Some Words on: Weight Gain on Psychoactive Medication

It is, very sadly, true. Using psychiatric medication often leads to substantial and rapid weight gain. When I was first put on an antipsychotic, which was Olanzapine (Zyprexa), I gained over thirty pounds in a matter of just a few months. After switching to Quetiapine (Seroquel), my weight stopped going up, and through a healthier diet I even managed to shed some of it, but I never went back to what used to be my normal weight. Now, I am constantly teetering on the edge of overweight. My BMI (Body mass Index) oscillates between 24.9 (which is borderline acceptable) and 25.1 (overweight). In addition to the weight, my entire body texture seems to have changed. Even without regular exercise, I used to be athletic and lean by nature. Now, I have cellulitis bumps on different parts of my body and look slightly out of shape. The only good thing about being fuller is that also my boobs have grown by one cup size. I’ve gone from A to B. This is not to say that you should try psychoactive drugs as a measure of breast enlargement. Absolutely don’t do it! Fact is, these medications mess with your metabolism on top of potentially messing with your mind and with all sorts of biological functions. So no games, please! Every now and then, marketing of psychiatric drugs includes enthusiastic statements like “does not cause weight gain” (the atypical antipsychotic Aripiprazole, aka Abilify, for example), which are to increase their attractiveness among the target group. This, more than anything, shows how common weight gain is as a side effect of these substances.

But what if you are already there? Is there any way of losing the pounds? First of all, it is important to remember that diets and exercise regimes which work fine on people who do not use psychiatric drugs, won’t be as efficient on someone who does. Weight loss will likely be slow and unspectacular. It is not impossible, but it is harder to achieve. Still, you should not feel discouraged. Both a healthy diet and regular workouts will boost your overall health and help you stabilize your mood. In fact, exercise has been found to be highly effective against depression. Also, physical activity offers a great opportunity for leaving the isolation of your four walls, getting among people, breathing some invigorating fresh air and catching lovely sunlight for some extra vitamin D. If sports and healthy eating habits fail to lower your BMI in a direct way, they can still contribute to it by making you less in need of medication. Both are, in any case, worth the effort.

If you decide to diet, do it responsibly. Please do not embark on a starvation course. Your body and mind need their nutrients, especially when your health is already compromised. Put together a balanced nutrition plan rich in fresh vegetables, fiber, “good” fats (red fish, avocado, nuts, etc.), protein and fruit. Avoid processed foods, refined sugars and carbs, sodium laden snacks and in general anything that reeks of junk food. Also, abstain from artificial sweeteners, preservatives or colorants. If you are on psychiatric medication, you are already consuming potent and potentially dangerous chemicals. Try not to add even more through your food.  As a rule of thumb, note that the less processed – or the more natural – a food is, the better. As for drinks: have no sodas; just water, teas and smoothies without added sugar. It is not necessary to take radical measures like turning vegan or saying goodbye to dairy products. If you associate the concept of healthy eating with a bunch of barefoot, skinny tree-huggers gnawing on raw carrots and celery, then you will need to reeducate yourself. Healthy eating means experiencing real food with real flavors made of real ingredients. Subsisting mainly on junk food is neither cool, nor manly, nor useful. Knowing what it can do to you, it is plain stupid and a waste of money, time and life. For those who sustain that “Junk food is so much cheaper”: Buying sodas and fries may save you a dollar in the moment, but an extra expense for whole foods can save you hundreds, if not thousands of dollars in medical treatment and work incapacity in the long run. I am not saying you should never set foot in a fast food restaurant again. I myself do it on rare occasions, and when I am at a party where a decadent buffet is winking at me… what the heck, I am at a party! So, be naughty every once in a while, but never let highly processed foods become a staple in your diet.

Nowadays, most foods are, first and foremost, designed to please our taste buds. The real purpose of food, which is to provide nutrition, is presented as a collateral benefit by the food industry. Creaminess, fluffiness, sweetness, crunchiness – all these are prioritized over nutritious value in food marketing. Most often, the “healthy”-tag is just another means of selling you virtual garbage as nutrition. Milk chocolate contains milk, which contains calcium, which is good for you. So, chocolate bars are healthy, eat as many as you like! Having been exposed to this type of discourses since childhood, many consumers have never developed a clear idea about what food actually is. They would never expect their car to run on soap water, but they do expect their own bodies and minds to run on meals and snacks devoid of nutrients. In other words, they eat things that are, in fact, not food at all. Popular wisdom such as “sugar is energy” or “if I feel full, then I have given my body what it needs” is completely misleading. You can feel stuffed after having eaten a shoe sole. Yet, your organism will get nothing out of it. You can fill a car tank with soap water – until it spills over, actually! It will no doubt be full, yet the car won’t run.

Nobody knows exactly how much damage our trashy diet is doing to us. We are likely to have seen barely the tip of the iceberg so far. Probably, more physical ailments, mental conditions and cognitive disabilities are a result of intoxication and deficiencies induced by our diet than we can fathom at this moment in time. Mainstream eating habits and ruthless food marketing have created a paradoxical scenario. People who consume processed foods can be morbidly obese and still malnourished. You can eat monstrous amounts of calories and still be dangerously deficient on nutrients. Many diets out there are just as much of a health threat as our trashy eating habits. Dieting is often misunderstood as selective starvation. The idea behind it is that achieving a lower weight will supposedly make you healthier. Every new issue of any women’s magazine will promote another grotesque diet, and each time it is advertised as finally being the real thing to get you into lollypop-shape in no time. Having only apple cider vinegar with chili powder for two weeks in a row while keeping your habitual level of activity should definitely make you lose a few pounds. But will it make you healthier? And remember, you are (likely) not a celebrity! You have no millions to spend on personal nutritionists, private doctors and plastic surgeons to patch you back up again. Celebrity diets can be survived only by celebrities.

So, masochistic dieting will not result in a healthy weight, but only being healthy will. In other words, the first thing you want to do is establish optimum health. You need to get rid of toxins, balance your hormones and provide your organism with the necessary nutrients. Reformulate your eating habits into a plan that leaves out damaging food products and embraces whole foods. And don’t worry: whole foods are at least as delicious as processed and prepared food. You will be astonished at the mind boggling variety in flavors, textures and colors nature offers you. No junk food can ever keep up with that.

If you are using psychiatric drugs, in addition to following a healthy diet you will need to make an extra effort in detoxing your metabolism and achieving hormonal balance. Very likely, your liver is working overtime to process the substances you are using. Give it a hand by consuming liver-cleansing foods and drinks. Mostly, that is going to be certain vegetables and teas. Cruciferous, slightly bitter veggies such as broccoli, kale, Brussels sprouts and cauliflower should be staples for you. In fact, cauliflower is incredibly multifaceted. It can be made into low-carb pizza dough, lasagna, hash browns and many other delicious dishes. Another advantage of vegetables is that you can practically eat as much as you like of them without putting your health at risk. Which other food allows for that? So, enjoy your greens! As for drinks, you can have freshly pressed lemon juice mixed with pure water, veggie smoothies and organic green tea. Many websites will also promote grapefruit juice as liver-cleansing, which is correct. However, remember that grapefruit can interact with your medication, so please abstain from consuming it in any form. There are more than enough safe options for you out there. For further inspiration, you can also browse health food stores for liver-cleansing herbal tea blends.

