Not another thread on psychiatric medications!

Great Debates
21

The evidence for this is so strong and so generally accepted that the list of cites available would be extremely long. Just looking at my own bookshelf, I can provide you with this:

Schizophrenia and Manic-Depressive Disorder: The Biological Roots of Mental Illness as Revealed by the Landmark Study of Identical Twins, by E. Fuller Torrey et al. From Chapter 4, “Where Does Schizophrenia Originate?”:

“There is probably no researcher currently studying schizophrenia who does not believe that genes play some role in the causation of this disease.”

In the twin studies discussed in the book, 28% of identical twins were concordant for schizophrenia, whereas only 6% of fraternal twins were concordant for the same disorder. This result is statistically very significant.

It almost certainly is a result of both genes and environment in combination. Obviously, if it was all genes, there would be a 100% concordance rate with identical twins. If there was no genetic component, the concordance rate would be similar to that of fraternal twins. Therefore, environment is obviously involved.

There are theories out there about obstetric complications, diseases, being reared by schizophrenic parents, etc., but I don’t have information about that at my disposal right now.

In Surviving Schizophrenia, also by Torrey, there is a study discussed in which the following groups were followed: placebo, placebo plus therapy, drugs alone, and drugs plus therapy. The one year rehospitalization rates were as follows:

Placebo alone: 72%
Placebo plus therapy: 63%
Drugs alone: 33%
Drugs plus therapy: 26%

This, plus other studies discussed in the book, “suggest again that drugs are the single most important element in preventing rehospitalization but that a supportive relationship provides a measure of additional prevention.” The supportive relationship he refers to is with a therapist.

The efficacy of antipsychotic medication, from the same book:

70% clearly improve on antipsychotic medication
25% improve minimally or not at all
5% get worse

These effectiveness rates are similar to those of penicillin against pneumonia or streptomycin in tuberculosis.

22

Thanks for the citations, Q.N. Jones. They’re largely contradicted by what’s on my bookshelf, which is about what I expected. I’ll take a look at them. In the meantime, don’t mistake silence for agreement. :wink:

23

For my personal edification, what would be the justification for the involuntary commitment of someone who is a threat to himself but not to others? I can’t think of any.

24

I’ve known a few people who were involuntarily committed immediately after suicide attempts.

25

I’m interested to hear which part of this stuff is still considered controversial. The evidence for schizophrenia’s basis in genetics plus environment has been widely accepted for many years.

26

I’ll concede that none of it is considered “controversial” by the psychiatric industry; but they have a long and continuing history of being wrong about a lot of stuff so I’m fairly skeptical about pretty much anything they believe.

I’ve been on an anti-psychiatry reading kick lately. I was looking for some insights into my own (largely negative) experiences with psychiatry, which happened when I was an adolescent and were due to depression. A lot of the literature that challenges psychiatry focuses on schizophrenia, because historically that’s where a lot of abuses occured and that’s where a lot of very angry ex-patients come from. What I’ve read so far suggests that, at a minimum, psychiatrists overstate the importance of genetics and neurophysiological problems, understate the importance of environment, and grossly overstate the efficacy of drugs.

I’ve been wanting to take a critical eye towards the pro-psychiatry material, and your two books sound like reasonable places to start.

27

Yes, that’s what I want a justification for.

28

OK, you want the long version. I was giving you the justification a doctor would offer for the psychiatric hold; you want the philosophical and legal justification.

Some people believe that it’s best to step in and stop people who are suffering from a mental illness that impairs their judgment from hurting themselves. The idea being that they’ll get them into treatment, they’ll get better, and they’ll change their mind about wanting to kill themselves.

They justify it legally by saying the following things:

  1. Most people will agree that it’s a good idea to try to keep these people from killing themselves, and to get them help. And that’s how laws get made–the majority of the people (well, their representatives, really) agree that something’s a good idea. As long as it’s constitutional, it flies.

As for the constitutionality part:

  1. It’s only a 48 or a 72 hour hold, so the infringement on personal liberty isn’t that great. (We’re talking about inpatient only in this case. Obviously, this argument doesn’t apply to longterm outpatient commitment.)

  2. These people are incompetent, and there are other procedures in the law to take personal freedom away from people who are incompetent to care for themselves. For example, older people who are senile may be judged unfit and a conservator appointed to manage their finances for them. Also, people who are judged incompetent cannot enter into a binding contract or a legal marriage. Taking rights away from the incompetent goes back to English common law. These laws have existed for a long, long time and have withstood legal challenges. (Excepting the outpatient commitment programs, but this same justification would be applied to them.)

Of course, philosophical objections remain. The other side of the argument is that any infringement on personal liberty is unconstitutional, and that a person should be allowed to kill themselves without interference, even if they are incompetent at the time. While reasonable minds may have this opinion, it appears to be the minority view, and it has been for many hundreds of years when it comes to the issue of personal freedom and incompetence.

