Chapter Two: Was he born that way?

When he was little, he had lots of friends …but they gradually faded away. Now, none came to the house after school.

“So. Was he born that way?”  A friend was asking me about Matthew. Her question gave me pause. The answer is layered and complex, like the disease itself.

The short answer could be: “yes,” “no,” “maybe,” “probably,” or “it depends.”

In fact, it is all of the above.

Confused? Join the club!

Her question made me realize that there is very little public awareness about schizophrenia, or SSD, in Canada.  

Schizophrenia is a sneaky, malicious illness. Unlike other serious childhood diseases, it does not show up when the baby is born or in early childhood. Instead, it lies there, patiently waiting – a sleeper mole in spy terminology – till the time is right to emerge and wreak havoc on the unsuspecting victim.

I have often called schizophrenia the cruellest illness because it appears out of nowhere just as the young fledglings are beginning to stretch their wings and take flight. Schizophrenia stops them dead in their tracks. They don’t get to practice and make perfect all their early attempts to soar into adulthood. They get stuck at age 17.

Neither the kid or the parents see it coming. It just arrives, one day, and hits the young adult right between the eyes. Literally.

About one percent of the population will develop schizophrenia. It occurs world-wide, regardless of gender, race, ethnicity, or economic status.

The one percent is an average. If you have a close family member with the disease your odds of getting it are much higher than one in a hundred. I know a very brave parent who has four sons. Three of them have developed schizophrenia.  

So, was he born that way? The answer seems to be “yes.”  Schizophrenia is classed as a genetic inheritance disorder. It runs in families. In fact, according to information in the National Library of Medicine, schizophrenia is known to be as much as 90% heritable. In my family there were members with illnesses that matched some of the symptoms of SSD.

But is it genetics alone that cause this disorder? Are there other factors that might bring about the disorder? Perhaps not everyone with a certain set of genes will develop this disorder. In the Nature versus Nurture debate perhaps there are other circumstances that might be the tipping point that triggers the disease.

For example, there are prenatal environmental factors that have been cited and researched as possible causes or triggers for schizophrenia.

When I began to research schizophrenia, I learned that an unusually large number of people who develop schizophrenia are born in winter. The theory is that there might be a prenatal virus effect that triggers the disease to hit a couple of decades later.

Matt was born in January of 1971. We had just moved to Toronto the summer before. I remember that first winter in Toronto very well. It was snowy and cold. My little girl, Julie, who had just turned one, had caught a bad cold. I recall December nights sleeping on the floor in her bedroom, worrying and listening to her difficult breathing.

Along with prenatal viruses, birth trauma is mentioned in texts about schizophrenia as another possible contributing factor.

There was a birth event that happened when Matt was born. When my labour began, I went immediately into North York General Hospital. I was given a couple of medications that made me drowsy. I think one was a tranquilizer. But Matt’s birth was held up for what seemed like hours but was probably around 30-45 minutes. Eventually they wheeled me into the delivery room, but there was no sign of the doctor. Everyone kept stalling and hanging around and busying themselves around the delivery table. Time seemed to stand still. We were all in limbo. Nothing was happening.

Then suddenly there was activity! I have a vivid memory of Dr. C. (an Obstetrician and Gynecologist) arriving, all out of breath, and taking off his galoshes. Someone mumbled something about him needing to finish a squash game. At any rate, an epidural was given, which gave me relief, and my son was born. Someone gave him to me to hold in my arms. I can still see him today as I saw him then. His dark eyes were wide open; he wasn’t crying, just looking at the bright delivery room lights. My first thought was how thoughtful he looked.

There is now a study run by the BC Children’s Hospital, called “Birth, childhood health and psychosis.” The goal is to find out the prevalence rate and types of pregnancy complications and early life events that may have contributed to the emergence of psychosis in patients with SSD. I wanted to participate but the cutoff age for patients is 45, and Matt is in his 50s now.

Apart from possible prenatal and birth trauma events, there is an environmental factor that has recently come to light from a veterinarian at UBC. He was warning people about letting their pet cats outdoors. Apparently, they can get a parasite which can cause certain illnesses in humans. The vet specifically mentioned schizophrenia! I was astounded.

We did have a much-adored cat! And she was an outdoor cat. She was with us for most of my kids growing up years.

So, genetics aside, Matt may have been set up as a candidate for the disorder, both before, during and after his birth.  Of course, I didn’t know any of that then. We were just overjoyed with a healthy baby boy.

Matt was pretty normal as babies go. My journal entry for February 3, 1972 describes my one-year old boy:

Matthew has such a happy Alfred E Newman smile. He has rosy cheeks, blue eyes with mischief in them and honey-coloured hair. He has a fantastic arm already and loves to throw things. He also loves apple juice, his sister Julie, and hitting things that make a noise.

Until Matt became sick, I had always thought that he and Julie had “normal” childhoods. They went to the local public school, which had a good reputation and great teachers. They liked school and did well academically.

Matt loved sports and was a keen athlete. He played hockey in winter and baseball and soccer in summer.  Baseball became “his” sport and was a happy confluence of circumstances: It was a sport he excelled at, it was his Dad’s favourite sport, and he had excellent coaches. Matt played in the select league in North York, Ontario, for several years. He was popular with his teammates and also his coaches, who would take us aside and tell us that they really liked having Matt on the team. They said he was “coachable.”

Growing up, Matt had lots of friends and made friends easily. He was self-confident and energetic and competitive and popular.

But when I began to research SSD and its possible causes, I discovered that there is an anti-psychiatry movement that insists that schizophrenia is caused by terrible emotional upset and traumatic events that happened in childhood.  They deny that the illness might be genetic and insist that bad parenting is to blame. Family blaming, and in particular, mother blaming, has done nothing but cause extra grief for families with children afflicted with this disorder.

I was racked with guilt by this revelation. Did we cause it? What could we have done differently? I spent many sleepless nights recounting in detail every upset and disappointment over the course of Matt’s childhood.

Was it because we didn’t give him the Holly Hobby Easy Bake oven he wanted for Christmas when he was four? I still haven’t forgiven myself for that. We did get him an Evil Knievel and a Smash Up Derby car toy, but we were caught up in gender stereotyping and sensed that an oven was not for boys. We gave it to both Julie and Matthew to share.

Was it because we moved into our first house just as he was entering Grade 7?  We didn’t think the move would be particularly upsetting for either of our children. We were still in the same school catchment area. They still had the same school friends and invited them over as before. But Matt missed his old neighbours who lived right next door and who used to play road hockey on our street. We didn’t realize the impact that moving away caused him.  However, much later, in a high school essay, he wrote that after settling into the new house and getting to know the new neighbours’ kids, he felt that they were the best friends he could have ever wished for.

Maybe it was the car accident he had shortly after getting his driver’s licence. Car accidents are traumatic, and maybe that triggered the awful illness that was to appear a few years later. He never drove again.

