Tag Archives: mental illness

Addictions and Mental Illness Do Not Belong Together

By Marvin Ross

For some inexplicable reason addictions is lumped in with mental illness or, to be politically correct, mental health. Combining the two is, in my opinion, like putting orthopaedic surgery together with chiropractic. Addictions are quite separate from mental illness and combining them does a disservice to the mentally ill.

I do no want to demean the seriousness of addictions but there is a fundamental difference. Addictions at some point involve choice. You made a decision to go into a bar and start drinking or to snort coke, take opioids or inject heroin. No one has a choice to become schizophrenic, bipolar, depressed or any other serious mental illness. There is no choice involved whatsoever.

Before you jump all over me, take a look at a court case before the Massachusetts supreme court called Commonwealth v. Eldred . Ms Eldred admitted to stealing in order to support her drug habit and was sentenced to probation with the term that she not use drugs and submit to regular drug testing. Ms Eldred tested positive for drugs in one of her tests and her probation was revoked and she was put in jail pending the availability of a treatment bed.

She appealed using the argument that the sentence of abstinence was cruel and unusual punishment as she has no choice but to take drugs as she is an addict. Addiction psychiatrist, Dr Sally Satel, co-wrote a brief with others arguing against the grounds for this appeal. Those grounds are that addicts are involuntary drug users who cannot be held responsible for their drug use. If that is upheld then it would “affect the future of successful treatment programs that are based on the verified principle that addicts can and often do say no to drugs” and “it would hobble successful judicial interventions that help addicts stay out of jail by making probation and parole contingent on testing clean for drugs”.

Dr Satel argues that this position runs counter to accepted science in her blog Addiction, she says, is not a chronic and relapsing brain disease. Addicts can and do learn to say no to drugs and recover in large numbers without intervention. Three epidemiological studies done in the US found that “among those who ever met the criteria for addiction to controlled substances, 76% to 83% were at the time of the surveys ex-addicts. They no longer used drugs at levels that met the criteria for substance dependence.”

Dr Satel also points out that the argument that is often used is that the drugs or alcohol change the structure of the brain so that the addiction continues and cannot be controlled. However, as she points out, all actions, including reading an article, change the brain and thus brain changes are not a valid marker for loss of self control.

One analogy that comes to my mind is smoking. It is generally recognized that nicotine is a very strong addicting substance and it is not easy to quit. My generation smoked a great deal as it was socially acceptable and allowed just about everywhere. One brand even advertised that 4 out of 5 doctors smoked whatever. Then, we were given more and more evidence of how harmful it was and it became socially unacceptable. The vast majority of us were able to quit and I don’t recall anyone ever arguing that we suffered from an illness and that we had a brain disease. Once we determined to stop, we did using a variety of methods. What was key in each and every case was a true desire to do so.

During the Vietnam War, it was discovered that 40% of US servicemen had used heroin and that nearly 20% were addicted. Government officials were stunned and worried and Richard Nixon set up a new office called The Special Action Office of Drug Abuse Prevention. Its goal was to prevent and rehabilitate as well as to track troops returning from Vietnam. What they found shocked them. Nearly 95% of the addicted servicemen gave up heroin voluntarily upon return to the US.

They stopped, it was hypothesized because they found themselves in a totally different environment from that of a hostile war zone. In contrast are drug users who go into rehab who relapse at a rate of about 90% once they return to their regular environment. That is an environment and life situation that caused them to become addicted in the first place.

The solution to addiction is not to treat it like it is a brain disease where the addict has no control but to try to change the life circumstances of those who do become addicted.

As Dr Satel said, addiction is not a conventional brain disease like Alzheimer’s. “Addiction is self-destructive drug use, and those who are destroying their lives with drugs deserve our help and sympathy, but they are not helpless victims” like those with serious mental illnesses.

