Tag Archives: psychiatry

Psychiatry at Crossroads: Learn from Addiction Medicine

Practicing psychiatry is very tricky.  Heavy-duty pills have serious side effects.  To some observers, psychiatric medications are prescribed only to make money and psychiatrists are seen as evil witches casting spells. The world is not so simple, as there are psychiatrists working to get patients off medications.

A number of websites such as Mad in America and Beyond Meds channel gripes against Psychiatry and its medications.  At the same time, there’s been a flood of people suffering from mental health and addiction problems in need of treatment.  Forbes Magazine recently reported that there’s a shortage of psychiatrists in the USA.

Politics of Mental Health Treatment

We suspect that veterans with PTSD* and marijuana use are promoting the increased demand for psychiatrists.  Back in 2005, SAMSHA and ONDCP tried to warn Americans that teen marijuana use can introduce mental health problems in those with no previous issues. The DSM manual, which is like a Bible for Psychiatry, gives guidelines for diagnosing and treating symptoms.

Parents Opposed to Pot recommends staying free from marijuana and other drug abuse as the best defense against having a psychiatric condition.  The turbo-charged marijuana of today puts a far greater number of people at risk than the weaker pot of the ‘70s.  In Colorado and Washington, dispensaries sell marijuana that averages 22 to 28% THC, compared to 1-4% back in hippy days.

Providence St. Peter’s Hospital in Olympia, Washington reports of 1-2 new psychotic patients every day because of “dabbing” mariju- ana extracts.  A standard treatment is to give an anti-psychotic medication, Risperdal, and then release the patients.  However, if there is underlying addiction, the brain needs to be off mind-altering drugs before a mental health assessment.

Changes in HIPAA Law could put more checks and balances on Psychiatry.  Because of HIPAA Law, families are not allowed to know enough.  An ideal system of mental health treatment would pull together families and psychiatrists and patients. When Representative Murphy introduced a mental health care reform bill two years ago, many people supported it because it promised to change HIPAA.   However, the ACLU and patients’ rights groups fought this provision and a bill passed the House without making this crucial change.

If the Affordable Health Care Act is revised, Congress should not  cut insurance coverage for mental health care or addiction treatment.

Psychiatric Practices and System Called into Question

Often insurance will not pay for optimal addiction treatment unless there is an underlying mental health diagnosis.  Even when there is a mental health diagnosis, treatment also fails if patients are released from hospitals prematurely.

The Washington Post reports of a Maryland mother who suffocated two children after she was released from a psychiatric hospital too soon.  This unfortunate woman, Sonya Spoon, had suffered from abandonment at four months age, lived in orphanages and suffered from a head injury at age 18.  Her adoptive mother had warned the doctors against releasing her from the hospital too early, before an antidepressant could take effect.

Despite complete failure in the mental health care system, the criminal justice system sentenced her to 45 years in prison.   It is tragedy on so many levels for both her and the two toddlers she killed.  Unfortunately, the prison system is filled with both addicts and those suffering from untreated mental health disorders.

Beginning in the Kennedy Administration, a movement to de-institutionalize mental health patients began.  Psychiatry hoped that medications could replace institutions.  Pharmaceutical companies jumped at the opportunity, produced new drugs and marketed them vigorously.  It would be nice if “magic pills” really did work all the time, but they often cause additional problems and outlive their usefulness.

Everyone admits there are failures in the mental health care system, and many of Psychiatry’s critics want to eliminate all pills and forced treatments. However, plenty of people believe psychiatric pills help them. (Please see comments below by Jane Thompson whose medications bring relief to Bipolar Disorder.)  To think all psychiatric medications are worthless is like thinking all mental illness develops because the parents are evil.   Amateurs should never tell others not to take their psychiatric meds.

