Lost puppies and the consequences of silence

I often write about the lost puppies – the issues that impact our lives but are lost in silence.

I’ve written a few articles on grief following the death of Carol, my dearest friend. The immense loss and prolonged grief of losing a friend is not on most people's radar, so many don’t ask, don’t talk about this and leave it in the realm of silence.

Silence is the worst prescription for healing. I say this as a doctor with expertise and decades of clinical experience in mental health. Yes, I’m that kind of doctor and that is exactly why I write about the lost puppy issues – to bring them out of the dark, silent places into the chatty, healing light.

Here I am again, on a lost puppy issue and this one is literally, and not just figuratively, about puppies.

Let me introduce you to Kai, my 100 pound Bouvier.

We met her as a tiny 15 pound puppy and, when flying her home from Toronto, Carol met us at the airport because she was always the first to meet all my dogs and children. Carol held Kai and, when she saw my look of longing to hold the pup, Carol responded by saying, “You have a lifetime to hold her, let me have this.” Yes, Carol was that kind of friend who could read my mind.

When Kai came home, she refused to be crated or even lie on the floor quietly. Unlike any other dog I’ve had, she wanted to be carried. At some point that night, out of sheer exhaustion, I carried her onto the bed and fell asleep with her. She slept the whole night, didn’t wet the bed and our nightly routine of sleeping together began. Kai was the first dog in 30 years of living with dogs that had done this. 

From the start, Kai was a calm but ardent student of language - a true kindred spirit. She listened carefully and developed an understanding of many words and phrases. As a family, we have had to modify our conversations so that Kai didn’t get excited about things we talked about in the past. We tried spelling words, but she soon picked up spelling too so woe to anyone who mentioned or spelled ‘car’ because that’s where you’d end up taking her.

Kai proved to a dog who not only remembers language but also music, so watching TV became difficult. She would rush into the room if she heard a familiar tune for an ad with a dog and then bark at the intruder. Kai also understands the meaning of music, so any music that sounded violent or frightening during a film would elicit barking. Luckily, I'm happier reading than watching TV.

When Kai went to obedience classes, she progressed so quickly that she was kicked out of advanced obedience because of boredom and put into a more challenging therapy dog course at the age of seven months. She sailed through that. She was a natural student, curious and calm.

When Carol got a cancer diagnosis, I flew back and forth to Toronto and Kai knew when I was leaving and that displeased her. She’s a bouvier, so her displeasure was signalled not by whining or acting out but by a calm, sad look. When I got back, I was often gutted, more so as it became evident that Carol was dying, and Kai was there by my side. Refusing to leave me even for a minute. Bouviers are work dogs and I suspect she was trying to fix me. I appreciated the effort. 

In my mind, Carol and Kai are forever linked. I spoke to both of them constantly and both understood the important things I felt. 

 The last few weeks have been difficult. Kai was diagnosed with dilated cardiomyopathy - the normal prognosis is six months to a year - much shorter than our expectations of having her for 5 years more.

We’re working off the hypothesis that this may be food related and reversible but it may not be. Regardless, I will lose this dog one day - sooner or later.

All the research on loss of a beloved pet shows that it can impact us as much as any loss with one important difference: the ability of those around us to understand the extent of this loss. When we experience grief, our brains undergo physical changes that can affect our thought processes and emotions. If the individual who is sick and dying is a husband, wife or child, people understand more easily and allow us to speak. This social support is a crucial ingredient in recovering from grief of all kinds but, as we know, many people think that pets are less important than people so many pet owners grieve in silence. 

If we stay silent, then all sorts of things grow: loneliness, bitterness, cynicism and anger. The consequences of silence are not merely unpleasant - they can be dangerous if they blossom into mental health issues like depression and suicidal ideation or even anger management issues.

There are consequences to silence on all issues of import and that is why we should all be brave – speak up.

Mental Illness Is Not a Political Football

I have previously written about the myth that those with mental illness are dangerous. Spoiler: they are not.

What is happening now politically is very concerning. Politicians are blaming mass shootings on mental illness and – as I cited before – Dr. Michael Stone, a forensic psychiatrist at Columbia University who maintains a database of 350 mass killers going back more than a century, has found that only one in five are psychotic or delusional. This means that 4 out of 5 mass murderers are people who are clinically sane.



