A defense of anti-psychotic drugs

Patrick H. writes:

I protest Terry Morris’s irresponsible, evidence-free attack on anti-psychotic medications. He and Zippy Catholic made wrong-headed arguments at Laura Wood’s site recently. Now Mr. Morris is compounding the problem by repeating his speculations and anecdotes here. Pardon my irritation, but it does not seem to occur to him that the individual babbling away in his story was NOT taking medications and that was the problem. I have a brother-in-law who is a paranoid schizophrenic and when he does not take his medications his mental state immediately deteriorates. Since he, like many paranoid schizophrenics, is in deep denial about his illness, he is constantly attempting to palm, pocket or hold in cheek to later spit out his medications. When he does this, when he misses doses, he begins to exhibit dyskenia, vocalizations, aggression and paranoid thinking.

There are far more cases of the mentally ill like my brother-in-law who hurt themselves or others when they refuse to take their medications. Mr. Morris is being grossly irresponsible in his mini-campaign against anti-psychotic medications, and I hope that this campaign—based on nothing but attitude and anecdote—goes no further on the traditionalist right than Terry Morris, Zippy Catholic, Jim Goad and Peter Hitchens. These people are as off-base and irresponsible as Jenny McCarthy, who followed someone later demonstrated to be a crank in a campaign against vaccinations because they supposedly caused autism. Jenny McCarthy convinced many parents to refuse their children vaccinations, and several have died from infectious diseases as a result. But Jenny McCarthy has the excuse that her own child is autistic, and as do so many parents when their children are sick or damaged, she is seeking desperately for someone or something to blame. And yet she has contributed to the deaths of many children in her quixotic campaign. What is the excuse of Terry Morris? He has none.

It would be a tragedy of immense proportions if the traditionalist right becomes caught up in a campaign against anti-psychotic medications. Far more desperately ill people would suffer and die if these individuals make those medications harder to obtain, or worse yet, convince caretakers to let psychotics, many in deep denial, lapse into paranoia, rage and violence. To say nothing of the fact that every relapse into schizophrenia deepens the damage the disease does. It is critically important that every effort be made to prevent relapse or breakdown. And those relapses will occur far more often if Terry Morris and his like get their way.

I pray with every fibre of my being that Morris, Goad, Hitchens, etc. are defeated root and branch on this issue, and the traditionalist right rejects their view.

LA replies:

First, Patrick H.’s comment was more aggressive in its original form. I significantly toned down his choice of words in order to make his comment suitable for posting. As I have noted previously, for some reason the defenders of psycho-active drugs get too personally exercised on this issue and go after the persons of their opponents rather than their positions. One long-time friendly correspondent even accused me of not caring about the truth, simply because I, who did not have a set stand on this issue, wrote a brief comment that did not meet with his requirements. And when I pointed out that his accusation that I was deliberately concealing the truth was not appropriate, he repeated the accusation.

Second, I believe that this argument can be resolved very simply: the critics of anti-psychotic drugs need to acknowledge that in many cases these drugs help people with severe problems and are not the cause of their problems; and the defenders of anti-psychotic and other psycho-active drugs need to acknowledge that such drugs are greatly over-used in America today and that to criticize this over-use is not to oppose the use of anti-psychotic and other psycho-active drugs per se.

- end of initial entry -

Karl D. writes:

I agree with both Patrick H.’s comment and your response. Many of these anti-psychotic drugs are really miracles of modern science. My cousin was bi-polar and when on his medication was a fairly normal guy. Could you still tell he was “off” a little? Sure. But he could interact, work a full time job and even have a relationship with a woman. His meds kept him from falling into those pits of mania both high and low. The problem was that many people afflicted with my cousin’s condition like those high manic periods and go off their meds. This often leads them to those crushing lows where they become so despondent they take their own lives. Which my cousin did ten years ago. I think there is a big difference between medicating people who obviously need it and the anti-depressant and anti-anxiety meds that seem to be in almost every American’s medicine cabinet these days. Xanax pops into mind. It seems everyone knows someone on Xanax.

