The Use of Neuroleptic Drugs As Chemical Restraints in Nursing Homes

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There’s an interesting article in the July-August 2014 issue of the AARP Bulletin.  It’s called Drug Abuse: Antipsychotics in Nursing Homes, and was written by Jan Goodwin.  AARP is the American Association of Retired Persons.   Jan Goodwin is an investigative journalist whose career, according to Wikipedia, “. . . has been committed to focusing attention on social justice and human rights…”

The article is essentially a condemnation of the widespread and long-standing practice of using neuroleptic drugs to suppress “difficult” behavior in nursing home residents.

Here are some quotes:

“According to Charlene Harrington, professor of nursing and sociology at the University of California, San Francisco, as many as 1 in 5 patients in the nation’s 15,500 nursing homes are given antipsychotic drugs that are not only unnecessary, but also extremely dangerous for older patients.”

“‘The misuse of antipsychotic drugs as chemical restraints is one of the most common and long-standing, but preventable, practices causing serious harm to nursing home residents today,’ says Toby Edelman, an attorney at the Center for Medicare Advocacy in Washington, D.C.”

“If one drug caused sleeplessness and anxiety, she was given a different medication to counteract those side effects. If yet another drug induced agitation or the urge to constantly move, she was medicated again for that.”

“Antipsychotic drugs are intended for people with severe mental illness, such as patients with schizophrenia or bipolar disorder. As such, they carry the FDA’s black-box warning that they are not intended for frail older people or patients with Alzheimer’s or dementia. In those populations, these drugs can trigger agitation, anxiety, confusion, disorientation and even death. ‘They can dull a patient’s memory, sap their personalities and crush their spirits,’ according to a report from the California Advocates for Nursing Home Reform.”

There’s an implication in this quote that neuroleptic drugs have these adverse effects only on frail older people.  In fact, they have these effects on almost everybody who takes them.

Back to the AARP article:

“And pharmaceutical companies have been aggressively marketing their products as an easy and effective way to control these issues.”

Gwen Olsen’s book Confessions of a Rx Drug Pusher (2009) provides some very compelling insights into this kind of pharma marketing, e.g.:

“It was the end of the third quarter, and I was behind in my sales quota for Haldol . . . So, I determined the best way to build my Haldol business would be to campaign for the institutionalized patient. These patients were not only encouraged to take the medication; they were actually given the drug. This completely eliminated the compliance issue.”

“I set about scheduling training in-services in the local nursing homes and mental health and mental retardation (MHMR) facilities. I increased my call frequency on physicians whom I knew to have nursing home relationships and directorship responsibilities.” (p 48) [Emphasis added]

. . . . . . . . . . . . . . . .

It is particularly heartening to see an article like Jan Goodwin’s in an established magazine such as AARP Bulletin (readership 37 million +).  It represents a huge advance over the take-your-psychiatric-medication-as-the-doctor-ordered drivel that passes for journalism in most mainstream media outlets.  I commend Jan Goodwin, and hope that we see more material of this sort in the future.

At the same time, however, I was disappointed in that the role of psychiatry in the promotion of these neurotoxic chemicals was not even mentioned.  Responsibility for the problem was laid at the feet of pharma, whose aggressive, irresponsible marketing was unequivocally condemned.

But pharma doesn’t write prescriptions.  And pharma didn’t invent the “illnesses” that legitimize these prescriptions.

For the past sixty years, psychiatry’s primary objective has been to promote the spurious and destructive notion that virtually every human problem is an illness.  Their efforts have been extremely successful, and this false notion today permeates our culture, our language, our political and social institutions, and even our nursing homes.

Using dangerous, toxic chemicals to drug a frail, elderly person into submission is possible because psychiatry has invented and sold the fiction that his agitation, anxiety, and aggression are illnesses, and that the toxic chemicals are medications.  Pharma certainly funded the fraud, but it was psychiatry that conducted the “validating research.”  It was psychiatry that codified and formalized the spurious diagnoses into a manual.  And it is psychiatry that lobbies unremittingly for the acceptance of these “diagnoses” by government entities and by other professions.

And this was not an innocent error.  Psychiatrists invented and promoted their fictitious illnesses and their destructive “treatments” to promote their own aspirations to be seen as a legitimate medical specialty, and to expand their business, their influence, and their prestige.

In this process, they have created a monster that feeds on human life, but they continue to insist, against rapidly mounting evidence, that their “diagnoses” are valid and their “treatments” effective, and have engaged the services of an international PR firm to marginalize their opponents and to sell this travesty to the public, the media, and the political establishment.  Psychiatry is not something that is basically OK, that just needs some minor corrections.  Rather, psychiatry is something fundamentally flawed and rotten: a wrong turning in human history; a blot on humanity’s collective conscience.

Let us hope that we see more articles like this in the mainstream media, and that more investigative journalists like Jan Goodwin will find the motivation and the courage to speak out against this disempowering and destructive edifice whose shadow has for too long been allowed to darken the hopes and aspirations of people of all ages.

* * * * *

This blog first appeared on Philip Hickey’s website,
Behaviorism and Mental Health

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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

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24 COMMENTS

  1. Thanks for this, Philip. You are right on point, as usual. The way elders get treated in the US is shameful and intolerable, and I don’t want psychiatry to get a free pass for their role in it.

    Hey psychiatry, Stop Drugging My Elders!!! It makes me furious.

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  3. The nursing home has a “captive audience” of people who are anxious, not feeling well and don’t want to be there, but they are not allowed to complain or they are given what used to be called “major tranquilizers”. ( I think we need to bring back that description because it is really what they are.)

    My mother was given haldol in the nursing home and developed tardive dyskinesia pretty quickly. She was miserable and I suspect she was experiencing akathisia also. They also gave her Valium.

    When we tried to talk to the doctor about it, he was always in a rush to get out of there and would just mumble that he knew what she needed.

    My mother was not disruptive or loud. She had had mini-strokes and her speech was almost gone.
    I never understood why they had to increase her mental suffering, and never got an answer.

    This is what psychiatry does, dehumanizes people. Mom was not drugged for her benefit, she was drugged to make the staff have an easier time of it.

    I read the AARP article too and noticed how the emphasis seemed to be on the untrained, underpaid, short staffing problem. THAT IS NOT AN EXCUSE.
    I also noticed that the author refers to this over medicating as “off label”use. Finding “on label” uses is subjective too, in my opinion.

    If you are in a place that is not home, is cold, noisy, has bad food, people taking “care” of you who hate their jobs, and you shed a few tears, you get drugged for being out of control.

    It might as well be death row.

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    • Great comment pencilect. I’m so sorry about your mother. It’s heartbreaking.

      “This is what psychiatry does, dehumanizes people. Mom was not drugged for her benefit, she was drugged to make the staff have an easier time of it.” <Exactly!

      And this is the very same reason that psychiatrists started giving major tranquilizers to psychiatric inmates in the first place.

      The phrase "anti-psychotic" is purely a marketing gimmick.

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    • Pencilect,

      Sorry to hear about your mother.

      You make very good points. The psychiatric practice of calling these drugs antipsychotics is a blatant lie. “Major tranquilizers” or “neuroleptics” are more accurate terms. And we should always remember that they are toxins.

      In my visits to nursing homes in recent years, I’m seeing so much more tardive dyskinesia than I did in former decades. Most people don’t realize that it’s caused by the drugs.

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  4. No you’re 100% right, Uprising. They are not antipsychotics – they are major tranquillizers. The reason ‘schizophrenics’ and ‘bipolars’ become long term disabled is because there is no real treatment on offer – they are treated instead with major tranquillisers.

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  5. Thank you for addressing this topic area, Dr. Hickey.

    In would-be, supposedly, independent articles we see the use of tranquillizer drugs by nursing homes to snow the elderly (which, to interject, is at the expense of the possibility of the patients improving…) portrayed as a bad thing — while the use of these dopamine receptor blockade chemical pills on those “with serious mental illness” is portrayed as a good thing.

    For those people who are non-Medically labeled as “with” major mental disorders – these sales products are the needful medications while, for those in nursing homes these drugs are to be seen as quote “chemical restraint.”

    Or is it that those with the SRI “severe mental illnesses” need this quote “chemical restraint” so that the voices wont command them to irrationally attack innocent normal people?

    The tacit answer to that is… “Well, Whatever! Whatever gets more of our sales products sold! We will say anything!”

    While others, legitimate doctors and so on, do what they can to help people with declining mental function the drug company Medicine (the powerful mediopharmaceutical establishment) seeks ways to sell more patent “medications” using propaganda spin to, in some way, in any way, frame their products (however crude and inappropriate) as “treatment.”

