Furious Seasons

About Electroboy's Article And About.com

I was contacted yesterday by a friend who told me that an article Andy Behrman, author of Electroboy, had contributed to about.com’s bipolar disorder site had been removed from the site. Behrman has contributed many articles to the site, but this was a new article and in it he had offered his experience on taking Abilify. His experience was not a good one. The article was posted to the site after approval by an about.com editor on May 12. It was removed a few days later.

I reposted the article in an earlier post today. It seems to me an honest article, assessing some of the side-effects of taking the atypical anti-psychotic. Behrman does not call for anyone else to stop taking the med nor does he argue that it is bad stuff. He just had a bad time on it. One patient’s experience. Just like posts I have made here concerning my own experiences with meds, both good and bad. In other words, he was offering the kind of honesty that we need in the mental health world if we are ever going to make this game work for patients.

Was Behrman censored? He was not offered a complete explanation of what happened by the about.com people. Also, I understand there was a banner ad for Abilify on the very page on which his article was posted (there is also a banner ad for Abilify currently running on Behrman’s articles page on about.com). Draw your own conclusions. And please share your thoughts and concerns in comments. I am curious how you all feel about our ability to offer intelligent critiques of meds when sites like about.com take down articles about bad experiences with meds. I am curious, too, about who you feel should legitimately control the flow of information concerning psych meds—patients or pharma companies or who?

Electroboy On Abilify

This article was orginally published somewhere else. I will get into that story in another post. I am reposting the article here with the author's permission. Andy Behrman is the author of Electroboy. His website is Electroboy, where the following article is also posted.

"Electroboy Takes a Fall on Abilify"
© 2006 Andy Behrman

I've taken a huge fall on my new medication regimen -- Abilify.

To those of us who battle bipolar disorder every day, it is not uncommon to have tried combinations of twenty or thirty different medications over years of trying to stabilize our illness. In my own experience battling bipolar disorder, I've tried thirty-eight medications (including the last failure) to "quiet the storm," not to mention nineteen rounds of electroshock therapy. Each time I do find temporary relief from this invisible illness, I feel as though I've found some permanence or cure.

But permanence is a relative term when it comes to mental illness. And cure is a term that I've learned is meaningless. It used to be when my psychopharmacologist and I would find a medication which would stabilize me for even a few months, I was ready to call friends and celebrate my cure. But at this point in my life, I know that my battle with bipolar disorder is a day to day fight and there is no such thing as a cure.

More than a year and a half ago, I added a drug called Abilify to my "cocktail" as prescribed by my psychopharmacologist of four years. At first I was proud that I seemed more functional because I desperately wanted Abilify to work for me and it was the "drug of the moment" for bipolar disorder. I had heard mixed reviews from both psychopharmacologists as well as many patients, but as usual, with all new medications, I wanted Abilify to stabilize my bipolar disorder and I went into it with an open mind.

After all, I had consented years ago to have 180 volts of electricity surge through my brain on nineteen separate occasions. And Abilify was only a tiny little pill. What harm could Abilify cause a bipolar patient? Little did I know the horrible side effects and downsides of Abilify which would take some time to wreak havoc in my life.

At first I had thought that I was "cured" again; but the proverbial earthquake jostled me into reality and I found myself back to where I was before I had been hospitalized for the first time. Abilify, a drug in which I had placed so much hope, was shaking up my life.

The first disastrous side effect I noticed on Abilify was a serious bout with akathisia, a frequent and common adverse effect of treatment with antipsychotic drugs. The clarity that I first felt on Abilify had progressed to an edgy agitation which could not be quieted. I felt a terrible feeling of inner restlessness and an urge to constantly stay moving, as well as "kicking my legs around" (whether it be underneath my desk or while I was trying to fall asleep in bed). All of this eerily reminded me of the darkness of my old mania.

Of course, I thought I was stronger than the Abilify and I'm ashamed to say that I thought I could "beat it" it with increasing my own dosage of anti-anxiety medication and even alcohol (a beer or two at 1 p.m. seemed perfectly acceptable to me and this was the first time I had had a drink in years).

Another horrible side effect for me were the problems that I experienced with my cognitive skills, which actually reminded me so much of my experience after electroshock therapy. One day while at lunch, I gazed blankly at a friend and could not for the life of me remember her name although I had known her for more than a couple of years. I was often confused and agitated over simple things: a misplaced piece of paper, whether I had taken my dogs out for a walk or not, and even focusing on a simple conversation. Abilify, my new "wonder drug" was failing me and I was embarrassed to tell anyone, even my wife (because we had an infant) and frighteningly, my own psychopharmacologist. What would he say? Because Abilify was relatively new, I figured it just had to work for me. But soon, after doing my own research, hearing from other people whose experiences were similar to mine as well as other mental health care professionals, and conferring with my own psychopharmacologist, it was clearly time to get off Abilify.

Luckily, I didn't suffer all of the common side effects of Abilify that people have written to me about (constipation, headaches, insomnia, light headedness, sleepiness and tremors) - - just akathisia and cognitive problems. But trust me, that was enough.

The stigma of "losing the battle" is certainly a tough one for anyone, but somehow for me, being a mental health advocate, writer and speaker, it seemed even harder, because I have always felt pressure to be a "recovered" bipolar patient. Therefore, "fessing up" to my fall is especially difficult for me.

In the end, my not sharing my ongoing experience with medication with other consumers will only result in their not asking questions of their own mental health care professionals, knowing what side effects to look for and being realistic about their treatment for bipolar disorder.

Thanks, Andy. If anyone wants to know more about akathisia, check its Wikipedia entry. Geodon did this to me, so have other meds. It is not pleasant.

Another Day, Another Post Article

The Washington Post continues to enravel the mental health system in the DC area. It's a fucking mess, of course, but apparently the WaPost's reporters weren't paying attention earlier, or their editors were looking for a news hook. Then again, maybe this is big news to everyone.

Either way, it's a decent article, as these things go. The reporter falls into two traps however: he cites the 1998 number for people with severe and merpsistent mental illness killing cops (it was 12 that year, for a rate of 5.5 times the general population, according to the Treatment Advocacy Center's slightly-flawed stats), and, once again, there is no mention of the fact that psych meds ain't proving to be quite the buffer against mental illness that they are claimed to be. Right now, to ignore what's up with meds while calling for increased psych beds in the DC area along with strengthened outpatient commitment is tantamount to saying a treatment for leprosy is working just fine when lepers arms are falling off.

The 5.5 rate stat continues to annoy me, principally because if they looked at 2005's stats (from TAC itself), then they'd see a rate of about one-third 1998's. Looks like we've either got a case of lazy reporting or someone's buying someone else's agenda a bit too easily.

But yes there is clearly a lack of inpatient beds in the DC area. If one good thing comes of the recent nonsense in Virginia, then I hope it is an increase in short-term psych beds. There will also be a re-examination of outpatient commitment laws, and that's appropriate. But not to question how well the actual treatment itself is performing for patients long-term is criminal. Or does the WaPost anticipate skipping that bit of news for now and, later, running a series on patients who have to take so many meds that they are turned into zombies? Or their kidneys explode? Or they develop diabetes?

Beyond that, I find it interesting that only officials from NAMI and TAC are quoted. There is no indication that the reporter contacted NMHA or the Bazelon Center, or, hell, MindFreedom for that matter. These questions are complex enough to demand a full and complete airing of all the issues around mental illness.

The mentally-ill deserve nothing less. In fact, they deserve a lot more than they are currently getting under standard-operating procedure treatments in America.

NOTE: I find it amusing that, over the last week, people keep finding this site through a search using the terms Treatment Advocacy Center and Philip Dawdy. Golly, I wonder who could be that interested. ;)

A Stupid Piece In Slate

I have long had a love-hate relationship with Slate. It's either a chippy, contrarian journal of thought or the smartest kid on the block. Here's an article that I think is sorta chippy. It involves the college student at George Washington University who was barred from campus after being suicidal. I link, you decide.

Opportunism Is TAC-y

The fine folks at Fuller Torrey's Treatment Advocacy Center posted this on their blog the other day:

"In a Maryland county, law enforcement doesn’t allow the crisis team to put their own lives at risk. That means if they are called to a standoff, there isn’t much they can do.

Not sick enough to get a hospital bed, too sick to get help from the crisis team – once again, it is law enforcement officers who are forced to fill this bizarre void, stepping in to deal with people in acute psychiatric crisis because the situation is too dangerous for those who are actually trained to handle it.

Sure, police get training on dealing with people in mental health crises. And it is a good day when police are able to stop a suicide. But an estimated 5,000 suicides a year are completed by people with bipolar disorder or schizophrenia, many of them untreated. Some people die in standoffs or shootouts – including some law enforcement officers.

Expecting police to be there in time to avert suicide isn’t really good public policy. Helping people before a standoff or suicide is far better for everyone."

My take is two-fold: One, I'd say that law enforcement in that Maryland county needs to make sure that they've got one officer on every watch in each precinct trained in CIT. To not have that training on the streets strikes me as a field day for a trial attorney. Also, TAC's post (they never use names for their posters, nice and Orwellian that) betrays a lack of understanding of how CIT has actually proven out over the last 10 years in major cities across the country. In Seattle, where it's been deployed since 1998, it has saved the lives of both citizens and cops.

Two: I think TAC is opening a second front in its advocacy for outpatient commitment or forced medication or whatever you want to call it. I won't be surprised if I see something along these lines cropping up in their campaign soon enough: "Sometimes suicidal people duke it out with the cops. Or they climb out on bridges where officers must go. Or sometimes they have weapons and the police must shoot them. People like this need our help. We must pass new laws so that any parent of a child or adult child can force their offspring into treatment if they say anything remotely suicidal-sounding. We only want to help."

And mommy and daddy must always be redeemed, even if it means that their offspring lead a medicated half-life.

Or am I being too cynical here? Either way, I'm not going to parse their argument, although I'm pretty certain that they don't know a whole lot about policing. Besides, I already see massive holes in their rhetoric, but that's for another day.

Two Readers Comment

A reader comments on yesterday's post on how CBT is rapidly gaining acceptance in the UK while hardly seeing the light of day in its country of birth (um, that'd be the US):

"I am a huge fan of CBT---it has basically taught me how to have a full life (though i do take lithium and it keeps major episodes at bay, and also, I don't believe that CBT alone would prevent future episodes, not for me anyhow). I agree that big pharma would lose out if CBT was practiced as much as it should. But I guess I would just add that CBT takes work, and courage, and commitment and time---and it doesn't offer immediate gratification. I guess I'm saying something somewhat harsh, which is that from my experiences, I've encountered many people in the face of mental illness who don't want to (or can't?)commit to a therapy that requires so much of them. They want a pill. CBT is all about changing your own behavior and cognitions, and it is amazing, but there is nothing passive about it."

