What is an acceptable trade-off for the meds?

I realize that if I don’t apply myself in this heat, the blog will wilt away. Even though I don’t have much to offer these days, you’re going to get a post anyway. Here are my latest musings about why I am so against meds when any “reasonable” person can see that meds are an important part of treatment.

Meds are a code word in schizophrenia for the doctor is in charge for life if you aren’t careful. Meds never cured anyone, in the context of mental illness, that is. Doctors will be the first to admit this, because after all, there is “no cure” for schizophrenia, is there? There is only management of this “disease.” This means that your life is placed in the hands of social workers and doctors and occupational therapists, who will manage your life to death while urging you to take charge of it, which is difficult (though not impossible) to do on meds, as I attempt to illustrate below.

It is axiomatic that an involvement with social workers, doctors and occupational therapists means your life is dysfunctional. This sounds like an obvious slight to generally good people doing difficult jobs, but, they are there to aid the dysfunctional. If you managed your own life better, there would be no need for social workers and doctors. If you want to get functional, you will eventually have to cut the ties that bind.

When I think of why I hate the meds so much, I always think of a lovely young woman in Chris’s day program. She was pretty and petite and developed into an absolute butterball on the meds. She went from being socially acceptable and very attractive in terms of appearance to being an outcast based on her appearance. She dropped out of the program for a while and when she reappeared, she had shed all the weight and looked great, but her eyes were very, very sad. Fast forward a few months into the program (and the medications). Her mother and sister continue to be slim and fashionable, and Rosita (not her real name) was once again huge. Setting aside her problems that got her a diagnosis in the first place, Rosita now had a further problem of social stigma based on her weight. She was also now a physical oddity in her own family. No doubt her family felt more pity towards her because of the weight. No doubt she felt it. A young woman her age would be interested in dating – how was this going to happen?

Doctors feel that this is an acceptable trade-off for the meds, which don’t cure anyone and supposedly help you manage your life better. At the same time, psychiatrists are offering you no real alternatives to the meds, such as the kind I write about in my blog.
So, yes, I hate the meds because they are symptomatic of the larger problem of hiding unpleasant truths from people while making others glaringly obvious and they prevent doctors from empowering their patients.

Would you prefer “small brain volume?”

Robert Whitaker has a blog post today on a research finding* published in the American Journal of Psychiatry.

In this NIMH-funded study, researchers reported that male neonates born to mothers diagnosed and treated for schizophrenia were found to have “several larger than normal brain volumes.” The researchers concluded that this was evidence that “prenatal and early neonatal brain development is abnormal in males at genetic risk for schizophrenia.“

In other words, researchers saw this abnormality as evidence of a “schizophrenic” process already underway in the male neonates. But the mothers diagnosed with schizophrenia in this study were taking antipsychotics, which are known to cause changes in brain volumes. Thus, it may be that the abnormalities seen in the brains of the male neonates were due to the drugs, rather than to any underlying genetic risk for schizophrenia.

The female neonates born to mothers diagnosed with schizophrenia did not have “larger than normal brain volumes,” which of course leads to further doubt about any conclusions that can be drawn from this study.

I am in full agreement with Whitaker’s conclusions questioning whether the drugs are responsible for the observed results and why this affects only males and I will go further. It’s not a good idea for the results of these kinds of studies to fall into the hands of someone like me. First of all, I’m a parent who has never gone to medical school, and why am I subjected to stupid words like “male neonate” when I guess what we are really talking about here are male babies, not male monkeys. Bullshit factor number 1. It sounds impressive and potentially scares the hell out of your non-medical school graduate. Your psychiatrist will trot this kind of medical vocabulary to keep you in line.

