Psychiatric Drugs: Neuroleptics The Effects of Haldol, Prolixin, Thorazine,Mellaril, and Other “Antipsychotic” Drugs –
Chap 3 Peter Breggin’s book, Toxic Psychiatry.) “People’s voices came through filtered, strange. They could not penetrate my Thorazine fog; and I could not escape my drug prison.” - Janet Gotkin, testimony before the Senate Subcommittee on the Abuse and Misuse of Controlled Drugs in Institutions (1977)
My concern is that people are having their minds blunted in a way that probably does diminish their capacity to appreciate life. - Jerry Avorn, M.D., Boston Globe, November 25, 1988
“It’s very hard to describe the effects of this drug and others like it. That’s why we use strange words like “zombie”. But in my case the experience became sheer torture.” - Wade Hudson, testimony before the Senate Subcommittee on the Abuse and Misuse of Controlled Drugs in Institutions (1977)
“Frequent Effects: sedation, drowsiness, lethargy, difficult thinking, poor concentration, nightmares, emotional dullness, depression, despair . . .” - Dr. Calagari’s Psychiatric Drugs (1987)
Alexandria sat in my office filled with fright-as much fright as she could feel through the dose of the psychiatric medication. The teenager’s face was flat in expression, her body sagged, she moved as if mired down. She looked profoundly depressed. And yet she wasn’t feeling at all depressed; she was terrified. She looked depressed because she was suffering from what we psychiatrists call “psychomotor retardation”-the enforced paralysis of mind and body that routinely results from treatment with neuroleptics, the drugs most frequently given to patients labeled schizophrenic.
A few weeks earlier, Alexandria had begun to see and hear things that weren’t there and to mutter incoherently about God and death. The parents of this sensitive, poetic teenager at first thought she was going through a phase, maybe even playing a role from one of her beloved novels. That was until she stopped coming out of her room. When they tried to coax her out, she screamed hateful things at them about how they came from the devil and wanted to hurt her. Alexandria’s parents saw an ad on TV promoting a local private psychiatric hospital for “the caring treatment” of adolescents, and they found hope in it. She was “acting crazy” some of the time, they later told me, but she was still herself when they left her in the hospital the first day. She was full of vitality and completely alert. When they said good-bye, she hugged them and cried. Her mother cried, too.
When they visited again the next day, they hardly recognized their daughter as she trudged toward them with shuffling steps and bent shoulders. She had been injected with Haldol. Alexandria’s parents took her out of the hospital and brought her directly to me.
Now I talked alone with Alexandria while her parents sat nervously in the waiting room. Out of the corners of her eyes, she looked inquisitively around my office. She touched a gleaming crystal and patted a model of a fawn. It was as if she couldn’t believe she was in such a bright and cheery room filled with wonderful distractions. I saw her eyes shift toward a small carved duck that was nearer to me, and I handed it to her. She said, “Exactly.” I wondered what lay behind that cryptic and seemingly inappropriate remark, but I said nothing. She seemed to be relaxing. She fondled the duck for awhile. “It’s so colorful,” she said. “It’s one of my favorites, too. I love birds. Do you like the Audubon prints?” She turned slowly in her chair to see them. “No,” she said. “He shot birds.”“Yes, I understand that,” I agreed. “I don’t like that either.” After a pause, she said, “What’s happening to me?” “What do you mean?” “My mind. I can’t think. I can’t feel.” “Tell me some more.” “Like those poor ducks .the ones in the photographs. The awful black-and-white photographs.”I had no photos of ducks in my office, only the model she was holding, and it took me a moment to realize what she was talking about. Newspaper photos came to mind. “The ducks in the oil spills?” “You noticed those pictures, too?” She perked up. “I feel like that, like a duck, my feathers all matted down and stuck together.” I gestured to indicate her arms, which lay heavily on the chair, stiffened by the drug effect.