Evolution has endowed us with an impressive organ between our ears, an organ that allows us to do all the things mankind has contemplated and accomplished. It has also endowed us with self-awareness. Now it has been pointed out that even a lobster demonstrates a kind of self-awareness when it distinguishes its own claw from that of another lobster. But you can be pretty sure the lobster does not contemplate the meaning of its life and the certain end of its life, nor what other lobsters think of it.
This terrible awareness of our own existence and the inevitable pain, loss, suffering to come, and inevitable death, are the necessary consequences of such a wondrous cognitive capacity.
This level of self-awareness has spawned centuries of puzzlement, theorizing, university departments of philosophy, psychology, sociology and theology, countless religious and fantastical explanations, and a search by each one of us for something, some idea, some activity, some habit, some guru, some God, and/or some substance to dampen the horror of existence, at least in the evening, or once a week.
As Marx put it: “Religion is the sigh of the oppressed creature, the heart of a heartless world, and the soul of soulless conditions. It is the opium of the people.”
We have always needed something to dampen awareness, to allow us to relax, feel safe, forget, to smile, laugh loudly, speak without fear, and come away saying, “Well, that was a good time.” And then, perhaps, fall back into work and worry the next day.
And now it is 2023 and we live in a time when our awareness is heightened by a bombardment of information, a time when we know something of the beginning of both the universe and human existence and can foresee the end of both. A time when we no longer fully understand the tools we use, a time when an AI platform can write my essays for me, a time when poor souls exchange their money for a blockchain in the sky.
Substance abuse has dramatically increased, along with the industry that tries to help. Gurus thrive. Evangelical con men thrive. The snake oil business thrives. Every day Google offers me several 30 minute videos that will shrink my prostate, give me better sleep, clear out all toxins, prevent cancer, and grow my penis. None of this is surprising.
And this is the moment the Canadian Centre on Substance Use and Addiction decides to recommend zero consumption of alcohol, while Health Canada says we can have two drinks per week.
Let us get real, people. Grandmothers gave better advice. “Moderation in all things” they would tell us, but we do need some of those things, in moderation. And when we forbid one of those things, we humans will turn to others. And alcohol, for those of us with the genes that allow us to metabolize ethanol efficiently, is not one of the worse things to which we will turn. In moderation, of course.
Meanwhile Google tells me there are ten or twelve health benefits to drinking whisky. So I will continue to have my two or three drinks most evenings.
Only a decade ago the ruling was three or four per day for men and two or three for women, and red wine especially contained some good antioxidants.
Well, okay, I’m just rationalizing. But. That is also what we do, we humans. We find ways to dampen the anxiety of existence and we rationalize.
Apparently Donald Trump does not drink. Wish that he would. I’ll bet George Santos will claim he doesn’t drink if asked, but maybe if he did some veritas might emerge.
Hard to believe that another year has passed and we’ve somehow managed to generate at least one post a week throughout 2022. We’re going to take a bit of time off until early January but we wanted to wish all of our readers the very best for the holiday season and a safe and happy new year.
Overall the world is in a better place than it was 50 and 60 years ago by most metrics.
So why the conflict, the unrest, the craziness, the threat of far right groups, the anti-vaxxers, the election deniers, the rise of anti-semitism, the heightened ideological divisions, anti-psychiatry, homelessness, increase in addictions, death from addictions and overdose, mentally ill on the streets, a surprising daily display of delusional beliefs, and a surprising growth of bogus cures and snake oil salesmen?
Fifty years ago, or so, I had a rudimentary understanding of the tools I used, how they worked, and a passing acquaintance of quantum physics, and the construction of the universe, some understanding of physiology, then anatomy, of immune systems, genetics, evolution, and ecology.
Today I am typing this on a machine I barely understand, then sending it to Marvin in packages of digital machine code, through the air and thin strands of glass and copper wire, at speeds I cannot imagine, to appear on his screen via mechanisms of electricity and light I do not fathom. Some time ago I asked a grandchild where the photo went when she swiped the screen on her phone from left to right. Down there, she said, pointing to the side of the phone. I realized I would be hard pressed to explain the right answer to that question.
