By Maria Mangicaro
A “Rubber-Stamp” Approach: The Failure to Detect and Treat Underlying Causes of Mental Illness
Staff writer Robert Farley, from the St. Petersburg Times, wrote a compelling article entitled: The atypical dilemma
, headlining Sunday, July 29, 2007. The article brought to light the dilemma facing more and more parents; a mental health professional labeling their child “mentally ill” and prescribing powerful anti-psychotic medication to control “abnormal” behavior.
The skyrocketing number of children being labeled as mentally ill, along with the lives of the individuals featured in this article, demonstrate the urgent need to challenge the medical necessity of anti-psychotic medications on children. This stigmatizing label affects the individuals, their loved ones, society and generations to come. This challenge must include the failure of the psychiatric profession to recognize and treat underlying causes of “mental illness”, as well as, the pharmaceutical industry’s lack of responsibility for the lethal products they manufacture.
The Pingleton family mentioned in the article tragically lost their 15-year-old son Brandon to suicide. Brandon hung himself in his bedroom with a guitar string just feet from his parent in the next room. Brandon was never suicidal until he was put on anti-psychotic medication. Since 1988, 38 families in Pinnellas County, Fl. have had a child commit suicide after being put on antidepressants. This problem needs strict scrutiny to reveal much-needed solutions and mainstream emergent paradigm shifts in mental health treatment.
The American Psychiatric Association(APA) publishes The Diagnostic and Statistical Manual of Mental Disorders(DSM), as a handbook for mental health professionals listing the different categories of mental disorders and the criteria for diagnosing them. It is used worldwide by clinicians and researchers, as well as insurance companies, pharmaceutical companies and policy makers. By consensual agreement within the American Psychiatric Association (Diagnostic and Statistical Manual III-revised, 1987), psychiatric diagnoses are descriptive labels only for phenomenology, not etiological or mechanistic explanation for syndromes. Thus, a psychiatric diagnosis labels a pattern of signs and symptoms, but offers no hypothesis concerning the mechanism(s) of the clinical phenomena.(Davidoff et al., 1991).
The APA also publishes practice guidelines to provide recommendations for the treatment of the psychiatric disorders listed in the DSM. The practice guidelines rely heavily on the use of medications to treat symptoms of mental illness. The guidelines do not provide evidence based recommendations for psychiatrists to test for and treat underlying causes of mental illness. Psychiatric diagnoses are arbitrary and misleading that a mental disease exists, when in fact the symptoms are caused by a detectable physical abnormality. The labels conjured up by the APA interfere with an individual’s right and liberty to contract medical professionals to deal with legitimate health care concerns.
Physical and mental disorders are correlative in nature. Individuals labeled mentally ill are subjected to poor health care and lack resources to overcome the standard practice of treating “mental disorders” with a medication regime, often worsening their condition. The APA admits DSM labels are nothing more than descriptive terms applied to patients who have certain sets of symptoms, with no regard for the underlying biological or physical causes. Whereas, a “labeling” system is necessary for communication purposes, the blanket psychopharmacological approach toward treating mental illness has failed miserably.
Bristol-Myers Squibb manufactures the atypical anti-psychotic medication Abilify. In October 2007, the FDA approved Abilify for the treatment of schizophrenic patients ages 13 to 17. A new warning was added to the black box label regarding suicidality and antidepressants in children, adolescents and young adults. A black box label is the strongest warning the FDA can impose on a pharmaceutical. Bristol admits in the advertizement for Abilify success of their product is based on guess work, “Abilify may work by adjusting dopamine activity, instead of completely blocking it and by adjusting serotonin activity. However, the exact way any medication for schizophrenia works is unknown.” This statement along with the list of possible side effects supports the fact there are no guarantees this medication will be effective or safe. The product may cause the user to suffer adverse side effects, worsen their primary symptoms, cause them to commit suicide, murder, or both.
