Anatomy of an Epidemic (Part Four)

In his book Anatomy of an Epidemic Robert Whitaker talks about best practices from around the world in treating depression and other mental disorders. One of them is from Finland:

The Turku psychiatrists decide on treatment based on case specific, but most important, they settled on group family therapy – of a particularly collaborative type – as the care treatment. Psychiatrists, psychologists, nurses, and others trained in family therapy all served on two- and three-member “psychosis teams”, which would meet regularly with the patient and his or her family. Decisions about the patient’s treatment were made jointly at those meetings. In those sessions, the therapists did not worry about getting the patient’s psychotic symptoms to abate. Instead, they focused the conversation on the patient’s past successes and achievements, with the thought that this would help strengthen his or her “grip on life”. The hope is that they haven’t lost the idea that they can be like others. The patient might also receive individual psychotherapy to help this process along, and eventually the patients would be encouraged to construct a new “self-narrative” for going forward, the patient imagining a future where he or she was integrated into society, rather than isolated from it.

“With the biological conception of psychosis, you can’t see the past achievements” or the future possibilities.

“I would advise case-specific use (of the drugs)”, Rakkolainen said. “Try without antipsychotics. You can treat them better without medication. They become more interactive, They become themselves”. Added Aaltonen: “If you can postpone mediation, that’s important”.

Psychiatrists and psychologist in Western Lapland have a different conception of psychosis. It doesn’t really fit in either biological or psychological category. They believe that psychosis arises from a very frayed social relationships. ”Psychosis does not live in the head. It lives in the in-between of family members and in-between of people”, Salo explained, “It is in the relationship, and the one who is psychotic makes the bad condition visible. He or she “wears the symptoms” and has the burden to carry them”.

Within 24 hours of a call, a meeting with mental health professional, patient and the family members is held. There must be at least two staff members present at the meeting, and preferably three, and this becomes a “team” that ideally will stay together during the patient’s treatment. Everyone goes to that first meeting aware that they “know nothing”, said nurse Mia Kurtti. The job is to promote an open dialog in which everybody’s thoughts can become known, with the family members (and friends) viewed as co-workers.

From the onset, the therapists strive to give both the patient and family a sense of hope. ”the message that we give is that we can manage the crisis. We have experience that people can get better, and we have trust in this kind of possibility”, Alakare said. It may take time for a patient to recover.

Open dialog therapy had drawn the attention of mental health professionals in other European countries. This approach produced good outcomes, “This really happens, it is not just a theory”.

Why does it work? “We like to know what they (doctors) really think, rather than just have them give us advice”, said the parents of the meetings. My own idea is that they value fair process and being recognized and treated as a special individual who is appreciated not as a crowd.

Natural antidepressants:

In Domestic Medicine, Buchan prescribed this pithy remedy for melancholy: “The patient ought to take as much exercise in the open air as he can bear. A plan of this kind, with a strict attention to diet is a much more rational method of cure than confining the patient within doors, and plying him with medicines”.

Two centuries later, British medical authorities rediscovered the wisdom of Buchan advice. In 2004, the National Institute for health and Clinical Excellence, which acts as an advisory panel to the country’s National Health Service, decided that “antidepressants are not recommended for the initial treatment of mind depression, because the risk-benefit ratio is poor.” Instead, physicians should try non-drug alternative and advise “patients of all ages with mild depression of the benefits of following a structured and supervised exercise program”.

Today more than 20 percent of the GPs in the UK prescribe exercise to depressed patients with some frequency, which is four times the percentage who did in 2004.

A “prescription” for exercise typically provides the patient with twenty-four weeks of treatment. An exercise professional assess the patient’s fitness and develops an appropriate “activity plan” with the patient than given discounted or free access to the collaborating YMCA or gym.

Patients work out on exercise machines, swim, and take carious exercise classes. In addition, many exercise-referral plans provide access to “green gyms”. The outdoor activities may involve group walks, outdoor stretching classes, and volunteer environmental work (managing local woodlands, improving footpaths, creating community gardens, etc.)

Throughout the 6 months of treatment, the exercise professional monitors the patient’s health and progress. Patients have found “exercise-on-description” treatment to be quite helpful. They told the Mental Health Foundation that exercise allowed them to “take control of their recovery” and to stop thinking of themselves as “victims” of a disease.

Anatomy of an Epidemic (Part Three)

The question was: Why have we seen such a sharp increase in the number of disabled mentally ill in the United States since the “discovery” of psychotropic medications? At the very least, there is one major cause. In large part, this epidemic is iatrogenic in kind.