When you put together your new diet, there are three factors which determine what you will be eating: what your body needs, what you should avoid and what you like. If you keep an open mind, these three need not clash. Don’t be afraid to try out recipes you had not known yet. This is also a good moment for having yourself checked for food allergies. Give your eating plan a thorough clean-up! As a result, you may have to quit a number of eating habits, but you will also discover a wealth of new options to compensate for those. And always remember to go for the fresh and natural! Now, keep in mind you won’t drop three sizes overnight. Although your medication-induced weight may be bothering you, its loss is not your primary goal! Your primary goal is to become healthier and strengthen your body and mind. As a secondary effect, weight loss is likely to follow an improved overall health.

Websites:

For those who prefer a conventional approach to weight-loss, turn to www.weightwatchers.com or www.weightwatchers.co.uk.

Articles:

This post from the blog beyondmeds.com deals with the author´s personal experience with weight gain on psychiatric medication and weight loss after coming off the drugs: http://beyondmeds.com/2012/08/06/weight-psych-meds/ You may want to have a look at the rest of the blog, too. It is elaborate and full of valuable articles.

Here is a blog article in English by athlete Cathy Brown on how she successfully managed her depression and her anger issues through exercise: http://www.changingmindschanginglives.com/2013/05/sport-changed-my-life-for-the-better/

Audiovisuals:

Seminar on the functioning of the liver in English by nutritionist Barbara O’Neill: http://youtu.be/KAGEhkZ-ssY Should you wish to find out more about O’Neill, visit her website at http://www.barbhealth.com/.

Dr. Eric Berg has developed a nutritional theory based on different metabolic types. According to Berg, every person corresponds to at least one of these types. As a consequence, different individuals metabolize food in varying ways and function at their healthiest on different food plans. Berg does not refer to the added complication of psychiatric drug use, but still his discourse offers fascinating and useful insights. To learn more, watch the following videos in English:

Dr. Berg’s Body Type Seminar: http://youtu.be/_m-R4RqRQqM

The Body Type Diets – What to Eat for Each Type: http://youtu.be/xvOwfkg9p2o

If you are interested in more of Dr. Berg’s theory, go to http://www.drberg.com/

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Some Words on: Mental Illness as a Sales Hit

“Mental Illness” has become a ubiquitous term in mainstream media. In many instances, they are promoted with the same nonchalance as over-the-counter medications, and little is said about their negative effects. As a consequence, consumers are more likely to start using psychotropic medications. At the same time, doctors are getting increasingly casual about prescribing them under the pretext of a hastily made diagnosis. Strangely, having a (not too scary) mental disorder is now almost a fashionable accessory to your personal presentation. Remarking at a cocktail party you have ADHD or anxiety disorder at the same time as being a successful professional makes you incredibly interesting. Don’t try this with schizophrenia or other spooky sounding conditions, though, unless you want to have the couch you’re sitting on all to yourself. Read more on social isolation and psychiatric conditions in my post “Some Words on: The Social Stigma of Mental Illness”.

The idea that you can have a “normal” life despite being mentally ill is one of the strongest messages the pharmaceutical industry uses for marketing psychiatric drugs. But they don’t only target potential consumers; they also offer attractive deals to prescribers. Tagging a patient with some or the other “disorder” and sending them home with a prescription is profitable for psychiatrists just as it is for pharmaceutical companies. As a consequence, prescribers with less than very sound work ethics are prone to over-diagnosing patients. Conveniently, the Diagnostic and Statistical Manual of Mental Disorders (DSM) gets thicker with every new edition, so more diagnoses can be cooked up and more prescriptions issued. Evidently, this puts patients at risk of being inaccurately diagnosed and unnecessarily drugged. They fall prey to the trust they learned to have towards health care professionals since early childhood. If something is wrong, Doc knows best how to fix it – or does he?

Where a psychiatrist draws the line between an emotional crisis and mental illness is up to his personal judgment. If you wonder why prescribers don’t simply test their patients for mental illness just to make sure they really need medication, the answer makes the psychiatric discipline appear in a rather unfavorable light. There are no tests. Not medical tests, in any case. No blood tests and no brain scan can reveal mental illness. Psychiatrists have no choice but to take at face value what the patient discloses about their state. In a clinical setting, doctors can also recur to observing patient’s behavior, but even that can be interpreted in many different ways. Apart from that, it is usually nurses or other clinic staff who deal with patients more directly and more often than the prescribing doctor, who therefore works with a lot of second-hand information. Then, there are the psychometric tests. Patients may be presented with a questionnaire, for example. Now, questionnaires are statistical tools, but they are no means of exact measurement. If you have someone do the same test twice, they are likely to give slightly different answers the second time – especially if the list of questions is long and graded answers are possible. Also, what does answering “no” to questions like “Do you enjoy social gatherings?” mean in psychiatric terms? Do you suffer from social anxiety or are you just not a party animal? And finally, what if a patient, out of shame or whichever other motivation, gives inaccurate answers? Again, questionnaires are a fine statistical tool, but they are not equivalent to a medical exam. Yet, this is what psychiatrists base their diagnosis on: personal accounts given by the patient, psychometric tests, observations of clinical staff or significant others. At the end of the day, the psychiatrist has to patch all these puzzle pieces together and try to match the resulting impression to one or the other mental pathology in the ever-changing DSM.

Just for laughs here: I got tested with those famous ink blotch cards by a psychologist when I was in my psychotic break. Her conclusion: I was “too creative”, because apparently my perceptions were not classical enough for her. Where other people would have seen an evil moth, I made out two dancing African ladies. When I remarked that I had a couple of degrees in arts and that it was therefore my job to be creative, she just said: “No, no, even as an artist you still need to be adapted.” In other words, I failed to be crazy in a normal way… Woman, I was immersed in psychosis and all you found wrong with me was my creativity??? No further comment.

So, a significant number of psychiatric diagnoses are given to people who are fundamentally healthy, but who are seeking medical help because they are naturally – and necessarily – struggling to overcome a personal crisis. Few psychiatrists will remind them emotions are our connection with reality, be they positive or negative. Instead, both prescribers and the pharmaceutical industry have a political and economic interest in making you forget that humans need grief, need sadness and need anger. In fact, it is questionable whether the feelings we call negative deserve such a bad reputation. After all, they warn us when things are going wrong, when we need a change, when we are in danger, when we need to take a break from our daily grind. Can it ever be healthy to suppress these signals? Wouldn’t it be better to acknowledge them and discover their source? Is conflict solving not the natural way of reestablishing balance and well-being in our lives? If you choose to numb your instincts with drugs, you may temporarily escape the discomfort of facing your problem, but you will also steer further and further into it without even noticing. What would be healthier: worrying about a difficult curve ahead or blissfully driving off the cliff? Not everything in life is made of pink cotton candy – it was never meant to be.

Then why are people so anxious about being “normal”? Whoever defined what normalcy actually is? Well, just look around you. Mass media bombard us with consumerist utopias 24/7. Wherever you turn, beautiful men and women with impressive careers live in stylish homes, throw hip parties, enjoy perfect health and, most importantly, have found the laundry detergent that makes all this possible. Tragically, the pharmaceutical industry has joined this very profitable ride. Feel imperfect in any way? Feel troubled, fearful or sad sometimes? Or have you simply not learned how to be happy? No problem, help is nigh. We won’t teach you how to resolve those issues, but we have a pill that can make you forget you have them. If your life is a mess, just sweep all that emotional clutter under the carpet and your existence will look as if it were perfect.

