Blog des AK Psychiatriekritik der NFJ Berlin

Monat: September, 2012

Antidepressant medications linked to type 2 diabetes mellitus

by foodconsumer

Thursday Sept 27, 2012 — A new study in Diabetologia suggests that using antidepressants may increase risk of developing type 2 diabetes mellitus.

Frank. B. Hu of Harvard School of Public Health and colleagues conducted the meta-analysis and found using antidepressant medications was associated with 68 percent increased risk for developing type 2 diabetes mellitus after adjustment for age.

Previous studies have associated with use of antidepressants with incident type 2 diabetes mellitus.  The current study was based on three cohorts of U.S. adults, 29,776 participating in the Health Professionals Follow-Up Study (HPFS), 61,791 women in the Nurses‘ Health Study I (NHS I) and 76,868 women in the Nurses’s Health Study II (NHS II).

At baseline, all participants were free of type 2 diabetes meliitus, cardiovascular disease or cancer.  The mean baseline ages for three cohorts, HPFS, NHS I and II wee 56.4, 61.3 and 38.1 years respectively.  Participants were surveyed at baseline and every two years for their use of antidepressant medications.

The researchers found during 1,644,679 person-years of follow-up, 6,641 cases of type 2 diabetes mellitus were identified.  Those who used antidepressants were at 68 percent increased risk for type 2 diabetes.   The risk increased by 30 percent among users of antidepressant medications after adjustment for other diabetes risk factors and history of high cholesterol and hypertension.  After adjustment for body mass index, then the risk increased 17 percent.

Specifically, using selective serotonin reuptake inhibitors and other antidepressants were correlated with 10 and 26 percent increased risk for type 2 diabetes mellitus, respectively.

The researchers concluded “ The results suggest that ADM (antidepressant medications) users had a moderately elevated risk of type 2 diabetes mellitus compared with non-users, even after adjustment for BMI (body mas index).

Antidepressant side effects are common including nausea, dry mouth, headache, constipation, drowsiness, dizziness, anxiety, weight gain, and agitation among other things.

Type 2 diabetes mellitus is estimated to affect 26 million Americans.  There is no cure for the disease, but the disease can be managed by taking prescription medications and long term dietary intervention.  Alternatively, as research suggests, some non-conventional remedies such as curcumin and cinnamon supplements can  help treat or prevent the disease.


Transforming the Traditional Mental Health System Through Peer Staffed Respite Programs

by MadinAmerica

This is a brief description of the project design and some reflections on “lessons being learned” at Second Story, a Peer Run Respite service in California, funded by a SAMSHA Transformation Grant.  Peer staff are empowering each others’ lives through Intentional Peer Support.

The program is designed to accept guests who self-present. The focus is on clients of the system of care who are beginning to notice familiar signs and symptoms, that if left unattended often will end up in a full crisis, needing hospitalization.  Second Story invites people to come before they are in crisis, to take personal responsibility and prevent spiraling into a crisis, which often results in an involuntary hospitalization. This may result in losing one’s independent housing, employment and much psychic distress as a result of a crisis episode, after which one then is faced with the daunting task of rebuilding their life yet again.

Guests may stay up to 14 days. Guests accustomed to traditional mental health services first are struck by the awareness that they are “treated as adults” with an expectation that one takes personal responsibility for their needs, goals and care.  Once in the program the house is their home, a community of peer staff, people who have self identified with lived mental health experience.

Former guests often stop by to talk, and visit with current guests. Sometimes they ask to volunteer, to give back to the community by running a group, gardening, cleaning, cooking, whatever they wish to offer. They are growing their own support community.

All staff have been trained by Shery Mead, Chris Hansen and/or Beth Filson in the philosophy of  “Intentional Peer Support”, developed by Shery Mead and now recognized as a “promising evidence based practice”.  This model is a basic foundation that all peer staff have adopted. They are highly committed to staying true to IPS as a tool for listening; “being with” rather than “fixing” someone.  By creating a safe place, guests have an opportunity to work through their own challenges, patterns and issues. The Peer Staff continue to practice IPS among themselves using a “co-reflection” model created for supervision by Shery Mead.