Some days, I wonder if I didn't do CBT on myself somehow, because I sure don't feel like "the loser in the dream" to quote one of Beck's metaphors. I'm still a loser of course, but that's another story.

And another read comments in response to a recent post in which I slagged on the rhetoric being used to describe Abilify as a "maintenance" drug based upon 6-week trials:

I almost hate to offer contrary information to you since I so agree with what you write. But in the interests of more information I'll mention that as of May I've been taking 10mg of Abilify since Feb of 2004. I was given it in Providence after I went in for a cutting incident and a few months afterwards I noticed I was feeling "better". I hate to say that, cause it surely jinxes my prognosis. But not this time . I'm still taking Abilify and I still think it's helping me.

Not that I'm stable , or not cuttting or not suicidally depressed, and a bit too hypomanic now and then but still a bit "better". So maybe there are a few of us who can benefit from maintenance therapy with Abilify. Maybe. I'm not a great objective model since I'm still so out of it so much but subjectively I have to say something good is going on. The only other psych med I take is klonipin tho I also take cogentin for the akathesia the Abilify causes in my legs and hands. (yes there are side effects, but mostly that one). Just for context - over the years I've been on at least a couple dozen meds and Abiify is the first to make me feel it's actually helping me.

Just so you know I've been dx'd since nov 1995 with BPl, BPll, BP nos, and schizoaffetive disorder as well as anxiety, panic, add/adhd and a few others like sad and personality disorders. Clearly I believe in the concept of the bipolar spectrum since I seem to flow back and forth on it constantly. Oh yeah, also ultradian rapidcycling and frequent mixed states are in there too. And chronic pain (oxycontin), and migraines (imitrex), and....

OK, too much information. Sorry. I just wanted to make the point about Abilify.

Thanks for your words, and the space to reply with mine.

Not a problem. I'm pleased you've found something that helps you.

On another front, I probably won't post much until Tuesday. I have over-done it with writing this month and need a break. On the other hand, I'll probably be back here in 2 days. Have a nice holiday.

John Blogs, I Link

More from the APA convention. Of particular interest is the pharma presence at the event. My own doc, who is there at the convention, always enjoys avoiding the pharma people. He refuses to talk with them.

I wih I could share John's optimism on how genetic knowledge is going to reshape treatments. He says we are 10 years out, I say we are 20 to 30 years out. Back in the late 90's, when I did a lot of reporting on the Human Genome Project, I was assured by researchers that it would reshape science within mere years. The genome was finished in 2000. Anyone seen science reshaped or any real deliverables reaching doctors' office yet? Didn't think so.

We Want Something Else And Other Delusions

Every so often, I run into an article that makes me think a bit differently about what's going on with mental health in our culture. It also helps my mood if the article confirms most of what I've been saying on this blog since last fall. The article is from the British magazine Prospect and concerns itself with the fact that cognitive behavior therapy (CBT) has completely swept aside, at least in the UK, psychoanalysis and other "talk" therapies. Not that that's news to anyone in the field, but to patients in this country it is news for reasons that have everything to do with how tilted systems of care in this country are towards the pharma model and our cultural prejudice for the immediate fix to eternal problems. We talk as if fixing behavior and feelings through meds is a cure when in fact it is little more than a treatment. Over time, it doesn't fix the brain--or whatever the hell the seat of our problems might be--so much as it tamps down our demons but leaves the embers burning.

I especially agree with the authors on:

"Does this mean that the big dream of the talking cure inspired by Freud has been swept aside by a biology of the mind? Far from it. Despite the development of increasingly refined pharmacological treatments, new drugs do not work much better than the old ones. At the front line of psychotic disorders, the beneficial effects of medication are often accompanied by devastating side-effects. Having made its big pharmacological leap, psychiatry remains largely a process of diagnosis, risk assessment, containment and care. Almost nothing has yet come of the great hope of the 1990s that—as with Huntingdon's and Alzheimer's disease—the genetic sources of mental illness would be revealed. For the moment, the big themes of mental illness have been distilled into "gene-environment interaction," the old question of how a person's life-circumstances trigger and shape his biological predispositions, and vice versa."

I don't think anyone with smarts claims that CBT can fix psychosis in a crisis situation, but it's been having such good results preventing nastiness with depression, some of the bipolar spectrum, personality disorders and, surprisingly, in some people with schizophrenia that the British National Health Service (aka, their socialized medicine bureaucracy) authorizes its use. And pays for it. (I've written elsewhere about the growing blowback in the UK against some psych meds and an embrace of CBTish approaches.)

In this country, the pharma/medical insurance/bio-psychiatric powers would likely fight a broader embrace of CBT in this country with hammer-and-tong--and hookers and money, if need be. These are rich and powerful interests and such interests will never give up their riches and power willingly--especially when their paradigm rests on treating long-term conditions as if they were perpetually repeating short-term patterns.

If you think I am joking, then consider the way atypical anti-psychotics are being adopted for practice in bipolar disorder (OK, the adoption period is over, it's full on sex now). Almost anyone who displays the least bit of psychosis, grandiosity, anger, delusional thinking and so on will be on Zyprexa or Seroquel right away. That's fine for addressing short-term crises (for chronically delusional schizophrenics, life can be a perpetual short-term crisis, of course), but most bipolars don't live in such a space all the time. And the anti-psychotics have never proven very effective at batting down long-term problems (I don't consider half-remission and full-remission of symptoms barely 50 percent of the time to be effective, especially given the toll of these meds' side-effects on patients. It's a bad trade-off.). Given all of that, then why the hell is this class of meds being pushed on bipolars for long-term use when they have limited powers of prevention?

It's like using what works all the time for the few and expecting it to work for the many. I have heard clearer thinking come from the mouths of delusional schizophrenics.

That said, we need to start embracing different approaches to treating mental illnesses in America. Whatever the approach, it needs to be patient-centered and have practical existential results. It's kind of hard to have that discussion in a public way in America when the opinion pages of leading newspapers fasten on the immediacy of a tragedy and print arguments supporting the notion that shot-term solutions are long-term solutions.

We want something else. Because the current solutions are failing us miserably as a culture.

Even More From The APA

McManamy keeps blogging from the convention and I keep linking. Interesting stuff yet again.

A TAC-y Move

As I've noted repeatedly of late, I have been trying to get some answers out of the Treatment Advocacy Center concerning their arguments for outpatient commitment. Are the patients they track who do violent things on meds or not at the time of their crimes? And so on.

Apparently, TAC doesn't like being challenged. Yesterday, I received the following email from Alicia Aebersold, the non-profit's spokesperson:

"I appreciate your interest in assisted treatment law and our statistics. However, my time is limited and I have to put TAC's mission first - so I must sign off. Best of luck."

I've been a reporter long enough to know when someone's cutting ties. That's kind of a stupid thing to do. Smart advocates I talk with tell me, no matter what cause they are reppin', that you always keep talking to the media even if you think they'll go against you. But TAC is taking the line of such noted advocacy groups as PETA, Focus on the Family, certain animal research facilities I could name, and others.

By the way, this is the same Alicia Aebersold who supplied Pete Earley with the people with mental illness kill cops 5.5 times more than the general population number, which he then used in an op-ed, and didn't tell him, according to Earley that the number was from 1998. That's sloppy advocacy.

Also, I've been a reporter long enough to know that when an advocacy group refuses to answer well-founded skeptical questions about its claims that is a group that is either deeply arrogant or has, um, issues. Still, I'm sure they are confident that they have vast influence on the media around the country, since their essential argument has been made on the WashPo's opinion pages 3 times in the last 2 weeks. Given the contacts they must have at the paper, I wouldn't be surprised if they have shit-talked me based upon my writings here. I guess we're going to find out just how open the Post's opinion pages are in the next week or so.

So, hey, a question for readers: Do you think what I submit to the Post should include an account of my trying to get info out of TAC and the group cutting me off? Do you think I should also reveal the following statement, which is attributed to one of TAC's board members, DJ Jaffe:

"People care about public safety," TAC publicist D.J. Jaffe told attendees at a 1999 National Alliance on Mental Illness (NAMI) conference. "Once you understand that, it means that you have to take the debate out of the mental health arena and put it in the criminal justice/public safety arena." Jaffe went on to point out that efforts by NAMI to enact 'assisted' treatment laws as a way to provide better care for the mentally ill had failed because the public doesn't care about the seriously ill."

What do you readers think I should do? Do you think TAC's position begins to sound a bit like political opportunism on the backs of two dead cops in Virginia? Or is it a straightforward response that shouldn't be questioned? Tell me about it in comments or in email please.

And if anyone at TAC wants to take issue with how Jaffe is quoted, you know where to find me. If you don't object, then I will have to assume that Jaffe's quote, cited by multiple sources, is in fact true.

Mental Health Advocacy and Politics

When I spoke with Pete Earley last week, we both wound up lamenting the level of politics in the mental health advocacy world and that we had both brushed up against it recently. Earley told me that NMHA had refused to let its vast network know of Earley's new book Crazy because it leans too heavily on TAC. Meanwhile, TAC won't answer my questions. NAMI National stopped returning my calls months ago, mostly due to a personality dispute. A few weeks ago, I was kicked off a panel on suicide survivorship by the folks at AAS/AFSP because I had argued that psych patients who'd survived suicide attempts and suicidality were survivors of suicide. I was told that only parents of suicides are survivors.

I'm sure Earley or I could piss off DBSA, too, if we asked the wrong questions. And on what I guess you'd call the far left of the mental health world, we have the MindFreedom folks. (BTW, if anyone thinks I am being rough on TAC in recent posts, please check this wild discussion thread on Wikipedia, wherein MindFreedom people and TAC backers go to war over how to describe TAC in its Wikipedia entry.)

What's discouraging to me, and to Earley as well I think, is that we are both essentially moderates in the politics around mental illness. His view is tinged by being the father of a bipolar, who declines treatment. My view is colored by being a bipolar who's had very mixed results from meds and sacrificed his body in the process. Both of those natural biases will create tension with someone in the mental health world. But both Pete and I want this crap to work and to work for patients. The frustration we both feel is that if you don't sit there and take dictation from Group X and repeat their claims in print uncritically, then you are cut off by Group X.

There's not a particular moral or point here, but I have to say that after having observed the mental health world as a patient for 17 years, and as a reporter for the last 5 or so years, that I am not convinced that a movement that is so divided is going to get us the kind of results we need in the real world for the people who actually live with this crap. And that sucks.

