Category Archives: Toronto

The Danforth Shooting – Violence and Mental Illness

By Dr David Laing Dawson

In the wake of the Danforth shooting a couple of my colleagues have been quick to point out that the association between mental illness and violence is small, that most people suffering from mental illness are more likely to be victims of violence than perpetrators of violence. They are worried about the stigma of violence attaching itself to mental illness. And of course they are right. Though one of them goes on to use those horrible euphemisms of “mental health issues” and “mental health challenges”.

Language is important as are the questions we ask.

If we expand the problem to “mental health issues” then I am sure I can rightly say that all acts of physical violence by one human against another are the products of “mental health issues”. Otherwise we will have to expand our concepts of normal and healthy to include physical violence.

And the use of such ill defined euphemisms plus our worry about stigma cause us to ask the wrong questions. Did he suffer from “mental health challenges” and “issues”? Of course he did. Is a circle round?

These are the better questions to be asked:

1. Did treatable mental illness play a role in the Danforth shooting?

(I have just read that the man in question “repeatedly cut into his face with a pencil sharpener blade” and talked of hearing voices – both symptoms of a treatable mental illness, a psychosis, probably schizophrenia)

2. If he did have such an illness why was it not being adequately treated?

(Not “supported”, “counselled”, “accommodated”, but treated)

And finally, because question 2 will always lead to imperfect answers, 3. How did he get a gun?

I have to add that while many people suffering from delusions never act on those delusions, especially if they are being treated, a very specific sign that a psychotic and delusional person will act upon a delusion (that is, attack his imagined torturers) is self injury to face or genitals.

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Yonge St. and Ready-Made Delusions

By Dr David Laing Dawson

In the early seventies a friend and colleague commented upon a popular piece of literature of the day being almost a manual for psychosis. I don’t remember if he was speaking about Timothy Leary or Carlos Casteneda or any number of other subversive ideas of the day. And his comment may have been both premature and prescient.

Our brains are organizing machines. They seek explanations, schemata, to provide satisfying linkages between our feelings and our observations, our expectations and our situations. Not about trivial matters. About these we can accept the influence of chance, leaky memory, luck, coincidence, and magic. But about the degree to which we have power, control, worth, status with others, and the vectors of threat, support, intimacy and sexuality between us.

The tools we use to do this include all our perceptual apparatuses and social information processing abilities. And when these are impaired our brains and our rising anxiety continue to demand answers, explanations.

A young man developing a psychotic illness in the 1960’s might conclude that he is being controlled with Radio Waves, or that he should don robe and guitar and preach love as a messenger of God. Delusional means of being controlled or controlling evolved through the years from the invisible hand of God or Devil, to possession, hypnotism, Xrays, radar, magnetic fields, radio waves, television, particle fields, and on to implanted microchips.

When we don’t have the tools to formulate a reasonable and acceptable schemata (usually by life engagement, communication with others, real others, understanding both textual information and contextual information, being sufficiently flexible to adjust from being an egocentric child and entitled adolescent to a simple mortal adult of the species) – when we don’t have these tools the brain still demands a schemata, a cause and effect, a satisfying sense of self in a sometimes hostile environment.

We then search. It used to be through books, song lyrics, common knowledge of the day, and imagination. Now this includes the internet. And one can find on our internet ready-made delusions and truly fake news: whole schemata already worked out for the person seeking – schemata and explanations for why he (or she) is failing, feeling despair, unloved, unsuccessful, without power, struggling, confused – schemata and cause and effect that blame others for all of our troubles.

And these ready-made schemata come with communities. Virtual reality communities in effect.

When we communicate face to face in real time and real place the ideas we share are always governed by the impact we see we are having on the other. We feel responsible for what we say, how we say it, and how it might affect the other. (with a few sociopathic and narcissistic exceptions)

Not so on many internet sites and forums. Text is spewed without the instant feedback from the face of the receiver and thus without any sense of social responsibility.

Over the years I have spoken with hundreds of young men (and women) developing psychosis, working through fractured ideas of persecution and grandiosity, seeking an ultimate answer. I hope the pills and support I give them will allow them to be satisfied with a good cup of coffee and a community of family and friends.

But now I know they may be up all night engrossed in the community of lies, blame and false hope that the internet can provide. “Incel”, ISIS, “Alt-right”, “white supremacy”…..”Flat Earth”, “conspiracy theories”…

Some of these are harmless but others may provide a ready-made delusion and a call to action for the man (or woman) whose social ability to formulate a healthy sense of reality is impaired, and who is desperately seeking relief.

The Failure in Police Reactions to Emergencies – Amended After Toronto

By Dr David Laing Dawson

Within the span of a few days the Hamilton Police demonstrated good judgment and remarkable restraint keeping two unruly mobs apart on Locke Street, saved a little girl’s life with quick compassionate action, and killed a teenager, a boy obviously in the throes of some kind of psychotic episode.

Why do they perform so well, even heroically, in some circumstances, and so poorly, tragically, in others?

I am not asking the question rhetorically, for the question may be worth serious consideration.

The first of these three situations was the most dangerous. It could easily have erupted into violence followed by five years of lawsuits.

The second required quick, focused action despite the horrifying sight of a child being caught under a moving train.

The third required a calm assessment of imminent danger (there was none) and then a calm slow approach.

