below is a recent blog post from the National Institutes of Mental Health Director, Thomas Insel, M.D. dated January 11, 2010 that takes liberties with the truth. Insel's words are promptly used to by DJ Jaffe as validation of his quest for a not so Brave New World; where anyone diagnosed with psychosis, and particularly with schizophrenia, is drugged under color of law for the remainder of their life. Isn't this the same way that the Germans instituted social policies leading up to WWII? What kind of a plan is this for any so-called advocate to repeatedly hit America over the head with? It is a plan based on ignorance, fear, and bigotry; absent altruistic intent and action.
January 11, 2011
Understanding Severe Mental Illness
"When a tragedy occurs like the shooting in Tucson this past weekend, all of us seek an explanation. While there remain many questions, a leading hypothesis is that the suspect has a serious mental illness (SMI), such as schizophrenia. The topic of violence and mental illness is never an easy discussion: with issues such as stigma, incarceration, public safety, and involuntary treatment in the mix. There is a legitimate concern that talking about violence and mental illness in the same sentence increases the likelihood that people with serious illness will be further marginalized and less likely to receive appropriate care. But tragic events, whether at a Safeway in Tucson or a classroom at Virginia Tech, require us to address this uncomfortable subject with the science available."
"Is violence more common in people with SMI? Yes, during an episode of psychosis, especially psychosis associated with paranoia and so-called “command hallucinations”, the risk of violence is increased. People with SMI are up to three times more likely to be violent and when associated with substance abuse disorders, the risk may increase much further."i DJ Jaffe used the preceding, but not the following, which would have put into perspective the actual percentage of violent crime committed by those diagnosed with schizophrenia, in comparison with all violent crime; and that those with a diagnosis are at increased risk of being victimized by violent crime.
As Insels states, "But, mental illness contributes very little to the overall rate of violence in the community. Most people with SMI are not violent, and most violent acts are not committed by people with SMI. In fact, people with SMI are actually at higher risk of being victims of violence than perpetrators. Teplin et al found that those with SMI are 11 times more likely to be victims of violent crime than the general population."ii
"The most common form of violence associated with mental illness is not against others, but rather, against oneself. In 2007, the most recent year for which we have statistics, there were almost 35,000 suicides, nearly twice the rate of homicides. Suicide is the 10th leading cause of death in the United States.iii Although it is not possible to know what prompted every suicide, it is safe to say that unrecognized, untreated mental illness is a leading culprit."
This above italicized statement is pure speculation. A statement like this coming from a scientist, who is in charge of directing the National Institutes of Mental Health, it is wholly irresponsible. Particularly since research shows that antidepressants are not statistically any better than placebo for treating depression; and even cause some people to feel worse, and SSRIs can actually increase the suicide risk! Citing overall suicide statistics, instead of data specific to those with "serious mental illness" avoids having to extrapolate relevant information from subjective reports from people who survived suicide attempts who are diagnosed with schizophrenia, bipolar and schizoaffective disorder who state that the horrendous adverse neurological and cognitive effects the drugs cause is what compelled them to attempt suicide.
Insel's inference that suicide is because not enough people receive treatment, i.e. psychotropic drugs; but failing to mention that many people can't tolerate the terrible adverse effects of the drugs, presents a biased and incomplete picture. Are we expected to believe that the permanent neurological, cognitive and emotional negative effects of the drugs that many cite as the reason for their suicide attempt, is due to a supposed lack of insight? Insel's inference is simplistic, biased and ignores the subjective experiences of an entire group of patients. Insel's high suicide rate theory that not enough people are being drugged, is not grounded in anything but thin air. The blatant failure to acknowledge, or validate the subjective experiences of a single patient, let alone an entire group of patients, is unacceptable. In this paragraph, Insel in effect, ignores the subjective experiences and treatment outcomes for thousands of patients. In so doing, Insel neatly avoids telling the truth about the real world outcomes for people given neuroleptic drugs. Insel fails his duty to the American people by failing to provide unbiased, accurate information on the suicide data for an entire class of people.
Insel's inference that suicide is because not enough people receive treatment, i.e. psychotropic drugs; but failing to mention that many people can't tolerate the terrible adverse effects of the drugs, presents a biased and incomplete picture. Are we expected to believe that the permanent neurological, cognitive and emotional negative effects of the drugs that many cite as the reason for their suicide attempt, is due to a supposed lack of insight? Insel's inference is simplistic, biased and ignores the subjective experiences of an entire group of patients. Insel's high suicide rate theory that not enough people are being drugged, is not grounded in anything but thin air. The blatant failure to acknowledge, or validate the subjective experiences of a single patient, let alone an entire group of patients, is unacceptable. In this paragraph, Insel in effect, ignores the subjective experiences and treatment outcomes for thousands of patients. In so doing, Insel neatly avoids telling the truth about the real world outcomes for people given neuroleptic drugs. Insel fails his duty to the American people by failing to provide unbiased, accurate information on the suicide data for an entire class of people.
"Treatment may be the key to reducing the risk of violence, whether that violence is self-directed or directed at others. Research has suggested that those with schizophrenia whose psychotic symptoms are controlled are no more violent than those without SMI.iv It’s likely that treatment not only helps ease the symptoms of mental illness, but also curbs the potential for violence as well."
