Tag Archives: Toronto

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.

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What to do at St. Michael’s College School

ownersmanualBy Dr David Laing Dawson

And for those not in Ontario, St Michael’s in Toronto is presently involved in police investigations where charges have been laid against students for bullying, assault and other charges pertaining to numerous incidents seen in videos spread on social media.St Michael’s is an all boys private Catholic secondary school

First we insist all schools be co-ed. We ban girls-only and boys-only schools. Then we stop overestimating the maturity and judgement of teenagers, especially when we find them in clusters, groups and herds.

The adolescent years are important. It is a time for these nascent humans to discover, navigate, as pioneers, the complexity of a sane, competitive yet compassionate society of human beings. They are discovering and forging boundaries, social contracts, the necessities of cohesion, cooperation. They are, at the best of times, overcoming fears and prejudices, and finding ways to satisfy their needs and desires while remaining kind and civil, building a unique sense of self while maintaining membership.

For this they need to be sitting in classrooms and walking the hallways with a full range of other human adolescents. Girls and boys of different sizes, shapes, abilities, and origins.

Putting all the boys in one school, and the girls in another, is a gross distortion of socialization during a very important developmental phase.

I could go on about this in abstract terms alluding to brain development, frontal lobe development, managing sexuality, gender identification, self awareness, expanding consciousness, and the need for all of this to happen within a good prototype, a good facsimile of the real world. But two small examples might paint the picture more vividly.

At the end of each Junior High School year my school held a convocation, an assembly, with the auditorium filled with students and parents. Besides speeches and singing, awards were presented. The three top students of each year had to go on stage to be presented a certificate. For three years I had to walk on stage and share these honours with a white girl and a Chinese girl. I remember fearing being teased by boys, my friends and buddies with their “manly” values, but I never was.

A generation later I have a photograph of a Student Council Meeting at M.M Robinson High. My daughter, Erin, is chairing that meeting. The members are sitting around the table. They appear to be listening intently as Erin points something out to them. They are all boys.

Contrast this with the current cover of The New Yorker. It depicts a room full of suited, older white men, all white, conferring with one another, and a door opening with a colourful array of women about to enter.

It is not at all hard to imagine, at an all boys school, with a tradition of manly muscular Christianity, how a gang culture develops with an emphasis on hierarchy, loyalty, dominance, and submission, with the infliction of pain confused with mirth, and the expression of sexuality becoming mixed with both.

We have a long way to go figuring out how to supervise our teens at home and at school now that their years of dependency stretch into their 20’s, unskilled but good jobs diminish, and these teens can now communicate with one another 24/7, and spend much of their time staring at screens, but closing the all boys and all girls schools would be one step in the right direction.

For more about raising adolescents, check out The Adolescent Owner’s Manual

The Danforth Shooting – Violence and Mental Illness

By Dr David Laing Dawson

In the wake of the Danforth shooting a couple of my colleagues have been quick to point out that the association between mental illness and violence is small, that most people suffering from mental illness are more likely to be victims of violence than perpetrators of violence. They are worried about the stigma of violence attaching itself to mental illness. And of course they are right. Though one of them goes on to use those horrible euphemisms of “mental health issues” and “mental health challenges”.

Language is important as are the questions we ask.

If we expand the problem to “mental health issues” then I am sure I can rightly say that all acts of physical violence by one human against another are the products of “mental health issues”. Otherwise we will have to expand our concepts of normal and healthy to include physical violence.

And the use of such ill defined euphemisms plus our worry about stigma cause us to ask the wrong questions. Did he suffer from “mental health challenges” and “issues”? Of course he did. Is a circle round?

These are the better questions to be asked:

1. Did treatable mental illness play a role in the Danforth shooting?

(I have just read that the man in question “repeatedly cut into his face with a pencil sharpener blade” and talked of hearing voices – both symptoms of a treatable mental illness, a psychosis, probably schizophrenia)

2. If he did have such an illness why was it not being adequately treated?

(Not “supported”, “counselled”, “accommodated”, but treated)

And finally, because question 2 will always lead to imperfect answers, 3. How did he get a gun?

I have to add that while many people suffering from delusions never act on those delusions, especially if they are being treated, a very specific sign that a psychotic and delusional person will act upon a delusion (that is, attack his imagined torturers) is self injury to face or genitals.

Follow Up – Education More Important Than Ever

By Marvin Ross

I’ve been contemplating a personal follow up to David’s blog on the importance of public education but I’ve been procrastinating. I decided to write it after having lunch with someone who was complaining that a grandchild was being sent to a private school at a cost of $25,000. His argument was that the local school the child goes to is quite good and he will have to be driven to the new school where he will lose contact with all his friends in the area.

