Problems With Forced
Psych Drug Treatment
First in a Three-Part Series Looking at This Issue

Commentary
By Nicholas Regush

ABCNEWS.com

Protests are planned by a patient coalition for the end of this month in California to condemn legislation that would allow easier forced psychiatric drug treatments, an insidious practice based on scientific misinterpretation and violation of civil liberties.

Move to National Policy
Unfortunately, this health policy has already gone national. Most states have laws on the books that enable health authorities to ensure that the mentally ill take their medications — drugs like Thorazine, Clozapine, and Haldol that will hopefully keep them free from the major features of severe mental illness, including disorientation and hallucination.
     As most prescription drugs do, these “neuroleptics” also cause side effects. Studies at the medical schools of Harvard and McGill University in Montreal, Canada, have shown that these medications can damage the brain, with some causing involuntary movements in patients who take them.
     More than 1 million of those who are mentally ill, including perhaps more than 100,000 homeless people, may eventually be subject to forced drugging, should this health policy continue to spread across the country.
     The proposed California legislation would pave yet another road to “community-assisted treatment.” This is one of those phrases that might suggest a gentle helpfulness. Well, forget that — we’re dealing here with a hard-boiled health policy that rules by court order and allows the chemistry crusaders to enter homes to demand compliance with drug regimens. The right to step out of hospital confinement and remain in the community is the trade-off for anti-psychotic treatment.

Advocates: Treatment Helps
Those groups supporting forced treatment deemed necessary by health authorities includes the Treatment Advocacy Center and the National Alliance for the Mentally Ill. One of the usual arguments is that there are many tens of thousands of mentally ill people who do not know they are sick. They therefore must be helped. If they are not, then many of these people will commit violent acts, including murder. So therefore forced drug treatment is not only good for the patient but also for society.
If anything, it is likely this call to fear has stoked public support of forced drugging.
Those opposed to “community-assisted treatment” and efforts in the works to make it even more draconian claim the scientific evidence offered up in support of quelling significant amounts of violence through forced drugging requires a vivid imagination. I agree. I’ve looked at the available science and I am mystified by some of the interpretation that has become the spine of this adventurism in the name of compassion and concern for public safety.

Unknown if Drugs Stop Violence
First, studies do show that some groups of psychiatric patients released into the community have a greater risk of committing violence. Other groups of patients do not. And here’s the additional rub: there is no appropriate follow-up study that has determined whether the absence of treatment leads to violence. The very foundation of forced treatment is ideology and not science.
Since this is the Internet, let me issue a challenge. Anyone advocating forced drug treatment who has credible scientific evidence that it will reduce violence should send me the references to the supporting science. We’ll post your positions and I’ll respond. Let’s get this issue into the open for debate. Let’s see what these policies really hinge on.
Next week, we’ll examine other claims made by the advocates of forced drug treatment.

Let's Drug the Obese
Second in a Three-Part Series
Looking at Forced Drug Treatment

Commentary
By Nicholas Regush

ABCNEWS.com

I have a compassionate idea. Maybe even a great idea. Why don’t we pass legislation to involuntarily commit severely obese people to enforced drug therapy in the community? This might help them shed those many extra pounds.
     And while we’re in the judicial mode, why don’t we pass laws that will scoop up three-pack-a-day smokers from the streets and get them on medication?
     In fact, forced drug treatment could be used on all sorts of disabled people who show a lack of intention to get themselves on the road to health.
     And if those beneficiaries of our largesse do not turn up at clinics to get their drugs, then we could send medical treatment squads into their homes.
     This would not only be a kindly move, but let’s face it, all those people who are ill and don’t want to do something about it are costing the health care system a huge wad of money. This is not good for society.
     Compliance with medical authority is everything! Non-compliance must be stopped!

Culture of Drug Therapy
Am I serious? No, I’m not. But I’m concerned that we’re creating a culture that will continue to spawn medical ideology that sees forced drug therapy as some kind of a moral duty.
     Medical authorities are already applying this type of spin in psychiatric treatment.
     Last week, I questioned the insidious and highly promoted notion that lack of treatment of psychiatric patients in the community leads to more violence. I repeat: there is no evidence for this mangled interpretation of the available data.
     Anyone who touts this violence nonsense grossly misunderstands how drug therapy of any kind must be viewed in the context of a total health-care approach. In psychiatry, it means understanding drug therapy in relation to community-based services. Unfortunately, the lack of sustained community treatment services in most parts of this country throws the care of psychiatric patients badly out of whack.

