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'We must never give up on the potential of people to recover'

From Saturday's Globe and Mail

Dr. David Goldbloom explains why people with mental illnesses face stigma and what can be done about it ...Read the full article

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  1. Michael Sharp from Victoria, Canada writes:

    Congratulations to the Globe.

    I am thoroughly impressed.

    As a mental health and addictions clinician, this very web-page, the likes of I have never seen on the Globe, and Gawd knows I spend enough time here, has done wonders to de-stigmatize mental illness.

    Thank you.

    It may well be, though, that because I am conversant in this subject and because ad hominem can be very nasty, i may sp[eak my bit on this thread...

    And then leave.
  2. M' dea from Canada writes: Will Dr. Goldbloom declare conflict of interest please?

    Has he at any time or does he accept any money or goods in kind from pharmaceutical companies, for himself, his work, his labs, his clinic, any research he's done, any speaking engagements, any consulting work?
  3. ryan rankin from Canada writes: Great job Globe. Excellent stories needing to be told. However Dr. Goldbloom doesn't strike me as very thoughtful, sensitive person, which I would expect from someone in his position. Instead he comes across as an extreme know-it-all.
  4. David Goldbloom from Toronto, Canada writes: M' Dea asks that I declare any conflict of interest with regard to the views I have expressed in the interview. I have not accepted any funding from the pharmaceutical industry for the last 15 years in terms of speaking fees, consultancies, advisory boards, research support, etc.

    I am the author of the University of Toronto Department of Psychiatry Task Force report on conflict of interest with regard to the pharmaceutical industry (www.facmed.utoronto.ca/Assets/about/pharmaceutical.pdf).

    All research that I conducted between 1987 and 1993 that received pharmaceutical industry support was published in peer-reviewed journals, including negative studies where no drug-placebo differences were found.
    The clinic in which I work at the hospital receives no industry support and I do not have a lab. In the last 15 years, any research support I have had comes from peer-reviewed research agencies.
  5. Jung Frau from Switzerland writes: My son was confined to CAMH for three months. Being novices when it came to schizophrenia, we accepted the standard advice given by CAMH that schizophrenia was incurable but manageable with medications. We also were advised at the time not to read too much about this illness. After a year, we decided that if my son was ever going to get better (i.e. finish university, be employed full time, have a girlfriend) we had to take a good hard look at the advice being given. The problem with institutions is that they are self-perpetuating. They have funded research programs and huge staffs and everybody seems to be profiting except the mentally ill, who, unsurprisingly, continue to be mentally ill. This isn't just true of CAMH, it is true of all institutions. I applaud the focus on getting mental health out of the closet. At the same time, there are cures out there that can be accessed and that are way cheaper in the long run than years of medications and missed job opportunities. Instead of our collectively wringing out hands and commiserating with others in the same boat, why don't we just do something about mental illness and GET OVER IT? Believe it or not, it can be done. . . even for schizophrenia.
  6. M' edea from Canada writes: Thank you Dr. Goldman for your response to my request for a conflict of interest declaration.

    I have only briefly scanned your document so I can't make any decision yet, but note in the abstract a statement about "harmonized research ethics"which certainly does pique my curiosity, if not set my hackles to rise.

    G&M why are you not requiring and publishing conflict of interest statements from all medical persons in such context?

    The health consumer will no longer be satisfied with smooth words.
  7. M' edea from Canada writes: Apologies for my error in referring to Dr. Goldbloom as Dr. Goldman.

