Psychosis as a Basic “Disturbance of Self”
February 22, 2012
Researchers in Australia and the U.K. found that a basic disruption of the sense of ownership of one’s experience and a lack of self-agency differentiated 49 patients at “ultra high risk” for psychosis from 52 matched healthy controls. This finding, the researchers say, is of both diagnostic and theoretical value, “shedding light on core phenotypic features of schizophrenia spectrum pathology.:”
Read more
Criticism of the DSM Goes Mainstream
February 21, 2012
Criticism of the upcoming revision of the DSM has gone mainstream, with Forbes Magazine weighing in on the economics of medicalizing grief, and Fox News questioning the wisdom of calling shyness a disorder. Allen Frances, committee chair of the previous DSM revision, writes today about the radical expansion of pathology that the new revision represents, and its current revisers’ “freezing out” of criticism.
Psychosis in the General Population
February 21, 2012
Schizophrenia Bulletin explores “the extended psychosis phenotype,” finding that affective dysregulation, psychotic experiences, motivational impairments, and cognitive alterations are distributed throughout the population, and suggestive of a continuum of vulnerability for psychosis more than a categorical phenotype. In assessing rates of psychosis in the population, however, methods of data collection account for more variance than any other factor. The high rate of self-reported psychosis, they say, may represent a continuum of the “psychosis phenotype” in the general population that is not in need of clinical care.
Read more
Psychosis Overlaps With Anxiety and Depression
February 21, 2012
In a representative community sample of 3021 adolescents and young adults, researchers in The Netherlands, Germany, Switzerland, and the U.K. found that 27% of those with anxiety and depression exhibited one or more psychotic symptoms. Further analysis suggests that psychosis, depression, and anxiety are overlapping and reciprocal. The results are to be published in the March, 2012 issue of Schizophrenia Bulletin.
Read more
Schizophrenia Bulletin Questions the “Psychosis Phenotype”
February 21, 2012
In an editorial introducing its March issue, Schizophrenia Bulletin explores the categorical distinctions that have defined and directed research into psychotic disorders since the late 19th century. Findings from cognitive, neurobiological and epidemiological research, they say, may support a more unitary concept of psychosis across the population. In a commentary in the same issue Patrick McGorry (see prior article) questions the limits of evidence-based health care in the treatment of psychosis, when “the status quo has manifestly failed.”
Read more
Some Avoid Antipsychotics Because They Value Psychosis
February 17, 2012
Side effects, mistrust, stigma, forgetfulness and lack of insight have all been studied as reasons that up to 75% of people with a schizophrenia diagnosis discontinue antipsychotic medication. Researchers in Germany, Switzerland and the U.K. explore the possibility that this choice may also be motivated by a preference for experiences that medication may eliminate. Psychosis is perceived by some as having benefits, the researchers say, while negative symptoms are perceived as debilitating. The researchers suggest finding treatments that are sensitive to the positive gains of positive symptoms for some, but ameliorate negative symptoms as desired. The study will be published in an upcoming issue of Schizophrenia Bulletin.
Read more
Mindfulness-Based Cognitive Therapy is Effective in Bipolar Disorder
February 14, 2012
Researchers at Massachusetts General Hospital and Harvard Medical School found that Mindfulness Based Cognitive Therapy increased mindfulness, lowered depressive mood symptoms, lessened attentional difficulties, and increased emotion-regulation abilities, psychological well-being, positive affect, and psychosocial functioning in a sample of 12 patients with bipolar disorder. The results are published in the February issue of CNS Neurosciences & Therapeutics.
Read more
Childhood Maltreatment Reduces Hippocampal Volume
February 14, 2012
Researchers at Harvard University, in the largest and most detailed study on the topic to date, found that childhood maltreatment is significantly associated with reduced hippocampal volumes. Reduced hippocampal volumes have been implicated with chronic and first-episode schizophrenia, depression, dissociative identity disorder, borderline personality disorder, and bipolar disorder. This is the first study to demonstrate that the condition is associated with childhood maltreatment irrespective of diagnosis. The results were published today in Proceedings of the National Academy of Sciences.
Read more
Benzo Discontinuation Improves Quality of Life and Reduces Symptoms of Schizophrenia
February 14, 2012
Researchers in Japan find that tapering or reducing benzodiazepines has a positive effect on quality of life, verbal and working memory, and psychiatric symptoms in people with a schizophrenia diagnosis, with no adverse effects. The study found that a daily dose reduction strategy of 25-50% per 2-4 weeks was safe. The study appears in the upcoming issue of Progress in Neuro-Psychopharmacology and Biological Psychiatry.
Read more
Hopelessness Predicts Suicide in First-Admission Psychosis “Above and Beyond” History of Suicidality
February 13, 2012
Researchers in Canada, The United States, and Israel found in a retrospective study of 414 first admissions for psychosis that high baseline score of hopelessness reliably predicted attempted suicide 4 to 6 years later.
Read more
Antidepressants Have No Effect On Bipolar Depression
February 10, 2012
In a review of 68 articles published between 2005 and 2011, Israeli researchers found that most well-controlled studies failed to show a significant effect of antidepressants on bipolar depression.
Read more
Negative Symptoms Have Greater Impact Than Positive on Outcomes in Schizophrenia
February 10, 2012
In a Schizophrenia Research article study of 1447 people diagnosed with schizophrenia as part of the NIMH CATIE study, researchers in Israel, Switzerland and the U.K. found that improvement in negative symptoms had a distinct and independent effect on outcome relative to other symptoms.
