Phony diagnoses hide high rates of drugging at nursing homes | Hacker News Reader

Phony diagnoses hide high rates of drugging at nursing homes

nytimes.com

396 pointswoodruffw318 comments

Phony Diagnoses not just at nursing homes, also in mental facilities. Was really surprised (better word-traumatized) that one flippant casual mention of not valuing my life in a private text message was enough to to get me detained by police in a facility for a night. "Doctor" threatened me with drugging just because I refused to answer some of their questions and instead insisted on a lawyer. Funny how freedoms can be taken away so dubiously even when not charged of a crime nor arrested in a system that exists outside the criminal system. I'm surprised and not surprised similar behavior happens in nursing homes.

Look at all the recent brittney spears stuff. An insane legal world out there noone knows anything about. I never would have guessed a situation like that would be possible and for so long.

Suicide is offensive to society and many individuals on a deep level, especially of people who do not have a "good reason" (such as a terminal illness). While it may have progressed beyond being a criminal act, it is still taboo enough for alternative and equally good avenues to exist for society to deal with it, in this case, police and physicians empowered by law with the "duty of care" concept. This is of course better than suicidal intentions being dealt with as criminal, but not as good (in my opinion) as it being dealt with as something that someone has a right to do and therefore cannot have force used against them, but perhaps should be dissuaded from, maybe similarly to abortion.

Step 1) fabricate an SMS

Step 2) call police

Step 3) enjoy

Wow so easy to take down your political enemies huh

I think you're joking, but this is actually so true that you might be committing a crime by suggesting it.

> this is actually so true that you might be committing a crime by suggesting it

Perhaps where you live. The legal system I live under has strong protections for freedom of speech that ensure that such a statement cannot be criminalized.

This statement is legal in the USA.

In Soviet Russia, government officials would remove someone, and then claim suicide. In America, they first claim suicide (risk), then remove them.

Soviet Russia also did use phony psychiatry to get rid of opponents.

Political abuse of psychiatry in Soviet Union has its own Wikipedia page.

There is a big difference between murdering someone and detaining someone for a day if a trained professional believes there is a high risk of suicide.

trained professional my ass. I have a disability, and I tell you what: Even the people "specialized" in certain disabilities usually have no idea what the fuck they are talking about. But they get good pay and are being treated like specialists by those which have even less of an idea... Outsiders usually have absolutely no idea whats going on.

Believing unaccountable decisions placed in the hands of powerful doctors without recourse results in a professional suicide assessment is not what actually happens. You may be detained for no reason and have no recourse. They may pump drugs into you.

Not only that, you may permanently lose some civil rights and privileges, such as the right to own a firearm or pilot a commercial flight.

Scary.

Any ideas of how to fix it?

Come up with a reasonable objective bar to pass before subjecting someone to confinement and medical treatment against their will. Right now police are all too willing to basically arrest someone off of some nebulous accusation. It should be treated no different than the standard of proof for an arrest and should face the same repercussions if done wrongly, both for police and an accuser.

Make it contingent on prompt medical evaluation. The current timeframes for involuntary commitment in certain states can leave people confined on a Friday afternoon and waiting to be evaluated until Monday morning. If it's urgent enough for involuntary confinement it's urgent enough to have a medical professional oncall for prompt evaluation.

The medical necessity of all involuntary medical treatment should have to be substantiated in front of a judge, even if the patient is released before statutory deadlines would have required a judge to approve continued involuntary commitment. The medical facility should have to explain their actions e.g. "On Feb 12th at 5:12AM patient started scratching the skin off of their left arm (Exhibit A) which necessitated the administration of 10 mg of Midazolam intramuscularly". Any medication should also be limited to the shortest duration feasible until a court order is issued, no depot injections of Haldol that will last a month.

No financial liability for the patient. The state doesn't have to foot the bill for all of it, you could mandate that insurance picks up the tab and leave the state to pay for only the uninsured. It's profoundly unjust to not only deprive someone their bodily autonomy but also saddle them with a mountain of debt with no recourse even if the involuntary commitment turned out to be unjustified. If it came out of municipal budgets maybe police departments would be more diligent about making sure that involuntary commitment was necessary instead of using it like a blunt tool to pawn off a tiresome person onto someone else.

This happened to a friend of mine. "Friend" of theirs who was angry they didn't have a romantic interest in him called the police claiming they were suicidal. Police came, handcuffed them, verbally abused them, and dragged them to a hospital against their will even though they were clearly fine. They were forced to stay there for ~a day and then had no means to get home, thankfully a friend was able to pick them up and drive them home from the hospital.

No consequences for the guy, of course.

Something similar happened to a friend of mine and you can find plenty of stories on the internet - the way suicidal people are treated by the police is actually cruel and I can't imagine it helps anyone who is really feeling suicidal.

My buddy got arrested, restrained to a hospital bed against his will, was given a cocktail of drugs, and had to stay there multiple days while getting a 'wellness check' every fifteen minutes where a nurse shakes you awake.

To top it all off they sent him home with a $60,000 medical bill.

Not a great way to treat someone who's going through a hard time. I definitely learned never to call the police unless someone is literally getting ready to jump off a building.

Wow, that sounds like a good way to make someone suicidal even if they weren't to begin with.

>the way suicidal people are treated by the police is actually cruel

The way people are treated by the police is actually cruel. If you dug into it you would be ill.

> I definitely learned never to call the police unless someone is literally getting ready to jump off a building.

This is an important lesson. Do not call the police unless you literally just want them to remove a nuisance and you don't care what happens to the person or how they are dealt with. Even then, police are just a wild card with the potential for life altering outcomes.

My brother called the police once because his then girlfriend was acting really crazy/violent after a night out drinking (not the first time) and they almost arrested HIM.

Calling police is rolling the dice on a range of possible outcomes often times putting you in the crosshairs and rarely resulting in what you would expect.

> while getting a 'wellness check' every fifteen minutes where a nurse shakes you awake.

Actually, speaking of practices that are implemented for the convenience of administrators rather than the benefit of the patient...

There is a popular belief that, if you have a head injury, you must stay awake because losing consciousness is dangerous. This is completely false. Your urge to sleep reflects the fact that that is what's healthiest for you. If (1) you are caring for someone with a head injury, (2) they want to sleep, and (3) you have no means of addressing a very serious problem such as massive internal bleeding, you should let them sleep, because that is their best chance to recover.

It is, however, absolutely true that, if you have a head injury, 911 will tell whoever is caring for you to make sure that you remain conscious, and if you're already in a hospital, the staff will do their best to ensure you remain conscious. This is not because staying conscious is good for you. It is because they are relying on an index of how severe your injury is ("is he behaving oddly?") which only applies if you're conscious. Everyone who's unconscious is behaving normally.

"convenience" is a hell of a word to use here when the alternative is that medical professionals would have no way to know if your condition is worsening. Which is to say, if you want to sleep you can basically just go home for all the good they'll be able to do.

If it's inconvenient to you then you always have the option of checking out of the hospital whenever you want: you are always (except in psychiatric hold cases) able to sign a form saying you understand it may be Against Medical Advice and want to leave.

> the alternative is that medical professionals would have no way to know if your condition is worsening.

There are other ways; they are more expensive, less accurate, and possibly more dangerous to the patient, but they exist.

But if you go back and read my comment again, you'll see that I'm talking about the popular belief that losing consciousness is detrimental to the patient. It isn't; it is beneficial. The doctor may have good reason to keep the patient awake anyway, because, if the patient suddenly starts to die, he might be able to do something about it.

But if you are not in that situation -- if there's nothing you can do if your injured friend suddenly starts to die -- then you should not be trying to keep your friend awake.

If the patient is conscious and starts exhibiting symptoms indicative of a medical emergency then there's the possibility of treating it. If they're unconscious you might not know about it until you start seeing cardiac or respiratory symptoms, at which point you've already waited too late and they could die, be left in a comatose state, or suffer from brain damage. How is improving the odds of preventing that not "for the benefit of the patient"?

Why on Earth would the police be considered the appropriate service to deal with this situation? There is no overlap between paramilitary law enforcement and social services.

This is where calls for defunding the police come in. Take some of the money spent on using physical force on those whose thoughts do not conform to social norms and use it on a more appropriate agency. We no longer regularly physically restrain and torture the mentally ill in treatment settings. Why do we insist on funding other institutions to do so?

Swatting only has steps 2 and 3 to worry about.

Step 1) plant evidence of crime

Step 2) call police

Step 3) enjoy

Do you propose that we do away with police, telephones, or crime, to solve this problem?

It's one of the two things every therapist will tell you that can force them to break the confidentiality. That it can take away your freedom, get you institutionalized, remove your ability to make your own medical decisions.

It's important to take ideations seriously but as someone who struggled with that at points in my life I never felt completely safe about discuss it.

It makes sense when you consider that the therapist is there to help you but only in a way that does not challenge society. You are right to not feel completely safe to discuss it, unfortunately. I'm not sure why this taboo has evolved to be so strong, though I would guess it runs very deep psychologically in peoples' fear of death and also has something to do with the potential societal implications to any culture which does not treat it as something to be dealt with with extreme prejudice.

>societal implications

I'd expect the quality of a party you're allowed to leave to be higher than one you're not.

I would agree, hence the offensiveness of suicide to society in the large.

american society.

Are you American?

It's not much better in Europe.

The majority of people who attempt suicide do not then go on to commit suicide. Though ironically it does mean that a suicide attempt is the strongest predictor for death by suicide - but the rate is still 1% over the successive 12 month interval.[1]

There is no strong evidence that suicidal people have a genuinely held belief that they wish to stop living, as opposed to a psychiatric episode that once passed does not reflect their actual world view. This, in part reflected in the fact that one of the riskiest periods for clinically treated depression is shortly after anti-depressive medication is started, since depression manifests in large part as a lack of motivation, and the first effect of treatment tends to be to allow people enough action to actually attempt suicide. But again: this is episodic.

Note that this is entirely different to terminally ill people seeking euthansia, who amongst other things will pursue the goal for years if necessary i.e. it is a strongly held belief of a rational mind.

Though finally I'd note I don't know what you propose "challenging" society is meant to mean here. A therapist isn't there to sign off on you killing yourself, nor is that ever required. That option, especially in the US with the absolutely minimal checks on firearms ownership, is constantly available and has exactly one outcome. Dead people don't feel, or have to justify, anything to anyone.

[1] https://en.wikipedia.org/wiki/Suicide_attempt

100 percent of those who succeed on their first attempt do not go on to try suicide again.

I wonder, though, if people who attempt and fail suicide are more likely to be the ones doing it impulsively after a psychiatric episode or other major emotional setback. If someone has thought it through and genuinely wants to die I suspect they would have a better chance of succeeding.

It means anything which violates the social norms and laws that undergird a society, one of which is suicide. Another might be illicit drug use, including psychedelics. Any solution or help a state-linked therapist provides must necessarily steer away, if necessary by force, from anything that involves these. This even may be if something like psychedelics could help the individual, although psychedelics are likely to become legal in the future for this purpose. Suicide in most jurisdictions is entirely illegal not excepting euthanasia and in such jurisdictions, a therapist engaging with a rational terminally ill person as you describe would not be allowed in an official capacity to have an honest discussion about euthanasia as an option for their situation.

> There is no strong evidence that suicidal people have a genuinely held belief that they wish to stop living, as opposed to a psychiatric episode that once passed does not reflect their actual world view.

I would argue that there is an overwhelming amount of evidence that suicidal people have a genuine held belief that they wish to stop living, in the form of genuine and sometimes successful suicide attempts. To redescribe it as a "psychiatric episode that once passed does not reflect their actual world view" is to simply negate the validity of the belief by viewing it through a medical rubric which affirms suicidality as something pathological. This is a value judgement. Compound with the complication that, as described through the comments on this post, any discussion of intent towards suicide can have severe consequences and therefore suicidal people will necessarily be coerced into denying their true beliefs of things, and must acknowledge the consensus view that their desire to kill themselves was in fact not "a genuine beliefe". That they may come at some point (possibly much later on) to have genuinely changed their mind not to kill themselves or to have kill themselves may be great but does not invalidate their previous belief at the time they were suicidal.

