Amoral Operatives

By Dr David Laing Dawson

Some years ago I wrote an email to an old High School and University friend suggesting we launch a class action law suit against our parents, our teachers, the city fathers of Victoria, BC,  the department of education, our coaches and profs, for misleading us about the nature of human society. I think at the time an egregious scandal was erupting in the USA where he lived and, of course, a smaller, slightly less outrageous scandal was being investigated in Canada.

And I am now, though not by choice, acquainted with the likes of Manafort and Stone and Corsi. Despite being something of a student of human behaviour I am quite astonished and bewildered by these and other “operatives.”

They are no longer young men, and they may spend their final decade in prison, but it seems from their teens through adult life they have wormed their way into front row seats within the opera house of corruption, despotism, greed and power. And here is my question: How does a Roger Stone seek out, find, acquire such jobs as consultant to or lobbyist for Ferdinand Marcos and Mobuto Sese Seko, along with Reagan, Nixon, and Trump?

I do not recall my University advisor and second year philosophy professor including in his list of possible career choices (along with suggesting I consider teaching English) making pots of money consulting to Viktor Yanukovych and Jonas Savimbi.

How do you get these jobs?

It appears that as amoral operatives these men were able to successfully partake of the spoils of a wide range of criminals, dictators and despots around the world, as well as American presidential candidates, throughout their adult lives, without running into trouble, at least until they hitched their wagons to Donald Trump.

Roger Stone has a tattoo image of Nixon on his back.

Matthew George Whitaker apparently said his job was to “throw himself on a grenade for Donald Trump.”

Paul Manafort is playing both hands, cooperating with but lying to Mueller, going for both a lighter sentence and a pardon from Trump.

Perhaps these men are necessary for the Idi Amins, the Marcos, the Hitlers, the Putins, the Yanukovych’s and the Trumps of this world.

Amoral operatives willing to feign sacrificial allegiance to anyone who might be able, at least for a while, bestow upon them money, status and power.

Perhaps they are more dangerous than the would-be despots, for who would that silly little failed artist with the silly mustache, or that blonde comb over con artist and that short bare-chested strutting Russian sportsman be without these second tier amoral operatives?

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Reflections on Child Sex Abuse

By Dr David Laing Dawson

With the child sex abuse scandals of the Catholic Church back in the headlines suggesting that these crimes are wide spread and more common than we thought (surprise, surprise), perhaps it is time, at least in the modern sections of this world, to accept the realities of our species and live within that reality.

To put it succinctly and bluntly, when your 14 year old son’s hockey coach drops by and asks if your son would like to come camping with him this weekend, you slam the door on him and call a parents’ meeting.

There is never a moment when your priest has a legitimate reason to be alone with your son or daughter. If he wants to do this he should be immediately suspect.

If you build it “they will come.” I think a century ago building the residential schools was a forgivable naivety. Who might know then, that not all the priests and sisters put in charge of vulnerable children were motivated only by notions of service and altruism?

Power (status, position, control), Sex (in all forms and some we haven’t even thought of), and Money. The prime motivators of this species. Money being strangely third, and really, just a symbol of power.

Now that is not to say there can’t be other motivators, altruistic, social, helpful, loving, giving, generous motivators, but, let us stop being naive.

This past September I was dragged to some monasteries and churches in Italy by my wife’s brother. In one monastery I lingered, looking upward at the child pornography painted on the vaulted ceiling. They were, of course, cherubs, but lovingly rendered with round bottomed pre-pubescent nakedness in teasing, inviting poses.

The family members look askance when I point this out.

This monastery, like others, was built 500 to 700 years ago, with fortifications, on the top of a hill. It is not difficult to imagine how, a few hundred years ago, the poor peasants would drag their offerings up the hill, a few coins and crops and chattel, to receive those empty promises of health and after-life.

The location and fortification of the monastery provides safety and security, and the likelihood of surviving the various wars that will envelop the countryside from time to time. The peasants provide labour and food. The order of sisters in an outer building provide various services. The landowners in the countryside provide money. A little accommodation is made for the changing mayors, monarchs, dictators, governors of the state.

All in all, a sweet deal.

But let us not be naive. Those cherubs. If I painted those on canvas and displayed them at Gallery on the Bay, the police would be knocking on our door within hours.

Editorial comment – a write up of our two new compilations but mostly

Hamilton psychiatrist David Dawson puts Donald Trump on the couch

Private Health Care

By Dr David Laing Dawson

As Donald Trump famously said, “Who knew health care was so complicated?”

In Ontario recently, with the Ford government, the words “privatization” and “health care” were connected in the same sentence.

