The Sad Case of Vince Li

The mental health system in Canada has been brought to the forefront of all of our minds with the shocking case of Vince Li, the Chinese immigrant who decapitated a Greyhound passenger and was recently found Not Criminally Responsible for his actions.

The family of the victim have publicly denounced the court system and have even said that Li is ‘getting away with murder.’ They were also quoted as saying that ‘he will be able to get a job in a day care and pursue life as he pleases.’

Frankly, it sickens me that these outrageous quotes and misinformed ideas have been allowed to spread through the media and the public opinion. It is understandable that the family of victim Tim McLean are completely shocked and abhorred by this unfortunate incident, but their distorted views are only bringing the plight of the mentally ill back another step.

Schizophrenia is one of the least understood of all of the major psychotic disorders. However, one thing is known for sure: people with schizophrenia are not any more likely than the general public to be violent. And in the rare cases that they do become violent, the violence is usually self-inflicted or geared towards close friends and family members. These types of situations are usually preceded by either a failure to take medication, experimentation with drugs and alcohol or extremely stressful life events, leading to a psychotic break with reality.

I have been following this case closely from the beginning and I admittedly have a more avid interest than most. As a student in the Mental Health and Addictions program, I will be doing my placement at the Forensic Unity of the Royal Ottawa Mental Health Centre. Although Mr. Li will be hospitalized in Manitoba, I am eager to be able to meet other patients with schizophrenia and other psychotic disorders who have come into contact with the law and hopefully piece together a bit of the puzzle.

Mr. Li most likely believed that he would be heralded as a hero when he jumped through the window of the Greyhound bus covered in blood from head to toe. Instead he was treated like ‘some sort of murderer,’ he later told a psychiatrist. In his mind, he had killed McLean on a direct order from God, because McLean was a demon. In his mind, he was doing the right thing. It was only weeks later upon being stabilized on anti-psychotic medications that Li came to understand the extent of his actions.

For some reason in mental illness, we tend to still somewhat hold the person responsible for their actions, where we never hold the same stance for physical illness. For example, the mother of the victim would probably not be as enraged if her son was killed by a driver who had an epileptic seizure behind the wheel. They are both out of the control of the patient, but for some reason we as a society still think the mentally ill should have to be punished for their actions.

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Fascinating Mental Health Books

If you’re anything like me (and I suspect you might be if you found yourself here in the first place) you enjoy reading about mental illness.  As most of my casual reading is on mental health, I thought I would point you in the direction of some amazing reads.

Bar none, the most fascinating book I have read on mental illness is by Richard Bentall.  His book ‘Madness Explained: Psychosis and Human Nature’ is a wonderful look at mental illness and the many misconceptions surrounding it.  Dr. Bentall has spent most of his professional career working with the severely mentally ill.  He has done extensive work on psychosis which is wonderfully presented in this book.

He explores the science behind hallucinations, voices, paranoia, depression, mania and everything in between.  The great thing about his work is that he does not believe in terms such as ‘schizophrenia, bipolar disorder’ and the like.  He makes an excellent case against the DSM diagnostic criteria of mental illness and does so with passion and poise. Definitely worth checking out for anyone who is interested in psychosis.

Next on the list would have to be Kay Redfield Jameson’s ‘Touched with Fire: Manic Depressive Illness and the Artistic Temperament.’   Jameson, who is herself a sufferer of manic depressive illness takes a look through time at some of the most creative people who have ever lived on our planet and relates many of their accomplishments to mental illness.  Although she touches on other illnesses such as depression, she focuses mainly on bipolar disorder.  This was actually the book that originally got me interested in mental illness.  Take a look, and prepare to have everything you thought you knew about mental illness torn to pieces.

Also by Jameson is her memoir ‘An Unquiet Mind.’  This is a remarkable memoir detailing her struggles with psychotic mania and violent depressions.  Perhaps one of the most heartfelt biographies I have ever read.

Last on this list is ‘The Day the Voices Stopped’ by Ken Steele.  A lifelong sufferer of schizophrenia, Steele eloquently brings the reader into his mind from madness to hope.  His powerful words are definitely worth reading for anyone who has the debilitating illness or knows someone who suffers from it.  The hope that it provides is monumental as Steele went on to become a leader and speaker on schizophrenia.

Oooh, I almost forgot ‘Electroboy’ by Andy Behrman.   This astonishing account of bipolar disorder is a definite must-read for anyone who is subjected to the illness.  It reads as a fiction story as most of his real life is far stranger than fiction.  Behrman is an activist for mental health and certainly has the life experience to back up his passion.

Hopefully this short list will get you started on your journey to understand the most complex thing on Earth: the human mind.

Exploring Stigma

*This was written for a teen-based publication, Evoke Magazine, but can be applied to all ages*

It’s an ugly little word that rears its ugly head in almost every aspect of human life.  But in order to combat stigma, we must first appreciate what it is, its negative power and the sneaky ways that we can all fall victim to it.

