The full report of the state panel looking to the April 16 massacre at Virginia Tech is now online. The webpage is here. I have also downloaded and read the report's section dealing with Cho's childhood, family, schooling, and mental health history. It is a very sad read, but it does seem that many steps were taken to properly evaluate and help Cho throughout his life. I'll have more to say about it another day.
You can read that section here.
At the time of his suicide attempt this past weekend, actor Owen Wilson was reportedly taking anti-depressants. This is according to his attorney. It is not clear what anti-depressants he was on, but I bet there's a pharma company or two biting its fingernails right now. I don't even want to get into trying to tease out what could've driven his behavior since Drew Pinsky (yep, Dr. Drew) went on at length on CNN the other night about how Wilson has had drug addiction issues and how his suicidal behavior may have been driven by that and not depression per se. More on this later.
But, as I've noted before, I continue to find the insistence by some in psychiatry, Big Pharma, and advocacy groups that anti-depressants are a lock-solid anti-suicide technology to be misplaced. Wilson's is just one of thousands of cases to argue against their near-religious views.
Thanks to Sara for passing this along.
A state panel is releasing its report on the April 16 tragedy at Virginia Tech later today. The New York Times got a copy yesterday and reported on it on the web last night. Among other things, the report notes that Cho had selective mutism, a form of extreme anxiety that is sometimes misdiagnosed as autism spectrum disorder.
In addition, the report notes that Cho's violent fantasies can be traced to the 1999 shootings at Columbine High School. Cho reportedly received Paxil (Seroxat) in 1999 and 2000. There is no indication from this report that he received medication after this point.
I have appended some bits from the Times article below and look forward to getting a full copy of the report as soon as it's publicly available. I'll talk more then about the mental health system Cho was briefly in and out of in December 2005. Clearly, the ball was dropped very, very badly in this case. Thirty-two innocent people died as a result.
I should note that back in April, Fuller Torrey and other psychiatrists went on television and proclaimed that Cho was a schizophrenic. Torrey, who heads the influential Treatment Advocacy Center, dubbed Cho a "classic" case. Torrey also wrote an op-ed in the New York Post. At the time, myself and others in the mental health community were furious that Torrey and others were offering a diagnosis that seemed wrong--Cho was a bit too organized for schizophrenia--and suspected that they were simply trying to create an exhibit A for their political agenda of forced outpatient commitment.
Many others also turned Cho into their poster boy for tightened commitment laws, as did Jonathan Kellerman. Hugh Hewitt, a prominent conservative political blogger, also dubbed Cho schizophrenic. Here's a reminder of what people were writing about back then.
Turns out that my diagnostic skills were closer to the truth than theirs as I asserted that Cho struck me as a case of Asperger's blended with psychosis (Asperger's is in the autism spectrum). Torrey and TAC owe people with schizophrenia in this and other countries a public apology, plain and simple. So do Kellerman and Hewitt. I am sick and tired of the knee-jerk assumptions people such as these make regarding schizophrenia.
For myself, I apologize to anyone with Asperger's who may have been offended by what I wrote in April. I was close with my diagnosis, but also I was wrong.
From the article:
"After that massacre, Mr. Cho’s middle school teachers in Fairfax County, Va., observed suicidal and homicidal thoughts in his writings and recommended psychiatric counseling, which he received. He also received medication in those years for a short time, the report said."
And:
"After a judge ordered the gunman, Seung-Hui Cho, to receive outpatient mental health care for making suicidal statements, Mr. Cho scheduled an appointment at the campus counseling center but was given only a pre-appointment interview, the report said, and no follow-up appointment occurred. Records of the interview are missing, and Mr. Cho’s parents were never informed by campus or local officials of his statements or brief commitment to a mental health facility, the report said."
And:
"The report said that in a paper in a middle-school English class, Mr. Cho indicated he “wanted to repeat Columbine.” He was sent to a psychiatrist, who gave him a diagnosis of “selective mutism,” or an anxiety-related refusal to speak, and major depression. He was given a prescription for the anti-depressant Paroxetine, which he took from June 1999 to July 2000, and “did quite well on this regimen.”
I'll leave it at that for now.
Jeff Lieberman, the Columbia University psychiatrist who led the CATIE study, has done an interview with primarypsychiatry.com in which he damn near proclaims the death of atypical antipsychotics. Speaking of various studies of new and old antipsychotics in schizophrenia, he says:
"The advantages of the SGAs to FGAs are appearing less dramatic and consistently, while in other studies the FGAs appear comparable or slightly advantageous."
SGAs are the atypicals, FGAs are the old antipsychotics. The only nice thing he had to say about atypicals was that they induce less tardive diskenesia. Keep in mind that atypicals when introduced in the 1990s were supposed to be the answer to the riddle of schizophrenia--no side effects, no zombieism, perfect control of psychosis. It sure hasn't turned out that way.
And if these drugs are so limited in effect for schizophrenics, then why the hell have the thought leader psych docs set up a treatment paradigm for bipolar disorder and other ailments where these drugs are literally the go-to agent? Why not just use them short term the way old antipsyhcotics were once used in bipolar disorder?
And could someone explain to me why the very high prices on atypicals remain justified?
I smell a rat.
Siobhan Reynolds of the Pain Relief Network debating pain management.
I'm not much for entertainment news even when it does intersect mental health issues. Celebrities are the most overdone, least-important, most-read corner of the media, both new and old. I just cannot get very interested in the bipolar rumors around Britney Spears because it's all just so much vapid speculation. (If she has bipolar disorder, she also has millions of dollars. She'll be just fine. You heard it here first.)
But suicide changes my usual disinterest. Over the weekend, Owen WIlson--a fine actor and, from what I've read, a fairly level guy--tried to kill himself in Santa Monica. Press accounts indicate that he tried to overdose on pills and slit his wrists, and someone called 911 and the paramedics got to the actor's home in time and things worked out as well as these things can work out. Apparently, Wilson has a history of depression and had just had a blowout fight with a close friend. He's in a hospital now.
Wilson issued a statement asking for privacy. He likely won't get much. He's a public figure and the entertainment media and blogs will chew him up and get into his life until Britney goes and does something stupid.
I have nothing special to say about Wilson's situation. Of course, I always scratch my head about how someone with talent, looks, money, and women falling off him would want to off himself. But, then, billionaires have killed themselves. Depression and suicidality and human psychology play games with people of every stripe. As we saw earlier this year with Richard Jeni and Brad Delp.
Very small. As I noted earlier, I stayed up much of the night to watch the lunar eclipse. The skies were clear and the view was stunning, but, since it was after 3 a.m., I was one of a few people watching. The view from my apartment was blocked by trees, so I took a beer and went down to the street where I stood and gaped at the show for a good 45 minutes. A couple of my neighbors were outside as well, one attempting to capture the moment with a digital camera. (Note to neighbor: turn your flash off. Use a very slow shutter speed.)
To me, the most fascinating bit is how the moon looks like a big pearly orb when it is in total eclipse. Freaky. No wonder ancient civilizations used to quiver and shake and pray to whatever god was handy when such celestial phenomena took place.
No pics from me. I don't own a camera.
