Tuesday, November 16, 2010

Sunday Mail: Mother's cry for her little girl lost

This opinion piece appeared over the weekend in reference to a Sunday Mail feature that is unfortunately unavailable online.

In South Australia's Sunday Mail from the weekend just gone, even the most hardened reader will find the story of Emma Pawelski heartbreaking and incredibly tragic. We find ourselves in the unenviable position of a mother paralysed with the question of what could have been, that horrific state of limbo where no course of action can make any difference whatsoever to that which has already taken place. Emma's story is deeply upsetting and leaves this insignificant blog writer with the most bitter of tastes.
The kind of bitter that causes one to hunch over with sickness.

It is understandable that Sharon McKell, Emma's mother, has written a book on the subject, with an accompanying mission to educate the next generation about the dangerous "allure of drugs". We saw the same response following the loss of Sydney teenager Anna Wood to an 'Ecstasy'-related death, when her surviving parents reached out to the public. Of course it is understandable, but it certainly is not the only response available to loved ones, nor is it one based upon reflection and consideration. At the risk of seeming insensitive and callous, I think, as difficult as it may seem, it is vital for those who have lost people dear to them in such circumstances to take the time to really consider what has occurred before running with knee-jerk, emotional reactions; and I think it is important that the more experienced and wise amongst us reach out, where possible, to assist with the difficult process of learning.

In the Sunday Mail article, Emma's mother speaks of feeling "betrayed and disappointed" in her daughter, eventually "badgering" her to just stop. I can't help but think of two young people I know of. One is a young female who has just turned twenty-one, currently working daily on the streets of St Kilda to support an intensive heroin habit. Where does she live? At home with her mother. What are her mother's primary concerns? That her beautiful daughter is safe, uses sterile injecting equipment, eats decent food regularly and has a roof above her head; and above all else, is in close, daily contact. The second person is a young male who is just past twenty-five years of age, has been diagnosed with bi-polar disorder, has previously attempted suicide and currently injects amphetamines and steroids. He has smoked cannabis in the past on a daily basis. Where does he reside? At home with his mother. What is her primary concern? That he is alive, safe and in close contact with her. Both of these young people are alive today and are reasonably healthy.

I am not blaming Sharon for her daughter's death, but I do find it frustrating that she seems to have chosen to completely externalise everything to do with her deceased daughter. She wants to know "exactly what happened" and wants young people who read the book to "think seriously about the choices they make, the company they keep and the consequences of their actions..." And in the article's brief moment of inward contemplation, Sharon explains that "I could have pushed Emma a lot harder but there were reasons that didn't happen." The reader subsequently discovers that one of those reasons is that Emma "hid a lot of things" from her mother.  Shouldn't we be having the kind of relationship with our children that fosters openness, where young people can reach out to their parents for support no matter what the issue is?

And what kind of system allows young women to undertake sex work simply to maintain a drug dependence? What kind of judge sentences drug users by day and then hires the sexual services of drug users by night, as occurred with Emma? For people like this, is Prohibition a convenient way to channel pretty young women into the sex industry for their consumption? ("Gee, if it wasn't for illegal drugs, I'd never be able to buy sex from someone as young and delectable as you!") Like I said earlier, the kind of bitterness that sickens you to the core.

With all due respect to Sharon McKell, families of all walks of life may be better off spending more time considering the following:

a) why humans use drugs
b) the role of drugs in the evolution of humankind
c) the most suitable response regarding the affected family member/s that is based upon the individual involved rather than what is socially acceptable
d) why the family member uses drugs and what drugs mean to the person
e) reducing the most amount of harm to the person/s from their drug use
f) helping the person/s to stay alive
g) employing the appropriate expertise to support the person/s if and when they make a decision to move on from drugs 
h) understanding the meaning of 'unconditional love'

I dare say that it was the hardness of Sharon's pushing that further entrenched Emma's isolation, alienation and increased risk. Think of the word 'push' - it means to increase the distance between yourself and someone else. Since when do we increase the distance for people we supposedly love? Shouldn't we be pulling such people towards us? Tragically, it must be easier at this point in time for Sharon to embrace the words of those who have themselves been misguided, for fear of the immense pain that would come from looking inward and genuine reflection.