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Anti-Psychiatry

By Marvin Ross

I really don’t get it – anti-psychiatry that is. I can understand that if someone has had a bad experience with a psychiatrist, they might be wary and hostile. After all, not all doctors are good and I have no doubt that most of us have run into a bad one over the course of our lives. I certainly have seen my share of rude, arrogant and stupid doctors from family practitioners to cardiologists but I do not condemn them all. I do not devote my energy to attacking emergency medicine because of a bad ER doc I’ve encountered.

A lot of the anti-psychiatrists I’ve encountered fall into this category. They’ve had a bad experience and generalize to all. But a lot of the others aren’t in this group. They are people who have decided that their time should be devoted to attacking psychiatry as their contribution to freedom of the individual or to the good of mankind. And, for the most part, they know very little of neuroscience, medicine or mental illness. If they truly want to make a difference, they should devote their time to advocating for better care and treatment for the seriously mentally ill or to help with the growing problem of refugees, world peace, homelessness, child poverty, and the list goes on.

For the most part, they are mistaken in their views of psychiatry as Mark Roseman pointed out so brilliantly in his review Deconstructing Psychiatry. I highly recommend that people read that. His analysis is far more detailed than mine but I would like to comment on a few of the common myths that he covers in more detail.

The one complaint that is common among the anti-psychiatry mob is that psychiatrists are controlling people who give an instant diagnosis and then force their patients to take toxic drugs.

People do not go to see psychiatrists by calling one up or walking into their offices. They need to be referred by a general practitioner or via a hospital like an emergency room. And they would only be referred to a psychiatrist if they had psychiatric problems that were beyond the expertise of the general practitioner. That referral would only be made after the general practitioner had ruled out non-psychiatric causes of the symptoms and behaviour.

Like all doctors, the psychiatrist will take a detailed history from the patient, consider possible diagnoses and recommend appropriate treatment. The treatment recommended is based on the professional guidelines outlining evidence based strategies. These are the practice guidelines used by the American Psychiatric Association. Similar guidelines are used in different countries. The cornerstones of any medical practice are to do no harm and to relieve suffering.

I often hear comments and criticisms that a psychiatrist put someone on toxic drugs that they were then forced to take for eternity. A comment to my blog on the anti-psychiatry scholarship at the University of Toronto stated “based on the results of a positive diagnosis (from a 15 minute questionnaire score) a patient (including young children) may receive powerful psychoactive drugs for years, the long term effects of which are not yet known.”

As I said above, the diagnosis is not based on a 15 minute questionnaire but on an extensive evaluation. And, regardless of the medical area, drugs are always (or should be) prescribed in the lowest dose for a short period of time and the patient brought back in for evaluation of efficacy and side effects. The goal is to find the lowest dose that is effective with minimal side effects. This is a process called drug titration.

If the drug is not effective or if it causes too many unwanted side effects, it will be changed. No one is forced to take a drug that does them little good in any discipline of medicine. Surely, the patient does have choice to continue with that doctor or not and to take the advice that is offered. People who see psychiatrists are not held captive.

When it comes to children, they are not seen in isolation as the anti-psych criticism I quoted above implied. They are seen with their families who, understandably, do not want their kids on powerful drugs. There are long discussions with the psychiatrist where all less invasive means are explored. When pharmaceuticals are prescribed, the parents are at complete liberty to stop them if they do not work or if they cause troublesome side effects. The children are not held captive by the psychiatrist and force fed pills against the wishes of the parents.

When a child does continue to take the medication it is because it is having a benefit and there are no troublesome side effects. I remember a mother who resisted Ritalin for her hyperactive child for years telling me how well it worked once she decided to give it a try. “I wish I had tried it much earlier”, she told me. “It would have saved so much grief.”

The anti-psychiatry bunch also assert that mental illnesses do not exist and cite the lack of any one definitive test to prove bipolar disorder, schizophrenia or other afflictions. Quite true but the same can be said for many other maladies. How about Parkinson’s as but one example. Doctors cannot measure the amount of dopamine in the brain (which is depleted in Parkinson’s) to definitively say that the person has the condition. They determine the presence of this condition based upon observing the person and his or her movements.

