Recently, a story was published by the Canadian Broadcasting Corporation (CBC) about a young man with mental health and addiction issues who died in a police-involved shooting in Saskatchewan.
Steven Rigby was addicted to alcohol and also struggled with an alcohol-induced depressive disorder. He had attempted suicide more than once and remained suicidal; he discussed this with family members, friends and even the doctors charged with his care. Despite this, he was asked to give up his space in the hospital’s psychiatric wing — the Irene and Leslie Dubé Centre for Mental Health — and was subsequently discharged. Soon after he was killed, in an officer-involved shooting, in what may or may not have been a suicide.
Steven Rigby was failed by the mental health system and, because of this, he lost his life. However, he was likely failed in more ways than just the one being discussed publicly (i.e., being discharged from the psychiatric facility). Steven’s mother noted that her son was on prescription anxiety and depression medications, which worsened his mental health and “amplified his suicidal thoughts.” According to her, in an email correspondence between Steven’s mother and myself, “His medication made him worse; his gentle nature turned violent after taking some of his medications.” Notably, this is not a key component of the CBC’s story. However, maybe it should be.
In 2010, a book titled “Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America” was published. This important book shocked many. It also changed how many mental health professionals view and conduct their work. The author, Robert Whitaker, reviews the scientific literature extensively. He provides copious evidence to suggest that, despite a psychopharmacological revolution in medicine, and specifically psychiatry, psychiatric drug use has not led to long-term, positive health outcomes for those diagnosed with mental illness.
In fact, the more that psychotropic drugs are used to treat mental struggles, the more the burden of mental illness and disability appears to rise in our societies. For nearly all mental illnesses — depression, anxiety, schizophrenia, bipolar disorder, etc. — the long-term health outcomes for patients given psychiatric drugs has actually worsened during the past two decades. Using both scientific evidence from within the field of psychiatry itself and testimonials taken from his interviews with children and adults, Whitaker clearly demonstrates that psychiatric medications increase the likelihood that people taking them will become chronically ill over time, rather than being helped.
Whitaker, and many other authors like him, also outlines the enormous health risks associated with psychiatric drug use. Some of these include: increasing and even doubling the risk of suicide attempts; elevating risk of stroke; increasing the risk of psychosis, liver toxicity and death; amplifying the chances of being diagnosed with Alzheimer’s disease; contributing to autism spectrum disorders or attention deficit/hyperactivity disorder (ADHD) following in utero exposure; brain atrophy in children; increasing the likelihood of additional mental illnesses and diagnoses, and a plethora of discontinuation syndromes. Consequently, an increasing number of peer-reviewed studies and a growing number of psychiatrists, doctors and researchers are discussing both the limits and dangers of standard approaches to psychiatric care, namely the use of psychotropic drugs.
Despite lack of efficacy and the many health risks associated with these drugs, such medications often remain a first-line treatment in both general medicine and psychiatry. Common medical practice is mostly predicated on quick diagnoses based on lists of symptoms and the subsequent application of a psychotropic drug(s). Often a doctor or psychiatrist adopts what is called a “shot-in-the-dark” approach to their prescribing.
Specifically, a doctor will begin at the top of the list of “recommended drugs” for a certain diagnosis, prescribing these medications one after the other to see if they help, playing with dosages, and also adding in new psychiatric medications to deal with side effects and secondary symptoms of the original drug prescribed. Notably, the side effects of common psychiatric drugs — fatigue, loss of libido, blurred vision, anxiety, mania and suicidal tendencies — may intensify a person’s mental suffering and can be a major reason why some patients decide to stop taking them.
I once had a counseling client come to me because he was experiencing insomnia after his car skidded off of the highway. He was not injured in the accident but he could have died as another car nearly hit his vehicle at high speed. Before coming to me he went to his family doctor who, after hearing his story, prescribed him an antidepressant. When he became more anxious after taking this medication, he was then given a benzodiazepine, a very addictive anti-anxiety medication. A month later, his anxiety worsened and he was prescribed a third medication, a mood stabilizer. Next, he was given an antipsychotic.
