All I want for Christmas is one reporter to consider why relatively few of those who take antipsychotics or have taken antipsychotics and have been injured have not sought the redress which might be afforded them, i.e. damages.

A lot of people look to me when either they or a loved one is urged to start treatment with an antidepressant (for some reason my reputation doesn't precede me very well). Of course I used to start seeing red but I've come to realize that it doesn't do a lot of good to say don't touch the stuff with a ten foot pole so now I do what you did -- I say these drugs have some mighty severe withdrawal problems that you might want to look into before starting. The other thing I do is tell them -- your doc, if he's any good, is going to taper you up to the "recommended" dose. If I were you, I say, I'd stay on the lowest possible dose that you think is making a difference. If you feel great at 10 mg, I say, and the doc is pushing for 20 or more, I urge staying at 10. That I find works better than getting them not to take it at all (which of course is what I really want) and, believe me, that is better than getting up to the pharma recommended dose when it comes time to come off. So I just got someone to stick at 10 despite the pdoc pushing for more. She says she "hates" it and wants to go back down to 5 but for some reason has been browbeaten into thinking she needs it because she is pretty grumpy -- unclear if that was her symptom before or not. In other ways she's doing quite well as far as "depression". Anyway I'm indebted to Joseph Glenmullen for this approach since he pointed out that a lot of people actually do better at smaller doses than bigger ones but pharma likes to market for one size fits all and that's the size for the biggest guy around. (Pharma doesn't want this secret to get out. They like it when you get dependent on big doses and make more money that way too.)

Have a happy thanksgiving Philip!

I've been a Seattle area resident for 18 years, and find the media to be luke warm, soggy and predictable, just like the paper in the driveway on a rainy day.

Break out online news blogs are a good idea, but they won't go far or be successful unless they cater to a broader audience.

I personally contacted Crosscut and requested a health/mental health news link, and suggested this one [which in my opinion is obvious]due to the expansive coverage that takes local and national news to a new level for mental health issues, and the person I contacted told me "NO."

Snooze ya lose.

Kudos, to the Seattlest for being smart and connected with the real world.

It's almost like the phoenomenon "if we don't talk about it, it will go away." Though, everyone is secretly doing it (taking meds.) God forbid, we are human and take control of our mental health. I guess the brain, unlike our other organs such as our heart, is not allowed to get sick nor are we allowed to talk about the sickness or the steps to take towards wellness.

Joe,
It's funny that you mention why we who have been damaged by neuroleptics haven't sought redress.

Just yesterday I called a few law firms. No one was in the least bit interested in taking my case. I didn't expect them to be either. I don't have a compelling case in that I don't have diabetes or some disease that is easy to point to---I just have a very long history of being drugged out of my mind to the point of having a very poor quality of life, while it did nothing for any supposed "underlying" condition. And now I suffer horrible physical side effects from withdrawal that no one ever warned me about. The law firms didn't see anything sticky about that. I don't have a psychiatrist who will back me up in any credible fashion either. That is what really made my case weak. My doctors think they've done me a service. Unfortunately most of us have to move on and let go because the people and companies that have hurt us are untouchable in general. My experience as I now interpret it is simply not the party line. I am not believable by the establishment.

Joe,

First of all, states are beginning to sue pharma companies, so legal action is actually in progess.

Gianna makes a good point in that some people only experience side-effects like weight gain, feeling drugged, etc. Those effects, while unpleasant, aren't going to result in an award. Sure, this is America and you can sue anyone for anything, but a lawyer will not take a case like that on a contingency basis.

Previously, many of these debilitating meds were prescribed to people who were already so far gone that the physical harm caused by the meds was perhaps better than the alternative. In addition, the mental health issues associated with those who suffered from the side effects prevented them from being taken seriously as a credible witness; in some cases, they were also likely wards of the state and were therefore unable to bring legal action.

Now, antidepressants, atypicals, etc. are being prescribed to a much broader cross-section of the population. When atypical antipsychotics are being prescribed to soccer moms as mother's new little helper, it's a vastly different game than prescribing them to people who had actually experienced psychotic breaks because it is much easier to measure, for example, the onset of debilitating physical issues as a side-effect of a medication and juries will be much more sympathetic to awarding people who had previously been considered productive members of society significant damages.

Within the next 5-10 years, I predict that we'll begin seeing individual and class action lawsuits over, for example, organ system failure and distress, suicide rates, etc.

As it is right now, I think we're at the tipping point - that moment of critical mass when enough people are using these meds to begin seeing what they REALLY do as opposed to what gets reported from a short clinical trial. Many of these medications haven't been on the open market that long (I believe Cymbalta has only been approved since 2004 as one example) and it took a while for the COX-2 inhibitors (like Vioxx, which actually was an effective pain reliever for me) to begin showing their undesirable side effects. Since I believe the COX-2 inhibitors are the best recent example of the legal course some of these medications will take, we also need to look at how long it took those medications to begin harming the people who were taking them and how long it took before a sufficient number of people were harmed to show causality.

Rest assured, with the reports of liver and kidney problems around some of these meds, that day is coming.

Re: redress and lawsuit:

I contacted a Zyprexa lawyer, and they wrote me a letter that said diabetes or no lawsuit. Same with when my daughter was dumped from Swedish First Hill medical floor when they "heard" she was a "psych patient". The security guards roughed her up, and shoved her out the door. The attorney I contacted re: that said, no broken bones, no lawsuit.

Pain and suffering, trauma, weight gain, loss of ability to work, function, attend school, tremors,increased liver enzymes, polycystic ovary syndrome....I guess none of that is lawsuit material. In another post comment thread here someone asked me if I was going to sue any doctors. There is no way I would ever win a case like that when doctors can now say the data was buried, cooked and they were "clueless wonders" themselves per the harm inflicted on my daughter via off-label use of Risperdal and Zyprexa for starters, back in 1999. No way would that case make it anywhere.

No one gave a shit that she was roughed up and dumped from Swedish, not even the mental health ombudsman.

Reporting Swedish to "ding" their record was my only advisement, and frankly when battling in court real time, and having a sick kid, I didn't have the time, and feel at minimum people should be fired for their treatment of her, and other mental health patients.

Yes, we have a lot to report about in this area regarding mental health issues, and I for one am grateful for the space on this blog where I can post SEATTLE AREA HUMAN INTEREST MENTAL HEALTH STORIES first hand.

Philip has this story and no one else. Period. Until someone hires him to write it for a print paper--then it's scattered about this blog, and my own for anyone in the Seattle area to read.

Hers is not the only story, as we all know. It is a navigation in a Washington State defunct, poorly ran, underfunded and inadequate infrastucture where separate agencies are not on the same page or ever connected. IF my daughter did not have me for an advocate [like all patients/clients have a right to have, but there is no FUNDING]she would be sitting in Western State Hospital today.

I learned to navigate a system that frankly took me 2 years of networking to figure out for one kid. It shouldn't be that way.

Again I say thanks for this blog and thanks to MvB at Seattlest for keeping stories flowing through that site.

I want to add to my comment, the reason why a very long time ago I decided if my daughter ever had a story printed about her, I wanted Dawdy to write it, because of his article, "No Exit", he wrote for the Seattle Weekly. I came across the story on the internet in January 2006, and thought it was so well done, held integrity, told truth, was not biased, it was gripping and eye opening. I decided at that point he would be the only reporter to write about her because I trusted his judgement based on his writing about mentally ill patients with integrity and dignity. I've yet to read anything from this area that can hold a candle to his mental health coverage. If you take a look at the side bar and read "No Exit" you will know what I'm talking about, and take a look at the photo--I've sat in a room like that watching T.V. with my daughter; and it was horrible, but I was prepared by that article, no doctor I've met yet has been inside Western who sent or wanted to send her there. Says a lot for why these stories need to be told.

Stephany: I think it would make a lot of sense for Phil and/or you to publish the story for everyone now, and not force interested people like myself to piece it together. In 1985, Bertha Plitt published through Exposition Press of Florida in Pompano Beach, FL, a book called "Paul: A Son's Torment, A Mother's Anguish" about her son, a manic-depressive schizophrenic who eventually committed suicide at the age of 35 due to inadequate medical care. Most events took place in Brooklyn, NY, Manhattan, NY, and in DC at the National Institute of Health. She named hospitals, doctors, the medications he was on (Prolixin and a MAOI). It's an engrossing book of 125 pages and has his photographs. I bought at a used book shop and haven't seen it anywhere. If I had a scanner, I'd have uploaded it. Since you have the material, I wish you had printed your story in one place in full. Please.

