The Warrior In Retreat
In my interview with DuBrul he was reluctant to discuss his more recent breakdown, so in trying to make sense of it as something other than an unpredictable purely random effect of aberrant biochemistry, I was forced to speculate.*30 Just as I provided in chapter 8 a nonpsychiatric explanation for his “miraculous recovery” from his misery and loneliness when he moved to the organic farm when he was twenty-four, so I could, drawing on my experience as a family therapist (see chapter 5), explain without any reference to psychiatric drugs what happened that led to him finding himself in Bellevue in 2008.
The purpose of this speculation is to present readers with more options for themselves, to give them an alternative frame of reference for their own unusual experiences so they don’t fall prey to the self-fulfilling prophecy of the psychiatrist: “If you don’t take your drugs your illness will come back.” People are not victims of aberrant brains; their experience usually is intelligible when considered in the context of their environment. People who are “bipolar” may well be more sensitive and more vulnerable, but that is not a flaw. So with apologies to DuBrul for speculating about his life on the basis of insufficient facts, for the benefit of other psychiatrically labeled readers, I will try to give a brief nonmedical explanation for his breakdown.
In September 2008 DuBrul had a “psychotic episode” (his first in seven years) and was taken to Bellevue. He was picked up by the police on top of a building in Manhattan. He was “barefooted and disheveled” (in the words of the hospital summary; see Scatter blog, October 16, 2008) “smashing a satellite dish because he thought it was broadcasting alien signals.” In his blog DuBrul related his action to “fantasies that creep up periodically that the world is going to turn upside down . . . and all of a sudden it’s going to be obvious that things have become incredibly fucked up and will never be the same again.”
What happened?
DuBrul evidently has mixed feelings about lithium. Although in 2007 DuBrul thought he did not need lithium, on many occasions he has reiterated the canard that lithium corrects an imbalance in one’s biochemistry. (In the statement written in 2011 he finally abandoned this canard; see this section, below.) As discussed in chapter 2, there is no evidence to support this theory. According to The Comprehensive Textbook of Psychiatry, “There is no evidence that bipolar mood disorder is a lithium deficiency state or that lithium works by correcting such a deficiency.”
Revealingly, the Textbook acknowledges and sanctions the fact that patients are in effect lied to by psychiatrists. “Patients are often told it corrects a biochemical imbalance, and, for many, this explanation suffices.” Furthermore, there are only a relatively small percentage of people who respond positively to lithium, despite the books by celebrities hailing it as a miracle drug. For most people lithium does not work—particularly in the long run. As author and British psychiatrist Joanne Moncrieff put it in 1997, “There are indications that it is ineffective in the long-term outlook of bi-polar disorders, and it is associated with various forms of harm.”1
Many patients are afraid to get off psychiatric drugs. They have been told that if they do so their “illness will return.” As Dr. Breggin notes, “Drug withdrawal presents a potentially frightening challenge to live your life differently without a guarantee you’ll be up to the task. This natural, almost inevitable fear may be worsened by years of being told that you have an incurable disease caused by biochemical imbalances that must be corrected with modern medical panaceas.”2
Just as there is a positive placebo effect, so there is what I term an inverse or negative placebo effect: the expectation that something will go wrong without the psychiatric drugs for support, the idea that one needs a drug or drugs to correct one’s alleged “imbalance,” and the fear that one will go crazy without them. The negative placebo creates a psychological dependence on psychiatric drugs. Those who believe in Psychiatry will be more likely to experience the placebo effect, both positive and negative.
The faith in Psychiatry is tenacious in our society; even “revolutionaries,” rebels, Marxists, feminists, those who challenge every hegemonic institution, are likely to place their faith in modern Psychiatry. In our secular scientific age, Psychiatry, like medicine in general, is God. Psychiatrists have wrapped themselves in the shroud of science since the 1990s, which was dubbed by the U.S. Congress and President George H. W. Bush “the decade of the brain.”3
As a psychologist and writer I have studied and talked to many people about getting off of psychiatric drugs. If they are succeeding and they “trip up” there is invariably some factor in the environment that explains it—not decreasing the drug itself. DuBrul had been decreasing the lithium with positive effect for months, judging from his own reports on his blog. (I should add that the longer patients have been on a drug and the more drugs patients are taking, the stronger the withdrawal symptoms will be.) I suspect DuBrul was wisely withdrawing gradually.