Alzheimer’s is another. Like with schizophrenia, it is diagnosed by eliminating all possible other reasons for the observed dementia and when none can be found, the diagnosis of Alzheimer’s is made. On autopsy, there will be found specific markers but no one ever gets an autopsy to prove that the doctor was correct. And rarely is anyone with schizophrenia autopsied on death but this is a lengthy list of the abnormalities that demonstrate that it is a disorder of the brain.

The anti-psychiatry group should be looked upon with the same disdain that sensible people look upon the anti-vax faction.

Psychiatry, Eugenics and Mad In America Scare Tactics – Part I

By Marvin Ross

Much of what I read on the Robert Whitaker website, Mad in America, stretches logic but this newest blog has to be one of the biggest stretches I’ve seen. Dr Robert Berezin, a US psychiatrist, warns that psychiatry is moving closer and closer to eugenics.

As defined by dictionary.com “eugenics is a word that made everyone at the event uncomfortable. … The very subject evokes dark visions of forced sterilization and the eugenics horrors of the early 20th century. … The study of hereditary improvement of the human race by controlled selective breeding.”

The most famous proponent of eugenics was Adolph Hitler who wanted a pure Aryan race but the subject has been advocated by many in recent history in an attempt to eradicate debilitating diseases. In fact, one could say that the reason for amniocentesis is to do just that. Sampling of the amniotic fluid of pregnant women can predict such things as Down’s Syndrome. And some parents will opt for abortion if Down’s is found but many do not.

Amniocentesis can also predict such genetic conditions as Tay Sachs Disease where the infant usually only lasts to about age 4. But, nowhere in the article by Dr Berezin does he actually show that modern psychiatry is planning to eliminate anyone who suffers from schizophrenia or any other psychiatric disorder.

What he talks about is the fact that genetics is being employed to try to understand these conditions better. He states that:

The accepted (and dangerous) belief is that psychiatry deals with brain diseases – inherited brain diseases. We are back to absolute genetic determinism. Today’s extremely bad science is employed to validate not only the idea that schizophrenia and manic-depression are genetic brain diseases, but that depression, anxiety, phobias, psychopathy, and alcoholism are caused by bad genes

I have no idea why he considers the genetic research to be bad science other than he does not agree with it. So what if he doesn’t. He does state that “The temperamental digestion of trauma into our personalities is the source of psychiatric conditions.” But, as Dr David Laing Dawson has written on this blog:

Childhood deprivation and childhood trauma, severe and real trauma, can lead to a lifetime of struggle, failure, depression, dysthymia, emotional pain, addictions, alcoholism, fear, emotional dysregulation, failed relationships, an increase in suicide risk, and sometimes a purpose, a mission in life to help others. But not a persistent psychotic illness. On the other hand teenagers developing schizophrenia apart from a protective family are vulnerable, vulnerable to predators and bullies. So we often find a small association between schizophrenia and trauma, but not a causative relationship.

Dr Berezin’s concern does not come from anything that anyone has said about aborting fetuses that genetic testing proves will be born with schizophrenia or bipolar disorder or any serious psychiatric condition. And the reason for that is that genetics and the understanding of the causes of these diseases is nowhere near a point that this can be demonstrated with 100% accuracy. Science is a long way from getting to that point if it ever is able to.

Suggesting that these research avenues will lead to abortion, eugenics or something similar is absurd and nothing but scare tactics perpetrated by someone who does not agree with the causation theories being investigated. If these avenues lead nowhere and it is discovered that science has been on the wrong path, then science will self correct. Attempting to generate unfounded fear is counterproductive.

Next Part II by Dr David Laing Dawson

A Dose Of Reality Is Needed For Mental Health Week

By Marvin Ross and 1st published in Huffington Post May 11, 2016

In Canada, the first week in May is designated “Mental Health Week,” and according to the Canadian Mental Health Association, the purpose is “to encourage people from all walks of life to learn, talk, reflect and engage with others on all issues relating to mental health”. We are encouraged to #getloud for mental health.