For comparison, imagine a society in which intent towards abortion was viewed as a pathological state of mind, and any talk towards such was met by extreme force from the state similar to that which it is for suicide, to wit: forced imprisonment, pharmaceutical intervention and koshing of a person until they no longer expressed (openly) a desire to have an abortion. A statement like "There is no strong evidence that these women have a genuinely held belief that they wish to not have their baby, as opposed to a psychiatric episode that once passed does not reflect their actual world view." may sound valid to people living under such a value system but we might recognise something more going on here.

What's the other thing besides mentioning suicide?

A serious intent to harm/kill others.

Yeah, I've read some incredible stories. Locking the doors behind the patient. Using some tiny remark as cause for involuntary institutionalization. It made me think american psychiatry was like american prisons where they get paid per person and are therefore incentivized to stuff as many people in the building as possible.

All the while I can drive 15 min and find thousands of obviously mentally ill people in need of involuntary mental health treatment (the type perhaps not even available at this point in the US) wandering around and the police cannot do anything about it because their only avenue for detaining them is to wait until they catch them committing a crime. And even then they are shortly released onto their own recognizance if it is anything short of attempted murder.

The reason they aren't in a psychiatric hospital is because the only reasons we can involuntarily commit someone is if they are a risk to themselves or others, and like stated elsewhere in the thread is generally reassessed by a judicial process every 72 hours depending on the state. What I'm reading in your post is that you're in favor of involuntarily holding more people which I find interesting because many others in the thread are complaining that it's too easy to have someone committed. There are a lot of armchair psychiatrists in this thread who have never seen someone in psychosis or truly manic suggesting that it's a joke to have someone committed. I spent 3 weeks rotating in a psych emergency department and only saw 2 patients out of probably more than one hundred total patients admitted for being suicidal. Neither were involuntary. From what I've seen unless you have just attempted or have a concrete plan to attempt suicide again you're not going to be admitted. There are just too many people who are in not-on-the-same-planet level of psychosis or mania that are taking up beds to admit someone who is not really about to attempt suicide.

Not trying to pick on your post or anything just thought it is a good example to say that it's maybe not as easy as it may seem to decide who gets admitted/committed, and the dichotomy in this thread shows that point.

Regarding potential overuse of sedation (benzos) or antipsychotics in nursing homes, it's easier for a nurse to push a doctor to prescribe meds to "snow" a patient than to spend time in the room and try to reorient a sundowning delirious dementia patient.

> Not trying to pick on your post or anything just thought it is a good example to say that it's maybe not as easy as it may seem to decide who gets admitted/committed, and the dichotomy in this thread shows that point.

Of course the topic of involuntary committal and people’s rights and prevention of abuse is extremely difficult, and that is why the pendulum swings back and forth. I just think it might be at or nearing the other end of the swing.

Keep in mind that the involuntary commitment system that was largely dismantled in the 80s was a hotbed of abuse - both of the people committed to it, and of the reasons for which people would get committed to it.

Falling out with your business partner? Want to get rid of your wife, so you can move in with your mistress? Your kid came out gay, or atheist? Dad has money, and you don't want to wait for him to die? Involuntary commitment was a fantastic solution for all of these problems.

If you weren't crazy before you get sent to a mental institution, you almost certainly would be after you involuntarily spent some time in one.

Yes, there is of course potential for abuse, but I am thinking the pendulum has swung too far in the other direction now.

> All the while I can drive 15 min and find thousands of obviously mentally ill people in need of involuntary mental health treatment. because their only avenue for detaining them is to wait until they catch them committing a crime.

Let's say you were wandering the streets of a major city, looking very odd to everyone else and muttering to yourself (likely someone you'd see on a drive who is "obviously mentally ill"), but otherwise very happy and not breaking any laws, would you want the police to be able to snatch you off the street and involuntarily lock you away?

Likely not, and this is why the laws in some countries like the US are the way they are.

> but otherwise very happy and not breaking any laws

This is obviously not the case with a sizable portion of the people wandering the streets. An ideal world is nice to theorize, but practically, there will always be type 1 and type 2 errors.

Transparency and other efforts to reduce them should of course be a never ending goal, but abandoning a problem completely because it cannot be done perfectly is not a long term solution either.

> Likely not, and this is why the laws in some countries like the US are the way they are.

I think the laws are the way they are because it was cheaper to simply dismantle whatever existed of the mental health care system rather than invest in improving it. And it is still cheaper to ignore it on the federal level while the rich people cloister themselves in affluent suburbs and gated communities.

> This is obviously not the case with a sizable portion of the people wandering the streets.

I'll bite.

Give me an example of someone who fits your definition of someone who should be forcibly taken under the wing of mental health treatment (whatever that entails) who isn't breaking any laws. Putting someone into a mental institution strips of them of all rights and requires convincing a judge to ever get out.

This logic essentially wants to "arrest" people without "arresting" them because they aren't doing anything illegal. That requires a very precise definition of the conditions under which you can do this.

Very much like a law.

> Give me an example of someone who fits your definition of someone who should be forcibly taken under the wing of mental health treatment (whatever that entails) who isn't breaking any laws.

I did not suggest involuntary committal for those not breaking laws. I wrote a sizable portion of those who need mental health treatment are breaking laws (more importantly, they are behaving in a manner that is destructive to other members of society - littering, biological hazards, fire hazards, property crime, etc). Whether it be for schizophrenia, meth and drug addiction, or some combination thereof that make involuntary mental health treatment the only option.

It's less about pay and more about liability. Mental health is terrified that someone will do something to harm themselves.

The incentive systems have yet to realize that there needs to be some balance in bad outcomes to support the good ones. It results in a system where any mention of self-harm is taken extremely seriously, even at the cost of a larger treatment plan.

I think we are seeing literal survivorship bias here where the person whose texts were taken too seriously is alive to tell their tale and everyone whose weren't successfully committed suicide.

> Mental health is terrified that someone will do something to harm themselves.

I can understand that but involuntary institutionalization should be implemented only if there's an immediate danger to someone's life.

A currently euthymic person mentioning casually there were times they wished they were dead is not cause for institutionalization.

A depressed person who not only thinks about taking their own life but has made plans for it and has the means to execute that plan is in great danger and in need of immediate help.

"detained...for a night"

"freedoms can be taken away so dubiously even when not charged of a crime nor arrested in a system that exists outside the criminal system"

I'm sorry this happened to you.

Not defending it, but I don't think it's fair to say your experience represents some runaway extra-judicial outcome.

For better or worse, in the US, a judge's approval is required to detain someone in a psychiatric facility beyond an initial period (in my state it's 24 hours).

This is more or less the same standard we apply to people arrested for crimes, no?

I.e. you can be detained involuntarily for a bit, but they have to put you before the court or let you go.

Are there any states where people can be involuntarily committed indefinitely without judicial involvement?

[edit responding to your edit] you were responding to the tone of my original comment, which I softened while you were responding, so sorry for the original combativeness. For what it's worth, holy crap does what you described suck. i would have done exactly what you did. no amount of knowing that it's not "indefinite" would have made it any better. the circularity of being falsely accused of something, and then having your (justifiable) non-compliance used to justify threats of further force, is blood boilingly unfair. sorry my apology sounded insincere. i sincerely feel that your experience should not be minimized.

Florida. I knew people in high school that were in there for weeks.

https://en.wikipedia.org/wiki/Baker_Act

"Examinations may last up to 72 hours after a person is deemed medically stable"

"There are many possible outcomes following examination of the patient. These include

(1) the release of the individual to the community (or other community placement),

(2) a petition for involuntary inpatient placement

...

(3) involuntary outpatient placement (what some call outpatient commitment or assisted treatment orders), or

(4) voluntary treatment (if the person is competent to consent to voluntary treatment and consents to voluntary treatment)."

[Numbers mine]

So assuming #2 and #3 are the "bad" outcomes: both seem to require a judge's order within 72 hours?

Unless the definition of "stable" has a wiggle room I am not appreciating? Or some other practical nuance?

Definitely can happen in Arkansas. BUT, it will not be indefinitely, it will be when the insurance money/mom and dad's bank account runs out.

Doesn't really seem like this is correct.

https://law.justia.com/codes/arkansas/2018/title-20/subtitle...

> (a) An individual with a behavioral health impairment who is admitted to a psychiatric emergency service under a crisis intervention protocol under this subchapter shall have a final disposition within a maximum of seventy-two (72) hours or be released from custody.

> (b) If the individual with a behavioral health impairment cannot be stabilized within seventy-two (72) hours of entering into a crisis intervention protocol, a participating partner may institute commitment proceedings as authorized under § 20-47-201 et seq.

> (c) An individual who has been released from custody and has chosen to stay at a crisis stabilization unit voluntarily under § 20-47-804(c) is not bound by the seventy-two-hour maximum time of detention under this section.

> (d) As part of the discharge process after the seventy-two-hour hold has expired and the individual is being released from custody, and subject to the consent of the individual no longer in custody, a crisis stabilization unit may provide the individual with a follow-up treatment plan and a request that the individual utilize the treatment plan, including subsequent appointments with a mental health professional.

Sounds like you're talking about (b), but I wouldn't really assume we're talking about children (as in America they don't really have rights).

Oh interesting, this must be new (2018?).

“Stabilized” indeed… (rolls eyes completely around head.)

California.

>I don't think it's fair to say your experience represents some runaway extra-judicial outcome.

Being involuntarily committed makes you a "prohibited person" and includes a lifetime ban on owning a firearm.[1] It wouldn't surprise me if there were other strings attached to having that on your record too.

[1] https://uclawreview.org/2021/08/18/pulling-the-trigger-on-am...

>Phony Diagnoses not just at nursing homes, also in mental facilities.

Schools too. My mum spent two decades as a primary schol teacher, and it's an open secret in that industry that Ritalin and other behavioural drugs are, at least in some cases, administered for the benefit of the teacher and other students in the class - not necessarily for the child receiving it.

> it's an open secret in that industry that Ritalin and other behavioural drugs are administered for the benefit of the teacher and other students in the class - not necessarily for the child receiving it.

Not necessarily does not mean never, so be careful of a claim like that, and maybe back it up. I have a daughter, now an adult, which Ritalin and/or Adderall provided real benefit. The only thing in question was how to find the right one and right dosage to minimize the side effects )lack of appetite and sometimes stomach aches). The difference was very clear, and was exhibited multiple times. For example when we let her go off it at her request during the middle of her sophomore year in high school, and she went from getting B's and C's to getting flunking a quarter of four of six classes, and then going back to not flunking anything and getting mostly B's by the end of the year when she went back on the medication. This was not an isolated incident, it happened 2-3 times over junior high and high school.

That's the thing about medication. Different people respond to it in different ways. That's why studies look for statistical significance, not "guaranteed to do what it says".

Edit: The language of the original comment has since been softened to no longer imply that's the only or main reason, which I appreciate.

The phrasing of the poster you're responding to does not discount the experience you're describing. I don't see how they could be more careful.

> does not discount the experience you're describing

It's not about saying it's not possible, it's about setting expectations, and scaring people away from a medication which may be helpful.

>> Ritalin and other behavioural drugs are administered for the benefit of the teacher and other students in the class - not necessarily for the child receiving it.

That clearly states the reason it's administered is not primarily for the child's benefit. While it doesn't discount that the child may benefit, it clearly sets the expectation that it's not the child's well being that's being considered. The natural extension of accepting that is to wonder if there's any actual benefit to the child or if that part is just in service to "the secret".

Implying that the reason a specific medicine is prescribed is not actually for the benefit of the patient might have real repercussions if it scares away someone that it could have haloed. At a minimum, I think a statement like that should be backed up in some manner.

I'm sorry, we cannot easily back this up. It would take confession of an intent, which most prescribers aren't even aware of.

A single mom, exhausted with 2 part time jobs and 3 young kids put them in front of tele tubies all day long. Is that for her own benefit or for the benefits of the children? We don't even have clear evidence of the overall impart of such educating programs on child development. But we have to use common sense and agree it benefits carers if they want to get more time for themselves. It doesn't imply careless attitude, or consciousness of the motive, the kids appear to enjoy anyway. I think the comment was made out of common sense: attention deficit of just one student can cause serious classroom management issues, it isn't naive or prejudicial to point out what we don't hear very often: the prescription isn't for the child own' benefit.

I could have explicitly acknowledged that sometimes the child's welfare is the primary concern. I could have used weaker language, too. I've updated my comment a bit to more accurately reflect my understanding.

