Why I Prescribe

Sandra Steingard, M.D.

March 3, 2012

This is about neuroleptics. It is about psychosis or madness or whatever term one prefers. It is about people 18 years and older.

I take Robert Whitaker’s and others’ criticisms of psychiatry seriously. As noted in previous blogs, I am most interested in the antipsychotic drugs and I have reviewed much of the primary literature from the chapter on this topic in his book, Anatomy of an Epidemic.  I believe that we need to be cautious when recommending these drugs and it makes sense to try to avoid using them. I am studying Soteria and Open Dialogue and I am involved with some initiatives to bring them to my state. I work in a clinic where we offer an array of services. I believe that we need to talk about a multitude of ways to improve health – eating well, exercising, getting adequate sleep.  Cannabis, alcohol, and other drugs can be destructive to a person’s well being; we encourage abstinence and we try to give a person the tools to remain abstinent.  Various forms of psychotherapy are often helpful and they are recommended and encouraged.  We have an evidenced-based vocational program and expanding peer recovery involvement. We help people who are homeless get off the street and into safe housing. It has always been clear to me that my role as the person who prescribes medications is and should remain a small part of a person’s treatment and recovery.

However, I still prescribe neuroleptics.

In a previous blog, I discussed my approach to my patients who have been on these medications for a number of years. This blog is about someone who has not been on these medications in the past or has been started on them only recently.

Most of the people who come to my office reporting that they are hearing voices or experiencing other psychotic symptoms do not come in with a specific request or agenda about treatment.  They are often scared and looking for guidance.  I have changed my approach in the past year.  I have known for many years that it was important to use the lowest dose of neuroleptic possible. I do not believe I ever told someone in this situation that she would need to be on medications forever. However, prior to reading Anatomy of an Epidemic, I would not have held off on recommending an antipsychotic.

These days, I try to wait.

When I first meet a person who is, for example, hearing voices, I try to explain the varying options for treatment.  I describe what I call the “mainstream” approach which is that the medications are considered first line treatment. I explain that I question that approach and have learned that some people feel better over time without medications.

Some but not all choose to try the medications.  This is usually because they are extremely uncomfortable or frightened and they want to feel better quickly.  I try to keep the dose low.  Many of them are interested in stopping their medications after they feel better and then we begin to reduce the dose with a goal to stopping them.

For those who decline medications, we offer them all of the other services I mentioned above.  If over time, their psychotic experiences persist, we again discuss the pros and cons of medications.

In contrast to the active discussions about the short-term efficacy of antidepressants, there is less attention on this website and elsewhere  directed towards re-evaluating the short term benefits of antipsychotics. The firmly held opinion of my psychiatric colleagues is that they are highly effective in improving symptoms of psychosis.  I invite readers and fellow bloggers to address this with me. Some of you have expertise in statistical analysis that I do not have.  My initial review leads me to several conclusions. First of all, the current data do support their modest efficacy in the short term at reducing psychotic symptoms (Cochrane review on haloperidol).  Secondly, the improvement comes with a high cost of side effects. The drop out rate from many studies is high.   Thirdly, studies do no include an active placebo. Bola et al looked at treatment studies of first episode psychosis and concluded that we do not yet have enough high quality studies data to form conclusions about efficacy.

I certainly have observed instances in which the drugs appeared to be extremely helpful but I am mindful of the drawbacks of anecdote in forming conclusions.   My best guess is that, as with many other treatments, there is a variability of response that reflects the variability of what we are treating.  It is important is to be open to stopping these drugs when they have not offered much benefit or when the side effects outweigh whatever benefit the person has experienced.  There is often a tendency to assume the person  will be worse off without the drugs and that is something that needs to be actively questioned.

In Open Dialogue, my understanding from Daniel Mackler’s documentary and my discussion with people who have trained in this method, is that they try to avoid using neuroleptic medications but they will suggest them in some instances.  There is a small group of people who take them for a longer period of time. It is hard for me to know how my current practice matches what they are doing in Finland, although I understand as a rule they will not start antipsychotics right away.