Bullshit factor number 2 to the medically uneducated is the “larger than normal brain volumes.” Well, that sounds scary in this context because the research is signaling alarm, but come on, shouldn’t larger than normal brain volume be preferable to “smaller than normal brain volume?” Where is the actual problem here? Bigger volume, more room to think and make connections? Right? Who says it’s wrong? Bullshit factor number 3 is that the NIMH funded this study. The NIMH is strenuously looking into the magic bullet solution for schizophrenia and other serious mental health problems. It pays lip service to complementary and alternative mental health solutions. Bullshit factor number 4 is that so far, there is no identified gene for schizophrenia, so to my medically uneducated brain, there is no established genetic risk for schizophrenia. If my mother suffered from a mental health problem, no doubt I would have psychological problems myself from interacting with her (see my blog portrait) but don’t try to pin genetics on this. Try blaming the environment instead.

Unfortunately, these kind of research findings find their way into the public consciousness and are of no help to anyone actually wanting to recover from their diagnosis.

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J. Gilmore. “Prenatal and neonatal brain structure and white matter maturation in children at high risk for schizophrenia.” American Journal of Psychiatry, published in advance online, June 1,2010.

Indeed, brain injury due to psych meds

I am posting this link from Beyond Meds as a public service for a fellow blogger who has been going through a tough withdrawal process after years of taking multiple medications, often at extremely high doses. She is finally off benzos, but is still suffering the lingering effects. A medical professional finally said it. She has endured injury to the brain because of using these drugs. It is the first time on her long journey that a doctor has put the blame where blame is due, on the medications for the protracted agony she has been going through. Critics have been saying all along what doctors have refused to acknowledge, that these drugs cause damage to the brain. I am using the phrase “damage to the brain” rather than “brain damage,” to make a subtle distinction. Damage to the brain can be healed, whereas “brain damage” implies that the condition is irreversible. That’s my interpretation, anyway.

I also feel it is important not to alarm people who are already struggling with the heavy anxiety and guilt that comes with the use of psychiatric drugs as part of the therapy. Since there are no “medically” sanctioned alternatives, and patients and relatives are not informed by the doctor about non-drug possibilities, antipsychotic medications are almost always part of the treatment plan. Therefore, it is extremely important to be vigilant with the doctors by doing your homework. Medication should be short term and in low doses. There is no justification for the use of two antipsychotics, scientific or otherwise. I do not believe in multiple diagnoses for a mental health condition. When your doctor diagnoses you as, for example, bipolar and schizoaffective, with OCD traits, what this means is that you have problems, and your doctor is one of them. He or she doesn’t have a clue how to help you so simply piles on the drugs. Your only defense is to hold your doctor’s feet to the fire to keep drugs to a minimum and learn to find other ways of coping.

Depression by e-mail and debilitating body odors

Science lite From the Boston Globe.

Screening college students for depression with an e-mailed questionnaire may be a promising way to track levels of mental health on campus. But connecting students with help looks more challenging, according to new research that also found depression rates higher among college students than in the general population. Irene Shyu and a team from Massachusetts General Hospital distributed a depression questionnaire at four unidentified colleges in Massachusetts, Pennsylvania, and California, using e-mail lists provided by student groups. A total of 631 students agreed to take the survey for a chance to win a $200 gift card.

There’s a sucker born every minute. The survey found that the rate of major depression in those surveyed was higher than the rate in the general public (about four percentage points higher.)

She’s at it again

For some people, worrying about bad breath or body odor can be so extreme they become housebound or suicidal, a Brown University researcher reported this week. Even though others can’t detect any smell, the preoccupation persisted among the 20 people whose cases Dr. Katharine A. Phillips described at a meeting of the American Psychiatric Association in New Orleans.

“Patients suffer tremendously as a result of this false belief and they appear to be very impaired,’’ she said.

I think I see where Dr. Phillips is heading. I’ve cut and pasted her previous infomercial from the New York Times on the subject of debilitating underbites.

The good news is that there are treatments that can help. The scientific research that’s been done indicates that serotonin reuptake inhibitor medications (for example, escitalopram, fluoxetine or fluvoxamine) and cognitive behavioral therapy are helpful for a majority of people with B.D.D. More research is needed on these treatments and on other types of therapy, but this is good news for people who suffer from this distressing, impairing and sometimes disabling disorder.

