Psychiatry has undergone a radical transformation since the rollout of antipsychotic drugs in the 1950s. The introduction of atypical antipsychotics during this time ushered in a new era of treating patients with psychosis and depression. Prior to this there were typical antipsychotic drugs that had more reported side effects. This aspect of the drug industry changed with drugs like olanzapine and risperidone which have been doled out to this date in most psychiatric wards. There is a vast body of internet literature that documents the history of antipsychotic drugs and their usage by patients suffering from mental illnesses. But do these drugs do more harm than good?
Scholars like Joanna Moncrieff have criticised the processes and problems of treatment in major wards across the world. To her antipsychotics need to be avoided as they atrophy the brain and cause more abnormalities. She stresses the need of therapy in the treatment of psychiatric disorders, doing away with conventional ways of controlling and even reducing the chemical neurotransmitter called dopamine that is believed to be linked to diseases like psychosis. Moncrieff’s work examines and analyses the ways in which psychiatry is influenced by political factors. She has also used a Marxist lens to interpret data and has come to conclusions about the nature of the drug industry in general.
In my research I have found out that the atypical antipsychotics are actually good medicines. According to Dr Kumar, a prominent psychiatrist in Bangalore, India, they balance levels of dopamine available to the brain, thereby reducing symptoms and providing peacefulness and calmness to the mind. Dr Kumar has treated hundreds of patients and has underscored that these drugs have the capacity to give a full recovery to them. It is anyone’s guess why Moncrieff et al. have concluded that they do not work as they should, as Dr Kumar has suggested that the atypicals do wonders for most patients. Moncrieff’s premise may be that the side effects outweigh the benefits.
It is true that the atypicals do possess side effects such as making patients tired, causing apathy, asociality, anhedonia and avolition. Many patients have described the effects in terms of how they are unable to get up in the morning as the meds make them drowsy and lethargic. While sleepiness and sedation make them weak and unable to do simple tasks like bathing oneself or doing household chores, the paradox remains that they do wonders at removing hallucinations and delusions. The context is such that one is damned if you do and damned if you do not. Patients who cannot handle the side effects may choose to wean off the drugs by themselves without careful consideration. This is dangerous as there are chances of the symptoms returning or a relapse.
People who have recovered from mental illness have said one has to fight till the end until the medicine is literally in one’s blood. Those to whom I spoke attributed their schizophrenia to recreational drugs consumed in the past. While one’s environment does play a role in shaping mental health, the truth is that many patients who suffer from both visual and aural hallucinations and delusions have a history of recreational drug use. Theirs is a world where they are trying to let go of the past while being affected by it, what the Hindus cite as reaping the effects of one’s bad karma. In the ward where I was researching I heard young boys who said that smoking weed was “normal” while other drugs were dangerous. The normalcy attributed to weed is a cultural phenomenon that has takers like Shashi Tharoor who have campaigned for its legalisation.
To me any drug that makes one hallucinate should be banned. Psychosis is not a fun disease to suffer from nor does anyone want it. Young people who indulge in recreational drugs need to understand their future. The patients I saw could not handle the atypicals themselves (given the side effects) and one needs to think about this when one is contemplating on recreational drug use. The normalcy attached to it is evident in Aatish Taseer’s article on how he had done MDMA with a member of the royal family in Windsor Castle. If we let recreational drugs become normal, we need to think twice about what it means to spend months in a psychiatric ward. Not only did I witness zombies who were walking around with nothing to do but I also saw that despite the side effects, the miracle of antipsychotics was true. Patients said they were calmer and more peaceful, their hallucinations and delusions had disappeared and their memory was functioning properly.
Yes, some said they were suffering from flashbacks. They said memories of how they behaved when they were in a psychotic state were coming back to them. They could not bear those thoughts as their dopamine levels were being reduced. But all of these memories of the past were going slowly, they added. It is said that antipsychotic drugs take time to work fully and one should never give them up suddenly. They have to run their own course. I saw a patient who told me he suffered from a relapse because he had stopped them without asking his shrink. One must always remember: stay on the medicine until the doctor tells you to stop.
Atypical antipsychotics have solved many mental diseases for many patients. As said earlier, they have the capacity to make a patient fully recover. In India, like the rest of the world, they are being used in many psychiatric wards. Their efficacy lies in controlling dopamine in the brain. While there are unwanted side effects which make them hated by some, patients who follow doctors’ orders are bound to heal some day. The number of people who are entering psychiatric wards is increasing day by day and those who used recreational drugs in the past need to understand that they do more harm than good – not the atypical antipsychotics which do more good than harm and reverse their negative effects.
