The Drugging of the Mentally Ill

My brother’s experience with mental illness has been something that I have been reluctant to describe in any detail. The reason being, is that he was a very private person, and also a very proud person. But I feel my brother’s experience has been a classic example of what is wrong with our current paradigm of care for the mentally ill—namely, its over-reliance on drugs. And the only way I can show that is by sharing what I feel are the key points in his story. I have divided the story of my brother’s illness into four main events, each punctuated by a delusional episode that caused hospitalization or the intervention of family and friends, and each with its own distinct mode of treatment. What I have left out are details about the specific life stressors that accompanied each event and which, by and large, are rather universal, like trauma, social conflict, social separation, and legal/financial troubles. I have also left out speculation about what may have contributed to my brother’s vulnerability to mental illness.

The first event occurred in Italy when Matt was hospitalized following a psychotic episode. As a first line of treatment he was prescribed antidepressants which, in a bipolar individual, as Matt was eventually diagnosed, have been shown to increase the likelihood of mania, depression, and rapid cycling (Hamilton 139-140). Matt stayed on that regimen of drugs on and off for several years. During that time he showed signs of hypomania, but would only seek treatment when in the depths of depression. Therefore, his diagnosis, and subsequent prescription of drugs, were based solely on those depressive states and not on a comprehensive analysis of his behavior.

The second event in Matt’s illness occurred almost ten years later. He became manic, delusional and, for a brief period, catatonic. This time the family rallied around him and provided support, both emotional and physical. We helped him solve the real-life stressors that were contributing to his aberrant state. With this support he got off his medication and stabilized himself, and for the next several years lived a fulfilling life. However, at some point during that time, he got back on antidepressants.

The third event, which just like the other two events was precipitated by a real-life stressor, occurred about three years after the second. He became manic and was hospitalized following an encounter with the police. This may have been the time at which he was diagnosed bipolar, and marked the introduction of mood stabilizing drugs (Lithium) into his prescriptions. He lacked the same familial support during this third psychotic break as he had with the second. Hospitals filled the gap, and this is when the true roller coaster ride began. Matt was hospitalized every year, sometimes multiple times a year, for six straight years. His mind became dependent on Lithium for its stability, but Lithium had side-effects that a man in his mid-thirties might find hard to bear. He would go off them to regain his energy and vitality, but his mental stability was now being propped up artificially by the drug, and when he was suddenly without it he would rebound even further into psychosis. The routine was very similar each time. He would go into a period of depression following hospitalization, which would then turn into mania. His mania would build upon itself until he was completely off the rails. He could somehow keep it together for his monthly, fifteen-minute interview with his doctor, however, leaving the doctor oblivious to Matt’s true condition. It was then up to the family to hold the tail of the tiger, praying no one got hurt, and wait for some accident to land him in the hospital again. Once he was admitted, we could all relax. He was safe. But then we had to face the horror that within just a matter of weeks he would be back out, with another script of drugs and no other healing therapy provided. Since Lithium was introduced in this country, readmission rates for mania have gone up (Whitaker 184). This statistic is directly in line with my brother’s personal experience.

The fourth event was Matt’s leap from the Biloxi Bay Bridge, six years after the third event, which he survived by swimming to shore with a dislocated shoulder and a collapsed lung. In the hospital he mentioned to the staff that voices in his head told him to jump, and thus his diagnosis was changed to bipolar schizoaffective, and he was prescribed a monthly shot of a long-acting antipsychotic drug. On this new regimen of drugs Matt spent the next four years without being hospitalized, and all of us breathed a sigh of relief. But simply because he wasn’t acting out doesn’t mean his life was well. The drugs allowed him to persist in a terrifying state of inaction and isolation, for the benefit of those around him, but it was at the expense of his long-term health. When another life trauma did arrive, he was even less equipped to cope. During a move out of state, he got off his medication and started to become delusional. He attempted suicide again—at least his third attempt throughout the previous decade. While in the hospital, he was put on a different long-acting antipsychotic and, about six months later, an oral antidepressant was added. Two weeks after that, he attempted suicide once more, and this time he succeeded.

In summary, I want to add what I feel are the lessons of my brother’s experience.

1. Diagnosis is a muddy affair. It is not made based on any biological markers; it is made solely on the behavior of that individual in the moment he is brought in for evaluation, which may not be indicative of his complete condition or may be only an extreme temporal phase of that condition.

2. The drugs that are prescribed, often, in the long term, exacerbate the illness they treat. As noted by Robert Whitaker, “outcomes for bipolar disorder have dramatically worsened in the pharmacotherapy era.” (Whitaker 177)

3. There is very little done within our current system of care to actually heal the sufferer of mental illness, like showing patience, support, and guidance toward behavioral changes that would benefit them.

4. Psychosis is, without a doubt, something that can be healed. Matt’s second psychotic episode was recovered from without medical intervention. In many ways, it replicated a form of care developed in Finland, called “open-dialogue therapy”, where the family is brought in to rally around a suffering individual and provide support and acceptance without the intervention of drugs. Those who receive this form of therapy fare much better than those treated with drugs (Whitaker 339).

It is my belief that one day we will look back on this “pharmacotherapy era” with the same horror that we now look back on the lobotomization era. Too many individuals are being forsaken to a lifetime of drug dependency, my brother being one. As our knowledge of the brain increases, we are becoming more aware of just how changeable it is. Yet, in order to pin it down with diagnosis, and subject it to a consistent barrage of chemicals, we must look at it as static—incapable of changing; incapable of healing. To meddle with something beyond our understanding, by flooding it with chemicals, is like throwing spaghetti at the wall to see what sticks. Yes, some does stick, but too many lives are being ruined in the process.

References

Hamilton, Sheila. All the Things We Never Knew. Berkeley: Seal Press,

2015.

Whitaker, Robert. Anatomy of an Epidemic: Magic Bullets, Psychiatric

Drugs, and the Astonishing Rise of Mental Illness in America. New

York: Broadway Books, 2015.