Pete Earley

FROM MY FILES FRIDAY: A year ago, I published this letter from a young woman dealing with her’s father’s mental illness and her own. I hope you find it as compelling as I did and still do.

Hi Pete Earley,

…I came across your book while looking for a source of comfort during my own family’s time of need. Two months ago, my dad was finally forced into treatment for his undiagnosed severe bipolar disorder and coexisting extreme alcoholism. My mother and I (I am an only child) have been trying unsuccessfully for years to get him help.

In order for him to finally be involuntary subjected to treatment, he had to have a major traumatic psychotic episode and had to contact Help 4 Addiction for his alcohol rehabilitation. He had a previous psychotic episode earlier this year that landed him in a mental health facility for one week. But the latest one proved even more traumatic to all of us.

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Dr. Tom Insel is stirring the pot again!

You might recall that the director of the National Institute of Mental Health upset many in psychiatry when he dismissed the DSM-5, the so-called Psychiatry Bible, in an April 29th blog  just weeks before the new edition was scheduled to be published. (In addition to his original blog, you might wish to read the New Yorker’s take on Insel’s words.)

Now Dr. Insel has published a blog that questions the long term value of anti-psychotics.  For those of us whose family members have been helped by medication, his comments are troubling.  Each time my son has stopped taking his medication, his symptoms have returned and he’s gotten into trouble. I’ve always known there may be adverse side effects. We have discussed them. The question that Dr. Insel didn’t answer is how are we to know beforehand when and if someone can reduce or stop taking their medication?

My friend, Dr. Dinah Miller, one of the author’s of the popular blog, Shrink Rap, raised this question when she reacted to Dr. Insel’s blog.

So perhaps you’ve heard that people with certain mental disorders need to stay on their medications forever.  Certainly, some do — they stop their medicines and each time they try that experiment they end up sick — in the hospital, in jail, on the street, or simply festering in the basement.  But some people stop their medicines and they don’t get sick, so clearly, not everyone with a given diagnosis must stay on medicines for life, but we don’t have a way of knowing who needs them and who doesn’t.  We know risks for populations (maybe, to read Dr. Insel’s blog, we don’t know them as well as we thought), yet we know nothing about a given individual until a doc stops the meds or the patient goes off them on their own.  We also know that the medicines have risks.  How much risk?  Who knows.  Here, one figure sticks: of those who remain on an older generation antipsychotic (Haldol, thorazine, prolixin) for 25 years, 68% will get tardive dyskinesia.  And that figure doesn’t say anything about dose.

Because medication is such a controversial issue, I’m not going to interpret what Dr. Insel wrote. Instead, you should read it for yourself.

Anti-psychotics: Taking the Long View

By Thomas Insel on August 28, 2013

 I turned sixty-two last Thursday and my wife, Patti, hosted a family party on Sunday.  When you have a blended family of seven, there’s always someone having a birthday but this one was different for me. I can’t say that I am going through a mid-life crisis because I already have done that, several times.  I am now old enough to collect Social Security so I have to acknowledge that I have walked over the  middle age line .

The first week of September is always a time of taking stock for me. Patti’s first husband, Steve, died on September 2^nd  when he and Patti were in their thirties. Her sister, Joanne, died recently from cancer and would have celebrated her 50^th birthday on Sept. 4^th. Whenever I complain about getting older, Patti reminds me that Steve and Joanne didn’t celebrate as many birthdays as I have.  Patti has no patience for self-pity.

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FROM MY FILES FRIDAY:  When Edward Snowden sought asylum in Russia after leaking National Security Agency documents to the media, I began getting telephone calls. Reporters wanted to know if I thought the Kremlin would welcome Snowden or turn him over to American authorities. I predicted Moscow would protect him.  If  Russia would have refused him asylum, spies currently working for Russia would have become alarmed — even though Snowden never worked for Russian intelligence. The following blog describes how important image and reputations are in the spy game, so much so, that the Russians tried to interest me in helping deliver $2 million to CIA traitor Aldrich Ames several months after he was arrested.

A Spy Story: Ames, Blood Money and Me,  published Nov. 15, 2010

If you’ve read my book, Confessions of a Spy: The Real Story of Aldrich Ames, you already know that I was able to interview the CIA traitor, Aldrich Ames, for eleven  days without government censors listening to our conversations.    This is because federal  prosecutors had notified everyone – Ames’ defense attorneys, the FBI, the CIA, and Justice Department – that Ames was not to be interviewed by the media, except for the officials who mattered the most — the deputies in charge of the Alexandria  jail.

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How do other countries handle civil commitments to mental hospitals?

Forcing someone into treatment against his/her wishes is not only controversial in our country, but in others too.  In the U.S., each state establishes its own specific criteria, but all states require someone to be a danger to themselves or others before he/she can be forced into a hospital. [Several have adopted looser language, such as  “gravely disabled” or “unable to care for self” to their criteria, but dangerousness  remains the key criteria.]

I was surprised recently when I discovered that our focus on dangerousness  is out-of-step with the rest of the world. Most other countries rely on what is called a  “need for treatment” standard.

Only one nation has more stringent rules than we do. That country is Germany and, I assume, the reason it has established so many hurdles in its civil commitment process is because of abuses in its NAZI era past.

Our checkered past also is at the root of why we adopted “dangerous” behavior as our threshold.  Before the 1970s, it was much to easy to force someone into a mental hospital and commitments were often de facto life sentences.

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