“Not just my arms . . . my mental wings,” she explained to me. “My mental wings and feathers . . . matted down and stuck together.” “It’s the medication,” I said. “It does that to everybody in the doses you’ve been given.” “The medicine?” A small smile flickered across her face. “It’s not me?” “No,” I said, “It’s not you.” “Oh, God,” she said, “I thought I had finally lost my mind.” “No, it’s nothing like that,” I reassured her. “It will wear off.” Alexandria had been on the medication for such a short time, only a few days, that it was safe to stop it abruptly. I promised never to force her to take any medication. After talking with Alexandria long enough for her to gain some confidence in me, she agreed to inviting in her parents. Then I explained to her mother and father how I would approach their crisis as a family problem. I would help them to relate better to this sensitive, spiritual young woman who was going through such a difficult time, and help all of them to better understand, support, and love one another. Sometimes it would be painful, I said, especially when Alexandria expressed the feelings of hurt and pain that caused her to speak so hatefully to them. But it would open up the opportunity for growth and ultimately for better relations in the family. I added that I liked Alexandria and that in our few minutes together I already sensed that she and I shared many feelings, values, and attitudes. I hoped to help her come through her part of the family crisis with a new and better understanding of herself and a great ability to express her anger in more productive ways and to live effectively in the world.
Once Alexandria found someone she could communicate with, she felt less frantic and more hopeful. The need to flee from reality was no longer so pressing. Through our work together, her parents learned to be more patient with her and to look more honestly at the negative impact of their own attitudes, especially their overinvolvement with her in a negative, critical fashion and their difficulty in expressing unconditional love.
Alexandria would have long-term personal and family difficulties to handle; but she was through the worst of her crisis in a matter of weeks. Indeed, her most difficult problem was recovering from the medication. It took more than a month before she felt in touch with her finely tuned feelings and before she could think with her usual clarity. It was relatively easy to help Alexandria with her acute “schizophrenic” crisis because it was her first experience with such overwhelming helplessness and fear and she was highly motivated. She understood her urgent need for finding a meaningful way of life and had the courage to pursue her ideals. Of equally great importance to this young person, her parents also were motivated to make changes in her best interest. They were willing to look at their own contribution to Alexandria’s crisis and to learn new ways to understand and to love her.
It also was relatively easy to help Alexandria because she had not been driven into hiding by years of psychiatric treatment. The longer a person has been subjected to the humiliation of being diagnosed and misunderstood by professionals, and the longer a person has been subjected to psychiatric drugs-the harder it is to make progress.
The agents inflicted upon Alexandria are known by a variety of designations, including major tranquilizers, antipsychotics, and neuroleptics. These words are synonyms. The original ones, including Thorazine and Mellaril, are called phenothiazines, and sometimes that term is used too loosely to designate the entire group. In psychiatry, the term neuroleptic is now preferred. Neuroleptic was coined by jean Delay and Pierre Deniker, who first used the drug in psychiatry, and means “attaching to the neuron.” Delay and Deniker intended the term to underscore the toxic impact of the drug on nerve cells (see chapter 4).
List of Neuroleptics -The public identifies most psychiatric drugs by their trade names-the proprietary trademarks under which the companies own and market them. With generic names in parentheses, a list of trade names of neuroleptics in use today includes Haldol (haloperidol), Thorazine (chlorpromazine), Stelazine (trifluoperazine), Vesprin (trifluopromazine), Mellaril (thiorldazine), Prolixin or Permitil (fluphenazine), Navane (thiothixene), Trilafon (perphenazine), Tindal (acetophenazine), Taractan (chlorprothixene), Loxitane or Daxolin (loxapine), Moban or Lidone (molindone), Serenfil (mesoridazine), Orap (pimozide), Quide (piperacetazine), Repoise (butaperazine), Compazine (prochlorperazine), Dartal (thiopropazate), and Clozaril (clozapine).(1)
The antidepressant Asendin (amoxapine) turns into a neuroleptic when it is metabolized in the body and should be considered a neuroleptic. Etrafon or Triavil is a combination of a neuroleptic (perphenazine) and an antidepressant (amitriptyline), and it combines the impact and the risks of both.
