And are often better writers as well. Last week, one of you posted a comment in response to me biting on the anti-psychiatry crowd (I respect their viewpoint but they are too often responding to the dimensions of the mental health world of a decade or more ago as opposed to addressing the far more subtle, and pressing issues of, today's mental health world). Here's the comment which articulates some things better than I can:
"People harp on the anti-psychiatry crowd with the claim that science has ALMOST irrefutably proven that mental illness is a genetic illness that MUST be cured with drugs, and that if you go off of those drugs, you endanger yourself or others. then they tend to spew the pharma party line: "it's a chemical imbalance". neat and tidy, simplistic explanations for people who have never taken an upper division cognitive science class. it's insulting.even if we are making major advancements in our understanding of the human brain (and what research are we to trust nowadays, with pharma dollars having more influence over the lab than ever before?), exactly how has that trickled down to the diagnostic process? how is that scientific knowledge present in the exam room with individuals? where is the conclusive MRI, DNA test? until that actually HAPPENS, i will remain highly sympathetic to the anti-psychiatry movements criticisms: the unbridled medicating of children, forced medication and the pharma-funded creation of bogus "mental illnesses" to establish new markets for psych drugs (e.g. SSRIs as a "cure" for everything from shopping too much to insomnia to shyness).
also remember, what gets called "extremist" here in the U.S.A. is often pretty mainstream in Europe. they don't have direct-to-consumer adverts for shit like Adderall and Seroquel. it's ILLEGAL. and we gobble 90% of the world's psych drugs. Europeans are far less likely to use polypharmacy to treat mental illnesses and RARELY medicate children. "america, fuck yeah!" rhetoric would have you believe that these poor inferior people of europe are not medicated enough and that these poor little kids need their amphetamines and seroquel. somehow, their societies seem to function extremely well anyway. now isn't that CRAZY?
that was LONG. i really am avoiding my reading assignments right now. no more dissing bezerkely, folks! it's really pretty conservative now, ok?"
There will be no 'dissing of Berkeley around here, since I went there as well.
Here's a decent opinion piece in today's Times on how nurturing psychotherapy actually misserves patients. Time for therapists to get tough, or tougher, in this doc's mind.
I started this blog a year ago today with some silly little ditty on a lefty protest in Seattle. I'm not sure if things have gotten more interesting around here since then, but I hope they have proven of use to someone. Not sure how much posting I'll be doing this week. Might be working, and might be on vacation. I've worked 6 days a week plus some evenings for the last 3 weeks and I am fried. Stay tuned.
OK, so I just had to say that, spurred by a Times article yesterday on the resurgence of Chan Marshall, aka Cat Power, a semi-talented weirdo indie rocker type who has always driven me straight up the wall. Maybe now that she's put down the hooch, gotten herself some psych help—like her shows weren't always a cry for help—and plugged her soul back together somewhat she can actually put on a coherent show. Which I'd be happy to pay to see next time she's in Seattle. Poor lady is having to take Seroquel to sleep, however. Let us pray.
The thing that's odd is that I think her depression and boozing point to this weird tendency in the American media to handle matters of madness in artists quite differently than they approach them in the rest of humanity. Which is to say the artists get handled with tongs and an odd deference, almost an acceptance of their state. For the rest of us, it's shut up and take your meds and stay out of society's way.
Which bring me to Peter Kramer's recent book, Against Depression. Kramer, you'll recall, is the auhtor of Listening to Prozac. His new book is essentially a deromanticization of the "depression is cool for creative people 'cuz it helps them create" mindset. His argument, to simplify, is that no one can create when they are depressed and that psych meds don't neuter creativity. It's an interesting thesis, one that could only have been written by a psychiatrist.
The fine folks at the Treatment Advocacy Center and I actually agree on something...er, more or less at any rate. The American media needs more Ben Careys and less of everyone else who swallows the straight dope that the mentally ill are inherently violent.
I had forgotten that the New York Times recently ran an article on ECT, so thanks to Liz Spikol for writing about it. Judge the article on its own terms of course, but I think Liz is right that it downplays the drawbacks of that horrid procedure. (Here's another NYT ECT piece.)It is one that should never be forced upon another human being unless they are in some kind of free will position to consent to it. Even at its best, ECT wipes out peoples' short term memories and it's pretty well documented at this point that it may have led to Ernest Hemingway's demise. The great one said that ECT "put me out of business"—meaning it scrubbed his brain and took away his art. Soon after, he went and killed himself. That enough is fair warning.
