One hundred years ago patients with psychosis were 4 times more likely than the rest of their contemporaries to be dead at the end of their first 5 years of treatment. The main cause of death was tuberculosis. The asylum was a place where if you had the wrong genetic makeup you were at great risk of catching tuberculosis, particularly if you were a young woman.
In 1954, chlorpromazine, the first of the antipsychotics, was introduced. It seemed extremely safe. In the early days chlorpromazine was given in doses of 50 mg three times a day. Twenty years later antipsychotics in some cases were being given in doses equivalent to 50,000 mg of chlorpromazine per day and the fact that patients still walked around fairly normally seemed to confirm the essential safety of the drugs.
Even if there was evidence the drugs shortened lives, in the 1960s a few years of life lost seemed a reasonable trade to many for the chance to get out of the asylums. But you can’t depend on people to be grateful for ever – and while losing a year or two of life might be a reasonable trade off, losing 10 or maybe 20 years is another matter.
Shockingly, over the last 5 years, a series of large studies, some looking at national databases, have shown that patients with psychosis are 2 to 3 times more likely to die in any one year than the rest of us. Death is primarily by heart attack or stroke. Being two or three times more likely to be dead may not sound much but other studies point to 15-20 years of lost life. The results have been consistent and have raised concerns about the contribution from the antipsychotics especially the second generation drugs which have bad cardiac profiles.
Even more shockingly, almost no-one knows what happens to patients with psychosis 5 and 10 years after they are first admitted – they do not know in New York, London, Berlin or Paris. No one in North Wales knew until this year. The studies that have already been done survey cross sections of patients and don’t answer this question. No doctor can in fact tell patients or their families how likely they are to be alive or dead 1, 5 or 10 years after first admission. If there are risks they cannot tell them what the risks are. This is important because if we know what the risks are we know what to look out for in order to minimize those risks.
What does happen in the first five years? Patients with psychosis, just as they were 100 years ago, are now 4 times more likely to be dead after 5 years of treatment than the rest of us. Patients with schizophrenia are 11 times more likely to be dead – this is much worse than 100 years ago.
Patients with schizophrenia are 10 times more likely to be dead at the end of the first year of treatment than they were 100 years ago. There is no other illness in medicine where such a statement could be made.
Death in the early years of schizophrenia does not come from heart attacks or strokes – it comes from suicide. In their first year of treatment, patients with schizophrenia are over a hundred times more likely to commit suicide than the rest of us.
Heart attacks and strokes do happen but they happen in patients over the age of 65 with delusional disorders or acute and transient psychoses.
See Healy et al (2012) Mortality in Schizophrenia.
Some questions:
Some of the reviewers of this article went into orbit – they did not want to see it published. Among the points raised were that of course we know schizophrenia causes suicide – if you didn’t find it one hundred years ago it’s because the hospital hid it well or patients were straitjacketed – anything except accept that we are doing worse.
Does schizophrenia cause suicide?
No, it doesn’t. The historical data show that the suicides do not come from the illness. Patients 100 years ago did not commit suicide – there does not seem to be a significant risk inherent in the illness.
Did patients 100 years ago have an opportunity to commit suicide?
Yes they did. They spent 99% of their time working on farms or in kitchens or sewing rooms.
Did the hospital hide the suicides?
No. The staff were under a legal obligation to report suicides to the authorities. When patients with mood disorders committed suicide, the records make it very clear what happened and that these reports were submitted.
Does de-institionalization cause these suicides?
No it doesn’t. If patients today were dying 5-10 years into their illness, when they have lost their social networks, jobs, and hopes, the idea that deinstitutionalization might be contributing would seem more likely but in fact they are dying before they lose their families, networks and hopes. One possibility though is that the institution was more of a protective factor for patients 100 years ago than we have appreciated. However it did not protect patients 100 years ago with mood disorders who went on to commit suicide in hospital.
So what causes the suicides? The evidence points to the antipsychotics. In placebo controlled double blind trials these drugs show an excess of suicides and suicidal acts with drugs like Zyprexa having the highest suicide and suicidal act rate in clinical trial history.
This is good news because if most deaths in young people with schizophrenia come from suicide and the antipsychotics make a contribution to this, there is an opportunity to correct the problem. The problem almost certainly stems from drug induced dysphoria. Patients are not on the right drug for them. A simple question – do you like the effect of this drug and do you find this effect useful, along with a willingness to switch from a drug that isn’t suiting someone to one that does, could eliminate the problem.
This is worth trying to make part of the culture of clinical practice because if we can eliminate suicides in year one of treatment we could go very close to restoring the life expectancy of patients with schizophrenia or other young people with psychosis to normal.
There may be no other measure in medicine that for such little cost could make such a difference to life expectancy.
There may be nothing else quite as good as this that psychiatrists could do to save their own skins. They have lost antidepressant prescribing to family doctors, clinical psychologists, nurses or pharmacists. But they cannot blame anyone else if things go wrong in the schizophrenia and psychosis domain. If they cannot ensure their patients safety, what brand value is there left in psychiatry?
