Last week when I opened up the Sunday edition of The Baltimore Sun, I read an op-ed piece written by three psychiatrists entitled “Haunted asylums are a Halloween staple: Does the fictional gore undermine psychiatry’s good?” The authors emphasized the point that rendering psychiatric treatments as horrific and damaging and “demonizing” patients who need treatment could deter those who need it most. But I had to take issue with their point about electroconvulsive therapy (ECT), a procedure where a doctor administers a current of electricity strong enough to induce a grand mail seizure, is “brief, still, and quiet.”
Because both my mother and I experienced ineffective treatment and overmedication for depression and chronic pain, I have spent the past twenty years trying to figure out what happened to us. Putting those pieces together involved reading research about psychiatric treatments, including the use of antidepressants, anti-anxiety drugs, and ECT. And contrary to what many psychiatrists will tell you, the treatments are largely ineffective at best and can be very harmful at worst.
In response to the three psychiatrists’ letter regarding the demonizing of psychiatry by using old asylums as places to terrorize visitors looking for a Halloween scare, I offer a more skeptical take on the current treatments one is offered by modern psychiatry. As someone who has experienced depression and anxiety in the past and watched friends and family members suffer, I am well aware of the serious nature of emotional distress issues, and I am in favor of evidence-based treatment. But for many people, the treatments run counter to the latest research, are ineffective at best, and sometimes even harmful.
One of the main problems plaguing modern psychiatry is its overreliance on the biological model of mental illness, often simply referred to as the chemical imbalance theory. Yet prominent leaders in the field have disavowed this theory, though many in the general public have not gotten the word. For example, Dr. Ronald Pies, psychiatrist, of SUNY Upstate Medical and Tufts Universities, denies the chemical imbalance theory that modern treatment is based on: “In short, the ‘chemical imbalance theory’ was never a real theory, nor was it widely propounded by responsible practitioners in the field of psychiatry.” And lest you think Dr. Pies is exaggerating, you could consult the latest research By Dr. Joanna Moncrieff et al in which shows that there is no serotonin imbalance in the brain.
Despite its leaders disavowing the theory of a chemical imbalance causing emotional distress, psychiatrists routinely prescribe “treatment” consisting of drugs that purport to correct a chemical imbalance—which we now know does not exist. And recent research states that antidepressants only work for 15% of the people who take them. Few, if any, doctors mention the horrors of sexual dysfunction, sometimes permanent, that afflict many people who take psychiatric drugs. Most people who watch TV have heard the litany of the more common side effects of psych drugswhich include insomnia, sedation, constipation, headaches, weight gain, blurred vision, tremors, and seizures.
And if you try two or three drugs and your doctor deems you to be treatment resistant .…meaning the drugs don’t work for you…then your doctor can administer an electrical current strong enough to induce a grand mal seizure. Electroconvulsive therapy [ECT] is a serious and harsh procedure by any measure, despite Drs. Phelps, Mutalik, and Appell’s assurance that ECT is “brief, still, and quiet.” Even so, recent literature reveals that for 50-70% of people who receive ECT relapse within two to four months and some as soon as four weeks. The doctors mentioned above fail to inform readers that harms from ECT can include permanent memory loss, brain trauma, and even brain damage.
We may be removed from the horrors of the “Field of Screams”, but research shows us that many of psychiatry’s current treatments, far from being precise and effective, are often deemed futile at best and potentially very harmful at worst. Given that many recent studies show that exercise is as effective as antidepressants in treating most cases of depression, shouldn’t patients be offered the least harmful method of treatment first? And after reviewing many of the harms that are possible with the use of antidepressants and ECT, let’s consider the results of National Institute of Mental Health study concluded about the course of untreated depression: “If as many as 85% of depressed individuals who go without somatic treatment [drugs, ECT, and other treatments] spontaneously recover within one year, it would be extremely difficult for any intervention to demonstrate a superior result to this.”
Author’s note: This essay forms the foundation for my memoir-in-search-of-a-publisher, Putting the Pieces Together: A Story of Overmedication and Recovery.
In 1959, my mother suffered what people commonly referred to as a nervous breakdown after my youngest sister’s birth. Mom spent six months in a local, Catholic psychiatric hospital while Dad and Grandma assumed command of the household. I was seven years old, the second-oldest of five children. Eventually, Mom visited us a few times on Sundays, and then returned home in November, presumably ready to assume her duties as a wife and mother. Sadly, Mom remained gripped by depression for the rest of her life.
