The Pro Choice Dilemma

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Like the omnivore’s dilemma…

Yes, we all like to say people should be able to choose whether or not to take psychiatric drugs, and for the most part I say the same thing. It’s politically correct and it sounds diplomatic, it sounds like offering people respect and self-determination, but is it really that simple anymore?

Now that psychiatric drugs, substances that are too dangerous to be sold over the counter, yet drugs that aren’t actually medicines for any biological illness or condition with any valid scientific basis, have created a worldwide health crisis, more than tripling disability rates in the past couple of decades, is it as simple as a personal choice? Public health standards (as poor as they are) in the United States acknowledge that we are affected by the behavior of others and the substances they use, with certain standards. For example, in the U.S, smoking is no longer allowed in public indoor spaces due to the health dangers of second-hand smoke, and drunk driving is illegal due to the risk it imposes on other drivers and pedestrians.

Psychiatric drugs, while currently posing as prescription medications (to treat illnesses that have not yet been proven to exist by any scientific test or biological markers) also affect others, not only the individual consuming them. Some of them cause dizziness, drowsiness and problems with motor coordination as well. For example, on the Stanford University medical website, they say “Depakote may cause drowsiness, dizziness, or blurred vision. Patients taking Depakote should not drive, use machinery, or do anything requiring mental alertness until the effects of this drug are known.” Also relevant, psychiatric drugs cause many cases of chronic disability and chronic poverty, which of course affects all of us financially and otherwise whether we have “chosen” to take them or not.

I don’t say any of this to scapegoat, blame, or otherwise insult those who are taking these substances for any reason, whether by force or choice or somewhere in the middle. Psychiatric drugs are harmful and we know that (the drugs companies themselves know that, which we see in their advertising), but this does not mean that people who take them, prescribe or advocate for them are bad or defective or anything else.

There is no choice, however, that we make for ourselves alone — absolutely none. Everything we do or don’t do affects the whole.

So when we talk about self-determination and personal choice, it is a nuanced conversation. If psych drugs were on sale at the drugstore next to homeopathic remedies, herbs, hugs and song circles, for the same price, we could talk about choice, public safety and social impact. I know that sounds extremely woo-woo, but even the idea that everything other than FDA approved drugs is witchcraft or New Age BS is one that has been sold to you by corporate media. I can’t think of anything more woo-woo than prescribing mysterious chemical concoctions (Depakote Ingredients (Depakote ER 250 and 500 mg tablets): sodium valproate, valproic acid, FD&C Blue No. 1, hypromellose, lactose, microcrystalline cellulose, polyethylene glycol, potassium sorbate, propylene glycol, silicon dioxide, titanium dioxide, and triacetin) for illnesses that have never been found to exist medically, yet requiring a doctors script and calling them medication. THAT my friends is witchcraft, but not in the good sense I have come to think of the (now reclaimed) term.

So how can we talk more honestly about choice? How can we include social responsibility on both sides of the equation? This includes social responsibility on the part of those presenting the “choice” (to vulnerable, suffering people) to offer other viable choices and make them accessible, affordable and socially acceptable (this responsibility falls largely on government and policy makers), and “choice” to take a drug that will not only affect you, your health and your personality, but everyone else you encounter and many people, plants, animals and ecosystems you will never encounter at all. There is no simplicity in saying, “it’s your choice” as if it’s all up to your individual ego to self-determine and affect you alone.

There is a choice, however, that taps into a larger field, one that chooses in a way that benefits the whole. We know when we are making those choices. There’s something about them that feels good, and is actually simple. Those choices cannot be manipulated by advertisements or fraudulent “science.” The more we practice making those choices, the more easily they come to us, and the less need humanity will have for a “medicine” that fractures our personalities, ruins our health and destroys the planet.

Paradoxically, true Self-determination takes all things into account and acts from a place beyond the self. Ironically, psychiatry, which should be the medicine FOR the psyche/soul, works against the Self by isolating it artificially from the interconnected web of reality, resulting in irresponsible action when taken as a life path.

