Category Archives: Uncategorized

More on Weinstein and Friends

By Dr David Laing Dawson

Say it ain’t so, Al, Jeff,  Kevin…..

What is happening?

We turn 16, 17, or so, and the mating game begins. The sexual competition. This plays out within many different cultural rules, regulations and customs. It can be an open market, so to speak, in some modern cultures and driven by family status and economics in others. But it is a competition fought with all the weapons and symbols of female and male desirability. For most primates this involves tests of strength and the flaunting of secondary sexual characteristics and pheromones. We humans have added a great many more symbols of availability and readiness, from lipstick to sports cars. (so many symbols, in fact, that decoding them can be complicated).

But the game is on, and perhaps it lasts from the teens to late 20’s, often now followed by a second inning between 30 and 50.

Some years ago someone observed wedding receptions to watch this mating game unfold with several generations present. The most interesting observation was that each party had at least one older uncle who danced randomly and crazily into the small hours, without self-consciousness, with enjoyable abandon. The writer’s conclusion was that this uncle was a man who knew he was no longer in the competition. He could drop all pretense, all posing. He could simply have a good time without worrying about which fair maiden might be watching and judging him.

Which brings me to my point. All these men being accused of sexual impropriety are older (and often no longer attractive) males surrounded by beautiful younger women (and men) who are not interested in them. They, the older men, are out of the game, sidelined, retired. The women are no longer sending them signals of availability. In other ways these men are admired and desired, but not sexually, not by younger women. The younger women are looking elsewhere.

This is not to excuse their behaviour. Their actions display anger and resentment about being left off the dance card, perhaps more anger, resentment and entitlement than desire. Time to grow up, gentlemen. We are not forever young.

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The ‘Ultimate Sacrifice’ and Other Consoling Fictions

By Dr David Laing Dawson

I understand the families of soldiers killed in war must find ways of understanding their loss, their grief, of honouring their sons and daughters, their husbands, brothers, sisters. I understand that those who send these young men and women into war must find ways, beyond guilt and despair, of understanding, of justifying their responsibilities.

I understand that when most of us conclude that the war in question was unnecessary, foolish, and tragic, the families and generals must double down on their consoling fictions.

General John Kelly, as a military commander who sends young men and women into war zones, and who lost a son in Afghanistan has as much a need as anyone to find consoling fictions. And in his recent press conference defending Donald Trump he did just that. He elevated the fallen, those killed in battle, to a very restricted strata of society, the best of the best. He lessened his guilt by emphasizing that these young people know what they are signing up for, that they are fully aware they may be sacrificing their lives, that they do it for “love of country”.

I understand his need to think as he thinks, to imagine his son sitting with Athenian Gods in a Parthenon of heroes. It is no less a fiction than the stories told to ISIS fighters, and to all young men and women in totalitarian states.

We must grieve and honour these soldiers and console their families. We must do this in a way that does not perpetuate the myth of glory, that does not undermine the more important message, “never again”. We must do this in a way that does not perpetuate the fictions of a warrior culture.

For it is these fictions, “the ultimate sacrifice” for “love of country” as a “choice made by the best of the best” by fully cognizant young men and women, by a special elevated breed of human — it is these fictions that will allow us to go to war again, nay, require us to go to war again.

More Assault on Democracy

By Dr David Laing Dawson

In my list of instructions (the order was arbitrary) for undermining democracy, point 9 included curtailing unfavourable reporting by newspapers and TV networks via “licensing bodies”. Donald Trump floated the idea in a tweet earlier this week, “at what point is it appropriate to challenge their license?” and then, apparently emboldened, directly suggested it a day later. “…licenses must be challenged and if appropriate, revoked…” His target this time is NBC.

The outrage has not been deafening. Perhaps because another Trump tweet suggested pulling FEMA out of Puerto Rico while accusing them of being in a financial mess of their own making, and he is about to sign a bill that will undermine the Affordable Care Act. He is also busy undermining multiple international agreements from NAFTA to UNESCO. And we are distracted by the crimes and misdemeanors of Harvey Weinstein and the killing spree of Mr. Paddock.