Psychiatry Lags Behind Other Branches of Medicine

Some branches of medicine, such as those that treat cancer and heart disease, have made great strides in the past century. Unfortunately, Psychiatry has not.  Many doctors besides psychiatrists are known to .  Books by Robert Whitaker, Joanna Moncrieff, MD and others call into question the overuse of psychiatric drugs.   Whitaker’s Anatomy of an Epidemic, 2010, won the IRE award for investigative journalism.  Whitaker is not totally anti-psychiatry as some people maintain. He has stated: … “It (Psychiatry) has a duty to develop selective-use protocols, which seek to minimize long-term use of antipsychotics (and other psychiatric medications). I also believe that our society should provide the resources to enable this rethinking of the drugs.”

No doubt Bipolar Disorder has been overdiagnosed.  Some individuals and professionals have classified drug and alcohol abuse as “medicating an underlying bipolar disorder.”  This interpretation excuses and dismisses the serious consequences of substance abuse.  At the same time, it may be hooking some people into taking pills, without getting them off substances of abuse.

The “chemical imbalance” theory of mental illness has never been proven.  In fact, this theory was never accepted by Psychiatry.  Some people conclude that psychiatrists and pharmaceutical companies have pushed this notion in order to make money and sell pills.  Today the marijuana industry is pushing marijuana for most mental health conditions, including depression, bipolar autism and ADHD in children.  Unfortunately, many with schizophrenia use pot, although it makes their problems worse.

The brain isn’t understood as well as other organs, and many times mind-body solutions are called for, instead of “medications.”

In Saving Psychiatry, Addictions Psychiatry Can Help

If Psychiatry became better at distinguishing the underlying roots of mental health issues, our treatments could be better.  British journalist Patrick Cockburn writes eloquently as to why he believes his son, Henry, became schizophrenic.  The diagnosis was precipitated by heavy marijuana use between the ages of 14 and 19.  After years of trial and error, and Henry’s refusal to take medication, the son has been stabilized with Clozapine.

Perhaps, because of a focus on pills for insurance purposes, Psychiatry often falters, despite the DSM Manual.  There needs to be better discernment of root causes.  Which illnesses are a result of substance use,** or trauma, and/or a combination of both?***  Treating trauma and Adverse Childhood Experiences (ACEs) before people resort to substance abuse would bring down the number of people needing psychiatrists. However, the most adverse cases of trauma or extreme psychosis may need to be medicated, including foster children whose parents suffered from drug abuse.   Even when psychiatric pills cause side effects, the alternative can be worse.

Addictions Psychiatry can help the psychiatric field when the “biological” model fails.  Addictions psychiatrists are trained to think more holistically, addressing the mind, body and spirit of a person.  If Psychiatry certifies more doctors in Addictions Treatment, it can make a difference and become a force for much good.

As for epidemic of Heroin, Fentanyl and opioid pill overdoses, policies focused on harm reduction have failed to stem the number of deaths by overdose.  Most states have passed making it easier for doctors and law enforcement to stop the overdoses.   Yet, this policy doesn’t treat the underlying addiction. Cost and insurance companies should not determine matters of mental health, or life and death.

Notes

*  PTSD is very real but only professionals should diagnose it.  At times, “bipolar disorder” and ADHD were also used too loosely and over-diagnosed.

**A NAMI (National Alliance for Mental Illness) Minnesota publication gives special attention to marijuana among the drugs that can cause psychosis, as well as legal drugs such as steroids and ADHD drugs. Epidemiological research of nearly 19,000 drug abusing Finnish subjects showed that marijuana most consistently led to a diagnosis of long term schizophrenia (Niemi-Pynttäri JA, Sund R, Putkonen H, Vorma H, Wahlbeck K, Pirkola SP. Substance-induced psychoses converting into schizophrenia: a register-based study of 18,478 Finnish inpatient cases. J Clin Psychiatry. 2013 74(1):e94-9).

*** Victims of PTSD who turned to marijuana with deadly results:  Cascade Mall shooter Arcan Cetin, an early marijuana user with PTSD killed five people at a Macy’s in Washington.  Stephen Bourgoin who recently killed five teens in a wrong way crash also suffered from childhood trauma, too.  Eddie Routh was a veteran with PTSD who smoked marijuana before killing Chris Kyle and Chad Littlefield.  NBC Nightly reported that Richard Rojas, the veteran who rammed into several people and killed a teen in Times Square, used marijuana before driving into the crowds.

