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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
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UCSF psychiatrist Sophia Vinogradov also works at the VA campus. She sees severely disturbed individuals unable to get help from other doctors. About 85 percent of her patients use prescribed medication in combination with behavioral therapy.

"With a very severe psychiatric illness, it's like having a cancer in your brain," Vinogradov says. "So sometimes you have to think about the medications a little bit like chemotherapy. They're crappy to take, but at least they're going to stop things from getting worse."

To those who study and work with the brain in mainstream psychiatry, it's not that Morrissey's diagram is far-fetched or nonsensical. It's just that more of the conventionally accepted science shows that meds are a better bet for alleviating psychosis than therapies alone.

Psychiatric drugs contain molecules that fix onto specific receptors in the brain and either block or enhance the actions of certain brain chemicals, thereby modifying how affected neuronal pathways work. For many, this reduces symptoms like hallucination and delusion. Vinogradov says non-medication-based approaches — psychotherapy, exercise, spending time with friends and family, meditation, learning new skills — can all alter brain pathways as well. But far less is known about how this occurs, she says, other than that it is somehow related to the brain's plasticity — its ability to constantly remodel itself as it collects new information and experience.

Vinogradov notes that psychiatrists who work on an insurance reimbursement basis often only get paid for 15 minutes with a patient, and must relieve their symptoms in the span of something like 12 such appointments or risk not getting paid for additional visits. She says this incentivizes treatment by quick-fix prescription rather than costly psychotherapy or other alternative approaches.

She has her own questions about the long-term viability of psychiatric medications, especially as a stand-alone treatment, and is researching behavioral methods for alleviating symptoms of schizophrenia. But with a lack of sufficient resources for mental health, Vinogradov says medications are still a very important part of treatment.

Israel puts a finer point on it; he believes medication is an absolute necessity for anyone diagnosed bipolar or schizophrenic, as there is no scientific evidence that self-care or therapy alone, or in combination with other alternative approaches, helps people with those diagnoses reduce their risk for potentially dangerous psychotic episodes.

He says encouraging them to think they can and should manage med-free goes against his profession's idea of informed consent — patients or clients having a full understanding of the choices they're making. "Nobody should be encouraging them to think they're in treatment, because they're not," Israel says. "They're getting a placebo."

To Bingham, it's the anti-psychotics that are the placebos — more expensive and dangerous crutches than pot or alcohol. He's spent years combing through psychiatric journals, becoming ever more convinced that the science behind the clinical studies is too biased and flawed to justify widespread use of anti-psychotics.

Bingham's used to hearing people say they couldn't live without their drugs, or that they have a relative whose life has been saved by them. Blunt by nature, he's changed how he converses with those people.

"I used to say, "Well, you can believe what you want, but I can just tell you that in my experience, with the right therapy and support, the drugs are unnecessary. They're only necessary if you'd like to cut yourself off from whatever feelings and emotions got you to the point of overwhelm where someone thought you needed the medication,'" Bingham says.

These days he says it how he did on the radio: If there were a better way, wouldn't you want to give it a try?

Full Spectrum has worked with about 200 people in the last couple of years, Bingham says. He doesn't compile stats, and doesn't track how people fare after they leave. Beyond the several who've given up the meds they were on, many others came in off meds but on the verge of taking them. Some decided to stay off, while others chose to go on them.

"The important thing is they were exposed to an alternative approach," he says. "Whether they're on or off meds is less important than being more consciously on or off them."

One young woman, now 20, came in with a schizophrenia diagnosis and a regimen of three anti-psychotic and sedating medications, twice daily. She spoke in various voices and couldn't converse with others. At Full Spectrum, she improved so much that her psychiatrist removed the diagnosis and worked with Bingham to help her off most of her medications. She's down to one pill once a day.

Dr. Robin Cooper is the woman's psychiatrist; she works at the Adult Care Management Program for the Family Service Agency of San Francisco. Cooper, who has been a clinician in San Francisco for 24 years, didn't initially know of Bingham's bias against medication. When he first brought up the idea of helping her wean off, Cooper was hesitant; she'd had a negative experience helping a bipolar patient of her own do the same thing. But in this young woman's case, Cooper came to believe she had been misdiagnosed — that her problems were due to developmental delays, and that previous psychiatrists had prescribed medications as superficial behavioral controls.

Cooper is of two minds about Full Spectrum. She thinks the quality of the psychotherapy and other services it has offered is extraordinary, but disagrees with Bingham's wholesale opposition to pharmaceuticals. She's therefore careful about referring clients, but still inclined to do so — especially given the city's bleak landscape of mental health services.

"A lot of what used to be day programs have been renamed as "re-socialization programs,' which means they're really just drop-ins," Cooper says. "It's horrendous, there's just no investment anymore in really cohesive programs, it's just been cut and cut over the decades. You really can't find a decent day treatment program anywhere anymore."

About The Author

Amy Goldwitz

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