Jacob M. writes:

I join in Patrick H.’s protest against Terry Morris’s and others’ attacks on “anti-psychotic” medications. The fact that Terry Morris used that term pursuant to previous discussions shows what is one of the biggest problems here: most of those taking a strong stand against psychiatric medications simply don’t know what they’re talking about. The original list the Thinking Housewife posted of all these crimes allegedly caused by medication was of people supposedly on antidepressants. Terry Morris then conflated antidepressants and antipsychotics, as well as, in a comment at The Thinking Housewife, conflating different psychiatric diagnoses, such as depression and ADHD. I’m afraid you seem to have made the same mistake in your second paragraph.

Antidepressants and antipsychotics are entirely different classes of medications. They affect different neurotransmitters, operate in different areas of the brain, and are indicated for different conditions. Antipsychotics are not greatly overused in America today. When Joe Schmoe visits his primary care doctor and complains of feeling a little down lately, he does not prescribe an antipsychotic. Most doctors who are not psychiatrists are wary of using these medications, and generally if someone is taking one of these medications, he has been seen by a psychiatrist who has at least suspected he has a mental disorder causing psychotic symptoms (delusions, hallucinations, what we call “disorganized” behavior.)

Antidepressants are different. Precisely because most of these medications (particularly SSRIs) have such a low side-effect profile, many PCPs are comfortable prescribing them, and if Joe Schmoe visits his PCP complaining of feeling a little down, he is likely to leave with a prescription for Prozac or Paxil, without having been seen by a psychiatrist or formally diagnosed with a mental disorder in which it is indicated, such as major depressive disorder, which has its own set of diagnostic criteria beyond merely feeling depressed. I suspect that in many cases the medication doesn’t really help, but doesn’t hurt either. Opponents of these drugs seem to have latched onto the fact that, in certain individuals with bipolar disorder, antidepressants can trigger a manic episode, and, while manic, persons with bipolar disorder may engage in dangerous behavior. However, to suggest that SSRIs spur people on to premeditated acts of mass murder is not a reality-based statement. Antidepressants are not given for psychotic symptoms. Whoever compiled that list at The Thinking Housewife was, I think, grasping at straws, and is not familiar with the concept that correlation does not equal causation. There are tons of people out there who have had SSRIs thrown at them because they once complained of feeling blue. That some killers had taken SSRIs is not surprising—you could probably group people by any characteristic and find that many of them had taken SSRIs.

Finally, Patrick is right that we will have many more deranged lunatics walking among us if Terry Morris and others who agree with him convince them to stop taking their antipsychotic medication. But I’ve never heard of this anti-antipsychotic medication movement before. As I said, I think people who are not familiar with mental health problems at all are getting their terms mixed up.

Buck writes:

Patrick H. describes a dreadful scenario and is arguing that we should adjust to it. It sounds like a game of Russian Roulette. Must we (we who don’t know his brother-in-law on sight) all ignorantly accept the risk that he so aptly describes? Are we to daily mingle ourselves and our children with paranoid schizophrenics who are—not maybe—but who are one missed dose away from some sort of aggressive episode? Drug them, but do it for them, so that they can have some peace. Don’t drug them as a way of protecting us. What are we doing? Are we all supposed to be foolish?

“There are far more cases of the mentally ill like my brother-in-law who hurt themselves or others when they refuse to take their medications.”

Come on. There has to be a wiser way to protect them and us. Do we really want to rely on the risky and unreliable drugging scheme to protect an unawares population? Thousands of paranoid schizophrenics and other pathologies freely moving among us and our children in secret is reckless. Drugs that sedate dangerous and violent citizens should be used to help them, not to haunt the general public and put us at risk. Everyone knows that there is an obvious solution. But, we won’t tolerate that again. We believe that all have equal and unfettered rights and freedoms. No greater good.

