Tag Archives: Bonnie Burstow

The Good, the Bad and the Ugly of Social Work

By Marvin Ross

Social workers can and do play a significant role in helping the mentally ill to recover when they work with psychiatrists, nurses and occupational therapists. In my personal life, I’ve just witnessed how a knowledgeable and caring social worker can impact recovery from psychosis in an inpatient setting.

Sadly, the training that many social work students (and others like psychologists and counsellors) receive from some institutions does not aid in that role. Susan Inman, the author of After Her Brain Broke, Helping My Daughter Recover Her Sanity, has long complained about the lack of science and medical training for many of these professionals. She said:

Many credentialed mental health clinicians have never received science-based curriculum on severe mental illnesses. Too many are still being trained in the parent blaming theories which contemporary psychiatric approaches to schizophrenia have long since left behind.”

For a number of reasons, I had occasion to look at the mental illness course being taught at McMaster University in Hamilton Ontario and it confirms all that Susan had to say. The course is called “Critical Issues in Mental Health & Addiction: Mad & Critical Disability Studies Perspectives for SW”. Part of the course objective is to:

“explore contributions from critical disability studies, mad studies and the historical influences of sanism and eugenics on contemporary mental health practice. Addiction will also be briefly explored within these contexts.”

Then, this is added

“Throughout the course guest speakers may be invited to share experiences and analyses on course themes from ex-patient, survivor, consumer, service-user, and mad perspectives.”

Nowhere do I see anyone coming who can provide the medical perspective which would include the physiology and treatment of mental illness. Given that McMaster has a world-class medical school and one if its teaching hospitals is a psychiatric facility, this is very troubling. It would be so easy to find a psychiatrist to talk to the class or to take a field trip to the local psychiatric hospital.

One of the readings in the first week is Geppert, C. (2004). The Anti-Psychiatry Movement Is Alive and Well. Psychiatric Times 21(3), 21. Retrieved December 4, 2009”. This article is no longer on the Psychiatric Times website that I could find and the professor referenced it in 2009. It would be nice if the professor asked his students to read something like Psychiatry and Anti-Psychiatry by Dr Allen Frances. There are many comparisons of these two approaches in that article and students should have an opportunity to see both sides.

Another set of readings for this course is by Geoffrey Reaume who is a professor of disability studies at York University in Toronto. His view of Mad Studies can be summed up by a quote he gave to an article on Mad Studies in University Affairs in 2015. He stated that “People with PhDs had oppressed mad people throughout history. I wanted to help liberate this history from the shackles of the medical model.”

Dr Frances had this to say in the article I cited above (for psychologist also read social worker):

Psychiatry is far from perfect, but it remains the most patient-centered and humanistic of all medical specialties and has the lowest rate of malpractice among all specialties.

Psychologists criticize psychiatry for its reliance on a medical model, its terminology, its bio-reductionism, and its excessive use of medication. All of these are legitimate concerns, but psychologists often go equally overboard in the exact opposite direction—espousing an extreme psychosocial reductionism that denies any biological causation or any role for medication, even in the treatment of people with severe mental illness. Psychologists tend to treat milder problems, for which a narrow psychosocial approach makes perfect sense and meds are unnecessary. Their error is to generalize from their experience with the almost well to the needs of the really sick.”

And he added:

For people with severe mental illness (eg, chronic schizophrenia or bipolar disorder), a broad biopsychosocial model is necessary to understand etiology—and medication is usually necessary as part of treatment. Biological reductionism and psychosocial reductionism are at perpetual war with one another and also with simple common sense.”

Another author used quite a bit in this course is Bonnie Burstow of the Ontario Institute for Studies in Education (OISE) at the University of Toronto. Dr Burstow is the creator of a scholarship in Anti-Psychiatry Studies. I’ve done two Huffington Post blogs about Dr Burstow. The first was entitled The Truth Behind U Of T’s Anti-Psychiatry Scholarship and the second was Time For U Of T To Rein In Its Anti-Psychiatry Activist It is worth noting that OISE is a post graduate school on teaching, learning and research. Nothing to do with science or medicine.

