Unlimited Growth Increases the Divide

Building in Gastown, Vancouver. The tenant in the top right apartment was hanging out the window smoking a cigarette till I pulled out my phone. We waved at each other, as they dipped inside for me to take the photo.

As I prepare to begin writing up what I have discovered about addiction over the last three years, I am struck by how little we talk about the social context of this problem.

I was struck today by a story about a lawsuit brought by the Seattle public school board against big tech companies. The lawsuit claims that social media are key contributors to the youth mental health crisis and that they have been deliberately engineered to create a dependence (Reuters, 2023). The mental health problems created online impact upon students, which in turn requires schools to dedicate time and resources to addressing these needs. Social media companies profit off their ubiquity, while the education system (along with families) bear the brunt of the consequences. If we truly valued education or mental health, we would not expect nor want teachers to take this on.

This is not unlike the implication of Purdue Pharma in the opioid crisis, which cost more than 1600 British Columbians their lives in the first nine months of 2022 (BC Gov News, 2022). In the US, a lawsuit alleged that the company put profits ahead of people’s health and wellbeing, resulting in an 8 billion dollar settlement with the US Justice Department in 2020, and criminal charges against the Sackler family (US Dept of Justice, 2020).

In 2018, the BC government began a class-action lawsuit against five pharmaceutical companies (including Purdue Pharma). They settled quickly, with Purdue Pharma paying 150 million dollars to BC to help in covering health care costs (BC Attorney General, 2022), a drop in the bucket considering the estimated 5 billion dollars that the crisis has cost Canada in lost productivity alone (University of Alberta, 2019). If we valued community, we would not expect municipalities to emend corporate irresponsibility.

Although discourse is slowly shifting, we are quick to individualize the problem of addiction. It is easier to reduce the issue to one of willpower or of disease, both of which situate the problem within the individual. As we begin to talk more openly about mental health, it is vital that we consider the wider social context of addiction.

Interestingly, the most consistent theme that has come out of my interviews with people who have recovered from substance use is the importance of connection to oneself, to others and to the world. Applying a wider lens to this individual experience, if we are really going to address the problem of addiction, we have to do so from this same perspective, by making connections between the individual and society.

References:

BC Attorney General (2022). https://news.gov.bc.ca/releases/2022AG0044-001031

BC Government News (2022). https://news.gov.bc.ca/releases/2022PSSG0069-001656

Reuters (2023). https://www.reuters.com/technology/seattle-public-schools-blame-tech-giants-social-media-harm-lawsuit-2023-01-08/

University of Alberta (2019). https://www.ualberta.ca/folio/2019/10/opioid-crisis-has-cost-canada-nearly-5-billion-in-lost-productivity-u-of-a-student-finds.html#:~:text=Folio-,Opioid%20crisis%20has%20cost%20Canada%20nearly%20%245%20billion%20in%20lost,than%2011%2C000%20lives%20since%202016.

US Department of Justice (2020). https://www.justice.gov/opa/pr/justice-department-announces-global-resolution-criminal-and-civil-investigations-opioid

Gaslight

Since I started my private practice two years ago, I've had to pay careful attention to social media trends in mental health messaging. This is increasingly the language people use, in session and in life, to describe emotional and psychological pains and discomforts. These are the terms they mobilize to articulate difficulties in their relationships with others.

Social media content can be viral not only in the breadth of their spread, but also in its invasive nature. In the early days of COVID, mixed messages circulated at lightning speed. We didn't know what to believe, or who to listen to. In the early days of COVID, public health officials and politicians scrambled to adapt measures and recommendations to what little we knew about a new virus. There is no doubt that they got some things wrong, but they acted on the information they had from specialists on infectious disease. Although little was known about the virus, we learned a lot very quickly,  in part because of the degree of contagion and the potential severity of the illness.

As complicated as it was finding reliable sources in regard to COVID, it is significantly harder with something as intangible as mental health. While social media can bring people together around shared challenges and experiences, issues of mental health can also fall victim to polarizing, simplistic, click-bait content in the same way everything else does . The spread and impact of such messages is more subtle than the COVID numbers that framed everyday life for awhile. We consume these messages and they influence us. Tourette's syndrome, a rare disorder with an estimated prevalence of 1% (Roessner, Hoekstra & Rothenberger, 2011) has seen a recent spike in diagnosis, which some physicians have speculated may be related to continuous exposure to TikTok videos about the disorder. This has led some researchers to suggest the need to recognize a new "Tourette-like disorder" that spreads through social media, with symptoms consistent with those of the influencers the adolescents followed (Müller-Vahl, Pisarenko, Jakubovski & Fremer, 2022).

The viral content builds us, as much as we build the content.

In Canada, access to mental health professionals is limited. We have begun in recent years to speak more openly about mental health issues, but if the resources and conversation is dominated by what circulates on social media, we are not doing ourselves any favours.

