Hacker News Reader

I'm sorry your friend went through all of that. I've had friends and immediate family in similar situations. It's a genuinely impossible situation to navigate.

Sometimes these situations turn out tragically because the patient was involuntarily given drugs, sometimes they turn out tragically because the patient wasn't.

I'm surprised they went with a time release injection -- from the sounds of it, when you say "time release" you mean on the order of 30-90 days, not "12 hours". I'd have expected them to just work on stabilization and then moving to an outpatient program. I'm very surprised they'd have used it without any history of it being effective.

In a more recent tale with a family member undergoing an involuntary stay, I'd have wished they'd used a longer term haloperidol injection.

There's not a one size fits all solution, and it's hard to balance legislation around personal freedoms vs recognizing when the patient is a harm to themselves/others, or even capable of making informed rationale decisions.

> My observation is that agony-inducing drugs are not actually helpful for substance abuse.

Haloperidol isn't for substance abuse, so I wouldn't expect it to perform well at it.

She'd made a deal with the devil: they agreed to release her from their September 2015 pursuit of an order for involuntary treatment if she agreed to take haloperidol voluntarily. We picked up the prescription, but she resumed drinking the day she was released. Her alcohol consumption got progressively worse, but I had no authority to intervene. After a week+ I took her liquor bottle away anyways, even though I did not have legal authority to do this. 10 hours later I witnessed full-on alcohol withdrawal psychosis.

When she got captured again, their thinking was "she's obviously back here because she didn't take her haloperidol". They never asked me about her alcohol consumption.

Whitaker's book points out that the Quakers' asylums fed people 4 meals a day and provided activities. iirc around 80% of the patients recovered to the point where they could leave the asylum. Think that was covered in Mad In America.

The psychotic patients who do the best, long term, are those who are never treated with antipsychotics. Those who do second best are those who are tapered off antipsychotics promptly. Those who do the worst are those who are maintained on antipsychotics in perpetuity.

That sounds like a horrible experience, and I hope you friend is being treated better now.

To be charitable and more specific, If you are stable enough there's nothing technically stopping you from not taking prescribed medication and self medicating - as long as you remain stable enough to not warrant involuntary treatment. The obvious risk is if your prescribed medication (or a combination of prescribed and self prescribed medication) is making an impact, you could get worse.

From this comment it sounds like there's a lot you're leaving out of this story, but I'd like like be caucious of making generalising statements from specific personally related scenarios.

> From this comment it sounds like there's a lot you're leaving out of this story

There's more than can be covered in a little comment.

I have the psychiatrists' September 2015 affidavits, filed in support of their petition for involuntary treatment. They say, essentially, "patient expects us to believe she was psychotic because she was drinking 2 bottles of liquor a day, and using cocaine. We know this is not the case because we previously got her 'stabilized' in 2008 and 2010 on haloperidol. She obviously does not appreciate that she is broken and requires anti-psychotics for the rest of her life."

My videos from August 2015 prove that she was actually fine before she ran out of alcohol, and that whatever deterioration the doctors think they're treating is entirely caused by palliative psychiatric drugs.

> All the anti-dopamine drugs are terrible. Some of the second-generation drugs that are forced on people are much worse than plain old haloperidol. The poor doctors are just implementing their training. Tragic.

Haloperidol has one of the highest rates of side-effects[1], like permanent movement disorders, in its class, and it is neurotoxic[2]. Movement disorders like tardive dyskinesia don't seem like a good time.

Second generation antipsychotics typically have lower affinities for dopamine receptors compared to older drugs, thus lowering the severity of side-effects associated with dopamine blockade. They have much lower risks of causing movement disorders. They also bind to dopamine receptors differently than the strongly antagonist first generation antipsychotics. Some of them are partial agonists, inverse agonists, and full agonists with lower affinities at dopamine receptors, so they have less "anti-dopamine" activity than haloperidol and older antipsychotics do.

I agree with you that these drugs have terrible side-effects, but I'd argue that being loaded with haloperidol is one of the worse options to be treated with when it comes to bad side-effects. There's immediate release inectable versions of olanzapine, ziprasidone and clozapine, all second generation antipsychotics, but I suspect they cost more than haloperidol.

[1] https://pubmed.ncbi.nlm.nih.gov/23810019

[2] https://pubmed.ncbi.nlm.nih.gov/28738100

My friend says she's 'allergic' to olanzapine (Zyprexa). I think it turned her into a zombie?

I think aripiprazole (Abilify) is the least-bad of the antipsychotics. None of them work when the psychosis is actually caused by malnutrition, cocaine, meth amphetamine, or alcohol.

Injection of these drugs is a form of violence.

Agree with you on the form of violence thing. Antipsychotics actually work well when it comes to relieving symptoms of stimulant psychosis, and the earlier stimulant psychosis is treated, the less likely it is to become a permanent psychotic disorder.