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“All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood.”
Universal Declaration of Human Rights
"People with mental disabilities have the same rights as everybody else.
It is time to act, unite and empower people to improve
mental health and human rights"
Mental Health Policy and Service Development
Department of Mental Health and Substance Abuse
World Health Organization
Attorney Jim Gottstein discussed inappropriate use of psychiatric drugs
The World Health Organization Recognizes an Epidemic of Violations of Rights Mental Patients
The care available from mental health facilities around the world including the USA is not only of poor quality but in many instances hinders recovery. There are also significant problems here in the USA. Because the care of mental patients occurs behind closed door and there is secrecy to the legal proceeding concerning involuntary treatment and forced commitment - this is a silent victim. Training of staff is minimal and outdated and the level of knowledge and understanding about the human rights of persons with mental disabilities is very poor. Thus staff often respond with forced drugging and restraints for staff convenience with little regard to the human rights of the patient. It is common for people to be locked away in small, prison‐like cells with no human contact, or to be chained to their beds, unable to move. Inhuman and degrading treatment practices are common, and people in facilities are often stripped of their dignity and treated with contempt. Violations are not restricted to inpatient and residential facilities. Many people seeking care from outpatient and community care services are disempowered and also experience extensive restrictions in their basic human rights.Violations often occur behind closed doors and go unreported ‐ unless people know that they are going on, action cannot be taken to stop them.
The Equal Protection Clause of the Fourteenth Amendment requires that the government treat all similarly situated people alike. Violations of the Equal Protection Clause are actionable under 42 U.S.C. § 1983.
"When we lose the right to be different, we lose the privilege to be free."
-- Justice Charles Evans Hughes
(1862-1948) Chief Justice of the U.S. Supreme Court
Discrimination Against Persons with a Mental Health Disability
Discrimination and the absence of legal protections against improper and abusive treatment cause much of the hardship faced by people with mental health disabilities. Improper discrimination may also take place against people with no disability at all – if they are improperly viewed as having a mental disorder, or if they once experienced a mental disorder earlier in life. People with mental disabilities are subject to de jure discrimination – the arbitrary denial of rights that are afforded to all other citizens. People with mental disabilities are often deprived of liberty for prolonged periods of time without legal process; subjected to neglect in harsh institutional environments and deprived of basic health care.
Persons who have been diagnosed with a mental illness are often deprived of the right to give or withhold informed consent, whereas individuals with other diagnoses are accorded the right to give or withhold informed consent for treatment. For example, a diabetic who refuses an amputation is provided a hearing before such a procedure can occur and a person with a communicable disease gets a hearing before she can be quarantined. The fact that the State has singled out people with mental illness as unworthy of due process constitutes discrimination based on disability.
Mental Health Rights
- The right to treatment services which promote the potential of the person to function independently. Treatment should be provided in ways that are least restrictive of the personal liberty of the individual.
- The right to dignity, privacy, and humane care.
- The right to be free from harm, including unnecessary or excessive physical restraint, isolation, medication, abuse, or neglect. Medication may not be used as punishment, for the convenience of staff, as a substitute for, or in quantities that interfere with the treatment program.
- The right to prompt medical care and treatment.
- The right to religious freedom and practice.
- The right to participate in appropriate programs of publicly supported education.
- The right to social interaction.
- The right to physical exercise and recreational opportunities.
- The right to be free from hazardous procedures.
Additionally, every mental health client has the right to see and receive the services of a Patients' Rights Advocate. All patients also have the following treatment rights:
- The right to give or withhold informed consent to medical and psychiatric treatment, including the right to refuse medications except in emergency situations where danger to life is present; or by court order where the patient is found to lack the capacity to give or refuse informed consent via either a Capacity Hearing and also known as a Riese hearing or via conservatorship.
- The right to refuse psychosurgery.
- The right to refuse electroconvulsive therapy (ECT) unless court ordered.
- The right to confidentiality.
- The right to inspect and copy the medical record, unless specific criteria are met.
- The right to have family/friends notified of certain treatment information with patient's permission.
- The right to an aftercare plan.
Deniable rights with good cause
Psychiatric facilities must also uphold the following specific rights, which can be denied only when "good cause" exists.
- The right to wear one's own clothing.
- The right to keep and use one's own personal possessions, including toilet articles, in a place accessible to the patient.
- The right to keep and spend a reasonable sum of one's money for small purchases.
- The right to have access to individual storage space for one's own use.
- The right to see visitors each day.
- The right to have reasonable access to phones both to make and receive confidential calls.
- The right to have access to letter-writing materials, including stamps.
- The right to mail and receive unopened letters and correspondence.
With good cause
Denying a patient's rights requires good cause. Good cause is defined as the belief of the professional in charge of care for the client that the specific right would cause
- a danger to self or others;
- a serious infringement on the rights of others; or
- serious damage to the facility;
and that there is no less restrictive measure that would protect against those occurrences.
Patient rights cannot be denied as a condition of admission, nor as part of a treatment plan (a doctor may not designate patient rights a 'privilege' or 'punishment'). Any time a right is denied under good cause, it must be documented in the patient's medical record and explained to the patient. The denial must be reviewed regularly and removed once good cause no longer exists.
When a right is denied, the reason given for denying the right must have some clear relationship to the right denied. For example, a patient may be denied the right to keep his cigarettes (the right to keep and use personal possessions) because he is burning himself and lighting fires, and lesser restrictive alternatives (supervision during designated smoking times) have failed. This rule prevents facilities from denying rights as a form of punishment; for example, if a patient misbehaves by throwing food at another person, then the facility cannot take away personal possessions or deny visitors for the day.
