Listening to Madness
Why some mentally ill patients are rejecting their medication and making the case for
Published May 2, 2009
From the magazine issue dated May 18, 2009
We don't want to be normal," Will Hall tells me. The 43-year-old has
been diagnosed as schizophrenic, and doctors have prescribed antipsychotic medication for him. But Hall would rather value
his mentally extreme states than try to suppress them, so he doesn't take his meds. Instead, he practices yoga and avoids
coffee and sugar. He is delicate and thin, with dark plum polish on his fingernails and black fashion sneakers on his feet,
his half Native American ancestry evident in his dark hair and dark eyes. Cultivated and charismatic, he is also unusually
energetic, so much so that he seems to be vibrating even when sitting still.
I met Hall one night at the offices of the Icarus Project in Manhattan.
He became a leader of the group—a "mad pride" collective—in 2005 as a way to promote the idea that mental-health
diagnoses like bipolar disorder are "dangerous gifts" rather than illnesses. While we talked, members
of the group—Icaristas, as they call themselves—scurried around in the purple-painted office, collating mad-pride
fliers. Hall explained how the medical establishment has for too long relied heavily on medication and repression of behavior
of those deemed "not normal." Icarus and groups like it are challenging the science that psychiatry says is on its side. Hall
believes that psychiatrists are prone to making arbitrary distinctions between "crazy" and "healthy," and to using medication
"For most people, it used to be, 'Mental illness is a disease—here
is a pill you take for it'," says Hall. "Now that's breaking down." Indeed, Hall came of age in the era of the book "Listening
to Prozac." He initially took Prozac after it was prescribed to him for depression in 1990. But he was not simply depressed, and he soon had a manic reaction
to Prozac, a not uncommon side effect. In his frenetic state, Hall went on to lose a job at an environmental organization.
He soon descended into poverty and started to hear furious voices in his head; he walked the streets of San Francisco night
after night, but the voices never quieted. Eventually, he went to a mental-health clinic and was swiftly locked up. Soon after,
he was diagnosed with schizophrenia. He was put in restraints and hospitalized against his will, he says. For the next year,
he bounced in and out of a public psychiatric hospital that he likens to a prison. The humiliation and what he experienced
as the failure of the medication were what turned him against traditional treatment. Since then, Hall has been asking whether
his treatment was really necessary. He felt sloshily medicated, as if he couldn't really live his life.
Hall and Icarus are not alone in asking these questions. They are part
of a new generation of activists trying to change the treatment and stigma attached to mental illness. Welcome to Mad Pride,
a budding grassroots movement, where people who have been defined as mentally ill reframe their conditions and celebrate unusual
(some call them "spectacular") ways of processing information and emotion.
Just as some deaf activists prefer to embrace their inability to hear
rather than "cure" it with cochlear implants, members of Icarus reject the notion that the things that are called mental illness
are simply something to be rid of. Icarus members cast themselves as a dam in the cascade of new diagnoses like bipolar and
ADHD. The group, which now has a membership of 8,000 people across the U.S., argues that mental-health conditions can be made
into "something beautiful." They mean that one can transform what are often considered simply horrible diseases into an ecstatic,
creative, productive or broadly "spiritual" condition. As Hall puts it, he hopes Icarus will "push the emergence of mental
Embracing "mental diversity" is one thing, but questioning the need
for medication in today's pill-popping world is controversial—and there have been instances in which those who experience
mental extremes harm themselves or others. Icaristas argue that some of the severely mentally ill may avoid taking medication,
because for some the drugs don't seem to help, yet produce difficult side effects. And while some side effects like cognitive
impairment are surely debilitating, others are more subtle, such as the vague feeling that people are not themselves. Icaristas
call themselves "pro-choice" about meds—some do take their drugs, but others refuse.
Mad pride has its roots in the mad-liberation movement of the 1960s
and '70s, when maverick psychiatrists started questioning the boundaries between sane and insane, and patients began to resist
psychiatric care that they considered coercive. But today the emphasis is on support groups, alternative health and reconsidering
diagnostic labeling that can still doom patients to a lifetime of battling stigma. Icarus also frames its mission as a somewhat
literary one—helping "to navigate the space between brilliance and madness." Even the name Icarus, with its origin in
the Greek myth of a boy who flew to great heights (brilliance) but then came too close to the sun (madness) and hurtled to
his death, has a literary cast.
