The first week of October is Mental Illness Awareness week in Canada and the organizers, the Canadian Alliance on Mental Illness and Mental Health, are to be congratulated for talking about mental illness rather than mental health problems and mental health issues. These are illnesses and we should recognize them as such rather than watering them down by suggesting they are merely problems and issues. They are problems and issues for those who suffer and their families but they are problems and issues because of the illness.
The five faces of mental illness who have been chosen to represent all who suffer are also to be commended for coming forth.
For mental illness week, I would like to dispel two of the myths of mental illness that are frequently mentioned -- that schizophrenia is not a disease and that medications make schizophrenia worse and/or are not needed.
There are some who say that as there is no simple test for schizophrenia, it is not a disease. However, many illnesses that no one disputes exist do not have simple tests for diagnosis. Diagnoses are based on clinical patterns exhibited by the patient. The diagnostic criteria for differentiating schizophrenia from other conditions is complex. Only after eliminating other causes, observing the patient and ensuring that the symptoms have lasted for at least 30 days and up to six months, is a diagnosis made.
The same procedure applies to fibromyalgia, Parkinson's, Alzheimer's Disease, MS, ALS and others. For none of these diseases is there a definitive test but rather the diagnosis is based upon a careful workup, a battery of tests and a process of elimination. And doctors do sometimes make mistakes but that does not mean that these are not real illnesses. Medicine is still an unsure science practised by a variety of people with different competencies. There is the old joke that is quite true that the student who graduated last from the worst medical school is still called doctor.
One sceptic commented that in the other diseases mentioned, autopsies will reveal the presence of disease but not in schizophrenia as there are no physical markers. Actually, scientists have discovered 51 blood biomarkers of schizophrenia and the Scientific American outlines changes in brain grey matter linked to schizophrenia. And this compilation of studies outlines the differences between those with schizophrenia never treated with medication and those who do not have schizophrenia.
The second myth is that there is no need for or little need for medication. Unfortunately, many forget history. The first antipychotic drug was introduced to the world in the early 1950s. At that time, the vast majority of those with schizophrenia spent their lives in asylums. The psychiatrist who was among the first to test chlorpromazine, the very first antipsychotic, was Dr. Heinz E. Lehmann in Montreal.
"For more than 10 years in my psychiatric work, I had been challenged and frustrated by hundreds of mentally ill patients for whom there were only shock treatments, that were sometimes dangerous and had only limited, temporary effects when they worked. Most mentally ill patients, once hospitalized, would remain confined for the rest of their lives."
As the result of his clinical trials, he was able to state:
"Our clinical results were so unique and surprising that they were almost incredible at that time. For the first time in history, there was now a drug that could suppress hallucinations -- frightening, morbid voices and visions that did not exist in the outside world but were very real to the patients -- and paranoid delusions of persecution."
Another pioneer in the 1950s was Dr. Ruth Kajander in London Ontario. She described treatments that involved immersing people in warm baths and holding them under canvas covers in the belief this would be relaxing for them. Patients were also drugged with morphine and opium and were left so sedated they couldn't eat or drink and in many cases they died.
For the first time, patients could be discharged from hospitals thanks to what some have described as the penicillin of psychiatry. Regrettably, more than the drug is required. While pharmaceutical intervention is the cornerstone of treatment, patients also require community support, cognitive remediation and other forms of psychosocial rehabilitation and that many do not get.
Unfortunately, many doctors are influenced in their prescribing by big pharma and some prescribe drugs inappropriately. Advertising costs for antipsychotics grew from $1.3 billion in 2007 to $2.4 billion in 2010 according to the New York Times even though the number of people with serious mental illnesses for whom these drugs are intended is stable. They are now being given to people with insomnia and anxiety.
As the author, Dr. Richard A. Friedman said in the above article, "antipsychotics can be lifesaving for people who have schizophrenia, bipolar disorder or severe depression. But patients should think twice -- and then some -- before using these drugs to deal with the low-grade unhappiness, anxiety and insomnia that comes with modern life."
Proper treatment for people with serious mental illnesses can do wonders and it is cruel to deny that these illnesses exist. Mental Illness Awareness Week is important to help spread that message.
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Linda Rosenberg: Rooting for Recovery
Further, in the majority of cases, neuroleptic drugs (aka antipsychotics) are not used. The five-year outcomes for O.D. patients are stunningly better than those of conventionally treated patients (see p. 224)
O.D. group vs. Standard treatment group (five-year outcomes)
Mean days in hospital 17 vs. 110
Use of neuroleptics 29% vs. 93%
On disability 14% vs. 62%
At the 5-year follow up, only 17 percent of O.D. treated patients were using neuroleptics! 17 PERCENT! And, 82 PERCENT of O.D. treated patients had NO RESIDUAL PSYCHOTIC SYMPTOMS. This outcome indicates that when it comes to treating psychosis, drugs are usually not necessary to achieve good results.