At the least it seems privatization once again surfaced as a possible means of fixing two persistent problems in our publicly funded care. The first of these problems is wait times for certain investigative procedures and certain kinds of surgeries. (For the most part these are all investigations and surgeries that can wait; that is they are not life threatening emergencies. And when I do get my appointment for an MRI of my knee I know I may have to wait a few hours, or be bumped if some urgent case arises.)

The second is so called hallway medicine. People admitted to hospital lying on gurneys in the hallways waiting for beds. This is indeed a complicated issue but not one that can be resolved by throwing the word privatization around.

But rather than address these issues I am writing this to call out a seldom mentioned problem with a “private” system of health care. And that is over treatment. If the patient is rich or his insurance very good the many private clinics in the USA are given an incentive to over investigate and over treat. Scans, blood tests, pills, surgeries, and residential care.

And to some extent the nature of the over treatment is then dictated by what the insurance company is willing to pay for. This is one aspect of the opioid epidemic. In many cases medicare or insurance will pay for pills being prescribed but not physiotherapy or gym membership. And over treatment is not benign.

Some early democratic presidential candidates are promoting medicare for all. Immediately other “experts” and politicians are saying we (the USA) can’t afford medicare for all. Nobody points out, and this is true, if you take all the money the US pays now for Medicare and divide it by the entire population, their per person cost is already higher than our (Canadian) per person cost and we cover everybody.

It is, compared to Canada, the wild west down here (as I am writing this in Florida). I have just watched TV ad after TV ad for prescription medicine, surgeries, assistive devices paid for by medicare, and then, seemingly unrelated but pertinent I think, an ad for a little packet of spring water along with testimonials of curing cancer, being able to walk again after paralysis, and good fortune in the form of a lottery win that paid off the mortgage and a check for $17000 inexplicably arriving in the mail.

I think the experts mentioned above are right. The USA cannot afford a full public universal health system, at least not without a massive public health information/promotion/prevention campaign, and not without accepting a whole bunch more regulation and over sight.

Reflections on Marx, Religion and Opiates For the Masses

By Dr David Laing Dawson

When Karl Marx opined that religion is the opium for the masses it was not the throw away line it is today. I am writing this as I watch the sun set over the gulf of Mexico and smoke my $5 robusto and sip my $20 dollar bourbon.

Within my limited historical scholarship it seems to me that humans, ever since evolution bestowed upon them the awareness of suffering, temporality, and death, have been seeking substances to dampen, or ideas to vanquish, the horrifying experience of that reality.

While some of those substances (LSD, mescaline, ecstasy, opium!) give one a temporary sense of alternate and eternal realities, others merely dampen it.

As I write this the clouds briefly accrue a God-like glow of crimson and then slip into filaments of white against the darkening sky, and the temperature drops a few degrees at this moment on this region of a small planet. I go inside to replenish my glass. Our two dogs come with me; one, oblivious to my thoughts, wants to share his chew toy with me.

While religions, all of them, from the old and organized, to new and old ideas of enlightenment and “oneness with the universe” attempt to obliterate the terror of being sentient beings with limited life spans, substances like marijuana and alcohol merely dampen that reality.

And while religion works for many it has also been the unholy source of corruption, perversion, suffering and death for others.

With a sweater it is warm enough to sit outside and miraculously the WiFi reaches a chair by the barbecue. The sky has become both misty and mystical. A scattering of stars appears between the low clouds. I know I should leave my cigar alone, for the second half will give me an overdose of nicotine and a dry mouth through the night. The replenished glass of bourbon with much ice to soften it will let my eyes linger on the beauty of the night without too many intrusive thoughts.

Marijuana would let me do the same I’m sure.

It is one of those realities that could be used to argue both for and against intelligent design: anything that can make us feel good, or relieve us of the terror of existence, when used excessively, can harm us. I will leave the cigar butt in the ashtray and I resolve to not replenish my glass again. The dogs lie on the cool patio stones beside my chair.

My companion comes out to join me, commenting how lovely it is, and asking if I would like a refill. My resolve vanishes as quickly as a startled gecko.

We sit together in the balmy night air, breezes bringing mist from the gulf, the dogs at our feet, and I think how quickly time passes, and I tell myself to stay in the moment.

Marijuana and Schizophrenia – Part II

By Dr David laing Dawson

It struck me recently the reason marijuana has been such a popular recreational drug is that while it causes distortions in perception (time passing, speed, sound, colour, light, music, intensity, memory, touch, focus etc) thanks to THC, it also contains differing amounts of CBD, a potent anti-anxiety, anti-arousal agent.