For generations most of us understood the tools we used, from the kitchen to the farm and factory. Even the internal combustion engine on wheels. This is certainly no longer true.
I was not religious then or now but those who did attend churches and mosques and synagogues 60 years ago were not constantly assailed by alternate beliefs, the corruption in their own institutions, and the eroding effect of science.
The peoples of the world as a whole may be better off but the roles, and tasks, and purpose, and memberships of many men in the developed world have been usurped by machines.
Science, modern medicine, and social attitudes have undermined age old certainties of gender, racial identity, cultural identity, and purpose. It is a quaint yet hopeful comment when someone says, “Everything happens for a reason.”
Science has not brought us understanding and certainty. It has brought us an awareness of how little we understand, how ultimately unknowable it all is. Yet today we are assailed by information, some based in reality, some fake, the trivial mixed in with the salient. On my Google feed I find Amanda Holden in another see-through dress, next to scientists creating a black hole in the lab, what actor was not cast in a decades old film, and how many children were killed in missile strikes last night.
And yet we crave certainty, predictability, organization, cause and effect. Unique among creatures on this planet, we need to know. Ah, think of life as a cobbler in a village pre-Gutenberg. Harsh but simple.
And then we build the internet and social media, where anybody can have a voice, a voice without responsibility or accountability. The very technology that allows me to have the British Museum, the Oxford English Dictionary, the Smithsonian, and the lectures of Bertrand Russell in my home also brings me Alex Jones, Donald Trump, a bevy of self-proclaimed influencers, and every malfeasance by Pfizer.
No rules, no limitations, no boundaries, no separation of fact and fiction. Therein lies the road to madness.
We should not be surprised to read a couple in New Zealand refuse a life-saving operation for their child unless the blood on hand for transfusion comes from an unvaccinated person.
Well, messenger RNA vaccines; these are something like manufacturing a clone of Paul Revere in the laboratory of a big (for profit) corporation and sending it out six months before the British arrive.
What could go wrong? Purdue Pharmaceutical? Boy Scout leaders and Priests taking my child on a camping trip? Hershel Walker? Anti-vaxxers disrupt a School Board meeting? A convoy of truckers takes over Ottawa. Putin decides he wants to be Emperor of a nineteenth century expanded Russia? Fourteen year old boy geniuses become billionaires? One of them misplaces a few billion? Fascism is resurrected all over the world? Deep fakes mean I can’t even trust my own eyes? Donald Trump leaves the old school scams of phony university degrees, signature steaks, and real estate tax fraud behind, and gets modern with an NFT scam. Jordan Peterson says Canada is about to collapse. Keven O’Leary is paid millions to promote worthless cryptocurrency and is paid in cryptocurrency. (At least I get to smile at the irony of that).
I think I shall have to invent my own reality and give it a test drive.
Covid and staff shortages in healthcare has led the right wing Ontario government to hint that drastic innovations like privatizing may be required to give health care a new life. Sadly, they are blinded by their own ideology and a lack of understanding of the issues. That may sway some to agree with them.
I for one am impressed with how well the system actually works despite the problems but more of that in a minute. Ontario already has parts of its health system privatized and it is a disaster. Since the election of an earlier right wing government under Mike Harris and his Common Sense Revolution, long term care has allowed for profit homes. Harris would become chair of the Chartwell Chain of residences and Wikipedia estimates he received $3.5 million for his services.
During Covid, it was discovered that the private long term care homes had the worst outcomes with far more elderly dying in their care than in the not for profit or municipal homes. The situation was so dire that the military was called in to help and the troops were shocked at what they found.
In October, I wrote about a private chain that provides so called supportive housing to adults with disabilities and the conditions were barbaric. The Global TV news has just done a multi -part expose on a private chain that provides housing and supports for vulnerable kids. The series outlines the findings of possible human trafficking and mistreatment, over medication, and possible deaths which the government has ignored. In fact, the office that provided oversight was disbanded in 2018 as a cost saving measure by the incoming Ford government. The report on the chain was never completed as a result.
