insight and cannot access the voluntary services of his agency.  There needs to be the political will to find innovative ways to help these individuals.

Perhaps there would be fewer  homeless mentally ill people if his agency was a little more flexible.  I was not upset that he did not have coffee with me, but very concerned. as a family caregiver and a taxpayer, that he and his Board are responsible for allocating millions of our tax dollars to his agency’s programs yet he does not appear to be interested in learning about the symptoms of these horrendous illnesses.

I later met with my MP, Majid Jowhari, who has arranged for  Home on the Hill to have input into his mental health platform for the upcoming federal election. We will be asking that there be more awareness of the symptoms of mental illness among mental health service providers and more effective mechanisms of accountability.

This short video (17 minutes) is of the Q and A with answers on how drugs work, dealing with lack of insight and cognitive remediation ( “Video by Billy Dennis”)

A Belated Mother’s Day for the Heroes of Those with Serious Mental Illness

A mea culpa as we neglected to mention mothers on mothers day. My  fellow advocate in the US always gives a shout out to all the moms who spend mother’s day visiting their ill kids in jails and wherever else they may be found. Katherine Flannery Dering, the author of Shot in the Head A Sister’s Memoir A Brother’s Struggle, published by Bridgeross posted this for mother’s day. It is worth the read.

Mother’s Day

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Katherine Flannery Dering

 

My younger brother Paul suffered from severe and treatment-resistant schizophrenia. He developed the illness at age 16, in 1976, and never really recovered. He was frequently delusional and paranoid, and sometimes threatened violence. But our mother never gave up on him, always believing that one day soon, a cure would be found. It was our job to keep him safe until then.

At the onset of Paul’s illness, psychologists still tossed around terms that blamed the mother in some way for the condition. The terms “smothering mothering” and the “schizophrenic mother” were bandied about in pseudo-scientific literature. At other times mental illness was often blamed on repressed homosexuality or an Oedipal complex – Freudian beliefs still popular in some circles. And in many people’s heads, it was linked to the sufferer’s own sinful ways or to some God-assigned stigma. Mother knew this was nonsense – or tried to believe it was nonsense, and carried on, determined to do her best for her son.

Paul’s care was often hampered by lack of funding and accessibility to good care. Because of the many false beliefs in the general population, insurance companies were permitted to set lower lifetime limits for expenditures on medical care for mental illness and higher co-pays – often 50%. This is how my parents reached the point that they could no longer afford to care for Paul themselves. After about 18 months, after mortgaging the house to the hilt to pay hospital and doctor bills, they were forced to sign him over to be a ward of the state, and he was committed to a state psychiatric hospital. But no sooner was Paul admitted, than hospitals began to close. Little by little, the less severely ill were released.

The nineteen seventies and eighties saw a public zeal to release all mental patients from mental hospitals. I had been living in Minnesota when Paul became ill, but in 1981, I moved back to New York State to be closer to my family after a divorce, and I began to become involved in his care. I found that New York had already begun to empty and close all the state mental hospitals. This wasn’t unique to New York; it was a national trend. Beginning as a trickle, the great emptying had become a torrent by the mid-1980s. The United States had 340 public psychiatric beds available per 100,000 people in 1955; by 2005 there were only 17 beds per 100,000. And hospitals still continue to close every year, across the country. Much of this shrinkage in capacity at psychiatric hospitals during these years was a result, direct or indirect, of the introduction in 1954 of chlorpromazine (Thorazine), the first effective antipsychotic, which made it possible, for the first time, to control the symptoms of schizophrenia and thus discharge some patients. Paul was on Thorazine and similar medications for many years.

By the mid-1980s, the doctors treating Paul were well aware that a neurological component was primary to the disease; it was not a behavioral issue. Doctors were also well aware that not everyone benefitted from the new medications; some still needed long term, supportive care. But despite the rapidly growing body of knowledge that pointed clearly to biological, neurological causes, old stereotypes persisted, and they took form in efforts to release all patients from mental hospitals.