Read more
African-Americans More Likely to be Diagnosed Schizophrenic
February 10, 2012
In a study of 610 psychiatric inpatients and outpatients from six academic medical centers across the United States, African Americans were almost three times more likely to receive a diagnosis of schizophrenia than non-latino white individuals, even after controlling for all other predictors.
Read more
England Seeks to Stop Antipsychotics For Dementia
February 9, 2012
English health minister Paul Burstow is seeking to outlaw the ‘silent scandal’ of inappropriate antipsychotics for dementia by proposing legislation that imposes up to five years in prison for prescribing the drugs without permission.
Read more
Antipsychotic Use Does Not Correlate With Conversion to Psychosis
February 9, 2012
Researchers in Brazil find, in a meta-analysis, that only 30% of youth deemed to be of ultra high risk of psychosis do in fact become psychotic, with 30% recovering. While a high level of positive symptoms and low social functioning was predictive of psychosis, high social functioning and low negative symptoms were predictive of recovery. Use of antipsychotics, at the level of multivariate analysis, was not predictive of outcome.
Read more
Cognitive Therapy Shown to be Effective For Schizophrenia
February 7, 2012
Researchers report in the February issue of Archives of General Psychiatry that cognitive therapy improved both positive and negative symptoms in “low-functioning” patients with schizophrenia. An accompanying editorial elaborates on society’s historical concern with positive symptoms, while the principal concerns of caregivers and service users has been negative symptoms. Antipsychotics, they say, may worsen negative symptoms, while cognitive therapy shows promise in ameliorating the most disabling and distressing aspects of the diagnosis.
Read more
Voice Hearing as a Dissociative Rather Than Psychotic Phenomenon
February 5, 2012
Researchers in England review in depth the evidence for voice hearing as dissociation, rather than psychosis, and suggest that voice hearing is a common experience that should be viewed in the context of trauma and the struggle to give words to difficult, overwhelming emotions.
Read more
Adverse Childhood Events Contribute Significantly to Most Mental Health Problems
February 2, 2012
John Read and Richard Bentall write in the British Journal of Psychiatry about the growing understanding and acceptance of the significant role adverse childhood events play in most mental health problems, and the theoretical, clinical and primary prevention implications of this profound shift. Their commentary provides perspective on two other articles in the same issue; on the impact of maternal depression on psychopathology, and of mistreatment in childhood on specific psychiatric disorders.
Read more
Religion and Spirituality Protect Against Depression
January 31, 2012
In The American Journal of Psychiatry, a longitudinal study of 114 persons at high risk for depression found that those who reported more religiosity at 10 years were 75% to 90% less likely to be depressed at 20 years. An editorial in the same issue discusses the historical and current relevance of religion and spirituality to clinical work and the validity of empirical research on the topic.
Read more
Psychosis is Not Unique to Schizophrenia
January 30, 2012
In a sample of 3021 adolescents and young adults with anxiety or depression, Dutch researchers found that 27% also had one or more psychotic symptoms.
Read more
Some Avoid Antipsychotics Because They Value Psychosis
February 17, 2012
Side effects, mistrust, stigma, forgetfulness and lack of insight have all been studied as reasons that up to 75% of people with a schizophrenia diagnosis discontinue antipsychotic medication. Researchers in Germany, Switzerland and the U.K. explore the possibility that this choice may also be motivated by a preference for experiences that medication may eliminate. Psychosis is perceived by some as having benefits, the researchers say, while negative symptoms are perceived as debilitating. The researchers suggest finding treatments that are sensitive to the positive gains of positive symptoms for some, but ameliorate negative symptoms as desired. The study will be published in an upcoming issue of Schizophrenia Bulletin.
Read more
Benzo Discontinuation Improves Quality of Life and Reduces Symptoms of Schizophrenia
February 14, 2012
Researchers in Japan find that tapering or reducing benzodiazepines has a positive effect on quality of life, verbal and working memory, and psychiatric symptoms in people with a schizophrenia diagnosis, with no adverse effects. The study found that a daily dose reduction strategy of 25-50% per 2-4 weeks was safe. The study appears in the upcoming issue of Progress in Neuro-Psychopharmacology and Biological Psychiatry.
Read more
Antidepressants Have No Effect On Bipolar Depression
February 10, 2012
In a review of 68 articles published between 2005 and 2011, Israeli researchers found that most well-controlled studies failed to show a significant effect of antidepressants on bipolar depression.
Read more
England Seeks to Stop Antipsychotics For Dementia
February 9, 2012
English health minister Paul Burstow is seeking to outlaw the ‘silent scandal’ of inappropriate antipsychotics for dementia by proposing legislation that imposes up to five years in prison for prescribing the drugs without permission.
Read more
Antipsychotic Use Does Not Correlate With Conversion to Psychosis
February 9, 2012
Researchers in Brazil find, in a meta-analysis, that only 30% of youth deemed to be of ultra high risk of psychosis do in fact become psychotic, with 30% recovering. While a high level of positive symptoms and low social functioning was predictive of psychosis, high social functioning and low negative symptoms were predictive of recovery. Use of antipsychotics, at the level of multivariate analysis, was not predictive of outcome.
