The Absolute Discharge for Vince Li was wrong

By Dr David Laing Dawson

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

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

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

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

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

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

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

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

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

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

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

Trump’s grandiosity.

by Dr. David Laing Dawson

I have been watching too much CNN. I must control this new addiction. It is bad enough to find oneself compelled to watch a train wreck or a car accident, to have to slow down and gawk, but now I’m following the ambulances into the ER and waiting to hear the pronouncements of the doctors and nurses and next of kin.

Each evening several panels comprised of both political persuasions dissect the president’s tweets and statements, seeking substance, direction, and meaning, seeking precedent for his personal attacks, sometimes deftly skipping past his actual words to re-frame and reword the proclamation in question. They are often concerned about the political advantage or disadvantage his words might have. As George Orwell and Mark Twain and others have told us, when the outrageous lie becomes commonplace it loses its ability to outrage us. It becomes “strong opinion”. It may even become “alternative fact”.

But none of these panelists seem to pay attention to a part of Donald Trump’s speech that I think they should. Perhaps they need a linguist on one of their panels. Like a child
Trump calls the judge a “so-called judge”; like an envious teenager he revels in the low ratings of Arnold Schwartzenegger; he demonstrates every day he has no boundaries, personal, professional, or ethical.

But this is the kind of sentence I find most frightening:

“I comprehend very well, better than I think almost anybody.”

Without irony or a wink he begins to tell us that he comprehends better than anybody, that he is smarter than everybody else. Then as he is forming the words he catches a glimpse of how this will sound to others, and he squeezes in the phrase, “I think almost”.

He did the same when he said, “I am very smart.” He squeezed in the word “like” to soften the statement a tad, even if it ended up sounding adolescent.

I can analyze this as a grandiosity that is really an over-compensation for insecurity, but it is, nonetheless, grandiosity: A belief in his own powers, in this case his intellectual powers, that far exceeds reality.

As President Kirkman said last season: “There is nothing more dangerous than a pawn that thinks it’s a queen.”

It is this grandiosity that will bring down the house, or some day implode in rage.

Understanding the Disease Model

By Dr David Laing Dawson

I had a friendly argument with a colleague the other day. He reminded me that we had been arguing about this topic for 40 years. I think our arguments are mostly ways of clarifying our own thoughts about a very complicated question involving concepts of mind, of cognition, and of the brain, that organ who’s function makes us human.

Mental illness, disease, disorder, serious mental illness, continuum, spectrum, problem, affliction – when is it both valid and useful to consider aberrations (or non-typical) variations in behaviour and thought, illnesses? In some ways these words are just words, and few would care if we referred to arthritis in any of these terms. But when it comes to behavior, thought, and communication (rather than joint flexibility and joint pain) our dearly held beliefs about self, autonomy, will, power, consciousness, and mortality come into play. The discussion becomes political.

Before the medical disease concept evolved in the 18th and 19th century most afflictions were considered very personal and specific, and the causes very personal and specific. An obvious grouping of afflictions might mean God was particularly disappointed in a whole family or tribe. The Miasmists thought that perhaps God did not have that much control over everything and proposed that the causes might be found in the atmosphere, the miasma, physical, spiritual, emotional. An excess or a deficit. The Naturopaths liked this idea but knowing nothing of physiology, metabolism, or nutrition, concocted potions and powders with dozens of ingredients positing that the body might choose from the lot that which it needed. Each of these ideas continues to echo in the pursuit of health today. Especially in the commercial exploitation of our pursuit of health.

The disease model is founded on the idea that if a number of people suffer the same symptoms and signs, and if their affliction follows the same course with the same outcome then perhaps these people suffer from the same “thing”. This in turn raises the possibility that the cause is the same in all cases and that a treatment that works for one will work for the others. To study this we need to name (diagnose) the thing and describe it’s symptoms, signs, and natural course. Given that we are biological beings it is reasonable to think that some of the signs of these diseases will be biological, and that the causes might be as well. But first the chore is to observe, study, collate, find groupings and test this hypothesis.

In a sense the disease model has picked off all the low hanging fruit, those illnesses with very specific causes and courses and, of course, those for which we have found specific treatments, cures and prevention.

