Tag Archives: OCD

Dwayne Johnson and Heroic Narratives

By Dr David Laing Dawson

Within the same time frame I was reading Marvin’s blog on the Mental Health Commission and the associated commentary, Dwayne Johnson’s story of depression popped up on multiple news sites. None of the sites gave much detail and I remain unsure if he suffered bouts of what we used to call “clinical depression”, and before that “endogenous depression” or if he simply suffered some difficult discouraging periods in life when his football career and a relationship ended.

In these brief news items Dwayne’s story is shaped as the narrative of an “heroic struggle”.

And I realized that most such stories are shaped and told in that form. It is a classic narrative form, and one we all want to hear.

Facing great odds, our hero, perhaps after learning some life lesson (humility, confession, love, trust, openness) battles his way through to success, health, and happiness. His weapons are will power, strength, hope, perseverance, and a little help from his friends.

It is the narrative form in the story of A Beautiful Mind’s John Nash. And it is the narrative form when the story is told about a victim of cancer.

The difference is that when we read the story and see the pictures of someone’s struggle with cancer, we know he or she has undergone one or many courses of radiation or chemotherapy, that he or she is still undergoing treatment.

The focus of the story may be on the courage and optimism of the patient, their loving  family, a special group of supportive friends, a cancer support group, or all that the patient is able to accomplish despite their illness – but we never lose sight of the fact of medical treatment for cancer.

It is good to bring mental illness out of the shadows. It is good to tell our stories. But we need to drop the euphemisms of mental health issues, and (a new one for me) mental health “situations”, and we need to include the fact of medical treatment for serious mental illness, because we don’t assume it as we do with cancer narratives. In fact, a very popular heroic struggle narrative is “I overcame my (illness, depression) without resorting to medication.”

This heroic struggle narrative has shaped the recovery movement; it has clearly influenced members of the mental health commission.

And who would bother watching a show, or reading a story with a tagline of: “A man develops depression, goes to his doctor; the doctor treats his depression and he gets better.”

This is not to denigrate the role of courage, optimism, hope, and support required to live with a chronic illness, or recover from an acute illness. But…

Update:

Another day, April 5 to be exact, and it seems it is OCD Day with several news items and videos appearing. Much is shared in these articles and videos, distinguishing crippling OCD symptoms from mild everyday forms of compulsions and obsessions. Psychological treatment is also explained, exposure and desensitization therapy. But not once, not once in the articles and videos I watched was it explained that there are medical pharmacological treatments that work with great success for about 90% of sufferers. Not once is this mentioned.

One of these medications has been around since the 1960’s, though at the time we didn’t know how effective it was for OCD and psychological/psychoanalytic thinking about the illness dominated.

I am not sure who or what is to blame for this. But for the psychologists who were interviewed to not mention this readily available medical treatment is akin to naturopaths not mentioning antibiotics when discussing the treatment of pneumonia.

Paradoxically, Jack Nicholson starred as a novelist with OCD in “As Good as it Gets” 20 years ago. At the end of the movie Nicholson’s character decides to be a better man and go back on his medication. Critics were not happy with that ending, and it did ruin the “heroic struggle” narrative. It was, as the third act of a story, very unsatisfying. “What? To quell his OCD all he had to do was take his medication?”  Well, yes.

 

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On the Efficacy of Suicide Prevention

David Laing DawsonBy Dr David Laing Dawson

In the past decade, make that two decades, we have witnessed a plethora of mission statements, lectures, programs, public health campaigns, TV ads, crisis services, anonymous telephone answering services, crisis lines, websites, information initiatives, task forces, white papers, all aimed at suicide, reducing the suicide rate in our communities, preventing suicide.

Yet the rate of suicides in Canada, completed suicides, remains statistically unchanged.

All of the above activities make us feel we are doing something about the problem. We are trying. But that is all they do.

The problem with a public campaign to prevent suicides is that it is akin to a public campaign to prevent heart failure. Both are end stages of other processes, but in the case of heart failure we know enough to target smoking, cardiovascular disease, obesity, hypertension, diabetes, rather than “heart failure”. We do not say, “Call this number if your heart is failing.”

We know the demographics of completed suicide. We know the risk factors. We know the specific and usually treatable illnesses that all too frequently lead to suicide. So if we truly want to reduce the actual numbers of people who kill themselves (not threats, small overdoses, passing considerations), then we need to stop wasting resources on “suicide prevention programs” and put them into the detection and treatment of those specific conditions so often responsible for suicide:

  • Some suicides are bona fide existential decisions, a choice to end one’s life of suffering: terminal illness, intractable pain, total incapacity.
  • Some suicides are the result of chronic complex social factors: unemployment, divorce, poverty, loss, alcoholism, addictions, isolation, and chronic illness. We can chip away at these factors with better support and rehabilitation services, improved minimum wage, retraining – but there is nothing we can do quickly and easily.
  • Some youth suicides are the result of impulsivity, intoxication, and an available instrument of death. Impulsivity comes with youth. Parents can keep an eye on intoxication. But we can make sure no instruments of death are available. Guns. Pills. Cars. Get rid of the gun(s) in the house. Lock up the serious drugs. Driving the family car is a privilege, not a right.
  • Some teen suicides today are the result of public shaming, bullying. Watch for this. Chaperone the parties. Monitor Facebook, Snapchat. No cell phones or internet in the child’s bedroom. It bears repeating: NO cell phones or internet in the child’s bedroom.
  • And then we have the specific mental illnesses that all too frequently, especially when undetected or under-treated, lead to suicide. These are Depression, Schizophrenia, Bipolar Disease, Severe Anxiety, PTSD, and OCD. And if we really want to make a dent in that suicide statistic then our programs, our money, our resources, should be directed to detection, comprehensive treatment, and monitoring of these illnesses.