Antipsychotic Medication & the Morality of Giving Drugs With Inevitable and Grievously Adverse Side Effects to the Mentally Ill When, By Definition, There is No Possible Method of Obtaining Informed Consent
Antipsychotic medications were originally developed in the 1950’s to treat patients with hallucinations, paranoia, extreme agitation and other symptoms of serious mental illnesses like schizophrenia. (unknown, 2004[i]) The drugs work by blocking the brain’s dopamine receptors in order to reduce disruptive mental processes in the patient. Originally, antipsychotics would put patients into a dull, almost semi-conscious state in which they could understand simple stimuli and respond to them, but weren’t capable of complicated actions or thoughts. This result was ideal for employees at mental institutions, since they didn’t have to deal with the adverse effects of the patients illnesses. Efforts have been made (with mixed success) to synthesize antipsychotic drugs that would allow the user greater intellectual capabilities.
An issue with antipsychotics that has remained relevant over the years is the number and severity of adverse side effects that occur with prolonged use. Since the brain’s dopamine receptors are blocked, dopamine collects in the synapses until the transmission & reception of nerve impulses are affected. Parkinson’s disease has been connected with this buildup of dopamine as well as tardive dyskinesia, a condition that causes constant tics and other involuntary movements. (unknown, 2012[ii]) Side effects of this nature occur in time with all dopamine receptor-blocking medications, even the most modern ones.
It seems as though the use of strong drugs on psychotic patients was pretty much at the discretion of doctors and caretakers at mental facilities at the time these treatments were being developed. Employees of these facilities probably didn’t need prescriptions (at least in the early days of antipsychotics), but if they did the staff doctors could easily write one up and authorize the drug’s use. Apparently the drugs effectively treated anxiety and depressive episodes; not a particularly surprising revelation given how they work. It’s not difficult to imagine situations in which a doctor might give a patient Haldol for a simpler psychological problem than it was intended for, perhaps even for a bad mood, especially considering the historical context & the way in which patients were treated in mental institutions at the time. The side effects of dopamine receptor-blockers weren’t well known about for a significant amount of time after the discovery of the original medications (tardive dyskinesia was “discovered” in the mid 1960’s; by that time Haldol had been mass-produced for seven years) but I doubt the poorly-paid employees of mental institutions back then would have too many qualms about administering it regardless of the long-term effects. In fact, Haldol, Reglan, and many other antipsychotic medications with proven (and inevitable) adverse side effects are still used frequently today. Clearly, the stabilization of the patient’s mental processes in many cases is worth the risk of future disability, and we don’t yet have a less harmful replacement for this treatment.
I have mixed feelings about the use of ancient drugs with hugely adverse side effects; even more so when they’re being given to people who don’t necessarily understand the risk or who aren’t given any choice because their behavior is too difficult to manage otherwise. I recognize that if there was a good alternative we’d be using it, and that antipsychotics in a lot of cases are the only thing preventing mentally ill people from being totally unable to communicate or function in society, but it just feels sort of skin-crawlingly not okay on a moral level to be giving these people drugs that, long-term, will not only make them unable to function properly in society, but will leave them unable to perform simple physical tasks or hold onto objects or really do anything at all aside from sit around sedated in a “home.”
I don’t want to totally disparage all the treatments discussed in Mad In America solely because of historical moral bias (some of them—particularly the Puritans’ moral treatment—were quite good), but I think it’s important to keep in mind that doctors and psychiatrists at the cutting edge of technology have used scientific reasoning to justify torturing and permanently damaging the minds and bodies of the mentally ill for a few hundred years, and it would be enormously presumptuous to assume that our science today is somehow far enough above our science from a couple centuries ago that we no longer have to be vigilant about the well-being of patients undergoing potentially harmful treatment. I try to imagine a future society looking back at the reasoning behind the techniques we used to treat mental illness, and judge from that perspective (under the assumption that the treatment was at some point replaced by a better one) whether or not our methods were justifiable. It’s easy to say that the negative effects of a particular treatment are unacceptable when you haven’t seen the patient’s psychotic episodes pre-medication, and I haven’t. I hypothesize that once our antipsychotic medicines are replaced with drugs or treatments that work better and cause less harm to the patients, the side effects of drugs like quetiapine (Syquel) and haloperidol (Haldol) will be viewed as necessary evils in most cases. The exceptions, of course, are the cases in which medication with extreme detrimental side effects were administered without informed consent (or any consent) to patients who weren’t having severe psychosis and therefore could have been treated with less drastic measures. Most antipsychotics have few noticeable short-term effects aside from the desired ones (which essentially amount to conscious sedation), and that makes the possibility of a doctor or aide obliviously giving powerful drugs to patients with less severe symptoms kind of worrisome, although the number of licensed doctors unnecessarily administering what we now know are potentially lethal drugs was probably a great deal worse before the medical community fully realized the long-term danger.
One of the perceptions I’ve had to edit over the course of this class was the idea that there’s some sort of symptom→diagnosis→treatment master formula for psychologists that ensures that each patient receives appropriate, standardized treatment. There are certainly guidelines that health professionals use to prescribe proper treatment, but the interpretation of a patient’s symptoms and the chosen course of action depend pretty heavily on the doctor’s opinion and personal (maybe even anecdotal) experience. This is especially true of psychologists; even today we really only have a rudimentary understanding of why people develop mental illnesses and what types of medicine or therapy will be the most helpful. I’ve heard the expression “trial and error” used a disturbing number of times with regard to prescribing dangerous drugs to the mentally ill. Unfortunately, there’s no way to be totally sure about which approaches will be helpful and which will not. We can only use what we’ve learned so far, and hope that someday we’ll know better.
[i] “Antipsychotic Medications.” MedicineNet. N.p., 18 Feb. 2004. Web. 25 Mar. 2014.
[ii] “Tardive Dyskinesia Introduction & Overview.” Tardive Dyskinesia & Reglan. The Peterson Firm, 3 Jan. 2012. Web. 26 Mar. 2014.