Psychiatric Drugs:
Neuroleptics The Effects of Haldol, Prolixin,
Thorazine,Mellaril, and Other “Antipsychotic” Drugs –
Chap
3 Peter Breggin’s book, Toxic
Psychiatry.) “People’s voices came through filtered, strange. They could
not penetrate my Thorazine fog; and I could not escape my drug prison.” - Janet
Gotkin, testimony before the Senate Subcommittee on the Abuse and Misuse of
Controlled Drugs in Institutions (1977)
My concern is that people are having their
minds blunted in a way that probably does diminish their capacity to appreciate
life. - Jerry Avorn, M.D., Boston Globe, November 25, 1988
“It’s
very hard to describe the effects of this drug and others like it. That’s why we use strange words like
“zombie”. But in my case the experience became sheer torture.” - Wade Hudson,
testimony before the Senate Subcommittee on the Abuse and Misuse of Controlled
Drugs in Institutions (1977)
“Frequent
Effects: sedation, drowsiness, lethargy, difficult thinking, poor
concentration, nightmares, emotional dullness, depression, despair . . .” -
Dr. Calagari’s Psychiatric Drugs (1987)
Alexandria sat in my office filled with
fright-as much fright as she could feel through the dose of the psychiatric
medication. The teenager’s face was flat in expression, her body sagged, she
moved as if mired down. She looked profoundly depressed. And yet she wasn’t
feeling at all depressed; she was terrified. She looked depressed because she
was suffering from what we psychiatrists call “psychomotor retardation”-the
enforced paralysis of mind and body that routinely results from treatment with
neuroleptics, the drugs most frequently given to patients labeled
schizophrenic.
A few weeks earlier, Alexandria had begun to see and hear things
that weren’t there and to mutter incoherently about God and death. The parents
of this sensitive, poetic teenager at first thought she was going through a
phase, maybe even playing a role from one of her beloved novels. That was until
she stopped coming out of her room. When they tried to coax her out, she
screamed hateful things at them about how they came from the devil and wanted
to hurt her. Alexandria’s parents saw an ad on TV promoting a local private
psychiatric hospital for “the caring treatment” of adolescents, and they found
hope in it. She was “acting crazy” some of the time, they later told me, but
she was still herself when they left her in the hospital the first day. She was
full of vitality and completely alert. When they said good-bye, she hugged them
and cried. Her mother cried, too.
When they visited again the next day, they hardly recognized
their daughter as she trudged toward them with shuffling steps and bent
shoulders. She had been injected with Haldol. Alexandria’s parents took her out
of the hospital and brought her directly to me.
Now I talked alone with Alexandria while her parents sat
nervously in the waiting room. Out of the corners of her eyes, she looked
inquisitively around my office. She touched a gleaming crystal and patted a model
of a fawn. It was as if she couldn’t believe she was in such a bright and
cheery room filled with wonderful distractions. I saw her eyes shift toward a
small carved duck that was nearer to me, and I handed it to her. She said,
“Exactly.” I wondered what lay behind that cryptic and seemingly inappropriate
remark, but I said nothing. She seemed to be relaxing. She fondled the duck for
awhile. “It’s so colorful,” she said. “It’s one of my favorites, too. I love
birds. Do you like the Audubon prints?” She turned slowly in her chair to see
them. “No,” she said. “He shot birds.”“Yes, I understand that,” I agreed. “I
don’t like that either.” After a pause, she said, “What’s happening to me?”
“What do you mean?” “My mind. I can’t think. I can’t feel.” “Tell me some
more.” “Like those poor ducks .the ones in the photographs. The awful
black-and-white photographs.”I had no photos of ducks in my office, only the
model she was holding, and it took me a moment to realize what she was talking
about. Newspaper photos came to mind. “The ducks in the oil spills?” “You
noticed those pictures, too?” She perked up. “I feel like that, like a duck, my
feathers all matted down and stuck together.” I gestured to indicate her arms,
which lay heavily on the chair, stiffened by the drug effect.“Not just my arms
. . . my mental wings,” she explained to me. “My mental wings and feathers . .
