“The Best Minds”: How the Dazzling New Book Falls Short

9
11442

In November of 1995, The New York Times ran a piece praising Michael Laudor, the self-described “flaming schizophrenic” who, in spite of his condition, graduated from Yale Law School and fought for the rights of the severely mentally ill. Michael wanted to be a role model, and by all means was the perfect candidate: not only was he incredibly intelligent, but he was also a mental health advocate with a remarkable level of insight into his greatly misunderstood condition.

Michael’s story was so promising that a feature film based on his life was in the works, with Brad Pitt set to play him. Three years later, on June 18, 1998, Michael brutally stabbed his pregnant fiance, Caroline Costello, to death in an episode of psychosis, confusing her with a “windup doll” that he believed had replaced her. Found unfit to stand trial, he was sent to Mid-Hudson Forensic Psychiatric Center, where he resides to this day.

a hand reaching out of a pool shaped as a headJonathan Rosen’s new book The Best Minds is an enthralling and emotional true story that grippingly details Michael’s deterioration—and eventual transformation into a murderer. The two men grew up together as close friends, giving Rosen a unique perspective packed with personal anecdotes and experiences of growing up alongside the man who would eventually make national headlines. Rosen successfully manages to humanize an individual who committed an inhumane act, and he does so while addressing the failure of the mental health system that was unable to adequately help Michael recover from his condition.

For those unfamiliar with the story of Michael Laudor, it follows a familiar and tragic trajectory. Like most individuals who experience a psychotic episode, he is institutionalized in a locked ward and medicated with neuroleptics. “They were giving him drugs”, Rosen writes, “but barely treating him therapeutically”. Michael would stay in the hospital—heavily medicated—for a harrowing eight months before eventually being discharged.

This experience is characteristic of the Western approach to treating severe mental illness: pharmaceuticals are at the forefront, and little therapeutic help is offered. Of course, this would not be a major issue if neuroleptics were an effective treatment for schizophrenia—something that Rosen appears to understand is not the case. He acknowledges that few schizophrenia patients desire to take medication, sometimes due to either their inability to recognize that they are ill, or because of the adverse side effects that nearly always accompany antipsychotic drugs.

Unfortunately, the complexities of neuroleptics run even deeper than what is described in Rosen’s book. It is true that medication adherence is a problem for those diagnosed with schizophrenia, but it is also true those who comply do not necessarily have better recovery outcomes. This has famously been demonstrated by the prominent schizophrenia researcher Martin Harrow, whose series of longitudinal studies found that patients not on medication had a far better prognosis than their medicated counterparts in the long run.

Nevertheless, Rosen acknowledges Michael’s complicated relationship with neuroleptics throughout the book, referring to the “powerful medication trapping madness and sanity together, masking and freeing him”. This paradox comes up repeatedly—the drugs that helped alleviate Michael’s psychosis made him worse in other ways, as captured in the following powerful passage: “He swallowed denaturing drugs to keep denaturing delusions at bay, slowly getting better by feeling worse. His reward for all this obedience was a dawning awareness of how changed he was from the person he’d been, and a growing fear that he might never go back to being himself again”.

Over time, Michael began to voice his complaints about “an unfamiliar array of cognitive frustrations” which he confidently attributed to his medication. But Rosen, on the other hand, raises the possibility that Michael’s cognitive decline was a symptom of his schizophrenia. The possibility that powerful neuroleptics were contributing to Michael’s decline is ignored—which, given that schizophrenia is seen as a degenerative brain disease—is not particularly surprising. However, neuroleptics may well have played a significant role—they carry some of the most severe side effects of all psychiatric medications, and have been demonstrated to permanently damage the brain over time. In fact, the idea of schizophrenia as a progressive brain disease has been challenged precisely due to the impact of these drugs.

Against all odds, Michael was able to attend Yale Law School, despite his cognitive decline and sedation caused by his medication. His former psychiatrists had cautioned him against doing so, instead suggesting he aspire to work as a cashier at Macy’s—a job they saw as more suitable for someone in his condition, an example of the subtle dehumanization that often accompanies a schizophrenia diagnosis. Yet Michael excelled in his new academic environment, where he soon met his future fiance, Caroline Costello, referred to in the book as Carrie.

