The Use of Neuroleptic Drugs As Chemical Restraints in Nursing Homes

There’s an interesting article in the July-August 2014 issue of the AARP Bulletin.  It’s called Drug Abuse: Antipsychotics in Nursing Homes, and was written by Jan Goodwin.  AARP is the American Association of Retired Persons.   Jan Goodwin is an investigative journalist whose career, according to Wikipedia, “…has been committed to focusing attention on social justice and human rights…”

The article is essentially a condemnation of the widespread and long-standing practice of using neuroleptic drugs to suppress “difficult” behavior in nursing home residents.

Here are some quotes:

“According to Charlene Harrington, professor of nursing and sociology at the University of California, San Francisco, as many as 1 in 5 patients in the nation’s 15,500 nursing homes are given antipsychotic drugs that are not only unnecessary, but also extremely dangerous for older patients.”

“‘The misuse of antipsychotic drugs as chemical restraints is one of the most common and long-standing, but preventable, practices causing serious harm to nursing home residents today,’ says Toby Edelman, an attorney at the Center for Medicare Advocacy in Washington, D.C.”

“If one drug caused sleeplessness and anxiety, she was given a different medication to counteract those side effects. If yet another drug induced agitation or the urge to constantly move, she was medicated again for that.”

“Antipsychotic drugs are intended for people with severe mental illness, such as patients with schizophrenia or bipolar disorder. As such, they carry the FDA’s black-box warning that they are not intended for frail older people or patients with Alzheimer’s or dementia. In those populations, these drugs can trigger agitation, anxiety, confusion, disorientation and even death. ‘They can dull a patient’s memory, sap their personalities and crush their spirits,’ according to a report from the California Advocates for Nursing Home Reform.”

There’s an implication in this quote that neuroleptic drugs have these adverse effects only on frail older people.  In fact, they have these effects on almost everybody who takes them.

Back to the AARP article:

“And pharmaceutical companies have been aggressively marketing their products as an easy and effective way to control these issues.”

Gwen Olsen’s book Confessions of a Rx Drug Pusher (2009) provides some very compelling insights into this kind of pharma marketing, e.g.:

“It was the end of the third quarter, and I was behind in my sales quota for Haldol…So, I determined the best way to build my Haldol business would be to campaign for the institutionalized patient. These patients were not only encouraged to take the medication; they were actually given the drug. This completely eliminated the compliance issue.”

“I set about scheduling training in-services in the local nursing homes and mental health and mental retardation (MHMR) facilities. I increased my call frequency on physicians whom I knew to have nursing home relationships and directorship responsibilities.” (p 48) [Emphasis added]

. . . . . . . . . . . . . . . .

It is particularly heartening to see an article like Jan Goodwin’s in an established magazine such as AARP Bulletin (readership 37 million +).  It represents a huge advance over the take-your-psychiatric-medication-as-the-doctor-ordered drivel that passes for journalism in most mainstream media outlets.  I commend Jan Goodwin, and hope that we see more material of this sort in the future.

At the same time, however, I was disappointed in that the role of psychiatry in the promotion of these neurotoxic chemicals was not even mentioned.  Responsibility for the problem was laid at the feet of pharma, whose aggressive, irresponsible marketing was unequivocally condemned.

But pharma doesn’t write prescriptions.  And pharma didn’t invent the “illnesses” that legitimize these prescriptions.

For the past sixty years, psychiatry’s primary objective has been to promote the spurious and destructive notion that virtually every human problem is an illness.  Their efforts have been extremely successful, and this false notion today permeates our culture, our language, our political and social institutions, and even our nursing homes.

Using dangerous, toxic chemicals to drug a frail, elderly person into submission is possible because psychiatry has invented and sold the fiction that his agitation, anxiety, and aggression are illnesses, and that the toxic chemicals are medications.  Pharma certainly funded the fraud, but it was psychiatry that conducted the “validating research.”  It was psychiatry that codified and formalized the spurious diagnoses into a manual.  And it is psychiatry that lobbies unremittingly for the acceptance of these “diagnoses” by government entities and by other professions.

