In 1861 Benedikt Morel, a physician in France, described a terrifying new illness. It involved young people in their late teens or early twenties about to enter what should have been the prime of their lives who instead sank into a profound and seemingly incurable state of what he termed precocious dementia. Morel painted a picture of a terrifying and seemingly close to incurable loss of cognitive function.
In short order all around Europe, there were similar reports of the new illness. Some called it adolescent insanity, others hebephrenia, and later dementia praecox.
An epidemic of insanity
A short while before, the English, French and Germans had begun to build the first specialist hospitals for any set of medical disorders. They were designed to promote recovery from mental illness by offering a focus on hygiene and a behavioral approach that would build up the morale of the affected person.
Very soon after opening however the beds filled so that fresh wards had to be built which in turned filled rapidly. Asylum superintendents in their annual reports asked whether insanity was increasing. Those who thought it was, put the changes down to urbanization or industrialization and the increasing pace of modern life.
In mid-nineteenth century, the patients who came into the asylums mostly had melancholia or acute and transient disorders. Very few patients had dementia praecox. But by the end of the century, dementia praecox accounted for by far the largest number of admission.
From recovering to warehousing
The early asylums were geared for patients who were expected to recover but few recovered from dementia praecox. Some of these new young mad patients only stayed in hospital for a short time. Three to five years after admission, the women in particular caught tuberculosis and died from it. But among those who did not die from tuberculosis, some were there 10, 20, 30 and in some cases 60 years later. The mission of the asylums changed from recovery to warehousing. The reputation grew that you only ever came out in a box.
Briefly around 1920 soon after its name switched to schizophrenia, the illness became popular. Artists, and others like Carl Jung who thought creatively might be allied to madness were happy to brand their struggles as schizophrenic.
But it is almost impossible to interest the media in schizophrenia now. Nobody wants to have anything to do with this graveyard of hope.
Don’t be ridiculous schizophrenia didn’t just start in the 19th century
In 1980 a controversy blew up in the ivory towers. Some argued that schizophrenia had only appeared in the nineteenth century and if so we should redouble our efforts to pinpoint a cause – especially as the antipsychotics were definitely not the cure. Indeed worryingly, dementia paralytica (tertiary syphilis – General Paralysis of the Insane/GPI) looked very similar to dementia praecox. If we had had the antipsychotics when patients with GPI came into hospitals they would have controlled these patients just as much as they control schizophrenia making it harder to recognize that penicillin rather than antipsychotics were the cure for GPI.
Most of psychiatry dismissed this idea, as did I. The increase in insanity was apparent rather than real – most argued. We were warehousing awkward patients. Doctors had a conflict of interest – the more patients the more powerful they were.
Then the data on admissions to the North Wales asylum fell into my hands. Yes there was an increase in first admissions for insanity in line with increases in the population. But beyond this there was a tripling of first admission rates for schizophrenia between 1875 and 1905 over and above the increases linked to population change, while the rates of admission for other disorders remained constant.
These findings cannot be explained by industrialization, urbanization, or culture change as North West Wales did not urbanize, or industrialize and had no shift in ethnic mix.
All the old textbooks from 1900 say schizophrenia affected men and women equally. All the textbooks from 2000 say it affects 2 or more men for every woman. In our records the figures for 1875-1924 show almost exactly the same number of women and men but the figures for 1994 to 2010 show 2 men for every woman. (See Healy et al, 2012).
Schizophrenia disappearing – are you joking?
But even more surprising, starting in 2005, perhaps a good deal earlier for women, first admission rates for schizophrenia have plummeted. Other surveys which look at admission rates for schizophrenia will miss this as first admissions only account for 15% of admissions. The figures have dropped from 15-20 new cases per year to 5 per year – figures not seen in North Wales since 1876.
A ward has closed. This is the kind of thing that speaks louder than academic articles.
What’s going on? The drop cannot be explained by early intervention services or home treatment teams or any other change in service because there has been no change of service in North Wales during this time.
What made psychoses chronic?