I cannot imagine anyone wanting that type of care throughout the rest of the health system. If we consider what is often put forth for a dual system, that makes no sense. The argument is to allow private care for those who can afford it and keep the public system. The problem is that we only have a limited number of doctors, nurses and other professionals. With a private system, many would migrate to there where they could earn a lot more money leaving very few staff for a public system.
As it is now, nurses are fleeing hospitals because they are overworked and undervalued. The government has capped their salaries to no more than a 1% increase. In order to fill in for vacancies, hospitals and long term care facilities are forced to bring in nurses from agencies at $120 an hour. Why not pay nurses what they are worth. The government categorically refuses to rescind the bill that restricts their pay.
The biggest problem with health care in Ontario is the stupidity of how it is run. As I explained in one of my op eds in the local paper, the problem is a rapidly expanding bureaucracy which has no value added component. Today, the Ministry of Health and Long-Term Care has two ministers and an associate minister devoted to mental health and addictions. In 2005, there was just one minister. All those chiefs need staff so that today we have one deputy minister assisted by three associate deputy ministers. In 2005, it was one deputy and one associate deputy.
Each of the above needs a fairly large staff to report to them to rationalize their existence. The more senior staff you have, the more juniors are needed. Going down one level we have the assistant deputy ministers who, today, number 14. Again, an entire bureaucracy is required beneath them to justify their existence. In 2005, there were only seven assistant deputies or one half as many as today. Has there been any improvement in care and delivery between 2005 and today as the result of this growth in bureaucracy?
No but there is a new organization called Ontario Health which has, I’m told, 30 Vice Presidents.
The provincial premiers are all demanding that Ottawa fork over more money but Ottawa rightly refuses unless their is accountability from the provinces on how the money is to be spent and how it was spent. Ottawa did give Ontario $450 million to improve the wait list for kids seeking mental health care. As a result, the wait list went from 18 months to 40 months and the money was used to develop a Centre of Excellence for mental health – more bureaucrats.
Despite this mess in health care and the delayed surgeries and long wait times, the system is working thanks to the dedication of the staff. At the height of covid, someone with Alzheimers in a good care facility for whom I was power of attorney, wound up in hospital. He was found one morning sitting on the floor at the foot of his bed and staff sent him to the ER at the University Health Network in Toronto.
He was suffering delirium from extreme constipation and was kept for months as he recovered. By this point, he needed long term care but his dementia had deteriorated to violent outbursts and he had to be watched by a staff person all the time. Staff were excellent, caring and compassionate and finally decided to refer him to the Toronto Rehab Hospital across the street where the psychogeriatric unit might have some success with his aggression. That would have made it easier to find him a placement.
Regrettably, he managed to escape from his wheelchair restraint, fall and fracture his hip. He was then moved next door to the ER at the Mt Sinai Hospital where the fracture was repaired. Sadly, and not unusual, he developed a pulmonary embolism and was moved into palliative care. Staff were kind, attentive and kept me updated on a regular basis so I could provide reports to his family in the US, the UK and Australia.
His passing was a tragedy but the care he received and the human contact and consideration was what we would all like. And this was at the height of the pandemic when staff were overworked and stressed.
I have other stories in a similar vein but it all illustrates how well served we are by a very dedicated, compassionate group of professionals.
They and the rest of us do not deserve the idiocy we see from our ideologue politicians.
I am a retired professor and up until 20 months ago, I was the mother of a young man who has since taught me life lessons that I never thought were mine to learn.
Devin, our only child and the centre of our lives, passed away at age 22 on Feb. 7, 2021, from what was later found to be an accidental overdose involving opioids.
While he had been under psychiatric care for the last few years of his life and hospitalized twice, there was nothing that could have prepared my husband or me for this unimaginable loss.
Devin was a sweet, affectionate and loving child. In adolescence he transformed, becoming increasingly isolated and inward focused, with a developing addiction to video games.