During this time, well-intentioned do-gooders, as my father called them, had sued New York State to close down the huge state institutions, made infamous by investigative reporting on places like Willowbrook, on Long Island, where developmentally disabled people had been mistreated. This movement was intensified by an aspect of Medicaid: its reimbursement schedules were written to withhold payments to large mental institutions, accelerating the closures nationwide. New laws called for smaller, more humane, community-based residential facilities for patients needing long term care. One by one the old hospitals closed; a few homes were built for people with Downs Syndrome and the like, but no one wanted crazy people in their neighborhood. Almost no smaller facilities were built for people like Paul.

The shrinking population of those suffering from the most serious mental illnesses rattled around on a few floors of hulking, ancient hospitals, many of them built a hundred years before as sanitariums for people with TB. Paul’s hospital was one of them, with bars on the windows and double sets of locked doors. We felt bad for him, but we knew he would be unable to care for himself on his own. The former patients who were released often ended up in slumlord- operated single room occupancy buildings (SRO’s) and adult homes, where they were still confused and unable to care for themselves and now had no supervision. The streets of New York and other big cities suddenly were full of mentally ill homeless people wandering around, sleeping in doorways, dying of exposure or getting arrested. Eventually, our prisons filled with mentally ill people who, only twenty-five or thirty years before, would have been humanely cared for in an institution—people who by law should have been cared for in new, smaller, community care facilities.

Every time there was a story in the papers or on TV about one of them, Mother cringed. A mentally ill man pushes someone off a subway platform. A mentally ill homeless person wanders the streets of New York City pestering passers-by, is killed in a bar fight, is found frozen on the streets…

Mother would steel her mouth into a thin line. This will not happen to my son. I couldn’t stop him from going mad, but I can try to make his life as good as possible, within its limits. She volunteered at the hospital library. She stopped by the ward on non-visiting days. My son is not alone, her presence said. I am watching. She joined NAMI, the National Alliance on Mental Illness, a new organization which advocated for both patients and their families. Her focus at that time was always on making the remaining hospitals comfortable for Paul. We couldn’t imagine that he would ever be released.

Determined to keep her son safe, Mother stayed tuned in to public hearings and release meetings – sort of like parole hearings – at the hospital. She showed up for all of them, ready to insist that Paul stay hospitalized. “You can’t just release him. Transfer him to a nicer, smaller place, yes. But I can’t handle him. He’ll set fire to the house. He’ll get into bar fights. He’ll hurt someone,” she told anyone who would listen. She wrote letters to our Congressman and State Assemblyman.

Sunday after Sunday, Mother made the one-hour, forty-five mile, drive up Routes 684 and 22, from White Plains to Harlem Valley Psychiatric Center so often, she could recite every gas station, restaurant, fitness center, farm, antique shop, motel, bank, diner, lumber supply store, army surplus store, church, fast food joint, office park, bakery, school, ice cream stand, car dealership, nursery, and garden supply store along the two-lane state road. My house was about halfway between Paul’s hospital and Mother’s home in White Plains. She would visit Paul in the early afternoon, then stop off at my house for dinner. Her Sunday visits to Paul and me became a ritual.

Mother also made sure we included Paul at all our family gatherings, often making the long drive to pick Paul up for Christmas and Thanksgiving dinner herself, and ferrying him to my house or my sister’s house for the afternoon. For his birthday she made cupcakes for the ward. He’s your brother, she would say to us. We can’t abandon him. He needs us.

Our mother died in 1993—too young, at only 71, leaving advocacy for Paul in the hands of his siblings. I  have often thought that if she had taken half as good care of herself as she tried to do for her son, doctors might have dealt with her cardiac condition before her sudden death. I’m ashamed to say we were not as diligent about Paul’s care as she had been; within a year after she died, Paul was released—delusional, confused, and unable to care for himself. We siblings tried to advocate for him with social services agencies, etc., but what he needed was supervised care. It didn’t need to be at the hulking psychiatric hospital, perhaps, but there were no smaller, community-based long term care facilities for him. And so began his downward spiral—group home to ER to group home. We siblings did what we could for him, tried to make sure he got medical care, and stood by him when he developed cancer. Unfortunately, he died at age 48, in 2008. Eleven years later, we still advocate for better care and speak out in his memory.

