Very good advice Philip and I'm glad you are giving it. Everyone needs to be engaged in their own care, whatever the illness, and if you're not you are very much at the mercy of a pharmaceutical and medical behemoth that really has lost sight of the goal to "do no harm". I know I'm one of the ones you refer to who appears to be taking an extremist stand on psych drugs although I have never advocated for their ban -- I know that is completely unrealistic. When people start studying them closely I just think they don't really believe the negatives can be that bad or the positives that small -- it doesn't square with the prevalence of their use. I'm just not sure what it's going to take to change the world view that has been so successfully hoisted on the public.

I very much agree with you about the need for patients to educate themselves. Too many people seem to think that just because they see one person with white coat that doctor knows what's best for them. I wish doctor's would do a better job overall in explaining these risks and avoiding prescribing drugs unless totally necessary. Patients need to remember cases that've happened fairly recently where it only became apparent that a drug had extremely adverse side-effects after many people had been prescribed.

I'd like to know if someone could get withdrawal symptoms from taking a drug off and on like that. One week here and there doesn't seem like it'd acclimate your body to the drug and make it so horrible to go off it. I know when I went off Effexor it was absolute hell, but I had been on it quite a while. Furthermore, why would he keep going on and off like that if he kept experiencing intense withdrawal? Ever since I tapered off Effexor I've had absolutely no desire to go back on it at all. That's just messed up. It doesn't make sense to me, but I really don't know.

Wow, I didn't know people were actually promoting that the meds should be banned. That, quite frankly, seems ridiculous. I still haven't seen anything that proves a causal relationship between SSRI's and violence. The literature that has been promoted hasn't left me convinced. Banning the meds seems like banning Marilyn Manson music. I'm sure you could take many things (like rock music) and create a relationship if you wanted to draw one.

That said, I'm not saying that they definitely don't cause violence. If someone would show me genuine peer-reviewed research and not loose anecdotes promoted by anti-psychiatry people, I would take it into consideration. Until then, I'm putting it in the same camp as "devil music" or Grand Theft Auto causing people to go out and kill people.

Re: being a responsible psych patient: I do think that once you are aware of the existence of some of these side effects; once you are aware of the existence of withdrawal effects; once you are aware that these meds are not entirely benign, and that not all criticism or warnings regarding these drugs come from Scientologists -- yes, you have a responsibility to use that knowledge wisely.

But be aware that many, many, many intelligent, responsible and good people are unaware of all of this, largely due to the intensive "patient education" they have been offered by advocacy groups and nonprofit agencies whose funding comes largely from Pharma, as well as by multiple board certified psychiatrists of excellent reputation.

I am fifty years old. I have been on medication of one type or another since the age of eighteen. I have been an Internet user for at least ten years. Throughout my adult life I have been an avid reader, and have even periodically combed medical journals for more insight into my own condition.

Despite this, it was not until two years ago that I even remotely understood any of the above basic factors about the medications I had been taking. I had repeatedly experienced withdrawal effects on multiple antidepressants, and was repeatedly told that these were simply the signs that I had a lifelong disease which required lifelong medication. I was repeatedly told that, because I was going downhill despite the lifelong medication, I was one of a tiny minority of patients with a rare and little understood condition called "TRD" or Treatment Resistant Depression... for whom the right medication had not yet been patented. (I continue to be offered Zyprexa, most recently about three months ago.)

So, as someone who was "stupid and irresponsible" for thirty years, I am reluctant to judge anyone too harshly who makes the mistake of going off a particular pill cold turkey. Just last month I was confidently instructed to do so by a very good psychiatrist (the pill in question being Lamictal). The man is not only considered top notch in his field, he is a genuinely decent and concerned human being. And I don't think he has been corrupted morally to where he would knowingly misinform a patient about a known hazard of a drug. His biggest problem is his reliance on leading academic journals and continuing ed programs hosted by the top notch med school that runs his hospital.

My sister lives in Seattle. In terms of "alternative" medical, psychological or lifestyle philosophies, I think it is quite a unique place. (For good or for ill, I think with a grin. Many trends that are considered absolutely mainstream by my sister's friends are but vague and fantastic rumors to me.) Perhaps in Seattle, anyone with a brain, two ears and a computer is well aware of these issues. It is very different in the Midwest, even in cosmopolitan Chicago. I have yet to link up with a single live patient, organization or health care provider who shares even a fraction of the more moderate views discussed on this blog, and I have done a lot of searching in the past two years. How is it in DeKalb, Peoria, Indianapolis, Kansas City, Des Moines? Probably the same, or harder. How about down South? I can't say.

So as I grieve over the five beautiful young local kids shot down by Kazmierczak, I grieve for him too. Reading recollections of those who knew him in recent years at NIU, he seems to have been loved and admired. "Revered by students and faculty alike" was a phrase used in one news story. "Gentle and hard-working." Jeez Louise. I do not know what he knew, or did not know, about his own condition or medication. At this point in time, I can't charge him with game playing or recklessness, much less fix the blame on him.

Coming Off Meds: Resources And Caution
A reader asks: "What I want to know [is] why guides to coming safely off meds are not widely available in the states?" Great question. Most likely because patients are not well-organized over here and because that's just not something most advocacy groups would ever do. In addition, there are all manner of legal issues for someone who publishes such information to consider, given our litigious society. What's more, each patient seems to respond to coming off a particular med differently. Interestingly, most docs don't know much about tapering patients either.

I think this situation is a big problem because a lot of patients who do come off med X or Y, for whatever reason, end up doing so on their own. In many cases, they cause themselves serious problems. God knows, I felt like hell coming off Lexapro and Risperdal. A buzzing neck and lightning bolts in the head are not much fun.

Anyhow, said reader offered this resource for information on tapering off meds. I cannot assess its accuracy, but pass it along for what it's worth to anyone.

Let me be clear on this: anyone coming off any medication should only do so after talking with their doctor. A doctor might try to talk you into staying on the med, etc., but if you put your foot down, then the doctor has an obligation to help you come off the medication. I am only talking about outpatient settings here, not inpatient. Different story there.

As a further caution, cops I know tell me that the mentally ill folks they really worry about having to deal with are those who have just come off their meds--not people who've been off meds for a decent time--as they can be highly delusional and highly combative.