The use of antipsychotic medication is a gamble. The pharmaceutical industry treats this gamble with a passive “you win some, you lose some” attitude. In many cases the pharmaceutical companies are not held libel for their defective product. Regardless of alarming suicide rates, the APA keeps their blinders on and sticks with the prescription regime.
According to January 1999 national news reports, ten days after Ryan Ehlis, a college student in Bismark, North Dakota, began taking Adderall to control his Attention Deficit Disorder and to help him with his college studies, he slipped into a psychotic fog, shot and killed his infant daughter, then shot himself in the stomach. He said God told him to do it. The criminal court found him innocent after testimony by a psychiatrist and by the manufacturer of the drug that the “psychotic state” was a very rare side effect of Adderall use. Various doctors testified Ehlis suffered from an “Anphetamine-Induced Psychotic Disorder”. This is a DSM label for a psychotic disorder caused by medication prescribed to help a less severe disorder. Medical experts and Shire US, Inc., the manufacturer of Adderall, commented that “despite the slaying, Adderall remains a safe and effective drug for controlling AD/HD.”
In a later civil court case, the United States Court of Appeals, District Court of North Dakota, affirmed the lower courts decision to dismiss a lawsuit brought by Ehlis against Shire. Ehlis contended Shire knew Adderall could induce psychosis and failed to adequately warn of the associated risks. The court ruled the “learned intermediary doctrine” barred the claims of failure to warn. This doctrine provides that a pharmaceutical manufacturer has a duty to warn a physician of the risks involved with a drug, and the physician acts as a “learned intermediary” between the manufacturer and the patient. “Thus, a warning to the physician is deemed a warning to the patient; the manufacturer need not communicate directly with all ultimate users of the perscription drugs.”
The treating psychiatrist for Elhis stated he (1) knew substance-induced psychosis was “within the DSM-IV,” meaning diagnostic criteria exist for this condition, regardless of the psychosis was caused by stimulant or other medication; (2) was aware some people can become psychotic without overdosing on certain medications, including Adderall; (3) knew the risks of psychosis was listed and identified in the package insert as a side effect for Adderall when he prescribed Adderall for Ehlis; (4) believed the statement in the insert was accurate; (5) continues to prescribe stimulant medications for adults since the incident involving Ehlis; and (6) continues to prescribe Adderall, because Adderall is a good medication. Ehlis’ psychiatrist evaluated him in a 45 minute session and prescribed a medication resulting in the death of his child, and serious injury to himself. Regardless of this tragedy, he feels the medication is safe and continues to prescribe it. Any reasonable person would consider this medication too harmful to ever prescribe again.
The Hippocratic Oath requiring new physicians to swear upon a number of “healing gods” and uphold a number of professional ethical standards states; “I will prescribe regimes for the good of my patients according to my ability and my judgment and never do harm to anyone. To please no one will I prescribe a deadly drug nor give advice which may cause his death.” Under the guidelines of the APA, psychiatrists who disregard and fail to treat underlying causes of mental illness while prescribing lethal anti-psychotic medications are practicing unethical standards of care. Physicians should be held to an ethical obligation to treat underlying causes of mental disorders before prescribing powerful anti-psychotic medications.
Advocates of anti-psychotic medications believe untreated depression, bipolar disorder and schizophrenia are behind most suicides and feel it is irresponsible to condemn multiple classes of drugs that have helped so many people. The recent shooting at Northern Illinois University is one example these proponents would use to support the notion that the non-compliance of prescribed medications caused Stephen Kaznierczak’s erratic behavior and shooting spree. From an uninformed point of view there is no acceptable rationale for a person with a psychiatric illness to be non-compliant” with a prescribed medication regime. Many allegedly insane people have very sane reasons for not being compliant with anti-psychotic drugs. Side effects such as tardive dyskinesia, Parkinsonslike syndrome, renal or thyroid damage, facial ticks, extreme weight gain are only but a few reasons.
