July 2011 edition
Re: A Silent Spring for Psychiatry, June 2011
In your editorial you state at one point that in 2008, 1 in 76 people suffered a mental illness and then you state that 1 in 50 suffer bipolar depression. This latter number seems ridiculously high, but it is impossible to have 1 in 50 with bipolar depression if only 1 in 76 suffer mental disease. Did you drop a zero somewhere?
This is a dangerous article. It makes no distinctions between severe clinical depression and the type of “depression” which a few decades ago was more about 1970s housewives being bored with being 1970s housewives. It makes no distinction between serious mental illnesses and the minor phobia that I have.
An increase in diagnosing or reporting does not necessarily imply an increase in incidence or misdiagnosis. It does not surprise me at all that there would be a doubling or more of “incidence” in the last 20 years, simply due to the reclassification of disorders. It is not very long ago that “shell shock,” what we now call PTSD, was not regarded as a mental illness.
The real questions should be whether there is misdiagnosis, whether there is overmedication (I believe so), how often drugs are switched, and whether there is an inappropriate use of some drugs, as is clearly the case with antipsychotics.
Your editorial quotes at length a reporter who, as far as I can tell, has no credentials on the topic. I have three degrees and an opinion on global warming, but am not a specialist in that area and would therefore never have the temerity to write a book on the subject. Reporters don’t seem to have such qualms.
No one pretends that drugs are the total answer but they are often quite indispensable.
Editor’s Note: The 1 in 76 figure Robert Whitaker used in his talk was referring to people on US disability rolls as a result of mental illness. This is only a fraction of the US population with serious mental illness. Whitaker used the figure to illustrate the apparent growth in serious mental illness, not to provide the fraction of the American population with mental illness. My apologies for not making that clear.
But there is no zero dropped in the numbers around bipolar disease. Whitaker did state clearly—and it’s elaborated in his book—that one in 50 (in the US) suffers bipolar disease. In Canada, one study by medical researchers, found a weighted lifetime prevalence rate of bipolar disease of 2.2 percent, which is more than one in 50. (See www.ncbi.nlm.nih.gov/pubmed/16491979). The Canada Mental Health Association says it’s more like one percent. In Canada and the US, about one in five adults will suffer a mental illness during their lives.
The growth in incidence levels is just the starting point for Whitaker—it led him to ask more questions. Again, I refer you to his book and website. Whitaker’s main point at his lecture was that studies of long-term outcomes show that people using the drugs actually fare worse than those not using the drugs. But, as stated, Whitaker accepts that sometimes drugs are the right approach.
Thank you for exposing psychiatric drugs’ false mystique. Psychiatrist Dr Peter Breggin has said: “I don’t believe that the desire to handle life through a psychiatric drug is essentially different from the desire to do it with alcohol, and I don’t believe that physicians should look upon it more favourably. (See Toxic Psychiatry: Why Therapy, Empathy and Love Must Replace the Drugs, Electroshock, and Biochemical Theories of the “New Psychiatry” and www.Breggin.com.)
I was diagnosed with “major depression.” Prescribed five antidepressants over nine years, I ended with Prozac. They were nothing more than timed-release sedatives and amphetamines— “downers” and “uppers.” I never took them again.
Then came two dramatic depression-dissolving experiences. First, a caring community organization gently nudged me into social interaction, after decades of isolation. And simply deep crying, connected to painful early childhood memories with Mom, worked.
After hundreds of “expert” psych-books, I believe Dr Arthur Janov has the most humanistic, complex and scientific insight into mental disorders. He exposed the “chemical deficiency” myth in the ’70s. Janov was John Lennon’s therapist. He helped Lennon permanently end heroin addiction and transform his life. See www.PrimalTherapy.com.
I seem to have had an awakening! Focus has morphed from a pulpy women’s magazine to a slick, appealing, content-loaded publication with good writing. Especially this issue.
I was caught by the two articles on related interests of mine. The first was Leslie Campbell’s editorial on the overuse of drugs. The other was Rob Wipond’s article on antipsychotic meds being used at an excessively high rate in long-term care facilities. I am circulating a link to the online issue to people I know who may share my interest in these two subjects.