Because my memories of that time are wrapped in thick layers of gauze, I’ve had to rely on others to fill in the gaps. My father, grandmother, and Mom’s close friends believed that Mom experienced postpartum depression, starting after my birth, and worsening with each successive child. My older brother shared this memory about a year ago when I asked what he remembered about Mom’s 1959 illness: “I came home from college and found her in the basement, banging her head against the wall, moaning, ‘I can’t take it anymore.’”
My heart ached when I heard that story, but I still puzzled over why Mom never recovered. Until I found Dad’s collection of records in a dusty box stashed in my sister’s attic. Old insurance and medication records, newspaper and magazine articles, and letters to doctors were neatly organized in an unassuming manila folder. As I leafed through the contents, intuition whispered that I’d finally have the missing puzzle pieces I’d searched for all my life.
Some of the most valuable clues were in a letter, typed on onion skin paper, that sat on top of the file. It was dated 1-17-83 and addressed to Dr. L., one of Mom’s many doctors. Dad wrote the following notes:
5th child born Feb.59. Normal birth and she carried baby in good spirits. About mid-April started having problems and had first visit with psychiatrist of May 8, 1959. Between then and June 22nd, ’59, he treated her with Amytal, Ritalin, Nardil, Trilafen, NaBu-4, Dexamyl tabs and spansules, and Tofranil. By the end of May ‘59 she was so bad, that even to my nonprofessional eye, I didn’t see how she could avoid hospitalization… She remained there to late Nov. 59. During this time, she received medicine and numerous EST [electroshock therapy] treatments.
The only drug I recognized in that long list was Ritalin, an amphetamine that had been widely prescribed for depression in the 1950s and ’60s. I quickly set to work looking up the rest, all the while screaming inside, How could anyone give a nursing mother with three small children and a newborn so many drugs in such a short period of time? A quick search on the website drugs.com helped me to understand the other drugs my mother took when she first got depressed. Amytal is a long-acting barbiturate; Nardil is an MAO-inhibitor (a type of antidepressant); Trilafon is an antipsychotic; Nembutal is a barbiturate used as a sedative; Tofranil is a tricyclic antidepressant; and Dexamyl is a combination of an amphetamine and a barbiturate.
It was easy enough for me to find the commonly listed effects of all of those drugs, and I wondered how Mom’s doctor could have prescribed all of them in such a short time. Dad’s records don’t indicate if she took all of them together, but even if she took a few, discontinued them, and started a few others, the chemical load must have overwhelmed her system. What struck me in looking at the effects of all the medications was that many of them could cause anxiety, sleeplessness, and agitation—three things I clearly remember my mother struggling with.
Now my brother’s story made more sense—I think Mom was banging her head on the wall because she couldn’t tolerate what the drugs did to her. Her doctor told a different story in the diagnosis that my father noted: “This psychiatrist [Dr. S.] diagnosed it [Mom’s illness] as severe depression with agitation and not due to childbirth.” The doctor’s assessment rang true in one sense—it seemed pretty clear to me that Mom’s severe depression with agitation was due to the massive amounts of drugs she was taking and was, indeed, not related to childbirth. But somehow, I don’t think that’s what the doctor meant. While I have no doubt that my mother struggled against overwhelming feelings of sadness and fatigue, which led to the initial appointment with Dr. S., I believe Mom’s breakdown was probably chemically-induced due to overprescription of drugs.
Dad had also kept some of the original prescription bills related to Mom’s 1959 hospitalization, and between August and October, she took Thorazine, Nembutal, and Tofranil on a regular basis, in addition to receiving an undisclosed number of electroshock therapy treatments. When she came home, the doctor had her on a regimen of Phenobarbital, Miltown (an antianxiety drug), and the tricyclic Tofranil. Dad supplemented that regimen with carefully measured decanters of white wine that I once caught him cutting with water. When he saw me watching, he cautioned, “Don’t ever tell your mother what you saw.” Nowhere in the thirty years of records is there any indication of Mom’s drinking, which all of us tacitly accepted as a significant part of her daily routine.
