Important development

psychgeribuff · May 10, 2014

Yes I do explain the side effects of psychoactive drugs to my paitients and there health care sureogates. They then have the chance to choose thier route of care. I am curious beOne77. Have you ever worked psychiatric intensive care? With psychotic patients?

JustKeepDriving · May 10, 2014

These are my thoughts on the subject:

I'm really tired of mental health being viewed as some strange entity distinct from physical health. Like some dude wandered out into the desert and ate nothing but magical mushrooms for 40 days and 40 nights, saw some incredible symbols he called "Axis!", then went home to his igloo in the arctic wrote the DSM while he was tripping out on acid and praying to the great god Thorazine.

Any illness is a condition that prevents your body and mind from working properly. There are multiple different ways to treat illnesses - both mental and physical. Take Esme's diabetes example - for some people exercise works to control type 2 diabetes, for others they require medications like metformin and severe diabetics are completely insulin dependent. Mental illness works like that too. There is a grading scale of any mental illness. Someone with depression might be able to manage it with exercise and yoga. Others do really well with cognitive behavioral therapy. Someone who is so depressed that they have hit that psychotic stage of depression is unable to manage it without medications.

In any medical area there are fads that happen, stuff that goes wrong and people that get hurt. That doesn't mean that the treatments are completely invalidated because someone (or a lot of someone's) messed up. Plus the medical field grows and expands, stuff changes as new research leads us in new directions.

I worked with the criminally insane. I can tell you that many of my patients were at much bigger risk for injury to themselves and others when they were off their meds. Plus every time a patient has a psychotic episode (goes off their meds after being stabilized) their return to baseline is often slower and they're never quite able to return to their original state of functioning. Research has shown that the ventricles in the brain actually enlarge in patients who manic and schizophrenic after episodes of mania and/or psychosis. Literally every time a patient has a manic or psychotic episode they lose brain mass.

If someone wants to discontinue their psychiatric medications I would always advise them to do it under the monitoring of a psychiatrist. Discontinuing any medication immediately can have worse side effects than the medication itself and most psychiatric medication has to be tapered. Some individuals, especially forensic psychiatric patients are not able to discontinue their medications by choice. My team and I would get orders from the judge to medicate them without their consent. Generally it was because they were such a harm to themselves and others that they could not function without medication. I had paranoid schizophrenics that would get stabilized, return to their communities, get off meds, decomp and then kill their best friends/family/children ect. These people had to be medicated.

I don't go by the "Chemical Imbalance theory" I go by the bio-psycho-scocial and diathesis stress model of mental illness development. Bio-Psycho-social: meaning that mental illness has many aspects, just like physical illness. Someone could have a biological susceptibility (maybe a chemical imbalance, maybe a deformity in the brain, or a brain injury), they could have a psychological (way of thinking such as beck's triad) or social circumstances (like a death in the family, a dysfunctional family structure, maybe they have been molested) that causes the occurrence of mental illness.

Diathesis stress model: Basically it goes like this - two people might have a biological susceptibility to mental illness (schizophrenia, depression ect) but one of them has protective factors (a great family, upper middle class lifestyle, access to resources) and one of them does not. Maybe the one without the protective factors encounters a certain stress in life (ex something off the Holmes and Rahe stress scale) and that sets off their biological vulnerability and they develop a mental illness (like schizophrenia). That same person without those protective factors lets say they never encountered that stress, they never would have developed that mental illness. While that individual, with all those protective factors - well he or she encounters the same stress but because they have all these resources to help them cope, they never manifest a mental illness despite their biological vulnerability.

Social epidemiology also shows how these two models also work with physical illnesses. It's why vulnerable populations - low income, minority, educationally disadvantaged - are much more prone to developing certain diseases (diabetes, hypertension, low birth weight babies) than individuals that are privileged.

I'll repeat this again: Mental illness like physical illness is not black and white - it is a "scale" so to speak of dysregulation. Some individuals are so sick that they require heavy duty medications like thorazine and haldol. Some individuals though are able to manage their mental illness through other means like mindful meditation, exercise and therapy. Every case is personalized. Does it mean that people aren't overdiagnosed? Yeah, sure. That happens even in the physical realm though too. I mean how many kids in the 80s had their tonsils removed before healthcare research and professionals were like, "This is totally over done and in many cases unnecessary".

Many, many, many medications come with side effects. Honestly, many traditional medications that you hear of all the time - Insulin, Heparin - are actually riskier than psychoactive medications. I can guarantee you that more people have died or suffered major disability from physical medications than psychoactive medications. Is that to say that psychoactive medications are without risk? Of course not. That is why it is up to us as nurses to educate our patients and our staff to watch out for extrapyrimidial side effects and symptoms of neuroleptic malignant syndrome.

Quite frankly I find it offensive that people would say "Mental illness did not exist until psychiatric drugs are introduced". I think that it completely invalidates the experience and feelings of those individuals who are mentally ill and need those medications to make it through the day. Meds aren't fun, I am completely empathetic - the side effects are difficult and there is a huge stigma about mental illness. However some people need those meds like other individuals need insulin - because without them they are so unstable that they are at risk to themselves and others. I promise you that many of the patients that I took care of you would not want around your family, your kids or yourself unmedicated. They are serial killers, child killers, pedophiles, rapists ect; and many of them are completely upstanding human beings medicated but will offend again when they get off their meds.

Just my two cents.

Long Term Care Columnist / Guide · May 10, 2014

Well said, JustKeepDriving. :yes:

And you're right about taking meds. Even my psychiatrist says, and I quote, "Taking meds sucks!" I don't know a single person who WANTS to take psych meds, not with all their side effects. Weight gain---check. Excessive drowsiness---check. Dizziness, blurred vision, tremors---check, check, check. And that's only the beginning.

But it's like you said, some of us need those drugs like some diabetics need insulin; they are lifesaving and life-preserving. I'd like to think there's enough room for ALL points of view under the proverbial umbrella. Thank you for offering your insightful perspective.

PG2018 · May 12, 2014

This book: Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America: Robert Whitaker: 9780307452429: Amazon.com: Books

Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America addresses this very topic. It's a very good book, and the author, a layman who cites all of his sources, does a very good job at expounding on exactly how psychiatry is nothing but a money maker.

It's scarey, interesting, and thought provoking. I gained a new perspective from it.

LadyFree28, BSN, LPN, RN · May 12, 2014

This book: Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America: Robert Whitaker: 9780307452429: Amazon.com: Books
Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America addresses this very topic. It's a very good book, and the author, a layman who cites all of his sources, does a very good job at expounding on exactly how psychiatry is nothing but a money maker.
It's scarey, interesting, and thought provoking. I gained a new perspective from it.

If psychiatry such a money maker, then why isn't enough funding getting thrown at it, instead of at prisons, which usually houses many people who need mental health services PsychGuy?

To say that psychiatry is a money maker is a slap in the face in which people that truly need it and benefit from it, is insulting.

Long Term Care Columnist / Guide · May 13, 2014

I've checked out all the links provided in this thread, but I'm not buying it. Perhaps it's because I'm too close to the situation, being a patient and all, or perhaps because I honestly don't care about the alleged evils of psychiatry and Big Pharma. No field of endeavor is without its bad seeds; I'm sure these industries have their share. I don't know. All I know is that meds and therapy literally saved my life. I also know that my particular mental health issue existed long before I ever had a word for it, and that it is not OK to invalidate peoples' experience of mental illness because it doesn't fit with the anti-psychiatry agenda.

BeOne77 · May 13, 2014

If psychiatry such a money maker, then why isn't enough funding getting thrown at it, instead of at prisons, which usually houses many people who need mental health services PsychGuy?
To say that psychiatry is a money maker is a slap in the face in which people that truly need it and benefit from it, is insulting.

"PsychGuy" - There is also "The myth of the chemical cure" by the prominent psychiatrist Joanne Moncrieff M.D. from Britain and the new one "Drug-Induced Dementia by Grace Jackson M.D. another well read and studied psychiatrist as well as her thought provoking Rethinking Psychiatric Drugs...which offers a rounded perspective...on the subject..

