The Chemical Lobotomy

 

When I was first hospitalized as a teenager, I was, or so I was told, very ill. I was experiencing delusions I would rather not discuss in any detail here. Suffice to say I was only ever a danger to myself, never to others. As a result of this, I was forced to spend six months in the local psychiatric hospital. I was heavily medicated with the most primitive antipsychotic known to man: Chlorpromazine (aka Largactil in the UK, Thorazine in the US and the Chemical Kosh/lobotomy in both countries).

Chlorpromazine was the first of a new type of medication known as ‘neuroleptics’. They were introduced in the 1950s and were the only class of medication capable of combatting the positive symptoms of schizophrenia such as delusions and hallucinations. They did not, as far as I am aware, do much for the negative symptoms.

I was reminded of this recently when I saw a documentary entitled ‘Inside Strangeways’ on Channel Five, a terrestrial tv station I rarely watch. In 1985 an infamous riot broke out in the prison. One of its triggering factors was the use of Chlorpromazine to subdue its more troublesome prisoners. They would be forcibly medicated; held down and injected. It is a horrific experience; something I have never really got over. Even though I now see that it was a tragic necessity, I still find it hard to dwell upon. The sense of violation never really goes away.

Throughout my first stay in the hospital, I was on such a high dose of Chlorpromazine that my vision was permanently clouded over. I needed Procyclidine (an anti-Parkinsonian drug) to combat the side effects of the drug I was already taking. Those were the days when the hospital staff would wake you up to give you a sleeping pill then wake you up periodically throughout the night by shining a torch into your bed space. But they were doing the best they could with minimal resources. I know that now but for a long time I resented it. Time does heal some things.

All of this happened in the early ‘90s and thankfully, over the years, much has changed. Atypical antipsychotics such as Quetiapine and Abilify have been introduced. Therapy is no longer contraindicated. People are prepared to actually talk to you nowadays. Medication is no longer the only avenue of treatment.

At the moment I am taking Quetiapine and Abilify. I am told I should be reconciled to the fact that I may have to take this combination of medications for the rest of my life. This does not sit well with me. I worry about the impact these drugs may be having on my physical health. Quetiapine has been known to indirectly lead to diabetes or liver damage. And. if you google it, you will find a list of side effects a mile long. The less serious side effects include dizziness, nausea, vomiting, drowsiness, constipation. The most serious side effects include high fever, confusion and permanent cognitive impairment (something I am terrified of.)

So I stand at a crossroads. I am tempted to simply stop taking the medication altogether so that I can be me again. But those around me say it is beneficial and I should continue taking it. I shall probably compromise and aim for the best possible results on the lowest dose of medication. This, I think, is the most sensible approach.

Slow Road to Dementia?

Cognitive Impairment in Middle Age

Slow Road to Dementia?

There is only one thing scarier than dementia and that is early onset dementia. But both of these disorders have a neglected second cousin: a neurological condition known as mild cognitive impairment. It has been established that cognitive decline can begin in your forties. The condition consists of ‘subtle deficits in cognitive function that nonetheless allow most people to live independently and participate in normal activities.’ It can be, in rare cases, a precursor to full on dementia.

I am on a variety of psychotropic medications. so I am susceptible to this condition.  I am taking more than the British National Formulary permits. At the moment I am experiencing memory loss, inability to think logically, inability to read fiction. Non fiction is okay. Strangely enough this is not listed as a side effect. Ironically, among the books I can read are those of my old nemesis Theodore Dalrymple. My brain empties of thought. I am forgetting words and names. I run out of material in the middle of a conversation. The conversations and concerns of others are perplexing. I am feeling  increasingly detached from the world around me. It feels as though the world was designed for the young. Then people started pulling away, which leads, in turn to a fear of intimacy. Suddenly I am middle aged and increasingly useless. I feel helpless in the face of this. All I can do is write about it.

Plagued by insecurities and doubts I did the worst thing imaginable.: I googled my symptoms. I can feel my brain slowly atrophying. Am I facing premature dementia? I am in my early forties. I am terrified. I see class action law suits against the company that manufactures my medicine. I read about weight gain and feel my flesh expanding. I read about pancreatitis and feel a sharp pain in my left side. How much is real? How much is psychosomatic? I have been perusing articles on the web dealing with cognitive decline. Just because you are paranoid, they say, it doesn’t mean that nobody is out to get you. I feel as though I have lost myself.

I have been researching solutions. Can this be overcome/ameliorated? What can medicine offer? I often panic when I am confronted with brain fog. This exacerbates the situation so calming tactics such as meditation and mindfulness are useful techniques. I also considered vitamin B12 deficiency. I am in the risk category for this condition. I am vegetarian and often neglectful of my diet. Blueberries are apparently a miracle fruit that may even be able to reverse cognitive decline. Physical exercise, even walking, can alleviate the condition.

