Posts tagged ‘Bipolar’

Beyond Meds and Beyond the Dosies

Gianna Kali’s always informative and often pharma-critical blog, Beyond Meds was up for a Dosie — a new award “created to find the best examples of social media in pharma and healthcare.” Out of the 550 nominees, not surprisingly, blogs critical of the pharmaceutical industry and the accepted current standard of health care did not figure largely in the competition. Gianna cut through the pack though and made it to the finals — a feat unto itself. While she didn’t win, it has to be said — even if it sounds like a variation an all too familiar cliche — that when you are ever more informed and informing, nobody loses. So, congratulations to Gianna for a successful blog, for sticking to your guns and for toughing out a very difficult and ongoing recovery.

In an entry on her blog, written to be posted in the event that she won (but worth posting anyway so I’m glad she did), Gianna loses none of the bite that makes Beyond Meds worth checking out and, like any gracious recipient would do, she offered a thank you to the those that helped her get to where she is today (emphasis mine).

I’d like to personally name the two drug companies that are most guilty of my own physical demise, though all the psychotropic drugs are potentially nasty and debilitating on them and in some cases especially in withdrawal.

Lamictal and Klonopin as far as I can tell worked together synergistically to make me as sick as I am right now. So that’s GlaxoSmithKline and Roche who are most responsible for my iatrogenisis.

Lamictal acts on glutamate and Klonopin (as all benzos) acts on GABA. Both these drugs have widely unrecognized withdrawal syndromes. For information on benzo issues see here. For Lamictal problems here.

The GABA/glutamate system doesn’t just regulate mood.  It regulates muscle movements, digestion,  and sex — anything that involves anything communicating with anything anywhere in your body. When the drugs are removed after many years all hell breaks loose and is experienced by the whole body and mind. Thanks GSK and Roche for the loss of several years of my life.

Never missing an opportunity to raise the important questions, Gianna sums up what many outside of the accepted mental health paradigm are asking every day in one way or another — questions that are certainly fundamental to Spit, Bristle and Fury. It would have been awesome to see these things brought up in the faces of the pharma marketing circle directly but what she does is vital to a movement to question the paradigm and she’s not just preaching to the choir. Ask the questions, seek the answers and engage in the discussion

And what is mental illness, anyway? Does anyone deserve to be the arbiter of normalcy? Why does Western psychiatry get to limit the parameters of human experience, oftentimes through coercion, based on an incomplete and flawed science of the mind and brain? And, more tellingly, are our tactics for dealing with troubled human beings more or less compassionate using chemical restraint? Or, have we as a nation abandoned the obvious violence of the lobotomy for the secretive and bloodless path of the neurotoxic pill? What are the consequences for humanity as this paradigm of care is exported to the rest of the world?

May 12, 2010 at 12:15 pm 1 comment

Kifuji on the Defense

The controversial Dr. Kifuji, prescribing psychiatrist for Rebecca Riley, appears to have evaded any criminal responsibility by exchanging her testimony for immunity. She is, however, up against a malpractice suit and some of the things that have come up are startling in terms of just how Rebecca’s very early death transpired and the role Kifuji played in all of it. I know I’ve brought up the doctor’s role in this before but every new fact that comes out is more frightening and infuriating than the last.

The Patriot Ledger ran an article that covers many of the almost too-bad-to-be-true circumstances that point to the fact that if Rebecca and Dr. Kifuji had never met, Rebecca might still be here. Regardless of your opinions on children and drugs, this case was wrong all around and the result of at least three people’s indefensible actions. Kifuji was more a drug dealer than a psychiatrist and while that’s not particularly uncommon, the young ages of her patients makes her a standout, even among the over-drugging crowd and the predictable end result in Rebecca’s case shows her to be  both reckless and ill qualified.

From the Patriot Ledger article:

Years before she became a board-certified psychiatrist, Dr. Kayoko Kifuji was diagnosing children as young as 2 as bipolar and hyperactive – and prescribing powerful cocktails of mood-altering drugs to quiet them.

By the time Kifuji finally passed the psychiatric board exam – on her fourth try – one of her youngest patients, Rebecca Riley, had a little more than a year to live.

