A Perspective on Suicide

“Some days you will be the light for others and some days you will need some light from them. As long as there is light, there is hope and there is a way” Jennifer Gayle

Caring_for_myself

I am not sure what the solution is to the tragedy of suicide. People need to feel that are loved and belong, including working on loving themselves. They also need to feel their life has meaning and a purpose. Viktor Frankl, a holocaust survivor, writes about this in his book Man’s Search for Meaning [1, 2].

There are nearly always reasons for living, no matter how bad things feel. It is important that we give encouragement to others in our family and community [3]. Over the last number of years I’ve met some people who saw themselves as well meaning, giving all sorts of judgements and “insights” into my life. As well as criticism. Without any empathy or understanding about my life journey. This led to feelings of frustration and discouragement. Listening non-judgmentally would have been a lot more helpful.

For over 3 years I was prescribed the anti-depressant Citalopram to help with anxiety and panic (until August 2008). I now suffer from a condition called Tardive Dysphoria which I strongly believe is connected to taking prescribed psychotropic drugs in the past. Medical journalist Robert Whitaker has written about this [4]. I am a lot more prone to suicidal ideation since these drugs than before taking them. While some people may feel they have benefited from anti-depressants, for others they have caused major problems.

In the US these drugs have a black box warning due to the increased risk of suicide in younger people, especially when starting, stopping or changing the dosage [5]. Anti-depressants are way over-prescribed. They are very powerful, mind altering drugs.

In suicidal mode the idea that all the pain will end might feel good at the time, but whatever emotional pain a person is going through will pass. It is important to reach out to someone, even if they don’t feel like doing that at the time. I once heard a man who has been through suicidal thoughts say that he did not want to pass his pain onto other people. When someone takes their own life it is devastating for those in this person’s circle i.e. family, friends and the community.

There is probably a reason or something causing their distress. Maybe a multitude of things that seem to be going wrong at the same time. It is easy to get overwhelmed and to go into a state of shock/high anxiety when faced with what seem like unsolvable problems e.g. worrying about a mortgage.

If people feel suicidal they shouldn’t be afraid to discuss how they feel with someone they can trust, a helpline, the Samaritans (116 123) or a private therapist. If a person has a problem, there is nearly always a solution. Sometimes the advice of others is necessary, as the person may feel they are in a fog and cannot think clearly or see any solutions.

As a society and community we need to be more supportive of each other. People may need to look at lifestyle e.g. alcohol, nutrition, stress and the various aspects of their life. If doctors were to take a more Psycho-social approach, as opposed to a biomedical approach, I do believe we may see some progress. Or maybe those in distress need an alternative to going to the busy GP surgery that is dealing with such a wide range of medical problems.

A number of years ago, in a documentary that covered suicide, I heard a doctor say that if someone takes an overdose of medication, they can end up alive and brain damaged. Probably worse off that before the overdose. Knowing this may deter a person from taking an overdose. While not being judgemental of a person in a very distressed state, drowning in the sea, lakes, canals or rivers is also a bad idea. A person can end up missing for weeks, causing even more distress to their family, friends and those that care about the person in their community. Not forgetting the huge level of dedication, effort and time that can go into searching for the the body, sometimes in very cold, risky, dangerous and difficult conditions. From listening to a friend who volunteers with sub aqua search and rescue/recovery, the body can end up in a bad state.


ASIST (Applied Suicide Intervention Skills Training)

One of the things that has helped me in dealing with suicidal thoughts, while also giving me the skills to be able to help others, is ASIST. Applied Suicide Intervention Skills Training is a

“two-day interactive workshop in suicide first-aid. It is suitable for all kinds of caregivers … people responding to family, friends and co-workers. ASIST trains participants to reduce the immediate risk of suicide and increase the support for a person at risk. It helps them seek a shared understanding of reasons for suicide and reasons for living.

The workshop provides opportunities to learn what a person at risk may need from others in order to keep safe and get more help. It encourages honest, open and direct talk about suicide as part of preparing people to provide suicide first aid. Participants also consider how personal attitudes and experiences might affect their helping role with a person at risk” [6, 7].

Suicides Rise Dramatically with Increasing Psychiatric Care

While some people may have had a positive experience with the mental health system, I feel that it wasn’t a suitable place for me. I was never told at the time that my symptoms could be caused by anti-depressants. An ambulance and police arrived at my house with my family and I was locked away for 3 weeks. I had not harmed myself of others and had no intention to do so. I do feel that Psychiatric intervention harmed me as opposed to helped. The only aspect that did help was Occupational therapy and the therapist Orla who got me into a course with the National Learning Network and into a work placement, one year on from my nightmare with the system.