By age 14, he had begun to experiment with marijuana, and while we as parents did not condone it, he secretly continued to use more potent drugs — we now know — to calm the turmoil that was taking root in his brain.
Severe psychiatric diseases often emerge at this age and take years to be fully diagnosed due to their complexity — not to mention the potential medical, legal and social implications of some diagnoses.
By Grade 11, he was being treated for anxiety and depression. By the time of his high school graduation, Devin was so anxious he was unable to attend.
The fact that he achieved that milestone is something we now regard as astounding.
Shortly after graduation, Devin was admitted to hospital for a psychotic episode. He had lost touch with reality and was hearing voices.
Because drug use can interfere with severe mental illness diagnosis, we were not told at this stage that he had a definitive illness. It was not until the post-psychosis treatment that I heard schizophrenia might be a possibility, but we needed to wait to see how recovery would unfold.
The word terrified me so much that I decided I would not read about it or learn more until, or unless, I had to. In the meantime, I would push on and do my best to help my son rebound from this crisis with the multitude of drugs required for his recovery.
As a mother, I was worried sick about his developing medical condition. In terms of his drug use, I was angry, guilt-ridden and even ashamed. How could this be happening to him and us?
As a teen, when Devin was becoming more socially withdrawn, we encouraged him to consider volunteering. Despite his pain, he embraced the idea.
He put in more than 600 hours of service — mostly with an organization devoted to increasing the quality of life for individuals with severe developmental disabilities, to help them live their best lives with dignity and respect.
Upon his death, they planted a tree and dedicated a physical space to his memory. They have even created an annual award in his name.
Devin’s condition was moving closer to a schizophrenia diagnosis in the few months before his death, when he went into hospital for a second time. We now know that Devin suffered from two potentially fatal diseases: schizophrenia and addiction. Both of these robbed him of the ability to live out his life.
And while you may recognize schizophrenia as a disease, I suspect there are many out there who question whether addiction deserves that label. Until this tragic outcome, I was one of them, having had no prior exposure to it and a lot of bias. I thought it was a choice.
Now I know better and see addiction for what it is: a chemical, brain-based compulsive disease. My son did not choose the path to addiction any more than he chose to become mentally ill.
What’s more, there is a grim connection between the two. According to the Centre for Addiction and Mental Health, “people with a mental illness are twice as likely to have a substance use disorder compared to the general population. At least 20 per cent of people with a mental illness have a co-occurring substance use disorder. For people with schizophrenia, the number may be as high as 50 per cent.”
Regardless of education, social status or racial/cultural background, mental illness has the potential to destroy lives and families. It contributes to a vulnerable population who do not necessarily look different from anyone else and are capable of giving extraordinary gifts to society.
Unfortunately, many are also at tremendous risk of being harmed by the ravages of a toxic drug supply and those involved in the trafficking of opioids.
While I am not naive enough to believe that my son’s troubles would have disappeared if he did not have access to opioids, I want people to see the inherent dangers, particularly to those with mental illness, that these drugs pose.
After all, their lives matter. Don’t they?
Sandra Ingram is a retired university professor and published author who lives in Winnipeg. This article first appeared on October 8 on the Canadian Broadcasting Corporation First Person Series
Greta Thunberg has called it her super power. And indeed, her blindness and deafness to the non-verbal nuances of human communication, and lacking the caution that that creates in most of us, allows her to barge ahead confronting world leaders advocating for a change in all human behaviour, though she is but a teenager.
A couple of times, talking with boys on the ASD spectrum, I have quipped that, “I was as smart as you are when I was 14. But then I discovered girls, and sports, and hanging out, and parties, and music, and clubs, and girls.”
It does appear that for most of us, a large portion of our brain is utilized to receive, interpret, and respond to pre-textual and contextual components of language. This includes body language, facial expression, context, assumed role relationship, eye movements, and the prosody and cadence of the text being exchanged. It has been said that up to 80% of the meaning of the words we use in speaking to one another can be found in the non-textual components of language. And it is in the non-textual components of language that we discern the nature of our current relationship and what we can expect in the near future. Just think of the thousand ways one can say, “Hello.”