    {Dr. Goldman is the host of the astoundingly radical CBC Radio One medical show "White Coat Black Art."}
  8. Jung Frau from Switzerland writes: It seems to me that stigma is not the problem in mental health. Rather, the problem is getting better or "cured". Most people (but not all, I will admit) want to get well. Stigma is the natural collateral damage when people do not get well. The psychiatric profession seems to have accepted no responsbility for its utter failure to help people heal. The statistics have barely changed in decades. Psychiatrists in particular seem to be more prone than the rest of the medical profession to attack colleagues and ideas with whom they disagree. Guess who suffers? The patients, of course! In Bern, Switzerland roughly two-thirds of newly diagnosed persons with schizophrenia recovered with little or no drug treatment in two to 12 weeks (Ciompi, 1994, 1997a, 1997b; Ciompi et al., 1992). You will not find that sort of information promoted by institutions like CAMH. Instead, you are told, as most families are told, not to "read too much" about the illness. Understandly, the more people do their own research, the better off they will be. I think the whole premise of the series that the Globe is doing is to soften the public up to look forward to the the next generation of drug treatment. Researchers have now discovered that the problem with schizophrenia and some other mental illnesses may be with the glutamine receptors in the brain, not the dopamine receptors. Stigma will continue because people will continue to be patients, enfeebled by their drug treatments.
  9. Tara Lene from Toronto, Canada writes: Jung Frau, google "Early Intervention in Psychosis" and you will find more heartening statistics (if that is what you are after). Also, while there is no "cure" for mental illness, many people go on to live healthy, productive lives that are relatively free of symptoms. (Myself being one of them.) I think a lot of us remember hearing about the devastation in mental health because those stories are the ones we can put faces to. Those faces are the ones we see circulating in the media, they are the faces we may see on the streets. I think the negative attention that the issue of mental health recieves sends a false message to those in treatment, or those thinking about seeking treatment. People who rely on the media for information about these matters may feel more than a little disheartened at the messages they are taking in. Everyone who is living with mental health problems should know that there are people out there with "lived experience" in the mental health care system who are out there trying to stimulate change, and who are advocating for accountability and better treatment. But you don't see those faces, and you often don't remember them, because they don't fit in with our stereotypes of "mental illness." Another note, a lot of people with lived experience see a problem of mental health as a "blip" - a negative experience in their life that they have overcome. Some people never want to return to that negative place and so they are reluctant to discuss it, and they are reluctant to become involved. This may be why we rarely hear those stories of success. A last note... hopefully this provides comfort to some: Many people live very happy, productive, and relatively comfortable lives after recovering from mental health problems. Those people worked long and hard to get to a better place, and likely had a lot of support to get there, but they are there; and so (I believe) there is hope and potential for everyone.
  10. Cana Dian from Toronto, Canada writes: I think there is a place for spiritual support for alleviating the symptoms of mental illnesses. Some research studies have shown that persons with a degree of spirituality recover quicker or are less prone to depression.

    Statscan's last census in 2005 shows that only about 17% of the entire Canadian population say they are not "religious" or don't belong to some faith. I'd like to suggest that if some of the religious mentally ill employees were directed to a "chaplain" or counsellor of their faith who is available during work hours and accessible in the workplace - that it would help increase productivity and reduce sick days.

    If a faith-friendly environment were engendered where workers don't feel so "alone" in their problems, they would feel more empowered to overcome their depression because they know they have support from their managers and from a "higher power". Coca-Cola and Sears are some examples of companies in the US who are benefitting from trying this approach.
  11. Daniel Ouellette from Montreal, Canada writes: Congratulations to both the Globe and Mail for its insightful and informative series on mental health and to Dr. Goldbloom for his active participation and leadership in that field. As an employee of a local community-based agency offering support and services to adults suffering from chronic and severe psychiatric illnesses, I feel the articles do some justice to the complex set of obstacles and difficulties our clients encounter in their daily lives. It's precisely the narrow focus on specific individuals that gives readers a richer and more accurate portrait of both the trials and the triumphs experienced by those individuals. As a person who's suffered from GID from age 4 (and "suffered" is, truly, the right word), and as a person who's managed to work out some satisfactory accommodation with the illness without resorting to pharmacotherapy or becoming mired in self-destructive behaviours and attitudes (aside from the erstwhile suicidal ideation), I have firsthand knowledge of some of those trials and triumphs. Mental illness can be a living hell. But it ain't necessarily so. While pharmacotherapy may be an adjunct on the path to wellness and wholeness, I strongly believe--based on my own experience as well as on much of the recent literature--that compassionate care; social support and outreach; public discussion and awareness-fostering (such as The Globe and Mail's "Breakdown" series this week and Dr. Goldbloom's continuing "mission"); the teaching and learning of coping skills and self-empowerment practices through individual and/or group counselling or therapy; creative activity; and disclosure to a trusted circle of family members, friends, colleagues, and even fellow sufferers, are all incredibly powerful tools on the road to recovery. Dr. Goldbloom rightly recognizes that there IS a risk of (over)pathologizing human distress. That risk can be minimized by our never forgetting that a person is more than just her biochemistry. Much more! Tiresia
  12. Jung Frau from Switzerland writes: Tara, Thank you for a very thoughtful message. I did as you said and googled "early intervention in psychosis" but a quick search did not reveal any statistics, just the message that it is preferable to intervene early and the chances for recovery are better. I do not agree that mental illness is not curable, though. That, to me, is a myth perpetuated by those whose livlihood lies in perpetuating the myth of mental illness. Mental illness is a deep rooted problem in dealing with life. It is not a brain disease as most would have us believe. Having been forced to deal with my son's deep rooted problems, I came to the realization that the longer he stayed on the medication, the more likely he was to never resume a normal life. Medications leave most people too tranquillized to be independent and self-supporting. They are often necessary when you are acutely psychotic but studies have also shown that an empathetic approach at an early stage has great success in bringing people out of psychosis. Try asking a doctor to help you get off the medication. They will object, intimidate, coerce, and tell you that you are delusional if you think that the non-medicated approach is better. Once you get off the medications, as my son has done, you are still left with the problem of dealing with life, which is everyone's problem. This is where insight is very inportant, and that takes time.
  13. Mary Kranenburg from St. John's, Canada writes: Talk, talk , talk. Everybody certainly has an 'expert opinion'...Not a brain disease, yes, it is a brain disease. Oh, it is as if you have diabetes..treatable and do not worry..you will be on the road to recovery, etc etc...and all around the Mulberry bush we go!!!!

