Why I don’t invest my faith in the latest scientific findings

I am reprinting an interesting comment to Dr. Sandra Steingard’s Mad in America blog post entitled Why I Prescribe. The writer of the comment demontrates how fickle scientific “truth” can be. The option she refers to in her opening paragraph is the option to accept or decline meds.

Marianne on March 5, 2012 at 6:24 pm said:

I wish I had been given an option when I was 18 and heard voices. I am 62 now, and still hear them from time to time, but I have figured out what they are. I took “anti-psychotics” for years. They made me eat more and didn’t change the voices.

I had to go along with the doctors to get out of hospital, that is lie to them.

For several years, their theory was that schizophrenics had “too much dopamine”. In 1968, when I was started on phenothiazines, there was something called the Thorazine Shuffle, or “pseudo-Parkinsonism”.

One never hears that term now, even though the side effects still include Parkinson-like rigidity. I also found out that phenothiazines are actually pesticides and Parkinson’s didn’t exist before pesticides were used for killing pests. (Insecticides, herbicides, rodenticides).

Now there are so-called professionals telling people that Dopamine is the “feel good” chemical in the brain! I still have journal articles from the 1960′s and 1970′s with the theory that was the opposite, and also about when L-dopa was being used for Parkinson’s patients, with short-term effects.

Can you explain how dopamine went from causing schizophrenia to being the “feel good chemical” without some major tampering by scientists?

I also cannot find a doctor who will work with me to get off of drugs. A long history of a label has caused me extreme misery over the years.

If only someone had told me those voices were from inside of me, instead of ECT and meds, and counseled me that things would be ok…I was only 18. If only there had been some compassion.

Reply ↓

Sandy Steingard

on March 5, 2012 at 7:48 pm said:

Marianne-

Thanks for your comments. Dopamine is the neurotransmitter in the so-called pleasure and reward center of the brain. As Whitaker and others point out, there is no evidence that there is an abnormality of dopamine in the brains of people who hear voices or experience other psychotic symptoms. The dopamine hypothesis of schizophrenia – that there is too much dopamine in the brains of people who experienced psychosis -was proposed because the neuroleptic drugs are known to block dopamine. Over many years, scientists never found any evidence to support the dopamine hypothesis of schizophrenia.
Perhaps you could copy some of the articles from this website so you could discuss it with your doctor. Philip Thomas, MD posted an excellent blog on this topic today.

Sandy

Risk/reward and dopamine

Here is an e-mail I sent recently to Chris’s psychiatrist, Dr. Stern. I based my concerns about the continued use of the meds on the dampening of dopamine levels to suppress anger and anxiety while simultaneously suppressing the risk/reward incentive.

Dear Dr. Stern,

The concerns I expressed about the medication suppressing the risk/reward incentive I think is very real. While Chris seems very stable in many ways, he lacks an enthusiasm and a willingness to stretch himself. I am puzzled why he is content to continue to audit one course at a time at university, rather than jump in for credit. Ian and I have not been pushing him in any way, just the opposite. We are letting things go along at the pace he wants to set. But, he is 26 now, and time is moving on. Leading a fuller life requires being willing to take some risks.

I don’t want Chris to become a perpetual patient and that is a risk that is very real the longer he continues with the medication. Already, because of the Serdolect (a drug I never wanted him to take), he has to check in with his family doctor to have ECGs. This is keeping him a patient by adding new medical visits to his schedule. In one week recently he had two appointments with you, one with Dr. XXX, and one with Dr. YYY for the ECG. I am all in favor of the work you are doing with him and twice a week is fine as long as you feel that greater progress is being made, but I am not at all in favor of adding medical complexity of more doctors and unnecessary medical tests.

Dr. XXX is connected with a program that I wanted to extract Chris from because the program failed to deal with the root cause of psychosis, offering instead a biochemical view of mental illness that didn’t help Chris for the two years that he was enrolled in the program. I feel that our wanting to meet with Dr. XXX and her chief threatens the program’s established view of mental illness as biochemical. This view is rapidly becoming out-of-date due to many recent published articles and books that question the efficacy of medications to treat mental illness and that look once again at mental illness as a logical reaction to pain.

