Columns

Although I've taken antipsychotics for more than thirty years, and I swear by them, they are not an ideal treatment. This is because an ideal treatment for a psychotic disorder hasn't yet been discovered. We have medications, counseling, and, to augment these, training oneself to recognize delusional thoughts. None of these three alone are enough; we need all three.

Medication causes a lot of problems for the patient. Antipsychotics depress the central nervous system. They restrict the flow of information in the brain. Everything is affected by this. It is harder to brush your teeth. It is harder to get up out of your chair and do calisthenics. Any attempt at connecting with, and/or exerting the body is harder.

Antipsychotics make it harder to concentrate. They make it harder to read. They make it nearly impossible to work competitively at most jobs. They can make life a miserable experience.

Antipsychotics are like a chemical straitjacket.

How many readers have been in a straitjacket? I have a vague memory of being in one once. I've also been "four-pointed." This is where you are tied to a restraint table with a leather strap at each limb. When four-pointed, California state law mandates that staff must check on you every fifteen minutes to make sure you are still breathing.

(Anything that resembles restraint to me triggers a lot of anger. This is because mental health treatment has given me PTSD. If my path is blocked, especially when I have no exit route from a space, I become very upset. This has happened to me in my kitchen.)

The alternative? There is none. Trying to go without medication doesn't work. I tried that several times, and each time, I barely got through it alive and intact. 

Not only do people with schizophrenia do well because of medication, we may do well in spite of medication. Sometimes producing a higher level of effort can get us past some, not all, of the limitations of being medicated. Medication introduces misery. However, trying to do without it means that the disease goes unchecked, and progresses into successively worse stages. 

Before medications were discovered, people with psychosis apparently were locked up in "insane asylums." From my best understanding of them, which is very limited, the conditions were horrendous. Eventually, the disease progresses past the stage of a patient being delusional and of hallucinating, to what is termed "the burnout stage." This can mean catatonia. Or it can mean complete inability to grasp reality, complete inability to function, except for maybe lifting a spoon to one's mouth, talking in no better than gibberish, and becoming a broken woman or man. 

I have been very fortunate. I've had three episodes of medication noncompliance. The first try almost worked, but the disease caught up with me following a life-threatening situation at the job I'd had at the time. I'd worked and practiced mindfulness for a year, had some level of delusional thinking, and might've been able to overcome that. However, by the time of the life-threatening situation (an armed robbery at a supermarket in East Oakland where I mopped and polished the floor), I was already beginning to relapse. The harrowing experience (I was locked in the store with the two gunmen overnight) may have only hastened my relapse--which may have been inevitable. 

If you have taken antipsychotics for a year or more, my layman's guess is that your chances of going off medication successfully are next to nil. If you suffer from severe psychosis, you might have one chance to get off medication and this should be under psychiatric supervision. Unfortunately, the vast majority of psychiatrists are unwilling to try this. And to try such a thing on your own is a very bad idea. This is because a trial off medication, to have even a small chance of working, must be accompanied by supervision and support from professionals. 

Medication is not a bad thing. It is not good or bad. It is necessary. However, taking medication can feel like either a splint that you wear permanently, or like a chemical straitjacket. Antipsychotics restrict the mind and body. Is this a good thing? No, it is not. Yet, unchecked psychosis is the alternative, and this is a waste of a potentially good life. And that is something you should take seriously. 

Until medical science invents something better than the current treatments for schizophrenia and bipolar, we need to avail ourselves of the current treatment. Meanwhile, there is limited investment in brain research to discover a better way.