What a sad story. My sister and father were both helped by psychiatric medications, so I know that medications are sometimes the right course of treatment. What is saddest and frankly, rather frightening, is that by overprescribing and misdiagnosing (or diagnosing too cavalierly) and engaging in flagrantly conflicted behavior, psychiatrists are providing their patients, already notoriously resistant to treatment, with good excuses to reject even appropriate medical treatment. And neither Salon nor the author of this story should be faulted for publicizing the truth. Responsibility for distrust of medications falls squarely on the professionals who prescribe them without adhering to minimal notions of professional independence.

Every medical student should be required to read an annotated version of George Eliot's Middlemarch, which was essentially the story of a doctor in the mid-19th century. Doctors were never compensated for their services and made money only from selling medications or other items -- and the best a doctor could do was to make sure that what they sold was harmless. Otherwise they earned nothing from their profession. It took enormous effort to convince society at large that it was better to compensate physicians for their services, because advice untainted by the need to hawk products was most likely to be in the patient's best interest. It is so sad to see so many doctors selling out their professional integrity.

I agree with bluesunquake:

"There are many good doctors out there. There are also many bad, greedy, incompetent and/or arrogant ones."

Remember that fifty percent of psychiatrists were in the bottom of their classes.

In the middle ages, doctors bled patients with leeches, hoping to drain out the "had humours" that made the person ill. Often this treatment killed people. Recently doctors have rediscovered leeches, but not to drain humours--the leeches are applied to head wounds to keep blood from building up on the brain. The difference between doing no harm and harming starts with the correct diagnosis of the problem, and correct application of the cure.

Ms. Bauer, we all owe a debt of gratitude to people like you, who are willing to share the sad horror stories lurking behind our culture's sick ease with prescription drugs.

Bless you and your son, who have suffered so much from these alleged treatments. It is a miracle he managed to stay alive during this harrowing episode that must have felt like decades.

Drugs are indeed crucial in treating most mental illness. Whether short-term (to help restore a chemical balance which the body maintains later through behavioral changes), or long-term in cases where that is not possible, medication makes it possible for people to heal, or at least to reach some kind of balance and decent quality of life.

You are mistaken, however, to exclude other forms of therapy ("Just like for any other organ disfunction [sic], drugs tend to be the only tools available for treatment"). CBT, for example, affects parts of the brain that neurotransmitters do not, and vice versa. From a 2004 study:

Of the two groups, only those participating in CBT showed decreased over-activity in the medial frontal cortex, an area of the brain implicated in self-monitoring and self-assessment. By comparison, the people who took paroxetine showed no change in this area, but they did experience decreased activity in the subgenual cingulate area, a limbic system region associated with mood regulation--an area apparently unaffected by CBT. (http://www.apa.org/monitor/apr04/cbt.html)

Other research shows that patients pursuing treatment with drugs or therapy alone, as opposed to a combination of drugs + CBT, do not experience as much success. This may be because as yet, we don't know how to pinpoint which kind of treatment best suits which kind of depression. Right now the state-of-the-art treatment is a targeted combination of medication and therapy; this has the best chance of success for illnesses such as depression, anxiety, PTSD, and even, recently, insomnia.

People seem to think (I'm not saying you specifically, it's just a common attitude) that if a problem is physical, then talking can't possibly affect it. But *everything* we do affects the brain, including talking, thinking, and writing. Words are the language we program ourselves with; this is why marketing firms are spending huge sums to study what sells and what doesn't, and the neurological underpinnings of the same.

People need to see themselves as whole, dynamic entities, and psychiatrists and psychologists alike need to see treatment in the same way. I write as someone seeking to make neuroscience her career. I've also worked as a supervised lay therapist for autistic toddlers, and seen how training and therapy dramatically helped them. I hope my minor jumping on to my soap box has not been offensive, but informative.

As a case worker for California's Regional Center system, I work with a number of young men and women with autism. One of the trends I have begun to notice is that young men with autism, typically between 14 and 18, experience a huge spike in behavioral difficulties. Given this age range, I feel fairly confident in noting that hormones have something to do with this; also, with the changes in hormones, size, weight, and so on, previously effective medications and/or dosages often cease being useful.

Most interesting, however, is the nature of the behaviors, and how they occur in both low and high-functioning adolescents with autism. I have seen a very common trend of hallucinations (typically auditory but also visual), suicidal ideations, increased anxiety and agitation, a diminishment of previously retained skills, and increased aggression (both verbal and physical). Mrs. Bauer's son, it seems, was demonstrating a lot of these. It is astonishing to note that the neuropsychologists diagnosed her son with psychomotor slowing; in the last five years, I have seen a small but significant portion of my consumers with autism demonstrate such symptomology. We know far too little about autism to make such a ruling so quickly. In fact, it has been my experience that it is exceedingly difficult to obtain a mental health diagnosis for an individual with autism for this very reason!

Part of the problem with using medication for individuals with autism is that it can be difficult to know if the correct underlying issue is being addressed. Behaviors that seem aggressive or psychotic, for example, could be stemming from anxiety; an antipsychotic might, for example, have side-effects that exacerbate the underlying anxiety.

I have been working with individuals with autism for five years, interacting with researchers at Stanford University and UC Davis's M.I.N.D. Institute, medical professionals, and psychologists and psychiatrists of all stripes. This is the first time I have heard of "autistic catatonia." And it makes so much sense.

As Mrs. Bauer can attest, the interaction between autism and psychiatric medications if still far too unknown to be anything other than extremely cautious. Mrs. Bauer and her son can be assured of one thing, however: By relating their experience, she has helped me to better understand the vexing case of a 17 year old boy with autism following a similar arc of behaviors to her son's, providing a path where all we had been seeing was a wall.

Thank you and best of luck.

Sincerely,

James F. Elliott, M.S.W., ACSW