Danish studies has been done on the link between Psychiatric care and suicide. Extract from this article [8] ~ As the amount of involvement that people have with Psychiatric professionals and Psychiatric care increases, the likelihood that they will commit suicide rises steadily and dramatically, according to a study in Social Psychiatry and Psychiatric Epidemiology. Taking Psychiatric medications makes people nearly 6 times more likely to kill themselves, while having spent time in the previous year in a Psychiatric hospital makes them over 44 times more likely to kill themselves … an accompanying editorial suggested the findings more likely showed that “Psychiatric care might, at least in part, cause suicide.”

I am hoping that coroners will keep an accurate record of what prescribed medication that the person may have been on at the time they died. Whether they had recently started to take Psychoactive medication e.g. anti-depressants or stopped taking such medication. It appears that sometimes this information can be overlooked. As many deaths are not recorded as suicide, we do not have an accurate picture of the number of people in this country that take their own lives every year.

Be_kind_to_yourself

Wellness Recovery Action Plan (WRAP)

A few years ago I got to do WRAP training with the charity Suicide or Survive. This training combined with ASIST has helped build up my resilience which I need to face into each new day and week. Having a WRAP plan in place can help a person who is experiencing emotional distress to stay well and to move forward. The 5 key concepts in WRAP are: Hope, Personal Responsibility, Education, Self-advocacy (standing up for yourself) and Support [9, 10].

A WRAP plan has sections on Triggers, a Wellness Toolbox, Daily Maintenance Plan, Early Warning Signs, When things are Breaking down, Crisis Plan and Post Crisis Planning.

WRAP can help the person identify triggers (events and/or reactions to people that can make their symptoms worse) and also to list activities that can help the person feel better. It may also be important for the person to write a crisis plan, so that if the person finds themselves in a crisis it has been outlined what their wishes are.

It is vital to establish who is there to support a person in their recovery and to build on this if necessary e.g. family, friends, connecting to others in recovery or by attending meetings with mental health support groups (e.g. Grow).

WRAP can even be used to help write an advance directive, where the person can specify such things as acceptable and unacceptable treatments. Including prescribed psychoactive drugs that have worked in the past and ones that don’t and whether or not a person sees Electric shock treatment (ECT) as an option for them.

Reasons to Stay Alive

I’ve just re-read Matt Haig’s very good book “Reasons to Stay Alive” [11]. In severe Depression a person may feel there is no hope or future. Matt highlights how it can feel like you are inside a tunnel that is blocked at both ends. “You are walking around with your head on fire and no one can see the flames”. When he went through a major crisis he didn’t want to be dead. He just didn’t want to be alive.

Drinking and smoking too much can be a big factor. As can diet and not getting enough sleep. Matt suffered from Anxiety, Panic attacks and Depression and compared that to being in a swamp with whirlpools in it. He writes “Minds have their own weather systems. You are in a hurricane. Hurricanes run out of energy eventually. Hold on”.

He compares his symptoms of emotional distress to back pain “It doesn’t really help me, when the pain flares up, that millions of other people suffer from back problems”. He lists some of his “Weapons for the war” ~ writing, reading, talking, traveling, yoga, meditation and running. Some of the things that help him with panic include yoga, slower breathing, meditation, acceptance (“Don’t fight things, feel them”), live in the present and Love.

One person tweeted this message to him about suicide “The hole you’d leave is bigger than the pain you suffer by being”.

“The key is in accepting your thoughts, all of them, even the bad ones. Accept thoughts but don’t become them”. Writing about things your enjoy can help. And refer back to that when you don’t feel so good.

Conclusion

There are no easy answers to suicide. But I do feel, based on the number of suicides I’ve heard of recently, our approach doesn’t seem to be working. I think it is time that we get some honesty from those with the power to influence public opinion. Instead of drug pushing, we need to hear that the “chemical imbalance” theory was an elaborate marketing campaign that sadly is not based on fact or Science. Some celebrity doctors, in their rush to push the drugs, forget about the significant number of people that these drugs are not suited to. Some of us don’t metabolize the drugs very well ( I have discussed this in the blog on Genetics). A pill is not going to mend a broken relationship or bring back a job that is lost. Or help with the bereavement process. There is no pill that cures life. At most it is a temporary sticking plaster but not a long term solution.

And if someone does decide to go down the biomedical route, they deserve full informed consent about these drugs. Something myself and many others didn’t get. People in distress also need crisis houses to go to, as an alternative to Acute Psychiatric units. An example of this in the UK is The Maytree [12]. Such crisis housing is part of the policy document Vision for Change which is now over 10 years old [13]. We need a new plan and a new vision.

At the moment there seems to be a lot of emphasis on celebrity culture and hearing the stories of celebrities. While that can provide short term inspiration, in a crisis the person in distress needs to have their own set of tools and resilience to battle through a rough patch. There is also a danger when mental health is over talked in the media. Family and communities may feel that the issues are been dealt with and may not realise someone in their own circle is in distress and needs support.

