Consquences, Meaning and Resolution of Madness

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In the first instance, madness can be located in the system and in the institutions, we are born in and struggle to live in.

Who and what we are naturally as human beings has to fit into the society we are born into (which of course we have no knowledge of when we come into the world). So, for the many thousands, millions in this world who have experienced madness to varying degrees it is the emotional pain associated with the confining institutions we are born into that either cause or exacerbate the problem.

Institutions such as the family, school, hospital. Of course, I am not suggesting that we should do away with these institutions just yet, only that they change in their outlook, culture, and work with human beings and humanity rather than against it.

Mental illness and work

There has been much said, written about and policies made to make people sick with madness go to work. There has always been and always will be a number of people who are willing and capable of working.

They never needed any ‘encouragement’ like discharge from day center’s, or obscure and hampering benefit rules such as the permitted work rules (which have quite frankly put off hundreds possibly thousands of disabled people from working) as mechanism for obtaining work.

People with mental illness very often make very good healers, just as they do in other parts of the world, in Africa and Asia for example. There is very high recovery rates in parts of these continents and other areas of usually what is known as the third world. They ( those displaying symptoms of mental illness) are not outcast but sometimes revered and quite often given roles (or work) in their societies that involves healing, whether it be emotional, spiritual or physical.

It is no good trying to fit a square peg into a round hole, many of us who are or have been mad simply cannot fit into the jobs and the associated working environment that exist without getting so stressed out that we are likely to become a danger to ourselves and also to those around us. Basically we have limited functioning capacity in a workplace.

This is a fact for many of us and it is a hurtful fact for us to face. It is because of this that we become outcast.

The Resolution

Primarily mental illness is treated by psychotropic drugs, this solution is forced on us in our society (the western world) and we have no choice. One problem that is encountered as a consequence of this is non-compliance.

Current resolutions to the problem of madness is to threaten and consider locking people up even though they have not done anything. Of course this is intellectually and morally absurd and shows the lengths some people will go to in order to ostracise a group of people they maybe fear and do not wish to allow the same or similar rights as the rest of the population.

A good resolution is simple, the medication may or may not help us, personally I take it (the bitter pill), there needs to be more education and discussion about psychotropic medicine, but just ask anyone who is involved in the administration of medicine, this is only a small part.

For Madness and is consequences to be alleviated our basic needs have to be looked at and provision made. Housing, food, warmth and human company. Most of us will not just take and not give anything back. We are as I have said before excellent all-round healers, entertainers, musicians, artists.

We have special needs, cannot, and should not be forced into a working environment that we are simply not capable of being productive in.

Guest Post by Chris Barchard. 'Can you always believe Psychiatrists?'

There is an old saying that goes “He lies like a physician”. Although this belongs to a bygone era when the term “psychiatrist” had not been coined people still sometimes mistrust what doctors tell them and psychiatrists are no exception to this. It is of course impossible to produce statistics to demonstrate the incidence of psychiatric disingenuousness and even if a comprehensive body of data existed there would still be questions about individual clinical opinion, actual lack of knowledge and mistakes on the part of particular doctors. However none of this proves that the practice does not go on or that it does. Rather than try to answer this contentious question directly I aim to point the reader in the direction of things that I have myself been told by psychiatrists and that others have told me anecdotally with a view to the reader assessing for themselves whether these are things to which a psychiatrist could reasonably be expected not to know the right answer and whether there are grounds to suppose that he/she would have a motive for lying about the matters.

Something I have been told all too often when I have complained about problems with memory, weight or sexual function is the suggestion that it is to do with age. The role of psychiatric drugs was to say the least played down. When I didn't know as much as I do now about the effects of psychiatric drugs I was a bit puzzled by this because my memory was much worse than others of my own age group, my weight seemed to have gone up as soon as I was put on certain antipsychotic drugs and I thought I was a bit young to be getting problems of sexual dysfunction. In fact all these problems have markedly improved on more modern drugs and I was only in my thirties when I can remember being told these opinions. All of these problems are well known side-effects of many antipsychotic drugs. As to a motive for deliberately misinforming me about these matters I would contend that the doctor concerned wanted me to comply with the treatment programme and may well have thought I would stop taking the drugs if I knew the truth. Furthermore when the issue of psychiatric staff being untruthful about the adverse effects of the treatments they dealt out was discussed at a local Mental Health Forum I used to attend, it was admitted by a senior nurse present that the fear of non-compliance with treatment by patients was the primary reason for withholding information about these matters.

