21 February, 2016

Retrospect—Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill

[Reviews from HexWhyZed are not in any way timely or culturally pertinent, just the impressions from a dimly-lit island in the distance and the flotsam jettisoned along its shores. They may also contain spoilers—you have been warned.]

It is a righteous fury I feel, and damn, it feels good.

I've always been an overtly sensitive person, emotions roiling just beneath the surface before erupting in sometimes inappropriate exhibitions of feeling. I was often chastised for this while growing up, creating a sensitivity to the condition of being sensitive. I've also had Depression for most of my life, and ten years ago I developed a chronic pain condition.

Invisible illness is inherently difficult to empathize with; humans believe what they can see, with the exception of old men in clouds and miracles burned on toast. Hearing voices? "Just ignore them!" Depressed? "Just decide to feel better!" In pain all the time? "Surely you're exaggerating." This is likely in defense of the fear each of us has of losing control—of our thoughts, our feelings, our very bodies.

While this fear may rationalize the segregation, imprisonment, and torture of the mentally ill throughout history, it does not excise the responsibility we bear regarding such treatment, especially its present persistence for profit. The origins, evolution, and current practices of "mad medicine" are the unsettling subjects in Robert Whitaker's Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill. 

I had my own preconceptions going into this book—indeed, how not? I knew I'd be horrified by the early days, forcing the most vulnerable among us to live in barbaric conditions, chained to basement floors in cages, beaten as a proscription against the "evil" within; by the lobotomies and electroshock; by the malign neglect that, in its kindest light, mimes the motions society inflicts on its marginalized populations. 

I also found myself to be utterly ignorant of the "science" of psychiatry, which I assumed to be the medico-scientific application of diligent research to assess and treat a broad spectrum of mental and emotional disorders. Whitaker writes instead of a profession trying first to acquire and then maintain legitimacy, often with a complete disregard to the suffering inflicted upon the patients in their "care." 

Some of this I can forgive or rationalize due to general medical ignorance, heightened by willful disregard of that ignorance. Most doctors had no proof that a treatment was successful other than their desire to succeed, a need so pathological that both compassion and common sense, not to mention scientific method, were early casualties in pursuit of industry. 

The results are self-fulfilling systems of need (illness), cause (evil spirits, chemical imbalance), effect (symptoms), and treatment (the stifling of symptoms). Physical violence against the mentally ill was so endemic because it was "proven" effectual, which is fairly inevitable when you set the standard of "well" at obsequious. Almost all of the "miraculous cures" that followed maintained the standard of compliance as evidence of health, even as corrosive agents were rubbed into the scalp, or injections of insulin to repeatedly induce comas; stabbing people in the brain with icepicks to produce devastating physical trauma...and on, and on, and on. Anything to shut them up—to pacify a population that, just a few years earlier, America tried to silence forever through forced, systemic sterilization. 

I knew that eugenics had been a fashionable topic before the collapse of Nazi Germany, but I had no idea how strongly the American public had advocated for and put into practice such a pernicious program of entitlement. Numerous laws were passed to round up and segregate all manner of "moral undesirables" based on the theory that such qualities as thievery, pauperism, and—yes—mental illness were caused by unfit "germ plasm" carried in such people's DNA. The goal was to sterilize them into extinction, and laws enforcing this goal were upheld by the Supreme Court of the United States. 

Buy wait—"What about the Constitution?" you might ask. "What about democracy and civil rights and all that jazz?" Whitaker includes a quotation that answers those questions quite succinctly. 

"It is the acme of stupidity to talk in such cases of individual liberty, of the rights of the individual," said New Jersey urologist William J. Robinson, a well-known eugenics advocate. "Such individuals have no rights. They have no right in the first instance to be born, but having been born, they have no right to propagate their kind."

Several other countries passed their own sterilization laws modeled on U.S. legislation, countries such as Denmark, Iceland, Norway, and a newly formed Nazi Germany. Whitaker quotes from the New England Journal of Medicine that Germany had become "perhaps the most progressive nation in restricting fecundity among the unfit." Over 45,000 Americans were surgically sterilized under these laws, which waned in popularity at the conclusion of World War II when Americans were confronted with the extreme conclusion of their eugenic enthusiasms. 

