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The Current Transcript for March 1, 2015

Host: Anna Maria Tremonti

STORIES FROM THIS EPISODE

Listen to the full episode

Prologue

SOUNDCLIP

Killing is a hard line. I am willing to sacrifice my livelihood and my family’s support over this issue.

ANNA MARIA TREMONTI: The voice of one doctor, a catholic personally, religiously opposed to the move toward physician-assisted death. Even as it affirmed the right to die, the Supreme Court ruled doctors have a conscientious or religious right to refuse. But in Canada a significant number of publicly funded hospitals and care centers are run by Roman Catholic orders and they're making it clear they will not be agreeing with requests for death. The moral and ethical dilemma of following one's conscience and the law, coming up. Also today, for years Anna found school difficult.

SOUNDCLIP

I didn't think I was entirely intelligent. Almost every year in the comments regardless of the subject it would say Anna needs to focus more, she has trouble paying attention and continuously finishing her work.

AMT: She was 15 when she was finally told she had ADHD, a diagnosis that would change her life because suddenly she could confront the problem. She is not alone. Far fewer girls are diagnosed with ADHD than boys. In half an hour we look at the consequences of late diagnosis for girls and women. And then, A People's History…

SOUNDCLIP

Every part of Canada, every person, every town and city will be transformed in the crucible of war.

AMT: Canada: A People's History was a ground breaking documentary series for the CBC in the 90's and the man behind it had been and would continue to shape the range and direction of documentaries in Canada for decades. So who better to consult on the state of the documentary today? Our Eye on the Media hears from Mark Starowicz in an hour. I'm Anna Maria Tremonti, this is The Current.

Catholic hospitals refuse to comply to new doctor-assisted dying law

Guests: Dr. Matthew Meeuwissen, David Nash, Eike Kluge

AMT: Some of Canada's oldest and most esteemed hospitals carry the names of saints. St Paul's in Vancouver, St. Luke in Montreal, St. Michael's nicknamed the urban Angel in Toronto. Most were founded by Catholic nuns long before the birth of Medicare and eventually folded into the public health care system we know today. There are at least 120 Catholic health care institutions across the country from teaching hospitals to long term care facilities, to palliative care facilities. They serve a diverse range of Canadians many of whom are not Catholic and many who do not realize these medical facilities are guided by the Catholic faith. But that fact has come into sharp relief as Ottawa drafts new legislation on physician-assisted death. The federal government has until June to comply with the Supreme Court ruling which struck down the former ban. Already Catholic health care facilities in BC Alberta and Ontario say their staff will have no involvement with physician-assisted death, arguing it contradicts the tenets of Catholic Health Care. In a minute we'll hear from a medical ethicist who says publicly funded Catholic health care providers should not be allowed to make that call. But first David Nash is the chair of the Catholic Health Association of Ontario which operates 35 facilities across the province. We have reached David Nash in London, Ontario. Hello

DAVID NASH: Good morning, Anna Maria.

AMT: What is it your association’s position on physician-assisted dying?

DAVID NASH: Well if you've described it fairly well. We believe that there is such a thing as organizational conscience and individual conscience and that we will not be participating as an organization, and we are there as we have been for years, to work with the conscience of the people who work in our facilities as well.

AMT: What are staff in your facility being told they can or cannot do then with respect to doctor-assisted death?

DAVID NASH: Well they're informed that there's not going to be participation in our facilities and…at this stage you raise a good point, we're still working through all of the details. We just do not have enough information right now as to where the government is moving in the province of Ontario, let alone in the federal government. So we have to work with planning assumptions at this stage. Until we get more information.

AMT: And when legislation is introduced to legalize the procedure, would Catholic run health care providers comply?

DAVID NASH: Well, compliance in what sense? In terms of compliance in the in the sense that the law of the land is not something that we are going to be taking on, in the sense that it's already been determined by the Supreme Court of Canada and if you see the Catholic position before the Supreme Court of Canada it was actually focused on the issue of conscience and the issue of participation and the issue of compassionate care and terms of palliative care and other forms of care. So we didn't take it head on the way perhaps people thought it might be taken.

AMT: Already there's talk of things like an option for the doctors who would actually find that they can't do it because of religious reasons, would refer a patient to another doctor or another facility. Is that what doctors in Ontario's Catholic health care facilities would be told to do?

DAVID NASH: Well again that's not what pulled to do. The facilities were they were working assumptions, that's an interesting point on referral though. One of the potential aspects of referral would be that patients can actually self-refer or one of the more you know--there's other ways of participating for a person, an individual who wants to explore physician-assisted death. That's the first step. The second step is the actual participation in it. Where the Catholic Health Care Providers are very concerned is that there's not enough emphasis at this point on the palliative that aspect of this, exploring as to why the person is looking at that, why they want to go down that road. Are they lonely? Are they you know are they depressed? All of these issues have to be looked at. This is a very very complex issue which people are trying to simplify. And the fact is it is far more complex and people realize.

AMT: And I want to pick up on something you said self-refer. Not everybody would be capable of that would they?

DAVID NASH: Well, yes. That's the interesting thing, in order for--according to the law with the Supreme Court of Canada, you were going to have to be competent. And so, that is a very key component in all of this, is that the person, it doesn't matter where they are, has to be competent in order to make the decision.

AMT: But self-referral would be hard for most of us to self-refer ourselves now to a doctor for anything. It's a complicated system.

DAVID NASH: That's a good point. That’s up to the government. We're talking about a process here where there won't be a large number of people seeking--there may be a larger number of people seeking information. But there won't be a large number of people actually seeking physician-assisted death, so the idea of a referral that's something for the medical community to look at as well as the government because they already have a self-referral in various other areas. So you're only dealing with--we're assuming you're only going to deal with competent people who can make who can make the decision.

AMT: And at the same time in some Canadian centers there might not be another institution. Catholic run institutions actually dominate in some cities do they not?

DAVID NASH: Well I wouldn’t use the word dominate. I think what you have to look at is there are many health care facilities that would be able to participate. You do raise a good point about the size and scope of Canada and the geography that--when you're talking about people in remote areas. So it's not a matter of just having a facility in a smaller community which may happen to be Catholic or maybe another faith-based organization, this isn't just a Catholic issue. And so those people again being able to obtain information—we’re sure the government--were assuming that that is going to be a primary part of what the government does and then the second part of that would be that they may not be able to access a facility. But who says that it necessarily has to be in a facility? We would anticipate as happens in many other countries and in the United States most of the times, people who are competent will want to have this happen at home.

AMT: And I want to raise something else you made the point of the conscience of an individual but you also use the phrase organizational conference and I want to explore that a little more. We spoke with Shanaaz Gokool the CEO of Dying with Dignity Canada. Listen to what she has to say about organizations.

