Posted by med_empowered on February 22, 2005, at 15:59:32
Hey! I posted the article on Seroquel because I'm writing a paper about the treatment/mistreatment of the "mentally ill" in the United States, and my take on the ethics (or lack thereof) of such issues as forced hospitalization and forced treatment. Here's the deal: when I started the paper, I had a slight suspicion something was amiss in all of psychiatry, especially when it comes to dealing with more severe mental illnesses. I knew that "mental illnesses" are found in higher rates among minorities and the poor, and that psychiatry also had a long history of sexism and homophobia. The more research I did, the more troubled I became until I reached the point I'm at now, the point at I realized that modern psychiatry is, for whatever reason, misleading the public and mistreating the troubled. Take our popular conception that "mental illness is an physical illness," for instance. We've all heard it, especially on this board--illness "x" is caused by an imbalance in the brain, and treatment(s) are available that correct it. Fact? Nope. No study has been able to pinpoint reliable, consistent differences between the brains of "normals" and "sick" individuals. This is true of all illnesses, but is important to keep in mind when dealing with severe mental illnesses, such as schizophrenia, since these illnesses often result in forced treatment or voluntary treatment with relatively dangerous "medicines". Since I'm talking about schizophrenia, I'll share what I've learned about it. Since schizophrenia became a diagnosis about 100 years ago, scientists of all sorts have done all kinds of research to find its "biological roots". We're talking: autopsies, blood tests, hair tests, brain scans, psychosurgery (LOBOTOMY), dialysis (not a typo; REALLY. NIMH funded research using dialysis on schizophrenics) and the use of numerous medications/drugs on schizophrenics. The only times differences between the brains of schizophrenics and "normal" people have been found are when: the mental illness was in fact due to a physical disease (encephelitis lethargica) that caused incredible brain damage AND when the treatments for the "illness" caused noticeable brain damage. That's it. In addition, the idea that schizophrenia must be a "biological illness" because neuroleptics can effectively "treat" it is fundamentally flawed. Here's some background on Thorazine, for instance: in the 1930's, phenothiazines (chemicals that would later yield Thorazine, Mellaril, and some other neuroleptics) were being used in the United States as a pesticide. While doing research on the toxicity of these chemicals, scientists found that they caused a reduction in activity among rats without inducing noticeable sedation. Fast forward to the 1950s: doctors needed a drug, or drugs, that could prep patients for minor surgical procedures without exposing them to the risks associated with full anesthesia--risks such as shock, for instance. Smith, Kline and French had an experimental drug they thought could do this that asked a French doctor to use on his patients. He loved it. The drug seemed to make his patients enjoy a sense of calm that approached apathy- not only did the upcoming minor surgical procedure not bother them, nothing at all seemed to. He decided to get more of the drug, and use it on institutionalized patients at a mental hospital...remember, the protection of human subjects wasn't such a big deal at this time, especially in psychiatry (lobotomies were still going on, after all). The shrinks loved it...but, contrary to popular belief, they didn't love it because it "cured" or "treated" illness; they liked it because it kept the patients calm and quiet, and therefore made them manageable. Early researchers compared this compound, which would be marketed as THORAZINE, to lobotomy. The drug company saw a huge oppurtunity...Thorazine was quickly approved by the FDA for treatment of nausea (its still used for this in some people) and then the drug company gave it a big makeover. Instead of being viewed as a "chemical lobotomy," the drug's makers pushed it as a "therapy" and a way to keep desperate patients out of the hospital, or bring them home if they were in the hospital. And soon, it wasn't just for schizophrenics anymore. Thorazine and the flurry of other neuroleptics ("antipsychotics") were also used for: "psychoneuroses," "senile agitation," aggressive behavior in children and teenagers, and they were also widely used in adult prisons, juvenile prisons, and in some countries (namely the USSR and China) as a form of social control...they were given to radicals and dissidents in massive doses. Sales took off...thorazine and other neuroleptics (again, the term "antipsychotics" is one developed by and for the drug industry.) were incredibly popular medications, despite the evidence of some serious problems. In 1957, the first known reports of what would later be called "tardive dyskinesia" appeared in the professional literature. Although European doctors seem to have responded by using smaller doses of the new drugs, American and British doctors not only used the higher doses found in the medical literature of the time, but they also EXCEEDED these dosage levels, sometimes giving patients many times the levels found in peer-reviewed journals. In the early 1960's, the first reports of what would become known as "neuroleptic malignancy syndrome" appeared in the professional literature. Although deaths had been reported prior to this, the connection between the new neuroletpics and resulting deaths had not been made; now, many psychiatrists saw a correlation. Still, American shrinks prescribed mad doses of