Why do politicians blame mass murders on the mentally ill? Many agree with Fareed Zakaria that “turning immediately to the "sickness" of the shooter and piously calling for better mental-health care is, more often than not, an attempt to divert attention from the main issue: guns.”

This may well be true but it is damaging to label those with mental illness as dangerous to society. The prevalence of mental illness is difficult to nail down but “Around 1-in-7 people globally (11-18 percent) have one or more mental or substance use disorders. Globally, this means around one billion people in 2017 experienced one.”

This means that when we think of those with mental illness we should think of our family members, our partners, our children our friends and neighbours because that’s where you will find them. Or not find them because many hide their symptoms and suffering for fear of - you know - being labeled dangerous. That’ll certainly send someone into hiding.

Worse - mental illness is being used as an insult to those with political views we disagree with.


This is my tweet from this week:






The politician my tweet was directed at is not as important as the patients this politician’s tweet was directed at: those with mental illness have become the scapegoats of politicians.

Paraphrasing MLK gave me pause. However, his writings are filled with empathy for those suffering from discrimination and I thought that it might be appropriate to use this for this very maligned minority.

What I want to address is my dream: blaming and insulting (along with the unrealistic depictions in books and on screen) presents a very unrealistic portrait of those suffering from mental illness. After a long career of treating mental illness, I can describe them with some degree of confidence. They are just like you and your family, friends and children. They have the same wonderful qualities and the same vulnerabilities, the same bad jokes and the same hilarious ones. I could go on, but you get the picture.


I feel I must say this very loud for the people at the back: mental illness is a medical diagnosis no different than that for diabetes. It requires diagnosis and treatment and both should be given with care and compassion. Just like someone with diabetes or cancer - everyone with mental illness will have their own unique personalty but not the ones that politicians try to give them.

I was pondering - ok, I was fuming - about this issue the other day and thought about the origins of medicine. Originally all disease was thought to be in some way connected with the evil doings of those who are ill. So, diabetes, cancer and depression fell into the same category: “In prehistory, people believed that pain and disease originated from evil spirits. Disease resulted when these evil spirits entered the body. Witch doctors and shamans were employed to exorcise wicked beings…”

The belief that illness is caused by evil spirits taking residence in a patient changed when modern medicine discovered the actual etiology of physical illnesses. However, some still think that there is something evil in people who have mental illness.

Today many use the term ‘mental health’ “… to reduce the stigma surrounding mental illness, and said ‘illness’ reinforced prejudices against asylum patients because it implied segregation between the sick and the well. Focusing on health countered a persistent misconception that only some people are prone to psychiatric problems.”

This terminology is a double edged sword. Focusing on what is healthy in these patients is a good thing. However, there is value in identifying an illness. To tell a patient they have a physical illness is often a relief because they finally have an explanation for the symptoms from which they are suffering. They can explain this to those close to them, and get comfort and help when the symptoms flare up. The same applies to those with mental illness. I have found patients are immensely relieved to finally have a diagnosis and treatment plan. I have seen their relief when they can speak to those they love and get support in the same way those with physical illness get to lean on those in their life. 



 I’m comfortable with the term ‘mental illness’ and also happy to use the term ‘mental health’ if people prefer. What I want is to end the stigma, to treat each patient as just that: a person with an illness that can be be diagnosed and treated. The illness doesn’t define the person. Their character defines them.

Hell hath no fury...

Imagine being so ill that you cannot even get out of bed. Or being too sick to spend time with your family and friends. Now imagine being too frightened and ashamed to tell anyone you are ill. Being so humiliated by your disease, that you can’t even tell your own doctor that you are ill.

One out of five people, 20% worldwide, have a mental illness. Many often go through this scenario. Some bravely ask for help. Some hide in the shadows. Some hide in alcohol or drugs.

When I was a young, inexperienced doctor, I was certain that the unfair stigma of mental illness would and should be eradicated in my lifetime. I felt that mental and physical illness were both simply illnesses to be treated. Now, after treating mental illness for decades, I know that I was correct. 

The suffering of those with mental illness is real, and as varied, as patients suffering from anything from a broken leg to heart disease. Just as there is nothing shameful in having cancer, there is nothing shameful about having a mental illness.