More From The APA Convention

John McManamy continues to provide updates from the APA convention. Of special interest is a conversation John had with one of the big shots in bipolar disorder research, Gary Sachs of Harvard. He's the lead researcher on the STEP-BD study. More results are on the way. From John's talk with him it sounds like the study hit upon some surprising findings, ones that might change how clinicians practice. I wonder if it will establish yet again that Lithium is still pretty good stuff. Or somthing like that. So far, the STEP-BD study hasn't been a ringing endorsement of current practices. Read John's blog. Leave comments.

A Correction

In a recent post, I wrote:

"I had an email exchange the other day with the lead author of the schizophrenia and violence paper. He assured me that, in terms of absolute risk, schizophrenics were not more violent than the rest of the population. He said he's troubled to see how the TAC people and others are using his results. "They know better," he wrote."

There are two errors in that graf. I wrote absolute risk. I should have written relative risk. Yep, there's a difference. Two, I not only misquoted my correspondent, but I misapplied the bad quote to the wrong point. The correspondent was not criticizing TAC.

I regret the errors.

While We're Talking About Honesty

I'd like to encourage TAC, which obsessively catalogs "preventable tragedies" involving the mentally ill, to start cataloging some of the other preventable tragedies in the mental health world. Patients raped and abused in state hospitals. State hospitals that dump delusional people on the streets--and, yeah, that insanity still goes on--and a federal government and state governments that refuse to appropriately treat and house the mentally ill in the community, despite the Olmstead ruling, so that they don't have to live in quasi-state hospital programs such as PALS out here in Washington State. It's surely a tragedy, a preventable one even, when thoroughly treated, stable patients get discharged from hospitals but have nowhere to go except, if they are lucky, crummy places like PALS and horrible residential treatment programs, because it robs their freedom when they are making exactly the kinds of sacrifices TAC wants. NAMI, NMHA and DBSA should do this, too.

What's more, TAC should also start cataloging the patients who've died and/or developed diabetes taking psych meds like Zyprexa. They should start cataloging the people who commit suicide while taking anti-depressants but weren't suicidal before--you know like with Prozac, Paxil, Zoloft and Cymbalta. Yep, NAMI, NMHA and DBSA, you guys too.

Preventable tragedies cut both ways.

More Thoughts On The DC Tragedy and Mental Illness In America

The Treatment Advocacy Center’s executive director Mary T. Zdanowicz had an op-ed on Sunday in the Washington Post. It’s not a bad piece, but of course I have some nits to pick in a moment. And yeah this is going to be a long post.

Still, it’s weirdly encouraging seeing so much ink splashed around on the matter of mental illness in America. Maybe now that eyes are getting opened in the nation’s power center we might see some real changes concerning how we treat mental illness in our culture. Because American culture is a mess on mental illness—people lose jobs, homes, money, friends, family, lovers and their damn souls the moment they develop, or get labeled with, a mental illness. Even in its moderate and mild forms. Why’s that?

Because we are still tagged with the old assumptions about the mentally ill being dangerous. We aren’t and there is ample scientific proof of that. Even for the most ill of schizophrenics. But American society hasn’t caught up with that reality and even if you are being a good actor and taking your meds, you are forever suspect. Should you cross the slightest behavioral tripwire, society is going to throw you out and then tell you to go live a reduced life. It takes a lot of fighting to get back from that status, which is why so few make it. All as a result of bullshit prejudice.

And that’s what burns me up about episodes such as the recent murders of two cops in the Washington, DC area. Those bad assumptions about the mentally ill are going to get pushed right back to the surface, after so much work has been done to shove them down into the murk where they belong. But I guess that’s the nature of the media and public discourse on these matters.

Which brings me to the op-ed. Like the other opinion pieces in the WaPost of late, it argues that outpatient commitment laws are weak and that delusional folks need to be forced into treatment. That’s fine. It amazes me a bit that it takes three opinion pieces in one of the world’s most important newspapers for the Post to feel that the argument has been made, especially since there has not been one opposing opinion piece published by the paper (er, as far as I know). Even the Mindfreedom people have been quiet this time out. But the broad point that TAC has gotten out there is acceptable.

But there’s a certain responsibility that comes when speaking to the conditions under which the most disadvantaged of our citizens will exist on Earth and how their essential civil liberties will be regulated. You had better have your facts in line, so that you don’t overstate your case. You had better be damn careful about what terminology you use.

People like me have fought for well over a decade against the moronic stigma around mental illness, not by doing anything more special than fighting back and making our lives work and paying our taxes and not asking for a handout of any kind. And, yes, playing by the rules and taking our meds, even when they crush us as much as the illness ever did. We have made some progress—people like me are actually allowed to have useful, engaged productive lives these days, although in my opinion we have to push against so much that it’s no wonder a paper came out at the APA convention yesterday asserting that almost 40 percent of all bipolars are unemployed. That’s fucked up.

And that’s why we will not tolerate dishonest numbers being used to describe the mentally ill nor will we tolerate language that is over-broad. We will not tolerate being tarred with the same brush we’ve managed to hold at arm’s length for so long. Everyone likes to talk about society’s needs and the pain of families, and a lot of public policy gets made on the backs of those concerns.

What about us? When do we count as something other than a brain to be zombiefied? Do you understand why some of us are a little touchy when we see one of these bad scenes go down and the media comes in and does its usual stigmatization dance because they just don’t get it? Do you understand that such a dynamic has major impacts on the lives of people who are playing by the rules?

People who don’t understand that, who don’t acknowledge it publicly and in print should be force-fed 800 mgs. of Seroquel for two weeks and then be asked to hold down an 8-hour a day job, or maybe to subsist while unemployed. Society is ok having us beaten to the ground and so are our families, who somehow feel redeemed as long as we are alive. But in this nation if you don’t have a job, then you are shit out of luck.

That’s what the game is about, fueled by opinionating like:

”Not all people with mental illnesses are dangerous; in fact, most aren't. But some people with severe mental illnesses can be dangerous, particularly if they are not taking their medication.”

That’s TAC’s ED in her recent op-ed. And it’s that kind of looseness of rhetoric and condescion of tone that makes things really problematic for the rest of us. Because what the public will take away from such phrases is that the mentally ill are dangerous—all of us—especially since TAC doesn’t offer the data and the studies to prove that such is the case. And, then, follows that phrase with a whisper in America’s ear:

” A recently published national study documented that schizophrenia patients with specific symptoms -- paranoid delusions, hallucinations, grandiosity, etc. -- were at least three times more likely to be violent than other schizophrenics.”

In other words, TAC just said: Most mentally ill are not dangerous. OK, some of them are. You know, the delusional ones. In the public’s mind, that turns into: My son was saying weird things the other day. He seems remote. He’s delusional and a danger to America. I think we must force him to take Zyprexa, even if he is 25 years old. And then we get:

” Psychiatric beds for patients in crisis are in short supply, so new laws also should facilitate court-ordered outpatient treatment, which has been shown to reduce violence, improve quality of life and reduce the stress of those who care for the mentally ill at home.”

Improves quality of life? By what measure? Whose life? Mom and Dad’s? The patient’s?

And that’s where I sort of part company with the family-led end of the mental health movement, or whatever the hell we are calling ourselves these days. It’s all about them, and their grief and their guilt and their “stress.”

I guess that’s why TAC now says it is standing by its numbers on the statistical risks that the seriously mentally ill pose to the public. , and now have two stats experts backing me in saying that those numbers overstate the case. TAC needs to get an independent expert to review their stats. It’ll be much easier for them to make their public policy arguments with accurate and fair numbers rather than using bogus ones and having clowns like me biting their ankles.

Mr. McManamy Goes To The APA

John McManamy, author of McManWeb is attending the APA convention in Toronto this week. He's tracking matters of interest to patients and others on his blog, John's Bipolar Stories.

Here's his first post. You guys should follow his coverage as the week goes along, sicne there are always interesting studies coming out of the APA conference.

Everyone's Favorite Bipolar Goes To Guns

Or fists. With a fashion designer, for god's sake. Yep, Axl Rose got into a dust-up with Tommy Hilfigger at a club in New York. Personally, I hope Axl kicked his ass 'cuz I'm more of FUBU or Sean Jean guy myself. Now clean yourself up, Axl, and show us your hypomanic edge and actually finish "Chinese Democracy." You've only had 10 years and you ain't Brian Wilson.

A Couple More Things

One, I promised to have a correction to an entry up yesterday. I had a crap weekend, and my back went out yet again. I'll try to get this done for tomorrow. Basically, I am correcting some assertions I made about risk, as well as a misquote. But I want to do it right, and need a bit more clarity of mind to do that.

Two, I have written a rough draft of my op-ed for the WaPost. I am going to sit on it for a day, do a little more reporting (hey, TAC check your voice mail!) and clean-up its inevitable flaws. Then I'll submit it and we'll see what happens.

Three, in the meantime, gnaw on this New York Times article by the wonderful Gina Kolata, asserting that health-mad, nannyed-to-death Americans are seeing no greater life expectancy than our far less health concious British pals. This calls for a cigarette.

Interestingly, as I've noted before, there is a bit of blowback going on against anti-depressants and other psych meds in the UK. Apparently, they aren't seeing the kinds of wonderful results they were promised. Hmmm, could it be...oh, nevermind. Nothing to see here.

Several Things

I've been down with a cold--my first since last year sometime, an achievement given our winter this year--so I'm playing a bit of catch-up.

First, here's an article on the young man who killed the two police officers in Virginia. It's the sad narrative of an otherwise normal young man, who started experiencing headaches and delusions last fall. His parents took him to three seperate mental health facilities and, according to the article, he'd been given meds. Not clear if he was taking them at the time of the shooting. Either way, I'm a bit troubled that he never wound up in the hospital and that it appears no one bothered to determine whether the family had guns that were accessible to a delusional son. It seems to me that a lot of people knew just how out there this guy was, but did little to intervene. I think this case fits the TAC crowd's narrative of "he couldn't get care" less and less as time goes on. I'll go out on a limb here and say the care he got was inadequate and that there seems to have been poor follow-up on everyone's part here. Friends, family, hospital, courts, etc. I mean how does a guy break out of a hospital and the staff do no follow-up with either the family or police to alert them to a potential problem?

Second, I am going to write a correction to a recent post in which I made some errors. I hope to do this tomorrow.

Third, I'm gratified that a bunch of new readers have found this site in the last week. I hope there's something useful for you here, whether you agree with it or not. Please leave comments.

Fourth, I am disgusted at the number of typos in a couple of recent posts. They are ones that a spell-checker won't catch. Note to self: stop posting at 12 a.m. and use a larger screen.