You and your publisher deserve a lot of credit for what this magazine is. Thanks to both of you and the other people who make it happen.
Jim Ricks, PhD
While it is important to scrutinize pharmaceutical industry marketing strategies, we should not jump to rash and ill-informed conclusions - as Leslie Campbell and Rob Wipond have been doing recently in Focus. Citing published works by the intelligent but highly controversial Robert Whitaker, Campbell and Wipond suggest “Big Pharma” has co-opted psychiatrists, health care workers and the World Health Organization (WHO) to create demand for their psychotropic drugs.
Let’s examine the facts. The surge in depression rates is, according to the WHO, a result of increased awareness and better diagnosis – not free pens and lunches from drug reps. The medical community has waged a long hard battle to reduce the social stigma attached to mental illness. Finally depression is being recognized as the widespread, non-stigmatized, debilitating disease that it is – and the number of people diagnosed is rising accordingly. Health Canada, the Center for Disease Control in Atlanta, the National Health Service in the UK and others all back the WHO viewpoint.
Are we to believe that the scientists and physicians at these institutions, some of the best and brightest medical minds on the planet, have been duped by pharmaceutical company spin? Or perhaps these researchers really want to hide the truth about antidepressants, so they can get juicy kick backs from drug companies. Sounds like the plot of a bad movie, but that is exactly what Whitaker, Wipond and Campbell are suggesting.
Whitaker’s recent work continues to be ignored by the WHO and even the media not because the sources he uses are weak – but rather that he misinterprets data and jumps to his own radical conclusions.
Harvard Professor of Psychiatry Dr. Andrew A. Nierenberg says that upon careful scrutiny most of Whitaker's arguments fall apart. He claims Whitaker’s book “Anatomy of an Epidemic” is so wrong it should come with a warning label stating “This book contains misinformation.” Dr. Nierenberg says Whitaker “omits contradictory data, misinterprets outcomes and draws false, unsupported conclusions”. This is typical of the reviews Whitaker’s book has received by the medical community.
Whitaker dismisses contrary views from world renowned specialists such as Dr. Nierenburg, saying they have been “co-opted” by the pharmaceutical industry. How convenient.
The efficacy of anti depressants is tough to assess scientifically. That's because the symptoms are subjective, and we rely on the accuracy of individual patient reporting. You can't “prove” a cure – there is no measurable, concise endpoint. The best we can do is a rough estimate of patient improvement. That weakness does not mean the drugs don't work.
Perhaps a more meaningful assessment of efficacy is the personal experience of physicians – the front line workers treating depression. Doctors consistently report that patient response to antidepressants is significant and often dramatic. In fact, there are few serious illnesses as treatable with medication as depression.
If Whitaker took the time to speak with these front line workers, both family doctors and psychiatrists, he would find unanimous and enthusiastic support for antidepressants.
Let’s be clear - there is no question whatsoever in the minds of physicians as to the effectiveness of these drugs.
Depression is a debilitating, life-ruining disease – and a major risk factor for suicide. When we demonize psychiatric drugs and the diagnosis of depression we discourage people from seeking help and/or taking their medication. This results in needless suffering, morbidity and potential loss of life. Campbell and Wipond would do well to consider the powerful implications of their misinformed opinions.
Re: The Crisis Behind Closed Doors, June 2011
I am so happy to see such a well-researched and well-written article on this topic. Thank you for shedding some light on an issue that certainly hits home for me. I have an elder in care in the system. She is being given one of these drugs (along with many others). She has never had a violent outburst in her life. This drug was prescribed at the time she first moved into the facility two years ago. She knows she “doesn’t feel right” but no one has the time to listen. In response they have upped the dosage of her antidepressant.
As an advocate living in a different city it is difficult to deal with these things through a monthly visit. Communicating to the ever- revolving shifts of nurses is hopeless.…
Your article has empowered me to step forward on behalf of my mother and try to make a change. Like Carl, I don’t wish to see her living in a care facility “out of her mind for the rest of her life.” It saddens me to know there are thousands more out there with no advocate. I believe our elders deserve better.
