Saturday, June 21, 2014

Harm Reduction Guide to Coming Off Psychiatric Drugs: Part 3

Harm Reduction Guide to Coming Off Psychiatric Drugs: Part 3
Written by Will Hall
Published by The Icarus Project and Freedom Center

Do Psychiatric Drugs Correct Your Chemistry Or Treat Illness?

People are told that mental disorders mean brain chemistry is “abnormal,” that illness is caused by genetic “predispositions,” and that psychiatric drugs are needed to interrupt a disease process and correct imbalances. However, this is not how medications work, and brain disease theories have not been proven by studies to be true. Believing these claims can reinforce a sense of being a helpless victim of biology, and leave people feeling there are no options other than medications.

Despite decades of costly research, no chemical imbalances, genetic predispositions, or brain abnormalities have ever been found to consistently cause a bipolar, depression, or schizophrenia diagnosis. The media report “promising” research that “needs further study,” but nothing conclusive has resulted. Even the fine print of drug company ads now typically says that conditions are “believed to be caused by” chemical imbalances, rather than making definitive statements.

Physical tests, such as brain scan or blood draw, aren’t used for diagnosis like bipolar, schizophrenia, or depression, and can’t reveal that your brain is abnormal. (Altered states with clear physical causes, such as, for example, concussion, dementia or alcohol delirium, are instead called “organic psychosis”). A baseline has never even been established for what constitutes a “psychologically normal” brain for all people. Three people with the same diagnosis might have very different brain chemistry, and someone with similar brain chemistry might have no diagnosis at all. While many people face physical problems like vitamin deficiency that a doctor or holistic practitioner can address, this might help emotional problems – or it might not --. Medicine has not discovered the biology of mental illness the same way as tuberculosis, Down Syndrome, or diabetes. Emotional distress and madness remain open to interpretation.

“Normal”. What is normal? I don’t think anyone is contesting that we’re trying to be normal. Normal is not a thing. We’re simply trying to find a better quality of life than what we’ve been living. That is why we resort to medication. 

What about genetics? Mental diagnoses can seem to “run in families,” but so do child abuse and poverty. Because of shared environment, expectations, and intergenerational trauma, family history can mean many things other than inescapable heredity. Studies claim 15that twins tend have a slightly higher chance of the same diagnosis, but this research is often flawed and results exaggerated. Parents know that children have different temperaments even at birth, but prenatal experience has an influence. Individual traits like sensitivity and creativity only become madness after very complicated social factors, such as trauma and oppression, have played a role. Even sequencing the human genome has not revealed any keys to mental illness, and the idea of genetic “predisposition” remains speculative and unproven.

My grandmother and my sister were/are both bipolar. The environments in which they grew up could not have been any more different. To say that it may strictly be an environmental cause, is too much of a stretch for me. I’m much more inclined to say that there may be a genetic link somewhere in there. 

In fact, the more neuroscience discovers about genes, behavior, and the brain, the more complicated the picture becomes. “Epigenetics” shows that instead of a “genetic blueprint,” the environment interacts to turn genes on and off. Using genetic science to oversimplify the diversity of human behavior is a throwback to the discredited concepts of social Darwinism and eugenics. It portrays some people as destined to be inferior, defective, and less than fully human.

This should be clear. That everything about us is a combination of not only our biology but also our environment. How we were raised, the things in our environment have a massive effect on our brains right down to the neuron level. This is probably why no two brain scans will ever look the same for two people with the same mental health issues; they’ve come about their problems through different environmental triggers and different parts of their brains have been effected.

Every feeling and thought exists somehow in the brain as an expression of biology, but society, mind, and learning intervene to make any causal relationship impossible to establish. Stress, for example, is associated with brain chemistry, but one person can thrive under stressful circumstances that are debilitating to another. The new science of “Neuroplasticity” shows the brain is constantly growing and that learning can itself change the brain: for example, psychotherapy can reorganize brain structure, and researchers found the brain regions associated with memorizing maps were enlarged in NYC cab drivers. If learning can affect the brain in such a profound way, then we are not as limited by biology as was once believed.

This is certainly true. Even being off my medication for only 6 weeks, with a lot of learned therapeutic techniques I am much more self-aware now. Even when I could feel my mood slipping, it was nowhere near as extreme, but when it wasn’t great, I had the tools I needed to keep it under control and express myself constructively and handle it appropriately. That’s not to say I would like to be off my medication forever, but I did notice that it was possible and there was a noticeable difference between this time and before I started taking my meds.

Without clear answers from science, psychiatric diagnosis is ultimately not a statement of fact but a doctor’s subjective opinion of a patient. The doctor inevitably relies on their own bias, assumptions, fears, and preconceptions. Doctors often disagree with each other, people sometimes have many different diagnoses over time, and discrimination based on class, race, and gender is common.

Hmm. Okay, for me this sounds like it’s only the doctors telling a person that there is something wrong with them and we, as individuals, never go to doctors seeking help in the first place. I sought out my doctor because I had been in extreme distress for over a decade and nothing I was doing on my own was working. I didn’t need a doctor to tell me that there was something wrong with me. I already felt that. I went to the doctor because I needed help feeling better. I didn’t only see a doctor though, I also saw my therapist. Doctors aren’t out to get you, they’re there to help you if you go to them for help.

