Editorial Note: This is the first of a two-part post by a father and daughter who want to remain anonymous for fear of reprisals – a very real and realistic fear.
This is about how my daughter was “led away” (the literal meaning of abduction), in a cruel and calculated act undertaken by people to whom her mother and I had ill-advisedly, and to our eternal regret, trusted to know what to do for the benefit of her health and safety.
My daughter was twenty three when a locum G.P. recommended an SSRI for anxiety related to a new temporary job over Christmas.
Her reluctance to accept medication was overcome by this doctor with the words – “if I were you I would take them”.
I was unaware that she had been given a so-called antidepressant and would have been profoundly ignorant of its wide repertoire of terrifying adverse effects. She was not then, nor ever has been depressed.
We noticed a fine finger – hand tremor, and nausea with occasional vomiting. Her mother became aware of urgency to void urine with no features to suggest urinary infection. Trusting pretty much all doctors from her lifetime in a medical family, my daughter carried on taking this SSRI.
A few months later, she was preparing very effectively for a fifth and final GCSE which her tutor had previously believed she would pass comfortably. It was the gateway to her aspirations to develop her future.
Had she not been pharmacologically kidnapped she would certainly have passed, continued to train and run half-marathons for charity and perhaps develop her highly regarded voluntary work for elderly blind people into a caring and committed career pathway.
In passing, I had mentioned to her that sometimes brief use of beta-blocking drugs can ease the racing heart beat and intense fears that are part of everyone’s exam experiences, but which in some are profoundly distressing. She went back and saw another G.P. who diligently noted a case reference to asthma so she couldn’t have a beta-blocker apparently. Instead, this G.P. switched her from one SSRI to another.
We then noticed our daughter becoming intensely agitated and distressed. I went with her to see a third GP, very alarmed at her deterioration.
Although I had been a physician for over thirty years, I was totally unaware of akathisia and its link with suicide and violence.
I had never heard this critically important medical word and I guess, neither had this GP. He recommended changing to another SSRI, which he described as “gentle”. He also made an unnecessary, and catastrophic referral to psychiatry.
I trusted him. Compliance was absolute. The akathisia intensified dramatically. It was impossible for my daughter to be still. She was writhing rather than restless with a dramatic increase in muscle tone. She was tormented by an inner pain and suffering which made her tear at her skin and constantly pluck out hair, eyebrows and eye lashes. How could I have failed to realize this was an adverse drug reaction?
She stopped eating and drinking fluids. The akathisia was too intense. She lost weight. She became extremely dehydrated and I feared that sooner rather than later acute kidney injury looked inevitable. All was dominated by the intensity of her agitation and overwhelming inability to be still.
The psychiatrist when we saw him dismissed my assessment contemptuously. We were astonished by his obvious intention to avoid and ignore any family information regarding how very fit, active and normal she had been immediately prior to this acute situation.
His demeanor during what little we saw of this consultation demonstrated his determination to exclude parental input. After leading our daughter away, he returned with a diagnosis of “psychotic depression” and at last chose to speak at us.
Coercion is the black art of persuading an unwilling person to do something by force or threat.
My desperation to have my daughter’s fluid balance restored and pronouncements of words which we misinterpreted as intention to care and restore to health led us to fearfully accept the advice for voluntary admission to hospital. They led her away from us in their car, asking my wife to collect her pyjamas and toilet bag from home.
It was just before Christmas. By the time my wife arrived at the hospital, they had sectioned her. There was a brutality and palpable abuse of overwhelming power. An entire family and a very physically ill young woman were about to be devastated and damaged irretrievably.
Had intra-venous fluids been promptly established to eliminate the diagnostic confusion caused by dehydration, the picture would have been very much clearer. Had even a low dose of diazepam been given with careful bedside assessment of her rapid re-orientation and restored clarity of thinking, then the correct diagnosis of SSRI induced akathisia would have been clinically self evident.
The catalogue of errors continued. Fluoxetine (Prozac) and Olanzapine (Zyprexa) exacerbated her akathisia which in turn exacerbated the dehydration and thus the confusion. She was too akathisic to eat anything. Further weight was lost. Very frightened, I checked a “dip-stick” analysis of a small, coconut brown urine myself. They caught me in the act and the well rehearsed and swiftly exercised regime for “outing” pushy parents commenced. Inevitably, indicators of ultra-concentration by the kidneys to save her body fluids went off the scale and her ketones had maxed, indicating starvation and the body metabolizing her own tissues.