Psychiatric medications are made for halting acute, disabling crisis, and nothing less than that. They are not dietary supplements you can just take on a daily basis to supposedly optimize your performance in everyday life. Yet, that is how they are being marketed. In countries like the USA and New Zealand, psychiatric drugs can be advertised on TV, along with cars, shampoos and what have you. Those commercials make it look as if mental illness were as minor a thing as the occasional headache or dandruff. People are made to believe they can just try any psychiatric drug and see if it helps them get along better with their boss or feel less stressed out by the tornado of over-sugared brats who obliterate their homes every day. In fact, many prescriptions nowadays are issued to patients who demand a specific drug they know from an advertisement. Way too often, prescribers comply without much ado. After all, the waiting room is crowded with people and every minute saved on one patient equals money earned on the next one.

Mental illness has become a booming market. No doubt should we be grateful for the many life-improving medications we have at our disposal, including psychiatric drugs. But just where does care end and exploitation begin? How is a consumer to distinguish between information and marketing? What means does one have to confirm the prescriber’s diagnosis unequivocally? Few medical disciplines are as double-faced as psychiatry is at the moment. Try convincing a non-diabetic of injecting themselves with insulin, and try making someone believe their life could be even better if they took psychiatric drugs. While the first is virtually impossible, the latter is easy. It is what happens many times over, every day, all over the planet.

It would be futile to wait for the health industry to change. As long as consumers believe medicine is always altruistic and trustworthy, they will be vulnerable to manipulation. Medicine, and psychiatry, SHOULD have a humanitarian mission rather than being a cutthroat business. But not all health care professionals and pharmaceutical companies want to know about that. However, the situation is not hopeless. You as a consumer and potential target sit at one end of the lever. You can ask questions and have a right to utter your skepticism. If you are unsure whether you need a prescription for psychiatric medication or not, the following actions can help you obtain a clearer vision of things:

  • Go for a second or even third opinion from another doctor.
  • Have a general medical checkup. Nutritional deficiencies, allergies, a damaged liver or thyroid dysfunction may be causing your symptoms. Also, have a neurological exam in order to rule out anomalies in your brain structure.
  • Take a critical look at your lifestyle and habits. Are you getting enough sleep, and if not, why (do you ingest a lot of caffeine, do you have sleep apnea, is your bedroom not dark or quiet enough, etc.)? Are you consuming any recreational drugs (including alcohol)? Are you getting enough movement and fresh air? Do you eat well? Are you regularly exposed to toxic substances?
  • What is going on in your private and professional life? Which stressors can you change or at least shield yourself from?
  • Are you carrying around an old childhood trauma or other painful experiences? These have to be worked on!
  • What is your universe made up of? Is life cold and empty to you? Find things to fill in those existential gaps. I am not necessarily talking religion here. I mean bring something into your life to help you appreciate your existence.
  • If you have a prescription, evaluate if taking the drug is worth the risk. If its negative effects outweigh the damage you are suffering from your perceived problem, refrain from using it.
  • Talk to a psychotherapist or counselor. Maybe your problems can be solved through therapy rather than drugs. If you are a believer, you can also consult with a spiritual guide.
  • Ask close friends, relatives or other people you trust how they perceive you. Their perspective may vary greatly – and in your favor – from your self-perception. Don’t be shy to accept their support and their love. Those are invaluable gifts.
  • Read, read, read. Remember: knowledge is power.

Having gathered enough information, make an educated choice. Whether you wish to try psychiatric medications or whether you prefer doing without them, both of them are valid ways, and for both you deserve respect and support. There is no shame and no guilt about any of the two. All is about building a life you’re able to love. Pick the best help you can find to get there.

The following are links you can learn more from.

Webpages:

MindFreedom is a website defending human rights in the mental health system. On this page, you can find links to various articles on doubtful marketing strategies for psychiatric medications. http://www.mindfreedom.org/kb/psych-drug-corp

Articles:

“Inappropiate Prescribing”: Article for the American Psychological Association (APA) by Brendan L. Smith, in English. http://www.apa.org/monitor/2012/06/prescribing.aspx

“The Psychiatric Drug Crisis”: Article for The New Yorker by Gary Greenberg, in English. http://www.newyorker.com/online/blogs/elements/2013/09/psychiatry-prozac-ssri-mental-health-theory-discredited.html

“Drug Companies Just Say ‘No’ to Psychiatric Drugs”: Article in English for Psychology Today, written by Pulitzer Prize nominee Robert Whitaker. http://www.psychologytoday.com/blog/mad-in-america/201106/drug-companies-just-say-no-psych-drugs

Audiovisuals:

“The Marketing of Madness” is a documentary on the marketing strategies employed by the pharmaceutical industry and the prescription of psychotropic drugs to patients who would not have really needed them. A must watch, available in English language on YouTube. http://youtu.be/IgCpa1RlSdQ

“The DSM – Psychiatry’s Deadliest Scam”, in English language, documents the shortcomings in the edition of the DSM, and how the manual impacts the entire psychiatric discipline, thereby affecting thousands of lives – not always for the better. http://youtu.be/PcuhhJ1BaMk

“How to Read Your Body”, by Dr. Eric Berg, gives simple guidelines on how to assess your overall health, in order to help you and your doctor pinpoint any underlying problems. http://youtu.be/VaUAe-csKjY.

Another video by the same author is “The Ultimate Stress Lowering Technique”. Apart from proposing stress reduction exercises, Dr. Berg also taps into the subject of inaccurate psychiatric diagnoses in stressed individuals. http://youtu.be/lsoYk5rioyw

 

Some Words on: Psychiatric Violence

The term psychiatric violence, or psychiatric abuse, describes the mishandling of power and authority health care professionals in psychiatry, or entire institutions, can expose their patients to. It comprises all sorts of aggression – active or passive. Psychiatric violence can occur on all levels of interaction between treating professionals and patients: social, psychological, chemical or physical.

Progressive thought currents in psychiatry advocate equality between the treating and the treated. More and more often, the right of patients to make choices and utter demands is recognized and respected. However, the outdated model of an authoritative doctor and his dependent and subdued patient is still very much alive.

Psychiatric violence occurs wherever doctors and nurses assume that someone who has been diagnosed with a mental illness is a person of diminished worth and respectability, and where psychiatric institutions consider it their main purpose to keep the mentally ill our of society’s way, as opposed to helping them reintegrate. Violent psychiatry robs distressed individuals of their humanity and punishes them for being dysfunctional. Humane psychiatry, on the other hand, dedicates to them attention, support and empathy – in short, authentic interest. I have experienced both models in action and guess what: humane psychiatry is the one producing positive results.

I’ve mentioned here on my blog that I was hospitalized a bunch of times during my psychotic break, in three different clinics over the course of nine months. The first two institutions operated quite a lot through psychiatric violence, which ranged from physical restraint to psychological abuse. Ironically, one of those two clinics had posters in its hallways, inviting patients and the general public to talks on psychiatric violence! It was the first time I ever heard of the concept.

Violent psychiatry will attempt to coax patients into compliance. In fact, their definition of mental illness hinges on the degree of compliance (or non-compliance, for that matter) an individual under examination displays. The discourse used reminds of the twisted logic of medieval inquisition trials: if you admit to being mentally ill, well then you of course are. And if you insist you’re just fine, that belief in itself will be considered a symptom of your craziness. Catch twenty-two! The same goes for the acceptance of psychiatric medication. If you are docile and willing to take your pills, that’s recognizing you are ill. If you refuse, it means you’re mentally deranged, too, because your fail to admit you need them, so your perception of reality must be distorted! In other words, if you come across the wrong sort of psychiatrist, you are destined for disaster the moment you set foot in their office. One way or the other, you will be diagnosed with something – accurately or not.