In the US, the entire month of May is devoted to “mental health”.

However, I have to say that I am perplexed about the reason we “celebrate” mental health in both Canada and the US. I assume we are celebrating, but I’m not really sure what we are celebrating or what we are doing.

What is not “celebrated” is our abysmal record on providing treatment and resources to those who suffer from serious mental illnesses like schizophrenia, bipolar disorder, severe depression and other illnesses. And note, I said illness not health. There is a difference. A poster circulating on the internet expresses the problem extremely well. It says:

Saying “Mental Health” for schizophrenia is like saying “Physical Health” for cancer

You can substitute serious mental illness for schizophrenia above.

Justin Trudeau had this to say at the start of the week, “Let us use our voices this week to help change the way society views mental health issues and those living with them. Now is the time to GET LOUD for mental health.”

And of course, he uses the word issue as in mental health issues. Hamilton psychiatrist and fellow blogger on Mind You, Dr. David Laing Dawson, discussed the use of the word issue in one of his blogs and commented that “by calling mental illness an issue we are placating the deniers of mental illness and we are reducing it to an abstraction, a topic for discussion and debate, rather than a reality in our midst….”

And he ended his blog by stating “But let’s stop with the “issue” when we are naming or describing a painful reality.”

The painful reality of mental illness in both the US and Canada is that we do not have enough resources like hospital beds, community treatment, housing, etc to provide the proper treatment that is currently available for these who suffer.

Readers of my blogs on Huffington Post know that many of them deal with the inadequate services that those with the most serious mental illnesses receive in Canada. It is hard to pick out one as so many of them deal with this problem. If we were to have a realistic group of people representing the faces of mental illness in Canada, we would have someone who is in solitary confinement in a prison and someone who is homeless.

One of Correction Services Canada’s top priorities is to deal with the mental health needs of its population. They estimate that 38% of incoming prisoners suffer with a mental illness. In his June 2015 report, the Correctional Investigator of Canada, Harold Sapers, found that “mental health issues are two to three times more common in prison than in the general community”.

In Ontario, the Globe and Mail recently analyzed the long-term solitary confinement of prisoners in Ontario and found that 40% were locked away for more than 30 or more straight days. This is twice the limit permitted by the UN in its Nelson Mandela Rules.

The Globe reported that:

On 40 per cent of the files, staff gave mental health or special needs as part of the justification for their prolonged segregation, a figure that seems to clash with provincial policy stating that segregation should never be used for inmates with mental illness until all other housing alternatives have been considered and documented.

In the US, a recent report disclosed that there are 10 times the number of mentally ill in prison than in state psychiatric hospitals. Most of them, the report states, would have been in psychiatric hospitals before they began to be closed. The largest mental hospital in the US is Cook County Jail in Chicago.

And what about homelessness? According to the Centre For Addiction and Mental Health in Toronto, surveys of various Canadian cities put the percentage of homeless who suffer from mental illness at between 23 and 67 per cent. Furthermore, “While mental illness accounts for about 10% of the burden of disease in Ontario, it receives just 7 per cent of health care dollars. Relative to this burden, mental health care in Ontario is underfunded by about $1.5 billion”.

Again, in the US, about one third of the homeless are people who suffer from untreated mental illness

In a 2015 survey done by the Mood Disorders Society of Canada, the top priority for the respondents (91 per cent) was the need to have greater access to professionals. Over one third (38 per cent) said that the wait for diagnosis was over 12 months. In the most recent tragedy that took place in the middle of Mental Health Awareness Week, a 38 year old man was released from Burnaby, BC General Hospital where he had resided for three days due to suicidal thoughts. His mother had asked hospital staff to release him to her care but they did not do that. They gave him a bus ticket and sent him on his own. He committed suicide shortly after.