What do I witness, notice and observe? I see people engaged in intense conversations, cooking and cleaning. Often people just come and spend lots of time sleeping.  Spontaneous music jams, board games around the kitchen table, or just watching TV. Taking walks, going on outings to museums and lectures, going to the doctor or for hikes in the mountains or along the ocean.

Some people maintain their job while returning to the house for support and community in the evening. Some go to school.  Normal life schedules outside of the house are supported and maintained if the guest so chooses.  Guests are free to come and go as they please, just letting someone know where they’re going and when they will return.  This may sound “normal”, and it IS, it’s not a program full of mental health formulaic groups and a mandatory schedule of activities that you are required to attend… but instead a place to “be with”, a  space to have support.

Some examples:

I’ve known clients who have been in the traditional system for 10 to 30 years. They are well known to the system, some have been labeled “Borderline Personality Disorder“ whose pattern when stressed and experiencing intense emotions has always been to cut on themselves or inflict some bodily pain, and go to the locked psychiatric hospital (as it’s “safe”). Now many of these same individuals are choosing to utilize 2nd Story, and after several admissions the old patterns begin to shift; most of these same individuals are no longer going to the hospital but instead coming to the house for a few days or weeks to get the needed support and engage in honest peer to peer dialogue.

People choose 2nd Story as it’s an opportunity to do life in a different way.  Disruption of their housing, employment or schooling is minimized when they come to 2nd Story.  People are transforming themselves, feeling empowered, blossoming and feeling their strength, shedding the stigmatizing labels and feeling okay to be who they are.

At a recent staff meeting I asked the staff if they felt comfortable broadening the criteria a bit to be able to work with people who may be freshly out of the hospital or a sub-acute setting. I suggested we focus on young people who may have just had a “first break,” were still in a vulnerable and fragile state (not acute) post hospitalization, and may be stabilizing on psychiatric medications for their first time.  Everyone was excited and open to this.

A few days ago I learned of a young man, 24 years old, whose family had taken him to the hospital. They had been struggling to stay with their son and keep him safe.  From the reports it sounded like he was in an extreme psychic distress, with auditory and visual hallucinations, and not able to sleep. This extreme state was scaring his family members. They felt helpless to do anything more but to take him to the psychiatric hospital. As they left him admitted to the hospital they told the hospital staff that he couldn’t return home (they were too scared) and felt he needed to go to a board and care.  When I heard about this young man, he had already been in the hospital for 2 weeks, had been “stepped down” to a sub acute crisis facility and was en-route to yet another sub-acute facility  where he could stay while the treatment staff  worked with him to get on various waiting lists for housing.

I felt compelled to see if we could intervene by extending an invitation to him to come to Second Story before he moved into the next phase of sub-acute treatment. I didn’t want him to be further exposed to the life of the traditional adult mental patient. I feared it would seem hopeless and, as so often happens with young people, despair would begin to set in as he learned to accept his diagnosis.  I was curious to see if he might move through this transition time from psychosis to finding insight from his experience and hopefully be able to get back on his life track; whatever his wishes and dreams might be.

I stopped by the house this evening to meet this young man. He had been at Second Story for only two days.  He was doing well; happy, beaming, having just returned from the ocean where he had walked with another staff member. He’s very busy reflecting, putting the pieces together, wanting to learn what this  experience was all about, trying to find meaning. He was having great insight into Mozart’s insanity by listening to his music, as well as Bach’s fugue.

It was wonderful to be with him as he was telling his story – while striving to make sense of it all.  He shared with me that while in the hospital he was given three different anti-psychotic medications which he was continuing to take on his own at the house. (Medications are not held and managed by peer staff, but rather guests who take medications must be able to self administer, and are provided a key to a bedside stand for storage while staying at the house.) He was finding relief, his mind was clearing and he was finally able to sleep.

He was grateful to be able to think clearly again as he had been extremely overwhelmed with voices, feeling scared, and not feeling “normal” for quite some time. He is now in a place where he can openly talk about what he was experiencing, and the peer staff understand. They can totally relate and as we sat and talked other staff members would share their stories of demons and voices and how they learned to live with this, how they feel special, and have at other times unraveled but the power of having a support system of family and friends who understand them has enabled them to live life to its fullest.