And this was not an innocent error.  Psychiatrists invented and promoted their fictitious illnesses and their destructive “treatments” to promote their own aspirations to be seen as a legitimate medical specialty, and to expand their business, their influence, and their prestige.

In this process, they have created a monster that feeds on human life, but they continue to insist, against rapidly mounting evidence, that their “diagnoses” are valid and their “treatments” effective, and have engaged the services of an international PR firm to marginalize their opponents and to sell this travesty to the public, the media, and the political establishment.  Psychiatry is not something that is basically OK, that just needs some minor corrections.  Rather, psychiatry is something fundamentally flawed and rotten: a wrong turning in human history; a blot on humanity’s collective conscience.

Let us hope that we see more articles like this in the mainstream media, and that more investigative journalists like Jan Goodwin will find the motivation and the courage to speak out against this disempowering and destructive edifice whose shadow has for too long been allowed to darken the hopes and aspirations of people of all ages.

 

  • Francesca Allan

    This isn’t news, of course, but it’s certainly encouraging to see the information get out there. As you point out, the practice is not restricted to nursing homes. From my own experience on psychiatric wards, neuroleptics are administered in higher and higher doses until the patient becomes manageable, i.e. obedient. (There’s actually a note in my hospital records which reads “Patient irritable with me. Plan: increase Risperdal.” Never a consideration given to the possibility that the psychiatrist was irritating and my response was quite appropriate.) The ultimate goal appears to be having a group of obese and compliant cabbages staring at the television screen. It’s a bizarrely constructed power structure that has little, if anything, to do with mental health. I think I’ve now made it clear to everybody that the next person who tries to force such “treatment” upon me will have his eyes gouged out with a spoon.

  • Jorge_Videla

    where’s the post on “scz isn’t a mental illness”?

    hearing voices, talking in a word salad, and bizarre delusions sounds like mental illness to me.

    one can argue semantics all day long, but curing the problem takes a lot longer than it takes a pill to have its effect.

    drugs are much cheaper/more economical.

    is doc hickey opposed to drugs as a “stop gap”?

  • Anonymous

    “word salad” was just a dehumanizing phrase coined by psychiatrists that don’t bother to take the time to even attempt to understand what someone is saying. To the person uttering the words, everything makes its own sense. There are plenty of articles on this blog about the nonsensical label “schizophrenia”. This blog’s message is not about “semantics”. To “argue semantics” is to argue over the words we use for the same thing in kind. When a psychiatry believer first encounters critics of psychiatry, it is very common to hear this “you’re splitting hairs over words” kind of argument, that isn’t the case at all.

    When the Catholic bishop sees the adulterer, he believes he is seeing something completely different in kind to the secular perceiver of the moral/rule transgression at hand. For the secular person, he sees a betrayal of monogamy, a betrayal of a promise, some hurt feelings, an adulterous act. The Catholic bishop sees a soul that will burn in hell if certain steps are not taken. Those are two radically differing interpretation of the act of “cheating on” your spouse.

    Likewise the nonbeliever in psychiatry, and the psychiatrist, perceive two completely things in kind when they perceive and interpret a problematic behavior, the psychiatrist sees a “symptom” of an “illness”, literally, with the same crystalline literality one percieves fatty cholesterol plaques in an artery to be a “symptom” of a bona fide medical problem. The critic of psychiatry sees not a “medical problem”, but an interpersonal problem, or a personal problem, or a problematic thought, one where wheeling in a pseudomedical interpretation is unhelpful and harmful to rectifying or even beginning to interpret the problem.

    Far be it from merely just being a fan of not using psychiatry-derived-originated language and labels, versus a believer in DSM labels, the psychiatrist and his critic are completely at odds conceptually, not merely semantically.

