Archive for the ‘Informed Consent’ Category

Psychiatric Drugs and Informed Consent- An Antipsychiatry Perspective

Psychiatric Drugs and Informed Consent – An Antipsychiatry Perspective
by Don Weitz
(Note: This article may not be republished without permission of the author.)

Ontario’s recent “Mental Health Week” (October 3-10) was just another sham. Mental health campaigns are not so much about informing and helping people in crisis or preventing crises, but a public relations exercise by and for the Canadian Mental Health Association. The CMHA is no friend of psychiatric survivors, antipsychiatry and social justice activists, mainly because it promotes psychiatry’s biomedical model of “mental illness”/”mental health” – including “medication” (psychiatric drugs), and the repressive “community treatment orders” which authorize outpatient forced drugging and other methods of social control masquerading as “treatment”.

I’m not only critical of CMHA but psychiatry and government because of their consistent failure to expose and investigate the epidemic of misinformation or lack of information about psychiatric drugs. I’m also critical of Big Pharma – the transnational drug industry. Big Pharma ceos and their media reps, in collusion with officials in government regulatory agencies such as Health Canada and the Food and Drug Administration (FDA) in the United States) and the medical profession, have repeatedly lied to the public about the alleged safety and effectiveness of the antidepressants and neuroleptics (“antipsychotics”). Big Pharma continues to produce false and misleading media ads that extol the safety and effectiveness of these drugs with little or no scientific evidence of safety and effectiveness – virtually no information about their long-term effects. Profit – not public safety – is its bottom line. With the support of Health Canada and the FDA, Big Phamra has generally denied public access to the results of their clinical trials. More cover-ups.

For example, take the antidepressant Paxil. GlaxoSmithKline (GSK), manufacturer of Paxil, deceived the public for many years by withholding critical information in its ads – namely that Paxil can cause withdrawal (“discontinuance syndrome”), a clear sign of addiction. Until recently, GSK also denied Paxil’s alarming ability to trigger suicidal ideas and suicide attempts, which it covered up for approximately twenty years. In recent class-action lawsuits in the United States and United Kingdom, GSK was ordered to pay out billions of dollars to patients who had suffered severe withdrawal effects of Paxil. In Canada, a similar class-action-lawsuit is in the works.

While lawsuits expose Big Pharma’s unethical or illegal drug practices, this is small comfort to surviving relatives of people who killed themselves or others while on these “safe and effective” drugs. Widely-respected environmental activist Tooker Gomberg jumped to his death in Halifax in the spring of 2003, a few weeks after being prescribed the antidepressant Remeron (mirtazapine). Like many other doctors, Tooker’s psychiatrist failed to inform him about the suicide risk and other “side effects” of Remeron. Angela Bischoff, Tooker’s partner and an equally respected environmental activist, is currently speaking out about the many risks of the antidepressants and criticizing the medical profession, transnational drug companies, and Health Canada for their insufficient or misleading information about antidepressant drug risks, their lack of accountability and cover-ups.

Consider the horrific murder-suicide case of Joseph Wesbecker, as reported by psychiatrist Peter Breggin in his1994 book Talking Back to Prozac. Sixteen years ago in Louisville, Kentucky, Wesbecker underwent a dramatic personality change. He became suddenly threatening and violent 4-5 weeks after taking Prozac. On one day armed with an AK-47 rifle, Wesbecker burst into his workplace, killed 8 workers and injured 12 others, then killed himself. Eli Lilly, manufacturer of Prozac and the neuroleptic Zyprexa (olanzapine) which can cause diabetes, denied a cause-effect relationship. The1991 edition of the Physicians’ Desk Reference (US doctors’ drug bible) barely mentions that cases of “suicidal ideation” and ”violent behavior” have been reported. However, during the last few years including 2005, the Compendium of Pharmaceuticals and Specialties (Canadian doctors’ drug bible) clearly warns that recent clinical trials show that Paxil and other SSRI-antidepressants can cause “ severe agitation… self harm…, suicidal ideation or other indicators of potential for suicidal behaviour in patients of all ages.” Despite these alarming findings, Paxil has not been banned in Canada. However, Paxil has recently been banned in the US and UK for children 18 years and under.