Where I might have been a tad optimistic was in my hope that all the stigma of mental illness would be eradicated in my lifetime. However, since I am not dead yet there is, indeed, time. I have seen a lifting of the stigma of mental illness, a willingness to talk about it and reach out and get help. 

What we still need to do is reach into the dark corners, the places where this stigma grows, and open the curtains and let the light disinfect the place. 

The one prevailing myth that needs some attention is that the mentally ill are dangerous. This comes from articles about murders or violent crime, where mental illness is brought up as a possible cause. Also, from the books where murderers are often mentally ill: yes, I mean novels about crime.



If there is a disinfectant for myth, it is fact. 

Since the U.S. has one of the highest incarceration rates in the world, with 666 citizens in jail per 100,000 of the population, we can assume that most of the dangerous people do end up in jail. However, if all those who are mentally ill were dangerous, that would mean that 20% of the population, more like 20,000 per 100,000 population, would be in prison. 

How about an analysis of those who are in prison? Large scale reviews have shown that, in the prison population, less than 4% have psychotic illnesses. 

The myths of mental illness and murder arise most frequently with the worst offenders: mass murderers. Dr. Michael Stone, a forensic psychiatrist at Columbia University who maintains a database of 350 mass killers going back more than a century, has found that only one in five are psychotic or delusional. This means that 4 out of 5 mass murderers are people who are clinically sane. 

Even analyses of those who are mentally ill and commit crimes shows that only 7.5 percent were directly related to symptoms of mental illness. 

So, is there NO connection between mental illness and crime, particularly violent crime? The answer is that there is a very small connection, and one that is present largely in those who are not treated and who also abuse alcohol/drugs.

Those who are depressed are three times as likely to commit a violent crime. However, 60% of people who kill themselves have a mood disorder and suicide is the tenth leading cause of death in the US overall, and the second leading cause of death of 15- 34 year olds. Since there are twice as many suicides as homicides, the most likely violence done by depressed people is to themselves, not to others. 



With schizophrenia, the risk of committing a violent crime was 3-5 times greater, but this was found largely in those not on medication. This research on violence and mental illness also showed that those who are mentally ill are more likely to be victims of violence than perpetrators.

For a final look at mental illness and murder, I present the full quote from the title of this article: “Hell hath no fury like a woman scorned.” Most of us would say that scorn is a good motivation for murder and that Shakespeare was insightful for writing this. However, Shakespeare didn't write it -  it was written by the playwright William Congreve. Further, this isn’t even what was written - the actual line is ‘“Heaven has no rage like love to hatred turned / Nor hell a fury like a woman scorned.”

Common, widespread ideas can be wrong - like the origin of this “Shakespeare” phrase and the idea that those with mental illness are inherently violent. Certainty is meaningless unless it can be backed by facts, and in this case the facts do not support the certainty that most people feel.

Sometimes our first impression is wrong. Even with things we feel that we know, such as Shakespeare or mental illness.

"I Hope You Get the Help You Need"

by Eve Fisher

Ripped from the headlines of South Dakota:

State Receives $300,000 for Mental Health Task Force.

Investigation continues into 50 year old woman's death (35 year old boyfriend claims he woke up and there she was, dead... Yes, there were a few drugs lying around...).

Man accused of killing state trooper wants case separated (he's planning on blaming the other defendants for everything).

https://commons.wikimedia.org/w/index.php?curid=7678578

Fourth of July State Park Camping Reservations open soon (we have some GREAT camping sites; really GREAT).

Report shows an elderly woman found in a freezer died of natural causes  (now why her son brought her to South Dakota in a freezer, that may not be so natural, but he died in February, so we may never have an answer to THAT mystery).

Officials tackling gopher problem at state fairgrounds (no joke, folks).

Entertainment Lineup  announced for RibFest 2016 (June 2-5th, W. H. Lyons Fairground)  .

And a story about someone sentenced to prison for various appalling acts committed under the influence of meth and God only knows what other substances he had in his system.  At his sentencing, someone said, "we hope you will get the help you need while in prison and can turn your life around once you [eventually] get out."