Oh I wish I were picketing down at the American Psychiatric Association Convention in New Orleans. That would be time well spent.

Anatomy of an Epidemic and alternative mental health

In Robert Whitaker’s Anatomy of an Epidemic there is no mention of alternative mental health remedies. This, I suppose, is understandable given that the book is about how pharma and her willing handmaidens have contributed to the epidemic of mental illness. However, from a consumer point of view it would be instructive to know if the people whose stories are told in the book ever seriously tried some form of psychotherapy or took vitamin supplements to help them get off the drugs.

It is clear even if you haven’t read this book that psychiatry has been hijacked by drug prescription and that psychiatrists (American ones, anyway) are handsomely remunerated for prescribing not listening. Psychiatrists have convinced themselves that the drugs are needed to help them do their job better, but their patients aren’t at all convinced. If they were, why is drug compliance such a problem? Why are people so fed up with their psychiatrists not listening to them?

Drug based psychiatry seems to be one area where the customer is always wrong. If manufacturers noticed that people were failing to use their products in they way they were intended, would they blame the customer? Of course not! Many psychiatrists, however, have this patronizing view that their clients are mentally ill and incapable of making rational choices when it comes to how they feel about what they are swallowing.

There is another way and people shouldn’t lose hope.

Taking vitamins, undergoing certain psychotherapies, practicing yoga and changing your belief system is not a quick fix, but it does work over time. As a relative, I can vouch that this also works for me. We all can benefit from the experience. Vitamin support should be a first line of defence if you are trying to get off your meds. Some people may not need this, but many do. Not everybody is going to have a hard time withdrawing from the drugs, but they will be the exception, not the rule. The drugs change your biochemistry. Your biochemistry is not changed because you are depressed or schizophrenic. For every study that claims it is, there is a study that refutes this. So why buy into the former claim? It makes you worse off in the long term, as Anatomy of an Epidemic so rightly points out.

Like diabetics need insulin

I must confess that reading Robert Whitaker’s book Anatomy of an Epidemic is getting me down. He has nailed the human carnage that usually begins with the psychiatrist saying to the patient, “you have an incurable disease and you are going to need meds for the rest of your life just like a diabetic needs insulin.” We have all heard this Orwellian phrase and it is absolutely untrue but that is what we have all been told. So begins the slippery slope that we have all been on. And when I say “we” I include people like me in this because I am collateral damage. I suffer too from being told my son is incurable and needs the drugs.

Someone on another blog, a psychiatrist no less, accused Robert Whitaker of sensationalizing the negativity, especially when it comes to the drugs. I don’t see it and the fact that a psychiatrist doesn’t see this is troubling, especially if he’s taken the time to read the book. Whitaker’s book is factual, he interviews psychiatrists, researchers and patients alike, and what they report is what I know to be true. People used to have mental illnesses and got over them or suffered from them episodically. Whitaker links the rise of the number of people collecting disability for mental illnesses to the long term use of drugs – they are being treated as if they have an immediate, life-threatening, chronic illness.

Teenagers, a group in which depression was almost unheard of a few decades ago, are particularly vulnerable. Antidepressants can kick start a lifetime merry-go-round of drug use. The number of young people in the book who went in for depression, were treated with an antidepressant, went manic and told they were bipolar is not surprising. I have learned enough on my own to know this happens. We are not anecdotal evidence. We are real and numerous.

Who ever heard of bipolar disorder a few years ago? I hadn’t until about fifteen years ago when a friend went fairly loopy. Now, bipolar disorder is the flavor du jour – seems like everybody has it and may include those who would prefer not to say they might be schizophrenic. You are never not bipolar these days, probably due to the drugs that you need to take like a diabetic must take insulin. I had heard of manic-depression, but only knew of one person over the course of my life who was diagnosed with it. Every so often she would flip out and have to be hospitalized and take her lithium. Otherwise she carried on as the life of the party – and died at a fairly ripe old age.