The North Wales nineteenth century figures nail down for the first time a specific increase in schizophrenia reinforcing calls to pinpoint what might have caused it. The modern data add to the urgency of these calls. While the factors that led to this increase in schizophrenia may not be the same as those leading to its decrease now, it would be very satisfying to find something that might both account for some of the increase and some of the decrease.
Two strong candidates come to mind. In the nineteenth century we began to use lead for more and more purposes. Lead pipes carried our water. Lead solder closed the tin cans in which food was increasingly put. Lead was added to food and even to the medicines we took. The paint we coated our houses in had high concentrations of lead. The paint on bars of cots that teething babies gnawed on were impregnated with lead. Our children wrote with lead pencils in school. When the automobile arrived, we put lead in gasoline and concentrations of lead in urban air grew rapidly.
Lead is neurotoxic to children in particular. If the brain damage it can cause is what made some psychoses chronic in later life, then to see a drop in admission rates around 2005 in North Wales, where lead was once mined, we would want to see a fall in lead concentrations around 1980. And in 1980 lead was being removed from water-pipes, paint, gasoline, and had already been removed from food and medicines. The soil concentration of lead in North Wales began falling fast at this time. Elsewhere in the USA in particular, rates of admission for schizophrenia track lead levels and those admitted have higher levels of lead than controls.
Another possibility lies in changing childbirth practices. In mid-nineteenth century we introduced anesthesia and this led male obstetricians to ever greater feats of heroism with forceps and other instruments, delivering blue and sometimes close to black babies from “mid-cavity”. Around 1980 there were major changes in practice with increased rates of Caesarean Sections and the active management of labor aimed at delivering pink babies.
From chronicity to recovery
It would be wonderful to pinpoint a cause. We are probably though looking for a cause for chronicity rather than a cause for schizophrenia. What may be happening is that what might have been acute and transient psychoses against a background of subtle brain insults turn into chronic psychoses. The question then will be what the original conditions look like – are they in fact acute and transient psychoses?
Some reviewers of our findings have been intensely hostile. They seem to hear a message that mental illness is disappearing. It isn’t. In same way that we will have respiratory illnesses as long as we have respiratory systems, but respiratory disorders like tuberculosis rise and fall – this is what happens to real medical disorders, so also as long as we have brains we will have mental disorders but specific disorders like dementia paralytica and dementia praecox can come and go.
There is good news here for anyone interested in recovery in mental disorders. The patients we see in future may be much more likely to recover. This opens up the possibility of reconfiguring services. But if something like lead poisoning once made some psychoses chronic we need to keep an eye out for other things that might do this in future. For example we should track what the outcomes are when we save intensely premature babies – in so doing do we cause the kind of damage that might lead on to chronic psychosis.
There is a message for anyone treating chronic psychoses. The patients are right when they say the drugs don’t cure. The antipsychotics can be helpful if used judiciously but realizing that a cure is not going to appear if we just hammer the dopamine system a little bit harder might let us devise more sensitive and nuanced treatment approaches.
We need more sensitive and nuanced approaches because at present more patients are dying earlier than they should and these deaths are linked to the way we are using antipsychotics.
It would be interesting, if possible, to compare these findings with lead mining in Scotland around the same period.
Children’s Employment Commission 1842: Sir Arthur Mitchell.
“Besides the washing of the (lead) ore there are two other processes which are here performed, – the getting of the raw ore out of the mines, and the smelting of it at the furnaces; but it is in the washing department that almost all the children and young persons employed about these works are engaged. It is as washers that the youths are employed, who, at 16 or 18, enter the mines, for their work in which they are paid at. so much in the shilling, as compared to the men. Has never worked in the mine here himself. In the smelting department the youngest people employed are youths of 10 or 18, taken in like manner from among those employed at the washing, or in carting ore about the works. Of the washers, who are all boys, the youngest are about nine years of age, and they are of all ages, from this up to 18……. They commence work at seven in the morning, and leave work at six at night, with one, two, or three days a-week an extra hour, sometimes an hour and a half, and on occasions as much as three hours, – once a-month perhaps, hardly that. For this overwork they are paid extra. The time during which, however, the works are suspended by severe weather – by the absolute freezing of the water, which alone stops them – is sometimes three or four months in the year. On the average the time of work is 42 weeks in the year. The regular number of hours work per day is 10, except on Saturday, when it is only five, the work being closed at 12 o’clock. Over-work may extend the time three or four hours per week more.”