And on Mother’s Day, I remember my mother and thank her for not only her unstinting efforts to care for her son, but also for teaching her children our responsibility to care for those who need help.

Follow Up on Smoking and Serious Mental llness and Psychiatry in Scandinavia

By Marvin Ross with an addendum by Dr David Laing Dawson

My blog on smoking turned out to be one of the most widely read blogs that we’ve done. I had made the point that people with schizophrenia have a shortened life expectancy of about 20 years compared to a shortened life expectancy from smoking of about 10 years. One of the reasons for the shortened life expectancy not involving smoking is the poor medical preventive care that these people receive from the health system.

Of course, there are those who argue that the treatment for schizophrenia – prescription medication – is a leading cause of death. I’ve just come across a paper from Sweden on real life mortality in a cohort of close to 30,000 patients. Data was collected on the period from 2006 to 2013 on all cause mortality among those with schizophrenia aged 16-64.

What the study found was that the use of long acting injecting anti-psychotics resulted in a mortality that was 30% lower than that for oral agents. Long acting paliparidone turned out to have the lowest mortality followed by oral aripiprazole. However, the use of any antipsychotics resulted in less mortality than not taking them. So much for the anti-medication faction who, in my opinion, have a great deal in common with anti-vaxxers.

My blog on open dialogue and the medication free units in Norway also resulted in a number of comments. Hakon Heimer pointed out that a recent article in Psychiatry Online found that “The present data on Open Dialogue are insufficient to warrant calls for further research on the program other than those projects that are currently under way.” The editorial on the research of Open Dialogue stated that “Unfortunately, the results of this review are underwhelming.”

Heimer is founder, project director, and executive editor of Schizophrenia Research Forum, an online knowledge environment for researchers, which is part of the Brain and Behavior Research Foundation. He also advises the National Institute of Mental Health in the US.

And then, I received this:

Linking up the mind emotions abuse illness and recovery

what a piece of dirt article , where is the bin, , how can anyone even accept the current system unless you a child abuser yourself… that all mentallness comes from and what the psychiatrist see all day, and then go hunting brain cells for 50 years and not do a thing,,,, if im wrong, show me or fuck of you bit of filth, or comment, the bomb is ready to blow, the troop are getting in place and the abusers just keep on abusing cause thats what abuse does

Not the first time I’ve had something like this nor will it be the last.

ADDENDUM:

Some other factors supporting these conclusions, including the lowest mortality being found with bi-weekly or monthly injections (vs pills):

Non adherence with oral antipsychotics is high. Depending on the definition of non-adherence, it is found in studies to be 20 to 40%, and underestimated by psychiatrists.

Non adherence with antipsychotic treatment results, for people suffering from schizophrenia, in higher rates of:

  • relapse
  • re-hospitalization
  • emergency visits
  • violence
  • being victims of violence and other crimes
  • arrest
  • incarceration
  • homelessness
  • suicide
  • Inattention to other health matters.

Thus the striking improvement in mortality with injectable antipsychotic medication could be simply attributed to improved compliance with pharmacological treatment.

However, non-compliance with all medications is a major problem. According to one study, about 1/3 of patients do not take all the pills they are prescribed while another 1/3 do not take what is prescribed at all.

Smoking and Serious Mental Illnesses

By Marvin Ross

smoking-918884_640
Image by Free-Photos from Pixabay

Over the years, I’ve written about the fact that a majority of those with serious mental illness smoke. In one of my earlier articles I talked about the research that shows that for those with schizophrenia, nicotine can be beneficial. In that article, I pointed out that “Recent research at Yale has found that nicotinic α7 receptors in the brain, when properly stimulated, are essential for proper excitation of the working-memory circuits in the cortex. Inhalation of nicotine is an attempt to stimulate those nicotinic α7 receptors. Smoking is not therapy and drugs to stimulate that receptor are being investigated. Until then, many of those with schizophrenia will continue to smoke.”

In a later article, I castigated the political correctness of so many health institutions for banning smoking by those with mental illness. Yes, smoking is harmful but for those with mental illness, they do find comfort and it is cruel to prevent them from smoking in specialized rooms. Those who can go out on a short pass can go out to smoke but not those in isolation. Being prevented from smoking only adds to their stress.