Here's something I wasn't aware of: a patient's right to know encompasses the right NOT to know. An abstract of the article, entitled "The 'right' not to know" by David Ost (a lung cancer doctor in NY) and published in J Med Philosophy, 1984 Aug;9(3): 301-12., follows:

"There is a common view in medical ethics that the patient's right to be informed entails, as well, a correlative right not to be informed, i.e., to waive one's right to information. This paper argues, from a consideration of the concept of autonomy as the foundation for rights, that there can be no such 'right' to refuse relevant information, and that the claims for such a right are inconsistent with both deontological and utilitarian ethics. Further, the right to be informed is shown to be a mandatory right (though not a welfare right); persons are thus seen to have both a right and a duty to be informed. Finally, the consequences of this view are addressed: since the way in which we conceptualize our problems tends to determine the actions we take to resolve them, it is important properly to conceptualize patients' requests not to be informed. There may be many reasons for acting in accord with such a request, but it is a mistake to conceptualize one's act as 'respecting a right possessed by persons'.

"The author rejects, as inconsistent with ethical theory, the view that a patient's right to be informed entails a correlative right to waive this right. He argues that informed consent is a mandatory right of an autonomous agent which carries with it the obligation to be exercised. Ost concludes that a physician who withholds information out of compassion is acting humanely, but that a humanistic value orientation requires that the physician do what he can to help the patient make autonomous decisions."

Phil,

I've a favour to ask of you: you state quite regularly that there is no correlation between mental illness, per se, and violence (which I'm quite prepared to believe, the UK's Audit Commission says so (Finding a Place: A Review of Mental Health Services for Adults, HMSO, 1994), mentions it apparently (I didn't want to pay for a copy, but found a synopsis, somewhere). Anyway, what authority are you citing, when you make that claim, because I'd quite like to write a piece on the subject?

Matt

I think that psychiatrists often hide behind that argument, Red Rover. That's their argument for withholding medical records. I'm doing it out of compassion, to protect the patient. When, in reality they withhold them because they don't want to deal with a problem. They don't want to have to deal with the fact that the patient is now going to know what they really think.

I think withholding information about harmful side effects of a drug is not about compassion, either. I think psychiatrists withhold that information because they know that many patients would not take the drug if they knew that it had a high potential for causing weight gain, diabetes, etc. That is not compassion, that's unethical. There are patients that would (and do)take these medications even knowing the risks, and that's perfectly fine by me. But, you don't know what the patient would choose if you don't talk to them about it.

Puckett,

While States' AGs are indeed suing pharma with respect to antipsychotics, they are not suing on behalf of those who were actually injured. Relatively few individuals likely to have both standing and capacity are seeking the relief which might be afforded them. For example, Utah's Attorney General estimated that 1500 Medicaid enrollees who took Zyprexa developed diabetes; however, it was estimated that only 100 individuals statewide have filed. (Phamalot, http://www.pharmalot.com/2007/05/19/ )

I guess this goes to the greater question: In a litigious society why do so few members of a putatively empowered group fail to seek redress? I have my own ideas not the least of which has to do with the disempowering nature of the mental health system where the Three C's are highly valued, Complacency, Compliance and Conformity. Anyone who has been on a psychiatric unit, or in a partial hospitalization program, day program, and/or sheltered workshop will know of what I write.

Sadly, both academics and providers talk ad nauseum about empowerment while few consumers find anything about the mental health system that is consistent with the representations that as so frequently made. Are all the assertions of systemic transformation predicated on mere shibboleths? In the Era of Recovery, don't putatively empowered consumers with diabetes who can closely associate their illness with Zyprexa litigate when injured? (SAMHSA Consensus Statement on Mental Health Recovery, http://mentalhealth.samhsa.gov/publications/allpubs/sma05-4129/)

It must also be remembered that many persons who are prescribed antipsychotics do not have a diagnosis of schizophrenia. Anecdotally, it appears that they are too often prescribed medications for depression are a SSRI, an antipsychotic and a neuroleptic such as Lamictal. The same is likely true for other diagnoses given the level of off-label use of antipsychotics.