I have mentioned before how much I admire Ben Carey's work at the New York Times. He's the paper's reporter covering mental health (well, he's one of them, in reality) and psychological issues. In today's Times, he writes the single best, most appropriately-nuanced piece on the murder of Wayne Fenton that I've read. He also writes about how Fenton's murder has reinvigorated some of the debate around forced medication and violence among the mentally ill. Read it for yourself. Send a letter to the editor if you like. It's a damn sight better than what's been in the Washington Post on these matters. But, then, Carey is reaching out to different sources that the reporters at the Post. Keep reaching, Ben. Maybe all the way to the people at Duke who research violence and mental illness and the efficacy of outpatient commitment programs.
As I noted yesterday, Aaron Beck just won a Lasker award—major recognition for his work and major validation by the medical establishment that CBT ain't no fly-by-night talk therapy. Even better, my friend John McManamy passed along a link to a paper examining the treatment of depression with meds alone, CBT alone, and the two combined. The results of the 12-week study were interesting. Meds-alone generated a 48 percent response rate (remission of part-remisssion), and CBT-alone hit that same mark. But combined the two generated a 73 percent response rate. The study is from 2000 and I am too tired to go look for any confirming studies. But i bet you it was research finding like that that finally elevated Beck's standing in the field.
John McManamy has an interesting post about his experiences on the Left Coast, including an encounter with the anti-psychiatry crowd. Like him, I find many in that crowd to be big problems, folks who would have you believe that mental illness is just a label and so on. While that's a legitimate critique of the psych world, their attacks against the industry and mental health care and all that is so tied into the 60's and the state of hospitals and mental health care then—which was truly horrible—but has little to say about today's situation. They are out of touch.
They piss John off, me not so much, because I certainly do understand their frustration. But yeah they are Scientologists in secular clothing much of the time. Thankfully, they're are not especially powerful in debates around mental health care, but their primary advocacy group, MindFreedom, sure makes its presence felt and I respect the people involved. I'm a free speech guy that way and respect their stance on forced treatment, even if I think it's too extreme. I even think Tom Cruise should say whatever the fuck he wants when he wants. It's up to people to not listen to him.
But then there are extremists all over the map in the mental health world. Some of them do infinitely more damage than the MindFreedom crowd ever will. But that's for another day.
First, I just posted something on Aaron Beck, my usual prattle, but right below it is an excellent post by my pal Puckett on his experiences with pain management and, in his case, the increased use of psych meds to try and manage his physical pain. His post is honest and great, and certainly goes to some of my long-held beefs with anti-depressants. Read it.
Second, I am under a vast production schedule at work this week—worked six days last week, evenings included and looking at the same this week—so I may be fairly mute unless I manage to find some free time aligning with some creative headroom. See ya' when that happens!
Aaron Beck, generally credited as the father of cognitive behavioral therapy, was awarded the Lasker Prize last week. It's not common for a psychiatrist, which Beck is, to win this nation's premiere medical research award. In fact, it so uncommon that the New York Times saw fit to headline its article "Psychiatrist Is Among Five Chosen For Medical Award." The others were biologists and such.
But it does happen, although usually to some flavor of research neuroscientist, as opposed to straight-up psychiatrists. For example, Seymour Kety, who did important genetic work in schizophrenia and the mapping of cerebral blood flow, won a Lasker in 1999. He was NIMH's first scientific director and is credited as being one of the prime movers in getting psychiatry away from the squishy land of psychoanalysis and onto the dry land of brain-based science. Not that the latter works that much better than the former, but I digress.
It's long overdue recognition for Beck from the medical academy, especially since many in the psych research world pooh-pooh the use of CBT in treating mental illnesses. Whether you can read into this that the medical research elite are turning their eyes in other directions when it comes to addressing mental illnesses is not a place I have the expertise to go.
The reality is that CBT has not been used widely in this country, because America likes its paradigms all or nothing and the dominant paradigm is the pharmacological one. As a result, CBT is not widely available (there are a lot of kissing cousin therapies out there, but none are quite as hard-assed as CBT is about making people address thought patterns) and can be pricey where it is. Nor is CBT as well-researched for its effectiveness as it ought to be.