BeOne77 · May 13, 2014

If psychiatry such a money maker, then why isn't enough funding getting thrown at it, instead of at prisons, which usually houses many people who need mental health services PsychGuy?
I feel as though only one needs to follow where the money is going to basically fund and refund the pharmaceutical companies which are basically feeding the "system" governed by good ole Uncle Sam and most of the benefactors are the doctors who are caught perpetuating, promoting and prescribing to the public most often not properly using informed consent which in fact if it was done in a manner that was fair to the patient then most people would probably not opt to go that route knowing the risks involved but also there are people who claim they need these drugs who claim that there lives have changed..granted they may have to the benefit or detriment only they can decide but the whole premise of people being a danger to themselves or others off the drugs once put on them could be viewed as a withdrawal effect and also what needs to be considered is that for whatever reason they were put on them in the first place was absolutely necessary or could have been handled in a variety of ways. Also what I find interesting is the Finnish way of dealing with mental health and psychosis which has a high recovery rate( Open Dialogue: a documentary on a Finnish alternative approach to healing psychosis â€“ Beyond Meds)which is essential not what American Mental Health is all about which pretty much says you will be on meds lifetime or which is what the physicians are suggesting in order to keep the cash flow coming in whereas many are finding healing without which kind of puts a dent in the "system".
.Places like the Soteria Houses are popping up pretty much treating the "mentally" ill as much as 70% without medication....So the question is how are these people different from the rest of the population who has also been diagnosed with a severe mental illness? And as far as funding goes, what kinds of services does mental health really provide? Besides therapy which I can see benefit for, what does the mental health "system" really do? Provide pharmaceutical support period..what other services do they provide...maybe Crisis counseling..suicide hotlines...a heck of a lot of business for therapists, but also I am wondering what is it about the US that we are in an ever growing need for such services? Most people who are in prison got there because they broke the law not necessarily because they were mentally ill and some as it suggests are, and that is why they are there but many I suspect are actually put on these drugs while there if not before they have probably been coerced one way or another to take something I suppose .Thinking of how hard it must be to get to sleep in prison.the overwhelming depression factor of realizing you are there and the guilt of your crime and acting out or any other behavior is probably most likely "modified" in some way by prison psychiatrists such as many in our nursing home population with its own method of social control of the use of antipsychotics and almost many given AD's.
So much funding has been thrown at Mental health but I believe the demand has outweighed it in such a way since all of the infamous shootings in which most if Not all were ON Psych drugs coming into question that the behaviors may have been caused by the use of the drugs which has been noted time and time again that many of these violences were caused by people who were On such drugs not in my belief that they were always originally "mentally" ill. And one has to take in to account the withdrawal or cold turkey of such drugs which also leads to harm of self in some instances...
So like in most medicine..there should be preventative psychiatry somewhere in the mix just as there is preventative health and wellness. So what are we doing for people "before" we just give them a pill? Or is this just the answer to just about any type of feeling we may have or unusual thoughts or behaviors which are bothersome to the individual or society? I also think that the hearing voices community may be on to something too here as well. A lot of people learn to live with this without medication....And one other point...It may have been Whitaker who explained in his study of antipsychotics that many people who are on them have a more propensity for relapse and hospitalization not those who have also been diagnosed as with just as severe or more so for the same types of illnesses...so I do think it is valid to seriously consider other avenues before just offering some of these more potent and powerful medications which have no long term studies regarding safety and efficacy...And I also wonder how psychiatry can throw a one size fits all cookie cutter approach to a patient regarding the Illness if it is on such a wide continuum as to say its a viable solution for anyone who happens to get labeled with one of these...And as I do believe you will always find a few people who promote and say that these drugs saved their life, until most often than not they take a look perhaps at what is going on in their body or perhaps remain spellbound as Dr. Breggin puts it...Not sure...its up to the individual mostly if they are not caught off guard by someone offering a chemical solution to the problems and challenges of life and how we are almost always taught not to feel..so the pills naturally take away that as well as a host of other functions as well.
Just thinking....my opinion..my two cents...

BeOne77 · May 13, 2014

PsychGuy: More interesting reads:

Another good one is "The myth of the chemical cure" by Joanna Moncrieff, M.D. a prominent psychiatrist in Britain...Rethinking Psychiatric Drugs by Grace E. Jackson and her newest Drug induced Dementia which may as well be worthwhile to gain an even more wider perspective on these issues...

PG2018 · May 14, 2014

"PsychGuy" - There is also "The myth of the chemical cure" by the prominent psychiatrist Joanne Moncrieff M.D. from Britain and the new one "Drug-Induced Dementia by Grace Jackson M.D. another well read and studied psychiatrist as well as her thought provoking Rethinking Psychiatric Drugs...which offers a rounded perspective...on the subject..

Great! Thank you. I'll have to give them a read.