Read more
David Healy Critiques Gibbons’ Reanalysis of Antidepressants and Suicide
February 8, 2012
David Healy critiques the reanalysis by Robert Gibbons of antidepressants and suicidality in children and adolescents that was reported on this page yesterday. He points out many failures of the study, including that factors other than antidepressants account more plausibly for the changes in reported suicide rates, and that Gibbons continues to draw conclusions from his previous study that had been called “astonishing,” “misleading,” and “reckless” by the British Medical Journal and disavowed by one of its authors.
Read more
Suicidal Thoughts and Behavior With Antidepressant Treatment: A Reanalysis
February 7, 2012
In 2004 and 2006, the FDA concluded that SSRI antidepressants increased the risk of suicidal ideation in children and adolescents. However, in this month’s Archives of General Psychiatry, Robert Gibbons and four other researchers report that they have re-analyzed the data for Fluoxetine and Venlafaxine, and have concluded that, contrary to the FDA analysis, these two SSRIs do not increase the risk of suicidal behavior in children and adolescents. Three of the five researchers report having received funding from pharmaceutical companies.
Read more
Lawsuit Filed for Alleged Zoloft-Related Birth Defects
February 7, 2012
Lawyers in St. Louis have filed a lawsuit against Pfizer that alleges 18 children were born with birth defects caused by the antidepressant Zoloft taken by their mothers while pregnant. The plaintiffs allege that Pfizer knew of the drug’s association with birth defects but failed to warn of the danger.
Read more
Eli Lilly To Freeze Base Pay in 2012
February 5, 2012
Citing financial pressure from the loss of its patent on Zyprexa, Eli Lilly announced that it will freeze base pay for most of its employees in 2012.
Read more
First Personal Injury Lawsuit Over Risperdal Starts in New Jersey
February 3, 2012
Gary Skala’s claim that 14 years of Risperdal caused his diabetes went to trial in New Jersey yesterday in the first personal injury lawsuit against Johnson & Johnson to be presented to a jury. The trial follows J&J’s losses in Risperdal-related cases in Louisiana, South Carolina, and to the United States Government, and starts two weeks after J&J’s settlement of claims regarding fraudulent marketing of Risperdal in Texas.
Read more
Bribery Alleged in Largest Antidepressant Study Ever Conducted
February 2, 2012
A 2011 whistleblower complaint that was unsealed on January 20 of this year alleges that Forest Pharmaceuticals bribed a principle investigator of the STAR*D (Sequenced Treatment to Relieve Depression) study to fix the results in favor of the company’s drug Celexa. The complaint alleges that because of this bribe, Celexa was the only antidepressant employed in the first part of the study, and also led to falsification and overstatement of the drug’s effectiveness. The whistleblower is Ed Pigott, who has blogged on the STAR*D trial for madinamerica.com.
Read more
Assessing Increased Mortality Risks of Antipsychotics and Mood Stabilizers in Dementia
January 31, 2012
An article in January’s American Journal of Psychiatry weighs the relative risk of mortality associated with various antipsychotics and mood stabilizers used in the treatment of 33,604 patients with dementia. An accompanying editorial in the same issue points out that the least risky options were also the least effective in curbing aggression.
Read more
Medications May Add to Mortality Rate in Schizophrenia
January 30, 2012
Dutch researchers write in the Journal of Clinical Psychopharmacology that, in a prospective study of 7415 persons with diagnoses of schizophrenia, use of a first-generation antipsychotic and use of a mood stabilizer were associated with higher mortality rates.
Read more
No Long-Term Efficacy For A.D.D. Medication
January 29, 2012
L. Alan Sroufe, emeritus professor of psychology at the University of Minnesota, writes in the New York Times Sunday Review that there is no evidence of long-term efficacy for A.D.H.D. medications. He argues that environment, rather than neurology or temperament, predicts the development of A.D.H.D.
Read more
Antipsychotics Increase Mortality in Parkinsonism
January 27, 2012
In a prospective study of 5,391 deaths among people with Parkinsonism, Canadian researchers found a significantly higher risk of death within 30 days for people who had been newly prescribed atypical antipsychotics. The risk of death was even higher for those newly prescribed typical antipsychotics.
Read more
Discontinuing Psychotropics Reduces Falls in Elderly
January 26, 2012
Australian researchers look at the literature on the effect of psychotropics on falls in the elderly; largest effect of any randomized trial was achieved by discontinuation of psychotropics.
Read more
Antipsychotics Increase Retrovirus Activity in Humans
January 24, 2012
Endogenous retroviruses, remnants of ancient infections that have become part of the human genome, have been associated with the development of schizophrenia. But researchers in Germany find that elevated endogenous retroviral gene expression may result from treatment with antipsychotics, rather than from schizophrenia itself.
Read more
Psych Drugs Leading Cause of Adverse Events in Canadian Children
January 17, 2012
For Canadian children 2 to 18 years, psychiatric drugs topped the list of “suspect health products” in 2010 based on reports of adverse events, Health Canada has reported.
Read more
Bipolar Office Visits Soar
January 17, 2012
The number of “visits” by bipolar patients 18 and older to office-based physicians in the U.S. rose from 3.7 million in 1998 to 7.8 million in 2009. In 1998, the office-based visits resulted in the writing of 700,000 prescriptions of second-generation antipsychotics to the bipolar patients, and this soared to 3.8 million prescriptions in 2009.
Read more
One in Five Americans Uses a Psychiatric Drug
January 17, 2012
Because of the increased use of generic drugs, there has been a slowdown in the growth of spending for psychiatric drugs in the United States since 2001. However, the portion of the population that used a psychiatric drug rose from 13% in 1997 to 19% in 2008, according to research published in Psychiatric Services.