Relationship_with_self

References

[1] Man’s Search for Meaning ~ Viktor Frankl
https://www.amazon.com/Mans-Search-Meaning-Viktor-Frankl-ebook/dp/B009U9S6FI

[2] Man’s Search for Meaning ~ Meaning as a Cure for Depression and other ills ~
https://www.psychologytoday.com/blog/hide-and-seek/201205/mans-search-meaning

[3] Viktor Frankl ~ Why Believe in Others ~
https://www.ted.com/talks/viktor_frankl_youth_in_search_of_meaning

[4] Tardive Dysphoria: Anti-depressants can turn mild/moderate Depression into a chronic condition ~
http://www.psychologytoday.com/blog/mad-in-america/201106/now-antidepressant-induced-chronic-depression-has-name-tardive-dysphoria

[5] Antidepressant Use in Children, Adolescents, and Adults ~

https://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/UCM096273

[6] ASIST leaflet (Applied Suicide Intervention Skills Training) ~
http://www.hse.ie/eng/services/list/4/Mental_Health_Services/NOSP/Training/ASISTleaflet.pdf

[7] Information on ASIST training ~ http://www.yourmentalhealth.ie/get-involved/news-events/

[8] Suicides Rise Dramatically with Increasing Psychiatric Care ~
https://www.madinamerica.com/2014/09/suicides-rise-increasing-psychiatric-involvement/

[9] WRAP (Wellness Recovery Action Plan) ~ http://mentalhealthrecovery.com/

[10] WRAP App Demo ~ https://www.youtube.com/watch?v=0BK_jLMToeM

[11] Reasons to Stay Alive ~ Matt Haig

http://www.matthaig.com/reasons-to-stay-alive/

[12] Suicide sanctuary ~
www.maytree.org.uk/

[13] Vision for Change ~
http://www.hse.ie/eng/services/publications/Mentalhealth/Mental_Health_-_A_Vision_for_Change.pdf

Other links that may be useful

* Psychopharmacologist & Psychiatrist Prof David Healy “Time to abandon evidence based medicine?” At 6 minutes he discusses the hiding of negative data from anti-depressant clinical trials ~
http://www.youtube.com/watch?v=A3YB59EKMKw

* Promoting awareness of the dangers of anti-depressants ~
http://antidepaware.co.uk/

* The dangers of giving anti-depressants to children. Jake McGill (14) ~
https://www.independent.ie/irish-news/courts/mother-of-boy-14-who-died-of-selfinflicted-gunshot-wound-welcomes-open-verdict-inquest-34115868.html

* Community Action on Suicide Prevention Education and Research (CASPER) ~
Maria Bradshaw, mother of Toran Henry (Maria now lives in New Zealand) ~
https://www.independent.ie/regionals/wicklowpeople/lifestyle/maria-leads-suicide-fight-30596376.html

* Pysch drug link to violent episodes analysed ~ Article that discusses the Shane Clancy case. His mother Leonie Fennell works hard at raising awareness about the dangers of anti-depressants ~
http://www.irishexaminer.com/ireland/pysch-drug-link-to-violent-episodes-analysed-400571.html

* Cutting jail benzo use reduces violence ~

www.irishexaminer.com/ireland/cutting-jail-benzo-use-reduces-violence-215716.html

Harry Kennedy, head of the Central Mental Hospital, said that since they stopped prescribing the medication in their prison clinics, the suicide rates there had fallen.

* Denmark ~ “Antidepressant regulations tightened following suicide”:

www.cphpost.dk/news/antidepressant-regulations-tightened-following-suicide.8243.html

* Kerry coroner makes emotional plea over suicides ~
www.irishtimes.com/news/crime-and-law/kerry-coroner-makes-emotional-plea-over-suicides-1.1365157

* ‘Suicide remains a taboo subject, something few people are prepared to talk about’

www.youtube.com/watch?v=US-oM-wBBxI

* Life After Suicide BBC Documentary 2014 “Documentary. Angela Samata explores why some people take their own lives and how those who love them come to terms with the loss”.
www.youtube.com/watch?v=HdIxzeA1F2k

* For prescribers ~ Guide to Stopping anti-depressants ~
http://www.rxisk.org/guide-stopping-antidepressants/

* Website about psychiatric medication, how it functions and the withdrawal process ~
http://www.comingoff.com

When suicide comes in clusters ~ What can we do to prevent copycat suicides ?
www.psychologytoday.com/blog/media-spotlight/201208/when-suicides-come-in-clusters

* Alcohol and suicide, Kendall, 1983 ~
www.ncbi.nlm.nih.gov/pubmed/6648755

* Smoking and Suicide: A Meta-Analysis ~

www.ncbi.nlm.nih.gov/pmc/articles/PMC4938402/

* Suicidal Ideation and Suicide Attempts in Treatment-Seeking Pathological Gamblers ~
www.ncbi.nlm.nih.gov/pmc/articles/PMC3397475/