There is good news on the heart attack front also. The increased risk of heart attacks and strokes lies in people over the age of 65 with acute and transient psychoses or delusional disorders. These patients are at prior risk of heart attacks or strokes, and in many cases we can detect this. The antipsychotics work on dopamine which has significant effects on the cardiovascular system, and in this way the drugs may tip these patients over the edge.
The antipsychotics already come with black box warnings for patients over the age of 65 – who have dementia. These warnings need to be extended to anyone over 65.
These are the patients who need to be screened before being put on treatment and monitored after they start. But it is a much smaller and more manageable group than all patients with psychosis. The acute and transient patients are also a group who do not need in any case to remain on antipsychotics in the longer term. This puts a premium on stopping treatment where possible.
Owing to the hostility of reviewers in order to get published we “toned down” the findings in an article just out in the BMJ Open – Healy et al 2012, so that the abstract of the article points only to the relatively benign tip of an iceberg that lies beneath. The fact that we toned things down may have meant BMJ didn’t press release the article in the way they have done recently for articles pointing to minor elevations in risk of Alzheimer’s in patients taking benzodiazepines. Getting journalists interested has proven difficult. Schizophrenia is not sexy. Young people dying unnecessarily lights no-one’s fire it seems – at least not these young people.
But that’s not all there is as the next posts La Reine Margot and the St Bartholomew’s Day Massacre may bring out.
“Schizophrenia… In their first year of treatment, patients with schizophrenia are over a hundred times more likely to commit suicide than the rest of us.” Dr. David Healy wrote.
I am one of those “patients” who tried suicide to escape my horrible future , but obviously failed.
Recently I overheard a conversation of a guy working at the local grocery store.
” Those schizophrenics they aint dumb. I have one living in my building.”
I confronted him and told him he hears voices just like the schizophrenic does.
I asked him “How do you differentiate between cold and hot?
Implying that he hears voices within.
He said he doesn’t hear voices (like the diseased schizophrenic), he has feelings.
He was outside with a group of smokers who don’t hear the voice to smoke cigarettes , they have the feeling to smoke that compels them to do the complex action of making money, purchasing, getting the cigarette on fire, etc.
Schizophrenics once medicated not to hear voices can not tell what they are feeling, or are disbelieved.
Feeling Cold
David McQuaid died of pneumonia after living in a 5 degree celcius room.
http://health.groups.yahoo.com/group/iatrogenic/message/1149
Feeling Hot
http://www.cbc.ca/video/#/News/Local_News/Montreal/1317903731/ID=2064849538
CBC News: Montreal – July 21, 2011
at 02:20 of the 30:42 broadcast “about 30 of the 106 heat deaths were mentally ill.”
“They dont realize they need to stay safe” Helene Racine.
Feeling to defecate
Death From Clozapine-Induced Constipation
http://www.biomedcentral.com/1471-244X/6/43
The worker concluded the conversation (making the joke) “Don’t come back with a gun and shoot up the store”.
As the mentally ill can’t control themselves, but he isn’t mentally ill being unable to stop smoking, smoking from the voices he doesn’t hear.
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“this is much worse than 100 years ago” and “Getting journalists interested has proven difficult. Schizophrenia is not sexy.”
According to certain Christian teachers, there was an outburst of demonic activity upon the occasion of Jesus’ coming to Earth, which was perceived as a great threat to Satan’s material kingdom. Other church scholars state that another such outburst is expected just before the Second Coming of Christ. Some fundamentalist Christians believe that that time has begun.
Professor Morton Kelsey, an Episcopal priest, a noted Notre Dame professor of theology, and the author of Discernment—The Study of Ecstasy and Evil (1978), states that demons are real and can invade the minds of humans. “Most people in the modern world consider themselves too sophisticated and too intelligent to be concerned with demons,” he commented. “They totally ignore the evidence around them. But in thirty years of study, I have seen the effects of angels and demons on humans.”
Kelsey insists that a demon is not a figment of the imagination. “It is a negative, destructive spiritual force. It seeks to destroy the person and everyone with whom that person comes into contact. The essential mark of the demon—and those possessed by demons—is total self-interest to the exclusion of everyone and everything else.”
Dr. Wilson Van Dusen is a university professor who has served as chief psychologist at Mendocino State Hospital in California. Based upon his decades of research, Van Dusen has stated that many patients in mental hospitals may be possessed by demons and that people who hallucinate may often be under the control of demonic entities. Van Dusen also affirms that he has been able to speak directly to demons that have possessed his patients. He has heard their own guttural, otherworld voices, and he has even been able to administer psychological tests to these tormenting entities.
An accomplished psychologist, Van Dusen has lectured at the University of California, Davis; served as professor of psychology at John F. Kennedy University; and published more than 150 scientific papers and written several books on his research, such as The Presence of Other Worlds: The Psychological/Spiritual Findings of Emanuel Swedenborg (1974) and The Natural Depth in Man (1974).