Some staff shared medication stories, some spoke of how they took extra good care of themselves with diet and exercise. Some said years later they worked with their psychiatrist to reduce their medications. Everyone had a different story and a different path, yet they all were respectful and supportive without judging or “advising.” The young man thanked me for paving the way for him to come to Second Story, he is clearly thriving and benefiting from this milieu.

I left feeling so happy that this new model of support is alive and having such a positive impact in our community.   I was able to witness the discovery of oneself through relationships with others. Once again, that old familiar “Soteria” like feeling warmed me as I felt the human connections. This is where the healing takes place. With or without medications, all are accepted – to be who they are.

After 30 plus years working “in the system” I have learned that we just don’t know…

We don’t know what causes these extreme states. Often, if we ask the right questions or listen carefully we learn that it’s triggered by trauma, or mind altering drugs from marijuana to hallucinogens, or sometimes it’s the developmental  transition into adulthood, which for many is easy and for others it’s not so easy. Researchers have yet to pin-point a brain related illness (often referred to as a chemical imbalance). We just don’t know.

We don’t know why these drugs provide relief to some yet not to everyone, why the medications work for a while and then stop…

I do know we must stay open, not rush to labels and diagnoses, but find a way to “be with” the person who is having a hard time, offer comfort, human compassion, listen and allow time to rest; whatever it takes. Medication can help with sleep and calming down after an extended extreme state; it’s another tool that can be helpful, even though no one really knows why. I say this cautiously as we do know that the long term effects of life on psychiatric medications will cause serious metabolic problems and major health risks.  We must allow time, provide human caring support, allow extended rest, and safe environments while the mysterious process works itself through…

Unterbrechung im Gehirn

by Freitag

Anti-Psychiatrie Über den Umgang mit dem „Wahnsinn“: eine post- und vulgärmaterialistische Rosengartensuche

Unterbrechung im Gehirn Nicht mehr Mensch, sondern Gehirn: Selbst wenn Liebe auf der Hand läge, wird die leidende Seele mit Pillen attackiert

Foto: Peter Granser/Stern/laif

Das Online-Wohlfühlparadies für Hypochonder und solche, die es werden wollen –„“ – behauptete kürzlich: „Bei einer Schizophrenie helfen Medikamente noch immer am besten.“ Das Portal berief sich auf eine „aktuelle Meta-Studie“, für die Daten von 6.000 Betroffenen ausgewertet wurden. „Ein Teil“ bekam während der „therapeutischen Betreuung“ Psychopharmaka, „und der Rest nur Placebos“.

Wenig später fand im Haus der Demokratie in Berlin eine große Veranstaltung von Psychiatriekritikern statt, die sich gegen die Therapie mit Psychopharmaka aussprechen. Eingeladen hatte der Verein zum Schutz vor psychiatrischer Gewalt, um eine Dokumentation über Alternativen zur orthodoxen Psychiatrie vorzustellen: „Auf der Suche nach dem Rosengarten“.

Diese Suche, die in verblüffendem Gegensatz zur psychiatrischen Praxis steht und vielen daher neu erscheint, ist eine Fortsetzung. Sie fing mit der Antipsychiatrie während der Studentenbewegung an. Damals wurden – beginnend in Norditalien – psychiatrische Anstalten geschlossen und die „Irren“ mit der Selbstorganisation konfrontiert. „Freiheit heilt!“ hieß eine Kampfschrift von Sil Schmid dazu. In Heidelberg gründete sich ein „Sozialistisches Patientenkollektiv“ (SPK). Es wurde schon bald von den Staatsorganen zerschlagen – wegen einer vermeintlichen Nähe zur RAF.

Symbole der Befreiung

„Gibt es überhaupt etwas in der Geschichte, was nicht Angst vor oder Hoffnung auf die Revolution [den Rosengarten] ist?“, fragte sich der französische Philosoph Michel Foucault, der bereits 1961 eine Studie über Wahnsinn und Gesellschaft veröffentlicht und sich in der Folgezeit immer mehr mit und für „Internierte“ engagiert hatte. Ähnliches traf auf den französischen Antipsychiater Fernand Deligny zu, der mit einer Gruppe „verhaltensgestörter Jugendlicher“ („Autisten“) die Anstalt verließ und sich mit ihnen in den Chevennen niederließ – auf einem „Floß in den Bergen“, wie sein Bericht darüber hieß. Analoge Projekte versuchten damals auch linke Psychiater wie Ronald D. Laing (siehe S.19) und Félix Guattari zu realisieren.

