Balancing Our Recovery Ecosystem

9
115
I have some trepidation as a social worker venturing into the world of ecology and biodiversity but during my recent visit to Hawaii, I began to realize there are some parallels in that world and ours.  Bear with me for some quick background.
Hawaii is a long ways from every other land mass in the world–the most isolated place with mountains nearly 13,000 feet in elevation on the Big Island and still growing its coastline there.  Human settlement didn’t take place until probably 300 AD or so.  What the early Polynesians found was a unique natural environment that had plants and other living things that had developed in isolation for probably millions of years.  Today, 90% of the indigenous plants are still around, although they constitute now only 10% of the total plant species around the islands.
There seems to be some degree of reasonable accommodation (if I can use a term that has some possibly crossover meaning with the field of social work — I’m stretching here, right?) between the original flora and fauna on the islands and those that came later.  But there are clearly some relative newcomers that can be considered “invasive species.”  Another relatively isolated area, the Yukon, has an environmental organization, the Yukon Invasive Species Council, that defines the term this way:
An invasive species is defined as an organism (plant, animal, fungus, or bacterium) that is not native and has negative effects on our economy, our environment, or our health. Not all introduced species are invasive.
So here’s the possible parallel in our fields — could psychiatric medications be considered an invasive species in the world of mental health?
Most of us would probably agree that there have been many traditional ways that people who experience the world differently have been understood — or not — or simply dealt with. Some of these “indigenous” approaches have been more positive than others.  We can recognize the most inhumane of these as various forms of isolation, demonization, discrimination, torture, institutionalization and worse.  More concrete examples include lobotomies, electroshock “treatments” and psychosurgery.
Other understandings from the past now seem obviously more humane and relevant–the consideration that individuals who hear things or see things or imagine things that others don’t actually have meaning for their culture — visions and insights that must be respected and given some meaningful application.  More modern approaches viewed people with unusual thought or verbal expression as articulating personal concerns that for whatever reason could not be translated into more ordinary language.  Family approaches have considered the ways in which what many would call mental illnesses are actually methods of calling attention to dynamics in the family that are not safely expressed otherwise.
Various cultures including many in our own  experiences have found that yoga, meditation, exercise, breathing exercises, and psychotherapy are methods for working through or around what might be considered mental health or psychiatric problems.  The world of western mental  health programs have developed more technical interventions like psychodrama, psychiatric rehabilitation, “case management,” supported employment and education, peer supports, and housing supports.  And we have been learning more and more about the importance of trauma-informed care.
That brings us to psychiatric medications.  In the early to mid 50s, we should remember that they seemed to offer dramatic hopes for improvements over the more obviously brain damaging practices in western mental health institutions.  Some people clearly improved and could move back into some form of community life after taking them.  Others responded well but may have been affected mostly by the belief that they could get better by those around them who believed in the medications–rather than the medications themselves.
Gradually, over the past half century, psychiatric medications have been increasingly seen in western cultures as a restoration of an alleged chemical imbalance.  This has become a culturally embedded belief largely prompted by a highly sophisticated  marketing and educational strategy employed deliberately by the pharmaceutical corporate industry.  The idea was then swallowed hook, line, and sinker by professionals in practice and training and even “research”–largely funded by the industry.  The term “15 minute med check” illustrates the common practice that is ubiquitous not only in hospitals and clinics but increasingly in jails, prisons, schools, juvenile corrections, nursing homes and drop-in programs.
It’s at this point that one can make the argument that psychiatric medications have become an invasive species–taking precedence over and reducing resources for any and all of the other traditional and nontraditional approaches.  I can provide many examples but one dramatic story of the drain on resources and the centrality of psychiatric drugs for children comes to mind from my own professional and administrative experience.  Sen Grassley of Iowa provided us a few years ago with a picture of the highest billers of psychiatric medications and there were 2 physicians in the community I was responsible for that knocked me off my feet.  One had prescribed $457,000 of Abilify to children and youth in just ONE YEAR.  The other physician wasn’t far behind.  The program in which they worked thought nothing was amiss.  I had to wonder what other supports and services to the families and schools could have been provided with the extra nearly $1,000,000 involved.
I’ve been reminded that not all invasive species have completely deleterious effects so I’m not making the argument that there is no one who can benefit from some  level of psychiatric medications.  I have dear friends in the advocacy world who do make use of minimal to modest doses of medication.  That is their choice and is often taken with full knowledge of the potential ill effects.
But isn’t it time we recognize the parallel between ecosystems, flora and fauna and our own world?