Other problems that mimic cognitive decline are depression, medication side effects, or an underactive thyroid. I am praying it is the meds. I am also praying that it is reversible.

edit: in case anyone is interested the illustration accompanying this piece is entitled ‘Iceberg’.

Alienation

I am restricting my contact with my fellow human beings to brief, and occasionally hostile exchanges on the internet.

A while ago a certain back bench Tory politician raised the issue of Twitter on her blog.  I think they call it Twittergate and if they don’t then they should.  She asked what at the time must have seemed like a perfectly valid question except that she did this in overtly hostile tones.  She wondered whether people who incessantly use Twitter – people with disabilities – should be out there seeking employment because their twittering habit clearly indicated that at the very least they were computer literate. There was a nugget of reasoned debate in the the future (mixed in) that followed this.  Some regular tweeters argued that for them twitter was a lifeline, sometimes it was their only connection to the outside world.  And this, they said, could only be a ‘good thing’.  I’m sure that may be true for some people, perhaps even many people, this may be true.  But there are those of us who haven’t really been helped by the expansion of online social networking.  Those of us who were isolated in the first place.  In some cases it may exacerbate their condition, especially if they have issues with social anxiety at the outset.  For there really is no substitute for real live flesh and blood companionship.  The internet is a poor substitute for that.

 

Oh, the Irony!

From Dr. Peter Breggin’s Psychiatric Drug Withdrawal .

And Do the Dumbest Docs Become Psychiatrists?

Perhaps ‘The Lancet’ should publish a paper on that:

http://pjmedia.com/lifestyle/2013/03/23/does-military-service-cause-men-to-become-criminals/?singlepage=true

http://pjmedia.com/lifestyle/2013/03/23/does-military-service-cause-men-to-become-criminals/?singlepage=true&show-at-comment=121304#comment-121304

http://pjmedia.com/lifestyle/2013/03/23/does-military-service-cause-men-to-become-criminals/?singlepage=true&show-at-comment=121488#comment-121488

Medical Student 1: You know, they really should abolish psychiatry.  It’s an embarrassment to the medical profession.

Medical Student 2: But then what would all the dumb docs do?

Medical Student 1: (shrugs) They could always become lawyers.

Addendum: I am rereading a rather interesting little book entitled: Instructions for American Servicemen in Britain 1942 reproduced from the original typescript, War Department, Washington D.C.

The blurb on the back cover reads:

‘…The British don’t know how to make a good cup of coffee.  You don’t know how to make a good cup of tea.  It’s a even swap…”

“…When you see a girl in khaki or air-force blue with a bit of ribbon on her tunic–remember she didn’t get it for knitting more socks than anyone else in Ipswich…”

“…It is always impolite to criticise your hosts; it is militarily stupid to criticise your allies.”

I love primary sources.

‘Laters’

In Response to the Telegraph’s Latest Coverage of Mental Illness:

http://www.telegraph.co.uk/sport/olympics/news/9847928/An-embarrassment-on-the-country-man-who-threw-bottle-at-Olympics-100m-final-during-manic-episode-escapes-prison.html

Or, more specifically, to this poster:

JacksonAliBaBa

2 days ago

People with “medical conditions” should be forced to wear high-visibility vests whenever they leave their homes. Then, the instant they start acting like twats, someone can immediately fill them in and/or hoik them off for a stint in the loony bin. For those who choose not to do so, they should be banged-up in jail. I hate the law allowing people to get off on all sorts of ridiculous technicalities.

Louise

just now

If you don’t believe that mental illness exists, my friend, then get out there and campaign for the cessation of the public funding of psychiatry.  Go on, I dare you.  Take on the generals instead of the foot soldiers.  And the protection of the mentally ill is enshrined in law.  That is why we have psychiatric hospitals and secure hospitals.  We’ve recognised that mental illness can cause people to lose control of their behaviour since the McNaughton Rule was devised.  So in 1843 the law was more compassionate to sufferers of mental illness than it is now?  I find that quite funny, in a really sick way.

By the way, you mention ‘medical conditions’ rather than mere mental illness: does this mean that you would force an elderly alzheimer’s sufferer to wear one of these ‘high-visibility vests too?

Just a taste of what some forms of mental illness can be like from the inside:  http://www.youtube.com/watch?v…

Bipolar sufferers sometimes experience auditory hallucinations too. 

The reaction to this story is truly quite horrifying.

First Extract of the Year

The Daughter’s Tale

Towering Oaks

1993

The oaks towered above me in the hospital grounds.   I explored everything that week. I explored the bowling green, the tennis court, the gym, the crumbling main building, the sloping lawns and the green, neatly trimmed hedges. There was even a hospital cat – a flash of white that streaked through the grounds. Before it became familiar and tedious.