On occasions, psychiatric violence can get rather blatant and bizarre. During my second hospitalization, a doctor yelled in my face in front of a group of fellow patients that I was sick to my head. An arts therapist at the same facility communicated to the prescribing doctors that I had “distorted vision” – she was convinced that every time I looked in another direction but hers, I was actually looking at her! In retrospect, I think it might have been nice of me to offer her some of my antipsychotic. Unfortunately, the prescribing doctors and higher ranking staff believed her without subjecting me to any kind of exam. They had no interest in finding out if I really had “distorted vision”. After all, the arts therapist was a qualified health care professional and I was just a nutcase whose words were not to be trusted, and who had been caught displaying yet another weird symptom of craziness.

Another genius of a psychiatrist asked me a handful of questions to find out if I showed any symptoms of schizophrenia. I answered all but one or two with “no”. His diagnosis after barely 10 minutes: “You’re schizophrenic. But that I already knew when I saw you sitting in the waiting-room.” And then, he added: “Oh, by the way, you’ll have to take pills for the rest of your life. I assume that’s clear to you.” I may have been psychotic at that time, but that made me neither stupid nor insensitive to inappropriate behavior. Fuck you very much, Doc! Or, yet a bit more blunt: during my first hospitalization in a “renowned” private clinic, I got physically restrained by one guy (who was a favorite patient and watchdog to the psychiatrist in command of the place), another man forced my jaw open and the doctor himself poured a medication cocktail into my mouth in order to knock me out. Again, I may have been psychotic, but I could still feel dread and I also remember the scene perfectly. That same doctor also had the unsettling habit of interviewing patients in his office with the blinds closed and sunglasses on. Even for someone perfectly stable, this setup would have been disconcerting.

Psychiatric violence goes far beyond treatment. In fact, critics of the psychiatric discipline accuse not only specific institutions, but the entire legal system of allowing for psychiatric patients to be robbed of their autonomy, their dignity and their human rights. This, the argument goes, is the case even when healthy patients are wrongly diagnosed.

For example, in some countries, legally assigned caretakers look after psychiatric patients. They are usually social workers who are authorized to decide on the patient’s behalf (yet not always in their best interest). They control communication with the prescribing doctor, survey the medication plan, and are authorized to have their protégé hospitalized whenever they deem it necessary – or convenient because they are planning a vacation and therefore need to get rid of the ill person for a week or two. I know this sounds cynical and certainly does not do justice to the many social workers who actually do have sound work ethics. Yet, I have come across sad cases. Families can turn to the legal system to have their problematic relatives hospitalized by court order and forcefully kept there for quite long periods of time. If they succeed in legally establishing the “insanity” of their kin, they gain complete control over his or her possessions and decisions. Families may legally be the closest instance to an individual, but they aren’t necessarily protective and well-intended. In fact, dysfunctions within the family are suspected to be a major cause of mental illness. Yet, by default, the legal system considers them the first ones who are entitled to decide in the ill person’s name. Thereby, family members can become yet another source of psychiatric abuse.  When a legal system is lenient towards psychiatric abuse, all sorts of parties can acquire power over the patient – psychiatrists, clinics, family.

The interface between psychiatry and the legal system acts very much like a fly-catcher: once someone gets stuck there, it will be very hard for them to ever free themselves and recover their autonomy. This is not an idea I have made up. Countless psychiatric patients spend years or their entire lives in and out of clinics, supported living facilities and under the “protection” of restrictive court orders. I need not go into detail about how that affects their chances of ever finishing an education, pursuing a career, or building a relationship and founding a family with a significant other. When I expressed my fear of ending up just like that to a nurse at an abusive clinic, she readily answered: “Well, the moment you set foot in here that became the track you’re bound to travel.”

Last but not least, another form of psychiatric violence is simple neglect. My second hospitalization was at a clinic where the prescribing doctor saw you for ten minutes once a week, if at all, and where the nursing staff refused talking to you if you had already addressed them with some kind of problem earlier in the day. Their therapeutic program was also utterly stimulating (yes, I am being ironical): the once weekly “gardening” activity consisted of grazing the parking lot for trash and discarded cigarettes for an hour or so. Hell is a place on earth.

Another feature of violent psychiatry is its propensity to sucking patients into a downward spiral of aggression and forced treatment. Whatever is done or said to you is supposedly all “for your own good”. How can psychological cruelty and neglect ever be for your own good? If your common sense is still functional enough to make you unappreciative of this kind of “help”, it is interpreted as another symptom of your desolate mental state. In short: if you allow psychiatric violence to be applied to you, you are being compliant and it is understood that you recognize you need it. If you speak up when feeling mistreated, guess what? You are deemed to be too ill to speak for yourself and the intensity of aggressions will likely be increased until you finally give in and shut up. Sounds familiar? I’ve talked about old school psychiatry’s witch hunt logic at the very beginning of this article.

The million dollar question is how to protect yourself or loved ones from psychiatric abuse. The keyword is “information”. Ignorance equals impotence. Gather information about your diagnosis and learn about your rights and treatment options. There is a lot of literature on psychiatry which is comprehensible and helpful for laymen (see the sources & reviews page). Luckily, mental health has gone from being a purely scientific matter to becoming a subject of general interest. If you are already caught in an abusive dynamic, your attempts of self-empowerment may be judged as paranoid, especially when you suspect your doctors or your family to be harmful to you. Even then, do not let anyone discourage you. Some doctors are in fact careless and some families are in fact harmful. As long as you are kept in the dark about your circumstances you will never be certain if you are as paranoid as they say or whether you are simply recognizing things for what they are. Do not let yourself be labeled as pathologically distrustful, ungrateful or obsessive. Seek information. You may eventually come across a piece that helps you find a new perspective, communicate more efficiently with your therapists and take informed decisions. In the end, it is irrelevant whether your inquisitiveness springs from paranoid ideation or healthy hunger for knowledge. It is your fundamental right as a human being to educate yourself about your condition. You are the one who is most deeply affected by it, so it is only fair if you know what is going on.

Psychiatric violence is a vast topic. I will stop here, at the boundaries of my personal experience with it. If you are interested in reading more, you can browse the internet or look for literature in online or local bookstores and libraries. If you Google search “psychiatric violence”, you will find that an overwhelming number of entries are about psychiatric patients developing violent behavior as a consequence of their illness or as a side effect of their medication regime. Searching for links on “psychiatric abuse” or “violent psychiatry” may yield better results. To save you some effort, I put together a small selection of links that offer information and are a good starting point for further research:

Websites:

Webpage on psychiatric abuse in English: http://www.psychiatric-abuse.org.uk/

Website in English on human rights in mental health: http://www.mindfreedom.org/

Webpage on different types of abuse, including psychiatric abuse, in English language:                http://we-are-survivors.webs.com/psychiatricabuse.htm

Website of the Citizens Commission on Human Rights in English. Apart from getting information, you can also report psychiatric abuse here: http://www.cchr.org/

Webpage in German, strongly biased against conventional psychiatry: http://www.zwangspsychiatrie.de/

Articles:

Wikipedia entry on involuntary treatment in English: http://en.wikipedia.org/wiki/Involuntary_treatment

Wikipedia entry on the psychiatric survivors movement in English: http://en.wikipedia.org/wiki/Psychiatric_survivors_movement

Article in the Journal of Medical Ethics: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1376496/