Posted by Philip Dawdy at 12:01 AM | Comments (5)

'Wow, I didn't know people were actually promoting that the meds should be banned. That, quite frankly, seems ridiculous. I still haven't seen anything that proves a causal relationship between SSRI's and violence. '

yes, these meds should be banned, as the connection between them and mass shootings is now solid.Show me one mass shooting/suicide in the last ten years in which the assailant WASNT on antidepressants.
Until they are banned, you will see more more such murder/suicides. Sticking your head in the sand wont save you when finally you become a victim or an assailant!

I have to agree with Joanna. After being on this site for awhile you somehow imagine that everyone must be aware of the issues surrounding psych meds but, in fact, there are tons of people who don't read the news, let alone blogs, and this includes psychiatrists. I have heard horror stories about what psychiatrists recommend and honestly, I don't think it's because they are deliberately being malicious. In fact I can say this just about unequivocally, they are in a class by themselves in terms of just how ignorant they are about the right and wrong way to take these drugs and how oblivious they are to what's going on with their very own patients.

brian: well i can name at least one that wasn't and that's the kyle huff massacre that i referenced in the post itself. as i noted there, no anti-deps or any psych med anything involved. no hard drugs. he wasn't even drunk. like i said, the dude was evil.

sara: i too am kinda shocked at how many docs have little to do wit hte net including my own. but that doesn't excuse patients from doign a simple google search or wahetver.

Thank you for pointing out the dangers of being irrational regarding psychotropic medications. Taking medication is probably the only reason Steven K. did not hurt himself or others a long time ago.

And, if you look at his consumption of Red Bull and cold medicine in his hotel room (ever heard of caffeine rage?), you can see that many factors played a likely role. Even the resident at the group home said that when S.K. went off his medication, he lost it.

You know, the nature of many brain disorders, including those affecting the frontal lobes (bi-polar disorder, ADHD, etc.) is a lack of self-observation. They often don't think they need medication; they think that everyone else has a problem, not them.

Depending on the symptom severity, there can also be no appreciation for consequences, a weak sense of empathy or conscience, Ever notice how so many of these shooters go on the rampage after being romantically rejected?

My guess is that his family knew very well the risks that Steven K. posed to himself and society. But they were powerless to do anything about it. Just like Britney Spears parents were powerless, until very recently. I also imagine that he had lots more than an anxiety disorder.

A few decades ago, we granted more rights to the mentally ill. Quite simply, that poses more risks to society. Especially a society where a person whose mental illness was so severe he had to live in a supervised group home, on medication, can buy guns at the spur of the moment.

I can't look at the pictures of the victims but I will say that I worked on this 'cause' all through the 1990s and at the turn of the century decided I would retire. Unfortunately I tossed out a lot of the literature on SSRIs that I had collected.

Then I was reading about the Edgewater Technology massacre [Prozac - a tripled dose] and I came across an account of the 7 people who were in the one room where McDermott shot and killed them. The last to be shot was a young woman with a six week old baby who had just returned from maternity leave. She laid her head down on the desk BEFORE she was shot. Just that one statement - no pictures - was enough to get me off my 'retired hiney' and back into business again. I vowed then and there that I would continue with this 'cause' as long as possible.

As for people being responsible for taking or not taking their meds, I don't see how a person can be responsible when they are INSANE because of the meds - the SSRIs. REMEMBER, PLEASE, THAT PSYCHOSIS IS LISTED AS AN ADVERSE REACTION TO ANTIDEPRESSANTS IN THE PDR. Sometimes, too, this insanity creeps up slowly on the person. I doubt that Steve K. gave it one thought that he shouldn't go off his meds because he was probably going insane on his meds and thought he didn't need them anymore because he had finally figured out the Problem With The Universe. So - the meds were irrelevant ----

Very good points about using these drugs responsibly and only withdrawing from them gradually, Philip. We know it's nothing new that there is evil in the world, but when it's such an irrational, senseless kind of evil as this it does seem to point to some kind of drug or chemical involvement.

I am a bipolar, and have been ON and OFF drugs for years. To explain my life is not that easy. I have been hospitalized several times and have had to change meds several times for many reasons. Some of these reasons have to do with money and not what will work the best. I do a lot of holistic things that help...meditation, tai chi, and other martial arts. I eat right and get plenty of sleep. In other words I maintain. But to get here I had to ride that bumpy road to do it. Some give up and drink and drug or commit suicide. I have never been homicididal. But I know where that feeling comes from. See depression in my mind is Anger turned inward. Some of you nicest people can be depressed and you wouldn't know it. But sometimes something makes someone snap...and it doesn't have to be anything to do with drugs. They have to fight that urge of both self destruction and hatred. It is psychological, and spiritual. It is the inner core fighting to cope. I can't explain in a simple comment. All I know is to fight my inner demons I have had to beat them into submission day in and day out...whether on or off drugs. The drugs are like a damn that holds back the flood waters...if you don't do anything about those flood waters or you lose that damn for whatever reason you are in trouble. You have to be proactive in you condition. NAMI has done great things for me. National Alliance for the Mentally Ill. I work a hard job and do ok. I feel so bad for these shootings that are attributed to mental illness. But knowing how many people are mentally ill out there...I really think it is a rare occurence. Most get suicidal without the homicidal in my mind. Just my 2 cents...
and God Bless the Families of NIU.
Joe

Philip, you take a very blase view of SSRIs, I cant tell fomr checking whether Huff was on an SSRI or not.BUT rave parties, which Huff is known to have attended are about drugs. These can include extasy, methamphetamine, speed and ketamine...and who knows what else!
Ive found an article that says SSRIs are entering the Rave scene:
www.benzo.org.uk/ssri.htm

I suggest you take a look.

Calling Huff 'evil' is absurd. A post on Huff says he wsa lonely and isolated and seeking to make connections, hence his entering the Rave scene.

Johanna said:

It is very different in the Midwest, even in cosmopolitan Chicago. I have yet to link up with a single live patient, organization or health care provider who shares even a fraction of the more moderate views discussed on this blog, and I have done a lot of searching in the past two years. How is it in DeKalb, Peoria, Indianapolis, Kansas City, Des Moines? Probably the same, or harder. How about down South? I can't say.

*************************************************
I live in the Midwest and have been on many AD's over the last eight years for help in dealing with sleep and neurological issues. Having dealt with six Neurologists and two rhematologists over that time frame I have found their collective attitude to be quite uninformed and dangerous when it came to discontinuing a med or switching to a secondary med when no positive results were gained with the primary med. I have had docs refuse to assist me with tapering off of meds, I have had docs that had me on the strongest dose of a med and want me to stop it with no taper while starting on the lowest dose of a secondary med and one Neurologist, when I told him that I was having dreams of killing my family and myself, told me to "suck it up, accept it and double the dose."