There are some people for whom the psychosis is not only scary but also dangerous. I have had patients who have done extremely risky things while psychotic. In these situations, someone else has usually started the drug because the person has ended up in the hospital or even jail but it is hard for me to criticize that decision.  I have read with great interest the descriptions of treatment in places where neuroleptics are not used and I have mixed feelings about the level of risk to which some people were exposed.  What if the person had actually jumped out of the window?  What if the person had left inadequately dressed and ran into a frozen lake in the winter?  What if the person had driven off at a dangerously high speed?

I believe there are some fundamental disagreements that can not be resolved. It is a risk benefit equation. I rate the risks of certain forms of psychosis as higher than the risk of taking drugs in the short run. I have no doubt that there are many people who come to this site who  evaluate this differently.  For me, these are complex and difficult questions about personal autonomy.  I do not pretend to have the one true answer and in each situation I try to make the best decision I can.

Sandra Steingard, M.D.

Anatomy of a Psychiatrist: Dr. Steingard chronicles how she is integrating information from Anatomy of an Epidemic into her community mental health practice. She also discusses changes in Vermont’s mental health system and the influence of pharmaceutical advertising on clinical practice.


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44 thoughts on “Why I Prescribe

  1. Sandra– You describe the conscious prescriber’s dilemma very well. I appreciate both your candor and your efforts to learn more about non-medical therapies. From ex-patient to provider—thank you! This is courageous.

    Vanessa

  2. Thank you for this honest appraisal of what it’s like to be a prescribing physician.
    In the messy world of real people, there can’t be a one-size-fits all answer. Meds may be the best choice for some people. They’re legal and a lot of people want them. But all people merit true informed consent: What is the medicine actually doing? What are the risks? What are the alternatives?
    In my world of primary care, I deal mostly with the mild to moderately distressed, the anxious and sad and overwhelmed, and here I think the role of medication is even murkier.
    If we prescribers were to discuss the following questions with our patients prior to initiating drug therapies:
    –Is the short-term, marginal benefit of this medication worth the known risks and costs?
    –Is it being used as a last resort rather than a first one?
    –Is it being prescribed for short term stabilization (which research supports for some meds) rather than long-term use (for which research shows worsening outcomes and comorbidities)?
    –At the moment of initiation of drug therapy, am I providing the patient with a plan and appropriate expectations for withdrawal?
    If all prescribing physicians were to ask these questions with every patient, then I think we would still find patients for whom medications were appropriate. But I’m convinced there would be a dramatic overall reduction in psychotropic prescribing and its attendant iatrogenic harm.
    Thanks again for your post.

  3. “For those who decline medications, we offer them all of the other services I mentioned above. ”

    Wow, I sure do hope that becomes the case in my area. I’ve been functional, mostly asymptomatic for years now and I’ve been trying to get off SSI but nobody will work with me if I’m not in “treatment” with some sort of assurance from a psychiatrists that I’m “compliant with treatment.”, services I’ve been denied include supportive employment, education assistance, trade school services and subsidized housing.

    • EAC, I have not been required to take medications in order to get help with various programs, although I have not applied to many. I have a therapist, and that’s treatment, too, and she fills out my paperwork. I see a psychiatrist who does NOT prescribe medication to me, but that’s not required that I see a psychiatrist. Maybe my state of MN is different, but do the rules for these programs that you want to access say that you must take medications, or do they say you must be getting treatment? Which counseling is treatment! I have bipolar, not schizophrenia, but I’m on the chronic and severe end of the spectrum. Meds were a disaster for me, so psychiatrists around here really don’t want me to take meds anyhow. But I was never required to.

      • “but do the rules for these programs that you want to access say that you must take medications, or do they say you must be getting treatment?” I don’t know what the rules say, the only person that I know who can set me up with these programs is my case worker at the department of human services, and he say’s that I must be in treatment to qualify for the programs that I was interested in.