Who’s to Blame? Yourself? Your Biology? Neither?

If biology and brain chemistry aren’t to “blame” for anxiety, voices, suicidal feelings, mania, or other distress, does that mean the blame is on you? Is it either your brain’s fault or your fault?
A psychiatric diagnosis can be a huge relief if the only other option is blaming yourself as lazy, weak, or faking it. When you feel powerless and people haven’t been taking your pain seriously, a doctor saying you have a mental disorder can be validating. Choosing to reduce or come off medication might seem like the wrong message, as if your suffering is not that bad and you don’t really need help. And not being able to come off can also feel shameful, like you should just try harder and it’s all up to you.

A psychiatric diagnosis is often just a starting point to help with treatment that may change over time as your doctor becomes more familiar with you. You can’t treat someone who is bipolar as if they are schizophrenic. It’s the wrong treatment. However, I do agree that it can often be validating.

This is unfair, either-or thinking that leaves people helpless and trapped in the mental health system. Pharmaceutical advertising preys on this dilemma: if pain is really serious, it needs medication, if not, you’re on your own. Empowerment means thinking beyond a narrow view, and embracing broader ways of looking at things.

Everyone needs support sometime: each of us has parts of our lives where we feel powerless. We all need to learn how to balance personal responsibility with asking for help. You don’t have to blame your brain to give yourself some compassion.

And if people ask, it’s your decision what to say or not say, such as “I’m a trauma survivor,” “I go though extreme states,” or “I’m different than most people, and I’m still figuring it out” -- or saying nothing at all. Connecting with others who share your experiences, such as peer support groups or the internet, can be crucial as you explore who you are.

Your suffering is real, whether you decide to take medications or not. Feeling powerless and needing help doesn’t mean you are a broken person or that you’re a passive victim of biology. Explanations like trauma, sensitivity, or spirituality are as valid as any. You still deserve help even if you don’t believe your brain is abnormal and even if you think outside the language of “psychiatric illness” and “mental disorders.”

How Do Psychiatric Drugs Affect The Brain?

Like any mind altering substance, psychiatric drugs are psychoactive and alter mind and behavior by affecting brain chemistry. Their usefulness, and risks, come from changing the brain/body and altering consciousness, including expectation and placebo.

Current medical theory is that most psychiatric drugs change the levels of chemicals called neurotransmitters (anti-convulsants, anti-epileptics, and “mood stabilizers” such as lithium appear to work by changing blood flow and electrical activity in the brain in general). Neurotransmitters are linked with mood and mental functioning, and all the cells of the nervous system, including brain cells, use neurotransmitters to communicate with each other. When neurotransmitter levels change, “receptor” cells, which receive and regulate neurotransmitters, become more sensitive, and can grow or shrink to adjust.

SSRI anti-depressants (“selective serotonin re-uptake inhibitors”) for example are said to raise the level of the neurotransmitter serotonin in the brain and reduce the number of brain serotonin receptors. Anti-psychotic medications like Haldol lower the level of dopamine and increase the number of dopamine receptors in the brain. This action on neurotransmitters and receptors is the same as for any psychoactive drug. Alcohol affects neurotransmitters including dopamine and serotonin, and cocaine changes the levels of both dopamine and serotonin, as well as noradrenaline, and alters receptors.

While these chemical changes in your body take place, your consciousness works to interpret and respond n your own way, Alcohol might relax you or make you nervous; anti-depressants energize some people or make others less sensitive. Because of the placebo effect and expectations, everyone is different. Your experience of medication may not be the same as other people, and will ultimately be uniquely your own. Trust yourself.

True. This is why that list of potential side effects is so ridiculously long; every person’s body and brain are different and may react differently. This is why you should have regular and frequent follow ups with your doctor. Doctors don’t prescribe drugs all willy nilly. Even for mental health issues. Yes, there is a certain amount of guess work when it comes to finding the right ones that work for you best without unacceptable side effects; because everyone’s body does react differently, but it’s not quite the crapshoot it sounds like.

And not for nothing, it can be the same way with physical medical drugs too. I have drug allergies. I’m allergic to penicillin and macrolide drugs which makes giving me antibiotics a real bitch. However it took me having a few really bad reactions to those medications before we figured that out. If I get sick I also get the most ridiculously expensive antibiotics which I prefer to simply avoid. With the exception of my love of wine, I eat very clean, I exercise constantly, and I live a preventative and healthy life style. I’m very rarely sick. Of course you can’t always avoid getting sick, but you can certainly take steps to keep your immune system strong and those things help.

My point is, it’s not just mental health drugs that are hit and miss. People react poorly to all drugs. Or they can react fantastically. Penicillin is lifesaving to billions of people and it damn near kills me. Some people hate the idea of antidepressants. I’ll happily stay on my SNRI because it improves my quality of life.

It’s important to have all of the facts, which is what this guide is helping us do, so that we can make informed decisions about what is best for us individually. It’s also good to know that there can be alternatives though b/c one size does not always fit all.

Stay Tuned.

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