Monday, March 23, 2009
I have a lot of respect for the Globe and Mail right now, a Canadian news publication.
Now, I'm not normally one to go off trumpeting the merits of various media or consumer products, but the Globe truly is doing a good (or better) thing. Right now, the paper is running a series of articles on mental health and the issues that surround it. In fact, an entire section of their online paper is dedicated to mental health. It's called the Breakdown Series.
I'm not quite sure why they've picked up on mental health, since most media outlets spend a lot of time either provoking contention in events that involve mental health, or they simply ignore the greater (and more serious) issues for want of an outrageous headline.
But here they are, the grand Globe, a national rag, doing a series on the lowliest and least popular of all health (and social) issues. And they're even trying to be sensitive to boot, it seems!
But I have an issue with their most recent online article relating to mental health, and this is an issues that has appeared in more than one article, by more than one author. (I know, I know, I should never expect perfection... and maybe I should be grateful for the ink we have right now, but I'm not one for table scraps under any circumstances!)
In Patients' rights frustrate families, the ugly issue of nomenclature - what to call people with schizophrenia - rears its ugly head.
You need to understand, this is a highly contentious issue, even among people themselves who live with the condition. Apparently no one likes to be called "patient;" and "nutbar" or "frutcake" or "schizo" are certainly unacceptable. And so a zillion fairly inaccurate euphemisms have been conceived and parlayed into our language; consumer, survivor, mentally ill, person with lived experience, client, and on and on and freakishly on and on. A million and one ways to politically or not-so-apolitically say something without saying it: A person who has the condition of schizophrenia. (Keep in mind that many of the euphemisms I stated are also generic catch-alls for basically any condition affecting mental health, and many have nuanced connotations... also so many are misnomers in and of themselves and their usage that I could likely write a volume of books about misnomers in mental health.)
So what evil word did Picard, the author of the article, use to describe a person with schizophrenia? He used the modifier "schizophrenic" in the 6th staccato sentence of an article of considerable length. He used the word schizophrenic to describe Matt, and basically every other person who lives with the condition of schizophrenia.
To be fair, Picard first described the inspiration for this article, Matt, as a person "who suffers from schizophrenia." And that's nice. We get an idea at least, that we are talking about a person with a disease that is harming them, until we get to pretty much the next sentence which basically identifies Matt (and people with schizophrenia in general) as a walking-talking disease process. To be sure, Matt's not got an easy ride, based on the description of his current circumstances, but I find it unfair to reduce the identity of a person to a disease process... to reduce all people who live with this condition... to the limited concept of what schizphrenia is.
And we know that the concept of schizophrenia as a condition affecting health is limited... especially in our media. Mostly our media is concerned with conjuring up images of the negative mythology that surrounds this illness. The media myths suggest that people with schizophrenia are crazed murderers, unpredictable people, untamable monsters with no access to logic or reason, and... you get the picture.
Since the Globe appears to be interested in dealing with the social issues surrounding problems and conditions of mental health, I have asked the Globe to put their money where their mouth is; to make a clear committment to a cause that they themselves seem to support.
We all know that the mythology that is heavily circulated in the media exacerbates the public's negative (and in my opinion, harmful) perception of mental health conditions. And so here is my comment (more of a request) to them:
And the Globe and Mail can make a simple yet profound change by retiring the word "schizophrenic" to the annals of journalistic anachronisms that don't belong in a newspaper any more.
People have schizophrenia. They are not schizophrenia, and schizophrenia is not them. Furthermore, "schizophrenic" is not an accurate modifier to describe a human being... it says far too much about a health problem (and more to the point... the negative mythology surrounding a health problem), and far too little about the person who happens to have a health problem.
Let us put our proverbial money where our mouths are, dear Globe... if we are going to report on the social injustices of mental health care or lack thereof in Canada?
Unacknowledged and unarticulated widespread systemic discrimination is the foremost among those social injustices, and is the primary cause of the "secondary symptoms" of mental illness (the poverty, the instability, the homelessness, skewed laws, and distorted public perception among them).
So please, for the love of humanity, retire the word Schizophrenic. Be the first major media outlet to humanize, instead of sensationalize, this very serious condition of health.
My blog: addressed2occupant (dot) blogspot (dot) com
And so dear reader, what will the Globe do? Will they rise to the occasion of this challenge... to commit themselves to the social issues not only in the breadth of topics they cover, but also in the depth of how they write about the topics they cover?
We shall see.