A serial killer inures himself to remnants of fear and anxiety by engaging in a self-designed desensitization process. The same process works with large populations. “This is an unusual presidency”, someone says on CNN, “He doesn’t fit the mold.” “Should we take him literally?” “Should we take him seriously?” someone else asks.

But I think I have been most disturbed of late to hear even the thoughtful and presumably liberal experts and pundits on CNN tell me that, with respect to North Korea, “Diplomacy has failed. We have tried diplomacy for 25 years and it has failed.”

And then even when they say war is not an option, they calculate the cost of war, conventional or otherwise, as being a few thousand U.S citizens residing in South Korea, perhaps a few million South Korean lives, and the devastation of the Korean peninsula.

So this is where we stand at the moment, 9 months in:

  • Limit, by threat and licensing, the free press
  • Create chaos and anxiety at home (the soil from which grows tyranny)
  • Vilify and dehumanize an enemy
  • Desensitize the population to the truth and reality of war.

(in case anybody missed the point, North Korea has not attacked anyone in 25 years, so “diplomacy” has been working)

Reality VS Reality TV, Las Vegas and Packing

By Dr David Laing Dawson

I confess I have been watching too much CNN of late. This is not conducive to good mental health. But one of the things very apparent this week has been the struggle on the part of hosts, interviewers, guests and pundits to find a clear narrative in the Las Vegas story. Somehow there seems to be a need for this real life event to conform to the conceits of fiction.

Perhaps this should not be surprising for so-called reality TV does just that. It takes recordings of (albeit within a contrived and manipulated context) real human behaviours and organizes them in the editing room to fit, to satisfy the demands of story telling and fiction. Perhaps the presidency of Donald Trump is another symptom of fiction infiltrating reality; he certainly treats his job as if he is still the producer and star of a reality TV show. “Maybe this is the calm before the storm.” “What storm, Mr. President?” “You’ll see.”

Fiction requires a definable conflict, clear motivation, and an inciting incident. In a Hollywood movie the inciting incident occurs 5 to15 minutes in. Fiction supplies a background that explains the principal characters’ personalities in simple terms. Each character has an arc of development. The second act comprises variations on the theme building to the third act resolution. We are seldom happy with an inconclusive ending. We crave identifiable heroes and villains. We crave motivation in the form of a logical sequence of events, or something with which we can empathize. For a series to work each episode must end in a cliffhanger. If not a cliffhanger at least a little foreshadowing.

Fiction abounds in our lives these days. We can spend every waking hour engrossed in fiction and not run out of new shows. And so it should not be surprising that the conceits of fiction are falsely shaping our perceptions of reality, or our expectations of reality. They even creep into popular psychology and mental health jargon. They have crept into our body politic. They have enthralled a substantial number of Americans into believing such a sorry specimen as Donald Trump would make a good president. They form the parameters of our questions about the Las Vega shooter.

I see this influence in the current search for specific childhood traumas that might explain the development of psychotic illness. I see it in the words “trigger” and “closure”, borrowed just like Multiple Personality Disorder and “alters” from fiction, in “recovered memory” and “flashback”. I see more than a bit of fiction in the popularity of CBT.

But real life seldom conforms to the rules of fiction. Lives are messy. Variables are plentiful. Folly is more common than conspiracy. Motives are seldom clear. Judgment is always limited. Feeling states can be fleeting or persistent. Pain, addiction, depression, and psychosis all cause tunnel vision, an inability to see anything beyond that which might alleviate the suffering. People do not acquire insight and learn great lessons within a 60 or 90 minute narrative.

It is reasonable I suppose, and very human, to try to figure out what mental state could guide a person like Mr. Paddock to do what he did.

But while we try to figure this out it distracts from the simple truth that a human being can slip into the kind of mental state that leads to the acquisition and use of immense fire power. If that serious lethal weaponry is readily available. If that serious lethal weaponry is readily available it will be acquired and used by someone to kill.

