6.3 Neuroleptic Treatment

Neuroleptic drugs are the treatment of first choice for schizophrenia.[20] They are alternatively known as major tranquillisers and antipsychotics.

The first commercially developed neuroleptic, chlorpromazine, was synthesised by French scientists in 1950 while they were attempting to develop an antihistamine.[21] Chlorpromazine was originally tried as an anaesthetic potentiator but proved to be ineffectual. It was then used as an antiemetic, but once again it was found to be not commercially useful, until an experiment was carried out in 1953 on ‘about 100 psychiatric patients and it was declared to be an effective antipsychotic’.[22] Thereafter it proved to be one of the most profitable drugs in pharmaceutical history.

This new drug was found to be highly sedating. One of the early French pioneers of its usage, a physician named Laborit, found it was very useful in calming anxious surgery patients. He noted of his patients that ‘There is not any loss of consciousness, not any change in the patient’s mentality, but a slight tendency to sleep and above all a disinterest [sic] in what goes on around him.’[23]

By targeting the dopamine neurotransmitter system of the brain, neuroleptics reduce the circulation of dopamine. Along with this reduction of dopamine, certain kinds of brain functions that depend on dopamine are also reduced. Some parts of the brain learn to compensate: ‘Following neuroleptic blockade of A9 neurons, post-synaptic dopamine receptor targets in the striatum undergo a compensatory increase in both numbers of dopamine receptors and their sensitivity. This dopamine supersensitivity or hyper-reactivity in the striatum causes tardive dyskinesia.’[24]

Tardive dyskinesia is one of a number of serious side-effects characterised by movement disorders which are associated with the use of neuroleptics. Once the dopamine supersensitivity has been established in this part of the brain, the movement disorders sometimes continue to get worse, and often remain permanently, even when treatment is discontinued. But it seems that other centres of the brain, which are also dependent on dopamine for proper functioning, and which regulate many of the higher emotional and mental activities, fail to make a similar compensatory adjustment by becoming supersensitive to dopamine. The result is that these higher mental centres close down, and this is why neuroleptic treatment has been referred to as a ‘chemical lobotomy’.

Neuroleptics have their main impact by blunting the highest functions of the brain in the frontal lobes and the closely connected basal ganglia. They can also impair the reticular activating or ‘energising’ system of the brain. These impairments result in relative degrees of apathy, indifference, emotional blandness, conformity, and submissiveness, as well as a reduction in all verbalisations, including complaints and protests. It is no exaggeration to call this effect a chemical lobotomy.[25]

In relation to the question of Article-18 rights, it is apparent that psychiatrists have prior knowledge that the thoughts and beliefs of their patients might be disrupted by neuroleptic treatment. However, there seems to be considerable divergence of opinion as to whether this disruption of thoughts will be beneficial to patients.

A recent text describes the psychiatric intention as benefiting the patient through ‘Alterations in thought. Antipsychotic drugs improve reasoning, decrease ambivalence, and decrease delusions … Antipsychotic drugs are effective in decreasing confusion and clouding … hallucinations and illusions are reduced’.[26]

Some of these intended effects, such as the claim that the drugs ‘improve reasoning’, have to be treated with a certain amount of scepticism. ‘Improved reasoning’ is probably best interpreted as a euphemism for the fact that the patient’s thinking has fallen more into line with the will of the psychiatrist administering the treatment.

But even if submission to the will of psychiatrists can be seen as leading to a beneficial outcome for the patient, neuroleptic treatment does not always go according to plan. The small print in an advertisement for the frequently prescribed neuroleptic Haldol,[27] for instance, warns of possible adverse reactions that are the opposite of those intended. Some of the possible effects are, ‘insomnia, restlessness, anxiety, euphoria, agitation, drowsiness, depression, lethargy, headache, confusion, vertigo, grand mal seizures, and exacerbation of psychotic symptoms including hallucinations and catatonic-like behaviour states which may be responsive to drug withdrawal’.[28] In addition to these possible reactions recognised by the manufacturer, researchers have also ‘found in a controlled study that some patients have a marked increase in violence when treated with moderately high-dose haloperidol’.[29]

This paradoxical admission by a manufacturer that neuroleptics might actually exacerbate psychotic symptoms, rather than ameliorate them, does not weaken an Article-18 case against the drugs. On the contrary, regardless of whether a treatment diminishes or distorts a person’s thinking processes it still interferes with the person’s right to freedom in thought and belief.

In a recent book, a British psychiatrist related how he had participated in an experiment that required him to take a 5 mg dose of haloperidol, a normal daily dose prescribed for adults with schizophrenia. The experiment was intended to test the effect of the drug on attention and concentration, and required him to sit in front of a computer screen and perform simple tasks.