This last story connects with the first one, about the mental health task force:

"A grant of about $300,000 will bolster the work of a task force proposed by the state Supreme Court's chief justice to study issues surrounding mentally ill people entering the criminal justice system.  Officials on Wednesday announced the grant from the Leona M. and Harry B. Helmsley Charitable Trust to the state Department of Health.  The state is providing more than $100,000 through in-kind contributions to support the work.

"Gov. Dennis Daugaard says the group is set to analyze why and how individuals with mental illness become involved with the justice system.  SD Chief Justice David Gilbertson says the criminal justice system often isn't the most appropriate and cost-effective response."  Mental Health Task Force

To which my answer is "d'oh".  

I've talked before about how our society has criminalized addiction, mental illness, and mental disability.  Some of it was purely political:  

"One of Richard Nixon's top advisers and a key figure in the Watergate scandal said the war on drugs was created as a political tool to fight blacks and hippies, according to a 22-year-old interview recently published in Harper's Magazine. 

"The Nixon campaign in 1968, and the Nixon White House after that, had two enemies: the antiwar left and black people," former Nixon domestic policy chief John Ehrlichman told Harper's writer Dan Baum for the April cover story published Tuesday. 

"You understand what I'm saying? We knew we couldn't make it illegal to be either against the war or black, but by getting the public to associate the hippies with marijuana and blacks with heroin. And then criminalizing both heavily, we could disrupt those communities," Ehrlichman said. "We could arrest their leaders. raid their homes, break up their meetings, and vilify them night after night on the evening news. Did we know we were lying about the drugs? Of course we did."  John Ehrlichman interview, CNN

Other reasons were the natural fallout resulting from the scandal of "snake-pit" mental hospitals about the same time that people figured out that mental health institutions were expensive.  In other words, the search for social reform AND economic reform:

"Perhaps what is most interesting about the change in policies of involuntary commitment is the coalition that helped bring it about: a combination of "law and order" conservatives, economic conservatives, and liberal groups that sought reform in the provision of mental health services. But the policy shift had hardly anything at all to do with the mentally ill or the practitioners who treated them. It was designed to lower taxes and shift responsibility away from the federal government. Ironically then, the need for reform perceived by those involved and concerned with the mentally ill (practitioners and families) was co-opted by the interests of capital."  Reagan and the Commitment of the Mentally Ill

In any case the result is that today, instead of going to hospitals, most of the mentally ill, mentally disabled, and the chronically addicted go to jail. (Explains why we have the largest prison population in the world, doesn't it?) According to NIH, "prisons have effectively become the new mental illness asylums". NIH Report on Prisoners and Mental Illness

And, according to the Atlantic: "55 percent of male inmates in state prisons are mentally ill, but 73 percent of female inmates are. Meanwhile, the think-tank writes, "only one in three state prisoners and one in six jail inmates who suffer from mental-health problems report having received mental-health treatment since admission." The Atlantic.

So when someone says "I hope s/he finally gets the help s/he needs" the simple answer is no, most of the time, s/he won't. They will be warehoused. They may or may not be put on psychotropic drugs which may or may not be suitable for their mental illness. If they are mentally disabled, they may be put on tranquilizers, just to calm them down. [This turns them into zombies.]  If they are addicted, they may go through a six week addiction program. Or not. Depends on if there's any money. And, when they've done their time - and most prisoners will eventually do their time - they will come out, in pretty much the same shape they went in, if not worse.

You can't fix people for free.  You can't put mentally ill people into the less-than-nurturing environment of prison and expect them to come out magically all better.  But at least there's a start. I'll take any mental health task force I can get.  Anything is better than nothing, and nothing has been the rule for a very long time.

Okay, now, a little question for all the mystery writers, the woman in the freezer - why do YOU think her son brought her to South Dakota?

Of Mice and Men, Again

A few weeks ago I did another weekend-long Alternatives to Violence (AVP) workshop at the pen.  As always, I came back dragging.  Three days is a long time, and it's a hard time, but then again, I wouldn't miss it for the world.  There are infinitely worse ways of spending my time.  (I know; I've done it.)