Nevertheless, psychiatrists and other physicians generally do not inform their patients about the possibility of suicide, violence, sudden death, and other serious risks of the antidepressants and neuroleptics – partly because of their indoctrination into the biomedical model, partly because of their obsession to enforce ”medication compliance”. During the last twenty-five years in Toronto, I’ve talked with and listened to many survivors about what doctors have told and especially not told them about psychiatric drugs. When I’ve asked survivors, “Did your doctor ever mention or warn you about any risks or alternatives…?”, the vast majority answered no. In short, psychiatric survivors, particularly people locked up in coercive and intimidating psychiatric wards, are kept ignorant about many serious “side effects of medication”. In Toronto, I’ve heard of only one or two doctors willing to help survivors withdraw safely and gradually. Despite their denials, many drug-pushing doctors are causing drug dependency or addiction in many patients, which is not only unethical but constitutes medical malpractice.

Health Canada – particularly its Therapeutic Products Directorate (TPD) – also deserves criticism. Despite the well-known health-and-life-threatening effects of Paxil and similar SSRI-antidepressants such as Prozac, Zoloft, and Effexor, TPD refuses to ban or tightly restrict their use. Instead, it issues “advisories”, which are weakly-worded notices to doctors and pharmacists informing them about serious risks of a few antidepressants and other drugs and simply asking them to be careful when prescribing these hi-risks drugs. – especially to children and the elderly. Health Canada’s “advisories” are unenforceable since they include no order to comply; this means doctors are free to ignore them and prescribe Paxil and other hi-risk psychiatric drugs to children and elderly patients – the most vulnerable. At the very least, serious and enforceable warnings, such as “black box labels” sometimes issued in the United States, should replace the “advisories”.

Also, consider the serious health risks of neuroleptics (*antipsychotics”), which are as dangerous as the antidepressants . Both classes of drugs target and damage the brain’s emotional centre (limbic system) as well as powerful neurotransmitters such as serotonin and dopamine. For over twenty years until the late 1980s, psychiatrists failed to inform patients about tardive dyskinesia (TD)-, a serious neurological disorder, despite the fact that TD and its serious health risks were well-publicized in medical and psychiatric journals – including the Archives of General Psychiatry and the American Journal of Psychiatry. TD is a disfiguring, painful and generally permanent neurological disorder caused by virtually all of the 20+ neuroleptics such as Haldol (haloperidol), Risperdal (risperidone), and Zyprexa (olanzapine). According to various studies, if you’re under 50 years old and prescribed a neuroleptic, you stand a 10%-25% chance of developing TD within 1 or 2 years. if you’re 60 years and over your chances are 40%-50%. Neuroleptics have also caused the frequently fatal neuroleptic malignant syndrome (NMS) and sudden death. NMS is characterized by high fever, delirium, “lead pipe rigidity” in some muscles and other serious effects. It also causes death. A number of published studies show that the fatality rate of NMS is approximately 25%. About 12 years ago, a close friend almost died from NMS while on Haldol at Queen Street Mental Health Centre (now CAMH). Based on the widely recognized prevalence rate of 2%-3%, my guesstimate is that well over 4000 Canadians have TD and over 1000 have died from this drug-induced disorder. Although Health Canada recently banned Mellaril, (thioridazine), it has never banned other equally dangerous, brain-damaging neuroleptics such as Thorazine (chlorpromazine), Haldol (haloperidol), Clozaril (clozapine), Risperdal (risperidone) and Zyprexa (olanzapine) It should.

To protect the public, government banning of hi-risk, harmful drugs is essential. Equally essential is public health education –such as government-sponsored public hearings on psychiatric drugs. To date in Canada, neither the provincial governments nor the federal government have held public hearings on the risks of and alternatives to psychiatric drugs. Given this appalling and shameful fact, the Coalition Against Psychiatric Assault (CAPA) took action in April 2005 by sponsoring two days of public hearings (“Inquiry Into Psychiatry”) in Toronto City Hall. These hearings were unique and historic in three respects. First, the decision to develop a strategy of resistance to psychiatric drugs was the direct result of a public and democratic process one year earlier – all the people at a public meeting in City Hall voted to direct CAPA to make psychiatric drugs and electroshock (ECT) its two priorities. Second, an independent panel of academics and health professionals facilitated the testimony. Third, only psychiatric survivors who have experienced psychiatric drugs were allowed to testify. The personal testimonies of over twenty-five of these courageous survivors were riveting, frequently alarming. They exposed and criticized many harmful effects of the drugs including memory loss, brain damage, and trauma, as well as several human rights violations including forced drugging and lack of informed consent. Survivor testimonies and a hard-hitting report of the drug are posted on the CAPA website http://capa.oise.utoronto.ca, click on ”Inquiry into Psychiatry” or ”Personal Narratives”.