Data on the population and function of “asylums” in this period are surprisingly extensive and detailed and included patients who were “boarded out”. Mitchell noted that patients were happier, better adjusted and healthier in private dwellings than in the asylum care. “ ‘If it is true of any single patient that his happiness and enjoyment can be thus increased, the State has no right to deprive him of that blessing, even if it cost a little more, instead of a good deal less’. He wrote of mental patients’ welfare: ‘To add to their happiness – to improve their well-being – has been the underlying aim of all my work’.
See:
http://ije.oxfordjournals.org/content/39/6/1429.full.pdf+html
Mitchell A. Contribution to the statistics of insanity. J Ment Sci 1877;22:507–15, Reprinted in Int J Epidemiol 2010;39:1413–16.
Smith GD. The antecedents of epidemiological methodology in Arthur Mitchell’s surveillance and care of the insane. Int J Epidemiol 2010;39:25–308
Noble AI. The curability of insanity. Am J Insanity 1913; 69:715–22.
Review of asylum reports, 1877. Am J Insanity 1878;34: 542–82.
I’d like to make a quick comment as on train on Blackberry, will do more detailed one later at home. Firstly please don’t let us medicalise young people and label them mentally ill. They have enough pressures in today’s world without this millstone round their necks.
Secondly re the schizophrenic label, it’s become very unfashionable with bipolar the label of choice. Stigma and discrimination have helped with this and of course Stephen Fry who’s made bipolar fashionable.
Re: the early death rates of people with serious mental illness: “1 Boring Old Man” has been closely following the Janssen trials in Philly, involving lawsuits by young men who grew breasts while on the antipsychotic Risperdal. The drug’s effects on the hormone prolactin were cited as a cause. I posted this note to his blog and he promptly instructed me to ship it over to Dr. Healy and his crew. Yessir:
A recent study published in Psychiatric Services found people with serious mental illness (those on disability for schizophrenia or bipolar disorder) dying from cancer at rates far above other Americans.
http://www.medicalnewstoday.com/articles/248101.php
A number of lifestyle factors were cited of course, including smoking. Thus it was tragic, but hardly shocking, to hear that people with serious mental illness had over four times the risk of lung cancer as the rest of us.
However, the figure that did shock was this: Women with serious mental illness have three times the breast cancer risk of American women overall. This can’t be due to smoking, as there seems to be no established link between smoking and breast cancer. It was mentioned that the seriously mentally ill are much more likely to be childless — but having no children, or postponing childbearing into your thirties, elevates your breast cancer risk only “slightly” according to the American Cancer Society. So what’s going on?
The most likely culprit, I think, is prolactin — and the source of all that prolactin would be the atypical antipsychotics to which just about every patient in America has been switched in the past twenty years. If this is so, it’s very scary … already the average American woman’s lifetime risk of breast cancer is one in eight. So these women would have a better than one in three risk — and as a group they get piss-poor healthcare with few screening exams.
My other concern is the young girls being put on these drugs as early as four years old. How is it going to disrupt their hormonal development, and what is their breast cancer risk going to look like? As serious as the questions around “man boobs” on adolescent boys are — and that is a very serious question — it seems to me like the effects on girls and women could be even more catastrophic. Dr. BOM, am I right?
Interesting research about breast cancer. According to Dr. Abram Hoffer’s research, schizophrenia is the antithesis of cancer. People with the condition of SZ rarely got cancer (his anecdotal observation based on thousands of patients) and Hoffer felt whatever was going on with “schizophrenia” offered further cancer protection to the immediate family members. I can understand the link to smoking, but the link to increasing breast cancer most likely is the medication used to treat.
Although, not related to this, it seems ‘Thalidomide’ is back.
Have the worst excesses of reinventing drugs come back with a vengeance when Thalidomide is now re-introduced as a drug to stop coughing.