I find we often project or minimize opinions and positions that don't account for our pet emphases. I agree with your take.

Take an example of someone who posts solely facts in a controversial topic. Folks that disagree with the direction the facts point will ascribe all manner of negative projection to said poster. But does that reflect on the facts-poster, or on the interpreters?

Online communication is such an odd thing.

In my case, it "worked" by making me far more anxious of failure and the judgement of others. For 8 years. I had never previously had suicidal thoughts but I did less than a year after starting the "meds." Then I got in trouble for discussing suicide with another student. The whole situation is more hellishly dystopian than a grimdark fiction writer could imagine. It's no mystery why gen Z are often aggressive doomers. Maybe we could re-evaluate the school system instead of drugging kids to be more scared and spineless? Once I quit the meds and went to college (and did fine btw but maybe because my brain was already permanently altered), it took about a decade for me to realize most people are pretty cool and don't expect you to bend to every whimsical demand of any size, and you don't need to be terrified of everyone around you who could tell you to do anything at any time and you'll get in massive trouble if you don't.

> I did less than a year after starting the "meds." Then I got in trouble for discussing suicide with another student

I'm sorry to hear that. I believe that's why we had mandated psychiatric visits while my daughter was on the medication. We couldn't get refills without meeting with the doctor to discuss how it was going. It definitely sounds like it wasn't working well for you, either because of how the medication expressed itself in your case or your specific school situation, or a combination thereof.

> Maybe we could re-evaluate the school system instead of drugging kids to be more scared and spineless?

While I'm not going to argue that school couldn't do with a bit of change, I'm not sure it's fair to extrapolate what everyone's experience is from what happened to you.

As an example, I remember an incident early in seventh grade there was an incident in gym class when we were being taught the fundamentals of wrestling, where after one match and unfortunate classmate earned himself the nickname 'boner' and the ridicule to go with it, which lasted a few years. This undoubtedly made his life much harder. A number of lessons could be taken away from that situation, but "we should stop teaching wrestling in gym class" is probably not one of the better ones.

Should we stop medicating students? Maybe. That probably depends on quite a lot of factors, most of which I don't know enough about. But I would hope that a better solution where those that the medication helps take it and those that it doesn't or the problems associated with it are enough to make it a bad choice don't is an achievable outcome that we should strive for.

> I'm not sure it's fair to extrapolate what everyone's experience is from what happened to you.

But the problem is generic. USA schools have all the code smells: employees who are “just doing their job Ma’am”, or reacting knee-jerk, politics being involved leading to no solving issues but communicating a lot on them; no-xyz policies (replace with any CNN topic of the time) which leads to extreme response to normal youth events (overreaction to suicide or misbehavior, police in schools, searches come to my mind, but there is worse), competition between children, not only in curriculum but also in who’s the most popular and the most bully, drugs… And finally, the prevalence of psychologists compared to other countries, but psychologists that prescribe Aderall (US schools are world-famous abroad for threatening to curb energy with drugs on, mostly, boys) instead of working with teachers to better alternate recess/manual classes/theoretical lessons.

Of course it’s easy to tell from abroad that something is wrong, but less easy to tell how to setup different social dynamics that would result in a better system (and France certainly has its own problems with schools). It might even be as subtle as too much sugar in kid’s food, which changes behaviors a lot.

In the US, we were told our son had too much energy and would be medicated when he gets older. We moved to the NL and the teachers say he’s perfectly normal, despite having more energy. She said it would only be an issue if he wasn’t learning; which might indicate an issue with focusing. It turns out, you can still have energy and learn at the same time.

Exactly this. This is one reason we homeschool. Public school in the US was so incredibly oppressive (cops patrolling the halls and writing lewd conduct tickets for kids cussin'???), I was frankly shocked that most kids and parents put up with it.

Ritalin (methylphenidate) has an effect on one type of serotonin receptors. Most physicians are unaware of this, and, indeed, many think that methylphenidate is an amphetamine derivative, which is not the case.

For many people, d-amphetamine or cannabis are better treatments with less side effects.

Do mean to imply that giving a 10-year-old a few hits from a bong as part of their morning and evening routine is advisable?

Its wild that THAT is where the line is wrt giving drugs to children, particularly in the context of giving kids incredibly powerful, schedule-class stimulants

Yes. One difference is that a number of legitimate studies have linked consumption of THC by those in certain developmental stages with functional deficits in later life (as with alcohol, and FES is definitely a thing). Of course, a rigourous scientific experiment would give definitive proof but would be unethical.

Are there similar studies regarding the ADHD meds?

I suspect the kind of poorly-controlled, correlative studies done for THC would also show correlation between ADHD meds in childhood and a variety of functional problems later in life. (The known comorbities of ADHD alone should account for that.)

Definitely not. Smoke is bad for the lungs.

Yes, I smoked weed for about 10 years after, partially because it was nice to relax for once even if it made me really dumb while high, and partially because "my brain is already ruined by drugs, what does it even matter at this point?"

Ritalin displays no significant activity on 5HT receptors, in contrast to dexamphetamine, which does have significant serotogenic effects.

Yes, they are not related, but both are taken for their dopaminergic effects, though they achieve this by different methods (reuptake inhibitor vs agonist).

Generally, in the course of treatment for ADHD, patients will get to try both to see which one they respond to better. They often exhibit strong preference for one over the other (personally, dex does nothing for me, even at recreational doses of 50mg).

Their risk profiles are very similar, and one cannot be said to have "less side effects", unless referring to a specific individual's response.

>The whole situation is more hellishly dystopian than a grimdark fiction writer could imagine. It's no mystery why gen Z are often aggressive doomers.

Ah yes gen z are the only ones... the only ones to be sad and mad. Never mind the generation having to be drafted and die in Vietnam. Never mind the generation having to fight in WW2. Never mind the generation having to take care of your ass.

I had breakdowns from social anxiety everyday in 7th grade in 2003. I got nothing. I would have rather have drugs.

the zoom zoom is showing. Go to bed please its past your bedtime.

>Not necessarily does not mean never, so be careful of a claim like that, and maybe back it up.

That's definitely correct. It can be a great help for some children, and some teachers (maybe even the majority) do make carefully considered decisions where the primary concern is for the welfare of the child receiving the drugs.

Other times, though, they just want some ratbag kid to STFU so they can get on with their job.

I distinctly remember overhearing a conversation where a teacher wanted to (in her words) "sedate" a problem child so that they don't disrupt the rest of the classroom.

> some teachers (maybe even the majority) do make carefully considered decisions

In the United States, teachers do not prescribe medications. They may make a recommendation that parents seek the guidance of a doctor, and a qualified medical professional (usually a psychiatrist) will diagnose the child, and the parent may choose to pursue medicating or not. In our case, we had regular checkup appointments with a psychiatrist where our daughter and us were present at the same time, and a later point in the session where the parents were asked to leave so the psychiatrist could speak with her privately.

> I distinctly remember overhearing a conversation where a teacher wanted to (in her words) "sedate" a problem child so that they don't disrupt the rest of the classroom.

Unless the laws have changed since then in Australia, Ritalin is a controlled substance, according to this, and it's not even guaranteed a general practitioner can prescribe it, and a psychiatrist is preferred.[1] Maybe you misheard, or maybe the teacher misunderstood what their capabilities were?

1: https://www.health.nsw.gov.au/pharmaceutical/patients/Pages/...

>Unless the laws have changed since then in Australia, Ritalin is a controlled substance, according to this, and it's not even guaranteed a general practitioner can prescribe it, and a psychiatrist is preferred.[1] Maybe you misheard, or maybe the teacher misunderstood what their capabilities were?

Just like in the US, teachers here can make recommendations for parents to seek medical treatment. Said recommendations can include comments like "I suspect your child has ADHD". While nothing is guaranteed, if the parent follows up on it there's a good chance the child will be medicated.

> Just like in the US, teachers here can make recommendations for parents to seek medical treatment. Said recommendations can include comments like "I suspect your child has ADHD". While nothing is guaranteed, if the parent follows up on it there's a good chance the child will be medicated.

Sounds like the system works then!

> if the parent follows up on it there's a good chance the child will be medicated.

You say that, but we went through three recommendations over 5 years or so and following doctors visits where we were told initially that it was hard to tell because she was young, and that she might grow out of it, and the doctors did not recommend medication at that time (so we didn't, until on the last one where that diagnosis and recommendation changed based on her age and behavior).

The problem with statements like "there's a good chance" is that it's likely based on your understanding of things and not actual statistics or hard data, and meanwhile I have my understanding of things based on my singular experience (anecdote) that's also not based on hard data, so without any of that data all I'd agree with you on is that sure, some parents might end up with medicated children that don't need it based on a teacher recommendation, but I'm not sure whether it's a "good chance" or not, and unless you have more info you haven't disclosed, I'm not sure whether you know that either.

>The problem with statements like "there's a good chance" is that it's likely based on your understanding of things and not actual statistics or hard data

That's a fair comment. I'd be interested to hear directly from someone who does have hard data, or at least a teacher who's actually done this multiple times.

Ritalin absolutely is a controlled substance in Australia and requires a psychiatrist or paediatrician to prescribe it. I've never heard of a GP prescribing it (unless they're also appropriately qualified as one of the above).

GP can prescribe it if the patient has been diagnosed by a specialist (like the psychiatrist/paediatrician you mentioned). They can't prescribe it if you have not been diagnosed. This is just so the patients can get repeats on their meds without having to see the specialists all the time.

Every `ratbag kid` is someones child, someone who's brain who has been at odds with the expectations foisted upon them their entire life, and who may be tired of failing but can't figure out how not do.

It makes me sad to read comments like this.

But overall such a kid disrupts the whole class so we have worse outcomes for the whole group, kid included if the teaching can’t continue

Have 2 daughters on adhd medication.

I held off a long time. But finally relented. Night and day difference. Rolling around on the floor endlessly to top of class.

I haven’t found one my body can tolerate for long. But it was so weird to feel normal and not this horrific agony at trying to stay on task.

Try sativa-type cannabis with a vaporizer. Steer clear of indica-type.

Self-medication is a symptom, not a treatment.

Get a prescription, then? Cannabis is a valid medical treatment for ADHD.

No thank you. I won’t go near they stuff. Even the smoke from someone else causes a severe reaction.

I do have an actual diagnosis and doctor for ADHD

Grades are not really a reflection of well-being though. Not saying that she is not better off with the drugs, just that you failed to show that.

You can be a horribly depressed empty shell pf a human, but still "function" in society.

I worked as a camp counselor- that’s a very popular situation for parents to have kids go on a medication vacation. The stories I could tell. After whatever insanity we’d be trying to figure out what in the hell was going on with the kid. Too often when we dug in it was a medication vacation - many for serious but some for less so issues.

My takeaway - don’t just stop taking these even if you think it’s just for adults benefit - there has to be a way to come off them more slowly

Isn't that child abuse or something? Dumping their kid into an isolated environment without their medication and without people's knowledge... Sounds like a horrible idea.

Because that child with behavioral issues is sharing a classroom with 10 to 20 other children. It has never been fair to everyone else to put up with the issues on the one.

In more brutal prior days, they'd be expelled and become the parent's problem. Now, they get medicated into compliance. It isn't fair to anyone, neither that child nor the others, that they get streamed in with everyone and everyone has to figure out how to cope.

I don't know what the right answer is, but pretending there isn't a problem in the first place is definitely not the beginning of an answer.

I'm not arguing the ethics of it, just stating that (at least to the best of my understanding) there is a culture of that thing happening.

I would say drugging young kids with stimulants that have lifelong dependency implications as a kind of sacrifice for the greater good of the larger class is just morally reprehensible.

Let's keep treatment focused on healing the individual, not drugging them into compliance. We are talking about kids here.

What do you mean with "lifelong dependency implications"? I take such medication and whenever I stop taking it for a time period, all of the side effects of the medication completely vanish. This type of medication is not addictive, actually it's a bit unpleasant, I don't think anyone would get addicted to it. And it's not like people with ADHD are rendered completely useless if they're not on their medication. We grow up like everyone else, and take on the responsibilities of becoming an adult. Granted, maybe a bit slower than everyone else but still.. there are no such dependency implications as you claim.

Have you tried researching the long term effects of these medications? There is plenty of scientific literature available.

Be sure to consider the age which the treatment starts. A major aspect of concern for all drug use is how it affects developing minds.