. matted down and stuck together.” “It’s the medication,” I said. “It does that
to everybody in the doses you’ve been given.” “The medicine?” A small smile
flickered across her face. “It’s not me?” “No,” I said, “It’s not you.” “Oh,
God,” she said, “I thought I had finally lost my mind.” “No, it’s nothing like
that,” I reassured her. “It will wear off.” Alexandria had been on the
medication for such a short time, only a few days, that it was safe to stop it
abruptly. I promised never to force her to take any medication. After talking
with Alexandria long enough for her to gain some confidence in me, she agreed
to inviting in her parents. Then I explained to her mother and father how I
would approach their crisis as a family problem. I would help them to relate
better to this sensitive, spiritual young woman who was going through such a
difficult time, and help all of them to better understand, support, and love
one another. Sometimes it would be
painful, I said, especially when Alexandria expressed the feelings of hurt and
pain that caused her to speak so hatefully to them. But it would open up the
opportunity for growth and ultimately for better relations in the family. I
added that I liked Alexandria and that in our few minutes together I already
sensed that she and I shared many feelings, values, and attitudes. I hoped to
help her come through her part of the family crisis with a new and better understanding
of herself and a great ability to express her anger in more productive ways and
to live effectively in the world.
Once Alexandria found someone she could communicate with, she
felt less frantic and more hopeful. The need to flee from reality was no longer
so pressing. Through our work together, her parents learned to be more patient
with her and to look more honestly at the negative impact of their own
attitudes, especially their overinvolvement with her in a negative, critical
fashion and their difficulty in expressing unconditional love.
Alexandria would have long-term personal and family difficulties
to handle; but she was through the worst of her crisis in a matter of weeks.
Indeed, her most difficult problem was recovering from the medication. It took
more than a month before she felt in touch with her finely tuned feelings and
before she could think with her usual clarity.
It was relatively easy to help Alexandria with her acute “schizophrenic”
crisis because it was her first experience with such overwhelming helplessness
and fear and she was highly motivated. She understood her urgent need for
finding a meaningful way of life and had the courage to pursue her ideals. Of
equally great importance to this young person, her parents also were motivated
to make changes in her best interest. They were willing to look at their own
contribution to Alexandria’s crisis and to learn new ways to understand and to
love her.
It also was relatively easy to help Alexandria because she had
not been driven into hiding by years of psychiatric treatment. The longer a
person has been subjected to the humiliation of being diagnosed and
misunderstood by professionals, and the longer a person has been subjected to
psychiatric drugs-the harder it is to make progress.
The agents inflicted upon Alexandria are known by a variety of
designations, including major tranquilizers, antipsychotics, and neuroleptics.
These words are synonyms. The original ones, including Thorazine and Mellaril,
are called phenothiazines, and sometimes that term is used too loosely to
designate the entire group. In psychiatry, the term neuroleptic is now
preferred. Neuroleptic was coined by jean Delay and Pierre Deniker, who first
used the drug in psychiatry, and means “attaching to the neuron.” Delay and
Deniker intended the term to underscore the toxic impact of the drug on nerve
cells (see chapter 4).
List of Neuroleptics -The public identifies most psychiatric
drugs by their trade names-the proprietary trademarks under which the companies
own and market them. With generic names
in parentheses, a list of trade names of neuroleptics in use today includes
Haldol (haloperidol), Thorazine (chlorpromazine), Stelazine (trifluoperazine),
Vesprin (trifluopromazine), Mellaril (thiorldazine), Prolixin or Permitil
(fluphenazine), Navane (thiothixene), Trilafon (perphenazine), Tindal
(acetophenazine), Taractan (chlorprothixene), Loxitane or Daxolin (loxapine),
Moban or Lidone (molindone), Serenfil (mesoridazine), Orap (pimozide), Quide
(piperacetazine), Repoise (butaperazine), Compazine (prochlorperazine), Dartal
(thiopropazate), and Clozaril (clozapine).(1)
The antidepressant Asendin (amoxapine) turns into a neuroleptic
when it is metabolized in the body and should be considered a neuroleptic. Etrafon or Triavil is a combination of a
neuroleptic (perphenazine) and an antidepressant (amitriptyline), and it
combines the impact and the risks of both.