Without good cause
If a right was denied without good cause, a patient can instruct his or her appointed public defender to file an Ex Parte application with the court to restore the right. After filing the application, a hearing is set and an opportunity to be heard by the judge concerning the merits of the case is reviewed; the judge determines if the right will be restored or remain listed as a "good cause" denial. An Ex Parte can bring relief in a matter when a person is deprived of any interest in liberty or property without due process of law.
If someone is placed on a 72-hour hold as a danger to themselves or others and admitted to a facility for treatment, they are prohibited from purchasing or possessing firearms for five years from the date of admission to the facility.
If someone has been placed on a 14-day hold, they are prohibited from purchasing or possessing firearms for five years under state law and for life under federal law.
Testimony At Toronto City Hall On You Tube. This was the 10th annual Conference on Human Rights and Psychiatric Oppression Toronto, Canada on 14 to 18 May 1982 . Testimony is about psychiatric drugs, electric shock treatment and lobotomy. In the video you see Judy Chamberlin, Leonard Frank and Others. The testimony is that of Donald Johnson.
"What finally emerges from the 'clear and present danger' cases is a working principle that the substantive evil must be extremely serious and the degree of imminence extremely high before utterances can be punished... It must be taken as a command of the broadest scope that explicit language, read in the context of a liberty-loving society, will allow."
Justice Hugo L. Black
(1886-1971) US Supreme Court Justice
Source: Bridges v. California
The First Amendment’s protection of free speech also protects freedom of thought. By forcing individuals to take mind-altering drugs against their will, the medical staff forcibly changes the ability of such individuals to formulate particular thoughts. The involuntary administration of psychotropic drugs affects patients’ mental processes, interfering with their freedom of thought.
“… it is the inherent nature of all human beings to yearn for freedom, equality and dignity, and they have an equal right to achieve that.”
His Holiness The Dalai Lama, New York, April 1994
Mental Illness and Decision Making Capacity
The MacArthur Treatment Competence Study, published in 1995, confirms that mental illness cannot be equated with incompetence, that many individuals with mental illness retain full decision-making capacity, and that even when such illness impairs capacity in one area, it may leave capacity unimpaired in others. The study measured four criteria of decision-making capacity — communicating a choice, understanding relevant information, appreciating a situation and its consequences, and reasoning about treatment options — and concluded that nearly one half of the schizophrenic subjects and 76% of the depressed subjects performed in the “adequate” range across all decision-making measures, and a significant portion performed at or above the mean for persons without mental illness.
See Thomas Grisso & Paul Appelbaum, The MacArthur Treatment Competence Study III: Abilities of Patients to Consent to Psychiatric and Medical Treatments, 19 LAW & HUM. BEHAV. 149, 171 (1995).
Paul S. Appelbaum, Assessment of Patients’ Competence to Consent to Treatment, 357 NEW ENG. J. MED. 1834, 1838 (Nov. 1, 2007).
Magnitude of Impairment in Decisional Capacity in People With Schizophrenia Compared to Normal Subjects: An Overview, 32 SCHIZOPHRENIA BULL. 121 (Jan. 2006).
Bruce Winick, The MacArthur Treatment Competence Study: Legal and Therapeutic Implications, 2 PSYCHOL. PUB. POL’Y & L. 137, 158-61 (1996).
Johannes Hamann et al., Patient Participation in Antipsychotic Drug Choice Decisions, 178 PSYCHIATRY RES. 63 (June 2010).
Christine Katsakou, et al., Coercion and Treatment Satisfaction Among Involuntary Patients, 61 PSYCHIATRIC SERVS. 286 (March 2010).
Patient Satisfaction and Administrative Measures as Indicators of the Quality of Mental Health Care, 50 PSYCHIATRIC SERVS. 1053, 1056 (August 1999).
Riittakerttu Kaltiala-Heino, Pekka Laippala and Raimo Salokangas, Impact of Coercion on Treatment Outcome, 20 Int’l J. Law & Psychiatry 311 (Summer 1997).
Francine Cournos, Karen McKinnon and Barbara Stanley, Outcome of Involuntary Medication in A State Hospital System, 148 AM. J. PSYCHIATRY 489 (April 1991).
Paul Appelbaum, Commentary, in MOVING FROM COERCION TO COLLABORATION IN MENTAL HEALTH SERVICES (David Pollack ed., 2004).
Francine Cournos, Karen McKinnon and Carole Adams, A Comparison of Clinical and Judicial Procedures for Reviewing Requests for Involuntary Medication in New York, 39 HOSP. & CMTY. PSYCHIATRY 851, 855 (Aug. 1988).
Irwin Hassenfeld and Barbara Grumet, A Study of the Right to Refuse Treatment, 12 BULL. AM. ACAD. PSYCHIATRY & L. 65, 72 (1984).
Steven Hoge & Thomas Feucht-Haviar, Long-Term, Assenting Patients: Decisional Capacity and the Quality of Care, 23 BULL. AM. ACAD. PSYCHIATRY & L. 343, 349 (1995).
Julie Zito et al., The Treatment Review Panel: A Solution to Treatment Refusal?, 12 BULL. AM. ACAD. PSYCHIATRY & L. 349, 357 (1984).
Tina Minkowitz is one of the Chairpersons of the World Network of Users and Survivors of Psychiatry and a Lawyer.
Tina was extensively involved with the drafting and negotiation of the UN Convention on the Rights of Persons with Disabilities and was one of 12 NGO members on an official working group that produced the first draft text.
Part 1: Human Rights Framework;
Psychiatric Disability; UN Convention on the Rights of Persons with Disability; Legal Capacity.
This interview is from the DVD "Visions" - for further info - www.qldalliance.org.au
International Enforcement of Mental Health Human Rights
The Vienna Declaration reaffirms, people with mental disabilities are protected by the same human rights law that protects all other individuals – including the provisions of binding human rights conventions. International human rights law creates a number of broad protections that provide important rights to people with mental disabilities.
