Anatomy of an Epidemic (Part Five)

Many of the people on SSI or SSDI that I interviewed spoke about how they felt they were caught in the tangles of a business enterprise. “There is a reason we are called consumers” was a comment I heard several times. They are right of course that the pharmaceutical companies wasn’t to build a market for their products, and when we view the psychopharmacology “revolution through this prism, as a business enterprise first and a medical enterprise second, we can easily see why psychiatry and the pharmaceutical companies tell the stories they do, and why the studies detailing poor long-term outcomes have been kept from the public. That information would derail a business enterprise that brings profits to so many.

The marketing machinery has lured more and a more Americans into the psychiatric drugstore. As new drugs were brought to market, disease “awareness” campaign was conducted and diagnostic categories were expanded. Now, once a business gets a customer into its story, it wants to keep that customer and get that customer to buy multiple products, and that’s when the psychiatric “drug trap” kicks in.

The “broken brain” story helps with customer retention, of course, for it a person suffers a “chemical imbalance”, then it makes sense that he or she will have to take the medication to correct it indefinitely, like ”insulin for diabetes”. But more important, the drugs create chemical imbalances in the brain, and this helps turn a first-time customer into a long-term user, and often into a buyer of multiple drugs.

The patients’ brain adopts to the first drug and makes it difficult to go off the medication. The first drug triggers a need for a second, and so on.

Such is the story of the psychiatric drug business. The industry has excelled at expanding the market for its drugs, and this generates a great deal of wealth for many. However, the enterprise has depended on the telling of a false story to the American public, and the hiding of results that reveal the poor long-term outcomes with this paradigm of care. It also is exacting a horrible toll on our society. The number of people disabled by mental illness during the past 20 years has soared, and now the epidemic has spread to our children. Indeed, millions of children and adolescent are being groomed to be lifelong users of these drugs.

What patients say: “The meds isolate you. They interfere with your empathy. There is flatness to you, and so you are uncomfortable with people all the time. They make it hard for you to get along. The drugs may take care of aggression and anxiety and some paranoia, those sorts of symptoms, but they don’t help with the empathy that helps you get along with people.”

From a societal and moral point of view, this is a bottom line that cries out for change.

Loren Mosher believed that psychosis could arise in response to emotional and inner trauma and in its own way, could be a coping mechanism. As such he believed there was the possibility that people could grapple with their hallucinations and delusions, struggle through a schizophrenic break, and regain their sanity. And if that was so, he reasoned that if he provided newly psychotic patients with a safe house, one staffed by people who had an evident empathy for others and who wouldn’t be frightened by strange behaviors, many would get well, even though they were not treated with antipsychotics.

“I thought that sincere human involvement and understanding were critical to healing interactions. The idea was to treat people as people, as human beings, with dignity and respect.” It was a twelve room Victorian house in Santa Clara, CA. which opened in 1971, Soteria House.

Another interesting theory is Tony Stanton’s “attachment theory”, which is based on the importance of emotional relationships to a child’s well-being. In the late 70s, he (while in charge of a psychiatric ward for children at a county hospital in CA) assigned a “mentor” to every child. The children were not medicated, and he saw a number of them become attached to their mentors and “blossom”.

“You just can’t organize yourself without a connection to another human being, and you can’t make that connection if you embalm yourself with drugs”. When a child enters Seneca Center’s residential program, Stanton doesn’t ask “what is wrong” with the child, but rather “what happened to them”.

He gets the department of social services, schools and other agencies to send him all of the records they have on the child, and then he spends eight to ten hours constructing a “life chart”. As might be expected, the charts regularly tell of children who have been sexually abused, physically abused, and horribly neglected. But Stanton also tracks their medication history and how their behavior may have changed after they put on a particular drug, and given that they children who arrive at Seneca Center are seriously disturbed, these medical histories regularly tell of psychiatric care that has worsened their behavior. The children regularly arrive at the center on drug cocktails, and thus It can take a month or two to withdraws the medication. And often they do become more aggressive for a time.

“Most times when the kids come in, they can’t keep their heads up, they are lethargic, they are just a blank and there is minimal engagement. You just can’t get through to them. But when they come off their meds, you can engage them and you get to see who they are. You get a sense of their personality, their sense of humor, and what kinds of things they like to do. You may have to use psychical restraints for a time, but to me, it’s worth it”.

Once they are off meds, the children begin to think of themselves in a new way. They see that they can control their own behavior, and this gives them a sense of “agency”, Stanton said. The Seneca center uses behavior-modification techniques to promote this self-control, with the children constantly having to abide by a well-defined set of rules. They have to ask permission to go to the bathroom and enter bedrooms, and if they don’t’ comply with the rules, they may be sent to a “time-out” or lose a privilege.

But the staff tries to focus on reinforcing positive behaviors, offering words of praise and rewarding the kids in various ways. The children are required to keep their rooms clean and perform a daily chore, and at times they will help prepare the evening meal.

