Canada's Healthcare Crisis

A major backbone of Canada is falling apart, and much of it is from poor policy decisions that has led to a serious doctor shortage. 

Mary Fernando, MD, wrote about it. 

"A personal post in two parts: 1. Someone I love needs a specialist but wait times are dangerously long because of our specialist shortage. 2. As a doctor who resisted large money offers from the US to stay in Canada, I've lost something more important than money: my family's safety. 

Too Poor to Live, But Not Too Well to Die

ETA: This perfect line from British MP Florence Eschalomi: 

"Freedom in death is only possible if you have freedom in life."

In March 2024, Canadians with mental health problems who haven't found significant relief from their condition will be able to get Medical Assistance in Dying (MAiD). 

As I wrote recently of the mental health crisis, 

"We no longer lock people up in asylums; instead, we give them less than they need to survive, and they end up living in tents that randomly get bulldozed into the trash by government officials. We're back to the pre-asylum days where people who couldn't work because of a mental health condition have to resort to begging in the streets. In just a few months, they'll be eligible for MAiD." 

Of course this is not to suggest that all homeless have a mental illness, but that many people with a mental health condition end up homeless because of a lack of supports. 

According to Stats Canada, 

"In the database, the underlying cause of death is defined as the disease or injury that initiated the train of morbid events leading directly to death. As such, MAiD deaths are coded to the underlying condition for which MAiD was requested, . . . In the case of a disability or mental health condition, deaths are coded to the underlying disability or mental health issue that MAiD was granted for." 

Diagnosing Mental Illness During Difficult Times

A guest essay in the NY Times makes some excellent points about the way we're framing mental health issues in kids. 

Psychologist Darby Saxbe discusses the well-intentioned but problematic way many schools have added mental health resources, like those focusing on emotional regulation or mindfulness:

"Recent studies have found that several of these programs not only failed to help young people; they also made their mental-health problems worse. . . . Researchers suggest, convincingly, that the teenagers weren't engaged enough in the program and might have felt overwhelmed by having too many tools and skills presented to them without enough time to master them. . . . I would venture three additional explanations for the backfiring. . . . First, by focusing teenagers' attention on mental health issues, these interventions may have unwittingly exacerbated their problems. Lucy Foulkes, an Oxford psychologist, calls this phenomenon 'prevalence inflation'--when greater awareness of mental illness leads people to talk of normal life struggles in terms of 'symptoms' and 'diagnoses.' These sorts of labels begin to dictate how people view themselves, in ways that can become self-fulfilling. . . . Greater awareness of mental health problems risks encouraging self-diagnosis and the pathologizing of commonplace emotions--what Dr. Foulkes calls 'problems of living'."

I agree that framing every negative emotion as depression or anxiety can be self-sabotaging for people. On top of that we're also forcefully ignoring how withdrawn and exhausted people can become from chronic illness from repeated exposure to viruses and from watching friends and family members suffer, not to mention seeing catastrophic news about climate change and the many conflicts around the world and the burgeoning rise of authoritarian governments. Nothing feels stable anymore. Many of us in my part of the world have lived relatively comfortable lives for a few generations, long enough to forget what it might look like and feel like to struggle profoundly and to watch the suffering around you. Our problems of living have changed dramatically in the last few years, and it can be hard to come to terms with that change, so we might end up thinking something's horribly wrong with us instead of the world at large.

Inaccessible Accessibility

Why is remote learning suddenly so difficult to access when we have all the tech we need to pull it off?

When I was in grade 12, I started to just show up to classes I needed to go to. I had high 90s, so I just went for clarification when I couldn't understand the textbook, and I showed up for every lab and test. That's what worked best for me as a learner. Unfortunately, missing classes didn't go over well with admin, and I was "disinvited" to be in school. I loved learning, and I did very well on tests and assignments, but I never actually finished high-school.

I didn't feel like a rebel or the trouble-maker they might have seen me as. I just found it painfully tedious to sit through lengthy explanations of something I already understood, and I was unable to (and not allowed to) just tune it out and do other work during class. Could you even imagine bringing a walkman to class?? It's rude to do other work while someone's talking, so every class was an exercise in tolerating the repetitive droning on and on until everyone understood and was quiet enough for me to finally start the homework questions. 

Then I went to university a few years later, as a mature student, and nobody took attendance, and I could actually learn in the way that worked best for me. I went to most classes because they were full of rousing discussion, but I didn't go when profs (often "instructors") just literally read out the textbook to us. I thrived in that environment that enabled autonomy over my own learning and went on to do a masters as well. 