**

I was at a party last night. A wedding celebration. Several generations, kids to octogenarians, many people I did not know. The theme was Halloween or Goth so devils, fallen angels, bent priests, strict nuns, metal, blood, and hints of S & M abounded. The music was loud, the bar open, the speeches emotional, and, as with any such celebration, some of the relationships quite complex. With Trump and Las Vegas not far from anyone’s mind, they intruded into the otherwise congenial conversation. And I wondered out loud what it would be like attending this kind of event in the USA. Would I be calculating how many guests were packing (indulging in concealed carry that is), would I worry that one of the bride’s sketchy ex-boyfriends might arrive with semi-automatic weapon, would I feel this relaxed and safe, would I worry more about the morose uncle putting away his fifth glass of whiskey, would I worry about the veiled insult within one of the speeches?

My American friends. You are crazy. Do you not understand the sense of peace and security and safety that comes from knowing the man next to you is unlikely to be carrying a gun?

 

Las Vegas Massacre

By Dr David Laing Dawson

At any age there are some conditions (medical and other) that can befall us and cause aberrations in thinking and behavior. At age 64 they are unlikely to include the propaganda of ISIS or the illness schizophrenia or a drug induced psychosis. But they do include psychotic depression, brain tumour, frontal lobe dementia, and/or a combination of depression and early dementia. Psychotic depression refers to a combination of depression and paranoia.

When such a condition leads to violence it is usually isolated to suicide or murder-suicide. Even then the difference between suicide and murder/suicide (the murder usually being of a spouse) is often decided by the presence or absence of a lethal weapon.

An excellent available and affordable health and mental health system could catch some of these, institute treatment and prevent tragedy. But the simple solution to preventing 20 kids in a school or 59 people at a music festival from dying is gun control. Of course it’s gun control. At least banning absolutely those kinds of weapons that can kill so many so easily.

I am writing this as professionals, journalists and armchair diagnosticians are all looking for a cause or motive for the recent mass shooting in Las Vegas. But my point is that such breakdowns, such dramatic (sometimes surprising, sometimes not surprising) changes in behaviour will always be with us. Sometimes an alert relative or family doctor can prevent a tragedy. But the difference between a single suicide or limited murder/suicide and mass casualties will always depend on available weapons.

I could make my guesses about what condition lay under Mr. Haddock’s murderous actions and suicide but I shouldn’t. For that is the wrong focus for any prevention of similar events in the future. If Americans, Congress and Senate are at all serious about preventing this kind of tragedy they need to forget trying to figure out what drove Mr. Haddock and look instead at the insane ease which which he acquired his guns.

PLEASE NOTE: the name of the shooter used here is Haddock in order to illustrate just how unimportant that person’s name is. The issue is gun violence and this article describes just how absurd the US emphasis on guns is https://www.vox.com/policy-and-politics/2017/10/2/16399418/us-gun-violence-statistics-maps-charts

Trump’s Successful Assault on American Democracy

By Dr David Laing Dawson

At the very beginning of the Trump presidency I wrote a (I had hoped, satirical) set of instructions for undermining democracy. Nine months later some news items have prodded me to reread my instructions. Those news items were: 1. Justice department asking Facebook for information on people who “liked” an anti-administration protest page. 2. ICE agents arrest over 450 illegal immigrants in sanctuary cities. 3. Trump stokes racial division through the NFL. 4. Tax proposal to dramatically shift more wealth to the top 1%, including Trump himself. 5. A bill before the senate to loosen gun restrictions. (I didn’t think they could be looser until reading the specifics, which include ending restrictions on selling silencers, concealed carry, and armor piercing ammunition).

It is time to revisit my instruction manual and see how Donald and America are progressing.

1. Make frequent reference to the utter failure of all previous administrations. Take credit for anything good that happened during the most recent administration. Done

2. Promote a cult of personality. Suggest the new leader has God-like powers, such as controlling the rain, and solving complex and intractable problems with forceful statements. Done

3. Paint a bleak picture of the current state of affairs and grossly exaggerate the risk, the dangers posed by outsiders and nonbelievers. Done

4. Promote law and order and military power as the only forces that can keep us safe. Done

5. Incrementally reduce voting rights by insisting on regulations that favor your supporters and disenfranchise others. Do this by claiming you are controlling corruption and fraud. Done

6. Choose an enemy or two, give them names, and promise to eradicate them. Use emotionally inspiring words such as evil, kill, wipe them out, get rid of them once and for all. Done