Share

***

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.

9 COMMENTS

  1. The most invasive species on this planet is us…

    As to meds being “invasive species” -they surely do eat up all the resources that could otherwise be used to help other people instead of pharma bottomline. Subsidized housing comes to mind. Or supported living. Or meals for children and additional teachers to offer them better education and more individualized training. Or care for elderly in their homes instead of institutions… one could go on.

  2. Robert,

    Great article.
    You raise some good metaphorical questions.

    IMO, the invasiveness of psychiatric drugs moves beyond the figurative, into the literal.
    These drugs invade the brain; alter its natural functioning, interfere with healing, and disrupt homeostasis – the “ecosystem” of of a human being.

    Duane

  3. Nice analogy, Robert. And there are definitely much better ways $1,000,000,000 / year could be spent to help children, than prescribing $1,000,000,000 on one antipsychotic alone, for the children. The neuroleptics have been known for decades to be torture drugs, so of course, they’re the opposite of beneficial for the children.

    How odd, your doctors thought nothing was amiss.

    Were your psychiatrists also unaware of the fact that the neuroleptics actually cause the schizophrenia symptoms? Here’s proof from drugs.com:

    “neuroleptics … may result in … the anticholinergic intoxication syndrome … Central symptoms may include memory loss, disorientation, incoherence, hallucinations, psychosis, delirium, hyperactivity, twitching or jerking movements, stereotypy, and seizures.”

    And as a grown adult, I was made “psychotic” on a child’s dose of .5 mg of Risperdal. So I’m quite certain it’s highly likely children put on this dose of an antipsychotic could suffer from the central symptoms of neuroleptic induced anticholinergic intoxication syndrome, too.

    And I’m curious, since the only difference in the symptoms of schizophrenia and the central symptoms of neuroleptic induced anticholinergic intoxication syndrome are inactivity vs hyperactivity, and the neuroleptics are major tranquilizers that make all people tired. How do the professions know when the schizophrenia symptoms are caused by supposedly “real schizophrenia” or “real bipolar,” and when they’re actually caused by an antipsychotic overdose?

  4. Medical and Psychiatric Foolosophy—- If we administer various poisons in amounts (time release) that only sicken but don’t kill ,we can make the people believe that poison is medicine, manage their condition for a lifetime (maybe somewhat shortened) and have financial security for ourselves and fellow guild members and our families. Thanks to the elite eugenic loving families that started medical schools in the first place like the Rockefellers which set the most diabolical example and all yet while posing as philanthropists.

  5. Thanks, Robert, this is very interesting and indeed a nice analogy. I have been pondering something related that I thought I’d pass by you.

    In the management of ecosystems–agriculture being the most striking case, forestry anohter–there’s a phenonenon or complex whereby interventions can appear successful if you radically decontextualize the situation. So, if your primary measure is the short-term production of biomass (or better yet, profit), then relying on petrochemicals (fertilizers, pesticides, herbicides) makes great sense. They’re cheap, production and profits rise, you’re all set. But if widen your view to other elements of the larger ecosystem, you start to notice things like human health effects, pollution of waterways, soil degradation over time, pest adaptations and the development of chemical resistance (which of course can be dealt with by using stronger and more chemicals…), less nutritious crops, and etc. I realize there are big questions of whether psych drugs even are effective for their intended narrow uses, but regardless of that I’d say that things like side-effects, long-term declines in effectiveness, iatrogenic illness, cultivation of social conformity, denial of underlying causes of psychic pain are all basically out of bounds and unrecognized in the mainstream psychiatric paradigm, just as all those ecological negatives are outside the frame of industrial agriculture.

    So actually, this would be less an analogy or metaphor, and more a fundamental process of modernity, and especially modern capitalism, that cuts across multiple realms. Bruno Latour said that “the repressed returns, and with a vengenance.” I think all of these examples involve a simplistic, short-sighted repression of inconvenient symptoms. Then the underlying causes eventually return with a vengeance.

