News and Information
Schizophrenia Update - Issue 5, December, 2002
Table of Contents

  • Brain Imaging May Detect Schizophrenia in Early Stages
    (New York Times, Dec. 11)
    Scientists have known for some time that people who suffer from schizophrenia show abnormalities in the structure of their brains.

    But in a new study, researchers for the first time have detected similar abnormalities in brain scans of people who were considered at high risk for schizophrenia or other psychotic illnesses but who did not yet have full-blown symptoms. Those abnormalities, the study found, became even more marked once the illness was diagnosed.

    The subjects in the study who went on to develop psychoses had less gray matter in brain areas involved in attention and higher mental processes like planning, emotion and memory, the researchers found.

    Experts said the study's results, reported yesterday in an online version of The Lancet, the medical journal, offered the possibility that imaging techniques might eventually be used to predict who will develop schizophrenia, a devastating illness that affects more than 2.8 million Americans. Doctors could then offer treatment while the disease was still in its earliest stages, possibly preventing further damage to the brain.

    But Dr. Christos Pantelis, an associate professor of psychiatry at the University of Melbourne and the lead author of the report, cautioned that much more research was needed before magnetic resonance imaging, the method used in the study, could serve as a diagnostic tool for individual people with schizophrenia.

    "I think it's still too early to say how helpful it will be," Dr. Pantelis said.

    Still, other researchers called the study's findings exciting and said that the areas of the brain in which the abnormalities were found would now be an active focus for study.

    "This is a terrific first step," said Dr. Paul Thompson, a professor of neurology at the University of California at Los Angeles and an expert on brain imaging and schizophrenia.

    Dr. Herbert Y. Meltzer, a professor of psychiatry at Vanderbilt University and an expert on schizophrenia, said, "It proves that the psychosis is almost a late stage in the evolution of the disease process."

    He added, "The key message is that this is a neurodevelopmental disorder and that changes in memory, learning, attention and executive decision-making precede the experience of the psychosis."

    People who suffer from schizophrenia typically experience auditory hallucinations and have blunted emotional responses and difficulty with activities that require planning or other higher-level processes.

    Some studies have suggested that the earlier the illness is treated with antipsychotic drugs the better the prognosis. At least two research groups, one led by Dr. Patrick McGorry, an author of the Lancet report, and another at Yale, are conducting studies in which young people who are experiencing some symptoms but have not yet developed schizophrenia are treated with antipsychotic drugs. But the studies have been controversial because it is not yet clear which symptoms predict later illness.

    In the new study, the researchers used magnetic resonance imaging to scan the brains of 75 people who were deemed "at high risk" for psychosis because they had a strong family history of severe mental illness or had other risk factors, including transient or mild symptoms of mental disturbance or a decline in mental functioning.

    Over the next 12 months, 23 of the subjects developed a full-blown psychosis and 52 did not fall ill, the researchers found.

    A comparison of the brain scans from the two groups revealed significant differences in the volume of gray matter in areas of the frontal and temporal lobes and the cingulate gyrus. All three regions have been linked to schizophrenia by previous research, Dr. Pantelis said.

    When the researchers conducted additional brain scans on some subjects who developed psychoses, they found further reductions in gray matter not seen in the scans taken before the illnesses were diagnosed.

  • Why do schizophrenics hallucinate, hear voices?;
    Mapping uncovers brain shrinkage

    By: Veronique Mandal Star Health-Science Reporter

    Cutting-edge brain mapping techniques have allowed scientists here to link schizophrenia to a shrinkage of grey matter, proving definitively that the disease is no less physical than cancer or diabetes.

    The deterioration can begin at childhood and amplifies with each psychotic episode, researchers at the Montreal Neurological Institute of McGill University have found.

    "There is such a terrible stigma about this disease but it is actually no different than any other physical brain disease," said researcher Dr. Tomas Paus.

    In one of the most advanced labs in North America, worth $35 million, Paus and his team used advanced MRI equipment and Positron Emission Tomography (PET) scanners to track what schizophrenia does to grey matter. The effects on children were espcially profound. Patients with early-onset schizophrenia had a much greater loss of grey matter, especially in the frontal and temporal lobes, as those who contracted it later in childhood, according to the Paus research, published in the Archives of General Psychiatry.

    "This is consistent with evidence suggesting that abnormalities in frontal and temporal lobe connections underlie the symptoms of schizophrenia," said Paus. "Thus a specific pattern with schizophrenia develops across the adolescent years."

    Deterioration in the prefrontal cortex of the brain affects verbal memory, attention, reasoning, aggression and meaningful speech, helping explain why schizophrenics sometimes babble incoherently.

    Overactivity in the frontal and right temporal lobes was associated with auditory hallucinations, a common and debilitating symptom of schizophrenics who claim they hear voices.

    Loss of volume in the temporal lobe also affects the limbic system, located deep in the brain and containing the hypothalmus, amygdala and hippocampus. Those are responsible for emotions and memory and abnormalities are associated with the delusions, hallucinations and disordered thinking common among schizophrenics.