Although Michael’s relationship with Carrie appeared to be great, he had stopped taking his medication, and began to develop delusions that there were two Carries, and one was not human (this particular kind of delusion is often referred to as Capgras delusion or delusion of doubles). Though Rosen implies that Michael’s withdrawal from his drugs led to his schizophrenia coming back in full force, he remains sympathetic to his decision: “I didn’t want anyone telling me that I had to take medication or stop taking it, or even knowing that I took it. Why should I think Michael’s situation was any different, or that if he decided to stop taking his medication it was any business of mine?”

Yet it was not long after withdrawing from his medication that Michael stabbed Carrie to death, which reignited the forced medication debate. Against the wishes of his lawyers, Michael refused to again start taking neuroleptics, despite his clearly psychotic state. After Carrie’s death, Rosen seems less sympathetic to Michael’s wishes, and seems to advocate for forced medication, writing that “the real tragedy was that a finding of delusional thinking, which could exonerate Michael after the terrible fact, hadn’t been sufficient to medicate him before it”. Eventually, Michael was subjected to months of forced medication, which allowed him to become competent to stand trial, where he was found not responsible for Carrie’s murder by reason of mental disease or defect.

It is unclear what role medication, or lack thereof, played in Michael’s actions. We know that Michael was on neuroleptics, among other drugs, for years, and that he was improving until he withdrew out of his own volition. It makes sense to assume that had Michael stayed on his medication, he may have continued to improve, and Carrie may still be alive today (indeed, this is what Rosen appears to imply).

Yet it is not impossible that Michael’s resurgence of psychosis—and the accompanying violence—was the result of abrupt withdrawal from drugs, not just schizophrenia. Antipsychotic withdrawal, especially when done without the help of a qualified professional, has been linked to a wide range of behaviors, including psychotic and aggressive behavior. Although this possibility is merely speculative, it is naive to ignore the effects years of neuroleptic use have on the brain, and the resulting withdrawal effects of discontinuation. It is a shame that Rosen ignores this discussion altogether, despite being sympathetic to the harmful side effects of neuroleptics he witnessed Michael experience.

It is also unfortunate that Rosen holds a firm belief that schizophrenia is a brain disease, not an extreme state of the human condition. There is an astounding lack of evidence supporting the biomedical model of schizophrenia, and the belief that it is a brain disease comes with consequences. This is represented in Rosen’s refusal to entertain any perspective that aims to conceptualize psychosis as something to be experienced, not suppressed. He is quick to dismiss thinkers such as R.D. Laing, Michel Foucault, or Thomas Szasz (Szasz, who spent his life fighting against coercion in psychiatry, is referred to by Rosen as “indifferent to the plight of people with severe mental illness”).

Instead, Rosen champions thinkers such as E. Fuller Torrey, whose work he cites throughout the book as a reference for treating schizophrenia. Torrey, once a major proponent of Thomas Szasz’s anti-coercive ideology, is now one of the most prominent advocates of forced psychiatric treatment. In his review printed on the back of The Best Minds, Torrey states that “the irony of the title is that the ‘best minds’ did not understand that paranoid schizophrenia is a brain disease”. This statement in itself is ironic, given the lack of evidence to back his claims.

The Best Minds could be seen as a book that is critical of conventional psychiatry, but it falls short on pointing out its true faults. Even though Rosen is well aware that the institution that has spent millions trying to find effective treatments for people like Michael was unable to help him,  he retains a certain degree of faith in psychiatry, and never really presents an alternative to the treatment Michael received—ignoring the promising alternatives that do exist—such as the Soteria House, a home-like environment where those experiencing psychosis are allowed to live out their experiences in a non-judgmental environment free from forced medication.

Instead, he leaves it up to us, as readers, to imagine how things could have ended differently. We are ultimately left with more questions than answers, but nevertheless, Rosen’s account of the Michael Laudor story has created a ripe opportunity for discussing alternatives—an important task, if we are to change the way schizophrenia is treated, in hopes that one day such tragedies will be prevented from occurring in the future.

***

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.

***

Mad in America has made some changes to the commenting process. You no longer need to login or create an account on our site to comment. The only information needed is your name, email and comment text. Comments made with an account prior to this change will remain visible on the site.

