Monday, August 31, 2009

Sailing with the Nephew and Friend

The Giri repairs have restored it to a functional ship once again. Tom and crew are to be commended. Stewart, from Protek tuned the rigging. I'd checked the Yanmar and thru-hulls and did a systems check to see everything was working earlier in the week. There's still some offshore systems like the wind-generator which are off line but mostly it's back to being nearly ready for another world cruise.
Kyle and Andrew said they were up for a sail and that suited me because, rafted to another boat, I wasn't able to take the Giri out myself and return. Rafting on return for sure would have needed an extra hand.
Laden with food from the requisite Safeway store shopping stop we were all set to go when I found my handheld radio wasn't working. I needed a backup since the main radio was down so made a quick run to Martin Marine to pick up a new one with built in GPS and emergency locator.
We untied the lines Tom's ship, Naomi, and were off. Then I realized the guys had thrown the dock lines onto the Naomi and rather than go back I had to make some more from the extra rope I had on board. "You know, you young guys look smarter than you act sometimes," I said. "Thanks, uncle" was the "whatever' kind of reply I got after that. The two of them really are bright and competent and turned out to be great crew. But young people do somehow look smarter.
We had to fuel up at the Coal Harbour fuel dock with a queue of other boats. The line handlers were the best.
Then it was passing under Lion's Gate to the freedom of English Bay. That's when the guys really proved themselves. I showed them the fundamental principles of sailing and tacking and left them to it while I made coffee and sat back to enjoy the glorious sunny day. Amazingly they missed big ships and small and tacked back and forth out to Pt. Atkinson. They weren't crisp as racers might be but otherwise solid sailors. The wind died off then.
I took the helm and the two of them went below to nap. I called them back up when it was time to anchor in Mannon Bay.
We got the dinghy off the deck into the water, young muscle helping with that and lifting the outboard. That's when the excitement began. I think my dinghy is rated for 2 1/2 people and I couldn't find the seat. It also leaks a little at the front and if I go too fast water comes over the back board. They sat on the pontoons holding on for dear life and I sat on the gas tank with my arm 'over' the outboard, the handle upright for steering as there was no room for it straight out with all the bodies and legs. This was an occasion where life jackets weren't just for regulation but a wise choice.
Doc's Restaurant on Union Steamship Marina was terrific. Busy day on Bowen with the Bowen fest going on. I enjoyed the Halibut while the guys had clam chowder. Later we listened to the band outside and enjoyed all the kids running about with neon rope. Returning in the dinghy at night was almost as exciting but the sea was glass and the canopy of star studded sky a joy to behold. I'd only a pen light, the batteries dying in the nav lights. Sitting on the tank I closed the vent so the engine sputtered, causing some concern to my passengers when I stood up to start it again. No problem. The GIRI with the new navy blue painted hull was easy to find amidst all the white hulls. When we got back on board I told them about the night in Mexico that we found the dinghy had been sliced, had to keep blowing it up with my mouth, got lost heading out to sea then couldn't find the boat in the flotilla. Andrew asked, "What I can't understand, Uncle Bill, is how you've stayed alive all this time." And I didn't have an answer but agreed it was a good question. Obviously God had other plans.
After that it was a great night at anchor.
In the morning the guys were keen to go fishing so we weighed anchor early and headed out. We had herring and anchovies but the fish weren't cooperative. It was a lazy sunny day trolling. We barbecued steaks and scrambled eggs for brunch. It was a veritable feast, Andrew proving a master chef on the barbecue while I worked the frying pan down below.
We passed Wreck and Jericho and English Bay Beaches. They were all packed.
Coming in on the tide we had a quick crossing under the bridge and whizzed across Coal Harbour. Then the guys handled the tying up rafting like pros as I struggled against a current to keep the boats alligned.
All we had to do was haul up the perishable food we'd not eatten along with sleeping bags and gear after I shut the boat down ensuring the thru-hulls were closed and everything was shipshape till the next trip.
Good to be out on the ocean with a smart, enthusiastic, competent crew. Glad the hull held and the mast didn't break. Fair winds, indeed.

Saturday, August 29, 2009


It's beautiful to see the sun breaking through the mottled grey clouds layered over blue sky. A city awakes slowly on a Saturday. I've found two young party guys strewn about the living room on couches and cots. They've come in in the wee hours of the morning yet because I said last night we'd be sailing they're moving like slugs now stumbling and bumping into furniture to wake. Their enthusiasm with life itself is decidedly youthful. I'm onto my second cup of coffee. Had I stayed up late with dancing and talking and smiling young women I'd sleep in for a day and skip sailing. They burn impossibly long candles at both ends while I'm struggling with a match. Yet it's fun to watch them rebound. They don't have aches or pains or memories of failures. They are not burdened with past but instead have this clean slate of future as a canvass to paint outrageous colours on. My pretty neighbour across the way is on her balcony eating toast while her husband reads the newspaper across from her. The trees are green with envy of the late summer flowers. They're waking with songs even the birds can't mimic. Birds are flitting about though. Without a farm cock to waken them they have arisen to the cries of gulls. I can smell the sea. The tide tables could be more favourable for getting away but we're motor through. My Yanmar has twice the power of today's First Narrow current. I'd just rather be leaving on an ebb with the speed of the ocean's breathing taking me in tow. One of the guys is eating breakfast slowly. They like a cereal called 'fruit loops'. The other fell back to sleep after sitting up for a few moments. The cat is eyeing him considering a pounce. I'll start to move myself and they're young enough to follow.

Friday, August 28, 2009

The Taxman Guru

It's really easy to be lofty minded sitting cross legged on the beach contemplating my navel and infinity, listening to my breathing, and thanking the all mighty for life. However........when the taxman calls and wants next year's taxes this year.......I find that I don't have that same peace of mind......I identify with terrorists and question why is my government spending so much time punishing good tax paying hard working citizens like myself when I know more than half my neighbours enjoy all the same benefits of Canada as I do but don't pay their way.......I also believe the taxman is one of them as our government is now made up mostly of people who have learned to 'beat the system' and 'work the angles' and 'massage the books'.
I went to school to learn science. They go to school to network and make deals and learn how to 'negotiate by intimidation." I feel I wasted my life on peace and love.....being kind to women and children.....not stealing even when no one is watching and sharing whatever I had generously with those who had less.
I don't believe my taxman or my government should harrass me. I know I've focussed all my efforts on serving them so that in the last decades they owe me some million or more in dollars for all that I have done that I wasn't paid for but did out of the 'goodness of my heart'. All the time I'm doing government's job. They're paid but I do the work they didn't do and I'm not paid for. I'm waiting for the back pay and the class action suits and all the other solutions that are now wanting. I know I have a heart and I wonder why my government seems so heartless.
If government people in general worked as hard as I worked then we'd all be rich beyond our wildest dreams. Indeed if we had the 'amount' of government we truly 'needed' then we'd not have to pay taxes because we'd be rich on the savings from getting rid of the immense waste that government creates.

Now that's the kind of rage and self pity and nonsense that goes through my mind when I'm in the thick of dealing with the criminals, misinformed collection agents and beaurocratic bullies, paid thugs and self aggrandising small minded Los Vegas style brown shirt bag men #*!!!*$####. It's not enlightenment. It's not spiritual and loving.

I'm old enough to know the billions of dollars wasted by my government and all the theft and corruption in the leadership, the lies and waste and ignorance. So I don't appreciate the smug and superior attitudes and threats of taxmen and taxwomen who delight in doing their jobs while not allowing me to do mine. Every time I talk to them I'm not working. They're getting paid but we're not. We only get paid for doing real work, real production, creation, not taxing everything that moves or breathes or doesn't. I want my government and it's taxmen to cut the fat and not have all the country tighten their belts another notch for the glory of wasteful, corrupt excessive government. And of course the government would rather squeaze the citizens. Who needs citizens really!

I want to quit. I want to walk away and say, get yourself another pansy. Half this province is on the underground economy and probably half the government is on some sort of take. Indeed when I worked with the government that's all I saw people doing, stiffing the tax payers, finding ways to do the least and get the most. And the leadership was the same genetic sorts who lead the Charge of the Light Brigade!

Taxmen and women may not be human but they're mortal. They're only able to maintain the attitude because they think it's not going to happen to them. That's what kept the SS going for as long as it did. When you realize you're in the same boat, that's when you stop axing and chopping the hull and pick up an oar yourself.

Now I find it easy to be at one with God when I'm on the beach but after a phone call from a tax man and hear his or her voice ooze with the fat cat attitude that only the indexed pensioned rich government worker can have in a country of suffering private businessmen and citizens ,well, I loose it. Expletive. Expletive. Expletive. So much for my spirituality.

