What makes

Martin Barkin run?

A t the end of yet another
75-hour work week I sat
down to get caught up on
my reading and came across the
article on Martin Barkin (Can
Med Assoc J 1990; 142: 628-631,
633-634, 636-637). I had often
wondered what it was that made
me different from Dr. Barkin
aside from his intelligence and
brilliant career as a clinician and
administrator. The answer was revealed in the article: he is the
ultimate pragmatist ("When government makes it illegal, it is illegal. When the law changed, I
changed").
However, there is a difference
between legal and moral or ethical. It was presumably legal to put
political dissidents in mental institutions in the Soviet Union
until recently, and it was probably
legal to deport Jews from Nazi
Germany. That did not make it
right.
There is a very fine line between being the ultimate pragmatist and being a quisling. I will
leave it to CMAJ readers to decide
on which side of that line Barkin

falls.
W.L. Gilbert Hopson, MD
946 Queen St. E
Sault Ste. Marie, Ont.

Suicide among teenagers

T he suicide rate among teenagers is now higher in Canada than in the United
States' and in fact has increased
280% since 1960, probably because of the apparently neverending socialistic universal programs that are helping people (and
thus their children) into "learned
helplessness".2 The fact that the
rate in the province of Quebec is
the highest in the world' has to be
accounted for; it is probably due
1362

CAN MED ASSOC J 1990; 142 (12)

four times more often than girls

(probably because girls "get into"
their feelings better) and that approximately 50% of depressed
teenagers become substance abusers.'
I consider it significant that
Anthony Burgess's tale of violent
"anomie",9 crafted three decades
ago,'0 is now a sold-out play (A
Clockwork Orange 2004) in London, England, the reason being
manizing modern society is doing that real life is now as bad as, if
to our teenagers. More than 25 not worse than, the play.
years ago both men forecast an
escalating suicide rate among US Ray Holland, MD, FRCPC
458
teenagers because of this sense of Box
80 Fraser St.
lack of meaning and responsibili- Port Colborne, Ont.
ty, but I don't think anyone expected the rate in Canada to ex- References
ceed that of the United States.
The breakdown of the tradi- 1. Sutherland R: Teen suicide. Med Post
1990; 26 (10): 11
tional family has left many young 2. Seligman
MEP: Learned helplessness.
people with too much adult-like
Annu Rev Med 1972; 23: 407-412
freedom, and the lack of a value 3. Erikson E: Childhood and Society,
Norton, New York, 1950
system in the home is aided and
abetted by the school systems, 4. Frankl V: Man's Search for Meaning,
Bks, New York, 1963
with their lack of standards and 5. Pocket
Bettelheim B: Love is Not Enough,
the irrelevance of subjects.6 In adFree Pr, New York, 1950
dition, teenagers are worried 6. Radwanski G: Ontario Study of the
Relevance of Education and the Issue
about their future more than ever
of
Dropout, Ontario Ministry of Eduas the computer revolution (which
cation, Queen's Printer, Toronto,
is making the industrial revolu1987
tion look anemic) gallops forward. 7. McLuhan M: Understanding Media,
Signet Bks, New York, 1946
As well, teenagers are overin8. Ayd FJ (ed): Underdiagnosis of deformed by the media, which have
pression. Int Drug Ther Newsl 1988;
transformed the world into the
23(2): 11-12
"'global village" of Marshall 9. Durkheim E: Suicide: a Study of Sociology, Free Pr, New York, 1951
McLuhan.7
10. Burgess A: A Clockwork Orange, NorIf depression (with which suiton, New York/London, 1967
cide is associated) is the most
missed medical diagnosis among
adults,8 the situation is even worse
with regard to teenagers,' in
whom depression is more difficult Metronidazole
to diagnose (requiring psychologi- and fungating tumours
cal testing within the clinical context). I saw more depression in I n "A medical potpourri" (Can
Med Assoc J 1990; 142: 866teenagers as a general practitioner
than I do now as a psychiatrist;
867) Dr. Patrick J. Taylor
97% of youngsters referred to me comments on the use of methave behaviour problems ("The ronidazole gel to reduce odour
squeaky wheel gets the grease"). from fungating neoplastic lesions.
In 1978, while a senior regisMeanwhile, where are those with
trar at Guy's Hospital, London,
depression?
Family physicians should re- England, I was presented with a
member that boys commit suicide similar problem. At the time, met-

to the identity crisis the province

is going through, which in turn
will aggravate the identity crisis
that teenagers go through.3
Drs. Viktor Frankl4 and
Bruno Bettelheim5 were both incarcerated in Nazi concentration
camps, and both observed that the
guards tried to break down the
prisoners' identity and sense of
value, meaning and responsibility,
which is precisely what the dehu-