It was withdrawn for it’s use in 1961. Remember that word, withdrawn. We don’t see this word anymore. Withdrawn, but not forgotten, as the worst medical disaster, ever, for horrifying birth defects.
The formulae for the drug has ‘since changed’ says John Hopkins University in the US. Professor Morice says this drug carries a large number of side-effects such as increased risk of blood clots and nausea.
Would you take Thalidomide for a cough??
Will Seroxat, too, come back in fifty years. Reinvented as a cure for a cough or a cold………….chilling stuff.
It seems that everyone has forgotten the Rosenhan experiment published in Science in 1973 under the title “On being sane in insane places.” It was around this time that a number of studies in the UK identified that it took psychiatrists an average of two and a half minutes to form a diagnosis on first meeting. Rosenhan, a psychologist, himself and seven mentally healthy associates, were admitted to psychiatric hospitals by faking auditory hallucinations. All were admitted, to 12 different psychiatric hospitals across the United States They faked identical symptoms, and 7 were diagnosed with schizophrenia one with manic-depressive psychosis. Their stays ranged from 7 to 52 days, with an average of 19 days. All were discharged with a diagnosis of schizophrenia “in remission”, which Rosenhan decided was evidence that mental illness is perceived as an irreversible condition rather than a curable illness. None of the pseudopatients were identified as impostors by the hospital staff, although many of the other psychiatric patients seemed to be able to correctly identify that they were imposters and guessed that they were researchers or journalists. A nurse charted that Rosenhan’s note taking was “pathological note taking behaviour.” Once admitted and diagnosed, the pseudopatients were not released until they agreed that they were mentally ill and began taking antipsychotic medications, which they flushed down the toilet. No staff member noticed that they were flushing their medication down the toilets. In a radio interview Rosenhan said, “I told friends, I told my family, ‘I can get out when I can get out. That’s all. I’ll be there for a couple of days and I’ll get out.’ Nobody knew I’d be there for two months … The only way out was to point out that they’re [the psychiatrists] correct. They had said I was insane, ‘I am insane; but I am getting better.’ That was an affirmation of their view of me.”
In a second experiment, Rosenhan used a well-known research and teaching hospital, whose staff had heard of the results of the initial study but claimed that these errors would not be made at their institution. Rosenhan arranged that, over a three month period, one or more pseudopatients would attempt to gain admission and the staff would rate every incoming patient as to the likelihood they were an impostor. Out of 193 patients, 41 were considered to be impostors and a further 42 were considered suspect. In reality, Rosenhan had sent no pseudopatients and all patients suspected as impostors by the hospital staff were ordinary patients.
The Cheshire Cat in Alice is more reliable. “And how do you know that you’re mad? “To begin with,” said the Cat, “a dog’s not mad. You grant that?” I suppose so, said Alice. “Well then,” the Cat went on, “you see a dog growls when it’s angry, and wags it’s tale when it’s pleased. Now I growl when I’m pleased, and wag my tail when I’m angry. Therefore I’m mad.”
Plus ca change, plus ca reste…..
Irene – This won’t account for the findings here. We have tracked all patients from the modern cohort for years and in the case of the historical records we have the entire case histories. There was certainly loose diagnoses and abuses during the 1960s and 1970s but if you deny the possibility of making reasonably accurate diagnoses on the basis of an entire medical history (not cross-section) I think we’re left with nothing and no possibility of anything.
Any chance we could stop pussyfuttering around and categorically state ‘loose diagnosis and abuses’, is happening now.
Why is it so important what happened before, can we wake up to what is happening now, today.
An avalanche of suicides has occurred during the last ten years, horrific withdrawal; suicides from antidepressants and chronic withdrawal from benzodiazepines; can we have less of the history, more the up to date, here and now, when more has gone wrong now, this minute, today, than has ever gone wrong before?
A little less ‘academia’, a whole lot more knowledgeable thought, on the dangers of these two classes of drugs.
‘If you deny the possibility of making reasonable accurate diagnosis on the basis of an entire medical history’, is the most intelligent, crucial, comment that I have read this week.
Yes there are loose diagnoses and abuses happening now.
