Time For US Healthcare to Catch Up With the Rest of the Civilized World

By Dr David Laing Dawson

Watching CNN, the reports, the discussions, the arguments, the experts, the talking heads, the Democrats and Republicans, Obamacare, The Affordable Care Act, Repeal and Replace, phase 1, phase 2, pre-existing conditions, medicare expansion/contraction – the whole exhausting American Healthcare discussion – two things come to mind:

The first is the obvious. For God’s sake just adopt the Government single payer option. Join the rest of the advanced nations. It is cheaper. It is better. Per person you already pay more in taxes to support your limited medicare and all the other complicated subsidies than we in Canada pay for the whole shebang. We are healthier. And it would free up a lot of administrators, accountants, politicians, and lawyers to do something useful.

The second was a little more subtle. All this exhausting time and energy arguing about, and designing, some polyglot public/private health care system is really not about health. It’s about an insurance scheme that will pay doctors and hospitals for medical fixing of acute illnesses and accidents. Medical fixing is just a part of being and staying healthy.

If you could settle on a single payer option then much of that time, energy, administrative overload could be better used to address health in all its complexities: prevention, social determinants, secondary prevention, tertiary prevention, maintenance, management of chronic illness, diet, obesity, lifestyle, addictions, mental health….. at the moment a kid with Cystic Fibrosis in Canada will outlive her counterpart in the US by 10 years.

There is one other aspect to the current American “health care system” of which I have lately become more aware. While the main concern remains large segments of the American population receiving no medical care apart from Emergency visits, or able to afford only partial treatment of acute and chronic illnesses, there is another side to this coin:

Over investigation and over treatment for those who can afford “the best”. Your celebrities often get shitty medical care, from Marilyn Monroe, to Michael Jackson to Prince to, apparently, Donald J. Trump. This is also true of many of your highly specialized for profit residential treatment facilities. Many offer some real medicine mixed with a lot of flimflam, with length of stay and investigations determined by the money available.

For Profit has no business in medical investigation or treatment. Inevitably it means many will do without and many will get too much. And the burden, ultimately, still falls on the taxpayer.

Insane Consequences Review – Mandatory Reading for Students, Politicians and Health Care Bureaucrats

By Marvin Ross

Insane Consequences How the Mental Health Industry Fails the Mentally Ill by US advocate, DJ Jaffe is a tremendous resource for anyone wishing to understand the industry that has developed around mental illness. And that is an industry that ignores the most seriously ill in favour of promulgating programs that are not evidence based, that are grounded in social theory rather than scientific theory, and generate jobs for the professional carers.

I am absolutely amazed at the amount of work that has gone into this volume. If anyone doubts Jaffe’s conclusions or statements, his sources are well laid out so you can check on them for yourself. A great deal of the problems with mental illness treatment in the US is its totally absurd health care system which baffles those of us who live in countries with universal single payer health care.

A few years ago, the Bridgeross author, Erin Hawkes (When Quietness Came: A Neuroscientist’s Personal Journey with Schizophrenia), appeared on an NPR radio show in Ohio to talk about her book. The interviewer was amazed at how much care and treatment she received in both Halifax and then Vancouver. How much did it all cost, she was asked. She thought for quite  awhile and said, “I think I once paid for an ambulance ride”. The interviewer was stunned.

But then, we don’t have absurd rules like the Institute for Mental Disease (IMD) exclusion. Because of this rule, Jaffe points out, Medicaid will not reimburse states for psychiatric beds. When the states cannot get reimbursed, they close the hospitals.

However, despite the difference in how health care is funded, most of what Jaffe talks about is relevant for Canada and, I suspect, other western countries. The seriously mentally ill are ignored for the most part, make up a huge proportion of the homeless and of the prison population. The focus, as Jaffe discusses, in the US and in other countries is on stigma which helps no one, on denying the connection with violence for those who are untreated, and on the misguided concept that people are free to decide their own fate when they lack the capacity to do so and are thus left to fend for themselves when they need to be hospitalized.

While medication is the cornerstone of proper treatment, there are still non evidence based theories being flogged as replacements for the medications. We have Open Dialogue from Finland that lacks any proper evidence, Mental Health First Aid, prevention programs to prevent illnesses where the cause is not known, and to foster peers with so called lived experience to replace trained medical staff. All discussed in this book.

