Psychic freedom

Psychic freedom

By Elissa Ely, 3/31/2002

IN THE 21st century, you can take a laundry marker and circle the changes in schizophrenic brains on a CT scan. You can point to portions of PET scans that won't light up in depression. Research names rise and fall on the details, which are not necessary to commit to memory - the point is, major mental illness has an anatomy and a physiology, and the pain that results can often be treated with medication. But it's a deal with the devil.

Half of all patients hospitalized for psychosis and treated with traditional antipsychotic medication discontinue them within a year after discharge. They do this for several reasons, and, if you ask, they are usually full of illumination, though sometimes their light has been bent through a strange prism. Some prefer their symptoms, especially the superiority of mania, where it is more natural to rule the world than start the wash. Sometimes the bent light blinds a person to his own illness and he sees nothing to treat. But most patients don't take medication for an excellent reason: The drugs are awful.

In medical school, it was considered part of training - in a Marine Corps kind of way - to let another student place an IV or wrestle a nasogastric tube down your throat. But few psychiatrists have tried their own medicine. It ought to be a requirement for the license.

They should try one of the flawed elder statesmen first, the classical antipsychotics from the 1950s and 1960s that cause shuffle, drool, and tremor. They were nuclear weapons, those medicines, destroying whatever crossed their path. The necessary was taken out with the harmful.

Now there are newer classes of flawed antipsychotics. They don't turn the young neurologically old. Instead, they raise the rates of diabetes, high cholesterol, arrythmias, obesity, seizures, incontinence, and (an afterthought) impotence. No one would want to swallow this stuff. Yet patients take them with greater compliance than they took the elder statesmen. You have to be out of your mind - or deeply in need of protection.

On these drugs, voices disappear in the treatment resistant. Thought makes sense and moves at a regular pace for the first time. The neighbor who had a line to the FBI turns out to be nothing more than a neighbor. Relationships exist without dread. Life, it is not an exaggeration to claim, holds possibility.

The devil is in this dilemma, which has been quietly helped along by the radical patient advocacy movement advancing side by side with neuroscience. Advocates (physicians among them) rightly recognize how toxic medications are. But they don't recognize how necessary they are. They put forth the gentle idea that a greater human net held under patients provides sufficient protection by hurrying to stand wherever someone is ready to leap. They recommend more services, structure, company, and counsel. They point to examples of cures without medication. You read them and feel hope rising. Who doesn't prefer an optimistic view to a CT scan?

Then I think of the man who tried twice to set his house on fire with his family inside; the one who fired pistols into a hotel wall while his baby slept next door; the woman who leaped off a building to escape voices and, when she did not die, leaped off a taller building; the one who believes her life is unsafe because the world can hear racist remarks broadcast from her mind.

Each had family who loved him or her before and through the illness, community workers who visited daily, rehabilitation programs, support groups, prayer groups, ministers, and therapists. Unsurvivable inner conditions brought them to the hospital. Medications allowed them to leave it. Then, and only then, the net could move usefully into position.

Patients struggle with the devil because, so far, he makes the only effective offer in town. His prescription takes away psychosis, but threatens medical disaster. So you rise to the battle. You check bloodwork often, talk (with sinking heart) and diet and exercise, use a second set of medications to try to outfox the side-effects of the first. You do it because psychic freedom, even at these costs, is preferable to illness. This is not what the researchers say. It is what the patients say - those who continue to take their pills.

The man who set fires has a job now. He carpools his children to school and takes antiepileptic medication to prevent seizures from antipsychotic medication. The woman who feared she would be executed for racism is in a group home for the first time in decades. She has gained 30 pounds. These are costs no one should have to pay, and it pleases the devil. Science will outrun him eventually, though.

Passionate intentions and formalized support are no less than any suffering being deserves, and a thousand times less toxic than medication. They ought to have the same effect. In a just world, they would. But in a just world, there would be nothing to cure.