The Generation (of males) That Never Grew Up

By Dr David Laing Dawson

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Image by kai kalhh from Pixabay

Once per month we host openings at our art gallery, with music and wine and food, and a few years ago a man attended, looked around and concluded that this was the right demographic and asked me if we would like to offer our guests samplings of craft ale. “Wow,” I said, “Free beer. Where were you when I was 18?”

Eighteen.

Meanwhile our Ontario Premier, Doug Ford, the one with his middle aged body always straining against his white shirt, clearly retains the priorities of an 18 year old male:

  • Cheap beer. (free would be better)
  • Beer available in every corner store, at all hours.
  • No more police raiding our tailgate and bush parties.
  • Higher speed limits.
  • Cheap gas.
  • Fewer teachers.
  • Larger classes (no one notices when you skip class or look at porn)
  • Fewer silly artsy classes.

And who needs ambulances, trees, day care, endangered species, cooler climate and health care if you have cheap beer?

And then I see that it’s not just Elon Musk who wants to visit the moon. Branson and Bezos as well. With all the money and resources at their disposal the best these billionaires can come up with is flying a rocket to the moon? Perhaps becoming honorary colonels in Trump’s Space Force? A cool idea when you’re 18 and you have not yet noticed our population is inching toward 8 billion and our planet is suffocating.

And then we have derogatory nicknames and ill founded declarations of extremes and of certainties flowing from the mouths of politicians. “It’s a disaster.” “The worst.” Taunts and threats and chest beating. It is High School all over again.

There is one irony in all this I just noticed. The man who lost over a billion dollars “building” hotels and golf courses and grand casinos in the decade between 1985 and 1994, is now reduced, in his building ambitions at least, to erecting a tax payer funded wall.

Meanwhile, we are now able to serve samples of an exquisite assortment of craft ales at our gallery openings during which we sometimes engage in intelligent adult conversation.

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

By Marvin Ross

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

If you want improvements, fight for them!

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

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

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

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

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

Update on the Dismantling of American Democracy.

By Dr David Laing Dawson

In 2017, when Sean Spicer was giving press briefings, I wrote out a list of things that Trump and his cohorts would have to do to dismantle the democracy of the United States of America, and for Trump to become President-for-Life, Supreme Leader, or King.

With Trump and his Administration now defying Congress, planning to insert himself front and center in the Fourth of July celebrations, and manufacturing three crises (Immigration, trade war, potential war with Iran), I thought it time to revisit this list and consider the progress he has made with just 18 months to go before the next election.

(If I were writing this today I would emphasize the all in point one, all previous administrations; constant reference to his brilliance and fitness in point 2; change point 3 to “paint a bleak picture of the current state of affairs in all other nations, compared to his USA”.

And I would add: undermine all treaties, agreements, and international cooperative agencies so your people feel more isolated and fearful, make this a family affair, completely entangle the affairs and interests of the USA with your own business interests and properties, and while disparaging all independent news agencies create your own controlled media presence, and, oh yes, pardon any convicted criminal who remains loyal to you and has an audience, e.g. Conrad Black. )

Here is the list from 2017:

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”, “loser”, “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, Marine Penn and Netanyahu. Be unpredictable for the others. Keep them on edge.

17. 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 canceling all social and medical initiatives started by 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.

 

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

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

Mother’s Day

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Katherine Flannery Dering

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Climate Change and Sharks

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Image by Hermann Traub from Pixabay

By Dr David Laing Dawson

I was reading today about the “climate change deniers” Trump is putting on a panel, The Presidential Committee on Climate Security. One of these people has publicly compared our demonizing of CO2 to Hitler’s attitude toward Jews.

But, overall, the tone that strikes me most is that of adolescent thinking processes.

That’s where sharks come in.

If you ask a child the simple question, “Would you swim with sharks?” almost all will quickly and firmly say “No.”

If you ask an adult if he or she would be willing to swim with sharks the answer comes quickly and in the same form as the child’s. “No. Are you kidding?”

But if you ask the same question of a teenager what often follows is a pause, some consideration and deep thought, some partial sentences, some qualifications, some reasoning such as, “Well, humans are not the natural prey of sharks….so…”

They are exercising their newly formed reasoning processes, often arriving at something like, “In a supervised pool, with a well fed shark, and ensuring that I am not bleeding anywhere, I think the odds of surviving are pretty good, so yeah, maybe I’d try it.”

Similarly the adolescent male’s reasoning process can arrive at the following conclusion: “I think there is an 80% chance that I can make this sharp turn driving at 100 K an hour (in mom’s car) without crashing, so let’s go for it.”

What is missing is perspective in the adolescent thinking, and in the climate change debate. An 80% chance of winning would be wonderful at a casino, and not too bad for a necessary heart operation. But not for taking unnecessary risks with one’s life.

Risk benefit analysis requires a pretty clear understanding of the potential long term results for self and others. This is often a task for which the adolescent brain is not yet equipped. This is not always a bad thing. For it is our youth, our teenagers, who are willing to embark on a journey with only 10% chance of success.