Von Triest aus, wo die europäische Antipsychiatriebewegung mit dem dortigen Klinikchef Franco Basaglia („Die Ausbildung zum Irrenarzt ist identisch mit der Ausbildung zum Folterer“) ihren Anfang genommen hatte, starteten die Psychiatrie-Betroffenen ab 1985 mit überlebensgroßen Symbolen der Befreiung – dem Pferd „Marco Cavallo“ und den „Bremer Stadtmusikanten“ – eine „Blaue Karawane“ zu (noch) geschlossenen Einrichtungen im Ausland bis hin nach Norddeutschland. Seitdem gibt es hierzulande in vielen Städten Blaue-Karawanen-Vereine und andere psychiatriekritische Initiativen.

In Westberlin veranstaltete die „Irrenoffensive“ 1998 ein Foucault-Tribunal zur Lage der Psychiatrie. Zuvor hatte sie – unter anderem zusammen mit dem Foucaultexperten Thilo von Trotha – ein Weglaufhaus (nach holländischem Vorbild) gegründet. Dieses noch heute funktionierende Asyl von und für Psychiatrie-Betroffene war 2011 auch an einer Reihe von Tagungen und internationalen Konferenzen beteiligt, deren Ergebnisse jetzt in der Dokumentation zusammengefasst wurden.

Mündig durch Gehorsam

Finanziert hat das Papier der Paritätische Wohlfahrtsverband, in dem Jasna Russo vom Verein für alle Fälle das Projekt koordinierte. Mit dabei waren ferner Zofia Rubinsztajn vom Verein für Frauen mit sexueller Gewalterfahrung in der Kindheit, Wildwasser-Selbsthilfe, und Patrizia di Tolla – Referentin für Psychiatrie beim Paritätischen. Von den Berliner Selbsthilfe-Initiativen, die in der Dokumentation zu Wort kommen, sei noch Tauwetter erwähnt – eine Gruppe von Männern, denen in jungen Jahren sexuelle Gewalt angetan wurde. Und von den Teilnehmern der Veranstaltung im Haus der Demokratie die Obdachlosen-Gruppe Unter Druck. In diesem Projekt, wie auch in den antipsychiatrischen Kriseneinrichtungen, haben die Helfer oft mit Leuten zu tun, die alles verloren haben: „Wohnung, Finanzen, Hoffnung“.

Der Bericht nun befasst sich mit dem „Krisenumgang ohne Medikamente“, mit „informeller Hilfe“ und „politischer Selbsthilfe“ sowie mit den „Erfahrungen mit Betroffenenkontrolle“ in verschiedenen Ländern. Vom Podium aus wurde erörtert, welche Rolle das Erfahrungswissen in der psychiatrischen Praxis sowie in der Ausbildung und Forschung spielt. Neben der Patientenkontrolle kam auch ihre „Beteiligung“ darin zur Sprache. So haben in den Reinickendorfer psychiatrischen Diensten etwa 200 Mitarbeiter Psychiatrieerfahrung. Und im Weglaufhaus sind die Hälfte aller Mitarbeiter Betroffene, wobei gesagt werden muss, dass die meisten eine Ausbildung haben. Um von der repressiven Staatshilfe wegzukommen, braucht es „formale Voraussetzungen“. Für eine Anstellung im Weglaufhaus braucht man etwa eine Sozialarbeiterausbildung. Im Offenburger Verein für Obdachlose werden inzwischen 6,5 von 17 Sozialarbeiterstellen von Betroffenen besetzt. Zugleich weigert sich der Senat, eine Mitarbeiterin von Wildwasser zu bezahlen, weil sie einen pädagogischen und keinen sozialpädagogischen Abschluss hat. Selbst der Aufenthalt in diesen Selbsthilfe-Einrichtungen kann zum Problem werden, denn er oder sie braucht dazu eine „Kostenübernahme“, die behördlicherseits verschleppt oder verweigert werden kann.

