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TAKE HEART: Five Beautiful Things from 2012 12/24/2012

Posted by ALT in Activism.
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5 comments

Have courage, my friends – take heart. Our non-violent revolution in mental health care is moving forward! Here are five beautiful signs of progress from the past year:

5. GlaxoSmithKline was held publicly accountable for fraudulent marketing practices, paying a $3 billion fine for illegal promotion of Paxil, Wellbutrin, and several other drugs.

(That’s the biggest fine yet for pharma, though there have been many others…)

Also in 2012, Abbot Pharmaceuticals paid out $1.6 billion for illegal promotion of Depakote, and Johnson found themselves in a bit of hot water, too, over their aggressive off-label marketing of Risperdal. CEO Alex Gorsky was forced to give a deposition – it’s rather enlightening.

The fine itself is not the point (it’s still just a drop in the bucket compared to the profits from these drugs — for all intents and purposes a fine is just another “cost of doing business.”) The important thing is that the pharmaceutical industry’s practices – including deliberately trying to create customers-for-life for psychotropic medications (see Gorsky’s testimony) by aggressively marketing to children – are officially going on the record, and they’re encroaching on the public awareness, too.

People are starting to think twice before they reach for the pill bottle, and that’s a good thing.

4. The 14th annual Sand Creek Massacre Spiritual Healing Run/Walk took place: one fabulous example of a community healing project done RIGHT.

Spiritual healing walkers' and runners' triumphal entry into Denver last year. (photo by: Leah Millis, Denver Post)

Spiritual healing walkers’ and runners’ triumphal entry into Denver last year. (photo by: Leah Millis, Denver Post)

Cheyenne and Arapaho from the Boulder, CO area have been staging this Spiritual Healing event every year for well over a decade, using principles of Restorative Justice to address the hurt that exists both for their people, descendants of the perpetrators of the original Sand Creek Massacre (one of the most horrendous examples of the US Government’s devotion to exterminating native cultures in this land), and all others affected by this tragedy.

This is some seriously inspiring stuff. More information here.

3.The Mad In America bloggers produced some excellent content, getting downright feisty on occasion.

Yes, MIA has been around for awhile, but 2012 was the year that the place came alive. Here are some of the standout moments to me:

-Mary Ellen Copeland shared the story of her mother, Kate, in a piece called (simply) “Remembering Kate.” She tells us how someone diagnosed with “severe and incurable manic depression,” abandoned to the back wards of a hospital for 8 long years, came back and lived an extraordinary life. I can’t recall the last time I read something so inspirational.

- Michael Cornwall detailed at great length his own unmedicated process through madness, his experiences helping others make a similar, unmedicated journey, and then posted some advice (Responding to Madness With Loving Receptivity: a Practical Guide) on how anybody can help another human being in emotional distress.

Here’s what it all boils down to: showing love, support, and empathy to your fellow human.

- On several occasions, Robert Whitaker took the opportunity to teach E. Fuller Torrey a lesson or two. (Torrey is the leading proponent of forced outpatient commitment, where your friendly social worker/law enforcement official visits you in-home and provides you with an injection of antipsychotics, er… I mean “intramuscular medication.” By court order. It’s time released — so you have anywhere from 3-6 weeks to recuperate before your next visitation.

Torrey has been caught time and time again using junk science [ie, falsehoods] to promote more drastic implementations of these sorts of civil liberties violations.)

This particular schooling, delivered by Whitaker in response to a fanciful critique of Anatomy of an Epidemic by Torrey [I say “fanciful” because it was, in fact, filled with lies], was especially lovely.

I think Torrey still needs to do a few hundred more.

A few hundred more ought to do it, eh, Torrey?

There are so many more writers worth reading at MIA: Laura Delano, Corinna West, Alice Keys, Matt Samet… to name only a few. Go there, read, and GET INSPIRED!

2. The fact that antidepressants are no more effective at treating depression than placebo HIT THE MAINSTREAM.

It hit the mainstream HARD. Old news to us, I know – the study that demonstrates this came out in 2002, after all.

But this vital information was on NPR, it was on 60 Minutes, it was everywhere! And it just might have inserted itself into some small corner of the public’s consciousness.