The face on my government is the tax department. All those politicians running around kissing babies are pretty labelling on a jar of arsenic. The tax department and the kinds of people who work there are the truest reflection of my government. Institutionalized Extortion at it's worst. Their attitude is what my taxes are paying for. It's the attitude that I loathe and fear. I'm afraid I'll lose it. I accept that I have to pay taxes and have paid more taxes than was due because I'm normal that way. I'm not like our government or the taxmen. I don't think like they do. I haven't focussed my life on how to get money out of people or how to 'bleed' people or how to 'insinuate' and 'demean'. It's the demanding, threatening, coercive, abusive, demeaning, judgemental, putrid, low life, contemptible, piggish, offensive, holier than thou, never make a mistake despite countless errors upon errors, superiority that offends me.
Yet, I'm humbled by the tax man. God sends him occasionally to me to test my peacefulness and serenity. I fail miserably. All my church going and spirituality and deep breathing fail when I hear that needling Toady Tone of voice. I see myself ripping out his or her entrails and feeding them to pigs. I know I should be praying for him or her and their family. I don't feel this angst when I am bit by a mosquito. Of course I can swat a mosquito and taxmen and taxwomen are above the law and live protected existences with the highest pay and priviledges that are rarely known to mere mortals. His or her brains are no differently wired from any other hive bug though.
He's laughing now at my and every other citizen whose struggling because of him or her. He gets bigger bonuses the more people he torments. If he could crack heads and shoot off knee caps he would. He/she does the emotional equivalent until he's once again allowed to do the real thing.
I know I should be praying for him. I know I should be. But I'm Tibet faced with China and the Dalai Lama and his people didn't fare any better. I'm not a saint. I'm a Canadian.
I know I'm not rich because of my poor decision to marry the women I have , to spend the money I did over and over again on women who blamed me for my inability to protect them from the taxman, my decision to remain in Canada forsaking all the highest paid work offered to me in the US, to buy "required" "essential" technology that became obsolescent before I opened the box, to not do an MBA or Law degree or go into banking or accounting, or grow drugs and live the rich and rewarded life of crime, or be a con artist, but instead to become a doctor and devoting my life to higher learning in my speciality rather than taking all the money management and financial courses my smart colleagues took instead of further study of medicine.
I know I am a failure. I am an utter failure. I am not a psychopath or sociopath. I'm not like Mulroney or Cretien or Harper or Campbell either. I lack some essential trait that causes me to be honest and truthful and worry about the poor and think that we're all in this together and no one is going to get out 'ahead" of another.
I know I've not managed my pittances because I paid for staff who stole and workers who didn't work and lawyers who failed and friends who never repaid the thousands they borrowed, and given thousands to charity and had accountants who failed to get the 'write offs' I found I was entitled to after the deadline closed. I've invested in causes that went bankrupt and bought countless things that didn't work and their warranties failed and paid for insurance that didn't come through, etc. I've been duped and lied to and mislead a thousand times. I was a fool to trust. If I'd been paranoid like the taxman who always treats me like himself and makes me so want to be a self fulfilling prophecy, perhaps I'd be a taxman myself.

I know I was more interested in all the wrong things, like sunsets, art and scienc e, good books, peace, god, and health care, education, love and family when I really ought to have been studying finance and thinking of ways to beat the taxman. According to the taxman all of us should have been thinking only about how to make money and avoid giving it to him so we could be rich like all those people who think like him. I know in his eyes I am only the unpaid tax of this month. In the eyes of my government too I increasingly feel they want me dead, since I'm older and less naive and likely to cost the health care system more. Euthanasia is a favourite government topic these days. They'd not euthanize tax men because there's no limit to their number and the good they do for government.

I know he sees me as puny,weak and silly, too. He only respects the truly rich and the criminals who have private armies, assassin squads and like our government officials, offshore accounts. He has no respect for integrity, good name, honesty, love, spirituality and things that I hold dear. The government encourages loyalty and frugality and service only to take advantage of the poor idealists who believe them. These realists despise the idealists but they legislate everyone else as cheap while claiming themselves, commoners that they are, as precious. I did ask what I could do for my country and I did it over and over again without pay. I am not rich or the super rich. I am a peasant like most Canadians.

But sitting cross legged I ask God to help me with gratitude. I am thankful that I have a job so that I can pay taxes. I ask God to teach me to love the tax man and accept that my government is unfolding as it should. The taxman is my spiritual guru. He or she reminds me that I am a killer dog who at any moment could crack and hunt down my enemies for edibles if I did not pray daily for grace. I really do want to stand upright and not drag my knuckles. The tax man is my helper in my pursuit of the holy just as China is Tibet's.
I don't condemn the terrorists or the road rage guys or the ones who go postal. I condemn their acts but now I even understand how guys in any military would want to go displace their anger from home and kill ragheads abroad. It used to be gooks and before that some other poor sod. An that poor young sod was doing the same thing, volunteer or conscript, dying young on the 'field of honour' than grow old on the 'field of dishonorable field of politics." If the government workers and tax departments did have honour the streets would be strewn with men and women who died on their swords when their corporate friends raped the national treasures and stole the future environment.

It's only really easy to be a saint when you're selling books about being a saint or you're getting paid to be a saint.
Spirituality is really a daily chore. Bite your tongue. Turn the other cheek. Be nice. They are not potty trained. Be nice. More bees to honey than shit. Don't read the newspaper. You can't handle hearing about another government corruption today. Exercise. Meditate. Spend more time in prayer. Know you can always just walk away. You're not indispensable. Hang up on the taxman and walk out the door and stand in a welfare line or take up a life of crime. Or muddle on. It's irrelevant to him. He doesn't care. Why should you. It's your life. This too will pass. Breath. Now practice being peaceful in the middle of the economic war. And when you get that right, grasshopper, we can get let out of kindergarden.

It's easy to love those who are like you. Even tax men care for their families and friends. But the test is loving the taxman and praying for him or her and knowing that Jesus taught that. The Bible is all about the taxman. Love them for they know not what they do.
would love to hear a Buffy St. Marie song, "Universal Taxman" or "Universal Beaurocrat."
Buddha would want us to love them too. I don't know about Mohammed because he seems a bit more down to earth, pragmatic and would jihad the tax department making the moslem religion more appealing some days despite the squabbling harems.
Gandhi would ask that we love the tax man. Martin Luther King said, it's going to be a hard day, so I must spend more time on my knees.

I for one must thank the taxman for teaching me humility, restraint and peace and mostly reminding me how much further I have to go to be a saint. The taxman is one of the greatest gurus of all really. I will only know enlightenment when I love the taxman. I will be a saint only when I love the tax man. What is the tax on saints these days, anyway?

Wednesday, August 26, 2009


I love Granville Island. I first came here as a summertime hippie wanna be travelling across Canada by thumb. Next I encountered it as a hip yuppie enjoying the Pelvic Bay nightlife. Then I became the mariner. Granville Island would be the place where I did my first sailing lessons at Cooper's Yachts. Then I'd have my 40 foot steel offshore yacht up on the hard bottom painting it for the next year of sailing. When I lived on my boat at the commercial fishing docks I'd dinghy over to Granville Island for the fabulous market. What a treat it was to have fresh meats, vegetables and fruits from the primo marketplace in Vancouver. Always there'd be musicians and art shows going on. Emily Carr College was up the street. I learned scuba diving at Rowand's. The bookstores were terrific. Everything nautical and always the fine dining restaurants with a real mix of day people. I loved getting a live crab or lobster and taking it back to my boat for an evening feast. I played alot of music back then and musicians came by in the evening for dinners. Then Granville Island was the place I went to see Theatresports and enjoy the Granville Island Theatre. Now I've been going back to eat at Cats Social House on their patio. Burgers, salads, calamari, chicken dishes. It's just the great Granville Island atmosphere. With out of town guests I took the little water ferry from West End to the Granville Island docks. The Wooden Boat Festival was on so we could walk along the docks and look at the polished shining variety from Master Steamer to a Viking long boat replica. It was this same dock that I left from for my sailing trips for Mexico, for California, for the Charlotte's and for Hawaii. The last night in Vancouver had to be at Granville Island. Here I was again enjoying all the nostalgia. My 26 year old nephew and his friend, great guys, back from doing the Grouse Grind and bicycling round the seawall for fun. Now I was walking them down memory lane pointing to all the little shops and places that make Granville Island unique and truly appealing. This is where the artisans really show their latest wares. And finally dinner at Cats Social House. Beautiful young waitresses, laid back neighbourhood pub restaurant atmosphere, quiet in the heart of a cosmopolitan city. Water all around. Granville Island between the two bridges of Granville and Burrard. A duck pond behind Cats. The guys even had Granville Island lagers brewed next door. The exotic Asian Caucasian waitress talked about marine biology. We discussed Canadian bilingualism and the changing face of Canada as the next generation of immigrants come of age. Seeing my nephew I'm reminded of my big brother, his father. We were once young too. Now we're older. It was a really social evening and again I liked Cats. Kind of place that makes for easy conversation. Great food too. We walked back to the water ferry. Now the guys are off to the Cellar night club where the young waitress told them a bikini contest was taking place tonight. I'm off to bed. It's been a long time since I was interested in anything the other side of Midnight. It's even weirder that I knew this young intelligent accomplished man when he was a baby.