The ability to play with other kids on the block, walk to and from school with them, and to hang out is an invaluable educational tool. I grew up in a Toronto that was just starting to break free of the grip of the Loyal Orange Order – a Protestant fraternal group that celebrated the defeat of the Catholics at the Battle of the Boyne in 1690. Most important jobs were reserved for Orangemen who proudly marched on Yonge St every July 12 behind someone outfitted on a white steed playing King Billy to celebrate the victory of William of Orange over Catholics.

Toronto was just beginning to see an influx of immigrants from all over the world at that time. Up to then, the main immigrants were Jews and Italians. The elementary schools were becoming mix of ethnicities and we all mingled and played together (with the occasional fights that were settled easily). As English Protestants ruled, classes began with the Lord’s Prayer and the singing of God Save the Queen. Once a week, some kindly minister conducted a class on religion.

Jews could be excused but I stayed as did most of the others as I recall. This invariably led to our existence being recognized by the holy man who talked about religion in general rather than his own denomination. We learned about and from each other. Groups of kids from different backgrounds would share experiences outside of class. I can still remember our comparing what we ate for Christmas dinner (which I didn’t have) and being intrigued because my best friend was Japanese and they ate octopus.

As I progressed through the years, more diverse people began showing up in class. At this time, most Blacks were descendants of those who came via the underground railroad but we were soon joined by people from the Caribbean. In elementary school, I went to a drop in centre across the street from our house run by the African Episcopal Methodist Church. One year, I was one of the three wise men in their Christmas pageant. Of new arrivals at that time, the most exotic was a new Algebra teacher called Mr Gupta. No one had ever seen a South Asian before but what was most remarkable was that his two sons were in his class. They were math whizzes much to our disgust.

I don’t want to give the impression that there was no racism as there was but it was slowly beginning to break down thanks to the children from large groups of people from diverse places. We mingled together in school, played and fought together on the playgrounds in the neighborhood and began to develop understandings of each other. In her book on growing up in Toronto as a child of Holocaust survivors (When Their Memories Became Mine: Moving Beyond My Parents’ Past), Pearl Goodman describes how playing with the neighbourhood kids and dealing with them in the local school, helped her contend with the views and trauma her parents had from their experiences.   The outliers were Jewish kids in the area who were sent to Jewish parochial schools rather than the public schools. They were quite different from us and even talked differently with the sing song accents so familiar to those whose first language was Yiddish.

During that time, there was even a radio program hosted by the Minister of Citizenship, Jack Pickersgill, who gave his audience information about the various immigrant groups (called New Canadians), who were flooding into the country. The Governments attempt to help them gain acceptance

Education was a prime reason that fear and distrust of others began to break down. Aside from the fact that most kids in my high school could swear in Yiddish (as Jews were the largest group), tolerance and understanding was starting to emerge in all areas. A holdover from the War was the fact that high schools in those days all had cadet corps affiliated with various regiments and often our teachers were called by their military rank. My history teacher was a major.

My school was affiliated with the Queen’s Own Rifles, an old and respected regiment that landed at Normandy on D-Day and fought its way north to help in the liberation of Belgium and The Netherlands. We had to go on a Church Parade one Sunday to the regimental church and when we got there, the Sgt had us all lined up. His command was Jews and Catholics, fall out and we did and spent the church service in the basement playing foot hockey while the poor Protestants had to endure a religious service.

Education helped us integrate and learn to understand and tolerate each other and is very crucial today more than ever. And it is this understanding and respect for each other that results in US Muslim Vets offering to stand guard to protect Jewish cemeteries from vandals or Toronto Jews standing guard at Mosques to show solidarity.

It has always been important for us to learn about and accept others as equals and that process flourishes when we all go to school together.

Racism – A Tale of Two Nations

By Marvin Ross

My intention is not to come across as smug which many Canadians can be when talking about the US. I am hoping to point out some fundamental differences between Canada and the US that, I think, deserve some analysis – and that is racism.

Despite the great similarities between the two countries, racism has evolved differently. I am not so naive as to suggest that racism is not a problem in Canada but it is much less so than in the US and certainly,  first Nations still have a long way to go. However, numerous people have commented that the support for Trump was motivated by racism given what he emphasized in the campaign and I totally agree. Actually, the great American satirist and commentator, H.L. Mencken, predicted the Trump win. He said:

“As democracy is perfected, the office of president represents, more and more closely, the inner soul of the people. On some great and glorious day the plain folks of the land will reach their heart’s desire at last and the White House will be adorned by a downright moron.”

And so, maybe the inner soul of many Americans is in agreement with what Trump said.

One study that is being quoted to explain what appears to be a racist backlash is research suggesting that having demonstrated that they are not prejudiced by electing a Black president, people feel they have license to demonstrate their discriminatory views.