  6. I love this, thank you. I think it’s spot on. Medications are synthetic and chemically alter our natural rhythm, which I would definitely consider to be invasive. They adapt us to the unnatural rhythm of society, so we adapt to what is going against nature, in order to, somehow, be compatible with an unnaturally driven society; that is, to conform. That’s my perspective, in any event.

    They also attack our internal ecosystem, killing our natural gut flora, which is the foundation of our auto-immune system. My healing was, in large part, gut healing in order to reverse this trend, and instead, to grow and nourish my inner ecosystem, gut flora. This elicited and strengthen my body’s natural self-healing mechanisms. I keep that part of me maintained well now, which is not much effort, so there’s no danger of backsliding, as my body is back to its completely natural rhythm now because I keep at bay anything that interferes with my natural rhythm. “Psychiatric medications” were the first thing to go, in this respect, and that bounced me right back to nature, eventually, after a bit of reparation and over haul.

    Interestingly, it has not put me at odds with society, after all, but allowed me to be fully integral within it, in a way I most enjoy, as per what would feel completely natural, comfortable, and empowering to me.

    Your analogy is perfect.

  7. Let us talk about qantitative numbers of the benefit of drugs.

    What is the goal: Symptom ease or recovery?

    Neuroleptics are used to ease symptoms and to prevent relapse with evidence at the beginning of the psychosis. There is no evidence that antipsychotics promote “psychosocial functioning, professional functioning, and quality of life” (Buchanan et al 2010 PORT Treatment Recommendations). Recovery treatment still wins terrain and will be put into a historical context. Mike Slade et al. 2014 describes the implementation of recovery with both usage and abuse of the term. Why is there still resistance despite very good treatment outcomes of recovery orientation such as Open dialogue (2)? How can a paradigm shift be made in the interest of patients’ health and health professionals who want their efforts to benefit many more patients?

    Open dialogue reports more than 80% recovery and the incidence of psychoses was reduced from 33 to 2 per 100,000 inhabitants per year (2, 12).

    Open dialogue uses approx. 60% less neuroleptics (antipsychotics) for maintenance treatment and achieves more than 60% increase in recovery (2, 12). Open dialogue reduces disability allowance/sickness to one third.

    Bjornestad, Jone et al. 2017 found in “Antipsychotic treatment: experiences of fully recovered service users”: “(b) etween 8.1 and 20% of service users with FEP achieve clinical recovery (Jaaskelainen et al. 2013)” with standard treatment according to the standard guidelines.

    Little effect in the beginning
    50% reduction or more of psychotic symptoms are achieved according to Leucht et al 2009 for 41% minus 24% for placebo equal to 18%, ie one for a small minority (1 in 6 patients) at the beginning of psychosis. Studies cover short-term and mid-term length. The Paulsrud committee found the same effects (1 in between 5 and 10 patients).

    Leucht et al 2012 deals with maintenance treatment with neuroleptics. The studies range from 7 to 12 months. The results for preventing readmission are 1 in 5 patients (NNT = 5) and the conclusions for further research are “focus on outcomes of social participation and clarify the long-term morbidity and mortality.” “Nothing is known about the effects of antipsychotic drugs compared to placebo after three years “(Leucht et al. 2012, p. 27).

    No evidence of long-term effect
    There is no evidence of maintenance treatment for more than 3 years (FHI: ISBN 978-82-8121-958-8). Bjornestad, Larsen et al. 2017 admits that evidence of maintenance medication is missing: “Due to the lacking long-term evidence base (Sohler et al. 2016) …” Thus, positive effects for patients are not evidence-based after 3 years and the probability of evidence-based positive effects is strict taken zero.