Patients taking the anti-psychotic drugs Zyprexa or, Clorazil have been know to gain so much weight that they are placed at increased risk for obesity-related disorders such as diabetes and cardiovascular disease. The average weight gain is 22 pounds the first year. That’s enough to make anyone depressed- which of course frequently leads to stronger, more dangerous prescription drugs. As a result, anti-psychotic drugs actually create their own cycle of revenue by keeping patients depressed and overweight. It is a shot in the dark approach, supported by no valid testing to determine a specific course of treatment.
The rubber-stamp method of treating mental illness in patients who have been totally compliant often fails. 20-year-old Desirae Crandall, from Central New York is an example of anti-psychotic medication’s failure. Desirae had 12 psychiatric hospitalizations in a 21/2 year struggle with mental illness. She was released from her last hospitalization and put in a cab from the hospital to a group home where she lived, she then took a bus to a local shopping mall and went to the second-floor atrium. She climbed over the railing, leaned back and plunged 35 feet to the basement floor. She was released from the psychiatric hospital for only a few hours before taking her life. For Desirae the medical model treatment approach was her only option, she was compliant under supervised care, and still ended up committing suicide in public.
Numerous peer journal reviews and scientific research support factual evidence there are underlying causes for mental health problems. One such review published in the American Journal of Psychiatry, November 1984 focused on lead as a causation factor. The authors of the article Organic Affective Illness Associated With Lead Intoxication state: “We suspect that ignorance about the psychiatric and medical manifestations of lead intoxication and about the sources of occupational exposure to lead contributes to the failure to recognize, report, and properly treat psychiatric disturbances associated with lead intoxication…Since psychiatrist receive little information about toxic behavioral syndromes during training, toxic etiologies of psychiatric syndromes and, in particular, the less spectacular manifestations of intoxication are often not recognized.”
Respectfully, the knowledge and training to become a physician is in-depth and vast, certainly a major achievement in life, however, the APA is in denial that knowledge of toxicology and nutrition are key factors in treating mental illness. Heavy metal toxicity has historically been linked to conditions of mental illness including: the effects of lead on the Roman Empire, artists like Vincent Van Gogh exposed to leaded paints, “Mad Hatter Syndrome”, linked to mercury used in the hat industry, and the fact excessive copper levels can cause schizophrenia. Recently lead has been found to be in the paint of popular toys imported from China, like Thomas the Train. Past exposure to such toxins is not considered by the mainstream medical model as an underlying and treatable cause of mental health problems.
There are numerous underlying conditions to mental health problems that go undetected and untreated. A list of some include; lyme disease, metabolic disturbances (e.g., vitamin B12 deficiency, thyroid problems) Cretzfeldt-Jakob Disease, head injuries, dental problems, food allergies, poor diet, solvent exposure, cigarette smoke and multiple chemical sensitivities. Regardless of the underlying cause, the APA rubber-stamps a blanket and stigmatizing label on each category of symptoms. Pharmaceutical companies attempt to manufacture “silver bullet” medications to control dopamine and serotonin levels for mental health conditions without considering nutritional influences on brain chemistry.
Renown authors Dr. Michael Roizen and Dr. Mehmet Oz focus their attention to illness on nutrition and exercise. In their book You on a Diet, give the factoid “About 95 percent of your body’s serotonin is found in your intestines, while your central nervous system has only 2 percent to 3 percent. Remember, serotonin is what helps control depression in your brain…Omega-3 fatty acids, which are found in fish, have long been known as brain boosters and cholesterol clearers, but they’ve also been shown convincingly to help with depression in pregnant women…Since many of us have low omega-3intake, it might explain some other instances of depression as well.” This information should be taken seriously by psychiatrists who need to be educated in nutrition and the mind, as well as toxicology.
During the 1940’s and 50’s cod liver oil, a source of omega 3 was given freely to young children, pregnant women and nursing mothers. Fifty years ago children lined up in school to receive a safe dose of cod liver oil, today they are lined up at the nurse’s office where potentially lethal and addictive drugs are passed out like candy. These children also must face the stigmatism of being labeled with a mental illness.