Aus dem Publikum kam der Vorschlag, an einer der Berliner Universitäten einen Lehrstuhl für kreativen Wahnsinn zu schaffen, um „die Ansätze von Beuys und Neuss zu verschmelzen“, und wo Psychose-Seminare angeboten und ein Stimmenhörer-Netzwerk aufgebaut werden kann. Als dazu der Hund von Zofia Rubinsztajn bellte, wurde auch dieser Beitrag aufgegriffen: „Ja, ich kann nur jedem raten, der unmündig ist, sich einen Hund anzuschaffen. Wenn der einem gehorcht, wird man sofort für mündig erklärt.“ Jasna Russo fügte hinzu, dass jeder Erfahrungswissen habe.

„Der Schizo weiß aufzubrechen“

Dies gilt auch für jeden anderen medizinischen. Die psychiatrisch Internierten und pharmakologisch Sedierten haben in den sechziger Jahren den Anfang gemacht – mit der Selbstorganisation, aber spätestens seit der Internetverbreitung haben auch alle anderen – von den Allergikern bis zu den Krebskranken – angefangen, ihre eigenen Erfahrungen, ihr Krankheitswissen untereinander zu diskutieren und es gegenüber den Ärzten in Anschlag zu bringen.

Das hört sich alles positiv an, wenn man jedoch die Berichte und Protokolle aus der Anfangszeit der Antipsychiatriebewegung liest, kann man gleichzeitig darüber verzweifeln, wie wenig erreicht wurde. Vorbei die Zeit, als der Psychiater Félix Guattari und der Philosoph Gilles Deleuze verkündeten: „Der Schizo weiß aufzubrechen. Er macht aus dem Aufbruch so etwas Einfaches wie Geborenwerden oder Sterben.“ Seit dem Untergang der Sowjetunion, dem Siegeszug des Neoliberalismus und der damit einhergehenden Privatisierungswelle hat ein geradezu sarrazinistischer Antihumanismus um sich gegriffen. Der Partizipationsforscher Jan Berg drückte es in Berlin so aus: „Mit der Hirnforschung, der Neurobiologie, hat sich alles gedreht: Jeder denkt, er findet jetzt die Schraube.“

Soll heißen: Man sucht allenthalben nach Mitteln und Wegen, um Verhaltensauffällige zu „normalisieren“. Im Verein mit der Molekularbiologie und den Neurowissenschaften bieten die Pharmakonzerne dazu immer neue Medikamente an.

Neurologische Mondlandung

Wie sich diese vermeintliche Helferwelt darüber hinaus auch neu organisiert, sei hier am Beispiel der AOK Niedersachsen erwähnt: Sie verkauft sich und ihre Mitglieder gerade an den amerikanischen Konzern Johnson & Johnson. Diese Privatisierung hat den nassforschen Namen: „Care 4 S“ – das „S“ steht für Schizophrenie. Dahinter verbirgt sich eine deutsche Tochterfirma von J & J: die Janssen-Cilag GmbH. Sie stellt Psychopharmaka her – und gründete zusammen mit der AOK Niedersachsen ein Institut für Innovation und Integration im Gesundheitswesen (die I3G GmbH). Diese Gesellschaft ist nun für die Installation eines „neuen ambulanten Versorgungssystems“ verantwortlich, das natürlich als „Netzwerk“ bezeichnet wird. Und dieses wurde bereits in den USA geknüpft: mit Johnson & Johnson an vorderster Front – als Teil einer ganzen Kampagne namens „One Mind for Research“. Diese organisatorische Zusammenführung von Wissenschaften, nationaler Gesundheitsinstitute, Psychiatrie und Pharmaindustrie hat nichts weniger im Sinn als analog zur Landung auf dem Mond nun das Gehirn zu erobern, um innerhalb eines Jahrzehnts Geisteskrankheiten und psychische Störungen erfolgreich zu „bekämpfen“. Die Organisation One Mind, deren ehrenamtliche Vorsitzende bei Johnson & Johnson angestellt ist, gab erst einmal eine Studie über die psychische Verfasstheit der US-Bevölkerung in Auftrag. Derzufolge leidet einer von sechs Amerikanern an einer „Krankheit mit Hirnbezug“ – wie „Depression, Autismus, bipolare Störung oder Schizophrenie“.