Take the Bethlem Royal Hospital National Psychosis Unit for which there is a blog dedicated to them (not mine by the way) You can find this on the website of Speak Out Against Psychiatry. This horrific hospital was not interested in
much else apart from experimenting and getting my daughter on Clozapine and Metformine which is being used OFF LABEL. She has multiple diagnoses and was given two main ones of Schizophrenia and Aspergers however how can a psychiatrist come up with a proper diagnosis if he just wants to st art afresh. When I brought on the ward lots of interesting books including Pharmageddon this was not appreciated. He turned around and said he had enough reading to do and generally was not interested. Fortunately when a wonderful group of patients came to my rescue and my daughters by staging a demonstration featured on You Tube, I was able to voice my opinion and say exactly what I thought about this horrific place. I do not believe their diagnosis of Schizophrenia as how can you assess anything when someone is taken off 150mg of Seroquel. That person is bound to suffer adverse behaviour. My daughter’s face was also covered in bruises at this hospital and I have not had a satisfactory answer. Abuse is rife that is for sure and as for the diagnosis unless someone has a drug free period like Prof Murray suggested in the first place, then how can you possibly assess a patient correctly. All too often psychiatrists are not willing to properly look back on past records to see what happened to that person and giving the drugs is cruel as this does not solve the problem and there is nowhere to come off them safely in the UK which is even worse. A proper assessment should be given drug free in a safe environment and if the withdrawal is done very very slowly and gradually over a period of up to 2 yrs then there is less likely to be suicide/homicides through patients suffering from chronic side effects wishing to withdraw and doing so too quickly.
David
I didn’t mean to imply that the Rosenhan study did have relevance. The point is, I think, that they didn’t have medical histories or relevant data, simply that they encountered preconceived notions of what constituted psychoses. The point I was trying to make – and obviously failed miserably – was that it is all too common for diagnoses of depression, psychoses etc. still to be made on the basis of no real information at all. I apologize if it sounded as though I were criticicizing your data. Of course an entire medical history – and in my view, physical assessment of new patients- is mandatory before one can attempt a diagnosis. It just doesn’t seem to be happening. I suspect that many of the contributors to this blog who have been, and continue to be, victims of more than loose diagnoses would agree. Perhaps if psychiatry, and medicine in general, were to be reminded of the Rosenhan study there might be some embarrassed change. One can always dream.
Peace!
Interestingly DSM-III was one response to Rosenham and this is now looking more like an adverse effect of Rosenham
On a personal note. I recently had a meeting with a psychiatrist friend in his office when he had a second year resident present. At one point I got on my hobby horse about over -medicating, particularly children and the elderly. Anyone who knows me knows that I feel everyone is entitled to my opinion and that I have been known to express it quite forcibly. I met my psychiatrist friend a week later and when he saw me, he started to laugh. Apparently, after I left, his resident asked him if I were bipolar because I seemed to be manic. Intermittent explosive disorder maybe, especially when I find teenagers on antipsychotics, with SSRIs and antiepileptics at the same time but bipolar? I shudder to think of that young man’s future patients.
Annie
I don’t think anyone on this blog has the slightest doubt that these drugs are dangerous, often lethal. The issue of diagnosis is inseparable from their use. Too many people simply going through a bad time, as we all do, are diagnosed as “depressed” when they are not but told to take a magic pill and all will look brighter. The ultimate of this lunacy – you should pardon the expression- is the intention to make grief a disorder. I am obliged to make two points. There are several physical conditions that mimic catatonia (depression) and need to be treated. This can’t be done, obviously, without a full and informed examination. The second thing is that there are forms of depression, probably hereditary in nature, that do occur and make life miserable for many people. These respond very quickly and very successfully to some of the older antidepressants that have been around for decades but no-one is using them – or very few are prescribing them partly because it’s rare, I find, that a psychiatrist will recognize these “atypical” depressions. My own conviction is that the widespread use of potentially lethal drugs is caused by fear of various kinds. Persuade someone that they have a disease and you have the cure, the patient’s fear is likely to overcome any misgivings they may have. Create a whole new bunch of diseases and persuade the population at large that they, too, are in danger of becoming “sick” and nonfunctional, and fear is a great prod. Physicians, either inexperienced or poorly trained fear that doing “nothing” will land them in court so, out comes the prescription pad. Try to get a parent to taper a child off high potency drugs and the fear of the consequences ( usually a withdrawal syndrome though not recognized as such) is enough to make the parent continue. You can train whole populations through fear – and that’s what has happened, a vicious, deliberate plan to make billions. It’s the same ploy that persuaded the US and other countries to accept the war in Iraq – planned, increased fear of (mythical) WMDs and the development of the War on Terror.