Fifth, Fuller Torrey himself will be making an appearance in the Seattle area in late June. His visit appears to be sponsored by one of our local NAMI affiliates. Since I know them, I think I'll have an interesting chat with them about Torrey. Or, hell, maybe I'll just show up at the event and ask him a bunch of questions. More news on his visit later.

Reason #99 Why Smoking Crack Is A Bad Idea

Not that this a surprise, but here's a study pointing out that, in schizophrenics, substance abuse causes more extrapyramidal symptoms (shaking, shuffling, etc.) than in patients without substance abuse problems. The main culprit appears to be crack, not weed or booze. Although, let's be honest, they wouldn't have the extra EPS problems if they weren't on meds in the first place.

As obvious as it is that no one, especially psych patients, should smoke crack, I can understand why they do. I've interviewed these folks before and asked them about it, once we got to know each other. "It's the only thing that makes me feel good," one told me. Assume for a moment that what he said is not some weird form of denial. If you were a longtime schizophrenic in whom the disease was not being improved by either time or meds and you were stuck sitting on your ass, unemployed and without a girlfriend or boyfriend (that's very often the case with schizophrenics), and without much of an education, what would you do to feel better? Probably smoke crack or pot or drink, knowing full well it'd only resolve some of your inner tensions for a short-time. It's not good for people to smoke crack, but I sympathize with the impulse.

It's all part of the rotten deal that is schizophrenia. I feel for people who have it more than I've got words for.

Sidebar: I know a young woman, 24 or so, who is bipolar. She was recently told by her doc that she could never again touch alcohol even. That seems pretty damn strict to me, and as a patient that got to be hard advice to follow to the letter. You want some release and for bipolars, with our geared up minds, it's kind of hard to live like a ascetic on a mountain. Besides, isn't all the treatment that people do supposed to make us normal and integrated into the regular world?

What The Washington Post Got Right...And Wrong

Two days ago, the second of two police officers shot by a psychotic young man with an assault rifle died. It's yet another tragic part of an already tragic event. Two cops and the young man are now dead. There is plenty of blame to go around.

In an editorial yesterday, the Washington Post made all the appropriate points about the tragedy, especially that the young man should have been able to get treatment or have been forced into treatment at several points prior to his going on a rampage. Then, in making its point about schizophrenia and violence, the Post's editorial board over-stepped a bit. I'll get to that part in a minute.

First, I agree with the paper that the outpatient commitment statute in Virginia is flat-out impractical. It says that someone can only be forced into outpatient treatment--translation: be required to take meds--if they are in "imminent" danger of harming themselves or others. In practical terms that means someone would have to be fully psychotic in front of a doctor or mental health professional in order to hit the trip wire for treatment. Psychosis is so transient that it can be gone within minutes, except in more extreme cases. In Washington State, the outpatient commitment threshold is lower: "If the court finds that a person, as the result of a mental disorder, presents a likelihood of serious harm, or is gravely disabled, but that treatment in a less restrictive setting than detention is in the best interest of such person or others, the court shall order an appropriate less restrictive course of treatment for not to exceed 90 days." The order can be extended another 90 days.

I've been reporting on mental health in Washington State for 3 years and known of no cases where this law has been used unreasonably against patients. The law here is similar to that in many other states. Why Virginia's is so weak is beyond me.

I have no trouble with short-term outpatient commitment and 180 days doesn't seem like too much to ask, at least as far as I understand the law's application in this state.

Where I part company with the Treatment Advocacy Center crowd, clearly behind much of the media push around this issue of late, is when it comes to forcing patients into long-term (ie, forever) outpatient commitment. If treatment isn't working after 180 days and the patient is still psychotic or delusional, then society either needs to step up and put the patient in a long-term hospital setting or it needs to let the patient make their own choice.

I'm not comfortable saying any of this, but we do need to strike an appropriate balance between individual liberties and rights and society's demands to protect itself against extreme anti-social behavior. Not many people in the psych world like hearing this, but the psych meds we have at our disposal these days are not the slam dunk solution that you'd think, and they are very damaging to patients' bodies, minds and souls.

There will never be a perfect trade-off.

As in Pete Earley's WaPost op-ed last week, there is an inherent assumption that the mentally-ill are prone to violence and that meds work all the time. We know the last part isn't true. So what about violence?

I demolished Earley's data on that point in an earlier post. And that negated his entire argument there. He later admitted to me that he was embarrassed about using the flawed data he did.

Yesterday, the Post used evidence from a recent paper on schizophrenia and violence, which I have dissected in another post. While the WaPost was careful to point out that the study's findings were based on 1,400 patients (3.5 percent committed acts of serious violence and 15.6 percent committed low-level assaults), that's not the message that the public will take away. You put the words violence and schizophrenia together and suddenly heads begin to nod, an old assumption reinforced.

What the newspaper missed were two key points. One, it's not unusual for violence, serious or not, to occur even when patients are medicated. The presumption made in the editorial and by Earley and TAC is that violent outcomes--rare though they are--are always preceded by patients not taking their meds. Not true. Especially with low-level assaultive behavior I have seen exhibited by patients, they were almost always on meds. It is also not uncommon for patients to assault staff members (and vice-versa sadly) at state hospitals--where the patients sure as hell are medicated.

What's more, in the study cited by the WaPost, the patients who committed these alleged acts of violence--none of them proven in court mind you--were medicated. That ought to make you wonder what the fuck is going on in our culture of treatment. That singular fact should tell everyone that the treatment we are offering schizophrenics isn't have such swell results. And make them skeptical enough to start asking some questions about how well meds are working.

In addition, the editorialists assumed that the 1,400 schizophrenics in the study were pretty much like other schizophrenics. Not true. As I've noted elsewhere, the CATIE study, from which the smaller study came, is comprised of schizophrenics who either come from homeless shelters or the most hardcore public hospitals in the country. That's not your average schizophrenic. In that audience, I am not surprised at all that 3.5 percent of them committed acts of serious violence. If they did so while on meds, then I think we all need to take a deep breath.

Take a deep breath. According to the paper on the study, all of the patients were medicated and all of them had been in treatment of some kind, on average, for 16 years.

Why didn't the WaPost either tease that out of the study itself or contact one of the authors? Or is it presumed that violence in schizophrenia must be tied to med non-compliance? (Although I am clear from re-reading the study that the patients were medicated at the time of their violent acts, I am going to double check this with one of the study authors.)

I have asked the nice people at TAC to tell me, if in their database of delusional folks committing violent acts, how many of those people were on meds at the time of said delusional act. Because since they are using them as the basis to argue for expanded outpatient commitment laws, then you'd think they'd want to be upfront about how many were on meds and how many weren't.

To date, I've gotten no answer from them. If they don't step up soon, then I'll publish the last email they sent me the other day as well as my reply to them.

Finally, I had an email exchange the other day with the lead author of the schizophrenia and violence paper. He assured me that, in terms of absolute risk, schizophrenics were not more violent than the rest of the population. He said he's troubled to see how the TAC people and others are using his results. "They know better," he wrote. He also passed along two other studies on the same subject which found the same thing.

For those of you who follow my blathering here, I have put off submitting an op-ed to the WaPost until after the second officer's funeral. I won't disrespect his memory, his family or his colleagues by going against the emerging consensus until next week.

Here's a list of outpatient commitment laws around the country.

Depression Increases In MS Patients

Stop the press! Here's an account of a study claiming that depression increases in MS patients and that that may help in understand depression in a more general population. I have a hard time believing that this even merited publication, but whatever. One of the two suicides I know of and which I could understand and approve of involved a young woman I vaguely knew many years ago in San Diego. She was 25 and already had great difficulty standing due to MS. Wheelchair bound at 27, she overdosed on pills. Depression in MS patients is hardly news.

Medicare Part D

A colleague of mine, Geov Parrish, writes in Seattle Weekly this week about the personal havoc this pharma-sponsored program is creating for him and others. Parrish is a double transplant--kidney/pancreas as I recall--and has lived well beyond what's considered the normal life span of someone with such transplants. A lucky guy and a determined one as well. Read the column just to see how badly the feds are fucking over average patients of every stripe just to make pharma companies and insurance companies happy.

Complaint Filed Over Vagus Nerve Stimulator Ads

The watchdog group Public Citizen today filed a complaint with the FDA over advertising by the maker of the vagus nerve stimulator, Cyberonics. The complaint basically alleges that the company had overstated the device's benefits and hadn't talked about just how narrow an audience of depressives it was aimed at--ie, people with chronic disabling depression who had run through all their other options short of ECT. Apparently, the company made it sound like VNS would be good for far more cases of depression.

I congratulate Public Citizen for forcing this level of accountability into the psych game, especially since reviewers of the company's clinical data at the FDA felt that using the device presented limited efficacy. So let's not let these folks get away with distorted ads. They are certainly more honest about the limited audience in this press release. I cannot turn up a copy of the ad itself.

It is also the place of organizations like NAMI and NMHA to require the same level of accountability by pharma and device makers. But they haven't, probably because they are dependent on contributions from pharma companies.

Interestingly, in the same Reuters story on the complaint, an investment banker advised that shareholders dump their shares of Cyberonics in advance of the APA's upcoming convention. The reason: their belief that the device is no big deal. Which makes me think that someone will be presnting a damaging paper on VNS at the convention. Stay tuned.

Atypical Sales For Schizophrenics Way Up

A research firm now estimates that sales of atypical antipsychotics for schizophrenics cleared $5 billion in 2005. Actually, since the figures seem to be worldwide numbers, I'd say that's an understatement. Atypical sales in the US alone were expected to hit $10 billion last year--50 percent of that for schizophrenics, 50 percent for bipolars. It'll be interesting to see where the final sales figures wind up.

But, for now, revel in being a target market!

Spare Me: Abilify For Maintenance

I'm not even going to detangle this. But Abilify's maker is now claiming that the atypical antipsychotic is a "maintenance" medication for bipolar disorder. They make this claim based on a 6-week study. No, I am not making that up. Maintenance in the psych world means a med taken for the long-term not 6 weeks, so I haven't the faintest how Otsuka gets to spin their meds healing properties this way.

I think pharma companies need to be held accountable for how they advertise and market their meds, right down to the language they use. Oh wait, the FDA has those regulations in place. And they enforce them so well!

I Spoke With Pete Earley

I sent Pete Earley, who authored that Washington Post op-ed last week, an email yesterday. He called me a couple of hours later and we talked, reporter to reporter. I told him that I thougt the numbers in his piece were distorted. He asked me to detail my claim, so I did in much the same fashion as I did in my recent posts.

He told me he was embarassed, especially since he had used an 8-year-old number--sent to him by the Treatment Advocacy Center--to describe present reality. He was troubled too that the number described on people with severe and persistent mental illness instead of all people with mental illness, as his copy had it.