        • Hi, In NC, if you have the diagnosis of schizophrenia then most programs and services are not available if you are not taking antipsychotics. I have a relative who attended a year long program, each week, not missing one appointment, and at the end of the year, they wouldn’t let him graduate because his psychiatrist wrote a note saying he wasn’t compliant. He had been told by his MD to stop taking antipsychotics and to never take them again because “They would kill him.” The doctor told us that, “the medication was damaging his liver and would eventually take his life.” The psychiatrist told us to fire that doctor. Compliance in NC means one thing and one thing only, which is taking an antipsychotic. The ACT teams will not invite people to groups or outings if they aren’t on their meds. My relative was released from a very good program because he didn’t always take an antipsychotic. They said he was a bad influence on other members, even though he functioned at a higher level than the people who were taking their meds. The group’s coordinator also got upset when I mentioned in a session with other parents that John Nash said that medication was not how he got well. I was never invited back to the group. The leader was upset with me for mentioning it. “We just don’t talk about that here,” I was told. It is a sad state of affairs!

  4. I think that what you should be doing is changing your thinking about neuroleptics entirely. Since we now know that they are not “anti psychotics” but they work by diminishing brain function, then couldn’t that allow doctors to find safer ways to diminish brain function? At least benzos don’t cause tardive dyskenisia. I liked to always think that once the truth became known about neuroleptic drugs and how they work, doctors would use other sedating drugs instead. Have you tried that?

  5. Sandy, this is great. I wish your sensitivity both to the terrible side-effects that these drugs cause and to the limitations on their efficacy were shared by other psychiatrists in the involuntary mental health system. I can’t psychoanalyze the other psychiatrists I deal with, but the rejection and outright mockery that I see coming from some of them is not encouraging for change in the approach taken by this system.

  6. Thanks for being so candid, Sandra. I believe in calling a spade a spade: so “neuroleptics” made more sense to me than “anti-psychotics” after a dose of haloperidol 12 years ago. Haloperodol is still seen as “the best cure for mania”, according to one eminent Australian psychiatrist, despite long term effects such as tardive dyskinesia. Why not calm the individual down (i.e. sedate him) with a drug that doesn’t apply the triple whammy of an assault on emotions, cognitive reasoning and motor skills? I realise in the hypomanic state in which I presented to staff at the hospital some short-term solution had to be found, but – as regular readers of Mad in America will be aware – I subsequently went cold turkey on leaving hospital and have been lucky enough not to have experienced any further hypomanic episodes over the past 12 years. I take no medication for my diagnosed “bipolar” condition: I simply eat healthily, exercise regularly, am creative and have a mutually-supportive relationship with my wife.

  7. This is a single reply to some of the comments above. I truly appreciate these perspectives. Thank you so much for reading.

    1. I have taken seriously the issue of names so I have tried to use “drug” and “neuroleptic” rather than “anti-psychotic” or “medication”, although in my editing, I may have not been completely faithful to this goal. Old habits die hard and I am the first to admit that my thoughts on this topic are constantly evolving.

    2. I do use sedatives (as do many of my colleagues). The problem is that they have their own problems, not the least of which is that they can be addictive. I think it would be important, as I noted in my last blog, to include a sedating agent as a control arm in any future study of drugs for psychosis or mania (and to answer a comment from an earlier post, it is not that I am promoting these studies but I am acknowledging that they will be done and this is a suggestion on a way to do them in a more informative manner). About 20 years ago, I was interested in trying to do a study on the treatment of psychotic agitation. We were going to use lorazepam, a benzodiazepine. I was surprised to find that there had been many studies done that looked at the efficacy of drugs in this class for the treatment of psychosis and they appeared to be effective. I was not sure what to make of this. I talked to some colleagues who offered their opinion that the studies were not well done and that overall the drugs classified as “anti-psychotics” were more effective for specific psychotic symptoms whereas sedating drugs just calm people down. I am not so sure about this anymore but I also want to be cautious in my use of ALL drugs.

    The evolution to the pharmacologic treatment of mania is interesting. In my opinion, prescibing practices in this field have been highly infuenced by pharmaceutical marketing. About 20 years ago, the use of neuroleptics was widely discouraged. Sedating medications were often used along with a mood stabilizer such as lithium. This was done because of the concerns about tardive dyskinesia and other neurologic side effects. Today, the newer antipsychotic medications are widely used and highly promoted. This is a marketing effect.