If there was one adjective that could be used to describe Matt from the moment of his birth, it would be “intense.” I remember clearly his kindergarten teacher telling us that Matt would be good at business because he was very  … assertive? dominant? focused? insistent? persistent? self-confident? I don’t remember the exact words she used, but he was all of these. His grandfather used to say that he would make a great lawyer because he could argue a point to get what he wanted.

I’m not sure if this qualifies as a traumatic incident, but certainly, around puberty, he began an intense yearning to go to a private school.

He wanted it desperately, extremely, fiercely. After grade 7, one of his two closest friends went to an excellent private school in Toronto – Crescent School.

We decided not to send him there. It was very expensive, and since we were in the catchment area for two schools which were among the best-reputed public schools in Toronto – Windfields Junior High School and York Mills Collegiate. We thought, why not use them? In retrospect, perhaps we should have made the necessary sacrifices and sent him to Crescent.

That said, I do not think that not sending him to a private school caused this very serious brain disorder, and I don’t think that sending him there would have prevented the illness from descending upon him.

But the private school milieu might have mitigated it. Maybe he would have had more friends, more of a social life. At least he would have still been with his close friend and it would have been one less disappointment for him to deal with. We will never know.

This is by way of painting a picture of a fairly typical normal home and household in our North York neighbourhood. Nothing special, but comfortable, with working parents.

While Matt settled in and seemed to be functioning well, in retrospect, there were warning signs that we should have seen but didn’t. Moving from junior high into high school, suddenly, there weren’t many friends coming around. When he was little, he had lots of friends, but in his teen years they gradually faded away. Now, none came to the house after school.

We didn’t know why. We were concerned, but we had no idea that this new, strange, out-of-character behaviour might be a warning signal that something was wrong … something medical.

In Canada there is a complete lack of public awareness about schizophrenia. SSD affects one in one hundred of our young people in their mid-to-late adolescence. It completely devastates their lives. It causes torment and anguish with their parents. It causes emotional scarring among their siblings that may never heal. It can, and often does, destroy entire families.

Public awareness programs could have helped alleviate much harm to Matthew and to our family.

Chapter One: Something’s Not Right

The only official diagnosis that I, as his parent and closest relative, have been privy to is schizoaffective disorder. And even then, it was just a fluke that I learned of it.

Before Matt’s hospitalization in 2004, I didn’t know much about insanity. Obviously, I had heard of the word before, but I didn’t really know what it meant.

The problem with insanity is that it’s hard to put your finger on it – to define it precisely. Much of the time you don’t know what you are dealing with. You just want it to go away.

But when you live with it, when it’s in your face 24/7, then you finally figure out that something’s “not right.”

That’s what my dad used to say about my sister when she suddenly returned home after working in San Francisco for more than two decades.

“Carol’s not right,” he would say.

Carol became extremely ill in her thirties. She had been super successful, a Canadian-trained nurse, an RN, living the dream in San Francisco. She had a great job, lots of friends. She was talented and musical and had personality galore. But she was caught in a downward spiral of mental illness and alcoholism that finally burst the dream and blew up her life.

At first, Mom and Dad were hopeful. They would say, “She’ll come around. Give her time. She needs to take a course to update her nursing skills, to let her work in Canada again.”

When that didn’t materialize, they thought maybe she could get a job at Safeway. But then they said she worries about the cash register. She didn’t think she could do that.

Days, weeks, months, and years rolled by. Nothing changed.

Her illness shattered the dreams of my elderly parents who were hoping for a nice retirement, but who saw no way out of the predicament they were in. They were suddenly being parents again, living with their adult daughter, and supporting her, as she had no income and no hope of ever having an income.

My Dad’s sister, my aunt Hazel, was “not right” either. When I used to tell people about her, I would say that she had schizophrenia. I don’t know that for sure. I don’t know where I got that from. I didn’t even know what it meant. Maybe I overheard mom and dad talking. At any rate, I have no evidence of a diagnosis. Now, decades later I am thinking, maybe she was bipolar. Bipolar disorder is also a very serious brain disease. Or maybe she had schizoaffective disorder. I am sure that we will get a better handle on these horrendous diseases someday.

But, in a way, it really doesn’t matter. It’s only a label. These disorders are probably all the same illness, manifesting itself in slightly different ways, based on severity, familial background, and life experience.  To keep things simple, I will refer to these disorders as schizophrenia spectrum disorders (SSD).

Auntie Hazel made a deep impression on me when I was growing up. She lived like a recluse in an old house that had no electricity. She had candles and walked around with matches in her hair. She played the piano and used to teach piano before the demons took over completely. I liked her. She came to our place one day and sat down at the piano and played wild dark crashing music, her own compositions. My mother said “All she ever eats are potatoes.” My sister said, “She’s nuts.”

My mother said that Auntie Hazel hated her. It all started when Mom and Dad got married and Mom moved into the family home. My grandfather and Hazel and my Dad lived there. So Mom was an interloper. When my grandfather died, the relationship worsened and finally Dad and his brother bought Hazel a house. It was then that she became a recluse. She would have been about 30.

I used to go over to her house and peek through the hedge. There was always a window open upstairs. People said it was because she was waiting for her long-lost lover to come back and marry her. I thought it was romantic.

Sometimes the kids would torment her. Stupid stuff, like throwing stones in hopes of breaking a window, or yelling at her. But nothing really awful happened that I know of except for the most awful thing of all, which is living a life with untreated schizophrenia.

She lived on her own for decades. She was finally admitted to the mental hospital in Selkirk, Manitoba. She died in 1969 at about age 71.

It is simply awful and unbelievable that in this country, people can be born, develop a serious illness and die in poverty and pain and starvation with mice and rats and bugs and goodness knows what, and no one really gives a damn.

But what is much worse is that it’s still true today. Almost a century later. We still don’t give a damn. 

My father’s other sister died suddenly in her sleep. While I was never told, there were hushed whispers of an overdose of sleeping pills. Two cousins, again on Dad’s side, died by suicide and another cousin attempted suicide with tragic results. His son, my first cousin once removed, is close to me in age and we correspond with our shared interests in genealogy and life in general. He has two sons, both with autism. He and his wife know very well the distress and pain and heartache of caring for very ill children.

But while I knew all this, I didn’t pay much attention, till my son got it.

With my family background I should have suspected it way earlier. I should have been the first to know. Insanity tends to run in families.

So, what is insanity? And how do you know if you’ve got it?

At present there are no blood tests for SSD although recently there has been a much-welcomed breakthrough at the University of Indiana. Similarly there are no definitive MRIs or mammograms or x-rays that could confirm a diagnosis. Not yet anyway. There are promising signs that scans can reveal subtle brain changes that may eventually help with diagnosis, hopefully early enough to mitigate and minimize damage to the brain. 

The main sign that something might be wrong is termed “bizarre behaviour.” This is behaviour that is not “normal.”