    Symptoms relief (12) and relapse prevention (Leucht et al 2012) are achieved only for a small minority in the beginning, RCT evidence beyond 3 years lacks completely and long-term use co-varies with more than approx. 40% reduction in recovery and approx. 40% increase in disability disability allowance/sickness (12). Nevertheless, psychiatry professors Jan Ivar Røssberg, Ole A. Andreassen, Stein Opjordsmoen Ilner (who educate psychiatrists) has a change-resistant, unrealistic and knowledge-resistant misrepresentation that antipsychotics contribute for “the vast majority contributing to the symptoms, functioning and higher self-reported quality of life. “(Doctors Journal, 12.05.2017). This delusion prevents the opening of drug-free treatment (3,4) in the psychosocial guidelines (“experimental, unethical”, Larsen: “giant mistake”, professional irresponsibility) and legitimises illegal forced medication. There is no evidence that antipsychotics promote “psychosocial functioning, professional functioning, and quality of life” (Buchanan et al 2010 PORT Treatment Recommendations). The county administration’s practice regarding complaints against forced medication has been weakened by naive unscientific belief in psychiatrists’ allegations and delusions. The county governor legitimises it by just giving 3% of the complaints pursuant and thus appears as a ridiculous appeal body (Ketil Lund). The Civil Ombudsman points out in law and order 05/2017 (Volume 56). Mental Health and Forced Medicine: “We are here in the core area of ​​the principle of legality: Forced medication should not occur without the requirements of the law being met.” Actually, “forced medication must be forbidden” (Ketil Lund).

    Experience data shows that recovery is weakened in the long run
    Harrow, M. & Jobe, T.H. (2012), Harrow et al 2014 (12) Long-term study shows that patients diagnosed with schizophrenia subject to drug-free treatment manage better in the long run, ie 50% significantly improved (higher recovery rate) after 15 years compared with 5%.

    Wunderink randomized study replicated results. After 7 years, 40.4% recovery recovered and 17.6% with neuroleptics (12).

    Harrow, M. & Jobe, T.H. (2017) concludes in “A 20-Year Multi-Followup longitudinal study assessing whether antipsychotic medications contribute to work functioning in schizophrenia”:

    “Negative evidence on the long-term efficacy of antipsychotics has emerged from our own longitudinal studies and the longitudinal studies of Wunderink, of Moilanen, Jääskeläinena and colleagues using data from the Northern Finland Birth Cohort Study, by data from the Danish OPUS trials (Wils et al. 2017) the study of Lincoln and Jung in Germany, and the studies of Bland in Canada, “(Among RC and Orn H. (1978): 14-year outcome in early schizophrenia; Acta. Psychiatrica Scandinavica 58,327-338) the authors write. “These longitudinal studies have not shown positive effects for patients with schizophrenia prescribed antipsychotic for prolonged periods. I tillegg til resultatene som indikerer rariteten af ​​perioder med fuldstændig recovery for patienter med schizofreni-antipsykotika for forlængede intervaller, vores Research has indicated a significantly higher rate of periods of recovery for patients with schizophrenia who have gone off antipsychotics for prolonged intervals. ”

    Using minimal neuroleptics is beneficial.

    The effects of current medication: More harm then good?
    Only little effect of symptom reduction in the beginning (Leucht et al 2009), no evidence for effect after three years (Leucht et al 2012), no evidence for promotion of recovery (Buchanan et al 2010 PORT Treatment Recommendations) and the excellent recovery results (Seikkula 2014) of Open dialogue with 83% unmedicated long-term (5, Seikkula 2016) have raised the question if antipsychotics do more harm then good in the long term.

    What is the possible harm?

    There have been questions about increased drug use of neuroleptics and antidepressants and increased disability benefits have a connection: Whitaker: Causation, Not Just Correlation: Increased Disability in the Age of Prozac (6).

    Clare Parish found that brain volume shrinks (“Antipsychotic deflates the brain”) also see Andersen et al. The reduction in brain volume due to prolonged “antipsychotic” use reduces cognitive abilities (PLOS Medicine: Antipsychotic Maintenance Treatment: Time to Rethink? Joanna Moncrieff. Published: August 4, 2015).

    Psychiatric patients have approx. 25 years shorter life. Recent research recommends reduced long-term use of antipsychotics to increase life expectancy for patients (Athif Ilyas et al, 2017). PETER C. GØTZSCHE, Professor, Dr. Med., Rigshospitalet Copenhagen writes “(T)o sum up, psychotropic drugs are the third most common cause of death in Western countries after cardiovascular disease and cancer.” (7). ‘Deadly psychiatry and organized denial’ (2015) writes P. Gøtzsche writes: “we could reduce our current usage of psychotropic drugs by 98% and at the same time improve patients’ mental and physical health and survival”(8). Professor Peter C Gøtzsche concludes 10. January 2018 «Psychiatry is a disaster area in healthcare that we need to focus on» (BMJ 2018;360:k9).

    http://wkeim.bplaced.net/files/recovery-en.html

LEAVE A REPLY