Nobody today is going to die at a ripe old age if they permit their doctor to turn their personal coping skills into a biological disease. Judging from the swollen ranks of those collecting long term disability they won’t even be working.

Big NIMH

One of the saddest lessons of history is this: If we’ve been bamboozled long enough, we tend to reject any evidence of the bamboozle. We’re no longer interested in finding out the truth. The bamboozle has captured us. It is simply too painful to acknowledge — even to ourselves — that we’ve been so credulous. – Carl Sagan

I swiped this quote from Beyond Meds because Robert Whitaker’s new book Anatomy of an Epidemic*, currently on my reading table, points to the “Big Bamboozle” in the pharmaceutical industry when it comes to the treatment of the mentally ill. As it was with Ida Tarbell and Standard Oil, Upton Sinclair and the meat packing industry, let’s hope that the Whitaker book will put an end to the encroachment of the big pharma/academia/American Medical Association alliance on your brain.

The meticulously documented book explains that it was the Medicare and Medicaid legislation enacted in 1965 that allowed the discharge of chronic schizophrenia patients from unsubsidized state mental hospitals into subsidized nursing homes, not the invention of Thorazine in 1955, as it is so often attributed. Patients treated with neuropleptics in a 1956 studied cited had a lower discharge rate for first psychotic episodes than those who had been treated with a neuroleptic. The general opinion of researchers back then was that patients treated with neuroleptics had lower discharge rates than patients for whom no neuroleptics were administered.

Unfortunately our societal belief that it was this medication that emptied the asylums, which is so central to the “psychopharmacology revolution” narrative, is belied by the hospital census data.

Numerous studies in the 1980s cited in the Whitaker book came to the conclusion that there was no evidence that the dopamine function of the brain is disturbed in schizophrenia. Still the public continued to be told that people diagnosed with schizophrenia had overactive dopamine systems, with the drugs likened to “insulin for diabetes,” and thus former NIMH director Steve Hyman, in his 2002 book, Molecular Neuropharmacology, was moved to once again remind readers of the truth. “There is no compelling evidence that a lesion in the dopamine system is a primary cause of schizophrenia,” he wrote.

The pharma bamboozle is particularly poignant because of the millions of lives wasted and lost. Parents have been told, by a medical profession that they trust, that their child has a brain disease, just like diabetes, and that in order to “protect the brain,” they must continue to take these medications, just like a diabetic must do with insulin. That guilt is overwhelming because it is personal and had we been less credulous, the outcome may have been different.

Having heard Dr. Thomas Insel, Director of the National Institute for Mental Health (NIMH), I have no great confidence that that organization, despite it being a supposed watchdog of public mental health, will suddenly “see the light”. He stated very clearly in that seminar that research has demonstrated again and again that current and past drugs are ineffective in treating mental disorders, but they were shining their flashlights looking for the key in the wrong areas! They just haven’t found the right drug targeted to the particular problem! There’s a term for that in business that eludes me. . . when you trash the old product in order to stimulate sales of the new one. Don’t worry, in the NIMH’s world, there are always exciting new drug possibilities. So, the Big Bamboozle will continue as long as the public is gullible. It will take a different pharmaceutical tactic, that’s all. The insulin for diabetics idea has been exposed, so we’re not buying that one, but what will it be? It’ll be clever, that’s for sure.

Here is where Dr. Insel’s flashlight is looking:
We must address mental illnesses, from autism to schizophrenia, as developmental brain disorders with genetic and environmental factors leading to altered circuits and altered behavior. Today’s state-of-the-art biology, neuroscience, imaging, and genomics are yielding new approaches to understanding mental illnesses, supplementing our psychological explanations. Understanding the causes and nature of malfunctioning brain circuits in mental disorders may make earlier diagnosis possible. Interventions could then be tailored to address the underlying causes directly and quickly, changing the trajectory of these illnesses, as we have done in ischemic heart disease and some forms of cancer. For serious mental illness, this is a new vision for prevention, based on understanding individual risk and developing innovative treatments to preempt disability.
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Anatomy of an Epidemic: Magic Bullets, Psychatric Drugs, and the Atonishing Rise of Mental Illness in America, author Robert Whitaker

