On July 17, I wrote a post on the use of neuroleptic drugs as chemical restraints in nursing homes. The article generated some comments, one of which touched on some very fundamental issues which, in my view, warrant further discussion. The comment was from drsusanmolchan and read as follows:
"All drugs can be dangerous toxic chemicals when not used appropriately. While many valid points are made in this article, it’s very one-sided and could be considered biased in that it’s written by a psychologist. I’ve seen many patients and families benefit from their use.
- Dr Susan Molchan (psychiatrist who
doesn’t ascribe to DSM or Pharma)"
"All drugs can be dangerous toxic chemicals when not used appropriately"
Let's consider an example of a real medication, prescribed to treat a real illness. If a person has complete kidney failure, he inevitably becomes anemic, because it is a secretion from the kidneys that triggers the bone marrow to produce red blood cells. To counteract this problem, nephrologists prescribe EPO, or a more modern substitute (darbepoetin alfa), which compensates for the kidneys' deficit, and resolves the anemia. This is a perfect example of a medication correcting a functional pathology within the organism. Of course, if the nephrologist prescribes too much medication, then the concentration of red cells in the bloodstream will get too high, and the medication can truly be said to be having a toxic effect.
But this is not at all comparable to what happens with psychiatric drugs. Despite decades of deceptive assurances to the contrary, no psychiatric drug has the effect of correcting a functional or structural pathology within the organism. In fact, the reverse is the case: all psychiatric drugs operate by creating a pathological state within the organism.
EPO and darbepoetin alfa can indeed become toxic if administrated in wrong doses – but they are not in and of themselves toxic to the organism. All psychiatric drugs are toxic in and of themselves regardless of dosage. The so-called therapeutic effect and the toxic effect are one and the same.
"While many valid points are made in this article, it’s very one-sided and could be considered biased in that it’s written by a psychologist"
Whilst I appreciate the recognition that the article contains "many valid points," I find myself troubled slightly by the notion that it could be considered biased because " . . . it's written by a psychologist."
My arguments against psychiatry are, and have always been, based on logic and evidence. Turf is not an issue. Indeed, I am as critical of psychologists who endorse psychiatry's spurious philosophy and practices as I am of psychiatry itself, and I am strongly opposed to the extension of prescription authority to psychologists.
I will admit, however, that I am biased! I am biased towards cogency, critical thinking, honest, impartial research, etc . . . And I am biased against spurious, simplistic explanations; corruption; and despotic paternalism. But I am not biased towards psychologists, as such.
"I’ve seen many patients and families benefit from their use"
What Dr. Molchan has written in this one short sentence is the essence of psychiatry's claim to legitimacy: the drugs work.
My contention, of course, is that the drugs don't work, in the sense that any putative short-term benefits are far outweighed by the long-term adverse effects. I have discussed this matter throughout the website with regards to the various classes of drugs that psychiatry uses, but for now I would like to focus on neuroleptics, which is what my original article was about.
My point was that the neuroleptics were – and are – being used as chemical restraints with people who are agitated, aggressive, or otherwise "difficult to manage." The article referred specifically to nursing homes and DD group homes, but it is my general contention that neuroleptics are used in this way in all contexts. Psychiatrists routinely refer to these drugs as "anti-psychotics," implying that they target crazy thinking. This is not only erroneous, it is a blatant lie. They are neuroleptics in the sense that they "grab hold" of the nervous system and have a marked tranquilizing effect. In an earlier post, Agitation and Neuroleptics, I drew attention to two experiments in which mental health workers had voluntarily taken neuroleptics in order to assess and describe the effects. Both studies reported marked drowsiness and sedation as the dominant effect. Neuroleptic drugs also give rise later to a wide range of devastating adverse effects, including a marked increase in movement and agitation – but that's a different issue.
My primary contention here is that they are used as restraints, and in many cases this is done without the client's consent.
Western laws on forcible restraint, both statutory and regulatory, have been developed over centuries, and are still developing. They vary somewhat from place to place, but in all situations, the restrainer is required to act within the limits of the law, and is subject to judicial review in doubtful cases, and to censure, if it is found that the degree of restraint was excessive.
By medicalizing agitation, aggression, and general "unmanageability," however, psychiatry has effectively skirted and insulated themselves from the ordinary legal safeguards that differentiate civilized society from police states.
In a civilized society, if a police officer injures a person he is restraining, he will be required to answer for this. Essentially he will have to show that the degree of restraint he applied was needed to ensure safety. Obviously there are cases of abuse – but that is the standard. An officer convicted of using excessive force will face sanctions.
But in the psychiatric context, the pretense is made that the chemical restraint is actually medicine needed to treat an illness. The resulting damage is ignored, and psychiatrists are almost never held accountable. On the rare occasion that they are held accountable, it is not to the ordinary legal standards applicable to restraints, but rather to the medical standard of "established practice." And these standards are drawn up by psychiatrists themselves. In this way, they manage to circumvent hundreds of years of common law, by claiming that they are doctors treating an illness, when in fact anybody who has had any experience with the system knows that the drugs are used as restraints.
The fact is that neuroleptic drugs do act as chemical restraints, and that is the main use to which they are put in psychiatric practice. Given their devastating adverse effects, this ought to be a matter of huge concern. The people who are forcibly restrained in this way are truly living in a pre-civil rights world. Their restrainers are not held to the same standard of accountability and responsibility as police officers and others whose jobs require them to use physical restraints on occasion. This situation is all the more disturbing in that the damage potential with the chemicals is so much greater than with physical restraints.
It is time that we as a society come to terms with the reality that these drugs are not medications in any ordinary sense of the term. They are chemical restraints with no medical qualities whatsoever. The travesty of hiding these procedures in the guise of "necessary medical intervention" needs to be exposed and brought to an end.
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This article also appears on Philip Hickey's website,
Behaviorism and Mental Health
Behaviorism and Mental Health: Philip Hickey is a retired psychologist. He has worked in prisons (UK and US), addiction units, community mental health centers, nursing homes, and in private practice. He and his wife, Nancy, live in Colorado, and have four grown children. His posts can also be seen on his website, Behaviorism and Mental Health.