In the rush to arrive at an unfolding situation each officer will develop heightened arousal. Stress hormones, adrenalin, breathing pattern, heart rate, blood pressure will all be aroused. This is commonly called the fight / flight response, but it is a complex system of brain/body arousal that allows for increased awareness of danger, heightened ability to focus, increased startle response, decreased pain sensation, decreased attention to ‘unimportant’ internal and external stimuli (e.g. time, hunger, thirst, chirping birds, other people), and heightened reflexes.

For the little girl with the severed limb this served her well. The officer reacted quickly and with full focus and efficiency without external distraction.

For the containment of the two mobs there had been enough planning, preparation, structure, and organization that each officer was able to quell or override their fight/flight response and diffuse the potential for violence.

Not so in the third example. The officers arrived in fully aroused state and entered the situation with heightened reflexes and heightened fear. Guns were drawn, triggers pulled.

Each circumstance is different. But in all the unnecessary police shootings of the past few years there has been one consistency: Police arrive in a rush on a call labeled as dangerous in some way. They are in a state of heightened arousal. They do not pause. They do not collect their thoughts or information. They do not pause in safety to slow heart rate, breathing, to scan the environment. They are hyper focused. They push forward. There is no thought of backing up.

In this state a cell phone can be seen as a gun. Awkward movements and slow response to commands can feel dangerous and threatening. The fact that no third party is at imminent risk does not register.

In a recent police shooting in the U.S. you can hear the heightened arousal, the full fight/flight response in the voices and breathing of the officers.

I have to conclude that some things are missing from police training. The first would be a pause upon arrival at the scene to determine if there is indeed a truly imminent threat to a third party. (Not a suicide threat, refusals, waving of arms, bizarre behavior, bad language, verbal threats – but a truly imminent threat to a third party. Is there anyone else on the street car, in the back yard, nearby in the field, nearby in the park, in the arrival lounge?). The second is the option to hold, rest, backup, breathe, take the time to dampen the state of arousal one is in at that moment, and then and only then proceed in a sane, calm, safe fashion.

And all that I suggest was done by the Toronto police officer when he confronted the driver of the van that had just wreaked havoc on Yonge St killing 10 and injuring many others. When the officer arrived, no one was in imminent danger. He even had the presence of mind to return to his cruiser and turn off the siren as it was distracting and preventing the officer and the subject from hearing one another. That also gaveĀ  him time to calm his nerves. At times, he backed away and, presumably when he realized that he was not in danger himself, he advanced and the suspect gave up.

We can only hope that this incident will serve as a training tool for others who might find themselves in a similar situation.

On the Jail Sentence of Toronto Police Constable James Forcillo

By Dr David Laing Dawson

As much as I know the shooting death of Sammy Yatim was entirely unnecessary, and as much as I know by simply looking at pictures of Constable James Forcillo that he is pugnacious by nature and that his fear/aggression response is close to the surface, easily triggered, I still have qualms about his conviction and sentence.

We put the gun in his hand. We assigned him to that job.

And in doing so we made one of two mistakes. Either he and his fellow officers were not sufficiently trained and prepared, or wrongly trained and prepared, or he is not a man we should have put in that position in the first place.

If 99 out of 100 officers could have resolved that event peacefully, without anyone getting hurt, then Constable Forcillo should have been reassigned years ago. To a desk job, community liaison work, anything not requiring a gun.

If only 40 out of 100 officers could have resolved that event peacefully, without anyone getting hurt, then their training and supervision is wrong. Tragically wrong.

I know it can be a combination of both. But those are the two tools we have: Screen and monitor our officers for signs that their primitive fear/aggression response is dangerously close to ignition, and train, train, train them to react differently in those situations.

See previous blogs on police training at https://dawsonross.wordpress.com/2016/04/04/on-improving-police-confrontations-with-the-mentally-ill/ and https://dawsonross.wordpress.com/2016/04/04/on-improving-police-confrontations-with-the-mentally-ill/.

Youth Violence

Dr David Laing Dawson

Four teenage boys were murdered in Toronto in the last few days. One was killed inside his school with a knife. An eighteen year-old was killed by gun(s) in a back alley, possibly by a group of four other young men. And two boys lost their lives by gunshot while either observing or participating in a large social-media planned fight between rival schools.

Each of the candidates for mayor of Toronto has been pushed to address the problem of youth violence. Each has tried in their own way. Mr. Ford by talking about all he has done for youth in the past. Mr. Tory by promising money and programs. Ms. Chow by talking about poverty.

CBC interviewed youth workers and counselors. Each promoted an expansion of what they are doing now. Each was understandably distraught and a little angry about these killings. As we all are.

But before we throw money at the problem, or promote our favored panaceas, or recommend the unlikely and impossible, might it not be wise to study these cases? Let the police do their job and then look closely at each event (and possibly a few others). Hire two social scientists to cull the information, interview people, and come to an understanding of each story. Give them a deadline and task them with finding any elements in the chain of events that led to these deaths that could have been interrupted. And do we have the tools and means to do so?

There may be no commonalities to these deaths. The stabbing inside the school is inexplicable so far (untreated mental illness?). The back alley killing smells of gangs and drugs and retribution. The killings in the park sound like a group beef between teenage boys (over a girl, some disrespect, a perceived slight, a territorial infringement?). This last would not be a new phenomenon, but today fueled and expanded by Twitter and Facebook, and at least one boy brought a gun to what should have been a taunting stand-off, words and puffery, or, at worst, a fist fight.

But lets look at these events closely, study them. Are there any common elements? Are there preventable elements? And only then ask the question: What tools and programs and incentives are needed to bring about this prevention?

Dr Dawson is a child and adolescent psychiatrist and author of The Adolescent Owners’ Manual