I’ve attended numerous medical conferences in the US and was stunned to see the divide between Black and White. The first conference I attended was the American College of Cardiology in Atlanta in the late 1990s. There was a parallel meeting of the Black Cardiology Association within it. There is also a Black psychiatry association founded in 1969 in part to address the barriers that Black psychiatrists encountered.. Then there is a Black caucus of the American Library Association to help recruit African American Librarians. In one hotel I was at in Houston, there was a meeting of the Hispanic MBA Association which was developed to open doors for Hispanics with MBAs.

I have American friends who tell me that a deep seated racism still exists but that it is (or has been till now) kept in check. Trump has let the genie out of the bottle as demonstrated by the reports of racist incidents all over the US since the election. And while this review of a book that I publish on the trauma of growing up as the child of Holocaust survivors denying the existence of the Holocaust was posted on Amazon just before the election, I suspect Trump’s rhetoric gave the reviewer license to come out of the woodwork.  When confronted with these racist incidents  in his interview on 60 Minutes, Trump thought much of it was generated by the media but did tell his followers to stop. What was disappointing was that the interviewer did not ask him what he expected when he inflamed his followers with anti-Hispanic and anti-Muslim rhetoric.

Toronto is one of the most racially diverse cities in the world and home to 230 different nationalities. It is home to a large annual Caribbean Festival, Greek and Italian Festivals, a number of China Towns, Korea Town, East Indian areas, and people who, for the most part, get along well as this example of multi-ethnic co-operation demonstrates. It was not always like that. Growing up in the 1950’s, Toronto was white, Anglo Saxon and Protestant run by the Loyal Orange Order. The big event was the July 12 Orange Parade which celebrated the Protestant defeat of the Catholics at the River Boyne by King William in 1690.

In 1875, Orangemen rioted because they took offense at a Catholic procession and thousands rocked the core of the city. Well into the 20th Century, Orangemen were the centre of partisan politics in Toronto. In 1933, Toronto, experienced the Christie Pits riot when a gang of youths unfurled Nazi flags after a predominantly Jewish baseball team won a semi final game. Jews, assisted by Italians, battled the flag bearers and their followers for hours all over the downtown in what was called the worst riot in Toronto history. Years later, that was the park where I played baseball and went swimming.

In my school days, there were very few Blacks other than the small numbers who mostly came via the underground railway, few South Asians, Chinese, and others. The main ethnics were Jews and Italians and we Jews new enough that certain parts of the city were dangerous for us to go to. The Danforth was one area (now Greektown) and the Beaches where the Nazi group allegedly came from. We also knew that there were quota systems in universities, bans against hiring Jews by hospitals, law firms, banks, etc,  neighbourhoods that would not sell to Jews, resorts that would not rent to them, and the list went on.

In my early teens, our Jewish family doctor referred me to a medical specialist for a problem. When my mother asked if he was any good, the doctor said, he is one of us at the Toronto General so he must be very good to be on staff. I later read that that specialist was specifically hired to break the ban of Jews at the hospital. My dentist of many years back then once told me that the only way he could get into dentistry was because he played on a national championship teen basketball team. He went to the director of recreation for the City of Toronto and told him of his desire to study dentistry but he couldn’t because he was Jewish. “Leave it to me” the official who was probably an Orangeman told him. He was accepted.

Similar problems existed for the few Blacks at the time and I have no doubt they still experience problems today but it is improving (I hope). Historian, Irving Abella, gave a very good history and reasons for change in an address in 2000 called Jews, Human Rights, and the Making of a New Canada.  Abella’s wife, a refugee who was born in a displaced persons camp post Holocaust, sits on the Supreme Court of Canada. Abella mentions that Bora Laskin could not get a job in law when he returned to Canada from Harvard Law School. His wife, a trained cosmetician, could not get hired at Eatons (the large department store). Laskin eventually became the Chief Justice of the Supreme Court of Canada. In 1961 when Louis Rasminski (who graduated from the high school that I went to) was named Governor of the Bank of Canada, Ottawa ceased being what former British High Commissioner Joe Garner called the most “anti-Jewish capital city” he had ever encountered.

How people actually managed to accept a less racist society in Canada is a mystery. Bringing in anti-discrimination legislation cannot change attitudes but it did. We may still have a long way to go but we have come very far in my lifetime.

The problem of licensing as mentioned by psychologists in the US has not happened here either. We have had a female Chinese Governor General, a Black Haitian female Francophone Governor General and a Black Lieutenant Governor in Ontario. As representatives of the Queen, they are really only ceremonial but they were out there for all to see. And the Lieutenant Governor, Lincoln Alexander, was voted in 2006 as the greatest Hamiltonian of all time by readers of the Hamilton Spectator. Steel City Hamilton is often referred to as a rust belt city. Alexander was the first Black Member of the House of Commons elected four times and has a highway named after him.