(No reason we shouldn’t take the time to remind folks of this important fact whenever we have half a chance, however).

1. 200+ protestors OCCUPIED THE APA’s annual convention in Philadelphia.

They carried signs, and they raised their voices loud, calling for alternatives to drugging, forced treatment, and dehumanization. They staged a dramatic “label rip” at the doors of the convention center, ripping pieces of paper bearing the diagnoses and labels given them by the psychiatric profession.

Pretty damn inspiring.

The paradigm is shifting.

Minds are changing, ever-so-slowly. We are making progress.

Here’s what I say… don’t stop. Not for a moment.

Don’t stop spreading the word in whatever way you can. Because the time is now! People need to hear our very simple message: that we’re ALL humans, and we ALL have the right to experience the world in whatever way we please.

Merry Christmas, all you humans out there!

Love,

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Long-acting injections of antipsychotics: pharma can’t shake the stigma, or the data! 05/17/2012

Posted by ALT in Pharmaceuticals, Treatments, Uncategorized.
Tags: , , , , , , ,
13 comments

In honor of Robert Whitaker’s recent kick-ass article beautifully re-affirming the central premise of Anatomy of an Epidemic (namely that anti-psychotic medications worsen long-term outcomes for patients, making schizophrenia into a chronic, lifelong disease when in its natural state it is episodic; and therefore that patients who refuse treatment with antipsychotics are scientifically justified in doing so), I thought we might launch our own little expedition into the stormy seas of antipsychotic/neuroleptic discourse.

I’m steering us straight towards the tempest, towards the ever-blurrier line between “compliance,” “adherence,” and outright “forced treatment,” towards a history of Orwellian language shift that simply can’t seem to shake the truth.

Long-acting injections of antipsychotic medication

Long-acting injections are monthly, time-released, intramuscular injections of antipsychotic medications.  They figure prominently in current “assisted outpatient” therapeutic practice (ie, forced drugging outside the walls of the psychiatric institutions), and are being heavily promoted by drug companies who see expiration dates on patents for oral antipsychotic medications looming in the near future or already arrived.  Can the pharma marketing machine succeed in making LAIs the next wave of antipsychotic blockbuster drugs?

It’s going to take a serious makeover.  You see, long-acting injections have got something of a “bad image” in the press, and in the hearts and minds of the people.  Perceived as brain-altering drugs violently administered to unwilling subjects, clinicans’ last resort to enforce adherence to an un-agreed-upon reality [treatment plan], a hideously efficient way for pharma to make a buck or two [hundred].

But is this really a case of “bad image”, of misperception… or is it an accurate appraisal of long-acting injections’ intended and fully acknowledged clinical applications?

As clinicians we struggle on a daily basis with patients who do not want treatment because they do not perceive that medication helps or because they do not conceptualise their experiences within a medical illness framework.  Long-acting injections have often been used to enforce adherence in patients who do not or will not take medication; they can be a mechanism allowing clinicians to take control.

-Richard Gray, RN, PhD*in “Antipsychotic long-acting injections in clinical practice: medication management and patient choice” [emphasis added]

And furthermore…

According to systematic reviews approximately 40–60% of patients with schizophrenia are known to be partially or totally non-adherent to oral antipsychotic medication. Long-acting injections are indicated where medication adherence is a cause for concern. Thus it is argued by some that it might seem reasonable to consider such injections for approximately half of patients with schizophrenia.

- authors Maxine Patel, Mark Taylor and Anthony S. David** in “Antipsychotic Long-Acting Injections: Mind the Gap” [emphasis added]

Yep.  We had you guys all wrong.  This isn’t about forcing patient adherence to clinicians’ treatment plans, and it certainly isn’t about expanding the market for LAIs.

Funny thing.  “Long-acting injections,” when first introduced in the 1960s, were referred to as “depot injections” … but the name acquired a strong stigma and had to be changed:

Many proponents of LAIs [long-acting injections] have attempted to dodge this [image problem] by rejecting the term ‘depot,’ which was perceived to be stigmatizing, in favour of ‘long-acting injection’ … this was partly an attempt to move away from stigmatizing stereotypes, and also to promote therapeutic optimism for a population for whom hope can be all too scarce.