    3. I want to make sure that I am not misrepresenting the services we offer at my clinic. While all of what I said is true, I started my blog that way to make it clear that I do not think that medications are the only treatment or even the most important part of treatment. We do offer all of those services and I am lucky to work in a state that has a long tradition of valuing community treatment (I come from the place where Courtney Harding did her research). At the same time, budgets are tight and we often feel frustrated that we are not able to offer everyone all that they might need to recover. Also, to make sure I am being honest and open, although we never deny services to someone who chooses to not take medications, I have been in the position of making a strong recommendation to someone to take medications if the psychotic symptoms interfere with that person’s ability to achieve some of his goals. This is a vexing and challenging issue that I am trying to constantly re-evaluate.

  8. Really appreciate your blog Sandra and the honesty of your words!! It sounds to me as though you are doing your best to provide real ‘informed consent’ along with an intentional shared decision making approach! I think that those 2 things are essential ingredients of an effective prescriber/client relationship. Psychiatry seems to be the only ‘health care’ field where clients/patients are routinely told (and sometimes forced) that they MUST take medications – and, when clients/patients refuse they are all to frequently discharged for ‘non-compliance’.

  9. I am most interested in this word “treatment.” Neuroleptics decrease certain kinds of noise, affect major complex biochemical systems in the body, and incapacitate important parts of our humanity. Our knowledge of how they affect the systems they act on, and even basic understanding of those systems at all, is excruciatingly thin.

    I understood from the Open Dialogue film that treatment in Finland consisted first of psychosocial interventions and just generally accompanying and being in relation to the person through the onset of psychosis. They worked through finding language for trauma before medicating – it seemed to be a window of opportunity. You can’t work through any of that when important parts of you are so sedated that you can hardly move, think, or feel. It means that actual treatment has to happen – and intensively – at the onset of psychosis. The person is not left alone for the first two weeks, yet not hospitalized or chemically restrained. They did not use the control mechanisms we impose on people herein the US, and I think that is why their rates of violent behaviors, even in people quite psychotic were very, very low.

    I think that neuroleptics do not treat the cause for most people – that the cause resides in a life trauma that will not go away with a pill. Masking the symptoms I believe is really dangerous if you are never going to invest time in the person to find out about the actual problem(s) or situation(s) at the root. These are the folks we see getting stuck forever in community maintenance, who cycle in and out of the hospitals. We could discuss and argue all we want about the biological basis of such things called “psychosis,” but I think it is only strongly biological in a minority, and those may be the people that ended up on low-dose neuroleptics in Finland.

    Please invest in people – time and money – at the beginning of their distress and let’s avoid this chronic agony, and avoid, too, the “brain disease” and “chemical imbalance” excuses for that lack of investment.

    • “We could discuss and argue all we want about the biological basis of such things called “psychosis,” but I think it is only strongly biological in a minority,”

      Lowry, I agree, and I think that the emotional and situational reasons for psychosis are often being overlooked in favor of the biological/biochemical imbalance. There are plenty of people being given a diagnosis of bipolar or depression these days, but the biggest increase is in the under eighteens. They are given drugs and the drugs put their body chemistry out of whack. They are the population that will improve most with diet and getting off the drugs. Then there are the classic cases (my son is one) who go psychotic at the stage of life when they are leaving home for the first time and are facing life’s challenges. They tend to be the super healthy in the physical sense. Pills, whether prescription or vitamins, aren’t the panacea for this group. Help for these people comes with compassionate therapy.

  10. Thank you very much for the clarity of your message, and a double thank you for not mentioning the word “schizophrenia” once. In my experience, psychiatrists tend to hold out “schizophrenia” as always a special case/the exception to the rule, and therefore those with this diagnosis will always need their meds.

    Your post is excellent, but a bit misleading because the origins of psychosis are complex, and, unfortunately, many people still think that it’s all about the biochemistry. Get plenty of sleep, eat well, avoid prescribed or recreational drugs, and your problems are solved. Chances are they are not. This is where healers and therapists have filled the gap that used to be handled by psychiatrists. There are vast numbers of alternative therapies that engage the body/mind connection, and when used in conjuction with healthy lifestyle options, will lead to better outcomes than merely getting off drugs and eating well.

    Thanks again for a good post.