Need for Community Services
Such services were never provided in the first place when droves of patients began leaving psychiatric state hospitals several decades ago to live as outpatients. Too much emphasis was placed then (as is the case now) on the power of drugs to set things right for these patients. Instead of bolstering community support systems, the judicial system has become more actively engaged in forcing therapy.
     And whenever there is a system change in medicine as audacious as the move to managed care, one can expect disruptions not only in doctor-patient relationships, but in access to services.
     Those who advocate forced treatment are the desperados of modern medicine. They can no longer see human behavior in context. They have sold out to the “magic bullet” society, in which drugs have become the proclaimed cure-all for almost everything.
     This is not to say that drugs can’t help certain individuals. They most certainly do. But often that help must be provided with a medical system that cares for a wide spectrum of human needs.
     But frankly, I might as well be screaming at the wind. My take on the drug enforcement trend in psychiatry is that it reflects an authoritarian trend that is stinking up a lot of medicine. Some of my previous columns, for example, have focused on forced treatment of children with HIV and improper use of anti-depression drugs in children. The outlandish use of Ritalin to quell what often is normal childhood energy in the classroom is yet another example of the quick fix mentality that is becoming more the norm.
     While I would never advocate that the severely obese and the three-pack-a-day smokers be placed on forced drug regimens, it wouldn’t surprise me in the least that we’ll see the day come when this will be strongly advocated and even widely applied. I’m not kidding about this.
     Next week, the most pernicious aspect of forced drug advocacy.

Infectious Mental Illness?
Last in a Three-Part Series
Looking at Forced Drug Treatment

Commentary
By Nicholas Regush

ABCNEWS.com

It troubles me when medical scientists seem to lose the ability to separate evidence from ideology. I detect an unfortunate overall trend in this direction, as regular readers of this column have probably noticed.
The ideology trend is particularly evident in ongoing campaigns to legally force psychiatric patients in the community to take medication. In the first part of this series, I underscored the lack of scientific evidence behind the claim that non-medicated patients are more prone to violence than those who are medicated.
Last week, I concluded that any drug treatment must be provided in the context of greatly enhanced community services. Psychiatry patients suffer from lack of appropriate support. Many have been dumped out of hospitals to fend for themselves. Efforts to pump them full of drugs are hardly the answer.

Belief Not Science
In researching this highly complex medical territory, I found myself wondering how seemingly well-intentioned people get off on the wrong track. I suspect it may come about when powerful personal beliefs color the available scientific data.
     Take a strong case in point — the position of psychiatrist E. Fuller Torrey, director of the Stanley Research Foundation, in Bethesda, Md. He has strongly supported legislation allowing courts to enforce the medication of patients in the community.
     Presumably he has the interests of patients in mind when he argues that lack of compliance with drugs may harm them. Groups fighting forced medication have targeted Torrey as someone who is trampling on freedom of choice and have portrayed him as a drug-company influenced peddler of potions.
     I’m not going to get into the debate about whether he is a “drug peddler” — at least, for now. I would rather focus some badly needed attention on a recent editorial co-authored by Torrey in the American Psychiatric Association journal, Psychiatric Services . It’s here that a more scientific argument for medication enforcement breaks down and becomes bare-naked propaganda.

Is Mental Illness Like Tuberculosis?
In this editorial, Torrey asks whether psychiatry can learn from tuberculosis treatment. His point essentially in this piece is that many people with TB have been forced to take medications in order to help them help themselves and to prevent spreading of disease.
     He’s driving at the fact here that psychiatric patients need to be persuaded strongly to help themselves as well. But Torrey is throwing more fuel on the fire of debate by indelicately mentioning an infectious disease in the same breath as one for which there is no such evidence.
     Does he really believe that noncompliance issues are similar in TB and mental illness? Does he think that TB infection is somehow akin to a mental illness “infection?”
     The intriguing fact is that Torrey does actually believe strongly that mental illness might indeed have a viral trigger. He has often speculated about this and is currently involved in research that is examining the possibility that certain genetic sequences in our cells (sometimes considered to be remnants of ancient infections) might be activated by a virus to cause damage to brain cells.
     I want you to know that I’ve remarked on some of this preliminary research in my new book, The Virus Within. I did so because Torrey’s scientific work with a research unit at Johns Hopkins University School of Medicine in Baltimore is worthy of our consideration.
     Too bad he leaves the confines of responsible science and walks across the bridge to an ill-conceived advocacy.
     This entire issue of the enforced drugging of psychiatric patients deserves enormous media attention because it has gotten well out of hand.

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