After Her Brain Broke: Helping My Daughter Recover her Sanity, by Susan Inman (introduction by Michael Kirby, Chair, National Mental Health Commission of Canada; with endorsements by E. Fuller Torrey, MD, Daniel Kalla, MD, Stephanie Engel, MD and others)
I ordered this book, not because I thought I would agree with it, but because there is actually another mother out there who has written about the mental health diagnosis of her child, which in this case is kickstarted by Paxil for some kind of depression/difficulties, thus raising bipolar, which then becomes schizoaffective, schizophrenia and OCD. With that many diagnoses, I would have lost my faith in psychiatry much earlier than I actually did. Susan Inman has not lost faith in psychiatry, only with the kind of psychiatry that doesn't come with a prescription.
Mothers come in all shapes and sizes and political leanings. If there is one thing that the author and I might be able to agree on is the dismal state of psychiatry and how badly it has served both patients and families alike. Where we differ is in the details. It would come as no surprise to anyone since E. Fuller Torrey endorses this book, that Susan Inman fully subscribes to the broken brain theory of mental illness. The title strikes me as an homage to psychiatrist Dr. Nancy Andreasen's book, The Broken Brain. Now even Dr. Andreasen has started to warn about the dangers of long term use of antipsychotic medication, something she helped promulgate. That's no help to the people who have suffered under this regime, but hey, again, that's how badly served people are by psychiatry. Susan Inman, despite the ten different medications her daughter has been on in about as many years, still clings to the idea that a better drug will be invented.
I can excuse that belief to some extent because the broken brain biochemistry model is what people have been told for decades by doctors they are supposed to trust, but I have a hard time with Susan Inman's other main point (and Dr. Torrey's): That the family background has nothing to do with a mental illness. She seems unwilling to even remotely entertain the idea that maybe there is something in the family environment beyond just a medical diagnosis of bipolar and epilepsy in distant relatives, that might have something to do with the rage and suspicion that her daughter spat back at her. No, the problem is with her daughter's biochemistry, she asserts. Her daughter is mentally ill. She bristles at the suggestion of Expressed Emotion, as one of the doctors in a family education class spoke about. She reasons that she and her husband have been very careful not to criticize their daughter. The problem with Expressed Emotion, in my opinion, is that it is a concept that nobody has bothered to properly explain and therefore nobody really knows what it is about. It is a concept that I believe is valid, and is much larger than the family criticizing their relative. It is also the emotion around being told that you are mentally ill and that you must accept your sickness. What it tells the suffering individual is that there is something wrong with them. Pity is also Expressed Emotion. So are medications. Expressed Emotion can be delivered by doctors and society. I had to find out about Expressed Emotion for myself. It is not mentioned much these days for exactly for the reason that Susan Inman found objectionable. "Fuller Torrey sees a lot of this work as just one of many efforts to find new ways to blame families." Really? If anything, I think that family background has been unexamined for decades for fear of offending people.
I'm a mother, too, and I may not be wild about people hinting that maybe I should take a look at myself, but what I cannot understand is someone who isn't intellectually curious and fearless enough to be willing to investigate the possibility if it could result in breakthroughs for her daughter. Susan Inman refuses to go down that path. She paints an idyllic but sketchy portrait of family life. How many of us are that fine and noble as parents? I am ashamed of things I have said and done in moments of anger when the children were small. Chris's childhood was normal enough, but mental illness is a lot more nuanced that what is on the surface. People on the outside looking in might think that ours was a normal family, and it was, but it isn't really. No family is normal. None. What is so hard about that?
Susan Inman has such fears about anything less than a perfect family for her children that I fear she has not stretched herself enough to be honest with her daughter or herself. A holistic person would feel her daughter is on to something, even if not understanding the root of it. Psychiatry has been too busy with the prescription pad in the second half of the last century to build on the base established by Freud, Jung and others in the first half. Freud appears to be utter rubbish to her. She has bought the medical model. She routinely dismisses the idea that there is another side to this. When a member of the Vancouver Playwrights' Theatre Centre writes a letter objecting to the terms of the guidelines of the conference the author is sponsoring, saying that there is no evidence that schizophrenia is a neurobiological disorder, she portrays the basis for his opinion as mental illness being invented by psychiatry and pharmaceutical companies to make money. Full stop. No acknowledging that this is a widely held opinion by many thoughtful people. Most people have no opinion about schizophrenia unless they have an intimate involvement with it, as I would assume the letter writer has. She sees his complaint as romanticizing mental illness. This is what she calls an anti-science approach, which makes me sad because science hasn't been especially good to her daughter or my son. When her daughter enrolls in a sociology class, she discovers to her horror that the teacher tells the class that pharmaceutical companies in cahoots with psychiatrists have made up a bunch of mental disorders for which there is no evidence. Well, isn't a first year college course (especially sociology) exactly the kind of place that should challenge your closely held assumptions? Not when it comes to mental illness, I guess.
To Susan Inman's credit, she is tenacious, but in a completely opposite way than I would go. She's joined NAMI to fight the stigma. I said NAMI perpetuates stigma. Stigma will remain as
long as people are not getting better. "Science" has enabled people to remain mentally ill and now it wants mental illness to be accepted by removing the goal posts.
To illustrate what a colossal train wreck the biochemical model of mental illness is, it is interesting to see how dosage is viewed in different countries. Of course, recommended doses are changing yet again, so what Susan Inman and I were told a few years ago is not what we would be told today, but here is her experience. She goes to the Menninger Clinic in the United States and is told that the level of meds her daughter was on in Canada was not high enough. Doctors in the United States administer much higher doses of antipsychotics early in the treatment because they have found it more effective in stamping out psychosis. This causes her to worry, naturally, that it is too late for her daughter. In Europe where we live, the doctors told me that in North America the doses are too high and that in Europe they have found that minimal doses work best. I am not thrilled with the European logic, either, because what is actually considered a low dose? If someone passed me an antipsychotic and urged me to try one, even at a low dose, I would decline. I don't think I would function very well.
Kudos to Susan Inman for being a mother willing to write about a difficult subject. No praise for perpetuating the NAMI biochemical "please don't even bring up the family environment" version of mental illness. Schizophrenia is not like any other illness. It has to be tackled with more imagination than just administering drugs. Refusing to recognize the importance of the family background will guarantee the persistence of the medical model and extended mental illness.
Posted by Rossa Forbes at 2:00 AM