SOUNDCLIP

The overriding concern here is publicly funded institutions should have to comply with Charter issues. We don't believe that the institution has a conscious. We believe that the people within those institutions have a conscience and can conscientiously object. But that the institution itself does not bear the bricks mortar and concrete filled with a lot of different types of staff who have a varying number of perspectives on this issue.

AMT: David Nash, she makes the point that how does a hospital have a conscience?

DAVID NASH: We're not bricks, mortars and--that's not the way you define a hospital. A hospital or health care facility that we believe in is one with care, compassion, provides comfort, symptom control, social, emotional, spiritual support. It is a person. It is recognized in law. Historically the governments have recognized that there is an organizational conscience. So what you're hearing is an argument in--we're hearing an argument for people who are taking a position. But it is in the face of the historical context that exists in the province of Ontario.

AMT: Do you have to be a practicing and observant Catholic to work in these Catholic run institutions?

DAVID NASH: No, absolutely not. In fact, if you take a look at--most of the time for example a number of our CEO's are not Catholic. And in terms of the patient, if you take a look at the people who choose to use a Catholic facility--

AMT: They're not all Catholic either but I'm talking about the people working there because when… so you could have doctors in a Catholic run facility who don't have a problem with physician-assisted death could you not?

DAVID NASH: Well you could.

AMT: And would they be allowed to then assist a patient in dying?

DAVID NASH: No. Not within the facility at this point and that's what we're working out, all of that. But you know, again, one of the more interesting things here is people are assuming that the majority--you read the newspaper, the majority of people support physician-assisted dying. Then when you get under the surface of that it's a completely different story. We're talking about two different things; one is the exploration where people are having difficulty, where there are some symptoms, some issues that need to be explored. The catholic facility wants to explore that with them. They want to give everyone an opportunity for the type of care that is required. What is the reason they're asking for this?

AMT: Right and I hear what you're saying but when someone does want that, if you're a publicly funded institution, are you at all concerned that there could be backlash on the fact that you’re publicly funded and somebody who wants it won't be able to get it?

DAVID NASH: No. No, we don't believe the government's going to change--do an about face on that and say all of a sudden, because there is a particular process you don't follow, you're not going to be funded anymore. We've been through this before with these arguments and—

AMT: On what?

DAVID NASH: Well on reproductive issues.

AMT: On abortion.

DAVID NASH: Yeah.

AMT: Okay.

DAVID NASH: So this is not a new issue and you know--we respect the fact that people have their point of view. But what you're hearing is an argument. That's what that is it's an argument for people who want to have the procedure available everywhere, anytime and we're saying no.

AMT: David Nash, good to hear from you.

DAVID NASH: I appreciate it, thanks Anna Maria.

AMT: That is David Nash Chair of the Catholic Health Association of Ontario. He joined us from London, Ontario. Now we contacted several Catholic health care providers for the story including Catholic Health Alliance of Canada, an umbrella group and their guidelines are followed by many institutions across the country. No one from that organization was available to speak with us today. For his perspective on the role and responsibilities of Catholic health care providers, I'm joined by Eike Kluge, Medical Ethicist at the University of Victoria, who joins us from Victoria, Hello.

EIKE KLUGE: Good day.

AMT: You've been listening to David Nash, what do you make of what he's saying?

EIKE KLUGE: Well I very much sympathize with his perspective because it is deeply grounded in his beliefs and that of the Catholic institutions. But the fact remains that as publicly funded institutions they have to follow public guidelines. Now there are ways around that and he mentioned the abortion issue. The way around that is to say we simply do not have the facility for example, for doing abortions therefore we can refer. The problem is physician-assisted death uses medicines, uses interventions which are available in any hospital, in any institution. And therefore that option isn't there and to make special exemptions for religiously oriented institutions whether Catholic or otherwise, runs into the problem that section 15 of the Charter says, you may not have a public policy that is grounded in religion. Discrimination on the basis of Religion is a ground for striking down that policy or that law. So they are really in between a rock and a hard place in this particular context.

AMT: Okay, I want to understand that because you have the right to refuse to do something because of your conscience or your religion right, that's also in the Charter?

EIKE KLUGE: Indeed. But that applies to individuals, not to institutions because institutions have policies as Mr. Nash indicated. They have a, while he didn't use the word policy, he used the word conscience, but in fact they are policies and policies are different from individual values. So, if a particular physician says I will not participate in this, that's fine. That's in accordance with the Charter, that's in accordance with individual ethics. But institutions are different in that very situation.

AMT: I just want to clarify that because he says that hospitals aren't bricks and mortar that a hospital is a person.

EIKE KLUGE: Yes, but he was making a legal point.

AMT: And what does the law say, because we know corporations are people, apparently.

EIKE KLUGE: Corporations are people but they are what are called constructive people, in other words they are in law treated as persons so you can sue them. They have policies however, and these policies are different from individually held values, held by you, me or anybody else. So this is why, or this is where the differences between institutions and individual physicians and individual health care professionals. And if one were to make an exemption for a particular institution because the institutional policy says this violates our values our, guidelines, then one is getting into the Charter problem.

AMT: So what are the options that Catholic run hospitals have when it comes to doctors-assisted death?

EIKE KLUGE: There are various options; one of them is simply to refer, simply to let it be known in public that this service will not be offered, therefore do not come to us and the people will be diverted or referred before they ever get there, so the problem wouldn't arise. That of course, runs into the problem that the very reason why they would say refer, would have to be something about, what is possible to offer in the institution. Abortions often require an operating room, something like that and you have to have a specialized reproductive section in the hospital. But you don't need that for physician-assisted death, so that wouldn't be open to them. So that's one option that one could explore but it wouldn't work. Then within the Catholic system itself, and Mr. Nash did mention that Pope Pius XII already said in 1956 that there are situations in which keeping someone and alive is inappropriate because it does not advance the greater good of the individual. It may be too burdensome, both psychologically, spiritually and even financially, he mentioned. So, one can craft a policy or a Catholic institution could craft a policy that would focus on palliation, but particular methods of palliation, one method that is usually referred to as terminal sedation. So would that be appropriate under those circumstances, is that do-able, probably yes because the position of Pope Pius XII was reconfirmed in 1980 by the Congregation for the Doctrine of the Faith which said the same thing, so that's another option. The third option is simply to reinterpret what assisted death means and use the doctrine of double effect. And the doctrine of double effect is the doctrine formulated by the Catholic Church already in the Middle-Ages that says if you do a particular action, that action has a negative outcome, but you don't intend the negative outcome, then you're going to be alright.

AMT: You're talking about reframing the wording and the understanding of this. What about the idea that a government might say--would take away the funding?