The catch is that unmedicated ADHD outcomes aren't good.

I worked with the same group of students for a 2.5 year period of pre-K and kindergarten. Low self esteem, anxiety and depression and to a less extent conduct disorder were plain to see in the majority of the low executive function students by the end of Kindergarten. I saw these negative outcomes develop as a direct consequence of difficulty managing behavior in class and keeping up with peers.

Particularly for kids with combined inattentive hyperactive ADHD symptoms it's nearly impossible for them to get through the day while keeping up academically AND keeping their behavior inside the realm of "acceptable classroom behavior". Lacking a robust support system for students with extra needs (think an additional teacher or teaching assistant in classroom at all times) there is a very finite limit to how much you can assist without creating issues for the progress of the class as a whole.

The reason that I am careful to use low executive function (EF) as the label at this age is that even for experts in this area it's incredibly difficult to predict who will "grow out" of their lower than average EF issues and who plateaus with maturity.

I think the current consensus that diagnosis and especially medication for ADHD is too difficult prior to 6 or 7 is correct. I've seen too many students have seeming miraculous gains in EF and catch up with peers in a matter of weeks to think that preschool is the appropriate time to diagnose and treat ADHD.

The students who continue to lag behind in EF are substantially behind in basic grade level knowledge when they set foot in primary school. The amount of catch up they have to do is substantial even for neurotypical students by time that a formal diagnosis and medication is an option.

Now add in the fact that a large portion of the parents of ADHD kids have a parent with ADHD or less than average EF skills. They are less able than most to give their children the extra out of classroom help they need.

Getting kids on medication ASAP once a diagnosis is confirmed and a well tolerated treatment is found is a no brainer. By the time that this comes into play you are already in educational triage. We're talking about 1st graders that can't read simple consonant vowel consonant words in some cases.

The obvious solution is putting in a low EF safety net in pre-k and kindergarten. Extra teachers in classrooms, extra help with literacy. Making sure all parents are aware that their child is has an elevated risk for ADHD diagnosis later down the road, so they can familiarize themself with the diagnosis and treatment options-- and more importantly so that people are assessing and testing to see if they catch up in EF function.

In more brutal prior days, there was corporal punishment - I was frequently caned and variously otherwise bodily punished as a child, because I was a habitual miscreant - were I a decade younger, I probably would have been drugged.

Personally, I’ll take the memories of violence over being medicated for life any day of the week.

Oh, and it generally worked - fear of retribution is quite the motivator.

Gentle reminder that in the good old times of beatings, these kids were more likely to end up in jails, being violent, more likely to end up addicted to drugs and so on.

Not that current time is perfect, but statistically it has better results.

Better for what ? Suicide rates in young population are going up for example. But even so - if your only goal is to prevent negative outcomes might as well put everyone in a coma and tube feed them - bound to get 0% crime, violence, addiction.

Hard to judge quantitatively - but TBH as fucked up as my childhood was I wouldn't want to grow up in the modern system and working with the zoomer generation I'm not impressed with the outcome.

You would had to really show more for me to believe the suicide rates go up because kids are not beaten enough. Extraordinary claim requires some proof.

> if your only goal is to prevent negative outcomes might as well put everyone in a coma and tube feed them - bound to get 0% crime, violence, addiction.

This is fairly absurd jump.

Also, beating kids into obeisance makes them more likely to beat others onto obeisance. Which has no repercussions if against a kid, but has large ones if against adults. And even if not physical, leads to bullies. The more authority they get, the more coercive bullying happen.

I doubt regular beatings work, but having authority over your child, even if it takes physical punishment to obtain is one thing I see extremely lacking with my peers who are parents.

But my point was more about comparing generations, I feel like a lot of struggles like having to learn how to control your temper or focus, are wiped away with drugs, and in general society is very good at removing historic hardships you had to overcome. On the flip side a lot of artificial stress and challenges are introduced with modern life (grade chasing since preschool, social media) - I don't feel like this would have felt meaningful to me so I don't envy the current generation of children.

It was the beatings? Just last week people like you were telling us it was all leaded gas's fault. Make up your mind.

My anecdotal experience was also that corporal punishment worked ... until I grew too old for it.

Having spent my formative years being motivated by avoiding beatings, rather than seeking praise, made it very difficult to adjust to adulthood in a world that relies on positive reinforcement for motivation.

For every "...and I turned out just fine", there are many who didn't. Your "memories of violence" aren't the alternative to "being medicated for life", they're often the very cause of it.

Maybe that is one place were we could spend more resources. Even if separating them from other kinds might sound wrong. It might be for best. That is move them to smaller groups with specialised teachers who have adequate support in place.

It is harsh, but clearly trying to integrate all of them to general population is not working for anyone, but administrators...

Wait, where on Earth are teachers free to dose students with “behavioral” drugs?

Officially, they can't prescribe medication, but they can recommend to the parents that a child see a doctor. If the kid is actually a problem child, the outcome for this will often will be drugs.

And the recommendation from the teacher comes with a friendly recommendation to a psychologist that works with other kids in the class. The teacher and the doc probably have wine together once a week.

In the land of sensationalist news stories?

The other side of this is parents latching on to this reality and thinking their child cant possibly have any attention deficit issues

My brother got an adult diagnosis and would have benefitted a from a child diagnosis

> administered for the benefit of the teacher and other students in the class

I agree that it is wrong.

But the protection of other students is not a bad thing in principle. It is a thing that is often missing. Yes the school should help problem kids. And absolutely, the school should make sure other kids don't get victimized in the process.

Drugging young children into quiet compliance and uniformity cannot be the answer.

This ADHD epidemic is localized in the US, so either people there are being overdiagnosed for the sake of sinplicity, so they can just be drugged; or there is something horribly wrong, causing all those children to suddenly develop ADHD.

My money is on the former explanation.

A lot of the behavior is driven by liability avoidance by doctors and mental health professionals. They do not want to be put in a long drawn out lawsuit, convicted or not by someone's family members because they didn't report and deal with someone who wanted to commit suicide. Remove that possibility and I think many doctors will stop doing that too.

I know a few and they really, really, really hate how the system & law forces them into this corner, to the point where they actively try to avoid suicidal patients, because they don't want to report them. There is a similar dynamic with being a mandated reporter for children when giving them therapy.

Mandatory reporting seems to be a tool invented to keep abused children away from health and mental care workers, since parents who are worried about mandatory reporting will simply choose to not have their child treated.

Even for those who dearly love and care for their children, it's not a great feeling knowing that the slightest misinterpretation _requires_ that health / mental professional to refer you for prosecution. Instead of helpers, doctors and therapists have to be viewed as threats.

Careful, criticism of the medical industry and concern for your rights is verboten. You will take the drugs the experts tell you to take, and you will like it.

When I traveled to the east coast near DC to help take care of my mother in her final years I talked with some people about my work with startups and the tech side projects I was developing and not only did they all think I was completely crazy but I got referred to a psychiatrist who was insistent that I should get started on antipsychotic medications right away.

Why would talking about tech make people think you're crazy?

I wonder what the side projects were…

Maybe brain wallets?!

I think this is meant to be a comment on SV culture.

A good job is one where you do the same thing in the same place with the same people year after year. Such a job should offer good benefits and be exceptionally stable.

In contrast working as a contractor, intentionally contributing to more than one job per year, taking a big salary hit to be on a cool project with cool people are all things that are completely and utterly insane. No reasonable people would do such a thing.

And one of my side project was a mini MPORG with no combat, just some puzzles. Obviously no one can make good money providing something like that, and turning such a thing into a good job opportunity is not possible.

Take your meds and get a steady job at a big company, or better yet the Federal Government.

It is kind of surprising to me that this is considered so odd. Have any long time tech workers here tried to explain how their work is organized to anyone who has worked for the federal government for a decade or two? Maybe I was just lucky.

Reminds me of Élan School [1] and how kids (under 18) can be abducted with the permission of their parents and put in confinement for dubious behavioral benefits, against their wishes – sometimes with the help of the judicial system.

The road to hell is paved with good intentions.

[1] https://en.wikipedia.org/wiki/%C3%89lan_School

Kids can be forced into electric shock therapy because of their parents.

There is a very good/gripping series of illustrations about the school drawn by one of its victims:

https://elan.school/

This is literal survivorship bias. I'm sure there are many people who are no longer alive because people did not take their texts seriously. I can easily imagine someone posting something just like this from the other side of the coin.

I can't possibly imagine how trauma, torture and debt can at all help with suicidal ideation. It sounds barbaric.

I don't think torture is a remotely accurate description of psychiatric care. How do you think they treat people with suicidal ideation? Tie them down with chains, stuff a sock in their mouth, beat them with whips, and inject them with deliriants? Seriously dude... You get a room that looks like a normal hospital room. You have the choice to take antidepressants or not. You do group and individual therapy for a couple days. If you're actually being held on a 72 hour hold, your time will be up and you will be free to go. Otherwise you may realize that being in the hospital is beneficial and you choose to stay.

I respond to these comments because I don't want people to hesitate to call for help if someone they know reaches out in need because of what a bunch of software engineers on HN who've never seen the inside of a hospital have to say about psychiatric care.

I'm mostly referring to what comments like this[1] one sound like. They may be lies or they may be isolated cases in specific states or counties, but it's not at all the first time I've read such accounts. Grain of salt since it's the internet of course.

[1] https://news.ycombinator.com/item?id=28497547

That doesn't justify violating somone and stripping them of their rights. There are plnety of possible nterventions short of that

> I'm sure there are many people who are no longer alive because people did not take their texts seriously.

So? If they wanted to die, that's what they wanted. Do we have to forcibly be required to live in a mental institution, pumped with drugs, for the benefit of others if we don't want to be here anymore?

No one is being forced to live in a mental institution because they sent someone texts one time that expressed suicidal ideation... There aren't enough psych beds to take care of the patients with schizophrenia, bipolar disorder, and suicidal intent with a plan to spare any to suicidal ideation patients. The OP spent one night in a psych emergency room, was not forced to take any medication, and was released.

People who are suicidal with a plan are not generally thinking clearly and are happy that they received care once they've been treated. We take people who are acutely intoxicated or unconscious to the hospital all the time and have no qualms about that.

Regarding being "pumped with drugs", I can only speak from experience rotating for 6 weeks at two different psych hospitals, but the only people who I saw forced to take medication were acutely psychotic, manic, or incredibly agitated. The schizophrenics that are picked up and brought to psychiatric hospitals generally are so psychotic that they would not be able to care for themselves - risk of harm to themselves. Same thing with acutely manic bipolar patients.

> People who are suicidal with a plan are not generally thinking clearly and are happy that they received care once they've been treated.

As if preference on this is always treatable. For example, what kind of treatment do you give a person who wants to die because they have no support network and had a stroke which rendered them disabled and homeless? What realistic treatment is going to give them hope? A bed in a state funded nursing home surrounded for the rest of their days by untrained, uncaring people who are just there for the low wage paycheck?

Suicide should be an accepted life choice. No one should be forced to live just because others want them to. "Life, liberty, and the pursuit of happiness".

LPS holds are 72hr. It's the only situation where you can be detained against your will. Unfortunately, many seriously ill people can not get the psychiatric help they need because of how difficult it is to forcibly medicate(in CA, at least) or keep a person beyond 72hr if they improve slightly.

IMHO, the system errors too much on the side of caution when it comes to psychiatric holds and ignores history of repeated hospitalizations.

I picked up my wife yesterday after a 72 hour hold at an in-patient center. I’m so glad that she legally had to be there. She tried to commit suicide Sunday night and spent Monday and Tuesday in the ER. It’s been a horrible week for all of us.

The behavioral health place she was at was not perfect, but she would not be where she is right now if it weren’t for her having to be there.

For years I have told myself that if I somehow become wealthy, I will spend my time and money improving mental health resources in my area. After hearing her stories about the place she was at (one of a couple hundred owned by a public company), I wish I had the resources to start a place that did everything right.

I’m sorry you had a bad experience. It’s really messed up.

That sounds like an extremely rough time. I hope you and your wife are alright.

I wish the absolutely best for both you and your wife.

I can't even begin to imagine how difficult this must be for the both of you. It must be terrifying having a loved one trying to commit suicide. I hope your wife and you find peace and happiness.

