With his finger pointed at me and in an authoritative tone as if to discipline an unruly child, Dr. Yasser yelled, “You’re mentally ill and will be mentally ill for the rest of your life! Vitamins don’t cure mental illness! Stop wasting your money!”
I received this scolding just five minutes into my first appointment with my third psychiatrist in two years, not long after being released from the hospital after yet another manic episode. He knew little more about me than my name yet made snap judgments against me based solely on the fact other medical doctors already rubber-stamped a psychiatric label on me.
I had hoped that Dr. Yasser would be different and more open-minded towards a patient incorporating complementary therapies into medication management, as I was doing. I had selected him as my new psychiatrist because he had a unique, holistic practice that offered walk-in appointments along with a day center featuring fitness equipment and a pool table. Dr. Yasser encouraged patients to meditate in front of large fish tanks, network with each other, and attend a daily support group he led.
Obviously, that was not the case, but I’d come prepared. Very calmly, I explained that I had experienced a lot of side effects from psychiatric medications and gave him a printout from my pharmacist listing my prescription history and the many drugs to which I had adverse reactions. I told him I felt my best option was to incorporate additional therapies to try and control reoccurring episodes of insomnia, mania, psychosis, and visual hallucinations. Psychiatric drugs alone were not working.
I explained that I had recently started acupuncture and massage therapy treatments in an attempt to find relief from severe insomnia. I also told him about my first appointment with Dr. Charles Gant, MD, Ph.D. at the Holistic Health Center that had recently opened near me. Dr. Gant uses a functional medicine approach to optimize his patients’ treatment by testing them for metabolic, infectious, immune, allergic, nutritional, toxicological, and other risk factors.
I then informed Dr. Yasser that my work history included long-term exposure to hazardous chemicals, and that results of lab tests run by Dr. Gant had revealed high levels of various neurotoxins in my body, including past exposure to lead found via hair analysis.
Along with using vitamin supplements and making dietary changes, I mentioned that I had been undergoing IV chelation therapy an FDA-approved, standard detoxification treatment for lead poisoning and acute radiation poisoning. A 24-hour urine analysis after my first treatment showed the excretion of aluminum, arsenic, cadmium, and mercury. I told him that as these poisons began to leave my body, I was starting to notice improvements in my sleep quality and energy levels, even my night vision.
Dr. Yasser wanted to know the name of the lab that ran the hair analysis. I had a copy of the results with me and handed it to him. He quickly flipped through the pages, tossed it back at me, and in a very arrogant tone stated, “That doesn’t mean anything, lead poisoning doesn’t cause mental illness and you have bipolar disorder.”
I sighed and further explained that I had visited a medical library to research the links between chemical exposure and mental illness and come across a 1986 study relating past exposure to lead found in hair analysis to symptoms of bipolar disorder. I handed him a copy of the study and once again he quickly flipped through the pages, arrogantly tossed it back at me, and said, “That’s only a pilot study, it doesn’t mean anything.”
After almost two years of suffering manic episodes requiring hospitalizations and dedicating myself to learning more about the field of abnormal psychology, the mind-body connection, and exploring holistic healing options, my perspective on “mental illness” was beginning to shift. Experiencing and witnessing how diagnoses of “mental illness” are made with snap judgments and not medical tests, along with how “mentally ill” individuals are mistreated and considered to be of lesser intelligence than others, fueled my desire to search for answers to the mystery of how I spontaneously became a “mentally ill” person myself. At that point, I was trying to find a psychiatrist who both took my insurance and was willing to work with me to follow wherever the answers led.
A Toxic Workplace
After graduating from college in 1983, I began working as a color-separation technician in the graphics department of a printing company. I developed a passion for the craft and became highly proficient at it, willing to work up to 70 hours a week during our busy seasons.
Although computer-aided technology had advanced digital imaging capabilities, the color-separation process still utilized a variety of volatile organic compounds for various stages of the printing process. Unlike lead-based paints (which were banned in 1978), lead-based printing inks continued to be used until 1986. The printing process also involved using large amounts of strong-smelling cleaning agents containing toluene, an organic solvent. Many companies, including the one I worked for, failed to properly ventilate equipment according to the manufacturer’s specifications or to follow occupational safety standards.