How does this relate to Harm Reduction? Aren’t there times when we need to isolate ourselves out and use psychiatry as a means to reduce even worse harm? This must be decided on a case-by-case basis. Harm reduction has its place as long as it doesn’t reduce us to fight-or-flight mode forever. I know very well the necessity of doing whatever it takes to get through the day or night sometimes. I’ve spent many years of my life living primarily in that mode. Yet building a life around sacrificing important parts of ourselves for the sake of survival can ironically lead to more problems surviving.

By making choices from a larger field, beyond the self, we are guaranteed something even greater than survival-an interconnected, soulful journey, where we are part of something larger rather than always separate and acting out of “self” interest alone.

The individuals and families I work with are moving more and more into an expanded awareness of the “Self” in self-determination; it is inherent in aspiring to come off psych drugs, this desire to be more inclusive in our sense of self, less isolated, even though Psychiatry will tell us otherwise. Psychiatry might twist the facts, try to convince us that their drugs will fix us so we can participate better in society, but this is where we must not be sold. We must hold to our essential knowing of ourselves that can’t be broken or fixed, and that is so inherently connected to all of life, it finds strength and power in the collective field itself and overcomes oppression without excessive isolation of the self as a biochemical entity alone.

 

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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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35 COMMENTS

  2. I like this article too. It takes on an issue that we who consider ourselves as anti-psychiatry probably have not thought through very well. I would never put anyone down for taking psych drugs long term, but telling people what you think is good for them can be condescending. Chaya, you deserve a lot of credit for being willing to grapple with this issue, and I really appreciate what you have written here.

    I am grateful that you have started a very important discussion.

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    • Thanks Ted. Yes, telling people what you think is right for them personally can be condescending, especially if they haven’t asked, but I think by admitting that we have some self interest in hoping for others to be free from psychiatry is important. Because none of us are free from psychiatry until all are free.
      Thanks!

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  3. Chaya,

    Mental health “parity” must have seemed appealing, (“fair, compassionate”) at first glance by those who supported it… NAMI pushed for it among its membership; and lobbied Congress for years, until it was passed into law.

    But it is not good law. It uses *force* to make other people pay for psychiatric drugs – through private insurance companies, which raises premium rates on everyone. I have now doubt whatsoever that it is one of the top reasons why health care quickly became entirely unaffordable for many people. Some of these drugs are so expensive that premium rates had to go up.

    Psychiatric drugs in federal and state programs are the same – taxpayers are *forced* to pay for them in Medicaid, Medicare and the VA. This was something Dr. Thomas Szasz found offensive.

    These “personal” decisions do not take place in a vacuum. Like the late George Carlin said, “A non-smoking section in a restaurant is like a non-peeing section in a swimming pool.”

    By the way, there are psychiatric drugs in our drinking water. Not good.

    I think we need to respect the right of others to make their own decision, but I think it’s important to be honest with these conversations… It’s not safe to drive on a cocktail of psychiatric drugs; it’s not safe to take them while pregnant, nursing; their long-term use often causes disability – which is not so much a “personal decision”, when the neighbor down the street has to pay (through taxes) for yet another person who cannot work any longer, due to the effects of the drugs.

    Duane

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  4. You’re right. First of all there’s no free choice when it comes to these drugs – people are either put on them by force or lied into taking them in the first place and often when they realize what’s going on and/or manage to get away from the coercive system, it turns out they are physically dependent on the drug and have to go through hell and back to withdraw if that is even possible.

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  5. I come down extremely strong on the side of individual choice across the board. That comes from my philosophical anarchist influences.

    But that choice depends entirely on full and completely informed consent. To me, this is the bigger issue that come first. Right now people are making choices about drugs based on false information, or inadequate information. The falsehoods or inadequacies of information is so pervasive that it is clear in my mind that it is willful.

    Right now, I believe the number of people choosing to take psychiatric drugs with truly and fully informed consent is exceedingly small. I feel like working to expose false information, distortions, and deceptions about both benefits and risks of drugs as well as the evidence base for medical model practice remains the most important and pressing task.

    It’s fortunate that I feel that way, because if we really come to a day where the debate within a movement is between whether we support individual decision making or whether or not we support coercive intervention to prevent people from making decisions about treatment they want to make because we don’t agree with it, I can’t and won’t stand on the side of coercion.