By the time he came to me for counseling help he was on four different psychiatric medications, all because he had experienced a traumatic event that had naturally disrupted his nervous system, which is a normal response to trauma. His mental health was far worse than just after the accident and he felt trapped, afraid to stay on his medications (because of how bad he felt) but also afraid to stop taking them. Importantly, no options other than these medications were recommended by this man’s doctor. Even more difficult to comprehend, a recent article discusses a young woman who had been prescribed 31 different psychiatric medications. If my client and this woman did not have problems with their brain chemistry before seeing their doctor or psychiatrist, they definitely did once they had.
Another issue is a lack of monitoring of patients once they have been prescribed psychiatric medications. Patients may be given several weeks or a few month’s supply of their medication(s) but they are, very often, not observed closely by the prescribing doctor or psychiatrist. Thus, no one is present or available to monitor their reactions or any side effects they might experience. If they do start having adverse reactions to their medications, such as severe anxiety, mania or suicidal ideation, it can be very difficult to get a timely follow-up meeting with the psychiatrist due to long wait times for such appointments.
In the case of Steven Rigby, once his medications started to cause an increase in anxiety and suicidal ideation, he drank even more to try to cope with or numb these thoughts. According to Steven’s mother, prescribing doctors never monitored his reaction to the medications he was given.
This element of the current medical model is highly problematic because people with mental illnesses, those in vulnerable positions, are not receiving appropriate care and support. Too often they are being harmed. Canadians have a basic human right to safe and appropriate medical help. Yet our current social and medical policies tend to ignore the scientific evidence from above, thus marginalizing vulnerable people, violating their human dignity and often making things worse for them.
Ryan Meili, the leader of the NDP in Saskatchewan, quickly responded to the Steven Rigby-Wilcox story and suggested that we need more mental health beds in the province. Yet mental health beds in psychiatric wards and hospitals simply means the prescription of more and more harmful psychiatric medications. I can think of few things less healing when in crisis than being placed alone in a bed in a psychiatric ward, cut-off from friends and family and the familiar, and placed on large amounts of brain-chemistry-altering medications that have health risks associated with their use and often result in horrible side effects.
Groups of researchers, mental health professionals and even psychiatrists have recently formed both the Critical Psychiatry Network and the Foundation for Excellence in Mental Health Care in response to this approach to mental health. These organizations, like author Robert Whitaker, question the assumptions that lie beneath psychiatric knowledge and practice. Moreover, people who experience mental health issues, those who have had a mental health emergency and those who describe themselves as “psychiatric survivors” have begun to come together in rights-affirmation movements to articulate their frustration with their treatment. I believe it is important to listen to these different understandings.
I also believe it is important that we practice humility and open-mindedness so as to gain greater insight into both the body and mind, and the interaction between the two. According to Sandra Steingard — Clinical Associate Professor of Psychiatry at the University of Vermont — our current medical perspective may not be the only, or even best, way to understand mental health struggles.
Psychiatric medications may be necessary — even a godsend — in emergency situations and especially in cases of frank psychosis. However, while psychiatric drugs may be effective for short-term use, and while some people may experience benefits on them over longer periods of time, generally they worsen the long-term outcomes for those with major mental health disorders (as demonstrated in Whitaker’s book). Consequently, it may be time to seriously rethink the current drug-based treatment paradigm for those who struggle mentally and emotionally and to consider incorporating non-pharmacological approaches from other medical systems into our models of care.
Whereas psychotropic drugs are used to help relieve symptoms and, consequently, do not cure mental illnesses, other medical systems are primarily concerned with treating what is perceived as “root causes” of unregulated bodily experience and mental dysfunction. These approaches may be safer and more effective than psychiatric medications. There is also growing scientific evidence, from the field of nutritional psychiatry, to suggest that micronutrient formulations are effective at treating depression, anxiety, ADHD, PTSD, psychosis and many other mental health issues. Simply put, psychiatric medications should no longer be our first-line of treatment for people struggling mentally and emotionally. There are other, safer options available.