Monday, May 21, 2007

Big Pharma and the Mental Health Crisis

Guest Post from Alison:

Note: This post grew out of some comments to a post that I wrote on mental health issues earlier this month and an exchange of emails between Alison and me. I appreciate the points she made about non-drug treatments for even severe mental illness. Like Alison, I am a layperson. But I have seen some devastating side effects from psychotropic drugs and it seems to me that they should be a treatment of last resort and used temporarily if at all possible. I believe that drugs do have a role to play in the treatment of some mental illnesses, but I also agree with Alison that too often drugs are simply thrown at mental health problems indiscriminately and often by family physicians who are not qualified to prescribe and monitor their long term use.

With the disclaimer that I am a layperson in regards to neuropsychology, the issue isn't whether psychiatric illnesses are biological or not but what works in helping people to recover from them.

Lots of diseases and disorders are biologically based but do respond to non-drug approaches better than drug approaches to either curing or maintaining optimal functioning. As for the chemical imbalance theory, the best way I can summarize that in a neutral manner is to say it has never been proven and has been discredited/discarded as overly simplistic at best. Our brains and bodies are always in and out of chemical balances of various sorts, and at this point researchers are looking more at proteins, but again it is never a simple balanced or not balanced explanation, there are multiple processes going on all the time. Also, all kinds of activities and situations affect the brain, not just drugs. Cognitive therapy has been shown to change the brain, trauma has been shown to change the brain, all kinds of good psychotherapy can change the brain. Depression and cognitive behavioral therapy (CBT) have been studied more than schizophrenia and CBT, but in England,CBT and "Hearing Voices" groups and new individual psychotherapy approaches that teach clients how to understand what triggers their voices, what they may mean and ways to keep the experience of voices from overwhelming them have all been shown to improve the quality of life and functioning of people diagnosed with schizophrenia.

In the old days in the U.S., psychotherapy was used and worked well on many people diagnosed with schizophrenia and bipolar disorder; more people with schizophrenia fully recovered before the advent of drugs than after, in fact, if they had access to good psychotherapy as most did not. When community mental health centers were formed (although never enough and never fully funded), the standard of care was psychotherapy and medication together, not medication alone as it is so often today. Drug "holidays" were more common as psychiatrists would test to see if their patients still needed to be on psychotropic medication over time. One rarely sees this today as the pharmacological approach (and big Pharma) have taken over psychiatry on the whole.The few places where intensive psychotherapy is being used successfully with people with psychotic illnesses in the U.S. are private hospitals such as Austen Riggs, which also has recently released research on the success of their approach and private practitoners who work with individuals with psychotic illnesses. Other helpful non-drug approaches to psychotic illnesses are peer support, either adjunctive or stand alone, social and employment supports and individualized wrap around services. There is also, of course, the long known but often overlooked fact that a certain percentage of people with psychotic illnesses will recover with or without any treatment at all---E. Fuller Torrey, hardly a progressive in these matters, says 25%, others say up to 60% if people are not kept on drugs indefinitely because the neuroleptics themselves cause structural changes to the brain. This is getting long and others have written much more eloquently about it, I would summarize that people with schizophrenia and other psychotic and affective disorders have a range of etiologies of their illness and a very large range of response to treatment and that many different kinds of treatments can be helpful, not just drugs.


AnonymousIsAWoman said...

I would like to add that Big Pharma alone is only part of the problem. A major obstacle to non-drug therapies is also the insurance industry, which would rather pay for somebody to be on a lifetime of dangerous and debilitating medication than to receive long term and possibly expensive psychotherapy even if the non-drug therapy is safer and more effective.

Too often our whole medical industrial complex has turned into "Dollars R US."

Catzmaw said...

My experience with the insurance side of cases has been that a) many people do not even have a threshold level of insurance coverage for any sort of mental health problems; b) those who have coverage have extensive coverage of pharmaceuticals but extremely limited coverage of therapy - usually only a few sessions allowed for each period; and c) people with "pre-existing conditions", the most needful, are the least likely to get help.

With regard to the criminal justice system rehabilitation programs are almost exclusively aimed at those who are NOT considered dual diagnosis. I have seen numerous clients denied access to alternative diversion programs because they have been labeled "dual diagnosis" and in need of medications. These programs have a therapeutic component, but they are almost always geared toward 12 step group therapy and life skills and employment training for probationers seeking to return to society.

About the only times my dual diagnosis clients get any real care is when they either are committed to a mental health care facility or I successfully talk a judge into allowing them to attend an outside inpatient treatment center. All the others are SOL.

Dual Diagnosis said...

Given the fact that already mental illness can be both an emotional and financial drain,it is rather sad to have doctors just resorting to use of drugs with severe side effects.
mani kanna
Dual Diagnosis