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    • You are so right about that! If a loving parent is told their child will become a delinquent unless they take Ritalin, most parents will be worried and at least consider the drug as an option. If they are instead told that SOME kids with this condition are more likely to be involved in delinquent acts, but that MOST kids in this category do not, and also that the Ritalin does nothing on the average to change that probability, nor does it increase the likelihood that your child will do any better academically or in any other way, the parents will make a very different calculation. If you go so far as to tell the FULL truth, that “ADHD” is a social construct derived from these kids difficulty managing in a regular classroom, and that alternative classrooms have been shown to be a much better place for them to learn, but that Ritalin is an option that may help them “fit into” a regular classroom better at least temporarily, while exposing the child to a range of risks that could be avoided if we changed the classroom structure, I doubt that most parents would seriously consider making that leap of faith.

      Truth is the enemy of toxic psychiatric interventions. I am completely OK with informed choice, at least for adults, but the key word is INFORMED!

      —- Steve

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      • Exactly Steve, the key word is INFORMED. Yet, since society is misinformed, where are we left in terms of choice? Choices are being made primarily out of fear and inaccurate information, thus not really choices and creating further isolation. Thanks for your input, totally agreed. 🙂

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      • true informed consent would include telling the parents of that child that there is no physical evidence that their child “has” ADD, in fact, the entire idea that their child is in any way mentally ill is an UNFALSIFIABLE THEORY.

        In other words, it is unscientific because there is no way to test for ADD which could prove that someone doesn’t have it (unlike, say, many real diseases for which a blood test or scan or something can rule it out).

        That level of honesty is required for true informed consent, in my view.

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        • Yes meremortal. It seems so complex to be a parent and navigate the mental health system, or health system at all. I wish we lived in a world that wasn’t so controlled by lies. It’s ever important for parents and everyone to think for themselves and do their own research. It is never wise to assume just because a doctor says something, it is true; most doctors, in fact have been trained out of their common sense.
          We must all reclaim our minds and develop our own abilities to discern what is true as we’ve been failed millions too many times expecting any system to do that for us.

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      • One thing that comes to mind: should we advocate to prohibit the advertising of drugs (which is a standard in most if not all European countries, at least for prescription drugs) and to prohibit the use of trade names. I think if someone knew they were taking METHYLPHENIDATE HCL and not “Concerta” or amphetamine instead of “Adderall” maybe people be less fooled by the propaganda. The names themselves are a product of PR specialists (Concetra is a great example – it’s meant to evoke certain association with highly-skilled performance).
        Tobacco products have to be labelled with warnings and graphic pictures in some places and it seems like campaigns like this work at least to reduce the number of smokers.
        Similarly maybe we should chip in for a billboard campaign showing the risks of psychiatric drugs (although it may be costly). Fight them with their own weapon.

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        • I think what would be even more key than halting direct to consumer advertising would be indirect advertising. The primary way Pharma advertises is through control of media, and “grassroots” or “advocacy” groups which they fund.
          The ads themselves read like anti-ads, with more space and time on side effects than anything else, and the tag lines are so stupid and obviously manipulative that I would be embarrassed if I did believe in the mental illness model.
          Still, having those highly expensive ads creates a disincentive for publications/shows to have any information critical to Pharma in them.
          So, yes, the ads are very problematic, despite being a good way to use some of Pharma money to educate the public on why they SHOULDN’T take psych drugs.

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          • I so agree re: pharma’s control of media and funding of advocacy groups. There needs to be many, many more support groups and communities that are completely unaffiliated with pharma in any way, including donations. It really is criminal. But it all boils down to money, everything needs money to stay alive it seems. I’ve been to support groups where a large percentage of the time was spent discussing problems with medications and psychiatrists, but sometimes you keep going back because there’s nowhere else to go.

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          • Cataract, yes, I have certainly seen a huge difference in quality of groups/organizations that take pharma money versus not. Even those that don’t take pharma money have a hard time staying authentic and not reverting to medical model jargon, but for those that do, it’s nearly impossible.

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          • It may seem like that to you and many here but these ads, even the stupid ones, still work on a big number of people. If they didn’t pharma would not pay for them.
            Look at campaign ads: they are manipulative and idiotic and what not and still they largely work.
            I agree that it’s just a small part of the problem but it’s one that’s pretty well defined and one could start there.