The neuroleptics are the most frequently prescribed drugs in
mental hospitals, and they are widely used as well in board-and-care homes,
nursing homes, institutions for people with mental retardation, children’s
facilities, and prisons. They also are given to millions of patients in public
clinics and to hundreds of thousands in private psychiatric offices. Too often
they are prescribed for anxiety, sleep problems, and other difficulties in a
manner that runs contrary to the usual recommendations. And too often they are
administered to children with behavior problems, even children who are living at
home and going to school.
No one knows the total numbers of neuroleptic drugs taken by
patients each year, but estimates are possible. While the overall number of
beds in state hospitals is down, annual admissions are up from the 1950s, and
most of the several hundred thousand patients admitted each year are diagnosed
as schizophrenic. Nearly all of these are prescribed neuroleptics. Hundreds of
thousands more are getting them through outpatient clinics. Well over a million
people a year are treated with neuroleptics on the wards and in the clinics of
state mental health systems.
Additional millions more are receiving neuroleptics or
antipsychotics through sources outside the state mental hospital system and
long-term clinics. Of the estimated two million patients in nursing homes, many
of them are on neuroleptics. Add to these patients the tens of thousands being
treated with these drugs in private psychiatric hospitals, and in the
psychiatric and medical wards of general hospitals, plus the tens of thousands
in institutions for people with retardation, the untold thousands in
board-and-care homes, still more in prisons, and hundreds of thousands in
private practice-and the total swells to many millions. Even homeless people in shelters are
sometimes forced to take them.
The National Prescription Audit provided by the FDA reported
twentyone million prescriptions for neuroleptics in 1984. These figures are
drawn from retail pharmacies and therefore do not include patients in institutions
or patients dispensed medications directly from clinics. Of course, many
patients obtain more than one prescription a year, but the figures suiz2est
that at least several million individuals are obtaining neuroleptics rrom
retail pharmacies each year.
That huge numbers of people are treated with neuroleptics is
confirmed by the figures occasionally released by the pharmaceutical
companies. The first neuroleptic was
chlorpromazine, whose trade name is Thorazine.
In a 1964 publication entitled Ten Years’Experience with Thorazine, the
manufacturer, Smith Kline and French, estimated that fifty million patients had
been prescribed chlorpromazine in the first decade of use (1954 to 1964). The
figure probably was worldwide. In recent years, haloperidol, sold by McNeil
Pharmaceutical under the trade name Haldol, has become the most prescribed
neuroleptic. In a letter to attorney Roy A. Cohen dated August 13, 1987,
McNeil’s director of medical services, Anthony C. Santopolo, provided a glimpse
at Haldol’s escalating use. The figures for patients first treated with Haldol
grew from 600,000 in 1976 to 1,200,000 in 1981.(2)
Overall, the estimate I made in my 1983 medical book,
Psychiatric Drugs, of five to ten million persons per year in America being
treated with neuroleptics probably remains valid today. The sheer size of these
numbers should motivate us to learn everything we can about the impact of these
agents on the brain and the mind.
Textbooks of psychiatry and review articles claim that the
neuroleptics have a specific antipsychotic effect, especially on the so-called
positive symptoms of schizophrenia, such as hallucinations and delusions,
marked incoherence, and repeatedly bizarre or disorganized behavior.
Meanwhile, very little is written in professional sources about
the apathy, disinterest, and other lobotomylike effects of the drugs. Review
articles tend to give no hint that the medications are actually stupefying the
patients and that life on a typical mental hospital ward is listless at best.
And so we must turn to the earliest research reports on the drugs. The
pioneers, eager to show the potency of their new discovery, were far more
candid and graphic in describing the effects to doctors as yet unfamiliar with
them.
The Nature of Lobotomy - To grasp what the pioneers said about
the neuroleptic effect, it’s important first to understand the lobotomy effect
to which it is compared. This link contains the history and description of the
surgical lobotomy.
The Birth of Chemical Lobotomy - Reports from the Drug Pioneers
& How Neuroleptics Produce Lobotomy - In 1952, the first shot in the
“revolution in psychiatry” was fired in Paris by the two pioneers Delay and
Deniker. They published their findings on chlorpromazine (Thorazine) in French
in Congres des Medecins Alienistes et Neurologistes de France. Read the straightforward description of the
apathy and lack of initiative typical of lobotomy.
The neuroleptics also are used in tranquilizer darts for
subduing wild animals and in injections to permit the handling of domestic
animals who become vicious. The veterinary use of neuroleptics so undermines
the antipsychotic theory that young psychiatrists are not taught about it.(3)
The brain-disabling principle applies to all of the most potent
psychiatric treatments-neuroleptics, antidepressants, lithium, electroshock,
and psychosurgery. The principle states that all of the major psychiatric
treatments exert their primary or intended effect by disabling normal brain
function. Neuroleptic lobotomy, for example, is not a side effect, but the
sought-after clinical effect. It reflects impairment of normal brain function.
Conversely, none of the major psychiatric interventions correct
or improve existing brain dysfunction, such as any presumed biochemical
imbalance. If the patient happens to suffer from brain dysfunction, then the
psychiatric drug, electroshock, or psychosurgery will worsen or compound it.
If relatively, low doses produce no apparent brain dysfunction,
the medication may be having no effect or producing a placebo effect. Or, as
frequently happens, the patient is unaware of the impact even though it may be
significant. Anyone familiar with the behavior of people drinking alcohol knows
how easily a slightly intoxicated person may deny being impaired or even claim
to be improved. Most people coming off cigarettes become abruptly aware of
missing the sedative and tranquilizing effects that previously were taken for
granted.
Brain dysfunction, such as a chemical or surgical lobotomy
syndrome, renders people much less able to appreciate or evaluate their mental
condition. Surgically lobotomized people often deny both their brain damage and
their personal problems. They will loudly declare, “I’m fine, never been
better,” when they can no longer think straight. Sometimes they deny that they
have been operated on, despite the dime-size burr holes in their skulls
palpable beneath their scalp. Superficially, the denial looks so sincere that
prolobotomists cite it to justify the harmlessness of the treatment.
Even without the production of brain dysfunction, the giving of
drugs or other physical interventions tends to reinforce the doctor’s role as
an authority and the patient’s role as a helpless sick person. The patient
learns that he or she has a “disease,” that the doctor has a “treatment,” and
that the patient must “listen to the doctor” in order to “get well again.” The
patient’s learned helplessness and submissiveness is then vastly amplified by
the brain damage. The patient becomes more dutiful to the doctor and to the
demoralizing principles of biopsychiatry. Denial can become a way of life,
fixed in place by brain damage.
Suggestion and authoritarianism are common enough in the
practice of medicine but only in psychiatry does the physician actually damage
the individual’s brain in order to facilitate control over him or her. I have
designated this unique combination of authoritarian suggestion and brain damage
by the term iatrogenic helplessness. Iatrogenic helplessness is key to
understanding how the ma’or psychiatric treatments work .
There is little or no reason to anticipate a physical treatment
in psychiatry that will control severely disturbed or upset people without
doing equally severe harm to them. If psychosurgery, electroshock, or the more
potent psychiatric drugs were refined to the point of harmlessness, they would
approach uselessness. In biopsychiatry, unfortunately, it’s the damage that
does the trick.
Whether or not some psychiatric patients have brain diseases is
irrelevant to the brain-disabling principle of psychiatric treatment. Even if someday a subtle defect is found in
the brains of some mental patients, it will not change the damaging impact of
the current treatments in use. Nor will it change the fact that the current
treatments worsen brain function rather than improving it. If, for example, a
patient’s emotional upset is caused by a hormonal problem, by a viral
inflammation, or by ingestion of a hallucinogenic drug, the impact of the
neuroleptics is still that of a lobotomy. The person now has his or her
original brain damage and dysfunction plus a chemical lobotomy.