These provisions of human rights conventions affirm the rights of personswith disabilities the following rights:
(1) the right to the highest attainable standard of physical and mental health;
(2) protections against discrimination
(3) protections against torture, inhuman, or degrading treatment;
(4) protections against arbitrary detention.
The major UN conventions, including the ICCPR and the ICESCR, create treaty-based supervisory bodies. Governments that ratify conventions agree to report regularly on the steps that they have taken to implement the convention – through changes in legislation, policy, or practice. Non-governmental organizations can also submit information for review by oversight bodies. Oversight bodies review both the official and non-governmental reports and publish their findings, which may include a determination that governments have not met their international obligations under the convention. The international oversight and reporting process thus provides an opportunity to educate the public about a specialized area of rights. This process can also be a powerful way to pressure governments to realize convention-based rights.
The UN Human Rights Committee was established to monitor the International Covenant on Civil and Political Rights (the ICCPR). Although it has yet to issue a general comment specifically on the rights of people with mental disabilities. It has issued General Comment 18 that defines the protection against discrimination against people with disabilities under article 26.52 In its comments on Article 7, it specifies that the protection against “torture...cruel, inhuman or degrading treatment” applies to “medical institutions, whether public or private.” In order to demonstrate compliance with Article 7, all governments that have ratified the ICCPR: should further address the conditions and procedures for providing medical and particularly psychiatric care. Information should be provided on detention in psychiatric hospitals, on measures taken to prevent abuses in this field, on appeals available to persons interned in a psychiatric institution and on any complaints registered during the reporting period.
"What finally emerges from the 'clear and present danger' cases is a working principle that the substantive evil must be extremely serious and the degree of imminence extremely high before utterances can be punished... It must be taken as a command of the broadest scope that explicit language, read in the context of a liberty-loving society, will allow."
Justice Hugo L. Black
(1886-1971) US Supreme Court Justice
Source: Bridges v. California
"The greatest right of a civilized person is to be left alone, unless he does harm to others or is threatening to do harm to himself."
-- Justice Arthur Joseph Goldberg
"Antipsychotic drugs have both an inherent potential for abuse and an actual history of indiscriminate use by the psychiatric profession. In this respect they are similar to psychosurgery and electroshock therapy, highly invasive treatments which psychiatrists embraced enthusiastically and used indiscriminately — until their tragic effects became publicized and their use was curtailed by legislative, judicial, and scientific pressure. Because many psychiatrists will not heed the warnings in the scientific literature as to the dangers and misuse of neuroleptic drugs, independent and unbiased decision-makers should decide whether orders for forced medication are justified."
Supreme Court Justice, John Roberts in the Amicus Curiae Brief of the American Psychological Association in Support of Respondent at 13-14, Washington v. Harper, 494 U.S. 210 (1990) (No. 88-599).
"Never impose on others what you would not choose for yourself." Confucius
Did You Know?
"Over ninety percent of persons with mental illness have no history of violence. "
Serper, M, Bergman, A. (2003)
Psychotic Violence: Methods, Motives, Madness, Psychosocial Press of Madison, CT.
The Real Truth about Outcomes on Psychiatric Medications
These drugs, over time, produce these results:
a) They increase the likelihood that a person will become chronically ill.
b) They cause a host of debilitating side effects.
c) They lead to early death.
Increased Risk of Suicide in Drug Treated Patients
In the largest study ever done to address suicide in schizophrenia patients it was found:
The widely cited lifetime rate of 10% for suicide in patients with schizophrenia is incorrect for both the pre- and post-community care eras.
The best estimate for the life time rate of suicide in patients with schizophrenia in the pre-community care era is of the order of 1% or less.
Although de-institutionalism is probably the single most important factor in determining suicide rates in patients with schizophrenia, pharmacotherapy appears to contribute to this risk, and is the element of current care that is undermost clinical control.
Healy, D. Harris, M. at el. (2006) Lifetime suicide rates in treated schizophrenia: 1875-1924 and 1994-1998, In Brit J. of Psych, 18, 8, p. 223-228. http://bjp.rcpsych.org/cgi/content/abstract/188/3/223
Increased Risk of Death in Patients taking Neuroleptic drugs
99 people diagnosed schizophrenic for 17 years were studied and it was found that the usage of even one neuroleptic drug increased the risk of dying by 3 fold (35% died). The use of 3 neurleptics increased the risk of dying in 17 years by 7 fold! (57% died)
Joukamaa, M., Heliova, M., Knekt, P. at el, Schizophrenia, neuroleptic medication and mortality, In Bri. J of Psychiatry (2006), 188, P.122-127.
Steve Muccio, executive director of PEOPLe, Inc., a peer-operated program in Upstate New York, describes working without coercion to help people with a mental illness or substance abuse disorder reclaim their lives and their dignities. He appeared at a conference sponsored by The Bridge in New York City, at the Columbia University School of Law, Nov. 20, 2009
Truth about Psychiatric Drugs
Warnings not clearly given to the public:
The drug industry makes it confusing that many psychotropic drugs have different names and different warning labels in different countries and thus what is known about dangerous side effects in one country may not be common knowledge for patients or even prescribing doctors in another country. There is suppression of the research findings of negative outcomes and also suppression of reports of clinical adverse events. There is little adherence to the guidance of the Food and Drug Administration guidelines in these matters, with hospitals and mental health professionals routinely ignoring FDA warning labels and withholding the truth from patients and their families. Even a cursory view of the serious effects of these drugs would make any person be concerned.