The disease model, and some rudimentary epidemiology, led Dr. John Snow to the source of an outbreak of cholera and then to speculate that the cause, residing in the water supply, “behaved as if it were a living organism”. This before we knew about bacteria, let alone viruses, prions, DNA, and neurohomones.

The same disease model has led to the near eradication of Polio. Drs. Alzheimer and Kraeplin applied the disease model to older people with failing cognitive processes and singled out an illness we now call Alzheimers. Dr. Alzheimer had the advantage of being able to examine the brains of his patients soon after diagnosis. Dr. Kraeplin went on to apply the disease model to a younger group of patients with peculiar cognitive difficulties, some similar to dementia, some not, and singled out a group he called dementia praecox, and another group he called manic depressive. Similarly and more recently the disease model singled out autism from the broader group of mentally handicapped children.

The disease model also allows us to study afflictions and find remedies before, sometimes long before we establish with certainty the causes of the affliction. Who on earth but a cruel idealogue would want us to stop treating and reducing suffering until we find an exact and specific cause of the affliction in question, be it cancer, arthritis, or schizophrenia. Yet that is the cant of the anti-psychiatry folks.

Yet the disease model allows us, sometimes by accident, to find remedies that work, can be proven to work, before we nail down etiology. Now, as mentioned earlier, the disease model has picked off the low hanging fruit, those afflictions caused by single alien organisms, and very specific genetic aberrations. We are left with those that are undoubtedly the product of complex combinations of genetic vulnerability, epigenetic influences in the womb, environmental influences, developmental timing, excesses, and deficits.

But we should no more give up on the disease model for schizophrenia and depression than for heart disease, cancer, arthritis, ALS, and dementia.

Our argument was actually about OCD. Having some Obsessive and Compulsive traits can be an asset of course, and of great help in medical school, while extreme OC traits can be debilitating. The “D” of OCD is the initial for “disorder” of course, but is OCD, in annoying to debilitating form, a disease?

Unfortunately the word “disease” has become freighted with negative association, and for my friend, too much associated with “biological cause”.

Ultimately he may think of OCD as a mind problem, while I may think of it as a mind/brain problem, but it is the discipline of the medical disease concept that allows us to study it and find remedies we can test.

When is it Too Late? Time For a Coalition!

By Dr David Laing Dawson

We talk about him incessantly. We worry; we laugh; we snicker, we cry. Every day we see his narcissism on display. Everyday we see him manipulated by a handful of petty tyrants. Everyday he displays his ignorance anew. Everyday we get to see his carelessness.

And I start to wonder. When did it become too late to stop Hitler? When did it become too late to stop the First World War? When did it become too late to stop Franco, Mussolini, Stalin, Idi Amin, Pol Pot? When did it become too late to stop the Great Depression, the war in Iraq, the rise of ISIS?

Things are moving quickly my American friends. Please get together, form a coalition, if necessary put your political careers at risk, but start your filibusters, begin the impeachment process now.

I don’t want my grandchildren living on a broken planet wondering when it became too late to stop Donald Trump and Mr. Bannon.

Quebec City – On You Trump

By Dr David Laing Dawson

Mr. Trump, this is on you.

Every country in the world has a few young men capable of committing a mass murder. They are angry; they blame others for their failures; they nurse grudges; they are easily caught up in conspiracies; they rebel against any authority; they lap up the hatred of others; they spend much of their time lamenting about the state of the world while drinking beer or snorting cocaine late into the night; they are unsuccessful with women. They deeply fear the world of adult responsibility. They play first person shooter video games. They like guns. They harbor racist grievances. Some are “loners” as the newspaper will call them, but this usually means a mental disorder that limits their ability to engage face to face with others, and allows them to build a delusional world view from other sources. Of course the impersonal sources from which they can build that distorted world view, and their place in it, has dramatically increased in the last 20 years.

But usually these young men hurt few but themselves and their families. They don’t (usually) act upon their darkest fantasies.

Unless they are given license to do so by someone with a loud voice. That would be you Mr. Trump. Your careless words, your disdain can unleash such horrors no matter that it was not your intention.

When I write my blogs about American politics my daughter reminds me I am Canadian. But we breathe the same air; your messages are clearly heard north of the 49th parallel. It is a sad thing the first young man who took your words and actions as license to kill was a Canadian. I trust our response to this will continue to be very Canadian.