The lack of involvement on Kifuji’s part was shocking. She saw Rebecca primarily for twenty minute sessions to adjust doses. Often she just used these sessions to put on paper her approval for the adjustments her mother was already making, having increased doses on her own and experimented with drug cocktails using drugs prescribed (also by Kifuji) to Rebecca’s siblings.

She relied almost exclusively on what Carolyn told her about the kids when diagnosing them and ordering increasing amounts of drugs for them.

Kifuji also trusted the mother to keep tabs on Rebecca’s heart rate and blood pressure for signs of problems with the four drugs she was on. Kifuji, a pediatrician who later became a psychiatrist, told Novotny during the deposition that she didn’t realize she had a blood pressure cuff in her office and could check the girl’s vital signs herself until after Rebecca was dead. She said she didn’t take Rebecca’s pulse with her fingers because Carolyn Riley told her the child’s pulse “was within normal range.”

Even a well intentioned mother shouldn’t be solely in charge of monitoring a child’s heart rate and blood pressure let alone a woman hell bent on gaining access to more and stronger drugs at the expense of her daughter’s health. Also, any pediatrician turned psychiatrist should think of performing such simple tasks as second nature. If not that, then what is a doctor for? How do you not even know you have basic medical equipment in your office? How does a doctor fail to check a child’s pulse? Oh, that’s right — her mother said. If that’s all there is to doctoring, it’s no wonder some might see her as just a drug dispenser. They can do the rest at home, it’s a mere technicality that you must be licensed to prescribe.

  • Asked why she didn’t report Carolyn Riley to child welfare authorities after learning that the mother had increased the children’s doses at least twice without checking with her first, Kifuji said: “I just can’t report to the DSS. I need to … my role is to work with the parent and not judging them.”
  • Asked if she ever told Carolyn not to give Rebecca cold medicine on top of all the drugs the child was on, Kifuji says no, “but it’s because Rebecca didn’t get sick, and I was never asked ”

Right — let a mother chemically abuse and experiment on a child but whatever you do, don’t judge and certainly don’t  give them any more information than they asked for. The article goes on to point out other times that Kifuji refilled prescriptions before they should have run out, never asking for an explanation, just dishing out more and more drugs.

She prescribed clonidine – the drug that killed Rebecca – during the child’s first visit to control the “impulsivity” that Carolyn Riley described. Rebecca was 2 at the time.

Impulsivity at two hardly makes a child a psychiatric oddity but when you look at some of her notes regarding Rebecca’s apparently troubling behavior it’s easy to get the notion that Kifuji sees childhood as a disorder unto itself.

“Then consistently hyper all the time. Climbs up to top of jungle gym without any fears and thinking. Gets into everything. Just walk up to someone and smack them. Never gets aggressive. Hits kicks and spits when she’s being disciplined and laughs. Started to say things scared her. Whines and fusses a lot.”

Kifuji described the toddler as dysarthric, meaning she could not properly pronounce some words.

“A bit tired since yesterday. Coming down on flu. Fine as long as she takes clonidine. Sleeps throughout. Without clonidine gets very hyper and impulsive.”

“Climbs up on top of bureau. Tantrums or sobbing when she was told to clean up her toys” and “she wasn’t listening to her mother.”

This child was drugged for one reason — she was stricken with a case of toddlerhood. Dr. Kifuji seems to see no distinction between behavior and disease. Now that psychiatry has largely gotten away from talk therapy, we’re supposed to see psychiatrists as doctors of the brain — linking behavior to dysfunction in the brain. If that’s the case, Kifuji doesn’t make it very well. She’s like a mad scientist but without the science.

She explained that some researchers believe the area of the brain called the amygdala is different in people with bipolar disease. But she admitted she didn’t know where the amygdala is in the brain.

Of course you don’t need to know the brain at all to dispense drugs in the manner that Kifuji had begun making a career of (there is a timeline of Rebecca’s “treatment” at the bottom of the article). You only need to know that if you sedate a child enough, you can drug the behavior out of them. Sure, that child may be a “floppy doll” sitting in the corner but a quiet floppy doll and certainly not disruptive and if enough people will pay you to drug the childhood out of their children to one extent or another, then you’re in business.

