Some words on: Splitting the atom with pill-cutters and patience

Logically, as I move on to lower doses of medication, also the adjustments on the way to the next smaller dose need to become finer. Pill-cutters work great when it comes to halving tablets, or even splitting sufficiently large, round tablets into quarters. But unless you can get hold of low-dosage pills, the utility of this gadget has its limits. More often than not, my attempting to cut pills into exact portions smaller than one half, has resulted in me plucking minute white crumbs out of the pill-cutter and piecing them together to approximately one day´s dose. Some pills simply resist being cut precisely. To avoid such hassle, I prefer using my pill-cutter in combination with a method of spacing out the intake of the old, higher dose in favor of the next lower one. The underlying idea is to gradually diminish the average amount of the respective substance in my organism until reaching the following lower target dose. Here is an example of how I have been doing it:

graphic sertraline withdrawal

I came across this procedure in Dr. Peter Breggin´s book Psychiatric Drug Withdrawal, and have mentioned it briefly in an earlier post on this blog as well. The graphic above does not reflect the exact way Dr. Breggin helps his patients decrease their drug intake, but it is an adaptation of his idea to my own circumstances. Another way of doing it by blocking high and lower doses according to a weekly plan would be to take the new dose on one day of the first week, two following days of the second week, three following days of the third week, and so on. It could look something like this – red spaces represent the old, higher dose of a drug and blue spaces the new, lower one:

suggestion weekly withdrawal plan

As you can see, the concept is flexible. You or your doctor may come up with other variations, even shortening or lengthening the duration of each step in your withdrawal process according to your own needs. In addition, I have to point out, once again, that I am not a professional in the medical field. This blog documents my individual way of handling medication withdrawal, but I am in no way qualified to give anyone else instruction in this matter. My hope and purpose is to encourage you to acquire the means and the support you need to improve your health. If you believe the method of psychiatric drug withdrawal I am describing in this article might also be helpful in your case or for someone you know, please seek further information with professionals and consult relevant literature. I am sorry if I am repeating myself with this sort of disclaimer, but I truly do not wish for anyone to get hurt in the execution of domestic experiments with psychoactive substances.

Up to now, I have been faring well using this method of dose reduction. All that is necessary is to keep track of where you are at in your plan – and to have your plan for each dose reduction written out for your reference. Personally, I keep a handwritten list of days and corresponding dosages, and tick off day by day. This way, each decrease in dosage takes me around five to six weeks. After completing the change, I wait for another couple of weeks before I make any modifications to my intake of the other drug I am using. Thereby, I hope to make sure each alteration of my medication plan is well under control in that I can recognize any adverse reactions and, most importantly, relate them directly to specific changes I have made. In order to take psychiatric medications, and also in order to wean off them safely, it is vital to notice the effects using them – or ceasing to use them – has on you. When you experience negative side-effects or withdrawal symptoms, you need to find out what caused them. A clear-cut medication and withdrawal plan helps generate such transparency, provided you follow up on it diligently. Being structured also allows for making well thought-through modifications to your plan if things should not go smoothly. Suffering adverse effects is, in itself, a destabilizing experience. The less panic-driven and better informed your subsequent actions and decisions are, the more likely you are to get back on track and prevent a full blown crisis from developing.

At this point, I would like to remind you always to remain process-oriented, rather than goal-oriented. Diminishing psychiatric drug intake is not about reaching the lowest dose possible in the shortest amount of time possible. Your success in this area is not defined by numbers. Drug withdrawal is not a sport. It is a process, which in turn will be accompanied by further processes regarding your overall health, your attitude towards life, your relationships with others, and your personal development. All those processes and gradual shifts are what you are after. Do not attempt to force spectacular changes. Instead, care for yourself and intend to remain grounded enough to weather your everyday life. If, at some point, looking back you can say you are feeling better about yourself than a while ago, you are headed in the right direction. Let every step forward and every choice be the natural result of your inner development and a subtle stimulus for further growth. Do what you can, but never try to find out where your breaking point is by challenging yourself to your limits. Do not hurry. Keep in mind it is better to walk calmly and securely than risking to stumble, fall and having to pick yourself back up all over again. Take all the measures you can to stay at peace. Protect yourself, nourish yourself.

Funnily, at present I am reading a book about writing and just came across a sentence I wish to quote here: “We´ll see progress in time. But we can´t expect to every day.” (Louise De Salvo, The Art of Slow Writing). In other words: do not drive yourself bonkers with undue pressure, nor let anyone else do so. As long as you are honestly working towards your health and your life´s improvement, you are doing well. Or, regurgitating a quote De Salvo took from Stephen King, describing his return to writing after a devastating accident which forced him to undergo long and painstaking rehabilitation: it all is about “[…] getting up, getting well, and getting over. Getting happy, ok? Getting happy.” King was referring to his writing, but really these words describe the essence of healing. Take note, in particular, of how King uses the verb “getting”, which clearly denotes process. PROCESS! This is what you are looking for. Getting healthier and, why not, happier!

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