Tuesday, April 28, 2009

Beyond Meds: Is There an Answer?

A few days ago, Beyond Meds "reprinted" a 2000 tract by clinical psychologist and author Ty Colbert PhD, entitled, NAMI Parent’s False Hope: Blindly Disabling Children for Life.

Dr Colbert has participated in NAMI, where he has observed parents achieving at best mixed success with their kids on meds. According to Dr Colbert:

"Even though these members (parents) are dedicated to helping their children, because they have been falsely convinced that mental illness is a biological disorder, they are blindly helping to disable their children, many for life."

Clearly Dr Colbert struck a chord, judging by the post's numerous spirited comments, some virulently anti-NAMI, but many from individuals who feel that long-term meds treatment has ruined their lives.

Dr Colbert cites the case of Gary, the son of two NAMI parents who became depressed shortly after being turned down for an athletic scholarship. He was examined, then sent home (this would have been more than 30 years ago, so we are presuming no meds were involved). Then, when Gary's thinking grew disordered and delusional, he was diagnosed with schizophrenia and prescribed medication. Despite this, his condition deteriorated, and 25 years later he is still struggling to reclaim his life.

According to Dr Colbert: "His paranoid thoughts and hallucinations were his mind’s way of trying to deal with all this pain." An insightful therapist, Dr Colbert contends, "could have helped Gary deal with his strong feelings of failure. In this way, Gary could have successfully worked through his pain and not lost his life to the disabling effects of the drugs."

It is a long stretch to claim that Gary lost his life to meds rather than schizophrenia or that talking therapy could have helped, particularly in describing events that occurred a quarter century before Dr Colbert ever laid eyes on Gary, but we get the point.

Indeed, at this year's International Congress on Schizophrenia Research I learned that 4 percent of the US population experiences psychotic symptoms without having schizophrenia. Clearly, then, we can make a case for extreme caution before slapping a label on someone and telling them they will need to be on meds the rest of their lives.

So what is Dr Colbert's clinical track record? Curiously, the one unequivocal success he cites in his piece involves helping a kid through his "dark spot." No mention was made of any symptoms approaching schizophrenia. Dr Colbert does say he has helped young people through their "psychotic breaks," but the best he can show for his efforts is Jerry, age 28, who is only just beginning to put his life together after 10 years on meds.

Dr Colbert points out that psychosis doesn't just come out of nowhere, but this is hardly news. The "diathesis-stress" model has been in circulation in psychiatry for at least three decades, the DSM refers to psychosis linked to stress, and research across a wide array of disciplines strongly supports the notion that our brains mediate how we respond to our environment. Dr Colbert contends that "the mind is actually functioning very creatively to protect the soul or self," but in reality he is describing a physical and biological organ very hard at work.

But, yes, we badly need Dr Colbert's voice in the conversation. Over the course of two decades he has been speaking out against the blind faith patients and families have placed in very imperfect and frequently disabling meds, and the terrible things that can happen when frustrated patients inevitably go off them without other therapeutic supports in place.

Having said that, it is appropriate to end on this cautionary note:

Some time back, an individual I know fairly well entered a program inspired by (but hardly modeled on) Loren Mosher's Soteria House. He was taken off his meds and underwent talking therapies designed to get him in touch with his feelings. (Soteria House would never have taken this individual off his meds.) While still in the program, he experienced a psychotic break and entered a restaurant brandishing a BB gun. He was arrested, criminally prosecuted, and served two years in a locked psychiatric unit, along with murderers and other violent offenders.

This individual is now on meds and is working part-time in an academic setting. The doctors in charge of taking this individual off his meds refused to take responsibility.


Gianna said...

the program could not have been modeled after Soteria as they did not take people off meds...they only took first episode "psychotics" who were drug naive...and then in only 3% of cases used very low dose neuroleptics for crisis intervention. The above scenario would never have happened and indeed could not have happened at Soteria.

they knew that once drugs were in the mix it was too dangerous...

and that is why I caution people so heavily about choosing to withdraw from drugs...it's risky business and virtually no one does it responsibly.

John McManamy said...

Hi, Gianna. Point taken. I should have said something along the lines of "inspired by Soteria." I will make the correction at once.

I also accept your good faith in looking for answers. Please keep posting.

cretin said...

I am really apprehensive about the psychoanalytic approach to mental illness as Dr. Colbert describes. When someone is in an episode of mental illness, every past event seems to be a cause when the cause could just be that something has gone wrong in the wiring. "I didn't get ice cream on my 12 birthday, so that 'trauma' must be why I am depressed 30 years later." Please! It would make sense if there was verifiable past physical or sexual abuse leading to depression, but most people survive that with no overtly ill effect. Maybe it is a psychological cause, maybe the sufferer is just genetically predisposed to get depression and happened to suffer past abuse? How does one tell? I don't believe that psychoanalysis even has an answer to that.

Early on in my treatment for depression (which later turned out to be bipolar disorder), I was sent to a psychologist who practiced psychodynamic therapy. Every past "trauma" was asked about in search of that "Ah-ha" moment. It went nowhere and I must say it bordered on torture. Since then I have followed the biological approach to my illness. It took a long time sorting through all of those imperfect meds to find the imperfect ones that work, but sometimes that is what it takes. I feel for those few for whom no medicine works; I also feel for those who have suffered the numerous ill-effects of these imperfect medicines. All too often doctors turn a deaf ear to their patients. But the fact that sometimes medicines don't work doesn't negate the fact that the illness may be just biological. Signaling pathways in the brain are carried out by dozens of proteins; any one is messed up and the signaling goes awry (i.e. illness). The problem may be they haven't found the right medicine to target the particular protein that has gone bad. There are no cures, just medicines to treat the symptoms, more or less. It is the same thing with cancer: there are so many hundreds/thousands of proteins that can go bad, there isn't enough drugs to target them all. That is why there won't be a cure for cancer, just a lot of treatments to tackle it in rather crude ways which seem to make the patient sicker than before. Sounds like some of the medicines for mental illness.

John McManamy said...

Hi, Cretin. In complete accord. If someone is having a heart attack, you don't ask the person how he or she feels about the heart attack or their anger issues or how they're getting along with their parents and so on. You apply the paddles and get the patient to emergency treatment.

Having said that, we do need to work through our unresolved issue. For instance, if we are in a toxic work situation, an antidepressant may help for a little while, but until we resolve the situation we are sitting ducks for another depression.

Also, a good case can be made for our meds numbing us from our feelings, thus depriving ourselves from doing what we need to do to achieve true healing.

But you are definitely right. Colbert's arguments read like a re-run between the food fights the Freudians used to wage with those who prescribed meds. Psycho-analysis, whatever its merits, clearly has no role in serious mental illness, at least not in the critical early treatment stages.