In the past, two of those doctors threatened to "fire me" as a patient if I continued to do personal research on the internet about my chronic conditions and the meds that they were prescribing me because I had the audacity to print some articles off of the internet and ask questions about them during my office visit.

The advice I hear the most from people that I have met online with similar health conditions is to switch doctors, to keep searching for a doctor that is more informed. Living in a rural section of the Midwest this is not easy to do. There are only two Neurologists in my whole county and they are in business together. Two of the four counties surrounding my county send their neurological patients to our county because they do not have any practicing Neurologists in their county. So, now I drive two hours south to a large city to a teaching hospital and have found a wondeful, intelligent doctor.

Philip,

Doctors are clueless about how to taper safely. When I insisted on tapering from a psych med at 10% of the current dose every 3 to 6 weeks, which is the excellent recommendation of the Paxil Progress boards, I was told that I was tapering too slowly by both the psychiatrist and the pharmacist. I am not making this up folks.

I held my ground but alot of people would have found that situation intimidating. I was able to speed up tapering that drug due to some supplements I was taking. But if it hadn't worked, I was fully prepared to slow it down again.

Not to belabor the point, but the nurse who runs the Paxil Progress Boards was told by her son's doctor to taper him from 50mg to 37mg of Paxil. His already horrific behavior worsened. Fortunately, she knew what was going on but most people don't have the medical knowledge she has to know differently.

I am now tapering Remeron. I know if I had asked my doctor, he would have had me tapering by half of a pill every two weeks. I just made a small cut after 4 weeks and it is too much.I am going back up in dose and waiting until I receive a digital scale so I can accurately measure the cut.

Philip, I know I sound like a broken record and I am sure you're sick of me but most doctors are clueless about this issue. If I hadn't seen the Paxil Progress Boards, I might be among the clueless. I thank god everyday for Laurie Yorke and the other folks who run those boards and teach people to taper their drugs safely.

AA

no you don't AA. you are fine. i would've thought 10 percent every 3 to 6 weeks was a paxil only withdrawal (ie, that drug needs to be tapered slower), but after my experience with lamictal i tend to think slower is better. i'll check their boards for specific info. clearly i need to create a page for this info here as well.

and you are right most docs are ill informed on this matter.

When you find a good doc, you are very lucky indeed. I know they are out there.

But unfortunately, I have to agree that they seem more rare than common. Given the hundreds of stories I've heard (from a support group that I moderate), it is downright frightening to witness some of the boneheaded things psychiatrists do and say. My favorite is when a patient will call to complain of unpleasant side effects and is told, "Double the dosage."

Just think of it...a doc who might have an undiagnosed disorder of his/her own, alone in a room with a vulnerable patient who desperately wants to rely on the doc.

When treatment makes no difference--or makes things worse--what does this often-frazzled and self-doubting patient do? File a complaint with the licensing board? Guess who would have more credibility?

But as far as weaning off the Paxil, I sincerely doubt that M.K.'s lack of knowledge on this was the problem.

re: banning SSRIs. What is going to happen, is what already is: doctors are sliding over toward rx'ing antispychotics, such as Seroquel, Abilify, etc. due to the well-marketed 'overall use' approval given by the FDA. Therefore, eventually blaming [these hideous crimes] will be all about antipsychotic use and coming off of them cold turkey, etc.

Most if not all of the antipsychotics have a side effect of psychosis,agitation and aggression,personality change, etc.

So, over time, the blackbox warnings on anti depressants will have slowed down the rx'ing of them and simply shifting them into another med, for another day to want to ban. Mark my words on that.

I write a small blog, and the number one search coming through google is Seroquel withdrawal. Every single day and people read my personal account of doing so.

Along with a page about Lamictal withdrawal or SSRI withdrawals here, it would be good to have a Seroquel page...[hint].Just to start into the antipsychotic territory.

I had the same effects coming off of Prozac as I did with Seroquel, and knew to recognize what was happening due to the priour Prozac withdrawal.

As for Seattle trends of thought and commentary vs. midwest? that is nothing new, and it's West Coast, Midwest and East Coast that have clear and defined exhibit in different viewpoint and thought. That's been around for ages long before anything happening in Seattle that would influence thought. It's just West Coast. That's why often times we read different viewpoints from East Coast doctors vs. West Coast, which can cause quite a difference in thought leader opinion. But, all of this is just my opinion.

Phillip,

Good stuff, and I was going to stay away from psych blogs for a while because what's going on is just too tragic, too upsetting. I think there's a connection between stopping these drugs and violence, but there's something you don't address - the shear expense of these drugs. I've been clean off of psych drugs for four years and eighteen months. I wish there was a 12 step program for coming off of these drugs as there are for other drugs with dangerous withdrawals (AA, NA, CA...). I stopped taking effexor because it was too expensive. At the time my parents had made the offer to send me back to school, I had accepted their offer. I did not have enough money to pay for the doubled dosage of effexor my pdoc recommended and my mother refused to pay, hence I discovered the reason for my physical exhaustion was not depression but anemia, a much cheaper problem to have, one that is diagnosable by medical tests and for most, including me, cheap to treat. Still, because I could not afford $300 a month (wouldn't have been able to pay rent if I did, or the copays for the pshrink), I came of effexor cold turkey. Luckily, I didn't harm anyone, and don't remember any dangerous side effects but I'm the lucky one.

Regardless of what I think about psych drugs, remember this, if you simultaneously slap someone with a label that renders them vitrually unemployable and require them to take an expensive drug, what the hell do you think is going to happen?

That said, I mourn the victims of the slaughter.

Sorry to add this, but I think you overestimate the power someone who sees a pshrink has. BTW, in New Mexico and, I think, several other states psychologists can and do prescribe drugs.

http://www.webmd.com/mental-health/news/20020315/psychologists-allowed-to-prescribe-drugs

Social workers are working to get this "right" too, don't know how successful they've been.

But usually these days any mental health professional one sees will be working in conjunction with a person with prescribing priviledges. Once a prescription is recommended, there is no "legally" valid excuse for not taking meds. All "legitimate" resources insist that it is irresponsible not to take these drugs so anyone who doesn't is really going out on a limb. A mother prescribed an ssri for "post partum depression" who reads Parenting Magazine and realizes she is harming her child by continuing to take the drug risks losing custody of her child if she tells her prescriber she wants to stop taking the drug. Don't forget that among the primary diagnostic criteria for Bipolar Disorder these days is being prescribed an ssri for some other "condition" and "confiding" in your MHP that you want to stop taking the SSRI. The clinical term for asking your MHP if you can stop taking an ssri is manic agnosia. You are lucky your doc allowed you to stop, but you are in the minority. You can't expect every psych "patient" to be an educated journalist or to have the power to be allowed to stop taking drugs. Even asking to take drugs can result in a serious curtailment of civil rights.