The neuroleptics are the most frequently prescribed drugs in mental hospitals, and they are widely used as well in board-and-care homes, nursing homes, institutions for people with mental retardation, children’s facilities, and prisons. They also are given to millions of patients in public clinics and to hundreds of thousands in private psychiatric offices. Too often they are prescribed for anxiety, sleep problems, and other difficulties in a manner that runs contrary to the usual recommendations. And too often they are administered to children with behavior problems, even children who are living at home and going to school.
No one knows the total numbers of neuroleptic drugs taken by patients each year, but estimates are possible. While the overall number of beds in state hospitals is down, annual admissions are up from the 1950s, and most of the several hundred thousand patients admitted each year are diagnosed as schizophrenic. Nearly all of these are prescribed neuroleptics. Hundreds of thousands more are getting them through outpatient clinics. Well over a million people a year are treated with neuroleptics on the wards and in the clinics of state mental health systems.
Additional millions more are receiving neuroleptics or antipsychotics through sources outside the state mental hospital system and long-term clinics. Of the estimated two million patients in nursing homes, many of them are on neuroleptics. Add to these patients the tens of thousands being treated with these drugs in private psychiatric hospitals, and in the psychiatric and medical wards of general hospitals, plus the tens of thousands in institutions for people with retardation, the untold thousands in board-and-care homes, still more in prisons, and hundreds of thousands in private practice-and the total swells to many millions. Even homeless people in shelters are sometimes forced to take them.
The National Prescription Audit provided by the FDA reported twentyone million prescriptions for neuroleptics in 1984. These figures are drawn from retail pharmacies and therefore do not include patients in institutions or patients dispensed medications directly from clinics. Of course, many patients obtain more than one prescription a year, but the figures suiz2est that at least several million individuals are obtaining neuroleptics rrom retail pharmacies each year.
That huge numbers of people are treated with neuroleptics is confirmed by the figures occasionally released by the pharmaceutical companies. The first neuroleptic was chlorpromazine, whose trade name is Thorazine. In a 1964 publication entitled Ten Years’Experience with Thorazine, the manufacturer, Smith Kline and French, estimated that fifty million patients had been prescribed chlorpromazine in the first decade of use (1954 to 1964). The figure probably was worldwide. In recent years, haloperidol, sold by McNeil Pharmaceutical under the trade name Haldol, has become the most prescribed neuroleptic. In a letter to attorney Roy A. Cohen dated August 13, 1987, McNeil’s director of medical services, Anthony C. Santopolo, provided a glimpse at Haldol’s escalating use. The figures for patients first treated with Haldol grew from 600,000 in 1976 to 1,200,000 in 1981.(2)
Overall, the estimate I made in my 1983 medical book, Psychiatric Drugs, of five to ten million persons per year in America being treated with neuroleptics probably remains valid today. The sheer size of these numbers should motivate us to learn everything we can about the impact of these agents on the brain and the mind.
Textbooks of psychiatry and review articles claim that the neuroleptics have a specific antipsychotic effect, especially on the so-called positive symptoms of schizophrenia, such as hallucinations and delusions, marked incoherence, and repeatedly bizarre or disorganized behavior.
Meanwhile, very little is written in professional sources about the apathy, disinterest, and other lobotomylike effects of the drugs. Review articles tend to give no hint that the medications are actually stupefying the patients and that life on a typical mental hospital ward is listless at best. And so we must turn to the earliest research reports on the drugs. The pioneers, eager to show the potency of their new discovery, were far more candid and graphic in describing the effects to doctors as yet unfamiliar with them.
The Nature of Lobotomy - To grasp what the pioneers said about the neuroleptic effect, it’s important first to understand the lobotomy effect to which it is compared. This link contains the history and description of the surgical lobotomy.
