Raphael Smith for Dr. E. Seeman/PY433 #2 paper
Summary of Torrey’s Viewpoint
Dr. Torrey (2001) has a view that is based upon this fundamental concept; “drugs to not cure, but rather control.” For this doctor, the treatment of schizophrenia is mainly one of balancing medicinal concoctions for the best effect upon the patient. The emphasis is on the correct use of medication, in this case antipsychotics, understanding the usefulness of them and their limitations. He pursues his course of persuasion using a list of questions to guide us in his writings.
In order to establish his premise Dr. Torrey first appeals to history. He cites the beginning of the discovery of antipsychotic drugs in the early 1950’s by a French psychiatrist. It was used originally as a sedative during surgery. He tells of the two classes of the drug. The first generation and the second generation are also referred to as typical and atypical. The typicals seemed to work by blocking dopamine receptors and atypical by their affect upon other neurotransmitters. With benefits come side effects some of which are acute dystonic reactions and akathisia along with Parkinsonian-like symptoms.
The next question addressed, in relation to his argument, is do the drugs change the brain? He states that they do change the brain but the same way any drug for any other organ of the body might have a structural affect leading to a desired functional change. In defense of some opponents of changing the brain he assures that the brain changes are relatively minor. The main changes are in certain glial cells in the frontal cortex. There does not seem to be any evidence of a loss of neurons he goes on further to state.
Dr. Torrey’s final issue addressed is the adverse effects of the drug therapy for schizophrenia. He begins by quoting another doctor, a drug expert, who says that antipsychotic drugs are the safest drugs available in medicine. He spends several paragraphs showing how compared to other drugs used in the practice of medicine antipsychotics are some of the best to use with least problems. There is given a clear idea that there are adverse effects to deal with but that it is still for most patients an overall improvement of condition. Tardive dyskinesia is the most important adverse effect of the typical drugs given to patients. This side effect involves the involuntary movements with the mouth such as sucking motions, and purposeless movements of the body. About 20 percent of patients will get this effect. The best help for it is to change medications to the atypical or second generation drug therapies.
The View of Robert Whitaker
In “Mad in America”, Robert Whitaker begins with an appeal to the historical accounts of how the insane have been treated in this country. He compares it to other countries, such as India and Nigeria, which have better success rates of returning the mentally ill to normal society. He calls our efforts in this country a medical failure, since most of our mentally ill become chronic drug users, homeless, institutionalized and remain that way as a result of our therapies for them. He talks about how we hide our sick away and do not seem to want to integrate them back into our way of life. He continues by saying that the way we dehumanize our mentally ill shows more about our lack of care and comfort for the patient and our care and comfort for ourselves.
He appeals to the reform movement that took place in the 1960’s that sought to bring back a moral treatment to the care of the mentally ill. During this time and after the field of psychiatry had to choose to ignore findings that drugs were making people chronically ill, not to mention the adverse effects that drugs involved, or make a change in therapies. The choice was to continue letting research pile up that showed the adverse effects of drug treatment as the main component.
He concludes by showing how antipsychotic drugs do not fix any brain structures or bring balance to chemistry that is awry. He contrasts the views of helping assist nature to heal itself or the drug heavy forcing of nature to do what we think best. He wants to examine in the future that humanitarian aspect to care and not just the cold clinical drug therapies that in his opinion do not work but enslave a patient to being unfeeling and unmotivated in pursuit of life’s benefits.
My Opinion
My position is that of the first author Dr. Torrey. I side with this view because, I believe that it is the best option we have for our mentally ill population. Fundamentally the Whitaker article comes from a whole different question and background. While I believe that Dr. Torrey represents the best of the individualized culture that we have grown up in, Whitaker is sincerely representing the more collectivist way of treating patients. This leads to viewing this issue from a non-Western mindset and I am not subscribing to that view.
I think that beyond this point there are some other interesting concepts that I would like to point out. The first question addressed, in this article by Torrey was dealing with whether or not these drugs worked or not. He states that the effectiveness of these medications is a well established fact. He allows as evidence to support his ideas the studies that show that 70 percent of patients of schizophrenia clearly improve. He goes into the different drugs used and the difference of effectiveness of the various medicines. He brings out how antipsychotic are really useful in reducing delusions, hallucinations,, aggressive or bizarre behavior, thinking disorders and other so-called “positive symptoms” of over awareness of the senses. These are the main symptoms that any person would want addressed in their care.
I think that Whitaker would like to down play this fact by citing that the drugs used do not bring balance to brain chemistry. He states this but my opinion is that drugs were not meant to cure but to control and in that idea is a picture of a repositioning of balance not a onetime feat. So while Whitaker make his point he is preaching to the wrong choir. His ideas would go over well someplace else but not in the U.S. with our current medical thinking.
I picked the Torrey article as my viewpoint for another reason. Most of Whitaker’s position is based upon the supposition that the 60’s reform had to do with mainly the drug problems of the mentally ill. But I think that there were a whole lot more issues surrounding the changes that reforms instituted than the main treatment of the mentally ill with drug therapy. There were social upheavals in every quadrant of society. Every social idea and institution was being reevaluated and many were being totally dismantled.
Dr. Torrey explained to my satisfaction the effect of antipsychotic medication upon the brain. The increase of synapses and the changes in the properties of these synapses may one day be able to be controlled by other medications as research in this area continues. This is more humanitarian than Whitaker gives thought to. Both of these authors explain themselves well but are looking from different perspectives and in my opinion Dr. Torrey’s position on this issue confirms my own opinion that we use the best therapies adapted to our individualistic society not comparing ourselves to others that have a whole different way of seeing the world.
Another reason I like Torrey article is that he next talks about early treatment and its effectiveness. In support of his initial premise he adds the information about the early use of drugs being associated with better clinical outcomes and a delayed treatment with a worse outcome. He cites studies that highlight his conclusion. But then, he allows himself to give the balance that recent studies did not subscribe to this view. He gives a call for the need of clarification, but until that happens to stay the course of early drug intervention. I like this balance. It basically says to me use what we have until better comes along. I think that as responsible science is conducted the will be the hallmark of it.
My Own Thoughts
I can see the need for more humane treatment of the mentally ill. Currently, we shut them down with medication and shut them out of society. This may be just how we are as a society, we like to make divisions. We tend to group people together. It may not be bad or good but just the way our thinking is. Our treatment compared to other more collectivist countries may seem harsh or insensitive but it need not be seen as such. I see that drug therapy may flat line a patient’s emotions but that may be better than them acting out some emotion triggered by a crazy voice telling them to hurt themselves or others. I think our treatment is humane by our own standards. We can always do better but we must use our own standard in deciding what is better, not some other standard adopted from a country unlike our own in so many ways.
The other insight that I gained was that historically speaking I can see the back and forth of care for the mentally ill. Some eras were better than others. I think that we are in a good era for the mentally ill. More and more understanding is being gained and applied than ever before on how the brain functions and malfunctions. Both papers added to my bucket of knowledge and I think that both had valid points of drug therapy and its benefits and treating the mentally ill as human beings. If they could be joined it might benefit the cause of helping those who suffer with schizophrenia.
I would like to see a better accounting for putting the care in patient care not only in one field of medicine but the whole realm of health care. We must fend off the automation of the health care system. This is not limited to one section of society. We have a general trend to selfish individualization that may prove destructive to our overall social fabric. This is the last that that came to me as a result of opening my mind to these articles.