In my second Huffington Post blog, I had this to say about Dr Burstow:

Burstow does not believe that the brain is capable of becoming ill, and that therefore mental illness cannot exist. Her doctoral thesis, according to the media spokesperson at her institution, was entitled “Authentic Human Existence: Its Nature, Its Opposite, Its Meaning for Therapy: A Rendering of and a Response to the Position of Jean-Paul Sartre” in 1982 at the University of Toronto.

Dr Burstow is the author of a book called Psychiatry and the Business of Madness which is not one of the readings for this course but exemplifies her position. Blogger, Mark Roseman wrote a very lengthy and detailed critique of this book which is well worth reading.

Roseman defines anti-psychiatry as:

a position that psychiatry is 100% flawed, has no redeeming features, is built on a stack of lies, necessarily does harm to all who encounter it, and must be abolished in its entirety. Moreover, the real proponents of antipsychiatry do not want to seriously engage in discussion with the broader community. They are not interested in critique, or divergent opinions, but only discouraging those seeking treatment, and attracting new followers to their movement.

The course does discuss medication but this is the description of that:

The Biological Mind: What are some of the critiques of the role of medication and the psychopharmaceutical industrial complex? How does neoliberalism matter in mental health? How do we think critically about suicide and self-harm?”

Here is the recommended reading:

Cohen, D. (2009). Needed: Critical thinking about psychiatric medications. Social Work in Mental Health, 7(1-3), 42-61.

Medawar, C. & Hardon, A. (2004). Sedative hell. In Medicines Out of Control? Antidepressants and the Conspiracy of Goodwill (pp. 11-27). N.P., Netherlands: Aksant.

Whitaker, R. (2001). Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill. Cambridge, Massachusetts: Perseus-p.3-19.

White, J., Marsh, I., Kral, M. J., & Morris, J. (Eds.). (2015). Critical Suicidology: Transforming Suicide Research and Prevention for the 21st Century. UBC Press. – Introduction

The titles give it all away. Whitaker, of course is an infamous anti-medication proponent and I have critiqued his views a number of times as have others more qualified that I am as in the debate between Whitaker and Dr Allen. The teaching of anti-psychiatry did not include anything pro-psychiatry and the discussion of medication contained no information on the benefits of medication. Should students not be given an opportunity to see the other side? McMaster and its teaching hospital has many first rate psychiatrists well versed in their specialties. I’ve observed the near miraculous results that properly prescribed medications can have on severe psychosis. Neoliberalism did not come up once.

The bottom line is that no one who graduates from this course will be capable of working in a psychiatric setting with patients. Hopefully, none of them will. The effective social worker I cited at the outset is a graduate of another university.

 

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Cockamamie Views From Anti-Psychiatric Advocate

By Marvin Ross

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Mental Illness and the Political Spectrum

By Marvin Ross

I have always been on the left of the political spectrum – more so in my student days – but I still consider myself left and vote for progressive ideas and progressive candidates. Progressive, of course, is a value laden term but what has baffled me has been the lack of progressive ideas by the left on mental illness.

I’ve just done a Huffington Post piece attacking the establishment of a scholarship in anti-psychiatry at the Ontario Institute for Studies in Education (OISE) at the University of Toronto. After it was penned but before it was published, I was sent a link to an article in Rabble.ca written by the founder of that scholarship, Bonnie Burstow, extolling the supremacy of Toronto academia in anti-psychiatry “scholarship”. She equates this anti attitude for the search for social justice and as diametrically opposed to Toronto’s Centre for Addiction and Mental Health.

Aside from caring for patients, CAMH has a research budget of $38 million a year, is a World Health Organization Collaborating Centre and home to the only brain imaging centre in Canada devoted entirely to the study of mental illness. Among the supporters and activists of anti-psychiatry, Burstow cites David Reville and Cheri DiNovo. Reville was a politician in the disastrous NDP government in Ontario headed by Bob Rae (1990-1995). DiNovo is also an NDP member of the Ontario Legislature.