* Stages of Compulsive Gambling ~
http://www.elementsbehavioralhealth.com/addiction/stages-of-compulsive-gambling/

{ Note ~ What I discuss in part of this blog is my own experience and is not medical advice. We all have our own unique journey. Do not stop or change prescribed drugs without advice. Change has to be done slowly under the supervision of an expert, due to the dangers of withdrawal  }

Advertisements

An Open Dialogue around ‘Psychosis’

“The deepest hunger of the human heart is to be understood” Stephen Covey

Psychosis_hand

Cabiria, 1914 (from a silent movie by Giovanni Pastroni). Trying to capture how terrifying Psychosis sometimes feels like, which is difficult and the clip that goes with this photo reminded me of the experience.

In November 2014 I went to the launch of the lengthy report “Understanding Psychosis and Schizophrenia” by the British Psychological Society (BPS) in London. There I got to meet and hear from some of the top experts and clinical Psychologists in the UK. A revised version was published in 2017 [1].

‘Psychosis’ is a loss of touch with reality, which is usually temporary. Because the general population don’t understand it, they can overreact. The person themselves may feel quite confused & scared. Especially if it’s their 1st experience. It can involve unusual perceptions e.g. the person feels they are under attack from evil and the need to protect themselves. In my experience, how I protected myself was influenced by religious upbringing. I even started to go to Latin mass to try and calm my brain down ! While some would have frowned upon that at the time, for me it was a coping mechanism. I only occasionally go to church these days, usually to light a candle and to sit in silence for a while.

As an example of one of my “psychotic breaks”, in my last experience I decided that the town I live in, which is prone to flooding as it is built on a river, was going to become immersed in water. I checked into a hotel that was a few stories high & took a bus to a ‘safer’, inland county. At the time I was frightened. It wasn’t based on reality but could have been based on news reports and worries about climate change. Stress and lack of sleep would have been a trigger, plus the fact that I was still going through drug withdrawal. It took at least two years to get the main effects of long term use of prescribed psychotropic drugs out of my system and I was left with long term sleep issues, the effects of which I still feel to this day.

Psychosis can be triggered by anti-depressant use and severe lack of sleep / stress [2]. I had been on anti-depressants for anxiety / panic attacks for 3 years when I had a ‘psychotic break’ in August 2008. Other illicit drugs can also trigger psychosis e.g. skunk cannabis [3].

Trying to make sense of the symptoms can help. In the context of the person’s life. As through making sense of experiences or learning to process them, a person is more likely to recover.

Usually the people around you will not understand and may be unsupportive. I went through my last ‘psychotic break’ alone (2012). I would not recommend that but maybe getting through it alone is why I no longer fear it. There was also a Spiritual aspect to the experience and I wish I kept notes at the time to give me more insight into what I was going through. In my terrified state, particularly at night time, with no support around me, I used the online work of Sean Blackwell to help me through. “Bipolar or Waking up?” [4, 5, 6]. I do believe this was more of an awakening and a spiritual journey. A part of my own evolution as a soul on this planet.

A significant percentage of people hear voices and for many this is not a problem. If the person has voices that are distressing or ask them to harm themselves or others and the person finds this overwhelming, they would need help and support in coping with the voices. There are people who have managed to integrate their voices into their lives, without been affected negatively by them e.g. Eleanor Longden [7] , Jacqui Dillon [8] and Rai Waddingham [9]. Dutch Psychiatrist Dr Marius Romme has also done a lot of great work in the Hearing Voices Movement [10]. Some children also hear voices and may need support.

Others experience hallucinations. If the hallucinations affect a persons quality of life, including ability to work, sleep and relate with others, the person may need help in dealing with their experiences.

Open Dialogue

I’m a believer in the Open Dialogue approach, where the person should be involved as much as feasibly possible in decision making about their care or treatment plan [11, 12].

Open Dialogue includes the gathering of clinicians, family members, friends and other relevant persons for a joint discussion. It was started in Lapland by Jaakko Seikkula et al. It is also used in other countries eg the Parachute project in New York [13]. In West Cork a successful pilot project was implemented [14, 15]. It would be great to see widespread use of this approach. If a more traditional, backward approach is used it can lead to more dysfunction within a family and the fracturing of relationships, sometimes long term, in my experience. It is important to get the approach right at the start. Not everyone will want family involved in their care.

I write more about the trauma of what happened me in 2008 in the blog Anti-depressants are great, until you have an Adverse Drug Reaction, where I outline some of the things that would have helped at that crucial time. Because of the way people in ‘psychosis’ are treated, I ended up with Post Traumatic stress for the past 9 years. It has improved via therapy and hard work on my self, but it is something that will probably always be there are a protective force in my life. A hyper vigilance and a lack of trust in others.