29

People have also been involuntarily psychiatrized for making decisions that a shrink considers to be not in that person’s best interest, thereby causing them to constitute a danger to themselves. Example: Arlene Sen was detained, placed on a locked ward, given a diagnosis, and subjected to forced drugging because she expressed misgivings about getting involved with any boyfriend and said her academic career was more important. Example: Laura Ziegler was held for arguing with her parents, and when she argued with the psychiatrist as well, was signed in as an involuntary and told “We’re going to teach you how to be a lady”. Example: Leonard Roy Frank was reported to a shrink by concerned parents when, subsequent to losing a good job in finance, he decided to live off his earnings and read the Talmud, grow a beard, and get in touch with his Jewish roots (he was not raised Orthodox). Example: Huey Freeman was held by the police at the bidding of a dormitory monitor who decided he did not have a “good attitude”, and on this basis commited by a psychiatrist and held until his 2nd (successful) escape. Example: Kate Millett, author of Sexual Politics, was detained and incarcerated in Ireland when word got out that she was not taking psychiatric meds that a US shrink had prescribed for her. Example: Marilyn <Don’t Remember LastName> was involuntarily incarcerated when her husband called a shrink and expressed concerns about her stability due to her having expressed some negative attitudes towards their marriage.

Example: me, goddammit.

30

And, of course, adolescents can be treated involuntarily at the whim of their legal guardians. There’s a diagnosis for any kind of odd or disruptive behaviour.

31

What are the dates for those examples?

What about people like John Hinckley Jr, or Andrea Yates? In Yates case, she chose to stop treatment-with tragic results.

32

A friend of mine got a sex change operation. As she was starting down that road, her sister tried to have her involuntarily committed twice. Fortunately, the sister failed both times.

I think most of us are aware that abuses of the system happen. I don’t condone them or defend them. But all human systems are imperfect. No legal process works perfectly 100% of the time. I know that’s no consolation to the people who have their lives seriously damaged by these mistakes and abuses.

Obviously, the abuses are evidence that the system needs some reform. But it does not constitute a complete argument that we should do away with involuntary commitment entirely.

I know approximately six people who were involuntarily committed after suicide attempts. They’re all glad that they were involuntarily committed. At the time, they didn’t want treatment. But once they were back “in their right minds,” they were glad that they weren’t dead. Their lives aren’t perfect now–almost all of them are still struggling. Nevertheless, they think the system worked just great.

However, I would never argue that their experiences mean that the system is perfect and needs no change whatsoever.

33

Legal guardians can force minors into almost any kind of medical treatment (some exceptions exist surrounding reproductive rights). Are you saying that mental illness should also be an exception? What are your reasons?

34

My mom’s in the biz, and while there ought to be no question that psychotropic medications do in fact relieve the symptoms of depression, sometimes to a phenomenal degree, it’s fair to say psychiatric nosology is pretty much a crock at this point. The DSM-IV is a wonderful compendium of definitions and neatly catagorized syndromes, but its practical importance is rather limited to the clinician trying to treat somebody.

Basically, you give bipolars mood stabilizers, depressives antidepressants, schizophrenics neuroleptics, etc. Unless that doesn’t work. In which case you give them something else. Maybe anything else. Maybe two or three somethine elses at a time. Or ECT. Just keep throwing something at it until it sticks. Maybe the patient just seemed depressive, but is really bipolar. Are there really degrees of bipolarity? Why do mood stabilizers sometimes make good antidepressants? What if your patient looks psychotic, bipolar, and ADHD all at once? Is it good if a drug makes a borderline personality disorder sufferer feel more confident? How do these drugs work, anyway? Why does this OCD sufferer respond to Paxil but not Prozac?

The list goes on and on.

We got the tools. We got smart people who use the tools. But the light’s pretty much out in the workshop, and the practitioners are often fumbling around in the dark. It’s not their fault; it’s just that we really don’t know how to diagnose and treat mental illnesses. We make guesses about syndromes which often overlap or mimic other syndromes, and whose underlying mechanism is almost entirely mysterious. There’s no quantitative measure, no concrete test to apply, no way to predict with any certainty if a drug will work for a particular patient or not. In no other specialty is the practitioner quite so dependant on intuition and experience above all other means of diagnosis. It’s more an art than a science a this point, and that makes no one happy.

But it’s the best we’ve got, presently.

35

Amen.

A really great book on this subject is Of Two Minds by T.M. Luhrmann. She’s an anthropologist who followed psychiatric residents around to see how they were trained and how it affected the way they practiced psychiatry. She followed two different groups–those trained primarily to medicalize the problem, with specific diagnosis and medication, and those who were focused more on therapy. The impact of changes in the insurance system in the United States over the last several decades on how psychiatric treatment is conducted is also discussed. It’s eye-opening, to say the least.