In a landmark research paper, the clinical psychologist noted the “striking similarities” between the hierarchy of the unseen world described by the Swedish inventor-mystic Emanuel Swedenborg (1688–1772) and the alleged hallucinations of his patients in a state mental hospital. Van Dusen began to seek out those from among the hundreds of chronic schizophrenics, alcoholics, and brain-damaged persons who could distinguish between their own thoughts and the products of their hallucinations. He would question these other supposed entities directly and instruct the patient to give a word-for-word account of what the voices answered or what was seen. In this manner, he could hold long dialogues with a patient’s hallucinations and record both his questions and the entity’s answers.
On numerous occasions the psychologist found that he was engaged in dialogues with hallucinations that were above the patient’s comprehension. He found this to be especially true when he contacted the higher order of hallucinations, which he discovered to be “symbolically rich beyond the patient’s own understanding.” The lower order, Van Dusen noted, was composed of entities that were consistently antireligious, and some actively obstructed the patient’s religious practices. Occasionally they would even refer to themselves as demons from hell, suggest lewd acts, then scold the patient for considering them. They would find a weak point of conscience and work on it interminably. They would invade “every nook and cranny of privacy, work on every weakness and credibility, claim awesome powers, lie, make promises, and then undermine the patient’s will.”
Van Dusen also found that the “hallucinations” could take over a patient’s eyes, ears, and voice, just as in traditional accounts of demon possession. The entities had totally different personalities from his patients’ normal dispositions, which indicated to him that they were not simply products of his patients’ minds. Some of the beings had ESP and could predict the future. Often they would threaten a patient and then cause actual physical pain. The demons were described in a variety of shapes and sizes, but generally appeared in human form, ranging from an old man to alleged space aliens, but any of them could change form in an instant. Some were so solid to the victims that they could not see through them. At times the patients would become so angry at the apparitions that they would strike at them—only to hurt their hands on the wall.
Van Dusen made detailed studies of 15 cases of demonic possession, but he dealt with several thousand patients during his 20 years as a clinical psychologist. In his opinion, the entities were present “in every single one of the thousands of patients.” He even admitted that some of the entities knew far more than he did, even though he tried to test them by looking up obscure academic references.
One of Van Dusen’s conclusions was that the entities took over the minds of people who were emotionally or physically at a low ebb. The beings seemed to be able to “leech on those people because they had been weakened by strains and stresses with which they could not cope.”
Considering once again some of the implications of Swedenborg’s thoughts and works, Van Dusen commented that it was curious to reflect that, as Swedenborg has suggested, human lives may be “the little free space at the confluence of giant higher and lower spiritual hierarchies.” The psychologist finds a lesson in such a consideration: “Man freely poised between good and evil, is under the influence of cosmic forces he usually doesn’t know exist. Man, thinking he chooses, may be the resultant of other forces.”
http://www.unexplainedstuff.com/Religious-Phenomena/Demons.html
Please, by all means, let psychiatry do it’s job and continue to focus on brains and drugs. Oh my word, what a tragedy.!
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MJK
Your post about the beliefs and pseudo research of the so-called Dr Van Dusen gives new meaning to Ashley Montagu’s phrase “genetic theories of original sin.” He used this term to mock the theories of the sociobiologists (the forerunners of todays’ Biological Psychiatrists) who attributed human behavior to the primal instincts of the animal kingdom. They basically argued that human beings were not capable of rising above their so-called “animal nature” of violence, war, and the individual self interests of greed. So therefore we should all forget about changing the world and accept a world of war, imperialism, and the self interest and “dog eat dog” competition of modern capitalism.
The theories of Dr. Van Dusen are just the flip side of the same coin stamped with the theories of Biological Psychiatry. When their bogus science used to promote genetic theories of “mental illness” don’t pan out it is just a short walk to ascribing the symptoms of what gets labelled as “schizophrenia” to demonic forces. Both end up demeaning those identified this way as either genetically defective or possessed by the Devil. This is not far from the racist terminology used to describe Black People in this country not so long ago.
Richard
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Scared, Richard?
I’ve professed the reality of satan my entire life. I was a child of 5 years old when it presented itself to me. It wasn’t a hallucination or imagination or dream. It was an absolute reality, and satan is a genuine PHYSICAL entity. I know what I saw. I’m not stupid.
We have all sorts of “end time prophecies” happening RIGHT NOW, including the prophecy of the Return of Christ. According to my watch, that “end time” is 2012. It isn’t a hoax.
“According to certain Christian teachers, there was an outburst of demonic activity upon the occasion of Jesus’ coming to Earth, which was perceived as a great threat to Satan’s material kingdom. Other church scholars state that another such outburst is expected just before the Second Coming of Christ. Some fundamentalist Christians believe that that time has begun.”.
Check out Kali Yuga.
Alarms should be going off in people’s minds. They should be “waking up”.
Some can say humanity is sick with epidemic “mental illness” but I say that is dishonest language with a dishonest and incorrect belief system to go along with it.
Satan and Christ ARE NOT FAKE, FALSE HUMAN CONSTRUCTS AND CREATIONS.
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Dr. Healy,
From a purely scientific viewpoint, I seriously question your conclusions, in this post.