The Birth of Chemical Lobotomy - Reports from the Drug Pioneers & How Neuroleptics Produce Lobotomy - In 1952, the first shot in the “revolution in psychiatry” was fired in Paris by the two pioneers Delay and Deniker. They published their findings on chlorpromazine (Thorazine) in French in Congres des Medecins Alienistes et Neurologistes de France. Read the straightforward description of the apathy and lack of initiative typical of lobotomy.
The neuroleptics also are used in tranquilizer darts for subduing wild animals and in injections to permit the handling of domestic animals who become vicious. The veterinary use of neuroleptics so undermines the antipsychotic theory that young psychiatrists are not taught about it.(3)
The brain-disabling principle applies to all of the most potent psychiatric treatments-neuroleptics, antidepressants, lithium, electroshock, and psychosurgery. The principle states that all of the major psychiatric treatments exert their primary or intended effect by disabling normal brain function. Neuroleptic lobotomy, for example, is not a side effect, but the sought-after clinical effect. It reflects impairment of normal brain function.
Conversely, none of the major psychiatric interventions correct or improve existing brain dysfunction, such as any presumed biochemical imbalance. If the patient happens to suffer from brain dysfunction, then the psychiatric drug, electroshock, or psychosurgery will worsen or compound it.
If relatively, low doses produce no apparent brain dysfunction, the medication may be having no effect or producing a placebo effect. Or, as frequently happens, the patient is unaware of the impact even though it may be significant. Anyone familiar with the behavior of people drinking alcohol knows how easily a slightly intoxicated person may deny being impaired or even claim to be improved. Most people coming off cigarettes become abruptly aware of missing the sedative and tranquilizing effects that previously were taken for granted.
Brain dysfunction, such as a chemical or surgical lobotomy syndrome, renders people much less able to appreciate or evaluate their mental condition. Surgically lobotomized people often deny both their brain damage and their personal problems. They will loudly declare, “I’m fine, never been better,” when they can no longer think straight. Sometimes they deny that they have been operated on, despite the dime-size burr holes in their skulls palpable beneath their scalp. Superficially, the denial looks so sincere that prolobotomists cite it to justify the harmlessness of the treatment.
Even without the production of brain dysfunction, the giving of drugs or other physical interventions tends to reinforce the doctor’s role as an authority and the patient’s role as a helpless sick person. The patient learns that he or she has a “disease,” that the doctor has a “treatment,” and that the patient must “listen to the doctor” in order to “get well again.” The patient’s learned helplessness and submissiveness is then vastly amplified by the brain damage. The patient becomes more dutiful to the doctor and to the demoralizing principles of biopsychiatry. Denial can become a way of life, fixed in place by brain damage.
Suggestion and authoritarianism are common enough in the practice of medicine but only in psychiatry does the physician actually damage the individual’s brain in order to facilitate control over him or her. I have designated this unique combination of authoritarian suggestion and brain damage by the term iatrogenic helplessness. Iatrogenic helplessness is key to understanding how the ma’or psychiatric treatments work .
There is little or no reason to anticipate a physical treatment in psychiatry that will control severely disturbed or upset people without doing equally severe harm to them. If psychosurgery, electroshock, or the more potent psychiatric drugs were refined to the point of harmlessness, they would approach uselessness. In biopsychiatry, unfortunately, it’s the damage that does the trick.
Whether or not some psychiatric patients have brain diseases is irrelevant to the brain-disabling principle of psychiatric treatment. Even if someday a subtle defect is found in the brains of some mental patients, it will not change the damaging impact of the current treatments in use. Nor will it change the fact that the current treatments worsen brain function rather than improving it. If, for example, a patient’s emotional upset is caused by a hormonal problem, by a viral inflammation, or by ingestion of a hallucinogenic drug, the impact of the neuroleptics is still that of a lobotomy. The person now has his or her original brain damage and dysfunction plus a chemical lobotomy.