I told him I would address that in my resposne which I hope to pen in the next day.

Oh, yeah, he's a nice guy, who is actively trying to do something to help the mentally-ill, just as I had suspected. I join him in that. But we all need to get our numbers straight lest we make flawed public policies based upon distorted numbers, especially in the wake of the tragic, senseless murder of a cop.

Pete Earley Now Has A Problem

And his problem is me. Or more accurately, my willingness to be skeptical about a statistic he cited in his Washington Post op-ed of May 12. In it, he asserted that "people with mental illnesses kill law enforcement officers at a rate 5.5 times greater than the rest of the population." With that stat, he turned every schizophrenic and bipolar I into a pariah and cop-killer, especially since his op-ed has since run in almost 200 newspapers, according to Google News.

He cited the nonprofit Treatment Advocacy Center as his source for that data. So I called TAC and asked them to get back to me with their sourcing for that data. They didn't call me back.

I poked around their site and discovered the 5.5 number on one of their facts and figures pages. This will get boring and technical for a few moments. Sorry, population statistics are sucky that way.

The number was footnoted so I clicked on it and learned that the 5.5 number was for 1998, which is to say that Earley used 1998 data to describe 2006. Using TAC's database--they are so obsessed with acts of violence committed by the mentally ill that they have a searchable database--in 2005, there were 4 murders of cops by people with mental illnesses. So that 5.5 number is now something under a rate of 2 times the general population.

It gets weirder from there. Here's how the TAC website describes where that 5.5 number was arrived at:

"The Surgeon General estimated that 2.6 percent of the U.S. population has a severe and persistent mental illness. [U.S. Department of Health and Human Services. Mental health: A report of the Surgeon General (1999).] Therefore, there were 7 million people with severe and persistent mental illnesses in the United States in 1998. [Bureau of Justice Statistics (2001). U.S. Census Bureau. Monthly estimates of the United States population. Available at http://www.census.gov/population/ estimates/nation/intfile1-1.txt. (Visited May 4, 2001).] People with mental illnesses committed at least eight of the 61 police homicides that occurred in 1998 (13 percent) at a rate of 11 per 10 million. [Treatment Advocacy Center. Preventable tragedies database. Available at http://www.psychlaws.org/ep.asp. (Visited June 26, 2003).] Fifty-three police homicides were committed by the rest of the population of 263 million, at a rate of two per 10 million. [Brown, Jodi M., and Patrick A. Langan. Policing and homicide, 1976-98: Justifiable homicide by police, police officers murdered by felons.] Thus, people with mental illnesses committed police homicides at a rate 5.5 times greater than the general population."

So TAC calculated the rate using a small subset, between 5 percent and 10 percent, of the total number of Americans with mental illness. That 2.6 percent prevalence of severe and persistent mental illness appears to be pasted together from the Surgeon General's 1999 report--combining the number of Americans with schizophrenia, bipolar disorder I and non-affective psychosis to arrive at 2.6 percent. Since that report appeared in 1999, it's fairly safe to assume that those numbers were pieced together in 1997 and 1998 (the government works slowly), and that they are themselves estimates from earlier in the 1990s.

Here and now in 2006, we all just got painted with a mid-1990s brush. Or, we were pelted with apples and oranges.

I could walk you all through why TAC's rate calculations are bogus--in 2006 we know that the percentage of severe and persistent mental illness is somewhat higher than the 2.6 percent of the 1990s, which used 1.3 percent as the prevalence of bipolar I, so that would decrease the 5.5 on its own. That 1.3 figure was the consensus number that came about in the early-1990s, and works out to about 3 million Americans. I think we all know, as do researchers, that we are now looking at something closer to 10 million, although the pharma companies talk as if it’s closer to 15 million.

There is also no age-adjustment in the rate for the general population of 263 million (it doesn't make sense to include in that general population number the many millions of youngsters and elderly who wouldn't be able to murder a cop unless they used a rattle or a cane), so that would drive the rate within the general population up and, conversely, drive the rate among those with severe and persistent mental illness down. In population stats, you’ve got to account for how your data might be skewed by its prevalence in sub-groups of the broader population.

But Earley didn't say "severe and persistent mental illness" in his copy. He said "people with mental illnesses." That's a much larger group than the 7 million upon which the rate of 5.5 times was based. Apples to describe oranges. For a reporter cum advocate who is actively trying to help us, that’s a remarkable breach of faith.

Estimates of the prevalence of mental illnesses in America vary widely from 10 percent to 25 percent, or about 30 million to 75 million Americans with schizophrenia, depression, the various kind of bipolar disorder, anxiety disorders and AD/HD. If you take the number of murders of cops killed by people with mental illness and calculate a rate using those numbers--and Earley specifically referred to that population--then you'd end up with a rate of the mentally ill killing cops that would be less than the general population. Not that I think there is anything "general" about the population that kills cops.

By now, easily more than a million people have read what Earley wrote. In his op-ed, he confirmed many peoples' built-in assumptions about the mentally-ill: we are fucked-up and only forced compliance with medication will get the kind of results society expects. What's more, we are now demonized as cop killers. That's fucking offensive to me, especially since I have friends who are cops. Its doubly offensive because the data he used doesn't even support his argument.

So what's Earley's point? His broad argument in other articles he's written of late as well as his new book Crazy is that America's system of grappling with mental illness is broken and a disgrace. He's right. He's right that too often it is too difficult to get care for the mentally ill and that as a result our jails are filled with the mentally ill and so are the streets of this country. The trouble with Earley's thesis is that it comes from the point of view of the father of a son with bipolar disorder who, when his son melted down, found it impossible to force the mental health system in Virginia to force his son to take meds and comply with treatment, because his son was resisting every step of the way. I can understand his position. Over the years, I've had a few friends develop mental illness. Some of them have refused treatment, refused to even acknowledge their condition, and I have had to cut off contact with them. Not fun.

I am weary of the family crowd who are very influential in setting policy goals, laws and research priorities in this country. Too often, they see the story of mental illness in this country through the stray cop killer, the son or daughter who killed themselves and the like. What they never acknowledge is that for every schizophrenic run amok, there is a John Nash. For every bipolar running naked down the streets, there is a you and a me. For every cop gunned down by someone flying off their meds, there are hundreds of police officers in this country living with depression and bipolar disorder who must suck it up and stay in the shadows.

Still, I agree with Earley that we need a global fix for this problem, post-haste. The trouble, though, isn't that we cannot force enough people into treatment. The big overarching problem is that we have a paradigm of treatment in this country that isn't especially effective. Psych meds work less than 50 percent of the time and are very rough on peoples' bodies and cognitive functioning most of the time. Some meds have been linked to suicides and diabetes. What's more, it's well known in the mental health world that patients can play by the rules, take their meds religiously, avoid booze and crack and still have the very kinds of problems that we want them to take meds to prevent. Especially chilling is that increased openness about treating mental illness has led to tens of millions of Americans taking psychotropic medications each day of their lives to the tune of $40 billion a year in sales. But, measuring our success by changes in the rate of suicide over time, the ultimate index of mental illness, it's easy to see that we haven't made much progress. The rate of suicide in this county, most pronounced among adult males, remains virtually unchanged since the late-1950s.

It's unfair to argue for people like me and like Earley's son to be forced into a system of treatment that produces spotty results and expect that to be the answer. It's OK to expect us to take meds and do all the other complicated existential handsprings in order to make life play out right—and work with us on making that work. But to call for forced medication for the many based upon bad outcomes with the few would return us to a system of vrtual confinement not too dissimilar from the bad old days of the snake pit state mental hospitals where hundreds of thousands of Americans were confined for life.

But Earley wants this system fixed and so do I. You'll never fix it by demonizing us, especially if you use bogus statistics and flawed assumptions.

Pete Earley's Op-Ed Blasts Around The Country

In an earlier post today, I referenced Pete Earley's op-ed from the May 12 Washington Post. It is now being picked up in slightly revised form by papers all over the country. Here's one example. By Google News's count, it has been picked up 181 times. Given how wildly distorted his op-ed was (the mentally-ill are all dangerous and must be forcibly treated, etc.), I hope to get the opportunity to answer him fully in the pages of the WaPost. If I do, it will be interesting to see how many papers pick it up.

I don't question Earley's good intentions in arguing for accessible treatment for the most seriously mentally-ill (an argument I've been advancing in print for two years now), but he's making the classic mistake of assuming that psych meds work all the time and in all places and are great for long-term use. For people like him, the civil liberties of the mentally-ill aren't that important. It's funny how often that argument is advanced by parents of the mentally-ill, who seem to be perfectly fine with the idea of their offspring being turned into zombies. People have got to want treatment for treatment to work. What's more I am still deeply suspicious of some of the statistics he uses. More to come.

Fuller Torrey Is Dangerous

I was attempting to write an op-ed tonight. It is a response to an op-ed in the May 12 Washington Post by Pete Earley, who seems to be the front man for those who argue that the mentally-ill should be forcibly medicated in outpatient settings with very little due process, acknowledgement of just how poorly meds work or regard for their human rights. Basically, I am still trying to figure out how to respond to Earley because the WaPo limits op-eds to 800 words and Earley did so much damage in his copy that it would take 3 times the space just to answer him.

Anyway, I was trying to settle my mind about one of the points Earley makes in his piece--that the mentally ill shoot police 5 times more than the general population does (whatever the general population that shoots police is) and that kinda made me do the old "Huh? What?" I've been reporting on cops for 7 years and mental illness for much of that time as well, and I have never run into that number nor have I ever had a cop mention it to me. So it made me skeptical. Where did that number come from? What's the supporting dataset? Earley had mentioned that the number came from the Treatment Advocacy Center.

TAC is Fuller Torrey's non-profit that goes around demonizing all mentally-ill Americans on the basis of the violent behavior of a few. Torrey is a controversial figure in psychiatry. He believes that a virus present in cat shit is the source of schizophrenia. I am not kidding. He has also spent much of his career accusing schizophrenics and bipolars of being John Hinkleys-in-waiting. He is also the author of the best-selling Surviving Schizophrenia. He is quoted in the press probably more than any other single expert on mental illness. He and his colleagues are powerful and argue for outpatient commitment laws before public bodies.

So I went to TAC's website looking for the data. I couldn't find it, but I ran into this press release: "NEW STUDY LINKS VIOLENCE AND SCHIZOPHRENIA." That was news to me since I am fairly up to speed on the psych journals, especially in regards to the CATIE study on schizophrenia. In the press release, Torrey asserts that violence is common among some schizophrenics, that the reason is because they weren't taking their meds, and that they must be legally forced into "treatment" compliance.