In particular, your recommendation that so-called “antipsychotics” should be more carefully prescribed (whether for so-called “schizophrenia patients” or anyone else) is hardly revolutionary; and, so, no one will reject it (of course); but, will it really solve the problem of suicide, that you claim to be addressing?
Hardly.
Your argument against specific meds (e.g., Zyprexa) may be well-meaning.
But, are one or two (or three) types of “antipsychotics” responsible for what has become the extraordinarily high rate of suicide, in this “patient” population, to which you allude?
No way.
Apparently, you’ve made it your mission to point out particularly ‘bad’ meds.
OK, fine.
But, that may be blinding you, to other issues…
Or, maybe you are blind because you’ve been trained in psychiatry (I don’t know).
Your whole slant, as such, is leading you to a conclusion, that’s quite flawed, for it allows you to begin, by forwarding arguments based on a pseudo-scientific premise.
You state, “Patients with schizophrenia are 10 times more likely to be dead at the end of the first year of treatment than they were 100 years ago. There is no other illness in medicine where such a statement could be made.”
That’s absurd.
“Patients with schizophrenia” cannot ever be considered a uniform group of individuals, unless or until psychiatric ‘diagnostics’ a standardized.
(And, good luck with that project!)
So, it would be far more accurate (and genuinely meaningful) to say, this: “Patients LABELED with ‘schizophrenia’ are 10 times more likely to be dead at the end of the first year of treatment than they were 100 years ago. There is no other ‘mental illness’ in medicine where such a statement could be made.”
You’ll notice I’m more careful with words, here, in order to be more genuinely scientific…
After all, truly, we’re not speaking of illness (in reality, “schizophrenia” is considered a ‘mental illness,’ which is very different from illness, properly speaking); and, there is no single condition of “schizophrenia”; instead, there are countless, varied circumstances under which people have been labeled with that so-called “diagnosis,” in the past 100 years; there have been a myriad of reasons why people were tagged that way; i.e., it (“schizophrenia”)is an umbrella term – and a drag-net.
It’s ‘diagnosis’ is culturally determined.
So, really, these suicide statistics, to which you refer, are measuring genuinely tragic rates of suicide, amongst people LABELED with “schizophrenia”; and, many (if not most) of those people were labeled for reasons that were unique to their unique environmental circumstances (here I am speaking of family politics as much as any other kind); surely, Dr. Healy, you understand all this?
But, you are most or all of these factors; and, so, you fail to note the changing meaning, of this word (“schizophrenia”), in the eyes, of the public, at large…
In my view you are ignoring the problem of stigma and how it changes, across time.
More and more, all the time, now: those who are labeled with “schizophrenia” wind up utterly ostracized – given the modern connotations, of that word.
E.g., read this passage, from a just-posted news item: “Court-appointed experts said Loughner suffered from schizophrenia, disordered thinking and delusions. He was determined unfit to stand trial in May 2011 after he disrupted court proceedings and was dragged out of the courtroom.”
See that news item; observe the now iconic picture of the man said to be suffering from schizophrenia:
http: //www.guardian.co.uk/world/2012/nov/08/jared-loughner-life-prison-gabrielle-giffords-attack
I have blogged further on this matter, here:
http://beyondlabeling.posterous.com/here-i-go-again-on-drdavidhealys-latest-blog
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A correction (small but significant) – regarding that line, near the end of my comment, which begins, “See that news item…”
It should appear as follows:
“See that news item; observe the now iconic picture of the man said to be suffering from ‘schizophrenia’:”
I feel it is important to note: I would never intentionally leave that word, “schizophrenia,” naked; it should always be in quotes (or, inverted quotation marks); for, again – emphatically: it is not a singular phenomena; to a very large extent, it means whatever one believes it means, as it refers to an extremely nebulous, ever-changing concept.
(That is why we cannot reasonably compare ‘schizophrenia’ to any physical illness.)
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“Even if there was evidence the drugs shortened lives, in the 1960s a few years of life lost seemed a reasonable trade to many for the chance to get out of the asylums. ”
Yet another person blogging here who obviously hasn’t read either of Whitaker’s books. The drugs did absolutely nothing to improve discharge rates in the 50’s and early 60’s. It was the enactment of Medicare and Medicaid in 1965 that paved the way for Deinstitutionalisation. And why do you blog so much when all your posts are just redundant babbling? I think you’ve made the same points here at least 20 times. I cant help but to wonder if you’re only blogging here for personal exposure as it seems every time your face falls off the front page you throw out another redundant blog post to get it back on.
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Not only that, but Dr. Healy seems to plod along without ever critically examining his language. The language Dr. Healy uses belongs on this site only if he is willing to have it critically examined. I do not understand the continued postings. Dr. Healy seems to have a one-dimensional agenda and is not at all interested in engaging with the audience on the site; which may be either vehemently opposed, has stopped reading a long time ago, or both.
I would love to see Dr. Healy actually engage in the site in a way that suggests his reason for posting really has to do with re-evaluating psychiatry’s current role in society. He asks, “What brand value is there left in psychiatry?” If Dr. Healy is truly asking a question, I challenge him to have the integrity to engage with his audience as we try to answer it together. If not, I am left thinking that perhaps he posts with absolute authoritiative confidence and never gives the page another glance. When so much change is needed, there may be very little value in such an obdurate position.
