Uncategorized

Back in 2006, when my son Franklin was in his late twenties and living in a group home in the Boston area, he refused to take Clozaril any more because of the required bi-weekly blood draws. His doctor prescribed Zyprexa as a substitute, and Frank suddenly began to gain weight ... a lot of weight. Later, I would learn that UCLA psychiatrist Dr. William Wirshing had said of Zyprexa prior to its 1996 approval by the FDA: “It is just un-stinkin’-believable. It is the best drug for gaining weight I’ve ever seen.” The doctor indicated that taking ten milligrams of the medication was equivalent to ingesting 1,500 extra calories per day. My outrage knew no bounds.

It's been five years today since I completed a six year withdrawal process from a large cocktail of psychiatric drugs. Today is also my 50th birthday which, frankly, seems much more remarkable to me at this point. Inside I am only aware of eternal youth. Upon having done an informal and small survey, it seems most people feel that way though it's not talked about much among the adults of our species. That which watches and experiences our lives in these bodies does not age. It's actually a wonderful thing. So I'm here wondering what comes next in this amazing trajectory which is the life being lived in this body that my parents called Monica.

I have devoted more than 40 years to the study of extreme mental states – my own and others. I have witnessed the extraordinary ability of people to survive and thrive after living through horrendous experiences. Remarkable feats of resilience attest to our untapped potential. I am acutely aware of an immense responsibility to communicate and use what I have learned so that others may have a somewhat easier task navigating the difficult and diverse states we call madness.

As I was researching my book A Disease called Childhood: Why A.D.H.D. Became an American Epidemic, I came across an interesting pattern in the history of psychiatry. In my mind I made up a name for this pattern and called it “neo-Kraepelinian Regret,” named after the 19^th century German psychiatrist Emil Kraepelin. Kraepelin was interested in classifying mental disorders by their symptoms so that psychiatrists would have a common language with which to communicate. His most famous contribution is his classification of the different forms of psychosis into manic depression, dementia praecox (which later became known as schizophrenia), and paranoia.

Millions of patients find themselves caught in the web of psychiatric sorcery - a spell cast, hexed, potentially for life. They are told that they have chemical imbalances. They are told that the most important thing they can do for themselves is to "take their medication," and that they will have to do so "for life." Most egregiously, patients are sold the belief that medication is treating their disease rather than inducing a drug effect no different than alcohol or cocaine. That antidepressants and antipsychotics, for example, have effects like sedation or blunting of affect, is not a question. That these effects are reversible after long-term exposure is.

Even the most level-headed individual can be rendered insufferable by taking an introductory psychology class. Suddenly the neophyte student will become an arrogant expert, deriding the ignorance of friends, family, and dinner companions. The use of the term “nervous breakdown” is a case in point. Uttering the words is a bit like blowing a dog whistle: Intro Psychology graduates will converge from miles around to clarify that there is no such thing . . . In this case, however, the phenomenon is not restricted to sophomores.

For those who actually believe that psychological problems are on the rise, serious inquiries must ensue. Many have rightly raised concerns about iatrogenic culprits, including drug-induced effects, but this too seems to fall short of accounting for the meteoric rise. Except for those forced to take psychiatric drugs, I would suggest that most seek out drugs in the hope of relieving iniquities caused by factors such as those I discuss below; unfortunately, this may not only lead to avoiding addressing the real issues, but may even lead to further complications of the drugs. Given this, I present five areas for further discussion, which I believe are causal agents for the mental health crisis.

An investigation found that many US hospital websites were more like advertising outlets than educational portals.

This week, JAMA Internal Medicine published online an interesting paper, “Cumulative Use of Strong Anticholinergics and Incident Dementia: A Prospective Cohort Study.” They found that exposure to anticholinergic drugs significantly increased the risk of developing dementia. This study has important implications for those who prescribe and take psychiatric drugs.

Our newest conference this coming April in Michigan is the high point of a transition that my wife Ginger and I have been making for several years. The origins of the change go much further into the past to sixty-one years ago in 1954 when I was an eighteen-year-old college freshman at Harvard and a friend invited me to join him as a volunteer on the wards of Metropolitan State Hospital. I was majoring in American History and Literature, with little thought of becoming a psychologist and no thought whatsoever of being a medical doctor and a psychiatrist.

As we struggle to invent a humane approach to the extreme states that get called “psychosis” or “madness” or “schizophrenia,” it may be helpful to investigate some of the better approaches developed in the past. While these approaches are not without their flaws, they are often surprisingly insightful. (It can also of course be depressing to notice how truths once more widely known were so easily “forgotten” as compassionate approaches got ditched in favor of the latest coercive innovations.)

We live in a culture bombarded by media and sped up by rapid-fire social interactions. It's definitely useful to grab hold of a simple, short, sound-bite term, to quickly describe what we are feeling or suffering. "Depression" is such a word - it evokes and encapsulates, conjures the images of that ugly pit of despair that can drive so many to madness and suicide. Yet at the same time the words we use, strangely, become like those pens deposited in medical offices and waiting rooms around the world: ready at hand, easily found, familiar -- and tied to associations, marketing and meanings we were only dimly aware were shaping how we think.