Clearly, as a society, we need more than simply being aware of mental health once or twice a year. We need a time when we can reflect collectively on how inadequately we treat those amongst us who have a brain illness. And we need to lobby to right that wrong. The money spent on these awareness campaigns could be put to better use providing more services for those who desperately need them.

The Word ‘Issue’ Has Become an Issue.

stone of madness

By Dr David Laing Dawson

There it was again. The local paper reporting on homelessness, reporting on the results of a survey of over 400 homeless people in our city. All very nicely written and laid out. The number of homeless people who have been the victims of violence; the number who struggle with addictions. And the over 80% who suffer from “mental health issues.”

Dictionary definitions of the word ‘issue’ include:

“An important topic or problem for debate or discussion” – the operative portion of that definition being “for debate or discussion.”

Now I understand that how we describe or name something may shift and change over time, often for good reason, often not. We no longer use the word ‘retarded’ to describe someone who has less than average intellectual capacity. It is a word that accrued a lot of baggage through the years, and became a schoolyard epithet, implying, at least in the vernacular of teenagers, something like “willful stupidity”, or “in bad taste.”

But euphemisms often creep into our vocabulary to hide the truth, or to reduce the sting of truth. Sometimes the euphemisms are simply more polite (‘disability’ may become ‘special needs’); sometimes they are obfuscations with only a limited reference to the original activity, problem, or thing (‘illness’ becomes ‘issue’), and sometimes they are softer vague words chosen to hide the reality of the action or intention of our governments, bureaucrats, and military, and sometimes they are even, a la George Orwell, antonyms of the word that would actually reveal the truth.

I don’t know how the word ‘issue’ became the mot du jour, sometimes even added as a totally unnecessary noun. As in ‘he has addiction issues’ instead of ‘he is addicted’. I suspect it is related to the actual meaning of ‘issue’, (a topic open to debate), and by calling mental illness an issue we are placating the deniers of mental illness and we are reducing it to an abstraction, a topic for discussion and debate, rather than a reality in our midst, and often the actual cause of homelessness.

Even if, reasonably, we want to reserve the words ‘disease, illness, and disorder’ for only severe forms of this reality, this plight, we still have other words to chose from that do not imply a debatable abstract: ‘problem, difficulty, trouble, worry’. We might even say “mental health concerns, including mental illness”.

But let’s stop with the “issue” when we are naming or describing a painful reality.

One Step Forward, Two Steps Back – Mental Illness Treatment Over the Past 150+ Years – Part V of IV

David Laing DawsonBy Dr David Laing Dawson

Since writing Part IV, I’ve read E. Fuller Torrey’s American Psychosis. So there is my historian tracing the manner in which the personal struggles of politicians, the belief systems of leading professionals of the time, egos, idealism, personal tragedies, and, of course, power, politics, and money brought about the disastrous transformation and destruction of the mental illness treatment system from 1963 to present time in the US.

Canada is always a slightly more cautious, reticent, little brother too often lead astray by his risk taking, grandiose big brother. We are not as enamoured with the profit motive; we have evolved a somewhat different social contract; our minimum wages and safety nets are better; our Federal Government dare not (thanks in large part to Quebec) tamper with social and health programs long the responsibility of our provinces (or initiate something unilaterally that would undermine or destroy Provincial Programs). So we still have most of our mental hospitals, and they are mostly linked and associated with our community programs. Our psychiatric leaders and teachers remained a little more grounded in the observations of Dr. Kraeplin than the fanciful extrapolations of Drs. Freud and Laing. We realize, I hope, that privatizing our garbage collection (providing we retain sensible unions) might be both fiscally and socially responsible, but privatizing the care of the mentally ill is not.