The neuro-diversity that is Aspergers has benefited humankind in many ways, from the breaking of the Enigma Code, to the development of computer sciences, the understanding of gravity, alternating electrical current, the theory of relativity, and the theory of evolution.
But quite suddenly we live in a world with technology that allows us to forgo that most complex and nuanced world of face to face communication. Emojis help but they cannot replace the raised eyebrow, the constricting of pupils, the tonal change at the end of a phrase, the tiny hesitation before a word is used, the forced laugh, the genuine smile…
I suspect Facebook was originally created to help certain young men acquire girlfriends without the trouble of venturing outside their dorms and actually talking with women face to face. Now Mark Zuckerberg wants us all, or at least our Avatars, to join him in the metaverse, to work and play in a virtual world, where eyes resemble the headlights of an ambulance transporting a talkative Alzheimers patient from the hospital to a long term care facility on a Sunday afternoon.
And Elon Musk.
I have wondered if this particular neurological organization, this particular diversity we call Aspergers, is actually an evolutionary step. What was once a small but useful group who were able to forgo the pleasures and anxiety of always trying to fit in, enabling them to pursue a single mathematical puzzle for days and years, could now become dominant as we merge with machines.
Who else might be content and even happy living with a family of robots in a geodesic dome on Mars?
“I don’t get poetry.” One of my Asperger patients once told me. “If you want to say that you enjoy walking in the woods after the first snow fall, why not just say it?”
During the 2015 Federal election in Canada, the Conservative Party thought they could win support by proposing a tip line where citizens could call and report the barbaric practices of presumably their immigrant and likely Muslim neighbours. It was not well received and the Conservatives lost the election.
We do, however, have barbaric cultural practices in how we treat the poor, ill and disabled citizens among us in Ontario. Last Spring, I wrote of the pitfalls of supportive housing from the experience of my family member being exposed to murder, addiction and trafficking. That was followed by a more theoretical one by Dr Dawson. The agency in question renovated old and abandoned buildings into very acceptable housing for those who needed it at affordable rates but then failed to adequately support the residents. The consequences of that is described in the linked articles.
The latest outrage was that one of the residents of that particular supported housing buildings died in his sleep and his body was not discovered for 7 days. It seems that no one noticed that the poor man was not seen even though dinner is served to residents, the staff is comprised of nurses, addiction counselors and others and they talk of wrap around support. Actually, a staff member did check his apartment a day before he was formally found and initially said he was asleep in bed, that there was an odour coming from the apartment but closed the door and walked away. Later, it was claimed that she knew he was dead and that it was so traumatic for her that she ignored it and did not report it to anyone or even call 911.
An outside health agency that the gentleman (Michael Miller) was involved with was concerned when they had no contact with him so they asked police to do a wellness check. That was when his body was discovered but it was in such an advanced state of decomposition that the coroner was not able to determine a cause of death. Michael’s mother told the agency that she was going to the local paper and was asked not to as that would “shame residents”.
When confronted by the press, the director claimed he opposed her going to the press “for the sake of our tenants, for the sake of our elderly, to stop stigmatizing vulnerable people.”
That makes no sense to me and if there is any shame, it belongs to the organization.
As bad as all this is, it pales in comparison to other residential facilities for the mentally ill, disabled and elderly where the service is nothing but barbaric!
The Toronto Star did an investigation into what is described as a grey area “where no one is in charge of proactively making sure these facilities provide a minimum standard of care to an ever-growing number of at-risk residents.” This sector exists because “homeless shelters, hospitals and rehabilitation centres across Ontario run out of room and affordable housing options start with years-long wait-lists, …. unlicensed facilities have become increasingly popular places to park marginalized people.”
The Star expose dealt with a chain of such homes throughout Southwest Ontario called Supportive Living . Take a look at their glowing website and then compare that to what the Star found in its investigation. The pictures will disgust you. Residents are of various ages and health conditions and many have mental illnesses and/or addictions. Others are older people with dementia or physical conditions who cannot find a placement in long term care.