      • Hi, Marianne,
        Here are some ideas based on my own research re my son. A lot of the time I was just going by my hunches as to what would help him. We did Family Constellation Therapy – the originator was Bert Hellinger, but there are many practitioners in the USA, I believe. Therapies like this, but not necessarily only this one are the kinds of therapies that look at the emotional roots of our problems. There is no therapy that says “this is what you should do if you have a diagnosis of schizophrenia” so it means you have to find a psychotherapist who practices a therapy that you think will resonate with you. I am not sure if FCT is the same thing as Family Systems Therapy, but you should check FST out as well. My son also did sound therapy, but a very specific type that isn’t done elsewhere. However, there are many forms of sound therapy springing up and that may be something you would like to investigate. The Hearing Voices Network is also making a lot of headway recently and is an on-line community of support.
        Best regards,
        Rossa

  11. I wish I had been given an option when I was 18 and heard voices. I am 62 now, and still hear them from time to time, but I have figured out what they are. I took “anti-psychotics” for years. They made me eat more and didn’t change the voices.
    I had to go along with the doctors to get out of hospital, that is lie to them.

    For several years, their theory was that schizophrenics had “too much dopamine”. In 1968, when I was started on phenothiazines, there was something called the Thorazine Shuffle, or “pseudo-Parkinsonism”.

    One never hears that term now, even though the side effects still include Parkinson-like rigidity. I also found out that phenothiazines are actually pesticides and Parkinson’s didn’t exist before pesticides were used for killing pests. (Insecticides, herbicides, rodenticides).

    Now there are so-called professionals telling people that Dopamine is the “feel good” chemical in the brain! I still have journal articles from the 1960′s and 1970′s with the theory that was the opposite, and also about when L-dopa was being used for Parkinson’s patients, with short-term effects.

    Can you explain how dopamine went from causing schizophrenia to being the “feel good chemical” without some major tampering by scientists?

    I also cannot find a doctor who will work with me to get off of drugs. A long history of a label has caused me extreme misery over the years.
    If only someone had told me those voices were from inside of me, instead of ECT and meds, and counseled me that things would be ok…I was only 18. If only there had been some compassion.

    • Marianne-
      Thanks for your comments. Dopamine is the neurotransmitter in the so-called pleasure and reward center of the brain. As Whitaker and others point out, there is no evidence that there is an abnormality of dopamine in the brains of people who hear voices or experience other psychotic symptoms. The dopamine hypothesis of schizophrenia – that there is too much dopamine in the brains of people who experienced psychosis -was proposed because the neuroleptic drugs are known to block dopamine. Over many years, scientists never found any evidence to support the dopamine hypothesis of schizophrenia.

      Perhaps you could copy some of the articles from this website so you could discuss it with your doctor. Philip Thomas, MD posted an excellent blog on this topic today.

      Sandy

      • Doctors don’t listen to patients. The crazy label takes away any credibility.
        I tried talking to my doctor about Mad in America when it first came out.

        He saw people for fifteen minutes and didn’t have time to talk about ANYTHING, except dosages, insurance, and so forth.

        Later I realized he would lose his way of living if he were enlightened by that book, and it was too much of a risk for him. And it wasn’t HIS brain that was being destroyed, so who cares.

        I am on my own, tapering off with no support.
        When I mentioned that to a nurse, she suggested I needed a “little bit of Abilify”. I just stopped talking, because that suggestion said it all– you can’t talk to these people whose minds are made up and then closed.

  12. Its hard to understand why someone who asserts that “Cannabis, alcohol, and other drugs can be destructive to a person’s well being” and encourages abstinence from those drugs, would prescribe others just as harmful. Given the history of the medical profession in prescribing Heroin, Cocaine and other now illegal drugs, I am genuinely interested in the thinking behind the distinctions you draw.

    • I think the drugs are helpful in the short run (although I agree with Dr. Thomas that the studies are inadequate – see his blog from today). I am worried about the safety of some people who have psychotic symptoms. You may disagree; I think the distinction is in how we weigh the risk of the medications vs. the risk (at least for some people) of being psychotic.

      Sandy

      • “Short run” is fine, possibly. If there is informed consent and the long run plan is explained and includes how the drugging will be ended. The only HOPE is in knowing the misery and drugs will end and life will begin again.

  13. The one thing I always think in relation to this today is that there are currently no other real options available.

    While I don’t have a history of psychosis, I do have a history of the most profound trauma, resulting in profound dissociation issues, anxiety, etc. There were times when I needed medications to provide what I refer to as emotional numbing. IF I had other options available, then no I would not have needed them. But in this day and age, when the ONLY option was a hospital stay, which would have made my situation a thousand times worse, then it was a tool that I used to managed my condition at that time.