    Research labs around the world have added to the bank of physical evidence that explains schizophrenic behaviour.

    Studies at the University of Toronto and other centres show an overproduction of the chemical dopamine, which is closely linked to psychotic symptoms in schizophrenia. Research at Johns Hopkins University, using a newly developed 3-D diffusion tensor MRI, points to evidence that schizophrenia involves decreased communication between the right and left sides of the brain and that miswiring between nerve cells impairs information processing and co-ordination of mental functions.

    Evidence that parts of the brain are not communicating is also found in the corpus callosum, which connects the two halves of the brain and is responsible for relaying information back and forth. It is thicker and longer in the schizophrenic brain. The ventricles, hollowed out cavities containing cerebrospinal fluid, are also enlarged, causing emotional flatness, lack of expression and a lack of pleasure or interest in life.

    Children whose mothers were underweight at the end of pregnancy had a three- to four-times greater chance of developing schizophrenia, according to research in Finland. Low birth weight and thinness during childhood also increased risk of the disease.

    Researchers from the New York State Institute of Psychiatry, writing in the Archives of General Psychiatry, found in one study that children whose fathers were age 50 and over at the time of their birth were also likely to have a psychotic episode.

    At the University of Florida's Brain Institute, researchers have discovered subtle differences in 10 brain structures which could indicate schizophrenia.

    The influenza virus is also under scrutiny. A study by researchers at King's College Hospital in London, England, found the virus present in 13.2 per cent of mothers who had children with schizophrenia. All but two occurred during the fourth, fifth and sixth months of pregnancy.

    The area affected is responsible for language, processing information, reasoning, planning and abstract thought.

    A study published in 2001 in Proceedings of the National Academy of Sciences, reported that retroviruses, which contain RNA instead of DNA, may play a role in the development of schizophrenia in some individuals.

    Adding to the suspicion that viruses or infection affect fetal brain development, scientists have observed that more schizophrenics are born in winter and early spring and in cities with very cold winters.

    GRAPHIC: AFFECTED AREAS OF THE BRAIN: Source: Star graphic: Susan Thomson-Stamcoff; CEREBRAL SLEUTH: At his lab in Montreal, neuroscientist Tomas Paus scans the brain. Photo special to The Star: Marcos Townsend

    Windsor Star
    October 9, 2002 Wednesday Final Edition

    SCHIZOPHRENIA: Prevalence of illness unluck of the Irish;
    Where you live, what you eat may play roles

  • By: Veronique Mandal Star Health-Science Reporter

    Geography plays a role in the incidence of schizophrenia, scientists suspect.

    American researcher Dr. E. Fuller Torrey discovered that southern Ireland has probably the highest incidence of the disease in the world -- four per cent of the population, compared to one per cent for the rest of the world.

    Torrey, executive director of the Stanley Medical Research Institute in Bethesda, Md., says the highest rates were found among the country's poorest people. He ruled out inbreeding as a cause, since successive invasions of Celts, Spaniards, Scots and English ensured a wide genetic mix.

    Emigration of the strongest, leaving behind the weakest, was another theory which also does not hold water, according to Torrey, since as early as 1850 a high rate of insanity was reported among the Irish in Massachusetts.

    Studies showed higher rates of schizophrenia among the Irish in the U.S. in 1913, 1920 and in the 1940s.

    There is also no indication that the rate of schizophrenia is decreasing. Recent figures show an eight-per-cent increase in first admissions for schizophrenia between 1965 and 1974.

    One factor being studied is potato consumption. When exposed to light, the potato produces a keloid called solanine which can cause gastrointestinal disturbances and psychotic symptoms, including hallucinations.

    Torrey says while it might sound far-fetched, in the 20th century it was proved that many people living in the southern U.S. were spending lifetimes in institutions for a mental illness which turned out to be pellegra, caused by a lack of the vitamin niacin.

    Other countries with a high rate of schizophrenia include Croatia, a part of Yugoslavia and some of the Scandinavian nations

    In other countries, such as New Guinea, Torrey says schizophrenia is hard to find. Low rates have also been found in Italy and Spain, as well as in most developing countries. Schizophrenia has also been hard to find in remote parts of Africa and Southeast Asia.

    Rates are higher in India and Sri Lanka, with studies in India showing that the illness is more common among the upper castes -- those who are more educated and exposed to western technology.

    Spud factor: Scientists are investigating a possible link between potato consumption and schizophrenia.

    Windsor Star
    October 11, 2002 Friday Final Edition

    SCHIZOPHRENIA: Early intervention key to thwarting disease

    By: Veronique Mandal Star Health-Science Reporter

    Scientists here are screening the home movies of schizophrenics to track the early onset of mental illness in children.

    The research is aimed at providing parents with a checklist of warning signs so they can intervene before children experience their first psychotic episodes. Reviews of home movies and tapes seem to suggest that children who go on to develop schizophrenia exhibit subtle movement disorders -- a tic or an odd gait -- before they are 10.

    In their prevention and early intervention program for psychoses (PEPP), researchers at the London Health Sciences Centre and in Toronto, are also screening people age 16 to 50 who are showing signs of psychosis -- hallucinations, delusions or disorganization of thinking, possibly accompanied by social withdrawal and bizarre behaviour -- but who have not been treated with anti-psychotic drugs.

    "Unfortunately, treatment often gets delayed for one to two years for people who are showing early signs and symptoms of psychosis and this leads to a slow and incomplete recovery where they do get treatment," said Terry McLean, the program's clinical and education leader.

    "A delay can interfere with the person's psychological and social development, cause family relationships to be strained and lead to prolonged unemployment and interruption in their education."

    McLean said her findings mirror those in Australia where patients treated within six months of the onset of psychosis have a better rate of recovery. Early intervention has emerged as a driving force in patient care, researchers say.

  • Windsor Star
    October 11, 2002 Friday Final Edition

    Bonded by their demons

    By: Veronique Mandal Star Health-Science Reporter

    On March 7, 2001 Scott Bedard began hearing voices that existed only in his head and it frightened him.

    Asked by his mother to record what was happening to him, the 17-year-old wrote:

    "I heard voices saying to pinch myself. ... I got mad and threw a fan because I got mad at the voices. I think people are making fun of me when they're not. I said shut up to my mom. ... I did not want to go to school because of the voices. I am scared of the voices. ..." He was sent home from Hotel-Dieu Grace Hospital with a drug prescription and an appointment at the mental health clinic the following week. On March 8, Bedard heard a woman's voice in his head combined with a radio playing music and a beating sound. He wrote:

    "The radio is still in my head even though I took my meds. ... I did not take a shower because the voices are telling me don't take it yet. .. The songs on the radio change every time. ... I grab the back of my neck for no reason. ..."

    Bedard stopped taking showers, became withdrawn, wasn't responding to his parents and began missing classes.

    A doctor increased his meds. On March 15 he wrote:

    "After I took my meds I am hearing voices of both men and women. They are telling me to hit myself. I am scared."

    After a year on risperdone, Bedard says he is doing better and can be around people for more than five minutes. Epival was added to his medications to still his racing thoughts because in a moment of uncontrolled anger he hit his brother.

    His mother worries Scott, six feet and 230 pounds, will hurt his dad. "A lot of that is because of the meds," says Laura Bedard. Recently, her son began hearing a man and woman whispering, telling him to hurt people. Terrified, his mother took him to the doctor to adjust his medication.

    Most of his friends don't know about his illness, but Bedard says it would help if they did. He wants to finish school and open a business.

    Schizophrenia runs in the family. The Bedards are aware of at least five immediate relatives who have it.

    Scott's aunt Diane Cullen, 25, suffers from bipolar and schizo-affective illness. Her bizarre trip into the disease began in 1999 on her way from Windsor to Hamilton. In the car she kept blacking out. At her aunt's in Glencoe she thought the devil was talking to her through tapes.

    In Hamilton, she thought Spaz her cat was possessed by a demon. Her boyfriend took her to McMaster Hospital where she thought everyone around her was dead.

    She told a doctor she felt like the "Father, Son and Holy Ghost," then passed out. When she awoke she was in a confinement room. Looking out her frosted window she thought the people on the ground were monkeys.

    She spilled orange juice on her right foot to remember which foot to walk with first. In her journal she wrote:

    "I'm getting really frustrated, please help me God. I didn't mean to harm anyone."

    Over the next four years she fought hard to get back some semblance of a life. It worked. The last entry in her journal reads:

    "My knight asked me to marry him on April 1, 2002. I hope everyone has a good life and remember to take care of your health. That should be number one on your list of things to do."

    Newspaper Correction on improper use of "Schizophrenia"
  • A good example (see below) of how calls to newspapers and other media can change how they present or misrepresent "schizophrenia",


    The Guardian (London)
    October 10, 2002
    HEADLINE: Corrections and clarifications

    In the opening line of our Notebook, page 23 (Finance) yesterday, we referred to the City's schizophrenia. We no longer use the word schizophrenia in that inaccurate and offensive way.

    It is the policy of the Guardian to correct significant errors as soon as possible. Please quote the date and page number. Readers may contact the office of the readers' editor by telephoning 0845 451 9589 between 11am and 5pm

    Windsor Star
    October 10, 2002 Thursday Final Edition

    'I thought I could fly out the window': Medication brings autoworker back from the brink

    By: Veronique Mandal Star Health-Science Reporter

    At the University of Windsor in the fall of 1970, Rick McKenzie had, by all accounts, a beautiful mind.

    A hockey player who had studied in the United States, McKenzie, then 25, was working toward his degree from the faculty of physical education.

    But that fall, Mckenzie began losing touch with reality. By Christmas he was hallucinating and hearing voices. "I couldn't write my exams, I was reading what I thought were hidden messages into the way people moved and would have conversations with people on TV that made sense to me," said McKenzie.

    "I thought I was invincible and would run into moving cars. On the second floor of a hospital one time I thought I could fly out the window. I sat and tormented myself with the notion but fortunately didn't."