Article in English by The Guardian (British newspaper): http://www.theguardian.com/society/2011/mar/15/mental-health-patients-forced-detention

Article in German by the weekly magazine Spiegel (you can run it through a translation program): http://www.spiegel.de/gesundheit/psychologie/zwang-in-der-psychiatrie-das-letzte-mittel-a-836111.html

Blogs:

A British mother shares her experiences with psychiatric treatment in the UK: http://psychiatricabuseuk.com/

Personal experience of a former psychiatric patient in the USA: http://www.experienceproject.com/groups/Am-A-Psychiatric-Abuse-Survivor/239188

Audiovisuals:

Interview with a survivor of psychiatric abuse by the Citizens Commission on Human Rights:  http://www.youtube.com/watch?v=ve92-PFytAU

The (Scary) First Step – Test Dose Reduction

The time has come! From tomorrow onwards, I will be taking a slightly reduced dose of my SSRI antidepressant. I will go from 150mg of Sertraline in the morning to 137,5mg for a week or two. This corresponds to a reduction of slightly less than 9%. Various sources recommend not to start with dose changes any greater than 10%. Therefore, although my next short term goal is to reduce my dose of Sertraline to 125mg, I will be going there through an intermediate step that will function as a test period at the same time. Both I and those closest to me will be monitoring my response – or the absence thereof – to this initial dose modification.

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My new toy – a “deluxe” (of course, I’m posh) pill cutter.

Now, how do I go about the dose reduction technically? I have 100mg and 50mg Sertraline tablets. They are of an oblong shape and dented in their middle in order to make halving them easier. But if I wish to try 137,5mg for a while, I will need to quarter the 50mg tablets. Even with my pill-cutter, that will hardly be possible. Reading through Dr. Peter Breggin’s book Psychiatric Drug Withdrawal (see sources), I found an easy enough solution to this problem. Breggin describes several drug withdrawals he was helping his patients with, and especially with very small dose modifications it was sometimes necessary to be inventive. This is what I’ve learned:

 

  • If a pill cutter won’t do the job, you can find out if your medications are available in liquid form as well. If they are, you can control your doses drop by drop.
  • Some drugs come in capsules filled with tiny pellets. Same as with drops, this gives you the possibility to make very gradual changes by removing some of the pellets from the capsule.

But careful: your mathematics must be very precise for both the drop-by-drop method and the pellet removal strategy. You need to figure out how much of the active ingredient is in a drop or in a pellet. If you are taking generics, you also need to make sure you are always using the same manufacturer, as concentrations and excipients may vary from brand to brand. And needless to mention, if you have trouble concentrating due to cognitive impairment caused by either your condition or your medication, you need to put an extra effort in getting your doses right. In the latter case, you may keep lists or put up sticky notes to remind you of how to proceed. If you live with someone who is willing to support you, you can also ask them to double check if you are handling your medication correctly and according to plan.

  • Given that I haven’t got hold of either Sertraline drops or capsules, I decided on another dose reduction method mentioned by Dr. Peter Breggin. I will be taking 125mg instead of 150mg every other day, simply by halving the 50mg Sertraline pill with the pill cutter and taking it together with the 100mg pill. Over time, the alternating doses of 125mg and 150mg will result in an overall dose reduction of 12,5mg.

If I tolerate this initial step well, I will proceed to definitely reducing my Sertraline dose to 125 mg. I am quite optimistic it will work because of experiences I have had with involuntary – alright, neglectful – dose reductions. For varying reasons, I have skipped taking my Sertraline altogether a number of times. Normally, I am rather disciplined and take the antidepressant immediately after getting out of bed and brushing my teeth in the morning. However, if a day is particularly eventful or something unexpected gets in between my waking up and my going to the bathroom, I run a slight risk of forgetting my Sertraline. The first few times it happened to me, I was extremely worried the omission was going to cause weird withdrawal symptoms or render me useless temporarily, but none of it was the case. My suspicion is that having used the same amount of Sertraline for about four years now, there might already be a certain concentration in my blood that keeps me stable even if I forget one pill every once in a while. This is just my personal hypothesis. Right now, I can name no sources to back it up scientifically. Also, so far I have never skipped more than one dose. Hence I don’t know how I would react to a permanent, if small, dose reduction. Still, for the above reasons, I am confident it should be no problem.

I will keep you updated on how things are going in my “withdrawal diary” section.

My Personal Withdrawal Plan – Sources and Outline

Although I seem to tolerate my current medication plan quite well, I have been striving to wean off my pills, or at least decrease the dose I am taking. But before I altered anything, I needed information. Despite my recovery from psychosis I have developed a profound mistrust towards psychiatrists and psychotherapists. Out of all the professionals who saw and treated me, maybe 20% actually knew what they were doing. The other 80% either didn’t care to help me, or they wanted to be helpful but didn’t have any idea how, or they were abusive of their authority, or they needed therapy themselves. No joke.

As a result, my first thought was that I needed information to be able to distinguish a competent psychiatrist from a quack, so I could pick the right support for my undertaking. Yet, by continuing to read about mental illness, treatment options and psychoactive drugs, I became more knowledgeable and eventually felt I was able to make informed and more autonomous choices regarding my recovery and withdrawal process. One book in particular stood out as being clearly understandable for any reader and for promoting a holistic approach to the treatment of mental illness and to medication withdrawal: Psychiatric Drug Withdrawal – A Guide for Prescribers, Therapists, Patients, and Their Families. It is one of the more recent publications of Dr. Peter Breggin, who draws on over half a century of medical experience in psychiatry. As a defender of the patient’s freedom of choice, Dr. Breggin promotes what he calls a “person-centered, collaborative approach”. Instead of turning the patient into a depersonalized and passive onlooker of their own treatment, Breggin places the patient at the very center of his therapeutic model. Around the patient, he constructs a support network consisting of a prescriber of psychiatric drugs, a psychotherapist, and significant others (family members, spouses and friends). The prescriber and the therapist can be one and the same person, but do not have to be. What is indispensable, though, is that the patient’s wishes and decisions are taken into account at all times, and that all participants in the collaborative, person-centered approach are communicating efficiently and monitoring the patient’s health development. As the title of the book reveals, Dr. Breggin writes for health care professionals, patients and their significant others alike. None of the information he gives is classified exclusively for one or the other. All people involved have the same right and access to knowledge. The patient and his or her loved ones are empowered rather than patronized. You might be able to guess by now that I highly recommend this book. Further on, I will be reviewing more literature, but for now this is my starting point.

First of all, it is important to understand that there is no standard recipe for withdrawing from psychotropic drugs. Every organism reacts differently to changes. Also, it is impossible to foresee how long it will take to wean off medication or to securely establish a new dose. As a general rule, however, slower is better, and small changes in dose are safer than big ones. This is especially true for those who have been on psychiatric medication for a long period of time. Certainly, you often hear stories about individuals who have successfully gone “cold turkey” or got rid of their pills in the course of a few weeks or months, but they were taking a high risk and were extremely lucky. They were literally playing Russian roulette with their lives. Reducing medication doses is not a sport, and there is no competition going on in who gets there first. The only reasons for withdrawing on the fast lane are life-threatening or disabling side-effects, dangerous drug interactions, pregnancy and medical conditions that turn the use of psychoactive drugs into an additional health risk. Personally, I am not in a hurry. Luckily, nothing in my life forces me to withdraw, and I can take it as slowly and safely as I like. And I like it very safe.