DuBrul mentioned conflicts he was having with his friends and housemates. He blamed the conflicts solely on himself, on his egocentricity, but I’m not sure the problem was not a group problem, as conflicts often are. In such situations one needs either family therapy or group mediation or, if those are not available, one needs to get away, one needs “space.” The solution is simple, but often implementing it is difficult. Finding space can be a problem for those who are not wealthy; some people end up getting themselves taken to a psychiatric ward just to get away. When DuBrul was twenty-four, as we saw, he found an organic farm to live on down the road from the dreary halfway house where he had been placed.
I had a client (later a friend), Lisa G., who was so determined to get off psychiatric drugs that she created her own emotional space. She was living with her mother and could not afford to live elsewhere. She was twenty-seven and had various “diagnoses,” from “bipolar” to “schizophrenic.” Fortunately, she had only been on the drugs, the “antipsychotics,” for a few years. She stopped taking the drugs (gradually), but she told her propsychiatric mother she was taking them. Only I knew the truth. What’s more, she acted, she told me, as she would have acted had she still been on the drugs. She acted listless, unemotional, slow. She found this situation very unpleasant. She put on a facade for over a year; by then she had saved up enough money to move in with a roommate. (Such a solution is courageous and admirable, but of course not always feasible.) Twenty years later, she has not taken any psychiatric drugs.
If one person decreases her dosage of psychiatric drugs it can alter the group’s dynamics. For example, perhaps DuBrul became more emotional when he reduced the lithium he was taking. Maybe his friends—even other activists—became frightened of his emotionality, knowing he had reduced his intake of the drug. This could have set up a vicious cycle, with his fear feeding off their fear. This is what happened to Kate Millett when she first tried to withdraw from lithium—although she was living with feminists and nonconformists. It is a common scenario.*31, 4 “Get enough sleep, have faith, and tell no one,” Millett was finally advised by an activist in the psychiatric survivors’ movement. She did, and despite seventeen years of using lithium, after spending six months in 1988 and 1989 decreasing her dosage, she stopped for good, with no ill effects.5
Staying on psychiatric drugs for a lifetime can be very harmful.†32 Robert Whitaker has demonstrated in his recent book (see this section, p. 246) the deleterious and often tragic effects of psychiatric drugs; some psychiatric drugs are worse than others (see discussion with Dr. Stastny in chapter 1). It is difficult to get a psychiatrist to prescribe a mild tranquilizer without a cocktail of others drugs. But as Dr. Stastny points out in chapter 1, a benzodiazepine used cautiously in emergency situations could actually help one cope with acute stress and avoid hospitalization. Many times a “psychotic” episode is triggered because of lack of sleep. Yet that could be remedied with a mild tranquilizer or prescription sleeping pill. Instead millions of patients are put on the most toxic drugs, allegedly to treat their “affective disorders.” In fact, Whitaker shows the drugs used create the very symptoms attributed to the psychiatric disorders!
The Mad Pride movement wisely respects patients’ right to choose to take or not take psychiatric drugs, but in light of Whitaker’s revelations discussed below and the power of the pharmaceutical companies, I think more thought should be given to the issue: How can there be legitimate informed choices made by patients when there is a major “cover-up” occurring about the effects of these drugs?
There ought to be Soteria-type asylums (see Dr. Stastny’s description in chapter 1 and the discussion of Diabasis in chapter 5), sanctuaries for people undergoing crises. (In his most recent statement included below, DuBrul implies also that there ought to be resources to help persons deal with trauma.) Had there been such a place, I think DuBrul would have gone there when he had the conflict with his friends in order to get “space.” The fact that he felt he was receiving “alien signals” is revealing: he felt estranged, “alienated,” from his friends. In a Soteriatype alternative, DuBrul would have been presented with the opportunity to finally get off psychiatric drugs. Considering there are no such sanctuaries in America anymore and DuBrul’s conflict with his friends was not being mediated, it is not surprising he ended up in Bellevue. He had no other way to get away, to get space.
