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In response to a
spate of books questioning the effectiveness of psychiatric
medications, I wrote this article for the July 2000 FOCUS, a
National Association of Social Workers' publication.
I interviewed
several researchers, therapists and their clients, as well as
one of the most severe critics of psychiatric medications, Dr.
Peter Breggin, a Bethesda-based psychiatrist and author of “Your
Drug May Be Your Problem: How and Why to Stop Taking Your
Psychiatric Medications.”
I believe the
decision to take medication is a personal one. Still timely, the
article remains a springboard for thoughtful discussion. I often
suggest clients read it before they decide to take
medication.
When Dr. Peter Breggin talks, people listen, and some stop taking
their psychiatric medications. After a TV talk show featuring
Breggin, one schizophrenic man threw away his medication, became
suicidal and spent two weeks on a locked hospital ward. While a
12-year-old boy, with the support of his parents and Dr. Breggin,
is putting his life back together —medication free — after
withdrawing from Ritalin and a handful of other prescriptions.
The current generation of psychiatric drugs, from Ritalin to
Risperdal, may be winning kudos from many doctors and patients,
but has only inspired indignation in Dr. Breggin. In his new
book, the Harvard-educated, Bethesda-based psychiatrist
describes today’s biochemical solutions to mental illness as no
less barbaric than lobotomies, no less ineffectual than
psychoanalysis.
"Compare today’s ‘biochemical imbalance’ slogan with yesterday’s
‘unconscious conflict’ slogan," Breggin writes. "I think
sometime soon we’ll look back on both and realize that neither
had scientific backing, yet both were accepted and promoted
uncritically by medical authorities; both were used to explain
absolutely any form of psychological distress; and both
ultimately left people more helpless because their message was
‘the problem is inside you but out of your control.’"
Judging from the headlines Breggin has been inspiring, including
a recent op-ed piece in the Boston Globe titled "Kids Are
Suffering Legal Drug Abuse," the best-selling
writer-cum-psychiatrist is causing more than a little confusion
and alarm. There’s no conclusive evidence that psychiatric, or
psychotropic, medications have long-term benefit, Breggin
asserts, and there are mountains of evidence that prove the
contrary — that these medications cause serious side effects,
withdrawal reactions and sometimes permanent neurological
damage.
Breggin urges readers to carefully wean themselves from their
medications, preferably with their doctor’s help. And, for those
considering the prescription drug path, consider the alternate
routes (i.e., talk therapy, family and community support.) Yes,
psychiatric drugs can provide temporary relief, Breggin
concedes, as can alcohol. But they don’t get to the root of the
problem.
The withdrawal emphasis is new, but the message — drugs are the
problem, not the solution — is one Breggin has been voicing
since before his Harvard medical residency at Metropolitan State
Hospital in Waltham, Massachusetts, and one he has been
promoting in previous books, including Talking Back to Prozac.
The evidence, according to mental health practitioners and
researchers, is not as bleak as Breggin would have you believe,
nor is it as affirming as one might expect, given the abundance
of anecdotes of lives resurrected with psychiatric drugs.
Lauren Slater, the Boston-based psychologist who recounts
her personal resurrection in Prozac Diary, knows the
scientific evidence supporting the biochemical imbalance theory
of mental illness is "at best, shaky." acknowledges that "very
little is known about how and why these medications work", but
is unwilling to dismiss the benefits of Prozac, among other
prescriptions, as little more than drug company propaganda.
Slater’s view is informed by such facts as there are no tests to
assess chemical imbalances in living human brains; evidence of
chemical imbalances have been found in the brains of deceased
mental patients, but have yet to be replicated. Drug companies
acknowledge their ignorance regarding how their own medications
work; according to the package insert for Zyprexa, one of Eli
Lilly’s newer antipsychotic drugs, how Zyprexa or any
anti-psychotic works is unknown.
"There’s probably a kernel of truth in Breggin’s stance," Slater
says, "that’s what makes it potent, dangerous. You can’t simply
shrug it off as idiocy." Yes, psychotropic medications can be
prescribed hastily, thoughtlessly, she agrees. Yes, they have
real risks.
"But chemotherapy has risks, too," says Slater, who practices at
East Boston’s AfterCare Services. "And people still choose to do
it. It’s important to allow people to choose what’s best for
them. Breggin’s making people scared of viable medical
treatment."
Breggin says he is no longer a lone wolf in his crusade against
psychiatric drugs. He’s organized more than 200 professionals
and 1,000 members with his Center for the Study of Psychiatry
and Psychology, his web site (www.Breggin.com)
and his "Ethical Human Sciences and Services" journal.
Biopsychologist Elliot S. Valenstein, professor emeritus
of psychology and neuroscience at University of Michigan, is one
professional peer who doesn’t wholly dismiss Breggin. While
Valenstein is careful not to discourage the use of psychiatric
drugs, he urges readers to rethink the "chemical imbalance"
explanation of mental illness, reexamine the research on drug
efficacy.