Evidently, withdrawal is easiest to plan being on only one drug. Now, I am on two different medications which counteract one another and are thereby meant to keep me in balance. In the morning, I take 150mg of Sertraline (SSRI antidepressant), which should have a stimulating effect. At night, right before going to sleep, I take 300mg of Quetiapine (atypical antipsychotic), to sedate me. My aim is to reduce doses alternately, maintaining the proportion between both drugs. I will start with the antidepressant. If everything goes well, the antipsychotic is to follow. Again, if the new dose works fine for me, I will keep it up for a period of time and eventually attempt another reduction.

As for the monitoring of my progress, my partner is around me every day and is in the know about my withdrawal plan. He will communicate any observations and concerns to me, is reading the same literature as I and is following my blog. Other friends will also be part of my private watch team. I do have a prescriber, yet I admit I haven’t decided on the involvement of a psychotherapist. Frankly, I feel reluctant to do so. Right up to my psychotic break, I had been seeing a shrink for several years, and she was unable to identify any warning signs or put her finger on the deeper causes of my troubles. I believe I’ve had it for now, as far as psychotherapists go. Also, after the ride I’ve sat through, I am quite confident I know myself better than a therapist who sees me once weekly could. In order to boost my general health and well-being, I will work out regularly, stick to a healthy diet, sleep enough and enjoy relaxation therapies – occasional foot reflexology and back massages.

The following is an illustration of how I ideally wish to proceed. This plan, as for now, has five phases that may be subject to changes, depending on whether I tolerate the dose reductions. If I don’t, I may need to return to the previous dose and postpone further changes for a long enough while to become stable again. You will notice I haven’t planned a complete withdrawal. While I was figuring out the graphics, the thought of actually putting this plan into practice made me feel all wobbly. In the attempt of outlining a sixth and seventh phase I might have fainted and slipped underneath my desk. So, let this be good for now.

I apologize for the miniature format of the graphics. The originals are a good size, but for some reason, they won’t come out bigger once inserted into this post. You can upscale your view of this page on the bottom right of your screen.

withdrawal plan phase 1

withdrawal plan phase 2

withdrawal plan phase 3

withdrawal plan phase 4

withdrawal plan phase 5

Some Words on: The Social Stigma of Mental Illness

I am very careful about whom I tell I had a psychotic break and am still taking psychoactive medication. It is only a few people who know. This is not because I enjoy being dishonest, and I am also not ashamed of my condition. The reason is that, no matter how intelligent or good natured most of our social and professional contacts are, they are very likely hardwired to start questioning your capacities and interpret whatever you do or say in terms of your supposed craziness from the moment they learn about it. It is not their fault. It is what society has taught them.

The mechanics of prejudice work like this: imagine you are at a dinner party. An acquaintance leans over and whispers in your ear: “See Henry over there? I think he’s gay!” For the rest of the evening, you will be looking for signs of Henry’s homoerotic preferences. He prefers Piña Colada over beer, strawberry ice-cream over chocolate and also dresses tastefully? Oh my God, he is SO gay! How could you not have noticed before? He brought his long-time girlfriend along to the party? Not a problem at all – he is probably in denial and hasn’t yet come out of the closet.

Along these lines, people who know about your diagnosis and your medication routine will read your every move as a sign of your condition. You forgot to send an email? That’s because you’re demented either by your illness or by your medication. You get pissed at a colleague who snatched a customer away from you? You have uncontrollable anger issues caused by either illness or medication. You tell someone in the office you had trouble falling asleep last night? Of course, you are a lunatic! Any of these situations happening to a “healthy” person is just stuff that happens naturally from time to time and need not worry anyone – after all, nobody’s perfect, right?

Again, I emphasize that this kind of over-diagnosing is not ill-intended in most cases. It occurs pretty much automatically. Most people, although educated and cultured, simply don’t know enough about mental illness and therefore are uncertain what to expect. This uncertainty generates mistrust, fear, and ultimately discrimination. I must admit I used to be no better. Years before my psychotic break, a fellow student at university admitted to being schizophrenic and taking medication. Although I didn’t want to be mean, I couldn’t help but fear that if I invited her home she might, out of the blue, snap and pull a kitchen knife on me. Now I know how unfair that was. Mental illness seldom is a threat to others. It is, unfortunately, a huge danger to the sufferer’s own happiness. The cruelty of my own prejudice hit me like a truck when I got diagnosed as psychotic myself.

My recommendation to you is: think through the possible consequences of telling any- and everyone. It is true that mental illness should finally be discussed more openly in order to put an end to discrimination. However, I warn you against thinking it up to you to make that happen all by yourself. Do not turn yourself into cannon fodder. Imagine calling up the Gestapo in the middle of the Holocaust and telling them “Hey guys, I wanna come clean, I´m Jewish…” No way! You need your lifelines intact. You need a job, you need your studies, you need your social contacts, you need a life! If you wish to make this world a better place for people with psychiatric diagnoses, there is a host of organizations you can support who will appreciate your contributions to their cause. See the appendix of this article for relevant links. Also, ask yourself if your diagnosis or your medication plan is relevant information at all, say, at your workplace. Can you do your job efficiently, just like everybody else? If your answer is “yes”, then what is the use of drawing attention to your problem? As long as you’re an accomplished, say, software programmer and reliably fulfill all demands, why would your boss or your co-workers need to know you’re receiving psychiatric treatment? It is not relevant. Imagine being at a job interview at some lab and saying: “Hi, I have a Master’s degree in molecular biology and graduated with honors. Oh, and I guess I should mention that I enjoy visiting swinger clubs on the weekends.” Why would you shoot yourself in the foot like that by disclosing a superfluous fact that will cast a shadow on your merits? It is neither intelligent nor honorable. Of course things are different when your condition does affect your performance negatively. If you suffer from an anxiety disorder which makes socializing difficult for you, you will not wish to be placed in the customer service department. In that case, your superior and your co-workers need to know and understand. Give them a chance to pick tasks for you that are manageable and offer you the opportunity of performing at your best.

To sum it all up, only tell someone you are on psychiatric medication when you are absolutely sure this person will not make your honesty backfire on you. The slightest doubt, the tiniest hunch that you feel, may well indicate it is not the right person to trust or not the right moment to speak. As a rule of thumb, do not trust people more than they trust you.

Your social network is made up of three kinds of contacts: those you must tell, those you can tell and those who – at least for now – you should not tell. Make sure you identify them correctly. People who absolutely need to know about your condition are your partner, your roommate, close family, your closest friends. Everyone else you have to gauge for suitability and trustworthiness first.

Is this way of proceeding ethical? Is it alright not to be an open book? If it is not relevant to the situation, there is no need for exposing yourself. Society seems to impose an absolute moral obligation to be open and sincere. But remember that the reactions you’ll get from people who can’t handle your confessions can be unethical and harmful to you (this is a parody of what I mean – watch this tragically funny NAMI sponsored commercial: http://youtu.be/Dw_I-G1smoo). It is one thing to be sincere and give others information they actually need in order to coexist with you, but it is another to unnecessarily feed yourself to the dogs. Being inappropriately heroic might cost you your job, your social circle, your inner peace and your dignity. Think twice. Decide wisely, for your personal integrity, independence and even your prospects of recovery are at stake.

 

Websites:

The following organizations aims to improve the life quality of individuals diagnosed with mental illness. This includes educating the public and those diagnosed with mental illness to create more awareness and better integration. Anyone can register as a member.