For non-Canadian readers, the NDP is the Canadian version of a Labour Party.

That disastrous government in Ontario brought in legislation to establish an Advocacy Commission to protect vulnerable people and to promote respect for their rights. That, of course, is laudable but the bill was so flawed and cumbersome that it was immediately repealed by the Conservative government that replaced them in power.

The Ontario Friends of Schizophrenics (now the Schizophrenia Society of Ontario), told the committee that:

Ontario Friends of Schizophrenics has had dialogue with officials because we have been persistent and because we have done our homework in making some solid proposals for improvements in the legislation. We have been unable to meet with a single minister of the three ministries concerned, despite repeated requests and despite the fact that people with schizophrenia are one of the largest groups in the vulnerable population that will be affected by these bills.”

They then pointed out that the bill excluded families; that it gave more power to the commission to enter someone’s home than the police have; that the test of capacity was ability to perform personal care rather than understanding; the low standard of capacity; no provisions for emergency treatment; and too much power to the Consent and Capacity Board.

The Alzheimer’s Society of Metropolitan Toronto was equally critical arguing that the new act penalized the family. Their presenter told the committee that:

“I have serious concerns about the prevailing use of unknown professional advocates with sweeping powers, heavy demands on their time, unclear qualifications and little accountability.”

In Ontario, the only improvement to the Mental Health Act was brought in by the extreme right wing at the time Conservative government under Mike Harris. They have not always been that extreme and the word Progressive precedes Conservative in the name of the party. That improvement to the Mental Health Act was Brian’s Law which enabled those with serious mental illness to be hospitalized if they posed a danger (not imminent as previously) and to be discharged from hospital under a community treatment order. They could live in the community provided that they were treated.

Only 10 members voted against the bill, 6 of whom were members of the NDP. The Health Minister after this was passed was Tony Clement who showed his support for those afflicted with schizophrenia by attending the banquet at the Schizophrenia Society of Canada annual conference when it was held in Toronto. As mentioned above, the schizophrenia group complained that no elected official would meet with them to discuss the flawed bill they were implementing. I have always had respect for Tony while detesting his ultra right policies further honed in the Federal Harper government.

The one member of the legislature who has done the most, in my opinion, to improve services for the mentally ill and the disabled was Conservative Christine Elliott. It was her pressure that resulted in the Liberal Government establishing an all party select committee to look at possible reforms. Despite an excellent report agreed to by members of all three political parties, nothing has been done. Sadly, she left politics after not winning the party leadership but she is the first ever patient ombudsman in Ontario.

And this regressive attitude on mental illness by the left is not unique to Canada. My advocacy friend, DJ Jaffe of the Mental Illness Policy organization in New York often comments that even though he is a Democrat, the most progressive people advocating for improvements in the US are Republicans. He is referring to a bill by Republican Congressman, Dr Tim Murphy called the Helping Families in a Mental Health Crisis Act. I suggested that Canada could use help in mental illness reform from a Republican back in 2013. In 2014 I wrote about how little we could hope for reform in Ontario.

To demonstrate further the left attitude to mental illness, you just have to look at the critical comments that my most recent blog on the anti-psychiatry scholarship garnered. One woman who is doing her PhD in Disability Studies at OISE claimed that I could not criticize because I am a white male member of the bourgeoisie. My proletarian father who worked in a garment factory on piece work and was a member of the Amalgamated Clothing Workers, would cringe in his grave located in the Independent Friendly Workers’ section of the cemetary.

That criticism goes on, quoting Barstow, that all that is needed to cure mental illness is that those with the illness know “we are cared for and that we are in control of our own lives.” Another critic said people “get better because they get free from psychiatry, find peers, get in touch with their inner experience, connect with and rely on others.” That same person also said “Psychiatry was invented by the privileged to dehumanise (sic) women, the neurodiverse, gay and lesbian and transgendered people, the poor, the Indigenous, and never-to-be-heard survivors of child abuse.”

I wonder how the scientists in the Faculty of Medicine or at the Centre For Addiction and Mental Health with their budget of $38 million a year feel about being told they are oppressors?