    Any medical student that goes onto specialize in psychiatry is in effect somebody who has turned his back on real medicine, and entered the realm of quackery. It boggles the mind how someone can spend years ingesting textbooks about the proven and demonstrable biological etiologies of all the maladies of the body, and then turn around and flush that all down the toilet by becoming a DSM labeling, tranquilizer drug dispensing, human vending machine / part-time torturer / poisoner of kids. I think it speaks to the abundance of quality rote learners and test memorizers our high schools produce, thinking for themselves, is clearly not something a medical student who goes into psychiatry excels at. In fact it remains one of the most burning questions why more don’t basically belly laugh their way out of the room on the first day of the first psychiatry lecture they are required to attend. How does that go? Does the professor put up some slides and say “if people act funny or believe funny things that’s a brain disease but you will go your entire career without examining a single brain so just trust us on this…”. It’s very sad and it’s an epic society-wide, globally significant, bad idea. It’s one of the worst, most mistaken, most misguided ideas, humanity has ever come up with, this idea of “mental illness”. It’s just a sorry state of affairs.

  • Bryan Jones

    It is important to continue to publicise this malpractice. I think I’m right in saying that there has been some formal recognition in the UK of this abuse of antipsychotics with people suffering dementia, and national targets to reduce this malpractice – unsure how much progress has been made though.

  • Phil_Hickey

    Jorge,

    You write:

    “hearing voices, talking in a word salad, and bizarre delusions sounds like mental illness to me.”

    But this immediately raises the question: What do you mean by a mental illness? What the APA mean by a “mental illness” is any significant problem of thinking, feeling, and/or behaving. My position is that:

    1. calling these problems “mental illnesses” adds nothing to our knowledge or our ability to help.

    2. is inaccurate, in that in almost all cases, there’s no actual illness involved, and

    3. legitimizes psychiatric intervention, which usually makes things worse.

    You write:

    “one can argue semantics all day long…”

    I certainly do stress the importance of semantics, in the sense of clarifying the way in which words are used. By discussing this activity as “arguing semantics” I think you’re falling into psychiatry’s trap. Psychiatry thrives on wooly thinking and ambiguous phrases. Clarification is vital.

    Am I opposed to drugs as a stop gap?

    1. All psychiatric drugs do harm, especially in the long run.

    2. “Stop gap” often gets extended to lifetime.

    3. I’m not opposed to people using drugs – that’s their own choice. I am opposed to psychiatrists pushing toxic drugs on people under the pretense that they are medications that correct chemical imbalances or other brain illnesses.

    By the way, there’s a three-post section on Schizophrenia is not an illness here.

  • Phil_Hickey

    Anonymous,

    Well stated.

  • Cledwyn o the Bastards

    Excellent points, and beautifully put.

    The meanings explicit and implict in this socio-culturally dominant way of conceptualizing human problems, experience, behaviour and thought are utlimately antithetical to the theories being advanced here, so this is about much more than semantics.

    Our understanding of an event, and our emotional, behavioural and attitudinal response to that event, depends upon the way in which we frame that event, inter alia. Interpreting these phenomena through a psychiatric framework, with all that that really entails, has had disastrous consequences for countless millions of people, be it in the social spheres of their lives, the biological, the mental, or the interpersonal.

    All psychiatric theory and the messages it transmits to society has done is created prejudice and fear, although there is perhaps something of a kind of feedback loop here, whereby immemorial societal prejudice against deviations from behavioural and psychological norms on the one hand, and psychiatric theory on the other, both feed each other (which came first, societal prejudice on this issue, or psychiatric theory, is perhaps a bit of a chicken and egg situation), so maybe it would be better to say that psychiatry theory reinforces the prejudice towards and fear of the outsider that, alas, is part of our heritage, substituting pseudo-scientific for theological justification of entrenched societal intolerance and hysteria vis-a-vis outsiders in accordance with the shift in the intellectual temper of the times.