9 COMMENTS

  1. Well. It has been established that neuroleptics used in people with no psychosis induced psychosis while taking them and after taking them. What percentage?, one can infer from the fact that 60% in old studies developed them with treatment, and around 30% had them before.

    Some package insert speak of 10% in both medicated and unmedicated patients, if I remember correctly. Withdrawal or not, that’s quite a lot medication induced hallucinations, while taking them.

    If we refer to literature, there is the book “el olvido que seremos” by Abad Falciolince, that narrates the story of a physcian and profesor that was killed during the cold war hot wars in latin america.

    In it, the son, the narrator, refers very clearly that he developed hallucinations after one can safely asume was a neuroleptic injection, because he was involved in a traffic accident as a young man. Aparently no previous psychosis, just a “missunderstanding”.

    So, casuistically, it’s a no brainer: neuroleptics can and do cause hallucinations and therefore delusions. As an attempt to explain the first.

    Even abnormal movements, when unexplained in a clear, useful form, to my mind can lead to delusions of “mind control”. And given that psychiatrists do not explain what those abnormal movements are, how they look like, and how society is going to react, and abuse on those, well, it pushes patients to exactly delusions.

    When priming people to perceive the world in a new way, will, by expectations lead in some cases to hallucinations. Just looking for confirmation of a different way of thinking and perceiving under duress.

    Capgras is kind of one of those diagnoses that invoke “organic” brain disease, since it involves the partial inability in some cases to recognize faces, i.e. mild prosopagnosia.

    That to me speak more of damage caused by neuroleptics than degenerative disease.

    And after arguments against or for neuroleptics, the thing that I think most people miss is that if schizophrenia was a degenerative brain disease, regardless no real evidence has been put forward to claim so, the fact remains that no treatment has been proven to prevent such neurodegenerative process. None.

    And on the contrary, as this piece argues, neuroleptics do cause harm, and probably, although not stated here, of a progressive kind when continued and/or on bursts. Decades ago I read a paper that argued that one of the most damaging ways of using neuroleptics is precisely in high doses to “sedate” or calm patients in acute situations. That was correlated with bad outcomes even some 20yrs ago.

    Suming up: neuroleptics damage the brain not only because of the cumulative dose, i.e. how many pills/injection over a life had been administered, but more worringly when used in spikes. i.e. intramuscular shots, particularly in large doses. Those were even 20yrs ago know to be more damaging. And the percentage developing tardive dyskinesia is still 5% per yer. So they are brain damagingg even in studies, that’s a no brainer too.

    Even Lorenzo’s oil is so partially efective. Dito for Alzheimer, or many other neurogenerative diseases. So, psychiatrists are actually arguing against treatment since they have no proof such neurodegeneration is prevented by medication. How could they? they have no mechanism, and guru/wisepeople opinion is bogus in science.

    That would require neuropathological studies of high quality, not questionaires and allegations from third parties, even if they are family and close friends. Psychiatrists are not suposed to write literature but science.

    Now, more on a limb, how many personalities one can remember with infrequent diseases, even rare, that given fame, fortune and “bad” acting/behavior, one could asume were neuroleptized, only for years later come up with neurodegenerative diseases at unusual ages for such diseases? Or infrequent, even rare heart disease?. I am not picking on personalities, they are predisposed to neuroleptization by being rich and under strong emotions, regardless of the culture they live in. I read/heard somewhere the camera is a monster…

    That to me suggests that neuroleptics do cause harm that sometimes look like rare or infrequente neurogenerative diseases, but I haven’t read anything about that. Hence my question.

    And anyone can write a piece of literature to push a narrative…

    Report comment

  2. Great Article, thank you Gidi,

    Neuroleptics create their own form of “Schizophrenia”.

    Even a well person can go MAD and Act Out attempting to withdraw from Neuroleptics, and this isn’t because they’re not taking their “medication” – it’s because of the longterm effects of the Neuroleptics on the brain.

    I ran into serious problems myself when I attempted to withdraw from these drugs – but I eventually managed to get a bit of detachment, and then my mind began to work in a productive manner.

    Report comment

  3. Using powerful chemicals that affect people’s perceptions when they really don’t know how they work and choosing to ignore the serious sudden withdrawal effects that have been reported is not good medicine, especially when non-drug alternatives are available.