I should also mention that Jaffe talks about the problems that caregivers have dealing with the system because of privacy laws. I quoted him in my Huffington Post blog on the problems that caregivers have with a suggestion that we all deserve a hug.

All of the book is valuable as a resource but what I found most helpful was his Appendix on the studies of Assisted Outpatient Treatment (AOT). These orders compel a mentally ill individual to accept treatment in the community. If they refuse, then they can be hospitalized. Jaffe cites about 20 studies that demonstrate the effectiveness of this program to reduce homelessness, incarceration, violence, reduced hospitalizations, and emergency department visits to name a few.

This book should be mandatory reading for all students in mental health counselling programs, nursing, social work and medicine. It also needs to be read by government policy makers. Money can be thrown at a problem but unless that money is spent wisely on evidence based programs, it is wasted. And that is what happens today.

Finally, because Jaffe is donating all his royalties to  the Treatment Advocacy Center and to Mental Illness Policy Org, purchasing the book will help those groups better advocate for the seriously mentally ill.

With Trump – The Devil is in the Details

By Dr David Laing Dawson

As the political theater continues south of our border, lurching toward a constitutional crisis, everybody is weighing in, asking every conceivable question, offering every conceivable opinion.

For part of this though, at least when it comes to Donald Trump, we need but listen closely.

Did he ask Comey if he, Donald J. Trump, was under investigation?

Did Comey answer?

Is any of this normal, ethical, proper? Might it even be obstruction of justice?

Is it true?

Listen and read carefully.

The truth, I think, lies in his use of the modifier ‘three’. As in “three times” Comey told him he was not under investigation.

This is not something he should have asked the Chief investigator of himself and his cronies, and the Chief investigator should not have answered. But did this actually happen even once?

The “three times” wording indicates the whole thing is a simple lie. A childish lie. An unnecessary embellishment. The kind of embellishment and exaggeration a child uses to sell his lie.

It is the kind of embellishment and gross exaggeration Trump always uses to sell his lies. “You know it, I know it, everybody knows it.”

As I have said before, during the impeachment process please take away the nuclear codes.

And this morning, it was suggested that Trump may be intimidating a witness http://www.politicususa.com/2017/05/12/donald-trump-intimidate-witness-threat-james-comey.html


The Real Reason James Comey Was Fired.

By Dr David Laing Dawson

CNN interviewees offered these three competing explanations last night:

  1. That he has lost the confidence of the public and law enforcement? An unlikely cause for a summary dismissal.
  1. That he mishandled the Clinton email problem one year ago? No. C’mon now. Trump would not fire Comey for that reason. Never.
  1. That the investigation he leads is closing in on the Trump-Russia connection? Well, Doh.

But there is a fourth, slightly less portentous possibility.

James Comey, in his recent testimony to Congress, said:

“It makes me mildly nauseous to think we might have had some impact on the election.”

Donald Trump won that election. So to paraphrase, Comey testified, before the world, that, “He feels sick to his stomach when he thinks he may have helped Trump get elected.”

Donald just might have taken that personally. He tends to do that.

Like Trump, MPD belongs in the entertainment section

By Dr David Laing Dawson

Multiple personality disorder (MPD) is fiction, is fiction, is fiction. It is not, not, not a bona fide clinical entity, a bona fide human experience, at least it is not a bona fide human experience that occurs on its own, and without the collaboration of an energetic therapist.

I am writing this because I recently ran into two situations involving the ongoing collusion of a believing therapist and a suggestible patient maintaining this fiction, and I watched “Split”, an M. Night Shyamalan horror film featuring MPD and some prodigious acting and special effects. After the embarrassing debunking of MPD by investigative journalists (and a few lawyers) 20 plus years ago, MPD was renamed and diffused (so to speak) as DID, (Dissociative Identity Disorder), which is what it is called in “Split”.

To be conflicted is to be human. To be deeply conflicted is to be a troubled human. To have urges and impulses that are entirely unacceptable to your civilized and socialized self is also human. To say, “I wasn’t myself.” when we find we have done something we should not have done, is also human.

Taking this internal conflict and dramatizing it by embodying each vector in a separate being is a literary technique traceable to the Ancient Greeks, and then famously used by Robert Louis Stevenson in his novella “The Strange Case of Dr. Jekyll and Mr. Hyde” in 1886.

