Following up on Tuesday’s post on the meaning of recovery, here is an article by the noted psychiatrist and advocate E. Fuller Torrey that appeared in Psychiatric Times which questions whether people living with a severe mental illness are Better Off Without Antipsychotic Drugs?
Dr. Torrey acknowledges the many studies showing that 21-29% of patients fully recover from schizophrenia with a full remission of symptoms and no need for continued treatment. This “glass half-full” scenario, as he calls it, is a source of great hope and optimism for many young people and their families who are impacted by mental illness. But Dr. Torrey is more concerned with the half-empty portion of the glass (really closer to three-quarters empty), representing the many people who will continue to experience great distress if their condition goes untreated.
The article in Psychiatric Times expresses deep concern about a growing movement within psychiatry and medicine, and embraced by many advocates, which holds that anti-psychotic medications are not necessary to treat mental illness and may actually do more harm than good. This view is presented in Robert Whitaker’s book Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America.
There are merits to the arguments on both sides of the issue. It is right to hesitate at the prospect of prescribing powerful psychotropic medications to a child of fifteen – possibly for the remainder of her life. What will be the long term effects of those medications on the chemistry and structure of a growing brain? Theories about the benefits of psychotropic medications abound, but Mr. Whitaker accurately points out that science has yet to supply a definitive answer as to how they help patients control their symptoms. He also raises valid questions as to why some patients seem not to benefit at all and why we have not seen an overall reduction in disabling mental illness since their introduction decades ago.
Dr. Torrey makes an equally compelling case regarding the consequences of not prescribing psychotropic drugs to people who experience psychotic symptoms. He writes about the “grand, unplanned experiment on the outcome of untreated schizophrenia” in the 1960’s when the massive deinstitutionalization of patients from state hospitals began. Half of all Americans living with serious mental illness are untreated at any given time. That’s 1.3 million people with schizophrenia alone, many of whom end up in our nation’s homeless shelters, city streets, jails and prisons.
The majority of people diagnosed with a serious mental illness will face lifelong challenges related to that illness. For those people, recovery may be a process rather than a final destination.
The right to self-determination is a key principal of recovery-oriented care, and with good reason. Being in recovery is an active process that involves a level of commitment to mental health and wellness. Those people not in recovery – in other words not in treatment or otherwise not managing their condition – may lack the insight and judgment to make good decisions about their care.
There is no self-determination in a jail cell or locked ward of a hospital. Dr. Torrey makes a compelling case that for many people living with serious mental illness, extended treatment with medications, accompanied by the appropriate supports, is preferable to no treatment at all.
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