    That was why I was placed on drugs and that is what was said to me at the time of getting me to agree to take them. However when things had passed, no attempt was made to take me off the medications or to even reduce the dose. With my insistence they agreed, but when I wanted to wean off slowly I was told it was not necessary. I remain angry about that. I do not have any regrets about when I went on the med’s at the time it really was emotional numbing or hospitalisation and emotional numbing was the best alternative.

    The biggest need is to be able to offer some REAL therapy, and I cannot for one second see the role that CBT plays in that. My thoughts are based on my experiences and simply telling me that they are irrational and I should believe you because you say so, is hardly going to be of any help to me. I need support to find new experiences to develop new memories and in return new thoughts.

    I do however have a great deal of respect for any doctor who will at least consider what is written in Whitakers books and not just defend it at all costs when no evidence is there. Changing patterns takes time, and perhaps that is the best evidence against CBT!! If you can’t change your prescribing habits overnight, then WHY do you expect those you support to do the same. Speaking generally here, not directing it to anyone in particular.

  14. In the garden were two … schizophrenics? Long standing “joke”, but it’s no joke. Isn’t it endlessly interesting that the most powerful book on earth starts off with a story of …

    mental illness?

    BS.

    Stop drugging people. Psyche is NOT a disease or disorder.

    Mis-information causes de-formation of mind. Proper in-formation is the ONLY “treatment” that will ever provide understanding. There can only be PEACE … in understanding. Without understanding, there is struggle, suffering, confusion and strife.

    Vital in-formation is nutrition for a Heal-thy mind. A lack of vital information, in addition to mis-information, produces a mind like a war zone.

    WORDS are the answer. Don’t feed people pre-SCRIPT-ions. Feed them the most accurate WORDS (script, write – hopefully you get the meaning) http://www.thefreedictionary.com/script.

    accurate = A CURE.

    The words have all the answers. “the truth is hidden in plain sight” – which is OUR WORDS.

    Psyche means “spirit”, psyche means “tricked ya!”.

    Stop “treating” (mistreating, really) PSYCHE as a “disease”, though we all know – psyche-active minds are very often NOT EASY to live with.

    The CURE is in accurate WORDS. Eat WORDS. Eat “SCRIPT-ure”. Any wonder why you mad-scientists NAME your DRUGS the way you do? “Abilify”?? “Effexor”??

    Time to swallow some ability now! Time to swallow some effects!

    WORDS. Eat THEM.

  15. Two great psychiatrists have written books about the enormous harm of psychiatric drugs with the most lethal ones both old and atypical antipsychotics. Dr. Joanne Montcrieff wrote the MYTH OF THE CHEMICAL CURE and she has a new one out about demedicalizing misery to help end psychiatry as a dishonest, “hidden” mechanism of social control, punishment, marginalization, stigma, poisoning and destroyed lives. Dr. Grace Jackson has written RETHINKING PSYCHIATRIC DRUGS to ensure informed consent and she gives all the reasons to avoid them like the plague they are. She has also written THE PERFECT CRIME about how psychiatric drugs like atypical antipsychotics and even SSRI’s can cause dementia while psychiatry denies the connection as they did with tardive dyskinesia for many decades up to the present or they pretend their benefits justify killing the patient about 30 years early when it has been found time after time that these poison drugs make any so called illness much worse and more permanent per Whitaker and many others.

    Dr. Jackson has a slide show about the toxic effects of the major psych drugs and their influence on disease and early death. Here is the hyperlink:

    http://isepp.wordpress.com/2012/03/07/training-lecture-on-psychiatric-drugs-the-important-association-between-psychiatric-drugs-medical-illness-and-premature-death/

    Of course, Dr. Peter Breggin’s many great books and web sites have always done a great job exposing how TOXIC PSYCHIATRY became when it sold out to BIG PHARMA for the bogus medical model. Given that these drugs can be lethal after even short term use, I don’t see how they can be justified for any reason. Most talk therapists say patients enduring the chemical lobotomy of atypical antipsychotics can no more engage in therapy any more than somebody who is drunk, and even if they could, it would not tranfer to their sober lives.