DuBrul was not in as dire a situation as most “bipolar patients,” on psychiatric drugs. As far as I know he was taking only one drug—lithium. Most patients are placed on several drugs. However, when DuBrul was at Bellevue he was undoubtedly given higher dosages of drugs than he had been taking—this is the routine on psychiatric wards—and unfortunately when he was released he was more convinced than ever that he needed lithium. After her first unpleasant experience of trying to get off lithium, Kate Millett also became more convinced she needed it. Only later did she realize in hindsight the role the environment (i.e., her friends) played in making it impossible for her to withdraw from lithium.
After he was released from Bellevue, DuBrul wisely did go to an alternative environment to recover—to the ashram mentioned above—but by this point he had no desire to wean himself off psychiatric drugs. Several months before his episode he had been planning to get off of psychiatric drugs. Now he was convinced again that he could not live without lithium. Very few people labeled bipolar are on only one drug, as I believe DuBrul was; most are on a “cocktail.” Fortunately DuBrul’s hopes of getting off drugs were revived again later. Yet apart from the potential physical harm caused by the drug, would taking the one drug undermine DuBrul’s self-confidence in the long run? I don’t know. For many persons, it certainly would. They are told they are mentally defective or disabled, and they believe it. They believe it until they have a chance—if they take it—to prove to themselves that their minds are not afflicted by a mental disability. Kate Millett, already a renowned writer, said she had to get off lithium to prove to herself that her mind was not flawed.
Study after study has shown in the long run those patients who are not treated with drugs do much better in terms of numerous criteria, but many patients will not take this leap because they suffer from the negative placebo effect. As we saw above, DuBrul’s original conclusion, expressed in The San Francisco Bay Guardian, that the “drugs were working” was based on his lack of knowledge about the power of placebo and the effects of a change in environment. Many “patients” are not even aware that the placebo effect of psychiatric drugs in general is so high; usually about 50 percent of depressed persons respond to a placebo, which is the same as those who respond to the drug.
In other words, the placebo effect accounts for the positive effects of the “medication.” Furthermore, it is the negative placebo—that is, the psychological dependence on psychiatric drugs engendered by the fear of getting off the drugs—that keeps most patients on psychiatric drugs for years. The consequence of this long-term drug use is at least comparable in magnitude of harm to that of tobacco-caused cancer in America in the era before most Americans stopped smoking.
As Robert Whitaker has meticulously shown, the mental illness epidemic is almost entirely iatrogenic. In 1955 there were 12,750 people hospitalized with bipolar disorder (then called “manic depression”). Today there are close to six million adults with this diagnosis, and according to John Hopkins School of Public Health, 83 percent of these six million are severely impaired.6 Prior to the drug era, the famous German psychiatrist Emil Kraepelin and others reported that only one-third of “manic-depressives” suffered more than three episodes in their entire lives. In other words, those in the United States who had more than three episodes amounted at most to several thousand people. Studies done by NIMH and others show that “manic” and “depressive” episodes are now frequent. The increase in the number is partially due to the enormous expansion of the criteria for the diagnosis of bipolar, but now we also know that psychiatric drugs cause chronic impairment, including continuous up-and-down cycles, which mental health professionals attribute to the alleged disorder.7 Let me reformulate: most people who think they are “disabled” or limited by “bipolar disorder” are, in fact, disabled by the medications they are taking to treat this supposed disorder.
Whitaker shows through a survey of the scientific literature that the antidepressants have a particularly adverse effect on “bipolars.” Those on antidepressants were four times more likely to develop “rapid cycling” and twice as likely to have multiple manic or depressive episodes.8 Also, as Dr. Stastny testifies in chapter 1, the custom now—largely for financial reasons—is to put people on multiple drugs, or “drug cocktails.” A patient labeled bipolar is likely to be maintained on at least four drugs. Thus, they end up suffering from what Whitaker calls “polypharmacy psychiatric drug illness.”9
This syndrome includes cognitive deficits, obesity, diabetes, cardiovascular problems, and thyroid dysfunction.10 In the predrug era, 85 percent of manic-depressive patients recovered and returned to work. Today only one-third of patients achieve “full functional social and occupational recovery to their own premorbid levels,” according to a review of the research published in a psychiatric journal in 2007. In typical psychiatric fashion the reviewer concluded that whereas the prognosis for bipolar used to be favorable, “contemporary findings suggest that disability and poor outcomes are prevalent, despite major therapeutic advances.”11 The reviewer makes no effort to reconcile his mindless acceptance of Psychiatry’s claim to have made “major therapeutic advances” (i.e., psychiatric drugs) with the deterioration in outcomes the studies document. The logical conclusion is there have not been any therapeutic advances: to the contrary, the drugs are harming people.