Stigma has the ability to create worry and self-doubt in anyone who bears its heavy brunt.  It has the ability to cause depressive thoughts, suicidal ideations and a negative self-image in impressionable young people.  It has the ability to change the way someone looks at the world.  It has the ability to take the drive and courage from a promising young mind with only a few words that can echo for a lifetime.

Stigma isn’t something that can be narrowed down to one specific set of behaviours.  It involves anything from labelling another as stupid, retarded, fat, nerdy, scrawny, crazy or any other demeaning term.  Essentially, it is deciding that someone else is inferior to you because you say so.

It isn’t until some people reach adulthood that they begin to realize the true impression that stigma left on their childhood experience.  Many young adults can speak at length of the pains of being labelled during elementary and high school.  It causes permanent damage and is certainly not something that is limited to the school experience.

The negative forces of stigma work in the real world as well.  They exist in creating political and racial divides, the stereotyping or profiling of minority groups and individuals and cause endless amounts of distress in our political and social world.  Unfortunately, much of that is out of our immediate hands.

However, it is the stigmas of everyday life that we can do something about.  When you break it down, stigma is caused by developing an uneducated assumption about a person or a group of people.  Therefore, stigma can be erased, or at least lessened, by becoming better educated about those around you.  Especially those who aren’t exactly like you.

It’s about not passing quick judgment on someone whose behaviour you might not understand.  It’s about not whispering to your friends in the hall that the desperately thin girl in front of you should just eat a hamburger.  It’s about not labelling a group of people ‘losers’ just because they don’t enjoy the same activities as you.  The bottom line is that it is about caring for your fellow humans and doing your part to ease the strain that we all feel as we struggle to find our place in the world.

Instead of labelling someone that is different than you, take the mature route and get to know them instead.  Get to appreciate your differences, which will in turn allow you to uncover your similarities.

Engage yourself and rise above stigma.  For the benefit of the future.

The Blood is Mightier Than the Sword

The reasons that a person might harm themselves are as vast and complex as our individual genetic makeup.  However, there seems to be one predominant goal associated with self-harm: release.

“I would resort to cutting myself for two reasons: the first being to release the tension, the build-up of emotions and thoughts that I just could not deal with. I wanted to scream but couldn’t,” said Julia P. who has battled and overcome self-harming behaviour.

Self-harm manifests itself in a number of ways but can be defined as any behaviour that causes ‘deliberate and often repetitive destruction or alteration of one’s own body tissue, without suicidal intent,’ says Armando R. Favazza, M.D., the author of Bodies Under Siege.

The most prevalent form of self-harm in Western culture is cutting, which involves taking any sharp implement such as a knife or a razor blade and cutting across the skin, usually drawing blood.

There has always been a certain stigma surrounding self-harm.  It was once thought of as a cry for attention or as a failed suicide attempt.  In fact, evidence points to the fact that most people who engage in self-harming behaviours are not trying to end their lives but are rather using it as a coping mechanism for unbearable emotional pain.  And many go to great lengths to hide their self-harming behaviours, which dispels the myth that it is simply a plea for attention.

Self-harm can disguise itself as cuts around the arms, wrists, shoulders, stomach, inner thighs  and ankles but can also include branding (burning the skin with a hot object), hair-pulling, self-strangulation, stabbing, carving words or symbols into the skin, head-banging, pinching, biting and even piercing and tattooing, when it is done to relieve emotional stress.

Self-harm does not have its own category in the Diagnostic and Statistical Manual of Mental Disorders but is rather mentioned as a symptom of other disorders, including depression, eating disorders such as bulimia nervosa and anorexia nervosa and personality disorders.  It is also commonly found in patients suffering from severe anxiety.

“I would want to scream but couldn’t.  It was like I wanted to blow up and scatter all over the place.  I would desperately search for something to stop it.  I just pulled a knife from the drawer and started cutting like a maniac up and down my arms and upper thigh. I would usually choose a serrated knife.  I liked to feel the ripping. With each cut I would feel calmer.  It was easier to deal with; I had something to focus on. It would give me a high . . . an almost euphoric feeling,” said Julia P. putting words to her battle with self-harm for the first time.

Although Julia cut to gain a sense of calmness, there were other reasons as well, that are all too common within the realm of self-harm.

“ I would cut and it would help me release the emotions that were hidden and building up to an almost unbearable level. It would help me cry when I couldn’t,” she said.

Self-harm has been linked as a response to a number of childhood incidents, including sexual abuse, assault, incest, feelings of worthlessness and helplessness, negative self-images as the result of an eating disorder, drug and alcohol abuse as well as family disruption or the death of someone close.

Although self-harm can be found across all cultural and age brackets, symptoms tend to begin at around the age of 14, according Dr. Favazza.

Although it is impossible to predict who might be inflicting self-harm, there are some signs to look out for, including wearing long sleeves in hot weather, spending more time alone, claiming to have an over-abundance of freak accidents, scars, cuts, bruises and other unexplained blemishes.