EIKE KLUGE: Well that's of course something that is really down the road. And in fact, Catholic institutions may be given the option. There's a precedent for that for example, in Vancouver there was a hospital for women's health, which was funded in part by the Salvation Army and the hospital wanted to offer abortions because of course that was mandated under the provincial insurance plan which identifies abortions as insured services. And the Salvation Army said no, we won't do that. Well ultimately they had to pull out. So this may ultimately be the case for hospitals if governments want to do this and this depends on the particular province and how strong politically the issue is in the particular province.

AMT: Just briefly what about public access to public healthcare. How does that play into this if we're looking at institutions that actually are quite large in some cities and have a real influence on healthcare in some of our major cities?

EIKE KLUGE: In the major cities Anna Maria, this wouldn't be much of a problem. The real problem--because of course you can divert, refer, do things like or let it be known in public that in fact if you have a disease or condition that causes unbearable suffering then we will not accept you, we will divert you to specialized units that deal with that. In other words, other hospitals.

AMT: But in smaller communities…

EIKE KLUGE: That's exactly it. That's exactly it. Pardon me for interrupting you, that is it. What do you do in a small town in Northern Ontario or in Nunavut or Alberta or BC where in fact the institution is a Catholic institution and to divert individuals simply isn't possible? If it is going to be done then it will have to be funded. One has to look at that too because diverting costs money. Therefore the funding has to come then from the hospital rather than from the government because the government is funding the hospitals to provide services. If they don't provide them, if they divert, they have to pick up the cost.

AMT: Eike Kluge we have to leave it there, but thank you for your perspective on this. It obviously is not something that’s going to go away as we get closer to this legislation. Thank you.

EIKE KLUGE: Thank you.

AMT: That is Eike Kluge, he's a Medical Ethicist at the University of Victoria. We’d like to hear from you on this. What do you think? What do you make of publicly funded Catholic hospitals objecting to physician-assisted death laws? Should they be mandated to provide the service? Let us know. You can tweet us @thecurrentcbc. You can leave a comment on this story on our Facebook page or e-mail us by clicking on the contact link cbc.ca/the current. And stay with us after the news we explore why so many girls with A D H D go undiagnosed and how that can have serious consequences for them in adulthood. I'm Anna Maria Tremonti and this is The Current.

ADHD in girls often misdiagnosed, leading to mental health issues in adulthood

Guests: Anna(last name withheld), Doron Almagor, Katherine Ellison

[Theme: Music]

ANNA MARIA TREMONTI: Hello, I’m Anna Maria Tremonti and you are listening to The Current.

ANNA: Almost every year in the comments, regardless of the subject, it would say Anna needs to focus more. She has trouble paying attention, you know, continuously finishing her work.

AMT: So, they would say Anna needs to focus more.

ANNA: Anna needs to focus, Anna needs to focus.

AMT: And did you know what needs to focus meant, as that kept showing up on your report card over time?

ANNA: I think as a kid, needing to focus just meant doing your work and not talking to other kids.

AMT: Before we go any further, I'm speaking to Anna. She is a 17-year- old high school student in Toronto. She's been diagnosed with ADHD, Attention Deficit Hyperactivity Disorder. Now, according to the Centre for Addiction and Mental Health, boys are three to four times more likely to be diagnosed with ADHD than girls. Increasingly, doctors and researchers who study the condition believe that those numbers can mean girls are being under-diagnosed or even misdiagnosed. ADHD can look very different in girls than it does in boys and that's why we are talking today to a young woman who is diagnosed so that we can learn from what she went through. So Anna, how old were you when you were diagnosed?

ANNA: 15.

AMT: What was happening in your life at the time that led you to look for a diagnosis?

ANNA: At the time I was dealing with some anxiety issues which led my parents to make the decision to take me to a therapist. We were seeing her for really long time, mainly talking about the anxiety, before she said-- I remember the appointment and she said I think Anna has ADHD.

AMT: So, what was life like for you before you were diagnosed?

ANNA: With regards to school life I had always struggled and it was always, even in high school, I had trouble focusing. I did for sure notice those symptoms of ADHD. Once I was told them afterwards, I could really easy associate them with events that happened before.

AMT: But, at the time you didn't know what that was so how would you like, when you were sitting in a class or something, how would you be before?

ANNA: Really unmotivated a lot of the time. To do my work, I would start and in about ten minutes, I can remember a specific moment in my English class in Grade ten before I was diagnosed, I just didn't want to do it and I remember saying to my friend, I just can't focus, I really I don't want to do this right now and I just, I didn't, really.

AMT: What about when you were writing a test? What would that have been like?

AMT: I can remember doing them and my focus would start to go and I was like, okay Anna, you know you only have a limited amount of time to do this, so I would almost force myself to do one side especially if it was double sided and take like a five or even ten minute break of just kind of sitting there.

AMT: Did you like school?

ANNA: I mean, I like the social aspect of it but I've never been a huge fan of school. I mean, I was bullied but it was also just feedback from teachers a lot of the time it wasn't always positive.

AMT: How did you see yourself when you would hear that kind of thing about focus or when you would find it really difficult to do stuff? What did you think about yourself?

ANNA: I didn't think I was entirely intelligent and I think that I obviously entered into like, you know self-esteem. A big part of that isn't just what you think of what you look like, but what you think of as how you are as a person. I didn't think I was entirely a smart kid.

AMT: And did you feel different, did you feel that there were parts of you that were different, then?

ANNA: For sure. I remember when I was younger in elementary school wanting to do something else and getting not being focused and especially my friend group, I remember they were a group of girls which were good at school, so I can remember getting unfocused and being at their houses and doing homework and they were like, Anna, we have to do this and Anna, you’ve got to focus, you have to help us we have to work, and I was always a little bit out of it, a little different.

AMT: And as you tried to make things better, you started to feel very anxious, am I right? You started to feel a lot of anxiety?

ANNA: Yeah, well whenever I feel unsure of things or I don't have a lot of control, that's what causes a lot of my anxiety and the first bit of ADHD is not having a lot of control over your own senses like focus and being able to sit down and not having enough to kind of--

Just your brain I guess, is more hyperactive than my actual body.

AMT: So, your brain feels different almost.

ANNA: Yeah. Yeah, for sure did. I did feel different from the other kids.

AMT: And that made it harder, I’m guessing.

ANNA: It did make it harder.

AMT: You were also lacking confidence right, as time went on?

ANNA: Yeah, well for sure. Lacking confidence in my work, always a little bit afraid to like raise my hand for the fear of looking stupid in class, and I think that, again, that all really comes from when you're a child and you're getting introduced into the school system and how it works. You know, you need that confidence for when you're older and I think that just carried through with being told that I have issues with my focus.

AMT: So, now that you have been diagnosed, first of all, how do you manage your ADHD now?

ANNA: Now I take medication Monday to Friday, usually just for school when I wake up and that's just to help with the focus and staying on task in school. That's been really helpful. I have for sure noticed a difference.

AMT: What kind of differences do you see?