7. Exaggerate the size of your support and the crowds attending your rallies. Refer to this as a movement. Done

8. Lie frequently and often. Use big, bold lies. This is a form of desensitization. More and more will believe your lies. The remaining citizens will stop caring. Done

9. Undermine the Fourth Estate. Seed distrust of news and information. Call all reporters and truth tellers liars. It will be difficult to fully control the media (this is not Russia) but consider using licensing bodies, libel laws and the courts to tie their hands. Done

10. Promote the idea that the people of your nation, your followers, are superior human beings, exceptional, and deserve to live better than others. American Exceptionalism. Or is that “Uber Alles”? Done

11. You will need the armed forces and intelligence agencies so flatter them frequently, while you replace their leaders with your own men. Done

12. You will need cabinet members and spokespeople who will unabashedly promote you and your statements and policies no matter how unpalatable or ludicrous they become. Some will be willing to do this for money, others for power and glory of their own, and others because of their own anger and resentment from earlier grievances. Unfortunately such people abound. But remember, it is not loyalty that binds them to you, but self-interest. Reward them generously; always be prepared to kill them. Done

13. Quickly disparage and render impotent any leader who opposes you. Memorable name-calling and disinformation will suffice. Done

14. Create a language of code words for anything that remains unacceptable for most citizens. For example: “alternative facts” for lies, “violence in the inner cities” for racial profiling. Done

15. Use hyperbole at all times. A person or event is either “great”, “fantastic”, “amazing”, or “a disaster”, “evil”, “total failure”. This fosters a dichotomous view of the world and will help dehumanize victims when the time comes to purge. Done

16. Find some allies in other countries by directly or tacitly supporting their extreme views. Examples might include Putin, Marine Penn and Netanyahu. Be unpredictable for the others. Keep them on edge. Done

17. In the meantime cater to the dominant political force in the democratic body by quickly implementing all their pet projects (e.g anti-abortion legislation), and by canceling all social and medical initiatives started by that upstart negro president . Done

18. Build monuments to yourself. Oops. I forgot. You already have. Good. Build more. Start with the Trump Great Southern Wall. Done

19. Throughout this process continue to emphasize that you are working for the people. Use the words “people”, “working people” and “democracy” frequently. As you usurp power explain that you are protecting democracy. Done

20. Have patience. Others may deliver you the crisis and fear that will allow an incremental or bold increase in power. When you assume new powers present yourself as reluctant to do so. Done

21. Use as much pomp and circumstance as possible. People love ceremonies. Emphasize the sacred trust your office embodies. Done

22. Visit a religious leader (televised of course). Ensure him and the American Public that you understand the enormity of your office and the need for God’s guidance. Try not to sneer or chuckle doing this. It is not wise to compare yourself to God, but you can hint that He favors you in some way. Done

23. Don’t worry about the physical quirks the cartoonists seize upon, the little black mustache for example, or the blonde comb over. Ultimately these will confer upon you icon status. Done

24. There will be protests and marches against you. Be gracious in your response to those that remain peaceful. Come down very hard on those that become violent. Emphasize these, and use them to accrue more power. But, be assured that any large gathering of people can become violent with a little help from your friends. Done

25. Toady up to the leaders of organized religion, the church.  With few exceptions these religious leaders will see you as a means of helping them achieve their long-term goals. They will not stand against you for fear of losing their own power. Done

26. Allow others to live vicariously through you. This is a fine balance. While allowing the people to view your sumptuous life style use colloquial language, talk as they do. Remind them you work tirelessly for them. Pretend that one day they can all live as you do. Done

27. Women are tricky. Have one or two around you but not many. They tend to have empathy for others, children, small animals. They tend to prefer compromise and cooperation. Reference your own dear mother frequently, and say how much you respect women. But subtly denigrate them by your own actions, and limit their voices and rights through reproductive and child-care legislation. Done

28. Gain increasing control of your population. You can start this by controlling all immigration and visitation to your country. Then pick the minority group most feared or misunderstood by your followers and order a registration process. This will appear harmless, like getting a driver’s license. Then incrementally increase the strength of this process, include more identifiable groupings, until all citizens must carry “papers” with them and submit to police checks. This will instill fear. In progress

29. Finally, incrementally increase your power and authority until you can accurately call yourself “president-for-life” or “Supreme Leader”. This will take time. At some point you will need a crisis at home (Terrorist attack for e.g.) or you will need to provoke a crisis abroad and at home (Palestinian response to moving embassy to Jerusalem for e.g.). This will justify your transfer of a specific power from a democratic body (congress/senate/) to your own office. This can be done on the grounds that only you know all the facts, and quick decisions are required. It is also more acceptable if the democratic bodies are perceived as ineffective or too partisan. Your people can ensure the latter condition is met. Coming soon via N Korea or Iran.