Where it has been researched, it's generally been found to be effective in treating depression, with or without adjunctive psych meds. Good for depression is what most people will tell you about CBT. But there is some evidence out there that in can be useful in addressing schizophrenia, especially for patients for whom meds aren't cutting it (the old half-working phenomenon). There is also evidence of its efficacy in treating bipolar disorder.
But again there hasn't been nearly enough study of CBT to say how effective it really is. And there are others in the research world who have attacked CBT and the few studies of its effectiveness by calling the studies poorly-constructed. All's fair in love and war, I guess.
As I have noted on this blog on numerous occasions, psych researchers in Britain are now openly questioning the effectiveness of the psychopharmacological paradigm, particularly in treating depression, and that nation's state health system is starting to back off the use of anti-depressants and beginning to embrace the use of CBT. We'll see how that plays out over time.
As I have also noted on this blog to the point of broken-recordom, the molecular era that Kety ushered into being hasn't proved out the way any of us would like it to. Still, American psych researchers, mental health advocates, policy makers and the media all act as if taking mental illness to the level of mental wellness is simply a matter of everyone taking their meds, better meds being developed and the brain being better understood. That's silly. We've been going down that path to the exclusion of any other way of thinking for almost two generations now.
Has anyone got some staggering population-wide results that show just how the current paradigm has redeemed the mentally ill over the long-term? I am not talking about just keeping someone alive and now-psychotic, for example, by doping them to the max. I am talking in lives lived well and lives rehabilitated above the status of janitor. We've been doing shit this way for closing on 30 years. Where are the results? Can anyone show me where the rate of suicide has radically decreased in this country in the last 50 years?
Beck is now 85-years-old. He deserves to be awarded the Nobel Prize in Medicine before he dies.
I have no appetite.
I apologize to everyone repeatedly because I seem to have a pronounced case of CRS and can't remember what I said. Luckily, I'm not in the habit of lying so I don't have to worry about keeping my story straight.
I started taking Klonopin to regulate my sleep schedule because Zanaflex had me waking up every two hours and walking into walls like a zombie, so now I'm waking up at 5 a.m. and napping every few hours throughout the day.
I'm on 120 mg of Cymbalta every day.
And my friend Hanae just laughs when I tell her about my medical regimen and the constant changes. She says they all sound like rejected names for Transformers. I guess that makes me Optimus Fucked.
This post started because I was reading over the comments on a previous entry about Cymbalta and was just a little bit stunned by how familiar it all sounded.
While I haven't had any problems with suicidal ideation, I have gone from 30 mg / day for a week to 60 mg / day which was recently increased again by my neurologist to 120 mg / day to help manage pain.
Here is what I know from direct observation and medical tests:
1. I am constantly thirsty and have dry mouth. I wake up in the middle of the night and drink two to three glasses of water.
2. I have short-term memory problems. I forget little things. I forget big things. I have to write everything down and even then, I sometimes forget it. I depend on other people to remember it for me. One commenter called it brain fog. That's a great way to describe it. I feel groggy when I wake up and groggy for most of the day until I take my meds in the evening, get groggier and pass out. In addition, it's difficult to focus on anything - tring to read and retain the information often seems pointless so I try to find "Quantum Leap" in syndication. My brain can process TV. My brain has difficulty processing more conceptual or theoretical stimuli.
3. I have NO libido. I finally understand the kind of frustration women can have when trying to reach orgasm. Without being too graphic, I masturbated for nearly half an hour one day without being able to reach orgasm. I don't bother trying now. Another side effect is a lack of erections - even the proverbial morning wood.
4. My blood pressure is normally around 120/70. The last time it was taken in a doctor's office (about a week ago and before the increase to 120 mg / day), it was 138/90. I commented that it seemed high and the nurse explained it away by saying that it's normal to have elevated blood pressure in a doctor's office. The only catch is that my blood pressure is usually 120/70 in a doctor's office. I don't get edgy in doctor's offices - not even when they tell me to turn my head and cough. Not even when they pull out the KY and a rubber glove. Being in a doctor's office doesn't explain that difference.