Not taking meds recommended is almost always the right choice, but it's also almost impossible to find credible information to tell you that. Most of us who are against psych meds are regarded and nuts, not to be trusted, which is why even your too mild cynism is a breath of fresh air.

Someone mentioned Kazmierczak's heavy consumption of cold pills in the last couple days of his life. THANK YOU. I hope someone pays attention to this because it just might be very important. If not to the victims of this tragedy, then to someone reading this blog. OTC cold pills can lead to a VERY DANGEROUS drug interaction which is not sufficiently recognized.

There was a murder in rural Illinois several years ago where the defense sought, quite credibly I thought, to mount a "Paxil defense." The man had been given Paxil for anxious depression with sleeplessness, after his wife left him for another guy. The Paxil made him agitated, rather than calm, but neither he nor his doctor made the link to the drug. They both just assumed he was getting worse, and the doc upped the Paxil. The guy tried an old trick -- taking Benadryl cold pills to help him sleep. BOOM. According to a defense psychiatrist, the Benadryl made it impossible for his liver to clear out the Paxil. His agitation escalated to psychotic rage, and he grabbed a gun. Severely wounded his wife, killed the other man.

He was convicted; the appellate court overturned it because the court did not give him a fair chance to present this "involuntary intoxication" defense. By the time of his second trial, however, his defense expert had been investigated and criminally charged for allegedly overbilling Medicaid. I have always wondered.... The man had zero history of violence, towards the wife or anyone else. She had just felt they were growing apart, and then she fell in love with someone else. I think that if the killing had not involved such a classic conflict -- the fatal love triangle, as it were -- the court might have taken his defense more seriously.

Thanks for the Midwest input Phil! Like you, I have been repeatedly prescribed up to double the standard adult doses of these drugs when the regular dose was not working. (Effexor, 375; Cymbalta, 120; Lamictal, 300 with an invitation to 400 which I turned down. And I am NOT a large woman.) I have heard providers characterize asking questions or doing research as "noncompliance", a classic sign of the "lack of insight" so typical of mental disease.

Would you feel comfortable naming the large city, or the teaching hospital? And is there any halfway reasonable patient support group there? If so, I would seriously welcome the tip. Thanks again.

Sorry -- I meant JEFF!

http://theicarusproject.net/alternative-treatments/harm-reduction-guide-to-coming-off-psychiatric-drugs

Harm Reduction Guide To Coming Off Psychiatric Drugs put together by the Icarus Project, 40 pages.

Also see: http://www.peter-lehmann-publishing.com/withdraw.htm
Coming Off Psychiatric Drugs: Successful Withdrawal from Neuroleptics, Antidepressants, Lithium, Carbamazepine and Tranquilizers

"i too am kinda shocked at how many docs have little to do with the net including my own. but that doesn't excuse patients from doing a simple google search or whatever."

I know plenty of patients who can barely afford food Philip, let alone a computer and internet access. There are many people, especially older people who have no idea how to even use the internet. Most people trust their doctors too.

well that's what libraries are for then. plenty of books on these issues, free net access, instructions in how to use it.

Yeah, libraries. Everyone lives near one and has transportation too. Right. Of course. And as I said before, most people do trust their doctors.

tina, no disrespect but a vast proportion of americans--something like 75 percent, according to nielsen--have access to the net from their homes. if the remainder don't have the basic gumption to get to a library, check out a book, log on there, or are just so trsuting of their docs, then i really can't do much for them. i'm not trying to be dismissive of their needs, but i refuse to believe that ppl need to just stand by and be 'victims.'

Philip,

Okay, so that would be people who have their own homes. As for "basic gumption", that's the first thing to go when certain meds are involved. I didn't intend to get into some debate over this, but now this is the second time within two days, that you're referring to not being able to do anything for "them"...like those schizophrenics that just won't "step-up" and do that hard psychological work to rid themselves of their delusions.

You're working from your own personal bias, as we all do, but to judge who is and is not doing their part in recovery and to decide how they should be going about it, is simply self-centered and wrong-headed. I don't know what makes you think you've earned the right to make that call for other people. You're never going to walk in anyone else's shoes but your own.

well my own personal bias is kinda informed tina. first, that net figure is not just ppl who own their own homes. please i live in a city that is 50 percent renters. two, we live in an age where even the homeless have voicemail and cell phones and internet access. i'm not joking. i've seen this firsthand working with the homeless. third, i've spent the last five years or so reporting on and observing people with very severe mental illnesses. you're right on one count--there are some who are too far out there to do any psychological work and meds and the warm embrace of the social workers don't seem to be doing much for them. but i've kinda been surprised at the numbers of ppl with severe mi's who are reasonably stable who do stupid things like smoke crack and then they wonder why they still have delusions. so while my 'do the hardwork' argument doesn't apply to everyone--and probably couldn't to some with schizophrenia--i am not convinced that people with depression, bp, anxiety, ocd, etc. cannot get off their knees and help their own conditions.

i know i am pushing this too hard for your taste but the reality is that if no one pushes back on the victim model of mi then nothing changes. if you think i am off base take a look at where people with physical disabilities were in our culture 30 years ago and compare that with where they are today.

Philip,

My own personal bias is quite well-informed. Thanks.

"you're right on one count--there are some who are too far out there to do any psychological work and meds and the warm embrace of the social workers don't seem to be doing much for them."

Guess I'm wrong on that count, 'cause that's not what I said, and certainly NOT what I believe. This whole "victim model" you're describing is little more than victim bashing. I certainly don't believe that people with serious mental illnesses can't help themselves, and certainly those with an incorrect dx that spend years on meds can help themselves as well, but only when they do happen to get the necessary information. Frankly, it just doesn't happen all too often. These mental health programs, when they are available, are heavily focused on teaching patients all about their "brain disorders" for which they will need meds for the rest of their lives. There's a great deal more misinformation out there than anything else, so when people are hearing these same things over and over from mhps and peers and the msm, they don't often know they need to look any further. That's a sad fact. People DO end up victims, because of that. Are there people who wallow in the victim-stance while they have all kinds of options? Yes, absolutely, but working from the approach that everyone has access to all the info out there and that all should be able to inform themselves and save themselves, is sadly unrealistic and leaves out a lot of what needs to be done to educate people.

tina, i'm the last guy around to engage in victim bashing. hell i've worked with these patients and sorry i am just coming to different conclusions than you are on some things. i agree with you though on the way patients are educated about their conditions. i'd like to see the proof from ppl who teach patients that they have a lifelong illness that ppl never get better or get in the clear of their illness.