Although Icarus and Hall focus on those diagnosed as mentally ill,
their work has much broader implications. Talking to Hall, I was acutely aware just how much their stance reflects on the
rest of us—the "normal" minds that can't read through a book undistracted, the lightly depressed people, the everyday
drunks who tend toward volatility, the people who "just" have trouble making eye contact, those ordinary Americans who memorize
every possible detail about Angelina Jolie.
After all, aren't we all more odd than we are normal? And aren't so
many of us one bad experience away from a mental-health diagnosis that could potentially limit us? Aren't "normal" minds now
struggling with questions of competence, consistency or sincerity? Icarus is likewise asking why we are so keen to correct
every little deficit—it argues that we instead need to embrace the range of human existence.
While some critics might view Icaristas as irresponsible, their skepticism
about drugs isn't entirely unfounded. Lately, a number of antipsychotic drugs have been found to cause some troubling side
There are, of course, questions as to whether mad pride and Icarus
have gone too far. While to his knowledge no members have gravely harmed themselves (or others), Hall acknowledges that not
everyone can handle the Icarus approach. "People can go too fast and get too excited about not using medication, and we warn
people against throwing their meds away, being too ambitious and doing it alone," he says.
But is this stance
the answer? Jonathan Stanley, a director of the Treatment Advocacy Center, a nonprofit working to provide treatment for the
mentally ill, is somewhat critical. Stanley, who suffers from bipolar illness with psychotic features, argues that medication
is indispensable for people with bipolar disease or with schizophrenia. Stanley's group also supports mandatory hospitalization
for some people suffering severe mental illness—a practice that Icarus calls "forced treatment."
Scholars like Peter Kramer, author of "Listening to Prozac" and "Against
Depression," also take a darker view of mental extremes. "Psychotic depression is a disease," Kramer says. As the intellectual
who helped to popularize the widespread use of antidepressants, Kramer is nonetheless enthusiastic about Icarus as a community
for mad pride. Yet he still argues that mental-health diagnoses are very significant. "In an ideal world, you'd want good
peer support like Icarus—for people to speak up for what's right for them and have access to resources—and also
medication and deep-brain stimulation," he says.
For his part, Hall remains articulate, impassioned and unmedicated.
He lives independently, in an apartment with a roommate in Oregon, where he is getting a master's in psychology at a psychoanalytic
institute. He maintains a large number of friendships, although his relationships, he says, are rather tumultuous.
Nevertheless, it's not so easy. Hall periodically descends into dreadful
mental states. He considers harming himself or develops paranoid fantasies about his colleagues and neighbors. Occasionally,
he thinks that plants are communicating with him. (Though in his mother's Native American culture, he points out, this would
be valued as an ability to communicate with the spirit world.)
On another night, I had dinner with eight Icarus members at a Thai
restaurant in midtown Manhattan. Over Singha beer, they joked about an imaginary psychoactive medication called Sustain, meant
to cure "activist burnout." It was hard to imagine at the dinner what Hall had suffered. While he and his "mad" allies were
still clearly outsiders, they had taken their suffering and created from it an all-too-rare thing: a community.
source site: Newsweek Online
Taking depression drugs? Tell your dentist - News
Shape, Sept, 2003 by Alice Lesch Kelly
Some medications for depression can increase the risk of tooth
decay, gum disease, bad breath and oral yeast infections. Here's why: Dry mouth is a common side effect of some of these drugs,
and since saliva washes harmful bacteria off teeth and gums, these bugs can proliferate in a dry mouth. "Make sure your dentist
is aware if you take antidepressants," says Gall T.
Galasko, Ph.D., a professor of pharmacology at the Southern
Illinois University School of Dental Medicine. Preventive measures such as drinking extra water, getting fluoride applications,
scheduling more frequent dental exams or using salivary stimulants such as sugarless gum or lemon drops can help.
COPYRIGHT 2003 Weider Publications
COPYRIGHT 2003 Gale Group
source site: click here
Facts About Antidepressants
A new study says some antidepressants are mostly ineffective, but
many previous studies show the opposite.
By Debra Fulghum Bruce, PhD
A controversial new
study suggests the widely prescribed antidepressants Prozac, Paxil and Effexor work
no better than placebo for most patients who take them, and many depression experts now cry foul.
What does the new study say about the ineffectiveness of antidepressants?
In findings published in the
February issue of the journal PloS Medicine, researchers conclude that when taken as a whole, the data show that only
a small group of the most severely depressed patients benefit from taking one of the antidepressants.