Now universities take attendance, and it's vital to attend, in person, even if nothing significant is gained from my presence in the room for myself, for my prof, or for the class. 

Staying Healthy Takes Work

If social media is any barometer of this, anti-mask abuse appears to be skyrocketing.

Fixed it for ya!

There are tons of comments by the Covid cautious about about being accosted at stores and in the street, followed by others suggesting that's just not happening. 

I wrote about being harassed on the street over a year ago, and a few people (men) commented that it never happens to them, so I added in: 

"If right now you're thinking, 'Nobody ever hassles me about my mask,' it could be because you're male or a more imposing female or neurotypical or you don't travel around alone on foot or by bike all the time, or you don't live a few blocks away from a site home to regular anti-mask rallies!"

I've actually found the level of harassment directed towards me has decreased in my area -- knock wood -- which could be because I travel similar route, and see the same people over and over, and people have grown weary of hassling me and having no effect.

On Helping Professions

Should mental health professionals be more concerned about the spread of a brain-invasive virus that affects mental health by doing a number on the brain??

Amanda Hu wrote 

"I feel like therapists and counselors as an entire profession (save a few individuals) not understanding how serious Covid is, thinking it's over and being part of the minimization of the pandemic is actually a crisis. We need the people who are supposed to guide us through grief and trauma to not be in denial of reality themselves. I've heard a lot of stories about avoiding Covid, or physical symptoms being pathologized even when the person has physical and medical proof of the damage Covid infection did to their body! I had a therapist I saw when I had a lot of climate grief a few years ago. I don't really see how she would have been able to help me if she didn't think climate change was real." 

And Dr. Mike Hoerger, a licensed psychologist, responded, 

"We need more psychologists who take the ongoing pandemic seriously. This means masking, using right-sized HEPA, contextualizing life struggles in terms of discrimination, exclusion, suffering, and loss, and empowering people to fight for safety." 

Children Risk More Illnesses after Covid

What every pediatrician in the world needs to read - from tern: 

Correct me if I'm wrong, but this is a really bad thing, isn't it?

I wonder what the percentage is after the 2nd, 5th, 8th, and 12th infection?

Here's a really really interesting point in the study: Only a tiny proportion of the kids have a constellation of problems.  The new issues are spread out across all the body's systems: 

"Only 2% of children had two disorders at the same time."

Do you understand the significance of that?

Fraud Fest in Waterloo Region

Catherine Fife and Debbie Chapman speaking to protesters.

It feels like we turned a dark corner in Ontario. In my hometown in particular. 

Doug Ford came to K-W to be greeted by tons of protesters including overt representation from ETFO, OSSTF, OECTA, CUPE, OBSCU, Liberals, Greens, and, of course, the NDP, which is very strong in the region. Faculty from UW, Laurier, and Conestoga College were all there, along with tons of educators. The Ontario Health Coalition the Waterloo Region Labour Council and the Environmental Defence all played a part in organizing it or advertising it. Tons of healthcare professionals were there and environmental groups and housing groups and ODSP advocates. 

Premier Ford had this exchange (0:55-1:28) with educator Ramzi Abdi,

Ford: I look at all the supporters in here. I don't worry about people being bussed in all over the place to demonstrate. [as if his opposition doesn't come from the region]

Abdi: All Ontarians too.

Ford: Absolutely, and I'll take care of them. [vaguely threatening?]

Abdi: You should do a better job of taking care of Ontarians.

Ford: We're doing a good job

Abdi: You're not doing a good job, my friend. Our schools are underfunded. Our hospitals are underfunded. You need to do a better job.

Ford: Guess what, we do, my friend. 

Abdi: I understand you think you're trying to do your best, but I know there are people in Ontario who are suffering. There are students in Ontario who are suffering.

Ford: There are people that need homes, and that's what I'm going to do. I'm building homes.

Maté: Part Depth Psychology, but Part Questionable Quick Fix

He received the Order of Canada, profoundly helped many people with addiction on the streets of Vancouver, and is much loved and admired, but some of Dr. Gabor Maté's claims feel like they don't hold water. And some claims might actually be dangerous if blindly accepted.

I've encountered Maté in a few courses I'm taking, and have been strongly encouraged to watch his newest film and read his book several times now; I opted for the former. One follower was excited to tell me, with great confidence, that ALS (Lou Gehrig's Disease) is caused by a specific trauma and that everyone is carrying unresolved trauma which, if resolved, can heal physical ailments like cancer. Okay. I have some reservations that I've kept to myself until seeing so many in academia wholeheartedly promoting some poorly substantiated claims.