The Falicy of Chemical Imbalance
Psychiatry doctors frequently mislead mental health patients. So a few basic facts regarding how these anti-psychotic drugs work is necessary. People with schizophrenia have no known “chemical imbalance” in the brain, antipsychotic drugs cannot be said to work by “balancing” brain chemistry. These drugs are not like “insulin for diabetes” nor are they like vitamins for the brain. Neither do these drugs correct any chemical imbalance and they do not serve as a corrective to a known biological abnormality. Instead, these powerful mind altering medications such as Thorazine or Clopazone and other standard antipsychotics (also known as neuroleptics) work by powerfully blocking dopamine transmission in the brain. The specific action of these drugs is to block 70% to 90% of a particular group of dopamine receptors known as D2 receptors. This prevents normal dopamine transmission. Please remember that low levels of dopamine is what causes Parkinson’s disease.
Informed Consent is a Requirement not a Courtesy
Informed consent is an essential human right which was guaranteed by the
Nuremberg Code and an ethical principle approved by the World Health
Organization, the United Nations and even the US government. This is a
human right that all human beings have under both international law and
under US Constitutional law. Mental health professionals need to honor
the ethical and human rights principle of informed consent. The human
right to have informed consent is a right that even prisoners of war and
convicted felons have and yet mental health patients, who have been
charged with no crime, have been routinely denied this basic human
right. As a third party decision maker, the legal guardian stands for
the human rights of the patient when the patient is incapacitated. The
legal guardian needs to stand firm and insist that he/she be fully
informed regarding all medical treatment choices including the dangers
of all drugs and treatments given.
The right to informed consent is delineated in the federal regulation Protection of Human Subjects, 45 CFR 46 also known as the Common Rule under the authority granted by the U.S. Department of Health and Human Services. The Belmont Report was written concerning the Ethical Principles and Guidelines for the protection of human subjects of research. Since 1945, various codes for the proper and responsible conduct of human experimentation in medical research have been adopted by different organizations. The best known of these codes are the Nuremberg Code of 1947, the Helsinki Declaration of 1964 (revised in 1975), and the 1971 Guidelines (codified into Federal Regulations in 1974) issued by the U.S. Department of Health, Education, and Welfare Codes for the conduct of social and behavioral research have also been adopted, the best known being that of the American Psychological Association, published in 1973.
Respect for persons requires that patients, to the degree that they are capable, be given the opportunity to choose what shall or shall not happen to them. Information about risks should never be withheld for the purpose of eliciting the cooperation of a patient and truthful answers should always be given to direct questions about the treatment and research. But a lack of informed consent is exactly what has happened to many mental health patients. The medical information about these drugs is often conveyed to the legal guardian in a technical, disorganized and rapid fashion and thus there is often not sufficient time to consider the information or to question it. Often there is no substantive discussion with hospital or clinic staffs in which the views of the patient and the legal guardian were honored and listened to; instead patients are often ignored as if they did not have any rights to express their dislike for medications or treatment options. There is often no voluntary agreement to participate in research thus there was no valid consent. Informed consent requires conditions free of coercion and undue influence and it is clear that while incarcerated in a locked psychiatric hospital ward there is the use of coercion. There can also be the use of undue influence by the court appointed attorney through offers of inappropriate or improper reward in order to obtain compliance vulnerable patients. The doctor in his/her position of authority who can exert a commanding influence and who can threaten sanctions can easily force patients to take drugs against their consent.
Involuntary Drugging Violates Due Process Rights
Due process rights are not be adequately protected and violations of contemporary standards of due process occur because:
(a) the forcible medication of patients who are competent to make medical decisions is allowed;
(b) the forcible medication of patients occurs without a finding that the patients would pose a danger to themselves or others without medication;
(c) there is no legal representation provided to the patient;
(d) there is no truly independent psychiatric examination of patients who refuse medication;
(e) there is no notice provided to the patient;
(f) there is no right to confrontation;
(g) there is no decision by an impartial decision-maker who is independent of the hospital and Defendants’ supervision;
(h) there is no limit to the length of time a patient can be forcibly medicated;
(i) there is no requirement limiting the type or dosage of medication with which a patient can be forcibly drugged;
(j) there is no meaningful review of involuntary medication decisions; and
(k) patients have no realistic means of appealing involuntary medication decisions
Antipsychotics Increase Chonicity of Psychosis
There have been several research studies that actually prove that these medications do not provide long term positive effects even though they may initially decrease or curb psychosis over the short term. But positive effects did not lapse and a year later, patient on these antipsychotics actually relapsed and made patients more psychotic over the long term. ( Schooler, N, et al. “One year after discharge: community adjustment of schizophrenic patients.” American Journal of Psychiatry 123 (1967):986-95.) The NIMH conducted three different studies that compared antipsychotic treatment with “environmental” care that minimized use of the drugs. In each instance, patients treated without drugs did better over the long term than those treated in a conventional manner. Rappaport, M, et al. (1978), Carpenter, W., et al. (1977) and Bola J, et al (2003). In addition in the Guy Chouinard and Barry Jones’ research study (1978 and 1980) they tested the theory that the reason for this relapse when patients are put on year long antipsychotics, was that the brain responds to neuroleptics and their blocking of dopamine receptors as though they are a pathological insult. To compensate, dopaminergic brain cells increase the density of their D2 receptors by 40% or more. As a result now the brain is “supersensitive” to dopamine, and as a result, the person has become more biologically vulnerable to psychosis than he or she would be naturally. So neuroleptics can produce a dopamine supersensitivity that leads to both dyskinetic and psychotic symptoms. Thus the outcome of treatment with an antipsychotic drug would increase the possibility of dopamine supersentivity and thus predispose the patient to psychosis more than just the normal course of the illness.
50% of Schizophrenics do fairly well without drugs
“Every chronic schizophrenic outpatient maintained on an antipsychotic medication should have the benefit of an adequate trial without drugs.”
Jonathan Cole, Maintenance antipsychotic therapy. Is the cure worse than the disease? Am. J. Psychiatry (1977): 133:32-6.