Tuesday, August 25, 2009


He reported the killings.
He kept facts and files.
He named the names,
And dotted the i's and crossed the t's.
He wanted the killing to stop.
He was scrupulous in his concern
Unbelieving in the callous cold killing,
He witnessed along with so many others.
Such killing is always public.
But only he and maybe others reported it,
To the proper agencies,
Who turned out to be there solely to ensure
That such information never saw the light of day.
First files were lost, delays upon delays, but mostly
He became the 'trouble maker' , "the difficult disruptive one"
Indeed the 'enemy', for persisting
And not changing the story and ignoring the dead.

Finally he was blacklisted even as the killers were let go.
Beaurocratically, they were dealt with,
Transferred or even promoted
Away from their crimes.
But there never was any prosecution,
Just cover up and more cover up
And he was hated for the necessity of the cover up

Why had he not lied and denied and remained 'mum',
As the rest of them had done.

At first it was subtle and then none too subtle.
The very people who had kept 'mum'
So more killing was assured, were rewarded.
Whereas he was made to pay in every way
For his care and concern for truth, life, love and liberty.
There was no money in the truth.
Killing was more rewarded.
There was no love in all the 'unnecessary death'.
Just profit. The greater good.
And there are no liberties,
Just those that are taken.

He was labelled a 'non team player'.
He reported the killing and the cover up
And the cover up of the cover up of the cover up.
But there was no 'whistle blower protection'.
Whistleblowers were only encouraged to come forward
To be identified.

Stand up and make yourself a target, flakey!

The reformer was the enemy of anyone
Who benefitted from the status quo.
The status quo was lethal, profitable
And unforgiving.

You cracked a few eggs to make an omelette.
What are a few or many deaths when the
Ends justified the means.
There were always profits to consider before life.

Don't talk to him about sacrifice.
If you don't have the stigmata of wounds,
You never were close enough to the truth
To have been a threat.

The Treo Smartphone is just plain DUMB!

I had a Palm and filled it with medical textbooks and aids. I paid hundreds of dollars for these electronic accessories. The promise was that if I remained in the Palm family I'd be able to access these gems of research and power. I had the first Treo smartphone and was pleased. Everything switched from Palm to the Treo and the companies that made medical products upgraded them to serve the first generation Treo. The battery on that phone died as the RAM became too small to meet the needs of Epocrates, the medical pharmacological updating software. The next generation of Treo seemed the answer.
It wasn't. None of the software I'd previously paid for would work on the next generation of Treo. I lost some thousand dollars of medical text books unless I wanted to carry around a palm and my new Treo. I lost the labs and diagnosis books because overnight they would not serve this generation of Treo. Some of the purchase were less than 2 years and their usefulness would be 5 years normally. The latest edition of Harrison went up in cyberspace.
I then bought Money and found it didn't work at all in the Treo despite the promise of Windows Mobile that I, being savy with computers and such, had indeed correctly downloaded the proper versions. All the SPB products don't seem to work. Hundreds of dollars on shells and such out the window because there's no support for any of the Treo or Palm products except that tedious email automatic sessions and a message that for hundreds of dollars I can buy a support for a product sold at $39 that doesn't work from the start and there is simply no way to return it.
Time is money and the Treo is now the costliest stupid phone in the industry.
Routinely I open my treo and it flips through a half dozen pages before I can access the phone or camera or word. Windows Media is often frozen on my computer. I do soft restarts and plug it into my computer and try to sort out the endless number of glyches.
Treo is a child's toy from hell.
It doesn't work with my Vista and it doesn't work with XP.
Meanwhile all my friends rave about the IPHONES and Blackberries. I see their happy faces and note they're computer illiterate and ask them about crashes and applications functions and cameras and all manner of usefulness of a smart phone and there phones are. My Treo needs an IQ test, a new interface and support in the industry.
It is demon possessed and the company should be ashamed to produce such a spurious product. I have wasted enough valuable time and money. I am leaving this Palm and Treo world. I was a loyal customer for over a decade and can not ever recommend anyone involve themselves with this company. The Treo Smartphone is just plain DUMB!

Night Fear

I cannot do this again
The clock face drooling and writhing in torture
As the ticks screech the day
In a contusion of painful memories.

Sunday, August 23, 2009

Salt Spring Island 17th Annual AA Rally - Sunday

By now the toilets were all working and the showers had hot water. The coffee was great. The Kiwanis breakfast was even better . The final speaker Vern from Whitbey Island was a joy to hear. He described life on the islands without electricity but lots of booze. Then one day he met a woman in AA who didn't like the way he drank and he 'wanted what she had'. He stayed sober and they moved in together but it was a while later that he met the love of his life. 12 years married and much longer sober, he spoke to finding God in his life in ways he'd never have thought possible. "Don't leave till the miracle happens", he said and we all stood applauding him and the spiritual singer, John, before who'd sung Amazing Grace to open the meeting. Holding hands we closed the meeting and the rally with the Serenity Prayer. The organizers were amazing. "I loved the woman speaker who told the story of starting Avalon Woman's centre" one of us said as we reminisced about the rally taking down tents and loading the car and motorcycle. Clean up was fun, many hands making the work light.
We figured we'd get a ride on the ferry on the motorcycle but the guys in the car weren't so certain. Typically generous Brian had offered the other tents a ride so his car was riding low with people and tents and musical instruments. Looked like a regular Indian bus when it left the campgrounds. Waiting in Long Harbour for the ferry was serenity itself as eagles circled the beautiful bay. Murray on his Harley rode on with us and the girls both 4'11'' exchanged phone numbers before we all headed up to the ferry restaurant for burgers and fries. A perfect day for a crossing. Blue sea and blue sky and all of us with red faces or tans from the hot sun. Saltspring Island Rally was awesome!!!!

SaltSpring Island 17th Annual AA Rally - Saturday

Tenting is a truly remarkable experience of learning again what one so easily takes for granted. Friday night was chilly. The ground was hard. I woke being elbowed and kicked by Laura who had learned that there were showers which opened at 6 am. "If I'm first there I'm sure to get one. But there's only 4 showers and there's 400 or more people. And the sign said they closed the showers at 11 am. " The next thing I remember is wakening again to, "There was no hot water. There wasn't any light. Men kept trying to get in the door because they didn't know I was in there. It was freezing. I couldn't find my clothes in the dark. The soaps still in my hair."
She was agitated to say the least and it didn't look like I was going to get any more sleep. So I crawled out of my sleeping bag and had one of God's luxuries. A Starbuck's can of Double Shot Expresso. It was a grey morning. My back and joints ached. The expresso helped. I left Laura thrashing about in the tent.
Walking up to the men's washroom improved things somewhat. Motion does that. The dogs were out. They're happy creatures in the morning and delighted to see another human afoot. When I got to the washroom I peed. It's a God given joy. My bathroom is steps from my bed at home so taking a long walk across a camp ground before having a pee makes it that much more enjoyable. I shaved after that. Looking in the mirror before and after didn't improve things all that much but I knew that if I didn't shave it would only get worse.
Then I showered. No line up. The women and men who'd thought like Laura had come and gone. There were also showers in the camp ground and some people are just downright dirty or preferred to remain so rather than take a cold shower. It was a bracing experience to say the least. But I was clean and that felt a whole lot better. I was awake too, maybe not as awake or excited as Laura had sounded but definitely awake. The coffee was brewed and ready in the hall so I got another cup and headed back to the tent.
Kiwanis makes a great breakfast for the Rally. By now Andrew and Brian were out and about. Brian likes morning and wakes happy. Bill, despite his mattress or because of it, wasn't early out of the tent and when he did get going it was in slow motion. I saw the other Brian passing with a towel and there was Rafael looking uncharacteristically dishevelled. Kate passed bleary eyed and character after character I'd seen in some other dimension appeared in morning mode. The pancakes and sausages were great. Now here we were clean, shaved and fed and ready for the morning meetings which were terrific too.
After Laura and I headed into town for the Farmer's and Artists Market. It's one of the events Salt Spring is known for, people from all over coming to buy the fresh produce, lamb skins, pottery, paintings, exotic art and colourful clothing. We counted ourselves lucky getting away with only a purchase of beautiful unique but inexpensive jewelry. After that we were headed off to Sabine's Fine Used Bookstore. Now there's an institution. I've been to Salt Spring dozens of times and love it best when I bring my boat so I can fill up on books. The motorcycle limits what we could haul but we still got a half dozen treasures . I founds Miles Smeaton, the great sailor's, book" Moose Magic" about Beryl and his animal farm in Alberta.
Lunch at Aunt Pestas Cafe sitting on the deck overlooking the boats was a truly relaxing fine dining experience.
Back at the Rally they had the Lamb Roast dinner. They made vegetarian chili and had smoked salmon along with salads but for me and many others the experience was the delicious lamb that had slow roasted on the spit all afternoon. Another bit of heaven on earthy especially when followed by blue berry pie and ice cream.
After that here were more speakers and then our tent area because a place of great fellowship. Bob is an amazing guitarist with an inexhaustible repetoire of songs we all could sing to. I'd had Brian bring one of my drums which turned out to be a god shot. It happened that Andrew played drums with Jeff Healy. I told him later "you made that one drum sound like it had a whole drum set hidden inside it." Well Kate, Laura, Nadine and and Cathy harmonized Bob sang and played guitar with Andrew making the drum sing. I had the Washburn filling any empty unused space in that wall of sound we created. Johny Cash joined us later. Then it was the Beatles, Eagles, Crosby Stills Nash, Bruce Coburn, Dylan, Lightfood, Stan Rogers, Lead Zeppelin and Yes all making incredible appearances.
Little Brother was the band that played after the speaker. The dance floor filled to them. What a great group. Laura and I sweated up a storm surrounded by young people who seemed to do this thing effortlessly. After a while we went back to join Bob and Bill singing with Andrew drumming out by the tents. Story telling and music continued into the night with the Milky Way running overhead across the crystal clear sky.
Laura climbed into the tent and sleeping bag first and I followed sometime later. Sleep was incredible. The night warm and the ground a whole lot softer.