Thus: It is not normal to lie down on hot pavement on a city street and refuse to move. Or dash into traffic and bounce off a few cars while your parent watches horrified and frozen. It is not normal to disappear all night and be found early the next morning talking to the neighbour’s car. It is not normal to wear winter clothes on a hot summer day. It is not normal to unplug the fridge because of the noises it makes. Or be fearful of turning on the TV because certain channels are … bad. It is not normal to pronounce that all doctors are idiots while demanding that the parent send them to Duke University. It is not normal to burn through tens of thousands of dollars using credit cards up to and far past their limits.  It is not normal to check in and pay for four different hotels, all on the same night. It is not normal to eat nothing but watermelon and sleep standing up, till your legs swell up with edema. It is not normal to decide to abandon your life and vanish without a trace. 

Matthew has done all of these things.

Ah, but so what? The anti-psychiatry zealots insist that we stop “medicalizing” people whose behaviours are merely eccentric. Quaint. Outside the norm. They just are living life as they wish, and we don’t have the right to interfere. We, the worried family and friends, shouldn’t judge them by our own standards of how one should live a life.  

And of course, this sounds eminently reasonable, and perhaps in some cases, it could be true.

But, in addition to being not normal, people with schizophrenia are also not rational. They are not in touch with reality. They see and hear things that we do not. Their perception of their environment is different from ours. They interpret signals from the environment differently from what is really happening around them. This causes them to experience what the texts cruelly call the “positive symptoms” of schizophrenia: The delusions, the grandiosity, the tangential reasoning, the hallucinations. 

Their behaviour should set off alarm bells. It should signal to others that the brain isn’t working the way it should. But it doesn’t at first, because no family is prepared for schizophrenia. They think it’s just John or Maggie acting bratty or weird. Sometimes – most times – the parents yell and chastise and shout and tell the ill person to smarten up. They say unhelpful things like “Get off your ass and get a job!” Or not say them, and lie awake at night wishing they had the courage to say them.

When things get worse, sometimes parents order the offending person out of their house. This doesn’t happen easily or quickly.

A friend said that his son tried to kill him before he realized that something was wrong. In my son’s case, we had to call 911 to raise the problem to the surface so that we and the authorities could deal with it. I still remember that day as one of the worst days in my life. It’s not the only worst day though. There have been many worst days. And perhaps a new worst day is still yet to come. 

There are three sets of symptoms that describe schizophrenia. Not all patients experience all of the symptoms.

They are: the positive symptoms, the negative symptoms, and the cognitive symptoms.

The positive symptoms are the hallmark indications of schizophrenia and the most well known. They cause the brain to misinterpret reality which produces the bizarre behaviours mentioned above. The symptoms include hallucinations such as voices, delusions such as the KGB is following me, and disordered thought. This condition is also called psychosis. The brain isn’t working properly. 

The negative symptoms are often the ones that friends and family notice first. There is sudden apathy, listlessness, lack of motivation, social withdrawal, inability to take pleasure in anything, lack of communication with friends and family. The ill person is not friendly and becomes reclusive. The negative symptoms are, in many ways. the worst and most harmful, because they can and often do cut off ties with family and friends.

While negative and positive symptoms are usually the most commonly described and noticed first, it was the cognitive symptoms that Matt noticed first. He came home from university one summer and said he has “lost his intelligence.” He said he could not longer think right anymore. This was more than a decade before cognitive impairments officially became a core feature of schizophrenia. He knew something was wrong with his brain. In fact he was so convinced that he bought a train ticket to New York and purchased a CT brain scan because he couldn’t get one in Kingston “in time”.

With Matthew, the delusions and the voices and the complete social collapse followed, but very slowly. This is called insidious onset and it’s bad because family doesn’t really know until much damage has already been done. 

I’m writing here about how schizophrenia manifested itself in my family. Every family with schizophrenia will have their own horror stories and anguish. My hope is that just knowing you’re not the only one will help ease the pain and allow rational thought to guide you.

His diagnosis? At one point or another he has exhibited symptoms of many of the disorders described in my copy of DSMIV.  Hallucinations. Paranoia. Delusions. Grandiosity. At times he seems persecuted, frail and needy. Anxious. Fearful. Anorexic. Hypochondriacal. Then he becomes imperious, dismissive, sneering, arrogant. Manic. Driven. Obsessive. Always intensely private. There were phases where he exhibited overly formal, almost courtly, mannerisms. He has been dangerously absent-minded and impulsive. There are often strange disconnects from reality when discussing current situations. Poor choices that make bad situations worse. Self sabotaging. Deliberately forgetting appointments. Calls and hangups. Self-harming behaviour looms large at times. The words jump out of the pages, all descriptive of Matt.

The only official diagnosis that I, as his parent and closest relative, have been privy to is schizoaffective disorder. And even then, it was just a fluke that I learned of it.

But I now know that Schizophrenia Spectrum Disorder (SSD) is far more serious than “something’s not right”.  It is the most serious and deadly of the brain disorders. To our shame, SSD has been ignored and under-treated for most of its history.

I still find my son’s illness hard to accept, even now, more than three decades after onset.

So how did it happen? When did it happen? How did we find out? How did he get to this diagnosis from the happy bouncy baby boy that graced our lives when he was born?

Introduction to my Memoir on Schizophrenia Spectrum Disorders

I am writing this memoir for two reasons. In no particular order, they are:

– to try to help the friends and family of people living with serious mental illness (SMI) by sharing my experiences and information and tips that have helped me to cope.

– to chronicle the many ways Canadian society is failing people with SMI and their families.

I had known for years that something was wrong with my son. While at first, I thought he was just being awkward — a rebellious adolescent — I soon realized that it was more than that. There was definitely something wrong with his thinking – his brain.

I felt relieved and vindicated when he was admitted to St. Michael’s Hospital in Toronto in 2004. Finally, doctors and nurses and the healthcare system in Canada will be able to help him!

And I was completely devastated when a few days later he was turned out onto the streets with no further supports.

But I quickly learned that Canada has been kicking this can down the road — ragging the puck so to speak — for decades.

“In no other field except perhaps leprosy has there been as much confusion, misdirection and discrimination against the patient as in mental illness.”

I am quoting former senator Michael Kirby here, who wrote this in a column for the Globe and Mail in 2008. Mr. Kirby’s mission was to document and report on the state of mental health in Canada.  He and his committee crisscrossed the country conducting their research and extensive interviews. In 2006, they produced a report: Out of the shadows at last. (The actual quote was lifted from an earlier report on mental illness that had been published in 1963. So, Canada has been thinking about the mental illness situation for more than half a century.)

Since he wrote it, nothing has changed. In fact, it has gotten worse. Having a serious mental illness in Canada today is worse now than it was in 1963, and even worse than in 2006.  Back then, there were mental hospitals that took care of our very ill citizens.  Canada’s psychiatric hospitals are pretty much all closed now, except for the forensic ones.

Jails, prisons and downtown streets are the new leper colonies for warehousing the mentally ill. Those with families get some attention, but that depends on the relationship. To paraphrase the quotation above: Not since we cruelly shunned and expelled people with leprosy, have we, as a society, treated people so terribly as we do those with serious mental illness.