Im Zentrum der Werbekampagnen von One Mind steht indes die posttraumatische Belastungsstörung (PTSD). Sie wurde durch die Vietnam Veterans bekannt und 1980 von der American Psychiatric Association anerkannt. „Die PTSD-Diagnose bedeutete eine Würdigung ihrer psychologischen Leiden“, schreibt die Soziologin Eva Illuoz. Von den organisierten Vietnamsoldaten aus wurde „das PTSD dann auf immer mehr Vorkommnisse und Fälle ausgeweitet, etwa auf Vergewaltigung, terroristische Angriffe, Unfälle, Verbrechen etc..“ Dabei geht es nicht zuletzt um die Rente, denn „die Klassifizierung von Pathologien entsprang der Tatsache, dass die mentale Gesundheit aufs Engste mit der Versicherungsdeckung verknüpft wurde.“ Heute, vor dem Hintergrund der Traumatisierung vieler Soldaten, die im Irak oder in Afghanistan eingesetzt wurden, „hat die Frage nach den biologischen Grundlagen der PTSD in den USA eine besondere Bedeutung“, schreibt der Journalist Matthias Becker. „Von den konkreten Erfahrungen, die die Soldaten im Krieg gemacht haben, ist allerdings nicht die Rede – wohl aber von ihren Gehirnen.“

Psychologisch deutet eine seelische Störung auf einen inneren Konflikt hin – etwa zwischen einem Selbstbild als guter Mensch und den Gewalterfahrungen an der Front. Diese Ebene kommt bei One Mind schlicht nicht vor. Stattdessen beschäftigen sich die beteiligten Forscher damit, wie etwa „die Repräsentation der Angst in der Amygdala unterbrochen werden kann“. Um Unterbrechungen im Gehirn geht es auch bei den Elektroschocks. Diese einst als Folter begriffene Behandlung von Irren erlebt in Deutschland nun als verfeinerte „Elektrokrampftherapie“ (EKT) eine neue Konjunktur unter Nervenärzten, obwohl man bis heute nicht weiß, was der Strom im Gehirn eigentlich bewirkt. Die Süddeutsche Zeitung meldete im August: „Die Fachgesellschaften sprechen sich dafür aus, die EKT künftig nicht mehr nur als Ultima Ratio, sondern früher im Behandlungsverlauf einzusetzen.“

Noch gibt es allerdings Psychiater, die die EKT ablehnen – weil sie befürchten, dass man damit die offenkundig schützenswerte Identität des Patienten verändert.

Mad Pride Netherland

Post-Prozac Nation: Did our Drugs Work?

by MadinAmerica

In 1995, days after having received my first psychiatric drug prescription, I purchased and speed-read Elizabeth Wurtzel’s best-selling memoir, Prozac Nation. Often compared to Sylvia Plath’s The Bell Jar in subject and cultural impact, this book put bio-psychiatry’s chemical imbalance theory of distress on the young person’s literary map. In the final two pages of her memoir, Wurtzel, a young and depressed Harvard University student writes, “One morning I woke up…it was as if the miasma of depression had lifted off of me, in the same way that the fog in San Francisco rises as the day wears on. Was it the Prozac? No Doubt.”

This tagline praise for Prozac made her the pharma-friendly ally to a growing number of young people who were, like I, told their fear, fury or heart’s desire were identifiable disease and expressions of faulty genetics. Thousands of young people in my generation were quietly ushered into the mental health system because we were energetic and disinterested in classroom lessons, or because we tried hard and alone to metabolize difficult life experience. We stumbled upon doctors, pills, psychiatric labels, and this best-selling book in the absence of someone we could talk to. Its plug for Prozac, alongside shaky scientific theory, helped to create our teenaged view that the drugs we had been told we needed were harmless and effective.

Elizabeth Wurtzel was well cast for the role of unofficial Eli Lilly spokesperson. She was young, beautiful and Harvard-educated. And while she accepted her mental health diagnosis and daily dose of medication, Wurtzel lived out a stereotypically counterculture life publicly packed with sex and rock music. With the distribution of this book, Wurtzel, an already established rock music critic, garnered fans of her own. They created fan clubs and joined her on book tour. During one Portland, Oregon stop, a young man offered Wurtzel his SSRI prescription slip, which, she signed in solidarity. Wurtzel’s book and rise to stardom happened to coincide with Lilly’s marketing efforts which sky-rocketed their stock value over 300% from 1994-1996.