But what about claims that the treatments reduce psychiatric
symptoms, such as so-called hallucinations and delusions? Gerald Klerman was
the major figure in transforming the image of the neuroleptics from nonspecific
flattening agent to antipsychotic medication. Klerman was an avid advocate of
biopsychiatry from early in his career and went on to become director of NIMH.
Klerman’s research findings were published in various places, including Alberto
DiMascio and Richard Shader’s 1970 compendium The Clinical Handbook of
Psychopharmacology. Klerman found that the four most improved “symptoms,” in
descending order, were combativeness, hyperactivity, tension, and hostility. In
short, the drugs subdue and control people. Hallucinations and delusions the
cardinal symptoms of schizophrenia - ran a poor fifth and sixth.(4)
Since drugged patients become much less communicative, sometimes
nearly mute, it’s not surprising that they say less about their hallucinations
and delusions. Had the investigators paid attention, they would have noticed
that the patients also said less about their religious and political
convictions as well as about their favorite hobby or sport. There’s no wild cheering for the home team
on the typical psychiatric ward. Furthermore, the drugs cause so much
discomfort (see chapter 4) that patients often stop saying what they believe to
avoid getting larger doses and to bring a more speedy end to the treatment. As
many ex-patients have told me, “I learned right away I’d better shut up or I’d
get more of that stuff.” What’s astonishing is that despite investigator bias
and the global inhibition produced by the drugs, communications labeled
hallucinations and delusions continued to be recorded.
Klerman vociferously claimed that his research confirmed an
antipsychotic effect, and few, if any, people bothered to check his data.
After I described the lobotomizing effect of the neuroleptics
during a 1989 debate with an internationally known psychiatrist, the opposing
doctor admitted that he himself had taken “one small dose of neuroleptic” and
then experienced an overwhelming and unbearable sense of “depression” and
“disinterest.” But he went on to say that his patients, because of their
“abnormal brains,” underwent no such lobotomy effect. Unlike normal people, the
patients supposedly felt better because the drug “harmonized” their biochemical
abnormalities. This was not the first time I’d heard this argument made by a
psychiatrist.
The outrage expressed by ex-patients in the audience
contradicted his assertions about the harmlessness of the medications. So does
the clinical literature cited in this and the next chapter.
What does it say about professionals when they argue that their
patients are so different from themselves? Biopsychiatry lives by the principle
that its patients are so different from other humans that almost anything can
be done to them, including surgical, electrical, and chemical lobotomy. By
contrast, the ethical helping person assumes that those seeking help possess
the same human sensitivities as anyone else, including the therapist.
Life in a mental hospital is so inhibited, constrained, and
suppressed that patients might seem better adjusted when heavily drugged. As
already noted in chapter 2, D. L. Rosenhan describes in the January 19, 1973,
Science that even the most highly regarded mental hospitals are humiliating and
oppressive places, even for normal volunteers masquerading as patients. Typical
state hospitals, where many drug studies are conducted, are intimidating and
frightfully violent. In Erving Goffman’s phrase, these “total institutions”
also stigmatize and demean their inmates. His analysis in Asylums (1961) helps
us understand why a drugged patient would seem better adjusted than a drug-free
person in such a setting; the chemically lobotomized patient fits better into
the social role of mental patient, with its obedience to authority, conformity,
lack of dignity, acceptance of mundane routines, and restricted opportunities
for self-expression. Similarly, books and stories by former patients in all
kinds of psychiatric facilities almost always describe them as wholly
suppressive and demoralizing.(5) To say that patients behave better in a mental
hospital when they are drugged is more a commentary on the requirements of
being an inmate than on the allegedly beneficial qualities of drugs.
Unfortunately, the patient may face an equally suppressive life
situation after discharge from the hospital. Board-and-care homes and nursing
homes are at least as boring and stifling as psychiatric hospitals. Often they
offer nothing but a bed, a TV, and perhaps a local park bench. Again, it is no surprise
that patients might seem to adjust better to them when drugged. Indeed, most
drug-free people would want to take flight rather than to waste away in a
facility that offers nothing in the way of rehabilitation, recreation, or
social life.
