By Lembi Buchanan

When I set out to write An Accidental Advocate, I did not realize how difficult it would be to share my own fears about violent behaviour associated with mental illness.

And yet, when my husband Jim encouraged me to write my memoir, he expected me to be completely honest about many of the challenges we have faced throughout our marriage. He wanted others to have a better insight into the complexities of bipolar disorder and its impact on families and friends. Not everyone understands the risks, certainly not the threat of suicide or even violent behaviour, when severe mental illness remains untreated.

Just the same, I worried about the stigma, that others might view Jim differently, and wonder if he might still be dangerous. I was also anxious about the impact on our children, Jonathan and Larissa since I had never mentioned that fateful encounter one morning when my world collapsed around me.

“Suddenly, Jim was on top of me, beating me with his bare hands. I shouted at him to stop and just as abruptly, he stopped, promising not to hit me anymore, if I stayed in bed. I’ll never forget the distant look on his face. I was terrified, lying there in a state of shock. One day, Jim was deliriously happy about our relationship telling me that I was the best thing that ever happened to him. The next day, he was suspicious of my motives, angry and threatening. Without warning, Jim violently assaulted me for no reason at all. At least, that’s what I thought.”

While I lay trembling under the covers, Jim packed up some of his belongings into a box and left the apartment. Although I was terrified that he might return, it never occurred to me to call the police. Instead, I called the locksmith.

I learned several weeks later that Jim had been listening to secret codes and messages over the radio, night after night, when I was asleep. The auditory hallucinations were very real, sending him on an important mission to save the world. He simply could not afford to take any chances, that I might try to stop him.

While most people living with a mental illness are not dangerous, some, if they are experiencing psychotic symptoms, may assault, and even kill those they love.

I was one of the lucky ones.

Carrie Costello, who lived in the upscale village of Hastings-on-Hudson in New York State with her fiancé Michael Lauder, was not as fortunate. On June 17, 1998, he fatally stabbed the woman he loved because he thought she was a wind-up doll intent on torturing and killing him. Michael had been diagnosed with schizophrenia when he was 24 years old and hospitalized in a psychiatric ward for eight months before entering Yale Law School and graduating summa cum laude. Referring to himself as a “flaming schizophrenic,” Michael sold movie rights to his story and was working on his autobiography prior to the tragic consequences when he stopped taking his meds. Michael was found “not guilty by reason of mental defect.” He resides at the Mid-Hudson Forensic Psychiatric Center to this day. His best friend, Jonathan Rosen tells the story in his recently published The Best Minds: A Story of Friendship, Madness, and the Tragedy of Good Intentions. 

We even have a term for these crimes, calling it “intimate partner violence.”

A Statistics Canada report, “Homicide in Canada 2020,” noted that there were 743 homicides that year. Police suspected the presence of a mental or developmental disorder in 20 per cent of persons accused of murder. Over half (56%) of these homicides were committed against a spouse or family member.

In the early morning of October 23rd, 2023, there were five lives lost in a murder-suicide tragedy in Sault Ste. Marie, Ontario. Although we have no information about the mental state of the man who did the shooting, surely, it was not the actions of a sane person to kill members of his own family, including three children.

Many of these tragedies can be prevented if people living with a severe mental illness get the help they need, when they need it. Fortunately for Jim, he was discovered only hours after assaulting me, on the roof of St. Patrick’s Cathedral in New York City waiting for a helicopter to take him to God. Instead, the police took him to the hospital where he was treated for his psychotic symptoms.

What could be simpler than providing evidence-based medications to treat a severe mental illness?

Bipolar disorder and schizophrenia, can be dangerous and deadly brain diseases, if left untreated. These are complex biogenetic medical conditions where heredity plays a major role in the lottery of life. And yet, anti-psychiatry activists and civil libertarians continue to reject advances in neuroscience as well as indisputable evidence of the efficacy of mood stabilizers and other drugs to treat the symptoms of these complex biogenetic medical conditions. They fail to appreciate how disabling a severe mental illness can be. Instead, they profess that involuntary hospitalization and coercive treatment are crimes against humanity.

Just as distressing are some of the claims made by leading voices on mental health and addictions, denying the genetic basis for bipolar disorder, including Canadian physician and author, Dr. Gabor Maté. In his new book The Myth of Normal, co-authored with his son Daniel Maté, he refutes the biological approach to mental illness, which he refers to as a “construct,” as if it is an abstract concept. Dr. Maté questions the imbalance of DNA-dictated brain chemicals as the cause of severe mental illness when he refers to psychologist Dr. Kay Redfield Jamison’s recollections of a manic episode in her memoir An Unquiet Mind. Dr. Maté makes a reference to her “faulty assumptions that exemplify the simplistic genetic narrative to which psychiatry still clings.” He also notes that “these assumptions are highly questionable and limit our understanding. Worse, they generate harm, both in the sense that they leave many people subjected to inappropriate treatments and in that they displace perspectives that could be far more complete, humane, and helpful.”

Instead of accepting the biological bases of severe mental illness, Dr. Maté claims that one of the main causes, not only of bipolar disorder but also other diseases, MS and ALS, even cancer, is childhood trauma. During a speaking engagement in London, England last year celebrating the launch of The Myth of Normal, Dr. Maté referenced a study of women, who have been sexually abused as children, as having a high risk of developing endometriosis. However, his hypothesis doesn’t explain my diagnosis, when I was 45 years old, of a very rare form of uterine cancer, endometrial stromal sarcoma.

There was no evidence of childhood trauma in my life, or Jim’s for that matter, as the cause of our illnesses. Fortunately, pharmacological treatments have prevented a recurrence of symptoms giving both of us a new lease on life. And we continue to take the drugs we need to stay the course.

Government policy and decision makers may see the value of adopting models of patient empowerment and peer support to make the most of scarce mental health dollars. And yet, relying on a do-it-yourself approach is not a substitute for specialized psychiatric services required by persons impaired by delusional thoughts, many of them living on our streets, unaware that they are ill.

Others, like Jim and Michael, were never candidates for compassionate and accessible voluntary services and supports in the community. They grew up in privileged homes and managed to mask their symptoms even when experiencing paranoid delusions. No one suspected, not even their own family members, that they were capable of harming the people they loved. I escaped with some bruises while Carrie, who was pregnant with their child when Michael stabbed her with a chef’s knife, became a statistic.

Whether we like to admit it or not, there is an elevated risk of violence among people experiencing psychosis. The numbers may be small but the outcome is always tragic, especially when it is preventable.

We need the political will to treat severe mental illness with the same urgency as physical diseases.

We need to provide an adequate number of psychiatric beds to enable all individuals to receive the care they need before they become candidates for involuntary admission or worse, end up in the criminal justice system.

Lembi Buchanan lives in Victoria, BC and has been fighting with the Canadian Revenue Service for years to get tax fairness for those with mental disabilities. She  is the recipient of the Meritorious Service Medal for her advocacy work by His Excellency, the Right Honourable David Johnston on March 4, 2016. She has also received numerous other awards, including the Queen’s Jubilee Medal in October 2002 and the City of Toronto Access Award for Disability Issues in December 2001