    The Townsend Letter is a magazine of interest containing pieces written by well-meaning, legitimate people. (See, https://www.google.com/?gws_rd=ssl#q=B-6+alzheimer%27s+OR+senility+townsend+letter)

    Legitimate people have important information. The reports of melatonin having an impact on slowing Amyloid beta protein accumulation and in reducing sundowning are of great interest and import (not reflected in the corporate influenced media’s lack of coverage).
    https://www.google.com/?gws_rd=ssl#q=melatonin+brain+amyloid+beta+%22sundowning%22

    The medical profiteers and their propaganda operatives in Psychiatry want the status quo that they have established where-in DSM (Psychiatric not Medical) “diagnoses” are made non-Medically by doctors using interview, word tests and objective professional opinion to classify people as disordered, and then (with the statement of the catch phrases Medical model, the biological causation theory) prescriptions of billable “Medications” being a lucrative racket. These “Medications” being exclusively centrally acting drugs (as these are Psychiatric diagnoses…) to control quote “symptoms” and not prescriptions of medications for Medical treatment as the Medical cause or pathology is just speculative, theoretical for these Psychiatric syndromes.

    With Alzheimer’s and with postpatrum depression which they sought for 10 years to bring into this manipulative propaganda system they have in place they again want to sell their “Psychiatric medication” wares.

    Co-opting Alzheimer’s into the Medical establishment fraud most interest and attention to Medical knowledge is derailed. Besides the opportunity to sell additional bogus crude Psychiatric drugs, the Alzheimer’s disease treatment is restricted to a handful of patent drugs of the aceytylcholine esterase inhibitor type.

    Hydergine became disfavored.

    They intentionally stalled for years the addition of memantine to their pitiful treatment arsenal of select favored patent drug products. Memantine was in use in European countries for years ahead of the USA. It works via a different mode of action (addressing excitotoxicity). Once accepted in the USa only one company was allowed to make it, and the propaganda associated with it stated that they had no idea of its mode of action (not wanting to mention excitotoxicity.)

    As with the fraud of The Authority assessed “DSM disorder diagnoses” here “the disease” in question, again, has a nebulous state of never really being able to say what it Medically is… while we certainly do have pills to sell you for treating this diagnosis!

    They worked for years to pull off this scam with postpartum depression, as covered by Amy Philo, Evelyn Pringle, John Breeding and others.

    Postpartum depression becomes one of these mystery diseases that cannot be fully explained medically, yet (though important research is underway!) …and early treatment is important. Such as with certain “medications.”

    In Psychiatry we have legitimate people such as Hugh Riorden, M.D., with postpartum depression prior to the take over by the Psychiatric Fraud types, we have legitimate people such as Joseph Hibbeln, M.D. and Lloyd Horrocks, M.D., with Alzheimer’s there are the legitimate people — and then there are the people of the lie (M. Scott Peck), the Medical, pharmaceutical “business with disease” (Eustace Mullins, Gary Null, PhD, Matthias Rath, MD, Peter Barry Chowka).

    Johnson & Johnson to pay $2 billion in settlement over antipsychotic drugs in nursing homes
    November 2013
    https://www.facebook.com/WNUSP/posts/10201825473370807

    _________________________

    Prescription Abuse Seen In U.S. Nursing Homes
    Powerful Antipsychotics Used to Subdue Elderly; Huge Medicaid Expense
    http://online.wsj.com/news/articles/SB119672919018312521

    By Lucette Lagnado
    Updated Dec. 4, 2007

    “In recent years, Medicaid has spent more money on antipsychotic drugs for Americans than on any other class of pharmaceuticals — including antibiotics, AIDS drugs or medicine to treat high-blood pressure.

    One reason: Nursing homes across the U.S. are giving these drugs to elderly patients to quiet symptoms of Alzheimer’s disease and other forms of dementia.”

    _________________________

    Stand up,

    Daniel Burdick S.E.A. Springfield Eugene Antipsychiatry

    _________________________

    “Antipsychotic medication” is not a phrase I enjoy seeing written unchallenged. All members of this class of sales item, patented brain-drug are dopamine blocker drugs (IE, that block willpower, interest, brain reinforcement, initiative and HGH, human growth hormone).

    These drugs are Thorazine “me too” drugs. Thorazine – a drug from 1954 – blocks dopamine. They looked for new drug chemicals (to get patents on) by checking to see if they had the same behavioral effect (using people and rats) of wakeful indifference. Then in later years, when they could chemically test for dopamine receptor binding – they used that as a way to look for new chemicals that could be candidates for a drug company patent.

    “Me too!”

    Because in both ways they were screening for candidate chemicals that had the same mechanism of action and same affect, Donald Klein, M.D. and David Healy, M.D. tell us that these are called “me too” drugs. Similar safety, mode of action and effectiveness as the predecessor drug so that they too can receive a new patent and be marketed as a new invention.