    My husband is tired of dealing with it for " 25 years " as he says. My 2 kids suffer...and I put it lightly..with this..as I do. I ruins your life and other's lives around you. I have just disclosed the problem at work to go on LOA....what will be next I do not know. I am so damn tired...do not want to take the meds anymore...do not want to talk about it to Drs etc. anymore...it is a loosing battle!!!
  14. Jonah Emery from Fredericton, Canada writes: I must respectfully disagree with Cana Dana about spirituality being used to treat mental illness.

    Spirituality doesn't "alleviate the symptoms of mental illness" it encourages them! It doesn't make someone less likely to suffer mental illness either. Indeed a big portion of people who suffer with depression are pastor's and especially pastor's wives. It's just kept secret.

    I used to be extremely religious and it mentally ruined me. Medical depression is something I have lived undiagnosed with for most of my life but religion was the parasite that fed off of it. Briercrest Bible College destroyed my mental health - losing 60 pounds in three months, complete inability to function in every day life, ruining self-actualization and self-determinism. My case is not unique.

    The spiritual answer to mental illness? "Pray harder; stop sinning." The stigma of mental illness has to make great inroads inside these communities.

    It was only after dumping religion and taking charge of my own existence, approaching my problem materially, and facing reality head on that I got out of that dangerous condition.

    Three years later I'm functional again. I hold a wonderful relationship, fulfilling friendships, and a full time job.
  15. Jung Frau from Switzerland writes: Jonah Emery - Mental illness is part and parcel of spirituality and religion. . I am not at all surprised that so-called mentally ill people are often ministers, musicians, artists. A natural interest in spirituality is what they are all about. The best treatments help people grapple with the existential and religious themes that excite them in the first place. People can be extremely religious, meaning they adhere to strict canons of the church as a force of habit or their own sense of guilt, but that is not the same as being spiritually aware and interested in the higher order of things. Most people who slide into mental illness become very interested and obsessed by religion and symbolism, but that doesn't mean that religion and symbolism is to blame for their condition. It is part and parcel of their condition. May I suggest, without knowing you personally, that (a) you were either going to Bible College out of force of habit or pressure or (b) sliding into mental illness and were naturally preocuppied with these themes.
  16. Jonah Emery from Fredericton, NB, Canada writes: Jung,