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Names, Jeffrey C, and Jonah,
You bring up a very interesting question and something I have thought about for some time.
On the MIA blog should there not be a policy that all bloggers, as a condition of their participation, be required to respond to those wishing to question or interrogate their positions?
If someone is given this type of public forum to promote their views and opinions should they not have the courage and respect to take the time to respond to people who might question their beliefs?
If we are going to change the world and, in particular, change the entire mental health paradym in this country, we all to need to be interrogating ourselves, as well as others, who might be suggesting they know part of the way forward in our movement. How else can we really learn and develop the necessary unity required to make revolutionary changes?
That being said I must say I have learned some things from Dr. Healey’s blog contributions. But it is frustrating to know that neither I or anyone else can actually question his beliefs and expect an answer.
I would hate to think that certain bloggers could use the MIA blog to promote themselves and their careers and not be using this site as a forum for learning, participating, and changing the world into a better place.
So to the blog moderators I pose this question: What about changing or modifying blogging requirements to include being available to respond to blog readers who raise questions or criticisms about blog contributions? I am not suggesting some one must respond to every single posting, but that they must make a good faith effort to reply to essential questions or comments made.
Richard
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Dear Richard,
In case you do not know it already, Pr healy and Mr Robert Whitaker are working hand in hands in their common web enterprise looking at letting sufferers of side-effects to report them for the world at large -and somer academic or ufficial bodies- to read and learn about it.
On the 9/27/2012, I Dr ivana Fulli, adult psychiatrist and psychopharmacologist by training in my past, asked publicly a polite question about that Pr healy and Mr Whitaker web enterprise -at a meeting on “Medical Error”- to Pr Dominique Maraninchi, director of an official French body(ANSM) in charge of reinforcing the protecting of the persons receiving care in France from doctors against any harm from drugs or indeed any medical or surgical material (like prothesis for example).
I asked Pr Maraninchi -a respectable former oncologist academic- if it would not mzake sense for him to have somebody in his team reading that blog and he answered me that he will stay away from commercial enterprises in a very gentle, matter of factly manner.
of course, I cannot exclude with a 100 % per cent certitude that those two are not just hoping to make a lot of money through selling their books and later selling their “risk website data” to the drug industry, university labs and the likes.
But I will give them both a chance because I think what they do is damned needed.
NB: I do not know Pr Healy, the actual person, and I do not even know a single person who received his care as a psychiatrist.
What i know is that before his good work I had GPs daring to tell me that no SSRI could made a young client of us impotent and that as a psychiatrist, even a pro bono one, I should know better.
DBy the way, do you happen to think that Pr Maraninchi was right about Robert Whitaker?
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Ivana
I have nothing but the highest regard for Robert Whitaker. His writings and world wide speaking engagements along with his involvement in creating this website has made a tremendous contribution to creating the groundwork for making revolutionary changes in mental health treatment in this country and throughout the world. I have heard him speak and felt his passion and connection to the many victims of Biological Psychiatry. I have also had a brief conversation with him at one conference and exchanged a few complimentary e-mails expressing great enthuisiasm for his work. I definitely view him as a leading figure on our side of the barricades.
If Robert Whitaker is in fact involved with Dr. Healy in creating some other websites regarding medication side effects etc. then I hope he takes advantage of this relationship to challenge and convince Dr. Healy of the importance of participating in active dialogue at MIA.
I stand by my above position that MIA bloggers should be required to engaged in active dialogue with those questioning their positions and beliefs. We at MIA must and need to be an interactive website if we are truly going to have a positive impact on changing the world. Nobody should be above criticism or avoid responding to their critics.
Richard
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Dear Richard,
Your writing and position are very clear and your demand of course raisonable understandable but it is for the masters of MIA to decide on that demand, evaluating their options by also taking into account other points of view and consideration.
For example, assuming Pr Healy is only one person really engaged in everything he does himself – the man has a lot on his plate and might not possibly answer questions on MIA in addition to his other duties and blogs. He might also have a personal life and family duties to attend to.
To my mind, the question would be: Is not the best sometimes the ennemy of the fair and is-it not better to offer an audience in MIA to a psychiatrist who is fighting a hard fight with the scope of making the side-effects of psychiatric drugs better known wildly?
Anyway, I am not to have a voice in that %IA internal debate. I just wanted you to know that Robert whitaker is a co-founder with Pr Healy and other of http:
//wp.rxisk.org/about/;
I never had the pleasure to see and heard Robert Whitaker but, like you, I admire him a lot. I had the passing thought of going to the South Padre Island meeting nexwt December but Texas is a far and expensive place to visit from Paris.
Best regards and many thanks for answering me in a comprehensive and pleasant way.
All the best to you.
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Several years ago after giving a lecture on how Prozac makes people suicidal the PR person responsible for Prozac in the UK introduced herself and said she was so pleased to meet me – I was doing more for the sales of Prozac than anyone else.