Respecting the power of words,
Thursday, March 19, 2009
a⋅sy⋅lum/əˈsaɪləm/ Show Spelled Pronunciati[uh-sahy-luhm]
|1.||(esp. formerly) an institution for the maintenance and care of the mentally ill, orphans, or other persons requiring specialized assistance.|
|2.||an inviolable refuge, as formerly for criminals and debtors; sanctuary: He sought asylum in the church.|
|3.||International Law. |
|4.||any secure retreat.|
2. haven, shelter, retreat.
(as Inspired by the Shot Gun Sister, and Jon)
are not about love,
nor do they remind us of love.
and soft lips,
belong not to the realm of love either.
shotgun in hand
staring down her sibling's oppressor.
Her twisted face
come around here
and you'll have no seed (or sword) to spare for love again.
(Love is fierce.
But not injurious.
And sister, you will be safe here.)
A million smiles,
a wink across the air,
love resides in not one of these gestures.
A coat (for warmth),
an arm (for strength),
a shoulder (for tears),
it seems we are getting closer.
empathy at hand
while his wife shatters their castle.
Stand over her
as his love
stretches into an arbor (of vine and flower) to protect her.
(Love is asylum.
But has no constraint.
And wife, you do belong here.)
Monday, March 16, 2009
We need you! Now! Fer realz!
Okay, we need to talk about psychosis and myths. We need to talk about those health conditions that make you lose contact with reality (psychosis as it relates to schizophrenia, severe depression, and bi-polar), and we need to talk about the myths that surround them.
Myth #1: People with psychosis are crazy axe murders.
The origins of this myth lie in two key areas: a) popular media; b) the heinously oversensationalized actions of people who are unwell.
Interestingly, the two origins of this myth conveniently play into one another. Popular media, like movies, for example, uses the medical condition of psychosis because it creates an alluring and seemingly complicated character that will do things that "normal" people would never do. And so axe murders are often described as psychotic, or insane, since it's just beyond comprehension that a person in possession of sanity would do such things.
When people with psychosis are in poor health, and are locked in the grips of a psychotic event, sometimes odd and even very unfortunate behaviour can happen... which tends to wind up in our news... over and over again, for any number of years following the event. Furthermore, since the behaviour of one in the grips of a psychotic event can be so unusual, this tends to make great fodder for semi-truthful, fictionalized tales, which supports the perpetuation of the mythology.
So, what is the truth? Are people with psychosis any more murderous or criminal than the regular population? Well, not really. The truth of the matter is that *most* crimes are committed by those who we would consider fairly sane people. However, people with psychosis still do commit crimes, at a fairly consistent rate with the rest of the population.
Can people with psychosis commit crimes that are motivated by their psychotic event? Of course. But you know how we can avoid that? By taking mental health seriously, and by ensuring that everyone has equal, compassionate, and appropriate access to preventative education and (if needed) timely treatments. (I'll discuss treatments and what I mean by this last sentence in another post, on another day.)
Just a last point about criminal behaviour and people: Crimes are more likely to be committed against us by people we know. The idea of "stranger danger" is a myth. And so the truth is that you will know, most likely, in some manner, the person who has broken into your home. Also, you are more likely to be assaulted, raped, and even murdered by someone you know and/or love than you are by a "crazed" stranger. Keep that in mind the next time you walk out your front door.
Myth #2: People with psychosis are possessed.
The origins of this myth lie in: Religion/Spirituality/Mysticism/Explaining the unexplainable by making up interesting tales that are not realistic given the information about the brain and its workings that we have today.
Okay, I'm not super religious, and I don't believe in spirits. I can understand that if you do believe in religion/spirits/ghosts/possession that this myth makes sense to you, since spirits are known to be pretty nasty, according to religious or spiritual lore.
But the truth is, psychosis is medical condition that has fairly clear symptoms, a pretty predictable progress, and a clear pattern in the activities and chemical actions in the brain. There is no definitive "test" for psychosis, but some tests will show unusual brain activity, and more refined tests (that are experimental and not used on people) will show problems with dopamine transmission. Furthermore, since medicine that deals with dopamine (and/or very good age-and-situation specific therapy) can help relieve the symptoms of psychosis, this gives us a lot of reason to think that this is a condition better treated by doctors, therapists, and loving families than preists or spiritual experts.
Consulting a doctor (or two, sometimes three) first, to rule out psychosis, would be more helpful than just attempting an exorcism or spiritual ceremony.
Myth #3: People with psychosis have access to "another dimension," "another world," "a different spiritual plane."
Origins of this myth: Religion/Animism/Shamanism/Mysticism/Delusional Thinking Itself (Yes, I said that one out loud.)