"As we learn more about the circumstances surrounding the tragedy in Tucson, we should be working harder to ensure people with SMI receive the care they need. Early intervention offers the best hope to prevent more tragedies in the future."
"For more information on SMI and other mental health statistics, please visit NIMH’s Statistics page."
"Information on coping with trauma."
iSwanson JW. Mental disorder, substance abuse, and community violence: an epidemiological approach. In: Monahan J, Steadman HJ, eds. Violence and mental disorder: developments in risk assessment. Chicago: University of Chicago Press, 1994:101-36.
iiTeplin et al. Crime victimization in adults with severe mental illness. Archives of General Psychiatry.2005 Aug. 62. 911-921.
iiiCenters for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS). www.cdc.gov/ncipc/wisqars.
ivSteadman HJ, Mulvey EP, Monahan J, et al. Violence by people discharged from acute psychiatric inpatient facilities and by others in the same neighborhoods. Arch Gen Psychiatry 1998;55:393-401.
my thoughts
This is beyond believable! What is likely true is that while use of neuroleptics may initially "curbs the potential for violence as well," it is causing neurological and cognitive damage. With continued treatment, the damage may progress to cause an increase in aggression due to the BRAIN DAMAGE! The drugs used to "treat" schizophrenia also often cause akathisia which is associated with aggression and violence. Patients who develop akathisia describe an inner restlessness that some have further described as relentless torture; a compulsion to always be pacing, rocking and be in constant movement. Some, after stopping the drugs, find the effects are permanent.
This is beyond believable! What is likely true is that while use of neuroleptics may initially "curbs the potential for violence as well," it is causing neurological and cognitive damage. With continued treatment, the damage may progress to cause an increase in aggression due to the BRAIN DAMAGE! The drugs used to "treat" schizophrenia also often cause akathisia which is associated with aggression and violence. Patients who develop akathisia describe an inner restlessness that some have further described as relentless torture; a compulsion to always be pacing, rocking and be in constant movement. Some, after stopping the drugs, find the effects are permanent.
I agree with Dr. Insel that, "Early intervention offers the best hope to prevent more tragedies in the future." I do not agree that drugs are always the intervention needed. With the serious deleterious effects and the potential for dependence, withdrawal and rebound psychosis which are adverse effects inherent with the use of all neuroleptic drugs, it is hard to fathom current standard clinical practice.
These well documented risks are not disclosed in the Consent process; causing me to wonder about the integrity of psychiatry, as an ethical medical specialty. This is a fundamental failing that is widely accepted that is ignored when writing clinical "standards of care." While failing almost universally and totally to disclose the potential for harm, Psychiatrists label patients who are traumatized, protest the harmful effects, and claim the drugs are not helpful as "noncompliant;" or worse declare that they have anosognosia. While it may be true that some patient's lack insight; it is equally true that psychiatrists can have biases which prevent recognition of their own lack of insight. Worse, are the professionals who minimize a patient's complaints about the prescribed drug's adverse effects, because they seem to be willfully blind to the patient's iatrogenic injuries, which are medically neglected.
These well documented risks are not disclosed in the Consent process; causing me to wonder about the integrity of psychiatry, as an ethical medical specialty. This is a fundamental failing that is widely accepted that is ignored when writing clinical "standards of care." While failing almost universally and totally to disclose the potential for harm, Psychiatrists label patients who are traumatized, protest the harmful effects, and claim the drugs are not helpful as "noncompliant;" or worse declare that they have anosognosia. While it may be true that some patient's lack insight; it is equally true that psychiatrists can have biases which prevent recognition of their own lack of insight. Worse, are the professionals who minimize a patient's complaints about the prescribed drug's adverse effects, because they seem to be willfully blind to the patient's iatrogenic injuries, which are medically neglected.
Many psychiatrists are apparently afflicted by an inability to think critically or understand that the patient's subjective experiences and opinions truly do matter in a supportive, therapeutic relationship. A therapeutic relationship requires mutual respect, particularly respect for the patient's human rights, and the ability to empathize with a pateint in distress. These are fundamental to earning a patient's trust on a human level and critical to the ethical practice of psychiatry. Why do so many psychiatrists not seem to realize this? Some don't even seem to understand that even a person in distress is aware if they are actually respected, or that trust needs to be earned by a psychiatrist who hopes to be able to help a person; even if the professional doesn't believe that a patient has any insight.
It seems to me, the way psychiatry is practiced relying on biased information, abuse of power and authority, coercion, police powers, and court orders; psychiatry is making sure, "that people with serious illness will be further marginalized and less likely to receive appropriate care." (and less likely to seek it!) As for Insel's, "legitimate concern that talking about violence and mental illness in the same sentence increases the likelihood" of those psychiatrically labeled being further marginalized; his concern does not appear to motivate the director of NIMH to rely on unbiased and valid information when writing his blog. It is dishonest (and unethical) for Thomas Insel to neglect mentioning that the very drugs he claims are "necessary medical treatment" in the prevention of aggressive and violent behavior in people diagnosed with mental illnesses, are in fact well-known to increase violent, aggressive, suicidal and homicidal behaviors for a statistically significant number of people who are prescribed neuroleptic, and other psychotropic drugs...
Shame on you, Thomas Insel!
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