Read more
Surviving Schizophrenia: A Memoir
February 21, 2012
Louise Gillett I was diagnosed with schizophrenia when I was just nineteen. I am forty-three now, and I have recovered – and I use the term ‘recovery’ in its fullest sense. I have been free of medication and free of …
Full Article
The Manifesto of a Noncompliant Mental Patient
February 14, 2012
Aubrey Ellen Shomo I see it everywhere: People with mental illness need medication. It sounds reasonable. Today, there are even political organizations that seek to make it easy to force a person to take it. It’s easy to look at …
Full Article
A Psychiatrist Remembers His Recovery from Schizophrenia
January 23, 2012
Nathaniel Lehrman, M.D. A psychiatrist since 1949, I was psychiatrically hospitalized on December 21, 1963 at New York City’s Mt. Sinai Hospital. I stayed for three months, was diagnosed correctly as “schizophrenic reaction, paranoid type,” and recovered fully. This report …
Full Article
From the Loony Bin To Stand-Up Comedy
January 14, 2012
Andrew Hays I was sixteen and going on seventeen and I had never gone crazy before. I think the most startling aspect of it is how utterly unable to acknowledge it I was. Even after. As many teenagers seem obsessed …
Full Article
Psychosis as a Basic “Disturbance of Self”
February 22, 2012
Researchers in Australia and the U.K. found that a basic disruption of the sense of ownership of one’s experience and a lack of self-agency differentiated 49 patients at “ultra high risk” for psychosis from 52 matched healthy controls. This finding, the researchers say, is of both diagnostic and theoretical value, “shedding light on core phenotypic features of schizophrenia spectrum pathology.:”
Read more
Criticism of the DSM Goes Mainstream
February 21, 2012
Criticism of the upcoming revision of the DSM has gone mainstream, with Forbes Magazine weighing in on the economics of medicalizing grief, and Fox News questioning the wisdom of calling shyness a disorder. Allen Frances, committee chair of the previous DSM revision, writes today about the radical expansion of pathology that the new revision represents, and its current revisers’ “freezing out” of criticism.
Psychosis in the General Population
February 21, 2012
Schizophrenia Bulletin explores “the extended psychosis phenotype,” finding that affective dysregulation, psychotic experiences, motivational impairments, and cognitive alterations are distributed throughout the population, and suggestive of a continuum of vulnerability for psychosis more than a categorical phenotype. In assessing rates of psychosis in the population, however, methods of data collection account for more variance than any other factor. The high rate of self-reported psychosis, they say, may represent a continuum of the “psychosis phenotype” in the general population that is not in need of clinical care.
Read more
Schizophrenia Bulletin Questions the “Psychosis Phenotype”
February 21, 2012
In an editorial introducing its March issue, Schizophrenia Bulletin explores the categorical distinctions that have defined and directed research into psychotic disorders since the late 19th century. Findings from cognitive, neurobiological and epidemiological research, they say, may support a more unitary concept of psychosis across the population. In a commentary in the same issue Patrick McGorry (see prior article) questions the limits of evidence-based health care in the treatment of psychosis, when “the status quo has manifestly failed.”
Read more
England Seeks to Stop Antipsychotics For Dementia
February 9, 2012
English health minister Paul Burstow is seeking to outlaw the ‘silent scandal’ of inappropriate antipsychotics for dementia by proposing legislation that imposes up to five years in prison for prescribing the drugs without permission.
Read more
David Healy Critiques Gibbons’ Reanalysis of Antidepressants and Suicide
February 8, 2012
David Healy critiques the reanalysis by Robert Gibbons of antidepressants and suicidality in children and adolescents that was reported on this page yesterday. He points out many failures of the study, including that factors other than antidepressants account more plausibly for the changes in reported suicide rates, and that Gibbons continues to draw conclusions from his previous study that had been called “astonishing,” “misleading,” and “reckless” by the British Medical Journal and disavowed by one of its authors.
Read more
Lawsuit Filed for Alleged Zoloft-Related Birth Defects
February 7, 2012
Lawyers in St. Louis have filed a lawsuit against Pfizer that alleges 18 children were born with birth defects caused by the antidepressant Zoloft taken by their mothers while pregnant. The plaintiffs allege that Pfizer knew of the drug’s association with birth defects but failed to warn of the danger.
Read more
Eli Lilly To Freeze Base Pay in 2012
February 5, 2012
Citing financial pressure from the loss of its patent on Zyprexa, Eli Lilly announced that it will freeze base pay for most of its employees in 2012.
Read more
First Personal Injury Lawsuit Over Risperdal Starts in New Jersey
February 3, 2012
Gary Skala’s claim that 14 years of Risperdal caused his diabetes went to trial in New Jersey yesterday in the first personal injury lawsuit against Johnson & Johnson to be presented to a jury. The trial follows J&J’s losses in Risperdal-related cases in Louisiana, South Carolina, and to the United States Government, and starts two weeks after J&J’s settlement of claims regarding fraudulent marketing of Risperdal in Texas.
Read more
Adverse Childhood Events Contribute Significantly to Most Mental Health Problems
February 2, 2012
John Read and Richard Bentall write in the British Journal of Psychiatry about the growing understanding and acceptance of the significant role adverse childhood events play in most mental health problems, and the theoretical, clinical and primary prevention implications of this profound shift. Their commentary provides perspective on two other articles in the same issue; on the impact of maternal depression on psychopathology, and of mistreatment in childhood on specific psychiatric disorders.