A young college grad in Texas with an MBA and a future in accounting develops an unspecified mental disorder. His name was Scott Sexton. He gets treated with Zyprexa. He dies due to pancreatitis. His family is suing Lilly.
I am so saddened and disgusted by this news that I have nothing to say. But I want to know a lot more about this young man, his life and what went down here. (Via AHRP.)
I've meant to link to Beyond Blue for some time now. It's one of the many spiritual blogs at beliefnet.com. The author, Therese Borchard, writes about depression, her go-round with the same, and psychology without being bratty or overbearing. She also doesn't write too much about meds. The precise opposite of me, you might say.
Here's a recent post on an interview with Martin Seligman, the father of positive psychology. Like Borchard, I know there are limits to the happy thought strain of psychology, but it is fascinating all the same.
Happiness is a deeply complicated subject and I'll likely be writing about it a bit in the future. Not that ripping apart research studies and banging on the pharma companies and select researchers doesn't make me happy.
Speaking of happiness, Seattle will be under a total lunar eclipse around 3 a.m. We had one in the fall of 2004 that, although obscured by clouds much of the time, was jaw dropping. It's clear here tonight, so I'll stay up for it and likely sit on a grass strip somewhere in my neighborhood (I have no yard and think the moon won't be in view of my apartment at that hour). If I am in the mood for it, I'll likely sit there and drink a beer.
Then, I'll be happy in my blue-moon sort of way.
Since it's a slow week, I thought I'd let readers know about what search terms drive non-regulars to this site. I am fascinated by peoples' searches because it tells me a lot about what's going on in the mental health world, at least on the patient end of things.
Over the last month, I've gotten a couple of hundred visitors looking for information about "lamictal withdrawal." People put that search in Google and I come up as one of the top hits. Same thing with adhdroadmap.com. People go to the 'Net after seeing an add for that site, pump in that term and I come up again as a top search. The nice folks at Shire ought to know that people aren't just going to their site, but are looking for skeptical information.
Interestingly, there haven't been so many Cymbalta searchers of late, but there sure have been a lot of ones for "snorting Seroquel."
Fascinating stuff, I know. Or maybe not.
Scientific Misconduct has an excellent post up about the Rita Pal case. For those of you who missed the fun here the other day, the background is right here. Since Aubrey Blumsohn is based in the UK, he appears to have even less patience for the British medical establishment than do I or many of you.
I am stunned by so many things in this case, particularly by the ignorance shown by the General Medical Council and the British Psychological Society of who the Internet works and how media works a bit differently on the 'Net. The short story is that once a document of some kind finds its way to the online world, then authorities--governmental and otherwise--generally lose control of said document (there are plenty of examples of this, including the Zyprexa documents case of the past year) and are on a fool's errand to try and put the horse back into the barn, as it were, and to try and intimidate people from leaking things to the 'Net in the future.
One bit of wisdom from Judge Weinstein's ruling on the Zyprexa documents back in February was the Judge's public acknowledgment that the Internet is about free speech and that it's a bad idea for judges to attempt to control such. Because their control of a medium that can be produced and published by literally anyone is very limited. To whit, the Blakemore-Brown transcript, which is at the center of the Pal/GMC fight, was downloaded by another 110 people in the last few days. Almost 1,000 people have now read what the BPS doesn't want them to read.
I'm just saying.
Two days ago, the FDA approved the atypical antipsychotic for use in treating schizophrenia in children and teens aged 13 to 17 years old and in treating bipolar disorder in children and teens aged 10 to 17 years old. Several readers have written to ask me what I think. I apologize for the delay in addressing this. I somehow pulled a muscle in my back on Tuesday and spent two days in epic pain (the price of no health insurance and the DEA telling docs what to prescribe for pain). I know quite a few of you out there are pissed off about the FDA's move.
On one hand, I don't think the approval is that big of a deal. Why? Risperdal is going off-patent later this year (it gets patent protection into 2008 for kids) and it's been so widely used off-label in children and teens that I do not think a new indication late in its product life will change much in the way of clinical reality or sales. I haven't chased down the studies used in the approval process, so if someone knows what they are, please pass them along. (Maybe some of my readers from Mass General and J&J would like to help with that.) I also think that FDA criteria for what gets approved are so loose that I could get whiskey approved as a treatment for depression. I'm only half-joking.
I do find it hard to figure out why J&J would spend tens of millions to get Risperdal approved when it has very little time to recoup its investment. When companies spend money like that, they have their reasons. And that brings me to another point.
What concerns me, on the other hand, is that the approval opens the door for the company to openly advertise Risperdal--a drug that I think is unwarranted for anything other than short-term use in bipolar disorder--as a safe and effective treatment for America's bipolar tweens. By which I mean the 10-year-olds to 14-year-olds being diagnosed with bipolar. I'm less concerned about the approval for schizophrenia because there just are not that many people in their early teens who develop schizophrenia. But bipolar disorder is a growth industry in children and teens and you can bet that J&J is going to market the hell out of Risperdal in ads and direct-to-physician sales calls. There will be lots of imaging ads about the disorder and so on. I can assure J&J that my readers are going to keep a close watch on how the company markets this drug for these children.
Apparently, John McManamy--a blogger and author of Living Well with Depression and Bipolar Disorder--is already pitching in to help J&J. In a recent post, he chides the media for describing the antipsychotic as "powerful," basically accusing them of engaging in scare tactics. I don't know what other term you would use to describe an antipsychotic. On their faces, these drugs are powerful, the sledgehammers of psychiatry. But I guess if you speak in front of a bunch of NAMI groups, as John does, then former reporters, as John is, begin practicing a different kind of journalism. And listening to a certain kind of parent to the exclusion of others.
He also goes out of his way to defend Joseph Biederman, the don of the Harvard bipolar child mafia, and kisses up to the Papaloses, authors of The Bipolar Child, to a degree that isn't worth commenting upon. What's funny is that the Risperdal approval isn't technically applicable to the bipolar children (aged 0 to 10 years old) about whom there is much controversy. Speaking of Biederman, Stepahny at Soulful Sepulcher has been doing yeowoman's work digging into the doctor's publication history on ADHD and bipolar disorder. Here's one of her many posts on this topic.
BTW, I am well aware that Risperdal was only approved for short-term (ie, acute) use in bipolar disorder, but as many of us know that translates into doctors who will let patients stay on it for years instead of taking a patient off the drug after seeing whatever short-term results. They do this at their patients' peril, given the drug's ability to cause EPS and neuroleptic malignant syndrome. Sadly, I experienced both after using the drug for a time. I think parents who let their tweens and teens with bipolar disorder stay on this drug for more than a couple of month risk injuring their own children. Oh, yes, Risperdal packs on the pounds, has a black box warning or two, and screws with heart patterns.
The drug is powerful stuff, after all.
I wonder how all the autistic kids who've used the drug have turned out.
UPDATE: Speaking of sycophants, the American Psychiatric Association is out with a statement in which it "applauds" Risperdal's approval. I've never known the APA to tout medication approvals this way before, so I must ask, WTF?