Now there may be a number of social factors contributing to the epidemic. Our society may be organized in a way today that leads to a great degree of stress and emotional turmoil. For instance, we may lack the close-knit neighborhood that help people stay well. Relationships are the foundation of human happiness, or so It seems, and as Robert Putnam wrote in 2000, we spend too much time “bowling alone”. We also may watch too much television and get too little exercise, a combination that is known to be a prescription for becoming depressed. The food we eat – more processed foods and so on – might be playing a role too. And the common use of illicit drugs – marijuana, cocaine, and hallucinogens – has clearly contributed to the epidemic. Finally, one a person goes on SSI or SSDI, there is a tremendous financial disincentive to return to work.

As a foster mother, Gately was required to follow “medical advice” and give psychiatric medications to the children who arrived on them. Most of the children were on cocktails, and it seemed to her that the drugs were primarily being used to make the children quieter and easier to manage.

She has kept track of a number of the ninety- six children, and as could be expected, many have struggled as adults. “When I look back on the kids that stayed on the drugs and those who got off, it is the ones that are off that are the successes.” She says. “Liz should never have been on the drugs. She got off the drugs and is doing great. She is a full time student in nursing school and almost ready to graduate, and is about to get married. The thing is, if you get off the drugs, you start building these coping mechanisms. You learn internal controls. You start building these strengths. Most of these kids have had very bad stuff happen to them. But they are able to rise above their past once they are off the medications, and then they can move on. The kids who were drugged and continue to be drugged never have the opportunity to build coping skills. And because they never had that opportunity as a teenager, as an adult they don’t know what to do with themselves”. It isn’t a scientific study, but her experience does offer a peek into the toll that the medicating of foster kids is taking. Most of those who stayed on the drugs, she says, ended up “filing for disability”.

Sam Clayborn from New York tells from personal experience what it is like to have been a foster kid in the US. He was born in Harlem and by age six he was living in a residential group home. He says: “They were not so hot on psychiatric diagnoses back then”, he explains. “They were more into beating your ass, restraining you, and just throwing you into an empty room. I’m glad I grew up when it was like that rather than what it is today, because if I grew up now, I’d be drugged up. I’d be doped out and zonked out”.

Starting around 2000, rates of black youth diagnosed with bipolar disorder soared, and based on hospital discharges, they are now said to suffer from bipolar disorder at a greater rate than whites.

Sometimes children with criminal records get to choose – to go to juvenile prison or mental institution, they choose the latter not knowing that they are damaging themselves.

“The Tuskegee syphilis experiments were nothing compared to this. That’s mild shit compared to what they are doing to black kids today. The pharmaceutical companies and the government are cheating in cahoots, and they are doing a wicked dance with a lot of people’s lives. They don’t give a shit about these kids. It’s all about capitalism, and they will sacrifice all the niggers in the hood. We are damaging these kids for life, and the majority of these kids will never rebound. These kids will be destroyed and they are going to make the SSI rolls more overwhelmed”.

“This is happening to a lot of the brothers today, and once they are on the medication, it take them away from themselves. They lose all the willpower to struggle, to change, to make something out of themselves and have success. They succumb to the chemical handcuffs of the mediations. It’s medical bondage is what it is.”

From the book “Anatomy of an Epidemic” by Robert Whitaker.

Anatomy of an Epidemic (Part Two)

Psychiatry has now three classes of medications it uses to treat affective disorders – antidepressants, mood stabilizers and atypical antipsychotics – but for whatever reason, an even greater number of people are showing up at Depression and Bipolar Support Alliance meetings around the country, telling of their persistent and enduring struggles with depression and mania. Patients get diagnosed with manic-depressive illness, informed that they suffer from a chemical imbalance in the brain, and put on Haldol and Lithium. Then comes a cocktail of drugs to counteroffer the side effects of the first two.

All of this physiology – 100 billion neurons, the 150 trillion synapses, the various neurotransmitter pathways, tell of a brain that is almost infinitely complex. Yet the chemical imbalance theory of mental disorders boiled this complexity down to a simple disease mechanism, one easy to grasp.

Once again this is a story of neurotransmitter pathways that have been transformed by the medications. After several weeks, their feedback loops are partially disabled, the presynaptic neurons are releasing less dopamine than normal, the drug is thwarting dopamine’s effects by blocking D2 receptors, and the postsynaptic neurons have an abnormally high density of these receptors. The drugs do not normalize brain chemistry, but disturb it, sometimes to a degree that could be considered “pathological”. That is how “create perturbations in neurotransmitter functions”. Knock down a “target symptom”.

The drugs ameliorate anxiety for a short period of time and thus they can provide a depressed person much needed relief. However they work by perturbing a neurotransmitter system, and in response, the brain undergoes a compensatory adaptations, and as a result of this change, the person becomes vulnerable to relapse upon drug withdrawal. That difficulty in turn may lead some to take the drugs indefinitely, and these patients are likely to become more anxious, more depressed, and cognitively impaired.