Read more
Bribery Alleged in Largest Antidepressant Study Ever Conducted
February 2, 2012
A 2011 whistleblower complaint that was unsealed on January 20 of this year alleges that Forest Pharmaceuticals bribed a principle investigator of the STAR*D (Sequenced Treatment to Relieve Depression) study to fix the results in favor of the company’s drug Celexa. The complaint alleges that because of this bribe, Celexa was the only antidepressant employed in the first part of the study, and also led to falsification and overstatement of the drug’s effectiveness. The whistleblower is Ed Pigott, who has blogged on the STAR*D trial for madinamerica.com.
Read more
No Long-Term Efficacy For A.D.D. Medication
January 29, 2012
L. Alan Sroufe, emeritus professor of psychology at the University of Minnesota, writes in the New York Times Sunday Review that there is no evidence of long-term efficacy for A.D.H.D. medications. He argues that environment, rather than neurology or temperament, predicts the development of A.D.H.D.
Read more
Legal Coercion, Recovery, and Human Rights
January 27, 2012
Mary O’Hagan, an international mental health leader with lived experience, writes on the paradox of increasing legal coercion of psychiatric patients, even as the recovery model–and respect for human rights–have become “accepted norms.”
Read more
Evidence That Sadness When Bereaved is Not Illness
January 25, 2012
While the DSM-IV recognizes that depressive symptoms are sometimes normal in bereaved individuals, this “Bereavement Exclusion” is targeted for elimination from the DSM-V. However researchers from NYU find that the evidence supports validity for the “Bereavement Exclusion” and its importance in preventing over-diagnosis of depression.
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Pfizer Files to Consolidate Birth Defect Lawsuits
January 24, 2012
With at least 59 lawsuits pending over birth defects allegedly caused by Zoloft, Pfizer moves to consolidate litigation near its headquarters in New York.
Read more
J&J Earnings Down 89%
January 24, 2012
The Wall Street Journal reports that Johnson & Johnson’s fourth-quarter earnings fell 89% following settlements for misrepresenting the risks and benefits of Risperdal, its once top-selling drug.
Read more
Alarm About Antipsychotics as Sleep Aids
January 23, 2012
Canadian sleep researchers, writing in The Lancet, warn that weight gain, lipid and glucose dysregulation, restless leg syndrome, sleep-walking and eating while asleep, and increased mortality are among the risks of prescribing antipsychotics off-label for insomnia. Cognitive behavioral therapy is among the validated alternatives.
Read more
J&J Takes Hit on Wall Street for Its Corrupt Practices
January 22, 2012
In the wake of the Johnson & Johnson’s settlements over its improper marketing of Risperdal, Forbes magazine comments on the company’s “vulnerable and now broken – image.”
Read more
J&J Settles Texas Medicaid Lawsuit for $158 Million
January 19, 2012
Johnson & Johnson has agreed to settle Texas’ lawsuit for the company’s fraudulent marketing of Risperdal. The is the first time J&J has settled a state’s claim for this reason. The settlement comes less than a month after J&J’s $1 billion settlement with the U.S. government.
Read more
Bipolar Office Visits Soar
January 17, 2012
The number of “visits” by bipolar patients 18 and older to office-based physicians in the U.S. rose from 3.7 million in 1998 to 7.8 million in 2009. In 1998, the office-based visits resulted in the writing of 700,000 prescriptions of second-generation antipsychotics to the bipolar patients, and this soared to 3.8 million prescriptions in 2009.
Read more
Op-Ed
February 15, 2012
A MadMother: We Have a Duty To Protect Children
Becky Murphy
February 15, 2012
The recent reports by ABC News and the Senate Hearing on December 1, 2011, which was presided over by Senator Tom Carper, are the latest of many investigations and hearings into psychiatric drugs being used on foster children. But the fact is that the indiscriminate use of psychotropic drugs prescribed off-label is widespread, and not limited to children in foster care. Children who live with their parents often have the same safety and protection issues as children in foster care and experience equally harmful effects from the drugs.
When children are harmed instead of helped with psychiatric drugs it is always tragic. When the child lives with his or her parents, the parents can’t understand why the help—the medication—is not helping, but hurting.
My son was diagnosed with temporal lobe epilepsy the month he turned seven years old. It is a neurological condition known to be caused by a brain injury, and can cause the same symptoms as schizophrenia. When he was diagnosed with temporal lobe epilepsy, he also had been getting mental health treatment services for over three years and had a diagnosis of PTSD. He had this diagnosis because he had been the victim of violent assault when he was three years old and in foster care.
My children were in foster care due to my own failure to deal with the effects of my own traumatic childhood. I placed my sons in foster care, when I became unable to care for them. My youngest son was placed in a home that had twelve reports filed with Child Protective Services. After he was victimized, I believe that the State of Washington attempted to cover it up, with little regard for how this would cause my son further harm. I was not informed of the trauma my son had experienced.
I brought my son home with a recommendation that intensive in-home services were needed. For years this recommendation was never followed, and my son continued to struggle without the help he needed. He got med management from the public mental health system.
The drugs prescribed included neuroleptics that have been prescribed to children off-label for decades. My son was first given Risperdal when he was seven years old in 1995 to “treat” his aggression. The betrayal of trust I felt when I learned about what this class of drug does to the human body is overwhelming. I am outraged to know that none of the things that I should have been told before giving consent were told to me by the psychiatrist who prescribed them.