    Obviously the DSM has undergone accretions and alterations that reflect more the influence of BIg Pharma, the medical pretensions of psychiatry, and the influence of a scientistic framing of human nature, experience and behaviour, than it does societal prejudice, but at root I still think psychiatric theory is largely, figuratively speaking obviously, the accumulated sediment deposited both through generations of fearing the Other and discomfiture and denialism regarding the insanity which resides in the minds of every man, although we can’t discount the vehicle it provides for the acquisition and consolidation of power, with psychiatric theory of mental illness in this sense being a functional equivalent of the theories of heresy and sin in former times.

    So taking into accounts what I believe to be its true roots in prejudice and fear; the emotional responses such a conceptual framing generally elicits amongst those who interpret the “diseased” individual through that frame because of the negative feelings the term mobilizes and its association with dangerousness, unpredictability and irrationality; the use such concepts have been put to in the service of oppression; its use amongst individuals as a term of abuse in conflictual interpersonal relationships and an attack on on someone’s dignity; as well as the fact that the historical and empirical data simply don’t support the notion that it best serves the interests of the patient; given all this, I think it fair to say that rejection of such concepts occupies not just a sound logical position but also a moral one.

  • Cledwyn B’stard

    “Psychiatry thrives on wooly thinking and ambiguous phrasing.”

    Sums it up up perfectly.

  • cledwyn bastard

    That should be “antithetical to each other in the attitudes and practices their prescribe”, in the second paragraph.

  • cledwyn b’stard

    Sorry, that should be “antithetical to the theories being advanced here in terms of the attitudes and practices they prescribe.”

  • Phil_Hickey

    Bryan,

    Thanks for coming in. The State of New York set reduction targets also, but I’m not sure how much has been achieved. Psychiatric practices develop a great deal of momentum, and are hard to arrest.

  • Jorge_Videla

    i agree with all that…but…

    “alien vampires are eating my brain…”

    get real!

  • Jorge_Videla

    look dearheart,

    when my cousin’s friend thought he was being followed by recruiters for the state university’s american football team…

    yes…in this instance…you are the jive turkey.

  • Jorge_Videla

    all genuine craziness is impossible if you merely appreciate how very little interest other people have in you.

  • Jorge_Videla

    thanks.

    What do you mean by a mental illness

    semantics. i’d throw out everything in the dsm except scz.

    I am opposed to psychiatrists pushing toxic drugs on people under the pretense that they are medications that correct chemical imbalances or other brain illnesses.

    but it’s a small % of psychiatrists who actually think this way. those who do are douche bags, of course. but in general their approach is…will the patient be helped?

  • Cledwyn B’stard

    Dearheart? If you want to engage in discussion with me, learn how to keep your emotions within well-judged limits and kindly refrain from using such adolescent tactics. I didn’t address my comment to you personally because I can see that you are a singularly unsavoury character incapable of viewing this issue without party pris and because I have no wish to waste my time arguing with someone who sees things from such a puerile perspective.

    What did you hope to prove by these effusions of adolescent sentiment, may I ask?

    “All genuine craziness is impossible….”

    What are you talking about?

    A jive turkey? What your arguments lack in strength, they more than make up for in vituperation. Abuse and aggression are expedients people commonly have recourse to when they cannot defend the grounds on which their arguments rest, and when they do not wish to cede the argument to one who clearly has more of substance to say than them on the issue under discussion. How about actually addressing what I’ve said, instead of making a spectacle of how thoroughly unpleasant you are?

    “When my cousin’s friend thought he was being followed by recruiters…”

    You are just ventilating your prejudice, and prejudging the phenomenon under discussion.

    Paranoia is a part of modern society, lareglely a symptom of the erosion of trust in our society. It is rarely a symptom of an illness.

    The belief in a paedophile ring and conspracies orchestrated by a ring has no substance, yet the masses believe in it. Satanic ritual abuse is another example, a paranoid delusion that in some parts has encompassed the whole gamut of class and recognizes no heirarchical bounds.

    Do you really want me to go on? Paranoia is not the exclusive possession of a few, nor in most cases is it symptomatic of an illness. It is something everyone experiences. People entertain paranoid, delusional ideas; they are two of the follies the human mind is heir to, as well as effects of the fear-mongering institutions such as the mass audio-visual, and a government that controls people by “menacing it with an endless series of hobgoblins.” (Mencken)

    No kindly go away and be vile someone to else.