Yet in our own slow and cautious way we are following the same path as the US. Completely discredited ideas about the causes, treatments, and “prevention” of serious mental illness, once promoted by the Psychoanalysists who designed the American Community Mental Health Programs of 1960 and 1970 are finding their way into our commissions and planning groups. Our linguistic avoidance of ‘illness’ in favour of ‘issues’ and ‘health’ is just another form of denial of the knowledge that, unfortunately, God help us, no matter how well we conduct our lives, we (and our children) can still be stricken with serious diseases of the body and brain. And, our cherished belief in inclusiveness, our understandable distrust of authority, even of scientific authority, and our wishful thinking and politeness, often allow equal voice to the speakers of nonsense on our commissions and task forces.

Much of the care of the seriously mentally ill has shifted to psychiatry programs and inpatient units of our General Hospitals. These are not for-profit institutions, but neither are they asylums; short stays are the goal; turn-over is rapid, and the doors we unlocked in the 1970’s are once again locked. (Security becomes paramount when the unit is situated on the fifth floor of a General Hospital next to the surgical suite and the Pediatric ward.) Overwrought privacy laws allow health personnel to avoid the onerous task of talking with families and other caregivers. Time consuming and difficult appeal processes facilitate psychiatrists prematurely discharging very ill people who are not, strictly speaking, imminently dangerous to self or others.

We too now have mentally ill homeless, and jails and prisons with burgeoning populations suffering from mental illness.

(I remember being mildly astonished, in perhaps 1990, to find that an Ontario Ministry of Health task force, seeking to determine the optimal number of psychiatric inpatient beds per 100,000 population, was using the State of Georgia as a benchmark. Not The Netherlands, Finland, Sweden, Denmark, but Georgia. It is sometimes difficult to resist American enthusiasm.)

We have had the opportunity of adopting some of the good and effective programs pioneered in the U.S. (the ACT programs) and avoiding some of their bad ideas; we are developing a number of programs to help the police (now often front-line mental health workers by default) in many jurisdictions; we have some means of mandating forced community treatment for those who remain at risk (though it is underutilized).

Still, our development of community programs to service the seriously mentally ill has definitely not kept up with de-institutionalization. We seem to be, once again, inexorably following the misguided steps of our big brother to the south.

But, we have not destroyed our mental illness treatment system, merely hobbled it. So, in theory at least, as a country with a smaller population than California, we should be able to fix it.

How Did We Get Here? Further Reflections on Recovery in Mental Illness

David Laing DawsonBy Dr David Laing Dawson

When trying to understand society’s, or a country’s, concepts, thoughts, approaches to, treatment of, mental illness, we can look at medical and scientific progress: This is the “march of progress” approach to understanding history – our advances in diagnosing and treating mental illness over the past hundred years. But history also tells us that attitudes toward mental illness have always been influenced by the economics of the time (only when we can feed our own children do we have the capacity to worry about our strangely behaved neighbour), our preoccupations of the time (being at war leaves few resources for the mentally ill), and, finally, the folk wisdom of the era.

Folk wisdom – the thoughts, rationales, explanations, assignments of responsibility and blame that linger in our consciousness long after being modified or disproved by science. Our brains are programmed to look for causation, a way of understanding an event, and, wherever possible, to ascribe blame. We also quite naturally and quickly look for a cause, a thing to blame, that we ourselves can avoid.

It is reported that a man younger than myself dies suddenly. I can’t help it. I search the report for cause, and relax when I find that he was a heavy smoker, which I am not. A woman is assaulted after midnight in a sketchy part of town. We know it’s wrong, but our brains immediately ask, “What was she doing there?” The child is behaving badly. We immediately think, “He could use some better parenting.”

It is always surprising to hear nurses blame the full moon for a perceived increase in the number of patients flooding the emergency room, though this “lunacy” has been thoroughly debunked by science. And otherwise intelligent people continue to ascribe perceived behavior to an astrological sign, or numerous other semi-mystical notions of alignment, karma, vapors, chakras, auras, and miasma.

Most of all it is comforting to think that if we behave well, and morally, and kindly, pray before bedtime, and avoid certain pleasurable but dangerous substances, we can also avoid dis-ease, illness, and a fall from grace.