5. Fatigue. Oh, yeah. I'm asleep by 10 p.m. or so. I wake up at 5 a.m. Take my first nap around 8 or 9 a.m. Take another in mid-afternoon. Back to sleep by 10 p.m. Exhaustion? You bet.
6. Dizziness. Yes, I've had some balance issues - a little staggering here and there.
The problem is that some of these symptoms can't be clearly identified as side effects of the medication because there are too many other potentially contributing or complicating factors. While most of the stuff that will kill or cripple me, including MS, has been largely ruled out, there are still dozens of possible conditions that could account for the fatigue, the memory problems, the dizziness and so forth. They could stem from the pain that I'm in, which is the reason my doctors prescribed this regimen in the first place. They could stem from atrophied muscles which, despite my best efforts, are likely on the decline. They could stem from fibromyalgia, which my mother had and which is the current best guess for a diagnosis. They could stem from pharmaceutical or chemical interactions - after all, I am on an anti-convulsant, an anti-depressant and an anti-anxiety medication and I'm not convulsing, depressed or anxious, nor was I before all this started.
What I know is this: I am experiencing a number of the side effects identified in the documentation that came with Cymbalta. I am experiencing a number of the anecdotal side effects that commenters have described.
What I also know is that the only thing (besides opiates) I have found so far which effectively treats my pain in any significant way is yoga. Yoga practice helps me maintain my flexibility, rebuild my strength, regain my energy for a brief period of time and temporarily reduce my pain. I don't feel as groggy or fogged after it and I usually get an hour or two of something that feels like my life before all this started.
However, because of all this, because of the pain and the grogginess, I'm unable to work, unable to drive and am still on disability and will be for the foreseeable future.
I still have my sense of humor though, although it's not really on display in this post. I guess that's because I just woke up from a nap and already feel like taking another one.
I don't post much around these parts, although I do read this blog as often as I can. When every day seems the same as the one before it and that day was hazy, filled with pain and nothing different than the day before, what's to report? When the treatments consist of increasing dosages, why bother writing when I can lay in bed and drift off to sleep ... or simply pass out from exhaustion, pain or a combination of the two.
And don't take this as depression. This is my reality. My primary means of resistance is yoga. My secondary means is teaching myself how to quilt, come hell or high water. It's just slow going when I have to learn how to iron and somehow learn and remember how to use my sewing machines and the quilting techniques that I'm slowly picking up in my less groggy moments.
After watching my mom treat her fibromyalgia with QVC, vicodin and sitting on the couch until she killed herself, I think a different approach is in order. After all, I already know one way that doesn't work.
Earlier this year, I wrote about an 82-year-old man who had ben jailed on attempted murder charges after trying to stab his wife of 60 years. He claimed that a bad reaction to Wellbutrin made him do it—and his wife agreed. There had been no previous violence in theri relationship. Yesterday, after a jury had found him not guilty, a judge freed him. Fascinating, especially in light of the situation with Jeff Reardon (see below). I wonder if Reardon was on Wellbutrin.
This Seattle-area Wellbutrin case, along with the Reardon case, represent two of very few times that I know of Prozac-type defenses working out. I don't know what to make of that.
BTW, here's a website that claims to catalog alleged acts of violence and delusion committed by people taking anti-depressants. It looks like little more than a colelction of news accounts to me, and, so, I have the same qualms about it that I do with the "preventable tragedies" database maintained by the Treatment Advocacy Center—the information is raw, unconfirmed and not peer-reviewed.
Mcmanamy writes of his experiences going to the DBSA west coast conference in San Francisco. Has brief moment of lost meds. Later, he tap dances. Good stuff.
I'm not sure if I consider this earth-shattering news, but it's sure getting some media attention. David Healy, a British doc and longtime critic of psych meds, has a new journal article out in which he claims an elevated risk of violence among people taking Paxil versus people taking a placebo. A relationship between violence and SSRIs has long been claimed by some, suspected by others, and outright rejected by still others. I'm not sure that Healy's paper adds any more weight to any of this, but when you add in the suicide risks attached to Paxil and pregnancy complications that supposedly come with Paxil, it all does make you scratch your head a bit. Still, I don't find Healy's evidence particularly persuasive.