This technique became a natural for film, for mystery and suspense, especially as acting and special effects improved. And then, unfortunately, a psychiatrist wrote a book called “The Three Faces of Eve”, which was made into a very successful film. Multiple Personality became part of popular culture and then migrated to professional culture, adopted by both naïve and excited therapists, and not a few charlatans. How wonderful for therapists to be able to talk directly to those disparate conflicts and impulses, to see them fully fleshed out with voices and names, and not simply talk about them through the filter of the patient’s observing ego. An industry was born. Therapy became theater.

Psychoanalysis is at fault here too, for it assumes a great deal about the integrity of the single human. It ignores the extent to which we are social, interpersonal beings, the extent to which we actually see and experience the world according to the social influences that surround us. The way we answer each and every question according to who is asking and the circumstances of the asking. (Sheldon excepted)

One line among five becomes longer if the others say it is longer. There is a ghost in the building if others say there is a ghost in the building. A sound effect or two and we are convinced. We know the patients of Freudian therapists report Freudian dreams while the patients of Jungian therapists report Jungian dreams. We know it takes a mere ten minutes to convince a child that there is a snake under his bed, a monster in his closet, 20 minutes for an adolescent, and about 60 minutes to convince an adult. We are all impressionable, some more than others. The more uncertain we are of our selves, our reality, our worth, our boundaries, the more malleable we are by social circumstances, other people and therapists, especially intense, believing, well-meaning therapists. Good God, I just read the American Government has spent millions studying ESP, psychics, the paranormal, from bending spoons to cat brains interfering with the electronics of incoming ballistic missiles. Our gullibility has no bounds. Did we learn nothing from that entirely fictitious and therapist manufactured pandemic of Satanic ritual child abuse that swept North America a few years ago?

Our brains do many things to protect us from the harshest, the most painful realities and moments of powerless terror. These include the phenomenon of dissociation (shutting off the experience and going elsewhere in the mind) but one of those things is not concocting a string of alternative identities, a cast of three to fifty, at least not without the encouragement of a colluding and abetting therapist. It may be method acting, but it is still acting. Without an audience it dwindles away.

Yes Virginia, Psychiatric Medication Does Work.

By Marvin Ross

As I’ve said so many times, anecdotes are not proof of anything but I am going to use one to demonstrate the efficacy of anti-depressants. The anti-medication people do nothing but give anecdotes of the dangers of psychiatric medications and the difficulties some have going off them. When research is cited, they usually attack it as being biased and/or funded by big pharma.

Research does show that for most and when prescribed properly, these pharmaceutical agents do help. As an example, I’m the power of attorney for someone with Alzheimer’s Disease. When he was first being assessed by a family doctor, he came out as being depressed on the Beck Depression Inventory. While he was under going evaluation, he was given anti-depressants which he only took rarely.

However, when he had his diagnosis confirmed by the geriatric psychiatrist, it was recommended that he go back on and stay on the anti-depressant to help with both his depression and his anxiety. In order to ensure compliance with that and the Alzheimer’s med, he was given a weekly blister pack. The pharmacist loaded the pills for each day and for the proper time.

He saw the psychiatrist a few months later and was assessed again on the Mini Mental Status Exam (MMSE). The psychiatrist noted that not only did he appear more relaxed and less anxious than at the previous session, but that his dementia score had improved slightly – not because his dementia was better but because he had less anxiety.

Then, a few months later, the home care co-ordinator showed up to do a reassessment. She called me amazed. My friend, she said, was far more relaxed and showed no signs of anxiety or agitation which were evident when she first assessed him. As she said, “he still does not know where he lives or what the date is, but he is very relaxed about everything”.

Yes, this is an anecdote that and not a definitive study but it is an example of the benefit of this class of drugs. For a list of the meta analytic studies done for anti-depressants that do show efficacy, visit this webpage. Check out the home page on that site for other resources. Thanks to Robert Powitzky for pointing me to it.

You’re Wonderful, Mr. Trump, But War is a Really Bad Thing.

By Dr David Laing Dawson

I apologize for being so obsessed with Donald Trump but with the doomsday clock being closer to midnight than ever before, with a rekindling of cold war tensions, with Noam Chomsky worried, the arid lands expanding, the oceans rising, this one incompetent man is in a position to do extraordinary harm to our planet.