"Our greatest glory is not in never falling, but in getting up every time we do."
Effects of Psychiatric Drugs
These psychiatric drugs are not of small risk but instead cause massive changes in the way the brain functions. Long term studies have indicated that there are severe debilitating and sometimes fatal effects of these drugs. Possible negative effects were minimized or not even discussed at all. There are risks of long term psychological harm, physical harm, social harm and economic harm. Many of these drugs cause symptoms that can themselves be construed as mental illness.The probability of developing Parkinsons’ like symptoms is also great.
NIDS - Neuroleptic Induced Deficit Syndrome:
Neuroleptic Induced Deficit Syndrome (NIDS) can be caused by these
medications which change in emotional awareness, sense of aliveness, and
in the speed, and clarity of thought. The treatment effects felt by
many people who have taken these medications are described as feeling
like a zombie. Neuroleptic effect is present when the following
features are observed:
1. Psychomotor Retardation – motor slowing, body not moving so well
2. Emotional indifference - not being emotionally responsive / not caring
3. Reduced initiative – not showing interest in initiating activity
4. Slowing of thought
As the dose of the medication increases, and more time elapses, it appears that the effects change – from sedative effects, into anti-psychotic effects, and possibly into other less desirable side effects; akathisia (restless leg syndrome), emotional parkinsonism (emotional blunting) and on into some other unwanted side effects. It is not uncommon when the first symptoms appear like apathy, emotional indifference, motor slowing or slow mentation that these were attributed to the underlying condition of the patient (the patient’s disease) when really they are the effects of the medication itself. A patient on these medications can initially demonstrate an improvement in symptoms only to later over time have that initial improvement go away or to only reach a certain point and then plateau or level off. There is also one more important one effect: neuroleptic dysphoria – which is like depression. When this happens when patients are often given even higher dosages of the drugs, leading to even more severe effects.
Many of the symptoms that are used to justify hospital treatment may actually be caused by the psychiatric medications given. So continuation of these medications only creates a self-filling prophecy that furthers the financial goals of the hospital institution and may cause further permanent brain damage.
Risk of Parkinson's symptoms
Many patients who take psychiatric drugs also develop Parkinsonian side effects - about 40-50% (or more) experience Parkinsonian symptoms. Julia Child, a very famous cook over in the US and the actor Michael J Fox are both famous victims of severe Parkinson’s disease. In Parkinson’s disease people lose these dopamine cells in the substantia nigra area of the brain. With antipsychotic medication, we’re not killing off those cells but we are affecting how they function and so Parkinson’s symptoms do occur in a fairly high rate of patients.
"Experience should teach us to be most on our guard to protect liberty when the Government's purposes are beneficent. Men born to freedom are naturally alert to repel invasion of their liberty by evil-minded rulers. The greatest dangers to liberty lurk in insidious encroachment by men of zeal, well-meaning but without understanding."
Justice Louis D. Brandeis
US Supreme Court Justice 1928
Source: Dissenting, Olmstead v. United States, 277 US 479 (1928)
Therapeutic Drug Dependence - Neuroleptic Withdrawal Syndrome
Therapeutic drug dependence occurs with psychiatric drugs. Although these drugs produce no tolerance and no euphoria, they produce enduring post-discontinuation changes that are as extensive and long lasting as the changes underpinning current disease models of addiction. Patients also get withdrawal or discontinuation syndromes when they stop taking their medication or when their medication is lowered in dose. When anti-depressant or anti-psychotic medications have been in the brain for a while and then the dose is suddenly lowered, or if the medication is taken away too quickly there is a reaction to that change called Neuroleptic Discontinuation Syndrome. So when a patient runs out of medication or is suddenly put on a lower dosage they can demonstrate exacerbations of psychosis, become delusional or even hallucinate. Seizures can also occur from rapid withdrawal from these psychiatric medications.
The danger of withdrawal from antidepressants and antipsychotics is well documented. The brain compensates for the blockage of the serotonin and dopamine receptors by growing additional receptors for these neurotransmitters. When the medications are discontinued or suddenly decreased, these additional receptors contribute to 'overload' of serotonin and dopamine flooding the receptor. This is known as distcontinuation syndrome.
What usually happens to the patient in withdrawal is that they end up back in the hospital again. These crisis admissions lead to being labeled with a new disease diagnosis – schizophrenia, or delusional or manic depressive and then placed on even greater dosages of even more dangerous drugs. The doctors in these instances are quick to blame the patient, for a relapse rather than considering when the patient last took his medication. Discontinuation syndrome can sometimes last for weeks or months - some people have said they can last as long as six months.
Risks of Psychiatric Medications
Adverse Effects of Atypical Anti-psychotics:
The so-called “atypical” antipsychotics are neither “atypical” nor “antipsychotic.” Not infrequently, these chemicals induce or enhance bizarre statements (disorganized speech or delusions), social withdrawal (depression), and sedation (encephalopathy), regardless of dose. The processes through which these medications exert destabilizing effects include receptor blockade (D2, ACH, histamine), electrophysiological (depolarization) blockade; direct toxicity (cell death); and induction of other disease processes (pneumonia, diabetes, hypothyroidism, PE). Unfortunately many prescribing clinicians are largely unaware of these problems and thus do not inform their patients.
Numerous psychiatric medications are dangerous and even life threatening adverse effects including: weight gain and diabetes, tardive dyskinesia (movement disorder), tremor, akathisia (restless leg syndrome), dyskinesia (uncontrollable movements, tics, tremors), dystonia, as well as the side effects of nausea, dizziness (low blood pressure), and insomnia. Dystonia is a neurological movement disorder, in which sustained muscle contractions cause twisting and repetitive movements or abnormal postures. It is painful to even watch a video of someone with dyskinesia or dystonia. The doctors when prescribing these medications tell patients and their families just to disregard these potentially life threatening and life altering side effects.