    McKenzie spent several years in and out of hospital, getting in trouble with the law and experimenting with different medications. Unable to complete his studies, McKenzie took a job at a Chrysler plant -- far from the career he'd planned but an opportunity nontheless to get his life together.

    He married a psychiatric nurse and had a daughter. Life was good. So good he went off his medication. He deteriorated. Got fired. And lost his wife.

    Realizing his mistakes, McKenzie went back on medication. He was given his job back, established a civilized relationship with his wife and became an important part of his teenage daughter's life.

    "I've been on the new medication rispiradone for 10 years and I'm really doing well," said the warm and friendly 56-year-old. "It makes me drool but I saw Michael J. Fox, the actor with Parkinson's Disease, chewing gum to control a problem with his mouth. It works for me, too."

    McKenzie said he is fortunate not to be homeless, able to take care of himself and be a productive member of society.

    McKenzie and others like him are examples of how the most successful battles against schizophrenia have relied on sheer force of will and a determination to fight back.

    Schizophrenia is a lifelong illness, but with support and love the very success story portrayed in the motion picture A Beautiful Mind -- in which John Forbes Nash Jr. overcame his affliction to capture the Nobel prize -- can be repeated.

    Congratulations to this Bill McPhee for his personal success story. You can view, and subscribe, to Bill's magazine on the web at


    The Hamilton Spectator
    October 7, 2002 Monday Final Edition

    'I lost my job. I hit rock bottom'; Starting a magazine gave back the life schizophrenia stole

    By: Denise Davy

    When Bill MacPhee was 19 his future stretched before him like an endless horizon.

    He was working as a commercial diver in South East Asia, owned his own home, had a wide circle of friends and looked forward to developing his career. Five years later he was spending his days curled up on his couch in a fetal position. He was often unable to move and used all his energy to keep the voices at bay. MacPhee was diagnosed with schizophrenia and put on medication to control the symptoms. But it took five years to find the proper medication to stabilize them.

    "It's not like breaking your arm and it takes six months to heal," said MacPhee, 39.

    "The medication is trial and error and it takes time."

    Like many who suffer from schizophrenia, his early symptoms of the illness were subtle. Words suddenly floated off the page of a book he was reading. He began to hear voices, sometimes from God telling him he was the chosen one. He saw faces. He became paranoid.

    MacPhee was hospitalized six times during those years, once for a suicide attempt. He lived in three different group homes but always ended up back with his family.

    "I lost my friends, I lost my house and I lost my job," said MacPhee. "I hit rock bottom."

    Then in one of those "meant-to-be" moments, he was connected with Martha Mason, who volunteered with the local literacy council. MacPhee had called there to get help with his penmanship. She saw his potential, not his problems, and got him involved in various volunteer efforts.

    One day while in the library he caught sight of a book about starting a business with little or no capital.

    "As soon as I read it I knew what I had to do," said MacPhee.

    His idea was to start a magazine for and about schizophrenia. He developed a business plan and 18 months later, Schizophrenia Digest was born. The first issue was an eight-page glossy and came out in June 1994. Today, the quarterly magazine is more than 40 pages and has a steadily growing circulation of more than 20,000.

    The magazine is the only one of its kind in North America and has earned MacPhee several awards, including this year's National Media award from the Canadian Mental Health Association. The most recent award was the Golden Jubilee Medal of Queen Elizabeth II, which is given out as part of the Jubilee year celebrations organized by the Department of Canadian Heritage.

    The Golden Jubilee Medal was set up to commemorate the 50th anniversary of Her Majesty's reign as Queen of Canada.

    MacPhee was one of four Niagara residents to receive the award.

    Schizophrenia Digest tackles the tough issues such as taking critical looks at the health-care system and also profiles people who have the illness. A story in one issue called Dealing with Denial, cites lack of insight as the main reason people don't seek treatment.

    It's nice to be recognized for his work, says MacPhee, but it's even more rewarding to be able to link people with schizophrenia and help them in some way.

    Schizophrenia is a brain disorder that affects 1 per cent of the population or 270,000 Canadians. There are many theories about what causes the illness, but the most widely accepted is the over-production of dopamine, a chemical in the brain that acts as a link to the messages being sent to brain receptors.

    The most common symptoms are disorganized thinking, delusions, hallucinations and changes in emotion and behaviour. Symptoms usually surface between the ages of 16 and 25. MacPhee said a stigma still exists around schizophrenia, which makes it difficult for people to integrate into society and become productive. He encountered that stigma when it came to marketing the magazine.

    "I knew it was a great idea but I was always having to convince others it would work."

    MacPhee said the movie A Beautiful Mind did more to increase awareness of schizophrenia than anything in the past 20 years. The movie portrayed the life of John Forbes Jr., a mathematical genius who won the Nobel prize for economics after struggling through 30 years of schizophrenia.

    "So many people feel isolated,' said MacPhee. "It's hard getting back your motivation and getting back into the workforce."

    As for future plans, he hopes to expand into the American market. Once again, the future stretches before him.

    "I realize I'm very lucky,' said MacPhee.