Too ill to try to eat or drink, she was documented to be demonstrating “manipulative behavior”, an excuse for vicious contempt, and ridicule. I had never seen “nursing” like this.
We used visiting times to try to provide intensive nursing ourselves. We “pushed fluids” with little sips, holding her upright and supporting her to eat tiny pieces of chocolate. We couldn’t take her home where her survival chances would have been so much greater.
Over an extended detention, the failure of “treatment” seemed to frustrate and anger the staff.
The disordered neurochemistry caused by the enforced drugging induces compensatory adjustment towards original equilibrium. This is “read” by the staff as confirmation that their “treatment” is finally of benefit, even though from the fifth day she had developed features of increasing and potentially irreversible tardive dyskinesia. We were assured – “It doesn’t happen on Olanzapine”.
Day release, sleep overs, begging pleading and despair finally resulted in the person we called our daughter, now profoundly damaged and permanently traumatized, being returned to us.
We asked for a second opinion, a request laughed at by her tormentors.
I had seen a fair amount of organic brain disease in my own work and was convinced that this had not been a classical, or even convincing presentation of serious mental illness. It was undoubtedly serious but no-one would consider a differential diagnosis. Why couldn’t they consider asking themselves: – “what if we’re wrong”?
This question must be one of the commonest thoughts permeating my own decades of clinical experience.
I requested brain imaging. Irrelevant, I was told – just like the features of tardive dyskinesia. They were going to keep her on Olanzapine “for at least a year”.
I wrote to a distant teaching hospital professor of psychiatry. We travelled a long way and he consulted and reported: – “well she’s not psychotic now” and she was returned with a recommendation for Citalopram, 40 mg per day. Much of what he had seen was Fluoxetine and Olanzapine withdrawal syndrome, about which we were all completely ignorant. We desperately wanted to save her from the dribbling gargoyle-like facial destruction of tardive dyskinesia. She had ceased all tablets with no taper. We had now inadvertently added powerfully to her suffering and torment ourselves.
We moved her to live over two hundred miles away in a different part of the UK. Once again, all drugs had ceased due to intolerable side effects.
The GP taking over her care listened, agreed, reflected on experience of variant CJD. We had seen this “mad cow disease” and he requested brain imaging. No evidence of brain malignancy could be identified.
All these years of physical and chemical kidnapping had destroyed her dreams hopes aspirations and all life’s chances and opportunities. Hopes for her future had been callously and arrogantly destroyed because routine SSRI believers and prescribers have been denied the opportunity to learn to recognise, diagnose and alleviate akathisia.
What a triumph of the power of marketing over medicine.
She was now referred to the care of a recommended member of the district psychiatry establishment.
This new psychiatrist had an unusual opening to each consultation.
“Hello”. “We have the power, but let’s hope we won’t need it”.
My daughter was assessed while suffering an extensive withdrawal syndrome. I lacked the experience and knowledge to appreciate this vital circumstance. To him, it was not worthy of consideration.
Explaining that Mirtazapine would help restore weight, there followed a classical challenge – de-challenge-re-challenge scenario with Mirtazapine as the re-challenge.
She immediately became profoundly agitated, started pulling her hair out, then eye lashes and eyebrows. Had the re-challenge been with Citalopram, paradoxically, she may have improved due to alleviation of withdrawal syndrome via re-introducing the withdrawn agent.
This recreated adverse drug reaction was a diagnostic opportunity of great advantage to these prescribers as it proved that they were right. She was mad and getting madder. Her father was obviously “a doctor in denial” who had to decide whether he was going to be “a father or a doctor”.
Hard to be a father when they were ignoring very severe drug induced brain injuries and when I was now the front runner as the causative factor in their ever unfolding diagnostic fantasies.
She continued to deteriorate. Her evenings with me were painfully and unforgettably punctuated with her loud wails of despair as her memory was now being destroyed. “How can I live without a memory Dad”.
Just as before, their anger and frustration caused by their therapeutic failure was hard for them to suppress. The standard modus operandi of mainstream psychiatry when confronting failure after failure of their treatment plans is to blame the patient. Pompous pronouncements of treatment resistance prop up their bruised egos.
This cruelty is typical of psychiatry’s ability to disassociate itself from the unimaginable suffering enforced upon those it professes to help.
Continued in Part 2.