National Alliance of Mental Illness (USA, in English and Spanish): http://www.nami.org/

Mental Health Foundation (UK) has a similar mission as NAMI: http://www.mentalhealth.org.uk/

Rething Mental Illness (UK): http://www.rethink.org/

Canadian mental Health Association (CA): http://cmhanl.ca/

Articles:

http://www.psychologytoday.com/blog/why-we-worry/201308/mental-health-stigma

http://www.mentalhealth.org.uk/help-information/mental-health-a-z/S/stigma-discrimination/

Article for the Canadian Mental Health Association (in English): http://www.cmhanl.ca/pdf/Stigma.pdf

http://www.changingmindschanginglives.com/2013/11/a-diagnosis-of-schizophrenia-set-me-apart-from-the-rest-of-the-world/

Audiovisuals:

Information video by the IWK Health Centre and the Canadian Mental Health Association titled Stigma and Mental Illness: http://youtu.be/LTIZ_aizzyk. Brief interviews with health care professionals and psychiatric patients portray the stigma of mental illness within the health care system. A must-watch!

Symposium about mental illness stigma hosted by Carleton University. You will find an extensive watch-list with videos of the speakers of the symposium here. http://www.youtube.com/watch?v=RMVfVuI0zwE&list=PL23BEAD8F06537216

A bold discourse not everyone may agree with, but that everyone should have listened to. Canadian essayist Stefan Molyneux talks about his theory on mental illness: http://youtu.be/J_O24tnqs_U (part 1) and http://youtu.be/mgqIUf8Jg-c (part 2).

Jayme-Lee Pablos, a psychology student reads her paper on social constructs and social stigma of mental illness: http://youtu.be/X3hJqB20r1g (part 1) and http://youtu.be/oiTCgxhKPok (part 2). Her work portrays an academic standpoint rather than looking to provide help, but it is interesting information.

Why Wean off Psychiatric Medication?

If everything is going so well, you might wonder, why am I intending to give up my tablets? For several reasons! A variety of sources claim that using psychiatric medication over long periods of time can have dangerous consequences. Quetiapine, for example, is associated with altered blood sugar levels and diabetes. Damage to the liver is another risk. Tardive dyskinesia and tardive dementia (involuntary movements and dementia occurring after long-term use of psychiatric drugs) are other potentially irreversible side effects. Cognitive impairment and chronic brain impairment (CBI) are not uncommon. The long-term effects of psychotropic substances on the brain are virtually unknown, but they are suspected to be devastating. Apart from that, case studies indicate psychiatric medication can induce manic states and drive people to commit suicide or other violent acts. The very companies who designed the drugs I am using admit they don’t know how exactly their products act within the human organism. Looking at the monetary aspect of taking antipsychotics and antidepressants, it can get very costly! Either insurance rates are insanely high if you declare needing treatment for a chronic psychiatric condition, or you have to pay for your medication out of your own pocket. We are potentially talking expenses of several hundred dollars every single month. Many of you may also find that having to swallow tablets at certain times during the day is tedious and violates your liberty. I, on the contrary, find no reason to complain about that. Being a woman, I have used contraceptive pills for many years, and those need to be taken at the exact same time every day. You can never forget one, even if you are still spaced out from last night’s party – now THAT sucks! In other words, I find things could be much worse. I simply take my antidepressant at whatever time I choose to get up and the antipsychotic at whatever time I decide to go to sleep. I have even forgotten to take the antidepressant a few times – no problem at all, I simply make sure to take it the next day.

This blog is no manifesto against psychiatric medication. Psychotropic substances put the fire out in my case. They brought the acute crisis to a halt and gave me time to pick up the pieces. I am fortunate my organism accepted the current combination of an antipsychotic and an antidepressant well. Yet, I emphasize it is absolutely vital for recovery to find complementary, non-chemical therapeutic measures to extinguish the embers after the big fire is out. Because they might alter your brain forever, I consider psychotropic drugs the very last resource to be employed. In my eyes, they are an emergency switch that should only be thrown when a temporary shutdown of the system is necessary.

While in some cases medication may be useful, most people with prescriptions from their psychiatrist would be better off facing their crisis and managing it with their psyche unaltered. Soliciting the attention of a psychotherapist, counselor or priest, spending time with loving friends or family, regular workouts, healthy nutrition and decluttering an overloaded agenda often prove more healing than pills. It is important to remember that stress is a natural and even necessary condition. All human beings eventually experience crises. They will occur repeatedly in everyone’s life, so it is important we learn to deal with them. Rough patches are part of the natural course of our biographies, same as joyful times are. Instead of suppressing emotional tension chemically, we’d do better learning to get over it and thereby grow stronger. Only when all measures fail and the individual sinks into utter dysfunction and alienation, as I did, should medication be prescribed – temporarily. This is my personal and subjective opinion. I make no claim of being in the right.

Not all psychiatrists would agree with me, yet even within the discipline there is no consensus on when to administer psychotropic drugs to patients, nor on how many, nor for how long. Scientifically unfounded affirmations such as “psychiatric medication has to be taken for life” or “mental illness is incurable” are spooking around under the guise of objective information. However, the entire concept of mental illness is still hypothetical in many aspects. Preoccupied about my future, one day I phoned the psychiatrist who had treated me during my last hospitalization. I asked him whether I needed to take my medication for the rest of my life. He did not hesitate one moment. Much to my relief and surprise, his answer was “No.” He said I could start weaning off by lowering the dose of the antidepressant a bit, and take it from there step by step. The conversation with the doctor happened a while ago. I wasn’t ready then. Today I feel secure enough to have a go at it. I am aware one should never go “cold turkey”, that is, stop taking the medication from one day to the next. After over three years of using those substances, my brain relies on them to be around. Also, reactions to spontaneous or rushed withdrawal have been reported to be just as dangerous and terrifying as some of the unwanted side-effects of psychotropic drugs. I shall write more on the perils of withdrawal in another post.

Withdrawing from psychiatric drugs being such a delicate undertaking, I must remind you again: do NOT use this blog as a manual on how to proceed in your case. If you wish to benefit from my posts, read them attentively, share them with others, or even let my blog inspire you to put together your own action plan. So, if I may use an already overused line: don’t try this at home! Unless, that is, you have researched carefully and designed a strategy for modifications in your treatment that is tailored to your specific needs. I will later describe in detail about how I am planning my withdrawal process and which sources I am using for information.

My Medication History – Why I Was Prescribed Psychiatric Drugs

Four years ago, I suffered what is generally called a psychotic break – a severe mental and emotional crisis that pushed me into total dysfunction in everyday life. In retrospect I believe the event had been announcing itself over time. In the back of my mind I had had a notion that something was wrong with me for a good while. I had not resolved various conflicts generated during my childhood and young adult life. I now believe they had kept accumulating and necessarily had to lead to a paralyzing overload someday. When the big crash finally occurred, it felt very much as if a knot that had been pulled tighter and tighter over the years had ruptured and left my existence in shambles. One could very well speak of a major seismic event in my head and heart. I could feel my mind racing, yet completely unhinged and in idle speed. Emotionally, it was such a traumatic experience that I found myself in a constant and paradoxical state of combined panic and numbness. I was convinced I was irreparably broken. 