The Centre for Mental Illness and Addictions in Toronto went so far as to ban tobacco from their property entirely.

I was just reading a new attempt to help those with serious mental illness kick their habit. It is laudable as there are health benefits to quitting but at the expense of mental health. Locally, one of the schizophrenia programs in Hamilton has long run a quit smoking program for its members and that has proven to be very difficult. I’ve been told that the participants can’t wait for a break so they can rush outside for a smoke and that some people have taken the course numerous times with no luck in quitting.

This new trial of a novel strategy is called SCIMITAR+ [Smoking Cessation Intervention for Severe Mental Illness] and was described by the American Psychiatric Association. The study involved 526 adults with SMI (which included schizophrenia, schizoaffective disorder, and bipolar disorder) who smoked at least five cigarettes a day. To quote from the report “The participants were randomly assigned to receive usual care (access to smoking cessation medications and a telephone helpline) or a tailored cessation intervention for 12 months. The tailored intervention included cessation medications and behavioral therapy adapted to meet the needs of people with SMI; these adaptations included providing assessments and nicotine replacement before setting a quit date, providing home visits, and providing additional face-to-face support following smoking relapse.”

The results are fascinating. After 6 months, 14% of the intervention patients had quit compared to 6% for the treatment as usual group. Clearly, this intervention helped more than the usual methods but 14% is not a very optimistic number. After all, 86% were still smoking. By the end of 12 months, the quit rate was 15% versus 10%. thus the majority of people were unable to quit.

I really have to wonder if any of this is of any value. Smoking is bad for health and of that there is no dispute but is it worth the effort to bug people with SMI to quit. As a society, we can still ensure their health with regular checks into lung capacity, blood pressure and blood sugar. A UK study found that just having a serious mental illness reduces life expectancy more than being a heavy smoker. One reason for that is that those with serious mental illness do not get as good medical assessments as those without a mental illness.

The importance of proper medical care was nicely illustrated by a US study. Researchers looked at cardiovascular deaths in states with expanded Obama Care (ACA) and found that there were 1800 fewer deaths per year in states that expanded Medicaid under the ACA.

The benefit of proper regular health assessments with appropriate interventions will go a long way to ensuring that those with serious mental illness benefit from modern medicine and it will extend their lives. That is where the emphasis should be. Forget wasting time and effort on smoking cessation.

Courage to Come Back Award for Bridgeross Author

By Marvin Ross

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Photo courtesy of the Vancouver Courier

Bridgeross author, Erin Emiru (Hawkes) and the author off When Quietness Came: A Neuroscientist’s Personal Journey with Schizophrenia has just been named recipient of the Courage to Come Back Award in Mental Health in British Columbia.

Erin is the second Bridgeross author to win this award. Sandra Yuen Mackay (My Schizophrenic Life) was the first. Sandra went on to become one of the 5 faces of mental illness in Canada as well.

Erin is an amazing young woman (and all my authors are). The promo for her book describes her life up to the time the book was published as:

The true story of a young woman studying neuroscience who, in her final undergraduate year, has a psychotic break, attempts suicide and ends up in hospital. Her struggles to get well and to pursue her PhD are described in this book. Her story is geared to people from a variety of backgrounds. As a neuroscientist, Erin reaches out to the medical community who need to hear this side of the patient. As a schizophrenic, she reaches out to others struggling with this disorder, hoping to draw alongside and offer empathy and hope. Finally, she wants the general public, family and friends of people with schizophrenia to be better able to understand and sympathize with those afflicted.

9780987824448_frontcover

Since the book came out, Erin has begun work as a counsellor in the Vancouver Assertive Community Treatment and giving talks to doctors, nurses, students and families. Two of the recommendations she was given for the award were quoted in the Vancouver Courier.

Leanne Maylam, a nurse who met Erin when she was very ill said that I “met Emiru in the mid-2000s and consistently saw Emiru at her worst. Emiru was dubbed “Houdini” because of her uncanny ability to free herself from the restraints needed to prevent her from self-harming.”