Salt Spring Island 17th Annual AA Rally - Friday

17 years ago some Salt Spring AA members and their friends decided to put on a rally which would celebrate the distinctive experience of Islanders. They had no idea it would grow into what it's become or that it would continue with increasing popularity as people come from all over Vancouver Island, the Gulf Islands, the American San Juan Islands, Vancouver and Frazer Valley and further parts of Canada and the US. This year they even had a visitor from Japan. The theme of the meeting was "Complete Abandon" referring to the idea in AA that a person who has completely abandoned his or her life to Alcohol will get his or her life back by completely abandoning himself or herself to a Higher Power. This can be anything but alcohol and usually begins with the program of AA and grows to a loving God.
Mike B was the Friday night speaker and what an extraordinary speaker he was. Growing up in California during McCarthyism he shared 'it was a time when the majority of Americans wanted 20 million or so other americans mom and dad weren't we moved to Mexico....later when I began to drink it made me feel....well....Repubublican." Hundreds of us filling the hall laughed and cried as he took us forward through time. "My friend phoned and said I had to try something. It was 1965 and he gave me LSD 25. I vaporized and probably met some of you in a distant galaxy. However when I returned to earth it was to find myself naked surrounded by 4 uniformed cops." Things didn't quite turn out as he hoped and eventually like so many when alcohol no longer seems to work he was one of the fortunate ones who found his way to AA and stayed. After that his life became what it is today, beyond his wildest dreams with success he'd never of imagined because he felt fortunate he'd not ended up in jail. When he finished the room exploded with applause as everyone gave him a standing ovation. The meeting closed with the Serenity Prayer.
Our group was famished so we headed into town in Brian's Pathfinder and found gastronomical heaven in Moby's Marine Grill. We had lamb steaks and lamb burgers and some of us wished they had lamb steaks or lamb burgers because those of us who did moaned with the greatest pleasure. However they did insist their beef burgers and salads and such were almost as delicious. KC Kelly was promoting his record Wild Card with gorgeous island women dancing up a storm to his raw island blues. A truly memorable night of food, friendship, and fun!

Salt Spring Island 17th Annual AA Rally - The Tents

Laura and I had our motorcycle tent. It's a one and a half man tent. Laura's 4 foot 11 inches and I'm 6 feet. We manage. We put up our tent in the afternoon. The guys arrived late.
Now Brian was in the military and he's tented alot. Putting up his 4 man tent in the dark wasn't even a challenge for him. Laura, Andrew and I, however had a wholly different experience trying to put up the 10 man tent. Things only began to progress when Brian joined us and to everyone's amazement we had the Coleman Taj Mahal tent of tents erected with red and white fly correctly placed after much rotation in a rising wind.
Meanwhile the other Bill hadn't quite grasped this whole idea of tenting. He's more at home in a 5 star hotel or board room. 2 years ago when we all attended that Salt Spring Rally he set up his tent without a fly. The fly is the covering that modern tents have which is a separate tarp that serves as a roof over the net ceiling of the main tent. This allows air to circulate and keeps rain out. Bill awoke from a dream that someone was pissing on him and found himself lying unprotected in the late night downpouring rain. In the morning the sun came out and he was able to dry his sleeping bag and clothing out. I lent him a spare fly I had. Everything was dry but he forgot to close the tent door while we were in town. The afternoon rain came at a slant and soak everything in his tent a second time. Not one to be put off by minor setbacks Bill even weathered the laughter of his friends that arose whenever anyone mentioned the word 'fly' around him.
This year Bill forgot his fly again. This only became apparent when having set up the 10 man test against all odds we looked to see what was holding up Bill. His tent was up minus the fly but he'd begun to inflate a gargantuan bodello mattress that filled his entire tent making it a Michelan balloon that threatened to lift off.
"There's no room for you to sleep in there," Brian offered helpfully.
"If you're trying to get a girlfriend, a mattress like that is sending all the wrong signals. Girls like guys to be a tad more subtle," someone else helpfully added.
The 10 man tent had been for communal gathering but it became evident that it was going to have to house the mattress. Bill and Andrew would share the tent.
Bill deflated his immense mattress and moved it to the ten man tent. He began inflating it again with the help of Andrew. This became known as the 'longest blow job'. Brian, Laura and I were holding our guts laughing at Andrew and Bill and the commentary between them. Andrew insisted he would sleep on the floor of the tent after that.
In the morning we saw that tents and campers were everywhere overflowing from the main field that surrounded the Farmer's Institute on Rainbow Road. It would be the largest ever Salt Spring Island AA Rally.

Salt Spring Island 17th Annual AA Rally - The Ferry

Packing for a weekend of camping is itself exciting. The motorcycle camping gear when not in use has lived in the dining room beside the fishing gear and winter snow shoes . If I take it to the storage locker I'll only have to get it out again. This trip we don't need the cooking gear since meals are provided. Instead, I am taking the Washburn Rover Guitar. Brian picked up the ten man tent and all my camp chairs Thursday night. He's coming over Friday night in his Pathfinder with Bill. I've got Road Trip and Camping fever. Laura gets it too after I pry her fingers from her beloved bath.
We carry the gear to the basement and load up the Harley.We're away. The trip to Twassessen is a rush. Getting out of town mid day beats all the traffic. The Deas Tunnel is another level of separation from Vancouver and work reality. Then it's the ferry itself. Laura loves seeing Mayne Island and I take her picture as we pass the lighthouse. Active Pass brings back memories of all the passages I've made day and night in all seasons in my 40 foot sailboat. Crossing water is aways symbolic of a spiritual journey.
The sky is clear. The sea breeze is sweet. The sunshine is glorious. Having hot dogs and coca cola on the ferry we meet Joe. He's headed for the rally too. The gathering is beginning.

Friday, August 21, 2009

I am not my thoughts

I am not my thoughts,
My thoughts are not me.
I am much more than these
I am heart and soul and mind
And relationships
Past and future.
I am the gestault of all that is
And is becoming.
My thoughts are but passing commentary,
Sometimes murderous with rage
Or suicidal with self pity,
But they are not me
Any more than my skin alone is me.
I have these
But I am more my action
I am more my love.
And I would have more lofty thoughts
And kind thoughts
Safe thoughts of wonder and miracle
And joyful thoughts
Fearless in love,
Loving thoughts.
But I would not be these alone either
For I am more than my thoughts
Much more, as you are too.
Meeting as we do,
In infinities.