Computer equipment was extremely sensitive to dust, so all of the computerized equipment needed to be housed in a very large, specially-constructed, sealed cleanroom environment. The company’s failure to install a fume hood on the film-processing unit caused vapors from sulfuric acid to corrode metal holding tanks which then leaked, mixing very harmful chemicals together and resulting in a caustic buildup of waste collecting under the machine. Fumes from the darkroom, therefore, went directly into the sealed cleanroom and into my work area. On a regular basis, I would clean up the hazardous waste that accumulated under the large film processor without proper personal protective equipment. It wasn’t provided, and I didn’t know to ask about it.
Although employees made many complaints, when managers dealt with them it was by implementing makeshift solutions. In 1988, after several female coworkers suffered miscarriages, someone made an anonymous complaint to OSHA. A subsequent inspection led to minimal improvements.
From the start of my employment with the printing company, my mother had expressed concerns over the health risks of these chemical exposures. She immediately noticed the pungent odors on my white lab coats. But I’d become so used to the strong fumes, which caused some of our clients to refuse to enter the building, that I no longer noticed them, and I foolishly ignored her concerns.
My Psychotic Break
This was the environment in which I was spending most of my time when I began my mental illness journey. In 1996, I was 33 years old, in excellent physical condition, had never used illegal drugs or alcohol, and was a nonsmoker. I had never experienced any sort of cognitive impairment. Mentally and emotionally, I always considered myself a well-balanced individual who made rational decisions and maintained a positive attitude. As a frugal person, I’ve always made spending decisions with careful thought. Yet on March 23rd of that year, I suffered my first acute manic episode.
The experience began with a powerful visual image of Jesus followed by a bright white light and other visual hallucinations. Additional symptoms included euphoria, paranoia, insomnia, racing thoughts, irrational spending, and religious delusions. I believed I was getting messages from God and had frightening premonitions of end times. While I felt a sense of safety and protection for myself, I developed immense fear for the safety of others. I began expressing my fears to my family. What I believed was a divine spiritual awakening, my family believed was a medical emergency.
My mother immediately assumed my sudden altered mental state had been caused by the chemicals I was exposed to at my workplace. But I wouldn’t hear it. So family members consulted with medical professionals, who advised them that I should be evaluated at a local state hospital’s emergency room. Once there, one of my siblings tried to advocate for me, asking the ER doctors to please check me for some type of poisoning. The doctors ignored that critical piece of information and instead isolated me in another room and then sent in six doctors, one at a time, who began asking me a lot of questions. Each doctor wanted to know if I was suicidal, and several asked me to spell the word “world” backward, which I was unable to do.
After hours consisting solely of this type of evaluation, the doctors told my family I had a mental disorder. Meanwhile, one of them told me I had the choice of either signing a paper agreeing to a 72-hour voluntary psychiatric admission, or I would be admitted under forced treatment with no guarantee of when I would be discharged. I agreed to the voluntary admission. I was told to take medication but never told what the medications were for or what my diagnosis was.
Inside the Psych Ward
Although the drugs were heavily sedating, the delusions and visual hallucinations persisted: I saw an image of a demonic creature along with haloes of white light around certain individuals. The drugs and the bizarre circumstances in the psych unit only added to my distorted personal reality.
While there, I met other patients who were suffering terribly from an illness called manic-depression (considered a “severe mental illness” and now called bipolar disorder). This was the first time I had ever met anyone with this disorder. Many had attempted suicide, and some were receiving electric shock treatments (ECT). From what they described, bipolar disorder seemed to be a horrible, debilitating brain disease and I believed that God had placed me there to help give them hope during their time of despair.
When I told one of the other patients that I would be discharged soon, she laughed and told me that I wasn’t going anywhere; the doctors had the right to keep me there for as long as they wanted. I did not believe they had the right to hold me against my will but one of the nurses confirmed that it was true. She said I could write a letter asking to be released, but it was up to the doctors to make that decision.