    "My definition of success is the more thankful you are, the more successful you are."

  • Windsor Star
    October 10, 2002 Thursday Final Edition

    SCHIZOPHRENIA: Survival after diagnosis of schizophrenia

    Studies conducted for a 10-year period

    (applies to U.S. and Canada)

    25 per cent completely recover

    25 per cent are much improved

    25 per cent are much improved but require extensive support

    15 per cent become hospitalized indefinitely

    10 per cent commit suicide

    Studies conducted for a 30-year period

    (applies to U.S. and Canada)

    25 per cent recover completely

    35 per cent are much improved

    15 per cent are improved but require extensive support

    10 per cent are hospitalized indefinitely

    15 per cent commit suicide

    -- Source: National Institute of Mental Health

    Vancouver Sun
    October 9, 2002 Wednesday Final Edition

    Mental institutions eroded, new supports needed: Deinstitutionalization has become a catastrophe for families

    According to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, a delusion is "a false personal belief based on an incorrect inference about external reality."

    Ruth Millar of Victoria knew all about delusions. Then, one night in 1998, her son drove a sword through her heart. Aaron Millar, who suffered from schizophrenia, had been living with his mother because she was unable to find satisfactory care for him. On the night of the homicide, Aaron was experiencing delusions and hearing voices warning him that his mother was about to harm the family.

    Unfortunately, the Millars' sad tale is far from uncommon.

    A six-month investigation conducted by the Windsor Star found that Canada's mental health system is on life support: The report noted deficiencies in institutional and emergency psychiatric care, in the availability of anti-psychotic medications and in provincial legislation aimed at coercing patients to take their medications.

    The report also lamented the insufficient training provided to police officers who confront psychiatric patients, and it highlighted the deleterious effect of the violent mentally ill on the criminal justice system.

    Many of the problems detailed in the Star's investigation can be traced to deinstitutionalization, the policy that favours treating patients in the community rather than in psychiatric hospitals.

    Conceived in the 1950s, deinstitutionalization was a response to evidence that confinement in hospitals frequently exacerbates the condition of psychiatric patients because it separates the patients from their loved ones and from community support.

    Provincial governments have embraced deinstitutionalization with a passion -- partly because the closing of hospitals can provide an economic windfall.

    According to the Canadian Mental Health Association, demand for acute care psychiatric hospital beds in British Columbia has been steadily increasing. Yet the number of beds was unchanged from 1986 to 1996, and then dropped in the next four years from 717 to 680.

    However, while governments are pursuing deinstitutionalization, the policy has come under increasing scrutiny. Critics argue that the policy is harmful to patients, their families and society at large.

    As far as patients are concerned, deinstitutionalization has has proven to be just as bad, if not worse, than the ill it was meant to cure: civil commitment.

    The policy arose as a reaction against the often brutal confinement of patients against their will. Yet deinstitutionalization has been implemented in identical fashion: While patients were once forced into psychiatric hospitals, they are now forced out, regardless of how ill or desocialized they have become.

    And in all of this, the patients themselves are not asked what they want, thereby proving that there's a fine line between what we do for people and what we do to them.

    As for family members, the Star's investigation says it all.

    Deinstitutionalization has been a catastrophe for families, largely because governments have been aggressive about ushering people out the hospital doors, but passive about placing patients in the hands of competent caregivers. The end result, as the Millars' story vividly illustrates, is that the patients' family members become the primary, and in some cases, the only caregivers.

    As the Star's report notes, family members are often assaulted and sometimes killed by their mentally ill relatives.

    Although the families of patients may try their best to support their loved ones, they are usually lacking in both the expertise and facilities needed to help someone confronting a serious mental illness. Sometimes love is not all you need.

    And when there is no love -- when patients have no parents or children or siblings who are willing and able to care for them, the streets and the penitentiaries become their homes. Patients who would have been confined in psychiatric hospitals in the halcyon pre-deinstitutionalization days are now languishing in jails.

    The report ought to be taken as a call to action. The rationale behind deinstitutionalization -- that patients do better when they are cared for in a supportive and loving environment than when they are warehoused in an institution -- is solid enough. But all we have done is eliminate the warehousing. The community supports that were once understudies to the institutions have failed to take the stage and the lead.

    If we are to care for the mentally ill and for their families and for ourselves, then we need to be just as aggressive at developing community psychiatric resources as we are at destroying the psychiatric edifices of yesteryear.

    If we believe otherwise, then we are the ones experiencing delusions.

    Windsor Star
    October 9, 2002 Wednesday Final Edition

    SCHIZOPHRENIA: Mentally ill jamming Canadian jails;
    'Internally, externally decaying' system

    By: Veronique Mandal Star Health-Science Reporter

    Canada's prisons are turning into the mental institutions of the new millennium.

    Psychiatric inmate populations have grown by more than 10 per cent a year since the early 1990s and by 2020, experts predict, 75 per cent of inmates will have a mental illness.