Yesterday, a British reader passed along an article from the London Register because my blog had been mentioned in the article. The story behind the article has serious implications for academic freedom in medicine in the UK and likely elsewhere as well. A British doctor named Rita Pal who writes for the NHS Exposed blog had linked to a document on this website. She's lost her job over this, and the General Medical Council, which regulates doctors in the UK, is investigating her. She's taking her case to the British High Court.
You'll need a brief refresher course to make sense of this, so here goes.
Some of you may recall that this past February, during the height of the Zyprexa scandal, I briefly wrote about the case of Lisa Blakemore-Brown, a British psychologist. She'd caused quite a stir in medical circles in the UK for challenging the validity of Munchausen's Syndrome by Proxy (MSP). MSP is an odd psychiatric diagnosis--a hospital addiction, in essence--and has been used in the UK to convict some citizens of felonies such as killing their own children. MPS strikes me as being along the same lines as repressed memory. Such "evidence" was admitted into courts in this country in the 1980s. Many bogus child abuse cases and convictions resulted before the evidence was proven to be eyewash. Blakemore-Brown denounced MPS and some doctors who believed in the diagnosis. As a result, the British Psychological Society decided to hold a fitness-for-duty hearing on her. Of course, she'd have to be insane to think as she did much less to speak such thoughts publicly! (The excellent blog Scientific Misconduct has documented the case exhaustively here.)
The hearing was held in private much to the frustration of some British doctors who wished to attend and write about the proceedings. Eventually, an anonymous reader forwarded me a copy of the transcript. I read through it, decided that the hearing was a rigged process, ascertained that the document was genuine and I posted it on my blog. This came roughly 10 days after I had posted the leaked Zyprexa documents on this blog. I then turned my attention back to Zyprexa matters and watched as hundreds of people began to download the Blakemore-Brown transcript. The BPS had deemed that document confidential and fought Blakemore-Brown's attempts to have it made public in the UK, so that the public could reach its own conclusions about how the BPS was handling her case and the entire MSP controversy.
The transcript continues to be available here.
Among other things, the BPS had used as evidence against Blakemore-Brown testimony from a psychiatrist who had never examined her. I saw the whole affair as having implications for academic freedom, regardless of what one made of Blakemore-Brown and the accuracy of her claims. Doctors have a special place in our societies. They are supposed to warn the public about bad medicine and those who practice it. Among other things.
Apparently, there was some interest in the document. Rita Pal linked to the document from her blog. Soon after, she lost her post at Worcestershire NHS Trust in early May. Her bosses had learned she was the subject of a General Medical Council investigation for linking to the document. I guess it's trendy at NHS hospitals to not have ethical opinionated doctors. Anyhow, Pal and her lawyers are taking her case before the High Court in an attempt to thwart the GMC investigation. I wish her luck. I'm glad the Register has seen fit to put some of this case out into public view.
I would expect that others in the UK are appalled by these events. I have no idea what American medical bloggers, especially doctors, make of the case. Aside from CL Psych who's been quite outspoken, they've largely been quiet. But remember the baby witch hunt that some in the blogosphere and media tried to start around Steven Nissen, a cardiologist at the Cleveland Clinic, who warned that the diabetes drug Avandia carried increased heart attack risks? No one questioned his sanity--at least not publicly--but some questioned his credibility in sharp terms. How the critics could ignore the crucial whistleblower role that docs are supposed to play on medical matters is beyond me.
Fortunately, our academic medical culture in the US is a bit more open and free than its British cousin. In the UK, David Healy has been attacked--and people have attempted to muzzle him as well--for questioning just how much suicidality SSRIs have induced in patients who've taken them. Here, things are a bit more under the surface. God knows, some American docs will write their colleagues off as quacks if they don't hew to certain treatment orthodoxies in the mental health world and will refuse to refer patients their way if they were, for example, to question the effectiveness of atypical antipsychotics. Which is exactly why several psychiatrists in the Seattle area have refused to talk to me on the record about these medications and their alleged overuse in children and adults.
One of the few doctors to stick his neck out over Zyprexa was David Egilman, the doctor who allegedly leaked the Zyprexa documents out of a court seal to the New York Times last year. It's not clear what price he'll pay in court or what price his alleged co-conspirator Jim Gottstein might pay. Eli Lilly has yet to formally move for sanctions against either.
No matter what, this environment is just chilling. If a British doctor can get jammed up over linking to a document indicating misbehavior by medical authorities, then what can happen in the States? I hope to never find out.
UPDATED: Based on Katie's comments, I poked around and did some more research. According to the FDA's congressional testimony about rogue Internet pharmacies, it looks like my initial numbers were - although not exactly accurate - not nearly as wildly off-base as I feared. While Katie is clearly correct in noting that, for example, a hydrocodone tablet only contains 5 milligrams of narcotics, Joseph T. Rannazzisi, the Deputy Assistant Administrator for the DEA's Office of Diversion Control referred to "dosage units of hydrocodone combination-products" ... specifically, 98,566,711 units prescribed by rogue Internet pharmacies in 2006. When multiplied by 505 (the total milligrams in a single dose of hydrocodone, including the anti-inflammatory and narcotic components) and then divided by 302,665,263, the result is 164 mg per person in the U.S. Based on these statistics, I stand by my original comments, considering that brick and mortar pharmacies continued their strictly controlled disbursement of narcotics, even according to the DEA's own information [PowerPoint].
Now, I would really like to see the report that the AP based its story on because the DEA's Congressional testimony seems to support my rough calculations while, if Katie's point is true, 300+ mg of narcotics for every American calculating ONLY the narcotic component of a "combination-product" means that my grossly over-simplified title is far more true than not (to the tune of more than 151 million one-month prescriptions, using the math of 300 mg multiplied by the U.S. population, then divided by 5 mg and divided again by 120 doses, a typical one-month supply or, if you divided by 12 to get a number for a full year, 12.6 million full-year supplies of narcotics), and that's way too much junkie business.
So we clearly have a discrepancy here with only a very few explanations:
1. Someone screwed up their math.
2. We're seriously fucked up and might as well turn our offices into shooting galleries.
3. Your best guess goes here because I'm fresh out of anything reasonable.
Many thanks to Katie for raising the question that prompted this additional research. On with the original story.
I'd like to begin with something pithy, but I can't think of any humorous anecdotes which don't involve Brenda Spencer today.
I woke up this morning, went to physical therapy and then went to my soon-to-be-stepdaughter's first day of school. My spinal cord stimulator was on for most of it and I still came home and took a painkiller.
Then I sat down to check email and found this lovely news item:
AP: Pain Medicine Use Has Nearly Doubled
Apparently, enough pain medication has been prescribed during the most recent recorded year of DEA statistics to give every American more than 300 milligrams of painkillers. In practical, everyday terms, think of that as slightly more than half a tablet of Vicodin. I'm more concerned about alcohol consumption and text messaging while driving
than what amounts to 1.5 million one-month prescriptions of Vicodin (estimated at 500 mg per tablet with an average of 300 million citizens and 4 tablets of Vicodin for a 6 hour dosage interval for 30 days). Basically, those numbers are misleading because - using very rough numbers here - it means approximately one-half of one percent of the population of the U.S. received a prescription for painkillers in the DEA's most recent statistics. Of course, the DEA isn't providing information about how many surgeons used an invasive procedure to remedy a patient's health concern during the same time, nor is the DEA providing any information about the number of terminal cancer cases treated during that time (UPDATE: More than 550,000 U.S. citizens died from cancer in 2007 alone), so it's difficult to gain any idea of how many truly questionable prescriptions were written, but gosh, 300 milligrams per person sure sounds like a lot, Wally!