In order for you to understand where I am coming from, you probably need to know a bit about how I got here. Throughout my psychiatric training I had always, in the back of mind, this question: What is the difference between my suffering and those of my patients? How come they get all this treatment and I got none? Why do they have a ‘brain disease’ (there was a time when I tentatively believed in this sort of thing), whilst I, who was at times symptomatically severe enough to warrant medication, have no brain disease? The answer seems plain to me now. I had suffered exactly in the same way as many of the people I see every day do, but I had been lucky enough to avoid labeling and drugging.

Many of us spend a lifetime avoiding our emotional pain, and it does become more and more toxic as long as we keep it buried. It will literally make us ill, physically and mentally, as Bessel Van talks about in the book, The Body Keeps Score. The little quip, "What you resist, persists" has proven very true in my life. The only way out of that trap is to stop avoiding and learn in whatever way makes sense to us as individuals to feel once again and to embrace and absorb and therefore transform the pain of our lives. This is how I am healing.

The Division of Clinical Psychology of the British Psychological Society published a paper titled Understanding Psychosis and Schizophrenia. The central theme of the paper is that the condition known as psychosis is better understood as a response to adverse life events rather than as a symptom of neurological pathology. The paper was wide-ranging and insightful and, predictably, drew support from most of us on this side of the issue and criticism from psychiatry.  Section 12 of the paper is headed "Medication" and under the subheading "Key Points" you'll find this quote: "[Antipsychotic] drugs appear to have a general rather than a specific effect: there is little evidence that they are correcting an underlying biochemical abnormality."

-The findings of many neuroscientific studies are really just random background noise.

This week a commentary, written by members of the University of Pennsylvania Department of Medical Ethics and Health Policy and titled “Improving Long-term Psychiatric Care: Bring Back the Asylum” was published in JAMA Online. The authors recommend a return to asylum care, albeit not as a replacement for but as an addition to improved community services and only for those who have “severe and treatment-resistant psychotic disorders, who are too unstable or unsafe for community based treatment.” The authors seem to accept the notion of transinstitutionalization (TI) which suggests that people who in another generation would have lived in state hospitals are now incarcerated in jails and prisons. While I do not agree, I do find there is a need for a safe place for people to stay while they work through their crisis.

  Editors' Note:  We at Mad in America have all known and loved Leonard. He truly represents the best of why we are engaged in these...

As a person who has been psychiatrized, but hasn’t faced long-term institutionalization, I have to accept that I can’t know that level of loss of power and vulnerability. (But I can tell you even short stays are enough to begin to understand.) And to be a person of color with psychiatric labels interfacing with the police? It’s like the perfect storm. (A type of ‘perfection’ that occurs more often than most, given that people of color are more likely to be diagnosed in the first place.)

With great regularity, I receive emails from people—“patients,” family members, and mental health workers—who are frustrated by this fact: the psychiatrists they meet, and the larger psychiatric community, are simply not aware of research that questions the merits of psychiatric medications. Many providers, for instance, do not know of Martin Harrow’s long-term study of schizophrenia outcomes. We at Mad in America started Mad in America Continuing Education to produce online courses that will fill in this knowledge gap. And now that we have our first courses up, we need your help.

When people are seeing the world really different than we do, it’s often reassuring to think that there must be something wrong with them – because if they are completely wrong, or ill, then we don’t have to rethink our own sense of reality, we can instead be confident about that own understandings encompass all that we need to know. But it can be disorienting and damaging to others to have their experiences defined as “completely wrong” or “ill.” And we ourselves become more ignorant when we are too sure that there is no value in other ways of looking or experiencing.

What are Extreme Experiences? Other terms for them are Spiritual Crisis or Spiritual Emergency. With the appropriate support many find the experiences profoundly transformative. However, observers or relatives may have different beliefs about extreme experiences: perhaps that a person is having a psychological breakdown or mental health problems, or is psychotic or experiencing schizophrenia.

On December 29, Nassir Ghaemi, MD, a psychiatrist and a professor at Tufts Medical Center, published on Medscape an article titled Psychiatry Prospects for 2015: Out With the Old, In With the New? In it, he writes that with the changes in health care "Clinicians can stop pretending that relationship and social problems have to be shoved into a biological-sounding DSM category (such as major depressive disorder or generalized anxiety disorder) and treated with the only thing insurance companies would reimburse long-term: drugs." So there it is, starkly stated: Clinicians, by which he clearly means psychiatrists, have been pretending.

When I was locked in a psychiatric hospital, I wasn't able to have much of a conversation with my parents about what was going on. Phone calls were tense and filled with silence, and as I stood at the ward payphone I was so confused and frozen in fear that each call just confirmed to them how lost I was. Every day as a patient centered around the various prescriptions I was on, and like so many people suffering in a psychosis, helping me became a wait to "find the right combination of medications."

So here we go again; another meeting with another young person who describes how he is in an acute crisis - you may call it - and is diagnosed and prescribed neuroleptics. He is told by the doctor that he suffers from a life-long illness and he will from now on be dependent on his “medication.” As long as people are met this way I see no alternative than showing that there are alternatives. If that means being "antipsychiatry," then I am more than happy to define myself and our work in that way.