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DRUGS FOR PSYCHOSES OLD AND NEW

A VIEW BY SOMEONE WHO HAS TAKEN MANY OF THEM

Chris Barchard

WHAT REASON?

So why am I writing this leaflet when there is much more comprehensive information about antipsychotic drugs out there on the internet or in books you can buy or read in a library? They detail all the supposed benefits and side-effects of antipsychotics, the effects on mortality - yes you may not live as long as you might have if you take these drugs - and so on. There is a spectrum of views written by those who swear by these drugs to those who think nobody should take them. What have I to add? In some ways not much. If you want the full clinical information this is not the place to find it, although there is some.

I remain unconvinced by the lobby that says nobody should take these drugs because it is my belief that a lot of us would be permanently in the asylum if that were the case. That is not to say that I do not respect those who have been able to stop taking them and been OK. I can’t say I’m one of them, not for lack of trying. I would more likely be in a padded cell or dead by now were it not for the drugs. I suppose this is just another take on it all. It may add something to the debate about these controversial treatments.

THE DOWN SIDE OF THE DRUGS

They are not a bed of roses. The doctor’s sites pay scant attention to the effect these drugs have on consciousness. Consciousness is something they have systematically avoided addressing because it cannot be observed in another person directly - except perhaps by some of the mad! It has been sidelined variously as irrelevant or even non-existent by some of the behaviourist school, something I find particularly dehumanising. Anyway back to the effects on consciousness - blunted feelings, a common complaint, feeling lousy in a way you’ve never experienced before, frustration because you can’t remember things or enjoy things properly, all pretty common, lack of attention and concentration, feeling like doing nothing, all of these things can be brought on by the drugs. OK some of these things may also be features of what got you put on the drugs in the first place; poor concentration for instance. But the psychiatrists tend to play on this kind of thing, the effects of age or other possible non-drug causes of debility to make you think the drugs are not a contributing cause or the main cause. The newer drugs, usually called atypicals, don’t tend to make you feel as bad as the older ones, known as typicals.

Some of these drugs can have a disastrous effect on your sex life although the newer ones tend to be better in this respect. I have seen so many people who have ballooned out after being put on antipsychotics and the newer ones can in some cases be worse than the older ones in this respect. Although the newer ones are less likely to turn you into a shuffling zombie with the shakes or make you feel so uncomfortable that you want to lie down but can’t rest when you do - that is hell. I would rather take the newer ones.

HOW MUCH USE ARE THEY?

Maybe if you remember what you were like when you first got put on them you might find an answer in that. But not everybody would agree with this idea. Some people felt markedly better before the drugs were first given to them and about this they probably had little choice. Some people have managed to cope with a lot of “symptoms” after stopping the drugs. Others have not. Psychiatrists are usually very reluctant to let you try. To be fair only a minority manage it successfully. But antipsychotics can be so damaging to both the body and the brain that I think more people should be given the chance to try. Psychiatrists cannot actually be sure whether stopping will be successful though to be fair in some cases they could be forgiven for taking the view that there is little chance.

I suppose antipsychotics enable some people to function a bit better on aggregate, in that you may be able to get by outside the asylum and not get into trouble with other people so easily. It does have a lot to do with how other people find you and this is to some extent dependent on the prevailing culture. In some countries (where the drugs are also less available) it is reported that there are much better outcomes because culturally there is a different attitude towards madness. This is not to say that in the same countries some people may perish because care they could actually benefit from as individuals is not available to them.

People vary a lot as to how they react to these treatments. Some people don’t mind them as much as others. Some people found their lives so out of control before being put on them as to be grateful for the net improvement. Others feel their souls have been destroyed, so dead do they feel. Few people are able to resume their careers unless they are lucky enough to take the drugs only temporarily, but even then they may have to overcome stigma just to get a foot in and still have to cope with it when they are back in the “normal” world.

The newest drug, aripiprazole, I have found to be the least debilitating of all the drugs I have taken. This is not an uncommon experience for those who take it. But not everybody can. Unlike the other drugs it does not act as a more or less complete block at the synapses. These are where signals are sent between brain cells and there can be many on one cell. If all of them were blocked the brain would shut down but this is not how it works. Aripiprazole allows, albeit weaker than normal, signalling to take place at the synapses it occupies. This actually results in an increase of activity in some parts of the brain which are underactive, as well as a reduction of activity in others which are overactive. This has a lot to do with why it is not as sedating and has generally fewer side effects for most people who take it than other drugs. It does not agree with everybody though.

I suppose the way you are on the drugs has to do with how you would be without them (underlying condition), your response to the particular drug you take and the dose. It’s not clear cut and the results vary between good but somewhat debilitated to poor with lots of symptoms and side-effects.

QUALITY OF LIFE?

I don’t really do quality of life, at least not in the way the psychiatrists and social workers do. That’s all “objective” things about mobility, functioning, personal circumstances and so on. I’m more concerned with whether I am getting anything out of life. I think a hermit living in a shack may have a better life in his head than a king. But you cannot measure that and that is a big problem to the “scientists”. It has to do with consciousness, almost a dirty word in some circles. As far as I’m concerned it’s about the most important thing. As far as existence goes the buck stops at consciousness whether or not you can see or measure it. All concepts of meaning stem from what goes on in consciousness. If there were not feelings there could be no values - everything would just be phenomena. From feelings and values stems a sense of meaning, which can at least to some extent be shared. The trouble with antipsychotic drugs is that they can blunt your capacity to feel so much that life becomes, at least for the while, meaningless. I’ve been there. It can make the idea of death seem like a relief when the chemical lobotomy is that complete. Fortunately for me that state has not been permanent but for others it can lead to the end. It’s not the measurable things that are most important in the final analysis although they can help along the way.

ANY REAL CHOICE?

Psychiatrists vary. I have noticed some changes in their behaviour over the years. Some of them will take your point of view seriously now but you often need to be pretty clued up to get them to put you on something new you haven’t tried before. Many of them will still be very paternalistic and use their right to the final say to see that at the end of the interview their idea prevails. They may or may not have a better idea than you. What they don’t want you to know usually is how much prescribing psychiatric drugs is trial and error. If, like me, you’ve been put on many different drugs by them, you have good reason to believe this. Psychiatrists are often accused of being on power trips, one of their main aims being to get you to do what they want and always wanting to be in control. It doesn’t always help. Being denied the opportunity to try something that could have lessened their suffering a bit, some people may even stop taking the drugs as a protest. This can be counterproductive. Again the situation is not clear cut. Some people may make bad suggestions to their psychiatrists. Psychiatrists will make judgements about you which, combined with their own style, influence the amount of ice you can cut with them. Some people can lose out because of this. The world is not fair.

Overall I would say antipsychotic drugs are a mixed blessing