There are times when getting someone on a 72 hour hold has been too difficult. I have been in situations where getting a 72 hour hold was necessary but was not possible. I'm glad it worked out for you. I can see both sides of it. I wish I knew a good solution.

I mean, speaking as someone who was clinically depressed for 25+ years, and about 20 of those years highly violent/homicidal/suicidal, in my opinion, a good solution would be to allow those of us with daily emotional pain and no regard for human life, access to cheap and mediated suicide assistance. Suicide is a human right.

There's a free service called crisistextline.org that I wish more people knew about.

I haven't finished the article yet. I got sidetracked by the claim that Haldol is "a powerful sedative." I understand that journalists are neither doctors nor pharmacists, but if you're reporting on a story about medical ethics, maybe know a little bit about drugs, how they work, and what the words you're using mean in a medical context.

Haldol is a typical antipsychotic. If the patient has no symptoms that indicate its use, they should absolutely not be taking it. There's a lot of side effects. Some may even persist after the medication is discontinued.

One of these side effects is that it can be sedating. I've been on the patient side of a misapplied antipsychotic myself. They can make you very tired and cause you to feel "drugged". This is not the same as a drug being a "powerful sedative". Words mean things. Words in a medical context have specific definitions and nuance. If you're reporting on medical malpractice, it's important to get the vocabulary correct so that the way you word something represents the truth rather than a sensationalized version of it.

I can definitely believe that these people were medicated in ways that were dangerous to their health for the convenience of the staff. However, when you call Haldol a powerful sedative, I have to assume you're either trying to make the situation sound as horrible as possible or you have no idea what you're talking about.

Haldol, Benadryl and one other drug are part of the common rotation used by nurses to sedate troublesome patients so they can skate out of handling said patient during their shift.

When said patient regains control of their faculties they are often confused and angry as a day is missing from their memory.

I assume the “one other drug” you are referencing is Ativan (lorazepam)?

Benadryl and Haldol arguably don’t belong in the same sentence at all, considering their ridiculously different effects and profile. You’re right that they’re used though. Is there any reason Haldol should be used like that at all, beyond it already being available as a psych drug? And even if Benadryl isn’t as effective (I dunno) surely something that isn’t as bad in side effects could be found? Many instances of said sedation are totally unnecessary, but many are eminently necessary to restrain someone actively violent.

I only ever saw this B52 trifecta used when untrained nurses from other units had to do a shift staffing the psych ward. Thankfully that particular psych ward was closed down 2 years ago due to repeatedly assigning untrained nurses to work in that department.

The regular nurses who had completed the state mandated training did not usin this combination of drugs on patients.

In a psych ED it was a lot more common to use 20mg ziprasidone and 2 mg lorazepam - "20 and 2" - for acutely agitated/psychotic patients. Before anyone passes judgement on doing that ask yourself if you've actually seen someone who is truly in psychosis or mania. I almost considered going into psychiatry because of how well antipsychotics and mood stabilizers work, particularly the monthly depot forms of antipsychotics, work and how they really do give patients their lives back.

I think psychiatrists have moved away from haloperidol and the internists or family doctors in nursing homes haven't caught up yet. Not that there's going to be much practical difference between Geodon and Haldol. Of course psych ED is a much different situation than on the floor of a nursing home where it might be more appropriate to use a low dose of Seroquel for delirious patients.

So if you were writing an article about benedryl, you would feel comfortable describing it as a powerful sedative?

It is with a high enough dosage, which nurses using it to knock out patients presumably are using

See also: "nightmare tripping"

Haloperidol is absolutely a powerful sedative (amongst its other effects). This isn’t a misplaced claim or hyperbole, it is used (and I have used it) to sedate agitated patients in hospitals.

I mean, it actually sounds like you don’t really know what you’re talking about. It’s not quite in our ‘take down’ class of drugs (think meth patient in the emergency room) but it sure as hell knocks patients out in IV/IM administration.

Which should definitely not be the administration in aged care, but even in oral form it is used unfortunately in a long term role as a sedative (which is not what it is indicated for), which is basically what the article is about

Having sedating properties is not the same as being a powerful sedative. If they had said it was used because it can be sedating, I wouldn't have said a word.

At this point, and reading your other replies, it really seems as though you’re just trying to justify a position you took which is not borne about by the factual evidence.

The other day I read an article in the paper about a woman’s journey with uterine fibroids and how it had affected her life. It contained a large amount of misinformation that my partner (obs and gynae doctor) objected to strongly but at the end of the day it’s been published and that’s that. But in this case what you’re objecting to isn’t even incorrect information.

I mean, the first typical antipsychotic, Thorazine was literally called ‘a lobotomy in a pill’. The trade name, Largactil, is because it was ‘large acting’ in basically turning the patient into a walking vegetable.

This is at a point in the history of psychology when asylums were being shut down and over the next few decades the large numbers of people who had previously been held in often awful conditions were released into society, and despite the literal sledgehammer effect of these ‘typical antipsychotics’, any side-effects we’re considered mild in comparison to not having them. Until the extrapyramidal effects started showing up.

Haloperidol acts on the same system as Thorazine.

Maybe it's an issue of dosage. At the levels you would prescribe outside of the hospital to a patient presenting with symptoms of schizophrenia, it can definitely cause sedation. At higher doses, you could probably say that it is a powerful seditive. It just seems disingenuous in the context of this article - to explain to the layman what the medication is - to call it a powerful sedative. It is an antipsychotic which has sedating effects.

Warfarin is a blood thinner. Warfarin was originally used as rat poison. If a nurse gave it to someone they didn't like to increase their risk of internal bleeding, would it be more accurate for a journalist to say that the nurse administered a blood thinner that was not appropriate or rat poison?

Your claim that describing Haldol as a sedative is disingenuous is entirely about intention and justification, not about anything material. Yes, you can use it with the intention of improving a schizophrenic's condition. That doesn't make it any less of a sedative.

If you give Warfarin to somebody at the dosages used to poison rats, it'll probably kill that person, too. I think I get what you were going for with the comparison, but all medicines are very light poisons at the dosages in which they are administered (all substances in general are poisons at the right dosages, really) but Haldol is a strong sedative at the dosages at the dosages in which it is administered.

And can we really say categorically that we aren't actually using the sedation itself (to some degree) to calm the schizophrenic?

Antipsychotics have horrific side effects but are useful in institutional settings to make residents/patients/inmates easier to manage - psychiatry is the tool used to legitimize drugging people without need for their consent in such settings, for the benefit of others and the institution. It makes me despondent to read an article like this as I believe there are too many perverse incentives and cultural taboos for this situation to change in any meaningful way.

Not all antipsychotics have horrible side effects. Let’s not lose nuance in response to the terrible unethical behavior depicted here. Modern antipsychotics often do good in helping people function when they wouldn’t otherwise be able to. The illnesses they treat are ones of terror and loneliness. I will note however that there’s no purpose in them here except to force submission, and that’s abuse and spits on the good that can be done.

> The illnesses they treat are ones of terror and loneliness. I will note however that there’s no purpose in them here except to force submission, and that’s abuse and spits on the good that can be done.

Modern antipsychotics are useful for conditions beyond schizophrenia. Seroquel is commonly prescribed for insomnia at doses lower than those used for Schizophrenia. Adding Abilify is a common second-line strategy when first-line antidepressants aren't giving proper results. Certain patients with bipolar disorder benefit from antipsychotic medications, particularly in the therapeutic delay before traditional mood stabilizers can kick in.

Like you said, the drugs themselves shouldn't be demonized. They're not perfect, but when used appropriately they're often far better than the underlying conditions being treated.

However, if doctors are simply making up diagnoses in order to prescribe the drugs, that's obviously not appropriate treatment.

I’m on Abilify and Vraylar. Makes me feel normal. Love it.

I think the negative and totally inaccurate depiction of psychiatric care on TV and in movies is why people are surprised that antipsychotics actually really help most people who are prescribed them.

Yes. Also, the name "antipsychotics" is of no help either.

The second generation "atypical antipsychotics" are really not much different from antidepressants. They just typically contain an additional dopaminergic effect (e.g. modulation). As someone else pointed out in this thread, Abilify is prescribed for depression and anxiety.

I'm on Abilify. It prevents the nasty mood swings that caused me to lose my first job.

I'm not aware of any that do not have horrible side effects. That is a value judgement I perhaps arrogantly think most people who have taken or been forced to take them (including myself) would agree with, maybe some people would not regard the side effects as all that bad. Certainly they can serve a good purpose and are a good tradeoff for many people who could not function as they'd like without them.

The issue is as you note in this instance, their use for something otherwise, that is, to force submission to make others' lives easier. It is not just in care homes that they are used for this purpose. Psychiatry as is practised within institutions such as prisons, schools, or care homes, serves as a way to legitimize dealing with difficult people using forced or coerced drugging, something we would not otherwise accept on the face of it. I don't see any good solution to this issue, especially not in the case of a care home where many residents will be deemed by all to not have capacity. Oversight can only do so much and when there are loopholes like the three excepted diagnoses mentioned in the article being exempted from public tallies, incentives will do the rest to close it.

EDIT: I'd like to add I have considered a bit more about other people I know who have taken or are taking antipsychotics (voluntarily), and they have never expressed extreme distress at their side effects. So I should have said 'can have' rather than 'have', my initial wording being influenced by my own experience.

I've heard seroquel is lovely for sleep and seems to be really well tolerated, but I haven't tried it myself yet.

Seroquel at low doses is hardly an antipsychotic. At higher doses it blocks the receptors that are associated with AP efficacy, and at that point, the negative extrapyramidal side effects start being felt.

what’s an antipsychotic without horrible side effects? As far as I know newer antipsychotics have less frequent side effects but they’re still extremely bad. Obviously that compares to the total dysfunction of severe mentally ill people who don’t take them. But to say there is an antipsychotic without horrible side effects isn’t correct.

If you look at the article, they were not prescribing modern psychotics, but old ones like haloperidol.

It is absolutely true, it happend to my grandmother. She was sedated because she had alheimzer and they didn’t want to deal with it. A tray of food would be brought in the morning and then taken back at night untouched, since she was sedated and they did not care that she didn’t eat for almost a week. Eventually she ended up in ER, had to be intubated and lost her ability to eat normally. That way she became bedbound and her life ended shorly after, something like a month and a half. Beside the alzheimer she was in good health but once in the nursing home it went all downhill.

Sorry to hear that. Unfortunately, the system knows just one way for the people who deviate from the normal - INCAPACITATE THEM.

I have an autistic child and I get so much pain thinking along the lines of what your grandmother went through.

Not really on-topic but related. Until 10 years ago in Germany there used to be compulsory military service but alternatively it was possible to work instead in social services of which nursing homes were a large quantity. I think coincidentally this was a good way to let not completely indifferent people work in not really great circumstances. Probably the dynamics there aren't the greatest, low pay and some people are probably just there because it was easy to apply. Apart from the dirty work I think nursing homes could be actually great places for the inhabitants and so much better than living isolated which is more common the older people get.

Antipsychotics are not something to be handed out like candy. They have serious, sometimes permanent and sometimes fatal, side effects in anyone of any age. The article notes how that class of medication increases mortality in elderly people in particular.

The fact that some people were prescribed haloperidol as the first line of treatment instead of a newer, safer antipsychotics also blows my mind.

I'm terrified of growing old in this country.

Personally, I'm excited to help contribute to the quarterly profits of the shareholders.

My grandparents were in a care facility for several years. By the end, they were each on so many different medicines that one of my other relatives had to keep records on everything to make sure dosages were right, they were getting the correct medicines for the time of day, day of the week, etc.

I feel like this industry for the care of elderly in this country just bears 0 responsibility.

The solution in my opinion to this problem is to permit euthanasia and for assisted suicide to become culturally accepted as an alternative to a drawn out death of dementia in a care home. The quality of life for many (not all) care home residents who are on these sorts of drug regimens is dire and in reality not entirely for their benefit, as is apparent to everyone including those responsible for oversight like Medicare. This system exists (primarily in the West) due to a combination of taboos surrounding death and profit/political incentives on the part of pharmaceutical and care home companies.

A nursing home around here for dementia runs $10,000 per month.

Same time we hardly pay that per year for k-12. Shows how messed up our priorities are.

