by Gwen Olsen
It is a travesty that neuroleptics are some of the most frequently prescribed drugs in mental hospitals and are widely used in board and care homes, nursing homes, institutions for people with mental retardation, children’s facilities, and prisons. These drugs are also given to millions of patients in public clinics and dispensed to hundreds of thousands of people in private psychiatric practices. Some of the symptoms for which they are prescribed are off-label indications such as anxiety and sleep disturbance. All too often, they are administered to children with emotional and behavioral problems, even children living at home and going to school (Breggin, Toxic Psychiatry, 51).
You may recall the outrage among Americans in the 1970s when Soviet dissidents revealed they had been tortured by the KGB with mind control drugs that completely destroyed their will to live and left them brain-damaged, psychotic, or delusional. At a 1971 disarmament conference in East Berlin, the consensus was that “psychotoxins were weapons directed against the further existence of an independently thinking and acting society.” The World Psychiatric Association further condemned the Soviet Union for the use of neuroleptics in Soviet dissidents in 1977, saying the practice amounted to nothing less than a combination of lobotomies and torture («Forced Drugging»). The drug that was frequently used in that torture was the neuroleptic I sold, Haldol.
The neuroleptics are the main constituents contained in tranquilizer darts and the injections used by veterinarians in subduing vicious animals. By impairing the limbic system, the arousal response is blunted, thereby tranquilizing the animal. Veterinary literature and practice has established these drugs must be limited to short-term use only. They are considered to be very dangerous to animals, even though it is often more difficult to produce the permanent drug-induced neurological disorders in animals than it is in humans. Why then would American psychiatrists presume them to be any safer in people?
The bottom line is that important aspects of the psychiatric treatment of women, children, elderly, and other ethnic groups have yet to be adequately studied. So, the side effects of these drugs that are specific to them are generally unknown.
Dr. Peter Breggin sums up his position on the use of neuroleptic drugs quite profoundly in his book entitled Toxic Psychiatry:
Despite the best efforts, we can never fully anticipate all of the damaging effects inflicted on the individual by the neuroleptics and other toxic drugs. We must assume that numerous harmful effects go unnoticed. There is an analogy here to environmental pollution, where likewise we can notice, measure, and anticipate only the most obviously damaging effects. By the time we do become aware of new dangers, we’ve already done an unconscionable amount of harm and for the health of many people, it’s too late (91).
Atypical Antipsychotics: One Man’s Trash Is Another Man’s Treasure
If there is anywhere that the scientific background of psychiatric drugs is questionable, it is with the atypical antipsychotics. Once again, the industry created a new name for the newer drugs to divert the negative publicity now associated with neuroleptic-induced tardive dyskinesia. Unfortunately, the atypical antipsychotics have also been found to cause many of the same side effects as the older neuroleptic drugs, including tardive dyskinesia.
At least the neuroleptics are pretty much seen for what they are, chemical restraints for combative, psychotic patients. However, the atypical antipsychotics are touted as breakthrough drugs and as a more advanced treatment option. They are also promoted as having fewer side effects and better outcomes that help schizophrenics lead more functional lives. I have talked to patients who say they are doing well on them, but a review of the scientific facts brings to light serious concerns.
One of the saddest elements of this story I uncovered was how the patients in these atypical drugs’ clinical trials were selected and treated. Robert Whitaker reveals the shocking history and continuing mistreatment of our mentally ill in his book, Mad in America. Among the many injustices committed against these poor souls were the clinical protocols that required patients to be abruptly withdrawn from their existing medications. The abrupt withdrawal was expected to exacerbate psychotic hallucinations and delusions. However, as Whitaker notes:
Abrupt withdrawal (as opposed to gradual withdrawal as we’ve already learned) is also known to put patients at risk of severe clinical deterioration. It is contrary to good clinical practice, and it increases the risk of suicide, which is precisely how many people died in the trials (270).
All told, seven people killed themselves in the Serlect (sertindole) clinical trials, another atypical that was launched in Europe in 1996 but later withdrawn because of cardiac side effects in 1997. Serlect was never approved in the United States. At least ten patients committed suicide in the Risperdal trials, fifteen in the Zyprexa studies, and four in the Seroquel (quetiapine) experiments. Even more appalling is the fact that when the trial results for these drugs were reported in the scientific journals, they completely excluded the loss of life that had occurred (Whitaker 272). Most of these patients had gone seeking help from their doctors and, instead, had been put at grave risk, treated like ordinary guinea pigs or lab rats for pharmaceutical research purposes!
FDA reviewers reportedly scoffed at the data submitted by Janssen and Eli Lilly during their face-off wars between Risperdal (risperidone) and Zyprexa (olanzapine) and pointed out how the manufacturers had biased the trial designs in order to produce superior results over the older neuroleptics. In fact, following the review of the first three atypicals, the FDA did not find any convincing evidence the atypicals were any more effective than the existing treatments. However, it is not necessary to prove superiority over existing therapies to win FDA approval for a drug. It is only necessary to show superiority over placebo. The manufacturers’ attempts to show superiority over older, less expensive neurolep- tics was a marketing ploy to gain market share for the newer drugs which sold for ten to thirty times the price of the older ones (Whitaker 282).