After Her Brain Broke

After Her Brain Broke: Helping My Daughter Recover Her Sanity, by Susan Inman (introduction by Michael Kirby, Chair, National Mental Health Commission of Canada; with endorsements by E. Fuller Torrey, MD, Daniel Kalla, MD, Stephanie Engel, MD and others)

I ordered this book, not because I thought I would agree with it, but because there is actually another mother out there who has written about the mental health diagnosis of her child, which in this case is kickstarted by Paxil for some kind of depression/difficulties, thus raising bipolar, which then becomes schizoaffective, schizophrenia and OCD. With that many diagnoses, I would have lost my faith in psychiatry much earlier than I actually did. Susan Inman has not lost faith in psychiatry, only with the kind of psychiatry that doesn’t come with a prescription. If you are a person, like I am, who believes that schizophrenia is not a brain disease and that medications are ruinous in the long run, then this book is not for you. I am dismayed about how heavily the author relies on E. Fuller Torrey. Many people feel that the references cited in this book, including E. Fuller Torrey, Dr. Nancy Andreasen, and the National Alliance on Mental Illness (NAMI) have contributed to the rise in the overuse of antipsychotic medications today.

Mothers come in all shapes and sizes and political leanings. If there is one thing that the author and I might be able to agree on is the dismal state of psychiatry and how badly it has served both patients and families alike. Where we differ is in the details. It would come as no surprise to anyone since E. Fuller Torrey endorses this book, that Susan Inman fully subscribes to the broken brain theory of mental illness. The title strikes me as an homage to psychiatrist Dr. Nancy Andreasen’s book, The Broken Brain. Now even Dr. Andreasen has started to warn about the dangers of long term use of antipsychotic medication, something she helped promulgate. That’s no help to the people who have suffered under this regime, but hey, again, that’s how badly served people are by psychiatry. Susan Inman, despite the ten different medications her daughter has been on in about as many years, still clings to the idea that a better drug will be invented.

I can excuse that belief to some extent because the broken brain biochemistry model is what people have been told for decades by doctors they are supposed to trust, and families are desperate. However, my son and my family and others are the products of the NAMI/Torrey/Andreasen cabal that insists that medications are the only way to deal with schizophrenia. We suffer at the hands of doctors who refuse to consider that medications aren’t helping and are actually hurting people’s chances of real recovery. The doctors weren’t honest with us. They never clued us in that there are competing theories of mental illness, and that medication is not always the way to go. This is called “full disclosure” in other areas of endeavor. Neuroleptic medications are a bitch to withdraw from. Telling the doctors that weight gain, increased risk of diabetes, tardive dyskinesia and early death is unacceptable when there are other avenues out there falls on deaf ears.

I have a hard time with Susan Inman’s other main point (and Dr. Torrey’s): That the family background has nothing to do with a mental illness. She seems unwilling to even remotely entertain the idea that maybe there is something in the family environment beyond just a medical diagnosis of bipolar and epilepsy in distant relatives, that might have something to do with the rage and suspicion that her daughter spat back at her. She is upset with anybody who seems to even hint at this. Like it or not, most people labeled mentally ill, I have found, do believe it is their family that contributed to their breakdown. (People don’t listen to mental patients’ actual complaints.) No, the problem is with her daughter’s biochemistry, she asserts. The family is not dysfunctional, her daughter is mentally ill. She bristles at the suggestion of Expressed Emotion, as one of the doctors in a family education class spoke about. She reasons that she and her husband have been very careful not to criticize their daughter. The problem with Expressed Emotion, in my opinion, is that it is a concept that nobody has bothered to properly explain and therefore nobody really knows what it is about. It is a concept that I believe is valid, and is much larger than the family criticizing (or not) their relative. It is also the emotion around being told that you are mentally ill and that you must accept your sickness. Organizations like NAMI do this very well. What it tells the suffering individual is that there is something wrong with them. How can someone get well if they are constantly told they are sick and that they must accept that they are sick or they won’t get well? That is like a school teacher telling a child that they are stupid, but if they want to do well, they must first admit their stupidity. This approach is discouraged in every other area except mental health, apparently. Pity is also Expressed Emotion. So are medications (feeling singled out trauma associated with being fat, drooling, unable to drink alcohol when everybody else can, etc.). Expressed Emotion can be delivered by doctors and society. (Schizophrenia is the Diagnosis of Doom.) I had to find out about Expressed Emotion for myself. It is not mentioned much these days for exactly for the reason that Susan Inman found objectionable. She writes: “Fuller Torrey sees a lot of this work as just one of many efforts to find new ways to blame families.” Really? If anything, I think that family background has been unexamined for decades for fear of offending people.