School aged kids and teenagers also require a lot less individual care and attention

Nursing homes have some similarity to schools, the staff is mostly occupied by a few problem patients while the rest quietly shuffle along

14% aren't even graduating our watered-down standards. I think they could use a lot more individual care and attention.

This is a stupid comment. You think a child is as much work as a psychotic elderly person.

That seems cheap if you break it down into per hour of labor needed. I can only imagine how understaffed they are. I would hope I can take myself out before I end up in one of those.

Okay, let's assume we do exactly what you outlined there. In 2031, do you not expect to read an exposé on how many "care home" residents are being pressured into signing euthanasia papers without understanding what they're doing? How do we avoid that world?

People will always need to make arrangements for their deaths well in advance before the cognitive decline prevents them from being able to do so. Such has always been the case with or without legal euthanasia.

I would definitely expect to read such an exposé and certainly there would be cases of people pressured into assisted suicide who otherwise would not want it. There is no good solution to this issue, in my mind. Some measures could be taken to prevent undue coercion like criminalizing those who did it but I'm not sure how it would work exactly.

Personally I think I would prefer euthanasia if I knew I was developing dementia and likely to end up in a care home similar to the one described in the article, or even one much better than that, so perhaps selfishly I would prefer a society where such is legal even though there would end up being abuses like you describe.

Jurisdictions that allow euthanasia or assisted suicide usually require that the patient be of sound mind as confirmed by a physician. But many nursing home patients are suffering from a significant level of cognitive decline and thus no longer meet the criteria. It's kind of a Catch-22.

Yes, it's unfortunate. The taboos (cultural or otherwise) and personal hang ups that people have surrounding death and dying prevent people from acting before it's too late. Ideally very-old-age/death planning would become as normal and culturally acceptable as planning your retirement and pension. The former is absolutely certain to happen but people will give almost all their thought to the latter.

So the solution to people being mistreated is to give them the option of dying instead?

You're right, it is not really a solution specifically to this problem, 'alternative' would have been better a better choice of words. Certainly I think it would be a good thing if people had the option of dying, even if they also had the option of going to a good care home - if only on the basis that dementia in and of itself may not be something an individual wants to experience even in the case where they are receiving good care.

We can think of care homes as like suppliers in a captive market, and we are the consumers - but it is even worse that a captive market in the sense that at least in a captive market you have the option not to buy, whereas we will be forced to. The existence of assisted dying as an option may even economically incentivize the care industry to improve.

Speaking from experience, people are not nearly as enthusiastic to make the decision to kill themselves (as dementia sets in) as every likes to imagine that they will be themselves. I have seen multiple cases of people who - in healthy middle age - made bold statements ("just shoot me when I get like that"), who later went on to write documents insisting that "all measures be taken to preserve my life". So not even "just let me die peacefully when it's my time", much less "load me up on opiates and finish me off in a month when I don't know who/where I am anymore".

I don't know why this is, but dementia is often a continuum, and the decision making that people make seems to change in early dementia.

Unless you are proposing that others get to make this executive decision that people with dementias lives aren't worth living, this solution is not practical.

More practical would be to accept that we are far better off over-medicating with pain meds to "keep people comfortable" with the implicit idea that it will shorten their lives. Everyone can pretend we're doing it for pain. Effectively it's like what you said but with some face-saving bullshit where no-one has to admit we're killing grandpa/grandma over the course of a few months. I'd much rather a few months on opiates at the end of my life than a few years on Haldol (JFC). Ugh.

“I don't know why this is, but dementia is often a continuum, and the decision making that people make seems to change in early dementia.“

Is it really demented thinking to want to avoid approaching death? I am there right now with my mom, and if she wants to press on, who am I to argue?

Agreed. I think people change their minds about how bad life would be if you can't function at a high level. A good deal of this is pride.

On Monday I will be an Intel Principal engineer again - but there's some Monday where I may need someone else's help to get the shit off my bum. From the perspective of that next Monday the indignity of the latter one is astonishing and humiliating, but there will be many intermediate stages where I get used to the idea that I am not what I was and to see that life is still quite pleasant.

"More practical would be to accept that we are far better off over-medicating with pain meds to "keep people comfortable" with the implicit idea that it will shorten their lives."

If it's reasonably certain that I will die soon or there is no chance for recovery I would like to try all kinds of drugs like heroin, cocaine and others. Why stay sober?

> I don't know why this is, but dementia is often a continuum, and the decision making that people make seems to change in early dementia.

More likely it is that theoretical death sometime in the future is something much different then real death sometime soon. Which is much different to actually doing it and following up.

The exact same thing happens in physical danger situations. People are brave and daring and when faced with actual situation, the start making real decision differently.

These doctors can’t be trusted to treat patients with Haldol. I certainly don’t trust them to properly administer euthanasia.

If they are fabricating schizophrenia dx, then they would also likely to fabricate medical cause for euthanasia.

One option might be to not require a medical cause for assisted suicide. Instead it could be something that people have an absolute right to do for any reason or none, though I do not think most societies would be comfortable with that. Perhaps heavy due process similar to that required in many jurisdictions for a woman wanting to carry out an abortion could be required.

“euthanasia” is already available. gun, knife, bridge, rope.

The truth we fail to face is that, in the grueling task of caring for the elderly and all the perverse incentives to cut corners, providing holistic care is an enormous labor of love that will tend to not work well outside of family, despite all the money we throw at it.

This is far beyond that. The doctors are brazenly prioritizing "not being bothered" over the health of their patients.

Over prescription of antipsychotics is still common in US psychiatric facilities, and even if not there are alternatives, like very high dosages of SSRIs or other specific medications with complacency as a side effect.

If the alternatives are a doctor who cares and a doctor who doesn't then the choice is clear.

But it is really difficult staying enthusiastic about treating someone, long term, who is never going to repay any extra efforts. Caring for the elderly/infirm is a really gruelling experience.

It seems quite likely that there physically are not enough doctors who have the mental stamina to do that. The options the average person faces if they can't care for themselves are going to be doctors who don't really care, or nothing.

Also, these facilities optimize down their number of employees to practically guarantee that they're all overworked. It's impossible to care in an environment like that - if someone has spare time to do anything beyond the rubric, then that is an avenue for optimization. The only thing holding them back is state regulations, and that doesn't make for a good outcome.

This article strikes a chord with me. After a long hospital stay, I sent my father to inpatient rehab (aka "nursing home") for two weeks. Before he went, they told me I could do daily visits outside his window. After he was there, they made me schedule visits ahead of time with their "activities coordinator" who told me I was lucky to get twice a week. They didn't bother to make him do any of his therapy, rather they just let him lay in bed the whole time. They put him on a bunch of new meds to make their job easier, double dosed his biannual medication, etc. It was of course impossible to get anybody on the phone to talk about any of the details of his care (and not for a lack of trying). I only discovered the meds after the fact when I requested the records (which was also its own ordeal, and they're not even complete).

Administratively though, they were on the ball. The intake paperwork pushed me to sign him up for a long term stay (complete with "sign here" highlights on patently unnecessary forms; I rejected them), and they wasted no time switching his insurance billing address to their own address. His stay ended abruptly one (early) morning, when they punted him back to the hospital with a dubious story. I believe it was because they knew his Covid test was coming back positive but didn't officially "know" yet, and this way they could keep their numbers down.

After the second hospital stint, I just took him home despite the extreme burden. I hired some private helpers and between them and myself being extremely involved with the visiting nurses/rehab, he did much better. I would have paid for more bona fide sessions of rehab if I could have, but that's our inflexible system.

If you have a good relationship with your family and one of them is in the position of "needing" a nursing home, it behooves you to save them from these horrible institutions that are mainly geared to milk their insurance. Even at decent hospitals and not during Covid, if someone else is not there and continually advocating, their care will be overlooked.

I’m assuming he was on Medicare, the gold standard insurance in the us?

Yes, but a Medicare Advantage plan through a traditional "insurance" company. I think it got him better drug coverage and a few fringe benefits. I wasn't involved in choosing the plan, I just stayed the course because it was mostly working out.

I don't believe that it affected his care. There were a fixed number of hospitals, inpatient rehabs, and visiting nurse associations, and they all took his plan. And I can't possibly see their behavior being different for a different payer - the incompetence was intrinsic to their deliberate bureaucracies. The only way to rise above would have been to find providers that didn't take "insurance" at all, such that the actual customer was the patient rather than another bureaucracy.

The Medicare rules were limiting by fixing the amount of rehab sessions he got per week. The length of his care would have been limited too (discharge rules), but I advocated to extend him within the system. But any bureaucracy is going to be similar, and thus the only way to fix that would be neutering the whole "insurance" cartel and forcing the industry into radical price transparency. Which is basically the line I was straddling with the private pay helpers.

What Medicare really helped with is making his copays sane and giving me solid footing to push back on billing fraud. For instance, one equipment supplier sent me a bill for 50% more than it should have been, and then shamelessly stood by their story on the phone ("you owe us this amount, so you need to pay"). I presume they successfully defraud many people that way.

In general unless your parents had tons of money you can just be honest with them, the person is 90 years old on a fixed ss income, the likelihood of you getting a single dollar is 0%. Just stop trying. Also great for advocacy in the hospital when they wanna discharge and you feel they still need to stay longer. They’re not allowed to discharge without consent, they’ll claim that you’re on the hook OOP for anything Medicare won’t cover… but if the patient has no money, who cares. The social worker can yell till she’s blue in the face about fiscal responsibility but at the end of the day, the hospital will have to eat the cost and actually perform the rehab correctly. (Speaking from experience)

"Caring for the elderly/infirm is a really gruelling experience."

I can see that in the facility where my parents live. Overall the place is fine but it's constantly understaffed and people aren't paid well. This is a way harder job than my much better paid tech job. I can slack off for days when I feel like it whereas the care personnel never can escape the grind.

It's sad that these people get paid so little considering how psychologically strenuous their work is and how much human benefit comes out of it.

IMO its a problem that we try to keep everyone alive at all costs disregarding quality of life. I would much prefer to just die before becoming incapable of basic tasks and being kept artificially alive.

i hear you.

unfortunately there are a lot of ppl in a situation where they did not declare that in time and we can't assume they would.

Most doctors don't accept this sort of end of life care. We should stop making it the default and make it elective instead. We treat animals far more humanely, allowing them to be put down when their quality of life goes down without much hope of improvement. Right now, if I want to avoid the nightmare fate of elderly or permanently ill people, I would have to commit suicide ahead of time. I would rather have a humane system that could take care of that when I am too far gone .

fact remains: everyone can opt-out

yeah but antipsychotics severely retard every mental process and have a high risk of permanent motor and intellectual disability (it really sucks to have tardive dyskinesia). There’s absolutely no reason that should be prescribed. https://freddiedeboer.substack.com/p/the-weight Freddie explains it in this article - he deems it worth it for him to be able to keep a job and friends, but it is in no way called for for random old folks to be disabled like that to make them easier to handle

It’s actually tardive dyskinesia (I assume you may have thought that the tardative stems from retarded as in intellectual disability). As far as I am aware, this movement disorder does not have any causal relationship with intellectual disability.

I agree with the principle behind your other points though, in an ideal world we would not prescribe these medications to the elderly to ‘aid in management’

whoops. Looks like tardive actually refers to it developing late in the course of treatment, https://www.dictionary.com/browse/tardive and dyskinesia refers to the actual disorder of movement

> I'm terrified of growing old in this country.

Have kids, raise them right, and you’ll be fine. It’s worked out pretty well for a couple thousand years.

Kids do not choose to be born. We can't expect them to serve us when we get old. They owe us nothing. We forced them into this world.

Such a nihilistic viewpoint.

Others consider bearing children a gift of life.

Where was the consent?

That's right - it cannot be given.

I think it’s a pretty great idea for people to “have kids, raise them right.”

I’m bullish on that strategy, even if there is no contractual guarantee that those kids will return the favor.

They generally do though. Have more than one so you have backups.

If you’re not abusive children tend to remember the 18 years you gave them fondly and provide assistance for your last few years.

It's an investment, not guaranteed to pay off.

It's kind of funny, my wife's mom abused her horribly and is now upset my wife and I won't take care of her. Treat your investments better lady.

That’s why the “raise them right” part is so critical.

The cynicism in the other answers is appalling. Treating people like investments...

Honest question, how old are you?