Usually such distortions in perception, especially for the naïve user, would lead to anxiety, arousal, sometimes fear and panic, and could obviously hasten along an evolution to psychosis. And some people do report very negative experiences after smoking a joint.

Clearly it is the CBD portion of the drug that allows those perceptual distortions to be pleasurable.

I am absolutely sure that marijuana does not cause schizophrenia, but it could easily hasten it along, especially with heavy use. On the other hand CBD is an effective, and so far apparently safe, anti-anxiety drug and possibly safer for controlling anxiety than prescription lorazepam.

But, as I have pointed out to teenagers who asked for marijuana prescriptions to quell the pain of a breakup, impending exams, getting a part-time job, they should and need to be experiencing anxiety. Some anxiety is necessary for growth, for learning, for engaging with the world.

Many boys who smoke daily from, say age 16 to 23, are still obviously, in many ways, 16 when you meet them at 23.

CBD yes as a good medicine.

Marijuana in moderation, at least until achieving some level of maturity.

Marijuana and Schizophrenia

By Marvin Ross

pot
Courtesy of pixaby.com

Now that marijuana is legal in Canada and in many US states, understanding the role of this substance in the development of schizophrenia is even more crucial. Schizophrenia has long been thought to be associated with pot smoking but the causality has been in doubt.

In my book, Schizophrenia Medicine’s Mystery Society’s Shame published in 2008, I cited the research that was current at that time.

The classic study was that of a long term follow up of Swedish conscripts aged 18-20 in 1969-70. A total of 50,087 young people representing over 97% of that country’s 18-20 male population reported on their use of cannabis, other drugs and on several other social and psychological characteristics. The researchers then looked at hospital admissions for schizophrenia amongst this group. It was found that cannabis was associated with an increased risk of developing schizophrenia. The greater the use then the greater the risk. The researchers concluded that there was no question but that the link between the two was causal. Cannabis use caused schizophrenia and the link was not explained by the use of other psychoactive drugs or personality traits.

However, it has also been hypothesized that schizophrenia leads to a greater use of marijuana likely because people are trying to medicate themselves. A number of years after the above study was published, Scottish researchers looked at all the studies that had been done on the link between cannabis and schizophrenia between 1966 and the end of 2004. That study agreed with the original findings. Early use of cannabis does appear, it said, to increase the risk of psychosis and that cannabis is an independent risk factor for both psychosis and the development of psychotic symptoms. Again, it has been argued that prodromal symptoms of schizophrenia lead to an increased use of marijuana. Then, while the disease is developing, being stoned speeds up the developing deficits of the disease.

Malcom Gladwell in the New Yorker and New York Times reporter Alex Berenson recently wrote about the correlation between marijuana use and violent crime. Gladwell cited a National Institute of Medicine research report and Berneson produced a book on the topic called Tell Your Children: The Truth about Marijuana, Mental Health and Violence.

Marijuana researchers objected strenuously to the link of marijuana to crime and I tend to agree. But Gladwell also linked pot use to schizophrenia and that too set off the marijuana researchers. Ziva Cooper, one of the authors of the National Academy of Medicine report, objected to the association of marijuana with schizophrenia. She said that the National Academy did find a link between marijuana and schizophrenia but that they also found a link between using cannabis and improved cognitive outcomes for people with psychotic disorders.

Now that I can also believe but the researcher is mixing apples with oranges. Marijuana is comprised of THC which is the hallucinogenic and CBD which is not. It is the THC that can push people to psychosis and when smoking pot, you do not know how much of each is in the joint. And, of course, the potency of pot today is much greater than it was in my day.

According to a research update in Psychiatric Times “Cannabidiol (CBD), the second most active ingredient in marijuana, has been hypothesized to have antipsychotic effects—in contrast to tetrahydrocannabinol (THC), which may promote or worsen psychosis”. Recent research in the American Journal of Psychiatry found that “CBD has beneficial effects in patients with schizophrenia. As CBD’s effects do not appear to depend on dopamine receptor antagonism, this agent may represent a new class of treatment for the disorder”.

However, people should be aware that when you smoke a joint or nibble an edible, you have no idea how much THC or CBD is in the product.

And, as the brain continues to develop till about the age of 25, those under that age should be cautious particularly if they have a family history.

Thoughts on Addictions and Illness

By Dr David Laing Dawson

One of the foundations of a civilized, organized society is the assumption that each member is personally responsible for his or her behaviour and will be held accountable. Then, over time, we cautiously make some exceptions through our laws and courts.

