EBM, Psychotropics, Suicide and You!

By the time you get to the end of this blog, I’m banking that you’ll WANT to follow the link to the video I posted here. But, please, let me prepare you before you jump in. I’m challenging you to THINK!

For those of you who don’t know me, I grew up in Brooklyn in the 1950′s when hospitals were much fewer and far between and doctors made housecalls. There were always extended-family members you could count on to get you through most common illnesses. It was also an age that when it was time to go, you just keeled over and died. None of this lingering shit! When your number was up, something acute would crop up and within days your dead body would be laid out in your own bed in your own bedroom and everyone would file in to pay respects, leaving food for the family on the dining room table on the way out the door.

(Yup, I’m old…I’m the little kid behind the guy who’s thinking, “Oh, Shit, wrong Alternative!”)

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Going to a psychiatrist was something only the very rich did and they didn’t talk about it. Discussion about, and treatment of, mental illness was largely confined to cases of mental retardation, extreme cases of what we call today “developmental disabilities”, or those who exhibited extreme signs of bizarre, antisocial, self- or other-destructive behavior. They were all taken out of society and placed in controlled communities (gated!) together. The rich retreated to their estates.

Everybody else was pretty much left to themselves, living in relative security that only bizarre behavior would expose them to the sanctions of Higher Authorities who would then mandate their treatment. It was a world where everyone had their ups and downs and no alarms went off unless there was a wide variation from the norm. Once you crossed the line into “mental illness”, however, you were X-d out of your place in the mainstream and you were marginalized, if not shunned by your peers. Also, it’s important to remember that most of the “inmates” in those institutions were of the lower class and/or people of color.

There was stigma to having mental illness back then. Today, it has become a big business. Can you see it?

Behind the closed doors of those institutions, which for all intents and purposes were prisons, the inmates were part of Grand Experiments. Many of them involved electricity and/or medications.  Truthfully, we know little about what really went on inside those walls but it’s fair to say that the first “subjects” in the initial “clinical trials” of so-called “therapeutics” for “mental illnesses” were not exactly willing subjects and had zero protection through checks and balances; it was a free-for-all for the experimenters!

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Scary as it seems, it hasn’t changed all that much. As you’ll see in the video, the experimenters just adapted to changing times and their guinea pigs happen to be walking the streets now!

Where things are different today is there are no more “Mental Institutions”. There are lots of people who are suffering mental illnesses but they are “controlled” by medications which means they are kept functional through chemistry. Functional enough to live on their own, anyway, mostly supported by welfare programs. At any rate, they’re amongst us now and they’re part of another Grand Experiment. For far too many of these people, unfortunately, when they run out of meds they end up homeless. This is part and parcel of our work in EMS; tending to their real or imagined needs.

Have you noticed the enormous percentage of our population who are using drugs once reserved for only the most severely afflicted! What do you think? If drugs had not replaced the institutions, would there be that many more institutions to accommodate our mentally ill today? Their numbers are growing fast, aren’t they; why is that?

Could it be the tremendous leap in advertising we’re exposed to through the pharmaceutical industry is contributing to this explosion? Can you see that people are being instructed on symptoms to look for (of mental illness), told what medications might be useful and then instructed to ”Ask your doctor!” Just turn on your T.V., listen to your radio, open a magazine or check in with a computer screen of some sort!

Continual, repeated exposure in all media is not about “ask”, it’s about creation of demand; Successful Advertising 101!

The people under treatment for mental illnesses seems to have increased exponentially in proportion to the rest of society. The mentally ill — whom now include the insomniacs, depressed and compulsive — are no longer on the margins, they are quickly becoming the mainstream! Why is that? Are there THAT many more of us who are at wit’s end? What IS mental illness, anyway; where’s the real line?

This video will at the very least, start you thinking about the subject and your patients in a new way. It does a pretty good overview of how they get the medicines they ask for. BTW, I have no vested interest in the video or the group who made or sponsors it. All I’m asking you to do is to examine the systems that influence your ability to serve; be aware and then respond accordingly. This isn’t even a call to action as much as Continuing Education without credits!