Finally, I feel it is important to mention Tony Trimingham, the founder of Family Drug Support, who lost his son Damien to a heroin-related overdose. Trimingham has delved deeply into both his heart and mind to come to terms with the life that his son led. Since his son's passing, Trimingham has gone on to champion harm reduction (needle exchanges, supervised injecting facilities etc.), comprehend the complexity of drug use and support other families in need.

Monday, November 15, 2010

Mike Judge's 'Extract' (2009)

Since his appearance in the wonderfully homoerotic Jackass 2, Mike Judge has further intrigued me, having enjoyed numerous moments over the years with the animated sit-com, King of the Hill. Intrigue has now transformed into respect, as Judge’s fourth feature film has been released on DVD with a ‘MA 15+’ rating accompanied by a “Strong drug use” warning. Like I said, intrigue and then respect.

Never mind the upfront statements that Judge makes with regards to the overly-litigious nature of America today, the plight of cottage industries in the ever-growing shadow of corporate monoliths, the validity of polygamy and the frustrating, persistent ignorance of suburban/ small town working folk (reminiscent of comedian Bill Hicks, whose love for his home in the Deep South also meant that its faults became easier to see). What matters most in this film, as alluded to in the preceding paragraph, is the manner in which Judge handles the issue of illicit drug use. It seems as if the Beavis and Butthead creator has exalted himself from the ranks of the dorm-room stoner to the wider world of ordinary citizens attempting to conceive what this whole ‘drug thing’ is really about.

As one would expect, Extract never takes itself too seriously, but in a similar vein to John Hughes’ Breakfast Club, Judge manages to deftly interweave a consistent poignancy throughout the film. And the drug-using characters are not exempt from such treatment. Drugs first appear in the movie when the viewer is introduced to ‘Dean’, the protagonist’s sole male confidant who works behind the bar at his regular liquor haunt. Dean’s introduction is not intended to cement credibility as he presents Aprazolam to Joel as a cure-all for any of life’s difficulties. However, Dean’s ‘far out’ mindset is depicted in line with the humour of the movie and the character (with due credit also deserved by a pleasantly surprising Ben Affleck) becomes less caricature and more affable and realistic, especially when compared to other cinematic peers.

Dean then accidentally hands Joel, who eventually acquiesces to his friend’s insistent suggestions, a hit of Ketamine instead of Alprazolam. But instead of the usual blurred camera effects and the hackneyed ‘drug-fuelled chaos’ scenario, Judge opts for a startlingly low-key experience whereby the previously uninitiated Joel maintains the ability to speak, does not vomit and avoids confrontation with the law. Of most interest to me was the depiction of a character experiencing drugs but still continuing to primarily be the same person in possession of the same traits, such as sense of humour, that were present prior to the consumption of the drug. The notion that people always transform into something entirely different following the use of drugs has been overstated in two-dimensional Hollywood and Judge’s departure is refreshing.

The low-key tone, representative of the entire film, then continues and the arrival of the second ‘feature’ drug scene is equally hilarious and realistic. Dean is again the facilitator and on this occasion he convinces Joel to smoke pot as a means to relaxation. Joel explains to his friend that his past experience of smoking is the quick onset of paranoia, a realistic scenario, but ends up smoking the five-foot long bong anyway. What the viewer soon discovers is that Joel’s ‘diagnosis’ is in fact inaccurate, and what he actually experiences is a disconcerting uncertainty borne of consuming an illicit, psychoactive substance that is exacerbated by unfamiliar surroundings. What Joel experiences, effectively depicted by Judge with the employment of first-person camera viewpoints, seems quite natural for a character with his disposition and social standing, but would also be fitting for anyone who is inexperienced and uneducated about drugs.