Hence I have learned as much as I can about what is helpful when a person is in distress. I’ve dedicated several years to learning via reading, listening to audio/visual presentations (of experts I respect), courses, conferences and various short training sessions. A summary version of what happened to me can be found under Other Relevant Resources at the end of this blog.

During my first ‘psychotic break’ (where I had not harmed myself or others) I needed:

  • truth and honesty about the anti-depressant drug I was on & its adverse effects (2)

  • An Open Dialogue approach

  • Re-assurance that my stay in the hospital was temporary ( the survival part of my brain was convinced I would be there for a very long time, possibly forever. This left me in a very distressed and agitated state and naturally so)

In places like Finland, where they employ the Open Dialogue approach and where prescribed psychoactive drugs are not the main form of treatment, they have proven that recovery is possible. They use early intervention and involve the person in decision making. In general, instead of the person ending up on disability they end up back as productive members of society.

Below is now 88 yr old Prof Ivor Browne giving a talk in the National College of Ireland in 2015. As opposed to being “anti-drug”, Prof Ivor Browne believes in using the lowest dosage of tranquilizing drugs possible for as short a time as possible. Ivor explained that people need help in understanding the psychotic process. He also recognises the importance of therapeutic relationships, personal friendships and loving relationships, when it comes to healing from trauma and distress. What are referred to as “Anti-psychotics” e.g. Olanzapine, as mainly major tranquilizers.

Anti_psychotics

For people to have “Recovery spaces”, they need to be with supportive people who can tolerate, be patient and interact with the person in ‘Psychosis’. Soteria is a network of people in the UK promoting the development of drug-free and minimum medication therapeutic environments for people experiencing ‘psychosis’ or extreme states [16].

If a person is a carer for someone in emotional distress e.g. A family member, the long term goal should be to enable the person they are caring for. It is important to keep the person as independent as possible, so that they do not become too reliant on someone else e.g. doing their own laundry, some cooking, housework / cleaning and having a diary to organise their week. The carer also needs to take good care of themselves.

The public have learned to associate the word ‘psychosis’ with violence and there is not necessarily a link, unless drugs or alcohol are involved [17, 18]. That can include prescribed psychotropic substances or withdrawal from these drugs [19]. People in distress need hope that they can recover and heal. Education from reliable, unbiased sources is an important part of that healing journey. As are supportive and understanding people who can hold space for the person in distress. These support networks also need education around Psychosis, what is helpful and what is not. Being judgemental, getting into arguments with the person, being critical and dismissive of their experience is usually unhelpful. Trying to stay calm and creating a calm space for the person, where they are not over stimulated, might be helpful. Everyone is an individual and has their own unique journey and experience.

Note: This blog is not medical advice and is mainly based on my own experience. But also on my extensive interest and learning in the whole area. Do not stop or change prescribed psychotropic drugs without advice, due to the dangers of withdrawal. Any changes need to be made slowly, under the supervision of an expert in this field. At the start of my journey I was never given that advice from the ‘experts’ I was dealing with and this delayed my healing journey.

Minor and major tranquilizers did help me at times e.g. with sleep, which can help restore some normality. But overall, in hindsight, I found that the large cocktail of drugs I was on (over a 3 year period) fueled symptoms, as opposed to ‘curing’ them. “The ethical use of psychotropic drugs is perhaps the single most important aspect of Psychiatric care that requires urgent attention” Dr Phil Thomas [20, 21].

* waiting on approval to include extra tips on how to help people who are in psychosis and what doesn’t help. Also advice for carers on self-care.


References

[1] Understanding Psychosis and Schizophrenia, revised version 2017 ~

https://www.bps.org.uk/system/files/user-files/Division%20of%20Clinical%20Psychology/public/CAT-1657.pdf (Edited by Anne Cooke)

[2] Antidepressant-associated mania and psychosis resulting in psychiatric admissions. Yale study (2001) ~ www.ncbi.nlm.nih.gov/pubmed/11235925

[3] Smoking skunk cannabis triples risk of serious psychotic episode, says research

https://www.theguardian.com/society/2015/feb/16/skunk-cannabis-triples-risk-psychotic-episodes-study

[4] Am I Bipolar or Waking Up? Sean Blackwell, 2011

http://www.amazon.com/Am-I-Bipolar-Waking-Up/dp/1461178258

[5] Sean Blackwell’s work ~ www.youtube.com/user/bipolarorwakingup

[6] Corrina Rachel speaking to Sean Blackwell about Bipolar ~

~ www.youtube.com/watch?v=WLIeS6idzD4

[7] TED video by Eleanor Longden (Voice Hearing) ~

www.ted.com/talks/eleanor_longden_the_voices_in_my_head?language=en

[8] Jacqui Dillon (Voice Hearing) ~

www.rte.ie/radio1/doconone/radio-documentary-sounds-mad-hearing-voices-psychology.html