For those of you who remember Quantum Leap, "Oh boy."
Or, perhaps more accurately (and certainly more appropriately), "There are three kinds of lies: lies, damned lies, and statistics."
Sure, there are some doctors out there who over-prescribe painkillers, but the problem is that most articles about this issue give the impression that the problem is more significant than it is; that there are hordes of doctors out there turning good American citizens into zombie addicts when really, the number of doctors who improperly prescribe pain medication is quite small and the patients who become addicted were abusing their medication instead of taking the recommended dosage at the recommended intervals purely for the purpose of alleviating breakthrough or otherwise unmanageable pain.
However, this perception has a number of ripple effects:
1. As noted in the article, some pain management doctors are so concerned about possible DEA investigations that they refuse to prescribe pain medication of any sort. While every pain management clinic that I've been to has prescribed pain medication, every one that has been willing to prescribe narcotics has also required me to sign a contract stating that I will not seek or accept any sort of narcotic relief from any other source. Earlier this year, that resulted in me sitting in an emergency room at midnight on a weekend getting injections of non-narcotic pain relievers to deal with breakthrough pain and calling my doctor on Monday morning to let him know what happened and why. I can't argue with the contract - it makes it much easier to detect drug-seeking behavior and the potential for abuse.
2. Patients in areas without a doctor willing to take effective steps to manage chronic pain may have to travel extensively to find a doctor willing to treat them appropriately, as the case of Sean Greenwood illustrated. This may look like drug-seeking behavior, but what else is a patient with intractable pain supposed to do? I'll grit my teeth and suffer because I have the larger goal of being able to advocate for pain management reform from a position of moral, ethical and legal credibility in mind; I don't expect anyone else to take that course of action, nor do I expect people who care about a patient suffering from chronic pain to stand by and do nothing. As medical science progresses, more conditions are identified and these conditions, such as fibromyalgia, are not always accompanied by clear-cut diagnoses supported by hard medical evidence. This doesn't mean that the pain isn't real or that the patient isn't suffering - just that a doctor can't point to a lesion on an MRI or report from a biopsy to explain why a patient is in pain and prove it conclusively. When you also account for variables in quantifying pain levels due to the self-reported nature of pain surveys and the spectrum of potential responses (and the inherently qualitative nature of those responses due to varying degrees of pain tolerance), things get very fuzzy and it's difficult to tell which patients are in desperate need and which are exaggerating the severity of their condition, contributing to federal efforts to marginalize pain management practice.
3. It encourages off-label use of other medications. It also encourages pharmaceutical companies to conduct clinical trials to determine whether a given medication can be considered effective in the treatment of other conditions. It's easy to understand why pain management practitioners would welcome additional pharmacological options - after all, I'm not aware of the DEA prosecuting anyone for prescribing Cymbalta, Elavil or Lyrica, among just a few options that I've been prescribed and that are commonly used as non-narcotic treatments for chronic pain. Unfortunately, medications such as Cymbalta do not have nearly the body of clinical knowledge around long-term effects that more traditional opioid agonists do. The simple fact of the matter is that medications like Cymbalta, Lyrica and so forth haven't been around for sufficient time to let us know what the long-term effects may be. By comparison, codeine, morphine and semi-synthethic opiates like hydrocodone have been around long enough for us to understand exactly what the long-term risks of ongoing use are. In essence, the fear of DEA prosecution is encouraging doctors to forgo tried and true methods which present a limited set of known and clearly understood risks in favor of newer methods which present an as-yet unknown set of emergent risks that extend far beyond dependency and into potentially permanent physical and psychological problems.
For a patient who is already suffering from chronic pain, what could be worse than medication prescribed to treat a condition working instead to expand the set of problems that they suffer from?
And yet this, for all practical purposes, is what pain management has been like for some years.
Simply put, it's a mess.
I'm lucky in that I have MRIs which show at least part of the cause of my pain, a doctor who conducts clinical research studies and is willing to try alternative treatments, and a medical jacket which shows that I have tried non-narcotic means of alleviating pain for more than a year with limited success before returning to narcotics. Not everyone has those advantages when trying to treat their chronic pain.
Some people have more or less credulous doctors, more or less documentable pain, and so forth.
I don't think I've put it quite this bluntly, but I feel very fortunate.
Liz Spikol has a good post on a state hospital being closed in Pennsylvania, her concerns about how deinstitutionalization has been screwed up in the past (you know, the epic screw-ups of the 1980s that birthed tens of thousands of homeless people, etc.) and a report from the Kaiser Foundation on how it can be done better. So go read.
Personally, I have written so much copy in my career on the whirlwind we've reaped as a result of deinstitutionalization that it pains me to see where it could get screwed up once again. Even on a small scale. The solutions are pretty damn simple and are mostly driven by adequate housing and health care delivery. The Treatment Advocacy Center crew would have you believe that these screw-ups have been as a result of patients not taking their meds and that all anyone has to do is take their meds and we'll end homelessness in America. That's so far off-base that it would amuse me for hours detailing how. But I don't have the time to get into it right now.
Ben Carey has a fascinating piece in the New York Times about the four years of academic backlash suffered by a psychology professor at Northwestern University after he published a book in 2003 pointing to some evidence that transgenderism might not be driven by genetics--the politically correct version of reality--but by desire. A witch hunt ensued with accusations of rape (why does rape always get trotted out in the gender studies world?) and bogus research and ethical improprieties. None of which proved out. But the man almost lost his career. None of which seems to matter to his accusers.
An interesting article, which scrapes the surface of this weird dynamic that's grown up in academia since PC-ness crashed on its shores 20-odd years ago. Let's just say that anyone--especially a man--who dares to challenge the supremacy of the "we're all victims and here's our theory, give us tenure or we'll sue" crowd is going to find themselves in the shit pot tout suite. Just ask Larry Summers. (Yes, I considered his comments off-base, but you either believe in academic freedom or you don't.) Or the professor at Northwestern.
Once upon a time, I unwittingly collided with the PC crowd at UC Berkeley. It was a most unpleasant experience and I paid a price for it. But that's for another day.
About a month ago, Shire began running a fascinating imagining television ad for a website called adhdroadmap.com. Shire is "your ADHD support company" and makes Adderall, the Daytrana transdermal patch and Vyvanse. I saw the ad again early yesterday morning on CNN--it was running around 5.30 a.m. EST--and noted how much the campaign resembles the Microsoft "we see your future" ads from a couple of years ago. Which is to say it's filled with all sort of bright, shot on film images of creative, wonderful ADHD kids and a glistening soccer mom overjoyed with their creativity and wonderfulness.
Unless I missed something, I think this is the first-ever television ad in the US for ADHD. You can view the ad online here.
