Tuesday, January 18, 2011

What a Waste

This afternoon, I cried through the funeral of police officer Ryan Russell which was on CBC. I wouldn't usually listen but I just couldn't get my mind off the senseless tragedy of it. For those of you who don't know or aren't from around here, last weekend, a man with bare feet stole a snowplow that had been left parked with the keys in the vehicle briefly. He went on a rampage across town, crashing into other vehicles and eventually running his car into a police car, killing Sgt Ryan Russell and then being shot himself by the police. From what little I can understand, the man is very, very unstable (obviously) and surely it must be a case of someone with poorly managed mental health problems ( I believe that the man was homeless and had checked into a shelter the night before). In light of the events in Arizona last week, it's hard to ignore the fact that our society has blood on our hands thanks to our insistence on keeping our heads in the sand about those who are struggling with these kinds of problems.

CBC did an interesting set of stories on "The Current" last week dealing with mental health. Some of the things I heard were really interesting and at times, downright bizarre. One thing I did hear from a psychiatrist was something along the lines of, "only 2 - 5 % of schizophrenics are violent and can be dangerous". Only??? He may be comfortable with those odds but I am not. I am not saying, in any way, that schizophrenics all need to be locked away but surely the risk that those who are not being treated or effectively managed means that we need to address the issue, not only for our own safety but even more for theirs.

Another thing that really grabbed me, and again, I see this as the crux of the issue, is around the ability of schizophrenics to accurately perceive their own level of illness. A doctor (again, I can't remember who) said that schizophrenia is a disease of the brain that effects the very part of the brain that is aware of the individual's own mental state - with a broken thermostat, how can you possibly judge the temperature accurately?

I realise that these issues are not as clear cut as they seem. Yes, the easy answer would seem to be to just force these people to take meds but it isn't that easy. Who is the judge of what beliefs are "crazy" and what are just different or divergent or creative? Will turning off the disease always necessitate suppression of the individual? Can medicating be an easy way to shut down someone whose ideas we don't like? Obviously, there are issues of personal freedom that would need to be wrestled through but, based on what Margaret Sommerville of McGill University, a prominent bio-ethicist said on CBC, there are court rulings that do lay down some guidelines and we are working to develop more.

I wish I thought that these issues stem from our desire to respect the personal freedom of those suffering from these mental illnesses but sadly, I don't think that is what it is really about. More basically, I think it is about money and it's about shame. Providing medical care, especially for chronic conditions that need ongoing monitoring, is expensive and these days, we are already trying to deny the fact that our society has to pay if we want to be healthy. We shut down all the psych wards as being inhumane (which may well be true) and emergency psych beds are almost impossibly hard to come by. In the meantime, we did nothing to increase accessibility to community based care and when families are dealing with a family member in crisis, other than calling the police, there is little that can be done to help. On the other hand, we just don't like to talk about this. It's scary, it's embarrassing and there are no easy answers. It's easy to blame the behaviour on drugs and bad choices and ignore the fact that these people are ill, no differently that a diabetic or someone with chronic heart disease. We wouldn't try and ignore people with those chronic conditions. I think one of the hardest parts of mental illness for most of us to understand is that it can't be measured clearly by ultrasounds or MRIs, it's manifestations are almost entirely behavioural.

On Saturday mornings, a group of us used to get together to do field training with our dogs. There was one couple who always came from VERY far away to train. I always wondered why they would bother. The wife and I got talking and I discovered that they had a schizophrenic son in his twenties at university and the training was their way of getting a break from the anxiety. I know that this woman and her husband went through hell. Their son had been in all kinds of trouble and his doctors refused to talk to them. She knew that one day, someone was going to be hurt and, to be honest, we all worried that one day, we would read in the paper that he had killed them in the night. Sadly, in the end, he killed himself. I will never forget my conversation with her after that - her grief, her guilt at feeling relief that it was over and the way the two of them fell apart. It was one of the most upsetting things I have ever watched.

So, today, we bury yet another victim. Another child is without a father, another family is destroyed by our fear and our denial. How much more does this have to happen before we face it head on?


  1. As you can imagine, my feelings on this are complicated, having lived through my mom's ups and downs with schizophrenia. I have seen the way the disease protects itself, the denial, the refusal to accept the disease or the treatment. The fact is, though, that even though that denial is pretty much what killed our family, I still would be VERY hesitant to give up my mother's freedom and right to live as she chooses in favour of forcing treatment. Not only because of the possibility of abuses as you mention, but also because I've seen how that goes. My mother was held down by four orderlies to be sedated one night. I've seen her vacant eyes, her inability to put together a thought under medication - this for a woman who was fantastically bright.

    I also hesitate because of the range of presentation. Not only because only a small percentage are even potentially dangerous, but also because roughly 1/4 of schizophrenics find balance within about a decade if left untreated, as my mother has. It is not known if treatment allows that. A whole lot more live with low levels of intrusive thoughts, but are no threat to anyone. Again, given how wide that range is and how much one person's presentation can vary over a month or even a week, I'd have a very hard time getting behind some plan for someone to assess a person and decide whether they need to be medicated or not based on that, and I also have concerns about medicated the crap out of someone who may be okay without it.

    It's not that I don't think this is all sad - I totally know first-hand how destructive this disease can be, how someone without a support network like my mom has thankfully had can fall through cracks and end on the street or even dead. I get that, and if we can help people and help prevent that, we would be helping a slice of people who are overrepresented in the criminal justice system and all manner of aid provision, and yes, it would make us an amazingly kind society. That sounds ideal. I just think it's way messier and multifaceted than trying to mandate medication. It's one of those things that is so shaded that I don't think there can be one suitable answer, and I don't know how anyone would ever sort through all the variants and cases and figure out who needs what appropriately, even with unlimited funding.

    Depressing and defeatist? maybe. But as I say, I just can't accept a one-size policy on something like this, having seen different sides of it from personal experience and working with the public and so on.

  2. I really appreciate what you have to say on this subject because you have a much closer perspective on this than I do. I agree that it's messy - finding a balance between personal freedom and management of odd or off-putting behaviours is in no way easy. I don't know what the answer is but I think that we have, to some extent, used the messiness and murkiness of the options to avoid talking about it at all. I think what concerns me more than anything is that there are so many people who NEED help and aren't getting it - they don't have strong support systems or, even worse, they have frantic families who can't seem to get help. Just last week, the father of a friend of my niece committed suicide after a prolonged battle with depression and alcohol. The truly tragic part of the story is that he was at the local hospital on the psychiatric ward when he hung himself. The should NEVER have been allowed to happen. We need to throw money at mental health issues and make access to care reasonably easy to get.
    And, we need to listen to those with a stake in the system (like those with mental health problems and their families) to help us to decide what to do.
    Thanks for discussing this, again, I really appreciate it.