    The trend prompted Dr. Richard Schneider, a forensic psychologist, criminal defence counsel now an Ontario judge and two colleagues to brand Canada's criminal code the "Mental Health Act of last resort" while presenting the prestigious Cambridge Lectures in Cambridge, England in 1999. They questioned why populations of the mentally disordered continued to grow while Canada's general arrest rates were falling.

    Today, Schneider blames the tough-on-crime attitude of the 1990s, the reform of the insanity defence and a prison system content to "warehouse" rather than reform its inmates.

    "The model championed by civil libertarians is based upon dangerousness," Schneider said. "We may only interfere with an individual's freedom if he is perceived to be a danger to himself or others. If an individual is not seen as dangerous he is free to roam the streets madder than a hatter.

    "The problem with this dangerousness-based legislation, some say, is that we are not able to determine with any degree of accuracy who should be contained and who should not. We make all sorts of mistakes. False positives and false negatives."

    Prison cells have become the catch-all for people unable to find beds in an ever-shrinking supply of mental institutions. The number of beds in Ontario's psychiatric hospitals dropped to 2,800 in 1997 from more than 5,000 in 1976. A further 2,000 could be lost by 2005 when six of the province's 10 long-term psychiatric hospitals are due to close.

    Dr. Marnie Rice, of the Ontario Review Board, said that in 1992 about four per cent of psychiatric beds were occupied by forensic patients. In 1997 that had increased to 18 per cent.

    "If no more (of the present) psychiatric beds are lost in the province all provincial psychiatric hospital beds will be occupied by forensic patients by 2004," said Schneider.

    Dr. Hyman Bloom, a lawyer and forensic psychiatrist, says Canada's care of the mentally ill is "broken and sorely in need of repair," and the growing number of mentally disordered offenders is "regressive ... and constructed on the failures of an internally and externally decaying system."

    More suicides than murders

    Schizophrenics are far more likely to take their own lives than someone else's. Fourty per cent of schizophrenics attempt suicide and up to 25 per cent succeed, according to the Schizophrenia Society of Canada.

    A Correctional Service of Canada study, released in 1992, revealed that 10.4 per cent of the federal male inmate population suffers some form of schizophrenia (compared to one per cent in the general population), another 29.8 per cent is depressive and 55.6 per cent have anxiety disorders.

    The lifetime prevalence of psychotic disorders was found to be highest among inmates in security units (29.3 per cent). In treatment centres, the rate was 25.3 per cent.

    Windsor Star
    October 8, 2002 Tuesday Final Edition

    SCHIZOPHRENIA: Widower demands the right to know

    By: Veronique Mandal Star Health-Science Reporter

    Ramsay Millar is telling parents across North America to demand information on their children's mental illness, because not having it killed his wife.

    Ruth Millar was stabbed to death in her Victoria, B.C. home by their 24-year-old son in 1997. Had she known he was schizophrenic, her widower says, steps could have been taken to safeguard the family. "This happens far too often and it's totally absurd that parents, who are on the firing line to be hurt, are never told how serious their child's condition is, what medications they're on and what precautions they should be taking," said Millar, a computer consultant.

    Doctors go too far in refusing to divulge diagnostic and treatment information that could prevent harm to the mentally ill person and family members, Millar said.

    "I don't think they want to give us the information but their thinking is backward and one day the issue will ultimately be settled by families in a class action lawsuit. There is a section in the patient confidentiality manual which gives us the right to know."

    That section is Article 22 of the Canadian Medical Association code of ethics, which states: "Respect the patient's right to confidentiality except when the right conflicts with your responsibility to the law, or when the maintenance of confidentiality would result in significant risk of substantial harm to others or to the patient, if the patient is incompetent; in such cases take all reasonable steps to inform the patient that confidentiality will be breached."

    Doctors knew three years before Ruth Millar died that her son, Aaron, had paranoid schizophrenia. "I was also not notified when he talked about suicide and tried it a few times," said Ramsay Millar. "He saw 11 psychiatrists over two to three years who said he was OK and did not put him on a treatment plan. He only received treatment when he got in trouble with the law."

    Dressed in camouflage gear and wrapped in tinfoil, Millar's son cut satellite cables at a Victoria newspaper and TV station, believing it would block messages from aliens. He was catatonic and talking gibberish.

    Unable to find residential treatment for Aaron, Ruth took him in. But one night, while she was doing the supper dishes, Aaron lapsed into a psychosis in which he became convinced Ruth was evil. He pulled a ceremonial sword from the wall and killed her.

    Ramsay Millar, now living in Portland, Ore., has become a crusader for the mentally ill, speaking openly about his wife's murder, lobbying governments and making documentaries in Canada and the U.S.

    Today, Millar's son is stabilized on the drug clozapine and remains under scrutiny of the B.C. Review Board, which oversees that province's mentally ill offenders. He working as a mechanic and teaches snowboarding.

    Dr. Jeff Daskalakis of Toronto's Clarke Institute, supports parents' right to information. "It's a cornerstone to treatment. If a family member is kept in the dark and cuts the loved one off because he won't seek treatment, it shuts the patient out of that family and alienates the person from society," said Daskalakis.