Use of the newer atypical antipsychotics has been linked to dramatic increases in triglycerides and the development of diabetes. This prompted a joint warning about these drugs to be issued by the American Diabetes Association, American Psychiatric Association, North American Association for the Study of Obesity, and American Association of Clinical Endocrinologists (“Risks of Anti-Psychotic Drugs Eyed”).
Additionally, on April 11, 2005, the FDA issued a public health advisory, and eventually a black box warning, alerting health care providers, patients, and caregivers to safety concerns regarding the off-label uses of atypical antipsychotics. The FDA’s statement said the treatment of behavioral issues in elderly patients with atypical antipsychotics had been associated with increased mortality in this population, and that clinical studies had substantiated a higher death rate associated with their use in geriatrics (U.S. Food 2005d).
So, even if some patients do receive a perceived benefit from the newer atypi- cals, there is the added risk that overall health may be negatively impacted, leading to additional medical complications or early death for many. All of these things must be factored into the risk-to-benefit ratio when assessing the true value of the atypical antipsychotics.
Antipsychotic drugs do not knowingly fix any brain abnormalities or balance any brain chemicals. What they do is suppress brain function in a manner that restrains physical mobility and diminishes certain psychotic symptoms. Like the older neuroleptics, these drugs grossly affect dopamine levels in the brain, a situation which is known to increase some people’s vulnerability to psychosis. Long-term outcomes with the use of any of the antipsychotics are dismal at best. The World Health Organization has reported the outcomes for psychiatric diagnoses to be much better in countries where these medications are not used or are used less frequently.
Regardless, total sales of antipsychotic drugs in 2004 grew in excess of ten percent year over year (IMS Health 2005a). Currently, sales of Zyprexa, Eli Lilly’s atypical antipsychotic and newest and sweetest cash cow, have now
surpassed sales of Prozac. (Although it went off patent in 2001, Prozac still brought in $559 million to the company coffers last year) (Swiatek). Despite stiff competition and the negative publicity from reports linking it to weight gain and diabetes, in 2004, Zyprexa sales ranked fifth in the top ten pharmaceutical products sold globally racking up a cool $4.8 billion in sales (IMS Health 2005b).
9
Crazy Just Like Your Mother:
Dolores' Story
“Nothing has a stronger influence psychologically on their children than the unlived life of the parent.”
—Carl G. Jung
“Mommy has a mental illness, just like Mamaw. It never goes away, and they don’t know how to fix it.” That’s how my father explained it to me as a little girl as we sat talking for hours about our family trials and tribulations. However, in my mind, that translated to “Mommy is crazy just like Mamaw.” This was in no small part due to the fact that when they were fighting, my father repeatedly told my mother, “You crazy bitch!” He would snarl between clenched teeth, either unaware or unconcerned I was listening, “You’re crazy, just like your mother!”
That particular explanation did nothing to quell my fears or make it any easier for me to cope with the tremendous mood swings my mother would have and the resulting chaos that would consume our household.
We were like a family of trapeze artists, never knowing which wrong step might send us plummeting to the ground below. In fact, I think the circus analogy is very appropriate for my family dynamics. Our lives were filled with adrenaline rushes and high drama. We were an organization of misfits, so to speak, that performed in front of audiences with polish and pizzazz. Just like in a circus, behind the scenes and after the show, abuses were taking place that were unknown to the outside world, suffered in silence by innocent captives.
The fights that would define my childhood sent me and my younger sister scampering to hide in closets. If my father had been drinking, the fighting was physical and violent, so we learned to take cover when things escalated. The chaotic noise coming from the hallway and bedrooms could be terrifying to the untrained ear. Furniture was overturned. Doors were slammed, and dishes crashed. We waited with bated breath until the crying, wailing, screaming, and cursing had stopped.
Sometimes, Mother would plead for help and beg us to call the police. On more than one occasion, I remember trying to live down the embarrassment at school of the police coming to our house. Everyone would know and be whispering about it the next day.
Following many of their fights, Dad would gather his things and head for a hotel for the night. Mom would eventually run out of steam and collapse, sobbing and exhausted on her bed. Only then would my sister and I venture out. We were like soldiers returning to the battlefield, surveying the damage and assisting the wounded. We were our mother’s caretakers. We were always there to pick up the pieces of her shattered life.
I don’t know when my parents’ marriage went south, but they had traumatic fights from my earliest memories on. My mother was never officially diagnosed with any mental illness, although she was treated for her nerves more than once. It is impossible to know now which drugs she was given, but I would be shocked if she hadn’t been given tricyclic antidepressants somewhere along the line. I do know she was given Valium.
Whatever it was she was given for her nerves initially made her sleep a lot. Eventually, it precipitated a cleaning frenzy that would last for days. There was a wild look in her eyes that I would later identify as mania, but, back then, I only knew that look meant trouble for me. Mother was on the warpath! Fortunately for her (and us), the SSRIs had not yet been discovered.