    Report comment

  4. 120 volt is needed for light a lamp. 420 volts electricity is supplied at the ECT. psychiatrists burn the brain with ect. then psychiatrists say ‘ECT is harmless’.psychiatrists lie. psychiatrists is a fake science
    if schizophrenia is caused by much dopamine in the brain and dopamine is not measured by psychiatrists be measured prolactin by psychiatrists. if dopamine increases prolactin drops. a thing which is made by psychiatrists is to prescribe diabetes drugs without measuring sugar. psychiatry is a fake science.

    psychiatry condemns people to live with family in turkey
    l lied to psychiatrist. psychiatrist was constant saying to family ‘your child is very very illness’ these are not called even those with cancer. really rosenhan is very right

    Report comment

  5. “the idea of schizophrenia as a progressive brain disease has been challenged precisely due to the impact of these drugs.”

    And those of us who have done our homework know that the “schizophrenia treatments” – the antipsychotics / neuroleptics – can create both the positive and negative symptoms of “schizophrenia,” via anticholinergic toxidrome and neuroleptic induced deficit syndrome.

    https://en.wikipedia.org/wiki/Toxidrome
    https://en.wikipedia.org/wiki/Neuroleptic-induced_deficit_syndrome

    For anyone here who might care, I will say so far so good, for my loved one who went into a hospital recently with what I think may have been a non-psychiatric, but also petrochemical based, “drug withdrawal induced super sensitivity manic psychosis.” (Albeit, the hospital blamed my loved one for quitting drinking a month prior, which may have had something to do with the situation as well.)

    Nonetheless, three days of a benzo did calm my loved one down enough to get in and out of the hospital (over a weekend) in 4 days. He’s still, occasionally, a bit manic … which is kind of cute … but he’s no longer psychotic. Thank God!

    He’s got some tardive dyskinesia issues, so he’s at the very beginning stage of his healing journey. But I’m trying to provide him with hope, based upon the knowledge that God did design the brain with the ability to heal itself, via neuroplasticity. And the kidney problem, caused by the drugs he was appropriately withdrawn from, seems to have subsided, which is good news.

    Is this a possible alternative to psychiatry’s approach to a first ever manic psychosis? I’ll keep you posted as to whether three days of a benzo can actually be a possible best approach to a person experiencing a first ever petrochemical drug withdrawal induced, or alcohol withdrawal induced, “super sensitivity manic psychosis.”

    Since I see it as relevant to the much needed conversation of alternatives to psychiatry’s, for profit only, systemic lies and fraud.

    Report comment

  6. I read a NYT review of Rosen’s book, “The Best Minds” with great interest. Michael Laudor’s experience is compelling and heartbreaking. Mr. Rosenfeld’s review is even more thought-provoking and I feel that if I was Jonathan Rosen, I would have had a few more people with deep knowledge of the use of antipsychotic medication weigh in on the draft of the manuscript before publishing in order to ensure that Mr. Laudor’s case was being presented fairly. Ultimately, I am most concerned for Mr. Laudor who is quite alive and living at the Mid-Hudson Forensic Psychiatric Center. I hope that he is well-cared for and doing as well as possible given the difficult circumstances, as I am sure that he has been abandoned by the majority of his former friends and colleagues. His and Carrie’s story is tragic anyway you look at it and should be the most cautionary tale for everyone treating individuals with serious mental health conditions. Clearly the current treatments fail a great many people. We can and must do better.

    Report comment

  7. Jonathan Rosen’s “story” of Michael Laudor was a mess of deliberately conflated “problems” he blamed on Michael, but were, in fact, produced by other people. The one you cited from the book is a perfect example. Michael can hardly be said to have “changed” when his body and entire life had been monopolized by by his psychiatrists from the second he was under their “care”. “Change” in a person implies, at a minimum, some difference between who they were and who they are now. Damage caused to a person by toxic “care” relationships is not a “change” in them. It is a consequence of fraud and assault, and it can be repaired in a safe, stable environment. Michael Laudor needed to disappear from psychiatry and his “family”, even if he never got another shot at fame and fortune.

    Report comment

LEAVE A REPLY