But what about claims that the treatments reduce psychiatric symptoms, such as so-called hallucinations and delusions? Gerald Klerman was the major figure in transforming the image of the neuroleptics from nonspecific flattening agent to antipsychotic medication. Klerman was an avid advocate of biopsychiatry from early in his career and went on to become director of NIMH. Klerman’s research findings were published in various places, including Alberto DiMascio and Richard Shader’s 1970 compendium The Clinical Handbook of Psychopharmacology. Klerman found that the four most improved “symptoms,” in descending order, were combativeness, hyperactivity, tension, and hostility. In short, the drugs subdue and control people. Hallucinations and delusions the cardinal symptoms of schizophrenia - ran a poor fifth and sixth.(4)
Since drugged patients become much less communicative, sometimes nearly mute, it’s not surprising that they say less about their hallucinations and delusions. Had the investigators paid attention, they would have noticed that the patients also said less about their religious and political convictions as well as about their favorite hobby or sport. There’s no wild cheering for the home team on the typical psychiatric ward. Furthermore, the drugs cause so much discomfort (see chapter 4) that patients often stop saying what they believe to avoid getting larger doses and to bring a more speedy end to the treatment. As many ex-patients have told me, “I learned right away I’d better shut up or I’d get more of that stuff.” What’s astonishing is that despite investigator bias and the global inhibition produced by the drugs, communications labeled hallucinations and delusions continued to be recorded.
Klerman vociferously claimed that his research confirmed an antipsychotic effect, and few, if any, people bothered to check his data.
After I described the lobotomizing effect of the neuroleptics during a 1989 debate with an internationally known psychiatrist, the opposing doctor admitted that he himself had taken “one small dose of neuroleptic” and then experienced an overwhelming and unbearable sense of “depression” and “disinterest.” But he went on to say that his patients, because of their “abnormal brains,” underwent no such lobotomy effect. Unlike normal people, the patients supposedly felt better because the drug “harmonized” their biochemical abnormalities. This was not the first time I’d heard this argument made by a psychiatrist.
The outrage expressed by ex-patients in the audience contradicted his assertions about the harmlessness of the medications. So does the clinical literature cited in this and the next chapter.
What does it say about professionals when they argue that their patients are so different from themselves? Biopsychiatry lives by the principle that its patients are so different from other humans that almost anything can be done to them, including surgical, electrical, and chemical lobotomy. By contrast, the ethical helping person assumes that those seeking help possess the same human sensitivities as anyone else, including the therapist.
Life in a mental hospital is so inhibited, constrained, and suppressed that patients might seem better adjusted when heavily drugged. As already noted in chapter 2, D. L. Rosenhan describes in the January 19, 1973, Science that even the most highly regarded mental hospitals are humiliating and oppressive places, even for normal volunteers masquerading as patients. Typical state hospitals, where many drug studies are conducted, are intimidating and frightfully violent. In Erving Goffman’s phrase, these “total institutions” also stigmatize and demean their inmates. His analysis in Asylums (1961) helps us understand why a drugged patient would seem better adjusted than a drug-free person in such a setting; the chemically lobotomized patient fits better into the social role of mental patient, with its obedience to authority, conformity, lack of dignity, acceptance of mundane routines, and restricted opportunities for self-expression. Similarly, books and stories by former patients in all kinds of psychiatric facilities almost always describe them as wholly suppressive and demoralizing.(5) To say that patients behave better in a mental hospital when they are drugged is more a commentary on the requirements of being an inmate than on the allegedly beneficial qualities of drugs.
Unfortunately, the patient may face an equally suppressive life situation after discharge from the hospital. Board-and-care homes and nursing homes are at least as boring and stifling as psychiatric hospitals. Often they offer nothing but a bed, a TV, and perhaps a local park bench. Again, it is no surprise that patients might seem to adjust better to them when drugged. Indeed, most drug-free people would want to take flight rather than to waste away in a facility that offers nothing in the way of rehabilitation, recreation, or social life.