The claim that my son’s condition psychiatric diagnosis was caused by a genetic or an inherited biological defect is not supported by any available scientific evidence. Psychiatrists have been claiming that they are “medically treating” unidentified diseases without ever discovering a biological dysfunction or disease process that causes a single one of the psychiatric diagnoses.
My youngest son is one of the many children who have been seriously harmed by the bio-medical paradigm of psychiatric care that permeates the public mental health system. I am his mother and I am painfully aware that I was misled by professionals about my son from the beginning. The services were never based on my son’s actual needs; and they were never “family directed/child centered” as Medicaid Guidelines required. We were given ‘help” which hurt, and were always based on the system’s needs, never on my son’s needs. The fact that the services were not therapeutic and were in fact detrimental was never a concern. The only concerns were the fact that the services were expensive and that my son did not improve. The lack of improvement was his and my fault.
After five years of such treatment, which involved repeated hospitalizations and discharges recommending the same intensive services which were then never provided, the state Division of Children and Family Services claimed that my son must become a ward of the State in order to have his mental health services covered. He, in fact, was already on Medicaid and he did not need to become a ward of the state in order to continue to be eligible. I believe the reason for this action on the State’s part was motivated by the fact that a larger percentage of my son’s care would be paid by the federal government once he was a ward of the state.
It was during this period of time that my son sustained serious injuries from the massive amounts of drugs prescribed to him, over my vehement protests. He has suffered from akathesia and tardive dyskinesia since he was 13 years old.
I have learned much about “the system,” “the drugs” and “psychiatry” from our experiences. I have learned, much to my horror, that the same drugs that disabled my son are now being given to countless thousands of children. I have learned that parents are still not being given accurate, unbiased information to make an informed decision and so in reality, cannot provide informed consent for treatment using psychiatric drugs.
As such, parents are being deprived their Constitutional Rights, which is their right to perform a basic moral duty for their own children. It is a parental right to protect one’s children from grievous harm due to any cause. Not informing parents of the well-known risks of taking neuroleptics and other psychiatric drugs prevents them from even knowing that the drugs can cause serious iatrogenic, or “physician caused,” injuries that can be disabling and even fatal. This deprivation of their parental rights is occurring as a matter of course.
Significantly, these parents and their children are being deprived of their Human Rights to Informed Consent in compliance with the Nuremberg Code, which according to U.S. law and international Law, is the minimum standard to be met when human subjects are involved in medical research. I state this because off-label prescribing of psychiatric drugs to children is experimental, as it is done in the absence of valid scientific supporting evidence.
I have yet to meet a parent of a child prescribed a neuroleptic or other psychiatric drugs who was given accurate information about the risks. I have met many parents who voiced concerns about their child’s deteriorating healthy once they were put on neuroleptics, but who were totally unaware that the drugs could be causing these problems. In one case, the child became obese, diabetic, had high cholesterol, suffered heart damage and became aggressive. All are well-known adverse effects of neuroleptics. But neither the 14-year-old nor his mother was told that these problems might be caused by the drug.
My research over the last dozen years has been driven by my desperate desire to find out how to effectively help my traumatized son, and my advocacy is driven by an overwhelming sense of duty to share what I have learned, and hopefully prevent another child and family from similar experiences. No parent should be lied to or misled by mental health professionals.
A psychiatrist told me last year that any parent who objects to giving psychiatric drugs to their child would, at best, be perceived as ill-informed, and at worst, as being impaired themselves. Implicit in this statement is a belief that no one has a right to NOT consent to psychiatric drugs being given to their children.
It is heartbreaking as a mother to know that the treatment my son received caused further trauma and disability. It was traumatizing for his older brother and myself as well. I know my eldest son has a burden that is not his, and so do I. The fact that Isaac was so harmed and so traumatized—he is now disabled—leaves us feeling guilty for not being able to stop it.
I have no small amount of sorrow that the reason my son experienced what he did was the result of my own problems, which caused me to place my children in foster care in the first place. Not a day has gone by that I don’t remember that it was my own failure as a mother that led to my son being placed in the care of someone who victimized him. It is more than a little unfortunate that my deficits which caused me to place him in foster care were the lens through which his ongoing need for treatment were viewed.
There are times I am haunted by memories. I can remember when my eight-year-old child suddenly claimed that his eyes didn’t work, and that I was the only one who believed him. Imagine finding out a decade later that one of the known effects of neuroleptics is on eye function, and how even adults complain that the drugs make it difficult to read. My son was in third grade and could read only with extreme difficulty, and no one but his mother believed him that there was a problem with his eyes. My son was then given another diagnostic label, as his psychiatrist determined that his refusal to read and do schoolwork was because he had Oppositional Defiant Disorder. His behaviors were then seen as further evidence of his having a genetic or biological defect in need of a psychiatric label and a psychiatric drug. This is only one of many painful experiences that I cannot remember without crying.
I cannot change the past, and the only way I think that I will have any peace is if I share what happened, and share what I’ve learned. My hope is someone else will be helped instead of hurt.
Some of what I have learned in my research:
Schizophrenia is a diagnosis of exclusion; which means conditions that are known to cause the very same symptoms, must not be present, or else they cannot be excluded. Temporal lobe epilepsy is thought to be caused by brain trauma. My son was brutally assaulted in foster care. This is acknowledged in my son’s medical record in his first hospitalization, and it was at that time that Temporal Lobe Epilepsy was diagnosed by EEG. His medical record notes that Child Protective Services were notified.