This myth is an interesting one, since it is heavily supported by some religious groups/belief systems. It is also supported by the condition itself, which can sometimes lean towards delusional thinking. (Delusions are what we call "false and fixed beliefs." They are beliefs that are not likely to be realistic, and they are beliefs that are held with a feeling of certainty, even if there is a lot of evidence to show they are wrong.) Furthermore, this myth is also supported by some older theories relating to mental health and its causes. (Perhaps I'll write more about this last point in another post as well, since I'm sure it begs for clarification!)
You know, I really wish that my psychotic event gave me visions of another world. I really wish it did. That would be a lot of fun, and it would make me a very special person who had a special view of life that others did not have access to.
But the truth is, my psychotic event really just gave me a lot of confusing and anxious feelings. What I think it did was mix up my memories and distort my concept of time, and spit it all out into the present like it was real and happening at that moment, with no order or clear logic that belonged to the context I was in. I was having thoughts and doing things that only made sense to me, and that sense of logic was next to impossible to describe to others, even though I did (and still do) understand it myself.
Confusing. Not fun. Not access to a new dimension. Definitely not "a vision." Really, I do wish it was a vision, since that would give meaning to an event that seems like it should be so meaningful.
I think my point is that the experience of psychosis can be very interesting, and can even seem insightful, but that mythologizing the "insights" or visions that come out of a condition of mental health can be very harmful. Many of us with psychosis experience painful emotions (anxiety, fear, suspicion, confusion), and feel disconnected from our loved ones when we first start to feel the symptoms of the condition. Things escalate and then our behaviour changes and people, our friends, families, and neighbours, find reasons to actively shun us for doing behaviours that none of us can predict.
Furthermore, in most cultures, a condition like psychosis has very serious social consequences. Even though a person can be revered for having visions by some groups, they are usually also feared (this is an interesting and tense paradox), and live on the fringes of society... Kind of like tigers in a zoo: fun to look at, interesting to interact with, but mostly unpredictable and fearsome, and thus always treated very, very carefully, and best if generally avoided.
In North America, we don't really think that people with psychosis have access to a special reality, and we just tend to think people with this condition are loonies or psychos or axe murderers... and so those of us with psychosis get pushed to edges of our social networks... this means, for us, fewer jobs, fewer friends, even being ostracized by our families. And really, all of that just amounts to a hell of a lot of loneliness and poverty and confusion for everyone involved.
This one is a harmful myth indeed. A soothing myth for the egos of some, maybe, but a very harmful one.
Myth #4: Psychosis is caused by a demanding and abusive world that won't accept people who deviate from what is "normal."
Origins of this myth: Early psychiatry. Reductionist environmental/social psychology.
Early psychiatry and even modern environmental psychology has invested a lot of time and energy trying to explain that psychosis is caused exclusively by the life and circumstances of the person who develops the condition. This is known as the Environmental/Social Model.
Another model is also trying to explain psychosis, this is called the Biopsychosocial Model. Before I tell you about the Biopsychosocial Model, I want to talk about one of science's Great Debates: Nature vs. Nuture. This is an important debate to talk about, since it will help us to understand why resolving this myth is important, and it will help us better understand the Biopsychosocial Model.
One of the big discussions that is happening in healthcare and mental health and psychology is what is called the nature/nurture debate. This debate is trying to pinpoint the origins of all kinds of things affecting people. On the "nature" side, we would bring up things relating to the genes (the traits that we inherit from our parents, like hair colour, skin colour, and on and on) and we discuss how a variety of things are caused by or related to our genes or our basic biology. On the "nurture" side, we talk about how our looks or behaviour or ideas are related to or caused by the places and people we grow up with.
And so if we were to take an issue like psychosis, the nature side would say: having an event of psychosis is a condition that is related more closely to the biology of the person who has it. We think this because psychosis can run in families; you are more likely to have a psychotic event if you have a family member who has lived with a condition related to psychosis (schizophrenia, severe depression, bi-polar). There is early genomic evidence that shows that psychosis (the psychosis that appears in schizophrenia) exists in a number of genes.
More support for the nature side says that psychosis happens when you change the dopamine levels; specifically, increases in dopamine amounts can increase your likelihood of having a psychotic event. And so changing the chemicals in the brain tells us that this is a condition that happens in the wiring/transmissions that happen in our heads.
For the other side, the nurture side, the debate tells us that people who grow up in certain environments or with certain life circumstances are more likely to get psychosis. In families where there is a lot of stress, there is also a tendency for more psychosis. And so psychosis can happen more often in families where a number of crises or tragedies occor, or when the family is poor and can't have the "stabilizing" effects of financial prosperity (talking about a stable supply of healthy food, a stable supply of medications for family members with health problems, access to supportive or even just higher education systems, stable access to transit to get to work or even to get to a doctor if needed!) In short, the nature debate tells us that those who are "assaulted" by life consistently, in terms of poverty, abusive or neglectful social/family conditions, food/necessity shortages, and unstable finances and housing, or just major life changes, are more likely to develop psychosis.
