by Susan Braider
The American public is acutely aware of the epidemic arising from Purdue Pharma’s strategy to maximize the sale of OxyContin. Fewer among us are aware of a similar scandal arising from AstraZeneca’s advocating the off-label use of Seroquel, a powerful antipsychotic. The residents of Utica should know that physicians are acting in a manner that puts their health first allowing all other considerations to follow.
AstraZeneca colluded with the FDA, in the manner Purdue Pharma infamously exploited, by encouraging leading VA psychiatrists to treat its thousands of veterans returning from the war zones in Afghanistan and the Middle East with Seroquel, a drug developed for the treatment of schizophrenia. AstraZeneca, like many drug companies, has a reputation of obfuscating and avoiding responsibility for the morbidity and mortality associated with Seroquel. Rather than respond to the questions posed by veterans and their families, AstraZeneca’s inaction and inattentiveness forced victims with adverse effects into court to secure information as to what happened, in an attempt to protect other veterans.
The concerns that arise from off-label use of Seroquel are not limited to this cover-up. These concerns demonstrate the manner in which every psychiatric patient is at risk, and that risk is to a degree unheard of in the rest of the medical community.
In Utica, the plans for the new hospital only demonstrate this ugly fact. It is widely accepted among therapists, psychiatrists, patients, etc. that access to treatment for serious mental illness is limited in our area. As MVHS began promoting the benefits of the new hospital, it became immediately clear that there would be fewer beds in the psychiatric service department. There will be fewer beds when the city is enduring an opioid fatality epidemic, fewer beds when the jails are functioning as public psychiatric hospitals, fewer beds with a growing homeless population, and fewer beds when residents who have serious mental illness have nowhere to turn, no safe place to go – when their suicidal ideation, impulsivity, paranoia, or hallucinations make living with insanity impossible, or nearly impossible.
We are at this cruel impasse where the first steps taken by the Reagan Administration destroyed the social safety net allowing the health insurance industry to impose managed care on psychiatric care. Psychiatric services were the first services to fall under the insurers’ control. Because psychiatric patients are the least likely to advocate effectively for their needs, efforts to moderate the draconian impact of managed care have been minimal. Bureaucrats, rather than doctors, decide when hospitalizations are needed.
The insurance industry transformed psychiatry, making psychiatrists administrators and pill pushers rather than listeners and healers. The listeners and healers, in principle, are the social workers and other allied health professionals; they charge much less than psychiatrists because their education and training were shorter and less costly.
But social workers are not psychiatrists. Their training is much shorter and very different from that of a psychiatrist. It would be inaccurate to suggest that a well-trained social worker cannot help many victims of mental illness, but, for individuals with devastating psychiatric conditions, cognitive behavioral therapy will not get to the heart of the issues that undermine the development of the patient’s personality.
There is no quick fix to help rebuild the psyches of people who were abused and assaulted as children, but healing can be achieved. Healing is being achieved when patients have the resources to engage in the kind of intensive psychotherapy that few psychiatrists are now trained to provide. The insurance industry has gutted psychiatry, putting Americans with serious mental illness at greater risk than they would have been three decades ago.
How is it possible that less was known about the brain thirty years ago, fewer drugs available, yet more people were mastering the skills of living with serious mental illness?
Why do political leaders and hospital administrators dismiss the needs of the seriously mentally ill, especially when many of them are dying from accidental overdoses or cardiac arrests from prescribed medication? Why would a community pay to jail and imprison people whose crimes are manifestations are their illnesses? Why do we have money to hire prison guards but not nurses?
The outcome of managed care is obvious: the prevalence of disability among the mentally ill continues to rise as does the incidence of suicide.
Victims of mental illness are warehoused in jails, their bonds with society broken as they drift into the street.
The insurance industry’s stranglehold over psychiatric treatment results in a system’s dependence on the use of powerful drugs as the first order of treatment for the seriously mentally ill. The talking cure, if you will, was abandoned – viewed as too costly. The dependence on medications to the exclusion of other forms of potentially effective treatment has become associated with an increase in what is known as iatrogenesis. Iatrogenesis describes illness brought on by a healer or resulting from treatment.
Once a victim of iatrogenic psychiatry myself, I attest that the original misdiagnosis of my condition and further misinterpretation of the reasons for the deterioration of my condition may have resulted from my lack of opportunities to talk – a lack of opportunity to describe the bewildering feelings brought on by the drugs prescribed to make me feel better. It was only when I found a psychiatrist who still believed in the talking cure that I learned about the adverse effects the drugs were having on me.
For eight years, the treatment I received, at great expense to my family, made me so sick and suicidal that I was at death’s door. Years of intensive psychotherapy mitigated the symptoms of PTSD and reversed the adverse effects of iatrogenic psychiatry.