    According to the Ontario College of Physicians and Surgeons, a doctor may give information about the condition of a patient, or any services provided to the patient, to "the patient's authorized representative, health professional for the purpose of providing care to the patient or for the purpose of research ... if they reasonably believe that the person will protect the patient's identity."

    Vancouver Sun
    October 7, 2002 Monday Final Edition

    Families of mentally ill pay terrible toll: Psychiatric patients are killing and assaulting their families at an alarming rate

    By: Veronique Mandal

    The sturdy oak bar snaps snugly across the door leading to Robbi-Lynn Jessop's bedroom. Her parents, Bob and Pamela, place it there each night to prevent their daughter from killing them.

    Once a gifted student at Riverside secondary school in Windsor, Ont., Robbi, 18, has for two years spiralled into the deepest abyss of schizophrenia. In 2000, she tried to set the family home on fire. Last year, she admitted to visions of stabbing her parents and two sisters, arranging their bodies liked toppled dominoes in a pool of their own blood.

    Unable to find a residential treatment centre for their daughter, the Jessops took the extraordinary step of barricading Robbi's bedroom each night and taking turns standing watch. Where once they lovingly tucked her in, now they fearfully lock her in. "Right now there are nights when I am so mentally tired I want to say, 'Here Robbi, here's a knife, just to put an end to it,' " says Pamela Jessop. "If only we could get proper help for her, things might be different. But the system sucks and if you're mentally ill, God help you."

    And God help your parents, siblings, husbands and wives.

    Forced to provide their children with the love and sanctuary no longer available in institutions, the families of Canada's mentally ill are paying with their lives.

    Assembling court transcripts, coroner's inquest reports and other archival records, a Windsor Star investigation has documented more than 130 murders and murder-suicides across Canada since 1997 in which mental illness played a prominent role. They occurred in a five-year period while Ontario, B.C. and other provinces were stepping up campaigns to close mental institutions and treat patients in the community.

    Psychiatric patients are assaulting and murdering their loved ones at an alarming rate, with family members the victims in three out of four killings committed by the mentally ill, the Star has found.

    The six-month Star investigation into mental illness in Canada, particularly schizophrenia, the most chronic and debilitating of the diseases, uncovered:

    - Critical gaps in institutional care, particularly 24-hour emergency psychiatric care, undermined by a lack of psychiatrists and delays in psychiatrists responding to calls.

    - Deficiencies in provincial laws aimed at forcing the dangerously mentally ill to take medication.

    - A staggering increase of mental illness in the criminal justice system, with a commensurate rise in the use of the insanity defence, particularly in Quebec.

    - Restricted access for many schizophrenics to the most effective, and costly, anti-psychotic drugs.

    - Inadequate training for most law enforcement officers confronting the mentally ill, who die at the hands of police at the rate of about two per year.

    Four years ago, Ruth Millar, 49, of Victoria, couldn't find suitable treatment for her schizophrenic son Aaron, 24, so she took him into her home. One night, as Ruth was doing the supper dishes, Aaron, tormented by voices which told him Ruth was going to harm the family, plucked a ceremonial sword off the wall and drove it through her heart.

    A coroner's jury, created for the inquest into Millar's death, called for immediate funding for a day hospital in Victoria for psychiatric patients and that money should be provided to staff an assertive outpatient and outreach program.

    Although charged with second-degree murder, Aaron was found not criminally responsible by a B.C. Supreme Court justice and he spent more than two years in the Forensic Psychiatric Centre in Coquitlam.

    In a 1993 case predating The Star's investigation, a 79-year-old Vancouver woman was murdered by the son of her nephew after she took him because he had nowhere else to go.

    Mark Andrew Bottomley, then 24, was charged with second-degree murder after Kathleen O'Sullivan's partially clad body was found in the lane behind her basement suite early Christmas Day. He pleaded guilty to manslaughter in September, 1994.

    Mental illness was unequivocally established as the cause in 108 of the killings since 1997 examined by The Star. These included murders in which a court found the accused not criminally responsible due to a mental disorder -- the former insanity defence -- and murder-suicides in which mental illness was found to be a determining factor. In these cases, 80 of the 108 victims were related to their killers by blood or marriage.

    A further 23 victims were friends, neighbours, employees, roommates or fellow residents of an apartment or rooming house, meaning that in 103 of the 108 killings, the assailant and victim knew each other. A scant five cases were random.

    The most recent case occurred about two weeks ago in Lorraine, Que. Andre Letellier, 30, whom neighbours said had a history of schizophrenia and roamed the neighbourhood singing and talking to himself, killed his parents and hanged himself.

    Many of the victims had opened their homes and hearts so their troubled loved ones could get well. Twenty-seven of the victims were parents or grandparents, ranging from middle-class Montreal suburbanites to the town historian in Smoky Lake, Alta. Their killers often led deceptively routine lives -- honour-roll students, gifted athletes, kids who paddled canoes and peddled newspapers.