"Gaslighting" was just declared the word of the year by Merriam-Webster. This is not surprising to me. They found a 1740% increase of searches for its definition on their site in 2022 (NPR, 2022). I hear it so much in my sessions to describe relationship dynamics that I think a lot about how people understand it and how they use it.

When I first heard the term, I recalled an old play that I'd read in theatre school called "Gaslight" by Patrick Hamilton (1938). I remembered little of the play, but traces of its elaborate psychological manipulation remained with me. I remembered being deeply disturbed by it.

This is in fact where the term "gaslighting" originated from, so I reread the play. A man murders an elderly woman in her home, in search of valuable jewels he knows to be hidden there but never found. Years later and newly married, he returns to the scene of the crime as a resident of that home. Over the course of the play, we discover that he manipulated this woman into marrying him because she had the means to purchase the house. Every night, he continues his careful search for the jewels,  simultaneously exercising various methods that control and alter his wife's perception of reality. He has the house, so he doesn't need her anymore.

What strikes me about the contrast between the play and what seems to be the popular use of the term today, is that in the play, there really is no relationship between the husband and wife. She existed only to acquire the house for him. She is not a person to him, she's a tool until she's an inconvenience.

Today, gaslighting is employed to label relationship dynamics. In my experience, this comes with the significant risk of shutting down conversation about different perspectives and ways of understanding. Relationships are complicated because they involve two different people sharing in life experiences together. Differences in every day experiences are part of that. It takes energy, patience, openness and compassion to have conversations about difference. This is particularly difficult when we are angry, hurt or unhappy.

I am not suggesting that gaslighting does not exist. There are, without question, people who go to extremes to control and manipulate those around them. Most people are not gaslighters though. A much more common problem is difficulty in communicating thoughts and feelings. I'm suggesting that the dynamics of relationships deserve careful, nuanced thought. This wasn't required of the wife character in the play, because there was no relationship in the first place. In fact, she discovers that they were not married in the first place, as her husband was already married to another woman, rendering their marriage null and void.

I encourage those facing challenges in their relationships to reach out for professional support. An encouraging trend that I've noticed in the last two years is the number of young couples seeking support early in their relationship. They are hoping to anticipate difficulties, facilitate growth and foster a deeper understanding of one another. Presumably, normalizing discussions about mental health has played a role in this. Mindful engagement with any social media content can expose us to new possibilities for engagement and growth. It can be a powerful tool for connection, rather than a way of driving us apart.

Click here to access the Canadian Mental Health Association's petition for universal mental health and substance use services:

https://www.actformentalhealth.ca/

Petition for Universal Mental Health & Substance Use Health

Flying to Montreal days after the mandatory masking on planes came into effect in 2020. My friend broke out the sewing machine to make one for me since there weren’t any masks for sale in our small town. I was one of nine people on the flight from Vancouver to Montreal.

Over the last few years, there have been important shifts in how we talk about mental health. Even before the pandemic, it had become less taboo for people to talk about how they experience life’s challenges. Over the course of the two years, while we were isolated from one another, we collectively experienced uncertainty. We engaged with mortality, we experienced loneliness. We felt trapped, stagnant. Everyone faced challenges specific to the precarities of their own lives, but we also shared in the experience of abrupt changes and threats to life as we knew it.

The pandemic shone a light on what health care workers have long known: Our health care system is fragile. Emergency rooms were beyond capacity long before COVID hit. Living conditions in long term care centres in Quebec have been intermittently raised in the news for years, notably when the 93 year old mother of Gilles Duceppe (former leader of the Bloc Québécois) died of hypothermia after being locked outdoors after a fire alarm went off in her private seniors residence (Laframboise, 2020). That the mother of such a well-respected politician could die in such a way foreshadowed what was to come when COVID hit the long-term care centres. Our public health care system should ensure that no one dies in such conditions.

It should also ensure that those who suffer from health issues, be they physical or mental, have access to treatment.

Under the Canada Health Act, only mental health services provided in a hospital are covered under provincial health insurance (CMHA, 2022). This causes a number of problems. First, hospital psychiatric units have limited resources that are stretched beyond their limits. These units often attend to the acute needs of people with complex psychiatric illness, but they rely on family and community partners to collaborate for long-term support. Meanwhile, ER overflows with people seeking emergency support for suicide risk. They may sit in ER for days before being discharged. They may or may not be referred to mental health resources in the community.

They may or may not have needed to be in ER had there been access to therapeutic support before the crisis moment.

Unfortunately, on a systemic and structural level, we don’t treat mental health issues like we do physical health. A lot of lip service is paid to its importance, but still little is done to improve access to resources. We place responsibility upon those struggling to take care of themselves, offering them little concrete support. It would be absurd to encourage people with broken arms to apply “self care” measures from social media, but this is how we continue to treat mental health.