[9] Rai Waddingham ~ http://www.behindthelabel.co.uk/

[10] Hearing Voices Network ~ www.hearing-voices.org

[11] OPEN DIALOGUE: an alternative Finnish approach to healing psychosis (by Daniel Mackler) ~

https://www.youtube.com/watch?v=HDVhZHJagfQ

[12] A collection of resources on Open Dialogue and Open Dialogue practices ~

http://willhall.net/opendialogue/

[13] New York ‘Parachute’ programme for people with acute mental distress lands in the UK ~

https://www.theguardian.com/society/2015/oct/20/parachute-therapy-psychosis-new-york-uk

[14] Mental health pilot focus of Finnish film ‘Open Dialogue’ ~

http://www.irishexaminer.com/ireland/mental-health-pilot-focus-of-finnish-film-open-dialogue-393492.html

[15] A fresh approach to mental health ~
http://www.irishexaminer.com/lifestyle/features/a-fresh-approach-to-mental-health-396031.html

[16] Soteria ~ www.soterianetwork.org.uk

[17] ‘Mental disorders’ are neither necessary nor sufficient causes of violence ~ 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525086/

[18] Dispelling the Myth of Violence and Mental Illness ~

https://psychcentral.com/archives/violence.htm

[19] Prescription Drugs Associated with Reports of Violence Towards Others

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0015337

[20] Psychiatry in Context : Experience, Meaning & Communities by Dr Philip Thomas

https://www.amazon.com/Psychiatry-Context-Experience-Meaning-Communities/dp/1906254729

Dr Philip Thomas highlights the limitations of neuroscience in explaining Psychosis or distress. He also explores how Racism plays a key role in many black people’s experience of Psychosis.

[21] My review of this book ~ www.goodreads.com/user/show/46943899-anne

This review was published in the Journal of Critical Psychology, Counselling and Psychotherapy (Volume 16, Number 1, March 2016)

Other relevant Resources

* ‘I was unaware of potential adverse effects to my prescribed antidepressants’

https://www.independent.ie/life/health-wellbeing/mental-health/aines-story-i-was-unaware-of-potential-adverse-effects-to-my-prescribed-antidepressants-31218347.html

* One woman’s account of suffering from psychosis ~

www.todayfm.com/One-womans-account-of-sufferinbg-from-psychosis

* Course ~ Caring for People with Psychosis and Schizophrenia (pharma funded which influences the advice given) ~

https://www.futurelearn.com/courses/caring-psychosis-schizophrenia

* Intervoice (International Hearing Voices Projects) ~ www.intervoiceonline.org

* Hearing Voices Network Ireland ~
http://hearingvoicesnetworkireland.ie/

* The Icarus Project ~ http://theicarusproject.net/

* CRAZYWISE – Official Extended Trailer ~

https://www.youtube.com/watch?v=iKfQd0bk214

* Peter Lehmann “Recovery from Psychosis and Depression by Taking Psychiatric Drugs versus Recovery by Coming off Psychiatric Drugs”

www.peter-lehmann-publishing.com/articles/lehmann/pdf/recovery-from.pdf

* 8 Tips to Help Stop Ruminating ~
www.psychcentral.com/blog/archives/2014/02/16/8-tips-to-help-stop-ruminating

 * Adverse effects of Prescribed Psychotropic substances (e.g. the anti-psychotic Olanzapine) may be found in my initial blog “Some of the many useful links…”

Lithium

To write about the subject of Lithium I have consulted Dr David Healy’s book “Mania: A Short History of Bipolar Disorder” [1]. Some quotes and information at the start of this blog are from his book. I am in awe at the level of detail and research that must have gone into it.

As an alkaline substance, Lithium was initially used to treat gout and rheumatic conditions. “While using Lithium to treat gout, Garrod reported that patients often showed a general sense of well-being”, pg. 92. Considering the more recent knowledge about inflammation that functional medicine doctors discuss, I find this fact interesting.

“The key individual in the emergence of a prophylactic use of Lithium for mood disorders is Carl Georg Lange”, pg. 94. Another person to use Lithium with some success in treating Manic symptoms in patients was John Cade in Australia. However the toxic effect of Lithium carbonate caused the death of some of his patients. “The use of Lithium was linked to cardiac difficulties and it was banned by the FDA in 1949 … The question of toxicity highlighted the need to establish a safe dose and to be able to monitor treatment”.

“But consider what makes for a placebo response. The natural history of mood disorders means that many will improve within a few weeks whether treated or not. It is also widely thought that sensible clinical advice on matters of diet, life-style, alcohol intake, and work and relationship problem solving may make a difference. It is suspected that patients’ perceptions that they are being cared for by a medical expert may make a difference, and this effect may be enhancing by being given a substance they think will restore chemical imbalance to normal – even if that imbalance is mythical and the substance is placebo. The fact that the patients present themselves for treatment may also make a difference. All of these factors are reflected in the placebo response. But it is not possible to quantify the distinct contribution of these components” pg. 129.