- Patel et al in “Antipsychotic Long-Acting Injections: Mind the Gap

As late as 2008, long-acting injections of Risperidone were still being called “depot” injections, but by 2009 articles like the one cited above made clear that this terminology had been abandoned.

But they couldn’t shake the stigma

Not only that, but serious, data-based challenges to the forced administration of long-acting injections –- and, more fundamentally, the existence of any clinical value for antipsychotics whatsoever —  are rapidly multiplying.  As one example:

We are embracing the increased use of outpatient commitment laws that force people to take antipsychotic medications, and we do so under the belief that these drugs are a necessary good for those people. This is an extraordinary thing for a society to do, to force people to take medications that alter their minds and experience of the world.

Yet, here is the story told in Anatomy of an Epidemic: If we look closely at Harrow’s study [citation here] and a long list of other research, there is good reason to believe that these medications increase psychotic symptoms over the long-term, increase feelings of anxiety, impair cognitive function, cause tardive dyskinesia with some frequency, and dramatically reduce the likelihood that people will fully recover and be able to work. If this is so, how can we, as a society, defend our increasing embrace of forced treatment laws?

-Robert Whitaker, author of Anatomy of an Epidemic, in the aforementioned kick-ass essay

From pharma’s perspective, another Orwellian language shift is needed.  Time to reset the dial of public opinion on long-acting injections… and so I give you the newest name for an old terror:

Intramuscular Medication

That does sound better!  It doesn’t make me think of needles.  Doesn’t even sound like an injection… sounds more like a “muscle relaxer,” only more intra.

I first saw the term a few weeks ago in Dr. H. Steven Moffic’s delightful little Psychiatric Times blog entitled “Is it time for Re-institutionalization?

Recently, I was asked to write a request to possibly extend the outpatient commitment of a patient of mine. What for, I said to myself? This would be a waste of time because he had not exhibited any more dangerous behavior, was taking care of himself, and was compliant with his intramuscular medication. However, when as part of the ongoing monitoring of my patient’s improvement, I asked him to rate on a 0-10 (best) scale how well the medication was working, he said “0”. When I asked why, he said it was because he didn’t need the medication. Uh, oh, I thought. Could this be Anosognosia?…

There’s no way he’ll be committed longer, but will he stay on the medication voluntarily? Without it he’d surely relapse into psychosis and possible dangerousness. If he then went inpatient again, would he only stay a few days, not enough to address his ideas about the medication? It didn’t help enough the first time around.

-Dr. Steven Moffic

But it’s cropping up elsewhere, too – in the academic literature, and in drug company advertising materials, of course.  You can even see the shift in brand names as new antipsychotic injections are approved over time; the earliest approved LAI, Janssen’s Risperdal, is frequently referred to as LARI [Long-acting Risperidone Injection], while the more recently approved Zyprexa injection’s official brand name is “Zyprexa Intramuscular.”

I forecast the increasing encroachment of the term “intramuscular medication” into the official, APA/pharma-approved, “therapeutic” language, until our fears of “long-acting injections” are a half-forgotten nightmare that no longer sees the light of day.

OR

Or we could insist on calling a spade a spade.

So-called “antipsychotics” are nothing of the kind (they’ve actually been shown to cause psychosis), and are much more appropriately referred to by their first given name, neuroleptic, which literally means “brain damage inducing.”  Why?  Because that is what the research proves, over and over again, they do.

From now on let’s choose names that accurately describe the items to which they’re attached.  For example, “rose” = a pretty flower that smells good.  A few other examples:

Intramuscular Medication = Neuroleptic (brain damage inducing) Injection

Non-compliant Patient = Conscientious Objector to the Chemical Takeover of His Mind

That sums it up pretty clearly, doesn’t it?


* (Oh, and by the way, Richard Gray has received funding and/or fees from AstraZeneca Pharmaceuticals, Bristol-Myers Squibb, Janssen Pharmaceuticals, Eli Lilly, Otsuka Pharmaceuticals and Pfizer.)