My symptoms apparently were not easy to classify. I literally received as many different diagnoses as I saw psychiatrists: major depression, bipolar disorder, schizoaffective disorder, schizophrenia. It is true that some symptoms of mental illness are common to all of these. There are no clear divisions between one mental illness and another, and psychiatry knows no scientific test methods to determine what you are suffering from. It is up to the psychiatrist to interpret what he believes to see in you. Also, most of the doctors I visited did not dedicate more than 10 or 15 minutes to our sessions, which is evidently not enough to make qualified observations, let alone guide me out of the crisis. In fact, the doctor who helped me most and invested the biggest effort in his patients’ well-being was also the one who saw no point in sticking a label on my problem. What mattered was my recovery. Further on, I will talk in more detail about my experiences with the psychiatric discipline – both positive and negative.

Before I was prescribed medication and the psychosis was in full swing, symptoms included: racing thoughts, sleeplessness, unorganized and contradictory thinking, unstructured speaking, inability to concentrate, incapacity of taking even the smallest decisions, paranoia, restlessness (akathisia), rigid stare, exaggerated need to make contact with people in the hopes of finding support, feeling existentially uprooted. At one point, I collapsed with what I now suspect to have been a minor stroke. I could literally feel an electric explosion initiating somewhere inside my brain and engulfing all of it in a few seconds. I began feeling ice cold and fell to the ground. I almost passed out. Terrified, I forced myself to open my eyes and get up. During the following hours, my legs would fold up under me, I had to force my eyelids open because they were constantly falling shut, and my speech was out of control – I was unable to form a thought and express it. My sentences were mostly incomplete. I also had no control over which of the languages I speak came out of my mouth. Despite my insisting to the people around me that something had “happened to my brain”, they preferred to believe I was just “low on sugar”. Even the psychiatrist who saw me a few days later did not consider it necessary to examine my brain. I felt I was in the wrong hands, but was powerless and exposed to other’s decisions. I described the incident to other doctors, but none thought it worth investigating. The first time I got a brain scan was seven months later. Around that time, also my blood and my thyroid were finally checked for anomalies. Nothing was found.

The first drug I was put on was the atypical antipsychotic Zyprexa (the active ingredient is Olanzapine). It did make me sleep, which no doubt was important. Yet, overall it had numerous unfavorable side-effects which added to the psychotic features mentioned above.  The negative effects were rapid and noticeable weight gain (about 35 pounds in six months), loss of willpower, deactivation of the menstrual cycle, lack of libido, unhealthy skin, and I still had that disturbing stare and was overall unable to engage in life.

When I got hospitalized for the third and – hopefully – last time, my medication was changed to 300mg of Seroquel (an atypical antipsychotic substance called Quetiapine) and 150mg of Zoloft (the SSRI antidepressant Sertraline). This cocktail seemed to work significantly better for me, and it is what I am still taking. All psychotic symptoms have vanished. The only downside is that I haven’t been able to return to my original weight – I am still about 25 to 30 pounds heavier than I used to be before the psychotic break. I also have recurrent nightmares and all sorts of unsettling dreams, which is a known side effect of Quetiapine. Apart from that, I am leading a happy and healthy life. I have a job, a partner, friends, pets, hobbies and a good overall health. My cognitive capacities are as good as they have ever been – I am pursuing a Master’s degree and also enjoy acquiring new knowledge and skills in my free time. Nothing is missing. Luckily, I have not noticed any cognitive disabilities caused by the medication. Although everything has been going just fine, my lifestyle needed to undergo major changes. Today, I am more careful with myself than before the crisis. I have become more conscious and protective of my mental and emotional health. I didn’t really know how precious it was until I lost it! Before the psychotic break, I tended to be merciless with myself. My schedule used to be crammed with duties and I seldom allowed myself to rest. In fact, relaxing would make me feel guilty and useless. In those days, I was notorious for my iron discipline and efficiency. I was working non-stop to keep up with my obligations. Today, I am way less masochistic. In fact, I’ve begun liking and trusting myself. I now consider spare time an important and pleasurable part of my schedule. I am still a busy person, but I am more selective as to which chores I fit into my day and to which ones to say “no”. Even when things get a bit intense at times, I don’t allow stress to take over. Of all the tasks that are at hand, I figure out which should be completed first, and I focus on that one. Then, I pick the next one, and so on. Tackling challenges one by one works a lot better than looking at the huge pile of responsibilities and getting overwhelmed by it. I also find I have become more discerning as far as priorities and not-so-important matters go. Allover, I’d say I am living more consciously and more lovingly towards myself and others. Definitely, life is more fun and more fulfilling now. It is something I believe everyone should strive for – mentally ill or not.

Personally, I am certain that medication alone did not put me on this new, better path. Many, if not the majority, of my fellow patients at the clinic were just as miserable on medication as they had been without it. I believe that love, attention and spiritual support from people close to you are at least as important as the correct prescription. Also, the last clinic I was in had a tight schedule of therapeutic activities which forced the patients to remain busy and engaged in reality. The staff was available for one on one support most of the time. In my view, it was the accumulation of all these factors plus my own striving for emotional wellbeing that helped me back into life. In fact, I now feel more secure and at peace with myself than I had ever felt before the psychotic break. Why that is so, I cannot be sure.  My becoming better may be, and that I would consider the worst case scenario, the sole merit of my medication plan. It is also possible, which I hope is the true cause, that the pills have, metaphorically, pushed my reset button and thereby allowed me to tackle my old conflicts and the challenges of life step by step, until seeing me out of the worst.

The “Getting off” – Project

My name is Felicia. I am an artist and writer in my late thirties. The “Getting Off” project is about my gradually weaning off psychiatric drugs. It is intended to become a personal logbook through which I aim to document and to share:

  • Which circumstances made me start taking psychiatric drugs in the first place.
  • For how long I have been taking them and how they have affected me, both positively and negatively.
  • Why I wish to reduce dosage or, if possible, stop taking them altogether in the long run.
  • How I set up my dose reduction plan.
  • The measures I am taking to ensure my safety.
  • My experiences and observations throughout the process of progressive dose reduction.
  • The observations of significant others who actively accompany my progress.
  • Information gathered from external sources.

Creating a blog on this subject will hopefully help both me and you readers. For me, it will motivate me to be more structured and observant throughout the process of withdrawing. Thereby, I will hopefully be able to recognize both progress and setbacks when they occur, thus improving the odds of being successful and remaining healthy. The latter also implies evaluating whether a complete withdrawal is desirable at all. Depending on my reactions, I might have to be content with a dose reduction for now. Withdrawing from psychiatric medication is not an end in itself, and it is certainly not a sport. The main objective must always be general well-being. If that means I need to remain on a reduced dose, so be it.

As for you, you may be taking psychiatric drugs yourself or be close to someone who does, or maybe you just are interested in psychiatry. Possibly, you are trying to wean off your medications or planning to do so, or maybe someone in your family, a friend or a colleague is. In all of these situations, following my “Getting Off” project can be helpful for you.

In addition to my main objectives, I will be publishing articles on different aspects of mental health, or the lack thereof. Titled “Some Words on…”, these will also be vastly based on my personal experience and research, yet as an appendix I am going to list links to websites, articles and audiovisuals dealing with the topic in a more professional and objective way.

At this point, I have to stress though that this blog is NOT a substitute for one-on-one medical advice. I am not a doctor and also am not qualified to diagnose or to treat anyone. Please also keep in mind that every individual case is unique in background and in development, meaning that what works for me might not work for you, and viceversa. You and I might not even be taking the same substances, let alone the same dose. Getting Off is the documentation of my particular path. I am happy to share it and would be delighted to know that it is useful to you as complementary literature and additional support to whatever situation you have in your life.

I am very much looking forward to your company.

Yours sincerely,

Felicia