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When a person visits the dentist, one is told repeatedly of the importance of flossing. Flossing, it is stressed, is vital to a healthy daily regimen, helping to prevent cavities and gum disease. The necessity of daily flossing has been considered so much conventional wisdom for decades, backed up as it is by experts such as dentists and oral hygienists, that few people think to question it. Yet in 2015, the Associated Press looked at research into the effectiveness of flossing and found that evidence for its efficacy was "weak, very unreliable", "of "very low" quality and has a "moderate to large potential for bias". Early this year, when the US Federal government published its most recent dietary guidelines, the advice to floss daily was quietly dropped. There is simply no real evidence that daily flossing works. On the Late Show, Stephen Colbert joked about the recent findings: "Based on this news, I am going to stop flossing – thirty-eight years ago!"
This story goes to show that expert opinion can be wrong or at least unfounded, but the purpose of this piece is not to talk about dentistry. Instead, I want to talk about something arguably far more serious - the conventional wisdom that there is such a thing as mental "illness" and that the best way to alleviate it is through medication. This idea is the big con, the big lie, of the late twentieth and early twenty-first century.
I wish to argue that psychotropic medication is at least ineffective, if not positively deleterious. I should say that I am not basing this claim on independent research. There is a serious methodological problem in attempting to research into mental illness anyhow (I shall come back to this later). Rather my argument is based on my own life as someone who has been a patient of the Mental Health System for the last ten years – on reflection upon my own experience and on my observations of others. It sometimes seems that everyone I have ever known has been diagnosed with depression or psychosis at some point of time. Ironically, I suspect that the decreased stigma surrounding mental illness has resulted in an increased rate of diagnosis - and certainly an increase in the number of people prepared to talk about it. But what is clear to me from looking at my friends is that often they are better off the drugs than on them.
The form of mental "illness" that I am particularly interested in is psychosis and the type of medication anti-psychotics. In recent decades, one particularly widely embraced theory of psychosis attributes the cause of psychosis to an overproduction of the neurotransmitter 'dopamine'. In fact, when I first came to the attention of the Mental Health System in 2007 having suffered an apocalyptically severe psychotic episode, my first psychiatrist told me that I had suffered "a dopamine explosion". Many antipsychotics work by reducing neurons' sensitivity to dopamine. It might seem, then, that we have a workable hypothesis concerning psychosis - that it is caused by a dopamine imbalance - and that psychiatrists invented antipsychotic medication subsequently but, in fact, the medication came first. It was discovered that conventional antipsychotics bind to dopamine receptors, that antipsychotics seem to work ('seem' being the operative word) and so the dopamine hypothesis was proposed, as it were, retroactively.
It would be convenient to believe that psychosis is caused by an excess in dopamine in the same way that depression is popularly imagined to result from a serotonin deficiency, and can be cured by an appropriate dopamine antagonist, but there is a problem with this easy answer. In her 2008 book The Myth of the Antipsychotic, British psychiatrist Joanna Moncrieff points out that early antipsychotics such as Clozapine were originally classed as 'major tranquilizers' and that antipsychotics do nothing to really remedy psychotic symptoms - all they do is sedate. Psychosis itself waxes and wanes quite independently of the particular drug one is taking – the term 'antipsychotic' is itself actually a misnomer. In my observations of other patients, I have never met anyone, taking medication voluntarily or compulsorily, who was entirely free from symptoms. In fact, to speak from my own experience, my worst period of psychosis occurred in 2009 while taking the antipsychotic Rispirdal. Last year, when at the clinic to receive my State-mandated Olanzapine injection, I met a trainee doctor and told him this. (I didn't tell him that I thought I had become psychotic because of the Rispirdal.) He expressed considerable astonishment. "You were psychotic when taking antipsychotics?" It seemed I told him that I believed that anyone could suffer a psychotic episode if exposed to enough stress. He said, "So you think everyone carries the schizophrenia gene?" – an absurd thing to say because, of course, if everyone carries the schizophrenia gene, the notion of a schizophrenia gene loses all explanatory power. It really makes you wonder what trainee doctors are being taught in Med School.
How then has the idea that antipsychotics work taken hold? The short answer is confirmation-bias. Psychiatrists and other health professionals often like to compare schizophrenia to diabetes but, while glucose levels in the blood can be objectively measured, there is no way to objectively measure how psychotic a person is. Any attempt is bogus. At the beginning of last year, when a reduction in my dosage had been mooted, the psychiatrist I was then seeing gave me a questionnaire asking me, among other things, to rate how paranoid I was on a scale of one to five - again absurd because, if I believed I was in the grip of a massive conspiracy, how could I answer honestly? I was also asked to rate my level of abstract thinking - supposedly because schizophrenics have difficulty thinking abstractly. I was asked what an apple and a banana have in common. I said that they were both fruit and told him that I had done harder tests.
If there is no way to objectively measures psychosis, psychiatrists can only be basing their diagnoses on intuition – and intuition, as many psychological studies have in recent years shown, is highly unreliable. For instance, it has been said about me at independent reviews that I was ill in 2008, well in 2009 and ill again in 2010, although the reverse was true. I am hesitant to talk about these reviews, except to say that my record was full of 'inaccuracies' - a person can be fined up to $10,000 for disclosing what happens in such hearings. I wonder if this law is more about protecting the doctors than the patients.
If antipsychotics are effective at all, it is as placebos. This might be halfway tolerable if there was not evidence that antipsychotics can be positively harmful. Sometime I believe in the 'nineties post mortem dissections of people who had been diagnosed schizophrenic revealed significant brain shrinkage; consequently psychiatrists revived a notion not current since the beginning of the twentieth century, that schizophrenia is a neuro-degenerative disorder. Because psychosis was now regarded as a brain-damaging illness, antipsychotics therefore were heralded as a way of preventing irreversible tissue loss. My first psychiatrist, the same one who told me that I had suffered "a dopamine explosion" also told me in 2007 that the Rispirdal I was prescribed for me was "fertilizer for the brain". There is a problem with this idea though, that psychosis itself causes brain shrinkage. All the schizophrenics in the study had been on antipsychotics for most of their lives and so it was actually impossible to determine if the 'illness' or the pills had caused the shrinkage. Around 2005, I believe, a study was performed on Macaque monkeys, none of whom, obviously, were schizophrenic, that showed fairly conclusively that it was the antipsychotics, in this study namely Haldol and Olanzapine, that caused the reduction in brain volume. It is the drugs rather than the psychosis that damage the brain. Naturally, most psychiatrists are very unwilling to accept the idea that the drugs they encourage or coerce people to take cause brain shrinkage but it seems incontrovertible.
This piece may seem overly negative. Even supposing antipsychotics (and other psychotropic medications) don't work, do we have an alternative? The best solution it seems to me is for Mental Health Professionals to try to find out what in the person's situation caused the illness in the first place and help the sufferer deal with this situation – I believe that psychosis is the result of a problem in the person's life, a problem that the person often has difficulty identifying and often little idea how to fix. For me, the solution was at once very simple and very hard to achieve. But you could argue that, today, the Mental Health System is still more part of the problem rather than part of the solution. Supposedly we live in a more compassionate era than the past but the same people who once would have overseen such barbaric practices as insulin shock therapy, lobotomies and permanent institutionalization still run the show. It is difficult enough for someone to suffer a bout of ill mental health without then becoming subject to a system based on bullshit and idiocy. Things need to change and one thing that definitely needs to change is the idea that mental 'illness' is literally an illness rather than a reaction to life events.
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