I’m a mother, too, and I may not be wild about people hinting that maybe I should take a look at myself, but what I cannot understand is someone who isn’t intellectually curious and fearless enough to be willing to investigate the possibility if it could result in breakthroughs for her daughter. Yes, there are good therapies that address this (even for schizophrenia!), but that would mean, of course, that they might tread into family background. Susan Inman refuses to go down that path. She paints an idyllic but sketchy portrait of family life. How many of us are that fine and noble as parents? I am ashamed of things I have said and done in moments of anger when my children were small. My son’s childhood was normal enough, but mental illness is a lot more nuanced that what is on the surface. People on the outside looking in might think that ours was a normal family, and it was, but it isn’t really. No family is normal. None. What is so hard about that?

Susan Inman has such fears about anything less than a perfect family for her children that I fear she has not stretched herself enough to be honest with her daughter or herself. A holistic person would feel that the person with the label is on to something, even if not understanding the root of it. Psychiatry has been too busy with the prescription pad in the second half of the last century to build on the base established by Freud, Jung and others in the first half. Freud appears to be utter rubbish to her. She has bought the medical model. She routinely dismisses the idea that there is another side to this. When a member of the Vancouver Playwrights’ Theatre Centre writes a letter objecting to the terms of the guidelines of the conference the author is sponsoring, saying that there is no evidence that schizophrenia is a neurobiological disorder, she portrays the basis for his opinion as mental illness being invented by psychiatry and pharmaceutical companies to make money. Full stop. No acknowledging that this is a widely held opinion by many thoughtful people. Most people have no opinion about schizophrenia unless they have an intimate involvement with it, as I would assume the letter writer has. She sees his complaint as romanticizing mental illness. This is what she calls an anti-science approach, which makes me sad because science hasn’t been especially good to her daughter or my son. When her daughter manages to enroll in a sociology class, she discovers to her horror that the teacher tells the class that pharmaceutical companies in cahoots with psychiatrists have made up a bunch of mental disorders for which there is no evidence. Well, isn’t a first year college course (especially sociology) exactly the kind of place that should challenge your closely held assumptions? Not when it comes to mental illness, I guess.

To Susan Inman’s credit, she is tenacious, but in a completely opposite way than I would go. She’s got involved with NAMI to fight the stigma. I said NAMI perpetuates stigma. Stigma will remain as long as people are not getting better. “Science” has enabled people to remain mentally ill and now it wants mental illness to be accepted by removing the goal posts. NAMI is an organization that encourages relatives to continue to medicate their relatives, thus putting real recovery even further out of reach. U.S. Congressional investigators have determined that, in recent years, the majority of NAMI’s donations have come from drug makers. The disclosure came about after longstanding criticism of NAMI for coordinating its lobbying efforts with drug makers and pushing legislation that also benefits the pharmaceutical industry.