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          • Btw, you’re 100% right to identify another problem: one thing is the influence of ads on end users but maybe more important is the role of ads as bribery of sorts: if you publish articles in line with our bottomline then we will pay a lot of money to advertise in your paper/site/TV program. Two birds with one stone.

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          • Yes, B, I suppose you are right that the ads do in fact work for some people. All the more reason a big part of this issue is for people to learn to think for themselves. Though I do think it is trauma and injustice that cause people to lose their capacity for discernment and want someone else to tell them what to do, be it a doctor or a TV commercial. Either way, it’s a method of zoning out and numbing out with the blind faith that someone else knows best. Of course it is comforting for us as humans to sometimes rely on others to help us…but a healthy individual usually can sense when this “help” is genuine or based on propaganda. Being dumbed down is a sad way to avoid pain, yet the one many are using. I wonder if it is that people actually believe the commercials, or if they are so tired and worn down that they give in in apathy to “going along” with the thing right in front of them.
            Anyways, thanks for bringing up the point that many people do buy into TV ads…it can be hard for me to wrap my mind around that, but when I do it makes me very sad.

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    • You are absolutely right Andrew. Though, perhaps the title of this article might (unintentionally) imply that I would be discussing choice vs force/coercion, in fact I was aiming to discuss choice of the ego versus a higher choice. When society is manipulated through lies disguised as science and medicine intended to make them scared, the choices end up being largely ego choices, choices that come from a sense of isolation and disconnection. An informed choice, as you say, would take the bigger picture into account, and as you say would be based on accurate non-biased facts.
      With this information, individuals would have a much greater shot ar making a choice that would take other people into account as well, since none of us are living in a vacuum where we can make choices that affect us alone. The pro-force advocates might use the same argument in favor of forced “treatment”, but since their information has been manipulated, they are coming up with a choice that is harmful and puts society in great danger across the board, on a large scale, which is what we have now.
      Thanks for reading and commenting.

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  6. Good article Chaya. It seems to indicate that we all share a common dilemma of poor self-awareness, when it comes to HOW we make choices. A dichotomy of being human, that is marked by a profound split in mind-body awareness?.

    Reading what you write: The individuals and families I work with are moving more and more into an expanded awareness of the “Self” in self-determination; it is inherent in aspiring to come off psych drugs, this desire to be more inclusive in our sense of self.

    I’m reminded of my own struggle to expand my sense of self, beyond my taken for granted self-ignorance, when all I understood about my brain & heart, were the “words” brain & heart. It was painful to admit to myself, that for most of my adult life, I knew more about how my motor car functions, than how I function.

    While, in reading the shift towards discussion of our common experience of SELF, here on MIA, I’m heartened by sense of movement in the right direction. The “individual” efforts by those of us with lived experience are sorely needed, in our “vocation” shaped rhetoric of human understanding.

    Certainly, in my own individual efforts to make sense of Dr John Weir Perry’s understanding that psychosis is “natures way of putting things right.” Going through it, in order to allow my nervous system to self-heal a trauma induced wound. Involved turning away from the avoidance approach of a medical vocation’s, limited intervention/treatment understanding of psychotic experience.

    While beyond the public rhetoric & taken for granted “politics of experience,” my experiential triumph over the inherent psychotic projections that we all suffer, has brought as sense that the current epidemic of mental illness, in our so-called developed societies, has an inherent purpose in our still emerging, common humanity.

    Dare I say, that it feels like the final battle between our heads & our hearts, for a clear eyed perception of heaven. The heaven that has always been, right in front of our eyes. A comment that comes from the broadening of my personal knowledge base, with a reading education into the latest “developmental neuroscience.” Science knowledge which is peculiarly absent from the literature of psychiatry, with its vocational interest in time constrained, prescriptive medicine, behaviours. As, like all vocational world-views, the profession rationalizes its own behavioural needs, imo.

    While on a personal level, it was the painful truth of my own rationalizations, which I was forced to face up to, in finally allowing the subconscious processes of my psychophysiological self, to heal the wounds of life’s experience. TRUTH & its much needed intervention in our current politics of experience, which always reminds me of Jack Nicholson in the movie A Few Good Men: You can’t handle …….