After an hour I felt terrible. The last thing I wanted to be doing was to be seated in front of that computer. Although I did not feel suicidal, I felt restless inside, as if I could not settle. On several occasions I had to get up and walk around. If I had not done so I don’t know what would have happened. On two or three occasions I came close to putting my fist through the screen, because I was so intensely frustrated and bored with what was going on. This sensation was a real physical sensation located somewhere in the pit of my stomach. I felt irritated by everything that was going on at the time. The feeling persisted well into the next day, to the extent that I found it difficult to concentrate at work.[30]

Another psychiatrist who deliberately took a small dose of the commonly prescribed neuroleptic Thorazine (chlorpromazine), in order to find out what it was like, wrote a description of the experience: ‘I felt overwhelmed by the blahs. I felt tired and lethargic, motivated to do nothing. My thinking was turned down from 78 to 16 rpms, my mouth got dry and I just didn’t care all that much about anything’. He went on to describe the effects he had witnessed of neuroleptics on mental patients in hospitals:

Thinking is slowed down—and at high enough doses ‘dissolved’—so that so-called ‘crazy’ or ‘delusional’ thinking is prevented (along with other kinds of thinking—including creative thinking). Emotions are blunted, pushed down. The result is some degree of (often total) indifference and apathy. Sterile, zombie-like personalities result when indifference is combined with the drug’s sedating effects. The sparkle, vitality and exuberance of an alive human being are cut off by these drugs.[31]

Surveys of patient attitudes towards neuroleptics have found that the drugs are almost universally disliked by the people who take them. Confirmation of this is to be found in the fact that unlike most other mind-altering drugs there is no black market for neuroleptics. One patient described the experience of enforced treatment with neuroleptics: ‘They knock you out. They cause aches and pains all through your body. They make you apathetic. They stop the whole spiritual transformation process. It’s like putting molasses in your brain. You can’t even concentrate enough to read.’[32]

Another patient treated involuntarily with Thorazine said:

The drugs caused me all kinds of problems. I couldn’t see. I couldn’t read my music or see across the room. I thought my eyes were going bad. The subjective feeling is actually one of disturbance. It’s important for people to know that it’s not a tranquillising effect at all. What you feel is a sense of inner turmoil. Viewed from the outside you might look less agitated because you’re not going to make much noise or show your spirit. I had difficulty thinking. I remember once trying to make a list of books I needed from class and not being able to finish the list. I had difficulty moving my tongue which I really resent because I still have residual effects today.[33]

These testimonies make it clear that when people are alleged to have schizophrenia, and are given forced drug treatment, their Article-18 rights to the freedom of thought, conscience and belief are violated. As if this isn't bad enough. On top of this there is also the likelihood of permanent brain damage as a side-effect. When this possibility is combined with the argument that so-called treatment is actually a ‘chemical restraint’, and is administered for the benefit of others rather than the patient, it becomes apparent that psychiatric treatment for schizophrenia also harms a person’s Article-12 (ICESCR) right 'to the enjoyment of the highest attainable standard of physical and mental health'.[34] The irony here is that Article 12 is supposed to provide the medical model with the basis for the 'right to treatment'. The 'right to treatment', in turn, provides the twisted logic that is supposed to justify psychiatric coercion.

From a human rights point of view it is clear that forced psychiatric treatment of people undergoing spiritual/mystical emergency is unequivocally wrong. However, these are not the only people whose human rights are abused by psychiatric labelling and forced treatment for schizophrenia. Many people experience this abuse when their real problems have more to do with their social relationships than with their minds.

[20] David Cohen and Michael McCubbin, ‘The Political Economy of Tardive Dyskinesia: Asymmetries in Power and Responsibility’, p. 472.

[21] Norman L. Keltner et al., Psychiatric Nursing, p. 227.

[22] Thomas Szasz, Cruel Compassion: psychiatric control of society’s unwanted, p. 167.

[23] F. J. Ayds, ‘The Early History of Modern Psychopharmacology’, quoted in Keltner et al., op. cit., p. 227.

[24] Peter Breggin, ‘Brain Damage, Dementia and Persistent Cognitive Dysfunction Associated With Neuroleptic Drugs: evidence, aetiology, implications’, p. 445.

[25] Peter Breggin and David Cohen, Your Drug May Be Your Problem, p. 77.

[26] Keltner et al., op. cit., p. 233.

[27] Haloperidol is the generic name; Haldol is a brand name for the same drug.

[28] Haldol Decanoate advertisement, Archives of General Psychiatry, August 1995.

[29] J. N. Herrera, ‘High Potency Neuroleptics and Violence in Schizophrenics’, pp. 558–61.

[30] Phillip Thomas, The Dialectics of Schizophrenia, pp. 111–12.

[31] David Richman, ‘Pursuing Psychiatric Pill Pushers’, in Sherry Hirsch et al., eds., Madness Network News Reader, p. 113.

[32] Seth Farber, Madness, Heresy, and the Rumor of Angels, p. 90.

[33] Ibid., p. 105.

[34] United Nations, ‘International Covenant on Economic, Social and Cultural Rights’, Article 12 (1), reproduced in Satish Chandra, ed., op. cit., p. 16.