What is interesting is that in late August, a court in Florida cleared former MLB pitcher Jeff Reardon of criminal charges after he allegedly robbed a jewelry store last year. The reason? The court found that Reardon was not guilty by reason of insanity due to effects of various mood stabilizers and anti-depressants he was taking. I've not been able to turn up any details on precisely what meds he was taking, but if the evidence convinced a court, then that's the first time I have heard of this particular defense being attempted much less working.
So maybe Healy is onto something. Or not, since courts in this country have consistently rejected so-called Prozac defenses in the past.
Wayne Fenton was buried the other day. In the Washington Post account of his funeral, friends said that he liked to hang out at taverns, crash movies without paying and had a little bit of the redneck in him. A man after my own heart. And a massive loss for all of us.
BTW, his alleged murderer is now being described as having schizophrenia, not bipolar disorder, as the Post previously reported. Although Fenton's alleged murderer reportedly admitted to the crime, I tend to use the term alleged until something is proved in court.
Last week, there was a slew of media coverage of a study asserting that bipolars lose 65.5 days of work a year (a combination of missed days and allegedly "lost" productivity), twice that of people with depression. The cause, according to the study by Harvard's Ronald Kessler, has nothing to do with mania and everything to do with bipolar depression, which is apparently more disabling than regular old depression. I'm not sure that I buy the study's assertions, at least in their broad implications, nor the resulting media coverage. (The study also lead to a nice thread in one of the bipolar group's on MySpace.)
But, then, I am having trouble with the study itself. It was part of a broader national health survey and, as such, was working with an interview instrument called CIDI. The survey is not administered by docs nor does it diagnose a mental illness or ask if the alleged bipolars were officially diagnosed (that would create survey bias problems also). Instead the survey was something of a proxy for diagnoses, meaning that the people identified as being bipolar could only be classed as being bipolarish.
Although I have not obtained a complete copy of the study yet (I was kinda busy with other things last week), another article in the same issue of AJP mentions something about the study that troubles me: It states that the bipolars losing all all those work days were, in fact, a subset of the people being identified as bipolarish in the study. This subset was comprised of people who worked 20 hours a week. To whit:
"From scores on the WHO Comprehensive International Diagnostic Interview (CIDI), investigators identified individuals who met diagnostic criteria for major depressive disorder or bipolar disorder. Among these individuals, they identified a subgroup of individuals that were employed at least 20 hours per week. Among these employed individuals, they found annual prevalences of 6.4% and 1.1% for major depressive disorder and bipolar disorder, respectively. These individuals were asked to report their absences from work as well as assess their performance at work on a scale in which 100 represents fully effective work performance and zero represents no productive work. The ratings of absenteeism and "presenteeism" (i.e., low performance while at work) were combined to estimate annual days of lost productivity and the costs associated with those losses."
It is from this subset, from what I can tease from accounts of the study itself, that the news went out that bipolars are basically a drag on the economy.
And our friends at NIMH may have helped the hype along with a press release that states, in part: "Each U.S. worker with bipolar disorder averaged 65.5 lost workdays in a year, compared to 27.2 for major depression."
That's horseshit, especially since the conclusion is drawn from a study that distorts the full range of experience of bipolars. It enables a discouraging tendency in the media to draw conclusions without looking behind the numbers. Why would they when they got the word from NIMH itself? It also reflects a tendency among researchers to focus their journal articles on the most-wounded subgroups of the mentally ill, which permits to media to play along and paint a false, incomplete picture of us. If you were an employer, would you hire someone with bipolar disorder after reading this news? Would you find a way to screen them out? Would you find a way to fire them?
Why don't Ron Kessler, one of the grand poobahs in the bipolar research world, and his colleagues focus some attention on highly-productive bipolars? Are we not worthy of study because it would upset the applecart of assumption about mental illness? Did that national survey turn up evidence of people who were bipolarish who worked 60 hours a week? In fact, who the hell were the people in the survey to begin with?
I work 60 hours a week, between the day job and this work. Why don't people like me get included in papers like these? I know quite a few bipolars in my professional life who are over-achievers—I am talking about highly successful lawyers, cops, software engineers and so on. Why isn't the media interested in them? I am not arguing for political correctness here, but I do expect NIMH and researchers to not misrepresent the the fact base on the broad range of bipolar disorder and those who live with. They are working with our tax dollars, after all.