Then I went to the abstract of the study he cited. (I'll get the full paper in a day or two.) It is something of a sub-study of the full 4,000 patent CATIE study. Here the sub-group is 1,400 patients. Of those, the study authors found that 19 percent had committed a violent act of some kind in the previous 6 months. That much of the data Torrey reports before going off on his usual tirade for forced treatment. That works out to about 266 people from the 1,400.

Here's what Torrey fails to mention. From the abstract itself: "Violence was classified at 2 severity levels: minor violence, corresponding to simple assault without injury or weapon use; and serious violence, corresponding to assault resulting in injury or involving use of a lethal weapon, threat with a lethal weapon in hand, or sexual assault."

Minor violence was reported in 15.5 percent of the cases or with 217 people. Serious violence was reported in 3.6 percent of the cases or in 49 people of the 1,400 in this study. I don't know about you, but I don't feel like seeing discussions about how we grapple with mental illness in this society being driven by 49 people out of 4,000 people in the entire fucking study.

What's interesting to me is that in his press release Torrey is wound up over the fact that most of the minor violence was directed against family members by patients being dragged off to the hospital. Having seen that dynamic play out before in the lives of patients I know, I can assure you that whatever hit mom or dad took from their son was partly driven by mom or dad screaming in their faces. I've seen this before. I wouldn't hit anyone over it, but I can understand how the supercharged dynamic gets out of hand and a shove turns into an assault turns into a crime turns into a poster child for Torrey. It's interesting to me that Torrey is so stirred up over it. I wonder if he ever had a son or daughter hit him, or if it is a result of his years working on the wards at St. Elizabeth's where John Hinkley is kept. It's interesting to me, too, that Earley seems to be tied in with Torrey--they are both in the DC area and I wouldn't be surprised if Earley leans on TAC for more than just the numbers of mentally ill people shooting cops data. I wonder, too, if Earley's bipolar son ever struck him. Anyone know?

But what's really interesting to me is that more people in the CATIE study weren't connected with violent acts, minor or major. In the original paper published last September, study authors outline the sad demographics of the 4,000 study particpants. I don't have the study with me, but from memory, my feeling was that it was like the study particpants had been plucked from homeless shelters around the country, VA hospitals and the outpatient clinics with the most hardcore populations. Most of the people in the study were unmarried, a huge majority were unemployed and barely educated. The average age was about 40 and most had been schizophrenic for about 20 years. Men outnumbered women. Strangely for a public health study, there was a high percentage of African-American participants (psych studies are most often heavily tilted towards Whites).

My point is that if out of 1,400 long-term, deeply schizophrenic men and women who had endured decades of the streets and the psychological torture of their illness that the most they could find was 49 people who'd committed criminal level assault, then I wouldn't call that quite the stirring indictment of schizophrenics that Torrey thinks it is. I would call it a victory for the other 1,351 patients and a rather stirring testimony to the strength of the human spirit. I don't say shit like that very often. But I am proud of those people.

I was proud of a schizophrenic I know last summer. I cannot go into too many details. But the bottom line is I was around her one day when shit started going bad for her, despite the fact that she is highly med-compliant and very highly medicated. All the same, she was trying very hard to fight back from losing most of her teen years to being hospitalized for very long periods. This day, she was doing poorly and I asked her to step outside and talk to me about it. In short order, she melted down and began stomping her feet on the ground and swinging her fists in the air. I stood there and said nothing for a minute, then began calmly encouraging her that she needed to slow her mind down, breathe deeply and suck it up, because sure having a wicked mental illness sucks like crazy, but it sucks less than losing control and winding up back in the hospital, which could have happened.

So she pulled it together and calmed down. She said she wanted to take the bus home from work, a crosstown ride. I thought that might not be the best idea, given all the weird stimuli available to the minds of schizophrenics on urban buses. Instead, I called her mother who came and took her home. She was back the next day and in fine shape. A few weeks later, I wrote her a letter of recommendation to college. She begins in the fall. While she hates how her meds make her feel, she takes them anyway.

So why does the Fuller Torrey crowd always insist that the story of mental illness in our culture be told through the relative few who've done acts of violence and not through people like this young woman? Or through people like me? What is their beef with the mentally-ill that they cannot get past? Why don't they every so often give some credit to us Ishmaels who have returned?

Whatever it is, it is disrespectful and dangerous in the mouths of people like Fuller Torrey and reporters who lean on his mindset a bit too hard. They are both clearly lining up to drive policy and clinical practice on treating bipolars and schizophrenics. They can say what they want, but they need to stop twisting the facts. What's sad to me is that in some ways Torrey and Earley and I are not that far apart, but those ways are few. I guess I now need to track down that violence against cops data.

I'll return to the WaPost stuff later.

What Do You Say About A Problem Like Paxil?

GlaxoSmithKline yesterday sent a letter to doctors warning that its anti-depressant Paxil raises the risk of suicide attempts in young adults. This came after a review by the company of clinical data on 15,000 patients. The FDA is apparently looking into the matter. Paxil already has a black box warning concerning its use in children and has long been know to make bipolars flip into manic states. There are also many reports of increased suicidality in adults who take Paxil--and speaking from my own experience I can say that the reports are true.

Needless to say, if Paxil works for you, congratulations. But if it doesn't and you are taking it now, please don't stop taking it suddenly. That can cause big problems. Talk to your doctor about how to taper off it, if that's the road you want to go down.

Word To The Researchers

Here's a new study claiming that in Canada 56 percent of people with depression seek help from a doc or mental health care provider while in the US it's 52 percent. The study size is smallish--only 150 people in Canada, for example. But those percentages do match up nicely with percentages I've gotten from psych researchers. About half of all depressives and bipolars seek help. The proportion is supposedly higher with schizophrenics because that illness is a lot harder to, um, ignore.

If you ask why this is the case, the earnest researcher will usually reply that people don't seek help because mental illness is stigmatized. That's part of the problem, of course. But after 15 years of wide-usage of anti-depressants in American society, word has gotten out on the street that anti-depressants just aren't as effective as anyone would like them to be, or as effective as pharma companies and advocacy groups claim that they are. Would you go rushing to a doctor for help with depression if you knew going in that the illness is stigmatized and you've got between a 30 percent and 50 percent chance of hitting upon a med that works well? Many people wouldn't. And that's a problem.

Economists like to call such things "disincentives." No kidding.

It's Mom's Fault

Or more accurately her depression's fault that her kids are a mess, according to this study:

"UNC Psychiatrist Erin Malloy, M.D. explains, "Maternal depression can be a risk factor for a number of different types of disorders in kids." Those disorders include everything from depression and anxiety, to attention deficit disorder. Now, a study of 150 mothers and their children suggests treating mom's depression helps reduce those risks in youngsters and also those who do have problems."

Um, I am not completely buying this, although I know it's considered unholy to challenge any assertion researchers make about children. To me, this all sounds like a set-up fed to the media by a pharma company. Is my skepticism warranted?

The text of the news announcer's script includes: "Depression hurts a lot of people, not just the person who is depressed." The news station is located in Indiana. Eli Lilly is headquartered in Indiana. The company has an onoing television ad campaign called "Depression Hurts." The campaign promotes Cymbalta. On its website, the imagery is mostly of women and in one panel there is a scene of a depressed mom with concerned children hovering in the background. Cymbalta has serious side effects, including suicidality, as I've blabbed about recently.

Are there any connections here? Nah. Couldn't be.

They Are From The Government

And the question is: Can they help? SAMSHA (don't make me type out its name) is a federal agency and just updated its website on the national suicide prevention strategy. The basic goal of cutting suicides to 15,000 a year by 2010 has been in place since 1999. It isn't going so well. Each year about 31,000 Americans kill themselves at a rate that's essentially unchanged since the 1950s. It's one of those things that I don't think the government can do much to address beyond making basic information available and so on. But SAMSHA thinks otherwise:

“Over the past five years, we have worked to align SAMHSA’s resources to create systemic change,” Curie said. “We have invested agency resources in the program priority areas and we have built a record of achievement, including the Access to Recovery, Strategic Prevention Framework, Mental Health System Transformation, and Co-occurring State Incentive Grants programs, among others. The Matrix serves as our guidepost for budget formulation, program development and resource allocation at SAMHSA. It focuses staff and the field on nurturing a few redwoods rather than letting a thousand flowers bloom.”

I don't know about you, but when I see the government mixing terms like "systemic change," Matrix (capitalized no less), redwoods and flowers, it makes me want to move to Mexico. Or call Keneau Reeves. Keep in mind these are the bright bulbs who are going to halve the suicide rate in this country. We are doomed.

Go To Jail, Loser

I am getting really sick of criminals claiming that bipolar disorder made them commit crime. Here's a creep in San Jose claiming that when he's manic, he thinks it's OK to molest little boys. No, it's never alright, and bipolar didn't make you do it. Go to hell and go to jail.

Ban The Internet!!

Ah, now the mental health crowd is going after what they call "internet addiction." To whit:

"While not yet defined as a true addiction, many are suffering the consequences of obsession with the online world, unable to control their use. From gaming to sexual and emotional relationships, the internet is taking over lives. More and more people will be confronted with consequences such as divorce and physical symptoms which will force them to seek both medical and psychological treatment.

Online marital infidelity (cybersex) can lead to divorce and harm personal relationships. Individuals who seek out sexual partners online also appear to be at higher risk for sexually transmitted disease. Furthermore, such behaviors can lead to cybersexual addiction. Previous studies have reported that 'Approximately 9 million people, or 15 percent of Internet users, accessed one of the top adult Web sites in a 1-month period.'"

While a healthy discussion of any obsessive behavior is always good, I sit here in wonderment. Have you ever heard of counselors going after book-reading obsessive disorder? Or how about excessive jogging and working out? Of course, you haven't. Why is it that activities that our behavioral monitors don't approve of--'net obsessions--are indicators of a disordered life, yet if you asked the same set of therapists whether they found problems with someone spending two hours a day in the gym and causing all sorts of problems in their personal relations as a result, you'd likely get the "Oh you are so naive smile" from them. If you asked them if a person spending 6 hours a night writing poetry that will never be published had indicators of a disorder, they'd likely say no. So why does the weird world of the Web get treated differently? Answer: most therapists are disconnected nerds. Have you ever tried to party with one?

But why don't we ban the 'Net or perhaps force ISPs to time out users who spend mroethan two hours online. Sounds reasonable to me.