Some of us are fortunate enough to access private psychotherapy, but we are a privileged few. We also shouldn't have to. We are indirectly paying for our mental health, be it through substance use, physical illness or loss of productivity. We are also indirectly paying for the mental health crisis through what is known as the revolving door between the emergency room, the streets and prisons.

We have normalized receiving patchwork care in an overstressed system. We have normalized burnout in health professionals. For two years, we kept a distance from friends and family to protect one another, and to protect our fragile system. The best way of supporting the heroes that we've praised, the essential workers, is to support them in their fight for a system that has the capacity to care for us.

The Canadian Mental Health Association is asking for the public's support in pushing the federal government to 1) Create a permanent Mental Health and Substance Use transfer to fund mental health care; 2) Create a Canada Universal Mental Health and Substance Act to ensure equitable access to treatment across Canada; 3) Fully decriminalize simple possession of illegal substances and invest in harm-reduction, treatment and recovery services.

Historically, our social programs have been born out of times of crisis (Guest, 1995). Let this be no different.

Click here for the petition: https://www.actformentalhealth.ca/

References:

Canadian Mental Health Association (2022). ACT for Mental Health. Federal Plan for Universal Mental Health and Substance Use.

Guest, D. (1995). Histoire de la sécurité sociale au Canada. Montréal, QC: Éditions Boréal.

https://globalnews.ca/news/6435607/gilles-duceppe-mother-death-lawsuit-anniversary/

https://www.cbc.ca/news/canada/montreal/coroner-report-long-term-care-deaths-1.6454935

Oreo

Even after two years here, the view from the beach a few blocks from home regularly stops me in my tracks. I feel like I’m running into a postcard as the sun sets over the water with the mountains in the background.

I run without music so I can hear the waves crash on the beach. I watch for herons and seals. I notice the first signs of snow on the North Shore mountains. As I cut through Stanley Park, I’m struck by the silence. I hear my feet on the gravel and notice the stillness around me.

Nature is so close and escaping into it seems to be ingrained into the culture of the city. Connecting to nature, to something bigger than yourself seems to be a reoccurring theme in my interviews with people who have recovered from substance use. I wonder if this theme would be as present in other places.

View from the Burrard bridge.

Yet surviving in cities requires a certain degree of disconnection. Unfiltered, the barrage of textures, sounds, sights and smells is too much to take in. There are too many people, too much movement. We become so effective at shutting out stimuli we don’t even realize we’re doing it.

I think about this a lot here.

Vancouver has the unfortunate contradiction of consistently holding a place amongst the world’s most liveable cities, while simultaneously grappling with its reputation as a city with a complex problem with homelessness.

Photos of missing persons are posted on the Facebook groups of the Downtown Eastside every day. Tents dot the city streets and parks. I regularly question if the people passed out on the sidewalks need help or if they’re sleeping. Calling for help each time I was concerned could be a full time job.

The other day as I walked home, a woman held out a leaflet to me. I hardly looked at her, and nearly hurried by without acknowledging her. I slowed when I heard her say, “Please, my son is missing.” I accepted the pamphlet without saying a word. I couldn’t imagine her suffering and could think of nothing to say. Importantly though, I took the time to engage in the smallest of interactions with a mother desperately searching for her son.

A few days later, a woman sitting in that same spot called out to me. “Do you want an Oreo?” I smiled and said, “No, thank you,” while reaching into my bag of groceries. I asked if she wanted an apple. “Sure, but only if you take the Oreo.” It sounded like a fair trade and I told her so.

That woman taught me that there are Neopolitan Oreos. It may not be a lesson I needed to learn, but I’m glad I took a moment to connect with someone who reached out.

Out of My Head

I spent a year living in Seoul, South Korea in the early days of blogs. It was my first time outside of North America, first experience in a place where I didn’t speak the language. Everything was new to me and I packed my observations and reflections on cultural differences into my weekly blog post. I shared my disorientation with my friends and family back in Canada, as I tried to make sense of a different way of seeing and experiencing the world.

I tried to keep it up upon my return to Montreal, but found I had little to say once I’d adjusted to life back home.

I believe I again have things to say.

Next week will mark my two year anniversary as a resident of Vancouver. I now describe the experience of being here as a sort of chronic culture shock. I notice differences and wonder what they means for the city and more broadly, for society.

I am a doctoral student researching addiction in Vancouver, BC. This particular lens is certainly part of my efforts to understand life in this city.

I am also a practicing social worker and psychotherapist. I closely follow how conversations about mental health spread and evolve. I have many thoughts, concerns and questions that refuse to fit neatly into social media posts, so I’m creating a space to get them out of my head.

Contemplating the contradiction of expensive coffee on East Hastings.