** (And it should come as no surprise that the authors have been reimbursed for attendance at scientific conferences and have received consultation fees from Janssen-Cilag and Eli Lilly, received investigator-initiated grants from Janssen-Cilag and Eli Lilly, have worked on two clinical drug trials for Janssen-Cilag, and have received hospitality and advisory or speaker fees from AstraZeneca, Bristol-Myers Squibb, Eli Lilly and Janssen-Cilag within the past 5 years.)

The APA is going to “Occupy Medicine?” Let’s show them a REAL occupation! 01/24/2012

Posted by ALT in Mental Health Policy and Inititatives, Patient Rights and Advocacy.
Tags: , , , , , , , ,
6 comments

The APA must have an almost supernaturally subtle sense of humor and irony – the finest and most unflinching I have ever encountered.

Or else they are so steeped in hypocrisy that even the most blatant contradictions, the most horrendous lies (cross-referenced, of course), are fervently preached as gospel truth.  A pack of true believers, indeed.

There’s a spirit of unrest sweeping this country – the recent and successful PIPA/SOPA internet blackout protest, the various “Occupy” movements, the multiple student protests on college and occasionally high school campuses being a few examples.  People are getting stirred up. 

Well, the APA doesn’t want to be left out.  Let it be known that they, too, can occupy something!

“Occupy Medicine: Reclaiming our lost leadership”

A call to arms was issued in the January edition of the APA’s journal, the Psychiatric Times.  It’s hard to know whether to laugh or cry bloody tears of frustration.  Let’s try to laugh, shall we?

It begins like this:

Maybe the “Occupy Wall Street” movement suggests a different kind of protest …What about “Occupy Medicine” for us psychiatrists? This may sound somewhat ridiculous, given that psychiatrists still make a good living, but we are surely in the 99% of medicine. In fact, we may be in the lower 1% for reimbursement… I’m often struck that plumbers make more per hour.

- H. Steven Moffic in “Occupy Medicine” Psychiatric Times article

Now this article is posted right next to the “Psychiatry Compensation Survey 2011,” an annual survey regarding income and income satisfaction of APA members, on the Psychiatric Times website. The average income of these 99%-ers was neatly displayed in colorful pie graphs just inches away from Moffic’s petulant cries for protest.

[click to enlarge

The majority of psychiatrists make over $175,000/yr, yet Moffic proudly proclaims them an oppressed part of the “99%”!  Is this that subtle sense of irony again?

Oh, and plumbers do NOT make more money.

As near as I can tell (and they didn’t include much information about their survey methods, so it’s hard to say for sure) – but it appears that this survey only counts money directly obtained through practicing psychiatry.  So it does NOT include any “extra” income, like money from pharmaceutical companiesYou know, honoraria, “lectures,” “consulting,” “research,” etc.  Considering that 1 in 4 doctors offer these kinds of “services” to pharma, adding that income would further enhance their salaries.

Nevertheless, over 40% of the psychiatrists surveyed were “disappointed” with their level of income. 

Yes, psychiatrists are a downtrodden lot.  Much has been taken from them.  For example:

Other medical and mental health professionals have taken over our business to a great extent.  Take primary care physicians, who now prescribe well over half of psychiatric medication prescriptions, despite evidence of limited expertise and success.

-Dr. Moffic

“Limited expertise and success,” eh?  One could surely say the same about psychiatrists!   But I digress…

Where psychiatrists are really bleeding money is in the land of diagnosis, which should, according to Moffic, be their own exclusive province. 

Where we’ve really given up our product is in diagnosis. Though the APA has put out the official diagnostic manuals in the United States for decades, it opened up its use to any clinician who claimed enough expertise and knowledge. The APA makes a lot of money selling these manuals to other clinicians, who far outnumber psychiatrists, but what does this do to our role and status? …

Psychiatry is a strange kind of business. We’ve given out our products for free, then watched as other businesses—whether they be other types of clinicians or insurance companies—take over what we do… as important as what the diagnostic criteria should be, so is who is qualified to use them.

- Dr. Moffic [emphasis added]

Their “products?”  But I thought the DSM was an objective, scientifically-derived set of criteria defining real, biologically-based diseases?  And psychiatry a scientific discipline, not a business?

