Anatomy of an Epidemic (53 page)
Read Anatomy of an Epidemic Online
Authors: Robert Whitaker
In 2002, Gottstein founded a non-profit organization, Psych-Rights, and the first thing that it did was mount a “public information” campaign. PsychRights brought various people to Anchorage to speak to judges, lawyers, psychiatrists, and the general public about the outcomes literature for antipsychotics.
*
Gottstein believed that this would provide a foundation for a lawsuit challenging the state’s right to medicate patients forcibly, and for lobbying the Mental Health Trust Authority to fund a Soteria-like home, where psychotic patients who didn’t want to take neuroleptics could get help.
“The public opinion is that the meds work, and that if people weren’t crazy, they would know that the drugs are good for them,” Gottstein said. “But if we can get judges and lawyers to understand that it’s not necessarily good for the person and potentially very harmful, they would tend to honor a person’s legal right to refuse treatment. In the same vein, if the public knew that there are other non-drug approaches like Soteria that work better, they would support alternatives, right?”
State case laws governing the forced treatment of psychiatric patients date back to the late 1970s. Although state supreme courts typically ruled that patients have a right to refuse treatment (in non-emergency situations), they nevertheless noted that antipsychotics were understood to be “a medically sound treatment of mental disease,” and thus hospitals could apply to a court to sanction forced treatment. At such hearings, hospitals regularly argue that no competent person would refuse “medically sound treatment,” and thus courts consistently order patients to be medicated.
27
But in 2003, Gottstein initiated a forced-drugging lawsuit on behalf of a woman named Faith Myers, and he put the medication on trial, arguing that the state could not show that it was in her best medical interest to take an antipsychotic. He got Loren Mosher and a second psychiatrist who knows the outcomes literature well, Grace Jackson, to serve as his expert witnesses, and he also filed copies of the many research studies that tell of how neuroleptics can worsen long-term outcomes.
Having become versed in the scientific literature, the Alaska Supreme Court gave PsychRights a stunning legal victory in 2006. “Psychotropic medication can have profound and lasting negative effects on a patient’s mind and body,” the court wrote. These drugs “are known to cause a number of potentially devastating side effects.” As such, it ruled in
Myers v. Alaska Psychiatric Institute
that a psychiatric patient could be forcibly medicated only if a court “expressly finds by clear and convincing evidence that the proposed treatment is in the patient’s best interest and that no less intrusive alternative is available.”
28
In Alaska case law, antipsychotics are no longer viewed as treatment that will necessarily help psychotic people.
In 2004, Gottstein launched an effort to get the Mental Health Trust Authority to fund a Soteria home in Anchorage, which would offer psychotic patients the type of care that Loren Mosher’s Soteria
Project did in the 1970s. Once again, he relied on the persuasive powers of the scientific literature to carry his argument, and in the summer of 2009, a seven-bedroom Soteria home opened a few miles south of downtown. The director of the project, Susan Musante, formerly led a psychiatric rehabilitation program at the University of New Mexico Mental Health Center; the consulting psychiatrist, Aron Wolf, is a well-respected figure in Alaskan psychiatry.
“We want to work with younger people who have been on psychiatric medications for only a short time, and by getting them off the meds and helping them get better, we hope to keep them from going down the path of chronic illness,” Musante said. “Our expectation is that people will recover. We expect them to go to work or to school, to return to age-appropriate behavior. We are here to help them to dream again and to pursue those dreams. We are not set up to funnel them onto SSI or SSDI.”
29
Gottstein now has his sights set on a legal challenge national in scope. He has been filing lawsuits that challenge the medicating of foster children and poor children in Alaska (the poor are covered by Medicaid), and ultimately he hopes to take one of these cases to the U.S. Supreme Court. He sees this as a 14th Amendment issue, with the children being deprived of their liberty without due process of law. At the heart of any such case would be a scientific question: Are the foster children being treated with medications that help, or are they being treated with tranquilizing drugs that cause long-term harm?
“I analogize it to
Brown v. Board of Education
,” Gottstein said. “Before that decision, there was widespread acceptance in the United States that segregation is OK. The Supreme Court had previously said that segregation was OK. But then in
Brown v. Board of Education
, the court said it wasn’t OK, and that really changed public opinion. Today you can’t get anyone to say segregation is OK. And that’s how I visualize this whole effort.”
As a society, we put our trust in the medical profession to develop the best possible clinical care for diseases and ailments of all types. We expect that the profession will be honest with us as it goes about this task. And yet, as we look for ways to stem the epidemic of disabling mental illness that has erupted in this country, we cannot trust psychiatry, as a profession, to fulfill that responsibility.
