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Antipsychotics Aren't the Anti-Hero

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I find it amazing that so many people accept the anti-psychiatry views of a medical journalist about medication and schizophrenia. I'm referring to Robert Whitaker whose book, The Anatomy of an Epidemic, is considered the bible for so many when much of his science and knowledge of the history of mental illness treatment is wrong.

Dr. E. Fuller Torrey, a psychiatrist and director of the Stanley Medical Research Institute that funds and conducts research into schizophrenia, recently reviewed Whitaker's conclusions and described them as "The Anatomy of a Non-Epidemic: How Robert Whitaker Got It Wrong."

Whitaker's main conclusion is that antipsychotic medications are bad. He argues that the outcomes for schizophrenia recovery rates have worsened with the introduction of medication. To demonstrate this, he cites a World Health Organization study. The problem is that the definition used for schizophrenia has tightened. Previously, acute psychotic episodes were included with schizophrenia but that is not schizophrenia. It is not unusual for someone to have an acute episode and then to never have another one. Today, schizophrenia-like symptoms have to exist for at least six months for someone to be diagnosed as schizophrenic.

If the acute non-schizophrenic episodes are called schizophrenia, then outcomes will be better. If the diagnosis of schizophrenia is limited to only those with true schizophrenia, the outcomes will be worse. And that is what has happened. Whitaker is comparing apples to oranges.

He also states that the outcomes are better in developing countries compared to developed countries. But, the two studies he cites were highly criticized when they were first published as they did not include only true schizophrenia for the developing countries as in the example above. More recent studies suggest that mortality was worse amongst the sickest patients in the developing countries. They died off, so the outcomes looked better.

China, a developing country, just announced that they are planning to establish a treatment network for serious mental illness to cover 95 per cent of the country by 2015. The news report states "the country has 16 million people suffering from schizophrenia and other severe mental diseases, and services and treatments for them are inadequate." If Whitaker is correct, they should already be doing well.

And, in India, over 60 per cent of people suffering from mental illness do not seek help and the entire family of the mentally ill suffer because of the prejudices against them.

Colonial times could be equated to a developing world and this is a description of treatment:

"By the 18th century, the religious fervour in Europe and colonial North America had given way somewhat to the rational humanitarian thought attributed to the Age of Enlightenment. The mentally ill were no longer persecuted as witches yet their situation was little improved. Although more asylums were beginning to spring up even in the American colonies, most of the inflicted were cared for by family, left to wander on their own or confined to gaols and poorhouses where the living conditions were wretched. Even those confined to asylums were kept shackled in chains or other mechanical restraint. The treatment of mental illness, which varied from asylum to asylum, consisted of duckings, beatings, chairs which twirled until the patient lost consciousness, bleedings, leechings and the administrations of purgatives and emetics."

The situation in Africa and Asia was no different. And, because of our policies of deinstitutionalization, we have gone back to those days. On any given day in the United States, Canada and many other industrialized nations, there are tens of thousands or more people with untreated schizophrenia living in shelters, parks, under bridges, in jail and on the streets. They are without medication and are sick and delusional. There are even thousands living in the tunnels under New York City and Grand Central Station.

Whitaker also claims that antipsychotic medication causes brain damage and is responsible for many of the symptoms attributed to schizophrenia. He cites the Vermont Outcomes Study which followed 168 patients for 20 years. Many in that study were able to go off medications but the average age of the patients in that study was 61. It is a well known fact, says Torrey, that as people with schizophrenia age, the need for medication declines. Another feature of the study was that the clinician personally followed up with his patients for years. The lesson, Torrey says, is that continuity of care and of a caregiver, is necessary for positive outcomes. Patients did well because they were older and they received continual care from one provider.

A recent review of the medical literature on the question of medications causing changes in brain structure stated:

"The findings that antipsychotic drugs produce structural brain changes should not be a surprise. Schizophrenia and bipolar disorder are known to produce structural brain changes as part of the disease process, so it is reasonable to expect drugs that are effective in treating these diseases to do likewise. Some opponents of the use of antipsychotic medication misunderstand such research, arguing that brain changes prove that antipsychotic drugs are dangerous and should not be used. On the contrary, this research is very important and may eventually lead to better and more effective medications."

Whitaker goes so far as to hypothesize (p. 214) that antipsychotic medication might even cause cancer. But, a recent study suggests that an antipsychotic appears to have an unusual property -- it can neutralize some cancer stem cells that allow tumours to come back after treatment. Further, it is known that people with schizophrenia have a reduced incidence of cancer despite a cancer-inducing lifestyle like increased percentages who smoke. So much for Whitaker's belief!

Another study that Whitaker cites was done by a Finnish psychoanalyst and began in 1969. The analyst used a combination of psychoanalysis and group family therapy. Whitaker claims that schizophrenia has now disappeared from this northern region of Finland. But, as Torrey points out, there are almost no publications describing the results of this study and it has never been replicated. Replicating studies is a foundation of scientific research.

A very recent study done by the prestigious medical journal, The Lancet, just concluded that after 50 years of antipsychotic medication use, the benefit of these drugs has been proven.

And, all of us with a relative with schizophrenia can attest to this fact. We have all seen the transformation when the right medication at the right dose is prescribed. It is a miracle and a vast improvement on the treatments used from the Stone Age and on!