Thursday, August 20, 2009

Fetishism and Paraphilia

This is a complex subject with no easy answers. The DSMIV has been criticized soundly for it's inclusion of sex related diagnosis. However, it's normal for patients to present seeking help with sexual and intimate relationship issues if the clinician is non judgemental and opens the subject or at least is open to discussing matters medical. Most psychiatrists and doctors in general would be unlikely to hear about paraphilia or sexual fetishisms simply because 1) people don't talk about them 2) people certainly don't talk about them to mommy or daddy figures 3) and people don't see them as a problem 4) psychiatrists and doctors don't ask. The most casual survey of a adult sex store though shows a vast array of objects and 'toy's'. Yet, sex toys and objects made to represent sexual parts are not considered in some definitions paraphilias though anthropologists at very least have considered these objects often of ancient history as 'fetishs'. The literature on fetishism is broad and includes those who might desire a 'type' of woman, say one with long legs or big breast, or a type of men, say one with slim butt or large penis. In the area of objects there is this confusion whereas the demarcations become clearer when the line moves out to the less common areas including self cutting in women and coprophilia or feces associated sexual behaviour in men and women.
There is an idea that what is normative is heterosexual coupling for reproduction or genital sexual intercourse and movement away from this missionary position of sexuality is in some way 'abherrent'. Indeed there's always this black feather on the white feathered chicken "difference' which gets a disease categorization from the conservative herd. Foreplay however has long been associated with much fetishistic behaviour from corsettes to lip sticks.
Developmentally 'imprinting' as seen by psychologists, can have a profound effect on sexual arousal and appreciation. English boys whipped in schools describe anecdotally involuntary sexual arousal and orgasm with subsequent preference for 'spanking' play. Neurological studies suggest some actual 'cross wiring' whereby a non normative sexual act can cause arousal and then be learned with the patterning following. Sexual Addiction research shows clearly that behaviours can be learned and unlearned by group therapy and individual practice.
There has been a strong suggestion however that if one 'prefers' some sexual activity, especially one which involves inanimate objects, over an actual sexual encounter with a real living human then that would indeed represent a paraphilia and the object would be a sexual fetish. This is distinct from what may be called the 'transitional object'. A young woman may take a fancy to a cucumber in her exploration of her developing sexuality in the same way as adolescent males not infrequently show up in emergency departments with unusual encounters which trap them, the vacuum cleaner nozzle being one such. Every radiologist working in emergency has seen any number of inanimate objects in vaginas or anal cavities from plastic fruit to screw drivers. They show up on the xray when a patient shyly complains of abdominal pain. "I"ve seen lots of lost vibrators but not one when the batteries were still working" said one crusty radiologist in the emergency late one night.
The idea of 'transitional object' is simply that in the process of learning there is not uncommonly exploration and once the 'normative' experiences are established alternatives die away. And in a world where sex was readily available for all this might be the case. However that's not the ideal world and 'objects' collected in Victorian times by doctors were often put on impressive displays.
It's increasingly felt that what "consensual" adults do in their bedrooms and what individuals do in their bedrooms is their own business. Hard as that idea is for people to grasp some people despite the state and religion enjoy the idea of 'privacy'.
However, there's a tremendous amount of shame confusion, and sometimes harm associated with paraphilia and fetishistic behaviour. Recently the material used in some 'dildos' and 'vagina simulator's' was recognised as having a slight medical risk with alternative materials being developed. Similiar questions have been raised about condoms and lubrications. Asked specifically about the sex toy material in clinic one day , I frankly had no idea, and despite a quick perusal of the limitted literature didn't know if the 'risk' was serious or not despite the fact that the industry is moving to the newer materials. Frankly I didn't know who in public health or medicine might know or answer the question without being suspicious of me, a psychiatrist and sexual medicine specialist. "Sure you're asking for your patients, doctor" wink. wink. And I figure if that's the perverse response I'm concerned about getting to questions of a medical and scientific natures it's much much worse for patients.
There is no doubt in my mind that the paraphilias and fetishism remain in medicine and psychiatry however I"m concerned that the diagnosis be associated with some form of acknowledgement that an individual who sees a clinician is 'concerned' about the issue and not that we, as psychiatrists and physicians, have to enter the murky political world of what is 'right' or 'wrong'. I am thankful that I've been available to be asked by patients about fetishist activities or paraphilias and been able to answer questions specific to 'physical health'.

Wednesday, August 19, 2009

Schizophrenia Controversy

Schizophrenia is considered a thought disorder with a genetic predisposition triggered by environmental factors. It is a deteriorating disorder that affects cognition, emotional stability and overall personality. It is commonly associated with delusions and hallucinations. The most prevalent form is paranoid. It affects approximately 1 % of the population and seems to exist in all cultures. The nature of the delusional material is related to the prevailing culture. Where the community is predominantly religious the content is often of a religious nature whereas in the modern world with computer chips and space age technology the content is often government or alien based technological. The onset can be insidious or more abrupt and classically affects adolescents and young adults though a sub group appears late in life. It is associated with a higher incidence of suicide. Psychosis or the feeling of being out of touch with reality is central. Also to the community the person appears odd or unusual.
Where the controversy arises is not with the diagnosis of 'psychosis' a rather straightforward and relatively easily made diagnosis but rather with the diagnosis of prevailing perpetuating state of schizophrenia. Schizophrenia as a label is life saving for those indeed with the disease though there is concern that it can be a 'self fulfilling' diagnosis. Yet, there are many schizophrenics I have known who are thankful for the diagnosis as it makes sense of a very fragmented reality and helps them and their family cope with this devastating disease. Friends of Schizophrenia brings hope and resources to the families, friends and patients suffering this tragic mental illness.
Though Schizophrenia was once the principle diagnosis of those in asylums, today the vast majority of those with schizophrenia will live full lives outside of the hospital and many will engage in important occupations and have full family and social lives. The movie Beautiful Mind, directed by Ron Howard and starring Russell Crowe is a very fine depiction of such schizophrenia.
The controversy is however with the diagnosis. For decades the Europeans have required prolonged psychosis before making the diagnosis whereas the Americans would make the diagnosis almost as a hip shot. The diagnosis of Brief Psychotic Reaction in DSMIV discouraged this latter cowboy diagnostic group and encouraged patience. Too often a person would present with psychosis and then the psychiatrist would retrospectively take a history which would then validate the a priori schizophrenia diagnosis rather than accepting the first visit to a psychiatrist as the point from which the diagnostic clock should begin. The French even suggested that a mid diagnois between Brief Psychosis and Schizophrenia be established which demanded over 6 months of frank psychosis. There are still the hip shooters but the evidence is overwhelming now in supporting the European approach. Research now establishes that early psychosis appropriately treated does not need to progress to schizophrenia. The black and white Americanism of the Old School is now replaced by a much more reasonable continuum. The new American approach actually suggests the potential for a cure.
Psychosis or first break Schizophrenia cannot be defined at initial intervention. The diagnosis of schizophrenia conservatively should wait for a year or more while the treatment for psychosis is nonetheless initiated immediately.
Schizophrenia is thought more of a degenerative brain disorder and the expected course is slow deterioration in social competence and decreasing independence. There may well be a link to the Autistic disorders or it may follow that schizophrenia is some slow virus type infection.
There's a quality of oddity and emotional lack.
In contrast the diagnosis of Schizoaffective Disorder is a schizophrenia/bipolar type illness with more stable outcome, less deterioration and alienation and more emotionality.
Bipolar is the mood disorder that is thought somehow related to the more positive outcome schizophrenics.
In the 80's when new thinking regarding schizophrenia and bipolar arose with new affective disorder treatments I witnessed some hundred or more schizophrenics responding to the new medications and having the diagnosis changed to fit the medication response. Schizophrenia was recognised to be a bit of 'garbage bag diagnosis' with a lot of bipolar and schizoaffective mixed in with the historically more definitive schizophrenia. It was recognised that schizophrenia responded to antipsychotics however these others responded to the type of drugs which were being used on mood disorders, such as the anti seizure drugs and lithium carbonate. Also ECT tended often to make schizophrenia worse whereas it was a definitive and excellent treatment for mood disorders often 'curing' them with a brief course of treatments.
A particular sub group of interest were the drug related psychosis. A forensic psychiatrist typified the gross ignorance and bias of the old school saying, "what we need is a marijuania anti psychotic mix injectable to improved compliance in schizophrenia." What wasn't recognised was that chronic or even intermittent marijuania use could cause and maintain psychosis leading eventually to schizophrenia. This is even more true with cocaine and the amphetamine. Some of the drugs of abuse cause such severe brain damage that it shows up as 'holes' in various brain imaging surveys. Gas sniffing and other inhallants are such profoundly damaging 'high's".
Schizophrenia itself appeared to be related to the length of time that the person remained in the psychotic state. Persisting paranoia for instance almost appeared to 'burn out ' some brain circuits which did not easily repair. Stopping marijuania and other drugs of abuse including alcohol and placing people in a supportive but reality testing environment proved highly effective in stopping the progression of the disease.
Many churches, temples, synagogues, and 12 step programs know those who were crazy as loons for the longest time only to eventually improve in the 'holding environment' of the loving community that did not support the delusional world. New treatments developed in psychotherapy that did not behaviourally reward psychosis but rather acknowledged it but then expected the schizophrenic's bed to be made anyway proved far more effective than the old 'drug em and leave em' approach. Maintenance of function rather than allowing isolation resulted in the most positive outcomes which included increasing numbers of 'cures'.
Today one can hear a person say, "I had schizophrenia but it's cured and I no longer have it" whereas that was unheard of only a decade or so ago. Indeed the old school tended to get around this 'problem of recovery and cure" by begging the question and 're diagnosing' those who did well." The circular reasoning said 'schizophrenia doesn't get well so these can't be schizophrenia". It's called 'saving the appearances' and we're all at fault for it some of the time.
Thankfully today it's no longer necessary as increasingly it's recognised that the continuum disease is such that there are those who resolve early if treated appropriately and hopefully and given sufficient time, resources and treatment to have a cure and those who have milder forms of the illness while indeed there remain those who are often now called 'intractible schizophrenia". Medications help all, though the milder cases may do better with lower dosages whereas severe cases often require dosage of medication far outside the 'label' use of the medication. The new atypical antipsychotics are a god send having fewer side effects and more specific action.
Drug addiction was a major source of schizophrenia too as persisting drug abuse not only interfered with performance of the antipsychotic medication but acted like opening a wound. Cocaine psychosis was once considered the best 'induced schizophrenia' model available. DSMIV now recognises a psychosis, thought disorder, anxiety disorder, or mood disorder associated with all drugs of abuse including alcohol. New MRI data suggest that the persistence of the influence of drugs on the brain is a minimum of three months in many cases clearly at variance with the old school approach that said the psychosis had to be associated with the presence of the active compound for it to be drug related. Today it is recognised that just as traumas like war and rape can have long lasting effects, as can head injuries, so can the chemical effects of drugs and alcohol. Addiction medicine has further shown that while cognitive function may restore initially so that a person is no longer frankly delusional, the problems with emotional stability and social functioning may persist well past the three months that a direct organic consequence can be documented.
Genetic research suggests that there is a need for three different locations of genetic change to predispose for schizophrenia itself, (damage at only two sites may influence the overall outcome or course for instance) ,a psychosis inducing trigger and now the lack or innappropriate treatment and the persistence of the psychosis for a year or two. With this the old life long disease will likely follow however with new medications and treatments patients even with this are least likely to spend time in hospital and may function extremely well with continued psychiatric care preventing any deterioration.
In the end it's also important to remember that Freud, to paraphrase him, as he accepted the Nazi government for what it was, said, Sometimes the Paranoids are right.
That's even more true today given the changing perceptions of the fabric of reality, the economic crisis and the lack of faith in the truthfulness of government, a wide variety of competing sources of internet information, the continued predation of the mentally ill and the greater stigma attached to schizophrenia and psychosis itself in the overall stigmatization of mental illness in general.
There remains a controversy regarding diagnosis with a spread still existing between those who hip shoot diagnose too early with devastating nocebo effects and those who diagnose too late and act initially ineffectively. Fortunately, it's recognised that psychosis needs treatment and protection but most importantly protection. In time continued research and improved treatments will ensure fewer with psychosis progress to schizophrenia and that schizophrenics can hope that the course of the disease may no longer involve continued deterioration.
It may indeed prove that patients will heal better than society at large which often appears more fragmented, psychotic and schizophrenic by the day.
One interesting finding was that schizophrenics appeared to vote with identical distribution to the normal voting population. While the researcher argued this showed that only some aspects of judgement were affected in schizophrenia I noted that he'd made an equally strong case for the poor judgement of the general population in political elections.
All of us though who have the priviledge of working with the mentally ill, especially the schizophrenics and those with psychosis know these individuals as frightened and a far cry from the way they have too often been portrayed by the media. There is indeed a powerful link between the sensitivity of those with psychosis or those who go onto schizophrenia and those with genius or special gifts. Family studies consistently show that the two run together. That certainly has been my clinical experience.