The Hippocratic Oath orders all physicians “First, do no harm”. However, many doctors have violated and continue to violate this Oath, as well as the ethical principle and legal right to informed consent, whenever they prescribe hi-risk psychiatric drugs and fail to inform patients about their many risks and alternatives. Similarly, although governments and the medical profession proclaim principles and laws affirming the public’s right to be fully informed and access health information, they violate these principles and laws whenever their officials refuse to hold public hearings on psychiatric drugs and withhold basic information from patients and the public. It’s time to pressure governments, including Health Canada, and the medical profession to stop these violations and start educating us about psychiatric drugs and their life-threatening “side effects.”

At the same time, psychiatric survivors can and should educate themselves, government health officials, and the public about safe and humane non-medical alternatives to the drugs–self-help groups, withdrawal centres, affordable and supportive housing, nutritious diet and exercise, and a liveable wage. All can help, heal and empower.

Recommended Reading:
Peter R. Breggin. Brain-Disabling Treatments in Psychiatry (NewYork: Springer Publishing Company, 1997)

Bonnie Burstow and Don Weitz. Psychiatric Drugs – A Public Health Hazard. A brief presented on behalf of Resistance Against Psychiatry (RAP) to the Toronto Board of Health, May 30, 1990 [unpublished].

Leonard Roy Frank. “A Prescription for Diabetes, Disease and Early Death”,
Street Spirit, vol.11 no.8, August 2005.

Report of the Psychiatric Drugs Panel. Toronto: Inquiry Into Psychiatry 2005
Biographical note: Don Weitz is an antipsychiatry activist, co-founder of the Coalition Against Psychiatric Assault, and host-producer of “Antipsychiatry Radio” on CKLN in Toronto.

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Bombarded by Drugs Video Now Posted

“You’ll have to excuse any lapses in memory I might experience, since I was only a child of six or seven when my experiences with psychiatric drugs began.”

The second video from the April 2005 hearings, Inquiry into Psychiatry, is now posted. Like the ECT Report video, this video also portrays moving and disturbing testimony from survivors of psychiatric medications. This is a difficult video to watch because the brave individuals who came forward to testify (and agreed to have their testimony recorded on video) lay bare very personal details of their lives that led to them being “bombarded by drugs,” rather than receiving other forms of support and therapy that would have been more appropriate. Particularly egregious examples are the multiple reports of people who were severely medicated as children or teenagers, rather than being rescued from severe physical, emotional, and sexual abuse at home and in school.

If anything, these heart-rending stories remind us of the danger of solutions looking for problems. With today’s growing arsenal of psychotropic medications, marketed heavily by the pharmaceutical industry, it is all too easy and tempting for physicians to turn to masking symptoms or controlling behaviours through chemical interventions, rather than helping an individual with underlying causes of personal turmoil.

Watch the video, and think carefully about the effects of being Bombarded by Drugs.

Authentic Informed Consent Form for Electroconvulsive Therapy (ECT, Electroshock)

A very informative article by John Breeding, Ph.D., that was published in Journal of Humanistic Psychology, a few years ago. It provides a very good description of the treatment itself and its effects – especially those that are denied or minimized by the psychiatric establishment. But what’s really great about this article (actually, it’s a book chapter) is the authentic informed consent form for ECT that he includes toward the end:

Genuine informed consent for electroshock is nonexistent because electroshock psychiatrists deny or minimize its harmful effects. For example, the American Psychiatric Association officially states, “In light of the available evidence, brain damage need not be included [in the consent form] as a potential risk.” (6) In addition, in all but one state ECT may be legally forced upon nonconsenting individuals who are said to be or are adjudicated mentally unqualified to give their consent.

There are many ways in which informed consent is violated. First, there is denial and minimization of harmful effects. The official APA literature and the typical hospital brochure are both travesties of truth. …pragmatically crucial, is that people become victims of this so-called “treatment” at a time in life when they are extremely vulnerable. At vulnerable times, people desperately need to trust and rely on others for help. Reaching out, they need complete safety and support. Their only hope, in this desperate state, is to trust the wisdom and guidance of the professionals to whom they turn for help. Informed consent is a superlative principle; it is not a protection in these conditions.

Breeding provides authentic information about electroconvulsive treatment, scrupulously annotated with references to published research, about the long term effects, and lack of efficacy of electroshock. Vital reading for anyone who is being encouraged to undergo ECT.