Clearly, an occupation is needed, so that psychiatrists can reclaim the [additional] wealth that is rightfully theirs.  There are some barriers, however.  You see, according to Moffic “psychiatrists tend to caring and compassion,” and so they have passively allowed the oppression thus far.  But Moffic remains hopeful:

Thankfully, the anti-psychiatry movement has died down. In an unexpected way, there’s more of a pro-psychiatry movement becoming embedded in our systems. These are our patient consumers and peer specialists. Could they be recruited as our advance force for Occupy Medicine? Who knows better?  Most naturally our patients and their families know what the illnesses have caused them to lose and what they need to recover.

-Dr. Moffic

Oh, that’s rich.

What say ye, psychiatric survivors?  Would you like to join forces with the APA in demanding that psychiatrists make more money?  Let’s catapult them into the top 1%, where they belong! 

Anybody? No?

Let me present an alternative

One that may be more to your liking.

In the run-up to the release of the DSM-V on May 5th, Mind Freedom International [MFI] is urging its members to “Occupy Normal.”  It is a “fight to stop corporate and government sponsored brain damage, trauma and an epidemic of human suffering” by “occupying the mental health system.” 

They have a number of ways you can participate listed on their website.  Additionally, a large protest is planned for that fateful day – May 5th – in Philadelphia, the site of the APA conference where the DSM-V will officially be released.  Lots of influential folks in the anti-psychiatry movement (which is alive and well, thank you very much Dr. Moffic!) will be there, including Robert Whitaker, author of Mad in America and Anatomy of an Epidemic.

Now what say ye, psychiatric survivors, peer supporters, and people who think critically about mental health in our society?  Is this an occupation more to your liking?

Oh, yeah.

Laboring In Madness: the birth of a new consciousness 01/10/2012

Posted by ALT in Mental Health Awareness, Philosophy/Spirituality.
Tags: , , , , , , , ,
3 comments

The new* “Mad in America” website/blog/forum has seriously got it going on

It’s got research.  Resources.  Recovery stories.  Best of all, the “Blogs” section showcases multiple writers, representing a wide spectrum of experiences and credentials… from “providers” and “consumers” to healers, advocates, researchers — and many of these folks sit at the crossroads of these different paths.  

What unites them is Robert Whitaker’s literary message (as put forth most recently in Anatomy of an Epidemic): the (mal)practice of institutionalized psychiatry in America, and his more recent efforts to bring the message into the real world, to actively practice a solutions- and positivity-based response to the evils he outlines in his works.

LOVE IT!

I can really see this site growing into the preeminent online gathering place for alternative thinkers in mental health.  Our community needs a home base, a place to process our experiences and articulate the many amazing ideas for reform and recovery we’ve all got cooking in our various noggins.  

Look what I found…

I found this true gem buried in the comments section of a Michael Cornwall article entitled “Initiatory Madness” (a stark and moving depiction of his own dealings with madness and abrupt loss of innocence at the age of 20).

[We must understand] the necessity for our waiting on madness to continue its often pain-filled birthing process in the sanctuary of our heartfelt compassion. Our first impulse when a loved one is in intense emotional distress and pain is to give them anything to relieve their hellish pain. It appears grossly irresponsible, if not cruel, to withhold medicine that would quickly numb the emotional suffering of a person in the throes of madness. But what the paradoxical evidence shows, is that if …any young person in their initial experiences of madness is not allowed to go through their purposive madness in the requisite healing crucible of a heart center sanctuary, then a huge majority of us would be stuck, trapped in a laboring process that can go on our whole lives. Birthing is painful but it accomplishes its task of bringing new life forward. But being suspended in the birth canal indefinitely, emotionally numbed out of fear of the raw emotions of transformative, life-renewing madness, is a tragic waste of our birthright.

- Michael Cornwall, PhD; in the comments section of his article “Initiatory Madness

Two things

  1. the parallel he draws between madness/the emergence of a new, awakened consciousness and labor/the emergence of a new human life
  2. the fact that both of these experiences, in all their terrible power, are our birthright

Labor is a (sometimes) painful opening.  A birthing woman is truly exposed in a way she may never again be in her life.  Emotions raw, body and mind experiencing something fundamentally new and perhaps even frightening, she needs support, comfort, and reassurance to pass through to the other side.  But despite the difficulties, remember that labor is a natural process, one for which she is designed by nature.   She was made to do this!  And it is her right, as a woman, to do it in the way that she sees fit.