It seems that millions live their lives in deliberately manufactured states of fear and succumb to snake oil remedies. Welcome to the Outer Anhedonias.
Dear Dr. Campbell-Taylor,
As secretary of the Anhedonian Society of Psychiatrists (ASP) I must object to your casting aspersions on snakes (some of our most distinguished members) and snake oils (some of our most prized remedies). Why, pray tell, do you think the ancient symbol of our honorable profession incorporates two serpents, inextricably entwined?
As for your provisional diagnosis of Bipolar Disorder Not Otherwise Specified, made by our young colleague, we find this to be a clinically useful substitute for the older, somewhat discredited “B word” once employed to refer to female persons who refused to sit down and shut up when we wished them to. As chair of the Women’s Section of ASP, which initiated the change, I note with pride that this is not only more scientific and less offensive, but our members can get paid to treat it! Feel free to call our Society for a referral.
Best wishes,
Polly Pharmacy, M.D.
Pill Hill, Outer Anhedonia
That is an excellent ‘personal’ point, Irene, by telling how easy it is to be misconstrued, when one gets emotional and forceful about serious medical malfunctions.
I have the same force, but have to be circumspect with it. As I was cruelly accused, I was afraid to speak up, in case the men in white coats came to get me.
I have now overcome that particular ‘psychological dilemma’.
Men in white coats no longer phase me, they are not, thankfully, in my life. They caused more havoc, than could have been anticipated, and so, although from a different perspective than yours, I have progressed, and can ease myself back into a more respectable form of a voice, with no drugs. Victory.
I would like to suggest that everyone read a remarkably courageous article in the BMJ by a psychiatrist who is also a patient.
http://www.bmj.com/content/345/bmj.e6994?etoc=
Dear Dr Healy
You conclude this blog post with “We need more sensitive and nuanced approaches”. Do you include ECT/electroshock as a part of this type of approach?
I wrote a blog post today entitled ‘women get ECT in Scotland twice as much as men’:
http://chrysmassociates.blogspot.co.uk/2012/10/women-get-ect-in-scotland-twice-as-much.html
where I express concerns at the statistics, and about the fact that older women get even more ECT, doubly discriminated against.
I cannot support the doing away with psychiatric drugs just for shock treatment to increase, which would be like going from the frying pan into the fire.
I’d be interested in hearing your response to the place of ECT in therapeutic ‘care’ and what other approaches you think could be a suitable replacement for antipsychotics.
Regards, Chrys
Chrys – about 10 patients per year per 250,000 people get ECT. Its given for benzodiazepine resistant neuroleptic malignant syndrome or catatonia, some cases of Parkinson’s disease unresponsive to anything else, melancholic patients who cannot take medications, and other severely depressed patients who have had it before and opt to try it again. It is never given to anyone who does not consent. But there are hundreds of patients getting depot antipsychotics who do not consent to this and anything between 2,500 to 5,000 who are on psychotropic drugs about whose risks they have not been informed.
You might read the foreward to Dying for a Cure, and also read the section on ECT on healyprozac.com
David – I have to disagree with your comment that ECT is never given to anyone who does not consent – in Scotland in 2010 it was given to 35% of people who lacked capacity and therefore did not consent. I would think the figures will be greater in other countries, as in involuntary ECT.
And I remember in 1978, as a psychiatric inpatient, that people got ECT for anything and everything, psychosis, postnatal conditions, and I had to run out of the hospital in my pyjamas to resist the pressure to accept ECT for postpartum psychosis, even though a voluntary patient.
Does this mean that you would like ECT to replace psychotropic drugs? Or do you have something else in mind?