Rightfully, this young fan felt a prescription slip would be the archetypal place for her to autograph.

Eighteen years later, her book is still touted as a Prozac success story. In the April 19, 2012 New York Times Magazine article, “Post-Prozac Nation: The Science and History of Treating Depression”, Dr. Siddhartha Mukherjee refers to her experience on Prozac as “transcendental”. He uses her story to question what he sees as America’s careless tendency to throw the proverbial baby out with the bath water as critics, patients and activists call attention to a conspicuous absence of reliable science and improved outcomes with use of these drugs, while exposing their potential dangers. Mukherjee cites Wurtzel’s words that before Prozac she was living in, “a computer program of totally negativity…an absence of affect, absence of feeling, absence of response, absence of interest.” Dr. Mukherjee asserts that, “just a few weeks after starting Prozac, her life was transformed.”

Last spring, I rested in bed under the covers and cradled my laptop computer to read this article. Mired in month four of a painful and still-protracted period of withdrawal from psychiatric drugs, I had called out sick from work, again. I read this article as my body, covered in welts, shook and ached. I slept for hours at a time during the day or else I sat and stared at the wall, nearly catatonic. But that was only the beginning. One month later I experienced episodes of paranoia and hallucinations. I saw cartoon-like rats running around my bedroom floor. Exposed wall pipes in a church basement turned into cameras. At the May 6th event in Philadelphia, “Imagining a Different Future in Mental Health”, I imagined a man in the pew across from me was concealing a gun and planned to kill me. I sat, breathing slowly and deeply to ground myself while following the sound of speaker Robert Whitaker’s voice, amplified by the microphone he gently held to question the ethics of a mental health system that isn’t clear about its own self-deception: “Delusion is just not a good foundation for good medicine”.

In more private moments, I cried. I considered suicide.

But there was also a part of me, deep and unshakable, that knew this mess wasn’t me. These visions and symptoms were my body’s final push to heal itself, to grow new receptors and recalibrate a chemical messaging system that had been perturbed by 17 years of 12 psychiatric drugs, up to five at a time, for supposed clinical depression turned bipolar, neither of which actually existed in the first place. I woke up to the fact that over the years, each time I had tried unsuccessfully to come off of these drugs, I was not experiencing a reemergence of mental illness, as I was told. I was going through psychiatric drug withdrawal and a phase of repair, which I now understood could take months, if not years to get through. This awakening, combined with Dr. Mukherjee’s NYT magazine article prompted me to reread Prozac Nation with a more critical eye. I asked the question: Did her drugs really work?

I was shocked to find what Wurtzel’s story reveals. Dr. Mukherjee and the majority of readers gloss over a critical detail of her experience on Prozac, and an entire second book in which she changes her tune about the drug’s effectiveness. In Prozac Nation, she reflects on the attempt she made to take her own life after taking Prozac, “The suicide attempt startled even me. It seemed to happen so out of context…it should have never have happened within a few days of returning to Cambridge, at a point when, even I had to admit, the fluoxetine (Prozac) was starting to kick in.” But in interest of preserving a particular narrative and, coincidentally, satisfying Eli Lilly’s need to spin a bit of bad press they endured in 1994 with their first product liability case which went to trial (Wesbecker vs. Eli Lilly), Wurtzel explains that swallowing a full bottle of Mellaril, a drug classified as an anti-psychotic, was par for a worthy course of treatment.

This sudden, trance-like drive to suicide Wurtzel describes is strikingly similar to my own experience. Within weeks of taking Prozac, I developed an insatiable appetite. I could not sleep. I began to behave in unusual ways, expressing uncharacteristic levels of anxiety, recklessness and aggression. Several incidents of self-harm landed me in a northern New Jersey psychiatric ward where I was held and told my behavior was an indication of even greater disease. I could be bipolar. Like Wurtzel, hospital doctors gave me two additional pills: one sedative and one mood stabilizer. Eleven years later Eli Lilly is forced by the FDA to include a black-box warning with its product which states that SSRIs can cause an increase in aggression, suicide (which they call suicidal behavior) and suicidal thinking in teenagers and young adults. I was 16 years old. I was not bipolar or anxious. I was having a reaction to Prozac. It would be years of struggle, strange symptoms and research before I’d come to understand the connection.