Many of these drugs cause symptoms that can themselves be construed as mental illness. One drug Abilify or Aripiprazole, is known to cause neurological side effects, gastrointestinal signs, movement disorders, disturbances in thinking, anxiety disorders, sleep disorders and even suicidal behavior. These are the actually side effects of the drug – yet when these symptoms occur they are attributed often to what they claim is the medical diagnosis. Doctors reported to the FDA that their patients had hallucinations, psychosis, heart rate, diabetes, cardiac problems, liver dysfunction, coma, and blood coagulation problems while on Abilify. Even a very cursory review of the FDA warnings and listing of adverse side effects would cause any responsible legal guardian to reconsider the use of these drugs on a loved one.
Psychiatric Drugs cause Parkinson's Effects:
Many patients who take these drugs also develop Parkinsonian side effects about 40-50% (or more) experience Parkinsonian symptoms. Julia Child, a very famous cook over in the US and the actor Michael J Fox are both famous victims of severe Parkinson’s disease. In Parkinson’s disease people lose these dopamine cells in the substantia nigra area of the brain. With antipsychotic medication, there is not actually death of brain cells but the drug does affect how the brain cells function. So Parkinson’s symptoms do occur in a fairly high rate of patients.
Fatal Blood Problems:
The antipsychotic Clozapine can cause fatal blood problems as well as other side effects of serious concern. Clozaril (clozapine) is a drug which was known to be associated with fatal cases of aplastic anemia which causes low white blood cell counts and predisposes patients to infections. Clozapine has also been linked to high blood sugar and diabetes. Doctors are supposed to watch for unexplained fever, fatigue and low energy levels in patients taking Clozaril. Clozaril has been strongly associated with possible fatal heart problems. [Presto v. Sandoz, 226 Ga. App. 547 (1997)].
Saphris or asenapine by Merck:
A new drug recently put on the market is Saphris or asenapine by Merck. Saphris like other atypical antipsychotic drugs is known to increase mortality. This drug causes very serious side effects including the permanent and totally disabling disorder called Neuroleptic Malignant Syndrome, and also Tardive Dyskinesia, Hyperglycemia and Diabetes Mellitus, Weight Gain, Hypersensitivity Reactions, Orthostatic Hypotension and Syncope (fainting), Leukopenia, Neutropenia, and Agranulocytosis (white blood cell problems), QT Prolongation: (heart rhythm problems), Seizures: Potential for Cognitive and Motor Impairment and Suicide (a mother’s worst nightmare). Adverse reactions to the drug Saphris include causing akathisia (restless leg syndrome, unpleasant sensations of inner restlessness that manifests itself with an inability to sit still or remain motionless) oral hypoesthesia (loss of sensation in the mouth causes difficulty in eating and talking), somnolence (sleepiness) and dizziness.
Risks of Using Combinations of Drugs
Mental health professionals have an ethical duty to inform parents about the potential lethality of drug combinations as well as adverse effects of individual drugs. Yet some psychiatric drugs actually are combinations of drugs. As a medication for ADHD, Adderall was approved for unrestricted use for treatment of ADHD by the FDA in March 1996. Adderall is a combination of stimulants (a combination of dextroamphetamine and amphetamine). In 2005 Adderall XR was pulled off the market in Canada after regulators linked the drug to 20 sudden deaths and 12 strokes. Fourteen of the deaths and two of the 12 strokes were in children. According to Canadian researchers the adverse reactions were not associated with overdose, misuse or abuse of Adderall XR. The effects of amphetamines and methamphetamine are similar to cocaine, but their onset is slower and their duration is longer. (U.S. Drug Enforcement Administration (DEA) fact sheet).
Stimulants are designed to enhance dopamine transmission. Atypical antipsychotics are intended to block it. Mental health professionals have an ethical duty to inform parents about the potential lethality of drug combinations as well as adverse effects of individual drugs such as the combination of both an antipsychotic with a stimulant. The use of stimulant plus atypical antipsychotic places the patient at risk of sudden death due to stroke or dysrhythmia (heart arrhythmia); neuroleptic malignant syndrome; tardive phenomena (irreversible movement abnormalities of face, tongue, neck, limbs, trunk); and diabetes. In one sense, the pharmacodynamic effects of stimulants plus antipsychotics would be expected to oppose each other. In another sense, the brain’s adaptations to each class of medication might be synergistic. This enhances the risk of movement abnormalities, dysphoria (an emotional condition in which a person experiences intense feelings of depression and discontent) , and psychosis. There are neurotoxic effects of use of stimulants and antipsychotics together; the dangers include the inhibition of neurogenesis and the induction of neurodegenerative changes. In other words, they prevent the healing process and can cause permanent brain damage and dysfunction.
Violence and SSRI use for PTSD and other mental conditions
No type of antidepressant is helpful in every clinical case or even indicated. These drugs can actually make the situation worse. As a class of drugs SSRIs can create a unique combination of side effects that may severely impair judgment and impulse control in individual patients. Excessive doses of antidepressants can cause brain dysfunctions including disorientation, confusion, and cognitive disturbances. In combat veterans suffering PTSD, impulsive behavior, especially if coupled with impaired cognitive functioning, can be dangerous. Antidepressants can also trigger similar, manic-like symptoms in people whose depression is part of a manic-depressive syndrome, which often gets overlooked when people are given SSRIs. Is public safety enhanced when “patients” are given SSRI’s and are persons on SSRI’s less likely to do gun violence? The pharmaceutical corporations would lead you to believe that a person taking these drugs is less likely to commit suicide and less likely to do gun violence to others. But is that really true?