There is a story that psychiatry doesn’t tell, which shows that our societal delusion about the benefits of psychiatric drugs isn’t entirely an innocent one. It had to grossly exaggerate the value of its new drugs, silence critics, and keep the story of poor long-term outcomes hidden. This is a willful conscious process, and the very fact that psychiatry has had to employ such storytelling methods reveals a great deal about the merits of this paradigm of care, much more than a single study ever could.

Writer suggests full disclosure.

The real question is “When and how psychiatric medications should be used?” The drugs may alleviate symptoms over the short term, and there are some people who may stabilize well over the long term on them, and so clearly there is a place for the drugs in psychiatry’s toolbox. However, a “best” use paradigm of care would require psychiatry, NAMI, and the rest of the psychiatric establishment to think about the medications in a scientifically honest way and to speak honestly about them to the public. Psychiatry would have to acknowledge that the biological causes of mental disorders remain unknown. It would have to admit that the drugs, rather than fix chemical imbalances in the brain, perturb the normal functioning of neurotransmitter pathways. It would have to stop hiding the results of long-term studies that reveal that the medications are worsening long-term outcomes.

How can we insist that our society’s mental health system be driven by honest science rather than by a partnership that is constantly seeking to expand the market for psychiatric drugs?

From the book “Anatomy of an Epidemic” by Robert Whitaker.

Anatomy of an Epidemic (Part One)

Melancholy, of course, visits nearly everyone now and then. “I’m a man, and that is reason enough to be miserable.” wrote the Greek poet Menander in the fourth venture B.C., a sentiment that has been echoed by writers and philosophers ever since. In the 17th century tome Anatomy of Melancholy, English physician Robert Burton advised that everyone “feel the smart of it…. It is most absurd and ridiculous for any mortal man to look for a perpetual tenure of happiness in this life”. It was only when such gloomy states became a “habit”, Burton said, that they became a “disease”.

To cure black bile (depression) Hippocrates recommended the administration of mandrake and hellebore, changes in diet and the use of cathartic and emetic herbs.

During the Middle Ages, the deeply melancholic person was seen as possessed by demons. Priests and exorcists would be called upon to drive out the devils. Then with arrival of the Renaissance in the 15th century, the teachings of the Greeks were rediscovered, and physician once again offered medical explanations for persisted melancholy.

Psychiatry’s modern conception of depression has its roots in Emil Kraepelin’s work, which had two major categories, and later three: depressive episode only, manic episode only and episodes of both kinds. In the short span of 40 years, depression had been utterly transformed. Prior to the arrival of the drugs, it had been a fairly rare disorder, and outcomes generally were good. Patients and their families could be reassured that it was unlikely that the emotional problems would turn chronic. It just took time – 6 to 12 months or so – for the patient to recover. Today, the NIMH informs that public that depressive disorders afflict one in 10 Americans every year, that depression is “appearing earlier in life” than it did in the past, and that the long-term outlook for those it strikes is glum.

There was an intellectual challenge to this theory’s legitimacy, an attack launched in 1961 by Thomas Szasz, a psychiatrist at the State University of New York in Syracuse. In the book The Myth of Mental Illness, he argued that psychiatric disorders were not medical in kind, but rather labels applied to people who struggled with “problems in living” or simply behaved in socially deviant ways. Psychiatrists had more in common with ministers and police than they did with physicians. His book helped launch an “antipsychiatry” movement by various academics in the United States and Europe. All questioned the “medical model” of mental disorders and suggested that madness could be a “sane” reaction to the oppressive society. Mental hospitals might better be described as facilities for social control, rather than for healing, a viewpoint popularized in “One Flew Over the Cuckoos’ Nest”, which swept the Oscars in 1975. Jack Nicolson’s character got lobotomized (part of his brain surgically removed) for failing to stay in line.

And finally internal issues: during the 1970s, there was a deep philosophical split between the Freudians and those who embraced a “medical model” of psychiatric disorders. In addition there was a third faction in the field, composed of “social psychiatrists”. This group thought that psychosis and emotional distress often arose from an individual’s conflict with his or her environment. If that was so, altering that environment or creating a supportive new one (ex. Soteria Project) would be a good way to help a person heal. The field had “identity crisis”.

But then they got an idea.

The purpose of DART, the NIMH explained in 1988 was to change public attitudes so that there is greater acceptance of depression as a disorder rather than a weakness. It regularly goes undiagnosed and undertreated. And that it could be a fatal disease if left untreated”. Welcome to the epidemic!

From the book “Anatomy of an Epidemic” by Robert Whitaker.

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