The pair now work together on the ACT team and Leanne added “I admire Erin. Through her courage, strength and tenacity, she has turned her struggle with her own mental health into a symbol of hope for those with their own struggles. Erin is not a ‘schizophrenic,’ she is a wife, a daughter, a sister, an aunt, a colleague… she is my friend.” .

One of her clients said “Erin understands me like I never thought anyone ever could. She is so kind and patient and compassionate and with her help I have been able to finally learn that my best is OK and to live a useful life.”

Erin is a staunch supporter of involuntary treatment which she once wrote saved her life.

This is her talk to a family conference in BC moderated by another Bridgeross author, Susan Inman (After Her Brain Broke)

Marijuana and Schizophrenia – Part II

By Dr David laing Dawson

It struck me recently the reason marijuana has been such a popular recreational drug is that while it causes distortions in perception (time passing, speed, sound, colour, light, music, intensity, memory, touch, focus etc) thanks to THC, it also contains differing amounts of CBD, a potent anti-anxiety, anti-arousal agent.

Usually such distortions in perception, especially for the naïve user, would lead to anxiety, arousal, sometimes fear and panic, and could obviously hasten along an evolution to psychosis. And some people do report very negative experiences after smoking a joint.

Clearly it is the CBD portion of the drug that allows those perceptual distortions to be pleasurable.

I am absolutely sure that marijuana does not cause schizophrenia, but it could easily hasten it along, especially with heavy use. On the other hand CBD is an effective, and so far apparently safe, anti-anxiety drug and possibly safer for controlling anxiety than prescription lorazepam.

But, as I have pointed out to teenagers who asked for marijuana prescriptions to quell the pain of a breakup, impending exams, getting a part-time job, they should and need to be experiencing anxiety. Some anxiety is necessary for growth, for learning, for engaging with the world.

Many boys who smoke daily from, say age 16 to 23, are still obviously, in many ways, 16 when you meet them at 23.

CBD yes as a good medicine.

Marijuana in moderation, at least until achieving some level of maturity.

Marijuana and Schizophrenia

By Marvin Ross

pot
Courtesy of pixaby.com

Now that marijuana is legal in Canada and in many US states, understanding the role of this substance in the development of schizophrenia is even more crucial. Schizophrenia has long been thought to be associated with pot smoking but the causality has been in doubt.

In my book, Schizophrenia Medicine’s Mystery Society’s Shame published in 2008, I cited the research that was current at that time.

The classic study was that of a long term follow up of Swedish conscripts aged 18-20 in 1969-70. A total of 50,087 young people representing over 97% of that country’s 18-20 male population reported on their use of cannabis, other drugs and on several other social and psychological characteristics. The researchers then looked at hospital admissions for schizophrenia amongst this group. It was found that cannabis was associated with an increased risk of developing schizophrenia. The greater the use then the greater the risk. The researchers concluded that there was no question but that the link between the two was causal. Cannabis use caused schizophrenia and the link was not explained by the use of other psychoactive drugs or personality traits.

However, it has also been hypothesized that schizophrenia leads to a greater use of marijuana likely because people are trying to medicate themselves. A number of years after the above study was published, Scottish researchers looked at all the studies that had been done on the link between cannabis and schizophrenia between 1966 and the end of 2004. That study agreed with the original findings. Early use of cannabis does appear, it said, to increase the risk of psychosis and that cannabis is an independent risk factor for both psychosis and the development of psychotic symptoms. Again, it has been argued that prodromal symptoms of schizophrenia lead to an increased use of marijuana. Then, while the disease is developing, being stoned speeds up the developing deficits of the disease.

Malcom Gladwell in the New Yorker and New York Times reporter Alex Berenson recently wrote about the correlation between marijuana use and violent crime. Gladwell cited a National Institute of Medicine research report and Berneson produced a book on the topic called Tell Your Children: The Truth about Marijuana, Mental Health and Violence.

Marijuana researchers objected strenuously to the link of marijuana to crime and I tend to agree. But Gladwell also linked pot use to schizophrenia and that too set off the marijuana researchers. Ziva Cooper, one of the authors of the National Academy of Medicine report, objected to the association of marijuana with schizophrenia. She said that the National Academy did find a link between marijuana and schizophrenia but that they also found a link between using cannabis and improved cognitive outcomes for people with psychotic disorders.