Now our modern, institutionalized, corporate medical structures would have us believe that birth is a medical emergency (perhaps even pathological!) requiring numerous invasive techniques and expensive procedures to deliver mother and baby from death’s door. 

And, of course, the machine that goes "PING!"

Cesarean rates in the US are skyrocketing  (the national rate rose by 53% between 1996 and 2007), and as a sometimes direct result so is the maternal death rate.  No amount of fuzzy math (don’t think they haven’t tried it!)** can hide this alarming trend.

But here’s the thing… women have been giving birth at home, without doctors, for literally thousands of years! And the majority of women around the world are still doing it.  And doing just fine.  How did we survive so long without these “life-saving” doctors and their “miraculous” procedures?

We don’t need them.  We are strong enough to do it with only the support and love of a few who care for us… and be the better for the experience!  By coming that close to our spiritual origin and our mortality as well, we are people with a new, heightened knowledge of our humanity.  We are people who know a deeper kind of love: visceral, unconditional, of the soul.  And by doing it together, we share this experience with our loved ones, we build community, we further cement the bonds of humanity.

Michael is right on… all of the above applies to madness as well.   In madness, we are opened to a new, deeper experience of reality.  This can be terrifying, and we will probably need some serious support and love to get through it safely. 

But we can do it!  Without coercion, or unwanted chemical intervention.  We wouldn’t have survived for thousands of years on this planet if we couldn’t. 

Taking the birth metaphor a little further…

Labor is divided into three stages: opening (first stage), expulsion (second stage), and placental (third stage). 

(click to see a larger image)

Between the first and second stages is a period called “transition.”

In transition, the woman is fully dilated and the head (usually) of the baby must pass through the opening and into the birth canal.  It is widely considered to be the most difficult part of giving birth.  Luckily it is also the shortest; usually just 15 minutes or so.

At this point, almost universally, women have a psychological crisis.  A mother previously handling birth well may go entirely to pieces.  “I can’t do this,” many mothers at this stage of labor have said.

Labor support people (doulas, midwives, etc.) are trained to recognize and perhaps even warn the mother about transition.  A mother who feels she can’t go on at this point may need nothing more than some strong encouragement from her supporters to move beyond the crisis.

Unfortunately, the purveyors of birth medications are also trained to recognize transition, and most women who had not planned on a medicated birth accept medication during this period (which is rather unfortunate, as the period is often over before the medication can take effect and the mother is subsequently numbed, unable to follow her body’s cues as her baby descends the birth canal).  

Back to madness

I can’t help but think that the well-known crisis of faith in oneself at “transition” has some parallels in the experience of madness.  If only professionals were trained to recognize the crisis (which sometimes takes a suicidal bent), and coach the person through it – seeing it as a phase of the process, rather than a medical emergency requiring immediate incapacitation – perhaps more people would be allowed to transition into later stages of their journey.

What Michael is saying is that many psychiatric patients are frozen (by medication) in early stages of their journey, never being allowed to follow their path.  They are “laboring” their whole life long, their bodies and minds prohibited from opening, their souls unable to heal. A transition to wellness and rebirth never takes place.

Their birthing processes halted, their strength and resources untested, resolution and rest an impossibility—it is a senseless waste.  And, in this consuming culture, I think we’ve all seen enough of senseless waste to last a lifetime. 

Enough.

      


*Well, it may not be brand, spanking “new”… I have been out of the loop for a couple of months.  But I’m happy to report I’ve gotten myself a little part-time office job, so I find myself suddenly blessed with plenty of free time for mental health blogging.  Which means: ALT is back in the game!

** In 1998, the CDC reported that the US maternal death rate could be as much as three times higher than the officially reported number (which is bad enough!), because maternal death reporting is a.) not standardized and b.) optional.  Every other developed nation has a standardized, mandatory, national system for counting maternal deaths and makes that data available to the public.  For example, the UK issues one of these — a comprehensive report containing data on all maternal deaths that occurred during the period spanned by the journal — every 2 years. 

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