This is why RxISK.org was set up – to do something rather than just speachify or blog.
On the labeling question – while labels are very important – good if they lead on to effective treatment and bad if they don’t – there have been suicides in healthy volunteers given SSRIs and antipsychotics that don’t seem to be attributable to a label.
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“…there have been suicides in healthy volunteers given SSRIs and antipsychotics that don’t seem to be attributable to a label.”
I fully presume that’s true. (Of course, it must be.)
But, in offering that conclusion, as your ultimate commment, on labeling, you seem to minimize (or, perhaps, deny – whether consciously or unconsciously) that immense harm which so often comes, from tagging a “patient” with the “schizophrenia” label.
Quite unlike what it would have been 100 years ago, that label is, today, an incredible (huge) burden to bear, as it is increasingly associated with some of the most infamous misanthropes who ever lived. (There’s little or no consolation in knowing, that the vast majority of people who are ‘diagnosed’ with that label are not particularly aggressive people – that, indeed, most are anything but aggressive.)
What most people know of “schizophrenia” comes from ‘learning’ about such widely televised personal failures, as Jared Loughner or Anders Breivik, wherein psychiatrists apply a ‘diagnosis’ of “schizophrenia” in order to, hopefully, spare some outrageously violent, hell-bent, convicted killer from the death penalty.
Fear of potential ‘danger to others and/or oneself’ reaches an apex with the presentation of that “schizophrenia” label.
In fact, I would think that, in your knowing of such a high suicide rate, amongst people who are labeled this way, it would be wise of you, were you to consider calling for the cessation of such labeling. (I.e., in the realm of psychiatry, critiquing bad meds is just one facet of the struggle against bad medicine.)
But, in any event, you admit that forcing psych-meds on a “patient” can precipitate suicide (you have said so in a recent tweet to me); so, I think you should not fail to acknowledge, that the “schizophrenia” label can do that, too; after all, given all its frightful connotations (whether or not they are actually deserved), “schizophrenia” typically comes to imply a need for compulsory ‘medical treatment’ – i.e., mandatory drugging.
(The follow passages are from my above mentioned blog post.)
That compulsory ‘medical treatment’(as well as imminent threats of such ‘medical treatment’) can become so incredibly frightening and demeaning, that the victim is left with no dignity; it can be so traumatic and scary, that one cannot live with oneself – especially, not with the ever-present reminders of that haunting “schizophrenia” label (and its accompanying untouchable status) which symbolizes the supposed ‘justification’ for essentially mandating such medicalization.
So, yes, surely, drug-induced dysphoria is quite common, yet all these factors combine and can, together, all-too-easily drive one to take ones own life.
These are combined causes, all of which are powerful generators of self-hatred and/or hopelessness; one or more of them may compel a person to choose self-destruction; they work together, synergistically.
That incredibly nebulous “schizophrenia” label is the linchpin.
[I say, let’s stop using it.]
Perhaps, we could get your fellow MiA blogger, Dr Timini, in on this conversation.
http://www.irishexaminer.com/ireland/expert-ban-psych-labels-such-as-adhd-174286.html
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Pr Healy, you should know better thant to trust what a bad Pharma ‘s PR told you and your speeches have impact worldwide on psychiatrists and GPs at least!
I will put that remarks of yours on your Irish love for any good sounding narrative, if you allow me that lack of respect from an Italian born -sarcastic by nature then..
More seriously, although I was not trained as an epidemiologist researcher and do not possess their mandatory good qualities, I am a strong believer in epidemiological researches being the best instrument for progresses in mental health due to clinical trials limitations -even fair and honest ones to my mind- due to no credible “labeling”, no lab test so far, but also liability for physicians conducting it … you name it.
I also, strongly believe in associationg clients to researches as a way to progress.
I, then, see RxISK.org as having the greates epidemiological research potential and being a client and researchers joint venture.
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Will,
I printed your last opus on paper in addition to saving it on my computer-a rarity for me since I have not much storage space.
If you will allow me a disgression:
“Exercise more and eat less ” equal obesity fighting message to teenagers and parents of obese children.
This doesn’t mean that “Exercise more and eat less.” is not the behavior in many an anorexia nervosa sufferer teenager.
“Exercise more and eat less” should still be the prevalent message to send around because anorectic persons will not need this message to stop eating enough and exercise a lot.
I believe , to go back to the subject of your post , that it depends on who you want to educate. For the many people ingesting SSRIs, using tapering off as a synonym for getting rid of medication is just safer on health ground. It is another matter when you provide education for health workers.
Thanks for your work. All the best to you.
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Sorry, wrong blog!
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As far as whether there’s an actual disease entity called schizophrenia, I can’t say for sure. Don’t know enough. Important subject. Look forward to learning more.
But I do know this: What we have in this column is a STORY. A damn valuable story, because it brings out solid information about what happened to people with those sorts of problems, who today would be called schizophrenic, 100 years ago. BEFORE any of today’s medications were even thought of. And the answer turns out to be that they were TEN TIMES MORE LIKELY to be ALIVE a year after seeing the doctor, than the same types of people with the same types of problems, are today. And the main difference is that those people did not commit suicide in the numbers that people labeled schizophrenic do today. Which means the modern so-called miracle drugs may be CAUSING most of the suicides.