The majority of the residents receive financial support from the Ontario Disability and Support Services Program and payments are made directly to the landlord to cover room and board. The amount paid ranges from $745 to $1095 a month depending on the region. There was a 5% increase in that allowance recently. The residents themselves get around $75 a month for their personal needs. Thus far, three attempts have been made to impose legislative standards on these homes but those bills never got past 2nd reading in the legislature. One of the attempts was accompanied by 44 municipalities supporting the effort. A fourth private members bill has just been introduced.
The Toronto Star’s sister paper in York Region, Metroland, recently reported on a group home in rural Newmarket north of Toronto for adults with physical and cognitive impairments. One of their residents was killed by a passing car while wandering the roads unsupervised. Local drivers have been warning about the elderly wandering the rural, unlit roads for years to no avail. One driver reported in 2017 that she almost hit an elderly man on the highway at night. He was dressed in pyjamas and “His entire backside, all the way down to his feet, was covered in dried feces.”
She went to the property to get help and found “many low-functioning residents with very high needs and little supervision”. This is but one of 22 such homes in that region that get subsidies from various levels of government to “look after” those who can’t afford better. Numerous calls from various individuals and organizations to investigate these places have been ignored.
Barbaric is the only word to describe what is happening and is being allowed to continue.
Now, in its wisdom, the Ontario government has decreed that patients in hospitals awaiting long term care placement, rehab, home care, mental health services or complex care can be moved against their will to wherever there is an opening. Even if your family is nowhere near where they want to send you and you have a fragile spouse with no car and not able to use public transit, that is where you go. Take it or pay the hospital per diem ($400) normally covered as part of our health benefits. The homes with vacancies tend to be the for profit homes as, during covid, they had a much worse mortality than did the not for profit or the municipally run homes (See table 2).
I would appreciate comments from those of you outside of Ontario on what the situation is like in your jurisdictions. Ontario, after all, has the largest share of the total Canadian GDP at 38.59% or $891,811 million compared to the other provinces and territories.
Since we began writing this blog, both Dr Dawson and I have railed against the use of the term mental health and mental health issues as a euphemism for illness. Hopefully, others are beginning to realize the foolishness of that term to describe illness. To paraphrase the Bard, An illness by any other name is still an illness.
A recent essay in the New York Times by Huw Green, a clinical psychologist specializing in neuropsychology, is also critical of the use of the term mental health which he states is used to describe both wellness and distress. While its use is supposed to be stigma busting, “it manages a double exclusion. It fails to actually name any mental health problems — those about which we ought to be raising awareness — and it also makes a claim that is sadly untrue; there are many people who, at least some of the time, do not have mental health.”
He then goes on to say what we have always said that by trying to avoid stigma, this term generates more stigma. He says “The change in language was supposed to address stigma. But it has simply moved our attention away from the very people who face the most stigma — those with diagnoses of schizophrenia, for example, or symptoms that do not allow ready participation in the mental health curriculum.”
What he describes is exactly what we see in government and health policy directions for the mentally ill. The emphasis is on the less problematic problems that people have to the exclusion of the very serious and disabling conditions. During the recent election campaign in Ontario, most politicians talked about the need for more psychotherapy to help us overcome the stress of covid, school lockdowns, transitory anxiety and other similar problems. No one talked about the homeless many of whom are people with untreated serious mental illnesses or the lack of psychiatric hospital beds.
It’s all like focusing your cancer care on those with basal cell carcinoma with a 5 year survival rate of 100% and ignoring pancreatic cancer which has a 5 year survival rate of 11%. No one dies of basal cell carcinoma in 5 years while 89% of pancreatic cancer victims die.
The suppression of a word, the avoidance of the use of a word like cancer, leprosy, syphilis, mental illness, or schizophrenia, increases stigma, mystery, and fear. It also does not make the reality of serious illness go away. Terry Fox did not run half way across Canada to create awareness and raise money for “bone health issues.”