Very quickly, my rational mind poked through my mental haze, and the reality of accumulating financial debt set in. I thought about not being able to go to work and having bills piling up along with mounting medical debt because my insurance at the time did not cover mental health services. I sat down with a piece of paper and a broken crayon, which was all they allowed patients to write with, and composed one of the best letters of my life. The doctors agreed to the discharge, gave me several prescriptions to fill, and set up a follow-up appointment with Dr. T., the psychiatrist who was overseeing my treatment.
Upon discharge, I had the prescriptions filled and I was shocked at the cost: $250 for a 30-day supply. In addition, the short hospital stay left me with over $3,000 in bills. The cost of appointments with the psychiatrist was $90 for a 15-minute session. In one week’s time, I had spent more money on medical expenses than I had spent in my entire life. But however disconcerting my first experience with psychiatry had been, I still believed “doctor knows best.”
Taking a Break
I was planning on returning to work right away, but my husband feared my illness was not under control and my parents wanted me to quit my full-time job to avoid continuing chemical exposure. My father insisted that I instead work full-time at our family grocery store. I had had no idea how debilitating my condition was, as I could not do even simple tasks without making mistakes. I was hypersensitive to sound and the background noises at the store were torturous. Within a few days, I had to stop.
It was obvious that I needed more time off from work, so I applied for disability leave and asked Dr. Tanquary to fill out the necessary form. This was where I first read that I had been diagnosed as having “manic-depression with psychotic features.” No one had ever told me, the patient, that I had a “mental illness,” and I was in disbelief. It did not seem possible that I had the same illness as the other people I had met in the psych ward. I was still confused as to how what felt like a spiritual awakening was actually a psychiatric disorder.
To help me better understand my illness, a family member reviewed with me information from a textbook from the abnormal psychology course they had taken in college, which was based on the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III). In it was a description of manic-depression that accurately described the symptoms I had experienced. The book stated that it was a hereditary illness. Reading the information in that textbook is what started to convince me that I really did have a “mental illness.” I was crushed when another family member said that my husband and I should not have children because they could inherit it. They, too, believed “doctor knows best.”
I went back to Dr. T. in tears and told him there was no way I could turn this form into work. It was too embarrassing. He was extremely understanding, took out a bottle of WiteOut, and changed my diagnosis to a much nicer-sounding explanation: “Patient is experiencing confusion, disorientation, anxiety.” I appreciated his act of compassion and felt immediate relief that at least I could have more time on disability to try and figure things out.
I was trying very hard to return to my normal routine and at that point, I was doing OK physically, so I attended a weekly step aerobics class with my friends. About 10 minutes into the class, I suddenly felt drained and had to sit down. By the end of the class, I felt like the Tin Man from The Wizard of Oz who needed oiling: all my muscles seemed to freeze up and I could barely walk. The next day the stiffness continued and when I went to put in my contact lenses, they popped back out. My eyes had to have a bulging look that made other people feel uncomfortable around me.
The muscle stiffness became so severe I felt paralyzed and could barely get out of bed to take a shower. My hands trembled to the point of not being able to hold a glass of water or a spoon. I assumed this was the depressed state that makes people with manic-depression want to kill themselves and quickly reached a point of desperation I had not thought possible just two weeks earlier. I reported my depressed state to my psychiatrist, and he added more medications to what I was already taking. I had immediate reactions to them. I felt like I was taking poison, not medicine, and I refused to continue taking them. It made me angry that I was spending my hard-earned money on products that were ending up in the trash.
One of my sisters, who is a physical therapist, explained that the muscle stiffness I was experiencing was not from depression but was a side effect of my medications. She also bought me vitamin supplements, explained how they would help, and urged me to find an orthomolecular doctor. I told her I already had a really good doctor. It did not seem possible “medicine” could make you feel suicidal.