Nor is life necessarily less stultifying when the patient
returns home to his or her family. As we saw in chapter 2, the families of
children labeled schizophrenic are, at their best, unable to relate to their
overwhelmed offspring. At their worst they are outright abusive. Typically the parents are overinvolved and
unrelentingly critical of their son or daughter. Again, it’s no surprise that
drugged offspring might seem better adjusted to life in these families, while
drug-free ones might continue to be resentful, rebellious, and difficult to
control.
Drug experts and psychiatric textbooks that tout neuroleptics
almost never concern themselves with the living conditions to which they are
asking or forcing the drugged patient to adjust.
Even considering the built-in biases favoring drugs in typical
research studies, the data do not unequivocally support the use of
neuroleptics.
In comparing hospitalization with and without drugs, the data
are not even consistent. For example, a team led by Maurice Rappaport reported
in 1978 in Intemational Pharmacopsychiatry that patients treated with placebo
in the hospital and no medications on follow-up “showed greater clinical
improvement and less pathology at follow-up, fewer rehospitalizations and less
overall functional disturbance in the community than the other groups of
patients studied.” Of the group that never received medication, only 8 percent
were rehospitalized. Of the group that received medication at some time during
or after hospitalization, 47 to 73 percent were rehospitalized. The worst
performance was for those patients who were drugged both during and after. They
suffered a 73-percent return rate.
Gordon Paul and his colleagues investigate long-term maintenance
drug therapy for “hard core, chronically hospitalized patient groups” in the
July 1972 Archives of General Psychiatry. These patients also were exposed to
an active psychosocial rehabilitation program on the wards. One group was abruptly changed from
medication to placebo without the staff knowing that a research project was
going on. It was found that in the early stages of treatment, medication
interfered with participation in the rehabilitation program, and that later on
it had no effect, beneficial or otherwise. The authors conclude that the
“widespread practice” of giving neuroleptics to chronic hospital patients
should be discontinued, because the medications are unhelpful, expensive,
dangerous, and interfere with rehabilitation.
Some researchers present a rosier picture for drug intervention.
In the Northwick Park study published by T. J. Crow and his team in the British
foumal of Psychiatry in 1986, 30 to 50 percent of the patients relapsed with
drug therapy and 70 percent relapsed without it. Even if we accept these
findings, however, they do not seem so astonishing in the light of the “natural
history” of what is called schizophrenia (see chapter 2). As noted earlier, regardless of the treatment
regime, one-half or more of patients diagnosed as schizophrenic eventually will
make a social and economic adjustment outside the hospital, and that about
one-third do well. The results of positive drug studies will seem still less
impressive when we examine the high rate of drug-induced permanent brain
damage, which can exceed 50 percent among long-term patients (see chapter
4).(6)
A review published in the October 1989 American Journal of
Psychiatry raises serious questions about the validity of the most accepted use
of neuroleptics-the control of acute psychotic episodes. From McLean Hospital
and Harvard Medical School, Paul Keck and his associates, including Ross
Baldessarini, could find only five studies on the use of neuroleptics in acute
schizophrenia that used scientific controls, cornparing placebo or sedatives to
the neuroleptics. These five studies found that “the same overall degree of
improvement was observed during treatment with all the agents tested.”
Specifically, Valium (a minor tranquilizer and sedative) and opium
“demonstrated efficacy similar to that of neuroleptic during the first day and
through 4 weeks of treatment.” In other words, sedatives and narcotics
performed as well as the so-called antipsychofic drugs in the acute treatment
of schizophrenia. The authors suggest, “Perhaps the early effects of
antipsychotic drugs are nonspecific and are largely the same as those of
sedative agents.”
More demoralizing to advocates of neuroleptics, Keck and his
coauthors also found that in some studies, a placebo performed as well as the
neuroleptics. They conclude that the apparent efficacy of neuroleptics in
treating acute patients may in fact be due to other factors, such as a respite
from conflicted home life.
The authors also remark that drug efficacy in the long-term
treatment of chronic patients is equally unconfirmed. Significantly, Keck and
his colleagues constitute a very respected research team from one of the most
esteemed institutions in psychiatry, and they are well-known advocates of
psychiatric medication.