It's like Shire has gone over into the Indigo Child camp. (BTW, the Indigo crap is the biggest bunch of bull I've run into in ages.) As one of the chirpy kids notes in the ad, "I don't always follow directions but someday I'll be on the board of directors."
Somehow, I doubt five-year-olds have advanced so much in recent years that their daydreams are filled with corporate boardrooms. But I'm sure their parents would like them to be. Whatever happened to kids wanting to be baseball players and firefighters and astronauts?
The ad features a multi-culti array of kiddos jumping around and painting pictures that no child could possible churn out. At the end, some kid has a trophy held aloft over his head. It's a roadmap for success. Four easy steps! Call for your free roadmap today!
Anyhow, the ad directs viewers to the adhdroadmap.com website and if you register with them, the company will send you an info pack. You bet I registered! Once you register, it takes you to a page of "tools." ADHD isn't my area of expertise, so I merely pass all of this along to show you all how much money pharma companies are willing to spend on creating markets. And to show just how weird our culture has become when we have pharma companies advising parents on how to manage their children. "Create a schedule. Try to follow the same routine every day" advises the Shire site and then proceeds to tell parents how to talk with their child's teachers.
Perhaps, I am old-fashioned, but I think companies overstep their bounds when they start dipping into telling people how to manage their children. Or are parents that clueless these days? And is our society becoming that Orwellian?
It turns out that the State of Minnesota has one of Eli Lilly's monitoring programs for use of psych meds. Here's an article from the St. Paul Pioneer-Press on the program. Some of the usual defenses and critiques are offered. Personally, I find it confusing that the states which have these programs cannot keep on top of their psych med utilization in their Medicaid programs on their own. But that's just me.
And thanks to those of you who passed the article along.
Anne Duffy, a psych researcher at the University of Ottawa, has a fascinating paper in the Canadian Journal of Psychiatry. In it, she debunks the Harvard bipolar child mafia's claim that bipolar disorder exists in children. I'll leave it to smarter readers to dive into her paper (pdf here) and tell me what she missed in her report. For me, she gives further weight to my contention that the Harvard researchers are engaging in leading the parents of a generation of children down a very ugly road.
The upshot of Duffy's paper is that bipolar doesn't exist in young children, but manifests in adolescence.
I wasn't able to give the paper the close read I would've liked--printer problems--but I'm sure it will cause the appropriate stir. And that the Harvard crowd will once again brag about how many papers they've co-authored as proof of their supremacy.
Duffy's paper won't be anything close to the final word, of course, but it is a shot for sanity in the profession.
Here's Duffy's conclusion:
"There is a lack of supporting evidence for the hypothesis that BD, as currently defined, exists in very young children. Clearly, in some cases, there are prodromal psychiatric disturbances in early childhood antecedent to the manifestation of recognizable BD. BD often starts in adolescence with an index episode of major depression. As described above, in some patients, there may be earlier, nonspecific prodromal symptoms, including anxiety and sleep and cognitive disturbances."
And:
"Chronic fluctuating abnormalities of mood, overactivity, and cognition and conduct disturbances have been described in very young children. Whether this syndrome represents an early variant of BD or some other psychiatric disturbance is at this time unknown and requires further research. In the early stages of BD, the presenting symptoms are nonspecific and not limited to the mood spectrum. Therefore, it appears that the risk of BD is best predicted, not by the presenting psychopathology but by the clinical course and family history."
Let me know what you guys think.
And that's just discouraging. The suicide rate among US Army soldiers is now a bit over 17 people per 100,000. That's about 50 percent higher than the rate in the general population, but is right in line with the rate of suicides among men in the general population. So it's discouraging all around.
If anyone thinks a bunch of pills will address this problem, they are deluded. They might help short-term, but they are hardly a long-term buffer.
In other news, Writhe Safely has fun dissecting the Treatment Advocacy Center's job recruitment ad.
An interesting press release on a law prof at USC who has schizophrenia and has written a book. I had never heard of either until now. Good for her for getting this far in life.
Here's an abstract to a BMC Psychiatry paper surveying the use of atypical antipsychotics in bipolar disorder. I cannot determine much from the abstract, but I'm sure the full paper shows your basic greater efficacy than placebo results. Nice for the short-term, but for the longer-term? Oh wait, there are hardly any long term studies. Hmmm.
As we used to say about bands in the 70's and 80's--"Nazareth is so commercial now, dude! How can you listen to them?"--will perhaps now be said about me. I have just pasted Google ads on this site. I am not sold on their location--so offer suggestions--but for the moment I am going to leave them on the right. I haven't the faintest idea how much revenue these ads will generate--not a lot is my guess--but I want to see for myself.
The PayPal button continues on the top right, of course.
An interesting piece on online support groups for all manner of health conditions from the Orlando Sentinel. John Grohol from PsychCentral is quoted and offers a bit more on what is now such a phenomenon of the Net that the mainstream media is now paying a bit of attention. What interests me is just how rapidly such groups--and, peripherally, that includes blogs such as this one--have grown in the last few years. In the mental health world, a lot of credit for this should go to Grohol who started PsychCentral back in 1995 and had been online more informally on old BBSs and such in 1991.
I think that the reporter misses a few components of what's driven online health groups and websites--especially the patient-run ones--and that's that the software to run these things is cheap (sometimes, it's free), that broadband access of some kind is readily available in most urban areas in the US (and is fairly cheap compared to what bad old dial-up once cost), that decent high speed computers are much cheaper than in the past, and that people love nothing more than to bitch with--and at--their neighbors, virtual and real, about health. And politics. And sports. And food. And whathaveyou. And that patients often know as much about what works for them medically as does your average doctor, specialist or generalist. I say that in as un-arrogant a way as possible (I know such talk pisses off some docs and healthcare types), but it's clear to me that there's a place in America's--and the world's--healthcare paradigm for peer specialists, as opposed to something like WebMD.
The Net is strangely mirroring human reality.
Think I am joking? The other day, I ran into an acquaintance who's had some recent battles with depression. This person strikes me as someone who could use some good old fashioned therapy, but that's not what their employer's medical insurance is down for--six therapy visits a year is laughable, and all too common, coverage--and so they were sent to a physician's assistant and the PA put this person on Effexor. As a first choice. Yikes. When the patient had a crappy reaction to the drug, the PA put them on Wellbutrin and ordered the Effexor stopped without tapering. The patient had all the usual problems with Effexor withdrawal--could barely think, for one--and then the Wellbutrin made them "manic" and then the PA had told them they had bipolar disorder, owing to the classic anti-depressants-spin-up-bipolars phenomenon which is now apparently passing for a diagnostic tool in some quarters. Yikes!
I asked some questions. I criticized the PA--PA's can prescribe in my state--for turning to one of the worst anti-depressants to begin a new patient on. And for fucking up taking the patient off it, for saying the withdrawal symptoms would be masked by Wellbutrin and then using the whole affair as a tool to tell someone they have a lifetime disability and need to take medications for the remainder of their lives. It was clear to me that the patient had not been manic--no hospitalization, no bizarro delusions, etc.--but had experienced something that was either hypomania or medication-induced hypomania. There had been no massive psych crisis going on. One of those cases that present to PCPs and the pharma companies describe as bipolar disorder 2. And off the patient goes with a script of Zyprexa or Seroquel or Paxil or Effexor. And a year later is wondering why things are still messed up.