This argument bothers me because it seems to devalue human life on a very fundamental level. If your children resent you for “forcing them into this world”—if they would have preferred to have never been born in the first place—that’s not a healthy or normal reaction, but rather, near-suicidal depression. Sure, some people are suicidally depressive, but that’s a very dark attitude to project onto one’s hypothetical children as a default assumption.

If your kids aren’t suicidally depressive but also don’t love you enough to take care of you in your old age, there’s probably something else they resent you for other than being born in the first place. Which isn’t necessarily your fault—some people are just irrationally resentful. But that is probably the bigger risk to worry about. It’s just that, compared to trusting nursing homes not to become abusive, it’s still a better bet.

It’s also not necessarily about obligation, at least not in the negative sense of the term. I took care of my father during the last year of his life, not out of obligation but out of love. (One might define love as the act of willingly accepting the obligation to care for another, but a willingly accepted obligation is not really the same kind of obligation.)

In any case, the goal is to go into old age having people in your life who are capable of taking care of you and who will choose to do so out of love. Having kids and maintaining a strong relationship with them gives you a good chance of reaching that goal. Institutions, on the other hand, will never love you and will instead just fuck you up with psychoactive drugs for their own convenience.

> if they would have preferred to have never been born in the first place—that’s not a healthy or normal reaction, but rather, near-suicidal depression

This is a common misconception, and completely incorrect. https://en.wikipedia.org/wiki/Antinatalism . This is a possible valid philosophical judgment that implies nothing about depression.

No, it’s a cognitive distortion associated with depression that some people have rationalized into a philosophical judgment, because it’s easier for some people to do that than to actually address the level of depression and misanthropy that they suffer from.

People did not live as long and would die of some cause such as illness long before they got to the age where they would develop things like dementia. Our situation with many people living to an advanced old age, an exceeding number by historical standards, is more recent (past 100 years or so).

Is that actually true?

Life expectancy is a bit of a misleading metric in that regard, since life expectancies are just averages. If a population has a life expectancy of 50, that doesn’t necessarily mean that 50-year-olds are dying of old age and no one makes it to age 80. It could mean that there are a lot more children and young adults dying and bringing down the average. So if you’re living in a society with a life expectancy of 50 years and you turn 50, your personal life expectancy is probably going to be closer to 70-80 because you’ve already managed to survive the causes of death that affect younger people.

And you may very well develop things like dementia. The concept of people becoming elderly enough to lose their mental faculties isn’t some unprecedented 20th century discovery. It is becoming more common, but that’s just because deaths from childhood illness, infectious disease, violence, and occupational accidents are becoming less common.

Yeah, that's frightening. Everything I read is exactly the opposite of what my education taught me to do.

Antipsychotics are supposed to be the last resort in geriatric care due to obvious effects on patient quality of life and functionality. Not even sure they're approved by the american FDA for such uses. If they must be used, pretty much anything will be better than haloperidol.

Reminds me of lobotomies of old. "Make the patient easier to care for."

The epithet of "chemical lobotomies" for antipsychotics is an appropriate analogy not just for the physical effects but also for the potential political uses.

> I'm terrified of growing old in this country.

This is what convinced me to have as many children as possible. Hopefully at least one of them will care about me enough to not let this sort of thing happen to me.

how many you got?

I’m fucked then.

Heh, yes.

I developed tardive dyskinesia from use of antipsychotics over a period of 8 months. It's been over 6 years since I've taken them, but it still has not gotten any better...

You can still develop TD regardless of the drug, given that pretty much any dopamine antagonist can cause it in the long term.

:( I recognize you from Twitter, that’s sad...

I'm not sure of you're aware, but there's actually drug treatments for TD now, such as Valbenazine. From what I can tell, they have pretty good efficacy/safety [1].

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5958944/

Supposedly, a haloperidol and lorazepam mix is effective in sedating someone that's agitated just long enough that it becomes the next shift's problem. Pretty sure that's what's happening.

It's fast acting so it's a great choice for someone in the ER that's having a psychotic episode or is violent. Yours is the only explanation that makes sense to me.

https://en.wikipedia.org/wiki/Haloperidol

"Haloperidol is relatively inexpensive, being up to 100 fold less expensive than newer antipsychotics"

The drugging in those places is an obscenity. If you're going to do that, you should be intentionally shortening people's lives with opiates, which at least is a lot more pleasant than getting loaded up with anti-psychotics to make people compliant. Unfortunately, the jig is generally up with that - everyone knows what opiates do.

I'm seeing a lot of bullshit on all these threads from people who are doing the whole "fake bravery about how they would just be euthanized" in this situation, and how life isn't worth living if you're demented, etc.

Here's how life goes for a demented person close to me:

A "fulfilling life" with dementia isn't that different from one without. You wake up, someone makes you a nice meal, you read the papers, shuffle around a bit, get helped to take a shower and dress, watch a movie (which you won't really take in, but it's some nice pictures), get a call from your daughter (who either lives down the road or thousands of miles away, depending on what you're remembering today), etc. On some days your carers will take you for a drive to look at the ocean, or out to a dinner.

You might dream that you went on an exciting adventure down the California coast and tell everyone about it; surprising that an 80-year-old man who can't walk unaided can take a sailboat out by himself. Everyone you talk to will enjoy your story and no-one will try to tell you that you are deluded.

Some days will be better than others, which is the same for anyone.

That's 24 hour home care - and it's not cheap. Neither is living at a facility at this stage. Often the money spent on medical heroics would be better spent on quality of life. Of course, packing folks off to a facility is necessary for some (in this case, we're talking about outright home ownership plus a modest level of wealth). And then a lot of other people frankly want to put hands on grandpa/grandma's money and/or house which is tricky if they are still living in it.

> That's 24 hour home care - and it's not cheap

Why don't they just eat cake?

This is the good end of the spectrum. The other end is that the patient lives alone, soils his clothes and doesn't change them for months/ gets lost and becomes homeless, gets infected and dies an animals death. Most of the patients live closer to the bad end.

Two points.

First of all, a lot of the grandiose claims here about how "if I was demented I would just get myself put down" are coming from tech people who could afford this end of the spectrum.

Second, 24 hour home care - or 'family care plus a certain amount of professional relief' is, while expensive, not much more expensive than medicalized fulltime care in a lot of facilities. You're not paying the overheads of a bunch of salaries and potentially the profit margin.

At the lowest end of the spectrum, things are indeed terrible. Aside from fairly extreme small government people, I think most people would want the state to step in. A lot of the places that are over-medicating their patients are collecting vast amounts of subsidies and pocketing the improved profits that come from getting to run staffing levels as low as they can get away with.

You’re mention of HN(/tech) people got me thinking about the difference between the experiencing self and the remembering self.

I can illustrate it as follows: You can go on a wonderful free holiday for two weeks, but the deal is you will not be able to remember it. Do you want to go?

Some people will say no. After all, if they cannot remember it then it is just loosing two weeks. These people prioritise the remembering self.

But some people will say yes, because woohoo it’s a holiday! It’ll be fun in the moment. These people prioritise the experiencing self.

I think this is a really interesting concept by itself.

In the case of tech people, I suspect they are mostly in the first category. So they are more in the ‘if I cannot remember anything then put me out of my misery. I essentially don’t have a self anymore.’

But I wonder if people in the second category will be of the mindset, ‘well, I’ll still have good days, which I guess I’ll enjoy at the time’

This is nothing new, and a worldwide phenomenon. If you have to read about this in nytimes for the first time, please get a life and talk to your fellow humans. Its a mixture of personell being overworked and sometimes being plain mean. This is the price we pay for not investing enough into the system that cares for the elderly, or, in other words, this is the price for having outsourced caretaking. And dont fool yourself. If you put a relative into a nursing home, you have absolutely no idea how they are treated after you close the door behind you.

> “People don’t just wake up with schizophrenia when they are elderly,” said Dr. Michael Wasserman, a geriatrician and former nursing home executive who has become a critic of the industry. “It’s used to skirt the rules.”

What will likely happen is that they will simply approve Haldol for additional uses, such as the cases where elderly are hallucinating and highly agitated due to the effects of Alzheimers. Then doctors won't be use the schizophrenia diagnosis, they will diagnose "Alzheimers-induced psychosis" instead.

The effects can be remarkably similar, which is one reason this may be occurring and not just staff shortages or cost cutting.

I am not taking sides on this, but there would be no uproar if Haldol was on-label for late-stage symptoms of Alzheimers. It would just be another medication used to help ease symptoms. I'd be curious if manufacturers are trying this route.

If I was in this terrible situation I'd probably want the Haldol but that's just me.

> Antipsychotic drugs — which for decades have faced criticism as “chemical straitjackets” — are dangerous for older people with dementia, nearly doubling their chance of death from heart problems, infections, falls and other ailments. But understaffed nursing homes have often used the sedatives so they don’t have to hire more staff to handle residents.

This problem will only get worse. A lot of it is driven by demographics:

(1) fewer children being born means fewer blood-relatives to share the home care

(2) although medical treatments can often improve lifetimes, they can't necessarily improve life quality

(3) as people stop dying from ever more diseases (e.g., cancer, cardiovascular disease), they'll start to succumb to psychological and physical ailments resulting from isolation and sedentary lifestyles, and these have no cures - only treatments.

(4) people often don't live where they grew up, which means that married couples can face a double-whammy of declining health of both parents, right about the same time and a geographical conflict that gets worse with time.

Those claiming the solution is multi-generational households haven't done the math. And I doubt they've attempted to care for a geriatric relative with rapidly-compounding medical conditions while trying to stay afloat financially after having raised a kid or two themselves.

And then there's the problem of medical costs that relentlessly rise much faster than inflation, putting ever more pressure on nursing homes, families, and governments.

A big squeeze is coming as the boomers enter extreme old age in droves while needing round-the-clock care, possibly for a decade or more, for geriatric conditions without cures.

> A big squeeze is coming as the boomers enter extreme old age in droves while needing round-the-clock care, possibly for a decade or more, for geriatric conditions without cures.

Many old people have drinking problems. Someone I know personally has certainly contributed to his own deterioration.

> And then there's the problem of medical costs that relentlessly rise much faster than inflation, putting ever more pressure on nursing homes, families, and governments.

Prasadic medicine is medicine that concentrates wealth, but doesn't provide what the patients actually need: https://news.ycombinator.com/item?id=21728864

Non-paywall link: http://web.archive.org/web/20210911161128/https://www.nytime...

One nit: The article switches back and forth between incorrect schizophrenia diagnosis (11% of residents) and prescription antipsychotics (21% of residents), but those should be treated as separate topics. Antipsychotics can be beneficial in many conditions beyond schizophrenia, such as insomnia (at low doses), bipolar disorder, or depression (to boost efficacy of primary antidepressant treatments). The "antipsychotic" label is an unfortunate holdover from long ago, but the drugs are actually much more useful than they sound. Current generation antipsychotics also have significantly fewer risks than first-generation antipsychotics. The article's attempt to call them "chemical straightjackets" is a cheap shot at a class of medications that can be very beneficial for several conditions. Overprescription is a problem, but that doesn't mean all prescriptions are bad.

The truly alarming stat is buried deeper in the article: The fact that 1 in 9 nursing home residents is diagnosed with schizophrenia is way too high. Schizophrenic patients will be overrepresented in nursing homes because they are less able to care for themselves in old age, but that's still an unbelievably high number. These misdiagnoses are what we should be focused on.

> Current generation antipsychotics also have significantly fewer risks than first-generation antipsychotics

This is true, technically. Newer generations still have severe and often debilitating side effects though. Which gives an arguably favorable risk benefit for severe conditions, but very questionable ones for one in five nursing home residents.

I have the paperwork from my friend's 2015 mental hospitalization. The doctors both said, essentially, "patient expects us to believe that she was psychotic because she'd been drinking 2 bottles of liquor a day, and using cocaine. We know she's a chronic mental patient who needs these drugs because we got her stabilized in 2008 and 2010..."

Antipsychotics do not treat alcoholism or broken metabolisms (cocaine, genetics, etc). There are always better options.

One of the most disgusting parts of western culture is how they relegate their old to these nursing homes.

What do other cultures do for people who can no longer take care of themselves?

Live in multi-generational family units where the family shares responsibility for (and benefits from) their own elders.

I wonder about the generational demographics of different cultures and how that impacts things. Many western cultures have fewer children to bear the burden of taking care of the elderly. The populations are shrinking for native born.

