“Macha”: An Anti-Psychotic Community

"Macha"

Macha had always been unapproachable
Not just by her classmates and peers
but her teachers, her parents
felt powerless to relate with her
she wasn't unfriendly
nor her demeanor unpleasant
She was, simply put, an enigma
impossible to define
impossible to predict
Her style was not normal
nor was it rebellious
Her choice of music was unnerving
Celtic lullabies to death metal
There was no label
nothing relatable
The school counselor was suspicious
any child who didn't get along
didn't communicate
anyone undefinable
unpredictable
wasn't necessarily dangerous
but definately had something wrong
Were the parents abusive?
No cigarette burns to tell
No bruises, no cuts
Nothing at all
She seemed happiest alone, though
and there was crime in that
there were rumors too
of other things
unusual things
that she spoke to empty chairs
giggled at the oddest times
"spaced out" a bit too much in class
smiled at phantoms
and spent three days
walking a dead cat.
How much of this was true
was certainly questionable
She denied everything
As did her best friend
whose pleading was hopeless
considering her lack of substance
When they were alone,
Macha would explain that others
couldn't perceive her
because she wasn't real
but her friend simply couldn't understand
She knew that Macha wasn't crazy.
And only crazy people saw things others didn't
After several tests, Macha was defined.
Predicted.
Labeled.
Schizophrenic.
A single word that meant nothing
yet explained it all
A few weeks in the hospital
and a regular dose of antipsychotics
coupled with antidepressants
to relieve unpleasant side effects
And she should be Perfectly
normal
in no time.

"Macha, Patient 47A"

The binding on her wrists were tight, because they knew she would fight it.
She had dislocated her thumb three times in the past week trying to escape
She went for the gag first every time. It was remarkable.
The binds were as padded as could be without being escapable,
yet somehow, she had managed to make her wrists bleed again
she would make anything she could bleed when she got the chance
they had had to clip her nails uncomfortably short
so she wouldn't attempt to scratch her captors to death
or failing at that, gouge her way into her own throat
Fortunately the medications kept her mouth dry
or they would have had to swab out her spit
to keep her from choking on it.
They had to keep something in her mouth at all times
lest she bite off her own tongue
She was a difficult one to manage
with eyes that glowered with ire and defiance.
It had started with refusal to take meds.
Then institutionalization,
Now this.
Most of the staff refused to be anywhere within her general vicinity.
one member had even offered a letter of resignation.
When it was apparent that her behavior would not cease
They locked in a medicated stupor
tranquilized at the slightest upset
A drugged, unwilling surrender.

Epilogue: Are Antipsychotics Anti-Psychotic?

My purpose in creating the fictional “Macha,” as well as my artistic renditions of the work, is to address the typically unquestioned authority of antipsychotic medication as the first and last solution to mental disorders such as schizophrenia. The use of such drugs as exclusive treatment is a current and growing trend in the United States, and it is my belief that this is primarily due to intolerance or misinformation. Although it may be true that medication is widely accepted in psychiatry as an adequate suppressant of symptoms and is often necessary for the treatment of the most severe and dangerous forms of illness, there is an insurmountable amount of evidence to suggest that it does so at the cost of cognitive improvement, recovery, little permanent benefit, and with devastating long-term side-effects. Therefore, it should only be considered as a temporary solution, and even then, only in the most ominous of circumstances.

I created Macha to be an example of what happens when medication is considered before alternative, less detrimental and more productive methods of treatment have been exhausted. As in Macha's case, there is a high probability that the popularity of medication is due to its instant gratification, a deficiency in information, lack of required effort, and the dearth of tolerance and patience for mental illness. Antipsychotic treatments, as they function currently, aren’t designed for patients so much as for the short-term suppression of the unnerving characteristics of psychosis. The alternative–facing the unsettling nature of this disease, understanding it, and supporting those who experience it– should be the goal of not only patients’ guardians, but their communities, and society as a whole.

There is such an overwhelming amount of evidence and research to suggest that medication is not only an unproductive treatment but a hindrance to recovery, that it is astounding how widely accepted, promoted, prescribed and suggested antipsychotic medication is today. It is so unbelievable, that even as an informed individual backed by a small army of researchers with conclusive evidence to support my current conclusions, I am forced to second guess myself out of sheer lack of acknowledgement. How can so much evidence be ignored by practitioners? Are educators ignoring pertinent data? Are the doctors? Is the prescription of pharmaceuticals more profitable and thus ultimately better received? Whatever the reason, the current status quo among professionals is disregarding this research, and conclusively condemning the majority of uninformed patients to detrimental, unproductive and oft times unnecessary forms of treatment. Since the majority of patients trust and rely on their doctors for information, the current state of affairs is grim indeed.