Well, here's the truth to this psychosis myth: In this case, both the nature and nurture debators win. Nature tells us that psychosis can be passed down through families. Nature tells us there are "genes" for psychosis, just like there are genes that mark cancer, just like there are genes that dictate eye colour. Nature tells us that we can change a person's brain chemistry to "create" or "take away" psychosis.
It gets complicated. The genes, science is thinking, become "activated" by a stressful environment. (Stress is translated by the body through a chemical called cortisol... A stressful event happens or even if you *think* a stressful event will happen, and your body makes more of this hormone, and then your body reacts to it by doing all kinds of things like having a faster heartbeat, feeling very hot or very cold, feeling nervous, and so on... more fodder for the biology discussion.) And so someone can be born with a "tendency" towards having this condition (the same way one can have a higher chance of getting a type of cancer because of their genes). But the condition may or may not come out, depending on the life circumstances/stressors/sensitivity to cortisol (stress) hormones of the person who has the genes.
And so people with a lot of stress in their lifetime would find these genes activated. And we're not just talking once in awhile work pressure stress, we're talking fairly consistent patterns of stressors. Stress that relates to uncertain living circumstances... stress that relates to being poor, like worrying all the time about food, medicine, and how to pay the next bill... stress that relates to big life changes, like going to university or even getting married... and you get the picture.
This blending of both sides, nature AND nurture, is called the biopsychosocial model of psychosis. It takes into account the traits a person is given to by their parents (bio), the environment and circumstances of the person (social), and even the person him or herself in terms of their age and experience and how they deal with life and its details (psycho).
Forever chipping away to find the truth and hoping these tidbits have helped a bit,
Tuesday, March 3, 2009
There is an alarming situation arising in our legal system. The following is taken from CBC.ca:
Family of man killed on Greyhound bus pressing for 'Tim's law'
The family of Tim McLean is stepping up its lobbying efforts for victim protection legislation they call "Tim's law."McLean, 22, was brutally killed aboard a Greyhound bus last July near Portage la Prairie.
His mom, Carol deDelley, has said Tim's law would put the rights of a victim of crime ahead of those of the perpetrator. The proposed legislation would prevent a person found not criminally responsible of a crime from being released into the community.
It would mean that the most violent, unpredictable people who have committed a crime would face incarceration for life, with no possibility of parole.
"I don't know what the outcome is going to be, but we want to inspire Tim's law to become a reality, to make sure that his life isn't wasted," said McLean's aunt Paulette Speer. "We want there to be more [support] provided to protect the victim and not the guilty person."
McLean's family is selling T-shirts, buttons and fridge magnets to support its effort to press the government for the legislation. The items are made by Speer and her husband, who operate a promotional product business in Winnipeg.
The family will sell the items at a rally in Brandon on Friday.
McLean was returning home from a job in Edmonton when he was stabbed to death by a fellow passenger aboard the bus about 8:30 p.m. on July 31, 2008.Vince Weiguang Li, 40, of Edmonton, has been charged with second-degree murder. His trial begins March 2 in Winnipeg. The case was moved from Portage la Prairie because Li has received death threats.
At trial, it's expected the issue will not be whether Li killed McLean but whether Li can be held criminally responsible for the death if he was suffering from a disease of the mind.
I respect the family's anger and frustration with this situation. I respect also that the family fears that someone "will get away with" killing their young son. But I think, in their anger, the family has lost perspective.
If we imagine laws as rules that are meant to protect citizens, this law that the McLean family is advocating for does nothing to protect anyone.
Hear me out.
Central to the creation of the law is the idea that people with mental illness who have committed a heinous crime should be held accountable for their crimes by being incarcerated for the rest of their lives. Now, we aren't suggesting that these mentally ill people be incarcerated in jail; no, we are saying that they should spend the rest of their lives in a psychiatric facility. I have been inside a psychiatric facility, and honestly, it's not much different from a prison cell. Especially if you are not there willfully.
These are the issues I have with this law and its implications:
Imprisonment is imprisonment, no matter where it occurs. Thus, under this law that is being advocated for, we are asking that a person with a psychiatric problem is locked away while we as a society throw away the key and proclaim that we are done with them. Essentially this is a death sentence, in a nation where we have decided that death sentences are immoral.