    Poison is for those people who have been branded by “Authorities” with a strange made up word – not for real humans such as nice elderly citizens: “Antipsychotic drugs are intended for people with severe mental illness, such as patients with schizophrenia ”

    In current propaganda the medical propaganda people are employing a gambit where the catch phrase major, severe or serious “mental illness” used. The google search engine now treats the letters SRI as equivalent to the words “serious mental illness.” See, https://www.google.com/?gws_rd=ssl#q=%22major+mental+illness%22++SMI+DJ+Jaffe

    The “Major mental illness” gambit is being played for instance to promote that some people may in fact recover better with out constantly taking their drug product “medications” while others who “have” real mental disorders of the severe, major kind (such as the S word) need their patent sales items – need serious treatment.

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  6. All drugs can be dangerous toxic chemicals when not used appropriately. While many valid points are made in this article, it’s very one-sided and could be considered biased in that it’s written by a psychologist. I’ve seen many patients and families benefit from their use.
    Dr Susan Molchan (psychiatrist who doesn’t ascribe to DSM or Pharma)

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    • How does the author being a psychologist suggest bias?

      I have no doubt you’ve seen antipsychotics have an effect on your patients. They are, after all, psychoactive drugs. It’s slightly troubling, though, that you talk about families of patients benefiting. That pretty much aligns with what the article is complaining of – drugging for ease of management.

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    • drsusanmolchan,
      Are you saying that your opinion is not biased and that you have not seen uncountable mistreatment of one kind or another to the people in nursing homes. How often do you go into a nursing home and how much time do you spend with each of your clients there?Have you noticed what is going on in these nursing homes and if you saw one of your fellow doctors or nursing home staff doing something not beneficial or neglectful or harmful would you have the integrity and courage to do anything about it? Do you have the courage to testify in a court of law against a fellow physician who has violated the rights of one or a number of their patients?
      For my dad the nursing was like death row even though they took top dollar, of $6000 per month.
      He and I were talking one day in the nursing home and my father said “Fred , do you really think I could live to be a hundred?” I said, ” Yes I do ,if they don’t kill you first .” Even though my sisters and I moved him to another “better” nursing home to avoid gross incompetence by nursing home staff and doctor,again for top dollar he was subjected to even more gross incompetence by nursing staff and doctor, the level of which is hard to even comprehend including having his oxygen suction machine taken away in the middle of the night , replaced with a broken one of a different design. (They needed his machine for someone on another floor) Then he was tranquillized after the head nurse Rachet suctioned him with the broken machine not even aware it was not suctioning. When my father tried to let her know that the mucus in his throat was not being suctioned she reacted by tranquilizing him quiet ,telling us the family that he was agitated.In the end they did kill him first.
      Fred Abbe , Eye witness to torture of seniors in nursing homes, and to torture in general by psychiatrists , medical doctors ,and their staffs including directors of nursing homes. Some of it due to extreme gross incompetence and greed.I swear to G-D.

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    • Dr. Molchan, thank you for joining the coversation. In all fairness, many pro med articles are written by psychiatrist that are extremely biased and it seems that too many of your colleagues never complained that it was one sided. And in all honestly, I think it is pretty impossible to have an article written by someone who is completely objective.

      Francesca Allen made a great point that if you are saying they greatly benefit families, the issue can be raised fairly or unfairly that you are drugging for ease of management.

      Also, when you say they benefit patients, how do you determine that objectively? The reason for my question is I am sure my psychiatrist felt the 4 meds I was on was greatly benefiting me. Meanwhile, I was deteriorating big time which led me to decide to get off of the meds which he did not support although to his credit, he was cooperative.

      Look forward to your response.

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    • Dr. Molchan,

      Thanks for coming in. My central point is that the problems being “treated” aren’t illnesses, and the drugs aren’t medications. In the nursing homes and in the DD group homes, neuroleptics are being used very blatantly as chemical restraints. It’s a huge issue, and I hope to write a post on it soon.

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  7. Oh, Dr. Hickey, I’m so grateful at least a few people with a Dr. in front I their name are on the side of the patients. Thank you for pointing out the improprieties of the medical community majorly tranquilizing our beloved parents and grandparents.

    “There’s an implication in this quote that antipsychotic drugs have these adverse effects only in frail older people. In fact, they have these effects on almost everybody who takes them.” Thank you for mentioning this, it’s exactly what I was thinking when reading it. And the neuroleptics can have even worse effects in at least a percentage of previously mentally healthy people. I was made psychotic within two weeks of being put on my first major tranquilizer. And I’ve found a medical journal article from the year I was born, 50 years ago, pointing this out as a possible adverse effect of antipsychotics in healthy people. But not one psychiatrist I dealt with had any clue any antipsychotic could have any adverse effect, greater than increased “Thirst,” in any patient ever. Isn’t it bizarre the psychiatrists have no clue what the medical literature states the potential adverse effects of their drugs actually are?

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