The Emperor’s new clothes

This excellent Tracking the American Epidemic of Mental Illness – Part II by Evelyn Pringle, comes eerily close to my own perceptions of what was going on with the day program that Chris was enrolled in for two years in the European country where we live. When we joined the program in 2004, it had already been operating for ten years and was touted as a success – by the psychiatrist who ran it. As with the Portland Identification and Early Referral (PIER) program, there was no follow-up as to the real outcomes of the young people who went through Chris’s program. Chris has been out of the program for at least three years, and so far we have received no follow-up asking us how he is faring. While he was in the program, we were aware of no statistics on the outcomes of the previous ten years. Like the little boy who saw that the emperor had no clothes, we were told to believe in the miracle that was happening.

Readers of this blog will know that Chris was not getting better during the time he spent in his program. My pleas to individualize his treatment, to begin by at least acknowledging that that the drugs weren’t helping him, fell on deaf ears. I felt the program was off-base in getting at the real problems of psychosis. The program believed in the second generation antipsychotics, particularly clozapine. I have my own reasons for believing in a financial incentive as the reason the program particularly pushed clozapine, even though it was, by then, a generic drug.

Here is an extract from the Evelyn Pringle article.

An August 2008 article, by Charles Schmidt in Discover Magazine, highlighted the PIER program with a byline that stated: “A new mix of therapy and medication may stave off psychosis among teens at risk.”

Schmidt discussed the case of Camila (not her real name), who entered the program in September 2001, when she was 14. “Camila and her family stuck with PIER for the four-year treatment program, which ended formally in 2005, and still keep in touch with counselors there,” he reports.

However, “Camila’s health still hinges on antipsychotic medication,” Schmidt says. “In the summer of 2007 she went off the drugs for a spell and her strange feelings returned.”

He notes that her reliance on antipsychotics raises issues. “On the one hand, it shows that the threat of psychosis hasn’t really been removed, it’s just been held in check.”

“What we hope is that the benefits of treatment will be lifelong,” McFarlane says in the article. “We don’t have any empirical evidence to support that yet, but what we’ve seen is that young people who still haven’t converted to psychosis after about three years of our treatment don’t seem to be at much risk.”

While he suggests that over time, some patients may be able to go off medications, McFarlane acknowledges that PIER hasn’t developed a plan for managing that process, Schmidt reports.

“As to when or if they can go off medication, that’s hard to say,” he told Schmidt. “I think many of our patients don’t feel a need to stop; they certainly don’t feel oppressed by it. At a certain point it becomes a personal choice.”

A fortune can be made from these life-long antipsychotic customers.