While Maté has some excellent techniques in the work he does, the way he presents and explains the material provokes me to look up research studies to try to corroborate many of his ideas.

I gobbled up his books twenty years ago, and there are some useful analogies and treatments in there, but even then there were parts that gave me pause.

ASD Assessments

Assessments for Autism Spectrum Disorder (ASD) are sometimes a piece of work. I'll look at two of them here.  As a reminder, everyone with ASD is really different from one another. If you know one person with autism, you know one person with autism. The diagnostic categories are general and symptoms can be incredibly broad. 

The ASSQ is about 25 years old but still used today. It's to be completed by people who live or work with the person in question. It mainly just asks, "Is this person weird?" Check out the use of language: Do they behave in a way that's eccentric, idiosyncratic, with a deviant style of communication, fussy, old-fashioned, robot-like, with a deviant gaze, unusual facial expressions, ungainly, awkward, bullied by others yet surprisingly good at some things, and, of course, lacking empathy.

Lacks empathy is a highly contentious item on ASD assessments. Many people with ASD have no problems experiencing profound empathy, and many are even empaths or highly-sensitive individuals (HSIs). The belief that there's no empathy in place is sometimes from misunderstood social cues, but sometimes it's from an expressionless reaction (flat affect) to a person despite a whole host of empathetic feelings going on internally. Communication differences for people with ASD can be in receiving or sending unspoken information.

Problems with Psychiatry

 Paul Minot, MD, wrote a thread inviting other threads on the practice of psychiatry. Caveat, I have no idea of the credibility of any of these claims, but some make a lot of sense to me: 

"I've been practicing psychiatry for 38 years. I love my job, my peers, and my patients. but I've come to the conclusion that I'm participating in the biggest intellectual scam of this era. We claim to be a science, but have no understanding how thought or behavior is generated. Many billions of dollars are spent each year in an industry built on a corrupt body of pseudoscience, cultivated and exploited by monied interests for decades. This scientific fraud has been more successful than any other of our day. Our diagnoses are contrived by our guild, the APA, with the collaboration of monied interests--and are so unrelated to actual science that they are copyrighted and published to profit that organization. In the process of selling a corporatist, medication-oriented model of treatment, psychiatry has been stunningly successful in redefining what it means to be a human being. Meanwhile, 20 years of peak psychiatry has resulted in a 30% increase of suicide in the United States--and American psychiatry has absolutely nothing constructive to say about it. Please tell me what I've missed." 

Chris Hedges on Our Current State of Paralysis

Hedges writes on Substack now, if you haven't been able to find him lately, and his piece today is excellent. 

He starts by pointing out the growing rich-poor divide that is seeing the top earnings increase by almost 90% in the last decease in the states, while the lowest struggle to find an apartment they can afford. The government is doing nothing about poverty, climate, infrastructure, health care, and violence by police or fearful neighbours. He says, 

Democracies are not slain by reactionary buffoons like Donald Trump, who was routinely sued for failing to pay workers and contractors and whose fictional television persona was sold to a gullible electorate, or shallow politicians like Joe Biden, whose political career has been devoted to serving corporate donors. These politicians provide a false comfort of individualizing our crises, as if removing this public figure or censoring that group swill save us. Democracies are slain when a tiny cabal, in our case corporate, seizes control of the economy, culture and the political system, and distorts them to exclusively serve its own interests.

This analysis helps to explain how many corporations have so easily walked us back to pre-New Deal years, stripping away workers' rights, ignoring environmental regulations, focusing on basic facts while eroding the critical thinking of the humanities in public schools and universities, and removing useful health protections in hospitals. We're already not a democracy, as Hedges has said for years, invoking Wolin's inverted totalitarianism. Today he quotes research from professors Martin Gilens and Benjamin Page, 

Forced Exposure in Hospitals

If you're feeling unwell, McMaster is advising you to NOT go to a hospital because they no longer require masks there, and they don't want people in there spreading their diseased germs around. Wha...?? Some doctors and nurses are excited to ditch their masks, despite the potential harm that could come to their patients. 

Of course this message blatantly ignores the over 30% of people who have an asymptomatic case and have no idea that they're carrying and spreading a brain-invasive vascular disease, which is how it spreads so brilliantly and why masks are so useful just in case!!

What Does Compassion in Education Look LIke?