The consequence of persistent global warming is the destruction of human life on this planet, preceded by years of increasing turmoil, migration, wars, destruction, suffering. Though not of my life or the lives of Mr. Trump’s proposed panel.

Is man made CO2 the cause? The cause or a major contributor?

The facts and the science support this to be the case with a small percentage of doubters. If the consequences of being wrong were minor we should let the argument continue. But they are far from minor.

Even if the odds were only 40% that man-made CO2 is a major contributor, we are not adolescents and so, considering the stakes for my grandchildren and their grandchildren….

And therein may lie the problem. Though Trump’s experts have adult brains perhaps they do not have the ability to imagine what life will be like in Africa, India, the small islands in our oceans, out coastal communities, our plains, and for our grandchildren – that is, for others.

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

By Marvin Ross with an addendum by Dr David Laing Dawson

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

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

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

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

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

And then, I received this:

Linking up the mind emotions abuse illness and recovery

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

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

ADDENDUM:

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

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

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

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

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

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

Of Insects and Teenagers.

By Dr David Laing Dawson

The other day I sat with a father and his 16 year old daughter. She was curled up in her chair, head bent over her phone, constantly texting seven friends. She did listen to the conversation though and stated that she was quite capable of “multi-tasking”. Then her head would go down again and her thumbs would flit about the screen of her phone. She was not attending school.

And it occurred to me that what I was observing was a hive. I was thinking bees, garden variety bees, drones at work in swarms and single file.

Bees are not quite Borgs. Each bee is a single entity but capable of working, moving in unison, in tandem, in swarms, subsuming any individual needs or impulses to the needs and actions of the hive. And though we know some genetics may be involved we also know this is achieved through constant communication. Movement and pheromones, choreography and smell.

The other thing we know about bees is that a hive is a hive and that it does not play well with other hives.

And something we know about humans is that though they have evolved to the head of the food chain, each carries within him or her the seeds of regression, the DNA of the species that came before us.

Pulling these disparate thoughts together was the smartphone, for suddenly, at least quite suddenly in historic terms, an instrument has landed in the hands of our adolescents that allows them to be bees, to form hives, albeit fragile hives, through a constant (24/7) stream of communication, checking and monitoring and correcting behaviour, appearance, pecking order, membership, attitude and bond.

Like bees, membership in one hive precludes membership in another. Unlike bees though, one misstep in these communications can bring expulsion from the hive, and unlike bees these teens have a full range of non-hive impulses, other needs to satisfy, other loyalties to balance, often in conflict with the hive.

The tendency to hive was always there among us humans, especially our adolescents, but usually limited by other loyalties, activities, communication time, boundaries and realities. A gang might form only when those other loyalties were weak or poor or broken.

We used to talk of peer pressure, peer pressure in conflict with the expectations of parents, and sometimes in conflict with the health and welfare of the teen. But back then unsupervised peer communication was limited to a few hours a day.

And now, quite suddenly, it is far more than this. The constant buzz and hum of the smartphone turns “peer pressure” into hives.

No wonder our adolescents are collapsing with anxiety or hiding in their rooms with increasing frequency.

Are Safe Injection Sites of any Value?

By Dr David Laing Dawson

Many years ago I attended a presentation on an illicit drug ban conducted in an Asian country. I think all the opium dens were closed. Over the next ten years, presented in graph form, the dramatic fall in Opium use was an almost perfect mirror image of the rise of heroin use. So, in reality, this intervention pushed people to engage in even riskier behaviour.

During those same years in North America, the rise in the numbers of therapists conducting marital therapy, exactly followed the rising number of (newly more acceptable) divorces. It seemed to me then that marital therapy was not an intervention to help people in their relationships, but rather an industry taking advantage of a social trend.

I recently wondered about Insite, the clean needle, safe injection site in Vancouver. After much controversy in the early 2000’s and battles with the Conservative Government of Canada, it has been funded and fully operational for over a dozen years. I understand the rationale, and it makes perfect sense, along with the fact that, on a survey, 75% of addicts said they would be willing to use a safe injection site. Clean needles will prevent the spread of hepatitis and HIV. Staff on hand can intervene with overdoses. Addicts can be referred to programs. Other health needs can be addressed.

So what has happened at Insite between 2012 and January 2019?

2015 stats show:

263,713 visits by 6532 individuals.

722 visits per day

440 injection room visits per day

768 overdose incidents

No overdose deaths.

2017:

175,464 visits by 7,301 individuals

537 visits per day

415 injection room visits per day

2151 overdose incidents

And, overall, deaths by overdose in B.C. have dramatically risen from 270 in 2012 to 1486 in 2017, and then 1510 in 2018.

During this same period death by overdose of prescribed drugs has fallen (and comprises only a small fraction of the total), while illicit fentanyl has flooded the market.

I am not trying to draw any cause and effect conclusion here, but rather to point out that we humans are a puzzling and contrary species. Interventions aimed at bucking trends and changing behaviour, no matter how much they are based on science, numbers, common sense, can be way off the mark, may even produce opposite results and many unintended consequences.