Personally I didn't sue for lots of reasons including the stress and energy it would take, but another reason was that my non-lawyer opinion was that it would be hard to prove the psychiatrist's care fell below the standard of care when the standard of care in psychiatry is so low across the board.

In answer to why so few people have sued: my guess would be a combination of having one's energies drained daily by one's disability, combined with the incredible stigma a label of mental illness carries. Just a guess here.

About 8 years ago I nearly died as a result of mismedication with Klonopin, compounded by massive maltreatment in the ER following a Klonopin-induced suicide attempt.

I never thought in my life that I would ever become SO angry that only a poultice of money would make me feel better, but when I finally got out of the second hospital I contacted 7 or 8 attorneys. First off, I learned that attorneys as a group are spectacularly ill equipped to deal with mental health issues. The minute I got to the part of my story about the suicide attempt almost every one of them lost it. One guy, who had been extremely cordial, started screaming at me. I was pretty amazed by this.

No one would take my case because, well, because I'm nuts. I have my mental health tee shirt so don't think anyone in a court room is going to believe me. I was told repeatedly I have no case. The fact I attempted suicide as a result of too much Klonopin would be too hard to prove.

About a year ago I read my discharge summary from the second hospital. The little weasel of a pdoc who treated me there, who I actually TRUSTED (silly me, but I was totally desperate and he seemed like a good guy) came up with a discharge summary that was a tissue of lies--all designed to cover his mistreating colleague's ass. The ER docs, who were joking about me within earshot of my husband, and who sent me home--twice--to die, got to keep their pack of lies also. Our word means nothing compared to whatever these folks want to put in their discharge summaries.

Oh gosh, I'm still pissed. Sorry 'bout that. But the thought of wading through a court case, mental illness in tow, is probably too much for a lot of people.

Sherry

This is what made me take a double take through blurry eyes and that 2nd cup of bad coffee this morning: hah!! excellent MvB ha omg.

A Reading From The Sustainable Book Of Knu-daw-neat.

I sued. I had no choice but to sue and yet suing hell. Of course as people who love me remind me, had I not sued, I would be in my abusive parents custody now, inpatient if they wanted, outpatient if I was obedient enough to suit them.

Still, very few lawyers want these cases. As Sherry says, our word means nothing to whatever those folks want to write. What saved me was that I had a close friend who attended the meeting my pshrink had with my family when he discharged me recorded the meeting, snuck a recorder into the meeting in her maternity pants - she'd just had a baby. Of course what the doc said in the meeting and to my friend, which we have on tape, was not reflected in the medical records.

Still some lawyers will sue but most won't. As we all know TAC has a self labeled bipolar j.d. in charge now who argues that forced drugging is a civil right.

Oh hell i've seen my daughter's chart [5 inch binder] and nothing matches up from hospital to hospital, doc to doc. I;ve got a social worker on audio tape myself discussing this insane stupid system. i also stood in an ER w my daughter locked up, while a nurse told me this:
"She is the most psychotic patient ever seen in the [U of WA]ER." then the social worker walked up to me and said, " I've talked to Dr.X."[who was the private hospital nightmare from hell, who drugged her up on 11 meds in 13 weeks]."You are a mother who stops treatment.", said social worker.

fuck it. who the hell knows what on earth to do.if i was a mother who stopped treatment, then put me in jail to save society.

I stood in the ER parking lot, and didn't know waht to do. this system sucks.

Called lawyers, on my daughter's behalf the last 2 years and no one wants her case, they don't want any of our cases.

Look at what happened to Gottstein when he got wrapped up with the Zyprexa Papers...Eli Lilly put all of its zillions of dollars behind the most ruthless lawyers and of course exerted all social pressure on the judge and legal system. Still here in Georgia we've had a few wins, and even though our side has had lots of casualties, the class actions are victories as is your struggle with your daughter Stephany. But it's hard and enough to drive you....