I now want to talk about my own experience with Lithium and some of the things I learned when on it. It may under certain conditions lead to kidney damage and/or damage to the thyroid. If a woman becomes pregnant on Lithium it can damage the developing foetus.

In 2008, after my Adverse Drug Reaction to the anti-depressant Citalopram and when mainstream Psychiatry had hastily labelled me “Bipolar 1” (while ignoring advice in DSM-IV-TR) I was put on Lithium [3]. According to this book, “Bipolar 1” only affects about 1 in 100,000 people, so it is a rare condition. I’ve also learned that from Prof Ivor Browne. From my reading, I do believe that the overuse of anti-depressants is one of the factors in the current Bipolar “epidemic”.

When I was introduced to Lithium, it appeared to be informed consent at the time. Someone talked to me about this drug and I was given some material to read, but it wasn’t true informed consent. I wasn’t fully aware of the truly toxic nature of this drug. I was put on 1000 mg and ended up on that dosage for nearly 2 years. I had regular blood tests to see if the the Lithium levels were in the so called therapeutic range, as well as thyroid function tests.

After the anti-depressant Citalopram caused mania / psychosis or what I refer to as “SSRI induced Bipolar type symptoms” in August 2008, I have 9 foolscap pages showing the large cocktail of expensive drugs I was on from when I left hospital in October 2008 up until August 2011. While on Lithium (and Seroquel) I had a long Manic episode in 2010, for about 3 months. I don’t remember Seroquel having any benefit at all. I don’t feel that Lithium did anything for me therapeutically either, in a true sense. I was eventually switched from Seroquel to Olanzapine in June 2010 and things improved i.e. I eventually came out of that horrendous episode, which may have seemed fun at the time but I also remember feeling that I just wanted the “manic” feeling to end.

I also decided to come off Lithium towards the end of that “episode” and I let the Psychiatrist know. I withdrew from Lithium in jumps of 200 mg, which is far too fast a rate. As I write this I wonder why the Psychiatrist didn’t give me a strict warning and a better withdrawal plan. I was still going to see him on a regular basis (up until January 2012 when I left mainstream Psychiatry behind me and their drugs, other than a few 5mg Olanzapine that I kept on standby for a while but then they eventually went out of date, which in hindsight meant this whole disaster was coming to some kind of ending).

When jumping down off Lithium at what I now realise was a fast rate, I would have gone into withdrawal, with all the symptoms that goes with that. I became very depressed after coming off it and, due to the brainwashing about Manic Depression, felt that this was just part of “my illness”. I was lethargic and lay in bed with not much interest in life. Based on what I now know about the complexity of the withdrawal process, I see this differently [4].

I felt that Lithium blunted my emotions and also remember the day when this “fog” lifted and I started to feel again. I cried when I realised what the drug had done to me. I regret taking Lithium.

My father was on Lithium for years and his thyroid was affected by it. While he died from prostate cancer, I sometimes wonder if the kidney failure he experienced towards the very end of his life had something to do with being on this drug long term.

An Unquiet Mind by Kay Redfield Jamison

When I first read An Unquiet Mind [2] a number of years ago, while still ingrained in the biomedical model and on the drugs, I thought it was a good book. When I re-read it recently I see things differently now, not forgetting that it’s over 2 decades since it was published (1995). Jamison is a talented writer.

When she talks about the marvelous kind of cosmic relatedness, “the webbings of the universe”, and how everything seems interrelated even when sometimes others can’t see, I can relate to that. It tries to describe in words the experience of mania / psychosis (loss of touch with so called reality), which is not so easy to write about or even to describe verbally. A person’s thoughts can become out of control and tolerance can be lacking from others.

She says in her book that she briefly took antidepressants but they only made her more dangerously agitated. She also claims that it is not uncommon for depressed doctors to prescribe anti-depressants for themselves and that the results can be disastrous.

Even though she praises Lithium as a wonder drug in her life, the efficacy and safety of Lithium is not as compelling as she claims. She also admits that she had she continued to experience fluctuations in mood while on Lithium. When she eventually had her dosage of Lithium reduced “it was as though I had taken bandages off my eyes after many years of partial blindness … I wept for the poignancy of all the intensity I had lost without knowing it and I wept for the pleasure of experiencing it again … the subtle, dreadful muffling of the senses”. I can relate to this when I think back to the time I was coming off Lithium.

Dr Jamison talks about the mind healing if it is given a chance. She also mentions how important love is in the healing process and that it can act as a very strong medicine.  The love and support of others helped her through.

