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Comment by troym | Hacker News Reader

> So the solution is to provide drugs that somehow deaden random neurons in somewhat random parts of the brain, and hope they don't cause massive side effects down the line?

The author didn't share a diagnosis, nor did he or she share the specific medication(s) that helped. Given that, how can you conclude that the drugs "deadened neurons"?

I share your skepticism of modern psychiatric medicine, and yet I think you might be missing some understanding and/or empathy for the patient. He or she is describing schizophrenia and major depressive disorder [1], and while often found together, either one can be utterly debilitating. It would not surprise me if the patient had the same concerns as you and I, but was so desperate, so hopeless that they were willing to take the risk.

[1] not a doctor, therapist, counselor or anything close

[edited to fix footnote]

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I am a physician. The few studies comparing long term antipsychotic use in schizophrenia have found that people do better with low/no medication. They are more functional, have fewer relapses and better quality of life. This is still a controversial view in psychiatry but the tide may be turning. Thomas Insel, the head of the NIMH, has stated

"antipsychotic medication, which seemed so important in the early phase of psychosis, appeared to worsen prospects for recovery over the long-term" in reference to these studies.

This is a nice overview. https://www.ncbi.nlm.nih.gov/pubmed/23512950

> The author didn't share a diagnosis, nor did he or she share the specific medication(s) that helped. Given that, how can you conclude that the drugs "deadened neurons"?

You mistake me for talking about the author. I was making commentary about the broad umbrella of psychiatric medicines.

Both I and my wife have taken those drugs, and the feeling in my body was that they deadened a part of ourselves. In my wife's words, "I still wanted to kill my self, but didnt have the will to do it." That's the deadening; feelings were 'grayer', tastes were bland, colors were muted.

> It would not surprise me if the patient had the same concerns as you and I, but was so desperate, so hopeless that they were willing to take the risk.

And I'm perfectly OK with someone with informed consent taking substances. And I consider making use of wikipedia and Erowid as part of that consent, as well as doctors in your stead. I'm also not OK with doctors covering up, glossing over, or blatantly lying about problems that can arise. And from what I've seen, the psychoactive drugs can cause all sorts of side effects, some short lived; others permanent.

My wife and I have had this discussion; Under what conditions would it be OK to forcefully administer psychiatric medicines? Our discussions seem to show no good way to handle this, as it goes from the men in lab coats prior to the 60s, to the abuse of patients ending in the 80s, to simple imprisonment now.

> My wife and I have had this discussion; Under what conditions would it be OK to forcefully administer psychiatric medicines?

That's a significant interference with a person's human rights, so it should be done as a measure of last resort, after all other options have been tried, and with a bunch of checks and measures built in. The person should pose an immediate risk of significant harm to themselves or to other people, and the person should lack capacity to make the choice. The people making the choice should be senior, experienced, and well trained.

And after it's happened there should be some kind of case review to see if it can be avoided in future.

For example, if the person became distressed to the point they are rapidly tranquilised the case review would look at behaviours of other people that created the distress.

There are other things they can do to help compliance with treatment, like doctor-administered injections instead of pills. The thing is that even when people agree to treatment, they might forget their medicine and then be off in a psychotic episode and too detached from reality to take it.

I know this entirely too well because my mother was violently murdered by someone off their meds and the doctors managed to decide that nobody was at risk in spite of her telling them she feared for her life.

So I'd be more inclined to say that doctors have good reason to make sure people stay on their meds and to change treatments to ones where compliance can be better enforced whenever necessary.

In so not to edit posts and context, our talks were about the current shoveling of the mentally ill in the prison system instead of treatment.

There was a recent reddit article in /r/news that talked about a Hawaiian prison that screaming, throwing feces, and other illness had taken over as the makeup of the prison. In general, we have collectively decided that there will be no/little support for the mentally ill, and that the jails and prisons will be the tool to stop them.

With the side effects as they are, how ethical is it to imprison them? They are ill, and we do not generally charge people if a legitimate illness causes a crime (no mens rea). And with the side effects, how ethical is it to force (by court) the drugs that 'cure' them?

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