I am sharing my concerns with you because I think you share to some degree the points I am raising. I do not have confidence that Dr. XXX and her boss feel to the extent you do that there is a time limit to medication. I hope they prove me wrong. I have been thinking, but have not mentioned to Ian, if we could eventually trade Dr. XXX for a private psychiatrist to monitor the meds (and work with you to reduce/eliminate them when the time comes). I know that you don’t want to be side-tracked by focusing on meds when you see Chris, and you like the idea of a second person to handle the meds. A private psychiatrist would be more open to working with the desires of the patient, instead of imposing the thinking of the institution on the patient. I have never met Dr. XXX, but know the program she is involved with.

These are my concerns which I thought I should share with you before we meet with Dr. XXX in the near future.

Best regards,

Rossa Forbes

Bipolar Chris

Chris came home from his first 45 minute Alexander Technique lesson a week later a different person. He was more decisive about where his body was going. He threw off the gloom that had been dogging him and became practically ebullient in his expressed enthusiasms. He was back on track, or so it seemed, for a few days. He rejoined the choir, signed himself up for another credit course at university and was beginning to establish a better sense of what he was doing in a room. This newfound enthusiasm lasted about a week and then, boom, he began to become unglued again.

When I walked through the door at night would I get the lady or the tiger? Sometimes I came home and Chris seemed more or less together and sometimes I came home and he would be staring off into space and showing the old hesitancy. Over the course of the next couple of weeks I noticed that his speaking voice dropped an octave or two. I shrugged off this weird new development as just another possible effect of the Alexander Technique and probably a good thing, but I wasn’t sure why I thought so. It may have something to do with my perception that lower toned voices signal confidence.

He appeared to be going through a somewhat manic phase, immediately signing up for a fresh course so quickly after dropping the other two, speaking more quickly and interrupting Ian and me with emphatic but off-base observations. One can only imagine what his classroom performance was like. I began to fear that he would have to drop the credit course he had only recently started. After discovering that he blew through his monthly allowance in one week, we began to dole it out to him in smaller amounts. The bipolar Chris was new to us.

Then his holistic psychiatrist phoned. “I have it!, she announced. “I think I can explain why Chris has been having problems recently.” She had stopped prescribing a certain amino acid supplement since August, believing that Chris no longer needed it. However, she had come to learn that it was important for her patients to continue this supplement for longer periods in order to bring the elevated dopamine levels within a normal range. What Chris had been going through was called protracted withdrawal.

Her muscle testing revealed that Chris’s dopamine levels were elevated in his glands and in the central nervous system. As the dopamine system is affected by the serotonin system she recommended an essential amino acid which synthesizes serotonin and niacin. We endured two more weeks of Chris’s quirky behavior before the needed product arrived in the mail. The change in Chris after only a few days on the added supplements was astonishing. He was able to sit with us at night and converse in a normal way, not from two rooms away. His sense of humor and playfulness came back.

This again reminded me again of the importance of getting the biochemistry right. I had been focusing of late on Chris’s problems as psycho/spiritual in origin, and had been discounting the importance of the biochemistry behind his actions. Once I began to appreciate that extra supplementation could indeed help him regain normal, I felt better and more optimistic about his immediate prospects than I had in a long time.

The second thing I learned is exactly the opposite of the first, meaning that if I thought that Chris’s problems were just a matter of getting the biochemistry right, then I would miss the importance of what I have earlier in this blog called the X-factor in schizophrenia. This is a most confounding, unpredictable condition. If you think you know it, you do not. It is also a chicken and egg thing. Does the biochemical imbalance come first, thereby causing mental trauma, or does the mental trauma come first, thereby causing biochemical imbalance? The wisest course of healing action is to keep an open mind and not place all your eggs in one basket.