Since the pandemic started, educators have been asked to use a "trauma-informed" approach to their teaching, i.e. pay attention to the psychological safety of their students. Some of the literature on this looks pretty good: build connections through empathy, be consistent and predictable in the classroom, be flexible to accommodate different needs, delight in students by finding the best in them, and co-regulate by sharing your calmness with others. But, in practice, it fell apart a bit.

In my own experience, I was made to be flexible at the expense of consistency and predictability in a way that overrode our guiding documents. And, I'd argue, in a way that wasn't compassionate. 

I practiced a trauma-informed approach long before it was called that, providing clear expectations but with many alternatives for people to choose. Before my classes start, I'd email a survey of questions to students asking if they'd have any concerns with general rules and deadlines, and where they'd prefer to sit in the room, what would make them most comfortable, what they like to be called, etc., so that when they walked into the room on the first day, they knew exactly what to expect and they had already had some say in what the room looked like. These are grade 12s, many over 18. With Covid, I added more questions about what would make them feel safe, and I asked if having windows open 1/2" would be okay to add some ventilation to the room. 

Then, once in the room, I again asked if people were comfortable where they were sitting and if it wasn't too cold. Everyone was fine. Except somebody wasn't, but they likely didn't want to be the odd one out in the class, so texted dad, who called admin, who marched down to my class immediately to tell me, "Kids can't learn if they're cold!" And the students learned a valuable lesson that day: Get dad to call admin, and you can make anything happen right before your eyes! 

We talked about what to do if you have a conflict with a person, that it's always best to start with to the offending person directly, and then go higher up if you feel like you're not being heard or not being treated fairly. "Resolving" a conflict doesn't always mean getting what you want, though. We have to measure out what we want, what others want, and if anyone needs something to happen differently to figure out what's fair. I asked them, What will you do in a few months, if you have a concern about a class in university? 

Get my dad to call the university. 

I shocked them by letting them know that university profs and administrators won't talk to their parents. 

Personal Troubles and Public Issues

"People do not usually define the troubles they endure in terms of historical change and institutional contradiction." Developing a sociological imagination is necessary so that, "By such means the personal uneasiness of individuals is focused upon explicit troubles and the indifference of publics is transformed into involvement with public issues....To understand the changes of many personal milieux we are required to look beyond them."        ~ C. Wright Mills in "The Promise"

"It is no measure of health to be well adjusted to a profoundly sick society"        ~ attributed to Jiddu Krishnamurti in Mark Vonnegut's The Eden Express

There was an excellent op ed on mental health, by Danielle Carr, in the New York Times yesterday. I'm saving pieces here. She looks at how we treat mental illness, and how futile some efforts have been. Many have been led to believe the problem is a matter of access to care, but she goes down a different road.

Are we really in a mental health crisis? A crisis that affects mental health is not the same as a crisis of mental health. To be sure, symptoms of crisis abound. But in order to come up with effective solutions, we first have to ask: a crisis of what?

It's politics. She uses the term "reification" to explain the institutional gaslighting in which political problems are spun as personal problems which conveniently "abracadabras" away any nosy questions about who started it and who benefits from it. 

It's how, for example, the effects of unregulated tech oligopolies become 'social media addiction,' how climate catastrophe caused by corporate greed becomes a 'heat wave'--and, by the way, how the effect of struggles between labor and corporations combines with high energy prices to become 'inflation.'

In medicine, it's called "medicalization," which focuses on an individual's body while ignoring the social system that's often at the root of the problem. Like with the mental health issues arising from Covid. Incidents of depression and anxiety have increased dramatically, but that's not surprising given the circumstances: "feelings of anxiety and sadness are entirely normal reactions to difficult circumstances, not symptoms of poor mental health." Looking at the data, economic security is the biggest predictor of a mental illness during a crisis: "it's not simply a question of the numbers on your bank statement - although that is a major predictor of outcomes - but of whether you live in a society where the social fabric has been destroyed."

Self-Diagnosis with Checklist Criteria: the Big Five and ASD

When I was a kid, my folks said I was a little slow to warm up to people and sometimes needed a nudge to interact. Then, in grade 11, we all had to do this really long test, filling in stacks of Scantron-type cards with our answers, which were fed into a giant computer that generated reports for each of us, which required a specialist to come in to interpret. The upshot of it all? I'm introverted, an INTP, and I should consider a career as a minister. Then twenty years later, I went to grad school and took a course in Carl Jung, including his typology. We were given a test to do, on paper, which was sent away to be carefully analyzed by a specialist. I got a 30 page typed report in return that said I'm still an INTP, and that can't predict my career goals (assuming it can is a fallacy of affirming the consequent*), but it can help me understand and accept why I need so much alone time, why I struggle to notice the mess I leave in my wake in a way that my partner (ex-partner) finds inexcusable, why I'm good at getting stuff done, and why I'm so scattered. This was a special privilege, getting this 30-paged report, offered only to us because we were taking the course. But another twenty years went by (damn, I'm old!), and now anybody can do these tests online and find out all about themselves. And it's FREE!!!  