Now that I can also believe but the researcher is mixing apples with oranges. Marijuana is comprised of THC which is the hallucinogenic and CBD which is not. It is the THC that can push people to psychosis and when smoking pot, you do not know how much of each is in the joint. And, of course, the potency of pot today is much greater than it was in my day.

According to a research update in Psychiatric Times “Cannabidiol (CBD), the second most active ingredient in marijuana, has been hypothesized to have antipsychotic effects—in contrast to tetrahydrocannabinol (THC), which may promote or worsen psychosis”. Recent research in the American Journal of Psychiatry found that “CBD has beneficial effects in patients with schizophrenia. As CBD’s effects do not appear to depend on dopamine receptor antagonism, this agent may represent a new class of treatment for the disorder”.

However, people should be aware that when you smoke a joint or nibble an edible, you have no idea how much THC or CBD is in the product.

And, as the brain continues to develop till about the age of 25, those under that age should be cautious particularly if they have a family history.

Time to Relegate Anti-Stigma to the Garbage Heap – Part Two

By Dr David Laing Dawson

There is a moment for most of us sometime in second year University studying linguistics, humanities, philosophy, psychology when questions of truth, reality and delusions become quite interesting. Is there really a difference between the man who believes the CIA is watching him (assuming they are not) and the man who believes Jesus turned water into wine without the aid of grapes and fermentation.

Is what we call a delusion just a lived experience no different than a thousand other unfounded beliefs the rest of us live by? Is it just a social judgment by which we differentiate?

The answer is no. Though it may not be readily apparent to other than a family member or someone who has spent years treating schizophrenia.

First of all the delusion, the false belief of the schizophrenic is almost always tormenting: being watched, controlled, denigrated, persecuted. And when it is not that, when it endows the schizophrenic with a power to right these wrongs, it is dangerous.

And secondly, most clearly differentiating a delusion from an ordinary unfounded belief is the accompanying cognitive deficit.

This is not a cognitive deficit that shows up on an IQ test. This is rather a more subtle and complex social information processing deficit. It is a deficit in the ability to stay grounded in this social moment including having a governing awareness of the effect we are having on others and of the consequences of what we say and do. It is this deficit that differentiates the disheveled man ranting about God on the street corner and the Jehovah’s witness knocking politely on my door.

Schizophrenia is a brain illness for which we have effective treatment.

And as Marvin points out, stigma is not reduced by railing against it. When the subject of the stigma is a frightening illness, stigma is reduced by naming that illness, understanding that illness, and ensuring that it is treated.

Time to Relegate Anti-Stigma to the Garbage Heap

By Marvin Ross

I am so terribly tired of all the effort and money spent on fighting the stigma of mental illness. I don’t really think it is that much of a problem. What is a problem is discrimination – the fact that mental illness does not get the health funding that it should when compared to other illnesses. There is a lack of beds, a lack of community supports, a lack of support for family caregivers and I could go on.

I feel a bit like Howard Beal did in the classic 1976 film written by the brilliant Paddy Chayevski and I am mad as hell. His famous line can be seen here

A couple of things have set me off. The first was the appointment to the Order of Canada of Professor Heather Stuart who holds the Bell Mental Health and Anti-Stigma Chair, the world’s first anti-stigma research chair at Queen’s University in Kingston, Ontario. I’ve met Heather, have corresponded with her a number of times, and years ago I backed her getting a grant from the Schizophrenia Society of Ontario to conduct a study of stigma by health professionals against those with schizophrenia so I’m pleased for her to win recognition. Sadly, her efforts to promote anti-stigma do not improve the treatment for anyone.

As an advocate in Kingston Ontario continually tells me, the streets of downtown Kingston are filled with ever increasing numbers of obviously untreated mentally ill. Maybe Heather should get off her endowed chair and try to get them some help.

The other event this week was told to me by a Toronto advocate who notified me of a bioethics lecture at the University of Toronto entitled Reflection on Mental Health Stigma, Narrative, and the Lived Experience of Schizophrenia (you have to activate Adobe Connect to see it). The presenter was a PhD candidate in philosophy at York University in Toronto.