ANNA: The first thing that I noticed, which made me really happy, because I remember coming home and telling my mom about it was, I remember it so specifically, it was in biology and we had this green package that had a bunch of questions on it, it was about two pages double sided, and I just went through the whole thing. I didn't stop and I remember finishing it, and I was just like, oh yeah I'm almost done. You know, this is nice, I’m almost done.

AMT: You were proud of yourself.

ANNA: Oh yeah, for sure.

AMT: Do you think of yourself differently now? Are you kinder to yourself?

ANNA: For sure, yes, a lot kinder. The whole diagnosis itself really answered a lot of our questions, so it wasn't so much that, with kids, especially teenagers and younger kids, they can think that they're not smart like I used to and think they're not intelligent and it's all them and they're the problem. And they are the person who needs to change that. But, in reality ADHD really is an issue and as soon as I was diagnosed and given my medication and I took that, it was just so much weight lifted off my shoulder and so much responsibility, as well.

AMT: Do you wish you'd been diagnosed earlier? Like what would change if they had figured this out when you were ten?

ANNA: I'm very thankful that I was diagnosed before I got into my senior year because it for sure has helped me. But, if I could choose to be diagnosed younger, I for sure would. Not even just the grades but that self-confidence, that self-esteem, of feeling like I wasn't really like the other kids or smart enough, that would have been explained and reassured that it's not you, Anna, it's just a part of you but it can be dealt with.

AMT: It's really important to hear your voice, thanks for sharing.

ANNA: Thank you so much.

AMT: Anna is a 17-year-old Toronto high school student with ADHD. We're using her first name only to protect her privacy. Well, what she's been describing will sound familiar to my next guest. Dr. Doron Almagor is a child an adolescent psychiatrist, and also the chair of the Canadian ADHD Resource Alliance. He's in Toronto, hello.

DORON ALMAGOR: Thank you for having me on.

AMT: Well, let's start by putting Anna's story in context. How many children on average are being diagnosed with ADHD?

DORON ALMAGOR: Well, in Canada we don't have great statistics. Anna’s story was very moving and is part of an overall issue that we've been seeing that girls with ADHD are not being attended to, as well as boys with ADHD. That's something that the literature has been showing for many years. It's been improving over the recent years, but still something that is missing in the overall treatment of children and adults with ADHD.

AMT: And, why do you think that is about girls? Why are they being under-diagnosed?

DORON ALMAGOR: There are three types of ADHD. As Anna was referring to, some types of ADHD don't have any hyperactivity symptoms whatsoever. We call that the inattentive presentation of ADHD. And if one has the inattentive presentation of ADHD, that doesn't show in itself, in the classroom, in a very obvious or any disruptive kind of manner. If someone has the inattentive type of ADHD, like Anna, they may actually have what we call more internalizing type of symptoms, meaning that the symptoms are kind of more on the inside. They might feel very anxious, depressed, but they won't really be causing any problems for the classroom. And teachers may not take that to parents or physicians, and they may go under treated. And that's something that we've been seeing in the literature and in clinical practice for many years.

AMT: Anna told us that she was seeking help for anxiety and then eventually the ADHD diagnosis came forward. How many girls with ADHD are misdiagnosed versus under diagnosed?

DORON ALMAGOR: We see that very frequently, that people with ADHD and girls in particular, and women, are misdiagnosed with issues like depression, like anxiety, personality disorders and until the underlying issues that are causing those symptoms, the kind of self-esteem issues that come from ADHD that Anna was talking about are treated, the treatment results are not going to be very good. Many girls actually need to go through, have a number of treatments with anti-depressants, anxiety medications, before the underlying ADHD is addressed.

AMT: And as a girl with ADHD moves through school, what are some of the risks associated with having that not recognized in a proper diagnosis?

DORON ALMAGOR: As Anna was mentioning, they can be actually labeled as being lazy or not academically inclined, or not having persistence, what people are calling grit these days, and that all makes it sound voluntary while ADHD can’t be controlled. It can’t be changed by someone telling you, you just persist, just focus. If they're being told that over and over again, you should focus, you should listen, that kind of creates a self-esteem issue and a self-image issue as someone not being intelligent, or not being able to do well, not being able to persist. We see that creating a host of issues like depression, like anxiety, under-performance, school avoidance. It could also lead to other issues. In some cases, people may turn to self-medicating with drugs, so we see a whole host of issues that develop and can continue over a lifetime, becoming worse and worse. Unfortunately, what can happen, is that over a lifetime, these lead to worsening, worsening psychosocial type of functioning and the real shame of it is, is that many of these issues can be addressed very successfully with treatment that we have.

AMT: And I'm really struck too, by the fact that we put so much pressure on high school kids in the very early years of high school to figure out what they want to do through high school when they leave that. If you if you have someone who has under-performance because of this issue, but they're seen as lazy or not academically inclined, this can change the whole course, the trajectory of their adulthood, could it not?

DORON ALMAGOR: That's exactly it. That's what we tend to see, is that these kids become labeled as being lazy, as not being academic, and they're basically slotted in particular categories that then carry with them throughout their adulthood. In adulthood, many of these people do become diagnosed, so many women are only diagnosed in later adulthood. Sometimes, only once their own children are diagnosed, they read up about ADHD and self-identify as having it. They realize all the symptoms fit what I may have had. At that point they may seek treatment, but the earlier treatment the better because the earlier we can change the trajectory, the more we can have an effect in later life. By the time they're older, they may have had a lifetime of failures, whether in employment or relationships, and therefore worsening depression and anxiety symptoms because of the ADHD.

AMT: Go back to the boys who were diagnosed. I know you don't have exact numbers in Canada, but give us an idea of the difference in numbers.

DORON ALMAGOR: We tend to see about a one to three, as you were saying, up to a one to four ratio of boys to girls being diagnosed. And that's again because of the kind of presentation that boys present with. Now, saying that, some girls do present with the hyperactive type of symptoms of ADHD, and not something that, again for whatever reason, even though they might be hyperactive, their issues are not presented as frequently as boys with ADHD.

AMT: What do we know about what's going on in the brain of someone with ADHD and whether that's different in boys and girls?

DORON ALMAGOR: We do know that girls’ and boys’ brains develop at different rates and at different trajectories. We know this from a lot of neuroimaging data. And, we know that in other psychiatric disorders as well, often onset comes at different times for men and women and that they present differently. In ADHD, which is also a neuro-developmental disorder, meaning that symptoms are happening because of the way the brain is developing, we expect the same and we do see brain differences in ADHD in boys and girls in some preliminary research.

AMT: And do those differences mean treatment should be different?

DORON ALMAGOR: No, treatment is the same for both boys and girls and men and women and it tends to include educational interventions, medical interventions, and psychological and behavioral interventions.

AMT: So, what advice do you have for parents who think a daughter might have ADHD?

