Great essay. Aside from the anti psychiatry bias in the press (which is in the paradoxical place of selling “mental health crisis” and “don’t trust psychiatry” at the same time) I think it’s important to have this story told often. Clozapine can be a terrible drug to take and it is also a miracle. Those of us who have seen it in clinic all have stories of people who essentially reemerged after being buried alive by their symptoms. I can think of three patients who I’ve never forgotten about.
The stigma of illness lurks behind the press coverage too. Because most people, journalist included, avoid spending time with severely mentally ill, it’s hard for non clinicians or non family members to appreciate just how sick and disordered the illness makes a person and how dramatic the change is when someone responds to clozapine. And your essay makes that point that the deaths we don’t see are more often those who die from under and untreated illness.
In the US the phrase was “dying with their rights on” as we grapple with the actual consequences of deinstitionization here.
Completely agree - clinicians and people with personal experience of severe mental illness have a totally different perspective from the mainstream discourse on this subject.
Clozapine isn't an easy medication to take, but I've also seen it bring stability to people with otherwise intractable schizophrenia.
It is astounding that Thioridazine has not been "rehabilitated" since its voluntary removal from the psychiatric pharmacopoeia since 2005, considering it's much less debilitating side effects than most first and second generation neuroleptics, as well as greater tolerability and more easily monitored serious adverse effects than Clozapine… As there are no easily locatable published RTC data comparing Thioridazine (production suspended 2005) and Olanzapine (launched 1995), it is tempting to consider the possibility that Thioridazine had better outcomes than the newer drug and was supressed for that reason… However, no one would imagine a conspiracy emerging from the pharmaceutical industry, would they?
Also grateful for a common sense and holistic approach to severe mental illness where everything that works is tested properly without prejudice. Every tool is a potential lifesaver and good cost/benefit analysis is essential. It’s also empowering for sufferers to have more options available.
Your logic is: patients might die, therefore we are justified in killing them.
You say you cannot see the people who would die without it, but you claim with zero evidence that they outnumber the people who would die from it.
That 1988 study blocked patient's dopamine for six weeks, then stopped blocking their dopamine, and they improved.
This is not only illogical, unscientific, and in clear violation of your Hippocratic oath; it's murderous.
In fact, someone should lock you up because by advocating for a deadly drug, you are admitting to being a danger to others.
It's worth noting that psychiatrists commit suicide at three times the rate of the general population. So you're arguably a danger to yourself as well.
Excellent article. My son needs clozapine akin to a diabetic needing insulin. We really need to get rid of the stigma. SMI lives matter.
Great essay. Aside from the anti psychiatry bias in the press (which is in the paradoxical place of selling “mental health crisis” and “don’t trust psychiatry” at the same time) I think it’s important to have this story told often. Clozapine can be a terrible drug to take and it is also a miracle. Those of us who have seen it in clinic all have stories of people who essentially reemerged after being buried alive by their symptoms. I can think of three patients who I’ve never forgotten about.
The stigma of illness lurks behind the press coverage too. Because most people, journalist included, avoid spending time with severely mentally ill, it’s hard for non clinicians or non family members to appreciate just how sick and disordered the illness makes a person and how dramatic the change is when someone responds to clozapine. And your essay makes that point that the deaths we don’t see are more often those who die from under and untreated illness.
In the US the phrase was “dying with their rights on” as we grapple with the actual consequences of deinstitionization here.
Completely agree - clinicians and people with personal experience of severe mental illness have a totally different perspective from the mainstream discourse on this subject.
Clozapine isn't an easy medication to take, but I've also seen it bring stability to people with otherwise intractable schizophrenia.
It is astounding that Thioridazine has not been "rehabilitated" since its voluntary removal from the psychiatric pharmacopoeia since 2005, considering it's much less debilitating side effects than most first and second generation neuroleptics, as well as greater tolerability and more easily monitored serious adverse effects than Clozapine… As there are no easily locatable published RTC data comparing Thioridazine (production suspended 2005) and Olanzapine (launched 1995), it is tempting to consider the possibility that Thioridazine had better outcomes than the newer drug and was supressed for that reason… However, no one would imagine a conspiracy emerging from the pharmaceutical industry, would they?
I wasn't aware of this - thanks for sharing!
Also grateful for a common sense and holistic approach to severe mental illness where everything that works is tested properly without prejudice. Every tool is a potential lifesaver and good cost/benefit analysis is essential. It’s also empowering for sufferers to have more options available.
Great summary of the history--puts things into proper perspective. Thanks.
Your logic is: patients might die, therefore we are justified in killing them.
You say you cannot see the people who would die without it, but you claim with zero evidence that they outnumber the people who would die from it.
That 1988 study blocked patient's dopamine for six weeks, then stopped blocking their dopamine, and they improved.
This is not only illogical, unscientific, and in clear violation of your Hippocratic oath; it's murderous.
In fact, someone should lock you up because by advocating for a deadly drug, you are admitting to being a danger to others.
It's worth noting that psychiatrists commit suicide at three times the rate of the general population. So you're arguably a danger to yourself as well.
🌞