Going Off Schizophrenia Medication – A Real Life Example

By Dr David Laing Dawson

In going through my old correspondence after a move, I came upon these two e-mails sent two months apart from a patient. Identifiers have been removed to protect confidentiality

Date: Wed,11 Feb 2009
To= “Dr. Dawson”
just writing to let you know that i have stoped taking my zyprexa medication for about a month
and i am feeling great. no problems to report. just told my parent’s about the change tonight and they told me to tell you. i am still working, driving and living… Iol i feel like my self… talk to u later. c ya!

Date: Wed, 8 Apr 200911:30:26 -0400
To: “Dr. Dawson”

hey dr.dawson

i’m having some problems. i feel so angry and depressed all the time. i quit my job because i
couldn’t do it. i felt like most the people i was working with didn’t want me there and it seemed
like they out to get me. i don’t know if they really were or if i was just imagining things. my boss
was annoyed with me because of my inability to function at an average level. i was coming home from work wanting to die because i felt like nobody even cared about the situation i was in. i was so stressed out i was throwing up in the morning and i would be nervous, shakey, dizzy, pouring sweat, and nauseous all day. what i would see would change, like the lights would all of a sudden get bright and the shade of things would change. my thought’s were racing and i couldn’t control them. i don’t think i can work and my parent’s are angry at me because i need a job. they threaten to kick me out all the time. i would really like to go on disability if at all posible. my parent’s will be disapointed if i do though. they always told me that for me it would be just working the system and any respectable person should work unless they are totaly handicapped. they don’t think aboput how that makes me feel. especialy when i go to work and come home crying all the time. i don’t know… maybe you can help.

The Consistency of Mental Disorders Over Time and Geography

By Dr David Laing Dawson

Recently a filmmaker from Nova Scotia, working on a project about “madness”, reminded me of The Stirling County Studies. These longitudinal studies found the incidence of Anxiety and Depressive Disorders (not angst or sadness, but defined disorders) to be 9 per 1000.

Which reminded me that we have been here before.

We have done the studies. We asked those questions last century. If the major mental illnesses are socially determined then we would find very different rates in very different cultures and socioeconomic conditions. This did not turn out to be the case. What we now call Major Depression, Bipolar Disorder, Anxiety Disorder, and Schizophrenia, occur in all cultures, countries, and socioeconomic classes in surprisingly consistent numbers. The names and the language used to describe these conditions are different, the understanding of them variable, but the actual numbers are very close. In fact the outliers tend to be exceptionally high incidences of bipolar disorder (manic depressive disorder) in a few tight knit and genetically isolated communities.

Of course the level of stigma, the treatment offered, and the course and outcome of these disorders are definitely profoundly affected by culture and multiple social factors.

We know schizophrenia afflicts the Inuit at the same rate as it does an English speaking middle class community in Toronto. They don’t (or didn’t) have the word schizophrenia, but they certainly have words meaning “not in his right mind.”

A late teenage boy may be developing a psychotic illness. He refuses to cooperate and refuses treatment. I tell the mother we have to watch this closely and I will take action when I can and should. She, a recent immigrant from a Middle Eastern Country, says to me, “Can’t you just hold him down and stick a needle in his bum like they do in the old country.”

An old classmate who became (as unlikely as it seemed) the Deputy Minister for Health for Papua New Guinea, talks of the natives of villages deep in the jungles tying to poles a newly psychotic citizen and carrying him through the forest for many miles to the nearest Medical Station for ECT treatment.

Working in a Psychiatric Hospital near Cambridge England in 1970 I found a surprising number of middle age Polish Men suffering from schizophrenia on the wards I attended. But it was only surprising until I learned of the history of the formation of a Polish Army in England in 1940. Then the numbers fell in line with exactly what we know about the incidence of schizophrenia in the age group of young recruits. And the later prevalence, for these are all chronic illnesses.

The diseases are the same. Quality and availability of treatment, course of illness, quality of life, outcome of illness and life expectancy are strongly culturally and socially determined. There is where we need to make a difference. But those factors are not amenable to diagnosis and treatment. We know what they are. And they can be improved through changes in attitude and through political action.

(I have a step granddaughter who has Cystic Fibrosis. We know the genetics of this illness with some exactitude. She is Canadian, living in a middle class family, and receiving Canadian medical care. Her life expectancy, with this illness, in Canada, is a little better than that of the average healthy Russian, and, strikingly, about 20 years better than that of a child born in the USA with this illness.)

There is much in this world that needs improvement. But denying the reality of these mind/brain illnesses would be big step backwards.

Addendum to Social Determinants – Biases in Interpretation.

By Marvin Ross

The problem with science (research) often lies in its interpretation. Scientific research findings are not static but are ongoing and evolving as more work is done and the results are dissected by those who understand the topic. It is all nicely summarized by a poster that I just saw on Facebook of all places.

Science is not the truth

Science is finding the truth

When science changes its opinion, it didn’t lie to you, it learned more.

That’s fodder for a number of blogs but I wanted to share two reports that a reader just sent me in response to the last two blog on the topic of social determinants of mental illness.