After all this, my question remains, how did Canada evolve into a more tolerant society willing to take in thousands of Syrian refugees when the US refuses most refugees and does not seem to have evolved much? Someone suggested that the violence of slavery and the violence of its ending in the Civil War marked the American psyche forever. I don’t know but I do think it is worth exploring the reasons for the difference between our two countries.

Meanwhile, let us hope that the Donald has enough sense to put a halt to the activities of his followers.

The American Psychiatric Association Annual Conference 2015 and Silly Season

newer meBy Marvin Ross with an Addendum by Dr David Laing Dawson

This year, the American Psychiatric Association (APA) is having its annual conference in Toronto starting May 16 and, again, they are being picketed. While most Canadians are enjoying the first long weekend of summer opening cottages, having picnics, planting their gardens and enjoying the fireworks –a hold over from our colonial heritage celebrating the birthday of Queen Victoria – anti-psychiatrists are marching.

Strangely, this is not an unusual event. The APA is the only medical organization that is regularly picketed and this year, opponents of electroconvulsive shock therapy (ECT), are gathering at Toronto’s City Hall Square to march across the street to the Sheraton Hotel. This is a rather curious locale since the conference is at the Metro Convention Centre about a mile from the hotel.

According to the facebook manifesto “this psychiatric organization constantly deceives, minimizes and generally lies about the devastating trauma, permanent memory loss and brain damage caused by electroshock. It actively promotes ECT and holds continuing education courses, funded by Big Pharma, at all its annual meetings.”

It goes on to say that “In its 2007 official policy position statement, the APA claims, “Electroconvulsive therapy is a safe and effective evidence-based medical treatment. ECT is endorsed by the APA when administered by properly qualified psychiatrists for appropriately selected patients.”

The APA and The National Institute for Health and Care Excellence (NICE) in the UK do not endorse the use of ECT based on a whim or without proper evidence and they do not recommend it for everyone. ECT is used for rapid improvement, in the short term, of these symptoms

  • Severe depressive illness or refractory depression.
  • Catatonia.
  • A prolonged or severe episode of mania.

It should only be used if other treatment options have failed or the condition is potentially life-threatening (eg, personal distress, social impairment or high suicide risk).

A metaanalysis published in 2014 that compared ECT with the newer transcranial magnetic stimulation concluded that ECT is the leading therapeutic modality for patients with treatment resistant depression.

ECT can be helpful! Now I would join the protesters if psychiatrists dragged unsuspecting patients out of their hospital beds, hustled them down the hall to a room where they attached electrodes to their heads and zapped them with electricity.

But this does not happen!

There is this thing know as informed consent and every patient, or their substitute decision maker if they are not competent, signs one. Before a doctor can treat – be it ECT or pumping toxic chemicals into the body to rid it of cancer – the patient must understand the potential risks and benefits of the treatment before consenting to it. With ECT, the patient is in extreme distress, nothing else has helped and they are desperate for relief.

For some stranger like those marching at the Sheraton Hotel in Toronto to think they can decide what is good or not good for a patient takes an enormous amount of chutzpah.

A Personal View of ECT from Dr David Laing Dawson

The year was 1969. I was a psychiatric resident in a new open-door nicely appointed psychiatric ward and I didn’t think much of ECT. It had been overused in the past, but all specialties of medicine have a history of finding a treatment that works (finally!) and then over-using it, from antibiotics to every kind of surgery. Still, it just felt wrong to induce a seizure, a convulsion, to fix a mental disorder, especially when we had no clue why it actually worked.

So I avoided using ECT, and had managed without it for about a year and a half.

And then a man in his twenties was admitted to my care. He was thin, almost emaciated, and not talking. He had been living in a small room in the back of his parents’ downtown apartment and had gradually ceased to look after himself or get out of bed. Now he lay on his back in a hospital bed. He did not speak. He made no eye contact.

I sat beside him and talked. Nothing. Over time I gave him several medications and then withdrew them. Nothing. I hauled him out of bed each day for a week, and, holding his arm, walked him around the hospital ward. Nothing. We could keep him hydrated with some nutrients but he was still not eating.

So it came down to ECT. Six treatments. His mood brightened. He made eye contact. He ate. He talked to me. He remained my patient for a few months, moving to the day hospital and then outpatients. Because he now talked with me I could figure out what medications might keep him well.

And for five years after that, every year, I received a Christmas card from him thanking me.

And today, perhaps with thanks to Jack Nicholson, of all the treatments and procedures administered by modern medicine for serious illness, ECT is one of the safest, most effective, and very carefully restricted and monitored.