Thursday, October 3, 2013

Voices from my files

I have a file in Microsoft Outlook where I keep all the stuff related to my correspondence with Chris's doctors, going back to 2003 when Chris was hospitalized at CAMH in Toronto, and continuing on through the two year day program he was enrolled in from 2004 to 2006, until the present. This time span allows a glimpse into how biological psychiatry was carried out in hospitals, with its constantly changing medications and dosages, its reliance on E. Fuller Torrey as THE schizophrenia expert, and its lack of constructive engagement of the family, to outline just a few of its problems. We are perhaps looking back on the beginning of the end of psychiatry as we knew it. Even within the time span cited, I have seen changes for the better taking place as the  tenets of biological psychiatry at all costs have been challenged. I like the way Eleanor Longden put in in her recent exchange with  psychiatrist  Allen Frances.

What I endured so disastrously was the application of a reductionistic biomedical model that is practised in numerous hospitals in the Western world. Voice-hearing was seen as a meaningless symptom of disease - leading to coercive, over-zealous prescription practices, the privileging of biology over psychosocial circumstances, and the overstating of medication's effectiveness whilst minimizing both its limitations, and the hazards of long-term use.

Over my next few posts, I'll be dredging up some of the e-mail exchanges I have had with Chris's doctors. Here are some messages from them dating from his time at CAMH, a time where I knew very little about what was happening to Chris, and when my husband and I just took what the doctor said at face value. I have the luxury of going  back and putting in my own comments (see footnotes)  based on what I have learned in the intervening years.

Dec./Jan./Feb. 2003/4 (3 month hospitalization)

CAMH doctor
The usual therapeutic range of dosages of Risperidone is between 4 and 6mg per day, although some people may respond to even higher doses. Chris is currently at 4mg, the lower end of that range. He had a good response to a lower dose of the medication, but his response has plateaued and currently is actually not doing as well as he was even a week ago.  Given our observations and his reported thoughts and perceptions, there is very little question in my mind as to the diagnosis of Schizophrenia.  [forbes1] 

CAMH doctor
Chris has identified a number of religious and existential themes
recently, and I also believe that he may benefit from speaking to someone about these issues [forbes2] . I know that he has shared a strong relationship with Father Strand in the past, and we have asked him if he would like for us to request that he visit Chris.  We will endeavour to make these arrangements for him according to his wishes.

CAMH doctor
During this period of recovery, as a family, to best support Chris it is important to become familiar with the illness and also the existing treatments [forbes3] and the vistas for new strategies in the future.  Some the books that I have found helpful are Surviving Schizophrenia by E. Fuller Torrey [forbes4]  as well as Living and Working With Schizophrenia by Thornton, Jefferies and Seeman.

About halfway through his stay at CAMH, after withdrawing his application for the Review Board, withdrawing from his university, and having narrowly avoided electroshock treatment because he stopped eating, Chris’s doctor writes:

With the increased clarity of his thoughts, Chris is also reporting that he is feeling depressed with poor appetite, energy and decreased enjoyment in life.  The magnitude of the thoughts and feelings that he describing and his clinical presentation at this time, is suggestive of a Major Depressive Episode.  It is unclear what the relative contributions of his depression and psychosis to his overall clinical presentation at this time. Depression can occur with psychosis and the depression is treatable with the addition of medication [forbes5] to target his mood, energy and appetite symptoms. With your consent, we propose to add Venlafaxine (also known as Effexor XR) in addition to his existing Risperidone, at a dose of 37.5 mg once a day.  The usual target range is from 75mg to 300mg once a day.  We anticipate that we would start to see a response in his depressive symptoms within 3-4 weeks of starting the medication.  The typical side-effects include nausea, insomnia and perhaps restlessness, which are usually time limited (less than 1 week) and responsive to alteration in the dosing strategy e.g. with food, morning vs evening dosing.

Medication to "treat" the illness to date: Risperidone, Effexor

 [forbes1]Diagnosis based on what the doctor thinks is going on in someone else's head. Not very scientifically rigorous.

 [forbes2]Logically, shouldnt that person be you or another psychiatrist?

 [forbes3]The best way to support someone as a family is to see the illness?

 [forbes4]Thats about all that was available in 2003. 
[forbes5]Just meds? No thoughts of actually empathically  listening to Chris?

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