Accepting My Diagnosis
I went back to Dr. T. and to my surprise, he confirmed that I was suffering side effects from the neuroleptic medications. I told him I was not going to take any more medication and that I no longer needed his services. He nonchalantly told me he wouldn’t recommend abruptly stopping medications because I would go through withdrawal. I didn’t think anything could possibly be worse than what I was already experiencing, so I told him I did not care. He warned me that it would only get worse, but I was adamant.
Boy, was he right about withdrawal. It was as if my body became a 24/7 torture chamber and my head felt like I had just gotten off of a Tilt-A-Whirl. It came to the point that I was physically unable to get out of bed at all. I had to crawl on my hands and knees to get to the bathroom. I wasn’t able to take a shower, my head was constantly spinning, I couldn’t sleep, and I was hypersensitive to sound and light. I could not hold down any food and I lost 10 pounds in just a few days. It was unbearable.
I decided to accept the fact that I was “mentally ill” and once again returned to Dr. T.’s office in tears, begging for help. I did not understand how I’d become “mentally ill” and asked how it could possibly happen so suddenly in an otherwise healthy, well-adjusted person. His response was, “You just hit the age it was going to happen.” In a very nice way, he explained that “mental illness” was a chemical imbalance. That made me feel less stigmatized. The constant spinning going on in my head did feel like a chemical imbalance, so it seemed like a more plausible explanation for what I was experiencing. However, I did start to wonder why psychiatrists don’t use a blood test to determine which chemicals are out of balance in one’s brain.
Dr. T. rattled off a list of other medications I could try. When he said lithium, I immediately chose that because it was at least something I recognized as a naturally occurring element on the Periodic Table. Though surprised at my choice, he explained how the drug works at therapeutic levels, the need to check lithium levels through blood work, and the possibility of lithium toxicity. He also prescribed the benzodiazepine Klonopin for my insomnia, and I complied with all of his recommendations.
I then spent several weeks in bed as I withdrew from the first set of medications and adjusted to the lithium, feeling embarrassed by what I was going through. I feared what family, friends, neighbors, and coworkers would think of me and the gossip that would ensue.
Within a few weeks of my beginning lithium, the manic symptoms subsided and so did the horrific side effects of the other medications, which I found out later were listed on my medical records as severe Parkinson’s-like syndrome and tardive dyskinesia. I was stable enough to go back to work at my full-time job, but before going back I asked Dr. T. if there was a possibility that the chemicals I worked around had caused my illness. He reassured me they could not. I showed him the vitamin supplements my sister bought me and asked him if they would actually help prevent future episodes. He looked them over and said they were safe but that I still needed medication. Since he’d acted like the vitamins were worthless, I stopped taking them.
Accepting the fact I was “mentally ill” was not easy, but I felt like I had no other choice.
A Path to Healing
After going back to work at the printer, I spent the next two years cycling in and out of manic episodes requiring hospitalizations, where psychiatrists reiterated that I had a chronic mental illness and should accept my fate. It was only because I finally took my sister’s advice and look into alternative approaches that I sought help from Dr. Gant, an internist who used a functional medicine approach, that the myth of my “spontaneous” bipolar disorder began to unravel.
Functional medicine practitioners use a battery of laboratory tests to discover whether toxicological, biochemical, structural, physiological, and genetic abnormalities are playing a role in their patient’s symptoms. They then focus on treating those underlying issues. In the case of severe mental disorders, nutritional supplement therapy is often used.
Dr. Gant’s approach was so different from any other medical doctor I’d encountered. He was so down-to-earth and treated me with the utmost respect, taking his time to collect a complete medical history. During our first meeting, he told me “Doctors are not God; you should think of us as your employees.” He ordered blood work to be done at a lab and gave me other prepackaged diagnostic kits to do at home and mail in. Those tests involved collecting samples of urine, stool, hair, and saliva. Dr. Gant explained that the test results would enable him to make more precise recommendations.
My results came back two weeks later. The blood tests revealed numerous abnormalities, including the presence of heavy metals including mercury, arsenic, aluminum, and lead. Though psychiatrists rarely learn this in their training, it is well established that these and other toxic substances can disrupt normal brain functions and lead to anything from fatigue to impaired coordination to poor memory. Most significant for me, such chemicals are linked to mood and personality changes that match the criteria for bipolar disorder or schizophrenia. In other words, they can literally make you mad.