Just looking at the above raw data I would have to wonder A. Without Insite would the deaths by overdose in 2018 have been 2510, a thousand more? B. Has the presence of Insite and all the de- stigmatization/acceptance surrounding it, actually removed psychological barriers that would otherwise prevent people from becoming addicted and engaging in increasingly risky behaviour? and C. Has the tightening of prescription opioid practices simply opened a market for illegal fentanyl and carfentanyl and pushed a whole population toward more dangerous drugs?

Has it been a good intervention broadly speaking or has it actually contributed to or even accelerated a social trend?

Or is it, like marital therapy, good for a few people but absolutely ineffective bucking a complex social evolution?

There has been a bit of a plateau in deaths by overdose in 2018 continuing so far in 2019. So maybe this social trend is peaking, and maybe it has very little to do with any of our well intended interventions.

 

Smoking and Serious Mental Illnesses

By Marvin Ross

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Image by Free-Photos from Pixabay

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

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

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

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

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

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

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

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

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

Psychiatry in Scandinavia

By Marvin Ross

There must be something in the water in Scandinavian countries that produces some strange treatment modalities for serious mental illnesses. The latest is drug free units within psychiatric hospitals in Norway. Previously, we had (and still do) the open dialogue program in Northern Finland which claims to cure almost all of schizophrenia drug free.

This program has been touted for years by the anti-medication/anti-psychiatry proponents of the US journalist Robert Whitaker and his adherents in Mad in America. I wrote about this program in Huffington Post back in 2013 and pointed out that there is almost no research showing it to be effective. A Finnish psychiatrist confirmed that “most mental health professionals in Finland would agree with your view that Open Dialogue has not been proven to be better than standard treatment for schizophrenia. However, it is also a widespread view that the programme is attractive due to its client-centredness and empowerment of the service user, and that good studies are urgently needed to establish the effectiveness of the programme. Before it has been established to be effective, it should be seen as an experimental treatment that should not (yet?) be clinical practise.”

At the time, some of my critics on social media attacked me for actually asking a Finnish psychiatrist what mainstream shrinks in Finland thought of the program. Just recently, I received a message from someone on Linkedin asking me if I was still negative about Open Dialogue as there is now new research showing how good it is. I replied that I was negative but would love to seen the research. I never heard from her again.

More recently (in 2015), Dr Dawson also wrote about Open Dialogue in this blog. He commented that “Even if some form of two year intensive counseling/therapy/group therapy worked as well as four weeks of Olanzapine, what on earth would be the justification for withholding the Olanzapine?” And he pointed out that “the psychiatrist and director of Open Dialogue in Finland, in interview, acknowledged that she prescribes neuroleptic medication for “about 30 percent” of their patients.”

Now, Norway has added to this anti-drug position and “By 2017 all health regions in Norway have established medication-free treatment services in mental health care, following a direct requirement from the Ministry of Health and Care Services.” (from correspondence from the Norwegian health ministry).

What is being offered is that “All the drug-free units emphasize creating recovery processes based on patients’ own experiences and wishes. Most services create treatment plans in collaboration with patients. The treatment in Vestre Viken HF in the South-Eastern Regional Health Authority and Vegsund DPS in the Central Norway Regional Health Authority have fixed schedules. Common treatment approaches of the drug-free units are psychotherapy; both individual therapy and group therapy, environmental therapy, art therapy, Illness Management and Recovery (IMR),psychoeducation, physical and social activity, exposure therapy, and networking; both in regards to relatives and work/education.”

Even though this program was first introduced starting in 2015 at the insistence of “user organizations” (and what they are is not defined), no evaluations have been done comparing those who do not get medication to those who do. That research is just recruiting patients and is not expected to have results until 2023.

The issue to me is should this drug free experiment have ever been begun in the first place and the answer is no. The evidence based consensus guidelines for the treatment of schizophrenia all recommend that anti-psychotics should be used in the acute phase and that they should be used in order to prevent relapses once the patient is stable. Not using accepted treatment for serious mental illnesses is as stupid, in my opinion, of oncology centres forgoing standard cancer treatment and allowing patients to try the type of quack remedies you find in alternative medicine.

The one survey that has been done is of psychiatrists and their view of this experiment. The research conducted by a Norwegian hospital was reported on by Mad in America who said “The research, which was funded by a grant from the Stavanger University Hospital, found that psychiatrists carried negative opinions of this initiative. They understood the programs to be unscientific and rooted in the perspectives of dissatisfied service-users within a patient group that “lacks insight” into their problems. These recent findings were published in the Journal of Psychopharmacology.”

Needless to say that Mad in America disagrees with the criticisms and argue that :

here exists substantial debate in the clinical and research literature over the long-term effects of antipsychotic drug treatment for psychosis and whether the significant safety risks outweigh any benefits. Also, critics have pointed to the impact of guild interests and institutional corruption on current guidelines recommending this treatment.”

Please not that the references they cite to demonstrate their points are all from Mad in America – a highly reputable source of all things scientific.

This entire situation is forcing me to go have a few pints of homeopathic lager!