But beware, Mr. Trump, you and Mr. Bannon have the capacity to unleash the contemporary equivalent of Krystallnacht.

Trump and the Threat to Democracy

By Dr David Laing Dawson

My optimism was short lived. After watching Trump’s speech at the CIA headquarters and Sean Spicer’s first press conference I wondered how one goes about dismantling a democracy. I assume there is no manual for this. So I thought I would create a Coles Notes version so we can all follow along:

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

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.

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

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

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.

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.

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

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.

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.

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”?

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

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.

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

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.

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.

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

17. 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/parliament) 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.

18. 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 cancelling all the social and health initiatives of that upstart negro president.

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

20. 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.

21. 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.

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

23. 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.

24. 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.

25. 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.

26. 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.

27. 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.

28. 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.

29. 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.

……………………

But Donald Trump’s performance at CIA headquarters was not so much of a man seeking autocratic rule but of unbridled narcissism. A narcissism that cannot be sated. Even a hint that the adoring crowd was not as big as Obama’s set him off on a delusional reconstruction, or, as Conway called it, “alternative facts”.

And his claim that 3 million votes were cast fraudulently may not be (by Donald himself) a clever ploy to undermine democracy but rather his narcissistic rage against a perceived slight. (Overall more people liked Hillary).

So I suspect he is not so much a would-be tyrant as a man needing constant adulation, threatened by any possibility he is not loved and admired as much as he feels he deserves.

But let me be clinical for a moment. In psychiatry we talk of “personality disorders” – dependent, borderline, narcissistic, sociopathic for example. Now we all have some of these traits. Who isn’t a little narcissistic? But what makes a human trait a “disorder” lies in its insatiability. A dependent person can find someone to take care of him or her and life goes on smoothly. Each satisfies the needs of the other. But for some the dependency must be re-enacted and reconstructed, reinforced in each and every encounter. Then we have a problem. A little normal/average narcissism can be satisfied by a simple comment perhaps once per week: “You look really good in that dress”. But it is a disorder when it must be reenacted and satisfied in each and every encounter. When it cannot be even temporarily sated. For most of us, being elected president would suffice, or even being treated well by a store clerk.

So Donald Trump’s narcissism is pathological, insatiable, needing to be reenacted, reinforced every day. He cannot tolerate even the smallest insult to his ego. This is a disorder. And such a disorder seldom ends well. In this case it could end badly for all of us.

And this flaw makes Trump an easy stooge for others who truly hunger for power and world domination. He is a blunt instrument with no guidance system of his own. I’m sure many in the Republican party are using him now, perhaps Putin as well, each hoping they can rid themselves of Donald J. Trump when their goals are achieved. Some of those goals are ideological, some are about power, some about money. But it is a high stakes game they are playing.

Please, when he has done all you desire and becomes uncontrollable, when you decide to impeach him, first take away the nuclear codes.

Cockamamie Views From Anti-Psychiatric Advocate

By Marvin Ross

Bonnie Burstow, the anti-psychiatry scholarship donor at the University of Toronto, gave a lecture in December on her book called Psychiatry and the Business of Madness. The lecture is on youtube for those of you who have the stomach to watch it. I managed 38 minutes of the hour talk and it is so full of absurdities that, frankly, it defies reality.

I recently wrote about her scholarship on the Huffington Post and that was followed by a number of other critiques of that endeavour – none favourable. Tom Blackwell, the National Post medical writer, called it an affront to science that could do harm. “This is a case where academic freedom should be quashed,” Edward Shorter, a U of T professor and expert in the history of psychiatry, told Blackwell. Dr. Joel Paris, a McGill University psychiatrist, is quoted saying he is ashamed of the University.

I can only imagine what they would have said if they saw this lecture so allow me to summarize the first half and point out the errors.

Bonnie begins by saying that psychiatry is so inherently wrong that it just cannot continue. She points out that psychiatrists are so powerful that they are the only ones in society who have the right to take away someone’s freedom. They have king like power like those of the 16th and 17th centuries who had the power to exile citizens forever.

Now she says these views are based on thousands of interviews and attending 15 consent and capacity board hearings. If she really did attend those meetings, she could not believe what she said and by equating shrinks to autocratic monarchs, she suggests that there is no recourse to anything they do. Each jurisdiction allows for holding someone for observation and the rules differ but are all basically the same. For the purpose of this blog, I will comment on Ontario since Bonnie lives in Ontario as do I.