However, an aspect of his personality seems to be emerging that I had not guessed would be there. Despite his bluster, his threats, his word salad provocations, when someone meets with him face to face he quickly backs down, changes his “mind”.

General Mattis convinced him that maybe torture was not a good thing. Someone else explained to him that health care systems are complicated. Someone else explained NATO to him and that perhaps it is not so obsolete after all. Trump meets with the President of China and China is no longer a currency manipulator. And now phone calls from Justin Trudeau and Enrique Pena Nieto have caused him to pass on withdrawing from NAFTA.

Which means several things:

  1. That bluster of confidence and narcissism is a thin veneer.
  2. A very insecure man lies beneath.
  3. Above all he wants to be liked, loved, respected.
  4. Face to face he quickly backs down.

So this means to keep our world safe and secure, the adults in the room need merely take him aside and talk to him. And others not in the room should finagle an invitation to Mar a Lago.

Unfortunately it also means that when his bluster and off-the-cuff proposals align with the self-interest of the only adults in the room they are unlikely to have that talk with him.

So America is stuck with a massive increase in military spending, fewer regulations, much less environmental protection, more tax breaks and benefits for billionaires, some fracking here and there, a little more oil and coal, a little less wild life, a few more guns – and those boys in uniform we call The Military, well, they may get to play with a few of their favorite toys. (Such as the MOAB and Tomahawks)

Then I watched “At Issue” on CBC. And although the panel on CBC is so much more gracious, thoughtful, and polite than any counterpart on CNN, they still seek meaning and planning in the words of Donald Trump. Like he actually thought these things out. Like he actually plans his flip-flops. As if he might actually be two moves ahead on the chessboard. NO. Just listen carefully to any extended interview. He knows almost nothing. He has no plan. He has no convictions. He cannot sustain a thought of any complexity.

He’s like a kid who once took an angry swipe at his pile of blocks, causing them to break the jar on the counter, which then poured chocolate jellybeans upon him. He spends his life trying to repeat this. I think the shrinks call it repetition-compulsion.

But here is the silver lining and my advice to all sane, sensible, reasonable, liberal, thoughtful leaders in this world. Don’t react to his tweets, his bluster. Don’t engage through media. Meet him face to face. Show him respect. Then tell him, respectfully, what he should do, and why. And smile all the while.

Justin, I think you are just the right man for this assignment.

Conscious Thought is Slow.

By Dr David Laing Dawson

My plasma screen big TV refreshes each and every pixel 200 times per second. Or is that every other pixel? And is there a formula that allows some of those pixels to rest in their current state for the full second? And this occurs after information has traveled from God knows where at close to the speed of light through copper wire and fiber optic cable.

My conscious mind cannot keep up.

But there are parts of our brain that must work almost as quickly. My optic nerve for instance. Or the message from burned finger to brain and then to muscle. Or from retina, to brain, to amygdaloid, to pineal to adrenal to heart and stomach so I might feel revulsion or delight or anger before my conscious brain manages to explain this.

Which is why most conscious thought occurs after the fact, after the action, after the experience, after the event. Which is why most conscious thought is rationalization, the explaining and organizing of an action already taken or a feeling already felt.

I am (slowly) thinking about this because I am trying to understand how it is so many cheered when Trump let fly those 59 missiles. The images of dead children on my plasma TV caused that very fast electrochemical chain reaction from retina to neuron to experiences of revulsion and anger. But how about we spend some time thinking and talking about how this civil war might be ended.

And every time I see Kim Jong Un on my plasma TV I want to slap him or deflate him. He, his terrified and sycophantic generals, and his strutting robot men, cause that same fast electrochemical reaction in my brain to produce hormones of disgust, of anger, and no small amount of incredulity.

And I know when I listen to the politicians and “experts” on CNN, I am hearing the thought processes that slowly justify the more instant wish to deflate this man. And then we cheer the armada, the threats, the bombast, and, God help us, we may soon be cheering the preemptive strike, or the overwhelming retaliation.

Please know this. Know this about our instant reactions and the slower thought processes that justify them. Know it is time to calm down, step back, and figure out how best to deal with such a man as Kim Jong Un and North Korea’s 25 million people to ensure we all have a future.

