On Friday, 1-29-16, I posted a blog by  journalist/author Robert Whitaker questioning the value of anti-psychotic medications. Whitaker felt compelled to explain his position about medications because of statements challenging him made by Dr. Allen J. Frances, Professor Emeritus of Psychiatry and Behavioral Sciences at Duke University Medical School in an email.  Here is Dr. Frances’ response to Whitaker’s response.

Do Antipsychotics Help Or Harm Psychotic Symptoms?

By Dr. Allen J. Frances

This is the latest, and perhaps last, of several debates with Bob Whitaker on the role of antipsychotics in treating psychotic symptoms. It was triggered by a recent email exchange that clarified our areas of agreement and disagreement. 

Bob and I agree strongly on the following:

1) Antipsychotic medicines are used far too often in people who don’t need them.

2) Even when necessary, doses are often too high and polypharmacy too common.

3) Antipsychotics are neither all good, nor all bad. Used selectively, they are necessary and helpful. They are harmful when used carelessly and excessively.

4) The treatment of people with psychosis relies far too much on medication alone, far too little on social engagement, psychotherapy, vocational rehabilitation, and providing adequate housing. We both like the normalizing, recovery models offered  by Trieste, Open Dialogue, and Hearing Voices. (click here to read more on this subject.)

5) The care provided for the mentally ill in the US is a disaster that shames our country. (click here to read my thoughts about this.) 

Bob and I disagree strongly on the following:

1) Bob believes that long term use of antipsychotics makes psychotic symptoms worse. He therefore recommends that patients try to avoid antipsychotic medicine altogether or taper off them, whenever possible. 

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Two internal memos, not previously made public, show that state mental health officials in Virginia were warned earlier than has been widely reported about “streeting” – the practice of turning people away from hospitals because of a lack of psychiatric beds.

The two in-house warnings were written by then Inspector General G. Douglas Bevelacqua and sent to James A. Stewart, who was serving as Commissioner of the Virginia Department of Behavioral Health and Developmental Services (DBHDS) at the time, and his upper management.  The memos are dated April 14, 2011 and May 12, 2011.

The public first learned about “streeting” from media reports when Bevelacqua issued an IG report on February 28, 2012, specifically about the practice.

These earlier two memos establish a timeline that shows DBHDS officials were aware of “streeting” some 31 months before State Senator Creigh Deeds and his son, Austin “Gus” Deeds were “streeted” with tragic results.

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I recently asked Washington area management consultant Steven Kussmann to suggest ways the mental health community could be more effective in achieving meaningful reforms. Here is the thoughtful and creative blueprint that he sent me.

Changing The Mental Health Movement From Within

by Steven Kussmann 

Less than 3% of our population self-identifies as gay or lesbian. Yet, the LGBT community created a movement that changed our nation’s definition of marriage and secured same sex marriage as a constitutional right! Change did not happen organically nor overnight. It was the result of a highly-effective social movement strategy and decades of well-targeted action.

The number of U.S. citizens with a serious emotional and mental health disorder is 10-times greater than the LGBT population. Why then do our social and political successes pale in comparison with those achieved by this community? What can we learn from them to achieve similar results? How can we apply those lessons to transform the mental health movement into a powerful engine for effective change?

The lessons are many, and their application requires a fundamental refocus of movement strategy and structure. To succeed as a force for real social and political change, the mental health community, both its leadership and grassroots network, must rethink and retool its strategy and tactics.

Here are five get-the-ball-rolling ‘lessons learned’ from the success of others the mental health community can act on now:

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In the past two decades, Robert Whitaker has published books and articles that challenge the conventional wisdom about the widespread use of medications in treating mental illnesses.  A research paper entitled: The case against antipsychotic drugs: a 50-year record of doing more harm than good, that the journalist/author published in 2004 is representative of the skeptical eye that Whitaker casts.