    I have learned the hard way to always do lots of research before taking any recommended drug.

  16. Drugging patients makes life easier for staff who look after them.

    Drugging so-called ADHD children isn’t for the children, it’s for the benefit of the teachers and parents.

    Drugging the elderly is for the benefit of their caretakers, not the person.

    And then there is the money, and the future money to be made by telling someone “you need this for the rest of your life.”

    This is neither “health” nor “care”.

  17. Dr. Steingard,

    I enjoyed reading your post.

    My own circumstances involved both the treating psychiatrists and ER doctors missing an obvious connection to long-term workplace exposure to chemical toxins and acute psychosis.

    Although the doctors were notified by my family members of the chemical exposure, they did not consider an occupational evaluation or substance-induced psychotic disorder. For over two years I was misdiagnosed with bipolar disorder before seeking evaluation and help through Functional/Integrative Medicine. I was 33-years-old at the time with no prior history of depression/mania.

    I wrote this narrative that was published in the Journal of Participatory Medicine last year:

    http://www.jopm.org/perspective/narratives/2011/03/28/psychosis-possibly-linked-to-an-occupational-disease-an-e-patient%E2%80%99s-participatory-approach-to-consideration-of-etiologic-factors/

    As a mental health advocate, I hope to encourage medical professionals dealing with patients exhibiting symptoms of psychosis to consider Best Practice Assessment of psychosis as outlined in the British Medical Journal.

    BMJ: helping doctors make better decisions

    Step-by-step diagnostic approach

    The evaluation of the acutely psychotic patient includes a thorough history and physical examination, as well as laboratory tests. Based on the initial findings, further diagnostic tests may be warranted.

    Organic causes must be considered and excluded before the psychosis is attributed to a primary psychotic disorder.

    The most common cause of acute psychosis is drug toxicity from recreational, prescription, or OTC drugs.

    The full article and additional research on underlying causes of psychosis/mania that can be misdiagnosed as schizophrenia/bipolar disorder is posted on this site:

    http://psychoticdisorders.wordpress.com/bmj-best-practice-assessment-of-psychosis/

  18. Donna,
    Thank you for your observations!

    I know a nurse whose mother had a lobotomy in the 1950′s. She was permanently disabled from it.
    This nurse was someone I trusted, but lost contact with her until a later hospitalization.

    I was shocked (ironic word here) to find out that she had become an expert in ECT. She described it as being so much different than it was before, that the voltage was lower, and pulsating, and just wonderful.

    Two of her patients came back from their treatments and the only difference from the old ECT and the new ECT was their faces were extremely red. They were as confused as ever, and sat in wheelchairs all day.

    One had been a co-worker of mine and ended up on permanent disability. This woman had a lot of problems with her strict religious parents, a weird marriage, phobias…all things that ECT didn’t “help” nor change.

    How anyone could do this to another human being is beyond me. They don’t think of them as “human beings”– that’s the problem.

    They would never consider having a treatment themselves, because they are so arrogant.

    I had 28 of them and they made me into a temporary imbecile that took me a year to recover.

    I thought Healy was a “good guy”. It’s disappointing to find that he sold out.

    • Marianne,

      Thanks for your usual validation and support when dealing with the unbelievable and inconceivable when dealing with man’s inhumanity to man (women included).

      I’m so sorry to hear about your negative experiences with this harmful practice and those you cared about too.

      Your sharing your story is a great form of support, validation and healing for you and fellow victims of psychiatry to remain sane despite psychiatry’s crazymaking, gas lighting, never ending lies!

  19. Thank you for your comments and the links to thse interesting and important articles. I had a very old article on the differential diagnosis of psychosis that was 100 pages long! The BMJ article loooks like an excellent update that I will use and share with my colleagues and students.

  20. My understanding, from long experience as a daughter, friend, and mother, is that if a reason for psychotic symptoms is lack of sleep, a benzo, as needed, might help. The problem is that a person can become dependent very quickly, and then getting off is a real challenge. Abrupt withdrawal presents serious seizure risk. A friend has a site called benzobeware. She successfully got off, but it took a very long time and was very difficult.

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