To his credit, the lecturer admits the existence of anasognosia and that people with schizophrenia do have cognitive deficits. However, he suggests that many people fear those with schizophrenia. I think many of us do if they are not treated and are in active psychotic states. He does seem to suggest that doctors should accept the delusions that people have and not ignore their lived experiences. He also suggests that people are told that there is no recovery.

What he did not seem to differentiate between was treated versus untreated and that is crucial. It is true that recovery to a totally healthy state is not normally possible but many people can and do recover to live as reasonable lives as possible. And some don’t. That is the reality.

The notion that people fear those with schizophrenia and distance themselves needs to be qualified. Maybe some do but they are not in the majority. Those people will also fear and distance themselves from people diagnosed with cancer or some other serious and chronic ailment. They are not in the majority. Most people are sympathetic and many will tell you of relatives or friends who also suffer. Despite some tragic examples involving the police, the majority are incredibly sympathetic and understanding.

I remember one case years ago when a man with schizophrenia took off (as often happens) and the police found him miles away from his home. As he was over 21 and not declared incompetent, the police could not take him back to his family but the officer phoned his father 3 hours away and told him he would keep an eye on his son till the father got there. He did, provided cell phone updates and kept it up even when his shift ended so the family could be reunited.

When David Dawson was shooting his feature film on schizophrenia, Cutting For Stone, we needed a police cruiser in the middle of the night for one scene. Two cruisers showed up for us and one of the cops commented that if any group needed more exposure it was people with schizophrenia.They were happy to accommodate (available on Amazon for streaming) and I got a chance to ride in the front with the sirens blaring.

Many people with schizophrenia are willing to expose themselves to the public by telling their stories in books. Many of them I’ve published thanks to the willingness of people like Sandra Yuen MacKay, Erin Hawkes-Emiru, the late Dr Carolyn Dobbins, and Sakeena and Anika Francis. Others have done the same in books and blogs like Christina Bruni, The Unashamed Schizophrenic and others. Some have exposed themselves in documentaries like the ones in the film The Brush The Pen and Recovery directed by David Dawson (available on Amazon for streaming).

The same goes for those with bipolar disorder like Victoria Maxwell and many others including a new book called Mad Like Me. This one was originally submitted to me but I turned it down for a number of reasons. The author, however, did take some of my suggestions, rewrote it and had it published. Or, a book that I reviewed in these pages called Shatterdays Bipolar Lives

I often receive requests from people with schizophrenia offering to tell their stories as I did last night from a gentleman in California. His e-mail to me stated “I have been contemplating writing this manuscript for several years,and have decided to now ,because I feel there is no shame in having a mental illness, as it is no different than having a disease such as Epilepsy. I wrote this book to be in an advocate/activist position to be able to speak for those who cannot. If my book, my story, can help just one person, one family, it will have been more than worth the effort of writing it.”

I think it would be well worth it for mental health agencies to run writing workshops for people with mental illnesses.

But, let me circle back to the issue of stigma. Who in their right mind would not be fearful of a dishevelled ranting, untreated schizophrenic wandering down the street. I almost hit one the other day when he suddenly walked out into the traffic of a busy street impervious to the traffic.

The best solution to this stigma was offered by Dr Stuart’s partner, the psychiatrist Julio Arboleda-Flórez, He wrote:

The lesson to be drawn from these papers is simple: helping persons with mental illness to limit the possibilities that they may become violent, via proper and timely treatment and management of their symptoms and preventing social situations that might lead to contextual violence, could be the single most important way to combat the stigma that affects all those with mental illness. While most myths about mental illness can be traced to prejudice and ignorance of the condition, enlightened knowledge does not necessarily translate into less stigma unless both the tangible and symbolic threats that mental illness poses are also eradicated. This can only be done through better education of the public and of mental health service consumers about the facts of mental illness and violence, together with consistent and appropriate treatment to prevent violent reactions. Good medication management should also aim to decrease the visibility of symptoms among patients (that is, consumers) and to provide better public education programs on mental health promotion and prevention.