Or is there no money or news in studying and writing about people with mental illnesses who do quite well in life and who aren't committing acts of violence? What's the agenda here? Once I confirm my suspicions with the entire paper, I will bring this to NIMH's attention and, if warranted, will ask they they distribute a correction or clarification to their press release.
To be deeply skeptical, let me point to a hypothetical possibility. Kessler's study asserts that bipolar depression results in loads of lost work days among a select subset of a bipolarish population. That is being spun that bipolar disorder itself results in many lost work days, mostly due to bipolar depression. AstraZeneca is the maker of an atypical antipsychotic called Seroquel. One of the alleged benefits of that drug, according to numerous studies (funded by AZ of course) is that it well-treats bipolar depression. It is already approved by the FDA for treating schizophrenia and acute-phase manic episodes. AstraZeneca has an application before the FDA seeking approval to market Seroquel for use in treating bipolar depression. I have little doubt that the FDA will approve the application. Once it does, what do you want to bet that AZ's marketing focuses on this lost work days hypothesis and points to Seroquel as a fix for that? What do you want to bet that the media plays along?
I bet I am right. Stay tuned.
On Tuesday morning (OK, at 12.01 a.m.), I put up a post asking people in the mental health community to move slowly, thoughtfully and contemplatively in response to the murder of Wayne Fenton, a psychiatrist in Montgomery County, MD, who was allegedly killed by a psychotic patient. The reason I made the request is that there are those in the mental health world who will use every moment of tragedy and its consequent emotional tug to justify their particular political agenda—and in this case there simply wasn't enough detail available about the incident to draw a particular moral. What's more, Fenton was associate director of NIMH and very well respected in the psych world and it would be easy for the rhetoric around his death to become super-heated.
While it isn't exactly heated yet, it's interesting how one advocacy group—the Treatment Advocacy Center—is once again exposing, in ways subtle and not subtle, the ideological divide in the mental health community over outpatient commitment, TAC's raison d' etre. For example, in a post yesterday TAC noted that statements of condolence had been issued by NIMH (previously linked to by me), NAMI National (a group founded by TAC's president Fuller Torrey and its sometime ally in the push for forced medication laws), AFSP, and in a blog post by Liz Spikol. TAC did not link to NMHA's statement on Fenton's tragic murder—but then there is a long history of bad blood between TAC and NMHA, which tends to be less enthusiastic about outpatient commitment and forced medication than TAC would prefer. (TAC also ignored my initial olive branch, but whatever).
Such a move may not strike anyone as more than symbolic. It is interesting though that TAC links to Spikol, whose work I admire greatly, because she isn't particularly warm to forced outpatient commitment, especially the more extreme version favored by TAC (I prefer softer forms of outpatient commitment, a discussion for another day). Like me, she sometimes says respectful things about MindFreedom instead of dismissing them out of hand as do too many in the mental health world.
Where I think TAC has gone 'round the bend is in asserting that Fenton's murder makes a prima facie argument for forced medication laws in Maryland (there isn't enough publicly available evidence about what form of treatment the alleged murderer was on or wasn't on to make such an assertion) and elsewhere, and that somehow the mental health system in this country has become a victim of "political correctness." That's a bullshit statement, but I will dissect that and other TAC assertions in a statement by the group's executive director on Monday.
For now, I join with TAC and everyone else in the mental health world in mourning the loss of Wayne Fenton. Despite our many differences in the mental health world.
NOTE: I know that an inevitable outgrowth of Fenton's death, given his stature in the field, will be to create an award of some kind in his honor. That's a good idea. I am wondering if instead of creating the usual research award, however, if it might not be more in keeping with Fenton's deep concern for the sickest of patients to offer an award to a once-profoundly-ill schizophrenic or bipolar who manages to make it all the way back to a life of promise and accomplishment. My hunch is that that's what the endgame of Fenton's clinical and research life was all about.
Besides, there are plenty of patients out there who have made it back from the depths of hell. Their singular achievements seldom garner recognition and seldom generate column inches in the American media. It's about time that changed.