I recall a particularly difficult time in 1969. I was ten, and my mother was twenty-nine. My Uncle Sonny had been killed in Vietnam. The funeral was a heart-wrenching display of raw emotion and grief. I had been asked to sing and was directed to stand behind the coffin. A curtain separated me from the congregation. I had a side view of the casket, but I could not see the audience. My knees trembled as the music began, and I felt faint from the heat. It was almost impossible to sing as my emotions swelled and caught in my throat. My grandmother snapped during the service, got out of her seat, and approached the coffin. She started dumping the contents of her purse onto the glass that allowed us to view, but not touch, Sonny’s body. (He had stepped on a mine and was missing body parts. Therefore, the casket was only halfway open and covered by glass.) She was searching for smelling salts she had been given while watching a neighbor’s ailing dog.
In the days following her brother’s burial, my mother’s moods were erratic and volatile. She would lock herself in her bedroom for days crying. She would refuse to bathe, eat, or interact with anyone else. Sometimes, I would sit outside her door on the floor reading, just waiting to hear her stir or get up to use the bathroom. Other times, I would sit, gently consoling her through the door as she sobbed uncontrollably from the other side. I attempted to coax her out of the room or to let me come in. When she finally did open the door, the room was dark and dreary with all the drapes drawn and windows closed and stunk of body odor. Piles of books, magazines, and photos lay strewn about the bed amidst discarded snot-laden Kleenex. Mom lay curled up in a fetal position wearing her housecoat and pajamas, appearing almost comatose on the bed.
As the school bus approached the farm road to my house, I would begin feeling anxious in anticipation of what I might find. Leaving Mom in one frame of mind that morning did not ensure you would encounter her in the same demeanor that afternoon. It was a crapshoot at any given time, but it was especially brutal that particular year.
This scene would repeat itself over and over again as I grew up. The family would literally walk on eggshells during these episodes, fearing anything one said or did could set Mom off!Eventually, I started losing compassion for my mother and closed my heart to the abuse perpetrated against her by my father. Part of me felt like she deserved it. She often started the fights! Part of me even cheered in retaliation when he blackened her eye or hurt her in some other way. However, I later realized that was my own coping mechanism to survive the psychological pain she had inflicted on me. Sometimes, it is easier to hate your abusers than it is to justify loving them.
Growing up with Dr. Jekyll and Mr. Hyde
Probably the most difficult part of bipolar disorder for a child to accept and assimilate is living with the two faces of Dr. Jekyll and Mr. Hyde. A child with a bipolar parent experiences life much like a roller coaster ride. There are alternating highs and lows that either thrill and elate you or scare you half to death! When my mother was hypomanic or in the initial stages of mania, her moods were childlike and free-spirited. She was so young to begin with, but, even so, she still appeared exceptionally youthful. An unlived childhood beckoned her to romp and play carefree as an adult. We would ride in her VW bug with the top down and the wind in our hair as the radio blared loudly.
I distinctly remember the immense sense of pride I felt about my beautiful mother when I was younger. She had long, thick, auburn hair and lovely blue- gray eyes. She also had a great sense of style and was always sporting the latest haircut and clothing design. Her gregarious, outgoing personality, coupled with an infectiously loud laugh, made her great fun during those times. Mom was intelligent, witty, and charming. She was a good cook and a phenomenal hostess. Because of these qualities, she collected a cadre of friends over the years. I loved to daydream with Mom because she lived large in her dreams. She had an inquisitive, naivety for her years and a spunky, determined outlook on life when she was consumed by grandiose ideas, usually her latest business venture that would be started in a flurry of hypomanic energy and then abandoned midstream when the dark clouds rolled back in.
These were the times I loved most, when we talked and laughed for hours on end and shopped until we dropped. Mom felt more like my friend than a parent, more like she does today. When Mom isn’t depressed or agitated, I would still rather exchange ideas and talk with her more than any
one else I know. For example, while I was writing this book, she was a constant source of information and discourse on the subject matter, although much of what was written was an unflattering reminder of her former self and quite painful for her to read and relive.
This same lost childhood made Mom determined to give me all the experiences and opportunities that she had not had. To that end, I took tap dance, ballet, and piano lessons. I played French horn in the band and was a member of the “Sparkettes,” my high school drill team. I also performed before local civic groups singing and reciting poetry. I was in choir and Job’s Daughters. I participated in theatre and drama projects at school, and I won several local beauty pageants. Mom would also encourage me to be a foreign exchange student my junior year in high school. All of these things were things my mother would have loved to do.
Needless to say, not being mature enough to understand her motivations at the time, I started to resent Mom for what I saw as her attempts to live through me. As an adolescent, I pushed for greater autonomy and independence, and she felt threatened and abandoned. Of course, that only escalated the tension between us. When the histrionics would start consuming my life again, I could barely muster the tender feelings of love and pride I had felt so intensely for her before. She would nearly always beg for forgiveness following our fallouts, dissolving into emotional tears that would often melt my angry heart. By the time I left home, I had little compassion remaining. I simply could not integrate the dualism. Of course, my father’s cruel response to Mom’s agitation and depression only added fuel to the fire of her despair. I couldn’t stand it any longer!