Tuesday, August 18, 2009

The Canada Line

We were just complaining last night that the government was spending a fortune on a "jock party" in Whistler. I like to put things in the perspective of high school to understand the adolescent workings of the world. I think I knew things best when I was a teen ager. Politics just got weirder. So we put our money in the pot and instead of it going to health care, education, science or the arts or addressing poverty or even crime the student council decided to spend it all on a party.
"I liked Expo because I could go to that but the tickets for this are sold out and it's not even in Vancouver. And they're closing the city streets down for two weeks". My friend said.

"The Sea to Sky Highway got done and that's a real improvement for everyone," I said. "And now the Canada Line opened and that's another big benefit."
"Olympic Village is supposed to be something else too." she said.
"I think it's amazing that we'll be able to get to and from the airport in less than a half hour on the Canada Line. I heard today that everyone was riding on it just for the joy of the journey."
"Your nephew is coming and that's like having party. It's causing you to clean the apartment. " she said.
"Yea, this 'party's at least having the effect that some things that everyone wanted in Vancouver and needed are finally getting done. I can't wait to ride on the Canada Line. All of Vancouver's international guests are going to appreciate the quick connection to Vancouver. Just like Heathrow or Shiphol. "
"The Canada Line is certainly a bright side of thing." she said.
"Sick, uneducated, scientifically ignorant, uncultured and impoverished we'll at least be able to ride out to airport to beg."
"I don't think it's going to get to that." she said
"Still I like the image. Maybe the homeless can get free passes and just ride the trains after the party is over."

Time Traveller's Wife

Kirk picked it. I wanted to see the movie, Dirty Bastards with gun fights and killing and such but Kirk said this was supposed to be an awesome movie. It really was but they tell me 50 dead men is coming out on the weekend so I'll get the killing and maiming I always trust Hollywood to deliver soon. The movie made me cry. Laura had read the book and was enchanted that Kirk picked this one. Ladies man. It's more than a chick flick but not quite a sci fi. No aliens or droids but extraordinarily intriguing tale like the Benjamin Buttons story. The acting and relationships intensely moving. I cried. Laura cried. But then Rachel McAdams playing Henry's wife Claire looked so like her daughter at times. "You see that too," she said when I leaned over and mentioned it. "You mean the clone." Henry (Eric Bana) with epileptic time travelling experiences unwanted and uncontrolled kept turning up in the oddest places and re enterring Claire's life in a truly wonderful love story. Audrey Niffenegger wrote the book, Time Traveller's Wife in 2003. "The book is deeper but the director (Robert Schwenke) did an amazing job of adapting it." said Laura. The children were the most amazing actors.

Wild Ginger Restaurant

Second floor Tinseltown. International Village near China Town. Wild Ginger Restaurant right behind all the food vendors in the food court, across from the elevators going up to Cinemark 12 Kirk and Laura were already there. Weng S. Wong is the manager. I'd hardly ordered the Szechwan fish noodle bowl when it arrived steaming hot. Kirk was showing us the trillion features on his IPhone. I was lamenting about the failure of Palm and Treo in comparison. He even played a whistle tune with a music program and quickly emailed photos of the moment. I was envious. He was having the Atlantic Tuna I'd had the week before. My Sczechwan was hot and spicy with succulent prawns and scallops and fish as little surprise morsels hiding in the noodles and veggies. Laura was waxing in the magic of meeting Leslie Neilsen, "the funniest guy on earth". He'd been filming a movie at the Arthritis Centre where she worked. We were lucky she'd made the dinner given all the swooning she'd done just seeing him. She had tofu mushroom brocolli and "it was delicious." Revived her after her encounter with heart throb. Kirk showed us how his Iphone screen could be like different types of weather. "The Americans who've never seen fog appreciate the visuals." Later he said he wanted to ask for more of the jasmine tea we so enjoyed so he could take it home in a doggie bag. The meal was superb and all served and all fed in less than an hour. Just in time to head up for the movie Time Traveller's Wife.