DORON ALMAGOR: The first thing they should do is take their child to a pediatrician, or the family doctor. That family doctor/pediatrician may be able to diagnose the ADHD themselves if they have the expertise. Or, if they don't, or if it's a more complicated case, they can make their referral to a more expert opinion.

AMT: Dr. Almagor, thank you.

DORON ALMAGOR: You're welcome, thank you very much for having me on.

AMT: That is Doron Almagor. Dr. Almagor is a child and adolescent psychiatrist, he's also the chair of the Canadian ADHD Resource Alliance. He's in Toronto. Well, mental health experts say misdiagnosing or missing ADHD in girls can lead to consequences in adulthood. My next guest knows all about that. Katherine Ellison was diagnosed with ADHD when she was 48. She is a Pulitzer Prize winning journalist, she's authored three books on ADHD and she joins us from San Anselmo, California. Hello.

KATHERINE ELLISON: Hi there.

AMT: Well, you've been listening in as I discussed ADHD with Anna and then Dr. Almagor and talking about girls going undiagnosed with ADHD into adulthood. You've lived that.

KATHERINE ELLISON: That's true.

AMT: So, you were undiagnosed for decades. When you look back, how did your undiagnosed condition affect your life?

KATHERINE ELLISON: I don't mean to complain, I've had a wonderful life so far but I did end up with one of the very common effects, which is a lot of anxiety and Anna described it very well when she said it comes from this feeling that you're out of control, and also different from other people, and you don't know why.

AMT: Can you give us examples of how that was affecting your life?

KATHERINE ELLISON: Well, one interesting thing that I really don't regret is that I was driven to a kind of career that had a lot of excitement and a lot of deadlines. I was a foreign correspondent and at times, the war correspondent for about 14 years, and traveled to lots of different places where there were emergencies all the time. That was very fitting to my nature because it gave me a structure and a kind of a way to focus my anxiety, believe it or not[laughs]. But, when I came back and settled in the suburbs with my two children, who were young, that's when things kind of started to fall apart because life became more routine and my anxiety surfaced a lot more.

AMT: And what led to your diagnosis?

KATHERINE ELLISON: I watched my son be diagnosed at the age of nine. So, peering over his shoulder as he was answering those questions with his doctor, I realized that I had had so many of those same symptoms and just figured it was a part of my personality or part of the things that were wrong with my nature.

AMT: What did you see in him that kind of made you go wait a minute?

KATHERINE ELLISON: A lot of distraction and forgetfulness and ability to really focus in on things that interested him a lot, but an inability completely to focus on things that were at all boring to him. People with ADHD have very low thresholds for boredom, which is why we're often considered defective of character, because boredom is usually seen as a flaw in people. But, it's really a neuro-biological trait.

AMT: Was there a difference in how his ADHD manifests from yours?

KATHERINE ELLISON: As a boy, he acted out a lot more and so he got into trouble. Which in a way, was lucky for him because then he got diagnosed and treated. Girls were conditioned so much more to cooperate and to think, what's wrong with me? And so, I guess I internalized a lot of my issues.

AMT: And so how did you feel after you were diagnosed?

KATHERINE ELLISON: I felt a lot better. All at once, I had those four little letters that explained everything and took a lot of the blame off of me.

AMT: Do you see your childhood differently?

KATHERINE ELLISON: I definitely see my childhood differently. As a kid, I remember so often being sent outside the classroom or to the principal's office, I had the same problem as Anna, that I talked in class and I felt it was just social, I couldn't see what the problem was and was always told to try harder, you're underperforming. Report card after report card said she's not working up to her potential, and I always thought if I just tried harder, I could succeed, but that really wasn't the way I was going to succeed.

AMT: You took your journalistic skills once you were diagnosed and started really looking into this and writing about it. Given how much time you spent researching ADHD, why is it important for ADHD to be a diagnosed early, or earlier, in girls?

KATHERINE ELLISON: Because the longer it's undiagnosed, the worst these problems can get. The anxiety that comes from feeling out of control and also feeling judged socially, can escalate to the point where for girls, you don't go out and harm others or make a ruckus like boys, but you harm yourself. So, there's a great deal more cutting, there's a great deal more eating disorders, substance disorders and suicide attempts. The research has shown that for girls and women, the effects can be actually more serious than for boys.

AMT: You say that adults, particularly women, are getting diagnosed with ADHD in record numbers. What's behind that?

KATHERINE ELLISON: I think first of all, the phenomenon of parents like me watching their kids be diagnosed and then looking inward is a big one. But, behind that is the incredible increase in awareness about the disorder. So, in the United States in particular, we have a lot of over-diagnoses. A lot of kids are probably being labeled when they don't need to be and even medicated when they don't need to be. But, we also still have some under-diagnosis, in particularly that's applicable to girls.

AMT: So how do you manage ADHD now?

KATHERINE ELLISON: The main thing I do is get exercise every single day which, I've always done ever since I was about 12. That helps tremendously. There's actually a lot of research that shows that exercise is really beneficial, not just for everyone, but particularly for people with ADHD. Sometimes, I take medication, not every day, but if I have work that's intrinsically not as interesting to me, it helps a lot and I think about it, and I continue to be educated on it, and talk to people about it, and try to take the shame out of it.

AMT: What does the exercise do?

KATHERINE ELLISON: John Ratey, who is the psychiatrist who wrote a whole book about this called Spark, talks about exercise as a kind of pharmacist’s cabinet because it does everything from and improve your mood with natural serotonin like molecules to released dopamine and just rev up your brain in ways that you really need it to. People with ADHD have kind of sleepy brains and that's one reason why we look for stimulation. We look for conflict and other ways to kind of spark ourselves into more alertness, and exercise really helps.

AMT: You made the point that you had a pretty good life and managed to have a great career without knowing you had ADHD, that you made it work for you in many ways, but you also make the point that you had anxiety and stress. When we look at the numbers on anxiety and stress these days, so many people--there's a connection there too, that is a little unsettling, is it not?

KATHERINE ELLSION: Yes, I mean I think that just in recent years, all sorts of mental illnesses that we used to think were temperament in character are coming into the light more, and that's a really, really good thing because there's been a tremendous amount of suffering that might have been helped more easily.

AMT: Katherine Ellison, it's good to talk to you. Thank you.

KATHERINE ELLISON: Great to talk to you. Thank you so much.

AMT: Katherine Ellison is a Pulitzer Prize winning journalist and author of three books on ADHD. She joined us from San Anselmo, California. We want to hear from you. Do you know a girl or a woman who struggled with misdiagnosed ADHD? Let us know. You can tweet us @thecurrentcbc. You can leave a comment on the story on our Facebook page or e-mail us by clicking on the Contact link cbc.ca/thecurrent

Mark Starowicz on the decline of documentary production in Canada as interest rises

Guests: Mark Starowicz

ANNA MARIA TREMONTI: Hello, I'm Anna Maria Tremonti and you're listening to The Current.