To begin with, psychiatrists are not the only ones to have the power to put someone in the hospital for observation. Any MD can do that based on very specific criteria. It is not arbitrary. The initial period is for 72 hours only after which the person is to be discharged, or can agree to remain voluntarily. If they still pose a threat to themselves or others, they can be held for a further 2 week period but that cannot be ordered by the doctor who originally signed the 72 hour committal. A second doctor must agree that it is necessary and sign the forms.

The patient is then told by the patient rights advocate that they can appeal if they do not agree and they will be supplied with a legal aid lawyer. This results in a capacity hearing before a board 15 of which Bonnie attended.

This is hardly imprisoning anyone nor is it done without respect for individual rights. Bonnie describes this as bringing the weight of the entire state, police, hospitals, families, universities who have been all sucked into this system. At the very centre of this conspiracy are the big pharma companies.

To illustrate what she calls the lack of substance to psychiatry, she recounts the experiences of her friend, Amy. For about 30 years, Amy has periodically taken off all her clothes and run down the street pounding on doors yelling “emergency, emergency”. Concerned homeowners call the cops who come and take her to hospital where she is locked up for a period of time. This has happened in various jurisdictions all over North America and Bonnie feels it is ridiculous. Her activities are simply “outside our comfort zone” so we define her as dangerous and sick. Bonnie does not even think people should call the cops.

I don’t know about you but if this happened in my neighbourhood, I’d call 9-1-1. I’m not sure what I would think but escaping a rapist would come to mind, or an abusive spouse or having been held against her will would be at the top of my thinking. The police are best able to deal with that. If they can find no reasonable reason for this behaviour, then of course they would take her to the emergency room.

This example led her to talk about violence of the mentally ill and a long discussion on the impossibility of psychiatrists being able to predict who may or may not become violent. She is correct on that score but her argument that is often heard about those with mental illness never being violent is absurd. Those who are untreated and those who are untreated and substance abusers are at far greater risk of violence than others. This link from the Treatment Advocacy Centre lists all the studies that demonstrate this fact.

She then goes on to talk about how mass shootings involve people who are often on psych meds and that it is the meds that likely cause these shootings. Psychiatrist Joe Pierre writing in Psychology Today argues that “In the vast majority of cases, we don’t have access to their medical records and we certainly don’t know if the medications, even if prescribed or otherwise obtained, were actually being taken.”

“And then, of course, there’s the issue of correlation vs. causality. After all, I’m fairly certain all known mass murderers were drinkers of tap water, which has also been linked to violent outbursts.”

At this point, Professor Burstow switches into “refuting” the concept of mental illness. She states that only a body can have an illness. A mind cannot be ill as it is only used for thinking. I kid you not! That is what she said.

She then goes on to say that the hallmarks of paranoid schizophrenia are paranoia and delusions of grandeur. What happens to the paranoia and the grandeur when the person dies and there is just a corpse. She asks her audience if any of them have ever seen a corpse with delusions and, since no one has, schizophrenia fails the test of an illness.

What can anyone say when confronted with this? Professor Burstow has failed the test of physiology. The brain is an organ that allows us the ability to think, speak, make decisions, and so on. Does she have any idea how it is that we can think in the first place? Obviously not. This summary provides an overview of the differences in the brains of those with schizophrenia compared to normal brains. There are numerous differences.

And this is a study showing the abnormalities in the brain of autopsied people with schizophrenia. Which of these abnormalities results in paranoia and delusions of grandeur is not known but the brains are different.

I gave up when she began talking about the longitudinal studies by Harrow in Chicago. This researcher followed a group of people with schizophrenia for 20 years and checked on them every five. What he found was that some people were able to go off meds and do well and they were doing better than those on meds. I’ve written about this a number of times and, in one of my Huffington Post blogs, I had this to say:

79 per cent and 64 per cent of the patients were on medication at 10- and 15-year follow ups. Those who were not on medication, did better on the outcome measures than those who were on but would that not be expected? Why they stopped the medication or were removed from it by their doctors was not explained, but we can presume that it was because they did not need the medication. In fact, Harrow states that not all schizophrenia patients are alike and that one treatment fits all is “not consonant with the current data or with clinical experience.” His data suggests that there are unique differences in those who can go off medications compared to those who cannot. In a paper Harrow just published in March, he points out that it is not possible to predict who may be able to go off medication and those who need the long term treatment. Intensified research is needed.