the drugs, and the FDA didn't require a warning about Tardive dyskinesia or neuroleptic malignancy syndrome to be put on the label of the neuroleptics until 1968. American doctors, it appears, considered this a minor problem, though nurses and orderlies who worked closely with hospitalized patients seem to have been acutely aware of what was now known as "the Thorazine shuffe". In the 1970s, a few American psychiatrists published reports in which they expressed concern that tardive dyskinesia was a)affecting many long-time patients and b)not receiving adequate notice. Most shrinks ignored this until after U.S. Senate hearings were held in the mid-1970s exploring the ill-effects of the neuroleptics, and law makers expressed concern of the "misuse" of neuroleptics in those who were not mentally ill (note that, apparently, it was still ok to expose "schizophrenics" to these risks). Around that time, psychiatric "survivor" groups, still regarded as a deranged nuisance by many psychiatrists (read Surviving Schizophrenia by E. ALfred Torrey for more on this...he hates these people) started a)pressuring law makers for investigations and reform and b) suing negligent shrinks. Suddenly, all of psychiatry was interested--in large part because of costly litigation. In 1980, the American Psychiatric Association organized the first "task force" on tardive dyskinesia. If you're still reading this, this task force was formed a full 23 years after the tardive dyskinesia appeared in the literature. Their findings: TD afflicts women more often than men, and the elerly more often than younger patients; elderly women seem to be at a high risk. About 5% of patients will develop TD per year of exposure to neuroleptics, and around 20% will develop TD (note: many people, even many psychiatrists, have pointed out flaws in the data, such as the under-reporting of TD, especially milder cases. Better studies suggest old antipsychotics will cause TD in at least 20%, with the estimated total being more along the lines of 40%). Despite the risks, it seems that psychiatrists still touted their drugs as safe+effective; indeed, to cite Dr. E. Alfred Torrey again (I cite him b/c he is the self-declared schizophrenia and bi-polar "expert" and a "patient's advocate"), "antipsychotics are some of the safest, most effective drugs available". Torrey also notes that tardive dyskinesia isn't such a problem, after all-- he points out that many patients appear "unaware of their symptoms" (though apparently he and other observers ARE aware) and also points out that INCREASING THE DOSE OF THE NEUROLEPTIC can suppress symptoms. This is true; since neuroleptics tend to reduce ALL motor activity, periodic increases in dosage will suppress the abnormal movements of TD, at least for a while. Flash-forward to today. It is estimated that at least 100,000 people have died from neuroletpic malignancy syndrome worldwide. The new "atypical" antipsychotics which were first hailed for their ability to treat "the negative symptoms of schizophrenia" are now thought to be superior only in tolerability, at least according to the published reports I've read. Lawsuits have already been filed about tardive dyskinesia from these drugs--especially Risperdal. Reports have emerged that even these drugs can cause the dreaded neuroleptic malignancy syndrome, so even the new drugs carry an FDA-mandated warning about tardive dyskinesia and NMS. In addition, the rights the "mentally ill" gained in the 1970s are being lost. In light of "expert testimony" emphasizing the value and low side-effects of the new drugs, many courts have authorized the forced "treatment" of unwilling patients. Many states now allow for the forced hospitalization not only of patients deemed "a risk to themselves and/or others" or "unable to care for themselves," but also of patients deemed "at risk of relapse or deterioration". The mentally ill in these states are also often subject to "outpatient involuntary commitment," in which failure to adhere to provided "treatment" can and will result in hospitalization. This means that millions, one day, possibly billions, of US tax dollars are being used to: build "hospitals" for those who don't want to be "treated"; pay psychiatrists who enforce "treatment"; buy neuroleptics and other drugs that can be forced upon those who don't want them and, finally, to defend this system against lawsuits and legal challenges. Forced hospitalization is supposedly a "therapeutic" measure, but think about it: people who don't want treatment are being forcibly treated--injected with drugs, given electro shock-- against their wishes. The hearings are usually held in closed court and the results are often sealed. Patients in many states are denied the right to sue for monetary damages if they feel their rights have been violated. By comparison, criminal proceedings--even against those who have CONFESSED TO THEIR CRIMES-- are held in the open. Many people who are found guilty don't even go to jail or prison, and in fact, have few restraints upon their freedom--parole/probation is increasingly popular for some crimes, especially drug related crimes, and remains a viable option even for some violent crimes, such as domestic violence. These are people who have been found GUILTY of CRIMES in accordance with applicable laws and the constitution. Increasinly, as cases of wrongly convicted/imprisoned people comes to light, those who are able to prove they were wrongly imprisoned/convicted are able to pursue legal action against the state or federal government to rectify the wrongs. It is not so with mental patients.
poster:med_empowered
thread:461854
URL: http://www.dr-bob.org/babble/20050222/msgs/461854.html