We have been spending a great deal of time and money pretending that we are doing something about it. But we continue to implement legislation and policies and programs that actually harm people with mental illness.  

People with serious mental illness die on average 25 years earlier than others in their cohort. Some die from neglect, others from physical illnesses that have gone unnoticed and untreated, and still others – about 14% — from suicide.

And as I write this, our federal government is about to make suicide much easier for the desperate and despairing mentally ill. Medical Assistance in Dying (MAiD) for people whose sole medical condition is mental illness is set to become legal in Canada in March 2024.

So how did we get here to this callous state? This is Canada – a wonderful country, arguably the best country in the entire world – but we treat our seriously mentally ill people worse than we treated lepers in the last century.

We have reached the point where we blithely go about our business, ignoring the complete mess we have allowed to happen in front of our very eyes.

Terrible cases jump out in the national headlines and briefly grab our attention, then fade…

Stabbings, shootings, subway suicides, subway homicides, cannibalism. Tent cities pop up in our parks filled with homeless, self-medicating people who are not rational.

Welcome to public urination and defecation, crime, arson and death.

Burbling along in the background, maybe not in headlines but happening nonetheless, there are the back stories. You have to be aware to notice them. For example:

In Ontario, we allow a clearly insane man to starve himself, in isolation, for over 400 days — in a hospital of all places — because he refuses treatment for his insanity. 

In Ottawa a suicidal teen is turned away from CHEO, and told that there is a 500 day wait list to get an appointment with a mental health professional.

In Toronto a hospital Emergency Department refuses to admit a depressed man who presents at their hospital emergency department and tells staff that he wants to kill himself. He is given a phone number for a crisis hotline and sent away. His obituary is heartbreaking.

In Vancouver, six people per day die from drug overdoses. Naloxone kits are everywhere. Signs in pharmacies admonish people to “Save lives, learn how to administer naloxone.”

In Hamilton, there were three separate murder trials in a three-month period where the perpetrator was termed NCR:  Not Criminally Responsible due to a mental disorder.

In many cities, people are frightened. Nobody goes downtown anymore. “Parricide” is new word I learned when researching the results of untreated mental illness.

I have no desire to terrify people nor do I wish to increase the stigma that goes with mental illness.

The reason that these horror stories can happen in a country like Canada is not rocket science.

The cause of much, if not most, of the homelessness, crime and social disorder occurring in Canada right now due to people who are living with untreated mental illness.

Some have not been able to access treatment, others have had their treatment discontinued, and many others have gone off their treatment for a variety of reasons. Still others, about 26% according to the Mental Health Commission of Canada, have simply not asked for help. “They prefer to handle it themselves.”  Oh well then, nothing to see here folks.

I contend that there would be far fewer crimes committed by people who are found Not Criminally Responsible if they had received proper treatment for their disorders in a timely fashion.

So far this century, our response has been to close psychiatric hospitals and refuse admission to psychiatric emergency wards in general hospitals because there aren’t enough beds.

In BC we have added exactly one net new treatment bed a year since 2012, for a total of 11 at the time of this writing. 

Doctors quake in fear of our privacy laws and disability rights laws which seem to trump science when deciding how to incorporate family support into the care of insane people.

Doctors are hesitant to help patients fill out the incomprehensible forms needed to apply for a disability tax credit. It is difficult and time consuming and too often the claims are rejected out of hand. Some with the money and time, go to court to try to get the DTC designation.

During the 2021 election the federal government promised $4.5 BILLION dollars for mental illness.  Not one penny has been seen by me or my loved one.

Meanwhile, Health Canada posts information on their website describing cannabis as a known trigger causing psychosis and schizophrenia in young people. Elsewhere on the same site, they helpfully advise readers where to find stores that sell cannabis, by province.

You can’t make this stuff up. Makes you wonder who the insane people are.

But back to insanity. What, exactly, is it, and how did Matthew end up with it? How and when did he finally get diagnosed?

Preface

Note to readers: From time to time I chronicle the state of schizophrenia spectrum disorders (SSD) in Canada. My son lives with this disorder, some of the time quite successfully, managing the symptoms and living independently with family support. But there are times when the disorder makes it hard or impossible for him to manage his life. I have been writing about this horrid brain disorder and how it has affected our family for decades. I am writing a memoir on the subject. It is a work in progress, and thus far it is untitled. From time to time I may post excerpts as I create them. Follows is the Preface to this memoir.

It was 6:00 a.m. Vancouver time, February 2nd, 2004. We had just gotten up when the phone rang.

“Who could be calling at this ungodly hour?” I wondered. The call display showed a 416 area code.

When I answered a woman’s voice on the other end said, “This is Dr. Goldstein. I’m a psychiatrist working at St. Michael’s Hospital emergency department in Toronto. Do you have a son, Matthew?”

My heart stopped. I sat down and said, “yes.” I was shaking.

This was the moment I had been dreading for more than a decade. I didn’t know what was coming next. I feared he was dead.

Aside from a brief visit at Christmas we hadn’t seen Matthew for more than a year. He had vanished and we didn’t know where he was.

The doctor was very good. She reassured us that he was alive, but not in good condition. He had been found unconscious in a hotel room and brought into hospital in an ambulance. She didn’t use the word suicide, but it became clear from her questions that she suspected he had tried to take his own life. She had many questions. Over the next 45 minutes or so, I tried my best to answer them.

When we hung up, relief washed over me. Finally! I thought, someone – a doctor! – had discovered what we had known for years:

It was not our imagination. My son really was sick. There was something wrong with him. Specifically, there was something wrong with his brain.

But now, thankfully, he was going to get care. Treatment! Doctors and nurses were going to look after him and find out what was wrong and fix it. I laid my head on the kitchen table and wept.

Matt was admitted to the psychiatric ward in St Mike’s and seemed to be doing well. He liked the hospital and a nurse told me was he receiving Zyprexa, the brand name for a new anti-psychotic drug called Olanzapine.

Seventeen days later, the phone rang again. It was three in the afternoon, so six Toronto time. Matthew was being abruptly discharged into a freezing February night in Toronto. He had no place to stay, no friends or family nearby, no money, no identification, no nothing. He had no means to cope with the freezing cold February night.

I begged the charge nurse not to do this. Why at night? When banks were closed and hotels were probably filled. He had no money, He said everything was lost when he was admitted.

I shall never forget the charge nurse on duty. My pleas for help, for mercy, for time for me to find help for him, fell on cold deaf ears. He simply said No. No. No. Over and over again.

When I asked “Why?” he said that Matt did not have an Ontario health card so would not be allowed to go a halfway house. I tried to explain that he had applied for BC health card but he still didn’t have it. The application had been lost so we had re-applied. But the nurse was unmoved. Matthew was heartlessly discharged into a freezing February night in Toronto.

I was panicked and frantic. They were basically sentencing my son to freeze to death.

This was my rude introduction to the barbaric state of mental healthcare in Canada.

It was the night that I learned how to scramble to save my son’s life.