What we don’t see in the pot-smoking scene is:

a)      Joel attempting to jump out any windows from drug-induced psychosis or the sudden onset of a belief in the ability to fly
b)      Joel running out of the room screaming in terror
c)      Joel accusing his smoking buddies of lacing the pot or any other conspiracy
d)      Joel making animal noises

Subsequent to the two primary drug-taking scenes in Extract, the film’s protagonist not only returns to his regular life, but actually makes decisions that lead to a significant improvement in his situation. Joel does not become addicted to crack-cocaine, does not lose everything and does not end up in front of a magistrate. In effect, the preceding story becomes a life lesson for Joel and he draws upon it to strengthen his marriage, develop his sense of compassion and improve the relationship with his employees. He even maintains his friendship with Dean, who remains the same and continues to work behind the bar. The zenith of the film’s treatment of illicit drugs, also presented in a matter-of-fact manner, arrives in the penultimate scene when a passing Dean pats Joel on the back and explains that “Some people are just not meant to take drugs. And you’re one of those people Joel.” No big deal. No proselytising; no redemption; no romanticising; no glorification; just a simple statement of fact that does nothing to detract from Joel’s credibility. Easily done.

No wonder this film never received a theatrical release. Click here for more information.

Monday, November 8, 2010

How the 10-plant rule sent much of a city to pot: David Penberthy

This article appeared in The Punch last week.

Now I wonder if any of David Penberthy's old school buddies who used to sink bucket bongs with him at recess have read this? And if so, I wonder how they managed to find enough tissues to mop up the tears of laughter that erupted before a single word was read. "But why?", I hear you ask meekly. The website looks okay and his mugshot is fairly ordinary (although you might need to tussle the hair and shake loose the tie to properly reminisce); what could it possibly be? Aww shucks, it's no big deal really, but THE PHOTO CAPTIONED "MONSTER HEADS" DISPLAYS YOUNG, LEAFY PLANTS THAT COULD GET A PERSON SHOT IN TOWNS WHERE SUCH LAMENESS IS LEGISLATED AGAINST! THERE IS NOT A 'HEAD' IN SIGHT, LET ALONE THOSE OF THE 'MONSTER' VARIETY! No biggie; just sayin'...

My current favourite TV show recently explained that the reason we can be so mean to others is because we are deeply insecure ourselves and it makes us feel better about ourselves when we dish out onto those around us. With all due respect Dan Harmon, sometimes it's just about returning power-wielding morons back to their seat where they will hopefully draw penis sketches whilst convincing their friends that they are hilarious and not in fact bi-curious or repressed.

Enough said really. Anyone with any clue about cannabis should stop at that photo caption and walk away into the night without further ado. The problem is, however, that many readers will raise up their Ray Bans or put down their 'Crownie' and marvel at 'Basketcase Adelaide' ("Look everyone. Those stupid crow-eaters thought they could make that shithole of a state seem interesting by legalising weed and now they're all stuck at home wiping the drool from their kids' mouths! LMAO!")

I could tackle Penberthy point-for-point, but instead I just want to raise a few matters of concern:

a) Can we all just ignore that idiot who has mistaken pot smoking for an Olympic event and too often uses the phrases "let's REALLY get stoned" or "you call that a joint?!"? Just like Bill Hicks' gripe about the guy who always wants to 'enhance' the trip, this joker (you all know her/him) just can't seem to GET that drug-taking is a completely individualised pursuit and you can bet your shitty, over-committed mortgage that he/she will be the first one to transform into 'anti-drug crusader', maybe even becoming the exaggerated example that parents everywhere refer to when justifying their ignorance. Dude, you completely overdid it with a product that is not even regulated and whilst it's understandable as a teenager to wake up immersed in the bucket next to your bed, there's a time limit on that. If you just checked your Id at the door every once in a while and realised your own insignificance, then some of us might be able to smoke in peace, instead of having to bear witness to your EXTREME drug taking. Go ahead, smoke everyone under the table, AND DON'T EVER BOTHER US AGAIN!

b) Can we all just ignore that idiot who insists that one needs to hold in the smoke for as long as possible to 'get high'? Not only is this not true, but smoking should be a pleasant, easy-going experience - IT'S NOT A SPORT! With the amount of tobacco being mixed with pot these days, I wouldn't be surpised if users are exacerbating their anxiety, or at the very least boosting their heart rates, by sucking way too hard.

c) Speaking of tobacco, can we not forget that 9 out of 10 smokers mix their pot and it may not be just tolerance that is leading to the endless cones on the daily? You may just be craving the nicotine hit and, again, way overdoing it. Totes.

