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.
There are many sides to mental health recovery. Jay’s blog takes The Family Side.
- Silver Hill Hospital: My Family’s 35-Year History with a National Leader in Quality Mental Health Care - February 7, 2023
- Connecticut Mother Who Lost a Son to Overdose Shares Her Story and Hosts Wilton Fundraiser to Benefit Laurel House - November 9, 2022
- Laurel House Offers $10,000 Racial Equity Scholarship for a Black or Hispanic Student Pursuing a Master’s of Social Work Degree - June 8, 2022
Your opinion, as I understand, Jay, is that self-determination by the patient being treated for mental illness is key to successful treatment of that illness. Does that imply that education about treatment for mental illness should start at an early age or before one's mind is clouded by the very illness he or she needs to treat? If so, does that mean that schools, in general, should offer a course in recognition and treatment of mental illness, or is it up to individual families to educate their children? What of the individual who demonstrates no symptoms of mental illnes until he or she is off to college, or has left home for the army or comes from a family who has little understanding of, or, perhaps, concerns for their family member who is experiencing bouts of mental confusion or illness. Where does that self-determination come from…how can we, as a society, foster that learning and the consequent understanding?
Your opinion, as I understand, Jay, is that self-determination by the patient being treated for mental illness is key to successful treatment of that illness.
That’s correct, with a big qualification…
Self-determination is a key principle of recovery-oriented practice. It may be possible to “successfully” treat the symptoms of schizophrenia without regard to this important principle, for instance, by forcing or otherwise coercing a patient to take medication. Out-patient commitment laws aim to do just that: provide court-mandated treatment to people who may be a danger to themselves and are presumed to have a diminished capacity to make decisions in their own best interest. Such treatment clearly violates the principle of self-determination. In the short term, it may succeed at causing the symptoms to abate and enable a patient to make more reasoned decisions. In the long-term, coerced treatment erodes trust and prevents people from taking charge of their condition and learning how to manage it.
To use an analogy from the world of addictions, you can physically prevent someone from drinking alcohol. But is that recovery? There’s a chance that the individual, once deprived of alcohol, will come to his or her senses and thereafter maintain sobriety. But without the self-determination to voluntarily abstain from drinking, he or she is much more likely to relapse once the outside restrictions are removed.
This is a huge dilemma in mental health. Forcing people into treatment against their wills violates the principles of recovery-oriented care. But there is no more self-determination on a locked ward or in a jail or prison cell, which is where the journey ends for many people with untreated mental illness.
Does that imply that education about treatment for mental illness should start at an early age or before one’s mind is clouded by the very illness he or she needs to treat? If so, does that mean that schools, in general, should offer a course in recognition and treatment of mental illness, or is it up to individual families to educate their children?
The Mental Health First Aid program offered by Laurel House and other providers across the country is an in-person training that teaches ordinary people, including educators and students, how to help others who may be in crisis or are developing a mental illness. For information on how to organize a training at a school or other setting, check the Mental Health First Aid page on this website… click here.
What of the individual who demonstrates no symptoms of mental illness until he or she is off to college, or has left home for the army or comes from a family who has little understanding of, or, perhaps, concerns for their family member who is experiencing bouts of mental confusion or illness. Where does that self-determination come from…how can we, as a society, foster that learning and the consequent understanding?
The desire for self-determination is an innate human characteristic. You can see it in willful 3-year-olds and stubborn 93-year-olds. We limit self-determination in 3-year-olds because they lack the skills and judgment to make good decisions for themselves. As they mature, we allow them to make more of their own decisions, and sometimes that will turn out badly. Learning involves risk and failure. Most people would agree that we learn as much from our mistakes as we do from our successes… maybe more.
People living with mental illness are just like everybody else in this respect. We can foster learning by providing them with supportive environments where every success is recognized, no matter how small, and where mistakes and failures can occur without having disastrous consequences.
I hope this answers your questions. Thank you for commenting.