This was when I learned that our mental healthcare system is a cruel joke – a patchwork quilt of people not talking to other people.

All I knew then was that my son was about to be ejected into a freezing February night in Toronto, with no place to stay, no money and no identification.

Since that night, nothing has changed. In fact, it has gotten worse. In 2004 there were psychiatric hospitals. Today most are closed.

Matt was not some unlucky patient who just slipped through the cracks. They knew his illness and chose to discharge him, against all medical ethics. People with schizophrenia spectrum disorder don’t “slip through the cracks”. They slide down a large bottomless crevasse where they just disappear and won’t be made safe.

People with schizophrenia are the homeless living on our streets. They languish in our prisons. They wander the streets hallucinating, muttering to themselves, hoping against hope that someone somewhere will realize they are ill, even as they protest that they are not. Paranoid and delusional, they stab people, push strangers off subway platforms and try to behead them. They are shot by police and armed guards. Sometimes they are brutally beaten to death by police. They kill themselves when they finally realize that life is unbearable and no one gives a damn.

Mathew did survive that night. I desperately called hotels in downtown Toronto till I found one that agreed to take my credit card and let a strange man with no identity spend the night.

I wonder how many mentally ill people freeze to death in Toronto? There are probably statistics.

Matthew’s plight in February 2004 was just one of many mundane examples of how our mental “healthcare” system is failing Canadians with serious mental illness. His crisis is just one of thousands of real-life stories that happen every day of the week in caring compassionate Canada.

The phrase “the banality of evil” – written about the mind-numbing horrors of World War I – now has personal meaning for me.

No one is ever charged with negligence or failing to provide the necessities of life. These are just the mentally ill. They do not count.

The prime reason for writing this book is to raise public awareness about schizophrenia and to describe the many horrific ways that Canada fails people with this serious mental illness. The disturbing reality is that a century ago, before we knew much about schizophrenia, we treated patients much better. A hundred years ago there were asylums to take in and comfort those with dementia praecox (precocious madness), the early name given to the psychotic disorder that begins in late teens and which is now called schizophrenia.

But the situation became worse than mere ignorance. The old phrase, “nature abhors a vacuum,” coined millennia ago by Aristotle, holds true today with respect to public awareness of schizophrenia spectrum disorders (SSD). In the absence of factual information about SSD, misinformation and disinformation has rushed in to fill the void. Thus we end up not only undertreating SSDs but end up with activities that actually do harm through mistreatments and spreading of wrong information.

The lack of knowledge harmed my son because I didn’t know what to do to help him and made lots of mistakes. The reader hopefully can learn from my mistakes about what helps and what hurts!

May 24 is World Schizophrenia Day

“So was he born that way?”  A friend was asking me about a family member with a schizophrenia spectrum disorder (SSD).  Her question made me realize there is very little public awareness about schizophrenia. 

 The short answer is “no.” When my son was born there were no symptoms – no indications at all that he was anything but a completely healthy normal baby.  Schizophrenia is a sneaky, malicious illness. Unlike other serious childhood diseases, it does not show up when the baby is born. Instead, it lies there, patiently waiting — a sleeper mole in spy terminology – till the time is right to emerge and wreak havoc on the unsuspecting victim.

 My son was a typical little boy. Loved school, loved sports, loved his friends. Played road hockey, soccer, baseball, went to summer camps… He graduated high school with offers of scholarships; graduated university with a bachelor’s degree. It was only after he went back to Law School that things went off the rails. Schizophrenia overtook him and stopped him dead in his tracks. That was 30 years ago.

How do you get it? Is it contagious?

About one in 100 people will develop schizophrenia. It occurs world wide, regardless of gender, race, ethnicity, or economic status. In males, the disorder makes its presence known in the late teens and early twenties; in females it takes a little longer, showing up in the late twenties and early thirties.  In BC where I live, there are about 40,000 people living with this devastating mental illness, according to the British Columbia Schizophrenia Society (BCSS).

And no, it is not contagious, nor is it caused by childhood trauma, as some believe. The one percent is an average. Schizophrenia tends to run in families. It is classed as a genetic inheritance disorder. If you have a close family member with the disease your odds of getting it are much higher than the one percent. I have a friend with four sons; three of them have developed schizophrenia.

While one in a hundred doesn’t sound very alarming when compared to other horrible diseases, it is important to remember that those are the odds of developing schizophrenia if you live to the ripe old age of 20. Illnesses are sometimes measured in Potential Years of Life Lost (PYLL.) When we look at schizophrenia that way, there are a lot of years lost when you start counting at 20.

 Okay, so how do you know if you’ve got it?

Symptoms of schizophrenia include reduced expression of emotions, psychotic symptoms such as hallucinations, delusions, and cognitive impairment.

Social withdrawal is usually the first symptom you might notice in a loved one or friend. They become reclusive. Friends stop coming around. Their social life vanishes. They may not attend their high school graduation. They spend increasing amounts of time in their rooms. These are called “negative” symptoms, and often mimic typical teen behaviour.

Delusions may be the first of the “positive” (psychotic) symptoms you notice. Behaviour and demeanor become increasingly bizarre. They become convinced that the KGB is following them. Or that food is poison. Or that they know the secrets of the universe and everyone else is an idiot. When psychosis happens, the ill person may hear voices (hallucinations) and become obsessed with certain thoughts

Cognitive changes are the third class of symptoms. These symptoms are not noticed at first, but in fact, cognitive impairments are now recognized as a core feature of schizophrenia. The patient knows something is wrong with their brain. A person’s intelligence doesn’t change, but the brain areas involved with judgement, memory, problem solving, and decision making are affected. It becomes difficult to make a grocery list or book an airline ticket or learn how to operate a cash register for a summer job.

But it doesn’t stop there. More than half of people with schizophrenia do not believe that there is anything wrong with them. This is due to a brain-based disorder called anosognosia. They refuse treatment or stop taking their prescribed medications which causes them to relapse, ending in tragedies or lengthy hospitalizations till they get better.

A huge problem with schizophrenia is that there is no easy way to diagnose it. No blood test, no objective biological marker that gives a clear diagnosis.

OMG. It sounds horrible!  

It is horrible, if days of hospitalization, lost productivity, years of potential life lost, numbers of suicides and the sheer devastation of ripping families apart count.   

Schizophrenia has the highest physician, hospital, prescription medication and psychiatric costs when compared to other mental illnesses.  But it doesn’t stop there. According to the BC Schizophrenia Society, schizophrenia costs the Canadian economy $6.85 billion dollars per year.  Schizophrenia accounts for 20% of youth suicides in Canada. Almost half of people diagnosed with schizophrenia attempt suicide. Between 12-15% are successful. People with schizophrenia die on average 25 years before their healthy cohorts.

Untreated, the disorder results in homelessness, poverty, family disruption, criminal involvement, addiction, and unemployment.