I’m writing to congratulate your magazine and writer on such a revealing article, opening the doors and minds of people to the shocking reality of one part of our health care system. And continuing to explore and ask, “What the hell is going on?”
I advocate for a family member who is in care, with a dementia condition. I was able to clearly state in the “care plan” that there be no use of antipsychotics. I asked that I be notified if there were to be any changes to medications, and when the doctor ordered a change, the person on duty phoned to tell me the doctor’s order. Just as it was to go forward to the pharmacy, I was able to say no and discuss some alternatives, along with some redirection ideas. People who are caring for other people in facilities come from all kinds of beliefs and workplace practices; some are willing to advocate. Advocacy and communication—including asking questions—with people working in health facilities goes along way.
Rob Wipond’s article states “nearly half of all seniors in long-term care in BC are being given antipsychotics...” He suggests drugs are overused because staff can more easily control the behaviour of demented and otherwise mentally ill people. He suggests other choices are often more appropriate.
Focus readers who have elderly relatives in long-term care are likely to be alarmed. Some might demand immediate change. It would be wise for families to proceed cautiously. Until a rigorously researched study is published, we won’t know if these system-wide charges are correct or not. Even then, the study cannot provide answers for individual cases.
For perspective, I offer specifics on one individual—my mother—who has benefited from an antipsychotic drug. (Confidentiality is assured since my mother and I have different names and she lives in another city.)
After going to bed at 8 pm, my 94-year-old mother woke up every two hours during the night and each time, thinking it was breakfast time, got up, dressed (a difficult, long process for her), and went downstairs with her walker. A caregiver would escort her back up to her room and into bed. This occurred four times a night for months. It was exhausting and confusing for my mother; it was time-consuming for the caregivers.
When her doctor recommended trying a low dose of Seroquel at bedtime, explaining it is often prescribed for dementia patients with sleeping problems, I read the literature and was reluctant to proceed. It didn’t seem this quiet, frail senior needed an antipsychotic drug. However, we had a huge problem to solve and I decided to try it. She has slept through the night ever since. Her quality of life is much improved. We are not aware of any negative side effects.
There is no way to provide 100 percent of the care that is desirable for every senior over the long term. There are no easy answers. All we can do is make the best choices we can and support the caregivers who are doing the job all those hours we cannot be there ourselves.
Rob Wipond replies: I agree every situation should be evaluated individually, and cautiously. Please note that an analysis of the scientific research conducted by the Therapeutics Initiative found that Seroquel and its generics are “widely prescribed in low doses for management of sleep disorders, despite lacking approval for this use” and “in the absence of evidence for effectiveness or safety.” The TI found many serious adverse effects even in low-dose regimens, including increased mortality. They stated that, “Drugs should be limited to short duration, intermittent use, or daily use only in exceptional cases.” More information can be found at their website: www.ti.ubc.ca.
Thank you so much for Rob Wipond’s excellent article on antipsychotic drugs in long term care in June. As a nurse who works in several nursing homes, I wholeheartedly agree with his comments about the serious problems that exist today. Physical and chemical restraints are used routinely in long term care and in hospitals. Staff do not have the time to use alternative approaches to dementia behaviors.
Quality of life for residents in care has deteriorated over the past decade because of reductions to numbers of care staff and team members such as music therapists, chaplains and social workers. Additional problems are caused because health authorities expect facilities to care for persons with special needs. For example, young, brain injured people and 50 year olds with multiple sclerosis should not be living in nursing homes.
What are the answers? We must eliminate use of physical and chemical restraints on frail elderly people. We need more care facilities that are designed to allow people to enjoy some quality of life. Staffing levels must improve and continuity of staffing must become a goal again. An elderly person in the community should not have a different support worker in his or her home every day of the week. We should have more Nurse Practitioners with specialized education in care of the elderly.
Please do not stop investigating and writing. Your work will improve the quality of many lives.
Name withheld by request
Re: Local food and other delusions
I am grateful for Ms Madden’s and Mr Henry’s candour. This article gently underestimates the new crisis that more local food would generate: “...the amount of acreage needed for large-scale agriculture would mean some trees would be coming down,” Henry warns. If we insist on as much local animal food as we eat now, Victoria would also be ringed by abattoirs, industrial dairies, egg plants, and a Sunshine Coast pocked with fish farms.
Unless local food is to remain a privileged luxury served at boutique restaurants, two simple changes are necessary: Land tenure reform as the “majority world” requires, and a meat consumption tax. This includes fish, chicken, dairy and eggs, which are massively subsidized.
Dr Jeremy Rifkin states in Beyond Beef: The Rise and Fall of the Cattle Culture: “There are currently 1.28 billion cattle populating the Earth. They take up nearly 24 percent of the land mass of the planet and consume enough grain to feed hundreds of millions of people.”
In the grocery industry as well as the restaurant business, local is often misrepresented, and for many of the same reasons Tom Henry speaks to in the June article.
Both industries work more efficiently with a constant, reliable supply line. Customers expect to get their pulled pork sandwich every week, and not just when supply allows. It takes extra commitment on the part of the retailer and restaurauteur to source from numerous local suppliers for products and deal with shortages that will occur. And it takes a different set of expectations from the consumer. A menu changing with local seasons might mean you have to wait another week for the promised strawberry mousse. It’s a good sign! Check out the Island Chefs’ Collaborative website for some committed chefs (www.iccbc.ca).
Grocers are jumping on the local band- wagon, but as in the restaurants, it is buyer beware. BC signage is left on the Mexican cucumbers, local is promoted in the off-season when there is often nothing in the store from the Island. Products from other continents are offered when BC ones are available. The definition of local can often mean BC, and this is good, but living on an island means we have to insist on Island produce if we are to walk the road towards food security.
What can you do? Ask questions of retailers that have BC and local produce in the off-season. Check the labels yourself to see where the product is coming from. Look for signage that names the farm and where it is located. Look for companies that contract local farms, as this helps the farmer with crop planning and guaranteeing the sale. Ask if your grocer is working with Island farmers to extend the season. Finally, look for companies that respect farmers. If their produce is dirt cheap, you know the farm it comes from is not sustainable!
How to Save Downtown (June 2011)
As someone who has worked Downtown for the last 20 years and who owns two gift shops in downtown Victoria, I have to say that Yule Heibel’s article hit the nail on the head. Business owners in our city’s core cannot keep picking up Downtown’s tax tab. Nor can we continue to assume the responsibilities of fixing Downtown’s problems. Having a population that resides Downtown will bring a new, fresh and invested perspective to our city’s downtown and the issues that it faces. It is the combination of residential and business that are the ingredients to creating a vibrant, healthy and dynamic heart to our city. I am thrilled every time I see any new building going up Downtown that incorporate the combination of business and residential. We all tend to care for and love where we work and live.
The Albertafication of Canada
“The electorate, exercising its inalienable right to both hayseed gullibility and full-sheeted insanity, handed [Stephen Harper] a majority,” says Gene Miller, in an otherwise sound analysis. But it was our antique voting system, not “the electorate,” that handed Harper his majority. Harper got less than 40 percent of the votes, only a couple points more than last time, but won 24 additional seats. Liberals, Bloc, and Green Party should each have elected a dozen more MPs to accurately represent those who voted for them. Most voters, as usual, got nothing for their vote, including a lot of Conservatives.
Your June edition was excellent! It did what a good current affairs mag should do: Man the watchtowers, helping readers prepare for change and live full, rich lives. David Broadland’s piece on double-talk at City Hall should be remembered at election time. Rob Wipond’s investigation of over-prescribing of anti-psychotic drugs was scarey and important. Even Aaren Madden’s piece on “local” food was a warning to us all.
This is useful stuff, and so much better than the usual paeans of praise to developers.
Where did all the trees go?
Readers most definitely should travel the “new improved” route from Lake Cowichan, Mesachie Lake to Pt. Renfrew and experience the landscape now modified by extensive clearcuts and slash/logs left to decay. It is an eye opener to see the changes from the forested slopes to what resembles a warzone. Clearcuts as far as the eye can see, with definite impact on localized climate causing drought, higher temperatures and extensive runoff erosion, changes in rainfall locations and destruction of the carbon sink. Perhaps the logging tenures should be replaced by turning the region to mixed sustainable community use.