American Madness

Intelligent Criticism in the Service of a Better Nation

Leaving the Snake Pit:
Have we gone too far in mainstreaming wackos?

Posted by Joel Friedlander | 2 Comments

the snake pitShould we bring back the asylums of yesteryear?

Is the promise of modern medication exceeding its actual effectiveness?

These are questions that come to mind having read yesterday’s Freakonomics Quorum post by Stephen Dubner.

The column, How Much Progress Have Psychology and Psychiatry Really Made? is definitely worth reading in its entirety.

There is one section I would like to discuss and that has to do with a woman whose son was bipolar and who committed suicide when he stopped taking his medications. The writer says:

“Four years ago I lost a beloved son to suicide due to bipolar disorder. As devastating as this is, I do believe that the treatment he received increased his quality of life and chances for survival. His doctors and therapists were compassionate and concerned, working very hard to assess and adjust his treatments, and I came to respect the complexity of his condition and what they were trying to do on his behalf.

Is it possible he was in some ways a guinea pig in terms of the various medications he took? Perhaps, but I believe they were our only hope of giving him a chance in light of the seriousness of his condition and his previous suicide attempt. When he did complete suicide, we discovered that he had stopped taking his medications, so I don’t blame the medications, but the lack of them.”

Now as horrible as it may seem, I feel compelled to take issue with this lady. The problem which caused her son’s suicide was the fact that he stopped taking his medication. We have recently had a spate of mass murders in America committed by psychiatrically disturbed individuals who were mainstreamed in society because they were on medication. The problem that resulted in the killings has often been that the patient stopped taking the medication.

Now there is no question that these medications can work, but the conundrum is that while they often work, the very use of them changes the chemical structure of the brain and after a while they don’t work. Or, after a while the illness takes hold of the patient again and they refuse to take their medicine.

How many times do we have to hear of some poor innocent soul who is pushed off a subway platform in front of a moving train, or who is stabbed to death by some psycho who has stopped taking his medication? Is it more important that these people get a chance to live normal lives, posing a severe risk to the rest of society, or is the safety of society in general more important to protect.

I personally have had several clients and colleagues who suffered from schizophrenia, depression, and bipolar disorders. The bipolar individual had a mild case and continues to practice law, unnoticed among the many lunatics who practice my profession. The depressed individual went to another profession for a time and then came back to the law and is quite well on Prozac. The schizophrenic patient would get along very well and then one day his medication wouldn’t be quite right and he would attack someone. Nice fellow, but don’t have dinner with him unless there’s no silverware nearby.

My point is that the chemical conditions of the brain which cause these diseases are not constant; they alter over time and the brain chemistry of the patient changes. Unfortunately we are not yet at a place where we can constantly monitor the chemistry of the patient’s brain so as to customize the medication to the patient’s ever changing chemical and mental condition. For this reason, such people are a risk to the health and well being of others and it may be prudent to limit their interactions in society.

I’m not saying that we need to reopen all the asylums that existed in the past, but we seem to have gone too far in the opposite direction.


2 Responses to “Leaving the Snake Pit:
Have we gone too far in mainstreaming wackos?”

  1. Matt Friedlander
    April 9th, 2008 @

    Yes, reopen those booby hatches that made being crazy a lifetime career option. =P

  2. Eric Hazard
    April 9th, 2008 @

    This may tilt the world on its axis, but I agree with you on this post. Much like yourself, I’m not sure what the solution may be. I would only offer that the dispensers of drugs better monitor their prescription treatment. Rather than use medication as a solution to the problem, more must be done at the treatment level, ex medication, to offer solutions to people who suffer from mental illness. But as you say, what level of treatment is appropriate? Definitely a question that deserves greater scrutiny in today’s world. Thanks for bringing this to our attention.

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