It just isn’t that simple, Bonnie. She did go on but I could not take anymore so ended there.

Trump and the Women’s March

By Dr David Laing Dawson

Sitting in the lounge of the Vancouver airport waiting on a flight to Edmonton I can see the snowy peaks of the North Shore Mountains lit up by the late afternoon sun. With closed caption description the large television is showing the inauguration parade, the slowed and often paused procession of a large black limousine surrounded by dozens of secret service agents.

A young woman is pumping milk from her breasts to a bottle under her shirt. I wonder where her baby is. Perhaps with her parents in Edmonton. A tall black man walks by, ear buds, furry boots, and dreadlocks. The faces around me are varied. One I think is Japanese, another appears first nations, two more are Chinese, then Korean, and then an Hispanic couple. A Malaysian man is sleeping, a white woman eating a salad from a plastic container. Many are bent over phones and laptops. Two Asian boys speak Mandarin to their mother. Her legs are slightly bowed as an older woman’s might be from a  deficiency in Vitamin D experienced as a child. A plump white woman walks by in slightly ridiculous brilliant red spike heels.

Trump’s inauguration speech is isolationist, a warning to others. He talks of ending crime in the cities by expanding police forces, of wiping out ISIS once and for all. He speaks of desolation and destruction in America, of violence and death in the inner cities. He uses the word “carnage”. He speaks of building the armed forces and respecting the police. He talks of America first, of placing a high tariff on items built by American firms in other countries. He speaks of the American education system and suggests it is rich but wasteful, a failure. He paints a bleak picture of America and hints at a law and order solution.

Our flight is late. The plane has come from San Francisco where it was delayed.

Once we are in the plane and seated with baggage stowed the flight attendant tells us the crew can manage communication in English, French, Cantonese, Mandarin, Japanese, and Korean.

Trump’s speech is that of a strong man, an autocrat. He doesn’t name an enemy apart from ISIS and previous administrations but his code words hint at a few. He will dismantle industry regulation and Obama Care. He appeals to patriotism, power and domination.

When our plane arrives in Edmonton the attendant asks all passengers to remain seated so a man from the rear of the plane can disembark first to make a tight connection. A minute later a worried Asian man hurries down the aisle. A tall white woman gives him an encouraging smile.

It is still and cold this morning in Edmonton, the ground snow covered, the air dense with ice crystal fog. I see on the CBC news network that a similar fog has settled on Washington, though judging by the dress of the half million marchers it is warmer.

We watch the CBC coverage of the gatherings in many cities. We chuckle at the more clever protest signs: “We shall not overcomb”, and a uterus with fallopian tubes in the shape of a raised middle finger.

And then I experience a brief surge of optimism. Perhaps the election of Donald Trump is but a catalyst, a shock, a wake-up call that will energize a counter evolution propelling us along the better pathway of inclusiveness, women’s rights and equality, cooperation, kindness, good social programs….

The very fact there are marches taking place in many cities around the world is evidence that isolationism is impractical.

But I also see that Iran has already warned that it can easily restart it’s nuclear program, and Trump is already signing some regressive policies into law.

In Edmonton we are visiting our son and daughter-in-law and their three children, all girls. I pray for their sake my optimism holds.

It’s Not Recovery, It’s Remission or Positive Management

By Marvin Ross

Anytime I criticize the recovery concept in mental illness, I get push back. I’m not surprised but the notion that recovery empowers people and gives them hope does not make sense. What I was pointing out in an earlier post was this. If you can’t recover fully or improve significantly, then recovery suggests that you weren’t trying hard enough and you are a failure.

It is only in mental illness among all the chronic illnesses where recovery is talked about. The dictionary definition of recovery is this:

“the act or process of becoming healthy after an illness or injury : the act or process of recovering. : the act or process of returning to a normal state after a period of difficulty. : the return of something that has been lost, stolen, etc.”