In his book Crazy: A Father’s Search Through America’s Mental Health Madness, author Pete Earley gives a much-needed, in-depth look inside the mental health care system. He explores how it affects the lives of individuals suffering from symptoms of mental illness, their families and society as a whole. This book portrays the very dark side of a treatment approach based solely on pharmaceuticals. The individuals whose lives are detailed by Mr. Earley continually cycle in and out of the jail system and the failed mental health care system. They are treated either voluntarily or forcibly with medications, continually become non-compliant, refuse to take medications and either end up back in jail or dead. Even the individuals portrayed in the book who are compliant with the standard treatment approach of psychiatric medication end up living unproductive, unfulfilled, lives. They are at the mercy of drugs that attempt to control their behavior by sedating them to the point of a zombie-like state.
The forecast for individuals who are struck by symptoms of mental illness is bleak and dismal according to the author who did not explore any alternative perspectives on mental health care. A schizophrenic individual who Mr. Earley researched was Deidra Sanbourne. She was involved in a class action suit attempting to improve the inhumane conditions of Florida’s mental health care facilities. Her situation and death were very tragic. She died of complications from a bowel obstruction while being treated in a hospital psychiatric ward. The medication Clozapine is used to treat severe cases of schizophrenia such as Deidra’s. Clozapine has caused bowel obstructions leading to death in schizophrenic patients. Deidra’s death could very well have been from the medication she was administered while being treated for symptoms of schizophrenia under the care of medical professionals.
Treating mental illness should not result in death. The book also reveals the very dark side of rehabilitation and reform for criminal offenders. The Delancey Street Foundation sets an example of a successful philosophy that gives hope for reforms within the criminal justice system. Mr. Earley’s search is one through the medical model treatment approach. His book demonstrates the failure on the part of the American Psychiatric Association’s labeling system and established guidelines for treating mental illness. New guidelines must be formulated that consider underlying factors of mental illness.
The website http://www.ProblemInSchool.com
has been started for parents and concerned individuals to connect through a common bond; the realization lethal drugs are not the solution to behavioral and/or learning disabilities in children. The overuse of psychophramacology seriously alters brain states over time. It may appear to temporarily abate symptoms, but it does not solve the underlying causes and for many patients, symptoms worsen. It will only be through individuals uniting together, sharing experiences and knowledge, becoming educated and empowered, and challenging the American Psychiatric Association(APA) on its’ labeling process, will changes be made to a system severely flawed by its rubber stamping methodology and shot in the dark treatment approach. The pharmaceutical industry profits from this labeling system by developing and promoting drugs with unpredictable and unforeseeable outcomes, while ignoring underlying causes and valid therapeutic treatments.
Under APA guidelines, anti-psychotic medications are prescribed freely to all, while the deaths linked to these prescription drugs climb. Individuals labeled mentally ill have a right to discover underlying factors contributing to their condition and receive treatment that would improve their health. While the APA has knowledge of underlying factors that contribute to symptoms of mental illness, there is a deliberate indifference on the part of this organization in favor of promoting strictly prescription based guidelines. The APA has a duty to individuals labeled by the DSM, as well as society as a whole, to create guidelines for medical professionals to test for and treat underlying factors. It is time for a change in the mainstream medical model approach of treating mental illness.
The rubber-stamp approach of the APA must be dismantled and laid to rest. To test for and treat underlying causes must be the standard guidelines applied in the mental health care system.
Patient’s in the mental health care system should no longer live under the “Supreme-being” Court mentality.
“It is better for all the world, if instead of waiting to execute degenerate offspring for crime, or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind. The principle that sustains compulsory vaccination is broad enough to cover cutting the Fallopian tubes… Three generations of imbeciles are enough.” U.S. Supreme Court Justice Oliver Wendell Holmes Jr.; Buck v. Bell, 274 U.S. 200 (1927)