Similarly when I was taking lithium the psychiatrist let me know that tests on my kidney function were giving slightly abnormal readings. Rather than admit this was the lithium damaging my kidneys he equivocated about the distinction between changes in kidney function and structural damage, obfuscating the issue of damage caused by lithium, saying it could be a number of things. This was in spite of lithium being the most immediate candidate of causation. He did not want to stop the lithium. I took affirmative action. It was my life and I wasn't going to take chances with this drug. So I took myself off it and it was little surprise that the kidney tests improved a little. The psychiatrist admitted grudgingly that the timing of this did make it look like lithium was the cause. Why might he have been disingenuous in the beginning? Compliance again seems the obvious candidate. I think he was so worried about my stability that he just wanted me to keep taking the tablets.

More recently I heard that someone had been denied aripiprazole, the newest antipsychotic drug, on the grounds that it was used when the patient needed to be somewhat sedated. Given that the person in question was taking olanzapine at the time this seems a rather improbable reason since olanzapine tends to be more sedating than aripiprazole. I have taken both and this is certainly my personal experience. I could only speculate why the psychiatrist in question might have tried to mislead this person. It might have had to do with cost although the difference may not have been great or it might have been to do with cautiousness about using drugs that have not been around for many years and whose long-term effects are thus unproven. Whatever the reason it seems that the psychiatrist may not have wanted to be open about it with the patient.

A more general situation can be described that was prevalent particularly in the 1990s when a whole new generation of antipsychotic drugs became available. Many psychiatrists were very reluctant to use the atypical antipsychotic drugs much when they first came on the market. They have become the norm as a first choice in treatment of psychotic problems nowadays. One of the commonest reasons that was given at the time was that they were no better than the older “typical” drugs. That very much depended on what you meant by “better”. If it was just reduction in positive symptoms: delusions, hallucinations etc., then there was a grain of truth in this assertion. But if someone's overall quality of life were considered then for many people it has proven to be wrong. It is worth noting that “atypicals” such as olanzapine, quetiapine, clozapine, risperidone, amisulpride and ziprasidone, are considerably more expensive than the previous generations of antipsychotic drugs in most cases. The same is true of aripiprazole which really is part of an even newer generation of this class of drug.

Life is such that it is usually possible to invent plausible alternative reasons for things which are not the genuine ones. Some people are frequently taken in by this but the more perceptive and knowledgeable can spot the flaws – at least some of the time. The question is whether psychiatrists at times withhold information and sometimes do this by giving misleading or false information to their patients. If they do then it raises questions as to whether it really is in the best interests of the patient to do this – it is certainly very undemocratic – and whether it is in fact counter-productive. As soon as someone gets an inkling they are being lied to it creates distrust and can in itself lead to non-compliance with treatment. I think a lot more people undergoing psychiatric treatment nowadays know something about the adverse effects of the drugs they are given than they did 20 or 30 years ago. In my own experience of knowing people who are to a degree “in the know” about this it does not usually stop them taking tablets. In some ways it makes one feel better to know that it's not all the illness that's giving one problems. It makes the illness seem that much less. Anxious uncertainty is almost universal amongst patients when they know little or nothing about what is being done to them. The idea that people with psychotic illnesses are quite unreasonable has been greatly exaggerated and knowing what risks there are associated with the treatments can remove one level of uncertainty. It may not be the best time to talk about this when one is in crisis but as reason returns so does the ability to distinguish the effects of treatments that are not to one's liking and to want to know the truth.

Because of more patients having knowledge it is probable that psychiatrists are more open with more patients nowadays but it is not something that should be taken for granted.

I have only given a few examples in this piece. Readers will know whether these ring bells for them and whether they have had similar experiences of their own. If the examples do resonate with them then it will have been worth bringing this issue out into the open.