Andre Picard, in the Globe and Mail, June 8th, 2008 stated bluntly that we are all to blame for the death of Mr. Lall's family in Calgary. Mr. Lall was undoubtedly mentally ill, probably schizophrenic, but did not receive the help he deserved to help him get well. No, we did not do the killing, but by our overall attitude toward the psychotic mentally ill, we are complicit. And Picard blames the stigma attached to mental illness as the real reason.

Picard is correct. But he did not discuss the reasons for this stigma.

It is the refusal of the psychiatric establishment to property educate the public how to recognize those who are ill, how to get them some help that is more than palliation even though that is better than no treatment for many of them. The book I wrote with Humphry Osmond called How To Live With Schizophrenia 40 years ago was the first major attempt to make the public aware.

No one denies that the sigma persists in spite of decades of efforts by the Canadian Mental Health Association to remove the stigma. Just talking about the mentally ill and claiming that it is just like any other disease is not good enough. The public knows that this is not true. It sees in their relatives and friends who become schizophrenic that they are not the same afterward and hardly ever go back to their earlier normal state if they were ever normal.

Senator Michael Kirby's committee properly started its report with descriptions of some of the stories they heard from patients who had been treated. Hundreds of Canadians told their stories. Their stories showed how people living with mental illness and their families experience the current system. Their words tell a story  about the lack of knowledge, compassion, information and services and about stigma and discrimination. These descriptions accurately describe how the mentally ill are treated and even if the system is as sick as it is, the major responsibility should be laid at the hands of the psychiatric establishment, which has not done a better job and which has not protested long and loudly enough that the system should be improved. 

Mentally ill patients face the stigma of being mentally ill, as also happens with some physical diseases. Diseases that are not understood and for which we have no effective treatment tend to be stigmatized. So it was with leprosy and tuberculosis many years ago. Families were very fearful of these conditions because there was no effective treatment and patients had to be taken to leper colonies and sanitariums for many months or years of treatment. Today even though there is reason to be fearful of the resurgence of tuberculosis there is no stigma attached as we have effective treatment for it. Syphilis is another example of a disease which was abhorred and stigmatized. But with the introduction of the proper antibiotics and with a change in moral sexual standards, it appears to have no stigma attached to it. Special treatment centres were created in hospitals for the diagnosis and treatment of this disease, although there were separate entrances away from the front entrance of the hospital. A very recent example is HIV/AIDS which carried the same severe stigma 20 years ago, most of which has dissipated because the HIV establishment has created the overall impression that we have effective treatment. We do have palliative treatment.

For the same reasons, the mentally ill - especially those who did not recover - were stigmatized and schizophrenia still is. Schizophrenics were said to have nervous breakdowns and these were discussed in hushed tones by families and friends and whispered about to each other even though no one knew what having a nervous breakdown meant. And the institutions where these patients went for help soon were enveloped by the same stigma. Strenuous efforts have been made over the past 100 years to remove the stigma first by changing the name of the institution and over the past 50 years by trying to educate the public that this is a disease just like others. But in fact it is not and the public was not fooled. Schizophrenia would be a disease just like other diseases if it were generally recognized as an easily treatable biochemical disorder with an excellent high recovery rate when treated by orthomolecular methods.

The earliest term for the old mental hospitals was asylum. I am sure that Dr. Conolly back in 1850 was happy with the term asylum being applied to his hospital where he was able to get a 50 percent recovery rate. But as the character of the hospitals deteriorated until 1900 the stigma of non-recovering patients became so bad that the term asylum was dropped. It meant that anyone in an asylum was mentally ill. The Oxford International Dictionary of The English Language defines asylum as follows: (1) A sanctuary for criminals and debtors from which they can not be forcibly taken without sacrilege (2) A secure place of refuge or shelter (3) A benevolent institution affording shelter to some class of the afflicted, the unfortunate or destitute (5) Lunatic asylums. I think the word is a good word and ought to be resurrected and asylum should be given, if necessary for life, for patients who have been so badly damaged that they will never be able to live an independent existence. Meaning #5 is the proper use of this word but without the adjective "lunatic". 

To counter the stigmatized word "asylum", it was dropped and an innocuous term was used instead such as Saskatchewan Hospital in Weyburn or Spring Grove State Hospital in Maryland. This did not help, for the stigma that had enveloped the original structure would not leave no matter how hard any one tried to blow it away. By 1950, another attempt was made by simply describing the location of the psychiatric wards within the hospital. At the Royal University Hospital in Saskatoon, it was called 5DE, an accurate description of the location of our wards on the fifth floor in wings D and E. It soon became obvious that patients from the rest of the hospital did not want to go to 5DE and it, too, carried the same stigma. I believe most psychiatric wards are still called psychiatric wards and a few places have names of their own to honour certain political persons such as the Eric Martin Pavilion in Victoria named after Eric Martin. It has the same reputation that any other psychiatric hospital has. It is not very good and patients resent and fear going there.

There is only one way to remove the stigma and that is to show the public that patients with schizophrenia recover and become useful members of society, that it is not an untreatable disease. And legal sanctions that applied only to highly contagious diseases such as leprosy, tuberculosis and untreated typhoid should be applied to Canadians who are mentally ill. After all, it is against Canada's constitution. Why do the provinces not obey except for Ontario? Maybe we will need to wait until each province is taken to the Supreme Court of Canada for another declaration.
       
The Globe and Mail ran a good series of reports on the mentally ill in Canada  on June 21, 2008. It should highlight to the public the serious nature of the problem facing us today. Perhaps it will open up the public purse some more and the mentally ill will get more effective treatment. However, reading the case histories will not change the overall level of stigma for so few of the schizophrenic patients  ever return to the point that they can pay income tax. They can be kept at home with lots of special care, but the track record of recovery is dismal. This is not made clear in these series in The Globe and Mail, nor will it remove the stigma from schizophrenic patients. It will help do so for depression but this has never been as feared by patients who have not suffered through it. Many of these psychotic depressions are really undiagnosed schizophrenic. The stigma is so great that even doctors are afraid of the term and will use other words instead.

There is lot we can do. We can demand from the psychiatric profession courteous treatment of the mentally ill. We must demand honesty in reporting the results of treatment using only palliative drugs and we must demand it looks at treatment which is more effective. The moral treatment of the insane used over 150 years ago by the Quakers and in Canada in the hospital on Queens Street in Toronto until about 1900 yielded about a 40 percent recovery rate. This was achieved by a combination of proper housing (not the streets), good food (not the junk served in hospitals today), and treatment with consideration and care. If one adds orthomolecular medicine, the recovery becomes much better. The psychiatric profession believes that very few patients recover based on the results that they see but it does not seem to care and considers palliative the best than can be achieved. If you have cancer, which would you prefer - to shrink the tumor and allow you to die with less pain, or to cure you of your cancer? We must have more accountability from the profession.

Dr. Hoffer, in private practice as a consultant, was recently honoured by the International Schizophrenia Foundation with a Lifetime Achievement Gala Dinner in Toronto, Ontario, for his commitment to the mentally ill and their families. His career in both practice and research laid the foundation for the Orthomolecular Medicine approach that is helping so many people today.

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