Before the western disease model developed as a way of understanding illness, most cultures, in different ways and to different degrees, held individuals morally responsible for their illnesses, especially, of course, mental illness.

Though we understand the western model of disease as an assumption of biological causes and pathways, of equal importance historically was the removal of moral culpability from the sufferer. (the illness was no longer ascribed to moral lapses that allowed the devil in).

Even so, if the sufferer committed a crime he or she was still held morally and legally accountable until the M’Naghten trial in 1840. Since then each western country has developed variations of the three factors that could, through due process, allow a judge or jury to arrive at a finding of not guilty by reason of insanity or mental defect, or, now in Canada, Not Criminally Responsible. These are: labouring under the influence of a defect or illness of the mind, and did not appreciate the nature or consequences of his actions, and could not distinguish right from wrong.

It is also a relatively recent development that we do not hold children accountable for crimes they commit, or some mentally handicapped or demented citizens, and adolescents are given a modified pass.

It is certainly compassionate to consider an established addiction an illness, and at least from that point, not consider the addict’s seeking and using of drugs a moral failure, quite apart from the assumption of biological determinism. But as for crimes an addict might commit he or she would have to satisfy all three of the precepts listed above for a finding of “not criminally responsible”.

The assumption of free will and personal responsibility is in itself a determinant of human behaviour. What happens when we remove that responsibility?

I think it fair to say that the incidence of schizophrenia or serious depression would not increase. But what about addiction? No matter how you slice it, the addict must do something (seek out, ingest, inject, snort) to continue being addicted. Of course not doing that thing brings about illness and suffering as well.

The general wisdom often voiced in the therapy world is that addicts and alcoholics will only change or engage in a rehab process when they are ready to, or have decided to. But that wisdom has always struck me as too generous. Experience indicates they will enter treatment and try to stay clean when they have to. When they have to or else face some serious legal, employment, medical, or social consequences. As I have written before this is not a particularly strong condemnation of addicts, for all humans mostly engage in the hard work of changing behaviour when they “have to”. (the wake up call of a heart attack eg)

Addicts also have certain striking personality traits. They are not tolerant of delayed gratification. They tend to ascribe cause and responsibility to someone else or some factor beyond their control, and they lie. True of all humans I suppose but definitely traits that make helping addicts problematic.

Now before you think I am being harsh on the illness of addiction please note that the treatment, rehab, and recovery programs for alcoholism and addiction all tacitly acknowledge these traits. They do so in their forms of group therapy that all emphasize taking personal responsibility, in the lie detector urine test before methadone is handed out, in the AA twelve step program.

It is definitely more compassionate to think of addiction as an illness rather than a moral failing deserving our scorn and condemnation. But to do this naively will help no one.

We have already made the mistake of administratively blending addiction services with those for the mentally ill with the consequence of attitudes toward each, models of care toward each, models of security and protection for each bleeding both ways, helping neither.

More on Homelessness and Mental Illness

By Dr David Laing Dawson

With seemingly intractable social/medical problems we tend to rant about them or offer sweeping, global, feel better (they make us feel better) but useless proposals such as “talk about it” for suicide, and more affordable housing or shelters for homelessness.

And we forget history.

In the seventies our community psychiatry teams (at least the ones I was involved with) made home visits, ensured patients stayed on their medication, intervened with landlords, and one team member was official liaison with all, what was then called, second level lodging homes.

In the eighties our Psychiatric Hospital formed a special team to help prepare patients for discharge and settle them in appropriate housing, and connect them with all the treatment and support they would need.

And this is the moment to intervene and to focus resources: preparation for discharge. Discharge from hospital, addiction treatment centers, and from jail. This is the moment to spend resources and money, finding, securing, settling in with all necessary supports. And those supports can include intervening with landlords, attendance at AA daily, a sponsor, a visiting nurse with anti psychotic medication in a syringe, community treatment orders, help with shopping, budgeting, ADL’s, peer support etc.

Many factors have combined to produce the current problem: loss of low skill jobs, epidemic of opioid addiction, lack of affordable housing, psychiatric treatment shifting to short stay general Hospital treatment and specialty outpatient clinics, and a well-intended but damaging shift to protection of individual rights at any and all cost, and an institutionalized denial of mental illness combined with a paradoxical acceptance of addiction being an “illness”.

(in this strange world of ours a man who believed he was born of the stars and a professor was deemed by the Supreme Court of Canada to be competent to refuse treatment though it meant he would be incarcerated the rest of his life, and another court reinstated a nurse who stole opioids from her patients to feed her addiction on the grounds that “her addiction was an illness”

Emergency shelters, delivering blankets and food to the homeless, clean injection sights, mental health teams working with the police, street homeless watch, a differently designed clothing donation box are all worthwhile band aids but if we want to actually make a difference over a long period of time we need to focus resources to help people through that difficult transition from hospital, treatment center, or jail into a settled housed life within a community including all necessary support to remain housed and stay on the medication that prevents depression, psychosis, or mania.