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Mental Health Care Fails at Addiction Treatment

We’re facing a national tragedy of mental health misdiagnoses because American psychiatry is failing to treat root causes.  Too often young people with mental health symptoms are lumped into categories and given potent anti-depressants, benzodiazapines and/or neuroleptics, while the doctors or mental health treatment centers ignore symptoms of marijuana addiction and fail to treat the addiction.  In some cases, a psychotic episode is treated as bipolar disorder or schizophrenia rather than drug-induced psychosis.*

It may be time for widespread re-education of psychiatrists and emergency room physicians. Continue reading Mental Health Care Fails at Addiction Treatment

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Postscript: Spot the Pot and Stop

See Part 1, Part 2, Part 3 , Part 4  and Part 5 of The Unraveling of Ryan, an anonymous testimony. Permission is required to reproduce the story.  Names are changed, but details are accurate. 

As a child, I was stung by bees several times.  Each time my reaction got progressively worse. The last time it happened was at age 16; the doctor told me I could die if it happens again. Why is marijuana use like a fatal bee sting that makes some people swell until they implode?  So many young  people develop adverse effects from using today’s high-strength pot.  Just because marijuana originated in nature doesn’t make it safe.

Research around the globe proves that marijuana causes panic attacks, paranoia, severe anxiety and/or depression.  American hospitals often don’t consider marijuana a factor in the picture of mental health, and that’s a tragedy.  There’s an urgent need for psychiatry to train more addiction specialists.  If users quit after the first episode of psychosis or mental health condition, they probably can avoid a permanent psychological problem.  However, these users must never go back to pot again.  It’s like avoiding the bee stings if someone who’s allergic doesn’t want a fatal reaction, or like someone in Alcoholics Anonymous who can’t take one drink again.

IMGMy nephew Jason, is one that followed this advice. In 2011, when he was 16, he experimented with marijuana and developed severe anxiety and panic attacks. Ryan was still alive at the time.  My brother and his wife took him to his pediatrician, who referred him to a psychiatrist, a psychologist and a pediatric neurologist.  Each doctor insisted that pot could not be the cause of Jason’s severe anxiety, panic attacks and sweats.  Maybe they didn’t realize that the highly potent pot in California today has 12-15 % THC, at least 5x what it was when those doctors were in school.

He survived because he stopped using pot, made more urgent after attending his oldest cousin Ryan’s funeral. He was never hospitalized and his brain fully recovered in nine months. Today, Jason plays Division 1 basketball in college.  When I saw my brother at Thanksgiving, he thanked me for sharing the knowledge about marijuana that has kept Jason alive and thriving. 

I’ve read about the COMT gene polymorphism which explains why there may be a genetic link for anyone who carries the recessive gene allele, about 25% of the world population. I contacted three researchers around the globe in hopes of getting my family’s blood analyzed. Even though the research has been published, a blood test for DNA recognition of this gene identification is at least 10 years away.

Stopping a Problem in its Tracks

A  young neighbor recently confessed he was a big pot user all through high school.   Suddenly, he’s been dealing with his mother’s unexpected illness and the stress of a job change.  He developed anxiety out of nowhere, but felt it was related to his marijuana use. His friends keep pushing him to use pot, and to use even more than he had before. (How could someone who would goad another young person to use pot be called a “friend?”)  Thankfully, this young man listened to his own body and mind.

Now I’ve heard that Amanda Bynes has gotten her life back on track.  As of late December, she plans to go to college, stay sober and study psychology.  Congratulations and best wishes for her  continual recovery.  Let’s hope this time she realizes that returning to marijuana could easily lead her to permanent psychosis.

Recent photo of Amanda Bynes, TMZ
Recent photo of Amanda Bynes, TMZ

A Story from Colorado

On a cruise to Alaska with my mother, a story emerged from a couple living in Colorado. Their 21-year-old son had developed depression, out of nowhere. The mom wasn’t concerned her son was smoking pot with his college roommates. “It’s just pot and I smoked while at UCLA in the 70s.” By the end of dinner, she wanted to heliport herself back home to save her son, because of the tragic events I had shared about my son and the high THC content of today’s cannabis.