People can recover from a bad cold or a broken bone but they cannot recover from a chronic illness regardless of what they do. Recovery is a term or concept that comes from addictions and is misapplied to mental illness. A recovered addict is someone who has stopped using addictive substances. Someone with a mental illness cannot suddenly stop being mentally ill. What they can do with the help of health professionals is to deal with the symptoms as best as can be accomplished and to reach a state of good management of the disease – a form of remission.

If you want to call that recovery, OK but it isn’t a true recovery. Whatever caused the illness in the first place, cells running amok as in cancer, immune systems attacking its own body as in autoimmune diseases, tangles and placque in the brain from Alzheimer’s, remains. Medical management has not progressed to the point where these conditions can be reversed. The best it can do is to help with the symptoms and to provide supports to make the life of the sufferer as good as it can be.

The concept of recovery does not take into account the variability of diseases. Symptoms are not always exactly the same for everyone nor are they of the same intensity. When someone is diagnosed with a chronic illness, they (and the family) get an explanation of it from their doctor. They are told what to expect and what the treatments are. Those treatments will include medications, education, and other relevant strategies.

This is where lived experience comes in. That is another stupid term in my opinion. Because each individual is different, their health care providers ask about their symptoms, severity and how various treatment modalities are working. The doctor knows the disease, the science, the treatments but only the ill individual knows how he or she is coping and what may or may not be working and the potential side effects. That is the lived experience they bring to the appointments and it goes for every malady.

The lived experience as part of the therapeutic alliance between health care providers and their patients has always existed. Lived experience reminds me of a panel I was asked to participate on for a “new innovation” – patient centred care. I did not endear myself to the hospital staff and doctors when I asked what was such a big deal. Central to hospitals and doctors is the patient. Without us, they have nothing so if patient centred care is such a big deal, where did the patient fit in before? It and lived experience are but fads and buzz words.

The proponents of lived experience then usually jump to the need and importance of  peer support as part of the therapeutic regimen. That’s fine as long as what it does is to provide a buddy with information, education and coping strategies. Most, if not all, chronic diseases have support organizations. The cancer society, arthritis, lupus, MS, you name it and all do that. But that peer support is not a substitute for the medical specialties.

When anyone is first diagnosed with a chronic condition, they are given some parameters. If you have type I diabetes, the parents (because it is from birth) will be told that it will be necessary for the individual to take insulin for their entire life and to be very careful about diet.

That insulin analogy is often used with schizophrenia. The person is told that they will likely have to take medication for the rest of their lives like an insulin dependent diabetic needs to take insulin. It might not be the best of analogies but it is used and it certainly makes the point. I suspect, but I don’t know for sure, that the much maligned idea that there is a chemical imbalance in the brain with mental illness was nothing more that an analogy to explain that which cannot be explained.

We all ask the cause even though there is never a good explanation. Why do I have inflammatory arthritis? It’s autoimmune but what does that really mean? My rheumatologist would probably shrug and say your immune system suddenly decided to attack your body. Why? No idea. How? No idea but take this and it may help reduce the inflammation (or not).

The patient or family asks why schizophrenia, bipolar, severe depression and the doc, at a loss, says there is a chemical imbalance in the brain. Well, maybe not but the brain is messed up and all that does is to give what sounds like a plausible explanation for the unwanted ailment.

The bottom line in all this is that when you do have a chronic illness, then you manage it as best as it can be managed so that you have as good a life as possible with the deficit. It’s not a cure and it’s not true recovery but it is the best that is available now. So, enough with this recovery talk. It is time to be realistic.

Strategies That Help Us Feel Better

By Dr David Laing Dawson

On Monday morning this week, driving to the clinic in minus 14 degree weather, while I was stopped at a light, a well dressed woman pulling a large suitcase hurried along the edge of the ice-filled gutter toward me. She waved at me. I rolled down the window on the passenger side. She told me in thick Spanish accent she needed a ride to the center of town. I unlocked the door. She clambered in, pulling the suitcase in after her. She talked quickly about many things. I dropped her off near the bus stop in the center of town. She blessed me profusely and I drove on to work.

At the end of the day as I walked to my car in the carport another woman flagged me down and hurried toward me, this time a Chinese woman wearing a dust mask to ward off the cold or viruses. She asked to borrow my cell phone. I dialed for her and watched as she told her husband where she was and that her car battery was dead. The call ended successfully and she smiled and waved at me as I drove away.