Recent cases of mass violence such as the Joseph Wesbecker in Virginia that shot his co-workers, the Virginia Tech murders, the Columbine Shootings, and the shootings at Fort Hood, all point to the fact that anti-depressant and SSRI medication are dangerous to the public. These medications can cause homicidal thinking which results in public violence and also in suicides. The pharmaceutical industry wants to use the returning veterans as a huge potential pharmaceutical drug customer base. All veterans are trained to use weapons and often have weapons easily at hand. With Post Traumatic Stress a major problem in the returning troops, we have a social problem to deal with their mental health needs. With the US government picking up the tab, the pharmaceutical companies are lobbying heavily to increase their expected profits from the sales of drugs for Post Traumatic Stress Disorder (PTSD) sufferers. The huge numbers of returning veterans are a prime target of their sales efforts. Big Pharma pours lots of money into the political campaigns of those who support their agenda. These huge pharmaceutical companies have persons on the President's New Freedom Commission on Mental Health that are pushing to do wholesale marketing of selective serotonin reuptake inhibitors (SSRI's) and other mind altering drugs to veterans with PTSD. The constantly expanding prison population is another target for the SSRI drug marketing and especially those prisoners facing re-entry and who will soon have Medicaid/Medicare to pay their pharmaceutical bills.
When SSRI antidepressants such as Prozac, Paxil and Zoloft were first introduced in the late 1980's and early 1990's there were reports of increasing violent behavior including suicide and homicide. There were in 2003 reports by British authorities and the U.S. Food and Drug Administration about unpublished studies showing an increased risk of suicide in children and teenagers taking Paxil. Prior reports of suicidal and homicidal acts in adults taking SSRIs have been minimized by the pharmaceutical company defenders and mainstream doctors, who claim that suicide is common in depression anyway.
The recent violence Nov. 5, 2009 at Fort Hood in Texas in which a military psychiatrist shot and killed 13 people and wounded 30 others gives us good reason to reconsider these psychiatric drug treatments for military personnel and veterans. This incident reminded me of the Northern Illinois University mass shootings where former grad student Stephen Kazmierczak killed 5 students and wounding dozens of others before committing suicide himself. This gunman had been taking the drug Paxil prior to his mass killings. The drug manufacturer had been deliberately withholding information about violent behavior as an adverse effect of the medication. Now the drug Paxil carries a black box warning about homicide and suicide. On Sept 14, 2004, an FDA panel voted 18 to 5 to require manufacturers of all antidepressants to add black box warnings to their product labeling. A month later, the FDA adopted the panel's recommendations.
The warning reads in part: "Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents with Major Depressive Disorder (MDD) and other psychiatric disorders. Anyone considering the use of [Drug Name] or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Patients who are started on therapy should be observed closely for clinical worsening, suicidality, or unusual changes in behavior."
The warning specifically links antidepressant use to suicidal behavior in four percent of kids on these drugs compared to two percent for kids on placebos.
Psycho-social treatment has better outcomes
A 11 month study compared typical hospital treatment with pure psychological treatment, noting the most severe cases went to the psychological treatment without medication. Results were no suicide attempts, elopements or other significant acts of violence in the psycho-social treatment group; however, typical hospital drug group with a higher staffed ward had 3 suicides.
Diekman, A., and Whitaker, L. (1979). "Humanizing the Psychotherapy ward: Changing
from drugs to psychotherapy." Psychotherapy: Theory, Research, and Practice. 16
Culturally Appropriate Community Supports for Mental Patients
The patient’s faith belief should be honored with what would be
considered to be culturally appropriate alternatives to the medical and
biochemical approaches to treatment. There should also be an effort to
provide appropriate peer support or other alternatives to the
traditional mental health system.
Psychotherapy is preferable to psychopharmacological treatment, and in many studies it has shown to be more effective than drugs (especially for PTSD) without the potentially troublesome and dangerous side effects. There are proven psychosocial techniques for modifying inappropriate behavior or speech. Mind/body connecting/focusing activities can be helpful. It is valuable to “make contact” with individuals who are unresponsive to usual forms of communication. Also, the mere act of “being with” a person who is experiencing profound emotional distress can provide great solace. [See Dan Dorman’s book, Dante’s Cure, for a real-life story of a woman who made a complete recovery from psychosis, and how that journey occurred.]
People labeled with psychiatric disabilities should be able to select from a menu of independently available services and programs, including mental health services, housing, vocational training, and job placement, and should be free to reject any service or program. Mental health treatment should be about healing, not punishment. Accordingly, the use of aversive treatments, including physical and chemical restraints, seclusion, and similar techniques that restrict freedom of movement, should be banned. Moreover, in part in response to the Supreme Court's decision in Olmstead v. L C., state and federal governments should work with people labeled with psychiatric disabilities and others receiving publicly-funded care in institutions to expand culturally appropriate home- and community-based supports so that people are able to leave institutional care and, if they choose, access an effective, flexible, consumer/survivor-driven system of supports and services in the community.
