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Just Say No 

Conventional wisdom says psychiatric drugs save lives, but for some San Franciscans the pills are a prescription for disaster

Wednesday, May 23 2007

Page 3 of 6

Michelle, now 25, doesn't criticize people who use psychiatric medication; she just knows that it's not for her. Her mother once told her she'd read that unmedicated manic episodes could damage her brain. But Michelle is convinced that if she were still on meds, she would not be living and working independently. "So if my tradeoff for that is not living as long as other people, I'm willing to take that risk," she says.

Not long before age 10, Michelle started having severe sleeping problems. For weeks, she'd stay up all night, and then she'd crash and do almost nothing but sleep for days. When she did see a therapist, he diagnosed her with juvenile bipolar in about 20 minutes.

A few years later, a different therapist told Michelle's parents that their child would be bipolar for the rest of her life. He told Michelle directly that she should get used to life as a dependent, because she was never going to be able to live alone, and there was a good chance she would kill herself before age 25. At 15, doctors started prescribing her anti-depressants, which exacerbated her sleep problems. The therapists eventually realized that her case of bipolar was more pronounced on the manic side, and at 18 a doctor put her on lithium and the anti-psychotic Zyprexa. The latter helped her sleep, but two weeks into taking it she woke one morning to the sight of an alligator sitting at her desk, wearing Victorian garb and drinking tea. She started throwing things at the vision and it disappeared, but she called the doctor and got off the Zyprexa. She continued taking lithium for about a year.

"I lost a lot of friends that year because they couldn't handle being around me, because I was no longer me," she says. "I was speaking robot, I had no inflection in my voice, everything was flat. I wasn't happy. I wasn't sad."

Michelle started cutting herself, trying to feel something. It hurt, but there was none of the emotional pain she expected. The big moment came at 19. For two years, she'd been living with and caring for her ailing great-grandfather, and he passed away. At his funeral, she found she couldn't cry. When she got home that day, she flushed all her lithium down the toilet and started planning a move to San Francisco with the $10,000 she'd just inherited.

The emotions started trickling out of her for a few days, and then the dam broke. When there were no more tears, everything shut down. In a move Michelle says she is still thankful for, her mother checked her into an institution. The doctors put her back on medication and respected her decision to wean off. They helped her reduce her dose over a month, for an easier transition than the abrupt approach she'd tried. They wanted her to stay longer, but she was determined to make the flight she'd booked. She checked herself out while on a very low dose of lithium.

"I was at a point where I was at a limit, I didn't care whether I came out here and committed suicide," Michelle says. "I decided that my last pill I was going to take was on the plane. So I took that pill, and I haven't had medication since."

The reasons people avoid psychiatric medications are diverse. Many dislike the common mood-blunting side effects Morrissey and Michelle experienced, which can also include sleepiness and lack of sex drive or inability to experience sexual pleasure. Newer anti-psychotics seem to cause the shakes (tardive dyskinesia) less often than older incarnations, but as reported recently, Zyprexa appears to cause increased incidence of obesity and high blood sugar — risk factors for diabetes. In the spirit of R.D. Laing, some mental "patients" are oriented against psychiatry in general, seeing their conditions not as illnesses but as alternative ways of experiencing the world. Some, like Bingham, believe the science regarding neurochemical imbalances as the cause of mental distress is unproven, and they oppose the dominance of pharmaceutical companies that manufacture and market psychiatric medications based on a purely biological view of the brain.

Cases of violence involving unmedicated people with psychotic diagnoses get a lot of media attention. In 2003, Elli Perkins of Buffalo was murdered by her son, who doctors later deemed schizophrenic. Perkins and her husband were Scientologists, opposed to psychiatric drugs and psychiatry in general. Last September, Virginia psychiatrist Wayne Fenton was killed by a young patient who was off medication after being diagnosed bipolar.

Dr. Josh Israel is very concerned on a daily basis about the possibility of these kinds of incidents. His office at the San Francisco VA Medical Center is adjacent to the locked psychiatric intensive care unit he directs. Veterans come in hallucinating or paranoid; they may have just assaulted a police officer, or been found wandering naked at the airport. He tries to get them on or back on medication. Usually they agree; sometimes it takes a court order. Electro-convulsive therapy is a voluntary treatment he offers the more severe sufferers, and many try it.

There are a lot of thick psychiatry books on his office shelves, and Israel wistfully gestures toward them when acknowledging how little we still know about how the brain works. "Looking at those, you'd think we'd know a lot more than we really do," he says. How psychosis affects the brain long-term, and even how treatments like medication, ECT, therapy, or alternative medicine ultimately alter brain structure for better or worse — these realms are still quite mysterious. The short-term is easier to understand, Israel says.

Dr. Israel has seen people who've done destructive things to themselves. "They've cut off digits, or testicles. There are people who have literally burned down their own homes. Things like that are not the inevitable result of not taking psychiatric medications, but no one — well, maybe not no one, but I would say it would be extremely rare to do those kinds of things on medication."

About The Author

Amy Goldwitz


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