——-

Carl Jung spoke of Hitler embodying the collective unconscious of the German people. We needn’t be as fanciful as Jung to see that a leader can personify and, by example, embolden the worst impulses of us humans, those impulses that may have had evolutionary utility when we fought over a watering hole and a hunting ground, those impulses that stand ready today to lead us down a dark path.

……………………

Talk Therapy & Mental Illness

By Dr David Laing Dawson

In the years between 1965 and 1975 I would loved to have discovered that psychotherapy (talk therapy) worked for severe mental illness. I had read Freud (Sigmund and Anna), Jung, Adler, Sullivan and many others. I read all the detailed case studies available. I read all the theories.

We unlocked the door of the first mental hospital ward I worked on in 1968 and started group therapy and community meetings. I learned how to talk with people who are psychotic. I spent many hours trying to penetrate the mask of catatonia, the wall of stuporous depression, to calm the ravage of mania, and the erosion of anxiety. I saw the pain of what we then called agitated depression.

And I found that humanizing the environment and finding ways of relating to very ill people are good things, but they do not cure, treat, or ameliorate the actual illness. Talking alone does not work, though, as I have said before, it is always good to have someone in your corner.

I studied the history of Asylums and the treatment of the mentally ill pre-asylum, and before the application of, dare I say it, the disease model. I read all the analysts’ and other therapists’ case studies and discovered that though the writers developed an elegant understanding of each patient, their actual patients did not get better. Much like some of the data mining studies referred to recently in this blog, the results belied the conclusions.

So I am sometimes puzzled and sometimes angered by the periodic waves of anti-medication opinion that surface in all forms of media. Actually I am not very puzzled because one can usually detect the underlying ideology or motive. The motive is usually the preservation of status and/or ascendancy of the non-prescribing counseling professions. The ideology can be traced to some kind of belief in the perfection of the human mind, spirit, and soul, and a quite reasonable fear of us humans tampering with this.

I am not against psychotherapy and counseling at all. For mental illness the best results are always realized with a combination of medication and good counsel. And I say “good counsel” rather than naming a specific brand of psychotherapy, for despite the continuing attempts to rarefy (also own, patent, and make money from) one form over another, it is the common elements of good counsel that are ultimately helpful: a professional relationship that offers acceptance, empathy, dependability, understanding, support without moral judgment, and, sometimes, wise advice.

We also know people need decent housing, adequate diet, a meaningful activity, membership in some group providing a sense of identity, at least one good relationship, and a bit of exercise.

So why can’t we just get on with it and spend our time and money developing good services for the mentally ill which provide all of the above, rather than argue over the relative merits of each?

Media Disservice to Public Understanding of Health and Medicine

By Marvin Ross

There exists an evil axis of reporters poorly trained in science and medicine, PR mavens and /researchers/universities/journals who feed off each other to present information to the public which can only be considered fake news. This article has been on my back burner for awhile but I’ve moved it up because of Dr Dawson’s last blog on the bad research and data mining on anti-depressants that he wrote about last.

I’m referring to the study that attempts to demonstrate that you are more likely to die if you take medication for your depression. Immediately after this appeared, we received an e-mail from a copy editor at a newspaper wishing that when papers write about stuff like this, they take the time to include comments from other experts who were not involved in the research. This is the report that we read although it has spread widely across North America. The lead author is not a psychiatric researcher but a professor of evolutionary psychology with an undergraduate degree in aerospace and then a legal degree.

What the copy editor suggested is what is supposed to happen but mostly does not. Anyone writing about current research should consult and quote someone not involved with the study in order to get a more objective view.