The Vancouver Police Department responds to thousands of mental health calls every year. There are about 14 mental crises a day, and that doesn’t count the suburbs which are policed by the RCMP. Last year, the Mounties reported more than 123,000 “mental health occurrences” — the RCMP’s term for a police interaction with someone suffering from a mental health crisis —in Canada.

We need to stop closing psychiatric hospital beds, in the misguided belief that the “community” can treat the ill person. When a deeply psychotic patient presents at Emergency, they need a doctor and a bed and treatment.

It is heartbreaking to watch someone spend days in hallways or makeshift rooms with only a curtain for privacy (in BC). But not as heartbreaking as having the patient arrive by ambulance, florid psychotic, only to be turned away by a nurse, and told that all he needs is a sandwich (Ontario). Both of these have happened to my family member, along with countless others.

There is hope though.

While there is so far no cure for schizophrenia, there are treatments. Timely treatment is vital. Medication and supported housing are at the top of the list to help patients recover. These two things lower the number of police 911 calls and trips to emergency. On time treatment would help solve a significant part of the homeless situation we have in Vancouver. But meds are not enough. We also need to offer cognitive remediation which improves patients’ ability to work and become more independent.

In a perfect world, patients would also have mentors, friends, family, food, a social life, sports, movies, maybe even a job! Kind of like what “normal” people have.

But before any of this can happen, we need to raise public awareness. As Susan Inman, author of “After Her Brain Broke, Helping My Daughter Recover Her Sanity” states, “Canada does not have a mental health literacy program.” I’d like to get that started today.

= 30 =

May 24 is World Schizophrenia Day

Schizophrenia is a devastating disability – a lifelong chronic condition which develops in the late teens or early 20s. It takes over the person’s mind and removes their ability to differentiate what is real and what is fantasy. This makes it very difficult to reason or think logically.

Schizophrenia spectrum disorders are among the most serious of the brain disorders — if days of hospitalization, lost productivity, years of potential life lost, numbers of suicides and the sheer devastation of ripping families apart count.   

According to the British Columbia Schizophrenia Society (BCSS), there are 40,000 people in BC living with this distressing mental illness. Schizophrenia has the highest physician, hospital, prescription medication and psychiatric costs when compared to other mental illnesses.  But it doesn’t stop there. According to the BC Schizophrenia Society, schizophrenia costs the Canadian economy $6.85 billion dollars per year.  Schizophrenia accounts for 20% of youth suicides in Canada. Almost half of people diagnosed with schizophrenia attempt suicide. Between 12-15% are successful.

Untreated, the disorder results in homelessness, poverty, family disruption, criminal involvement and unemployment.

All this from an illness that afflicts just 1% of the population. Yet, with adequate treatment and services people can recover.

The 1% who develop schizophrenia are teenagers who are just about to spread their wings and embark upon their own life adventures. They don’t get to live their imagined future. Most don’t graduate, marry or work. They are not able to follow their passions into exciting jobs, or do any of the things that we do to fill our lives with joy and meaning. 

Schizophrenia is a terrible disease.  No one sees it coming. There are no cures and no vaccines. There aren’t even biomarkers such as blood tests to assist with diagnosis. But thankfully, it’s treatable.

So what is it and how do know if you or your loved one has it?

Behaviour and mood changes are the main warning signs that something is amiss. There are three categories of symptoms, designated as negative, positive and cognitive.

Social withdrawal is usually the first symptom you might notice in a loved one or friend. They become reclusive. Friends stop coming around. Their social life vanishes. They spend increasing amounts of time alone in their rooms and don’t talk much. These are examples of negative symptoms.

Delusions may be the first of the positive symptoms you notice. Behaviour and demeanor become increasingly bizarre. They become convinced that someone is stealing from them. Or that food is poison. Or that they know the secrets of the universe and everyone else is an idiot. Then comes hallucinations such as hearing voices. These are examples of positive symptoms.

Cognitive symptoms are harder to notice at first, but in fact, cognitive deficits are now recognized as a core feature of the disease. The patient knows something is wrong with their brain. It has changed and doesn’t work as well as it used to. Cognitive deficiencies crop up when trying to plan a day’s events or book an airline ticket or learn how to operate a cash register for a summer job. A person’s intelligence doesn’t change, but the prefrontal cortex doesn’t work as well and this impacts working memory, judgement, problem solving, and decision making.

And it doesn’t stop there. More than half of people with schizophrenia do not believe that there is anything wrong with them, due to a brain-based disorder called anosognosia. They refuse treatment or stop taking their prescribed medications which causes them to relapse, ending in tragedies or lengthy hospitalizations till they get better.

So what can we do to help?  There are many ways we can help people with schizophrenia to live fulfilling lives, and at the same time lower the societal costs that we all pay when they are not treated.  

They need access to timely psychiatric treatment. But medications are just the beginning. There’s more. They need cognitive remediation plus behaviourial and occupational therapy. In a perfect world, they also need mentors, friends, family, food, a social life, sports, movies, maybe even a job! Kind of like what normal people need.

But before any of this can happen, we need to raise public awareness. As Susan Inman, author of “After Her Brain Broke, Helping My Daughter Recover Her Sanity”  states, Canada does not have a mental health literacy program. Since we already have the perfect platform in place, I propose that the Mental Health Commission of Canada take on this role. How about it MHCC?

=== 30 ===

Let’s focus on mental illness, not mental health

Prolog. I wrote this in 2011. Since then, nothing much has changed, except for the closing of psychiatric hospital beds. So it’s still relevant. My loved one was miraculously declared cured two weeks before Riverview Hospital in BC was closed in July of 2012. 

 

I almost spilled my morning coffee when I read the sub headline “Reduce Stigma of Suicide, report urges.” The draft report, published in the news, was from the Mental Health Commission of Canada.

There have been so many commissions on mental health that I have lost track. They publish reports that proclaim mental illness is “Out of the shadows at last.” They are headed up by CEOs with six figure salaries. With great fanfare, they issue media releases to communicate their latest “mission statements,” “focus areas” and strategic plans.  They offer career opportunities on their glossy websites. The MHCC is just the latest incarnation.

In the meantime, in between time, people with serious mental illness are wandering around the streets, talking to their voices, living in filthy conditions, with no food or warm beds. They suffer from neglect, pure and simple – right here in downtown caring compassionate Canada. But nothing ever changes. In fact, due to hospital closures, things are getting much worse.

So, reading that we need to reduce the “stigma of suicide” stuck in my craw. I appreciate that mentally ill people face stigma all the time, from potential employers to landlords to just making friends. But those are the ones who still want to live.

I have had close relatives who suffer from mental illness. I know of the absolute grief and horror of suicide. But so far, “stigma” has not been top of mind for anyone caught in the awful aftermath of either a successful or failed suicide.

Here is what mentally ill people need. I wish the MHCC would pay attention. This is from the school of hard knocks. There are two things:

First they need meds. As in med-i-ca-tion. You know – pharmaceuticals.

I realize that this little piece of news will upset all those people who are permanently outraged at Big Pharma for making Obscene Profits on the drugs they have developed.