That first week at the hospital was awash with sunshine.   The rest of the world, the city with its bustling crowds seemed centuries away. Had it ever existed?   Or was it only in my imagination.   The hospital was a separate world with its own language, its own rituals, set apart from everything else – alienated, set apart from everything else.   Some of my fellow patients revelled in being different, revelled in being apart from everything else.   Trains crashed, planes crashed, volcanos erupted, wars broke out all over the planet. Explosions in the middle east rippled round the world, barely touching us. We were far, far removed from that.

The hospital would not exist for much longer, I was told.   Tesco had made a bid for the land.

I sat in the patients’ lounge in the morning meeting, the sun on my back.  Someone was talking about bathing his face in the morning dew, about how healthful it was.

‘I won’t be here for much longer,’ I told a nurse who responded: ‘You may not have much choice in the matter.’

I would come to look back on those first sun-washed days at the hospital with nostalgia.   I was lethargic from the medication but strangely happy.   There was nothing to worry about: no essays, no tutorials, no lectures.

I felt free, liberated of all responsibilities.  Nothing bothered me.   I was oblivious to the rotund man with the hearty laugh and the toothless old crone in the corner.   I did not see the man who called himself Nostradamus Reincarnated and ran round the ward shouting: ‘The world is a process of disintegration.   The world will end. The world will end.’

I felt serene. The orange flowed gently through my veins. I had no desire to do anything but lie on my bed with my palms upturned, staring at the ceiling. June was nearly over, term was over.   There was nothing left but myself – the only character in this one act charade.

I could barely move.   My limbs were leaden and yet in some strange, sick way I enjoyed feeling like this.

I enjoyed the feeling that boundaries had been established.

One can only handle so much freedom.

I could not walk without assistance.   I felt the hand of the nursing assistant around my arm. There was no flesh, her hand gripped only bone.

The medication had temporarily banished history.   I sat up in bed. However they did mean that on some mornings I woke feeling as though someone had bashed me on the head with a sledge hammer.

I had lost herself. I was a floating sheet of paper.   Blank, of course.

I was having my life cut and spliced by the omnipotent author governing the universe. Who was this being?   I imagined it as a monolithic video recorder. That recorded every word you voiced, every action you initiated.   I hoped it included features like play, pause, forward, back and, of course, erase.

And when I slept, I dreamed.

I dreamt of walking on a beach with my father, hand in hand, the sand yielding beneath our bare feet.

‘It’s been a long time,’ my father  said.

‘Too long,’ I replied.

The magical kingdom was still within I. Roses blossomed. I was being smothered by so much beauty.   Music poured out of the speakers.   Voices whispered: ‘You are special.’.

I was coasting along, floating.   I had escaped academia.   The academic layer of my being had been painlessly peeled away.   No more screaming over unfinished essays.   Apparently my tutors had all granted extensions for me.   I was willing to bet that I wasn’t going to be a name on their Christmas card list. But all this was done but at a price: I was sacrificing my personality and possibly my very self.

Medical Ethics (The Scourge of Incompetent Doctors Everywhere.)

The original source of a doctor’s duty of confidentiality is the Hippocratic Oath. Regarding confidentiality Hippocrates said: ‘Whatever, in connection with my professional practice or not in connection with it, I see or hear in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret.’ The obligation of confidentiality spoken of here is not absolute; it is up to the doctor to decide what information ‘ought not to be spoken abroad.’ Another Oath of confidentiality is the Declaration of Geneva which says: ‘I will respect the secrets confided in me, even after the patient has died.’ Here, however, the obligation is absolute. These are two sources of a doctor’s duty of confidentiality which, although they differ in extent, both highlight the importance of respecting the confidentiality of patients. J NI Ethics Forum 2006, 3: 146-153

‘The better part of valour is discretion; in the which better part I have saved my life.’

Falstaff, Shakespeare, in Henry IV, Part One, 1596.

Why Would a Psychiatrist Think That…

the idea of a discovery for the causes of Schizophrenia is ‘boring’…

Things Ain’t What They Used To Be

 

Why is it that drunkenness is regarded as a predatory monster that has crept up on us over the last decade or  so?

My mother vividly recollects the 1970s when she was in nurse training. She remembers accompanying her hard drinking friends to night clubs, resting her head on a beer stained table and falling asleep. She was a cheap date. She found it impossible to keep up with them. I live in a university town and the medical students are renowned for their hard drinking behaviour. But this has always been the case. Nobby’s son is a taxi driver who remembers a time in the early seventies when medical students behaved so disgracefully as a result of inebriation that the local taxi companies refused to carry them. And in our hospitals health care staff: from the consultant to the office cleaner would take any drug they pleased from the medication trolley. There was a nationwide investigation into this and security was tightened. The nurses ran the ward, just like the NCOs run the army.

And it would still be like that now if it were not for those pesky managers.