Public Comment

The "placebo effect" is classically known among most doctors to potentially make an ill patient well. The placebo effect is not fully understood. It might consist of a sugar pill, a completely inert pill, given as though a medicine; yet it can and often does make many patients feel better! 

In scientific trials of drugs, placebos are routinely given to a "control group." The "control," in pharmacology, allows the scientists to filter out the acknowledged placebo effect. Studies are done labeled as "double-blind studies" meaning the persons administering the medicine or giving the placebo are not told whether they're giving the "real thing" versus the "fake" or inert pill. Those in both the "test" group and the control group are subject to the same conditions, as close as the scientists can get it. 

It is considered unethical to give placebos and lie to the patient about it. The patient should be informed that she/he is in a study and might be getting a placebo. I certainly would want to be told and wouldn't want to be lied to about what I'm getting. According to all sources I've reviewed, doctors do not lie to the patients, and if you're getting a shot or pill, you can assume it is the real deal. 

In modern psychiatry, I've read one paper that said doctors are unhappy about the increasing efficacy of placebos in treating mental illnesses. Doctors might feel slighted. It seems this is remotely akin to slipping decaf to someone who is a hardcore caffeine addict and doesn't want their caffeine to be faked. Doctors make their living on treating sick people. If the much-loved psychiatric drug is upstaged by a sugar pill, this seems to be upsetting to some doctors. 

When we take an antipsychotic, we get more than a mind-altering substance. We get an idea that something is wrong with the brain, and we are taking an action to remediate it. This could be more profound than you might think. You have adopted a "postulate" that tells you an error needs to be addressed. This can have a wide-ranging effect on thoughts. We have conceded we are subject to an error in thought. We are taking steps to correct it. 

In that case, why is it so difficult to convince many psychotic people that they should be taking their medication? 

There are a number of reasons for this. Antipsychotics often cause physical, mental and emotional suffering. Antipsychotics are almost like a chemical straitjacket. You can't move normally. Even brushing your teeth can become arduous. Your thinking is vastly limited. Even though being psychotic takes you away from truth, antipsychotics impede the flow of thoughts. It is hard to think and even to read a book on antipsychotics if you compare the medicated person versus the younger person a year before the psychosis got really bad. Antipsychotics cause depression. It is very hard to be happy on antipsychotics. Antipsychotics can be hell to take. No wonder patients don't like them. 

The above is true only some of the time. There are a lot of patients who obtain a lot of relief and help from antipsychotics because the drugs brought them back from the brink, brought them out of their horrible non-reality and restored normalness. This is often external help in a circumstance where we couldn't help ourselves on our own. Side effects can create suffering, but this is better than not having any use of the mind, or having a mind that has run amok, and that is directing you to take destructive actions. 

Other than side effects, we have the other side of the coin, in which a psychotic person refuses medication because of their ego. If you think about it, it's a very hard "pill" to swallow when we acknowledge a physical or mental defect. Not everyone feels this way, but many do. Family and physicians wonder that it is hard for us to come to grips with the idea our brain doesn't work, that we have a brain defect, that, as a result we are "disabled", and, furthermore, that our lives and prospects for the future are prognosticated to be crap.  

Many Americans pride themselves on being of "good stock." Many have self-images in which we want to see ourselves as seamless. We want to believe in ourselves as worthy, as lacking significant defects. To acknowledge a major "defect" is a hard jump. This is normal. 

Anosognosia isn't the sole reason for noncompliance. It is one of the reasons. Yet, doctors and treatment professionals have failed to do enough to make life bearable for patients. We're offering medication, but what is the point to that if life contains nothing but misery? The mental health treatment system needs to get a clue that serving up pizza and cookies isn't enough to make a mentally ill person happy; it will only make them chunky. 

This is not to say that mentally ill people can't seek happiness on our own. Many of us can and do. Yet there are some who could benefit from being given something more, something to look forward to. 

I've gotten jobs, a spouse, and before that, girlfriends, on my own and haven't needed any help from the treatment system obtaining any of it. Truly, the treatment system has done more to interfere. 

I suggest more social activities for those who could benefit from going out on a date. The treatment system often falls short of providing opportunities for legitimate gratification. 

Medication makes the lives of mentally ill patients saner yet sometimes intolerable, especially when the side effects are too awful. This needs to be offset with something good, if we are to see any kind of progress.