Flowers in the Bloodstream: one man’s quest to make the prescribing of long-acting antipsychotic injections an ethical obligation 01/19/2012Posted by ALT in Mental Health News, Mental Health Policy and Inititatives, Pharmaceuticals.
Tags: anosognosia, anti-psychotic injection, antipsychotic, Boycott Normal, DSM-V, Janssen, schizophrenia, Ted Kaczynski, Unabomber, Xavier Amador
This is an ad I saw in my sidebar the other day. Look at what they did. It’s so devilishly clever, isn’t it?
(click image to enlarge)
If you’re a real “psychiatrist who cares,” you’ll talk to your patients about [or, rather, talk them into] a long-lasting injection of anti-psychotic medication – essentially, Risperdal — directly into their bloodstream.
Now some patients are not going to be compliant when it comes to having these akathisia-, diabetes-, tardive dyskinesia-causing, brain-shrinking drugs with [at best] dubious efficacy forcibly slow-released in their bodies for a month. So Janssen has kindly provided several little educational videos (accessible by clicking on the ad, or here) to help doctors figure out how to do that.
They’re set up to look like academic lectures, and they have nice-sounding titles like “Positive Engagement: Therapeutic Alliance & Long-acting Therapy Given by Injection in the Treatment of Schizophrenia.” I felt really good after I read words like “positive,” “engagement,” and “therapeutic.”
But then I watched one of them.
It features a man by the name of Xavier Amador, Ph.D. giving a powerpoint lecture designed by Janssen.
In it, he explains what is really meant by those lovely words I mentioned above.
Most fascinating is the manner in which he approaches “therapeutic.” According to Xavier, part of the problem with schizophrenics is that they don’t always agree that they’re suffering from a lifelong illness, that recovery is impossible, and that they need drugs for the rest of their lives.* They don’t know they’re sick!
There’s a special name for this in psycho-babble – it’s called anosognosia.
Here’s the key: folks who do know they’re sick (again, by the above definition), are the ones most likely to take their medications. To be compliant. And so the real role of the “psychiatrist who cares” is to therapeutically convince the patient that he is indeed sick in this manner, and that he should take his meds, preferably via injection.
Dr. Xavier Amador, funded by Janssen, has spent a good deal of his professional career hawking an evidence-based practice (he calls it “LEAP”) guaranteed to do just that.
He goes into greater detail in another presentation, also funded by Janssen, which he gave at a government-sponsored conference in New Jersey last year.
Entitled, “I am not sick, I don’t need help,” the presentation is all about anosognosia, how it “impairs common sense judgment about the need for treatment,” and how overcoming it is “one of the top predictors of long-term medication adherence.” [which he appears to equate with recovery]
What causes anosognosia? Our beloved Amador posits that it may be
Psychological defense? “Culture” and/or Education? Or Neuropsychological Defects??
- Xavier Amador, in his presentation “I am not sick, I don’t need help” [emphasis added]
Yes, it is somewhat funny that a self-proclaimed “academic” would stand – in all seriousness – in front of a slide bearing that message.
But as it turns out Amador has been standing in front of silly slides and saying equally ridiculous things for years.
Amador and anosognosia go way back
All the way back to 1997, in fact, when Amador was involved in the trial of Ted Kaczynski, also known as the “Unabomber.” Kaczynski did not want to mount a defense based on a plea of mental illness or insanity and actually went to great lengths to block his attorneys from doing so. He maintained that his actions were deliberate, a logical result of his personal philosophy as outlined in his Manifesto and extensive journals (which he stated he kept, in part, to prove that he was not “mentally ill”). Kaczynski wanted people to understand the motivations for his actions and not have them be discredited as the “ravings” of a schizophrenic – and he was willing to risk the death penalty in order to so.
Nevertheless, a court-ordered psychiatric evaluation conducted found him to be schizophrenic (full text available here – also by court order, so that the public might gain a “better understanding of the Unabomber’s [schizophrenic] motivations”).
That he was found to be schizophrenic really comes as no surprise. As one of my favorite studies shows, even people displaying no psychiatric symptoms whatsoever have little trouble obtaining that label.
And what were Kaczynski’s symptoms? His “lack of personal relationships,” his “delusional thinking involving being controlled by modern technology,” and (drumroll, please) anosognosia.
Amador, who served as an independent expert for the court, reviewed Kaczyinski’s extensive psychiatric records, neuropsychological test results, and the infamous unabomber diaries. Amador then supplied the court with mounting evidence that Kaczynski’s refusal to be evaluated related to anosognosia, a manifestation of Kaczynski’s schizophrenia.
- from this article on Amador’s anosognosia activism
That one of Kaczynski’s three main symptoms of schizophrenia was his detailed and carefully documented denial of having it and resistance to being labelled doesn’t appear to strike Amador as funny. I might add that Kaczynski’s other main symptom — “delusional” worries about the all-important role technology seems to play in our society and the isolating effects that understandably follow — has troubled me, and hundreds of thousands of others, from time to time. Does that make us all sick?
I guess it does if they say it does!
The article goes on to share some of Amador’s initial inspiration to coin and then promote the term “anosognosia:”
It was his experience as a clinician and as a brother of someone with schizophrenia, Amador said, that led him to do research on anosognosia, “which is not to be confused with denial,” he emphasized, although in the beginning, he did not make that distinction. “That’s what I called it when my brother refused to take his medications, and that is what I called it when after his third hospitalization, I found his Haldol in the trashcan,” said Amador.
I suppose there’s no other possible explanation for a thinking, feeling, decision-making, adult human being throwing his Haldol in the trash can.
From a made-up word to the DSM-V: Amador takes anosognosia to the next level
About a year ago, when the DSM-V Task Force was really going at it hot and heavy, Xavier Amador issued this appeal on the Internet:
…Right now, there is no proposal to measure insight in persons with schizophrenia or bipolar disorder much less require that clinicians diagnose a subtype (with or without insight or with or without anosognosia). Such a requirement will drastically change treatment plans and hospital discharge plans. If a doctor has to diagnosis a lack of awareness of illness, then s/he is ethically obligated to address this problem, this symptom, and the non-adherence to treatment it causes. Rather than simply send the person on their way with a prescription they will never fill. I hope you will comment on the website Dr. Torrey recommends below.
We don’t have much time as the deadline for public comments is less that one month away…
Doctors will be obligated to ensure adherence to treatment plan… ”psychiatrists who care” must make sure their patients take their meds (perhaps in the form of injection)…
Isn’t that the exact sales pitch Janssen is using for their long-acting injection of Risperdal?
If anosognosia is officially added as a “symptom” of schizophrenia in the DSM-V, it essentially would make prescribing long-acting anti-psychotic injections to folks who “don’t know they’re sick” an ethical obligation!
Sounds like Janssen, and any other pharmaceutical company that manufactures a “flowers-in-the-bloodstream” shot, is going to score. Big time.
Thanks in part to the presumably very well paid** Amador.
And that’s just one more reason why we need to protest the DSM-V.
Join me in Philadelphia — or do it from anywhere else in the world! — on May 5thin saying “enough is enough.”
*This definition of schizophrenia, though it is endorsed by the APA [American Psychiatric Association] and NIMH [National Institute of Mental Health], is of course completely false. See Robert Whitaker’s research, and also the work of Loren Mosher, as proof. Also, a few recovery stories as living proof.
**Just how well paid? We’ll know his exact price in just a couple of months, but for this kind of a score, I’m expecting to see a lot of zeros.