I also found homemade spreadsheets where Dad listed the dates and medication amounts for Mom’s drugs, often annotated with notes about her responses. The information in those charts prompted me to investigate possible medication effects that may have influenced Mom’s internal state which led her to attempt suicide in 1967. At the time, she was taking a combination of Aventyl (a tricyclic which can cause restlessness, agitation, and anxiety), Dexamyl (amphetamine and barbiturate combination), and Phenobarbital (a barbiturate which is linked to nightmares, nervousness, depression, and anxiety). The effects of all of these medications, combined with Mom’s continued daily drinking, probably led to the intense feelings of despair that drove her to slit her wrists in December. Dad found her in the bathroom that night. I accompanied my parents to the hospital, while my two siblings, ages twelve and thirteen, stayed home and cleaned up the bathroom. None of us ever spoke of that night again.
What about therapy, I wondered, and how did Mom’s psychiatrist treat her after that tragic night? One would think the doctor should have increased Mom’s routine visits to keep a closer watch on her. But according to Dad’s records, that’s not what happened. In fact, Mom’s doctor saw her twice a month, beginning in January of 1960, only about two months after she was released from the hospital, and continuing through June of 1968. However, in the weeks immediately following her suicide attempt in 1967, he did not see her more frequently, a fact which seems to indicate a lack of support and concern. By August of 1968, Dad’s notes indicate that Dr. S. wanted to hospitalize my mother. Dad’s notes and the conversations I can remember ring with the angry charge that “Dr. S. just threw up his hands and gave up on her.”
Because Dad was adamant about keeping Mom out of the hospital, he sought out Dr. M., a well-known psychiatrist who performed electroconvulsive therapy (ECT) treatments in his office. Between August of 1968 and June of 1970, Dr. M. administered thirty-nine ECT treatments to my mother, sometimes giving her as many as five treatments in a month. The one time I remember accompanying my father to help him bring Mom home, I was shocked by her dazed look and unsteady walk. I remember her sleeping through the next day and experiencing memory loss from that time forward. Dad told me that Dr. M. did the procedure without anesthesia, but from some of the reading I’ve done on earlier ECT administration, it seems likely that Dr. M. probably used a short-acting barbiturate to sedate Mom. Otherwise, how could she submit to so many treatments? And how could Dad willingly put her through that pain? I think both of them must have been more desperate for relief than any of us kids could have guessed.
I wish I could say that Mom got better after all of that ECT, but she never attained such a reward for all of her efforts and suffering. In 1973, after suffering from mysterious dental pain for several months and finding no relief, a neurologist helped Mom and Dad to see that she was suffering from depression. Mom was hospitalized for at least a month and endured detox for both barbiturates and alcohol, but she was unable to maintain her sobriety once she came home. I was sickened to learn that Mom’s doctors routinely prescribed Thorazine for her from 1969 to 1983, a practice which would explain why she suffered from tardive dyskinesia and later from severe full-body trembling, possibly akathisia. Mom was hospitalized again for several weeks in 1993, and for the first time, her psychiatrist confronted the family about her alcohol dependence and informed all of us that her MRIs showed evidence of small strokes and blood in the brain. He asked all of us to pledge to refrain from serving alcohol at family gatherings, but we were split on the issue of whether Mom had a problem or not, so she continued to drink along with all of her medications until her death in 2002.
I remember my mother suffering from horrible, visceral anxiety where she would take deep, fast breaths and then wring her hands as if she were Lady Macbeth. Now that I understand more about her medications, I realize how impossible it is to determine if my mother was actuallyvery depressed and anxious or if she was one of the early victims of polypharmacy, trapped in physical and emotional pain due to overmedication and a lack of supportive therapy. It seems clear from the records that Mom’s doctors saw her condition as biochemical and treated her accordingly, tweaking the pills as they went along, and in a sense, resigning themselves to maintaining her “treatment resistant” condition with the only tools they believed in.
Despite all of her sedating and numbing medications, Mom lived a rich and meaningful life. She cared for us, made sure we had regular, nutritious meals and provided a supportive presence when we needed help. Mom hosted her bridge group, participated in a book club, and made weekly trips to talks at the local art museum with one of my aunts. She was also a gifted artist with a degree in costume design from Maryland Institute College of Art, but her talent never matured once all of us were born. Sadly, she never picked up a paint brush in all the years I knew her.
As a child, I made two vows: to help my mother get well and to never be like her.
Want to read the rest of the story? Please hop on over to the Mad in America blog where this essay was originally publishedin May of 2019.