I also read Wurtzel’s 2002 follow-up book, More, Now and Again: A Memoir of Addiction to find out if what happened to my life over time on these drugs, happened to hers. In this memoir, readers find Wurtzel doubting the value of the drugs she was prescribed. She writes that her old, “reliable antidepressants were not working so well, the whole regimen needed a boost.” Here Wurtzel uses the word ‘regimen’ to describe what had, over time, become a cocktail of drugs. The “boost” she and her psychiatrist summon comes in the form of Ritalin, a stimulant prescribed to treat her curious emergence of extreme fatigue and an inability to concentrate, two common effects of a serotonergic system which has been damaged by the long term use of psychotropic drugs. Though in her case and mine, this was not known or admitted by the prescriber.

I was told the onset of fatigue and memory loss were manifestations of continued depression. Or else I had an entirely separate condition called Chronic Fatigue Syndrome, which itself was unexplainable. My provider encouraged me to stay on prescription medication, offering to up doses or add more pills. Like Wurtzel, I was offered a stimulant to help me stay awake and alert to treat what I would discover were effects of the drugs I was told I needed. However, given my experience with benzodiazepines, another highly addictive class of drugs, I declined.

Ultimately, Wurtzel’s life on psychiatric drugs inspires her to write, “I start to think that this is a cabal of the pharmaceutical industry to make us into addicts.” This book walks readers through the years she spent in drug rehabilitation centers, step-down facilities and therapist’s offices.  Essentially, we see the same thing happen in Wurtzel’s life that happens in so many peoples’ lives, including my own. One diagnosis and one drug in a young person quickly become new symptoms, which become multiple diagnoses, and multiple drugs, which pave a life-path of unwitting addiction, even to those drugs like antidepressants which we’re told are not habit forming.

Dr. Mukherjee left this critical perspective on the devastating, long-term effects of these drugs out of his New York Times Magazine article.

While some people feel helped by psychiatric drugs, so many of us, particularly those who were denied informed consent, who were not offered alternatives, or who were forced to take these drugs, feel violated to discover they were also causing us harm, perturbing multiple chemical messaging systems in our bodies. These drugs created the symptoms doctors could not explain—everything from acne to cognitive dysfunction, amenorrhea to dissociation, and a worsening of the symptoms which the drug was meant to treat.

Four months ago, when I endeavored to reread Prozac Nation, I didn’t have to check it out at the local library. I have held onto it over the last 17 years of my life as a patient in our mental health system. No matter how many times I took off for a new state, coast, crash pad or credential, ditching bell bottoms and other appliances along the way, Wurtzel’s book and my psychiatric drugs stayed with me—as did my distress. Now, in some kind of strange synchronicity, it sits on my bookshelf in the same quiet Cambridge, Massachusetts neighborhood in which Elizabeth Wurtzel lived while writing this book. Though it’s ideology and apparently incomplete picture of her life (and mine) on psychiatric drugs make it difficult to read, I don’t toss it just yet.

Prozac Nation stands as a reminder of the failed promise and language of bio-psychiatry. It also highlights what the first and real problem was for me at age 16. Still underlined are the words that drew me in, made her an ally, and which could have inspired great dialogue had they not been sidelined by psychiatric drugs. She writes, “I feel like a defective model, like I came off the assembly line flat-out fucked and my parents should have taken me back for repairs before the warranty ran out.”

At 16, I stood alone, enflamed with a fear of questioning the politics of family, my own identity and life’s purpose. The elusive feeling of brokenness which Wurtzel describes, a common imprint of traumatic experience, was something I could relate to. No one said, “Let’s imagine you aren’t broken”, or “How did you come to entertain this idea about yourself?” or “Let’s talk about this brokenness…what does it look like?” bio-psychiatry did exactly the opposite. This ghostly fear or cast spell, smoke-screened by weight loss and a withdrawal from all that I loved, was actualized, codified and amplified by our bio-psychiatric model of mental health care. I only started to heal eight months ago when I shed my labels, swore to endure whatever psychiatric drug withdrawal would bring, and swiftly exited the system.