Opioid Epidemic and Childhood Trauma – NO!

By Dr David Laing Dawson

Social worker, Alexander Polgar, writing in the Hamilton Spectator suggests that the current opioid epidemic and death by overdose can be traced to “adverse childhood events”. This of course is patent nonsense. Some children do suffer terrible things that affect them their entire lives. But, from a statistical view point, the children growing up in the last 30 years (in Canada) will have experienced the fewest adverse events than any generation in history before them. (prenatal care, safe childbirth, child protection laws, diminishing physical punishment, plentiful food, no measles, mumps, smallpox, polio, pertussis, fewer sibling deaths, available medical care, safe toys, safe playgrounds, safe pools, safe beaches and lakes, accommodation in schools, organized play, sports, new safety rules for everything, child labour laws…). Sure, the parents may be more likely to divorce, but they are much less likely to die.

In the late 40’s and early 50’s my classes of 35 or so always had one kid with scars from a boiling water accident or a fire, another not coming back to school after a summer of polio, one on a cane or crutches or with a withered arm, another pockmarked from some communicable disease or other, and another two or three undernourished, lice ridden and dirty. Not to mention the shaming and physical punishment some teachers used to control behaviour. And in those decades many children grew up without fathers who had been lost to them in the war.

While one might be able to trace a specific addict’s misery to childhood trauma, to blame the current epidemic on an epidemic of childhood trauma is nonsense.

I could make a case for the problem being the opposite.

Clinically I have many discussions about “motivation”, as in “my child is not motivated.” or the teenager saying “I’m just not motivated” with respect to going to school, getting a part time job, joining anything. With some I joke that I don’t have a pill for motivation. With many of course I look for the anxiety or depression or circumstances underlying the apparent lack of motivation, now redefined as avoidance. With others I engage in a longer discourse about the nature of “motivation”.

Now, it is pretty clear to me that the prime motivator for humans and human children throughout history has been necessity. Without necessity we fall back on, I suppose, pleasing our parents, keeping up with our social group, plain old curiosity, immediate sensory gratification, the pleasure of an adrenaline rush, and perhaps, occasionally, finding an inner flame of ambition or artistic seeking or even altruism.

The other day I had a quite interesting conversation with a very bright, self educated, articulate 15 year old. Not in school, and as he said himself, not motivated to do anything. He rationalized that any “motivation” was pointless because life itself was pointless. He could talk about existentialism, absurdity, about the expanding universe, even the nature of consciousness.

So with him I engaged in a rather intellectual discussion about the nature of “motivation”. Of course from a social perspective, a “lack of motivation” equates to “not being willing to do what someone else thinks you should do.” But when we talked of the prime motivator for most humans being necessity (to avoid being cold, starving, hurting, wet and banished) he agreed, and pointed out that he faced no such necessity. Nor did most of his peers. They dressed as they liked from a selection of clothes in their closets; they always had a roof and a bed in a heated home; food in the refrigerator; much more than a penny in their pockets; and no one who could “make them go to school, or work”.

He was “motivated” to seek a few days a week of instant pleasure from weed, MDMA, mushrooms or acid, the chemical compositions and history of which he knew at least as well as I.

Now I may also get the opportunity to treat this young man’s depression, once he has done his own research on SSRI medication, but, thinking of this generation as a whole, I can go back to my main point. Which is that we have removed necessity as a motivator for many of our children and teenagers and young adults.

They are not experiencing more adverse events but fewer, and they are always ensured of their basic needs being met without any effort on their part, and, with the safety and esteem building tone of today’s parenting and pedagogical methods, coupled with the proliferation of things and activities that offer instant gratification (Good boy, wonderful picture, nobody fails, every child is special, dress as you want, here is an Iphone and a laptop, video games, information by clicking a mouse, substances that eliminate anxiety and stimulate the pleasure centers of the brain), the necessity of an extended period of work and discomfort to achieve something seems almost anachronistic.

I have said at times to some of the teen boys refusing to go to school, “But that’s where the girls are.” only to realize that, no, today, naked women reside 24/7 on the laptop in his bedroom. So even the vaguely formed wish and longing hope of sexual gratification after a lot of struggle, social embarrassment, attending school, joining the drama club, staring at, avoiding, talking to, asking on a date…. has been replaced by no-effort instant gratification without having to shower, brush your teeth and get dressed.