Philip,

This kind of judgment passing about those whom you believe haven't done whatever it is you think they need to do to inform themselves and avoid harm is a very subtle form of victim bashing. Tragedies happen every day and are that not under our control. We don't know what we didn't know until we know it. People DO get harmed before they've had the chance to know the dangers. Often that's how people find out or wake up to the fact that they do need to look further, but it's sometimes too late.

"i'd like to see the proof from ppl who teach patients that they have a lifelong illness that ppl never get better or get in the clear of their illness."

I'd like to see that "proof" too, or maybe not. We know it doesn't exist, except in the cases where it is believed by the patients and lived out that way. When patients hear "truth" over and over from those who are supposed authorities on the subject, that word becomes the "proof". People live according to it. Lives are being constructed by it, beginning with little two year olds who are being medicated and will likely NEVER question as they grow up whether than can do or be anything else. Mentally ill becomes their identity. It happens even with adults. Are those the wannabe victims?

Blogs are great, and the net is very often a lifesaver, but it's not enough to say that people should just be able to inform themselves. It's not that cut and dried.

I have to say I agree with everything Tina has written. The arguement that MI patients have access to the internet and can get all the information they need is wishful thinking.This arguement does nothing more than blame the patient. How many times have we been told "
don't believe what you read on the net", Compared to "trust your doctor"? How much crediablity will a psych patient have when they state "I trusted the internet and not my doctor"?

I would be curious to know Philip when you are working at the shelter, how many times you offer a resident use of a computer or advised them to look the information up once they are out of the shelter? And if you offered this information, did you tell them where on the internet they might find the information? My guess is, is if this communication went on at all, you advised them to talk to their doctor.

I'm certain the drug companies are enjoying this decussion as once again the responsiblity of insuring their medications are safe is taken off them and placed on the patients. This entire discussion goes a long ways in helping the issues surrounding the right of the mentally ill. Lets blame the patients for their ignorance for trusting the medical community.

Philip, Here is the main point in all this that you are missing: Psychiatrists DON'T LIKE PATIENTS WHO ARE "DIFFICULT". And the "difficult" label translates into: Any patient that takes the time to become really educated, and to keep up to date on the medical science, research studies and pharmacology... AND who has the gall to bring up what they have learned in a session with the doctor and "challenge" the doctors authority.

Yes it is fairly easy for a fairly intelligent person with a MI to get online and learn TONS of stuff about meds, thier illness, alternative treatments, how to safely taper etc etc. BUT when a patient armed with this information goes into the Psych Docs office and says something intelligent like:
"Well since you suggested I switch from Seroquel to Geodon I decided to go online and go read the PI sheet (the prescribing information), search on PubMed for adverse reaction reports etc." "And what I found was that the PI sheet said that Geodon has Seritonin and Norephinephrine REUPTAKE INHIBITION ACTION, as well as being a D2 and 5HT(2a?) antagonist/having antipsychotic action. I also read that it has "activating properties" just like many antidepressants do, and read some reports that out of all the Atypical antipschotics it is the most likely to trigger mania." "So I was thinking that since it has seritonin and norephinephrine reuptake inhibition action JUST LIKE EVERY ANTIDEPRESSANT DRUG I HAVE TAKEN AND THEN BECAME MANIC, THEN MIXED WITH PSYCHOSIS, and then after quitting such a drug had to deal with months of rapid cycling that even strong drugs like atypical antipsychotics take months to end... well I was thinking that maybe Geodon wouldn't be the best first option for me to try in an attempt to get off the Seroquel." "Could we please look at some other medication options than this drug because I just don't think it's wise to put me on something that shares a similar psychopharmacological profil with drugs that I have had seriously bad rections to".

.... Well you know what sort of reaction you get to being an educated patient and having real reasons based on science as to why you want to switch meds, or not take a certain med and try another one instead OR EVEN FOR WHY YOU WOULD LIKE TO SLOWLY TAPER YOURSELF OFF A MED RATHER THAN DO IT OVER THE COURSE OF A FEW WEEKS OR COLD TURKEY? - YOU GET TREATED LIKE A PIECE OF SHIT. And you get to have an "arguement" with your doctor where the point is no longer what can the doc do to best help you but HOW can the doc prove he's right (even if he's not) and that you're an idiot/asshole to even be bothering trying to be educated and daring to bring up a valid point in your appointment.

Doctors don't like patients that do a better job of keeping up to date and paying attention to how meds work and how some meds that are suggested are too similar to other meds they've tried and had a bad recation to. And they don't like it when you tell them that you would feel much safer coming off a med slower than they recomended because you feel that you are having withdrawal symptoms (or dealing with a discontinuation syndrome). Usually the doctor will label you as "obsessive" if you go to the trouble of becoming educated, and usually they will become DEFENSIVE, rude and even cruel if you DARE to make a valid point about you're treatment.

When it comes down to it you can have all the education in the world, but when you take that knowledge to your psychiatrist and the response you get is being told you are wrong over and over, and if you dare to argue that you are not wrong you start getting labeled with diagnosis that are not correct as a "threat" to make you back down, and you basicaly end up scrweing up your doctor patient relationship. With the way that these doctors know how to mess with ones head, it's no wonder that even an educated person can end up doing something stupid because thier doctor told them to do it, NOT because it was the right thing to do but because the doctor was PISSED that the patient knew something they should have known but were too lazy or buisy to brush up on, and so the doctor stops trying to do what's right for the patient and starts giving recomendations that serve only to make things go about in a manner that will prove that the doctor is right.

Even something as simple as going to the doctor and saying:
"I know you said that I should cut my dose of X med by 1/2 every two weeks, but since I have been trying to do that I have felt so terrible. So I went online and found some sites that say it's always better to go as slow as you can when coming off a med so as to prevent any withdrawal symptoms or any rebound episodes, so I think I am going to start cutting my dose by no more than 10% every two weeks".