And then there is brain surgery or NMD (neurosurgery for mental disorder) which happens in Cardiff, Bristol and Dundee:
http://www.mind.org.uk/help/medical_and_alternative_care/neurosurgery_for_mental_disorder_psychosurgery#where
Where they say it can only be given if a person consents, but as this is after ingesting many different neuroleptics, two course of ECT with a 6 month gap, CBT and other stuff, I wonder if a person is capable of informed consent.
The good thing about anti-psychotics, for me, is that I was able to taper them and get off them all, within a year, by taking charge of my own mental health. If I’d had shock treatment the damage would have been done, the probable memory loss, the headaches immediately following, and then more anti-psychotics or anti-depressants. For everyone getting ECT is on psych drugs as well, a double whammy.
Chrys – if you read what I wrote I said here. In North West Wales. If you want to know more about the history of the other treatments you mention read my chapter in Shock Therapy by Shorter and Healy. Re antipsychotics – there is much more visible evidence of brain damage on these than with ECT – there is also more easily demonstrable cognitive dysfunction and memory problems with antipsychotics and benzodiazepines than with ECT. I have yet to see a psychiatric patient who is not getting or has not had large amounts of antipsychotics and other medications prior to ECT. I’d invite you to read some of the background issues HERE here, as well as Dying for a Cure.
David – I’ve already read your piece on the Shock Therapy Controversy and note your concern that a young woman, your patient, died because of the marginalisation of ECT. You describe it as a “blindspot”. It obviously had a major impact on your view of ECT. That you were unable to ‘save’ this person or prolong their life.
I don’t see psychiatrists as people who are there to take charge of my life or to be responsible for my life. Same with the GP who I go to for medical advice or to consultants in general hospitals who advise in their specific areas. When it comes to it, the decisions about my life and my body are for me to make. And I have never believed in the biomedical model so any brain stuff is a no no for me.
For mental ill health is all about the problems of living, traumatic happenings and spiritual journeys. So brain shocks and brain surgery are completely out of order, in my opinion. Like tackling a skelf in the finger with a sledgehammer. The wrong tools for the job.
Chrys – looks like we both agree paternalism is wrong. But this also means you can’t force others into the kind of treatment you approve of – we can both try to make sure people are informed. The main thrust behind my point is even if its conceded patients getting ECT are at risk of brain damage – although whether by virtue of the ECT or the meds is almost unprovable – can anyone dispute that more brain damage stems from the meds than from ECT? And if the meds cause more problems, surely focussing attention on a treatment that 10 people per quarter of a million get each year is a waste of energy other than it has provided a mythic symbol that all sorts of people like Clint Eastwood have used. We should stop talking to empty chairs and start engaging with the real thing.
And to add, I recently supported my son off haloperidol, in 6 months, from a 25mg injection, to pills, reducing them by a small amount every 3wks. We were able to do this in negotiation with the psychiatrist, even when he was on a CTO, a hospital based community treatment order.
I think that peer support is one answer to helping people get back in control of their lives. ECT is no answer at all, in my opinion. It is far too dangerous and abusive. Like a kick in the head by a horse, or a person.
My mother had many courses of ECT against her will in the 50’s and 60’s, this made her very scared of the psychiatric system. In later years she was on a depixol injection and she could live with this, worked full-time, had quality of life. She went for the injection voluntarily. I don’t think she needed it but she was OK about doing what psychiatrists said. As for me I have never believed psychiatrists and would have to test their every word.
For the psychiatric system is all about power and control, a paternalistic system that thinks it knows best. But is only seeing through a glass darkly.
Compared with involuntary antipsychotics involuntary ECT is pretty uncommon anywhere. Please read the stuff I’ve suggested.
David – I’m now a writer, activist and campaigner in mental health matters, challenging human rights issues in psychiatric ‘care’. Which means local focus and if others are listening well that is fine too, although I’m not too bothered about empty chairs.
I’ve never been keen on taking psych drugs, they don’t suit me, and I managed to resist ECT. But the issue for me is that we need something to replace the psych drugs, to help people work through their mental distress so that the drugs are not an answer. And I don’t want ECT coming back into favour as an alternative to the drugs. Heaven forbid.