Some years ago while giving a talk in The Netherlands about treating “borderline personality disorder” I was told it was illegal for Dutch hospitals to discharge someone to the street. I don’t know the details of that illegality, and it is a bit extreme for our social contract in Canada, but we certainly could keep patients in hospital a little longer while a special team ensured successful housing and compliance with treatment post discharge.

Band Aids are not a Solution to Homelessness

By Marvin Ross

It’s winter in Toronto and, as can be expected, there is a cold snap. Not surprising of course but with every serious drop in temperature, the medical officer of health announces a severe cold weather alert so that agencies can look after the homeless.

The city opens special shelters so those poor souls do not freeze to death as often happens in the winter. The number of homeless in Toronto and other Canadian cities is a blot on our supposed safety net. Our solutions to homelessness are totally inadequate.

This past week, a poor woman sleeping in an alley in an attempt to keep warm was run over and killed by a garbage truck backing into the alley as the driver did not see her. As a consequence, one charitable group is handing out visibility sashes to protect the sleeping souls from this happening to them as well.

https://globalnews.ca/video/embed/4865296/

Shortly before this event, another woman died when she was trapped in a charity box used to collect clothing items as she had presumably gotten into it to keep warm . I find it totally disgusting to see the numbers of homeless in downtown Toronto sleeping on sidewalk grates in the financial capital of the country (Bay St) with all their possessions piled around them. They are invisible as humans as the bankers, stock brokers and other business types walk around them failing to see the human beings hidden under the blankets.

One year, driving into Toronto for a meeting, I watched as I was stuck in the rush hour traffic as a van pulled up blocking the curb lane. The driver got out with breakfast for the just waking up homeless on the sidewalk.

It is nice to have breakfast in bed wherever you are but this was and is a totally useless exercise. In 2018, the number of homeless in Toronto was 6000 but today it is 9000. Project Winter Survival (one of the many aid groups in Toronto) has been besieged with requests for survival kits this year: homeless aid groups sought 21,000 kits, up 60 per cent from last year. Jody Steinhauer, the founder of Project Winter Survival was quoted in the Toronto Star stating that “we need to put the pressure on the city of Toronto: open up 1,000 shelter beds, get people into housing long-term with support solutions so that next year at this time, we can be indoors and being proud.”

According to the Homeless Hub at York University in Toronto, “30-35% of those experiencing homelessness, and up to 75% of women experiencing homelessness, have mental illnesses. 20-25% of people experiencing homelessness suffer from concurrent disorders (severe mental illness and addictions). People who have severe mental illnesses over-represent those experiencing homelessness, as they are often released from hospitals and jails without proper community supports in place.”

One study carried out by McGill University in Montreal, found that it is costing over $50,000 a year to provide support to one homeless person without resolving the problem. These costs were comprised of services such as supportive housing, treatment for substance use, emergency department visits, ambulance trips, hospital admissions, police and court appearances, social assistance and disability benefits, and incarceration.

Matthew Pearce, the head of Montreal’s Old Brewery Mission, told the CBC that “homelessness is not the problem. It’s a symptom of a problem” and that “It’s a symptom of inadequate services for people with mental illness. It’s a symptom of inadequate options for affordable housing for individuals.”

The researchers said that there is a “need for a comprehensive response” to the problem, and the importance of preventing vulnerable people from finding themselves in that situation in the first place.

Yes, the homeless need to be kept warm and safe but they also need to have treatment for the conditions that allow them to become homeless in the first place. Until we start to do that as a society, we will only be putting band-aids on the problem not solving it.

Books Based on Mind You Blog Now Available

By Marvin Ross

We are pleased to report that you can now get Mind You the Realities of Mental Illness: A Compilation of Articles from the Blog Mind You and Two Years of Trump on the Psychiatrist’s Couch in either print, kindle or Kobo versions.

Both print editions are distributed by Ingram which supplies almost all bookstores everywhere. The print editions are listed in Amazon world wide, Barnes and Noble, Books a Million, Chapters/Indigo. Kindle editions are, of course, available in all Amazon websites internationally and Kobo is also sold internationally.

A tip for Canadian purchasers. Amazon is selling the books at the US price of around $17.95 whereas Chapters is charging $23.95 for each of the books.

All reviews welcome.

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