I’ve Never Been The Naked Guy

A couple of years ago I went on a date. Things were going well and she and I had moved from beer number one to number three. We'd gotten to that point where old relationships were being discussed. She mentioned that she once lived with a bipolar boyfriend. I told her that I was bipolar. She had a nice tan and the color in her face changed then. Her boyfriend, she said, had melted down once and run naked down Boren Avenue on Seattle's Capitol Hill and ended up in the psych unit at Harborview. She said he hadn’t taken his meds. Then she said she had to leave. We split the bill and I tired to talk with her on the sidewalk. I told her I'd never been the naked guy and that shit with bipolar and me had played out fairly well in recent days. I'm not him, I said.

I can't take that chance, she said, and left me standing there.

I was pissed and not because I wasn't getting any love that night. I was angrier over her gut assumption that all bipolars come in the same size. That's not true at all, I tired to explain to her in an email later that evening. Some of us have done really damn well, sticking with treatment and meds even when they didn't work, and doing whatever we've had to do, psychologically and existentially, to claw back into American life. And we've gotten there. Maybe not most of us, but a few of us at any rate. I explained to her that I was one of the few and planned to continue wearing my clothes. Never heard back from her.

It's funny how people carry long-held beefs with the mentally-ill and hold them against people who are examples of exactly how the system is supposed to work. Allegedly we are the ones American society is supposed to want to embrace in our new age of no shame for those beaten-up by nasty illnesses and abnormal behaviors. But that hug-fest rarely goes on.

I saw an ugly example of that dynamic play out on a larger scale last Thursday evening. That night about 100 residents of a traditionally lower middle class neighborhood gathered in a library conference room to denounce a planned project to build apartments for homeless people with mental illness in their neighborhood. This is a neighborhood where residents paint themselves as progressive and burning for diversity in American society. I'm sure if you asked them if they were down with "social justice" for America's disadvantaged, they would have gone glassy-eyed and nodded their heads.

But from their mouths I heard the same basic bullshit then that I heard from my date. The mentally-ill are dangerous. They don't get better. They're going to ruin our dreams of gentrification. The dicey part for me was that I was at this meeting as a reporter and I had to breathe deeply several times. There's only so much hypocrisy I can tolerate. You can judge how I handled it in what I wrote for my paper.

As pissed off as shit like that makes me, I am more frustrated that I am not more the norm than I am the exception. That's what I am told is the case. Typically, researchers pin the blame for patients getting poor results on patients not taking their meds. I place the blame elsewhere. I blame researchers, psychiatrists, pharma companies, the media, policy makers, employers, advocates and families for turning the game into one of meds-only. That's a psych patient's only option when the bad voodoo settles on their world: take your meds. And if you don't have good results, take more of that med. And if that doesn't work, or if it fucked up your body in the first place, then switch to this other med. And then take more of that, or switch to something else. And, then, let's add this in with that. And, OK, let's add a third med. That ought to do it.

The maddening thing is that when that doesn't work and a patient starts backing away from some of their meds, then the patient is at fault and labeled non-compliant. That's crazy. And that's what I wanted to tell the woman I had beers with and all those pretend-progressives at that meeting (many of whom were arguing for forced medication). That they are crazy because there isn't a psych patient in the world who wouldn't do anything to feel better and make life work out for them. There isn't a bipolar or schizophrenic who wouldn't take some gnarly meds if they produced robust results for most of the people most of the time. They would take them even if they had to sacrifice their bodies in the process. But that trade-off just isn't in the cards for most of us.

My experience is all of this is fairly unique. I've taken my meds without fail for 17 years even when they weren't giving me more than half results. Only for four months did I do a med-free experiment and then I was back on three meds that were beating the shit out of my body and mind and not working with a damn. It was only a couple of years later that, out of desperation, I went to my doctor and said I wasn't going to take all my meds anymore, that they were eating me alive and not giving me the kind of results I had a right to expect. It's thorny times like that in your life that often produce a strange wisdom. You take a chance and see what happens. I went down to one med nine months ago. Despite a few short-lived setbacks, I've been remarkably well. Clear-headed. Running my mind instead of my meds running it for me. Even my doctor doesn't have much of an answer for why this is working. For why I am "recovered." For why I am one of the few and not the norm.

I don't have a firm answer either, aside from a string of good luck. But I know from long experience that if my present regimen were going to fail me, then it would have already. So there's more than luck and random chance at work here. I want to know why this is.

And not knowing pisses me off. Because I want to know what we can do for each and every psych patient to make them whole again. So I don't have to go to anymore public meetings and hear the squealing fears of urban MIMBYs as they trot out the old assumptions that the mentally-ill are not redeemable and that they need to be forced to take their meds so that all the normies feel better about themselves. And so that I don't have to go through another date assuming the worst about me because of the worst that went down with someone else--all because their meds were intolerable yet America's only answer for them was to take more meds.

Eli Lilly Can't Help Itself

Ah, my good pals at Eli Lilly just cannot leave a good thing alone. They've just filed a supplemental application with the FDA to get approval for Cymbalta's use in treating generalized anxiety disorder. What's more, the company is in Phase III clinical trials for using the drug to treat fibromyalgia. Cymbalta is both a floor wax and a dessert topping! It also fucks up peoples' bodies and causes suicidality (cf. here and here). I cannot wait for the new television ads for Cymbalta and GAD. I wonder how the lady with the snot-filled voice will spin the drug then.

Screwed Up, American Style

There was a fine article in yesterday's New York Times Magazine examining just how aggressively the religious right is going after--get ready for this--contraception. Apparently, going after abortion rights isn't enough for them. So wild are these folks that they are actually articulating that all sex should happen only in the context of conceiving a child. Which mean coitus interruptus will be back in its rightful place as the primary form of birth control.

The South Dakota legislature passed a law earlier this year banning almost all abortions. The law is presently stayed, pending legal challenge which means it ought to end up in the US Supreme Court. If SCOTUS hears the case and, in a couple of years, upholds the law, then women's right to an abortion is over in America.

That's just how successful the religious right has been in recent years. Oh, yes, almost forgot all those anti-gay laws that were passed in the 2004 general election.

But if you think that conservatives are the only threat to rights and freedoms in this country, then you are only paying half-attention. Liberals have been busy and perhaps just as successful through the lib-driven public health movement. There are now smoking bans in 12 states and hundreds of US cities. One of the craziest is in Washington State, where it wasn't enough to just ban smoking in bars, they had to ban it within 25 feet of the entrance to any building. It's just the start. What's more, the lefty nanny statists are going after food and soda pop, having declared war on obesity. They'll go after booze, too. You watch. (I wrote about this annoying drift in American life earlier this year.)

Not enough for you? Washington State just banned online poker, meaning anyone who lives in the state and gets nabbed playing hold-em online faces a Class C felony and up to 10 years in the joint--the same as for child abuse. Gee, thanks state legislature for helping run my life, and thanks to the Washington State media for not even covering the ban much less questioning it!

And, now the mayor of Seattle wants to enact some form of gun bans in our city.

Where will it stop? That's just my point. After 40 years of an increasingly-open society, America is dialing back the clock in any number of ways. Backers of these restrictions usually cite moral and health reasons. I don't trust such reasoning at all.

What's this got to do with the mental health world? Quite a bit. It's this same kind of nanny state thinking that wants to force all teens to be screened for depression at school, even if they show no outward signs of depression. Gee, I wonder how many of those kids will end up on anti-depressants simply for acting morose and gothy and having tattoos (which the public health crowd also considers a problem because they can link tats to kids with bad grades)? Advocates of this approach will cite community health as the basis for prying into teens' private lives and private feelings. One of these days the community is going to start pushing back against all this nonsense. But everyone is waiting for someone else to be the man or woman who does that.

Cymbalta And Its Problems

A reader was good enough to pass along the following about Cymbalta:

"The Associated Press reports that nearly a fifth of the volunteers testing Eli Lilly's antidepressant drug, duloxetine, dropped out after Traci Johnson, a 19-year old student committed suicide at a company laboratory."

There's more on that incident here, in which a 19-year-old woman killed herself after taking Cymbalta.

And another reader comments in response to my post yesterday on the new Cymbalta television ad:

"I once took this stuff. After 5 hits of the lowest dose, I, for the first time in my life, knew what suicidal ideation was. I never even called my pdoc, I just stopped taking it or I would've ended up hospitalized. Anecdotally, I've heard of some people having success with it, not me though. Scary stuff."

Here's the official FDA warning notice on the drug.

Meanwhile, the financial press is crediting Cymbalta sales with boosting Eli Lilly's financial picture. Sales of the anti-depressant were up 118 percent over the previous year to $233 million, which means sales ought to hit about $1 billion this year. I guess advertising works after all. But what's interesting to me is that on the ad there is no mention of suicidality or other side effects at all. Then again, what's wrong with suicidality in the first place? These patients are depressed! Or did I miss something? If you have Cymbalta stories of your own, pass them on and I'll post them. I never took Cymbalta myself--Eli Lilly's wonderful Prozac fucked me up enough--but it sounds like a scary little molecule.

Oh Boy! New Risperdal

Hey, you knew you were getting bored with Risperdal in its regular pill form or in its long-acting injectable form, and Johnson & Johnson is here to help: A new formulation of our fave atypical is now in medium-acting, 24-hour release. Yay J&J!

Acne Drug Linked To Depresssion In Women

The drug Dianette is under review in Britain after reports that it caused serious depression in 100 women. Dianette is also used as a contraceptive. Weird.

Depression Hurts And So Does Cymbalta

Not to make light of depression--it's bad, it's evil, I know it oh so well--but the new television ad campaign for Eli Lilly's Cymbalta is a bit much. It's called "Depression Hurts." Both the ad and website stress that depression not only affects your mood and your mind, but makes your body hurt and victimizes families of your love. Pain all around. The voiceover in the ad is a woman, identity uknown, whose throat sounds like it's building up with snot when she stresses that depression hurts. She must be a method actor.

All kidding aside, why doesn't Lilly shut the fuck up and start making anti-depressants that end depression for the majority of people who take them--I'd settle for 70 percent!--without any side effects as opposed to the usual 30 percent getting full relief complete with nasty side effects? It's that usual scenario that makes my throat fill with snot.

Futher Proof That Zyprexa Is Evil

From a new short report in a psych journal entitled, I kid you not, Pornographic effect of olanzapine. I only wish I could've made that one up. Instead, I'll give nature credit.

Where I Been

I took a few days away. Was depressed and needed to disengage from regular life for a few. I hope I am back to "normal."

On Male Suicide: A Reader Comment

A reader--ok, one of my closest friends--posted the following in reply to my post on male suicide the other day:

"Maybe it's because society's expectation of us is that we are the straight-laced, button-down go-to-work 8-to-4 / 9-to-5 / 10-to-6 guys.

Maybe it's because by that age, we're realizing that most of our dreams are unfulfilled and likely to remain that way.