... Will get you a response like this: "This medication you're on/trying to get off of DOESN'T HAVE A WITHDRAWAL/DISCONTINUATION SYNDROME! So if you're feeling worse it's not because you're quitting hte med too fast it's becuase you need(ed) that med or something like it to control your underlying illness." "Listen you have one of two choices: You can get off this med to get rid of X,Y and Z side effects that you are tired of dealing with and you can get off it at the schedule I gave you to discontinue, and durring that time we will start you on X drug, or we can raise you dose back up and you can stay on it and just live with the side effects". "Listen I'm the doctor, I know these things and you need to listen to me. You can't believe everything you read on the internet."

So people get INTIMIDATED or PUSHED BY THIER DOCTORS to do things the way the doctor wants them to do it EVEN IF THEY SHOULD KNOW BETTER because they are a reasonably intelligent person who HAS EDUCATED THEMSELVES.

What NAMI and all these other organizations need to do is give patients the facts they need to know: That you doctor IS NOT always right, and that sometimes even if the doc gets argumentative, defensive, threatening or even down right cruel, if YOU KNOW BETTER you need to get a second, third, fourth or fifth opinion until you find a doctor that wont treat you like shit because you have done a good job becoming an educated patient. That even if the doc says there is no withdrawal syndrome for X,Y or Z med, that doesn't mean that you couldn't possibly be experiencing one. ANY PERSON CAN HAVE ANY REACTION TO A MED, and if you have a doctor who will not LISTEN TO AND BELIEVE YOU when you say that you are dealing with such and such symptoms, you need to find a new doctor... not just stick with the old one and let them push you over the edge and tell you that you're stupid and have no right thinkng that all those hundreds of hours you've put into educating yourself about psychiatry and psychopharmacology, could possibly have taught you anything. When the doctor tells you that you are manic and obsessive and delusional because you have VALID questions about your meds, your tapering schedule or you go in when you are depressed yet are still able to talk "science" because you are intelligent... so they diagnose you as manic and delusional because you are crazy, therefor stupid, therefor couldn't possibly have understood anything you've read in the persuit of being an educated consumer........ well that is when you need to say "sorry man but I'm not playing this game. I'm going to find myself a doctor who respects me." ... and prevent yourself from staying in a "relationship" where your doctor isn't going to do the best thing for you but instead is going to do whatever he pleases JUST TO MAKE THE POINT THAT HE HAS THE POWER INT EH RELATIONSHIP... and part of him doing whatever he pleases is to push you into doing what he wants you to do and into doubting yourself and doubting everything you've learned.

DOCTORS WANT YOU TO BLINDLY TRUST THEM. They act in ways that STRONLGY discourage thier pateints from having faith in themselves and being able to question the doctor and follow thier gut and what they've learned.

As long as this is still the case with so many doctors it is hard to completely blame the patient for not being educated. Even myself, as smart as I am have been pushed into doing some dumb things by doctors because they talked me out of having faith in myself and what I have learned over the years. When the PhD is telling you that you are dumb and they are right, and you are "crazy" and not been able to accomplish even a fraction of what they have in thier lives due to how "crazy" you are... it is easy to be MANIPULATED. I NOW KNOW that I will simpy have to keep searching for the right doctor but so far it has cost me over $1,000 to go thru a number of visits only to find that once again I am face to face with another doctor who's EGO and sense of AUTHORITY is more inportant to them that helping thier patients get well. Having to deal with the sort of BS I have had to deal with from THESE SORT of doctors has caused me great distress at times. I can completely understand how it could drive someone to despiar and to doing something stupid and quittin ghtier meds cold turkey.... I mean really doctors DO STILL SUGGEST TO PEOPLE TO QUIT MEDS COLD TURKEY.

If anyone needs to go online and educated themselves it is the doctors. Yes patients should do it to, but until the doctors can stay as up to date as the patients then there is still going to be this "power play" drama, defensiveness BS that patients get from their doctors over the fact that they are educated consumers. And as long as that is still happening it means that there is going to be a patient popultion that could even be AS educated as thier doctors yet still not be able to use that knowledge because they don't have the PhD or MD and the doc does and the doc uses that, and thier position of authority to manipulate patients into doing what the doc wants them to do..... because you know how us people with MI are told over and over that it is a symptom of our illness and a lack of insight that drives us to question meds, and question our doctors.... and that is always held over our heads even if our reasons for asking the doc to slow down our taper schedule or suggest a different med option than the first one he suggested... even if our reasons for these things are completely rational, logical and based in medical science, we are still told we are delusional becuase DOCTORS DO NOT LIKE TO BE "challenged". They definately HATE IT when you point out that you know or noticed something that they missed and they can make your life a living hell over it if they want. SO it's no wonder so few people "second guess" or question thier doctors, EVEN IF they know they should be.

I believe knowledge is our best weapon.Period. I've always researched, and in medical libraries before internet.[UCLA medical library, 1982 when I had toxemia with a pregnancy, I read and became informed and knew what to do health wise and baffled the doctors at the successful pregnancy as a result.]

I've asked pointed questions to psychiatrists for the last decade, and I arrived many times into their offices with print outs from the internet, which can hold package insert information. That simple and basic information is available to ALL patients who ever receive a medication. You just have to ask for it from the pharmacist, if it's not in your bag. Many times, the doctors challenged my ideas, thoughts and dare I say one told me "to go become a psychiatrist if you want to act like one"--and all I had was the same information they FAILED to give me.
I have been told by psychiatrists and PCPs:

1. Zyprexa that was given to me by a PCP for anxiety[yes an antipsychotic for anxiety in 2003]that I was all off base walking in there with internet information explaining that the severe edema in my ankles was a side effect from the med. He told me "don't believe what you read on the internet". I told him it was Lilly's own package insert fine print. The doctor left the room and logged onto the internet, and I was off of Zyprexa. I then told him to report it to the FDA.

Informed? you bet. Why would anyone take a medication without attempting to know what it might do? Because yes, I agree that most Americans, TRUST DOCTORS BLINDLY.

I have been told this by a teaching hospital, 30 year veteran and published high end psychiatrist:

"I am the doctor."

When I questioned the medication he had my daughter on that kept her awake for 10 solid days.

My OWN psychiatrist has been taking notes as I tell him about side effects re: Seroquel withdrawal, and Lamictal, etc. The informed psychiatrist, in my opinion is one who understands the meds and hears the patient, and those psychs are rare ones.

I have been attempted to be shut up and slammed down so many times for being an educated patient, that it pisses me off.

We are labeled as pushy or "doctor shopping".

