This extraordinary image is from an advert for Clozapine.
Mental illness can unquestionably bring distress – it can be haunting, dislocating and deeply disturbing. But the side effects are often more severe. Drugs like Clozapine are used by the military for torture purposes. Healthy volunteers commit suicide after a few days exposure to them.
Treatment induced problems happen more often than illness induced difficulties. The haunting suggested in the Clozapine advert happens during a relatively brief window when people are on their way into a psychosis, and sometimes on their way out. In mid-psychosis there is often tranquility. But there are vastly more entrances into and exits from drug treatment than entrances into and exits from psychosis, and Clozapine induces a terribly difficult exit syndrome that for many becomes the illness the treatment is used to treat.
This quote from David Foster Wallace is usually taken to refer to psychotic depression. But it applies much more to akathisia than depressive psychosis. Depressive psychoses are vanishingly rare compared to treatment induced akathisia, and of those affected most people with depressive psychoses have a modus vivendi with their paranoia or nihilism.
The mistake that is often made is to make a diagnosis of depressive psychosis in someone who was relatively mildly depressed to begin with who then becomes worse after being put on treatment. It is very common for doctors to then tell the person and their family that it is now clear the condition is a depressive psychosis when it’s not.
Katinka Newman’s The Pill that Steals Lives is an extraordinary example of just this happening.
Treatment induced agitation and psychosis is several hundred times more common than proper depressive psychosis. As with many other prominent suicides, it’s difficult to tell from the outside what happened Wallace. Bruce Springsteen though, featured here some months ago in Born with an Inner Restlessness, looks from his account like a case of treatment induced problems but with the star attributing his problems to his illness.