Dr. Gant helped me to understand how my original diagnosis was considered a “functional psychiatric illness” and how my primary psychiatric disorder should be considered as secondary to an “organic mental disorder,” a term previously used to describe a dysfunction of the brain that was meant to exclude psychiatric disorders.
Now that we had some answers, it was time to remove the underlying causes of my illness and to provide me with treatment that could heal the damage. Because of the severity of my symptoms, Dr. Gant recommended I undergo intravenous chelation therapy, which is a standard treatment for lead poisoning. After the tenth treatment, I began feeling better. After 22 chelation sessions over eight months (plus complementary therapies including massage and acupuncture), my hallucinations stopped, my manic episodes ceased, my cognitive abilities improved, and my insomnia subsided. During this time I’d also gone back to Dr. Tanquary, who helped me to adjust the psychiatric medications I was still on and, as I continued to improve, to taper off all of them.
I eventually stopped seeing all of my mental health providers (who by this point also included a psychotherapist) and decided I could no longer keep working at the facility that was quite literally poisoning me. I gathered support from Dr. Gant, an occupational medicine doctor, a neurologist, and a workers’ comp attorney and quit my job. Then I initiated a New York State workers’ compensation claim.
The entire claim process took over a year and involved requesting all of my medical records. As I looked the records over, I noticed abnormal results for various tests performed during my psychiatric hospitalizations–such as hyperthyroidism–that had never been mentioned to me. After an in-depth assessment by a series of medical and occupational safety experts, I was officially diagnosed with a “substance-induced neuropsychiatric and cognitive disorder” due to toxic encephalopathy, which they traced to long-term exposure to workplace chemicals. Following extensive legal proceedings, I was awarded a settlement in reimbursement of my medical expenses and lost wages.
Solving Medical Mysteries
It turned out that the same Abnormal Psychology textbook that solidified in my mind that I had bipolar disorder also held information that would explain why my mother had been correct all along about the origins of my “mental illness.” For along with diagnoses that are commonly thought of as severe mental illness (SMI), such as bipolar disorder and schizophrenia, the DSM also includes diagnostic codes for psychotic and manic symptoms that are caused by general medical conditions and substances. These conditions should be coded as “psychosis due to a medical condition” or “substance/medication-induced psychotic disorder” but, as my case clearly demonstrates, errors occur in the psychiatric labeling process.
While there are no tests that can prove the presence of a mental illness, there are many tests to determine whether a person has a physical condition causing them to act or behave in a way that meets the criteria for a psychiatric disorder. Unfortunately, most patients do not receive those tests before being labeled with a psychiatric disorder. But even if an underlying medical condition is discovered, the DSM still considers the individual to “have” that mental disorder, and their diagnosis will reflect this fact (for example, bipolar disorder due to hyperthyroidism).
Psychosis due to a medical condition can involve a surprisingly large number of different conditions. Some are very easy to detect and treat, such as dehydration or vitamin B12 deficiency, while others are far more serious, even fatal. A friend of mine told me his teenage niece was originally diagnosed with bipolar disorder, but it turned out she actually had Creutzfeldt-Jakob disease (CJD), a degenerative brain disorder that leads to dementia and premature death. Sadly, besides suffering a horrific death, the girl’s erratic behavior and the belief that she “just” had a mental disorder resulted in her family becoming alienated from her until they learned otherwise.
One of the more famous examples of psychosis due to a medical condition is that of journalist Susannah Cahalan, whose memoir, Brain on Fire: My Month of Madness, recounts her experience of distress that was considered to be schizophrenia. Because of her parents’ advocacy, Susannah was kept out of the psychiatric ward and on a medical floor. After a consultation with a neurologist, who administered her a simple mini-neurological exam of drawing a clock, Susannah was found to be suffering from an auto-immune disease, anti-NMDA receptor encephalitis. She was treated for the condition and has since recovered; many others are not so lucky.