In another study, “Neuroleptic medication was used in twenty cases and it was subsequently discontinued in four cases, which means that 16 patients (20.8%) continually used neuroleptic medication.” This study concluded with “However, the procedure of the research does not allow any conclusions to be made of the use of neuroleptic medication generally. We can answer the research question by saying that neuroleptic medication seems to be possible to reduce in the treatment of psychotic problems. But we did not have any research on how, for instance, a low dosage of neuroleptic medication at the outset of crisis had effected those cases where severe psychotic problems were present at the two-year follow-up. This question needs further clarification.” This paper can be downloaded here http://www.mindfreedom.org/kb/mental-health-alternatives/finland-open-dialogue/jaako_seikkula_paper.rtf/view
As to your other point that neuroleptics cause changes in the brain, I am not surprised. This is what a neuroscientist with schizophrenia had to say about that (and she takes her meds). http://thetyee.ca/Opinion/2012/07/16/Thanks-for-Medication/
Marvin Ross
I would encourage folks to read this study for themselves, and draw their own conclusions.
Regarding your point that “neuroleptics cause changes in the brain,” my point was that neuroleptic drugs can cause DAMAGE to the brain, in particular atrophy in the prefrontal cortex and increased susceptibility to psychosis due to dopamine super sensitivity. If Erin Hawkes isn’t bothered by drug-induced brain damage and chronic impairment, that’s her choice. Here is what a psychiatrist with a Ph.D. in biochemistry has to say about his own schizophrenia diagnosis (he hasn’t taken his “meds” in more than 30 years). http://www.guardian.co.uk/society/2009/nov/18/mental-health-psychiatric-patients-rights
In a 2003 Open Dialogue nonrandomized, 2-year follow up of first-episode schizophrenia, hospitalization decreased to approximately 19 days; neuroleptic medication was needed in 35% of cases; 82% had no, or only mild, psychotic symptoms remaining; and only 23% were on disability allowance. Medication was still used. See http://www.ncbi.nlm.nih.gov/pubmed/14606203
See Part Two for the rest
Marvin Ross
1.) Real chronic diseases cannot be prevented with talk therapy. Yet that is how schizophrenia is being prevented in Western Lapland. So how can schizophrenia be a neurological disease like Parkinson’s or ALS?
2.) Antipsychotics are not generally used for the treatment of psychosis in Western Lapland. Why should they be considered necessary anywhere? Regarding the treatment of newly psychotic young people, Finnish psychiatrist Viljo Rakkolainen suggests, “Try without antipsychotics. You can treat them better without medication. They become more interactive. They become more themselves.”
We need to bring Open Dialogue Therapy to North America. Not to due so would be cruel, especially since we know that neuroleptic drugs cause brain atrophy http://archpsyc.jamanetwork.com/article.aspx?articleid=211084 and breakthrough psychosis caused by dopamine supersensitivity. http://www.jneurosci.org/content/27/11/2979.full
by-standers has captured the minds of society-- people who prefer a simplistic approach to life's problems. So they are not bothered by the fact that,scientific brain research has unequivocally concluded that schizophrenia and allied disorders, such as manic depression, are biological brain diseases. And the appropriate medication, though certainly no cure, provides some amelioration of the terrible symptoms: hallucinations, delusions, unbearable anxiety, with cruel critical and constant voices in their heads.
Relief for this misery alone should compel compassionate people to understand the need for the medication that helps them to escape from these unbearable symptoms of schizophrenia.
I can only hope and pray that this time I will be able to safely withdraw from them and at least get back to the point where I can actually do something about it. Already tried 4 times but had incompetent doctors have me go way too fast and had terrible withdrawal that gave me the worst headaches that anyone on Earth could endure and made me puke my guts out for weeks.
Here's an analogy for you. The accelerator in the car you are driving is stuck down and you are going 100 mph headed straight for a brick wall. You put the car in neutral and turn the keys to shut off the engine and slam on the brakes, but instead of the engine shutting down and the car stopping, your brake pedal won't push down, the steering wheel locks up and a curtain is pulled over the windshield. You're still going 100 mph into a brick wall, only now you have no choice but to hit the wall or jump out of the car.
Some helpful resources for you. A free downloadable booklet, "The Harm Reduction Guide to Coming Off Psychiatric Drugs" http://theicarusproject.net/alternative-treatments/harm-reduction-guide-to-coming-off-psychiatric-drugs
And here’s an online help site by folks who have gotten off psych drugs. http://survivingantidepressants.org/ Despite the name, they help with all kinds of psych drug tapering, not just antidepressants. Good luck!