Monday, August 17, 2009

Gender Identity Disorder Screening

25 years ago I was one of 20 psychiatrists in a discussion about whether patients with gender identity disorder should have surgery or psychotherapy. The consensus was that surgery was wrong and that the only treatment indicated was therapy. The discussion was being lead by a psychoanalytically trained psychiatrist and we were all junior. I was the only one who argued in favour of a surgical solution. That was as much to do with my community medicine and public health training as anything else. I thought that if 'therapy' didn't work after a reasonable time then clearly consideration of a surgical 'solution' to the 'problem' would be more indicated than continued costly ineffective therapy.
Years later I found myself seeing transgendered patients who had a very negative experience of the process because, quite simply, the basic recommendations for good outcome as laid out by the Harry Benjamin International Gender Dysphoria Association. had not been followed. The Harry Benjamin organization as part of it's 'triadic' approach to GID recommended 'real life experience' ie living full time in the gender to be. Indeed it was early recommended that one spend a year in the role of the perceived gender before or after the introduction of a trial of hormones. Surgery only followed this process. Importantly it was recommended that other psychiatric conditions be excluded before the diagnosis was made. One idea that seemed predominant at the time however was that if you were 'transgendered' this would lead to abuse of drugs and alcohol. This was prior to the present day standard idea of 'dual diagnosis' and the recognition that addiction is a primary disorder and not 'secondary' to other disorders or likely to respond to anything but treatments specific for addiction.
Working in addictions as well it is not uncommon to see people doing drugs and alcohol have many confusions, not surprisingly since the central processing unit is being played around with. One of these confusions is gender identification. Indeed some people on drugs or alcohol believe they are inhabited by aliens or channelling plant life. Yet here were people being lined up for surgical transformation without their drug and alcohol abuse or dependence issues being addressed. The outcome success of the surgical transformation however is directly related to the better pre surgical adaptation. Drug and alcohol dependence predisposed to poor outcome.
Further there are those who are simply delusional. I've met a dozen deities or more in my practice so it's not surprising that psychotic individuals who might otherwise think themselves as not themselves might also think themselves as not their gender. I have treated such individuals with standard antipsychotic medication and they have lost the sense of the otherness of their body almost overnight. In contrast transgendered folk aren't improved with antipsychotics though schizophrenics and manic depressives may be.
The actual diagnosis of Gender Identity Disorder is not fixed in stone. It's easiest if there's a diagnosis made in childhood but mostly the diagnosis is made in an adult who by history gives the criteria as deliniated in the DSMIV. There may or may not be collateral or outside verification of this diagnosis. As for the diagnosis itself it's critical to understand that it fluctuates with symptons of dysphoria waxing and waning at times.
Surgeons and endocrinologists prescribing hormones have commonly established criteria such as requirement for psychiatric assessment principally to rule out the conditions which may mimic GID. Dissociative Identity Disorder or multiple personality disorder is another such condition. While the desired therapy and surgery would have pleased one of the personalities the others would have been sorely displeased for sure. Surgery is clearly not a recommended treatment for DID whereas it is for many GID. Some surgeons recommend anywhere from a half dozen in a year psychiatric visits or reports from over 2 years pre surgery psychiatric therapy before agreeing to do surgery.
In earlier years there wasn't such caution but as more people have had surgery and the procedures become more common and have a better outcome more people are coming forward. However there are those who have sued surgeons and the courts have increasingly become involved.
This is not surprising in this area as there were young women in the sixties and seventies who having decided they didn't want children sought hysterectomies. Unfortunately in their 30's they changed their minds and sued the surgeons. Even more unfortunately the courts found against the surgeons and for a while surgery on female reproductive organs required more than usual consent procedures for women before the age of 25.
Surgeons have generally taken the approach that if they're going to be sued they'd rather not be standing alone. Their favourite companion is usually an internist though as a psychiatrist I've been approached by them for pre cosmetic surgery assessments of those who have unwarranted expectations. This also occurs with GID as some individuals whose personal lives are bereft of relationships believe that overnight a sex change will cause them to have a friendship network and be desirable. This is the sort of matter that should be addressed pre surgery because it clearly can have negative effect on the perceived outcome.
When surgery goes wrong the worst isn't the suing of surgeons. Trans sexual therapies are meant to improve the life of the individual not make it worse. An increase in suicide has been associated with some clinics and that increase has been directly associated with lack of screening. Drug and alcohol addiction in GID is more likely made worse by surgery and certainly psychosis or dissociative disorder and other mental health conditions which can mimic GID or be transitory will not benefit from surgery.
Having the misfortune of knowing transexuals who have killed themselves after surgery, a colleague in one case, and patients who came to the emergency suicidal, it is readily apparent to those working in this field that there is a need for screening out those who are clearly not GID or at least recognising that psychiatric issues that need to be addressed first before surgery if a good outcome is to be expected. Because of the better outcome for surgery in non smokers for instance some surgeons have said that quitting smoking is a criteria for them doing a variety of surgeries including gender reassignment surgery. Certainly this is good medically but it also seems to be a way of assessing motivation for surgeons natually wanting good outcomes.
The actual surgery is only a part of the care and post operatively there is a regimen that needs to be followed carefully for good results. Willingness to follow recommendations before surgery is the best indications of likelihood to follow recommendations post surgery.
The other factor in terms of screening is that these procedures are often paid by insurance agencies who are committed to cost saving. State or provincial or federal health plans want the best cost outcome. As I originally argued if surgery could replace a lifetime of inadequate therapy then clearly from a community medicine and public health and funding basis surgery was superior. However more than one major university affiliated transgender surgical clinic has shut down when the 'cost' in human life and suffering did not show improvement. Lack of adequate screening and pre surgical preparation was seen to be the principal reason for the poor outcomes.
Screening in this sense is not limited to GID. As a surgical resident I screened alcoholics for heart valve replacement. Because of the problems of liver disease and bleeding in alcoholics they were not candidates for mechanical heart valves but were given the less long lasting 'pig' valves because these were associated with fewer complications in alcoholics.
Finally the treatment for GID is not solely surgery and hormones as many with GID opt to lead a life in the gender of their orientation without medical or surgical assistance. There are also increasingly those among the young people who view themselves as 'gender queer' and work to having society change to accept this third alternative. Politically they view medications and surgery as evidence of the rigidity and lack of enlightenment of society and see indeed the need to educate society that there is more than binary code in nature and humans. Rather than 'pass' or 'fit in' to existing society they want society to grow up and accept the existing variety so that individuals who are 'intersex' will not feel the need for 'sexual mutilation' as they describe this process.
Alternatively, sex reassignment surgery can be acquired privately and paid for individually without need of insurance or third party involvement where one makes an individual contract with a surgeon who feels sufficiently comfortable with the individual as to not require any mental health assessment in contrast to the Harry Benjamin recommendations. International surgical units provide this service and may have very good physical results.
Finally it is clear that sex reassignment surgery is beneficial for many in ameliorating symptons and correcting a mismatch between internal perception of self and external presentation. Individually I have seen many cases where this is the case. However, in the process of screening I have had to say 'no' or appear to 'deny' patients obsessed with the idea of a surgical solution to their mental health or addiction issue. This has resulted in threats and intense anger that causes few to want to work in the process of screening especially when the individuals seeking this service may have heavy duty drug addiction, psychosis, severe personality disorders and/or criminal sociopathic backgrounds. There is a desire among doctors to to be appreciated for their more often than not underpaid work. In this field the tendency is for individuals to be angry with the system that doesn't understand their 'need' and therefore not appreciate what they feel 'entitled' to or to feel extreme rage if they feel entitled to a treatment that is denied them until they address their mental health or addiction needs. It's rather a no win situation for the psychiatrist in contrast to the surgeon or endocrinologist who commonly are truly appreciated for providing the desired therapy
One of the simplest recommendations for good outcome has been for involvement in the transgender community support resources. There are several in which transgendered folk can get together and discuss their experience and care. This has proven as effective for good out come as pre natal classes proved for obstetrics.
In those who have addictions not surprisingly a year after abstinence treatment there are those who remain committed to surgery and those who have changed their minds or want more time to consider the options available to them.
It remains too that surgery is a life threatening procedure with the morbidity and mortality that surgery and anesthesia does carry, though relatively speaking the risks decrease each year. Finally the surgical procedures are relatively irreversible so that like any life long decision it's worthy of patience and deep consideration. Those who are fully informed also have the greatest likelihood of the best medical and surgical outcome. In Canada screening remains the best medical and psychiatric practice.

Edward Witten

Reading Physics I came across this gentleman who among physicists has been thought to be the next Einstein. His work in Superstring Theory, Quarks and Black Holes has made him a 'name' in his field. He's like David Letterman to the talk show host circuit, or say Pavarotti to the Opera Crowd. One day we may know Physics so that when asked we might mention the leading physicist of the day rather than think, just Einstein and Newton, not that either of those were a slouch. But it's a tendency we have when things are in our face. Who would have known that John Lennon would be who he was when he was playing strip clubs but today he and McCartney are who they are. Edward Witten is that 'guy' in physics. What I like about him is that he's readable, like Einstein. His articles are not just for physicists but are understandable to the college educated not just the mathematical elite. He's made sense of the 26 dimentional world of string theory with an idea called "M-Theory". Not explaining the "M" in the word, it's been said to stand for 'membrane'. Now being biologically minded, I just have to love a physicist who thinks organically.