Writes Valenstein, author of Blaming the Brain: TheTruth
about Drugs and Mental Health: "There is a tendency to
confuse the giant strides that have been made in our knowledge
of brain chemistry and neuropharmacology with our still
primitive understanding of the causes of mental illness and
knowledge of how drugs can produce psychological changes."
While impairments in the brain’s dopamine system have been
correlated with the diagnosis of schizophrenia, and deficiencies
in serotonin levels have been linked with depression, neither
have been shown to cause the respective diagnoses.
Do psychiatric drugs work? The empirical evidence from the
landmark National Institute of Mental Health study of
phenothiazines (including thorazine) as well as reviews of
today’s antipsychotics, is less conclusive, more ambivalent than
generally believed. The 1961 NIMH study reported improvement in
95% of patients who received phenothiazines, but noted
improvement in 50% with placebo. According to more recent
research from Albert Einstein College of Medicine, four weeks of
antipsychotic drug treatment fails to alleviate symptoms in
about 50% of schizophrenic subjects, while 25-40% risk disabling
tardive dyskinesia.
Antidepressants turn out to be only slightly better than
placebo. Even the most optimistic studies found that two-thirds
of participants did as well with placebo as with prescription
antidepressants. Several studies revealed a high rate of relapse
(more than 60%) after antidepressant treatment was discontinued,
and, while still being administered, a waning of therapeutic
efficacy.
"The views of psychiatrist Peter Breggin are similar to those of
Thomas Szasz and Michel Foucault in that they also
have argued that drug treatments are used to incarcerate and
subdue people who are unwanted and inconvenient," Valenstein
says, "rather than for treating people with illnesses. Breggin
reflexively dismisses any argument that there could be
biological factors that predispose people to mental illness and
which might have to be addressed with biological solutions."
Breggin’s views typically provoke more disdain, less
perspective. Though Listening to Prozac author Dr.
Peter Kramer has sparred with Breggin on talk shows, he
refused to be interviewed for this article. "Dr. Breggin’s prior
work is not of a quality that would tempt me to look at his
current work," Kramer says.
Dr. Jerrold Rosenbaum, Harvard Medical School psychiatry
professor and Massachusetts General Hospital associate chief of
psychiatry, has deemed Breggin "an anti-psychiatrist." "He makes
his living offering a consistent, one-sided criticism of
psychiatric medications," Rosenbaum says, "which can lead people
to abandon their treatment, result in their suffering, their
family’s suffering, and, in some cases, [can lead to] destroyed
lives and death."
One woman with manic-depressive illness echoes Rosenbaum’s
concern: "I know that many people with mental illness, myself
included, struggle daily with the issue of taking our
medications. Sometimes because we don’t want to believe we are
sick; sometimes because of the side effects. People like Peter
Breggin do a great disservice to the mentally ill by feeding the
‘you-can-cure-yourself-if-you-just-believe-you-can fantasy’ many
of us have."
Breggin believes he’s serving the mentally ill better than most
— that he’s one of the few psychiatrists willing to tell clients
what they deserve to know.
"Patients commonly discontinue their medications abruptly,"
Breggin says. "By explaining the importance of careful
withdrawals, I could save lives and a great deal of suffering."
Despite his denouncement of psychiatric medications, Breggin
believes adult clients have the right to take them. Children, on
the other hand, have no choice, and should never be given
medications.
"Giving these drugs to children should be criminalized," he
says. "It’s too damaging to a child’s growing brain and ethical
perspective to use these drugs to control behavior."
That’s the gist of what he told the Frasers of Rockville,
Maryland, when they consulted Breggin a year ago about their son
Andrew. After five years of increasing doses of Ritalin for
attention deficit disorder, clonidine to counteract the Ritalin,
and Prozac for depression, the then 11-year-old’s original
psychiatrist was recommending an anti-psychotic medication that
can cause permanent neurological damage.
"We were at our wits’ end," says Bruce Fraser. "We kept going up
and up on these medications and seeing more of a marginal
return."
With school and parental support, Breggin guided Andrew through
the withdrawal process and concomitant adjustments to family and
school life. "In retrospect, we realized we’d placed our hopes
more on medications, when we really should have focused more on
family relationships," says Bruce Fraser. "I think a lot of
parents fall into that trap because they’re desperate. I’m not
going to say Andrew’s problem free, or a straight-A student,"
Fraser says, ‘but he’s doing much better."
How to make sense of the conflicting anecdotes, interpretations?
Suggests Walter A. Brown, clinical professor of
psychiatry at Brown and Tufts University medical schools: Tell
clients to discuss their concerns with a doctor they trust.
"I think it’s very difficult to make sense of the tremendous
flood of information one gets from books like Breggin’s. The
general issues Breggin raises are worth thinking about," Brown
adds. "Do these drugs have a down-side? Can they cause problems?
But the conclusions he draws are irrational."
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