It was when she finally said her son does too much pot with his friends that I couldn’t hold my tongue. Her boyfriend (not the boy’s father) was Dutch and had a ponytail, so I had instantly judged him to be cool with marijuana, since there have been marijuana coffeehouses for decades in Amsterdam. To my shock, he said that lawmakers in the Netherlands recently capped the strength of pot!! Then this woman blurted: “Tim’s been attending a drug education series at the local Sheriff’s Department for several weeks. He’s been telling me the same thing about pot as you did, but I’ve been blowing him off, as though it was just “‘crazy talk.’”

Afterwards I felt upset that I had violated my vow not to discuss anything about pot or my son Ryan when I boarded the ship.  My mom saw the woman later and said: “You just may have saved that young man’s life.” Her boyfriend had been feeding her the same facts I had, but she continued in denial until hearing the story of my son’s pot use and my belief that it led to his tragic demise.IMG_0014

Wake up, America to the Looming Mental Health Crisis

After losing my own kid, I caution parents not to live in denial of marijuana, as I did.  Your child will be exposed to marijuana and is likely to experiment with it.  It is my mission to prevent other young people from going down the same path my son did.

If a person who uses today’s highly potent marijuana goes into psychosis (or depression, panic attack, other psychiatric presentation), the mental health system needs to first address the drug effects and the need for addiction treatment. Next, educate the person about brain health and wait for the drug-induced mental illness to run its course.

In California, which has unregulated medical marijuana, it’s been common to rope young marijuana users with psychotic symptoms into the label of a permanent, debilitating mental illness rather than give them addiction treatment.  For some, the diagnosis of bipolar disorder may be more comforting than advising them of the absolute need to give up marijuana.  When it comes to strong males like my son, they also flood them with powerful, unnecessary pharmaceutical drugs.

Our children and teens need to learn the true harms about today’s pot, especially to their, young, developing brains. The marijuana financiers should stop pretending they know about medicine.  Medical marijuana practitioners are doing far more harm than good, as the one who gave pot to my friend Leah’s son, Brandon.

A new Ventura County website suggests that some communities might be waking up from these delusions brought on by changing social norms, and “medical marijuana.”  Just because something originates in nature doesn’t mean it’s safe.  Like some people die from a bee sting, a part of mother nature, some people die from the consequences of using marijuana, or they spiral out of control.

If marijuana is legalized nationally, the need for mental health treatment will explode.  Psychiatry is a tricky field with less success than other medical specialties, like heart disease or emergency medicine. The fallout will be huge.   Wake up, America. We are in uncharted waters, as marijuana use is growing nationwide and your kid may be the next casualty.

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The Unraveling, Part 2: Denial, Denial, Even as Dog has Seizure

(Part 2 of 4, an anonymous testimony submitted by a reader.  Part 1)   For a person who had never shown the slightest mental instability and then goes into an altered reality—literally overnight–disregarding a drug classified as “hallucinogenic” as a trigger is outrageous. Mental health treatments fail when the root cause(s) are ignored. The culprit was the mind-altering chemical in marijuana, THC, which today’s pot has been genetically modified to produce in outrageously high amounts.

Psychiatry has morphed over the last 30 years, placing medical management (prescribing pharmaceutical drugs), ahead of getting to the bottom of things. The best way to minimize an encounter with the psychiatric system is to never use mind-altering substances including marijuana, and all its derivatives, as well as brain stimulants like Adderall, anti-depressants and anti-psychotics.

When I kept questioning the rush to diagnosis my son and the failure to recognize the THC connection, even my work colleagues (pharmacists, physicians, and nurses) would say: “This is about the right age when they break.” Or “Just accept what your son has — a mental illness.”

The out-patient psychiatrist was even worse.  He charged $250/session and took no insurance. At the only family session after Ryan was released, I questioned why would they diagnose him with bipolar depression since it has a high familial link? This doctor refused to answer me but eventually mumbled in response, “environmental,” which may mean he knew that THC can alter young brains.  (Bipolar 1 is the term used today, distinguished from Bipolar 2, if the mania is longer or more severe and/or the person has a manic episode before having depression.)