I ran across an old interview of Wayne Fenton, who was murdered on Sunday by a patient, from Fred Goodwin's "The Infinite Mind" series. Here is a show summary, explaining what Fenton had to say about violence among people with psychosis:
"Drs. Goodwin and Fenton discuss the public image of psychosis and compare it with the research on that subject. Dr. Fenton says that people who are psychotic are far more likely to be the victim of violence than a perpetrator. Public opinion is shaped, he says, by a few high-profile cases like the man who shot up the Capitol building. For every one case like that, he says, there are probably two or three million people quietly dealing with a psychotic condition."
Kind of ironic in hindsight. And here's something Fenton said in a Washington Post article a few years ago:
"All one has to do is walk through a downtown area to appreciate that the availability of adequate treatment for patients with schizophrenia and other mental illnesses is a serious problem in this country. We wouldn't let our 80-year-old mother with Alzheimer's live on a grate," he said. "Why is it all right for a 30-year-old daughter with schizophrenia?"
Although the folks at TAC tried to spin that as directly relating to the mentally ill, it really doesn't quite fit. America has a really rough time getting its mind around the necessity to house the homeless, regardless of what put them on the street. I don't get it myself, but there you go.
Just so no one thinks I am not properly recognizing the work of Wayne Fenton, here's his obituary. It's clear the fellow had a more nuanced view of mental illness than Fuller Torrey and TAC.
It's discouraging that only 6 hours ago I posted to my blog, alluding to the possibility that the murder of Wayne Fenton would be used by some in the mental health world to bang the drum for forced medication and would also present the Washington Post with yet another opportunity to screw things up. I shouldn't have written of it as a possibility—both events have already come to pass.
This morning's Post carries an article in which Fuller Torrey—the head of the Treatment Advocacy Center, the prime mover for outpatient commitment laws/forced medication—says that outpatient commitment of the alleged murderer would've prevented this tragedy. In addition, the paper once again trots out the notion that the mentally ill are violent by citing Torrey's claim that 750 murders a year are committed by the mentally ill. That works out to about 5 percent of all murders in the country. I look forward to poking into TAC's database, which I've found to be error-riddled in the past, to assess that claim. I also look forward to having the time to do so, given my current work demands.
Here's part of what the paper attributes to Torrey:
"Each year, people with serious mental illness commit about 750 murders, or five percent of homicides, in the United States, said Torrey, who just completed a manuscript about the consequences of untreated mental illness. In most of those cases, the victim is a family member. Police, mental-health providers, public figures, priests and strangers make up the rest, he said."
A reporter citing a source's unpublsihed manuscript? Um, if it's not published anywhere, much less in a peer-reviewed journal, why would the reporter cite it? Why would an editor let them? As a reporter myself, I find that incredible. I'd never cite an unpublished study and I've generally found that researchers are loathe to discuss the details of their work until its published.
And then:
"Maryland is one of eight states that lack an outpatient commitment law, which would require a person with a mental disorder to take medication or receive therapy for an illness or else face court-ordered involuntary hospitalization. "So what options did the family have to force him to take the medicine?" asked Torrey, president of the Treatment Advocacy Center in Arlington, which is lobbying for commitment laws across the country. Virginia and the District of Columbia have such laws."
Since my first post, it has become clear that the alleged murderer has bipolar disorder. What's less clear is whether he was on meds at the time of the crime, had recently gone off meds (in which case, he could well have had residual meds in his system), was undergoing a med switch, had blown off meds for ages or had been having a bad reaction to meds (a sadly too common circumstance with meds for bipolar disorder). I hope further details become available soon.
Why are these points important? One, Fuller Torrey is a deeply biased source and reporters and their editors should be deeply skeptical of his opinions and data, given his track record for misstating reality. (They should also be deeply skeptical of sources and experts who are willing to come to the phone on the Labor Day holiday and of the PR people who are willing to hook them up on a holiday.)
Two, in its database of violent acts committed by the mentally ill, Torrey's TAC fails to account for whether the people who were violent were in fact on meds at the time of their alleged crimes. That's not a minor point, since Torrey/TAC's rhetoric depends upon accepting the premise that people not taking meds leads to violence and that meds are a buffer against violence, but there are many examples of people committing violent acts who were on meds at the time of said acts. It's a point you'd think Torrey would want to be very careful with, at least for the purposes of intellectual honesty, especially given that he will likely be waving that unpublished manuscript under the noses of the both the Maryland and Virginia legislatures in coming months.