Psychiatrists are living in an Alice in Wonderland world. They have to be: on the one hand, they make their living today as psychiatric drug pushers, while on the other hand, they still think of themselves as legitimate doctors. Millions of persons’ lives are destroyed by the iatrogenic epidemic of “mental illness”—and virtually none of the psychiatric patients realize that they are suffering not from a brain defect, nor from a psychiatric disability, nor from a genetic disorder, but from the emotional ravages that are caused by months or years of ingesting toxic, mind-disabling psychiatric drugs! Consider also that today the “seriously mentally ill” are dying fifteen to twenty-five years earlier than normal; these statistics have risen so high recently due to the practice in the last two decades of placing an increasing number of patients on “antipsychotics” and on drug cocktails. Patients are dying from cardiovascular ailments, respiratory disease, diabetes, metabolic illnesses, and kidney failure to name just a few. Whitaker notes, “The physical ailments tend to pile up as people stay on antipsychotics (or drug cocktails) for years on end.”12
In the comments above I focused on bipolar adults—the tip of the iceberg. The epidemic is far more disturbing when we take into account the children and infants now put on psychiatric drugs: the hazardous effects of Ritalin and Prozac and the neurological impairments caused by neuroleptics (“antipsychotics,” as they are euphemistically termed). Neuroleptics are the most destructive drugs on the market, and many patients are forced to take them, sometimes by court order. The rationale for involuntary treatment is that anyone who is reluctant to take psychiatric drugs is too sick to know what is good for them.*33, 13 Nor did I describe electroshock—often forcibly administered to insufficiently submissive patients in state hospitals.14
Unfortunately there are “patients” who do not want to know about the effects of psychiatric drugs. It’s painful to face the fact that the doctors in whom you placed all your trust are themselves misguided and—even with the best of intentions—may be prescribing “medications” that are harmful. But the sooner you face this fact, the sooner you can protect yourself.†34
As of 2009 DuBrul had still had not read—or at least he never refers to it in any of his writings—Toxic Psychiatry by Peter Breggin, and yet Dr. Breggin has probably encouraged and empowered through Toxic Psychiatry (and other books) more people to get off psychiatric drugs than any other single person in the country. Dr. Breggin has been a major influence on Mind Freedom, as mentioned in chapter 3 on David Oaks. DuBrul had not read Kate Millett’s The Loony-Bin Trip. Kay Jamison’s book, An Unquiet Mind, is read by thousands of so-called bipolars; Millett’s is not. Psychiatrists recommend that their educated patients read Jamison. They do not mention Millett, and why should they? Their goal is to make a living, not to affirm the sanctity of the soul.
In The Loony-Bin Trip, Millett wrote:
The psychiatric diagnosis imposed upon me is that I am constitutionally psychotic, a manic-depressive bound to suffer recurrent attacks of “affective illness” unless I am maintained on prophylactic medication, specifically lithium. For a total of seventeen years I deadened my mind and obscured my consciousness with a drug whose prescription was based on a fallacy. Even discounting the possible harm of the drug’s “side effects” it may seem little consolation to discover that one was sane all along. But to me it is everything. Perhaps even survival for this diagnosis sets in motion a train of self-doubt and futility, a sentence of alienation whose predestined end is suicide. . . .
It is the integrity of the mind I wish to affirm, its sanctity and inviolability. Of course, there is no denying the misery and stress of life itself: the sufferings of the mind at the mercy of emotions . . . the divorces and antagonisms in human relationships, the swarm of fears . . . the crises of decision and choice. . . . They are the things we weather or fail to . . . they are the grit and matter of the human condition. . . . But when such circumstances are converted into symptoms and diagnosed as illnesses, I believe we enter upon very uncertain ground.15
With her successful weaning from psychiatric drugs after fourteen years, Millett indeed affirmed the integrity and sanctity of the mind, undermined the psychiatric narrative, and set an inspiring example for thousands of people who followed her.