  • Cledwyn B’stard

    Obviously that should be “hierarchy”,, “parti pris”, “largely”, and “now”, just in case you stoop even lower than you have already gone and try to use that against me.

  • Cledwyn B’stard

    ?????????????

  • Cledwyn B’stard

    Great advice from the man responsible for such such nuggets of pure sagacity as “all genuine craziness is impossible if you merely appreciate how very little interest other people have in you”, which you no doubt esteem an oracular utterance, rather than as an example of the kind of writing that supposedly qualifies one for a diagnosis that rests purely on the opinions of experts and which he seems to take pleasure in attaching to people, comfortable in the erroneous notion that he is one of the god of Reason’s elect.

  • Cledwyn B’stard

    Are you trying to say (and perhaps this escaped my comprehension because I never assumed that someone would be so childish to resort to such patently false insults that belong on a playground; or because you use the word “is” instead of “seems”, perhaps) that people have very little interest in me (and what, you’re the cynosure of all eyes or something, are you, the self-confessed “drunken loser”? Let’s assume for the sake of argument that your supposition is correct, if there is such a lack of interest which I appreciate, then your appreciation of this I would surmise has been purchased through personal experience, not that I repose any faith in popularity as a measure of worth, as you seem to at least temporarily for the convenience of your making an insult in lieu of anything that could be described as a cogent rebuttal) and the limits of my appreciation extend no further than my supposed appreciation of the lack of interest I supposedly inspire in people (which by the way isn’t true; while as a “schizophrenic” I eke out my existence on the margins of society, I do have family and friends, and I have received praise from a number of quarters whose opinions I esteem highly, not that it is of any import or relevance in assessing the value of my arguments, not that anyone but an arrant pillock would invest importance in such things.)?

    Where did I say craziness is impossible? The fact that you feel the need to misrepresent my position is a pretty good indicator of the difficuity you must have had in formulating a response that actually deals with what I am saying.

    I do not deny that there are irrational perceptions and behaviour, and that there are points of views out of the ordinary. That is at best a mere figment of your emotionally charged imagination, and at worst a deliberate misrepresentation of my position; a pathetic caricature that redounds to your discredit.

    What I say is that the line seperating sanity from insanity runs not through human society but the human mind itself.

    You seem to have little interest in understanding people like myself who have had their experiences bent and twisted to fit the procrustean categories of psychiatry. Your lack of sympathy for and prejudice against such people is writ large in your comments.

    In contradistinction to the poison you have vented underneath my comment, and the detritus of your thinly disguised hissy-fit, I have substantiated my point of view.

    You have basically laid down your observation (or outright distortion) of reality peremptorily, which bespeaks a temperament ill-adapted to tolerating deviation from your own opinions, as, to my mind, exhibited in the manner of your delivery, as if you were the Pope laying down decrees ex cathedra, when in reality the degree of substance and depth to be found in the arguments of dogmatists like you is usually inversely proportional to the measure of arrogance with which they are asserted, so that the one increases as the other decreases.

    Like most believers in schizophrenia and all the bigoted assumptions built into it, you speak as if no elaboration is needed, as if the facts speak for themselves, so frighteningly enamoured are you of your own conspicuously crap opinions on this, which are little more than observations presented as proof of things that remain to be explained and proven, “the schizophrenic” being little more than a kind of human Rorschach blot for people like you, which you project your subconscious prejudices onto.

    Such arguments, as Dr Szasz once pointed out, occupy the same logical and empirical status as saying someone is a witch because she has a supernumerary nipple. This is the nonsense of a mind held in the grip of a mass delusion.

    The argument of people like you can be summed up as, “we know a schizophrenic, when we see one!”

