To the Editor:
Re “There’s a Reason So Many People Quit Antipsychotic Drugs,” by Daniel Bergner (Opinion guest essay, June 4):
Thank you to Mr. Bergner and The New York Times for countering hate and prejudice and raising a voice of reason on the subject of forced psychiatric treatment.
There are so many of us: those who were harmed by forced treatment, those whose loved ones were harmed, those who lost loved ones to horrible physical side effects of psychotropic medications or to suicide when people chose death over another round of forced treatment.
Contrary to popular prejudice, most mentally ill people, including the homeless, do want help. But the treatment they receive is not helpful.
Patients flock to the few places that offer effective, humane treatment modalities (Open Dialogue, Soteria House). Providing housing without preconditions along with access to voluntary mental health services is the best evidence-based practice recommended by the Substance Abuse and Mental Health Services Administration of the U.S. Department of Health and used with great results all over the world. It reduces homelessness and saves taxpayers money. But it does not create a lot of profit for pharmaceutical companies and psychiatric hospitals.
I am one of many, many mothers who were shocked by what their child had to go through in a psychiatric hospital and who fought a desperate struggle to liberate her from the treatment that only made her worse.
Yet in the general media, one can hear only from parents who advocate more forced treatment and more hospitalizations. Parents like me are entirely marginalized and invisible. It is a rare occasion when a national newspaper represents our side of the story.
Yulia Mikhailova
Socorro, N.M.
The writer is chair of the advocacy committee of the U.S. chapter of the International Society for Psychological and Social Approaches.
To the Editor:
I cannot tell you how infuriating it was to read Daniel Bergner’s essay opposing mandated treatment for the mentally ill.
I am the father of a son who succumbed to mental illness, dying by suicide before his 20th birthday. I saw the suffering he was going through. And above all, I know that he was, in the throes of his illness, unable to make rational decisions about his treatment. He was obviously a risk to himself and others.
The one thing above all that parents of kids struggling with mental health want is to be able to keep them safe, and to prevent them from doing something horrible that can never be undone. If that requires temporarily compelling treatment, imperfect as it may be, we have to give it a chance. Because I know the alternative can be much, much worse.
Bruce Mayer
Tolland, Conn.
To the Editor:
I read Daniel Bergner’s essay about the limitations of antipsychotics with interest, but was disappointed by what was ultimately a counterproductive and stigmatizing perspective.
Mr. Bergner argues, without evidence, that acute treatment is mostly counterproductive, that antipsychotics have not improved in 70 years and should not be central to treatment plans, and that peer-based supports are more effective than medications.
Studies around the world have found that providing effective treatment, whether for mental illness, H.I.V., epilepsy or substance use disorders, is one of the best ways of minimizing stigma and enabling social acceptance.
Media messages that emphasize solutions can mitigate stigma, whereas essays like Mr. Bergner’s that undermine effective solutions may lead people to abandon treatment and further stigmatize them in the eyes of the public, leading to greater isolation.
Care for psychosis requires control of symptoms like delusions and hallucinations, as well as supporting social connections and a healthy sense of identity.
Antipsychotics can rapidly stabilize the brain circuits underlying the illness and enable people to pursue whatever is meaningful to them. Medication alone is far from sufficient, and the city and state can invest in promoting more effective and humanistic mental health services.
Comprehensive treatment integrates careful pharmacologic treatment (including monitoring and mitigating side effects), with development of skills to self-manage effects of the illness, support in achieving educational and vocational goals, family support and education, and person-centered crisis services. Some of these services can be best delivered by peers who have recovered from mental illness themselves.
We absolutely have a long way to go in supporting people with serious mental illness, but denigrating a critical component is irresponsible.
Tim Becker
New York
The writer is a child and adolescent psychiatry fellow at NewYork-Presbyterian Hospital whose research has focused on stigma and recovery.
To the Editor:
As a retired psychiatrist who worked many years in a busy crisis unit, I take exception to Daniel Bergner’s assertion that science hasn’t made great strides in antipsychotics for seven decades.
In fact, for the past 30 or 40 years, the field has made tremendous strides in psychopharmacology. (Has he never heard of second-generation antipsychotics and mood stabilizers that improve psychotic symptoms as well as mood and cognition?) He asserts that individuals are hauled off to ER’s and forcibly injected with Haldol (Haloperidol).
Haldol was approved in 1967, and today many clinicians try to avoid its use except in emergencies such as acute mania in which a patient is out of control and presents a danger to other patients and staff. In such a situation, would Mr. Bergner tolerate nurses and other staff members (including the doctor) being bruised and battered?
Emergency medications (“chemical restraint”) are often used when facilities don’t have adequate manpower to control agitated patients. The bigger issue here is lack of adequate facilities and staff due to cuts in funding, not overuse of medication.
Steven Speiser
Santa Fe, N.M.
To the Editor:
Daniel Bergner’s article highlights the problems with current antipsychotic drugs, but unfortunately it fails to note the underlying total lack of understanding of the basic genetic and biochemical cause of schizophrenia, which has eluded medicine for over 100 years.
Since its founding in 2007, the Stanley Center for Psychiatric Research has pioneered an effort to find the genes that cause schizophrenia, in order to provide the basis for a molecular understanding of the pathogenesis of psychotic illness.
Dramatic success in the past two to three years has infused hope that true understanding of the underlying pathological biochemistry will follow, and will stimulate new scientific approaches toward the discovery of medicines that have better efficacy and that are better tolerated.
Edward Scolnick
Wayland, Mass.
The writer is emeritus chief scientist of the Stanley Center for Psychiatric Research at the Broad Institute of M.I.T. and Harvard. He was head of research and development at Merck Research Laboratories and retired as its president.