By chance, I was included in an email exchange where Whitaker objected to being labeled as someone who is unilaterally “against” medications.  Dr. Allen J. Frances, Professor Emeritus of Psychiatry and Behavioral Sciences at Duke University Medical School, suggested that Whitaker clarify his views. In this guest blog, Whitaker explains what his research has shown him.

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This photo was taken by my son, Evan Luzi, near his apartment. It is untouched – the work of the wind – as the snow around it was clean with no tracks.

Patti and I were in the Virgin Islands taking a rare and long anticipated five day vacation when we heard that a blizzard would be hitting the Washington D.C. area, starting at 4 p.m. on Friday (1-22-16). Patti suggested we catch an earlier flight home on Thursday.

“No way!” I said stubbornly. “I’m not giving up two days of vacation. Besides, weather forecasters are always exaggerating. It makes for better ratings.”

A call to American Airlines set off alarm bells on Friday morning. If we didn’t leave the island immediately, we would be stuck in St. Thomas until late Tuesday night. Stuck?

Ordinarily, the threat of being forced to stay in a tropical paradise while the entire upper East Coast was under three feet of snow would be a no-brainer. Bring me another Pina Colada while I watch a perfect Caribbean sunset, please.

But I was scheduled to testify before the U.S. Senate Judiciary Committee on Tuesday (1-26-15) about the importance of Crisis Intervention Team training and jail diversion. I didn’t want to miss that hearing.

Patti and I scrambled to the airport and took off for Miami, the first link of our trip home.

And that is as far as we got on American Airlines, which promptly cancelled the next leg of our flight. We were stranded in Miami on Friday during a downpour of rain. A kind but frazzled flight agent told us that we had been re-booked on a flight that would leave late Tuesday night for Dulles Airport.

“But I have to get back to testify before a Senate committee on Tuesday morning,” I said, hoping that statement would make it sound as if the safety of the entire free world depended on me giving testimony.  (I would later learn that Vice President Joe Biden’s flight had been redirected to Miami and that he couldn’t get home to Washington either.)

My plea didn’t work. Worse, American Airlines refused to give us our bags.

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RESILIENCE: Two Sisters And A Story Of Mental Illness, the intimate memoir that I helped Jessie Close write is now available in paperback with a dramatic new cover!

It’s the brutally frank story about Jessie’s struggles with bipolar disorder and alcoholism, and her inspiring recovery. Her talented sister, Glenn Close, widely acclaimed as one of the finest and most versatile actresses in Hollywood, was instrumental in helping Jessie and her son, Calen, after he also was diagnosed. As most of you know, Glenn is a co-founder of the anti-stigma non-profit BringChange2Mind. As part of its campaign, it has produced two powerful Public Service Announcements for television. Glenn also generously wrote three personal vignettes for RESILIENCE which are included in both the hardback and just released paperback. She has graciously allowed me to reprint one of them.  You can order the paperback edition of Jessie’s book  here.

From RESILIENCE: Two Sisters and a Story of Mental Illness

By Jessie Close with Pete Earley and Glenn Close

Vignette Copyright by Glenn Close @2015  Used by permission

It’s strange how memory can distill something down to a single image and yet somehow that single image retains its power to invoke all the other senses. I realize now that my memory of my little sister, Jessie, when she was a child is a collection of images around which other sensations move in and out of my consciousness. Maybe that’s because, compared to most other families, our family has a shocking lack of pictures, especially throughout Jessie’s childhood and beyond. For the most part, at a certain point the pictures just stop. Hers is the only baby-picture book that remains painfully incomplete. Of course, Jessie was the fourth child, and our mother’s days were full of tending to three other kids, a herd of various pets, and a husband who came home from interning at Roosevelt Hospital in New York City only on weekends, if then. I treasure any pictures of us that were taken as we were growing up because they shine a light onto memories full of shadows. Without their validity and light—solid evidence surrounded by a solid frame—all is vague and mutable. So I will attempt to reconstruct a few memories of Jessie from images in my mind’s eye that I have carried with me all these years.

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