"You need a second opinion," I told this person. And pressed them to go see a real live specialist of their choosing. Therapist, psychiatrist, whatever. Someone who knew how to diagnose and was a bit less aggressive with their gun slinging. Pay for it out of pocket if you have to, I told them.
I seriously doubt this person would've gotten such advice from WebMd or some pharma-sponsored site like depression.com. Which really operates as a portal to pills.
Grohol also writes about Google and Microsoft's plans to tap into users' obsessions with health and offer some kind of personal medical software. Or something. It's a bit unclear what they are after, but these guys will chase any advertising portal that opens up. Much as newspapers and radio and TV have. John's somewhat dubious of their plans. So am I. What amuses me is that some of my near-neighbors are inevitably working on the technology--and that they are out of their minds if they think millions of Americans want to put such details online. Blogging is one thing. Putting your medical history online in bankbook detail strikes me as something else. At least for the average person.
Speaking of average, here's a patient diagnosed with bipolar disorder concerned about muscle spasms they've developed after taking Risperdal at 1 mg. for five months. I've said it before and here goes again: atypicals should not be used long-term except maybe for people with actual chronic psychosis--and that ain't bipolar disorder most of the time--because they just cause too many problems for too many patients. Muscle spasms, EPS, TD, diabetes, weight gain. Fun stuff like that.
Speaking of problems, here's a mother of a 10-year-old who's been diagnosed with ADHD, oppositional defiant disorder and, now, bipolar disorder. 125 mgs. a day of Seroquel plus Adderral. We live in quite a world these days.
Which brings me the fine Experimental Chimp blog popping AstaZeneca for an interesting editing job on Seroquel's Wikipedia entry. I wonder how much pharma companies pay marketing types to go around and do that sort of thing.
All of which shows you that at same point, the pharma companies will always try to impose their edits on user-run medical information.
Yeah, the Net and computing have sure grown up in the last few years.
The FDA is ordering Pfizer to pull an ad for its injectable formulation of Geodon because the company omitted significant warnings about diabetes--the black box warning that regular Geodon carries, for example--and claimed that the drug was more effective than Haldol. The FDA says there's no proof of that. And so on. The ad appeared in an unnamed journal.
Pfizer has had no comment so far.
Back to my docs today for all sorts of fun.
In the wake of last week's post about Cymbalta withdrawal, I listed all the side effects I was feeling, complete with descriptions. I printed out information about those side effects from various sites, including those sites that translated Eli Lilly's seemingly benign commentary about "sensory disturbances." I walked in with guns and bandoliers of ammo, ready to stay a while, not unlike Pike Bishop confronting Mapache.
And this is why I love my pain management doctor.
I handed him the printouts and he started reading them. He listened to me describe what was going on. I talked about the anecdotes and experiences of patients weaning off Cymbalta and other SSRIs and SNRIs and their methods to make the withdrawal as easy as possible. And, as usual, I pointed out that I obviously don't know where in the pain management pipeline I am compared to his other patients but, given that it was only approved for use in 2004 and I'm coming off it in the middle of 2007, I'm guessing I'm one of his first patients to do this, so right now, I'm the tip of the iceberg. And by the time I said that, he had already added all of this to my chart.
I couldn't have been happier with his reaction - which was action. He was writing notes, making plans to talk to colleagues who have researched SSRIs and SNRIs to identify how best to deal with the gap between 20 mg and 0, whether using a solution or another med. If the brain shivers haven't stopped in a couple of weeks, I'm off to one of the nearby medical schools or Chicago for PET and functional MRI scans because I can trigger the shivers through rapid eye movement so we can actually induce the condition. Like me, he's kind of curious whether anything will show up ... and what it would mean if it does.
While we both know that there's little he can do for me, this isn't exactly about me anymore. This is about working together to make things easier for everyone who comes after me, about his next patient who comes off Cymbalta and letting them know what might happen ... or being able to develop a better weaning schedule so it doesn't. And my approach to this is that I'll take the hit for the team if it will yield clinically or diagnostically useful information. Someone has to be first and it might as well be me because I know I can shake it off and get right back in the game.
And I thought all those years of hauling amps and sleeping on concrete floors and focusing on leaving everywhere better than I found it so the next band coming through would also be welcome were only quixotically noble.
I walked out of my doc's office today with an order for a full blood screen and liver panel. I walked out of there feeling like, whatever else I did that day, I had accomplished something. It may be a bit too late to treat my symptoms, but I've gritted my teeth through worse and, most importantly, my doc now has more information which he can use to help the next patient get through this more easily.
And that'll do, pig. That'll do.
For now.
Today is my 45th birthday. In some ways, the timing of my off-meds experiment was on purpose--although this is the right time of year to give it a go--and a gift to myself. The experiment continues to go better each week. Last week was very good overall, but I still don't feel 100 percent yet. One hundred percent of what? you ask. Whatever it is that I expect. I'll know when I get there.
Now, that I have been off Lamictal for a bit over three weeks, I had the first recallable dream I've had in ages last night. I've had recallable nightmares--especially on Seroquel--but not what most of us would think of as dreams. Last night, I dreamed of a scene from an article I just finished writing--I'll get into that closer to its publication date--and I bought an old Ford F-150. Then, I went fly fishing. Don't remember what I caught. Nice dream all the same.
I wonder how surprised my psychiatrist will be when I lay out my Lamictal withdrawal experience later today. I continue to be amazed at the 50 people or so each week who read my Lamictal withdrawal posts of last month. Something is up.
Anyhow, there's been a bunch of good writing out there in the mental health blogosphere.
CL Psych, who like me is on a bit of a break from constant writing, notes that Wyeth's antipsychotic was not approved by the FDA. He also passes along this epic post by The Last Psychiatrist concerning antipsychotics and dopamine occupancy and why drug makers and doctors shouldn't talk about efficacy. It's great funny stuff. Oh, yes, giving people two antipsychotics at once isn't such a swell idea either. He's one of the few people who can make the theoretical end of psychopharmacology interesting.
Will Meek at PsychCentral on job stress and depression in the UK.
Peter Rost is pretty much a rock star in the pahrma blogging world these days. Here he is being quoted in the Los Angerles Times in the paper's series on how Big Pharma creates drugs to treat conditions and, then, goes out and markets the conditions, sometimes creating astroturfing groups in the process. Hm. Have I ever said anything around here like that before?
That's all I've got time for right now. It's good to be away from writing for a while every so often. I need to recharge and dream.
It has been a long time since I've posted anything here, largely due to surgical interventions to address my chronic pain, filing for disability benefits, physical therapy and a laundry list of other things that have been taking up my time as I'm trying to lift up the derailed train of my life and get it back on track.
And with a lifting limit of 15 pounds and all sorts of motion restrictions, I really shouldn't be trying to lift anything at all. That's part and parcel of having become a bionic man and running electricity straight into my spinal column to induce parasthesia so that my back doesn't hurt as much.
Wait ... you did WHAT?!?!?