    For as Bertram Karon points out, we don’t really want to know about schizophrenia & psychosis, because of what such “knowing” will teach us about the human condition.

    Best wishes,

    David Bates.

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    • Wow, very well said David. Some beautiful statements you make here, that show me you read very deeply into the article and got my message in a profound way–always satisfying!! It’s true, society seems to have these fears of our own condition, of speaking honestly about it and it’s a relief some of us here on this site and elsewhere can come together to discuss that as human beings.

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  7. Chaya

    Very thought provoking and insightful post.

    Your words in the following quote really jumped out at me:
    “Paradoxically, true Self-determination takes all things into account and acts from a place beyond the self.”

    We live in a capitalistic profit based society that teaches us that it is human nature to be selfish and to “Look out for number and stab people in the back in order to get ahead.”

    This is the exact opposite of your prophetic words.

    True self determination requires us to view our freedom in the context of the whole. We are not really free unless everyone has both the right and the ability to be free.

    The measure of a truly free society is to examine the level of freedom for that society’s most vulnerable citizens. The United States falls to the bottom of the scale in this measurement.

    Richard

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  8. Bit like alcohol init? You have free choice to drink, but not if it adversly influences my life. As a society we limit access to alcohol because of it’s widely known dangers. Alcohol compaines try to stop governments limiting access and try to push the individual being responsible angle.

    There are no easy answers but going for the suppliers, regulators and prescribers is probably both more effective and morally easiser than talking to users. Th0ugh if the use of psychiatric drugs by someone directing in your life is adversely affecting you then you have every right to tackle it and maybe put some limits in.

    The therapaist Bertram Karom would only treat people who are not on psyche drugs or who have plans to come off them as he said it was less effective to try to help people on them and he wanted to be effective.

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  9. Yes…another factor I’ve been thinking about is how we are all psychologically affected when a large portion of our friends and colleagues are on psych drugs. It drastically influences the quality of our relationships and our ability to trust and understand one another, when so many are taking a daily drug which no one, not even the doctor who prescribes it, understands.
    These things may be “subtle” compared to, say, a drunk driver running someone over, but they don’t feel subtle to those of us who are awake, alive and sensitive in our interactions. Having a lot of numbed people around us is painful for all of us, whether we are the one being numbed and distorted or not.

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  10. This is where you guys start showing your social engineering/totalitarian colors.

    First of all, yes, making choice available for psychiatric meds, but not for other things would be inconsistent. And? How is this an argument against the choice principle? It’s an argument against selective choice, for sure, but not against choice as such.

    Secondly, psychoactive substances have been around since the beginning of civilization. The right to ingest these things was so self-evident that the very idea of trying to ban them would have seen absurd. It was more fundamental than the right to vote. It wasn’t until the 20th century that drug prohibition became the norm (for selected drugs, anyway).

    Thirdly, look at the actual consequences of a repressive response to these things. Alcohol Prohibition? How did that work out? Gang violence? Narco cartels beheading people? People overdosing on the streets because they aren’t aware of the purity or because they mix their drugs with other drugs to enhance their effects, as a result of poor education or? Crackdowns on “legal” opioids leading them to start using street drugs or to mix them with booze because they don’t have enough pills for the desired effect?

    Not to mention the fact that in traditional societies as well as places like 19th century England, drugs like opioids were widely used but problems were not nearly as large as they are now.

    The drugs themselves are just part of the story. The social context matters even more, as does the personality of a user.

    Do you have a problem with heroin prescriptions in the UK as well? Or the heroin maintenance programs in Switzerland, which are highly successful?

    Why did the use of opioids rise to a similar extent in the same period in the US and the UK, but the problem use and overdose rate remained about the same in the UK, while it rose drastically in the US? And why has the number of heroin users in the last years in the US been falling but the number of heroin deaths has actually increased in the same time?

    Why do Northern European countries have a bigger problem with alcohol binge drinking and related violence than Southern European countries ever though alcohol is a lot more socially incorporated in the latter, and kids already learn to drink with their families at a young age? Maybe it is precisely because of that?

    Again, context is highly important.

    Nuance, yes. You seem to be missing most of it.

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