And the axis of evil is this. Researchers do their stuff and want to be recognized for their brilliance and their contributions to the good of society and (most important) to make it easier to get academic tenure and grants in the future. The PR people are anxious to get maximum press for their publication or university. In the case of universities, it looks good for their funding people and to show to alumni during fund raising. Reporters need a story and so often will simply reshape a press release into a news item.

If it is a breakthrough discovery in a laboratory petrie dish or mouse model, it gets hailed as “a new treatment is coming” and those with that disease become hopeful only to discover there is no new treatment. In the case of this particular study, all those who are anti-psychiatry will have more ammunition. I can’t find the figure but it is something like 20,000 promising therapeutic agents investigated to get one that is actually used and is on your pharmacy shelf. Those are the odds. We have all seen over the years the announced breakthroughs in Alzheimer’s Disease. In the mid 1980s, I wrote a book on Alzheimer’s called the Silent Epidemic and, for the most part, it is still relevant today. That is how many miraculous discoveries have appeared in that time.

Data mining is a common activity for some so that they can churn out papers. When I used to cover medical conferences, there was always at least one study by a Veterans Administration doctor who had culled through their huge store of medical records on mostly older male veterans and would manage to present their paper at the conference. The medical writers rarely took this work seriously.

Sadly, the public is inundated with stories which do nothing but raise false hope for sick people and cause many to rush out and waste money and endanger their lives. Think of the liberation theory for MS which turned out to be false but desperate people spent money and some died in pursuit of ridding themselves of their disease. For the most part, journalists do not specialize in a beat like medicine and health. Those who do  have a good grasp of science and knowledge of their subject matter. The others do not and  also do not have time to properly research.

I still laugh at this but a number of years ago, I started to freelance for a newspaper for doctors that had just launched. Their goal was to inform docs and sell advertising geared at doctors. One of the articles I wrote mentioned medical imaging and the editor called to ask me to define that. She was worried that doctors would not know what that meant but I told her that if they didn’t, they should not have a medical license. It means x-rays, CAT scans, etc. I gave up and told the publisher that his paper would not last. It lasted longer that I thought it would but it soon went out of business.

Take what you read on medicine in your local papers or media with a grain of salt.

On ECT and The Variability of Bodily Experience

By Marvin Ross

ECT or shock therapy has to be the most contentious treatment in all of medicine, in part, due to its depiction in films which is highly negative. My initial view of it was coloured by my favourite aunt when I was a kid. She had what in those days (1950s or 1960s) was a nervous breakdown. Her husband had died and then her brother (my father) died suddenly of a heart attack.

One of her symptoms was unusual pains in her chest and back for which no organic cause could be found so her physician nephew had her admitted to a private sanitarium rather than the infamous Toronto Hospital for the Insane at 999 Queen St W ( actually the Ontario Hospital and now the Center for Addiction and Mental Health). She underwent a series of ECT treatments and was eventually discharged.

After discharge, she confessed to me that after each treatment, the staff asked her how she felt and if she was still experiencing the pains. She told me that if she said yes, she got more shocks so she told them she was fine, the pain had gone away and she was discharged. But, she told me, she still had the pains. I can’t recall how long after but she died of a stroke. I’ve always wondered if they had missed atherosclerosis as diagnostic skills were quite primitive in those days as was treatment for heart and stroke compared to today.

Fast forward to the late 1990s and I was a regular visitor to the psych unit at our local hospital. One of the patients was a young mother with schizophrenia who, I was told, attempted to kill herself and her young children. She was getting ECT. A few months later, I was picking up a coffee at the hospital snack bar when an attractive woman said hello to me.

“You don’t recognize me, do you” she said.

“I’m so and so and this is the new me post ECT. I was discharged, I feel really well and I’m here for an outpatient visit with my psychiatrist”

Psychiatric Times just ran an interview with the author of a new book called Electroconvulsive Therapy in America: The Anatomy of a Medical Controversy by Jonathan Sadowsky, PhD. The one question he was asked that I found very interesting was this:

“Patients have both attested to damage it has done and expressed gratitude for the relief and hope it can provide.” How do you explain this seemingly paradoxical disparity in the experiences and opinions of patients?