Also people tend to live lot longer and specially lot longer with limited capabilities. So there is more of those needing support and lot more support needed.

It'd be remiss to not note most of the time in culture where multi generational family units are the norm, responsibility lands on women in the home or household support in extended families and the economy doesn't often require two incomes to be middle class.

Indeed. The household has a full time employee/manager there so to speak.

This. But would also add 1) live in socialist countries that provide home care, or 2) or live in countries where there is extremely cheap labor due to endemic poverty (much of the third world), low rates of labor participation, or imported labor (HK/Singapore/Gulf states)

And these low wage workers just don’t have parents?

What socialist countries provide home care?

The system is a shambles everywhere.

You can do that in America. People don’t do it because they don’t want to. Would you enjoy living with your parents again?

Yes, I would.

You can have mine.

This is typically true for the elderly who can take care of themselves or require minimal help.

Once you need round the clock dementia care, it is more than extended family can provide — unless one or more adults take themselves out of the workforce for years.

They can have professional home care nurses/aides when needed. Sure, that costs money but the nursing home isn't free either.

Nursing homes are often paid by Medicaid. They typically won't pay for long term in home care.

Nomadic tribes would simply leave them behind.

Or the elderly would wander off on their own to die, after they perceived themselves to be a burden.

And need to consider that elderly being able to wander off is still good state today. They could very well survive with relatively affordable assisted living. But in some cases we are keeping people alive who can't even walk anymore.

https://en.wikipedia.org/wiki/Senicide

A lot of this has to do with a lack of resources. There isn't enough labor available at home to take of the elderly most of the time and the ones in a home typically require extensive care. My father and mother in law both went to a nursing home because they couldn't perform basic daily activities.

The article points out that many nursing homes are just as understaffed though, that's why this practice is so widespread in the first place. If our elderly are going to be badly cared for either way, it might be best to keep them in a family environment where at least they won't be kept constantly on drugs.

Western countries don't have enough kids and strong enough family units (a bunch of relatives living in close proximity say), for this to work. I'm an only child and there's just no way I could have my parents live with me if they needed care.

Moreover, the elderly in 3rd world countries tend not to live as long, many of the old people in Western countries are.. for the lack of a better word, living far past their expiration date.

The patients in the article have dementia, which requires all day care, often by a professional. Where else would the elderly receive such care?

The trade off is that then the old drag down the kids in terms of careers, where they can live, time that might be otherwise invested in children, etc.

One side of my family is Chinese/Jamaican and the other White, so both cultural sets of values exist in my family and both sets of grandparents are worried about being a burden later on and while the polite thing to say is that they aren't, they genuinely are, especially if you don't have a lot of kids or they don't live nearby.

My Chinese/Jamaican grandfather had to leave his mother behind in Jamaica to build a life here in Canada and she supported that decision as it meant breaking the cycle of poverty for good. None of her descendants (at least for a while) would own nothing but two old dining chairs.

did you ever live with mentally ill old person?

It may be incredibly hard to the point that it is even difficult to describe it

I find it pretty hard to see it that way. Most people aren't equipped to deal with the senile. Taking care of aging family members just causes stress for the caregivers and the old people can tell that they're a burden. Surrounding them with people in similar situations and trained caregivers plus the option to be drugged out of their misery seems like a much kinder thing to do.

>One of the most disgusting parts of western culture is how they relegate their old to these nursing homes.

Most people can't afford it and last time I checked, Medicare doesn't cover it at all or not enough to make it affordable.

Of course in the 80s and 90s, long term care was much more affordable and wasn't as, uh, let's call it, profit seeking.

I work in developmental disabilities, the situation there is much the same. A lot of the time their lives just suck and the consequences of that is "solved" by giving them behavior controling medication because giving them good fulfilling lives is hard and expensive. I don't see any reason it would be different for nursing homes.

You could say the same about my use of an antidepressant.

The tragedy of the articles situation is that someone in a nursing home or assisted living has little or no agency to improve their lives, so the meds seem forced upon them. The common man has the perception of having agency to improve his own situation, so it's not as tragic to have to be on antidepressants.

I probably could have quoted it, but I was referring to "giving them good fulfilling lives is hard and expensive." Absolutely the captive nature of assisted living makes any transgression worse, but I guess underneath my unintentional irony there's a grain of truth in that they aren't trying to give them those lives anyway, they just want them to be easier to manage. In a certain sense it's a maiming.

When I have dementia, what is a "fulfilling life"?

Personally, if I'm at the point where someone wants to give me haloperidol because of age related dementia, it is probably long past time for me to depart from this Earth.

The movie “I care a lot” (fiction) does a good job of showing the incentives issue in elder care.

I hope this NYT report will trigger some more oversight and maybe blow a few cases open because the trend it highlights is very concerning.

We see it in education, healthcare, and at work. The path of least resistance is to do what makes things the easiest to manage, not what leads to the best outcomes.

unfortunately, there are some people who cannot function in the world without antipsychotics. a large number of people suffer from psychosis which in severe cases makes controlling their behavior, or even basic cause-and-effect thinking, impossible. the side effects of these drugs are terrible, but the alternative is worse.

abusing these drugs as tools of control when they aren't needed is evil in itself.

on top of that it's just going to give more credibility to the anti-psychiatry crusaders who want to give people suffering from psychosis the "freedom" to destroy their lives and minds.

I still argue that antipsychotics are generally overused and that many cases that require them are either currently perpetuated or were in the past caused by technological or societal conditions, regardless 20% in these nursing homes is dramatic vs the overall 1.6%, down to .5% among older people. https://sci-hub.se/downloads/2020-10-18/9d/dennis2020.pdf

There are always causes behind the symptom of "psychosis". People commonly develop metabolic problems.

My "crazy" friend was doing okay, back in July [ref: my comment history]. I watched her open a bottle of sugar free electrolyte drink concentrate and drink a serving. Over the course of the next hour she got paranoid and flipped on me, "DON'T FOLLOW ME, I DON'T KNOW YOU", and disappeared.

Brains need glucose and fructose, b-vitamins, thyroid hormone, vitamin A, etc. Stressed brains use more glucose than brains at rest. Old people commonly lose their metabolisms.

I think what I observed was the fake-sugar in the sugar-free drink causing insulin release -> low blood sugar. The normal response to low blood sugar is cortisol release, but people who have a tendency to psychotic disorders can't make cortisol. It was fascinating to watch & reconstruct.

p.s. your sci-hub link is titled "Characteristics of U.S. adults taking prescription antipsychotic medications, National Health and Nutrition Examination Survey 2013–2018"

The fact is that moving into a home full of strangers at the end of your life is a very cruel end to one’s life, and people fight it the way they fight kidnapping or torture. The best solution is to have your kids take care of you, the second best solution is to die. Nobody wants this which is why people need to be stuffed up with drugs to be manageable, like those tigers they use in tourist photo attractions.

Wonder if working from home will do to this, will change the demand for nursing homes in the future?

Just another devastating indictment of our entire philosophy of how we handle health care in the US—to wit, cynically, and as a profit center—versus basically every single other advanced nation.

How many horrifying examples do we need to see before we change it?

the psychiatric system is routinely used as tool to squash political dissent in many countries where it is not a "profit center"

The "hide" part from the title:

> But there is an important caveat: The government doesn’t publicly divulge the use of antipsychotics given to residents with schizophrenia or two other conditions.

There needs to be judicial punishment for the care workers and higher ups who administered the drugs. Merely sweeping it under the rug is not enough.

It's probably because of cost cutting. If you care for 10 patients in a shift, that's one thing, if you care for 50, that's when bad things happen. The buck stops at the top right?

Is there any doubt that there is an over-consumption of medical products? This is not just limited to nursing homes or mental institutions. The chronic consumption of pain killers, sleeping pills, anti depressants etc is seems endemic to developed countries.

Of course there's the angle of financial incentives, but to me it seems that modern society has chosen the easy path to deal with the health implications of our modern way of life - namely popping pills - instead of taking a hard look at our health problems and working toward long term sustainable solutions, especially for environmental problems.

The current COVID-19 crisis is a case in point. I'll risk being ground to a pulp by the HN community and say that IMO vaccines are one solution but not necessarily the best. To date they have provided neither herd immunity (very hard to reach on a global scale), nor long term protection (look at Israel).

A better solution would be providing a better environment - cleaner air and water, a less stressful life style, and better integration of human habitats with natural ecosystems. We know that the virus kills mostly people with pre existing conditions. A better long term treatment would have been to reduce those pre existing conditions - diabetes, obesity, heart and lung diseases. This can be done through better food, less work, more physical activity, and even more social involvement.

Sadly, modern society demands short term gratification over long term sustainable sobriety.

So in the USA today we have:

1) Both adults working long hours to move up the corporate ladder, neglecting their kids and their elderly parents in order to afford the rent etc.

2) Kids are stuck in public school as a glorified "day care center", and if they fidget or can't sit still they are diagnosed with ADHD and given amphetamines like adderal and ritalin. Boys are diagnosed with ADHD more than girls, for perhaps obvious reasons (https://theconversation.com/why-is-adhd-more-common-in-boys-...)

(However, we can improve this. Finland doesn't have nearly as much ADHD diagnoses, for instance, because the kids are able to have a lot of exercise during the day, rather than only being trained to be corporate drones https://www.bbc.com/news/world-europe-37306818)

3) The elderly, as we can see here, are being drugged also

4) One in four middle aged women is on antidepressants (https://www.theguardian.com/commentisfree/cifamerica/2011/no...)

5) There is an opioid epidemic, primarily among men whose jobs have disappeared (https://www.brookings.edu/policy2020/votervital/how-can-poli...)

The #4 and #5 have gotten worse since 2007, as many men started making less money, but women continue to want to be with men who make more than they do. Single, childless women make more than men, and sometimes choose to have a child and raise them as a single parent. (https://www.wsj.com/articles/SB10001424052748704421104575463...)

We could fix a lot of this by giving people a Universal Basic Income. Then, both men and women would have the power to negotiate shorter workweeks with their employers, spend more time with their children, and take care of their parents – things that are currently not remunerated by the market (although there are some government programs that pay family members for taking care of their own parents). They might contribute to open source software, do science, learn a musical instrument, practice their religion or learn something from a massive online course.

A high enough UBI would also allow us to abolish minimum wage laws, allowing companies to give free internships legally, so teenagers and new entrants can gain skills on the job and become competitive.

Finally, it would reduce the pay gap / penalties that a woman has for choosing to have children, because both parents would be able to afford to work shorter hours.

Rather than teaching women to "lean in" and work 10 hour days like many career-oriented men, we should be teaching both sexes to "lean out" and spend more time with their family. I would argue that women had a better work-life balance than men, until recently. At least during the pandemic, many have learned that they don't have to commute long miles just to sit in a chair. That's already good for the environment and gains people a few hours every day.

Just curious: Has a government project involving throwing trillions of dollars at something ever worked out as intended? It’s a serious question, I’m trying to think of a time it’s easier worked and I can’t.

Interstate highway system?

The Apollo program comes to mind, although I don’t know if that hits the “trillion” mark, even adjusted for inflation.

FYI: for people who don't know what's really going on.

The homes in the US are prescribing unnecessary medication for 3 reasons:

1) To bill for the medication and dose administration.

2) To bill for the skilled nursing staff.

3) To make the resients more docile, reducing caretaking costs.

These perverse economic incentives greatly impact the residents' health.

It's important, especially in the US, for all patients to have an advocate (asking questions and helping to make good decisions) mediating between the patient and provider. Ideally that's a family member.

Besides over-medication risks, there are also lawyers fleecing the elderly out of their assets. It's low-risk to the lawyers because elderly patients die, and what's the family going to do - sue a lawyer?

Source: San Jose Mercury News has had several articles on this over the years.

And yet, these are the "experts"/"doctors" that the Americans trust when it comes to telling them that they need to get vaccinated.

I've never made a phony diagnosis or incorrectly prescribed anti-psychotics in my life or made any medical errors of any kind so clearly I'm perfect. You should trust me when I say that you should get vaccinated.

Sudden infant death syndrome (SIDS), hides high rates of women killing their infant babies. Apparently society is not ready to admit that women are capable of doing this. So this is just a convenient disease to hide it under. Watched a documentary on this many years back on CBC.

SIDS is much more likely if the mother is underage or a smoker.

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