As I’m about to send this, Karl D.’s comment is posted. It reinforces my point with the sad case of his cousin. His cousin was miserable and suicidal without his meds. His cousin needed them to have some semblance of a normal life.

“The problem was that many people afflicted with my cousin’s condition like those high manic periods and go off their meds. This often leads them to those crushing lows where they become so despondent they take their own lives.”

His cousin went off his meds and killed himself ten years ago. They all, at some point, want, can and will go off their meds. What was the right thing for Karl D.’s cousin? Who can monitor him and others who must take their meds every day? What kind of secure and supervised situation makes that possible and eliminates the majority of the risk to him and to us?

We’re discussing this because of a host of mass murders, not because of the tragic suicide of an ill loved one. If individuals and families can’t make the tough choice, how is our modern liberal society ever going to? We accepted the huge trade-off that we made in the past. Now, we seem to be profoundly conflicted and tortured over our new trade-off.

Ed H. writes:

The arguments about whether or not anti psychotic medication is of benefit to the patient misses the point. Those that claim they are of great benefit will point out that proof of the positive effect of the medicine is that when they refuse to take it they deteriorate rapidly. But that’s what psychotics and schizophrenics habitually do over and over. They refuse to take their medicine because they feel they don’t need it or they don’t like one or another side effect. Can’t we take this refusal as evidence that the mental illness never leaves them and they are incapable of freedom? Every story of psychotic rampage has the perpetrator at some time or other under psychiatric care and medication until he or she exercised their liberal “freedom” and decided they weren’t sick after all, that the doctors were sick, that psychiatry was a conspiracy, that it was all a government plot, that the CIA was controlling them, or that Jody Foster secretly wanted them to kill the President. The mental health care debacle leads quickly to the larger debacle of liberalism itself with its bedrock principle that all deserve freedom, and that deviance is merely a matter of perspective. But there is a cure at hand. If these same psychiatrists who hand mental patients a bottle of pills and tell them to report back in two weeks were made criminally responsible for the murders and suicides that result, then their indulgence in liberal fantasy would come to a quick and permanent end.

LA writes:

There are a two distinct issues at play here. The defenders of anti-psychotic drugs say that it is anti-depressants are over-prescribed and cause harm, not anti-psychotics, and that anti-psychotics are being unfairly blamed for the violent behavior caused by the over-use of anti-depressants.

The other side then comes back with a different argument: Yes, they acknowledge, it is not the over-prescription of anti-psychotic drugs as such that is the problem, but the fact that anti-psychotics are used as a substitute for confinement in a public hospital, leaving incurably psychotic and potentially dangerous people at liberty amongst us.

Based on what has been said so far, it seems to me that we are within reach of a set of positions that everyone could agree on, resolving this feud:

(a) Anti-depressant drugs are greatly over-prescribed in this country, they often lead to psychotic or violent behavior, and this over-prescription should stop.

(b) It is not anti-psychotic drugs in themselves that cause psychotic or violent behavior, but the underlying psychosis that the drugs are intended to suppress. However, psychotic individuals will not voluntarily keep taking their anti-psychotic medicine, and when they go off their meds they frequently become psychotic and violent.

(c) Therefore dangerously psychotic individuals, in addition to being given anti-psychotic drugs, also need to be confined in an institution where they will be required to take the drugs and where they will not be a danger to society.

Clark Coleman writes:

Rather than point (c) of your summary, in which we institutionalize those who need anti-psychotic drugs, I wonder if there is any workable “halfway house” scheme in which someone could live under supervision, be forced to take their drugs each morning, and then could go off to work, see friends and family in the evening, be back by 11:00 curfew, etc. A small number of violations would lead to institutionalization. Perhaps such a scheme cannot be devised successfully; but if it could, it would be a lot better than large scale institutionalization, both in terms of financial cost and the waste of human life that comes from not being allowed to work.

Posted by Lawrence Auster at December 23, 2012 12:31 PM | Send