Every situation of self-harm is different but one thing is for sure.  If you or someone you know is cutting himself or hurting himself in any way, it is important to talk to a mental health practitioner, because there are likely underlying psychological reasons for the behaviour that need to be addressed.

In some cases, medications such as SSRI anti-depressants, including Paxil and Zoloft, have been found to be effective, but individual cognitive behavioural therapy, which is centered around finding healthier ways to cope with life stressors, has been more effective at terminating symptoms.

In many cases, simply talking about it with a loved-one, trusted friend, teacher, or guidance counsellor can be enough to start the healing journey.  Self-harm is much more common than was once thought and is certainly nothing to be ashamed of.  Talking about it and taking the issue out of the closet is the first step toward a healthy body and mind.

Starving to Perfection

Starving to Perfection

Eating disorders are developing the reputation as having the highest mortality rate of any illness, as well as being one of the most under-diagnosed psychological conditions today.  And far too often, it is too late when someone takes notice.  The signs differ from one person to the next making eating disorders difficult to spot to the untrained eye.  Close attention is needed in order to recognize possible warning signs such as reluctance to eat with the family or in a group, repeated trips to the bathroom after meals, complaints of never being hungry, distorted views of their body, mood swings, and having less energy and interest in previously enjoyed activities – all should be taken very seriously.

“Eating disorders occur in secret,” says Teresa Sullivan, a psychotherapist in practice for 23 years who specializes in treating eating disorders.  “People are usually in denial that they have a problem so it can go on for years before someone notices.”

Society puts a tremendous amount of pressure on us to be thin so it’s really not all that surprising to learn that eating disorders typically occur in early adolescence with poor self-esteem and body image as the most common contributors.  Anorexia is one of the most common eating disorders.  It is the pursuit of thinness, with anorexics going to extremes to maintain an unsafe body weight often in secret to conceal their behaviour from others.  They obsess over counting calories and fat, measure food portions, read food labels and keep food journals.  Fixated on weight, body shape and size of clothing, they only see a ‘fat’ person when they look in the mirror.

Fueled by the media, they deviate from normal, healthy attitudes about body image to self-starvation including unhealthy diets, purging, fasting and excessive exercise.  What is not immediately apparent is the denial of the dangers of anorexia.  As self-starvation persists, more body fat is lost and complications become evident.  Doctors can see the amount of weight-loss, digestive problems, Amenorrhoea; the absence of menstruation, and damage to the esophagus and larynx from acid reflux.  Dentists see salivary gland  enlargement (chipmunk like features) which are indicators of bingeing and purging, as well as tooth decay.  Other physical changes include weakening and swelling of the muscles and joints, periodic fractures, thinning and brittle hair, dry and flaky skin, ease of which the body bruises, a jaundice-like skin tone, brittle finger nails, low blood pressure, palpitations of the heart and possibly kidney failure.

“It’s all about control,” says Jennifer, 24, from Toronto who is battling an eating disorder.  “Whether you are anorexic or bulimic, you are ultimately seeking control over an otherwise chaotic life and mind.  An eating disorder completely takes you over.  You become it and it becomes you.  All that you can control is what and how much food you put in your body.  It’s when you lose control and your body shuts down that things get really scary,” she says.

Bulimia on the other hand, generally occurs with anorexia but can exist independently and is characterized by binge eating followed by self-induced vomiting, fasting, the use of laxatives and over-exercising.  Bulimics eat a large portion of food; more than most people under similar circumstances within a fixed period of time and feel a loss of control over how much and what they eat.  The need to remove food from the body before it can be digested to prevent weight gain is overpowering.  More difficult to detect than anorexia because sufferers tend to look ‘healthy’ and have fewer physical complications.  It too can be equally destructive to the body.

“On the surface the body appears okay – thin usually, sometimes fit looking, but internal damage is occurring to the heart, kidneys, liver, intestines and oesophagus.  They develop compulsive tendencies and can often become depressed,” says Sullivan.

Recognizing the warning signs is crucial in treating an eating disorder.  The longer it goes unnoticed, the longer treatment will ultimately take.  There are a number of treatment options out there for you to explore.  However, treatment can take months or even years depending on the severity of the condition and the length of time it went untreated.  In severe cases, hospitalization is required to stabilize the vital organs, but once the body regains some of its physical health, the underlying psychological causes for the disorder can be explored.

“It’s not like I just woke up one day and knew I had an eating disorder,” said Jennifer.  I guess I was always conscious of my weight, even as a young child but it only go to the point of being noticeable to others when I was in high school.  I would go weeks without consuming anything but water while exercising up to six hours a day.  I lost a considerable amount of weight.  That’s when my parents stepped in and I started counselling.”

A positive body image starts with a healthy attitude.  If you or someone you know is suffering from an eating disorder, contact your family physician, a crisis intervention team, the school counselling office or any other medical professional.