Images from Nazi concentration camps forced a reconsideration of society's "human waste," and the psychiatric community decided to look at things from a more "scientific" perspective. One desperately hopes this will lead to a renaissance of treating the mentally ill as whole and developed individuals in turmoil. It does not. Whitaker explains on page 75: 

Psychiatry had a palpable need for a therapeutic triumph, one that would rescue its public image and provide a balm for its own inferiority complex. And with that emotional need spurring it on, psychiatry was primed to shortcut the research process and skip straight ahead to the part about announcing therapeutic success. 

This was the age of the trans-orbital lobotomy, excessive use of electroshock and hydrotherapy, and, until 1950, clitoridectomies for women driven to literal hysteria. Madness by ladyparts! The public was told these were all safe procedures performed out of care and kindness, even when conducted without patient consent or, indeed, in the face if vehement protest. Psychiatrists theorized why such procedures were necessary and sold it as fact. Somehow they convinced the American public that forcing brain damage upon the mentally ill was good for them, and the public bought into the delusion. But it was only the rehearsal for their greater success, and deception, still to come.

After the litany of inhumanity and bullshit listed above, you'd think my fury would have reached its zenith. Alas...at least when they were coring out sections of brain and whipping patients to submission there was a rare and brutal honesty about it.  However, the moment psychiatry was introduced to psychopharmacology they became compulsively obsessed with one another in a destructive codependence on a 60-year crime spree. Their first scheme was called Thorazine.

So how did an insecticide used to kill parasites in pigs change everything about the treatment of mental illness in America? Why did supposed scientists first report that the drug was nothing less than a "chemical lobotomy" later claim it to be an anti-psychotic medication with relatively mild and temporary side effects, when in fact it was likely to cause permanent brain damage and motor dysfunction identical to Parkinson's disease? 

They got paid. That's why. They got paid a lot. When the new versions of Thorazine came out—drugs like Haldol—they lied even more. By the time the next-gen "antipsychotics" were released, like Risperdal and Seroquel, the lie was so pervasive and the money so big and the system set up to perpetuate it all so practiced that it became the profession itself, and it continues to do so. 

The lies are so huge, the deeds so diabolical, the motives so petty, and the infliction of needless suffering so enormous that I don't know if I will ever be able to trust the word of a psychiatrist again; that—even though the book focuses mainly on disorders with psychosis, such as schizophrenia and bipolar disorder—I'm seriously contemplating weaning off the anti-depressants I've been stabilized on for 10 years. 

I don't even know if it's an anti-depressant at all, or if it's an "anti-depressant" the same way that Thorazine is an "anti-psychotic," which is not at all. Thorazine works by interfering with the dopamine receptors in the brain, causing all those problems with motor skills, the drooling, the flat affect, and, in fact, forcing the brain to overcompensate by producing ever more dopamine receptors, causing patients thus medicated to become hypersensitive to dopamine, forever altering their brain chemistry.

They ignored the early evidence of Thorazine's effects, found out how it worked in the brain and thus proclaimed that must be the origin of the disorder, grasped at the evidence they wanted instead of the evidence that was there, and then paid a bunch of people to write a bunch of bullshit and thus kicked off the "therapeutic success" they'd been yearning for all those long years. 

But to keep making money they had to add new drugs, only this time they'd be smart about it. They doctor clinical trials so their product has no choice but to be superior. They yank people off their stabilized medications to intentionally induce psychosis in trial participants, then use them as examples of placebo. They fail to report suicide and other deaths and fail to follow up on why, sometimes, up to 80% of a trial's participants drop out. It has become a streamlined, multi-million dollar charnel house of psychic agony. Done on purpose. For profit.

I know that humans have done and will do virtually anything and everything for money, and that likely all they haven't done is due to the failure to think of doing it, but these are doctors. Worse, they are doctors charged with the care of people deep in crisis who have turned those crises into an officially-sanctioned scam.  

People may still persist in delusions of virginal visitation via grilled cheese, but the continual appeasement of such bad science, and thus bad medicine, in American psychiatry is something my conscientious anger simply will not abide. 

My sincere thanks to Robert Whitaker for stoking such flame.

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