One entrenched myth is that the antipsychotics helped to empty
the state mental hospitals, thereby returning many people to more useful,
better lives. The American Psychiatric Press’s Textbook of Psychiatry (1988),
for example, declares unequivocally: “The rapid decline in the number of
patients in psychiatric hospitals has been among the most persuasive examples
of how pharmacologic therapies in psychiatry have a beneficial impact not only
on the individual patient, but on society as well” (p. 770). The overall process was given the
misnomer “deinstitutionalization.”
In reality, the drugs did not cause the emptying of the state
hospitals, which did not begin in earnest until 1963, more than eight years
after the introduction of the neuroleptics in America. At that point, the
hospital population had been relatively static for many years-558,000 inmates
in the peak year of 1955 and 504,000 in 1963-and admissions actually had
skyrocketed. After 1963 a rapid decline in inmate population began throughout
the country. In that year, “mental illness” became covered for the first time
under federal disability programs, culminating in Social Security Disability
(SSI). Now the patients could be sent to old-age homes and board-and-care
facilities, to be paid for by their meager disability checks. The states had
successfully shifted the financial burden from themselves to the federal
program.
“Deinstitutionalization” is itself a misleading term, because
very few of the discharged patients became independent. Most were transferred
into other supervised facilities, usually with even less to offer than the
state mental hospitals, which at least had expansive grounds and a few
organized activities. Some of the inmates were cast out on the streets as
homeless people. At the same time, the infamous “revolving door policy” began,
with frequent short readmissions to drug the patients again before sending them
back to their dismal, lonely surroundings.
The primary function of drugs in this process is to make it
easier to ship robotic patients from one place to another. That the drugs did
not cause deinstitutionalization is confirmed by the Swedish experience, where
the process is only now beginning in that country, twenty-five years after the
introduction of the drugs. Emptying American hospitals was a matter of social
policy-moving patients out and taking fewer in -not a medical miracle.
The aged made up the largest portion of the old state mental
hospital population, and they were the first to be thrown out during
deinstitutionalization. A 1989 study by Jerry Avorn and his colleagues from
Harvard, published in the New England Journal of Medicine, surveyed fiftyfive
rest homes in Massachusetts. They found that 39 percent of the inmates were
receiving neuroleptics and that 18 percent were receiving two or more. Several
other studies confirm the drugging of the elderly in understaffed, oppressive
nursing homes throughout the country.
Private board-and-care homes are no better. Psychiatrist Theodore van
Putten and his colleague J. E. Sparr wrote “The Board and Care Home:
Does it Deserve a Bad Press?” in the July 1979 Hospital and
Community Psychiatry. They describe patients lobotomized by the drugs, suffering
from blunted feeling, passivity, and lack of initiative, interest, and
spontaneity. Most lived “in virtual solitude.”
A number of other former inmates have ended up as street people,
but not nearly so many as are institutionalized in other settings, such as
nursing homes, board-and-care homes, and jails. Furthermore, homelessness as a
problem is directly attributable to economic changes. There has been a drastic decline in low-income housing, coupled
with an increase in numbers among the very poor. Deinstitutionalization in
Denmark, by contrast, has not produced rampant homelessness, because the
government provides sufficiently large disability payments and enough
affordable housing to keep ex-inmates off the streets.
That many American homeless do have severe psychological
problems merely confirms that our more helpless citizens suffer the most
acutely and quickly from economic pressures, such as low wages and high
rents. Homelessness itself is
undoubtedly not good for one’s mental stability.
We should reject psychiatry’s call to subject ever-increasing
numbers of the homeless to enforced medication with neuroleptics. When it
diagnoses, drugs, and incarcerates the homeless poor, psychiatry covers up the
political issue-society’s unwillingness to provide jobs, housing, or an
adequate safety net. People victimized by socioeconomic conditions are turned
over to psychiatry for further abuse. All of us then rest more easily-except
for the victims.