We know that alcoholism and addiction include an action taken, engaged in, by the sufferer, engaged in willfully, of free will, and that recovery from addiction will entail a mind set, a decision, a commitment, a major effort on the part of the sufferer. So with alcohol and addiction programs this process is supported, encouraged, often through peer support, non-judgmental encouragement, soul searching, an acknowledgement of weakness, a trust in a “higher power”, and even, in some programs, forms of confession and penance. When we talk of treatment for alcoholism and addictions we are really using the word “treatment” to mean a complex sophisticated form of persuasion. We don’t really have a treatment for those two problems beyond persuasion and support.

In the post WW II era, our mental hospitals became “psychiatric hospitals”, and, a few years later, at least one ward in most general hospitals became a psychiatric ward, or colloquially, a “psyche ward”. This naming was important. It acknowledged a medical specialty, and a group of diseases treated by that specialty, much like an orthopedic department, a gynecology wing, a surgery ward. In fact the federal funding in Canada to support general hospital psychiatry wards (via federal provincial transfer payments) was a considered effort to acknowledge mental illness as illness, deserving of the same attitudes, funding, and professional support as “physical” illnesses.

Through the 1970’s and 80’s it appeared to be working. Programs were developed, new more effective medications were developed, attitudes were changing, physical facilities were improved, and maybe, we thought, this de-institutionalization will work.

Mind you, addictions got short shrift from the mental health system in those years (though the hospitals were psychiatric hospitals, the overall system of care was still called “the mental health system”). Generally addicts and alcoholics were told that they would have to get those problems attended to before we could help them with their mental illnesses. They had to first attend detoxification programs and then alcohol and addiction programs, which often had little patience for either mental illness or psychiatric treatment.

So detox centers, alcohol and addiction treatment programs developed apart from and separate from psychiatric wards and hospitals. And from these centers the “recovery model” developed. The word alone is nothing but positive, but it contains all the implications and expectations and attitudes outlined four paragraphs above. It implies that full recovery is possible, if you put in the effort. Peer support, will power, the power of positive thinking, goal setting, avoiding negative thinking, take life a day at a time, take responsibility for yourself……..

And, absolutely, for addictions and alcoholism, recovery can be defined as a life free of alcohol and drugs, and it is certainly achievable.

And through all this, our folk wisdom, that wisdom that often governs legislation and attitude, maintained a conviction that, ultimately, alcoholism and addictions are the sufferer’s responsibility. If he does not get well, or clean and sober, he is culpable, or at least, ultimately, to some degree, the architect of his own fate. And folk wisdom was shifting to believe that this is not true for schizophrenia, manic-depressive illness, depression or anxiety disorder. These are illnesses requiring treatment. They are usually chronic illnesses. Full and complete recovery is rare, though medications can alleviate symptoms and prevent relapse. There is nothing the sufferer can do on his own to prevent or stop these illnesses. And for these illnesses we do have actual treatment.

And then…. actually I’m not sure how this happened…. but somehow the bureaucrats and perhaps a few idealists, managed to bring these two systems under one much more economical roof. Three words were lost in this recent transition: “psychiatric”, “illness”, and “hospital”.

And suddenly we now have a multitude of “Centers for Addiction and Mental Health”.

And while this undoubtedly saves money, and perhaps serves better those who suffer both addictions and mental illness, it has had, in my opinion, some very negative unintended consequences.

  1. The recovery model, well suited to addictions, has been foisted upon those suffering from mental illness.
  2. The stigma of mental illness has been entrenched by the use of the paradoxical euphemism “mental health”.
  3. We have inadvertently allowed the folk wisdom of acknowledging personal responsibility for addictions (blame) to rub off on those suffering from diseases of the brain, those suffering from schizophrenia and manic-depressive illness.
  4. And ultimately it has allowed us well-meaning citizens to feel comfortable that now, not in 1950 or 1960 or 1970, but now, in 2014, our jails and prisons are filled with the seriously mentally ill.