And I think the use of force in psychiatric treatment is at the root of the problem, rather than the drugs. Therefore a focus on getting rid of the force could be a more effective target. With no force then people could choose whether or not to take the psych drugs. And many might still choose to take them. And that would be up to them and not the psychiatrist.
But I think the psychiatrist won’t want to give up their power base, for it’s a seductive presence, and the feeling of being depended on by defenceless women, and men, must be quite alluring. That’s why we have to take back the power from psychiatry and bring about a transformation of the psychiatric system. Making it more of a maternalistic system.
Like Athena the goddess of heroic endeavour, who preferred to use wisdom to settle predicaments, our mental health system should have the maternal traits of caring and nurture, rather than authoritative and hierarchical posturings. And I don’t mean like social work services which have become handmaidens of psychiatry.
As Dr James Le Fanu has been saying for the past 20 years, over a similar timescale to schizophrenia coronary heart disease (and related types of atherosclerosis) rose to be the biggest killer in The West, then declined – and it seemed to sweep across the world geographically from Western Europe outwards (as I recall), just like a slow motion infectious epidemic. Indeed, Le Fanu thinks coronary heart disease probably was an infectious disease, not least because most human diseases are due to infections. I would think the same applies to schizophrenia – that it was due to an infection, cause unknown. But we are still not very good at discovering new types of infectious diseases; and indeed seldom look for them.
You are right Chrys – we need to think about the mental health system we DO need, and fight to make it happen. If we could begin to see that on the horizon, perhaps ECT really would be used very cautiously, only with informed consent, as a last resort in emergencies, and we could all move on.
I had ECT back in 1985; it did me no good at all. Nada, zip, zilch. More could be said, but your last post brought one thing back to mind that really made me laugh. To wit: It was only AFTER I had “failed ECT” that a really radical notion started to form in my doctor’s head. Maybe we need to get serious about all the whiskey she’s pouring down on top of the meds! You’ll laugh, but this was an idea his whole residency program had trained him to discount. The drinking was unfortunate, sure, but it was just a symptom of the underlying endogenous such-and-such …
So he told me bluntly that nothing good was going to happen until I got the bottle out of my face. There was a group called AA, which being a foreigner he understood only vaguely, but they were good people who tried to help each other. Go! I thought stopping the booze would surely be the death of me, but wasn’t that what I wanted after all? And the poor guy had worked so hard to help me. So hell, I tried it. No lightning bolts, for sure, but a year later my good ex-shrink took me out to lunch so he could hear about my first semester of college. “Maybe it was the ECT taking effect after all, in a delayed fashion,” he mused. “Oh, but Dr. C,” said I, “how would that even work?” “You’re right,” he said, “it makes no sense at all.”
Thanks Johanna – interesting comments from your ‘good ex-shrink’ about it making no sense at all. About the wisest thing that psychiatrists could say, about any of their treatments, which are like trying to take a sliver of wood out of your finger with a sledgehammer. The wrong tools for the job and much damage done to the finger.
The mind and body continuum, mental distress and our attempts to deal with it, are not helped by psychiatric drugs, although they may give temporary relief. Like alcohol, recreational drugs, smoking and whatever else helps people get through and on with life. The ECT I have major concerns about and like you I think it should only be used very carefully, with consent, as a last resort when the cocktails of psychiatric drugs have done their worst. They call it treatment-resistance but it’s really system failure.
I can’t be bothered with the psychiatric system trying to blame the patients and families for the system’s failure to sort or help a person through trauma or transition or mental distress. It’s a lame excuse. They’ve just got to own up that their treatment hasn’t worked and there’s no sense in it at all.
“Our children wrote with lead pencils in school” — ha-ha! Pencils were invented as a way of holding graphite, which has a leaden colour and was known as “black lead” but is in fact pure carbon. Children wrote on slate with sticks of chalk or other soft stone, which didn’t need a wooden casing. It was only when “black lead” pencils became cheap that children were able to chew on them and ingest actual lead from the paint.
thanks for the clarification