Nor is life necessarily less stultifying when the patient returns home to his or her family. As we saw in chapter 2, the families of children labeled schizophrenic are, at their best, unable to relate to their overwhelmed offspring. At their worst they are outright abusive. Typically the parents are overinvolved and unrelentingly critical of their son or daughter. Again, it’s no surprise that drugged offspring might seem better adjusted to life in these families, while drug-free ones might continue to be resentful, rebellious, and difficult to control.
Drug experts and psychiatric textbooks that tout neuroleptics almost never concern themselves with the living conditions to which they are asking or forcing the drugged patient to adjust.
Even considering the built-in biases favoring drugs in typical research studies, the data do not unequivocally support the use of neuroleptics.
In comparing hospitalization with and without drugs, the data are not even consistent. For example, a team led by Maurice Rappaport reported in 1978 in Intemational Pharmacopsychiatry that patients treated with placebo in the hospital and no medications on follow-up “showed greater clinical improvement and less pathology at follow-up, fewer rehospitalizations and less overall functional disturbance in the community than the other groups of patients studied.” Of the group that never received medication, only 8 percent were rehospitalized. Of the group that received medication at some time during or after hospitalization, 47 to 73 percent were rehospitalized. The worst performance was for those patients who were drugged both during and after. They suffered a 73-percent return rate.
Gordon Paul and his colleagues investigate long-term maintenance drug therapy for “hard core, chronically hospitalized patient groups” in the July 1972 Archives of General Psychiatry. These patients also were exposed to an active psychosocial rehabilitation program on the wards. One group was abruptly changed from medication to placebo without the staff knowing that a research project was going on. It was found that in the early stages of treatment, medication interfered with participation in the rehabilitation program, and that later on it had no effect, beneficial or otherwise. The authors conclude that the “widespread practice” of giving neuroleptics to chronic hospital patients should be discontinued, because the medications are unhelpful, expensive, dangerous, and interfere with rehabilitation.
Some researchers present a rosier picture for drug intervention. In the Northwick Park study published by T. J. Crow and his team in the British foumal of Psychiatry in 1986, 30 to 50 percent of the patients relapsed with drug therapy and 70 percent relapsed without it. Even if we accept these findings, however, they do not seem so astonishing in the light of the “natural history” of what is called schizophrenia (see chapter 2). As noted earlier, regardless of the treatment regime, one-half or more of patients diagnosed as schizophrenic eventually will make a social and economic adjustment outside the hospital, and that about one-third do well. The results of positive drug studies will seem still less impressive when we examine the high rate of drug-induced permanent brain damage, which can exceed 50 percent among long-term patients (see chapter 4).(6)
A review published in the October 1989 American Journal of Psychiatry raises serious questions about the validity of the most accepted use of neuroleptics-the control of acute psychotic episodes. From McLean Hospital and Harvard Medical School, Paul Keck and his associates, including Ross Baldessarini, could find only five studies on the use of neuroleptics in acute schizophrenia that used scientific controls, cornparing placebo or sedatives to the neuroleptics. These five studies found that “the same overall degree of improvement was observed during treatment with all the agents tested.” Specifically, Valium (a minor tranquilizer and sedative) and opium “demonstrated efficacy similar to that of neuroleptic during the first day and through 4 weeks of treatment.” In other words, sedatives and narcotics performed as well as the so-called antipsychofic drugs in the acute treatment of schizophrenia. The authors suggest, “Perhaps the early effects of antipsychotic drugs are nonspecific and are largely the same as those of sedative agents.”
More demoralizing to advocates of neuroleptics, Keck and his coauthors also found that in some studies, a placebo performed as well as the neuroleptics. They conclude that the apparent efficacy of neuroleptics in treating acute patients may in fact be due to other factors, such as a respite from conflicted home life.
The authors also remark that drug efficacy in the long-term treatment of chronic patients is equally unconfirmed. Significantly, Keck and his colleagues constitute a very respected research team from one of the most esteemed institutions in psychiatry, and they are well-known advocates of psychiatric medication.