When a doctor diagnosed my son with schizophrenia, I asked him whether it was necessary to rule out the neurological condition he was diagnosed with, perhaps by performing another EEG. The psychiatrist said that it was not necessary. I later discovered that temporal lobe epilepsy was apparently ruled out by removing the diagnosis from my son’s medical record.
My son was prescribed Ativan/lorazepam to “control impulses,” which is not an approved use of this drug to this day. Lorazepam is a benzodiazepine that is highly addictive, and according to the manufacturer, is meant for short-term use only. After a decade on the drug, my son was finally slowly weaned off it. The withdrawal was horrible. My son was then put back on the drug at twice the dose, and this by a doctor who did not know my son and did not speak to anyone who did, including his primary care doctor and the mental health provider who had tapered him off the drugs in the first place. The reason that he was tapered from the drug in the first place was that my son had cardiac damage from the drug, and this was an attempt to minimize further damage.
My son was prescribed Divalproex ER, known as Depakote, “for aggression.” This was another drug prescribed “off-label” and one that is contraindicated for concomitant use with the neuroleptic drug, clozapine, which was also prescribed off-label to my son. Clozapine is still not approved for pediatric use, more than a decade after it was first given to my son. Both clozapine and Divalproex ER are also not recommended for people with a diagnosis of epilepsy, and/or a history of brain trauma.
My memories of this time in our lives are still a wound that has yet to heal. I thought my son was going to die. I used to dream of hiring mercenary Marines to rescue him.
America’s children need us to stop investigating how bad the over-drugging of children is. Each new investigation is a little more horrifying than the one before. Instead, we need to act. The lives of America’s children depend on us doing something about what we have found, and acting on the information we have.
We Americans pay the doctors who prescribe these dangerous drugs to children. We have an ethical and moral duty to ensure that we are not paying for children on Medicaid to be mistreated and harmed by programs we pay for. When one is aware of this sort of injustice and of harm being done, failure to act and to protect children makes one complicit. We, as a society, must act without delay to help children in need of our care, compassion, and protection.
I need to know that what was done to my son isn’t going to keep being done to other children. The children whose lives have been lost altogether—like Rebecca Riley and Gabriel Meyers–deserve to have their memories honored.
My son needs a fair amount of assistance and he needs protection to this day, even though he is now grown. I protect him out of necessity because of the serious damage the drugs have done to his brain and his central nervous system. My son is terrified of clinics, doctors’ offices and hospitals. But I have hope, and believe recovery is possible. I have to work hard not to dwell on all that my son has lost, and know it serves no useful purpose to think of what could have been. I love who he is, and what matters most is being present and aware of what is.
Op-Ed
January 31, 2012
The Reality Is In Our Heads
Dan Kriegman, Ph.D.
January 30, 2012
Sandra Steingard’s recent post, “Is It All In Your Heads,” has occasioned a spirited discussion—on monism, dualism, and what may be going on when someone hears a voice. In her post, Dr. Steingard reflects on some common criticisms of mainstream psychiatry, and in the process of sorting out her own thoughts, she sets forth a basic belief that I—and almost all psychologists and psychiatrists—share. Our brains are evolved biological structures that clearly function according to the rules of the physical world.
Her piece and the responses stirred up this thought for me: How can one understand the relationship between human psychological experiences and the material world in a manner that doesn’t lead to a medical conclusion that, in mainstream psychiatry today, might be summarized as, “The problem is all in your brain, take your meds!” (I am not saying that Dr. Steingard came to that conclusion; however, that is the conclusion that is instinctively drawn by many in the field when they speak of distress and other psychiatric symptoms arising from the brain.)
To better understand my thinking on this, I should note that I’m a psychologist who has written extensively about evolutionary biology. I don’t think you could find anyone who believes more in the notion that everything is mediated biologically. But I also find myself in accord with Bishop Berkeley who fairly conclusively demonstrated that the only things that can be known to exist exist in minds: There is no physical world that can be known outside of a mental experience of that world.
Furthermore, modern physics has fairly conclusively demonstrated that the physical substrate of the world of our experience is nothing like our experiential world, i.e., relativity, quantum, and string theories point to a fundamental, underlying reality that is utterly unlike the experiences we are referring to when we use words like chairs, cars, dogs, or people. So in a profound way, modern physics has demonstrated that what really is out there — i.e., the “reality” that exists independently of our mental construction — is not the mental construction that exists in our heads.
Consider. The fundamentally relational ground-of-being is fraught with mysteries and paradoxes. It has a mind-boggling dimension as it confronts us with incomprehensible facts. For example, where is the experiencing self that knows? Is it in the bouncing molecular billiard balls of our nervous systems? Your experience of “green” (not to mention such things as “love”) is not merely a pattern of electrical stimulation being passed through some nervous tissue. Clearly there is some relationship between our nervous systems and our experience. But a pattern of nervous excitation is a pattern of nervous excitation, not “the experience of green.”
The preceding statement is one way of describing the mind-body problem that is highly relevant to this whole issue and can be discussed without bringing in any unnecessary dualism. Rather than introduce dualistic notions to this discussion, I will attempt to demonstrate that materialistic monism — which is the dominant philosophical worldview underlying almost all mainstream science, not just psychiatry — leaves us with incomprehensible paradoxes that simply indicate that something must be misleading in such an approach. Let me explain this further.