Nothing made any sense to me, and the nightmare continued. My daughter-in-law’s family was immersed in the belief of mental illness. “My whole family has bipolar problems,” her mother stated. No big deal, his wife said, though Ryan came back to normal after 10 weeks. My husband and I went to several psychiatric doctors trying to find a more reasonable physician who would look at the whole picture, but all followed the same philosophy. I even challenged them with the American Psychiatric Association’s classification system which qualified a bipolar I diagnosis as inaccurate when illicit substances are in evidence. (At the time, the DSM IV manual was the classification guide for psychiatry.) Mothers like me read everything and know when a diagnosis doesn’t hold. Denial was going on, but I don’t think the “experts” understood who was in denial.

No one ever suggested Ryan had addiction or dependence on pot or any drugs. I asked several times, as my thinking was that anyone who had basically had a brain break should go for rehab/counseling. These ‘experts’ reassured us,” Ryan is just a recreational user.” I kept researching and showed my son and his wife the volumes of research about the marijuana-psychosis link. I told them, “If Ryan ever goes near any mind-altering substance again, it could trigger schizophrenia.” At the time, I was unfamiliar with the “skunk” strains of pot, and didn’t know most of their friends were using it.

In mental health programs, if there is presence of THC or other drugs in the toxicology report, please give the patient the education to help them understand addiction and how the brain works. The attending physician should be certified for Addictions Treatment.  I’ve read there should be at least a six-month wait to fully evaluate a person’s mental health function after stopping the substance, but it didn’t happen for Ryan.

Back to Normal? How Long?

My son’s wife dutifully gave Ryan his medicine — not that I believe any of them helped him come out of psychosis faster). Ryan gained 55 lbs. in 5 months, leaving stretch marks all over his statuesque physique. Our son had gained so much weight, complained of “brain fog” and once out of psychosis weaned himself off the meds. In total, he spent five months on the anti-psychotics.

I never believed my own kid would ever go near another mind-altering substance again. Neither my husband nor I had ever touched an illicit substance in our lives. Sadly, parents who think they raised their kids sensibly, spent quality time with them and modeled a healthy lifestyle, can be woefully unaware of “today’s culture.” The drug is everywhere; one in six teens who use marijuana become addicted to it.

We found out later that some close friends were using pot so Ryan was persuaded to start using “recreationally” at age 19.  About that time, he began dating the girl he married, also a user, but not someone I’d expect to be into pot.

Sad for me, when I met individually with Ryan’s five close friends, each called him “best friend,” because he gave everything of himself to his friends. Some “fessed up” to using marijuana with Ryan. One said, “But he never did the really bad drugs like I’ve done.”

Ryan’s dog had seizures about a month before our son’s second “episode” of psychosis.  Long story short–I helped my daughter-in-law get their dog to the family vet. She told the veterinarian their dog had eaten snail bait, but he disagreed. I had no knowledge my son had returned to pot, and his wife didn’t share that fact. Indeed, now I realize that their dog had found their bag of pot. The vet told us it was not epilepsy, as I thought. He was unsure if he would be able to save this dog. Following an expensive intravenous (IV) hydration, the dog survived.

After Ryan experienced his next breakdown, he confessed, “Jodie had eaten pot before his seizures began.” Later, the vet assured me “Pot doesn’t cause seizure, but makes dogs lethargic, sleepy.” Several months ago, a Colorado veterinarian wrote an article in the LA Times about the escalating number of dogs having seizures from contact with pot edibles. I marched the article to our vet, grabbed his arm and implored him to educate himself and spread this information to his colleagues.

If our family vet had recognized the symptoms of today’s pot which causes seizures, and if I had been sharp enough to have asked the vet to do a drug screen, we could have made a difference.  But, we didn’t realize that Ryan had gone back to using pot, thinking he had beaten the addiction.  (Parts 3 and Parts 4 will follow.  Part 5, to be published in December, will explain how the author has helped others with her knowledge.)

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