It will also annoy those idiots on the fringes of rational thought who think that psychosis can be cured with mega-vitamins or herbal tea and acupuncture.

It won’t. And there is no evidence that it will anytime soon.

But there is plenty of evidence that anti-psychotic drugs help people with serious illnesses such as bipolar disorder and schizophrenia.

Anyone with a family member who is suffering from the symptoms of untreated mental illness will understand what I am saying here.

Their brains have gone haywire, chemically speaking. The symptoms are hallucinations (voices), delusions (the waitress is an KGB agent), and deranged thought (the TV’s channel three is dangerous, the refrigerator is talking to me).

They are completely out of touch with reality.

Psychotic illness wreaks havoc with patients and their families. It ruins their lives.

It gets so bad that, at black moments in the middle of the night, when things have spun out of control, and you have been tried and tested beyond endurance, and you are tired and can’t think straight, you actually start to wish that your loved one would disappear out of your life. Just leave. For good. You don’t care how or where they go. You have had it. At 3:00 am this sounds better than where you are right now.

But then morning comes and with dawn’s light you feel a bit better, and gird yourself with hope and energy and face the onslaught of another day.

So meds help. I’m not saying they’re perfect. Even the newer atypical anti-psychotics have some pretty disturbing side effects. By “newer,” I refer to anti-psychotic drugs that became available in the nineties. They are more effective, with slightly fewer of the horrendous side effects of older drugs invented in the fifties.

Frankly, the only thing worse than taking these powerful psychotropic drugs is not taking them. They have saved countless lives and made awful situations less awful.

The second thing they need is housing, Why? Because if they don’t have a place to live, it’s really hard to remember to take their meds. Why? Because they don’t have a place to put the little bottles. Like, duh, a medicine chest. Or the kitchen counter, or whatever piece of furniture the patient chooses as most likely to remind him/her to take the meds.

Sure there are other things that would help patients to get through the day. In a perfect world there would be friends, family, food, a social life, sports, movies, maybe even a job! Kind of like what normal people need. And even some cognitive remediation and behaviourial therapy!

But first they need meds. And a place to put them.

Someone near and dear to me recently stopped taking the pills that kept him symptom-free. I guess he felt that the side effects were severely impacting his life.

So now, instead of fussing about weight gain, dry mouth, tremors, insomnia, somnolence, and lack of motivation, we worry about delusions, hallucinations, paranoia, impulse control, mania, poverty and how he will manage living on the street.

And always, lurking in the shadows, is the worry about suicide.

The last thing to cross our minds is a worry about stigma.

I hope that the MHCC becomes more grounded in reality. We don’t need more commissions pontificating on mental health.

We need strong agencies who will prescribe decisive action on mental illness.

 

Epilog. It has been seven years since my loved one was released from Riverview on an Extended Leave. There have been many mini crises and a few major ones since. Right now things are on a semi even keel Nothing great, but we are thankful for a bit of a break. 

Perfect Mother

My Mother died in April 1993, just a few days short of her 87th birthday. I don’t need the annual Mother’s Day celebration to remember her. I just wish that she were still here so I could keep on giving her those sappy sentimental cards that let people say things to their moms that they don’t say when face to face.

I miss her a lot, and I suppose I always will. Even now, a few times a month, something will happen and I will think: “I wonder what Mom would think about that?” or “She would have loved this picture.” Mom was the only person in the world with whom I could be completely honest — to whom I could admit to shortcomings or brag about successes and not have them taken the wrong way.

Mom was completely unselfish. She made me think that I was the only important thing in her life, and she told me in a million different ways how she loved me. In her quiet way, she always managed to steer the conversation away from herself. She wanted only to hear about my successes, my kids, my garden, my dinner parties, my job. And yet, on my 85th birthday, when I’m sitting in a nursing home, I don’t think I will get a phone call all the way from California, as she did, from a chap whom she taught in Grade 4 in the 1920s. He never forgot her, nor do many others whose lives she touched.

Elsie Cochran, my mom, lived her life in Manitoba, mostly in Carman, the prettiest town in Canada. When she was born in Morris, there were no cars, TVs, computers, dishwashers, cellphones. She flew in an airplane for the first time when she was in her 70s. She raved about the flight, and told us how they “spoiled” her. (They had served her lunch.)

She taught school till she married and, in my view, exhibited reckless abandonment with her first pay cheque. I remember calling her up to agonize over the cost of a really neat black dress I wanted. It was $65 and I was hesitating, as it would consume about a quarter of my monthly salary. This was in 1963. She told me that in 1924 she blew her whole first month’s pay (by happenstance, $65) on a wonderful dress she coveted. Flapper style, it was constructed entirely of gold lace and intricate beading, with a frothy pink underslip. I knew the dress well as I had worn it many times in our attic, as an eight-year-old imaginary princess.

I bought the black dress and wore it for years.

Mom was, before anything else, a realist. After she married my father in 1928 she settled down to be a housewife and mother. In other times and circumstances, I suppose that this situation would have proscribed the rest of her life. The Second World War intervened though; Dad went to war and Mom went to work when I was a baby. She ran his business and never stopped working. This was long before working mothers and daycare issues became grist for political mills.

It was only after she died that I came to realize she was a person, too, with hopes and dreams and passions that I will likely never know completely. One of her greatest dreams was to see London, England, which she never did.

But Mom rolled with the punches. She was never bored, thus never boring. I loved talking with her. Our conversations were eclectic and wide ranging; I sought and respected her views on travel, art, politics, cooking, sewing, along with just chat and good old gossip about common acquaintances and famous people.

When she became too infirm to live without care, I know that she hated to leave her beloved home and garden in Carman. But she made sure that I saw only her happy shining blue eyes filled with curiosity and quiet acceptance of this new twist in life’s path. And always I felt her unconditional love for me, even during those times when I suspect she was quite annoyed with me.

I have already seen London, and many of the other delights offered on this planet. My goal is much harder than my mom’s: I want to be like her. I want to have the same inner serenity and acceptance that let her find happiness in growing a walnut seed into a grand tree that still shades the front porch of her former house.

This is a elusive and difficult dream. But one thing is for sure: Because of my mom and her upbeat, realistic attitude, I am never completely alone. I feel her every day giving me guidance and warm looks and love. It feels great. So, Happy Mother’s Day Mom. You were the perfect mother.

Happy Dominion Day

On Canada’s birthday, I would like to say “Welcome/Bien Venue!” to all our new Canadians.

 

You have chosen Canada as your new home, and you have chosen well. You will enjoy telling your relatives back home about our enlightened society, free healthcare and magnificent geography.

 

But having been processed by officialdom, doubtless you already know this.

 

There are, however, a few customs and quaint peculiarities unique to Canada that might have been omitted from your welcome package. Here are a few hints and tips to speed you along the path to becoming a ‘real’ Canadian.

 

Government

Canada is a democracy. This is practiced every few years during Elections. In between, it is a dictatorship, presided over by the Prime Minister. The PM has absolute power over everything.