“The question of feeling in charge of yourself and being responsible for yourself is the central issue in their lives.” Stanton said. “They may only partially get there while they are with us, but when we are really successful, we see them develop this sense of “O, I can do this; I want to be in control of myself and my own life”. They see themselves as having that power”.

Even more important, once the children are off the medications they are better able to form emotional bonds with the staff, and the staff with them. They have known rejection all their lives, and they need to form relationships that nurture a belief that they are worthy of being loved, and when that happens, their “internal narrative” can switch from “I’m a bad kid” to “I’m a good kid”.

Please, read the rest of the book by Robert Whitaker “Anatomy of an Epidemic” for more thorough understanding of mental health situation in the United States.

Anatomy of an Epidemic (Part Four)

In his book Anatomy of an Epidemic Robert Whitaker talks about best practices from around the world in treating depression and other mental disorders. One of them is from Finland:

The Turku psychiatrists decide on treatment based on case specific, but most important, they settled on group family therapy – of a particularly collaborative type – as the care treatment. Psychiatrists, psychologists, nurses, and others trained in family therapy all served on two- and three-member “psychosis teams”, which would meet regularly with the patient and his or her family. Decisions about the patient’s treatment were made jointly at those meetings. In those sessions, the therapists did not worry about getting the patient’s psychotic symptoms to abate. Instead, they focused the conversation on the patient’s past successes and achievements, with the thought that this would help strengthen his or her “grip on life”. The hope is that they haven’t lost the idea that they can be like others. The patient might also receive individual psychotherapy to help this process along, and eventually the patients would be encouraged to construct a new “self-narrative” for going forward, the patient imagining a future where he or she was integrated into society, rather than isolated from it.

“With the biological conception of psychosis, you can’t see the past achievements” or the future possibilities.

“I would advise case-specific use (of the drugs)”, Rakkolainen said. “Try without antipsychotics. You can treat them better without medication. They become more interactive, They become themselves”. Added Aaltonen: “If you can postpone mediation, that’s important”.

Psychiatrists and psychologist in Western Lapland have a different conception of psychosis. It doesn’t really fit in either biological or psychological category. They believe that psychosis arises from a very frayed social relationships. ”Psychosis does not live in the head. It lives in the in-between of family members and in-between of people”, Salo explained, “It is in the relationship, and the one who is psychotic makes the bad condition visible. He or she “wears the symptoms” and has the burden to carry them”.

Within 24 hours of a call, a meeting with mental health professional, patient and the family members is held. There must be at least two staff members present at the meeting, and preferably three, and this becomes a “team” that ideally will stay together during the patient’s treatment. Everyone goes to that first meeting aware that they “know nothing”, said nurse Mia Kurtti. The job is to promote an open dialog in which everybody’s thoughts can become known, with the family members (and friends) viewed as co-workers.

From the onset, the therapists strive to give both the patient and family a sense of hope. ”the message that we give is that we can manage the crisis. We have experience that people can get better, and we have trust in this kind of possibility”, Alakare said. It may take time for a patient to recover.

Open dialog therapy had drawn the attention of mental health professionals in other European countries. This approach produced good outcomes, “This really happens, it is not just a theory”.

Why does it work? “We like to know what they (doctors) really think, rather than just have them give us advice”, said the parents of the meetings. My own idea is that they value fair process and being recognized and treated as a special individual who is appreciated not as a crowd.

Natural antidepressants:

In Domestic Medicine, Buchan prescribed this pithy remedy for melancholy: “The patient ought to take as much exercise in the open air as he can bear. A plan of this kind, with a strict attention to diet is a much more rational method of cure than confining the patient within doors, and plying him with medicines”.

Two centuries later, British medical authorities rediscovered the wisdom of Buchan advice. In 2004, the National Institute for health and Clinical Excellence, which acts as an advisory panel to the country’s National Health Service, decided that “antidepressants are not recommended for the initial treatment of mind depression, because the risk-benefit ratio is poor.” Instead, physicians should try non-drug alternative and advise “patients of all ages with mild depression of the benefits of following a structured and supervised exercise program”.

Today more than 20 percent of the GPs in the UK prescribe exercise to depressed patients with some frequency, which is four times the percentage who did in 2004.

A “prescription” for exercise typically provides the patient with twenty-four weeks of treatment. An exercise professional assess the patient’s fitness and develops an appropriate “activity plan” with the patient than given discounted or free access to the collaborating YMCA or gym.

Patients work out on exercise machines, swim, and take carious exercise classes. In addition, many exercise-referral plans provide access to “green gyms”. The outdoor activities may involve group walks, outdoor stretching classes, and volunteer environmental work (managing local woodlands, improving footpaths, creating community gardens, etc.)

Throughout the 6 months of treatment, the exercise professional monitors the patient’s health and progress. Patients have found “exercise-on-description” treatment to be quite helpful. They told the Mental Health Foundation that exercise allowed them to “take control of their recovery” and to stop thinking of themselves as “victims” of a disease.

%d bloggers like this: