Consent to Waltz, Capacity to Tango, Connect to.. using statin and antihypertensive examples shows how we on one side and our doctors on the other can get blindsided by treatment and end up incapacitated.
These difficulties are magnified with psychotropic drugs, where the availability of a mental illness on which everything can be blamed makes it almost too easy to default into blaming the illness.
Decades back, a real neurological disorder – Anosognosia – got repurposed. The real disorder is rare and involves a lack of insight tied to visible brain scan lesions. Given mental illness, supposedly causes a lack of insight, this was a concept begging to be repurposed.
Your insight that treatment has caused a neuroleptic induced deficit syndrome (NIDS) was rediagnosed as negative schizophrenia. Your argument to the contrary that it was your drugs proved your lack of insight.
Any refusal to continue meds that you were right to think were harming you led to threats of or actual compulsory detentions, or threats that your children would be removed from you unless you took your drugs. You can express a point of view but no-one listens.
Anosognosia is less commonly heard now, but not because it’s inappropriate use has been recognised or medics have become any wiser. They have a new toy. Functional Neurological Disorder (FND). They dismiss you, blithely saying the range of problems you claim you have could never be caused by any known medical disorder – ignoring that this diverse range of problems is almost a cardinal feature of drug-induced toxicity.
They label you as FND (hysterical). A mention of FND in your medical record is a one-way ticket to never being taken seriously again.
Anosognosia is a real condition and there may be real instances of a real disorder that is both neurological and functional, but until the ‘FND community’ make it clear that ruling out drug toxicity is an absolutely required first criterion for an FND diagnosis, they are likely to have a lot of sensible people resolutely lined up against their lack of insight.
We can expect a lot of FND from our dance partners at the moment – See Capacity to Waltz, but on our side also instead of dancing as fluently as we might normally do, on meds our ability to read cues and get the dance steps right can cease to function.
Gripped by and Discarded by GlaxoSmithKline gives a gripping example of this. Shane Cooke, a wonderfully normal, mild-mannered, young man, given paroxetine for normal stress he would almost certainly have managed without paroxetine, after starting began to hear a voice and to have rage attacks and ended up driving his car through the front door of a mental health unit. He didn’t, and his family didn’t and his partner didn’t figure the drug was to blame and everything would be fine if he just stopped.
Unfortunately neither the medical nor legal system realised paroxetine was to blame and as a result Shane spent over a year in jail and all his previous life plans went out the window.
If we avail of an SSRI in the short term to manage a crisis, it may cause dramatic toxic reactions like Shane’s. When we almost equally dramatically return to normal on stopping the drug, this should lead to a Not Guilty by Reason of Toxicity verdict – but doesn’t.
Without a dramatic reaction like Shane’s, avoiding a Not Guilty verdict can be even harder.
Even with a dramatic reaction, a brief course of an SSRI to manage anxiety or stress doesn’t usually fundamentally change us. But using an SSRI to block anxiety for longer than that can and perhaps almost always does change us at least while we remain on treatment – which can be for decades.
From the first few days on an SSRI, patients used to looking at these things can see change in the body language and personality of doctors or nurses who take an SSRI – these are things that healthcare staff can’t see in their patients because they are no longer looking – See Good Trips on SSRIs or I Come to Praise SSRIs not to Bury Them.
You can learn to spot it too but first you have to realise things can be spotted and you have to start looking. Rosie Meysenberg created SSRI stories because of the obvious personality changes these drugs produced – See The Story of SSRI Stories (We hope to resurrect this soon).
When SSRIs mute our sense of the effect alcohol is having on us we can slip into an alcohol use disorder. When SSRIs mute our emotions we can progressively slip further into doing things carelessly, into doing things we would never normally do, and we can end up paying a life-changing price.
Notes on a Scandal gives a dramatic example of this – women, like school-teachers, taking sexual advantage of teenage boys. There may not be a complete change of personality here. The woman may not be driven by libido so much as driven by an absense of libido and a desperate attempt to feel.
After the crime, we can be left bewildered as to how things happened that we could never have imagined ourselves doing, unable to explain how Jekyll became Hyde.
As someone who took an SSRI for a temporary blip put it after a bitter learning experience – I now know I could have coped back then. I didn’t need those drugs, certainly not for as long as I was left on them. In a crisis, I now learn I have, or I develop, the ability to cope. If I was still on the pills, I would never have coped with what I have to cope with now. Anxiety like Pain is important.
Male and Female It Created Them
There are several ways SSRIs can lead to homicides. There are toxic rage episodes like Shane’s. There is the emotional blunting SSRIs can cause, in some more than in others, so that they watch the beheadings video’ed by ISIS a decade ago, or engage in masochistic sexual encounters – in order to feel.
Something else can also happen.
Nearly a century and a half ago, Nietzsche figured we had killed God. Freud joined him soon after writing about The Future of an Illusion. Both were embracing the idea that evolution (It) was the primary mechanism driving our behavior rather some divine spark from a God (Him) or gods (hims and hers). In the absence of Guidelines from above, could we down below tell right from wrong?
It (evolution) created sexes. Before sex, it had created senses and serotonin.
Women were the semi-invisible sex to Nietzsche and Freud. For millennia, many men weren’t certain women had souls, and possibly didn’t get to ‘Heaven’ other than perhaps as virgins to reward martyrs and were a man’s property or slaves who bore children.
Successful men (the new demi-gods) got places because they were favored by the gods (luck) but thought it was down to their own determined self-interest – just like Jason of Argonaut fame – and that God favored them because they were self-interested. The Protestant ethic enshrined this idea.
Medea
Women had disturbingly killed their children in the past. The most infamous of these was Medea who supposedly as a revenge on Jason killed their children. Rather than infamy, Euripides made Medea the Lead in a Tragedy. The leads in Greek Tragedy are extremists who go against the conventions – not quite the same thing as a hero. But it’s difficult to think Euripides was not on Medea’s side.
While still locating the story in pre-Trojan Greece, Natalie Haynes’ recent No Friend to This House brings Medea into the 21st century. Spoiler alert – Jason not Medea is the No Friend. But it will take more than Euripides and Haynes to change the Medea narrative – the revenge on a faithless husband by killing his sons. The revenge narrative is what a prosecutor used to convict Marilyn Lemak – See Trial and Punishment. It’s a narrative that people ‘can buy’.
This narrative may occasionally be correct but Marilyn showed no signs that something like this might happen before going on an SSRI. She did show the subtle signs of being on an SSRI – not the rage or desperate attempts to feel again – but subtle signs that are consistent with what can happen to many of us when put in a sensory deprivation tank.
The constant stream of sensory inputs we get from our bodily senses create a flickering set of images and emotions that gate control most of our behavior. Some of these can be alarming and out of character but they get pushed to one side by the incoming sensory torrent.
The flood of new information slows down to a trickle or can stop when we are in a sensory deprivation tank – or on an SSRI – and Marilyn was on a crazily high dose of an SSRI – like a slowly boiled lobster.
This creates conditions where one image can come to dominate – or even become a voice seeming to command a course of action – a command hallucination as Lindsay Clancy may have had. We become like a boat that has lost its stabilizers – much more likely to turn over in the face of an outsized wave.
This is also what happens in hypnosis. Doing as we are told and focussing on one thing, ignoring everything else, can put some people who are good at doing as they are told into a trance.
Interviewed after she had killed her children and asked why, many of these women, including Marilyn, respond in a way that sounds like hypnosis. They seem to have been compelled to take a path that opens up even though they had no idea why they were taking it and after the event cannot understand what happened. Unlike Medea, the path for most of these women usually involved an attempt to kill themselves but one of the few things women are less successful at than men is killing themselves.
When both the woman and her children are dead, a jury usually has little problem figuring the balance of her mind must have been disturbed. But if she is left alive and can’t explain what happened, in the absence of a narrative that makes sense, it’s harder to avoid a prosecutor’s demand that they must convict.
Juries need a convincing counter-narrative. This can be reached in some cases depending on the details of the case – one that shows how drugs can have an effect on thoughts we all have from time to time leading one to dominate the way it never could do without the effect of a sensory depriving drug. An SD drug acting on a system more primitive than Estrogen or Testosterone.
Entitlement?
Does Nietzsche help explain the male equivalent to a supposed female template?
Evolution, he figured, had led to civilisation, domestication and the suppression of primordial male impulses. Had led to a crisis in masculinity. Twentieth century versions of Nietzsche have stressed that in order to find a meaning and purpose in life, men, in particular whose lives were cramped and who were suffering from quiet desperation, need to find their inner Wild Man, their Iron John.
There’s little in Nietzsche that says men need to do much more than venture out into Nature to rediscover their true selves. Post-Nietzsche these ideas have accumulated a layer of drastic actions aimed it seems at truly shattering the constraints holding men back. What about wiping out a family?
In recent years, Finland has had a spate of school shootings by young men almost certainly on SSRIs. The common response among Finns is he’s been reading too much Nietzsche. There has also been a spate of school shootings by young men in Thailand. It’s unlikely Thai teens have been reading Nietzsche but social media versions may well be linked.
The most striking case in recent years was James Holmes, a shy university student who had, like many people, vague misathropic ideas. Zoloft acted like Miracle Gro on these ideas. He began fantasizing about doing something, laying out his developing ‘manic delirium’ in a diary. He told his doctor that if she knew the thoughts going through his head, she would lock him up.
She told him he was responsible for any thoughts he had. How responsible are you if you’ve been put on Miracle Gro whose consequences neither you nor your doctor could normally even begin to imagine? What would a jury make of the fact that both your parents, not knowing you had been on Zoloft, and put on similar drugs to manage their shock had reactions like yours? See Prescription for Murder and The Man Who Thought he was a Monster
Holmes killed 12 and injured 72 others at the premiere of Dark Knight Rises at Aurora Colorado. Meeting Holmes in person it was difficult to avoid the sense that like Marilyn Lemak he was mesmerised. His lawyers didn’t choose to play this defense.
Seronauts?
What comes now is where I have problems and need input – especially from readers who’ve been on SSRIs – Seronauts.
There are a growing number of cases where fathers taking SSRIs wipe out families. These killings are not done in acute onset rage attacks that start a short while after beginning treatment, with confusion and amnesia after the event – all consistent with a delirium. No family or friends seem to see this coming.
There are usually clear signs of planning and intent. There is often something semi-Nietzschean in the background and a sense that drastic action is needed. A wife, young children and sometimes other family get killed often savagely – partly because killing to the point of silence often takes more time than expected. The man makes no attempt to kill himself. He may clean up afterwards. He may even be semi-triumphant. There is no amnesia. He gives a coherent account in police interviews when he turns himself in.
We don’t have any accounts from any of these men of SSRI effects that might open a door to understanding what is happening in these cases. In the absence of being able to meet and listen to them for clues – which will have nothing to do with Nietzsche or their social media feed per se – we need more input from men like The Man Who Thought he was a Monster – and his wife.
Opening a door on what might happen aims at saving lives – it does not mean opening a jail door other than to go in and interview them. Why let them simply sit there?
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