    It would definitely be option "b."
  17. Robin Smythe from Toronto, Canada writes: It seems like the stigma surrounding psychiatric drugs is especially innaccurate and damaging. I've noticed that many people (who are almost never professionals) actively try to discourage others to try medications by giving the impression that doing so would make them "weak," "emotionless," "doped-up," "drug addicts," "incapable of dealing with life," etc. Even worse are people who make it seem like any medication is by default a drug-company conspiracy to make money, not to mention those who promote the vague idea that drugs are "unnatural" or "poisonous to the body" for no good reason at all. The fact is that for many people these drugs work wonders. And the double-blind placebo-controlled trials verifying their effectiveness can't simply be dismissed. I cringe to think of all the people who could benefit from medication, but don't even try because of all the illogical, almost puritanical anti-drug rhetoric. Taking psychiatric medicine should not be something to be ashamed of! Of course drugs aren't the answer for everyone, but for some people they are life-savers.
  18. Jaliya Temple from Canada writes: I have yet to read the entire series, but I am grateful for it. I'm a 49-year-old woman who experienced major trauma from infancy onward; I live with lifelong major depression and PTSD. Part of my healing -- my ongoing commitment to live as compassionately and realistically as I can -- is to recognize both the permanent changes in my brain that probably can't be altered, and the more "reachable" symptoms that I work with day to day. I believe that what we call "mental illness" is based both in the brain (and thus in other regulatory systems, like the immune and endocrine) and in that nebulous entity we call the "mind." How we live as a species, too, is of major influence. Practical compassion will emerge as we understand and accept that brain, mind, and body are one, and that symptoms of "mental illness" are, indeed, body-based, just like diseases like cancer are. The challenge lies in how functional, brain-based diseases like depression are manifested: largely through behaviour and changes in personality. That is the arena in which our judgments and mistaken beliefs lie. Thank you to all the researchers, writers, and people who were/are willing to consider and speak of these issues with clarity, intelligence and kindness. The most serious concern, of course, is with cruel and demeaning attitudes. When we, collectively, overcome our chosen ignorance about "mental illness", there will be deeper healing and stabilization.
  19. Engaged Parent from Nova Scotia, Canada writes: Jung Frau ~ Thank you. I whole heartedly agree, it is time to "stop wringing our hands and do something about it". My 25 year old son is bi-polar and we have known since he was 2 that something wasn't right. I am exhausted with a system that continues to tell us that there is help...and yet never delivers. My opinion is that we are looking for a simplistic answer to a complex issue. My son is a brilliant, artistic, loving and sensitive person who has never felt that he fit in this world. It tears him up when he sees injustices in the world, he fears the outcome of global warming, he mistrusts the governments intentions, he mistrusts doctors and their connections to pharmaceutical companies. He yearns to live in a self-sustainable environment growing his own food and using his creative talents harnessing energy from the wind and sun. The North American approach to life has only one track...go to school, get a high paying job, buy stuff, buy more stuff, have children, raise them with the hope that they leave home and don't move back in, hope that you can afford to retire at a young age and then, finally get to do what you want to do. Anything outside of this 'norm' is not considered acceptable. Oh, and it is very unacceptable to be emotional, particularly if you are male. A year ago I began doing Yoga and felt a very strong spirtitual yearning during the sessions. I had previously thrown out the fundamentalist christianity that I was raised in and believed until I was 35 ~ pray and stop sinning was the only advice and support that we received. The spiritual teaching with Yoga is that we have lost sight of who we truly are. My thought is that our society is at an all time low ~ we have an abundance of wealth but we live in poverty of spirit, physical health and overall well being. We have lost our connection to nature, to healthy foods, exercise, neighborliness and strong human relationships. Not surprising that mental health issues are on the rise.
  20. R S from Canada writes: I have been taking anti-depressants for 12 years: for the first 10 of those years, under the care of a psychiatrist, and then following a move, under a family doctor's care (psychiatrists are even harder to come by than family doctors in the community to which I have moved). It has always been, and continues to be, a struggle for me to accept the need for medication. I have spent at least half the time during each doctor appointment (which have ranged in frequency from weekly at first to once every other month - the minimum my psychiatrist required for review) on just discussing the medication itself. I imagine I will always question the benefits, the drawbacks, and various other aspects of medication - and this may be overall a good thing - because it means I continue to make an effort to learn about new discoveries in this area, and to think through and understand to the best of my ability what the illness and the therapies are about.

    As for the acceptability of having mental illness, we have a long way to go - that's my feeling (before posting this, I changed my name on G&M to something that makes it harder for me to be identified) . Public personalities, such as Margaret Trudeau, speaking about their mental illness, does help, so I hope they continue to do this.
  21. R S from Ontario, Canada writes: I just want to say to Mary Kranenburg from St. John's: I understand some of your frustration, and your concern for your kids' and husband's suffering due to your mental illness. But they also benefit from all you have given to them of yourself, which has included good things, over the years. So, please try to look at some of the positive aspects.