    If I were to discuss the relative merits of our two positions on this issue, the best I could say is that you have a talent for compensating for the paucity of ideas you bring to this issue with bad attitude. True, I have reciprocated the undertones of contempt in evidence in your abortive attempt at a witty, cogent response, but given that the comment you responded to was clearly in no way designed to provoke you, and that I do not recognize the authority that Christian moral precepts like “turn the other cheek” have been invested with by culture and tradition, I feel justifed in doing so, knowing that you instigated this and that, even in the eyes of those who do not recognize the distinction between instigating an argument and reacting to it, at least I have things to say beyond presentation of my own observations as truths so self-evident no serious elaboration on why they are true is required (the fact explains itself).

    I shall not continue to fritter away any more time trying to reason with one whose arguments aren’t founded upon reason.

  • Jorge_Videla

    dear god dude. calm down.

    i wasn’t insulting anyone.

    i’ve never thought i was a vip. but i never wanted to be a vip. we’re all losers in the end. bill gates to some mexican who picks at garbage heaps. For what shall it profit a man, if he shall gain the whole world, and lose his own soul?

    and i’ve always thought very little of vips.

    the crowd is untruth.
    hell is other people.
    beata solitudo, sola beatitudo.

  • Jorge_Videla

    dude!

    you’re proving my point.

    i’m not your enemy or better than you. but get real already!

  • Jorge_Videla

    dude!

    i’m in the bgi study.

    i know what it’s like to be smarter than anyone you’ve ever met.

    but we’re all headed toward the same end.

  • Jorge_Videla

    anyway dude. trust me. really. i’m not kidding. you’re obviously very very smart. just don’t be so f—ing serious/intense (and yes, i have been described as such!).

    and, i should say, you’re obviously not crazy or a scz.

    my point was…i’ve seen crazy…it’s very rare…but it does exist.

    and as fast eddy said to burt, “you don’t know what winning is. you’re a loser.” google it. i think you and i are fast eddies in a world of burts (played by paul newman and george c scott). http://en.wikipedia.org/wiki/The_Hustler_(film).

  • Phil_Hickey

    Jorge,

    You say: “but it’s a small % of psychiatrists who actually think this way.” That’s certainly not my experience of psychiatrists. Almost all the psychiatrists I’ve encountered in the past forty years operated exclusively from the brain-illness-corrected-by-drugs philosophy.

  • Jorge_Videla

    maybe it’s different out here in pdx.

    but my experience is anecdotal. yours is likely representative. or maybe it was just none of them thought i was really that crazy. one even told me, “your problems don’t amount to a disorder.”

    i think you mentioned working in corrections. i imagine there it’s very different, especially in america. with its world beating incarceration rate i think criminals are seen by staff as subhuman.

  • Cledwyn B’stard

    The only point in arguing with people like this would be to provide others with an object lesson in the futility of argument, as well as existence.

  • Phil_Hickey

    Jorge,

    You mention that one of your psychiatrists told you that “your problems don’t amount to a disorder.”

    The problem with this is that, within psychiatry’s system, this is an inherently meaningless statement for two reasons: firstly, because they provide no way of gauging the severity of a problem other than a psychiatrist’s subjective opinion; secondly, because of the “not otherwise specified” (NOS) category which allows them to “diagnose” a disorder even in
    low-severity situations if – again in the psychiatrist’s opinion – this is warranted. DSM-5 changed the words from “not otherwise specified” to “other specified” and “unspecified.”

    DSM-5 also acknowledges quite bluntly:

    “However…it has not been possible to completely separate normal and pathological symptom expressions contained in diagnostic criteria.” (p 21)

    In practice, however, they ignore this reality and continue to promote the fiction that depression, bipolar, schizophrenia, etc. are all illnesses that one either has or has not.

    Best wishes.

  • Jorge_Videla

    http://en.wikipedia.org/wiki/I_know_it_when_I_see_it

    it’s unscientific to be sure, but it does describe reality.

    psychiatric diagnoses cannot be like physical diagnoses. cannot.

    the psychiatrists i’ve met regard the dsm as, at best, meaningful only to those who’ve done a residency.

    the “establishment” and the “rank and file” are like americans and their congress.