    "He was cheerful, witty, unassuming," mourner Perry Anglin said of Geoff Fertuck, a 35-year-old schizophrenic who stabbed to death his parents, Ed and Margaret, before throwing himself in front of a freight train in the Montreal suburb of Beaconsfield. "He was so tender and gentle and full of self-doubt that he didn't realize what a terrific person he was."

    A report recently issued by the Quebec coroner's office said Fertuck was found to be schizophrenic in August 2000 while he was being treated for depression. In January 2001, a psychiatrist told Fertuck's parents it would be dangerous to keep him at home. But they decided to keep looking after him while his condition was monitored by a psychiatrist and a social worker.

    On May 16 of that year, the three were found dead.

    A 911 call on the night of June 13, 1997 captured the horror of 11-year-old Kenny Meehan as he witnessed his father Joseph, 43, nearly dismember his younger brother Michael, 8, in their Toronto home. Suffering what psychiatrists called either bipolar disorder or a form of schizophrenia, Joseph Meehan fell under the delusion that his son was the devil.

    "My dad's killing my brother," Kenny told the 911 operator. "He's got blood all over him ... I'm gonna die. He looks so sick. He was strangling him. Oh, my God ... I think he's not alive."

    Two years ago, a Toronto court ruled that mental illness rendered truck driver David Patten, 45, not criminally responsible for the bludgeoning death of his parents Manus, 81, a retired garbageman, and Clare, 73, a retired nurse, with whom Patten lived. He beat them in their driveway with a red-handled spade.

    Patten thought he was the "leader of the British Army" heading into the Third World War and could avert the conflict by killing the devil possessing his parents, according to court records.

    "He thought he was killing the devil inside his father and that his father was still alive and the devil was then transferred to his mother, so he killed her," testified Dr. Graham Glancy, a psychiatrist who estimated Patten suffered from mental illness for more than 20 years, perhaps since Grade 8.

    Schizophrenics often perceive their caregivers as enemies because they enforce difficult rules. Under a new Ontario law, designated decision-makers -- typically parents -- can obtain the legal authority to hospitalize their children or force them to take medication that often carries unpleasant side effects such as weight gain.

    Many of the killers in The Star's investigation were defying court orders to take their meds, often in the belief that because their symptoms had subsided, they were cured. Typically, the assailant experienced a quick snap into psychoses, striking out as if in a trance. Many heard non-existent voices which cast their victims as NASA spies, satanic agents or seven-foot monsters.

    "It's a very common story to hear that the victims have been parents or someone close to the mentally ill person" said Dr. James Young, Ontario's chief coroner. "Family members are seen as the enemy, the people who call the police, take them to hospital or seek a court-ordered admission."

    The cases involved some of the most brutal attacks this country has seen -- bizarre acts of dismemberment, decapitation and cannibalism. In a 1997 murder in Toronto, Gregory Workman, 44, said he stabbed his mother Noel, 77, five times in the neck, chest and back because he believed he was a surgeon carrying out a medical procedure.

    "I lost my mind, and two people lost their lives," Brian Eugene Wessel, 30, told a Regina courtroom in January 2001 after pleading guilty to manslaughter in the deaths of his wife and brother-in-law in Fort Qu'Appelle, Sask. Four days after his supply of anti-psychotic medication ran out, Wessel cleaved the pair in their sleep.

    It's the nature of psychosis that the mere act of killing isn't enough; a ritualistic climax is also required to quiet the voices, said Dr. John Bradford, a leading Canadian expert on criminal insanity.

    "The mind is so disordered the person acts in a frenzied rage, often with amazing strength," said Bradford, head of forensic psychiatry at Royal Ottawa Hospital. "If the mind is convinced the victim is a demon you can imagine how desperate the person is to get rid of such a threat. It's very sad but not unusual."

    Family peril was the key finding of a Star investigation into mental illness in Canada -- particularly schizophrenia and its close cousin, bipolar disorder -- prompted by the April 9 killing of Windsor heart specialist Dr. Percy Demers. Earlier that day, Demers was unable to get his mentally ill son Thomas, who had stopped taking his medication, admitted to hospital.

    Thomas Demers is charged with murdering his dad.

    The mental health establishment has long asserted that psychiatric patients pose no greater threat than the general population. However, a growing body of evidence suggests that those not taking their medications -- and the estimated 10 to 15 per cent who do not respond to treatment -- are prone to violence.

    A recent study by the American Psychiatric Association, cited by Bradford, showed the risk of violence is six to seven times higher among people with major depression or schizophrenia. The risk rises to six to 12 times higher in schizophrenics who drink alcohol and 35 to 40 times higher for those on cocaine.

    "Unfortunately there is a correlation between severe mental illness and violence," said Bradford. "Up until the early '90s psychiatrists played down the fact there was a relationship because we were worried about the stigma to patients."

    Clearly, families and friends are shouldering more of the burden of caring for the mentally ill. Over the past 30 years the number of mental-health beds in Canadian hospitals has dropped by more than two-thirds, to 15,011 from 47,633.

    Meanwhile, the mentally ill represent the fastest growing segment of Canada's prison population, with estimates that by 2020, more than 60 per cent of people with schizophrenia will have a criminal record.


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