Now, a story like that is what you call ammunition. People are always being told that the disease causes suicide, and the meds prevent violence, and every “schizophrenia”-related tragedy you hear of, like Jared Loughner’s killing spree could be prevented if only we could give all “those people” a great whacking Haldol or Seroquel injection for their own good. And along comes a guy with some solid evidence that says the official story just can’t be true.
I believe I would listen to a story like that even if it came from a drug sales rep or a TV evangelist. As long as the guy had the facts to back it up. To listen to a dissident doctor who might in your opinion concede too much to the medical model, but who’s stuck his neck way out to alert people to the hazards of these drugs? Shouldn’t be impossible.
There’s a whole world out there of people we need to convince. To do it we need evidence like this. A lot of the people who can bring out the evidence are not going to be people you regard as total kindred spirits. But if we only talk to total kindred spirits, we’ll never get anywhere.
As for columns that are double-posted, both on MIA and on the writer’s own blog, I kind of like the one-stop surfing … wish we had more of my favorite mental health blogs reposted here. I think Ivana is right though, most such bloggers won’t be able to keep up with the comments on their own blog and MIA all the time.
I guess the alternative would be to ask those bloggers to pick just one or two a month to post on MIA, and be sure to cruise over and comment on the comments. Or else ask them to provide a hyperlink to the home blog so people with something to tell the author could easily link over.
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Good points made Johanna. I’d like to see more bloggers writing here and for links between their own blogs and here.
It is difficult to keep up with blog comments as we don’t get an Email or anything to let us know when someone has commented. At one point I had 110 comments, including my own, on an MIA blog post. It got very time consuming, especially when some of the comments were derogatory and what I would describe as uncivil.
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http://davidhealy.org/
Thanks for your many informative posts and comments.
For myself, I would lose a lot by not reading the many comments on the MIA reposting of Pr DH s’blog since -try as I might- I couldn’t -for the life of me- find the time to open and read individualy the many “MIA blogs” I read regularly enough.
Thanks for your blog and experience – but, sorry about that, I know a French psychiatrist, Dr Solange Beaumont, who, in a Paris meeting on October 2012 had not enough bitter words for the fellow French psychiatrists who accused her of making up any psychosis diagnostic in her son (who was hallucinating and delusional and feeling persecuted) and accused her of stressing him out of his wits -many a French psychiatrist still hold the mother ‘s behavior responsable from psychosis and even autism on Freudian grounds-
Her son ended up sleeping – for real- under Paris’s bridges and in danger for his life. Now the young man takes neuroleptics and works in a bank thinking about finding himself a wife. She had to plead to many colleagues before one consented to admit the young man in a psychiatric ward.
If her son wouldn’t refused it -because he doesn’t want to see psychiatrtists and suffer expertises for the court procedures- she would push for legal action because she thinks psychiatrists ‘ denial of her son hallucinations and delusions and refusal to give him neuroleptics almost killed her son.
Solange worries about long term effects of neuroleptics and, of course, would welcome safer drugs but her son is not on a high dosage regimen and it is -for now- the minimum dosage he can get without getting hallucinations and delusions that his fellowworkers are dangerous to him. The man wants to work and not be a tramp and it is his choice of life.
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Dr Fulli,
One is described, by yourself (a psychiatrist), as someone experiencing “hallucinations and delusions” –- as though this should automatically tell us, that: here is one who’s somehow, necessarily, in need of psychiatry, yes?
Well, in my opinion, that way of reasoning is pure nonsense.
Personally, I strongly believe, that these words you’ve employed (“hallucinations” and “delusions”) can actually be used, quite accurately, to describe the everyday, internal experiences, of many (and, probably, most) people, who are considered ‘high functioning’ members of society.
But, psychiatrists will generally tend to deny this.
And, so, I challenge any psychiatrist to expose the entirety (this is to say, reveal absolutely everything) of his or her own thought processes, for an entire day.
I suggest you, yourself could try this: leave no thought or idea unspoken.
Were you to do this, then, afterward, you’d be considered, by your colleagues, as a person, at least ‘somewhat delusional’ — if not highly delusional.
The so-called “schizophrenia patient” is ‘just’ a person who has exposed too much of his/her inner life, to the wrong people. (I mean that, with all conviction.)
Meanwhile, for you or anyone else, as a ‘mental health’ professional, to publicly accuse someone (who could easily be Googled) of supposedly suffering “hallucinations and delusions” seems unethical to me; and, for you to do it without offering any details, of what “hallucinations and delusions” supposedly led to his medicalization, precisely, is offering nothing but innuendo, about that person — in the aims of fully discrediting that person, to ‘justify’ denying him/her the right to think for himself/herself.
You admit nothing of this fact, that those who have ‘lived experience’ of ‘recovery’ have found clues to their own eventual enlightenment, in the midst of supposed “hallucinations” and/or “delusions”.