If we were to look closely through a special microscope that showed every nerve cell glowing brightly as it passed an electrochemical impulse along its shaft to the next cell, and if we were able to watch in very slow motion, we might see a similar pattern occurring each time our subject looks at a green wall. And a different pattern when the person looks at an orange wall. But when we look at the person’s brain tissue and examine the pattern of nervous stimulation, try as we may, no matter how closely we look, we will not see “green” or “orange.” So, where in the monistically conceived world is the experience of green or orange?
Well, we do know that the color sensation/experience is being “known” by an experiencing self. After all, you do exist, and you do have experiences such as “green.” But where is your experiencing self in the spatial dimensions of the physical world? As much as it may be tied up with brain activity, it simply isn’t “in the brain”; again, no matter how carefully we look we will not find the experience/sensation/awareness of green when we examine your brain tissue.
As Henry David Thoreau wrote, “With all your science can you tell how it is, and whence it is, that light comes into the soul?”
This “mind-body problem,” along with numerous other impossible questions/paradoxes, lead us to a fundamental state of awe that need not include any of the dualistic, magical thinking typically associated with words like “soul.” We can remain monists (or better yet, just avoid the monist-dualist dialectic and stick to the paradoxical facts that defy our understanding) without any spooky spirits thrown into the works. We need posit no hidden homunculus in the brain. We know that the experiencing mind, psyche, self “arises out of” — or is “tied to” or “correlated with” — phenomena in the material world. Simultaneously, it does not exist in, cannot be found by examining the material world.
Bishop Berkeley, the British Empiricist, took it one step further: All known features of the material world exist only in minds that cannot be located in that physical world. Minds arising out of a physical world? Or a physical world that exists solely in minds? The incomprehensible, the paradoxical, is real.
Thus, there may be something essentially misleading about the materialistic, simplistic biologizing that has gripped modern psychiatry. Dr. Steingard wrote, “The experience of hearing a voice that no one around you can hear is reflective of a set of brain processes.” And surely it is. As she noted and as I already ceded in my description of the issue above, every mental experience has a relationship to biological brain processes.
There is, however, an implication in such words that something essentially different is happening in the brain of a person who hears a voice that others can’t hear. Given my extensive experience as a practicing clinical psychologist, this is an interesting but questionable conclusion. While I have treated people who have been diagnosed with some form of psychosis, the vast majority of my patients have shown no signs of psychosis. Yet all of my patients hear voices nobody else hears. Almost all the time.
I confess that I too hear a continuous dialogue in my head. It is true that I experience the voice in my head as my own voice; I feel like I’m talking to myself. But I hear my voice in my head. I actually talk to myself. Paraphrasing Jackie Mason, I typically enjoy talking to myself because I happen to agree with what I say. When I talk to myself, I don’t start any arguments. I find my thoughts to be quite intelligent. If I have something stupid to say, I say it to somebody else. When I die, I’m afraid I’ll have nobody to talk to.
But seriously, there need be no discernable, no significant difference between brain processes that are correlated with a voice that no one else hears that is experienced as emanating from oneself and a voice that no one else hears that is experienced as coming from someone or somewhere else. We all have brains that produce both voice sensations, though some of us seem to feel the voices we hear (that no one else hears) are our own voices most of the time, except maybe when we are very tired, physically ill, dreaming, or just awaking. Others more often hear voices no one else hears and feel like they are not their own voices.
The point is that the biological differences between such experiences may be so negligible or subtle or so far beyond our rudimentary understanding of how brains and psychological experience are related that it may be many, many centuries before we are able to pinpoint them, if indeed we will ever be able to do so.
I would suggest that the fundamental difference between the two experiences — between hearing a voice that no one else hears and feeling it is your own voice and hearing such a voice and feeling it is not your own voice — may not be profitably understood by talking about something going on in a person’s biology, neurological processes, biochemical functioning or any other materialistic metaphor.
It may be far more profitable to talk about the fundamental misery experienced by people who have been subjected to horrific abuse and trauma when their worlds are inundated with alien voices that only they hear that often criticize, abuse, cajole, and/or appear to be harshly ordering them around. Rather than analyzing the biochemical processes involved, it may make far more sense to try to understand the attempt to stitch together a stressed, depleted, fragmented sense of self with a voice that speaks to the subject and tells the person that he or she is the divine offspring of the Almighty Creator, an experience that religious mystics throughout the ages have voiced.
I am not suggesting that Dr. Steingard doesn’t understand this. Indeed, she may practice in this manner when she does psychotherapy; her piece clearly demonstrated that she is a thoughtful, sensitive clinician who is struggling to make sense of a field that has become quite muddy, at best. However, I am suggesting that, as of today, the point she was making — derived from the notion that every human experience can be understood as biologically mediated, a notion that I happen to agree with — may be virtually inconsequential in developing our best understanding of the human experience called “madness.”
As the founder of self psychology, Heinz Kohut, pointed out, we can try to understand the human experience of a great painting by analyzing the pigments used by the artist. It is doubtful, however, that we will make much progress in deepening our appreciation of inspiring art using that method. Not today. And even if pigment analysis progresses to levels unimaginable today, I doubt we will ever be able to use it very profitably to understand the moving human experience produced by great works of art. Just so, there is nothing on the table or the scientific horizon to indicate that the analysis of bouncing, molecular, billiard balls in nervous systems is likely to illuminate the human experience of green, not to mention beauty, love, heartbreak, overwhelming anxiety, or the sense that a voice that no one else hears is not our own.