This disappointment stems from the reality that Chris has a responsibility and obligation to speak truth to power. He has missed, or rather, thrown away, an incredible opportunity to educate Canadians with little exposure or understanding of psychotic illnesses, to the intensive challenges and impacts that they create for those who suffer with them as well as their families.
He appropriately acknowledges the early history of the Schizophrenia Society of Canada (SSC) and the families who worked incredibly hard to create a national organization that could advocate for the rights of those family members with severe mental illnesses. At one time it used to be families who advocated for their loved one’s care and treatment which made sense because it was most often the families who would help care for and support their loved ones with these illnesses. Families still retain similar caregiving roles today, but now their voices have largely been diminished and extinguished by the “family blaming” tendencies of the psychiatric and consumer survivor movements.
The reality is that while Chris has heaped glowing praise on these families within the article, historically he has treated families who support loved ones with psychotic illnesses quite differently.
For example, in 2012 Chris was responsible for planning a Mental Health Commission of Canada Conference (MHCC). This conference hosted various speakers who throughout the course of several different presentations, engaged in family blaming; a commonly held view within the psychiatric and consumer survivor movements. In an unrelated instance, and taken from Susan Inman’s article “The New Mental Illness Stigma? Offering Support” : “In an interview in Canadian Christianity, he (Chris) spoke of families being the obstacle to people getting treatment because they don’t want to let out the “family secret.”
Taken from the Globe and Mail article, Chris goes on to say: “The growth of peer-support networks for families and individuals with mental illnesses and the strengthening of the person-centred, recovery-oriented model of treatment have helped drive positive change in mental health services.”
When he says a “person centred recovery orientated model of treatment” he’s referring to patient-led and directed treatment. It encourages patients to choose what they think works best for them. It seems an increasingly popular cultural norm to reject the medical model in favour of holistic, social, and spiritually based models, AKA the anti-psychiatry movement.
I would argue that the person-centred recovery-oriented model of treatment has helped drive positive change in mental health services. It would depend on who you ask, I suppose? It also very much depends on whether the individual with psychotic illness has a “lack of insight”, because in that instance, treatment is almost always refused. “Lack of insight” is the inability for an individual to understand that they are ill. “It is estimated that 50-90% of patients with schizophrenia and 40% of patients with bipolar disorder demonstrate anosognosia or severe lack of insight.” It is caused by cognitive damage in the frontal parietal lobe and for some, it is a feature of their illness.
Ask any family member with a loved one who is severely mentally ill, has lack of insight and remains untreated, how much they like the “person centred recovery-orientated model of treatment” and I’m pretty sure you’ll end up with a very different answer.
It used to be the case that those who met the criteria of a province’s mental health legislation and who were a threat to self or others would be involuntarily hospitalized, and in some provinces, treated. This was done to keep the individual or others safe until such time that they could attain stability and be released.
In today’s climate of reduced psychiatric inpatient treatment beds, individuals who meet those criteria are not guaranteed to be involuntarily admitted if there isn’t a bed to put them in. Only the sickest get care. This leads to those who are still significantly ill being released into homelessness. Increased rates of incarceration as a direct result of not being able to “choose care” due to illness and lack of insight is also a very real consequence of the person-centered recovery orientated model of care. Still a fan?
As for peer support? What Chris neglects to mention, is far more relevant than what he does mention. Like the fact that the peer support networks for individuals with mental illnesses he’s referring to have no formalized training for severe mental illnesses (SMIs) like schizophrenia, bipolar disorder, or major depressive disorder. Although Peer Supporters need to be in recovery from a mental illness themselves to be peer supporters, there -are no mechanisms in place to keep them safe in the event they are triggered on one of their many calls. Additionally, there is no way of knowing if a peer supporter who may have had a negative experience in their own mental health treatment may let that colour their own biases and responses about medication and hospitalization to those who may really need that type of support.
Of course, peer support is not inherently all good or all bad. Like most things in life – it depends on the context. Peer supporters can be embedded in ACT teams (assertive community treatment) where they work alongside mental health professionals in a team environment. In this environment their assistance and experience can be invaluable. More than that, peer supporters have the potential of being a fantastic support and resource within the mental health system – IF they have current and relevant training on psychotic illnesses.