The first is “The Social Determinants of Mental Health” which appeared in the International Review of Psychiatry in 2014. On page 14, the authors stated that:

Mental disorders include anxiety, depression, schizophrenia, and alcohol and drug dependency. Common mental disorders can result from stressful experiences, but also occur in the absence of such experiences; stressful experiences do not always lead to mental disorders. Many people experience sub-threshold mental disorders, which means poor mental health that does not reach the threshold for diagnosis as a mental disorder. Mental disorders and sub-threshold mental disorders affect a large proportion of populations. The less commonly-used term, mental illness, refers to depression and anxiety (also referred to as common mental disorders) as well as schizophrenia and bipolar disorder (also referred to as severe mental illness).

In countries around the world, a shift of emphasis is needed towards preventing common mental disorders such as anxiety and depression by action on the social determinants of health, as well as improving treatment of existing conditions. (emphasis mine)

Social determinants do not always lead to mental disorders. And, looking at the research they cite, they only talk about depression and anxiety which is not surprising.

The second paper I was sent is from Simon Fraser University in Vancouver called Homelessness, Addiction & Mental Illness: A Call to Action for British Columbia. The authors of that paper state on P 14 that:

Nearly all of the modifiable burden of illness associated with substance use and mental illness is socially determined (WHO, 2013). A body of research integrated by the World Health Organization affirms that mental health and addiction are determined by social, economic, and physical environments, and that the inequitable distribution of these determinants has profound effects on individuals and societies (Allen, Balfour, Bell, Marmot, 2014; WHO, 2013).

Their source for stating that is the first paper I referred to above and, as you saw, that paper says no such thing.

Unfortunately, personal bias and ideology can lead to tunnel vision when it comes conducting resarch and interpreting it. A few years ago, I noticed a comment in Mad In America (MIA) “debunking” what they called the myth of schizophrenia as a progressive brain disease. They based that on a research study co-authored by Dr Robert Zipurski. MIA stated that “decreases in brain tissue volumes are attributable to antipsychotic medication, substance abuse, and other secondary factors.”

As I know Dr Zipurski, I called him to find out what he really said which you can read in my Huffington Post article. I wrote:

“As for brain deterioration, he does state that MRI studies show significant brain volume reduction in chronic schizophrenia and in patients presenting with first episode psychosis and schizophrenia. Those changes seen in patients at first episode are developmental changes in the brain. The changes in the brain are present initially before any medication has been given. And, he points out that changes in brain volume are also caused by cannabis and tobacco use for everyone. Those with schizophrenia smoke more than those who do not. A sedentary lifestyle and stress in everyone also results in reduced brain volumes again, regardless of antipsychotic use.”

If we really want to make progress in understanding and developing better treatments, we have to purge ideology from our research and its interpretation.

More on Social Determinants of Mental Illness

By Marvin Ross

Has anyone ever heard the suggestion that we should look into the social determinants of Alzheimer’s Disease, epilepsy, ALS or other neurological ailments? I didn’t think so simply because these are neurological brain diseases and that line of investigation would be futile and stupid. But, for some reason, we hear that said of serious mental illnesses like schizophrenia and bipolar.

I can understand that suggestion coming from Mad in America because we all know they do not believe that these are biological illnesses. What is surprising is that the prestigious medical journal, The Lancet, makes similar claims in its editorial on Sept 18, 2021 having been influenced by the current head of the American Psychiatric Association, Vivian Pender. But then, the Lancet just did an article called Periods on Display which they characterized as “Historically, the Anatomy and Physiology of Bodies with Vaginas have been Neglected”. That got them quite a bit of negative publicity and may suggest a lack of insight.

Poverty, income inequality, racism, mysogeny, homelessness are major problems in our society but they do not cause neurological illnesses. In order to demonstrate that they do, we would need to prove that no one or very few born into privilege ever develop any of the neurological diseases mentioned above including schizophrenia, bipolar disorder, major depression and others. That is definitely not the case so how do we account for those of privilege who do get schizophrenia, etc? We can’t because they do suffer from those maladies.

The discriminating social conditions mentioned above do make it more difficult for the victims and their families to get the help that they need but they are not the cause.

Early on in my family’s adventure with schizophrenia, my son was in hospital with a professor who held an endowed chair in the faculty of medicine. He was bipolar and had been off his meds. He and my son became friends when the professor was not locked in the isolation room which was necessary a few times. The hospital and the medical school occupied the same building so the professor would have a nurse go to his office to pick up his mail for him. What were the social determinants of his bipolar disorder – he had a medical degree, prestige as a professor and a physician, wealth and he was a white male? There were none!

In last week’s blog, Dr Dawson pointed out that the first step in treatment is medical but then other things need to follow. Medical doctors first treat and stabilize the patient but then, what is needed is proper supports like an adequate income, shelter, meaningful activities, nutritious food, friendship, case management and so on. There was a time when some of that was looked after but no longer. Hospitals do not keep patients long enough to properly stabilize them, our society refuses to provide adequate income or housing and, if the ill person does not have a family who can help, they are out of luck.

Disability payments in most jurisdictions are well below the poverty line and adequate housing in almost non existent.

In Ontario (and I’m sure it is not unique), the government thinks that those with disabilities need to go out and get work even though they are disabled and can’t. their concern is to get people off disability and into full time employment. That is their solution. Affordable housing is rare and so our parks are filling up with people living in tents. Toronto just spent $2 million to clear the homeless out of the parks and had they spent that on the people living there, each would have received $33,000 according to one journalist. Meanwhile, the number of panhandlers at traffic lights where I live has risen considerably since COVID.

The social ills need to be eradicated but also those with serious mental illnesses need proper care and treatment which means more than being stabilized and tossed out onto the street.