In between these events, during the day, while walking from the secretary’s desk down the hall to my office, I noticed a large group of people in the boardroom standing in a circle with arms raised above in that position of lordly praise. I turned to the secretary and said, “My God, we have a revivalist meeting going on in there.” She said, “That must be the CBT group.” And I said, “Let me know if they start speaking in tongues.”

All of which got me thinking about what, besides pharmacological tweaking of the neuro- hormones in our brains, makes us troubled humans feel better.

Last time I looked there were literally hundreds of varieties of counseling and therapy, each with its own proponents and economic systems. But might not reality be simpler than that? Much like all that we know about good nutrition can be summed up in one short sentence: “Eat, not too much, mostly plants.”

Here is my short list of things that help us feel better when we are sad or depressed, worried or severely anxious, mildly distressed or in a state of panic.

  1. Help others. I am sure it is simply in our DNA and one of those traits that allowed us to grow our tribes and dominate life on earth. And this is why becoming an addiction counselor is one of the most successful ways of overcoming addiction.
  2. Do something in a group. I suspect it doesn’t matter if it is CBT, RTB, ABC, curling or building an ark together. It is being part of, participating in a group activity that helps us feel better.
  3. Touch. Hand to hand, hand to body, body to body. Within a consensual primary relationship of course. But failing that, perhaps a pet, a friend. And failing that, a massage therapist and even a chiropractor.
  4. Talk to someone who is actually interested in your life. The best counselors, therapists, professional or not, besides being empathic and non-judgmental and possessing some wisdom, have one other important trait. They are very curious about other people’s lives. They listen.
  5. Share a laugh. Laughter is probably not really the “best medicine”, but it is a signaling system unique to our species. (Hyenas and Kookaburras “laugh” for other reasons). For us it is a shared moment lacking in threat, caution and animosity, a moment of letting down the guard. And we always feel better for at least several minutes afterward.
  6. Understand. Have a way of understanding, or organizing, or thinking about, yourself and the world around you. Again I am sure it doesn’t matter a great deal whether it is a profoundly complicated mix of anthropology/neurology/evolution/ and quantum mechanics or the AA 12 step program, or the teachings of Buddha or Jesus or Mohammed, as long as it is not rigid, nasty, nihilistic and exclusionary. But the brain demands organization of its experiences, its sensory input. It need not be true in any absolute sense to be helpful. And this is probably why we have so many theories of psychology, so many forms of therapy and counseling. So if you want to believe in astrology and it gives you a way of understanding your friend’s behaviour, go ahead.
  7. Move. Exercise. Long before we knew anything about the dopamine, the serotonin in our brains, and the manner they are influenced and, in turn, influence our sense of well-being, Hippocrates proclaimed his treatment for depression: “Go for a walk. And if you are still depressed upon returning, go for another walk.”
  8. Quell the Inquisitor in your brain, at least for part of each day. By “inquisitor” I mean that brain mechanism that,  at its best, allows us to plan our day,  govern our behaviour, censor our worst notions, doubt and second guess our poor ideas, and at its worst tortures us obsessively with fears and follies. Find a way of taking a holiday from this. Preferably not with alcohol or marijuana. But rather with real holidays, meditation, yoga, playing a sport, playing music, engaging in an absorbing activity. For me it is painting, art. You will know when you have been there because you have lost track of time.
  9. Get a good night’s sleep. Our biology is probably programmed, for optimal performance, to stay active and outdoors through the daylight hours, and then go to our mats, our caves, our beds shortly after the sun goes down. This leads to two sleeps of about 4 to 5  hours each, with a period of semi-wakefulness in between. But then we discovered fire and telling stories around the fire, and Mr. Tesla and Edison came along and we never really adapted. So, turn off the lights and the electronics, use, within reason, whatever aids you require, and get some sleep. The cleaners can’t come through and remove the debris if everybody is still working in the office.
  10. Make something. A birdhouse, a cake, a sous vide prime rib, a back porch, a fire pit. I suspect again that it doesn’t really matter what we make, but we are undoubtedly programmed to be rewarded (internally at least) by our own productivity.  It is how we survived to become the dominant species. Of course this making of things has included making better and better weapons, which is in part, I think, the source of the current puffery of Kim Jong Un, Donald J. Trump, and Vladmir Putin.  Okay. That last thought means it is time to revisit item 8 on this list.