The answer was what I have tried to say about medical treatments and recovery in schizophrenia in general but not as elegantly as this author. This is what he had to say:

“The human body is not a mass-produced machine, where given inputs such as therapies produce automatic and predictable results. Most clinicians and lay people know this but often act as if they don’t. One result of this mechanistic conception is resistance to the variability of bodily experience. But this variability is easy to show.”

And so, some people do well and others do not just as some drugs work well for some people and in others not only don’t work but have horrific side effects. We are all different and good clinicians have to recognize (and do) that trial and error is required to find the correct treatment for any given individual.

In a recently released study out of the Karolinska Institute in Sweden, it was found that there is considerable variability in the efficacy of anti-psychotics to prevent relapses in patients with schizophrenia. This study involved 29,823 patients aged 16 to 64 years with a median follow-up of 6.9 years. It was also a naturalistic study where each patient served as his/her own control to avoid selection bias. Long-term injectable antipsychotics, paliperidone and zuclopenthixol and the oral clozapine had the lowest risk of rehospitalization.

Going back to ECT, another recent study found that remission rates for patients with severe mood disorder are lower among those who have had ECT as inpatients. Earlier studies had shown that ECT leads to better remission rates in people with major depressive disorder and results in reduced mortality.

The bottom line is that despite the bad press that ECT and other treatments may have in the media or among the general population, many will experience positive outcomes. Keep an open mind.

The Doctor gives us one hundred years.

By Dr David Laing Dawson

What an interesting time to be alive. I had grandparents who drove some of the first mass produced automobiles; parents who listened to the radio, took penicillin, and flew in planes; I grew up among a generation of boys who dismantled cars and rebuilt them to drive when we got our licenses at 16; we watched television going from black and white to colour, and analogue to digital, from large boxes to thin screens; we bought 64K computers; watched the first messages pass through the internet and modems; watched portable phones, libraries, laptop computers, arcades, cameras, pagers, slide rules, and calculators merge into this ubiquitous instrument we call a smart phone; we learned to say double helix, and then genome; we saw small amounts of data stored on microfiche evolve into terrabytes of data stored in something smaller than a thumbnail; my son and daughter work in the high tech industries; my grandson is studying artificial intelligence at University; and Stephen Hawking tells us we need to colonize another planet or two within 100 years or risk extinction.

If he is right, then the generations alive today are humans who have links to the early days of mass production in the industrial revolution, to the beginnings and early evolution of modern science, medicine, and agricultural practices, right though the digital age, space travel, and on to the destruction of the planet.

Our dramatic success over the past few generations (give or take some stupid wars, genocides and catastrophes) is leading directly to the demise of our species, all within a dozen generations. That is impressive if sad.

Hawking includes possible “acts of God” in his list of destructive forces (direct hit by a large meteor) but most scenarios include one form of suicide or another (pandemic spread around the globe, nuclear holocaust, the consequences of over population, and global warming).

Biologically our evolution has spanned millions of years. Until the industrial revolution our social evolution had been almost as slow and incremental. Capitalism, democracy, science, medicine, and technology have jet propelled (literally and figuratively) this social evolution the past 150 years.

Before then we were creatures surviving within a complex ecology, our population very slowly increasing, subject to the whims of weather, drought, wars, and pestilence. We had minimal effect on our planet. We could build a boat, a city, a canal, and a damn, but the oceans and forests continued, the rivers, deserts, and most of our earth’s life forms persisted. To survive through those centuries we needed to expand, explore, conquer, and exploit.

Not now.

Now quite suddenly we are the shepherds of our own destiny as a species, a life form. To survive we must all cooperate. We must give up notions of magic and Gods and competing feifdoms. We must stop population growth through all humane means of birth control. We must husband our planet’s resources rather than exploit them. We must have in place an international program ready to act instantly when the next pestilence arises. We must stop talking about economic growth and replace this with equitable economic distribution. We must stop destroying our oceans and forests. And of course we must either reduce our CO2 emissions or figure out how to capture them.

A tall order. Especially when some leaders of our fully industrialized nations want to pull us back to an age of competing xenophobic fiefdoms. A hundred years is but a blink of a galaxy’s eye.