PG2018 · May 14, 2014

If psychiatry such a money maker, then why isn't enough funding getting thrown at it, instead of at prisons, which usually houses many people who need mental health services PsychGuy?
I feel as though only one needs to follow where the money is going to basically fund and refund the pharmaceutical companies which are basically feeding the "system" governed by good ole Uncle Sam and most of the benefactors are the doctors who are caught perpetuating, promoting and prescribing to the public most often not properly using informed consent which in fact if it was done in a manner that was fair to the patient then most people would probably not opt to go that route knowing the risks involved but also there are people who claim they need these drugs who claim that there lives have changed..granted they may have to the benefit or detriment only they can decide but the whole premise of people being a danger to themselves or others off the drugs once put on them could be viewed as a withdrawal effect and also what needs to be considered is that for whatever reason they were put on them in the first place was absolutely necessary or could have been handled in a variety of ways. Also what I find interesting is the Finnish way of dealing with mental health and psychosis which has a high recovery rate( Open Dialogue: a documentary on a Finnish alternative approach to healing psychosis â€“ Beyond Meds)which is essential not what American Mental Health is all about which pretty much says you will be on meds lifetime or which is what the physicians are suggesting in order to keep the cash flow coming in whereas many are finding healing without which kind of puts a dent in the "system".
.Places like the Soteria Houses are popping up pretty much treating the "mentally" ill as much as 70% without medication....So the question is how are these people different from the rest of the population who has also been diagnosed with a severe mental illness? And as far as funding goes, what kinds of services does mental health really provide? Besides therapy which I can see benefit for, what does the mental health "system" really do? Provide pharmaceutical support period..what other services do they provide...maybe Crisis counseling..suicide hotlines...a heck of a lot of business for therapists, but also I am wondering what is it about the US that we are in an ever growing need for such services? Most people who are in prison got there because they broke the law not necessarily because they were mentally ill and some as it suggests are, and that is why they are there but many I suspect are actually put on these drugs while there if not before they have probably been coerced one way or another to take something I suppose .Thinking of how hard it must be to get to sleep in prison.the overwhelming depression factor of realizing you are there and the guilt of your crime and acting out or any other behavior is probably most likely "modified" in some way by prison psychiatrists such as many in our nursing home population with its own method of social control of the use of antipsychotics and almost many given AD's.
So much funding has been thrown at Mental health but I believe the demand has outweighed it in such a way since all of the infamous shootings in which most if Not all were ON Psych drugs coming into question that the behaviors may have been caused by the use of the drugs which has been noted time and time again that many of these violences were caused by people who were On such drugs not in my belief that they were always originally "mentally" ill. And one has to take in to account the withdrawal or cold turkey of such drugs which also leads to harm of self in some instances...
So like in most medicine..there should be preventative psychiatry somewhere in the mix just as there is preventative health and wellness. So what are we doing for people "before" we just give them a pill? Or is this just the answer to just about any type of feeling we may have or unusual thoughts or behaviors which are bothersome to the individual or society? I also think that the hearing voices community may be on to something too here as well. A lot of people learn to live with this without medication....And one other point...It may have been Whitaker who explained in his study of antipsychotics that many people who are on them have a more propensity for relapse and hospitalization not those who have also been diagnosed as with just as severe or more so for the same types of illnesses...so I do think it is valid to seriously consider other avenues before just offering some of these more potent and powerful medications which have no long term studies regarding safety and efficacy...And I also wonder how psychiatry can throw a one size fits all cookie cutter approach to a patient regarding the Illness if it is on such a wide continuum as to say its a viable solution for anyone who happens to get labeled with one of these...And as I do believe you will always find a few people who promote and say that these drugs saved their life, until most often than not they take a look perhaps at what is going on in their body or perhaps remain spellbound as Dr. Breggin puts it...Not sure...its up to the individual mostly if they are not caught off guard by someone offering a chemical solution to the problems and challenges of life and how we are almost always taught not to feel..so the pills naturally take away that as well as a host of other functions as well.
Just thinking....my opinion..my two cents...
Super post! Thanks. Yes, that was Whitaker. The Soteria Project is huge in my mind, and when I learned about that I seriously started to question psychotropics. Compounded is the fact that nations who don't pressure "crazies" with psychotropics show better remission and recovery than us "first-world" nations who do push pills.
Yes, for all those who challenge me, lol, I do think drugs have their place, but I don't think they're the end all/be all that many in psychiatry make them out to be.
Phenomenal topic here. I completed a paper last semester, prior to reading Anatomy of an Epidemic, about improving access to care among the mentally ill particularly preventive psych. care which I think is something the U.S. is seriously lacking. Interestingly, it was NAMI, who I found to
have the best, umbrella of ideas about how to do this. I got the feeling that Whitaker did not have any warm and fuzzy feelings for NAMI.
I want to point out, I have the name PsychGuy because it wasn't taken. I am a career changer, two year old RN, working on my master's to become a psych NP. I wanted to point that out as I don't have any overwhelming credentials or background in mental health.