Alternative To What?

stone of madnessBy Marvin Ross

Two interesting events this past week. Scientists at Northwestern University in Chicago announced a major breakthrough in the cause of ALS which may lead to an effective treatment. It has taken a team of researchers studying one family who are genetically prone to this disease to uncover what they believe is a cause using, of course, the scientific method.

In Orlando in contrast, we had the 28th annual Alternatives Conference put on by the National Mental Health Consumers’ Self-Help Clearinghouse and funded by the US Government. Their theme was Creating the Future: Change, Challenge, Opportunity and that “Learning from each other is a clear example of self-help, mutual support, and the principles of recovery in action!”

Looking through their program, I don’t see anything that in any way suggests that they are going to come up with solutions to the cause or effective treatment of mental illnesses. And effective treatment (recovery) does require an understanding of why and how these conditions afflict us. We are nowhere near that. What I do see is a lot of talk about peers helping peers and concepts like Emotional CPR.

I’ve always had a problem with the term alternative. It is as irritating as political correctness but on two occasions I did attend alternative conferences – the Total Health Expo Billed as “North America’s premier natural health show”. The event has been held every year since 1977 by the Toronto-based Consumer Health Organization of Canada. Both times I attended, it was with physicians and I described that visit for a magazine.  

The one person there who talked about mental illness (depression) was Carolyn Dean who claimed that 784,000 people are killed annually by doctors in the U.S., but thought that the true number might be five times greater. Dean is a popular speaker who recommends magnesium for many ailments and currently lives in Hawaii. She is a medical graduate of Dalhousie University in Halifax and then had her medical license revoked in Ontario in 1995 for “incompetence and professional misconduct.

She claimed in her talk that when she appears on TV in the U.S., she is not allowed to talk about depression and St. John’s Wort. She told the assembled faithful that the networks tell her the subject is too heavy for the audience. But she says that is not the real reason. She believes that pharmaceutical advertisers probably have a clause in their contracts with networks preventing them from mentioning anything other than prescription drug treatments.

Now I don’t know how far out the Alternatives delegates in Florida are as I was not there but I have to wonder at their use of the term alternative. I agree with Montreal scientist Jonathan Jarry who said in his Cracked Science Video on homeopathy that there is no shame in looking after our health if we feel underwhelmed by the medical system. It’s natural to look for alternatives (as the folks in Orlando are doing) but these substitutes are often not based on scientific evidence.

I’ll go even farther and support the  definition put forth in an editorial in the New England Journal of Medicine by two of its editors. In 1998, Marcia Angell and Jerome Kassirer said:

It is time for the scientific community to stop giving alternative medicine a free ride… There cannot be two kinds of medicine — conventional and alternative. There is only medicine that has been adequately tested and medicine that has not, medicine that works and medicine that may or may not work. Once a treatment has been tested rigorously, it no longer matters whether it was considered alternative at the outset. If it is found to be reasonably safe and effective, it will be accepted.”

So, if the Orlando alternative folks want to support each other as is indicated in their tag line that’s great. But they need to realize that all pills, substances, medicines are placebos. All have the potential to make us feel better, at least for a while. But some of these placebos also have scientifically proven pharmacological effect, proven help beyond that of a placebo. Those are true medicines. The others are not. But as long as the others make us feel better, give us hope, do not bankrupt us, do not cause harm, and do not prevent us from seeking real medicine, they are fine. The last two phrases being the most important: if they do not harm, and they do not prevent us from seeking real, scientifically proven, medicine.

And the drawing at the beginning of this blog is of an old treatment for mental illness – drilling a hole in the skull or trepanation. It was mainstream for a large part of history and, according to Wikipedia, “In 2000, two men from Cedar City, Utah were prosecuted for practicing medicine without a license after they performed a trepanation on an English woman to treat her chronic fatigue syndrome and depression.”