[Note — RE: “hallucinations and delusions that his fellow workers are dangerous to him” …I would say, it is perfectly natural for him to be concerned, that they could be a danger; for, they are surely fearful of him — given his psychiatric status; and, they would surely report any seemingly ‘unusual’ behaviors to the authorities…]
“Her son ended up sleeping – for real- under Paris’s bridges and in danger for his life.”
Really? How intriguing…
This reminds me of Kurt Cobain — who did that, prior to becoming a massive rock star. And, yet, he eventually wound up another suicide statistic.
What was his downfall? It’s my understanding that, throughout his life, he was misled by psychiatry.
First, he was put on Ritalin (i.e., prescription amphetamines), as a kid; that turned him into an addict.
Then, later, he was ‘diagnosed’ in ways, which implied, that he should be on psych meds.
Apparently, he was not fully convinced, by psychiatry, that he had ‘bad’ brains; yet, he was in pain; and, so, he chose illegal drugs, to sooth himself. One could easily conclude that his became his undoing — as did the pressures of fame.
But, I think he was undone by the fact, that no one he knew could offer him a healthy alternative to medical-coercive psychiatry.
And, do I figure he would have made any more of his life had he fully accepted the psychiatric “patient” route. No. In fact, he found his muse — for a time; and, I doubt that would have happened, had he been under the ‘care’ of psychiatry.
So, I seriously wonder: was Solange Beaumont’s son in any more danger living under a bridge, than he is now, endangered, by his having been fully absorbed, through coercion, into his mother’s religion (Psychiatry)?
“Now the young man takes neuroleptics and works in a bank thinking about finding himself a wife.”
Surely, then, all is find and dandy with him!! (Yes, I am interjecting a bit of sarcasm, there — because nothing else seems more fitting.)
“The man wants to work and not be a tramp and it is his choice of life.” (His choice?)
(Note: I will offer no more sarcasm here.)
Simply, I will suggest, that, in English, ‘tramp’ is highly a derogatory term — full of negative ‘moral’ judgement; and, Dr Solange Beaumont’s son is not living his own life. He is living — for the time being — a life that’s been more or less forcibly imposed upon him.
That is hardly what I’d call living; especially, as it is a life only made possible via the imposition of brain-damaging drugs.
Note, finally:
From what you’ve described, the psychiatrist mom’s son was offered only medical-coercive psychiatry; she saw no other alternative, to his living under a bridge?
Well, that being the case, considering what I know (first-hand) of medical-coercive psychiatry, had I been her son, I would have MUCH preferred to have had her allow me to work out my own salvation.
And, by the way, I would not impugn the motives of Dr Beaumont; I’m sure she means well.
But, thank heavens I had a mom who was not a psychiatrist — thus, who, after barely more than three years, could let go entirely of her will to have me subjected to your ‘medical’ religion.
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I was answering to Chris Muirhead with respect for her work but also the belief that not everybody’s son is the same as her sons.
Dr Solange Beaumont is an activist in a French association of mental symptoms ‘sufferers and their families who want more respect, less paternalism and less stigma.
She has every right to be vocal and public about her family experience and I can’t see why Chris Muirhead could use her name and not Solange Beaumont.
( In addition to Beaumont being a very common French surname and many female doctors using their maiden name and having sons using their father’s surname).
“First do not harm” and refusal of paternalism applies also to those who think they benefit from drugs
To put the record straight,I personaly have not prescribed neuroleptics, antidepressants or electrochocs since 1989 but I am happy that some people are offered the choice of different psychiatrists in place of me or in addition to me. Plus,I could afford my “clean hands” with respect to those heavy prescriptions only because my husband paid the rent and I stopped working in hospitals and did pro bono work for restricted populations.
We are in a diagnostic mess and it would be easier if nobody felt helped by neuroleptics or antidepressant pills.
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Johanna,
You write, “As far as whether there’s an actual disease entity called schizophrenia, I can’t say for sure. Don’t know enough. Important subject. Look forward to learning more.”
May I recommend to you, this book, ‘Schizophrenia: The Sacred Symbol of Psychiatry’ by Thomas Szasz.
Here’s the entirety of a meaningful, very brief review, by a reader, at GoodReads.com:
“Szasz is a psychiatrist who takes his medical training seriously. The basic argument of the book is that ‘schizophrenia’, like many psychiatric disease categories, has no known etiology, no known causal agent. It is, at best, a very vague descriptive category which has proven to be variable over time, like most of the Diagnostic and Statistical Manuals’ nosologies. A real psychological disease would be that caused by the Triponema pallidum bacterium in its tertiary phase, viz. syphilis.”
http: //www.goodreads.com/review/show/81990955
I feel that reviewer sums up the book’s most essential message quite well.
And, in my view, Szasz was spot on, correct, when he said, “Psychiatry is a ‘pseudo-science’ if it insists that something can remain a ‘disease’ and yet have no specific, known pathophysiology.”
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Schizophrenia is well know killer and a pain full disorder. psychiatry of madness can be a good name of it so what we should do for free online psychiatrist< that can help for this psychiatry of madness.
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