The Anti-Psychiatry movement and the Trump Administration
I have worked in the mental health field for nearly 2 decades and most of that time has been dedicated to working with people living with “severe and persistent mental illness”, as illnesses like schizophrenia, bipolar disorder, and severe depression have been called.
For 6 years, I was a therapist at the Johns Hopkins Bayview Schizophrenia Clinics, first as the Early Psychosis Intervention Clinic therapist and then as a therapist in the Adult Schizophrenia Clinic. I loved this work and loved the clients. In fact, I left for private practice only because I was no longer able to keep up with the heavy administrative burden that comes with clinic work. As many clinicians I have spoken to over the years agreed, “It’s the paperwork, not the patients, that burn us out”.
The point is, I have worked with patients with extreme mental illness, folks so psychotic that they were totally disconnected from reality, totally unable to care for themselves, truly in a state of extended, seemingly endless torment. Unless you have been close to someone suffering from a psychotic episode, it’s hard to understand the depth of suffering, both for the individual and their loved ones.
I have worked closely with wonderful people who had fallen into depression so deep and dark that unthinkable things happened to them. I have had so many appointments with clients where I was seeing them for the first visit after yet another hospitalization, helping them try to get stabilized and begin to rebuild after another terrifying mental illness episode, dealing with disruptions in work, relationships and even involvement with law enforcement. I have worked with people who later died because of behavior related to their illness. A young patient got so upset and scared when they misinterpreted something that happened in the clinic they became dysregulated and ended up with a pile of police and security guards on top of them. They were repeatedly sedated and hospitalized. To this day, that one still chokes me up.
To sum up, I have seen some things. I have witnessed. I have stood by my patients and their families and did anything possible to support them. Sometimes, it wasn’t enough. But we tried. The major thing that tended to make the difference in whether someone got better was taking meds as prescribed and actively working with their prescriber to assess effectiveness and side effects and make changes carefully. That and not smoking marijuana, but that is a story for a different post. (Marijuana increases psychosis in vulnerable people, this is a hill I will die on.)
I KNOW that psychiatric medication saves lives and make lives worth living. I’m a big advocate for a particular drug called clozapine, which is an anti-psychotic medication that for some desperately ill people is literally a life saver. There’s a great story about some mothers who were so fed up with the difficulty accessing this medicine – lots of roadblocks and complications for reasons I won’t go into – that they held a “die-in” at the FDA headquarters. Due to their fearless and relentless advocacy they succeeded in getting some of the roadblocks removed. I think of these family members and of the patients I worked with who were able to recover from treatment-resistant schizophrenia and chronic suicidality.
It’s true that antipsychotic medications have a lot of side effects, including metabolic impacts, weight gain, flattened emotional range. Many folks don’t like the way they feel when taking them but again, working with a provider to find the best medication protocol can make the side effects bearable and keep people well (and out of the hospital). They are best administered as part of a comprehensive treatment protocol that includes all the supportive strategies.
Are certain types of meds over-prescribed? Sure. Benzodiazepines (Ativan, Klonopin etc) and Ambien come to mind. Are some patients not thoroughly educated on side-effects, drug interactions and withdrawal issues? Yes, and as a field we need to do better. Do some prescribers give titration schedules that are too quick when a patient is coming off a medication? Sure, unfortunately. Are there meds that are meant for short term use that end up being prescribed long term? Yes. Are there meds that are approved and in widespread use despite minimal research proving that they are more effective than placebo? Yeah, although that doesn’t necessarily mean they don’t work.
One of my frustrations in clinic work was that, due to our healthcare system and the fee-for-service model, we could offer patients medication and some rehab services because those were billable to insurance. But we really could not offer a more holistic range of services that would include safe housing, education and resources for better nutrition, access to positive social experiences.
Many people depressed and anxious because we are living in grim and uncertain times where many folks are priced out of a decent standard of living no matter how hard they work. Are people disconnected and missing community? Do most of us need more fresh air and sunshine? Are people horrified by the news and feeling helpless? Sure to all of these.
I believe we need a more just and humane society in which the many stresses that render modern life difficult are reduced and the focus of society is on wellness and community, where folks are not terrified that a job layoff will mean no medical care at all for themselves or family.
However, the MAHA (Make America Healthy Again) movement, whose champion RFK Jr is unfortunately our Secretary of Health and Human Services, is trying to disrupt belief in psychiatry field in general and psychiatric medications in particular.
RFK Jr. has stupidly stated that anti-depressant medications are harder to come off of than heroin. While some people do have a horrible experience coming off antidepressant medications, especially abruptly, many do so with no problems at all. I don’t think anyone addicted to heroin has simply stopped abruptly with no withdrawal or relapse.
It appears, from statements he has made, that SSRIs (serotonin re-uptake inhibitors, a popular class of antidepressant) are just the tip of the spear and he intends to come after all psychiatric medications (antipsychotics are targeted for their side effects, especially weight gain because being overweight is seen as a moral failure to MAHA). This is wrongheaded, cruel and dangerous.
It’s discriminatory to genuinely disabled people who need psychiatric medications to live decent lives. In our current system, many severely mentally ill people go untreated and end up in jail and prison and often have co-occurring substance abuse problems.
It’s important to note that mental distress in our society is very related to social problems such as financial stress related to rising prices for everything including food and housing, unpredictable violence, having to navigate complex and dysfunctional systems for getting needs met, failing social safety nets, the frightening 24 hour news environment, etc. I could certainly go on. I routinely treat clients with diagnosable Post-Traumatic Stress Disorder caused solely by the toxicity of their workplace. Taking away people’s access to medications is not going to solve the problems that are leading to widespread distress and hopelessness. MAHA is not the answer to our mental heath crisis. Shaming people who are barely surviving for not eating enough organic food or not working out enough is not helping.
When working with patients with severe mental illness, one of the battles I frequently had to fight was the patient’s family members and significant others who objected to the patient taking psychiatric medications for various, mostly ill-informed, reasons.
I worry that the MAHA attack on psychiatry is in fact an attack on those with mental health struggles as less-worthy members of our society, and I strongly object to that.
All posts are written by Kathryn, no AI.