Mental Illness in Covid Times

For me to stop teaching in a physical classroom, because I don't feel safe in there, I need a note from my doctor indicating that I have a mental illness that prevents me from working and then take a sick leave. It can't just be a note that says I can't work in the building, that I have a situational anxiety that prevents me from working in an unsafe space; it has to be a note that says that my illness is so debilitating that I can't work at all. It was made clear to me that that's how anxiety works: Either you don't have it and you can work, or you do have it and you can't. Period.

Except that's not how anxiety works at all.  

Anxiety can get triggered by specific aspects of a situation. Someone might be unable to write a test in a room full of people but be completely fine to write it in a room alone with the teacher. Some people can't present in front of 30 people they don't know, but can really excel in front of a choice of three friends to bring along as their audience at lunch time. Teachers have been accommodating students with anxiety like this for years. Just IMAGINE if we told students with anxiety that if they really have it, then they have to take a leave from school, that it's impossible for them to do any work in any other way. 

On Policing: Maintaining Institutions

Victoria's Secret

I'm just kicking around the idea of defunding the police and trying to picture how it all works and how we get from here to there to explore if it's necessarily the best route to obliterate the police force or just to de-militarize it. Police take up a huge part of municipal budgets, and seeing cops in riot gear or with armoured trucks (worth a third of a million each) when people are struggling to access mental health facilities or find basic shelter or even get enough food is baffling in its excess. But, when cops had little more than billy clubs and rope, the threatening aura didn't disappear.  There were reports of cops being racist and cruel and barbaric before all the equipment; the armour just makes them faster. So, while much of that money could definitely be better used elsewhere, changing the budget doesn't touch the heart of the issue.

One key problem with any powerful institution that needs to be dismantled is the subtle peer pressure to turn a blind eye in order to maintain the illusion of perfection in the institution. The machine convinces us to save it at the expense of the individuals it was made to serve.

On Policing: Checking Up or Checking In

Two things happened recently that have me thinking about the nature of policing of one another beyond blue uniforms. It's that policing attitude I'm questioning.

#1. At an online meeting with an admin of my high school, we were told our marks are due Monday morning, a few days ahead of our typical schedule, and then it was suggested that we'll have to figure out how to continue delivering content to the end of the week even after the kids know their marks are in. In an earlier meeting, a colleague expressed concerns about students who finish their 3 hours of work in one day and have no work for the rest of the week. We have this weird idea that school is about keeping students busy so that they'll stay out of trouble. One reason for truancy laws is still to "Get kids off the street and get rid of daytime crime." In the classroom, we're cautioned not to let kids leave early or else we're liable for anything that happens to them until the final bell rings. The one thing that I absolutely love about distance learning is no longer having to track attendance and lates, and no longer being remotely (ha!) responsible for whether or not they're dressed appropriately or eating or playing a game on their phone during class. I just offer an opportunity for learning, and it's entirely up to them to seize the day! If the kids finish early, or if school finishes early, I shouldn't be expected to entertain them. They should be free to discover and develop their own forms of entertainment! There is a potential for creativity to flourish in the absence of make-work activities. I gave them their final marks last Thursday, even! Let the wild rumpus begin!!

I'm Fine, Really

"You'd say I'm putting you on, but it's no joke, it's doing me harm You know I can't sleep, I can't stop my brain You know it's three weeks, I'm going insane you know. I'd give you everything I've got for a little peace of mind."                - The Beatles

First of all: The numbers don't matter!! Seriously, don't even look at them! They're like a weather forecast: It's only sometimes accurate and shouldn't be used to plan anything important. Say you're planning an outdoor wedding, and the forecast says totally sunny, then you'd still put up some kind of tarp just in case, right?! Whether the projections are horrific or hopeful shouldn't have any effect on our behaviour right now anyway; we STILL have to stay home as much as possible and stay well washed. We're all hoping the numbers go down to know when the curve has flattened, but once that happens, which could be a long way off, we still have to behave the same. So don't look. Of course, I'm mainly reprimanding myself here.

My concern is that when the numbers look bad, people will fall into despair and stop caring about taking precautions, and when they look good, people will decide they can relax their precautions because it's almost over!! Either way would be a shitshow.