One entrenched myth is that the antipsychotics helped to empty the state mental hospitals, thereby returning many people to more useful, better lives. The American Psychiatric Press’s Textbook of Psychiatry (1988), for example, declares unequivocally: “The rapid decline in the number of patients in psychiatric hospitals has been among the most persuasive examples of how pharmacologic therapies in psychiatry have a beneficial impact not only on the individual patient, but on society as well” (p. 770). The overall process was given the misnomer “deinstitutionalization.”
In reality, the drugs did not cause the emptying of the state hospitals, which did not begin in earnest until 1963, more than eight years after the introduction of the neuroleptics in America. At that point, the hospital population had been relatively static for many years-558,000 inmates in the peak year of 1955 and 504,000 in 1963-and admissions actually had skyrocketed. After 1963 a rapid decline in inmate population began throughout the country. In that year, “mental illness” became covered for the first time under federal disability programs, culminating in Social Security Disability (SSI). Now the patients could be sent to old-age homes and board-and-care facilities, to be paid for by their meager disability checks. The states had successfully shifted the financial burden from themselves to the federal program.
“Deinstitutionalization” is itself a misleading term, because very few of the discharged patients became independent. Most were transferred into other supervised facilities, usually with even less to offer than the state mental hospitals, which at least had expansive grounds and a few organized activities. Some of the inmates were cast out on the streets as homeless people. At the same time, the infamous “revolving door policy” began, with frequent short readmissions to drug the patients again before sending them back to their dismal, lonely surroundings.
The primary function of drugs in this process is to make it easier to ship robotic patients from one place to another. That the drugs did not cause deinstitutionalization is confirmed by the Swedish experience, where the process is only now beginning in that country, twenty-five years after the introduction of the drugs. Emptying American hospitals was a matter of social policy-moving patients out and taking fewer in -not a medical miracle.
The aged made up the largest portion of the old state mental hospital population, and they were the first to be thrown out during deinstitutionalization. A 1989 study by Jerry Avorn and his colleagues from Harvard, published in the New England Journal of Medicine, surveyed fiftyfive rest homes in Massachusetts. They found that 39 percent of the inmates were receiving neuroleptics and that 18 percent were receiving two or more. Several other studies confirm the drugging of the elderly in understaffed, oppressive nursing homes throughout the country. Private board-and-care homes are no better. Psychiatrist Theodore van Putten and his colleague J. E. Sparr wrote “The Board and Care Home:
Does it Deserve a Bad Press?” in the July 1979 Hospital and Community Psychiatry. They describe patients lobotomized by the drugs, suffering from blunted feeling, passivity, and lack of initiative, interest, and spontaneity. Most lived “in virtual solitude.”
A number of other former inmates have ended up as street people, but not nearly so many as are institutionalized in other settings, such as nursing homes, board-and-care homes, and jails. Furthermore, homelessness as a problem is directly attributable to economic changes. There has been a drastic decline in low-income housing, coupled with an increase in numbers among the very poor. Deinstitutionalization in Denmark, by contrast, has not produced rampant homelessness, because the government provides sufficiently large disability payments and enough affordable housing to keep ex-inmates off the streets.
That many American homeless do have severe psychological problems merely confirms that our more helpless citizens suffer the most acutely and quickly from economic pressures, such as low wages and high rents. Homelessness itself is undoubtedly not good for one’s mental stability.
We should reject psychiatry’s call to subject ever-increasing numbers of the homeless to enforced medication with neuroleptics. When it diagnoses, drugs, and incarcerates the homeless poor, psychiatry covers up the political issue-society’s unwillingness to provide jobs, housing, or an adequate safety net. People victimized by socioeconomic conditions are turned over to psychiatry for further abuse. All of us then rest more easily-except for the victims.