 

The Prime Minister

The PM is, by custom, the leader of the governing party. Party leaders are chosen at fun-filled conventions with balloons! The voting delegates do not have to be Canadian citizens. However they should either be alive and/or at least 14 years old. Dead delegates can have their pets vote on their behalf. Instant delegates can arrive by bus as needed.

 

Elections

Canada uses the Rep-by-Pop method to elect Members to Parliament. The amount of Rep you get for your Pop depends on where you live. Voters on Prince Edward Island (population 140,000) get four MPs. Voters on Lulu Island where I live (similar pop), get one and a half MPs. This is in the Constitution.

 

Constitutional Matters

Canada is a constitutional monarchy. The constitution is called the BNA Act. It cannot be amended. The monarch is Her Majesty, Queen Elizabeth the Second. She has reigned over us for more than sixty years. She lives in England and has no power. Our stand-in Excellency is called the Governor General who is appointed by the PM. Canada has a tradition of appointing non-traditional identities, often members of minority groups who are politically marginalized. For example, our current GG is a middle aged white male.

 

Language

Canada has two Official Languages, English and French. If you have problems with one, turn the cereal box around.

 

Geography

Canadians are proud of our magnificent landscape, with its towering mountains, fertile plains, rivers and lakes, rocks and trees, from sea to shining sea. The bulk of this is permanently frozen over in a vast wasteland called tundra. Global warming is fixing this.

 

Values

Canada welcomes all races, creeds and ethnicities. Canadians pride themselves on their tolerance and inclusiveness. Canadians hate bigots. Especially American bigots. Bashing Americans unites Canadians from sea to shining sea.

 

Religion

Canada is 85% Christian. It’s okay to call Christians radical, right-wing, red-necked, racist bigots. Don’t try this with other religions.

 

Justice

Avoid the court system. Lodge your complaint with the Human Rights Commission. It’s free and you will get retribution and vengeance while ruining your foe’s life and livelihood. Plus, you don’t have to prove anything.

 

Culture

Feel free to celebrate diverse cultures here. You can stop traffic, get wasted, and parade through the streets naked. Urinating, defecating and killing small rodents are okay too, but take care to call it Art.

 

Children

Your children have certain restrictions: They can’t drive till they are 16. They can’t drink, smoke, receive welfare or vote till 18. They can become prostitutes at age 14.

 

Business

Try to lose money. Canadians view profits with distrust.

 

 

Metric or Imperial?

Yes

 

Taxes

It’s popular for Canadians to demand that The Rich pay their Fair Share of taxes. In Canada, The Rich is anyone above the poverty line.

 

Healthcare

Free and accessible healthcare is a sacred trust. In Canada, healthcare is neither free nor accessible. If you get seriously ill, go to the United States. That is where all our doctors and nurses are.

 

Sports

Hockey is our national game. You won’t be able to afford a ticket to a game, but you can watch our best Canadian players playing on American teams in American cities on TV.

Football is not called football here. It is called soccer. Our football is like your rugby. It is played by players who hardly ever kick the ball.

 

Street Life

Don’t smoke. If caught, insist that it is pot.

 

If someone on roller blades being towed by vicious pit bulls blasts by you and knocks you flat, apologize.

 

It is not okay to go through a red light, despite what you may have observed.

 

Weather

You will notice a change in climate. Buy warm clothes. It gets bloody cold here. But it’s a dry cold, eh?

 

So, as I said, Welcome to Canada! If you follow these common sense tips you will fit seamlessly into the rich tapestry that is Canada.

 

Happy Dominion Day!

Manners

Copyright c 2012, 2016 by Marilyn Baker

Manners are important and they are evolving as this century unfolds. By manners, I don’t mean somebody’s rules on which fork to use first or precisely how to set a table. But basic manners are important for human relationships. They make life run more smoothly.

I have observed deterioration in how people treat each other. I put it down to an over-abundance of self-absorption and an under-abundance of caring about the other guy.

Essentially, having manners is about showing respect for other people. It means making another human being feel welcome and comfortable at your house. It means being sensitive about others’ feelings. At its most basic level, it means not grossing people out.

Queen Elizabeth exemplifies good manners. She is awesome actually. She reportedly picked up her finger bowl and sipped from it, because that is what one of her guests did, thinking it was soup, and she wanted to protect him from embarrassment. If you take your cue from the Queen you are taking care to consider other’s feelings.

But you don’t have to be the Queen to have basic manners. Having good manners will make others’ experiences in your company a pleasant affair. At the very least, it can prevent social interactions from becoming horrid disasters.

Here are a few suggestions. We might as well start with the dinner table.

Don’t talk with your mouth full and keep your mouth closed when chewing. Nobody wants to see the contents of your mouth. Sit up straight, take your elbows off the table and don’t lean back on the two hind chair legs.

Don’t talk about ickey stuff while eating. I refer here to words such as pus and vomit. Some people, perhaps a bit socially insecure, tend towards subjects like that when in polite company. They are hoping for a laugh, which they usually get (a nervous titter would be a more accurate description). But they will never know whether they are being laughed with or laughed at and how many people in the group have mentally written them off their social lists.

It goes without saying (or rather, it should not be necessary to say) that you shouldn’t emit any disturbing noises from either end of the intestinal tract while at the table. So, no belching, burping, loud coughing, throat clearing, sneezing, spitting, etc. from the top end, and no alarming noises from the bottom end. Excuse yourself and attend to the restroom for urgent problems. Otherwise, squeeze the spincters tightly please.

And take the goddamn ball cap off. If you find yourself constantly wearing it at the table because it annoys friends and family, ask yourself why you want to continue a relationship with these people. Consider that you both might be happier without each other’s company.

While using someone else’s bathroom, leave it as you find it. So, if the toilet seat was up when you entered, and there was water splashed everywhere, and the towels were strewn askew and the toilet paper was streaming down onto the floor, then great! You don’t have to do anything. If not, then fix it.

When given something, say thank you. If you can’t bring yourself to say thank you, don’t accept the gift. It’s simple. Just say no and give it back.

If you do accept it, say thank you, and, depending on the gift, follow it up in writing. If treated to dinner, for example, you should call or email the hosts the next day.

Please smile when greeted by someone. This includes family. Children who are unconditionally adored by their parents tend to pout a lot – it’s cute and gets attention. But what’s cute in a precocious little brat’s pout is no longer cute when the kid becomes an adult. Grown ups who pout are merely rude. Narcissism is highly likely here and should have been nipped in the bud when the kid was four. Or two. Around my house pouting and frowning can get people cut out of wills.

It’s wonderful that you want to get married, but try not to bankrupt your parents with the “perfect” wedding. Especially if it’s not your first one. And don’t let greed pervade the invitations. So, no, you can’t say “No giftware” on the invitation. That is extremely bad form. You have to gracefully accept and thank people for every gift. Even the ones you hate. In writing. Sorry, but that’s life.

The bottom line is simple. Treat people, especially family and friends, with respect. Someday you will be glad you did.