I haven’t heard such rhetoric since the days of Trotskyites on university campuses in the 1960’s but would love to see these critics spend some time in a psychiatric hospital ward with unmedicated schizophrenics, those experiencing the mania of bipolar disorder, or in a severe depressed state. I’m sure they would find some way to rationalize why their attempts to free them from “dehumanizing” psychiatry did not work.

The Course of a Psychotic Illness – In Response to Psychiatry and the Business of Madness

By David Laing Dawson MD

In the late 1960’s and early 70’s when a young man or woman in a psychotic state was brought to the hospital by family, by ambulance, by friends or police, we would admit him and keep him safe. He would have a physical examination, some blood tests, and be fed, if he was willing to eat. If she was delusional, hallucinating, talking in an incomprehensible manner, we would optimistically hope that the cause of this was the ingestion of illegal substances, perhaps LSD, Mescaline, mushrooms.  We would wait a few days before concluding otherwise. In fact, we sometimes waited one or two weeks, even three weeks, before concluding that this was a psychotic illness not induced by drugs. Drug induced psychosis actually clears quickly; it doesn’t take weeks, but we might indulge in wishful thinking along with the boy or girl’s family.

The history, the symptoms, the family history might clearly point to one of the psychotic illnesses studied and delineated over the previous hundred years (schizophrenia or manic-depressive illness), or not clearly one or the other, perhaps both. Nonetheless we now had effective treatment, drugs that actually work. These would be prescribed. And over the next few weeks to perhaps 8 weeks, our young man or young woman almost always got substantially better. The few that did not progress that quickly had been quietly ill for years before the admission. Average length of stay in the hospital grew shorter and shorter, at that time somewhere between 20 and 60 days.

But the other bit of folk wisdom with the backing of experience was that it usually took at least three admissions to hospital before such a patient achieved long-term stability. And this happened for four main reasons: we prematurely stopped the medication, severe side effects forced us to stop the medication, the patient stopped taking his medication, or the patient, stable within a quiet, supportive environment, entered a new, complex, chaotic and demanding environment that provoked relapse (a relationship, university, a job, travel, even a poorly considered therapeutic program.)

And throughout this process, the family, the patient, and the caregivers all struggled to find a way of understanding, talking about the illness, and finding a balance between cold truth and hope.

It often took three or four admissions before the patient and his family could come to terms with having a mental illness that required medication for a long time. This was not aided by our own optimism, our hope that a six or twelve month course of these very new medications would be sufficient to keep psychosis at bay for years to come.

What actually happened, inevitably, after stopping the medication, was a three or four or even six month period of wellness sans drugs, giving unfortunate support to the conviction of not needing them, followed by relapse of illness, of psychosis.

So these admissions and recoveries and relapses and re-admissions often spanned 5 to 10 years before stabilization was achieved. And, for those who eventually stayed on their medications, another 5 to 10 years of recovering the lost skills, the lost time, of learning what to avoid, of finding a way to live a full life with a chronic illness. Not least of those adaptations is finding a way of thinking about, accepting, as part of one’s past and present, several periods of psychosis, of misreading the world, of damaging relationships and sense of self, of being delusional.

I have been living in and around the same city now for 45 years. And from that period in the 1970’s I have known a few people who gradually made complete recoveries while consistently taking their medication, adjusted over time. And while they have recovered and lead full lives they know they are vulnerable; they know what to avoid; they know they must stick to some routines. I know others who take their medication and have achieved stability if by no means full recovery. And I know of others who have not, who have never been willing to take this medication over a long period of time. Some have died. A few others I see around town occasionally, one in a torn raincoat, walking down the center of the street gesticulating madly and talking to the clouds, another, a woman, standing outside a variety store haranguing exiting customers about incomprehensible injustices, and another plodding along the sidewalk, his head bent in unusual fashion, talking to himself.

But never, in those 45 years, have I seen someone who suffered from this kind of severe psychotic illness, recover fully without consistently taking his or her medication. You’d think by now, if it were possible, I would have seen it.

See Psychiatry and the Business of Madness in Mad in America