The treatments of choice  for as many mental illnesses as we can define are called psychotropics and I don’t have to tell you the percentage of your patients who are on them. How many of your patients are taking more than one, two, or three+ different ones? Did you ever wonder why that’s going on? For you guys and gals who’ve been at this game for the last ten years or so, please, tell us all about the huge difference you’ve seen in their usage!

And how has your working life become more complicated because the psycho-active drugs your patients use tend to affect multiple aspects of their physiologies? Their “effects” are not limited to psychological ones, and their unstudied and unknown interactions with other drugs can significantly impact the efficacy of your treatments! Who is doing the monitoring here and who is warning us as soon as there is evidence that people are being harmed?

Here’s a good example to chew on. Are you aware of this conclusion drawn from this article Risk of death related to psychotropic drug use in older people during the European 2003 heatwave: a population-based case-control study. (Pub-Med)

Use of any psychotropic drug was associated with a 30% increased risk of death during the heatwave, with a significant dose-response relationship between the number of psychotropic drugs and the risk of death… CONCLUSION: Our findings suggest that a causal relationship may exist between psychotropic drug use during a heatwave and increased risk of death in older people.

Who picks these people up? Has anyone told you that you’re NOT dealing with repercussions of heat-stroke, but with the ameliorating effects of psychotropics? These are things you need to know and unless something changes radically and fast, your workload in areas like this will increase substantially. Why? Because economic forces are at work.

For illustration that something just might be askew here, and to further pique your curiosity, let’s zero in on one aspect of your job where evidence of the effects of our (prescription) drug-oriented culture are painfully obvious; suicide! The video does NOT go into detail about this, but here’s an illustration I’m sure you can relate to.

Are not these calls some of the most personally challenging ones you must deal with?

Let’s face it, there’s something special about attempted and succesful suicides because you’re likely to wonder, “What would it take for me…?” At least two of my former paramedic colleagues found out the answer to that question and acted on it.

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Unfortunately, as you will soon learn, a decision to step across the threshhold into suicide can take a whole lot less than you think. And evidence shows it could be propelled by treatments prescribed to reduce depression and lessen the chance of suicide! This entry is so very much connected with my last blog, By the time you get to a shrink, it’s too late! it’s almost uncanny. And, quite frankly more disturbing than I even imagined!

In fact (since I’ve completely KILLED any notion of brevity here!), you’re reading this because I wanted to double-check my notion that psychiatry today is largely about handing out prescriptions. I simply wanted to learn more about the effects of the psychotropics they dispense.

Now, I have to say please, look at your patients, look at yourself and look at this video and see how easy you, too, could find yourself at rope’s end (literally!) even after getting help! But let’s start here to illustrate how you’re being told you’re trained to intercede on behalf of the deeply disturbed when what you really may be doing is trying to counteract prescription-related effects.

In the article Treatment-induced suicide. Suicidality as a potential effect of psychiatric drugs,  published in: Journal of Critical Psychology, Counselling and Psychotherapy (United Kingdom), Vol. 2 (2002), No. 1 (Spring), p. 54 – 58, Peter Lehmann says:

In 1976 Hans-Joachim Haase of the Psychiatric institution Landeck, Germany, reported that the number of perilous depressive occurrences after a treatment with psychiatric drugs increased at least ten times when compared with before the introduction of psychiatric drugs. The increase of the suicide rate is »alarming and worrying«, said Baerbel Armbruster of the Psychiatric Department of the University of Bonn, Germany, in 1986 in the Nervenarzt – without, nevertheless, alarming the (ex-) users and survivors of psychiatry and their relatives, or even the public.

From what I could gather in internet searches, approximately 50%  of suicides in the U.S. have been under treatment by psychotropics. The question that is being asked is Which came first, the chicken or the egg? The most authoritative study I came across happened in Sweden. In Psychiatric drugs and suicide in Sweden 2007 A report based on data from the National Board of Health and Welfare, it says: