Independent and unbiased blog about a wide range of depression-related topics
As we all know, the pharmaceutical industry can keep the price of antidepressants artificially high because for the time being, their patents give them a monopoly.
But what will happen in the future, when these patents expire?
Something like this?
• source: a 1928 ad for LUDEN’S MENTHOL COUGH DROPS.
I wish I could say that for the past few weeks nothing happened here on this blog because I was away on a wonderful vacation in sunny France. The truth, I’m afraid, is that I’ve been far too depressed to write a single word. Luckily, I’m recovering now.
So how to celebrate my return to the land of the living?
Well, to go a little easy on myself, here is another image from my collection of old pharmaceutical advertisements. Showing how in the good old days, pharmaceutical companies tried to convince psychiatrists of the magical qualities of their newly-invented medicines.
Often, what strikes us today in these old ads is that they demonstrated little respect for the patients for whom the medication was intended. In many cases, these ads tried to visualize mental illness in ways that we nowadays would find crude or even disturbing. For another example, see the Nembutal ad here.
Below is a circa 1960 advertisement for Thorazine (American brand name; known in Europe as Largactil). Based on chlorpromazine hydrochloride, it was introduced in the 1950s as a calming antipsychotic drug and quickly became very popular. Psychiatrists were happy to prescribe it to patients with psychotic tendencies.
I will let the ad speak for itself:
With this frightening ad, the people of “Smith Kline & French Laboratories, leaders in psychopharmaceutical research”, wanted to show what they thought psychosis did look like.
Shall we try to find a musical equivalent? How would it sound?
Maybe the Finnish rock band Poets of the Fall has something that comes close to an answer. If you want to know more about them and hear more of their fascinating music, please go to their official Poets of the Fall website.
This is just their song Psychosis from their 2008 album Revolution Roulette – and if you feel inclined to complain that it doesn’t sound soft and sweet, the answer is of course that this really shouldn’t sound soft and sweet:
(click the “Play” button – if it does not work, install Flash)
Yesterday, in a brief article Anxiety vs. Depression at Psychology Today, psychiatrist Fredric Neuman tried to explain why psychiatrists often prescribe antidepressant medication even if the patient indicates that her main problem is anxiety or panic attacks rather than depression.
He states that major depression can often have not a kind of sad feeling as its predominant symptom, but rather anxiety. According to him, when there are also other well-known symptoms such as interrupted sleep, loss of appetite and loss of sexual interest, this specific combination of symptoms can be clear enough for the psychiatrist to diagnose a case as depression: even when the patient would label herself primarily as suffering from waves of anxiety, not from depression.
I suppose he may be right – but only, of course, in those cases where (a) this anxiety or panic does indeed come together with other main symptoms of depression, and (b) where this occurs not incidentally but frequently, throughout most days over an extended period.
Brief as it is, Neuman’s interesting article leaves several important questions unanswered. Here are the two questions that came to my mind immediately:
1. Many people experience anxiety or sudden panic attacks once in while or even frequently. By itself, this may not necessarily be abnormal or an indication of illness; it can for example be caused by actual worries, or by a temporarily overactive self-protection mechanism. Can we be sure that psychiatrists will not jump too easily to the conclusion that such anxiety indicates an underlying depression?
In other words, can we be sure that psychiatrists will not too easily prescribe antidepressant medication – with sometimes far-reaching and undesirable side effects – even in simple cases where in fact it might be better to just address this anxiety by itself?
2. Neuman does define “depression” but did not really define “anxiety”. So this raises the question what degree of anxiety a psychiatrist should consider bad enough to justify the prescription of antidepressant medication. I suppose this applies to anxiety that is so intense that the patient cannot function normally in daily life anymore. But will it also apply to intermittent feelings of anxiety that the patient merely finds unpleasant or disturbing? Where exactly do we draw the border line between serious anxiety and fairly “normal” anxiety?
In other words, can we be sure that psychiatrists will not too easily prescribe antidepressant medication even in simple cases where in fact it might be better to explain to the patient that sometimes anxiety (just like grief) is not a kind of aberration but a natural feeling that we should accept as one of the many facets of life?
Neuman is a qualified anxiety expert (at the Anxiety & Phobia Center of White Plains Hospital) so I hope he will soon give us a follow-up article with a little more of his views on anxiety in relation to depression.
• tip: In my own perhaps too simple view, the best short-term way to counter a frightening, paralyzing, irrational attack of anxiety is this.
Seek out someone else who at that moment can be more rational than you. Do not yet start a talk about possible causes of your anxiety: for this will often just not work in your present panicky state. Instead, together with this other person try to do something, some kind of simple distracting activity.
• footnote: At the bottom of Neuman’s Psychology Today article is also a link to his personal blog, but due to a typo it will send you to an error page. Here is a link that works.
Please don’t worry. This is not going to be some kind of dumb rant against pills or the pharmaceutical industry. I just want to show you how what was considered normal in psychiatric health care 50 years ago, is seen a very different light by us today.
And by implication, how what we now think is normal, may be considered weird 50 years from now.
50 years ago, a popular tranquilizer was the drug Nembutal. It is based on pentobarbital, which as a barbiturate is rather dangerous. It’s not only addictive, easily creating drug-dependency. An actual overdose will simply be lethal. It has long remained in use as a strong tranquilizer, for example to reduce anxiety. But in modern psychiatry it has largely been replaced by other, hopefully less dangerous drugs. It is now mainly being used by veterinarians: for euthanizing animals.
In the USA, it has recently also been used as a simple way to carry out executions, replacing more complex mixtures of lethal drugs. In March 2011, Ohio prison inmate Johnnie Baston was the first to be executed by a single-drug dose of pentobarbital (see this Washington Post article). In July 2011, when already 18 people had been executed in this way, the Danish pentobarbital producer Lundbeck announced that it would no longer accept the use of its drug for execution purposes (see this Guardian article).
Flashback to 50 years ago. Here is an old advertisement that shows how back then, this same drug was promoted (and used) for psychiatric treatment of children:
For us today, this advertisement looks just weird. Not just because it presents the use of Nembutal to tranquilize children as something normal. It also looks weird by itself.
It shows a friendly slogan “when gentleness is important”. But this strangely conflicts with the crude, caricatural, in modern eyes almost disrespectful and disturbing way the child is depicted in the image. The kid looks like a little Frankenstein, a little monster. One look at him and we’re supposed to understand immediately why, yes of course, this boy does need a gentle Nembutal treatment, real quick, before he… (fill in your darkest Dracula fantasies here).
I’ll happily leave all other interpretations of this weird advertisement to you.
Now, instead of flashing back 50 years, flash forward, to 50 years from now. To 2062. How will people then look back to today’s practices of easily diagnosing unruly, not-concentrated children as “ADHD” and sedating them with medication, instead of taking adequate educational steps?
Frankly – Frankensteinly – I think those people in the future will find this way of treating children just as unbelievable and weird, as we find this old Nembutal advertisement.
We can repeat this same time-travel thought experiment for many other primitive practices within psychiatry, such as the still far too easy and liberal use of electroshocks. What will people in 2062 think of the fact that I, a depression patient, got electroshocks even after I got a heart failure during one of those treatments?
There are many more examples of still-existing psychiatric primitiveness: again, I’ll leave this little bit of thinking to you.
The point is: if we can clearly guess how 50 years from now people will find us weird, then why should we wait those 50 more years before making some simple, obvious improvements in psychiatry? Let’s be a little more critical about what we’re doing today! Let’s work a little harder! Let that future begin now!
• note: OK. I admit, maybe this whole demonstration here was a little on the demagogic side. But in essence, I don’t think it’s untrue.
Maybe I’m just too impatient? And now I come to think of that, would this impatience be one more cause of depression?
This portrait here is not Emily Autumn, who is filling the rest of this post.
First, here is my daughter Sophie (portrayed by my friend Frans-the-painter). She is a nearly-graduated expert on medieval literature and manuscripts. She also writes, she makes beautiful drawings, she moderates a sci-fi/fantasy role playing game, she sings in a choir that brings everything from Yiddishe folk songs to Haydn church masses, she worked in a leather shop, she’s into custom-built computers, she cooks great meals, and she is a keen follower of alternative music and culture.
Don’t tell me I should be proud of my daughter: she does it all on her own power.
She’s the one who told me about Emily Autumn.
Emily Autumn is a unique, very flamboyant, punky-style American singer who has many dedicated followers. Having bipolar depression, she was hospitalized after a suicide attempt some years ago, and one of the recurring themes in her music is psychiatry, or maybe I should say anti-psychiatry. You can find Emily Autumn’s website here: The Asylum.
Last month Sophie was at one of Emily Autumn’s live concerts, and she was very impressed by its atmosphere, Autumn’s performance, the crazily dressed fans and the music itself. One of the songs Sophie told me about was Take the Pill, a kind of anti-psychiatric pamphlet translated into a bitter, sarcastic song. After listening to it, I felt compelled to comment on the actual text Autumn is singing here.
As you know my own stance is not rigidly anti-psychiatry, but not pro-psychiatry either: I would describe myself as “a fair critic”. I will never state that all psychiatry is by definition Evil: in some cases, professional therapy (including pills) can perhaps do some good, or even be needed – temporarily – to prevent a disaster. But I also do know very well that psychiatry is way too much commercialized, pushing extreme solutions onto people who might do better without, often resulting in a kind of counter-productive overkill.
I am convinced that in today’s situation, let’s say 80% of all habitual antidepressant users would do better without. The remaining 20% might benefit from them.
In my own past, pills and electroshocks may have helped me incidentally (perhaps preventing more suicide attempts than the two I survived). But they never helped me in a structural way. Against the advice of some psychiatrists, I stopped having electroshocks five years ago, and last year stopped taking pills altogether. On the whole, I feel better for it. But I know that what applies to me, is not necessarily true for anyone else: we’re all different.
I will use my own experiences here as a base for commenting on Emily Autumn’s Take the Pill song: giving you the complete lyrics, mixed with my own comments where I see fit. But first, here is my unique patented Depression Music Player so you can listen to Emily herself. Click the “Play” button to hear her singing Take the Pill:
(if the player does not work, install Flash)
take the pill that makes you weaker
take the pill that makes you sick
comment: Taken literally, this is sometimes true. Nasty side effects can hit some of us. But there also are people who don’t really notice any side effects.
… take the pill or you’ll be sorry
comment: Yes, this is what psychiatrists often suggest. What they mean is (if you’re in very bad shape at least, if you are suicidal) that if you don’t take medication you may not live to regret your decision to refuse them.
Maybe some psychiatrists do indeed use this suggestion as a kind of threat, to persuade you with force. But the same suggestion can of course also mean they are genuinely worried about you.
… take this bloody pill and make it quick
take the pill that kills your sex drive
comment: Yes, this is one of the most frequent side effects, experienced by many of us. Losing sexual urges and satisfaction affects not only yourself but also your relations with others; this can make your depression much worse.
Somehow, psychiatrists tend to grossly underestimate the importance of this. They keep prescribing medication that has this effect even when there are alternative pills that do not have this effect.
One other thing: in some cases, it’s not the medication that killed the sex. Sometimes, it’s the depression itself that has this effect.
… take the pill that makes you cry
take the pill that burns your insides
take the pill that makes you want to die
comment: Yes, there are known cases of antidepressants generating suicidal impulses instead of reducing them. This does not happen often, but it is a potential danger. This is one of the many reasons why you should never take those pills without regular checks with a qualified psychiatrist, for as long as you use them.
… be careful what you say
today could be your day
you no longer rule your body
comment: Yes, sometimes this is how it feels: medication-induced numbness resulting in the feeling you no longer have control over yourself. For example, you are moving but it does not feel like you are moving: more like a zombie.
This does not happen to all of us but it does happen fairly often: and equally often, you will become fully aware of this effect only after you’ve stopped taking antidepressants.
… you no longer own those rights
you will wake up when we say so
you will sleep when we shut out the lights
enjoy your stay
‘cause you can’t run away
comment: I’ve been hospitalized in a locked ward a few times myself, and of course this is certainly not a pleasant experience. But I want to add a few footnotes here.
It’s obvious that personnel in such a ward want to sleep you regularly, in their own practical interest, and so you won’t disturb other patients, and also because regular sleep can give you more energy to fight your own depression. But I myself have never encountered a regimen of brutally enforced sleep.
In fact, some of the most nice and personal conversations I ever had with psychiatric nurses did occur when I got wandering through the ward in the middle of the night, ran into a night-shift nurse who had little to do at that time, and got into a long talk with her before going back to my bed.
The interesting background dilemma of using locked psychiatric wards is of course that two things conflict here: the patient’s right of freedom, and the patient’s right to be protected against his own self-destructive urges. These two things have to balanced against each other somehow.
I’ll admit that this balancing may not always happen properly or with enough care. On the other hand, if psychiatrists think there’s a serious risk you will run off and impulsively jump from a bridge, can you always blame them for temporarily locking you up rather than taking the risk?
As for the constant supervision, the control and lack of privacy in some institutions: my first suicide attempt was by hanging myself while hospitalized. If they hadn’t discovered me in time, I wouldn’t have been around now. Yes yes, I know, you don’t need to tell me you wouldn’t have missed me, either… ;-)
… get back in line, get back in line, get back in line
get back in line, get back in line, get back in line
comment: I’m not sure what exactly Emily means here. If “get back in line” means that people try to force psychiatric patients into some predefined mold, in standard “normal” behavior patterns, that is indeed wrong. To a slight extent, I’ve sometimes experienced that myself: when it happens, it’s usually because psychiatrists and nurses (out of lack-of-time, laziness or lack-of-involvement) try to go the quick and easy way. When your behavior in some way is just irritating to them.
But I must say I’ve also found often enough that people tried to accept and respect my own peculiarities. And believe me, I sometimes can be a little strange or oversensitive…
On the other hand if “get back in line” simply means making your behavior a little more social again, then I would say there’s little wrong with that. For example, if ward personnel try to involve you in some activities with fellow patients again, then in the long run that might make you feel better.
… you’ll be just fine
take the pill that keeps you quiet
take the pill that keeps you blind
comment: Yes. Sure. Blind. I really must agree here. The first time I was able to fully, candidly, clearly overview and analyze my own situation and my depression, was after I quit taking antidepressants. Not during the years I took them.
… take the pill that wipes your memory
comment: I agree again. And this is even more true when it comes to electroshocks: in my case, they wiped out and destroyed important parts of the hard disk within my head. I can, for example, since those shocks not remember a thing about the difficult birth of my daughter Sophie. And with those parts of my memory, parts of my life, parts of my former personality were also wiped out forever.
This is another very important side effect that may not happen to everyone, but once again an effect that when it happens has a huge impact, and that psychiatrists tend to grossly underestimate.
… take the pill that’s f*cking with your mind
that’s all you have to lose
that’s funny
best that you’re not procreating
best that you don’t multiply
better still, let’s sterilize you
comment: Come on Emily. Are you serious? This is something that only the Nazis did, back in the 1930s and 1940s. As far as I know, no one in psychiatry advocates or tries to sterilize psychiatric patients today. Maybe I’m naive, but I just can not believe this. Please correct me if I’m wrong. If this really happens somewhere, there’s reason for worldwide action and protest.
… take this pill, the doctor’s standing by
pull up your skirt
and yes, it’s going to hurt
comment: Taken literally: yes. Sometimes. A needle, for instance. That can be very unpleasant, but it does not always mean it is just bad. Last year I had to have a gall bladder operation; that did hurt more than anything psychiatrists ever did to me – more than electroshocks.
But the other side is, after a few months I had overcome the feverish and painful side effects of my gall bladder operation. After five years, the nasty side effects of the electroshocks are still bothering me: that damage will probably last forever.
… get back in line, get back in line, get back in line
get back in line, get back in line, get back in line
you’ll be just fine
don’t you wanna be sedated
don’t you want to ease this pain
if the pills are not effective
then we will electroshock your brain
comment: I’ve had about 110 electroshocks. Really. In the beginning I was so exceptionally depressive and suicidal that maybe, I’m not sure but maybe, the first few shocks actually helped saving my life. I don’t know. In my case, the problem was that therapists went on shocking me with regular intervals, for about three years, even when probably it wasn’t necessary anymore. A treatment-on-autopilot. That’s plainly dangerous and wrong.
In general, electroshock treatments are so radical that they should be given only as the very last resort option, and only with the patient’s express content, after giving ample information and discussing it with him in an open, honest way. If there still are places where people get shocked against their will, that practice should be stopped. Right now.
… we are not happy with your progress
you’re not yet considered sane
if these pills are not effective
we’ll electroshock your brain
don’t even think of spitting out
we know your tricks, we’re on to you
we will check underneath your tongue
comment: In principle, forced medication is just as bad as forced electroshocks. In practice, maybe we can imagine a few cases where psychiatrists might find arguments to defend such a practice, saying that it’s no big deal and – as a kind of short-term safety measure –in the patient’s own interest.
But I still would find it very dubious, something that ought not to happen. Personally: as far as I can remember, I myself was never forced to take pills. Lucky me?
… we know exactly what you’ll do
your accusations are a joke
your credibility is shot
just keep your eyes down and your mouth shut
that’s the only choice you’ve got
so you’re a doctor and i am just a crazy little girl
who would you believe?
comment: Yes, some psychiatrists, especially in institutions, tend to assume a paternalistic we-know-best attitude, not taking the patient seriously. That’s not just wrong: it also is counterproductive. It will make the patient only suspicious, and sometimes with good reason. It will get in the way of a positive therapy, hampering instead of helping. All therapies should be based in the first place on open and informative communication between therapist and patient: the latter should be listened to (and answered to) seriously.
I suspect in this respect I may have been a little lucky because of my background: even when I was totally immobilized and almost incommunicable by my depression, psychiatrists possibly recognized I was a PhD with a university research job: in other words, to some extent one of their own kind. I’ve often had the nagging feeling that just because of that, they took me a little more seriously than many other patients, even when I tried to interfere on behalf of some fellow patient. But everyone deserves to be taken equally seriously!
… well he’s a doctor and you are just a crazy f*cking bitch
who would you believe?
we’ve filled your prescription, you’ll never run out again
we’ve filled your prescription, the drugs are your only friend
comment: Hmm… I don’t know. When suicidal I sometimes had the feeling that death was my only friend, but I’ve never had the feeling that pills were my only friend. Nor do I remember therapists actually suggesting something like that to me.
But don’t worry Emily, I do get your meaning, just like everyone else will. Psychiatrists sometimes like to suggest too easily that pills will solve everything. They won’t.
… we’ve filled your prescription, you’ll never run out again
we’ve filled your prescription, the drugs are your only friend
now, take the pill, take the pill, take the pill, take the pill
take the pill, take the pill, take the pill, take the pill
take the pill, take the pill, take the pill, take the pill
take the pill, take the pill, take the pill, take the pill
take it, take it, take it, take it
take it, take it, take it, take it
swallow, swallow, swallow, swallow
swallow, swallow, swallow, swallow
Emily Autumn is an artist, and artists exaggerate. They have to. Without exaggeration and sometimes even a little distortion, there would be no art. It’s exactly this that makes art stand out from plain, dull reality. It’s exactly this that makes art effective, impressing, and beautiful.
Art does not always have a message, but Emily’s art does have one. Apart from the necessary exaggeration, basically she has a true and important message. Your own interpretation may be different from mine, but I feel it boils down to this:
Psychiatry should respect people’s individuality and human dignity. Not, as still happens too often, ignore, overrule, or even destroy it.
• tip: None this time. Maybe go to Emily Autumn’s website and get some of her music?
• note to blog followers: Sorry for the double (automatic) post notification. By mistake I posted an unfinished draft here first, so I had to trash that and then post the right version. That’s why you got it mailed twice.
May 20, 1864 –
Poet John Clare (70) dies peacefully in the Northampton General Lunatic Asylum where he had been living his last 23 years. Due to his background and his knowledge of nature, in his own time he was known as “The Northamptonshire Peasant Poet”.
Originally an uneducated farmhand, as a successful poet he had felt out of place everywhere: not at home among simple villagers anymore, but not at home among his more refined reader public either.
Besides deep depressions he also suffered from periods of delusion: thinking he was Shakespeare or Byron, he had set about rewriting their poetry.
One of his best known poems, I Am, written in the asylum shortly before he died, expressed loneliness and a longing for both the innocence of childhood and the blissful emptiness of death.
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