In Canada, a life sentence for a crime of 1st degree murder is 25 years to life, with a chance for parole at 25 years. Keep in mind that in this case the accused is being charged with second degree murder. A second degree murder charge carries a punishment of a life sentence with a possibility for parole at 10 years. We cannot disburse a lifetime of imprisonment with no chance of parole, ever, at all (essentially a prolonged death sentence), and proclaim then that our nation is death sentence free. This would be a legal paradox, and a national moral hypocrisy.
The paradox would exist in the fact that there would be a dualistic legal system where "normal" criminals get due process in a system that believes they can be rehabilitated, where a death sentence can NEVER be applied. (The death sentence being a life sentence without option for parole.) And "crazy" criminals would get punished by a system where a death sentence can be applied to them, and only to them, because of their mental health status.
Our laws are designed with the idea that criminal behaviour is rehabilitative. Thus we have designed punishments and in-jail treatment programs that help people to understand the harms their behaviour has caused. After they have served their time, we allow people the opportunity to go back into society to try to carve a new path. Sometimes we even let people out of jail earlier (on parole), if they have demonstrated a consistent pattern of good behaviour and rehabilitation.
Our mental health care system believes that people who have experienced a mental health event can be rehabilitated. In fact, there are many successful treatment programs that have enabled people who have had disruptive health events to find their way to a state of good health and to move on in their lives to be productive and community-oriented citizens.
The consequences of this law; lifetime imprisonment in a psychiatric facility with no chance of parole; contradits not only the philosophy of our healthcare system, it also contradicts the central philosophy of the Canadian legal system:
People who have committed crimes can be rehabilitated, our legal system dictates.
Science and mental health research tells us that people with mental illness can move on to healthy productive lives (rehabilitation).
So when a person with a mental illness commits a crime, how does the scope of the context change to dictate that the person is beyond our reach for rehabilitation? How can we begin to imagine that a person with mental illness who has committed a crime should be locked up in perpetuity with no chance for parole?
The implication of this advocated law is not that the person is the problem (as is the case with regular criminals where we believe that rehabilitation is possible, and where our "life" sentences potentially max out at 25 years). Implied in this law, is that the mental illness is the problem. In effect, this law is not punishing people, persay, it is punishing mental illnesses, and the people who happen to have mental illness. Which leads us to point...
This advocated law is flagrantly discriminatory.
In no other circumstance of health do we tell people that they should be treated differently because of their medical condition.
Mental illness is a medical condition that can have regretful effects on behaviour, but which can be relieved by medical intervention.
Why does having a medical condition allow our legal system to consider throwing its values out the window? Again, our legal system believes that criminals can be rehabilitated. Why does a health condition change the scope of this belief? Locking a person away in a psychiatric facility in perpetuity without the chance for parole is a declaration that the person is beyond rehabilition.
Mental illness can be rehabilitaed, medicine tells us.
Mental illness can even be prevented, research suggests.
Thus, the crimes perpetuated during a mental health event are likely PREVENTABLE.
According to our evidence from science and medicine, it would make more sense to consider laws relating to access to treatment.
If we are imagining that laws are created with the intent to protect citizens, then laws relating to treatment would protect citizens in two ways:
a) The person with illness would be protected from the ravages of an untreated medical condition.
b) All citizens would be protected from crimes that are perpetuated during a mental health crisis.
The advocated law makes no steps to ensure protections for any citizens. In fact, the advocated law entrenches not only the status quo of systemic discrimination, but further deepens the social marginalization of persons with mental illness and establishes an indefensible precedent for widespread systemic discrimination. After all, if our own legal systems are allowed to treat people with mental illness differently than every other citizen, then why shouldn't ordinary citizens follow the lead of our political/judicial systems?
Number Four (Last Point):
Our legal system already has a way to deal with issues relating to mental health and the law. If the accused is found not guilty by reason of mental defect or insanity or whathaveyou, he will be shipped to a forensic psychiatric facility where he will have to undergo a minium number of years in treatment. Furthermore, he will not just "be set free," he will have to prove that he has been rehabilitated, and if he is even let out, he will have to live a certain number of years under the combined watchful eyes of the legal system and his health care team.
So really, the accused will get the kind of treatment he needs, and he will get it where he needs it, if he is found not criminally liable due to his health condition. Under our current laws, the accused will be punished by a legal system that believes he is capable of being rehabilitated, whatever shape that rehabilitation takes.
This is the same right that all persons entering the legal system are entitled to. Having a health condition makes Mr. Li's access to legal rights no different from any one else's.
He just won't get the death sentence that this family is advocating for.
Respecting the rights of every Canadian citizen,