Blaming a 21st century problem on a 19th century scourge is not helpful.

It is very hard to understand and assess the vectors and forces that affect one’s own time, but the causes of teenagers doing stupid and dangerous things, and the causes of adults injecting themselves with something that offers equal odds of a pleasurable few hours or death, probably lie elsewhere.

Psychosis impairs brain function beyond the apparent symptoms. Depression impairs brain function, the scanning, filtering, perceiving functions. Depression eliminates perspective. Similarly, once addicted, the addiction impairs brain function. It seems to eliminate any sense of time and perspective, any way of thinking about long and short term priorities; it clearly impairs the brain’s ability to assess risk; it impairs the brain’s ability to consider short term pain for long term gain. It wipes out empathy. Once addicted the human brain becomes as if a shark’s brain with a solitary single purpose.

So we must treat addiction itself as an illness, offer detoxification and rehabilitation services and reduction-of-harm care. And this includes safe injection sites, and maintenance programs.

Secondary prevention of relapse should be another focus, and we know of several groups we could target for this: recently discharged from hospital, psychiatric hospital, drug treatment centers, jail, or prison.

Primary prevention is much more complicated. But there are some factors that could be addressed:

  1. Physician over-prescription of Opioids, both in dosage and length of time.
  2. Illegal availability of these drugs from a variety of sources, including the internet.
  3. Self medicating for something better treated by professionals in other ways: anxiety, depression, PTSD
  4. The simple fact that this is a very profitable business for many in the chain of supply.

Which means:

1.Education, guidelines, controls for physicians, pharmacists.

2. Taking a look at ways to stem the flow of drugs across borders (other than another “war” on drugs).

3. More readily available mental health treatment, sensible pain management.

4. And perhaps consider removing the profit motive by legalizing and providing opioids for addicts in a controlled fashion. Is this approach working in Portugal?

And then teenagers, early twenties. Though they have newly acquired logical thought processes and information at their fingertips, they do not have perspective, experience, and fully developed frontal lobes. They take risks uninhibited by the knowledge of a 10 or 20  or even 40%  probability of a disastrous outcome. They often respond to warnings in a paradoxical fashion. They still need parents, and parents who are willing to intervene in a strategic fashion and not give up.




Please Stop Listening to Donald Trump

By Dr David Laing Dawson

There was a point in my mother’s dementia when she could engage in a ten minute conversation with an acquaintance or stranger without the person discovering that she, my mother, could not tell you her address, age, the date or day of the week. She was adept at the speechisms, the smiles, the nods, the all-purpose declarations of pleasantness, of good weather, of well being, of the “So nice to see you again”, “lovely weather we’re having” kind of remark.

In a perverse sort of way it reminds me of Donald. Though his fill-ins, rather than being pleasantries, are a rather random assortment of extreme declarations: bad, very bad, terrible, horrible, disastrous, disgraceful to wonderful, terrific, great, best, like you’ve never seen before.

Note that both “lovely weather we’re having” and “like you’ve never seen before” work adequately no matter the reality.

Donald probably knows his addresses (they are easy to remember), the date, his handicap, the names of his children, but he clearly knows little else. His throwaway statements of “big league” and “disaster” stir his audience, but they also hide a chasm of knowledge and a lack of any detailed understanding.

We can be sure that when he rants about the dairy industry, Canada, and NAFTA, he knows nothing about these subjects. When he tells Fox News interviewer Maria Bartiromo about the “most beautiful piece of chocolate cake you’ve ever seen” and how he leaned across and told the President of China that he had just launched 59 missiles “at Iraq”, it wasn’t a slip of the tongue in a rapid conversation. Maria corrected him, simply saying, “You mean Syria?” He repeated her “Syria” without blinking, and went back to talking about dessert.

But he is POTUS and so the pundits, politicians, reporters, experts, panel members all try to find meaning, thought, policy, and direction in his utterances. Beside my own mother’s dementia it conjures images of courtiers, earls, and nobles trying to find wisdom in an idiot king’s sighs and passing of gas.

I think Trudeau and Merkel understand this. Let’s hope Kim, Xi, and Vladimir do as well.