A common misconception is that medication is required for the recovery of individuals with mental disorders such as schizophrenia. However, schizophrenia reverses naturally in the majority of its victims, and the highest rate of recovery has been observed in non-industrial countries where antipsychotics are not used. A fifteen-year multifollow-up study published by The Journal of Nervous and Mental Disease supports this claim, documenting the extreme disparity in recovery between schizophrenic patients who took antipsychotic medication and those who remained without it. According to their study, at the end of the fifteen-year period, twelve out of sixty-four patients were in a period of recovery. Of the sixty-four, twenty were not on any form of medication and eight of those twenty (fourty percent) were in a state of recovery; two of the thirty-nine patients on antipsychotics (five-percent) were recovering; and two out of five patients on medications but not antipsychotics were recovering. This article is not alone in its conclusion. One need only begin to browse the vast number of references it cites for further evidence. For even more authoritative research backing this conclusion, browse this index of authoritative articles dedicated to the subject.

M.D. Matt Irwin offers an explanation for why this lack of recovery in patients might occur. According to his extensive research, the physiology of people who have been exposed to antipsychotics and other drugs naturally adapt through “alterations in receptor number and function.” This "creates a physiological dependency which reinforces psychological dependency." The current emphasis of psychiatrists on drug treatment might also cause issues of social, psychological and spiritual nature to go unaddressed. A combination of these factors could worsen the outcomes, especially since tolerance of severe adverse effects of antipsychotics among patients is low and many choose not to take them unless forced to do so.

Obviously, the difference in recovery between patients on and off antipsychotic medications is not marginal. Even so, it can not be denied that there are plenty of cases of schizophrenia that are too severe to simply “cope with” and “tough out”. In such situations, antipsychotics might be necessary for short to mid-term therapy but should never be used as a primary or sole form of treatment. This is why anyone with a mental disorder or the guardian of anyone with a mental disorder–be it schizophrenia or otherwise–absolutely must educate themselves on evidence-based, alternative methods of treatment–treatment which offers permanent recovery benefits whether or not the individual requires a term of medication. A method that has been proven effective in multiple cases is cognitive behavior therapy (CBT). This system uses mental techniques such as developing alternative explanations for symptoms, and altering thought processes to “reduce the severity of, or distress from, the symptom regardless of whether the patient accepts a diagnostic label.” One of the greatest advantages of cognitive behavior therapy is that it does not rely on the patient accepting his or her symptoms as a function of a mental illness in order to be effective. In fact, in the United States, American-based guidelines for treatment of schizophrenia such as those issued by the American Psychiatric Association and the schizophrenia patient outcomes research team recommend cognitive behavior therapy for treatment-resistant patients for this very reason. However, it is unfortunate that in the United States only the stubbornly defiant are receiving what the United Kingdom has already accepted as adequate, acceptable and readily available treatment. An article printed in the American Journal of Psychiatry titled “Cognitive Behavior Therapy for Schizophrenia” specifically addresses the lack of cognitive behavior therapy as a primary method of treatment in the United States in comparison to the UK and the severity of this issue due to its empirically researched and supported benefits.

One example of such an examination is an piece studying cognitive behavioral therapy in schizophrenics with command auditory hallucinations, which found that patients undergoing this form of therapy had fewer episodes, complied to auditory hallucinations less, and generally acted in less ways to appease them. Although the hallucinations did not cease, they became less of a hindrance and burden on the lives of patients. Conductors of another, similar study discovered that after one year, patients who had undergone cognitive behavioral therapy, starting at the time of hospitalization and while acutely psychotic, benefited greatly over those who did not receive this therapy. They noted that the benefits extended to both the positive and negative symptoms of schizophrenia as well as overall social interaction.

Even though the severity of schizophrenic symptoms may require temporary treatment with antipsychotics, this represents a minority of cases. Those who wish to undergo such treatment, and guardians who are considering putting their children on antipsychotics should be fully aware of the long-term consequences, increased relapse rates, drug withdrawal symptoms, decreased probability of recovery and side-effects. They should also be relieved of any disillusions that these pharmaceuticals are a completely safe and effective form of treatment, because there is plenty of evidence to suggest otherwise. The greatest offense a guardian, or the community responsible for an individual’s care can commit, is medicating a person with a mental disorder out of sheer convenience. Antipsychotics are quick, easy and deceptively effective at suppressing symptoms, but their aid ends there. In and of themselves they are not, and should not be considered a healthy, productive form of treatment.