That is a fact. I also believe that patient education often only happens once something bad happens to a patient and that is when they start to research their medications.

I think it is safe to say that homeless people DO have internet access via the libraries, as I have observed several using the facilities to clean up in the rest rooms.

Not ALL homeless, or MI patients want to help themselves. I'm sorry if that disturbs anyone, but I don't care. I've spent hours on the streets talking with homeless/and/mentally ill patients asking them point blank why they live the way they do. Most tell me it's their lifestyle and their home. They don't feel safe in shelters and one gave me a long talk about her choice of meth use over Seroquel for her SZ.

Not all people period, want to make life better for themselves, and this is where it becomes a self-determination issue that expands beyond homeless labels, or mental illness labels.

There are plenty of people out there not living up to society's standard of living. There's a judgement placed on individuals to conform, and not everyone is interested in education, learning etc. That is not a bad thing, it's personal choice.

Good post. I appreciate your effort to grapple with some of the complexity in this situation.

I want to mention that Thresholds and the group home are both based in my old neighborhood... about 5 miles from where I live now. There is a great deal of talk about anti-depressants in this case. We don't know a great deal about what really went on with this guy and his treatment, but frankly I've never known anyone who was in the Thresholds program who wasn't on anti-psychotics and/or serious mood stabilizers. That doesn't mean he continued with these medications, but if he was on them, I wouldn't be the least bit surprised if they were a part of his continuing regimen. Discontinuing these certainly could have been a factor in his actions -- but this is all speculation on my part.

A good deal of the ranting I've read in the blogs seems rooted in the political and personal preoccupations of observors who feel certain that their paradigms and explanations apply to a person and a situation they actually know very little about. I've read rants decrying secularism, guns, gun-free zones, multicultrualism, our materialistic value system and loads of ill-informed criticism of mental health providers, drugs and services. What seems most lacking in much of the discussion is any sense of humility or uncertaintly on the part observors who are operating with precious little information.

"Not ALL homeless, or MI patients want to help themselves."

I believe anyone who is truly suffering wants to help themselves. Often people don't know how, and when reaching out for help, they get handed tools that may or may not be useful to them.

Yeah, knowledge is our best weapon. My point is that it is not equally accessible to everyone. Package inserts? Oh, very useful. I've always read them myself, but then there are those who can't read at that level, can't read at all, can't comprehend what it means, etc.

Your personal experience and the experiences of those whom you've chatted with don't add up to the right to decide who is and is not doing what they need to do to get well. That's a very personal journey. Under the right conditions, anyone can help themselves. Not all people are afforded the same opportunities. And THAT is just the way it is. But pass judgment on those whose shoes you've never walked in.

It's very easy to look back, with hindsight, and know the process that it took to recover and to see those who are still stuck in the mire and be frustrated with them, thinking they just aren't "stepping up", but that is self-centered, and pointless.

Hey Phillip,
Just some personal thoughts to add to the mix.

About psychiatric juvenile group homes.
These are not country clubs or summer camp.
If you can imagine an orphanage combined with high school level dorm setting, combined with a flavor of psychiatric hospital and a dash of juvi detention you get a juvi psych group home.

I spent four years in them. The State run jobs are the worst, barely a notch above juvi hall/psych prison. The private ones can actually afford to hire a few humans amidst the keepers. The food is better, the cook cares just a fraction more and you can taste the difference. Nevertheless group homes are a nightmare.

They exist in artificial structure that kids are made to conform to or else. Threats and coercion are the norm. It was horrible living in them. You do not get ‘care’ you get ‘treatment’. Which nearly always means drugs, structure living programs and therapy. That’s it. Everything is in terms of compliance or noncompliance. Acting out always ends up in restraint. I went into those places with extreme PTSD at 14 and I stayed at red alert in these places until I was 18. You can not relax. You are not safe.

There is no trusting the staff and opening up to anyone. You have no privacy, few rights and no say over anything. When you confine a population like that of 40 girls and boys every single day is insanity hour all day long. It turns out when you force teens with severe mental and emotional problems to cohabitate in a structure of unreality unlike anything they grew up, they get stressed!

In these places it is not unusual for kids to attack each other and the staff. The staff attack back. They call it restraint but it is assault and battery. If you grew up with child abuse, only to have staff pin you down to the hard floor all your triggers go off. They add injury to the injustice. Your room mates are cutters, ODD/ADD, teen addicts, criminals. Some would never hurt anyone but themselves. Others physically assault you because of a perceived bad *look* in the blink of an eye. There is no escape from the other kids or the staff.

When you get sick of it and run away, you get recaptured and punished for it. You are put in isolation for days. One kid brings a miniscule amount of contraband, like a single cigarette, and the entire facility is locked down while the staff ransack everyone’s stuff. Even in the middle of the night you are woken up because someone is getting restrained again or it’s time for another random room search.

You see kids twitching, going into seizures in their chairs or slurred speech in groups because of their psych meds. Sexual assault especially male on male is rampant. Then there is staff favoritism which can make or break your entire stay there. Or at least a particular shift. It is simply and truly awful.

You don’t get training on how to be an adult. You are not taught anything. The on site schools are sub par and lean to those with learning problems and low IQ rather than those with higher IQ. It is like an abusive dysfunctional drama family x 100 and worse, they are all strangers.

To this day, I can vividly remember the things I saw being done to people and the things done to me while I was there. It took me years to get over the nightmares playing in my head from 4 years of psych group homes Phillip. Not to mention the rage, the anxiety and triggers. I was a mess when I got out of them at age 18.

Robert Hawkins was in group homes too. They said “everything had been done to treat this kid while he was services” These group home admins are full of shit. You do not get help at these places. All you can do is survive them with your personality intact. Many do not.

As chance would have it. I met two former group home ‘alumni’ years later. One girl, as soon as she turned 18, got pregnant and on welfare. She had many problems when she was a resident. One boy, was a homeless bum. He was addicted to heroin and sold meth and pot to pay for his habit. He was wanted in half a dozen states and had abscesses from shooting up with low quality drugs all over his body.

I can assure you people, that both this Steven kid and Robert were not being 'cared for' in these facilities. Such nonsense.

Tina are you wearing my shoes?

No Stephany. I'm not. That's The Point. Nobody can live anyone else's life or know their lived experience in the way that only the person living it can.

I think it's good to see this serious discussion among well intentioned caring people. Openly airing our disagreements is crucially important.