36

Thank you for your earlier reply Q.N. Jones, but I’m quoting this because it’s closer to what I was actually looking for. Where you offered a dry exposition, I was simply looking for your opinion. The legal case for involuntary commitment, I was already familiar with and found philosophically wanting. What I want is for someone to tell me why s/he believes I should not be allowed to kill myself if I so choose (and I would argue it is a legitimate choice). Maybe you don’t believe this, it’s hard to tell. Should I read your quote as a defense for this measure on utilitarian grounds? Are the six people you personally know were saved (and the many more you don’t) worth the occasional abuse in your opinion?

37

For me, it depends on the situation. I definitely believe that there is such a thing as “rational suicide.” This is mostly seen in people with terminal illnesses or chronic, untreatable pain. But it’s also clear that there is such a thing as “irrational suicide,” in which people become incapable of making a rational decision about suicide because of mental illness or some other reason.

I personally don’t think it’s a terrible violation of either type of person’s rights to involuntarily commit them for 48 or 72 hours. If they’re not mentally ill, any medications they’re given are unlikely to alter their fundamental perception of the world (although they may be sedating or have other unpleasant side effects). They can go home, quit taking the meds, and kill themselves if they like. But, for a lot of people, that intervention will change their minds about suicide altogether, and help them realize that they have lots of reasons to live and the potential to be happy again in the future.

I am not a fan of longterm outpatient commitment. I think that should be an option only for patients who are demonstrated to be a harm to others.

Worth the abuses discussed by AHunter3? No. But I think it’s possible to rid the system of those sorts of egregious abuses without dumping the short-term inpatient involuntary commitment system altogether. I think the statutes could stand to be more specific as to what qualifies as a “significant harm to self.” I think this should be limited to suicide and serious bodily harm with a significant risk of permanent physical damage or death.

38

AHunter3, I’m going to post this first and then go back to read, which is probably never wise. Those of us who have found relief through psychiatry and medication are not always blind to problems that exist and we do acknowledge them from time to time. How quickly you forget! :wink:

This is from the other thread. (Maybe I should have been more specific, but you had just explained in detail some of the things you distrust about psychiatry.):

Originally posted by me:

BTW, I was held against my will once even though I was supposed to be there on a “voluntary” committment. This was after I had been misdiagnosed by a really bad shrink who put me on the wrong meds. (Imagine stellazine, melarill, trofanill, and lots of thorazine for depression!) My insurance coverage ran out and so my parents placed me in a state hospital to keep me for killing myself. (They shouldn’t have worried. I didn’t have the sense to.) The admitting doctor did not even interview me. I was there for several days and did not see him at all until I convinced my parents (who kept hanging up on me) to come and get me. As I was being discharged, the psychiatrist talked to me for the second time to tell me that I was just spoiled. That was almost forty years ago. The thought of it still turns me cold and makes me shake.

But there is nothing that anyone can say that will make me believe that the psychiatrist that has treated me for the last sixteen years is dark and sinister. He is gifted and knowledgeable and works hard at what he does. Although he is unusual, I don’t think that those qualities are in a psychiatrist.

I don’t fault the “scientist” for the fledgling “science.”

I’m going back to catch up now.

39

Zoe:

Mea culpa. Zoe. You are entirely correct :slight_smile: And yes I did very much appreciate that & should’ve searched it up and cited it as an example!

40

The “right to commit suicide” thing has come up internally in the mental patiets’ rights movement. Judi Chamberlin once said, at a conference, “OK, yes, you have the right to commit suicide, but you do not have the right to commit suicide in my living room.”

People, individually, and society as a whole, have the right to intervene, but it is not intrinsically or properly a right without limitations, IMHO. I don’t think the fact that someone has attempted suicide should be allowed to constitute prima facie evidence that that person is incompetent or mentally ill. Danger to self, yes.

Danger to self in the sense of intentional suicide should be allowed IMHO if the person in question is clear and rational about their reasons and continues to maintain the intention beyond a stipulated waiting period to establish that it’s not a passing whimsy. I don’t think it should be limited to terminal illnesses, etc. If a rational person simply feels that 21st Century earth is unfit for human habitation and would consistently rather be dead, it’s ultimately their call to make. It’s cruel to make life a life sentence!

Guinastasia:

Those are old examples. I have plenty of current-day examples but the names, and the varying status of the relevant privacy issues, don’t roll from the top of my head as easily. As long as there are no genuine checks and balances preventing them from imposing psych incarceration and forced treatment w/o having to meet a disinterested 3rd party’s standard evaluation of fairness, it’s not going to stop.

If nothing else, fear of lawsuits tends to outweigh reasonble respect for our self-determination. That and a misplaced confidence in the wisdom of the Holy Doctors and a begging-the-question tendency to think “But we can’t give the patient’s perspective very much weight here, after all the patient is by definition nutso!”