d) "Do nothing culture"? What are you talking about David? For many smokers, there is nothing worse than being bored when stoned. What about all those users who can't stop doing stuff after they smoke. Here are some examples of smokers who do amazing things:

Band of Horses

Kenny Hoyle

e) "...the explosion in the size and reach of bikie gangs in the City of Churches was fuelled by those laws" - huh? So how come in Victoria and New Zealand, for example, bikie gangs have become super-powerful from Prohibitionist laws? You might want to check your facts David, because you might find that during that era Adelaide weed was renowned for being cheaper and of much better quality. Certainly anecdotal reports from Melbourne buyers indicated as much. Also, I wonder how powerful the gangs would have gotten if there was a legitimate retailer in the mix - remember David, decriminalisation is not the same as regulation.

I hear you say, well how do people receive accurate information or how do we avoid the misinformation spreading? Well, if I can make a suggestion, if drugs weren't solely in the hands of 'black marketeers' and drug education stopped being a work of extraordinary fantasy-fiction, then we might stand a chance. Because really, I don't care about your new Bob Marley flag, your big dog, your oversized car or that new video game console you recently scored by trading a quarter-ounce - people would much rather buy their drugs cheaply, with guaranteed quality and accurate information, from a person who's not just interested in tax-free dollars.

Wednesday, November 3, 2010

Misleading claims in the mental health reform debate

The following article appeared in the Australian on August 07, 2010 and has been kindly provided by Melissa Raven. Below this article is a link to a more recent, in-depth opinion piece that has been co-authored by Melissa:


Dodgy facts no path to mental health reform

MENTAL health has a prominent profile in Australia. 

It's become a key election issue, creating opportunities to advocate for constructive reform of the mental health system. But some inaccurate claims are being made.

According to John Mendoza, former chairman of the National Advisory Council on Mental Health, more than one-third of Australians who take their own lives have been discharged inappropriately from hospitals. In fact, data suggests that less than one-third of those who commit suicide have had any recent contact with the specialist mental health system.

Inappropriate discharge is an important factor in only about 1 per cent of all suicides, so Mendoza's claim inflates the true figure by a factor of 30. Improvements in discharge planning and follow-up are needed, but would be irrelevant to most who take their own lives.
Mendoza's misrepresentation of the significance of hospital discharge misleads the Australian public and politicians, and has the potential to misdirect suicide prevention strategies and resources.

Australian of the Year, psychiatrist Patrick McGorry, claims there's a "waiting list of 750,000 young Australians currently locked out of the mental health care they and their families desperately need". Surveys do suggest that this many young people have untreated mental disorders at some point in a year. But diagnosis, particularly when made in surveys rather than clinically, isn't the same as treatment needs. Many disorders are mild and transient. Only 17 per cent of young people with disorders have severe impairment, and 51 per cent of them go in for treatment.

Undoubtedly, some untreated young people would benefit from treatment, but most are not "locked out" of treatment, and most don't "desperately" need it.

Not seeking treatment in the health system is an appropriate choice for many troubled young people. Many use appropriate self-management strategies, including exercise and seeking support from family members. Many at risk of mental disorders would benefit more from social and educational reform than from mental health reform.

It might seem churlish for a psychiatrist to draw attention to such inaccuracies. Does it really matter if some claims are exaggerated? The system is in crisis and radical change is needed. McGorry and Mendoza's proposals have the support of mental health community groups, the public and politicians, so shouldn't we make the most of the momentum, especially during the election campaign?

But it matters that we're being misled by authoritative-sounding claims without anyone bothering to check them.

Furthermore, as the debate is now framed, several crucial issues are being sidelined, including the role of social disadvantage in suicide, the need for early intervention with children and families, the rights of chronically mentally ill people to live with more dignity, and the need to respect and enhance the valuable contribution of GPs to mental health care. The mental health system badly needs reform, but too much is at stake to make rushed decisions based on inaccurate claims and populist sentiment.

Jon Jureidini is a child psychiatrist and associate professor at the University of Adelaide.

Click here for the opinion piece: http://www.onlineopinion.com.au/view.asp?article=10793