Story of antipsychotics is one of myth and misrepresentation

Bipolar isn’t psychotic. Jacobnmartinez

Antipsychotic drugs are usually considered to be one of the 20th century’s major medical breakthroughs. They are often believed to be so effective that they brought about the closure of the old mental asylums and enabled the mentally ill to return to the community.

But newer antipsychotics, such as Zyprexa and Seroquel, are no longer just used to treat severe mental disturbance but have broken into the mainstream to become some of the most profitable drugs in history.

They now rival statins (used to lower cholesterol) and antidepressants in terms of the revenue they bring in. And in England, their use has increased by two thirds over the last few years. The most lucrative market is for treating the newly fashionable diagnosis of bipolar disorder.

But far from normalising these drugs, we should be worried about their increasing use. While antipsychotics can be useful for those who are severely psychotic, these dangerous drugs should be considered with a heavy dose of caution.

Bizarre practices

The first drug considered to be an antipsychotic was chlorpromazine, also known as Largactil or Thorazine, which was introduced into psychiatry in the early 1950s.

Even from these early days, almost nothing about the story of antipsychotics is as told.

Henri Laborit in 1991. Erling Mandelmann

Henri Laborit, the French surgeon proclaimed as a hero for introducing it to psychiatrist colleagues, was using it in a highly dangerous procedure he devised called “artificial hibernation” or “sedation without narcosis”. But the procedure killed off most of the dogs it was demonstrated on during Laborit’s tour of the US.

Psychiatrists who used chlorpromazine and other antipsychotics in the early days regarded them as special sorts of sedatives and documented the reduced responsiveness and reactions which were part of the artificial state they produced. They suggested the drugs worked by inducing an inhibition of the nervous system and that they reduced psychotic preoccupations by slowing thought processes and flattening emotions.

People (both with mental illness and volunteers) who’ve taken antipsychotics also report a state of physical, mental and emotional suppression. Those suffering from mental disorders describe how the drugs can help to diminish disturbing thoughts and experiences, but at the cost of stifling important aspects of their personality such as initiative, motivation, creativity and sexual drive.

As Richard Bentall, an expert on psychosis and a volunteer into a study of Droperidol, described it:

For the first hour I didn’t feel too bad. I thought maybe this is okay. I can get away with this. I felt a bit light-headed … [After being asked to fill in a form] I couldn’t have filled it in to save my life. It would have been easier to climb Mt Everest … It was accompanied by a feeling that I couldn’t do anything, which is really distressing. I felt profoundly depressed. They tried to persuade me to do these cognitive tests on the computer and I just started crying.

Antipsychotics gained a reputation as “chemical straight-jackets” and they are still used for the control of disturbed and aggressive behaviour in mental health units - and as animal tranquilisers in veterinary medicine.

Antipsychotics: the chemical version of a straight-jacket? Mark NL

Side effects

There’s been much debate more recently about the value of antipsychotic treatment but there’s reasonable evidence that they can reduce the symptoms of an acute psychotic episode in the short-term. It’s more difficult to judge their longer term benefits.

On the one hand, the drugs may suppress mental processes in people locked into a persistent psychotic state just enough to enable them to regain a foothold in reality. But for some, the benefits may not outweigh the considerable mental and physical impairments the drugs can produce: neurological damage, diabetes, heart disease, impotence and brain shrinkage.

Serious effects have been obscured because the frank descriptions provided by early clinicians were replaced by a vision of the drugs as a cleverly targeted, sophisticated and essentially benign treatment. And despite no convincing evidence to support the theory, the view emerged that they work by reversing an underlying “chemical imbalance” or other such abnormality rather than by inducing an abnormal or altered state.

This idea has enormous appeal for psychiatrists, politicians, consumers and the pharmaceutical industry. The belief that they reverse a chemical imbalance has been particularly useful in distracting attention from the serious harm they can do.

It has also enabled antipsychotics to be marketed to a wider segment of the population and fostered a movement that antipsychotics should be started as early as possible, without waiting for a definite diagnosis. Even more worrying, there has been a trend to prescribe them as a preventative measure in young people who are not psychotic but might be “at risk”.

The bipolar market

The popularity of antipsychotics has occurred partly through the transformation of the concept of bipolar disorder over recent years. Once considered rare, episodic and seriously disabling, bipolar disorder has expanded - under pharmaceutical industry influence - into the vague notion of “mood swings” that can apply to almost anyone.

Although drugs such as antipsychotics have only been properly tested in people with classical bipolar (previously known as manic depression) and have never been shown to be useful for everyday variations in mood, people who might previously have been characterised as “depressed” may now be encouraged to view themselves as bipolar. In this way antipsychotics can corner some of the vast antidepressant drug market.

The way antipsychotics have been misrepresented, their benefits inflated, their dangers minimised, illustrates how what is presented as neutral and objective “science” may in fact conceal a whole array of political and commercial interests. The psychiatric profession wanted to present a new image to society and politicians wished to replace costly mental institutions with cheaper community care.

All of this has helped transform antipsychotic drugs from dreaded chemical straight-jackets to modern-day soothers, lining the coffers of the pharmaceutical industry along the way. It’s time we woke up.