That's right. I channeled Steve Austin and even though I may not be better or faster or stronger, I don't hurt as much. Let me 'splain.
After months of ineffective medications, constant pain and fighting with insurance, my pain management doc and I decided to do something relatively experimental and implant a spinal cord stimulator. The short explanation is that it's a little battery that runs an electrical current into my spinal cord to intercept pain signals before they reach the brain. It's a pretty nifty little device, but my doctor and I were looking at using this to treat a condition that it isn't frequently used to treat. We figured that if it worked to some degree, we could delay more permanent surgical procedures until better treatments come along.
So in we went. Here I am, almost two months out of surgery, and I have a battery implanted in my hip with leads implanted in my spinal column and a remote control that looks like a garage door opener to control the whole shebang. Since I have to point it at the impulse generator, it might as well be a remote control for my ass because that's what it looks like.
Somewhere along the road, my pain management doc and I returned to using narcotics to manage the pain. I rolled off the Lyrica, Elavil, Klonopin and all the other fun drugs that wrecked my sleep schedule, gave me nightmares, didn't block the pain, etc. My pain management doctor, pain management counselor, physical therapist and I all worked together to develop a comprehensive, holistic treatment plan that incorporated dieting, stretching and flexibility exercises derived from yoga and pilates, resistance and cardiovascular training, a consistently decreasing regimen of medications and constant check-ups to make sure the plan was still working.
And all of these things were necessary. Although my weight gain was trivial compared to many reports of what happens to people on these meds, I still gained over 35 pounds (so far, I've lost 15 of it). Although I'm not doing any power-lifting, the resistance training was crucial to rebuilding lost muscle. And so on. And so forth. And so it goes.
And then, after following a carefully planned schedule to roll off of the medications to reduce the impact, I came off Cymbalta completely on July 30, taking my last dose before going to sleep on July 29.
To say that the week and a half since have been an interesting ride is a bit like saying that John Holmes fucked a couple of people. Technically true, but the order of magnitude is so much greater than can be explained that it's best just to leave it at that.
However, here's my life over the past several days:
1. Insomnia and inability to stay asleep when I go to sleep. I've sent Philip way too many instant messages at 3 a.m. lately. I've averaged around two hours of sleep per night since last Friday or Saturday. I don't think I've had a single full REM cycle in that time. Wrecked? Not so you'd notice, as long as you're used to zombies staggering about your abode groaning "Braaaaains ..."
2. Nightmares. When I do get to sleep for the hour or two of unconsciousness I seem to get at any point, it doesn't really matter since I wake up more tired than before because my dreams were things of filth and horror. I can't remember them in particular, but the dread of descending into a cave occupied by a cult for one of the Elder Gods near Miskatonic University doesn't seem as threatening.
3. "Sensory Disturbances." God, what a euphemism and what a set of fucked-up side-effects it describes. The Saturday before I went off Cymbalta, I tried to kick a soccer ball around a local park with my fiancee's daughter and overdid the level of physical activity a bit, so when I was hurting for the next few days, I was worried that I had displaced the spinal cord stimulator leads and might need to have them adjusted. At least, that's what I thought until I searched for Cymbalta withdrawal on a lark and found a handful of Web pages describing some of the known issues with stopping a regimen of SSRIs / SNRIs, including this little gem:
Now, this page is on Wikipedia, which I don't always trust because it often strikes me as scientifically unreliable; however, I can't ignore the fact that this page describes EXACTLY what I've been feeling. Anecdotal? Well, sure, maybe for a doc whose patient is describing these symptoms, but for me, they're fact. This is what I've been dealing with since I stopped taking Cymbalta, this is what I've been living with for the past several days during which the effects seem to be worsening, and this is what I'm dealing with as I write this post, because every time I look down at the keyboard to make sure my hands are where they're supposed to be, it triggers another one.
4. Mood swings. I normally have a great deal of patience for my fiancee's daughter. She's a great kid and I love her to pieces. Yet over the last week, I'm almost forcing myself to withdraw because I go from zero to a five-minute time-out at the moment when I first hear the initial hint of a snotty comment coming out of her mouth. My patience doesn't exist right now. My fiancee came back from visiting some friends for a couple of days and was frustrated that - in spite of all this - I hadn't done anything to pick up the apartment in her absence. As I told my counselor yesterday, I went from zero to fuck you in nothing flat then - after I was done stomping around and growling like a dinosaur - I went to bed and cried myself to sleep for the two hours of restlessness that passed for unconsciousness on Monday. Today, I had another nice little crying jag about this mess. While I'm sure the insomnia and nightmares aren't helping, this is really just beyond the pale.
5. Night terrors / sweats. I keep hearing these two terms thrown about in relation to each other and I'm not entirely sure which one is correct, but I might as well wake up wrapped in a towel that had been soaked in a sink filled with cold water. Suffice it to say that it doesn't improve how I greet the day, or whatever portion of it I have to confront, to wake up feeling like I had jumped into a pool with all my clothes on.
I have said several times over the past week that, if I knew then what I know now, I would never have shifted from narcotics to psych meds to treat chronic pain. I've gone through withdrawal and I know how much it sucks. It really isn't even remotely fun. However, compared to this, opiate withdrawal is like a trip to Disneyworld because at least sedation helps get through the worst parts.
This?
I got off the phone with my doctor's nurse earlier this afternoon. After describing what's going on to her, she mentioned that she might be able to get me a few doses of Lunesta to at least address the insomnia and I asked her to double whatever dose I was on before because Lunesta only sort of worked the first time and, putting it very bluntly, I told her that I wanted whatever I take to hit me with a hammer so that I can finally get to sleep and stay that way for a while. In other words, if my dosage was X mg before, I want 2X. I'll only be on it for a brief period, so let's make good and damned sure the shit works. Even if I wake up with a soggy pillow because I started drooling to add to the fun.
And that, at this moment, seems to be the best we can do. My pain management doc was able to trank me down when I was coming off vicoprofen so that I escaped all but the first day or so of opiate withdrawal. This? Well, the treatment regimen for this seems to be, and forgive me for getting a little technical and throwing around some medical jargon here, sweet FA.
Bear in mind, this is just the stuff I can remember right now with a brain that feels like it's sitting on a skillet, "sensory disturbances," a memory that makes a sponge look solid and so forth. I hope that this jagged mess of side-effects passes soon so that I can get back to some semblance of normality.
And, in the meantime, I think it's time to have a liver / kidney screen done to find out if anything has changed significantly as a result of these meds.
I'm trying to resume writing and to do so more frequently, but it's difficult; this post has been well over 12 hours in the making for nothing more than several hundred words describing my personal experience. As I realized the other day when trying to do some work on my Web site for the first time in more than a year, I could barely remember how to begin. And when I combine all that with the insomnia, with the inability to get a decent rest, with the pain which can still be quite debilitating, with all of the rest ... well, writing, an activity that was always a refuge for me in the best and worst of times, now seems like someone I used to know who has changed so much that I can scarcely recognize them.