For the past twenty-five years, the psychiatric establishment has told us a false story. It told us that schizophrenia, depression, and bipolar illness are known to be brain diseases, even though—as the MindFreedom hunger strike revealed—it can’t direct us to any scientific studies that document this claim. It told us that psychiatric medications fix chemical imbalances in the brain, even though decades of research failed to find this to be so. It told us that Prozac and the other second-generation psychotropics were much better and safer than the first-generation drugs, even though the clinical studies had shown no such thing. Most important of all, the psychiatric establishment failed to tell us that the drugs worsen long-term outcomes.
If psychiatry had been honest with us, the epidemic could have been curbed long ago. The long-term outcomes would have been publicized and discussed, and that would have set off societal alarms. Instead, psychiatry told stories that protected the image of its drugs, and that storytelling has led to harm done on a grand and terrible scale. Four million American adults under sixty-five years old are on SSI or SSDI today because they are disabled by mental illness. One in every fifteen young adults (eighteen to twenty-six years old) is “functionally impaired” by mental illness. Some 250 children and adolescents are added to the SSI rolls daily because of mental illness. The numbers are staggering, and still the epidemic-making machinery rolls on, with two-year-olds in our country now being “treated” for bipolar illness.
As I noted earlier in this chapter, I believe the MindFreedom Six showed what must be done if we are going to halt this epidemic. We need to become informed about the long-term outcomes literature
reviewed in this book, and then we need to ask the NIMH, NAMI, the APA, and all those who prescribe the medications to address the many questions raised by that literature. In other words, we need to have an honest scientific discussion. We need to talk about what is truly known about the biology of mental disorders, about what the drugs actually do, and about how the drugs increase the risk that people will become chronically ill. If we could have that discussion, then change surely would follow. Our society would embrace and promote alternative forms of non-drug care. Physicians would prescribe the medications in a much more limited, cautious manner. We would stop putting foster children on heavy-duty cocktails and pretending that it was medical care. In short, our societal delusion about a “psychopharmacology” revolution could at last fade away, and good science could illuminate the path to a much better future.
*
In the interest of full disclosure, I was one of the speakers at several of those events.
“Few dare to announce unwelcome truth.”
—
EDWIN PERCY WHIPPLE (1866)
1
This book tells a history of science that leads readers to a socially awkward place. Our society believes that psychiatric medications have led to a “revolutionary” advance in the treatment of mental disorders, and yet these pages tell of a drug-induced epidemic of disabling mental illness. Society sees the beautiful woman, and this book directs the reader’s gaze to the old woman. It’s never easy to hold a belief that is out of sync with what the rest of society believes, and in this instance, it’s particularly difficult because the story of progress is told by figures of scientific authority—the APA, the NIMH, and psychiatrists at prestigious universities such as Harvard Medical School. Disagree with the common wisdom on this topic, and it seems that you must be a card-carrying member of the flat-Earth society.
But for those readers still wondering about the history told here, I offer one last story. You can read it and decide for yourself whether you are now, metaphorically speaking, in the flat-Earth camp.
After I interviewed Jaakko Seikkula at the University of Jyväskylä, he asked me to give a short talk on the history of antipsychotics to a few of his colleagues. Now, Seikkula and others at Keropudas Hospital in Tornio did not decide to use antipsychotics
in a selective manner because they thought that the drugs
worsened
psychotic symptoms over the long term. Instead, they observed that many people did better when off them. Thus, when I spoke to Seikkula’s colleagues at the University of Jyväskylä, this notion that antipsychotics can make people chronically ill was something they hadn’t thought much about before, and at the end of my talk, one of the members of our circle asked if this could be true of antidepressants, too. He and others had been researching the long-term outcomes of depressed patients in Finland, and charting too whether they had used the drugs, and they had been startled by their results.
So, dear readers, ask yourself this: What do you think they found? And are you surprised?
To read many of the source documents listed here, go to
madinamerica.com
or
robertwhitaker.org
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10.
Silverman,
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11.
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31.
Smith,
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32.
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38.
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42.
Swazey,
Chlorpromazine in Psychiatry
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43.
Ibid, 8.
44.
Ayd,
Discoveries in Biological Psychiatry
, 215–16.
45.
Ibid, 127.
46.
Ibid, 195.
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16.
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J. Martinot, “Striatal D
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26.
P. Deniker, “The neuroleptics: a historical survey,”
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27.
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P. Deniker, “The neuroleptics: a historical survey,”
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D. Healy,
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32.
E. Valenstein,
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