In January 1980, the editor of Clinical Psychiatry News,
psychiatrist William Rubin, wrote poignantly about the fate of
deinstitutionalized patients:
Patients aren’t warehoused in snakepits any longer. They sit
instead in wretched welfare hotels and Bowery flophouses. The shopping-bag
ladies and other casualties wander the streets, prey for all the vultures,
until they are harmed or in some other way attract the attention of
law-enforcement authorities. Then they are sent back to the state hospitals;
cleaned up; pushed through the revolving door back into the community.
As most observers now agree, so-called deinstitutionalization
was not a blessing to the former inmates; it was a callous abandonment. It is
simply false to claim that deinstitutionalization returned thousands of inmates
to productive lives in the commun ity.
In their book Community Mental Health (1989), Loren Mosher and
Lorenzo Burti describe Soteria House in California, a nondrug psychosocial
treatment home that was compared to a control group of patients going through
the regular psychiatric system. Using small, homelike quarters with
nonprofessional therapists, Soteria outperformed the traditional mental
hospital system and neuroleptic drugs. In a chapter in his 1989 book The Limits
of Biological Treatments for Psychological Distress, Bertram Karon reviews a
variety of studies showing the superiority of psychotherapy over neuroleptics
in the treatment of schizophrenic patients. Karon’s own psychotherapy project
showed that patients did best in the long run when they received no medication
or used it only during the times of worst distress. In chapter I we saw how
effective untrained volunteers can be in helping people gain release from
custodial institutions.
Loren Mosher’s Soteria House project, Karon’s psychotherapy
research, the Harvard-Raqcliffe Mental Hospital Volunteer Program, and other
psychosocial approaches will be described in more detail in chapter 16.
In summary, the neuroleptic drugs are chemical lobotomizing
agents with no specific therapeutic effect on any symptoms or problems. Their
main impact is to blunt and subdue the individual. In the next chapter we’ll
see that they also physically paralyze the body, rendering the individual less
able to react or to move. Thus they produce a chemical lobotomy and a chemical
straitjacket. Indeed, there is relatively little evidence that they are helpful
to the patients themselves, while there is considerable evidence that
psychosocial interventions are much better. The drugs are also the cause of a
plague of brain damage that afflicts up to half or more of long-term patients.
We turn now to that drug-induced epidemic.
Footnotes:
1. Clozaril
(clozapine), the center of considerable controversy, will be discussed in
chapter 4. Although physicians sometimes fail to realize it, many other
nonpsychiatric drugs are also neuroleptics. The list includes some
antihistamines, such as Tacaryl and Temaril; some antinausea drugs, such as
Compazine and Torecan; and some drugs used in conjunction with anesthesia,
including Inapsine, Largon, and Phenergan, which is also used as an antinausea
and anti-mofion sickness agent.
Serpasil (reserpine), a rauwolfia derivative, has neuroleptic qualities
and is used as an antihypertensive and rarely as an antipsychotic. Serpasil is one of many trade names; others
include Harmony], Raudixin, and Sandril. In nonpsychiatric usage, the doses are
usually sufficiently small to avoid producing a neuroleptic toxic effect on the
brain and mind, but caution should be exercised, especially in regard to
Compazine, which can cause severe neurological reactions in relatively low
doses.
2. The rate
was increasing by 100,000 to 200,000 per year and is probably much higher now.
The figures were based on submissions to the FDA and therefore probably were
limited to the United States.
3. Veterinary
literature and practice has established that these drugs must be limited to
short term use only. They’re too dangerous for animal consumption, except in
emergencies and terminal states. Yet they are less dangerous to animals, in
whom it often is more difficult to produce the permanent drug-induced
neurological disorders seen in humans (see chapter 4). Recently, our frisky
Shetland sheepdog was given a very small dose of neuroleptic to prevent car
sickness. My daughter Alysha soon noticed that he became more obedient and
“stopped barking at everything.”
4. While combativeness
and hyperactivity were markedly reduced in 49 percent and 3 8 percent of
patients, respectively, hallucinations and delusions were markedly reduced in
only 30.5 percent and 21 percent. Other
problems typically associated with mental illness were unimproved by the drugs,
including judgment, insight, and emotional tone, or affect.