In January 1980, the editor of Clinical Psychiatry News, psychiatrist William Rubin, wrote poignantly about the fate of deinstitutionalized patients:
Patients aren’t warehoused in snakepits any longer. They sit instead in wretched welfare hotels and Bowery flophouses. The shopping-bag ladies and other casualties wander the streets, prey for all the vultures, until they are harmed or in some other way attract the attention of law-enforcement authorities. Then they are sent back to the state hospitals; cleaned up; pushed through the revolving door back into the community.
As most observers now agree, so-called deinstitutionalization was not a blessing to the former inmates; it was a callous abandonment. It is simply false to claim that deinstitutionalization returned thousands of inmates to productive lives in the commun ity.
In their book Community Mental Health (1989), Loren Mosher and Lorenzo Burti describe Soteria House in California, a nondrug psychosocial treatment home that was compared to a control group of patients going through the regular psychiatric system. Using small, homelike quarters with nonprofessional therapists, Soteria outperformed the traditional mental hospital system and neuroleptic drugs. In a chapter in his 1989 book The Limits of Biological Treatments for Psychological Distress, Bertram Karon reviews a variety of studies showing the superiority of psychotherapy over neuroleptics in the treatment of schizophrenic patients. Karon’s own psychotherapy project showed that patients did best in the long run when they received no medication or used it only during the times of worst distress. In chapter I we saw how effective untrained volunteers can be in helping people gain release from custodial institutions.
Loren Mosher’s Soteria House project, Karon’s psychotherapy research, the Harvard-Raqcliffe Mental Hospital Volunteer Program, and other psychosocial approaches will be described in more detail in chapter 16.
In summary, the neuroleptic drugs are chemical lobotomizing agents with no specific therapeutic effect on any symptoms or problems. Their main impact is to blunt and subdue the individual. In the next chapter we’ll see that they also physically paralyze the body, rendering the individual less able to react or to move. Thus they produce a chemical lobotomy and a chemical straitjacket. Indeed, there is relatively little evidence that they are helpful to the patients themselves, while there is considerable evidence that psychosocial interventions are much better. The drugs are also the cause of a plague of brain damage that afflicts up to half or more of long-term patients. We turn now to that drug-induced epidemic.
1. Clozaril (clozapine), the center of considerable controversy, will be discussed in chapter 4. Although physicians sometimes fail to realize it, many other nonpsychiatric drugs are also neuroleptics. The list includes some antihistamines, such as Tacaryl and Temaril; some antinausea drugs, such as Compazine and Torecan; and some drugs used in conjunction with anesthesia, including Inapsine, Largon, and Phenergan, which is also used as an antinausea and anti-mofion sickness agent. Serpasil (reserpine), a rauwolfia derivative, has neuroleptic qualities and is used as an antihypertensive and rarely as an antipsychotic. Serpasil is one of many trade names; others include Harmony], Raudixin, and Sandril. In nonpsychiatric usage, the doses are usually sufficiently small to avoid producing a neuroleptic toxic effect on the brain and mind, but caution should be exercised, especially in regard to Compazine, which can cause severe neurological reactions in relatively low doses.
2. The rate was increasing by 100,000 to 200,000 per year and is probably much higher now. The figures were based on submissions to the FDA and therefore probably were limited to the United States.
3. Veterinary literature and practice has established that these drugs must be limited to short term use only. They’re too dangerous for animal consumption, except in emergencies and terminal states. Yet they are less dangerous to animals, in whom it often is more difficult to produce the permanent drug-induced neurological disorders seen in humans (see chapter 4). Recently, our frisky Shetland sheepdog was given a very small dose of neuroleptic to prevent car sickness. My daughter Alysha soon noticed that he became more obedient and “stopped barking at everything.”
4. While combativeness and hyperactivity were markedly reduced in 49 percent and 3 8 percent of patients, respectively, hallucinations and delusions were markedly reduced in only 30.5 percent and 21 percent. Other problems typically associated with mental illness were unimproved by the drugs, including judgment, insight, and emotional tone, or affect.