Maybe it's because all we see ahead of us is an endless succession of cubicles in a grid layout, writing this or that report for this or that asshole boss. I told you the other night about someone whose very presence all but constitued a hostile work environment - maybe some of us are seeing 50 years of that staring them in the face with increasing uncertainty in the political, economic, ecological and other landscapes and deciding that it simply isn't worth sticking around to find out what happens next.

Some amount of that has to be the result of undiagnosed mental illness (i.e. mental pain), but I wonder how much of it is also due to socialization - after all, boys are generally taught to do, not whine, and I'm sure that suicide seems like an amazingly simple and convenient way out of things.

Based on all these ideas, it's easy to see the responsible family man bearing the weight of a life he didn't want buying a life insurance policy to make sure everything is covered and driving across the train tracks when the bar is down because most of us can't go start a Fight Club.

I'm not sure that beating on drums (see: Robert Bly) or beating the shit out of each other (see: Tyler Durden) is the answer, but I don't think you'll be able to identify the underlying causes of suicide in early to middle-aged white men without examining their work, relationships and other pressures that could trigger this sort of thinking.

Think "Bowling Alone" mixed with Durkheim and you have an idea of what I'm getting at."

As usual, he puts it better than I could have. Bowling Alone is a good book and also adddresses why I am so po'd at the nannies who go after low-level civic misbehavior--we all need places to hang out and go, even folks who are not intellectual elitists. That's what diversity is all about, right? Or are we all just supposed to comply with their wishes and do wholesome things and think pure thoughts?

I Won An Award

Ordinarily, I'd link to the press release or whatever and move along. But there's nothing to link to. So, anyway, I won the award for Best Coverage of Mental Health from the National Mental Health Association yesterday. I'm doubly flattered since it's the second year in a row I've won an award from NMHA (the competition, I am assured, is judged by throughly-sober noted journalists). I'm flattered. With luck, I'll be able to make it to DC in June to pick the thing up--shit, I need a vacation anyway.

Thanks to those of you who read my blather here for all your kindnesses in the past. Back to the regular shit.

No Silver Bullets, No Heroes Or Fuck Zyprexa

As I mentioned two days ago, a new study came out examining whether Zyprexa could be used to prevent, or delay, the onset of psychosis in people--most of them teens--assumed to be at risk of developing schizophrenia. I got a full copy of the paper yesterday. The results were not good both for Eli Lilly, Zyprexa's maker, and for the prevention paradigm of the public health model--at least in how it's applied in mental health settings.

In the study, 55 percent of the patients taking Zyprexa dropped out of the study due to side effect of the drug. Consistent with many other studies of the antipsychotic were patients who gained weight rapidly and who had elevated heart rates. The study did not examine patient blood sugar levels--utterly asinine given Zyprexa's well-known ability to kick start diabetes in patients. Two dozen patients have reportedly died from taking Zyprexa. So why the researchers didn't examine that question as well is hard to image. Last summer, Eli Lilly settled a class-action suit brought by patients and families of dead patients for $750 million (the pay out to plaintiffs will be $690 million) rather than have a multi-billion dollar verdict go against it in court.

That over half of the study subjects bailed 'cuz they couldn't handle taking the med is indictment aplenty. In the recent CATIE study, 64 percent of the patients discontinued Zyprexa for similar reasons. Meds ain't worth a shit if they ruin your life.

But that was just the beginning of the bad news for Eli Lilly. All of the patients taking Zyprexa who later developed did psychosis did so within 4 weeks of beginning treatment with the drug. I am not inferring that the drug caused psychosis. But it's a lame bit of chemicals that's advertised for managing psychosis in schizophrenics and bipolars (and is one of the world's top-selling drugs) and cannot get the job done out of the chute. Lamery, thy name is Zyprexa.

Study authors concluded that the drug didn't prevent psychosis, but perhaps only delayed its onset. But they couldn't--or wouldn't--say for sure whether that alleged delaying (a few months, tops) was the result of some patients taking the drug and getting a benefit from it. But, then, only 16 percent of the patients who took the drug received a benefit at all. That's just way too small a number to be enthusiastic about using Zyprexa for people believed to be at-risk of developing psychosis--schizophrenia, in other words.

But, then, Eli Lilly paid for the study, so what do you expect the docs to say? You know what's coming. They called for further studies to bear out their findings. Why do these guys always act like the jury is still out on both a drug and class of medication that have been widely-discredited? House payments.

Another point: for the last 20 years or so, researchers and public health officials (and pharma companies, of course) have been searching for the silver bullet med. The molecule that will turn them into heroes for prescribing it to patients. In the case of the public health crowd, they'd like to be declared heroes and redeemers for then forcing the silver bullet down every person's throat should they act a little sketchy.

Bad news, guys. It's not going to happen here. Not with Zyprexa and not with any of the other atypical antipsychotics. Not for bipolars, not for schizophrenics. This ain't the world of infection and Zyprexa is no penicillin.

So, in other words, fuck Zyprexa.

There were some other key studies in the same issue of AJP. I'll come to them in he next few days.

A Reader Writes

In reference to my earlier post on atypicals and risks to children:

"I wonder how many parents read that article and shook their heads, feeling screwed over and guilty at the same time. Yes, some meds help some people, that is what is wrong with this picture. This is a crisis in this country, it is time for mental health to walk out of the shadows and become a larger than life issue. It has been plaguing us for too long, too many people live miserable lives for this not to be up there with AIDS , Breast Cancer. Silence is not golden. It is sad. It is real."

Exactly.

Seroquel, Suicide And Spring

AstraZeneca has recently touted Seroquel as an anti-suicide drug, aprt of the company's multi-pronged attempt to turn the atypical antipsychotic into the new mood stabilizer for bipolar disorder. Now, here's a story from Yonkers, NY which indicates that a jail guard who had just begun taking the drug murdered his wife and, then, turned the gun on himself. His relatives blame Seroquel. I report, you decide.

Indian military hero kills himself after gunning down "terrorists." War makes people do crazy shit in its aftermath.

A British study claims that people, especially women, born in spring and early-summer months are at an increased risk for suicide, about 17 percent higher. I was born in August.

Antipsychotics Carry Risks For Children

No shit. Sounds like something I've been saying here for months. Now USA Today has an article as good as any I have seen in the mainstream media about these risks. What's more, it appears to be a good investigative piece which turn up 45 deaths in kiddos where atypical antipsychotics were suspect. And then there's the weight gain, the cognitive slowing, the...could've written it myself.

So if these meds are so problematic in adults and if there is so little research about their safety in children, then why the hell are we allowing doctors to so freely prescribe them. And why are parents letting this go on, especially when they may be addressing little more than behavioral oddities?

Also, could we please knock off diagnosing kids with bipolar at 6-years-old and younger? That's just out of order, except in very extreme cases.

Male Suicide

I'm glad to see that Australia is beginning to fund work looking into male suicide. Far too many men needlessly off themselves each year--too many women also. But with men the numbers are staggering: 75 percent to 80 percent of all suicides in the US each year are male. That works out to about 24,000 men killing themselves each year--far more than are killed by homicide or AIDS/HIV. By far the greatest number of suicides are among men aged 24 years to 65 years, not amongst teens as the media might lead you to believe.

The question is why. The answers are too complex for me tonight, but it's got a lot more to do with peoples' souls than it does with straight-up mental illness and psych meds. And this is something that requires attention in this society. Maybe it doesn't get much attention because 62 percent of all suicides--about 20,000 people a year--are white men, and no one in the public health or research community can make white men fit into their little universe of the oppression model. Yeah, that makes me kinda bitter.

I've Got To Start Getting Paid For This Shit!

I've been away for a few days. In April, I wrote entirely far too much in this blog and my head was about to explode. Besides, the staying on meds thing seemed like a good place to end the month. But I am back.

And just to keep track of the output in this factory, I wrote a bit over 15,000 words in this blog last month. That brings my total since I started this 7 months ago to 67,000 words. When I did my last calculation a month ago, I was running 8,600 words a month. Now, I am at 9,500 words a month. That's on top of the day job. I've got to start getting paid for this shit! Not that anything I write makes sense.

Kidding aside, it amazes me how many people say they are writers (or film makers or rockers), but turn out very little prose. I see examples of this all the time--creators who don't create. When I was a younger guy and trying to write novels, I would write 1,000 words a day whether I needed it or not. Same dynamic back then--I wrote and had a day job while the people with the nice notebooks and the fancy pens talked about how smart they were.

I am not saying that to be snotty, but I'm just saying.

Yet Another Important Study Is Out

In a newly-released study in the American Journal of Psychiatry, researchers report on an NIMH study in which they gave Zyprexa to kids who were believed to be at risk of developing psychosis and full-blown schizophrenia. The basic hypothesis: If we treat psychosis before it happens can we then prevent psychosis. Answer: sorry, Eli Lilly, but that little market segment ain't going to pan out for you. Here's an account of the study from the New York Times. I'll comment further once I've read the study in full.

An Advocate Dies

This is a sad, beautiful story of a schizophrenic who died recently. His name was Rene Miserez, 55, and he spent most of his life working for the State of Connecticut and working for his fellow schizophrenics. Sorry to see him depart.

Happy May Day. Now For The Same Old Shit

OK, maybe not shit--but bullshit. Yesterday I awoke to a Seattle Times editorial pleading for rational gun control laws. As queasy as the words "control" and "laws" make me, my stomach really gurgled when I read:

"Start by enforcing existing laws, especially those that would reduce access to guns by criminals and crazy people."

Typically, that line would close "criminals and the mentally-ill," so it's hard to understand what the Times was getting out there except to understand that someone on the editorial board got very lazy. And I have my hunches as to who it was. But "crazy people" is a term that strikes me as being as dubious as "faggot" or "cunt" and I hope I am not the only one out there who understands it that way. As for the Times edit board, these are the same tools who endorsed Bush in 2000.

And that little dollop of nonsense reminds me of this which I ran across last week in the Duluth News-Tribune:

"In February, several patients at an unlicensed mental health facility in Columbus, Ga., told the local Ledger-Enquirer newspaper that they had recently worked security at the Georgia Dome in Atlanta during football games of the University of Georgia and the Atlanta Falcons. The facility, the Greater Grace Community Center, has recently been shut down, but the newspaper was able to verify much of the patients' story. Among the facility's patients are those diagnosed with anti-social personalities or bipolar disorder or homicidal tendencies." (Emphasis mine.)

This was posted in some silly column in the paper called "Questionable Judgments." Whoever wrote it doesn't know much about bipolar disorder--we are just about the least anti-social people I know of and, near as I can tell, aren't especially dangerous compared to the average American.

But myths die hard in America, don't they?