Stephany, you wrote this:"Not ALL homeless, or MI patients want to help themselves. I'm sorry if that disturbs anyone, but I don't care." I know you realize that if you delete "homeless, or MI" the sentence would still be true, i.e. not all patients want to help themselves. This sort of thinking is common and troubling. It's an example of society condemning "homeless and MI" as mental defectives and simultaneously expecting a HIGHER standard of behavior from THEM than from ourselves. Stephany, you are a tireless advocate and I know you don't mean harm.

Phillip wrote: "Stop treating yourself like a victim and treat yourself like an intelligent human being with a social conscience," regarding the people prescribed and diagnosed in the MH realm. Again, this could be said of any human, but would you really say it to someone diagnosed with cancer who couldn't decide whether to go through with chemo or not? No, because you would regard that as a validly difficult choice. Would you really say that to a loved one of one of the kids killed in Illinois - well, they made an informed decision to go to that University and take that class so they got what they deserved? Of course not. So why on earth would you expect someone who makes the effort to go to a mental health professional because s/he feels responsibile for her/his mental health to expect that the doctor is either lying or misinformed when the doctor tells her or him that they have a brain disease and thus can't trust their own feelings and must take drugs for the rest of their lives?

What's going on in the mental health world is a holucaust, not treatment. You can see that in all of the statements here that They are different from us and don't deserve fair treatment. I suspect the torture the shooter endured during a year at a psych hospital partially to blame for his future behavior. I'm not saying it justified his behavior, I'm just saying what happens in those places is never justified and never helps. Even though ALL mental health professionals acknowledge that most teen mental health problems are largely environmental, I bet no teen with insurance has ever been turned away from such a place.

As for the homeless in libraries, surely you've read the recent TAC piece about banning the homeless from libraries. And by the way, before we begin using the terms homeless and mentally ill interchangably, think about how you'd behave if you lost your house. Look at the economy. Do you really think the only reason for poverty is untreated mentally illness? I know you don't and I'm sure you realize that homelessness can cause mental illness and that in our nation we have the resources to prevent all homelessness. Let's do that before we start blaming someone sleeping on a cart starving for not googling the psych meds he can't get an appointment to get a refill for anyway.

I live in Communist Wisconsin. I am Court ordered to take 7 different Medications. Actually 6 the Seventh is for the Irritable Bowl Syndrom I have now developed from the "overmedication". Whatever you do stay far away from this state! The biggest drug dealers are Psychiatrist and big Pharma. No matter how educated you are, there is still forced outpatient treatment. If you thought The Patriot Act was bad try this on. Stunts like NIU only give fuel to argument that persons with MH issues need to be controlled. Chemically Restrained by the law, but it is a load of crap!
This is no free country and if you think it is, perhaps you need some medication to help you deal with that delusion you are having.

Sally, I was referencing people that ARE homeless who I interviewed on the street, and others who said they are both. Just referencing my personal experience and basically it was the people themselves who told me they have no desire to change. I am not using broad use terms here, I am sharing stories based on speaking to real people[their stories].

I was in fact told, from several they prefer living outside, don't like shelters, and prefer meth vs. Seroquel for their SZ.

Maybe my comment reflected differently based on my wording. I found the people I speak to and visit with [on a regular basis for over a year now]to be the kindest, and most caring people I've ever met. So, when it's cold I give them gloves, or when it's hot I leave a bottle of water. We have very interesting conversations, and yes they are in fact homeless and some are mentally ill. I've heard quite a few life stories, and they are very candid as to their lifestyle, and the choice of it.

This is not to be fogged up with "homelessness or mentally ill" and wording, etc. I was sharing based on real experiences with a few people. Not ALL homeless, and not ALL people with mental health issues.

How would I feel if I lost my house?

Ask me in 4 months.

Stephany, I can feel your fear of losing your home. My savings are wearing thin and still no job, but since, after being labeled mentally ill, I finished law school with no meds, I can't get disability. So if I lose everything there are no kill shelters where I can leave my pets, though I'm working on positive thinking and do want to help myself so hopefully that won't happen. But I have seen a horrible sub group of the homeless, those folks who can't get disability because in spite of their labels they are clearly not mentally ill and yet can't get employment or housing because of their labels. Social Security isn't for people who are mislabeled and I am afraid, oh but I must be positve. My point was that not all people want to help themselves. People don't get homeless or labeled mentally ill for lack of trying any more than Paris Hilton or Prince William got rich by their own efforts. Not wanting to help yourself should not be a precedent for being given the life, liberty and right to pursue happiness, etc that all of us US citizens are legally entitled to. But you know this. Sorry I'm preaching to the choir. Hope you don't lose your house.

thanks sally, life should be about choices, and this time, i don't think i've got any. taking care of my daughter and all of the long advocacy days were worth her freedom; and this is a cruel outcome for myself as far as i am concerned--it's crap. some of the people told me they prefer the life outside, that is their choice too. i've got lots of stories based on my experiences, and one thing i can sum it up with is the people ive met are some of the best people ive ever met in my life. they are who we should be taking care of, but not 'in your face' kind of way. i mostly lend an ear and they tell me about themselves. they are just "you and me". i don't like using words like "they" "them". etc.
i also had many inpatient psych ward women cry to me upon discharge because they were being sent to the homeless shelters. one woman said she was clean for the first time in her life, and didnt want to go to a shelter. all i could say as she sobbed ,was that we are here, and that counts somehow. what else to say. i wish i could do more. like i said i'm not generalizing, just sharing my experiences. i'm pretty sure ive gotten this way off topic here, but wanted to reply.

Sorry, but one more thing: Humane Society does not kill animals [Sally's reference to "Kill shelters"]. They find homes, and the only animals to be "put down" are those that are severely SICK. I've volunteered at one for years...and I was hesitant to, because of the misrepresentation that the dogs and cats are put down upon arrival. They are not.

There ARE positives in this world, if we stop to take a look for them, they DO exist.

Stephany, just to clarify, I wrote there are no kill shelters where I can leave my pets. What I meant was there are shelters that are no kill where I can leave my pets, what we down south who volunteer at such places call no kill shelters, though I see when you read it how it could seem like I meant there are not any kill shelters...that's not what I meant. A no kill shelter is a shelter that does not kill in my jargon.

As for the homeless, I just wrote in another post about a homeless man who told me about being arrested in a local hospital for trying to break into the locked ward to get help.

I'm sorry you don't have as many choices as you deserve. We should all have the right to decide what happens in our lives.

oh i read that backwards, got it on the "no kill pets" shelters now.

I think we must have enough courage to face Depressants.