    I try to remind myself: "this, too, shall pass" when undergoing the harder times, but that's when that thought is least likely to come to mind. I lost a friend to suicide 4 years ago this November, and I saw (& felt first-hand) the awful impact it had on his family and friends. Because I care about others (as well as myself), this is another thing that helps me see myself though the worse times.
  22. Emily Winters from United States writes: I am a very happy and 'stable' Bipolar girl. I will be 53 next month, and I was diagnosed about 12 years ago. It was hell up until then, not having known whay I was always so up and down, and it was still hell until a few years ago. I was on and off different meds until after my very near successful suicide attempt. Then, luckily, I was prescribed the right meds, for me. Because of my life experience, the books I've read, the doctors I've seen, the other Bipolars I've met, I feel very comfortable with my illness. I was always honest with myself about my illness, and wanted to get better. I have no problem telling people, depending on the 'surrounding' of course, that I am Bipolar, I do this so that they can see that I am a 'normal' person, with a happy outlook on life. Life can be good if you have a good support system, a good doctor, and the right meds. If the meds aren't working, or you don't like your doctor, change them. Mine were changed constantly until after my suicide attempt. I've been on the same meds for 8 years. They are working for me. We need to educate people. Recently, I was at a dinner party, and somehow or other I mentioned my illness. The host was an idiot, and said "Oh, it is so chic now to be Bipolar." And he called me "Avant-Garde" because I told him I was diagnosed years ago. I shut him up when I quoted some statistics, said it was no picnic, and that I hoped he would never have to experience a family member with this illness. Bottom line is, it doesn't have to be total torture. Change your doctor, change your meds, and tell people close to you to help monitor your moods and behaviour. Life can be good.
  23. Patricia Teskey from Kawartha Lakes, Canada writes: Thank you Dr. Goldbloom for your insights. I find it helpful to consider that an illness affecting a person's thinking and emotions causes loss of their sense of identity in a way that a broken leg might not. This helps me understand the deep loss of self-confidence I see in a family member with schizophrenia. I see my role, then, as family, to encourage him to take on new challenges bit by bit and to celebrate successes as a way of rebuilding self-confidence. Second, I wish to share my experience with the terms schizophrenia, schizophrenic, and related schizo- words. I no longer use these words outside the "schizophrenia community" because they have so much negative baggage in popular culture, and their use as terms of casual ridicule is now entrenched. For example, many established dictionaries have accepted a secondary (non-medical) meaning for schizophrenia as "split personality" and its usage as a metaphor for ridiculing people who are indecisive. The Canadian Oxford, the official dictionary of the Canadian press, includes this usage, which is why many journalists make no apology for using it this way. Whenever I have used the word schizophrenia to describe my own family member, I see a wall go up between myself and the person I am talking to - their facial expression stiffens and they draw back. So now, when someone asks about my family person, I simply describe his symptoms in non-threatening language. For example, I explain that he has a lot of anxiety and trouble sleeping through the night. When I say that it's a neurological disorder that is managed with medication, which is true, people don't back away. They just say, "Oh, I see," and continue to be interested. Medically, I find the term"schizophrenia" to be inadequate. It means "break from reality", which is actually a definition of psychosis - not of this illness, which includes a wide range of other symptoms. And people with bipolar disorder and depression can also have a psychotic break.
  24. foo barbar from To, Canada writes: Truth be told the 'mental health profession' is a joke for many. What many people need is a long all expenses paid vacation away from the insanity of modern life where one values oneself in terms of "productivity" to ones employer, under the sick euphemism "contributing to society", there's nothing glorious about working many jobs in the underclass nor are they really 'contributing to society' they are working jobs that add no real long term value to humanity and destroy the environment.

    I agree with Bertrand russell - too much work is done in the world. Lastly people who are poor and have mental illness need money and more time off with their family/friends/loved ones, or if they don't have any, need help in building relationships with other people.

    It's alarming how clueless the medical profession is to the economic system that creates the problems in the first place. Mental illness is a result of stressful conditions of a sick materialistic society. With all the advancements in technology, the competition for wages and 'the good life' has gotten more difficult, as the structure of society and the job market has changed, this has put tremendous pressure on 'cognitive skills', and not everyone can go to university and hope to get a good job, considering most good jobs that pay well require a university degree.

    Employers also submit to credentialism, even for jobs that before wouldn't require it.

    Most certainly, some do genuinely suffer from deep cases of mental illness, but other mental illnesses are merely the result of a over-stressed, income insecure, relationship poor, overworked society.
  25. gordon foster from Canada writes: Regarding psychiatric medications that are intended to stabilize and restore the recipient to their former state of mental health swiftly and efficiently: where are they? I'm sure quite a few people are fed up with the costly life-long prescriptions that merely mask symptoms without treating the root cause.
  26. David Johnston from Victoria, Canada writes: Dear Doctor, I wonder how "stigma" is measured. When the year 2020 arrives how much will this have been changed by our Mental Health Commision? Will Canada's Gross National Product reflect the change in our measured "stigma"?
    I believe there would be self stigma at the personal level. Also there would be a social level of stigma that would have to be measured as a change over the whole population.
    What is it that will not change over the next ten years that we can use to measure stigma? How was it measured in the other G8 countries?
  27. Betty L from toronto, Canada writes: the doctor should stfu. mental illness is psychological not psychiatric. psychiatry is medical and usually with serious medications, ecectricity and surgery. he should keep his mouth shut about mental problems.

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