News Stories on Integration into the Community
Press Releases by Brazelon Center
Judge Grants Enormous Victory for New York Adult Home Residents; Orders State to Provide Supported Housing for All Qualified Residents Who Want It (3/1/10)
Disability Groups Win Landmark Case Affirming Rights of People with Mental Disabilities in State-Funded Adult Homes (9/8/09)
Federal Court Upholds Rights of People with Mental Illnesses in Adult Homes (2/19/09)
Lawsuit Seeks Community Integration for Thousands of New Yorkers with Mental Illnesses (7/1/03)
Judge: Mentally Ill Should Move Homes to Neighborhoods, ABC News, (3/4/10)
Judge Orders New York City to Move Mentally Ill Out of Large, Institutional Housing, The New York Times (3/1/10)
Judge Orders Out Mentally Disabled Residents of Adult Homes, If They Want To Live On Their Own, New York Daily News (3/1/10)
Federal Judge Rules NY Violated Americans with Disabilities Act in Housing Mentally Ill, AP (9/8/09)
State Discriminated Against Mentally Ill, Judge Ruled, New York Times (9/8/09)
Press Releases in Illinois
Federal Court Asked to End Isolation of Illinois Residents with Mental Illnesses (4/23/06)
Federal Court Advances Challenge to Illinois Policy Warehousing Residents with Mental Illnesses (11/20/06)
Historic Agreement Reached to Transition Illinois Residents Unnecessarily Housed in Large, Dehumanizing Nursing Homes (3/15/10)
Press Releases by Brazelon Center
Lawsuit Challenges Unwarranted Confinement of People with Mental Illnesses in Connecticut Nursing Homes (2/6/06)
Statement from Bazelon Attorney (2/14/06)
Judge Denies Connecticut’s Request to Dismiss Charges that It Unnecessarily Warehouses People with Mental Illnesses in Nursing Homes, Violating Federal Law (4/1/10)
Thousands with Disabilities Locked Away in Nursing Homes, The [New London] Day (12/19/04)
Many Mentally Ill in State Are Housed Without Proper Care, The [New London] Day (8/7/05)
Civil Rights Agency Probes State's Handling of Mentally Ill, The [New London] Day (12/4/05)
Group Probes Mentally Ill in Nursing Homes, Associated Press (12/4/05)
Mental Health Care Probed: Rights Group Questions State's Placement System, Hartford Courant (12/5/05)
Lawsuit Seeks End to Warehousing of Psychiatric Patients, WFSB-Eyewitness News(2-7-06)
Firm Willing to Talk with State about Lawsuit, The [New London] Day (2/15/06)
Rell Urged to Change Policies for Mentally Ill, Hartford Courant (2/15/06)
Mental Health Policy Costs State Medicaid Funds, Hartford Courant (5/3/08)
Media in Illinois
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Reference on effects of psychiatric medications:
Dr. Grace E. Jackson MD ‘What Doctors May Not Tell You About Psychiatric Drugs’ Public Lecture, UCE Birmingham June 2004
Reference on Iatrogensis:
Weingart SN, Ship AN, Aronson MD (2000). "Confidential clinician-reported surveillance of adverse events among medical inpatients". J Gen Intern Med 15 (7): 470–7. doi:10.1046/j.1525-1497.2000.06269.x. PMC 1495482. PMID 10940133.)
References on Tardive dyskinesia:
Breggin, Peter R., M.D. (2001), Tardive Dyskinesia Legal Settlement, Breggin.com
Brašić, James Robert, MD; Bronson, Brian, MD (21 January 2010), Tardive Dyskinesia: Treatment & Medication
Crane, George E. (Sep 1973a), "Is tardive dyskinesia a drug effect?", AJP (American Psychiatric Association: American Journal of Psychiatry) vol.130 (no.9): 1043–4, ISSN 0002-953X, OCLC 104768868, PMID 4727768
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Fernandez, Hubert H., MD; Friedman, Joseph H., MD (Jan 2003), "Classification and Treatment of Tardive Syndromes", Neurologist (Baltimore US-MD: Williams & Wilkins: The Neurologist) vol.9 (no.1): 16–27, doi:10.1097/01.nrl.0000038585.58012.97, ISSN 1074-7931, OCLC 111183504, PMID 12801428
Glazer, William M.; Morgenstern, Hal; Doucette, John T. (Apr 1993), "Predicting the Long-Term Risk of Tardive Dyskinesia in Outpatients Maintained on Neuroleptic Medications" JCP (Memphis US-TN: Physicians Postgraduate Press: Journal of Clinical Psychiatry) vol.54 (no.4): 133–9, ISSN 0160-6689, OCLC 119262955, PMID 8098030
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Libby Zion Law - Serotonin Syndrome - Medical Error
1. Philibert I.; Friedmann P.; Williams W. T.; for the members of the ACGME Work Group on Resident Duty Hours (2002). "New Requirements for Resident Duty Hours". Journal of the American Medical Association 288 (9): 1112–1114. doi:10.1001/jama.288.9.1112. PMID 12204081. edit
2. Zion, Sidney (December 18, 1997). "Hospitals Flout My Daughter's Law". New York Daily News. Retrieved 2009-02-13. "After it became clear to everybody, including a New York County grand jury, that Libby's death was caused by overworked and unsupervised interns and residents, the Libby Zion law was passed: No more 36-hour shifts for interns and residents; from now on, attending physicians would be at the ready to supervise the young, inexperienced student-doctors."
3. Fox, Margalit (March 5, 2005). "Elsa Zion, 70. Helped Cut Doctor Workloads.". New York Times.
4. Jane Ellen Brody (February 27, 2007). "A Mix of Medicines That Can Be Lethal". New York Times.
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11. Hoffman, Jan (February 7, 1995). "Jurors Find Shared Blame In '84 Death". New York Times.
SSRI's and Suicidality and Violence
The Kauffman SSRI Study:
Joel M. Kauffman, Ph.D., professor of chemistry emeritus at the University of the Sciences, 600 S. 43rd St., Philadelphia, PA 19104-4495,
Journal of American Physicians and Surgeons Volume 14 Number 1 Spring 2009 11
Potential conflicts of interest: The author has neither a financial interest in any drug mentioned, nor in any alternate treatments for treating any mentalillness.
Richard DeGrandpre. The Cult of Pharmacology: How America Became the World’s Most Troubled Drug Culture
Durham, N.C.: Duke UniversityPress; 2006.
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Medical Whistleblower Advocacy Network
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"Never impose on others what you would not choose for yourself." Confucius
"It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat."
Roosevelt- Excerpt from the speech "Citizenship In A Republic",
delivered at the Sorbonne, in Paris, France on 23 April, 1910