Extending the bounties of madness

by Michael Patrick O'Leary

This article appeared in Lakbima News on Sunday November 14 2011. Unfortunately, they gave the writer’s credit to Herman Melville rather than me.

Man’s insanity is heaven’s sense

Herman Melville

The Sri Lanka Daily Mirror recently reported that 25% of Sri Lankans suffer from mental illness. I could not trace an authoritative source for this figure and was puzzled because the item also said there was a shortage of psychiatrists in Sri Lanka. If psychiatrists are lacking, who was qualified to count and what were their definitions? Is there really a problem or is this a case of what Mikkel Borch-Jacobson has called “conceptual gerrymandering”?

There are articles, for example one in the Lancet, which explain why there might be a high incidence of mental illness in this country – the long-running war and the fear of terrorist acts, the tsunami, poverty. The high suicide rate is given as evidence of extensive mental illness.

In the world in general, are there more people today with mental illness than there used to be? Are the stresses of modern life driving more people mad?

Mortimer Ostow MD, wrote that the normal practice for psychiatrists when dealing with a new patient was to complete a questionnaire, possibly by computer, the results of which would lead the psychiatrist to a code number and diagnosis in the current Diagnostic and Statistical Manual of Mental Illness (DSM). The psychiatrist would then refer to the three-volume handbook Treatments of Psychiatric Disorders. Treatment is primarily medication.

Each new version of the DSM has included more mental illnesses than the previous edition it was replacing, although the latest, DSM V, has dropped a few types of schizophrenia. In 1973, homosexuality per se was removed. RL Spitzer argued that what was at issue was a value judgment about heterosexuality, rather than a factual dispute about homosexuality.] The controversy stirred by Spitzer’s paper did not prevent him becoming editor of DSM III.

What’s in a Name? Were there bipolar people in the olden days?

Very few people had heard of bipolar disorder before 1980, when it was introduced in DSM III. (Thank you Robert Spitzer.)

We are told bipolar is merely a new name for manic depression. This is not true because muddle has been introduced by naming different types of bipolar disorder.

David Healy explains that the term ‘bipolar disorder’ was introduced in 1966 by Jules Angst and Carlo Perris. On the basis of 3,872 admission charts from the asylum at Denbigh, North Wales, between the years 1875 and 1924, Healy concludes that manic depression was rare. He arrives at a figure of ten cases per million each year, that is 0.001% of the general population. In 1994, the US National Comorbidity Survey estimated that 1.3 % of the American population suffered from bipolar disorder. Four years later, Angst estimated 5%: 5000 times higher than the figure suggested by Healy. There is now a ‘bipolar spectrum’, which includes a very accommodating ‘subthreshold bipolar disorder’.

Bipolar children?

On 13 December 2006, four-year old Rebecca Riley died from an overdose of the medication cocktail prescribed by her psychiatrist, Kayoko Kifuji. At the time of her death, she was taking Seroquel, a powerful antipsychotic drug, Depakote, a no less powerful anticonvulsant and mood-stabilising drug, and Clonidine, a hypotensive drug used as a sedative. How could Kifuji have prescribed a two-year-old psychotropic medications normally intended for adults suffering from psychotic mania? Apparently such things are now considered “normal”. Kifuji was cleared of any misconduct. Rebecca’s parents were convicted of murder.

The prevalence of paediatric bipolar disorder multiplied by a factor of 40 between 1994 and 2002. ‘Warning signs’ for parents are : ‘poor handwriting’, ‘complains of being bored’, ‘is very creative’, ‘intolerant of delays’, ‘curses viciously in anger’, ‘elated or silly, giddy mood states’.

In an interview with the Boston Globe, Janet Wozniak, director of the paediatric bipolar programme at Massachusetts General Hospital, stated her credo: “We support early diagnosis and treatment because the symptoms of bipolar disorder are extremely debilitating and impairing … It’s incumbent on us as a field to understand more which pre-schoolers need to be identified and treated in an aggressive way.”

Treatment of people deemed by the professionals to be mentally ill has often been aggressive to the point of barbaric violence, including sending electric currents through the brain or scooping out pieces with an ice-pick.

Clearly Rebecca’s home circumstances were not conducive to a happy childhood but was there any hope that a toxic cocktail of powerful anti-psychotic drugs would improve her life? What of other children guilty of being silly or giddy?

The Problem with Psychiatry

In his work generally, Niall McLaren focuses on difficulties with the field of psychiatry as a whole. Going all the way back to Freud, there has been a lack of scientific rigour. McLaren believes that mental disorder is a reality but sufferers are denied effective treatment because academic psychiatry has failed to provide practitioners with a consistent treatment programme. McLaren demonstrates that psychoanalysis is not scientific in nature.

Malcolm Macmillan has shown that Freud’s theories of personality and neurosis- derived as they were from misleading precedents, vacuous pseudo-physical metaphors and a long concatenation of mistaken inferences that cannot be subjected to empirical review- do not provide a cure or even prove authoritatively that an individual is actually mentally ill.

Extending the bounties of madness – Inventing sickness to sell ‘cures’.

Some critics see a method in the madness of ever-increasing categories. It has been seen as deliberate disease-mongering for profit by the pharmaceutical industry. Of the authors who selected and defined DSM IV psychiatric disorders, roughly half had financial relationships with the pharmaceutical industry.

Expanding and diluting the definition of manic-depressive illness to include depression and other mood disorders, allows antipsychotic or anticonvulsant medications that were initially approved only for the treatment of manic states, to be foisted onto more people.

Healy concludes that “All available studies on the longer-term consequences of antipsychotics indicate that they probably reduce life expectancy.” Anticonvulsants are liable to cause kidney failure, obesity, diabetes and polycystic ovary syndrome. Atypical antipsychotics can cause significant weight gain, diabetes, pancreatitis, stroke, heart disease and tardive dyskinesia (a condition involving incapacitating involuntary movements of the mouth, lips and tongue). They can, in some circumstances, cause neuroleptic malignant syndrome, a life-threatening neurological disorder, and akathisia, whose sufferers experience extreme internal restlessness and suicidal thoughts.

I have witnessed these side-effects. A now-elderly lady, who is perhaps too gentle and innocent for this harsh world, became quite understandably sad at the harsh circumstances of her life. She was not mad or ill, just a little melancholy from time to time, for good reason. Inappropriate medication did not cure her unhappiness, it increased it. She was sent to Angoda because she showed signs of dyskinesia and erratic behaviour directly caused by the ‘cure’. Now the medication has been altered and she is happy.

There might be worthwhile risks in taking such toxic medications in cases of acute mania but not for depressed elders or hyperactive children.

The market for atypical antipsychotics is currently worth $18 billion – twice as much as it was for antidepressants in 2001.