For less severely depressed patients, the antidepressants were found to work no better than placebos, leading the researchers
to conclude that most patients who take antidepressants probably shouldn't be on them.
Does this study contradict numerous positive studies on antidepressants?
Yes, it does. In a statement,
American Psychiatric Association President-elect Nada Stotland, MD, maintains that studies like this one, which compare a
single drug to placebo, do not accurately reflect the way doctors prescribe antidepressants
Stotland says many people
who are depressed do not respond to the first antidepressant they try. "It may take up to an average of 3
or more different antidepressants until we find the one that works for a particular individual. Therefore, testing any single
antidepressant on a group of depressed individuals will show that many of them do not improve."
What do other findings show about using antidepressants?
Numerous studies support
the benefit of antidepressants in improving mood, increasing ability to function socially,
and easing physical complaints of joint pain, insomnia, and low energy.
According to Ronald R. Fieve,
MD, psychopharmacologist and professor of clinical psychiatry at Columbia Presbyterian Medical Center in New York City, its
not unusual for an antidepressant to take 2 to 6 weeks to have an effect on a patient's
"People must realize that
we've come a long way in reducing the side effects of antidepressants since first prescribing
the tricyclics," Fieve says. "And while drug companies have reduced medication side effects with the newer [antidepressants], there's still not much improvement with onset of action or efficacy."
Fieve notes that in his practice,
a good number of patients dramatically come out of their depression within 10 days to two weeks. "About 65% see improvement on the first antidepressant, and
85% of patients succeed on one to three antidepressant trials."
Why wouldn’t an antidepressant
According to Fieve, sometimes
the doctor chooses the wrong antidepressant, or the right antidepressant
in the wrong dosage, or does not administer the antidepressant for at least 6 weeks at the
highest dose tolerable to achieve full therapeutic results.
In addition, if the depressed patient has problems with alcohol or drug abuse and takes an antidepressant, the medication
isn't getting at the real problem. There are also patients who are heavily medicated on tranquilizers who wonder why an antidepressant doesn't work to ease their depression. Coming off the tranquilizers may improve
mood, Fieve says.
Can alternative treatments help in treating depression?
For minor depression (dysthymia), Fieve says that exercising
regularly, reducing stress, and improving sleep can help patients relax and feel better.
But what about those with major depressive disorder? "Medications
are necessary," Fieve says. "Psychotherapy is also a useful adjunct in combination with medications."
What about teens and antidepressants?
The latest findings published in The Journal of the American
Medical Association show that depressed teens who don't respond well to the first prescribed antidepressant medication begin to
improve if they are switched to a different antidepressant medication and also offered "talk" therapy.
The combination -- switching medications and offering talk therapy
-- works better than simply changing medications, the researchers found, although switching medications alone also offers
What are the common signs of depression?
Symptoms of depression vary per person but may include depressed mood most of the day, particularly in the morning, diminished
interest or pleasure in activities, weight loss or gain, insomnia or excessive sleep, fatigue or loss of energy, impaired
concentration, and feelings of worthlessness or guilt, among others.
Teens and children with depression may experience apathy, social
withdrawal, weight loss, insomnia, fatigue, isolation from family and friends, a drop in school performance, and even drug
or alcohol abuse.
Fieve said there are standard guidelines for diagnosing and
treating a host of mood disorders, including major depression, dysthymia, seasonal affective disorder (SAD), bipolar depression,
and others published in the American Psychiatric Association's Diagnostic and
Statistical Manual, Fourth Edition – the DSM-IV.
What causes depression?
The causes of depression are many. For some, depression
occurs after loss of a loved one, a change in one's life such as getting divorced, or after being diagnosed with a serious
medical disease. For others, depression just happens, possibly because of their family history. Medications can cause depression,
and nearly 30% of people with substance abuse problems also have major depression.
How do most doctors treat depression?
Standard treatment of depression includes antidepressants
and/or psychotherapy, as well as a multifaceted program of diet and lifestyle changes and alternative therapies. Experts believe
that different treatment approaches work for different people -- and it's not easy to predict what might work.
What if my antidepressant doesn’t seem to work?
Talk to your doctor. You may need to try a different type of
antidepressant until you find the right fit and may need additional treatment, such as talk therapy. Just like with any chronic
medical condition, it takes patience and perseverance to get the best outcome with depression.
source site: Web Md
FDA Seeks Antidepressant Suicide Warning
By ANDREW BRIDGES
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