SOUNDCLIP

This is documentary short film. You cannot.

[Crowd applause]

It's not even documentary feature. You know, Al Gore got one of those and Michael Moore got one. This is, no, you cannot make a dime on this.

[Audience laughter]

These people will never be rich as long as they live. So this Oscar means something because all they do is tell stories that are important. Now you all do, but you also get rich. But these people all they got is this Oscar is going home in a Honda Civic.

[Audience laughter and applause]

The person who owns this, this Oscar is going to be the nicest thing they ever own in their life.

It's going to give them anxiety to keep it in their crappy apartment.

[Audience laughter]

AMT: That’s comedian Louis CK at the Oscars Sunday night, joking about how even the most successful documentary-makers have it tough. While he was talking about documentary shorts, actually, in reality, the majority of documentary work is a labour of love. Funding is hard to come by, and the financial return can be meagre. But today, the storytelling is as rich as ever. My next guest shaped radio and then TV documentaries in Canada for nearly four decades. Mark Starowicz is the former head of CBC's documentary unit. He revamped CBC Radio's As It Happens, he created Sunday Morning. On the TV side, he was the force behind The Journal and Canada: A People's History. He retired from CBC last season and has since started his own documentary company. Today, as part of our occasional series, Eye on The Media, Mark Starowicz joins me in our Toronto studio to talk about the state of documentary making in Canada. Hi, welcome!

MARK STAROWICZ: Hi, Anna Maria.

AMT: Do you drive a Honda Civic?

MARK STAROWICZ: I drive a 1999 Buick which cost me $2,000. So I’m even lower down the scale.

AMT: Well, there we go. But, you know, it turns out, of course, that Oscar for the documentary short went to a Canadian for her second Oscar, actually.

MARK STAROWICZ: It was her second.

AMT: And Pakistan claims her as their own, we claim her as our own. Pakistani Canadian Sharmeen Obaid-Chinoy for A Girl in the River. But how much is that characterization of the struggling doc maker not so funny?

MARK STAROWICZ: Well, you're right. I mean, it's true: you're not going to make a million, and it's a terrific struggle. If you're making documentary, not reality programs, or pseudo documentaries, or docu-soaps, or genres like that, you're not going to make a million. But if you’re rigorous, you will move mountains. And it's okay to take a Honda Civic home. It's a genre that you can really make, as she did, I mean, she changed the law in Pakistan on honour killings.

AMT: That’s right, that’s right.

MARK STAROWICZ: So, you know, what I love about the form and that example speaks to it, it's empowering, it's... You can change things with the power of film, and you can access that technology now, whereas before, it was only accessible to elites. Now, we've seen such strides. We're hearing voices, women's voices everywhere, First Nations voices, making documentaries in the last five years. LBGT community is sort of flowering with voices now. So that just give you an example of the power of the media.

AMT: Well, there are those who would say that we're in a renaissance with the documentary. Major film festivals show documentaries, Toronto's Hot Docs series, which is all documentary, marks its 23rd year this spring, the theaters are packed at festival time. How would you describe the state of documentary production in Canada right now?

MARK STAROWICZ: Well, first to confirm what you're saying, I mean, we living the golden age with the documentary. And there are there are people, Kevin McMahon leads them, who are moving to have the documentary declared Canada's national art form. And it is the Canadian national art form; it’s also the art form of an entire generation. You remember times when documentary equated boring; documentary equated, simply you watched, you know, you are against apartheid, you are in a voice of women meeting, or a United Church basement meeting. It was narrow. Anti-Vietnam war. Well, this is the anthem of this generation, it is the art form, I think, of the millennial and post-millennial generation.

AMT: And why is that? Is that because the technology has suddenly made it more accessible for people to tell their own stories?

MARK STAROWICZ: I think that's a very large part of it, that you can lay your hands on the technology, you can edit it yourself. The other reasons are mysterious, and I'm not entirely sure. Because technology alone doesn't lead to commitment, and this generation, to make a documentary, you’ve got to believe in something, and fight hard for it, and it's a long slog. That doesn't ipso facto come with technology. So it comes out of, I think, also says something good about the generation that is that it's inclined towards reform, and is reaching for the instruments of reform. So, I think there's a political and social analysis of it as well.

AMT: And also the ability to get it out there, and I want to talk about this further, many documentary makers still go through broadcasters. A lot don't. They either, they do feature film release, which is probably even more of a struggle, but they also-- or they just upload the thing and find another way. Like, there are many ways to get your documentary out there, whereas before, it was kind of a closed door, was it not?

MARK STAROWICZ: Well--

AMT: [interposing] Or a very exclusive door to get through.

MARK STAROWICZ: It was exclusive, it was difficult. You had to be more professional and have more of a track record. We’ve still got to be careful. I mean, your question, which I didn't properly answer, was the state of production in the country. I mean, the good news is there's more talent, more commitment out there than has ever been before, and more receptivity in the audience. 160,000 people lined up last April just in Toronto alone for Hot Docs. People lining up, there was something close to 175 films the starred. So people want to see these. Unfortunately in Canada, we are steadily producing fewer and fewer documentaries. Since 2008, there’s been a 23 percent decline in the production of documentaries, 21 percent decline in in the amount of money spent in documentaries. We used to produce 2,000 documentaries the year, we produce 1,400 now. So paradoxically, as the appetite for documentary increases, demonstrably increases with the audience, more people are lining up around the block to see documentaries. When young people and diverse people of all origins are making them, and there’s a passion associated, we’re kind of marching in the opposite direction.

AMT: And why is that?

MARK STAROWICZ: Because of two things: one, serious cutbacks, in public broadcasting, largely, but also in consolidation in the private sector. The country's essentially divided into four broadcasting. regional monopolies: Rogers, Bell CTV, the Shaw Corus cluster, and Quebecor. And there used to be more doors to go to when you were selling a documentary, you could sell the first play of the documentary to the Movie Network, and the second play to TVO. Now, everybody's consolidating; what used to be four doors is one door, and they're buying up all your rights. They're paying less. Pay less, fewer doors, fewer documentaries.

AMT: And I guess, also, on the ability for people to buy elsewhere. So for example, there's always, there seems to be a lot of buzz about American documentaries in Canada, in the same way we used to talk about American dramatic series get a lot of attention.

MARK STAROWICZ: Well, this is--

AMT: [interposing] A lot of buzz around Making a Murderer, for example, on Netflix.

MARK STAROWICZ: Right, exactly. And as excellent as it is, I mean, a film like Not Criminally Responsible by John Kastner, I think is in the same league. But you know, let's look at, there's an idea that there is kind of a liberating thing going on, where we can get our documentaries anywhere and just upload them. Well the trouble, if you just upload a documentary, the documentary maker didn’t get paid. But I’ll tell you who is getting paid, and where the leakage is in part, in the system. So the first problem is consolidation, which is fewer doors, companies buying each other up, and monopoly is a problem. I mean, it's something we have to talk about. And this is not even talking about newspaper, the decline in newspaper diversity. And let's take Netflix. It has four million subscribers, costs about eight bucks to subscribe to Netflix.

AMT: I'm one of them, by the way.

MARK STAROWICZ: I’m one of them, by the way, totally. Practically a night doesn't go by that my family doesn't watch Netflix. So I pay about a hundred bucks a year. Four million times one hundred bucks is four hundred million dollars. They don't even have an office in Canada; much less pay a penny of tax. So that's okay, good luck on them, but that's four hundred million dollars of televisual money going out of the system, you know, in comparison the CBC’s budget is around a billion.

AMT: Some would say but that's all about competition. That--

MARK STAROWICZ: [interposing] But it’s no competition, and that brings me to the point. That's just Netflix, they’re in 197 countries. Then there’s Amazon, then there's Hulu, and then there’s TMN-- AMC, rather. You've got series that are big, like House of Cards with Kevin Spacey. 12 or 14 episodes, I forget, that cost four million dollars each. And they’re dumped, or downloaded, in one single weekend. We're not all watching 70-minute documentaries on our iPhone, like everybody was going to predict the industry was going to disintegrate into bits, we’re doing the exact opposite. We're cocooning all weekend, watching things on a huge screen. And--

AMT: [interposing] But, so what is it that stops Canadians from competing on that, why can't Canadians upload the same kind of thing?

MARK STAROWICZ: Well, because it's an issue of production. I mean, if we're going to be paying less for documentaries and having fewer opportunities to produce them, if we're going to lose 2,000 people in the documentary sector as we have, just in lost jobs, we're not competing in that universe, because we're not--The only way Canada, basically, the whole history of Canadian programming has always been, you’ve got to produce in order to keep your voice on the airwaves. You've got to tell your stories, you have to support your industry, nobody else is going to tell our stories, Netflix isn't going to tell our stories, they’re not paid to, they shouldn't be obliged to tell our stories.

AMT: But that, I'm going to go back to Making a Murderer, because a lot of people say that's a flawed series. However, it's one small place in the United States of America, one story, one guy, like a whodunit, only done in a documentary style, in a serialized thing. That story could be anywhere, and it was picked up, it was watched everywhere. It wasn't just watched in the U.S., it was watching in Canada, it was watched in Europe. So if we have no borders, why can't we compete on that same level, given our great history in Canada of making great documentaries?

MARK STAROWICZ: We can compete.

AMT: Are we just not thinking that way?

MARK STAROWICZ: We're just not funding the documentary makers. We're not making it possible for them to do it. Sufficient numbers, we're actually turning, shutting down the taps of funding, provincial funding within the private sector is shutting down the taps on supporting.

AMT: Do you think that any Canadian broadcaster, if they could've got their hands on Making a Murderer, would have been able to grab it? I mean I'm just--

MARK STAROWICZ: Absolutely. Sure, absolutely.

AMT: [crosstalk] So then, in fact, do have the money, if they want to.

MARK STAROWICZ: They can have access to American money to do it. I mean, you know, Ric Bienstock produces with Tales from the Organ Trade with HBO, but the problem is, at the very time that you can prove that there’s popularity for a documentary, were producing fewer, and at a lower budgets. Not because you don't have the talent, because we don't have the access. Changing the issue to, well, don’t we have access to American funds, and to Netflix or HBO, well we do, but I shouldn't really be the equation, should it?

AMT: No, you're saying that we should have the same here. Well, let's talk about the evolution of the documentary in this country. When you started The Journal’s documentary section on CBC Television, what was the goal?

MARK STAROWICZ: Well, there was either the 90 minute report-- 90 second report on the news, or there was perhaps five, six major documentaries a year on CBC, usually not very topical. There was nothing in between. So the goal there was to bring insights, witness, to the front line of the issues of the day, to the stories of the day. So you know, Ann Medina on the front lines in Beirut, or Peter Kent in the Killing Fields of Cambodia. We were pretty much the only place in the world that was producing 15 minute documentaries, 20 minute documentaries, full-edition half hour documentaries. We had ten documentaries--

AMT: [interposing] On prime time television, too.

MARK STAROWICZ: On prime time television. I mean, The Journal was 50 percent interviews, but 50 percent documentary. And they were very, very popular, it was never a surprise to me the documentaries were popular. Now, the roots of that, and so it's important to note that the roots of that lay heavily with radio. And the documentary tradition was kept alive by the National Film Board, certainly the CBC Public Affairs Department, and radio. And a lot of the people who did The Journal came from CBC Radio Sunday Morning, and As It Happens. Sunday Morning was a three hour program that sent one man, one woman documentary units around the world and, you know, come back in a week. So you know, Sadat's coming to Jerusalem, go. Good luck. Send your report back within seven days.

AMT: And I should say my very first radio documentary was for Sunday Morning.

MARK STAROWICZ: Was it? What was it about?

AMT: I remember it was on James Keegstra.

MARK STAROWICZ: The teacher.

AMT: The man who lost his teaching license for teaching that the Holocaust was a hoax, and he was writing to get it back. And this was before there was actually a case in criminal court on hate legislation. This was while he was fighting to get his teacher’s license back, and I remember Sunday Morning worked right through the night. And in fact, at 2:00 in the morning, I was based in Edmonton. 2:00 in the morning, I was standing outside, recording my voice so I could have ambient sound behind me, because that's what the producers wanted. [laughs]

MARK STAROWICZ: Well, we didn’t want everybody to sound--

AMT: [interposing] But you did a lot of, and you in fact did, I mean, it was that kind of a turnaround, you worked literally through the night on the weekends to bring that show to air.

MARK STAROWICZ: Yeah, I mean, nobody slept Saturday night at all. But that was, you know, that’s where you got Terry McKenna, you got Susan Reisler, you got a lot of the people. And news magazine, and radio. The short answer is to bring depth and insight into unfolding events, and that was a total gap in the market. BBC filled it to some degree, but you couldn't find it in the American networks. You could before in Edward R. Murrow and See It Now, but it had vanished. It was the highest rated program in CBC Radio, and it was essentially a documentary program.

AMT: So that was the model that then went to television prime time, to again, do quick turnarounds, but find issues of the day, or the pressing issues of the time, and go do longer pieces on them.

MARK STAROWICZ: That's right. Front line. Eyewitness. You are there, and Canadian eyes on the world. You know, We were used to seeing a foreign news on American channels. Not always, CBC did an excellent job on the whole. If there was a long form of any kind, it was with an American presenter. We were basically colonial.

AMT: Okay, and so CBC really set the standard. Did CBC drop the ball?

MARK STAROWICZ: When?

AMT: Did we drop the ball, in terms of, we’re talking about documentary production now that is carried by Netflix, and HBO.

MARK STAROWICZ: [interposing] No, no, no. No, CBC is one of the last bastions that’s still, you know, fighting for the documentary. I mean, we produce 36 hours a year, 18 what used to be Doc Zone, now if First Hand, and then 18 Nature of Things, there’s a couple of specials, they’re entering, they're going into documentary short form for on the Internet. But it's still, you know, still less than produced before. And the ravages of the budgets of the CBC have been so spectacular that the fact that as much documentary exists, and it's and it's really growing, is a testament to a dedication to the documentary. And the people that deserve mention are T.V. Ontario, The Knowledge Network in B.C. I mean, these have been holdouts in the best sense of the word.

AMT: Well, when we talk about the funding for documentaries, what does it cost to make a documentary? What's the range of cost for a high end documentary?

MARK STAROWICZ: Ranges. The range is enormous, but the documentary organisation of Canada estimates it to be somewhere around four to six hundred thousand dollars for a one-hour network documentary, costs all in. You can make a documentary for forty thousand, as well. But on the whole, you're talking about a half million dollar operation.

AMT: And that becomes more and more difficult to get.

MARK STAROWICZ: Becomes more and more difficult.

AMT: Now, so let's talk a little bit more about the digital world, because we were talking about Netflix, were talking about what is more accessible more easily now. But how has, like, how do documentary makers adjust? Because we still expect top of the line shooting, we still expect great stories, we just want to get it everywhere, be it our phone or our computer or our tablet. So how has the digital world changed the ability to make documentaries or, like, what do we have to think about going forward?

MARK STAROWICZ: It's made the cameras infinitely cheaper. You can edit them on your laptop. It's empowered the director a lot more, but it also masks a lot of issues. Even if you can edit it on your laptop, and buy a $4,000, or even you know, do one on your iPhone if you have to, that's not the model. It takes a village to make a documentary, as Susan Reisler says, my colleague. And you know, the editor, the assistant director, the camera. If you're starting out as a documentary maker now, start building your village now, start making the alliances; but they have to be paid. So the fact that one person can devote themselves almost obsessively to a subject for a year and live in their parents' basement, is not a production model for the documentary. So digital in essence has made some things cheaper, but hasn't lowered airfares, hotel fares, rates of editors, rates of camera persons. It still costs money to make a documentary.

AMT: So what advice do you give to young or new documentary makers who are trying to navigate this big world?

MARK STAROWICZ: I thought about this. Above all, it’s not about you. Documentary can be made into a vanity forum, and don't become a vanity form practitioner. The documentary about the person, the subject, the people that you are filming. You're an enabler. You're giving them voice, or bringing voice to them, you're channeling their story. It's not about you; it's about them. And a lot of, some of the wrong kind of point of view, where sort of auteur documentaries are egotistical in that sense. Number two, just because you can film everything doesn't mean-- you have to be rigorous. You really have to be rigorous. You’ve got to know how to write, you've got to know all the intricacies of cinematography. And number three, you've got to fight for the right to do it. I mean, in the end, you've got to fight for a community to have the empowerment to make the documentary, which is what I'm trying to say, which is we’ve got to fight. We have the illusion that it's easy to make a documentary, and it's relatively fundable. It isn't.

AMT: So what role should the public broadcaster have in keeping documentaries front and centre?

MARK STAROWICZ: Well, the public broadcaster has to be the centre, the driver of the documentary. If the point of the public broadcaster is giving voice and empowering and telling our stories and broadcasting our stories to the world, it comes in essentially two forms, which is drama and documentary. The CBC is at the heart of the documentary production industry; a large number of the independent producers out there were nurtured either within the CBC, or by commissions from the CBC. So that's number one.

AMT: We still see, there are private broadcasters that are still funding documentaries.

MARK STAROWICZ: There are.

AMT: Rogers has a fund, Shaw has a fund, do they not?

MARK STAROWICZ: Rogers has a fund, Shaw has a fund, and there’s Discovery Channel and History Channel, and various other things. But Bravo doesn't do documentaries much anymore; you won't find many independent documentaries on Global or on CTV. And so back to the issue of public broadcasting, it's National Film Board, T.V. Ontario, CBC, Knowledge Network where the fence line is drawn.

AMT: And I'm talking to you about this, you have retired from the head of the documentary unit and from the CBC, but now you're back in the trenches. You're now an independent producer.

MARK STAROWICZ: Yes.

AMT: What are you working on?

MARK STAROWICZ: Well first of all, my name of the company is Grand Passage, which is named after a place in Nova Scotia, hello Grand Passage. I’m working with my daughters, and I'm working on a documentary for Nature of Things about the race for the planet Mars.

AMT: So you've already got a place to put it? [laughs]

MARK STAROWICZ: Well you've got to be out there pitching. Someone said, and we were at a conference, you're living a father's dream and a documentary editors dream; you've got a documentary company with your daughters. You should call it Star of Legend Daughters. And my daughter Caitlin, my elder daughter, shot back and said, well, we were actually thinking. Star of Legend Father.

AMT: There you go, here you go. So the documentary lives on in this country. Your words are encouraging.

MARK STAROWICZ: Oh it not only lives on, given a chance and a little water, and a little tender loving care, I mean, it can thrive. And it's our art form.

AMT: Mark Starowicz, thanks for coming in.

MARK STAROWICZ: Thank you very much, Anna Maria.

AMT: Mark Starowicz, former head of the CBC's documentary unit, now an independent documentary producer. He joined me in our Toronto studio. That is our program for today. We've been talking about the future of documentary in Canada. Now, a couple of weeks ago, we spoke to. Canadian filmmaker, Pakistani-Canadian filmmaker Sharmeen Obaid-Chinoy about her documentary, A Girl in the River: The Price of Forgiveness. And you can hear that interview at cbc.ca/thecurrent. She was speaking to our guest host Amanda Lindhout in that interview. Sunday, Sharmeen Obaid-Chinoy went on to win the Oscar for best documentary short. This is her second Oscar. And after accepting her Academy Award, she spoke about how her time in Canada helped inform her storytelling. She gets the last word today. I'm Anna Maria Tremonti, thank you for listening to The Current.

SOUNDCLIP

When you live in a country like Canada, you begin to realize how right things can be. And then when you travel back to Pakistan and to other countries, which are in conflict, you can see what's going wrong. And I think it's important to see what the human, what human beings are capable of. I mean, Canada has a stellar record in human rights; it's got so much that I learn from. And I think going back and forth between Canada and Pakistan has taught me that you need to strive to make Pakistan a better country, and people like me who invest in that country, who start difficult conversations, practically risking our lives to do so, that there is a payback and a reward at the end of it. Thank you.

[Music: Sting]

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