Several times she refers to the hereditary nature of Manic Depression and she mentions ongoing genetic research, but in reality no true bio-markers have been found. Even today over two decades later. While Dr Yolande Lucire has discovered that there can be a problem metabolizing the drugs and there may be a genetic aspect to that [5], in general nothing of real significance has materialised because of genetic research into Manic Depression / Bipolar, that I’m aware of.

She talks about the brain-damaging effects of stopping medication. While people have to be very careful changing or stopping prescribed drugs, if anything the opposite is true. The drugs cause brain damage. Olanzapine, for example, which came to the market in 1996 [6].

Changes in the brain can sometimes be explained by treatment history, as opposed to “mental illness”. Symptoms are not always beyond our control and we are not as “beholden to medication” as some would like us to believe. But that takes patience, self-discipline, persistence and daily work on physical / emotional well-being. As well as tolerance of setbacks and support from others. I do not believe it is a life long illness or disease, but if you tell your sub-conscious that it can become a self-fulfilling prophecy.

Hope is another cornerstone of the healing process. I do feel that my symptoms were mainly iatrogenic i.e. caused by taking the SSRI anti-depressant Citalopram for anxiety (between 2005 and 2008). I haven’t experienced Mania / Psychosis in nearly 5 years (December 2012). I was prone to relapse for at least 2 years after all the drugging. I am now free of of prescribed psychoactive substances, but if I had to write how I got there I would find it difficult. Support from doctors was lacking. They seem to have no problem getting you on a drug but stopping their cocktail of drugs is frowned upon.

I still struggle with other issues e.g. sleep. I do not believe that I have Manic Depression / Bipolar. If I did I would not be ashamed to say it. But I no longer feel conditioned into believing this. I do however suffer from Tardive Dysphoria (long term, sometimes severe Depression after being through drugging and the whole ordeal). In some ways I miss the highs. I occasionally experience a mild high, but I’m not complaining. Or a bit of a mixed episode which I feel is connected to being on the drugs. Female hormones are also a factor. I’m all for personal responsibility, but the bottom line is I feel mainstream Psychiatry got it very wrong at the start and caused major, ongoing, devastating trauma in my life on many levels. I’m still coming to terms with that and learning to let go.

{ Important Do not stop or change prescribed psychoactive drugs without consulting your prescriber, due to the dangers of withdrawal. Any changes need to take place under the supervision of an expert. Some people may feel they benefit from Lithium or other drugs I mention here. What I discuss in part of this blog is my own experience and is not medical advice. We all have our own unique journey }


References

[1] Mania: A Short History of Bipolar Disorder by Dr David Healy (2008)

https://www.amazon.com/Mania-History-Bipolar-Disorder-Biographies/dp/1421403978

[2] An Unquiet Mind by Kay Redfield Jamison (1995)

www.amazon.com/Unquiet-Mind-Memoir-Moods-Madness/dp/0679763309

[3] Article by Dr Peter Breggin ~
http://breggin.com/wp-content/uploads/2005/01/31-49.pdf

DSM-IV-TR “emphasizes that a diagnosis of Mania or Bipolar Disorder should not be made when the hypomania or mania first appears while the individual is taking a medication that can cause these symptoms”. DSM-IV-TR (2000) ~ Diagnostic and Statistics Manual. Fourth edition, text revision

[4] Coming off Psychiatric Medication ~ Advice for Prescribers ~
http://www.comingoff.com/lith.php

[5] http://www.drlucire.com/adverse-drug-reactions.html (Dr Yolande Lucire, Forensic Psychiatrist)

Dr Lucire explains that not all people are born with a full complement of metabolizing enzymes, increasing the risk of side effects which can range from mild to life-threatening. Changing dosage up or down and starting / stopping drugs are also crucial times, sometimes affecting the person months after stopping.

[6] “The Influence of Chronic Exposure to Antipsychotic Medications on Brain Size before and after Tissue Fixation…” ~ http://www.nature.com/npp/journal/v30/n9/full/1300710a.html

In 2005, a study funded by the maker of Zyprexa / Olanzapine, found that chronic / long term exposure to this major tranquilizer causes shrinkage of the brain. “significant reduction in brain volume that affects both gray and white matter”! I learned about this from honest Psychiatrists Dr Peter Breggin and Dr Joanna Moncrieff. I was put on Zyprexa, at what I now consider too high a dosage (10mg) long term in 2008! I did not have informed consent about this powerful but potentially damaging drug. Very short term use would have been enough and proper advice about withdrawal and stopping. Something I never got from a private hospital. I was let out the door with nothing but a prescription. I ran to the train and thought all was great.

2 weeks later I went into what I now know to be withdrawal and akathisia (a severe inner restlessness). I ended up back in hospital for a month, a broken woman. The year that followed is a complete blur and the last 9 years have been difficult because of what I was put through. Mainstream Psychiatrists I saw at the time withheld valuable but vital information.