The workshop was crowded:  21 of us jammed into a 10 x 12 room.  All ages, races, religions, crimes.  Quite a mix.  There are always those who drive you crazy, those who give you hope, those who you want to never see again, and those who break your heart.  I'll never forget the very young man who said that maybe meth wasn't all bad:  at least when he did meth with his dad, his dad talked to him...

This time the heartbreaker was a mentally handicapped young man, whom I will call Lennie.  He had a great time at the workshop.  As I said later on, "AVP is one of the few places where adults will play nicely with him."  And where he won't get made fun of, or insulted, or shoved around, or robbed, or beaten up, or raped, or killed.  We generally have a Lennie in every workshop:  They might not understand AVP, but they know it's safe.  And there aren't that many safe places in prison for the weak, the elderly, the physically or mentally ill, the physically or mentally handicapped.

First, some statistics:  according to Kaiser Health News, 73% of women and 55% of men in state prisons have at least one mental health problem; it's 61% of women and 44% of men in federal prisons; and 75% of women and 63% of men in local jails.
http://kaiserhealthnews.org/news/by-the-numbers-mental-illness-jail/

Those are pretty horrendous statistics. And when we come to addiction:  well, 65% of all inmates meet the criteria for addiction, and alcohol and other drugs are "significant factors in all crimes, including 78 percent of violent crimes, 83 percent of property crimes and 77 percent of public order, immigration or weapons offenses as well as probation and parole violations." http://thenationshealth.aphapublications.org/content/40/3/E11.full

As Alex Briscoe, the health director for Alameda County in northern California, said “We’ve, frankly, criminalized the mentally ill, and used local jails as de facto mental health institutions."

"Prison crowded" by California Department of Corrections - http://www.cdcr.ca.gov/News/background_info.html. Licensed under Public Domain via Wikimedia Commons - https://commons.wikimedia.org/wiki/File:Prison_crowded.jpg#/media/File:Prison_crowded.jpg

Briscoe's right.  We've criminalized the mentally ill.  Even worse, we've criminalized the mentally handicapped, lumping them in with the mentally ill, which they're not.  For one thing, there is no pill or therapy that will ever "cure" or "treat" the mentally handicapped or make them "normal".  Look at Lennie.  About 10 years old, mentally.  Laughing his head off at every joke that he could understand, and most that he couldn't.  Having the time of his life whenever we did a Light & Lively exercise (silly games, but one of the ways we loosen people up and get the blood flowing; plus - hint! - laughing people learn more than bored people).  Lennie was constantly trying to be helpful, from handing out pencils, to reminding me to turn on the coffeepot, to picking up the trash, and so happy when you thanked him.

Yes, Lennie's been convicted of a crime, but he swore he didn't do it.  He might be right.  He might have made an easy scapegoat for someone else.  (It's been known to happen.)  He also might not have understood what he did, or what he was actually convicted of.  I've run into that before, too.  I've also met Lennies who had no idea at all why they were there - just that something bad had happened, and they were locked up.

I don't know which of these is worse.  What I do know is that putting a Lennie in prison doesn't do any kind of good, unless the idea really is for them to be repeatedly assaulted, robbed, humiliated, raped, and/or killed.  Again, there are no medications that will make Lennie more than 10 years old. He will never get "better".  He will never "learn his lesson," "pay his debt to society" or "grow up" because he can't, and there isn't a damn thing that can ever be done to make that happen.

So what do you do with Lennie?  In my perfect world, Lennie would be in a group home, where he can be given care in a safe, structured, respectful environment where adults will let him play games.  But putting Lennie in prison is as cruel as taking your 10 year old child, or grandchild - no matter what they did - and putting that child in prison and saying, "Well, that's the way the justice system works".  Or, "Yes, a group home would be better, but we just don't have the resources for it."  If that's our justice system, it sucks so much swamp water, we've got alligators. And if we don't have the resources - i.e., money - for such things, again I ask, what is money for?

To be honest, if this is the best we can do, and if there isn't going to be any change...   What is right?  What is just?  What is cruel and unusual?  What do you do when the situation is hopeless?

All I can think of is the ending in Of Mice and Men:

The crash of the shot rolled up the hills and rolled down again...  Slim came directly to George and sat down beside him, sat very close to him.  "Never you mind," said Slim. "A guy got to sometimes."   - John Steinbeck, "Of Mice and Men."