Antipsych drugs

Antipsychotic Drugs:

You probably read this article, and perhaps the reader comments, at Dr. Helen's place. The article posits that antipsychotic drugs should be regarded as releasing the "real" person from within a person suffering from a psychosis. The authors object stridently to the notion that these drugs are "mind-altering," although the drugs clearly do alter the mind. They want us to reframe our understanding of the drugs as being, in effect, "mind-releasing."

My disdain for psychology knows no bounds, but medical psychaitry is another story. It is almost an actual science, as it demonstrates testable, replicable results, and operates, in its smaller claims, on the null hypothesis. Its larger claims -- the overriding models of the mind -- are not truly falsifiable with empircal tests, which is why I don't consider it to be a true science. However, it is a far, far better case than psychology, which seems finally to be a form of magical healing (somewhat like consuming powdered rhino horn in your tea).

That said, this study raises several questions for me. I suppose today I'm feeling like making lists, as here is another.

1) Some of Dr. Helen's commenters note that courts have required people to take antipsychotic drugs before trials hinging on an insanity defense. If we are to regard the drugs as releasing the "real" person, does that mean that the "real" person is not guilty for crimes they committed while not on such medicines? If not, why not?

The study seems to make an excellent case that -- through impaired attention and "executive function" cognition -- there really is a 'different person' here. Should these drugs then serve as an alternative to punishment -- the destruction of the "person" who committed the crimes, while leaving the new "person" free to go about a new life?

2) If the person is only "real" while on the drugs, can anyone refuse these drugs? In other words, if society objects to your personality, can it require you to take drugs to alter it? If you're not "really you" off the drugs, then presumably you have no right to object to what is done to the "real you." Only the "real you" could refuse the drugs, and he isn't here.

If case (1) is decided in favor of the study's ideas, it seems to me that case (2) becomes pressing. If we have to set people free who commit crimes while not on medications, surely then it becomes a pressing social need to make sure that everyone, everyone at all, is on his proper cocktail. Otherwise, they go free for whatever they did while off the pharm.

3) By the same token, can a person on the drugs opt to go off them at all? Is that a free choice that society would have to accept, or is it a form of banned self destruction -- like suicide? Does it not endanger society, by allowing them to take advantage of the 'get out of jail free' card posited in case (1)?

If we chose to accept the choice, how long would it be valid? After a certain period, when the last of the drugs was out of your system, wouldn't we be back in case (2)?

4) Dr. Helen says out that you probably wouldn't refuse treatment for diabetes, and so asks 'Why would you refuse it for (mental illness X)?' There are two objections to that analogy, however:

a) Diabetes is a case in which the body is not self-sustaining. Many things classified as "mental illnesses" are unpleasant, but will not result in a predictable decline and death. The analogy is not valid, for that reason. What is classified as a "mental illness" is not clearly an "illness" in the same way that diabetes is -- it's just a state that many people find undesirable.

b) Even if the analogy were valid, if one had a desire to refuse treatment for diabetes -- for whatever reason -- one would be free to do so. Precisely because these states are defined as illnesses affecting the judgment, however, it is not clear that the study's suggested understanding would leave room for refusal of treatment. For the reasons noted above, we risk creating another situation in which the judgment of society is placed above individual liberty. Surely we have enough such socialism already!

c) If point (b) is decided in the favor of the state, however, what guarantee do we have that the definition of "illness" won't be expanded? We've seen any number of attempts to define political or sexual leanings as pathologies. Given the unscientific nature of the fundamental models of both psychology and psychiatry, how can we trust them to define what we are "really" like? How can we trust them to say, "There -- this is the combination of drugs that makes you normal"?

Overall, I wonder if the greater good isn't in retaining the clear and traditional understanding. "Mind altering" drugs alter the mind. They make it into something that it wasn't naturally.

We may prefer that something -- many people prefer to alter other natural qualities, as for example their eyesight. This is a personal choice, though, which ought to be respected.

I realize that there are some people who would be happier if they were drugged, but are not capable of realizing it in their natural state. It may be that we, by refusing to adopt this new understanding, doom them to lives of misery when they could have been cheerfully altered.

Surely that is the lesser evil, though, to giving the state the power to define how we "ought to be" -- to say what is normal for you, or for me. With all respect to those people who may live worse lives because we don't adopt this proposed new understanding, I can't see my way clear to it.

I simply lack the trust, both in the government and in the academic disciplines involved, to ceed that kind of control. I'm not willing to accept their right to judge who is, and is not, "normal" -- or, worse, to judge what sort of alterations are necessary and required to make you "normal." Accepting this study and its judgments would require those concessions.

UPDATE: On reflection, I think I should add that the study doesn't advocate a lot of the things I discuss here. It's recommendations seem to be limited to this: adopt the understanding that antipsychotic drugs release the real person, and administer those drugs before a person is tried in court, because it's important that the person's mind be clear if they are to be competent in their defense.

I don't see how you can take that step, without taking the others -- not as a slippery slope "what comes next," but because those other issues seem to flow naturally from the principle being established. However, to be fair to the study, it should be clear they don't consider these questions.