And through this all, I have to laugh any time someone from the SSA or the law firm representing me asks whether I've gone through any workplace retraining programs. I had the lightest duty job in the world as a consultant. I can't retrain to go work in any industry or sector which requires lifting over 15 pounds - I could probably kiss the rest of my discs goodbye. And how in the hell am I supposed to retool when the issue is that the discs in my back are gone and the meds that I was told to take to alleviate the pain have destroyed my short-term memory at least temporarily? I can barely remember how to get started writing - when I do, remembering what I want to say is tough. And I'm supposed to believe that a class which will supposedly teach me a skill or set of skills will somehow make all of this better?
I call bullshit.
And with that, I need to try to rest a bit. Perhaps unsurprisingly, I'm exhausted and about ready to go face down on the keyboard. I'm sure I'll write more on all these as things clear up and I'm better able to translate my thoughts to the keyboard.
In the meantime, I am that poster of a wistful-looking cat clinging to a branch with "Hang in there, baby!" printed on the picture in Cooper Black. Some days, it seems like hanging in there is all I can do.
Recently, I wrote about yet another case of forced ECT on a psych patient in New York State. Thanks to much pressure from members of MindFreedom International and likely readers of this and other mental health blogs as well, the patient's lawyer reports that the state is not going forward with the procedure.
Since posts like these often attract newbie readers, let me again state my position on ECT: ECT should never be performed without a patient's active consent. If you want the procedure, go ahead and have a nice day. If you don't want the procedure, then the state has no right to force it upon you.
A Canadian living in Brazil named Sean passed along a YouTube video of his yesterday. He's done a series of videos explaining his belief that his bipolar disorder, which he was diagnosed with in 1996, was in fact a spiritual awakening of sorts. Or as he puts it on his new blog:
"My 'crisis', which I had over 10 years ago, was, by far, the most important and beneficial experience of my entire life. It was a true awakening of monumental proportions. Why? Because I was lucky enough to block out all of that bullshit and follow the apparently insane voice which was inside of me. I rejected the opinions and analysis of everyone - the psychiatrists, my parents, the police. I know the sacred when I meet it."This blog and all of the attached videos and links are dedicated to all of those people who have been stigmatized as being mentally ill, when in fact, the opposite was happening to you.
"You were not going crazy, you were just waking up!"
The first of his videos is below. The other four in the series may be found here. I haven't had time to watch all of his videos yet, but I am deeply sympathetic to the view that alleged mental illnesses may, in fact, be a spiritual awakening of sorts. In Sean's case, he wound up in a psych hospital while he was in the midst of going through a Landmark Forum course. I'll keep my thoughts on Landmark to myself as, like the Church of Scientology, they get rather touchy and all legalistic when anyone says anything about them.
Here's Sean.
For the curious among you, it's been a little over two weeks since I went off-meds and a little over a week since my Lamictal withdrawal problems ended (at least as far as I can tell). Back story here and here.
The last week has been pretty good. The biggest thing I have noticed is that I really, really have to be on top of when I eat. I'm not sure how to explain that to you, except to say that I truly noticed when my blood sugars are low, generically speaking, much more so than when I was still on Lamictal. I've also been fairly aggressive with taking vitamins, particularly in light of some recent research showing that people with bipolar disorder have low folate levels. So I've been taking folic acid each day plus a B-complex plus a decent multivitamin. I'm not sure if the vitamins are having any impact.
Other than that, it's all nice and level. The real test will come from mid-September to November. That's when I often have my worst depression of the year.
It's also interesting that I am now getting about 10 hits a day from "Lamictal withdrawal" Google searches.
Here's a story from Tucson, Ariz. about a kiddo who was diagnosed with ADHD, later had his tonsils removed due to sleep apnea concerns, and, boom, his ADHD is all gone. At first, I thought this sounded a bit too weird to be true. But there has been actual research published on this phenomenon. Here and here. Make of it what you will.
Liz Spikol has a fabulous post criticizing the Treatment Advocacy Center's simple-mindedness. My use of the term asshat makes a cameo.
In other news, I am scaling back blogging for the next week or so. It's summer and it's not raining in Seattle. That's why.
Most of you know that, on Monday, Supreme Court Chief Justice John Roberts suffered a seizure, fell down and whatnot. Since he suffered a seizure of some kind--petit mal? grand mal? no one's saying--in 1993, there are reports that Roberts now crosses a clinical barrier into epilepsy.
I am fascinated by the Roberts story in so many ways. First, I wish him, his family, his family dog, and pet goldfish all the best. This has got to be a very weird interruption in his life. But since the Chief Justice is no ordinary person--he's the Chief Justice for God's sake!--permit me to say some extraordinary things. Mostly in jest, but to serve a point.
I want the Chief Justice medicated and right now. Dope that guy with Lamictal, stat.
Why? Because he has a neurological illness--a kissing cousin of mental illness for the purposes of this metaphor--and treatment means medication and medication means side-effects and side-effects mean injuries and he's a Chief Justice who gets to decide the law of the land on regulations affecting pharma companies, drug regulation, class action lawsuit procedures, federal discrimination law, civil rights and the like and he'd be taking some of the same anti-convulsants that have proven to be kind of rough on millions of people with bipolar disorder and epilepsy and for once it'd be nice to have someone sitting in a power chair in this country who feels our pain. Who has to go through all the tradeoffs in life that we do. Who has people wanting him fired because he acts weird sometimes. Who has some citizens keeping their distance from him because they think they know how he'll act. Maybe he'll lose his drivers license. And so on.
OK, perhaps I am dreaming out loud a bit too much there, but the Chief Justice being diagnosed and medicated would be staggering in a social sense. When I was in high school, a classmate of mine had epilepsy and people used to call him crazy behind his back. I know things have improved, but they aren't that much better when it comes to social regard for people with alleged disabilities. I wonder what people think of the prospect of Roberts' being on 1,500 mgs. a day of Depakote and possibly sitting on the high court for another 30 years. Would it do anything to wipe out the lame assumptions regular people and doctors make about people with mental illnesses each day? You tell me.
In an even weirder way, I can personally appreciate the spot Roberts is in. In 1993, I twice experienced the kind of mental brownout and loss of contact with reality that the Chief Justice went through in 1993 and the other day. One day, I was driving along I-5 in San Diego and suddenly I was three miles farther down the road and couldn't account for getting there. Something similar happened a few weeks later. Having been diagnosed with bipolar disorder in 1989, I had done enough reading to know that browning out like that could be something. So did my psychiatrist and the neurologist he sent me to. (Yes, I had decent health insurance in 1993.) I underwent two EEG studies, an MRI (I did not enjoy that procedure one bit) and took Tegretol for several months. Then, whatever was going on, died down and the docs decided that I'd had some transient seizure activity as a result of a concussion the year before, and back I went to being a garden variety bipolar.
In a way, I hope that's Roberts' outcome. Whatever was going on, goes away and he goes on with being John Roberts, Chief Justice. And no one bats an eye. But I hope he never forgets the fear and trembling he's felt the last few days and remembers it very clearly when, in the future, cases involving the lives of more common Americans--in ADA cases, say, or when pharma companies lie about their products--come before the court for cert, review and judgment. We could use some bias in our favor on the high court and in public life.
I've never forgotten how scared I was during my brownout phase.