To illustrate what a colossal train wreck the biochemical model of mental illness is, it is interesting to see how dosage is viewed in different countries. Of course, recommended doses are changing yet again, so what Susan Inman and I were told a few years ago is not what we would be told today, but here is her experience. She goes to the Menninger Clinic in the United States and is told that the level of meds her daughter was on in Canada was not high enough. Doctors in the United States administer much higher doses of antipsychotics early in the treatment because they have found it more effective in stamping out psychosis. This causes her to worry, naturally, that it is too late for her daughter. In Europe where we live, the doctors told me that in North America the doses are too high and that in Europe they have found that minimal doses work best. I am not thrilled with the European logic, either, because what is actually considered a low dose? If someone passed me an antipsychotic and urged me to try one, even at a low dose, I would decline. I don’t think I would function very well.

Kudos to Susan Inman for being a mother willing to write about a difficult subject. I have wrestled with the rating I want to give this book. It’s a gripping read. My hesitation is that when someone first is given The Diagnosis of Doom the doctor may suggest that you read E. Fuller Torrey, and now maybe they will include Susan Inman’s book. If you want to actually get over your diagnosis, you will have to look elsewhere. The web is full of self-help advice from people who’ve been there and emerged transformed. No praise to this book for perpetuating the NAMI biochemical “just take your meds and don’t even bring up the family environment” version of mental illness. Schizophrenia is not like any other illness. It has to be tackled with more imagination and respect than just administering drugs and telling your relative that it’s brain damage. Refusing to recognize the importance of the family background will guarantee the persistence of the purely pharmaceutical model and extended mental illness.

Brainless and mindless

The day program that Chris was involved with for two years made me a critic of the mental health industry. Chris was clearly not recovering, was horribly overweight, and yet the doctors refused to consider that maybe medications weren’t helpful in his case. (By the way, no matter what your diagnosis was in that program, you all got the same drugs. This reasoning strikes me as not very scientific.)

Ron Unger points out this hypocrisy in his latest blog post. It’s well worth a read.

Here’s psychiatrist Daniel Carlat’s take in today’s New York Times on why this is so. About the only thing I can say to this shabby admission, is well, at least he’s honest with his readers if he hasn’t up until now been honest with his patients. The lack of intellectual curiosity about what makes the individual tick is appalling in most doctors. There are enough Daniel Carlats beginning to rethink the psychopharmacology model that there is hope. However, to these doctors, schizophrenia is always a special case, so I don’t hold out much optimism that much will change unless change is forced on them by “schizo positive” activists.

After J.J. left my office, I realized, uncomfortably, that somehow, over the course of the decade following my residency, my way of thinking about patients had veered away from psychological curiosity. Instead, I had come to focus on symptoms, as if they were objective medical findings, much the way internists view blood-pressure readings or potassium levels. Psychiatry, for me and many of my colleagues, had become a process of corralling patients’ symptoms into labels and finding a drug to match

Paranoid or “on to something?”

My husband, Ian, fondly recalls his high school teacher telling him back in the 1970s that in the future, we would all be faced with the “problem” of what to do with our leisure time, due to advances in labor saving devices. We all know how that worked out. If we do have leisure time, it might be because we are unemployed. There is now an imbalance of work in many industrialized societies.

You know the standard line “as a journalist, I don’t believe in conspiracy theories?” This line is supposed to make people like me who do, go underground in fear of being labelled small-minded, low I.Q. or a paranoid right winger.

So, here’s one conspiracy I’ve been mulling over lately. The set-up: People are supposedly living longer, well into their nineties. There are more and more old people blowing out their 100th birthday candles. We have been told that advances in medicine will make people live longer healthier lives. At the same time, old, sick people are a burden on society. The national coffers will not be able to keep up with the health care need. So, how is this going to play out?

The solution? Convince people that they will benefit from taking advantage of the latest labor saving medical advances, such as, but not limited to, antipsychotic medication. Studies show that long term use of antipychotics shortens an average lifespan by twenty-five years. Extrapolate that to medications for other conditions, and who knows how far the predicted lifespans can be brought into line with national budgets?