Three, the state of the art in mental health treatment is sadly lacking in broad efficacy and effectiveness—not to mention bang for the buck—and that's not a point I need to belabor, since it has recently been hammered home with the results of the CATIE, STEP-BD and STAR*D studies. Ironically, all of those studies were funded by NIMH and Fenton would have been intimately familiar with their results. (I'm sure the Post is, too, given that the paper's medical writers have written about the CATIE study. So why doesn't the knowledge that is known to the paper's medical writers make its way over to the metro desk?)
But if anyone needs an example of meds going bad on patients and, in some cases, making them do unusual things, look no further than the recent case of former MLB pitcher Jeff Reardon. Due to my lengthy summer hiatus from blogging, I haven't touched upon his case yet. Suffice to say, the poor fellow was doped on anti-depressants, went out and robbed a jewelry store (a man with no money problems) and a court found that he'd been temporarily insane due to the meds not his illness. I wonder what Fuller Torrey would make of that.
That's enough for the moment, except it's obvious that the implications of Fenton's murder are going to be far-reaching. More than I had feared.
As I've been hinting for a few weeks, I planned to return to regular posting around Labor Day. Two thoughts: first, I am very troubled that my return is spurred by the murder of Wayne Fenton (see below); second, I may not be fully back yet. It has been a very demanding summer for me at the day job and the coming weeks promise to be equally demanding of my time and psychic headroom. So, I am sorta half back and let's see what happens.
UPDATE: Soon after I posted, the Washington Post updated its online account of the murder to include assertions that the alleged murderer confessed to the crime, that he beat Fenton to death with his fists, that he was either bipolar or schizophrenic, and that he and Fenton were allegedly arguing about whether the young man would continue taking meds. These were not included in the original article. My original post follows.
Wayne Fenton, a psychiatrist who devoted his life to working with the most profoundly-ill schizophrenics, was killed on Sunday, allegedly at the hands of a schizophrenic. Police in Montgomery County, MD charged 19-year-old Vitali A. Davydov, reportedly seen after the crime with blood on his hands, with murder. Ordinarily, this would be a tragedy and a very odd sui generis case (I have looked and cannot find a reference to a similar case), but this one is more so.
Fenton was an associate director at the National Institute of Mental Health and NIMH has issued a statement. His list of published articles is long—he collaborated with some of the top names in the psych world. One, or example, was Jeffrey Lieberman, who is principle author of the CATIE papers on the lack of effectiveness of antipsychotics in treating schizophrenia. I have little doubt that the psych world will be shaken to its core by this tragedy—not only because of Fenton's prominence in the field, not only because of his obvious devotion to the mentally ill (he was working in his private practice on a Sunday), but because these are touchy times in the mental health world, which is riven by ideological fissures. You know what those are—and you know who is behind them.
Already, the fine folks at the Treatment Advocacy Center have posted to their blog, rightly calling the event a tragedy and profound loss to the mental health world. They are correct. Mind Freedom's David Oaks sent out a press statement on Monday, calling on advocates of toughened outpatient commitment laws—forced medication, as Oaks terms it—to not turn Fenton's murder into a political cause celebre. In effect, Oaks was taking a preemptive strike at both TAC and NAMI, both of which regularly use every act of violence perpetrated by the mentally ill to call for forced medication of the mentally ill.
I'm with Oaks on this one. Fenton was too important to this field—and well-understood the dicey relationship between meds and human autonomy—to turn him into a cheap metaphor. I hope all involved respond with great delicacy until all the facts are in. I hope that I can include the opinion writers and the reporters at the Washington Post in this, since last time out—following the murder of two cops by a psychotic young man in Fairfax, VA—the paper completely screwed things up. (See this and this, for example.)
Besides, it's not clear to me whose agenda would be served by this case, not at this point. The alleged murderer was seeing a doctor (Fenton was filling in for the patient's regular doc), but it is not clear at this time whether the young man was on meds. I'll do my best to keep an open mind as the facts roll in and the commentariat fires up.
Until then, I recommend contemplation and, failing that, prayer. This is a profound loss. Let's hope it doesn't turn into an even more profound mess. I'd prefer to keep my can of whoop-ass holstered for the time being.