Vinyl Cafe with Stuart McLean
Driving home from White Rock in the Ford Ranger Truck, had the pleasure of listening to CBC's Vinyl Cafe. It had been a while since I'd heard Stuart McLean and he was even more funny than I remembered. The show focused on Winnipeg, where I grew up, with the Winnipeg band Weakerthans singing their "I hate Winnipeg" 'anti-anthem'. Stuart got the Canada's Stephen Leacock Award for Comedy. Canadians are pleased that our country is known for that whereas other countries have Nobel's and other such taudry awards. I read Stuart's book, Vinyl Cafe once on a plane flying over America and sensitized to so much I take for granted in my own heritage I could sense entering Canada's loftier air space. A lot less hot air. Our cool patient minds come from ice fishing. With skates we're smoother and glide through life. We actually have wilderness untouched by commercials. Stuart, better than anyone, reminds us of what is best about Canada and being Canadian.

Sunday, August 16, 2009

2009 GASTOWN Motorcycle Show & Shine

Laura and I cleaned up the Harley and rode across town to the 2009 Gastown Motorcycle Show & Shine. There must have been a thousand or more motorcycles there. Jim Byrnes was making some mighty fine music. Trev Deeley had a number of vintage motorcyles from their Exhibit. The Hell's Angels and Jesters parked a ways down the road from the Christian Gospel Motorcyclists. In amongst the big Harley Davidsons' the Triumphs, Ducatti's, Suzuki's, Hondas and Kawazaki's mingled. The Azzikr choppers were all the rage. Tricycles came in all shapes and sizes. The Vespers and Aprillias poked perky heads out here and there. The Yamaha kids motorcycle instruction and ride was the piece de resistance. The kids would fall off or crash and be back on the motorcycles without a second thought. Showed the adults how easy it really was.


Non alcoholics literally never think they have a problem with alcohol. They don't have to control their alcohol or drug use because it's never out of control. Certainly no one is concerned about their drinking or drugging. That's what the first two questions of the CAGE screening test refer to. If a person is concerned about their drinking or others suggest they cut down, 8 out of 10 of these people will definitely have a problem with alcohol.
The World Health Organization recommended a year of abstinence if there was a problem. Further, if a person couldn't go a year abstinent then they definitely had a problem with alcohol and abstinence was the best recommendation.
Alcoholics Anonymous recommends Abstinence for life. Narcotics Anonymous and Cocaine Anonymous and Marijuania Anonymous all make the same recommendation.
There is this idea of "Controlled drinking" and it's most commonly the first step to finding the motivation to quit drinking completely. Most alcoholics have in some way tried to control their drinking by limitting the number of drinks or switching from spirits to beer or some such thing. This may slow down the roller coaster but it rarely works and never really stops an alcoholic from drinking in excess. Eventually the alcoholic will return to abusive drinking. But as one AA said, you don't have to ride the garbage truck all the way to the dump, you can get off anywhere along the route.
It's the first drink or drug that sets one up physically and mentally to have the craving for more drinks even if it's not that first drink that one time. But in contrast to what the alcoholic thinks it's the first drink not that last that does the damage.
More than 70% of people after 3 years of abstinence if they try to return to controlled drinking will return to alcoholic and abusive drinking. At 5 year of abstinence 50% appear to be able to return to controlled drinking without returning to abusive drinking for a matter of a year or more. The other 50% however return to abusive drinking but it's rare that they with thier experience of abstinence return to their previous level of drinking. Vaillant's and other's research showed that after 5 years of abstinence it was more likely that a person never identified as having an alcohol problem would have serious social problems secondary to alcohol use than that person who had been abstinent. There are further studies that show that at 7 years of abstinence if individuals return to controlled drinking only 30% will go on to abuse alcohol. This suggest that abstinence itself is a healing process. However 15 year follow up studies show that those who remain abstinent are healthier and more successful than those who return to controlled drinking. Not only that but they may indeed surpass the projected trajectory of success in work, relationships, and well being of their original cohort. Abstinence appears not only to be curative but also to induce superior functioning. AA members with more than 5 years of abstinence and membership were shown early to be twice as successful across the board as their original cohort.
Abstinence works. It's the gold standard. The whole recovery movement with it's various alternatives is riding on the coat tails of the successful abstinent pioneers of AA. Indeed it's the AA members with continued sobriety whose lives are the model of recovery that have caused society to give alcoholics and addicts the second and sometimes more chances. The millions of recovered members of AA have shown by their example that the disease of alcoholism and addiction is treatable. Once considered a fatal illness without any hope of treatment millions of members in AA and other 12 step abstinent recovery programs have proven that this is not the case. The original Big Book of AA was called a Way Out and it certainly is that for those people who can be honest with themselves, admit their problem and follow the 'simple' program of Alcoholics Anonymous. Abstinence works. "Controlled drinking" is usually a 'glum affair' in marked contrast to the 'happy, joyous and free' experience of abstinence that is so much a part of the fellowship of AA.

Saturday, August 15, 2009

25th Annual White Rock AA Round Up

Robbie from New Jersey was the speaker at White Rock. "We're an organization that recruits members from prisons and mental hospitals," he said. "I'm thankful that men like the man here who has 56 years of sobriety and the man with 51 and the woman with 50 years are here. When I came into AA it was old timers who were there to take me in. Without them I'd probably continued to live on the street doing crime to feed my addiction. Thanks to them I've been sober since family who never wanted to see me again accepted me back when I was 6 years sober welcoming me with open I've a job and family and laugh more than I ever believed."

Tina the chairperson for the organization committee was a thorough delight poking fun at her husband. She interoduced one of the founders and we all heard with laughter how the early committee members, often with little sobriety and some relapses, had funny difficulities getting together a major event with thousands of participants. They had the fire department and RCMP there. The RCMP came to ask them if they had a liquor license because when they asked one of the members outside who they were he said, "We can't tell you."

After the speaker the band began to play and everyone was dancing.

Road Rage

I drove my truck to White Rock. Normally I can't pay attention to the traffic because I'm on a motorcycle. Driving a motorcycle in Vancouver is a life attending event. Every second is an acid trip as your life flashes before your eyes as driver after driver attempts to kill you. In a truck I can see what normally my reflexes are alone responding to.
Most people aren't actually driving but consider their car a moving cell phone booth. At least one fellow who was weaving was very drunk. I don't know about the other weavers. Weaving in their case looked more like some kind of evasive driving routine. The starters and stoppers seemed just to be epileptic. Alternatively they may have not gone back for the follow up pacemaker visits. Another was actually reading the newspaper while driving. And some women was talking at length to to their children in the back seats. The principle disruption though was the slow driver. They created waves of chaos around them with a dozen spaces ahead of them.
Somehow I missed the sign to White Rock and ended up heading out Granville to the air port. Possibly the shocking policeman standing in the road tauting and daring us to drive him down while he presumably checked to see if we were wearing a seat belt caused another level of chaos on the road . There's no need for policemen to be in the middle of the road no matter how macho it may seem to them. If it nearly caused me a heart attack, imagine the elderly spinster worried he'd draw a tazer on her.
Unnerved I got into Richmond where there are absolutely no signs for the millions of us each year who make this mistake and want to find the American border but can't because there isn't any signnage. Who would want to go anywhere but Richmond?
Driving the truck was illuminating. I thought all the drivers were smoking dope around me when I'm dodging them on the motorcycle. They may have been snorting coke but I didn't see any reefer being passed around from the vantage of my truck. Maybe these days worried about the smell they just take a hit for the road.
It's crazier by the day out there. Seeing all the drivers completely unaware of the flow of traffic or that driving slow is equally a hazard to driving fast I'm not surprised people go postal on the road. I prefer the motorcycle even if it's a throw of the dice whether I'll get anywhere alive. Driving in the truck I actually saw how little attention people were paying to the road. That alone could explain the road rage. Some people instead are actually driving vehicles and wanting to get to their destinations alive.
Instead of police standing in the middle of the road doing silly things maybe we could allow them to drive about and pull over drivers that are just plain dumb. Then make them repeat their driver's test talking on the cell phone and reading newspapers while impaired. They only get a license if they can drive under their own preferred driving conditions.
Alternatively they could issue Walther PPK's to us motorcyclists and give us a Darwin Award'sLicense to Kill.