Substance/medication-induced psychotic disorders can be caused by the effects of recreational drugs, prescription medications, and/or over-the-counter medications. Even the routine use of over-the-counter cold medicine can result in acute psychotic symptoms that are said to be clinically indistinguishable from schizophrenia.
Psychotic symptoms can also result from intoxication of many different substances including alcohol, amphetamines, cannabis (marijuana)—or, in situations like mine, occupational/environmental exposure to toxic chemicals including lead. Lead poisoning continues to be a problem in communities like Tampa, Florida where factory workers were exposed to dangerously high levels of lead in the air and in Flint, Michigan, where the city’s lead crisis now affects the school systems, with students showing signs of neurological and behavioral problems associated with past exposure to lead in their water.
Psychosis can also be caused by misuse of certain prescription medications, and for some people, such as college student Ryan Ehlis, even taking prescription drugs properly can induce a psychotic episode. Ten days after Ehlis began taking Adderall for his diagnosis of attention deficit disorder, he became delusional and killed his baby daughter. He was acquitted of murder charges by a judge “who ruled his psychotic state was an extremely rare side effect of Adderall,” according to a news report at the time.
My experience has convinced me that all individuals and their family members who seek emergency help for symptoms of psychosis or mania have the right to know these could be symptoms of many different serious medical conditions. I feel psychiatry’s concept of “mental illness” is misleading and prevents individuals who are suffering from potentially life-threatening illnesses from getting accurately diagnosed and treated.
Looking back, I realize my life would have turned out much differently had doctors taken my mother’s concerns about chemical exposure more seriously. During my initial visit to the ER for mania, a best-practices approach would have been for the doctors to consult the hospital’s Department of Occupational Medicine in order to take an occupational history and obtain the Material Safety Data Sheets on the chemicals used by my employer. Notification should then have been made to the Occupational Safety and Health Administration to conduct a safety inspection of my workplace. Failure to do so jeopardized not only my health but the health of my coworkers.
As a patient, I recognize I was in an altered state and difficult to deal with. Still, I feel I was treated with disrespect by the doctors who communicated more with my family than me. I felt like my family members were considered to be the intelligent, sane people worthy of communicating with and I was the stupid, crazy person who should just shut up, be locked away, and take her medicine regardless of its harmful side effects.
Psychiatric patients like me are very often at a disadvantage to advocate for themselves. Many rely on family members to make decisions in their best interest. But when kin like my mother do advocate for us by challenging psychiatry’s cookie-cutter approach to diagnosis and treatment, they are too often ignored. When patients like me raise these issues, we are chided and gaslighted.
I believe many lawmakers and lay mental health advocates are spoon-fed information and brainwashed into advancing a pro-psychiatry, pro-forced treatment agenda for anyone manifesting unusual behavior. By sharing my experiences, I hope others will gain additional insights into serious problems within the psychiatric treatment system and be inspired to take a proactive stance, digging deeper for answers in order to advance safe, humane, compassionate care based on best-practices standards.
What might that care look like? For a start, before assigning the diagnosis of a functional psychiatric disorder, doctors should perform their due diligence when clinically evaluating mental symptoms to rule out “Psychosis Due to General Medical Conditions” and “Substance-Induced Psychosis.”
Psychiatry is the only industry that has the authority to create forced consumerism (i.e., involuntary treatment) without following such best practices. The U.S. District Court’s 1971 decision in Wyatt v. Stickney determined that patients have a “constitutional right to receive such individual treatment as will give each of them a realistic opportunity to be cured or to improve his or her mental condition.” In light of this, I believe all healthcare consumers are entitled to be educated on their options and to choose the type of treatment they receive for what appears to be “mental illness,” whether it is medical-model psychiatry, functional medicine, or other modalities.
Improvements in the diagnostic accuracy and treatment of psychosis will prove beneficial and cost-effective for both mental health consumers and society. But that can only happen when the medical community takes the time and finds the humility to implement them.
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Editor’s Note: Read Maria Mangicaro’s 2011 peer-reviewed article on her experience with toxic encephalopathy in the Journal of Participatory Medicine here.
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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