I agree with Chris’ thoughts on early psychosis treatment, IE: “the earlier you identify early psychosis, and the earlier you intervene and provide treatment, the less likely the individual will develop full-blown schizophrenia. The result is you have better outcomes because if you can prevent future psychotic breaks, there will be less damage to the brain and its functions.” But again, this message is delivered in a way that provides the reader with only part of the picture, and that is my main problem with it.
For instance, does it matter that we increase our access to, or numbers of early intervention spaces if people are not going to choose care? Remember a little something called the “person centred recovery orientated model of treatment” and “lack of insight”?
Also, since teenagers are the demographic most likely to suffer from early psychosis there is the “mature minor” designation most provinces have in place that must be taken into consideration. Each province has different criteria but here in Nova Scotia, a mature minor is deemed as: “a minor who can understand and appreciate the nature and consequences of his/her decision and its alternatives is able to give a valid consent regardless of age. In most cases, children entitled to make personal decisions in Nova Scotia will have reached adolescence. As, in Nova Scotia there is no set age a child must reach before he/she is able to provide consent for treatment, assessment or release of information, the psychologist must thus determine, on a case-by-case basis, whether a child is capable of making decisions in his/her best interest.”
This means a young teenager who may present to a family DR or ER physician (who may not be well versed in treating or diagnosing mental illness, AND who may miss key indicators that signify them), can potentially, if they meet the mature minor criteria, refuse treatment or to share any medical information with their parents.
This, I might add, can happen at times when it is crucial for early intervention and treatment. Delaying, or not treating can mean chronic severe mental illness down the road that is medication resistant. How would you like “person centred recovery orientated model of treatment”, if it were your teen presenting to an ER, meeting the criteria of a mature minor, having undetected “lack of awareness” (doesn’t believe they are ill or need treatment), refusing treatment and who insists that their parents not be notified? Not so much now, I’m guessing.
Fast forward ten years and you may have a loved one with a severely entrenched chronic mental illness that they are unaware of (lack of insight) and that wreaks havoc within their own life and the lives of everyone who loves them. It continues to be a sad reality for many families – mine included, because it is very avoidable, with early access to treatment and care.
We recently passed through an interesting social experiment from which we should learn.
Boris Johnson is a better educated, more articulate, smarter version of Donald Trump. Both men, to the surprise of many, managed, using the same populist tropes fashioned to rouse and focus the anger of their respective populations, to achieve the top political positions of their countries. Both “ruled” with flamboyance and flim flam. When Boris took one too many liberties with the truth his political career ended simply and quietly. There was no backlash, no outpouring of grief and anger, no seeking of revenge, no denials, no marching in the street, no violence, no groundswell of support and demand to reinstate Boris as Prime Minister.
On the other hand Donald Trump kept piling on the lies, the outrageous behaviour, the cons and grandiosity. He did lose the election for a second term but we all know what happened next.
We humans, many of us for sure, retain a trait that once provided genetic Darwinian survival value. Projection, identification, thoughtless loyalty, unquestioned fealty. Some commingling of our need for reassurance, a God, guidance, the embodiment of all we hope we are and could be, a protector, a symbol of unity, of past, present and future.
The people of the U.K. and the Commonwealth have the Crown for that, Her Majesty, and now His Majesty, a Royal Family. It is anachronistic, silly, fantasy and fairy tale stuff. But then so are we. The viewership of Game of Thrones rather exceeds that of Question Period in the House of Commons.
Because we have the Crown, our Head of State, our (actually powerless) symbol of all that we hope we are individually and collectively, Boris Johnson and Justin Trudeau are just politicians who have or had important jobs, who cannot get away with the outrageous behaviour of Kings and Potentates, and who can be removed from those jobs without much disruption at all. Without weeping and wailing and threat to democracy. Because we have a separate, symbolic Head of State, and a Royal Family, that provides, without threat to our democracy, sufficient fanfare, intrigue, scandal, and a few good deeds to keep us tuned in.