Yes, the parents physically gave the drugs to Rebecca but they were used as a weapon and that weapon was provided by Dr. Kifuji. If she had given them a blackjack instead and told them how many times you have to hit a kid for effective behavioral treatment, this would be a different case entirely. Our view of prescribed medicine as care makes us resistant to the notion that drugs can be poison but they clearly can be and often are, particularly with psych drugs. When this happens, we need to respond accordingly.

There are no less than three guilty parties here in a case of chemical assault that ended in a child’s death. It’s bad enough that Dr. Kifuji was granted immunity making it impossible to hold her criminally accountable, even as more facts come to light pointing to her role not in anything resembling care but in a death. If she is not held civilly and professionally accountable, we’re saying her actions are acceptable, even desirable and we’re signing off on a prescription for some seriously detrimental treatment. I’m relieved to see she’s at least going to be made to answer for her actions. She’s certainly got a lot to answer for in this suit. Now we’ll have to wait and see what passes as accountability these days.

April 14, 2010 at 10:47 am 4 comments

The Devil and Entertainment

It’s been an interesting couple of weeks for fans and admirers of indie music icon, Daniel Johnston. He recently commented on the documentary of his life and music, The Devil and Daniel Johnston. While I had already developed an interest in Daniel’s work and his story — which are inseparable — aside from the documentary, I had little to go on and it certainly gives you a strongly focused view of his life. Unfortunately, it may have been narrowly focused as well. The film has been criticized as being unbalanced in its portrayal of him as an always tormented, sometimes institutionalized semi-genius scratching out recordings in garages and basements while battling some pretty strong demons, namely bipolar disorder for which he was institutionalized. That’s not to say all of those things aren’t true, just that they’re not all of the truth.

If The Devil and Daniel Johnston is your only glimpse at his story, you’re likely to take away only one view of him. In hindsight it becomes a little clearer that in the film he was defined by several lapses in mental health while less interesting little details such as long stretches of productive wellness were downplayed like long straight interstate roads to more interesting breakdowns. To be fair, things like the incoherent rambling, sometimes violent outbursts and the plane crashed he caused could distract most people from music. It was a great film in many ways with a lot of tenderness and a good glimpse of his vision but you have to bring your own sense of balance to it. Be careful though, it might break your heart.

From BBC 6 Music:

“It wasn’t really fair because it really talked about the worst experiences of my life,” Johnston said. “I wish they had included more music instead of making it one of those Stranger Than Fiction shows.”

So, onto the music. Since one of his most characterizing breakdowns, he’s been hard at work — writing and releasing albums like he’s sending out pages from a journal — including one of my favorites, Fear Yourself. All of his albums are packed full of strange but endearing lyrics in that lo-fi recording so many people have come to know and love (or hate). One thing is certain — after all these years, regardless of the state of his mental health at any point, his songs are extremely exposing and honest which is refreshing among a sea of John Mayers pretending to feel something because it sells records housewives and teenaged girls.

His website refers to him as a”pilgrim of indie music with 30+ albums, hundreds of songs, and dozens of fans.” In fairness, that was written before the success of the documentary propelled him into the center stage spotlight. He’s now got countless fans, and devoted ones at that. All that notoriety and demand has led to well attended and often sold-out shows around the world and dramatically increased prices on his original artwork. This has finally allowed him to live off of his creations — products of the very mindset that have made things so difficult for him and often the people around him.

“It’s really cool that I’m making a living after all these years. I’m doing a lot better than I’ve ever done…I was starving to death working for McDonalds when I first got on MTV.”

He’s been working with a fervor but not just for its own sake or simply to meet an increased demand. Pouring his energy into creative outlets and always looking for his next opportunity appear to serve a distinct purpose in Daniel’s life. Given the limited options the world allows for someone with his extreme and changing states of mind, he may be left with little choice.

“I’d like to direct my own movies. I’m working on a film of my own and I want to direct it all myself,” he said. “[I’m planning] a variety show, with songs, videos and comedy skits all together.”
“I’ll do anything to stay out of hospitals, I spent five years in mental hospitals. All I can do is try again.”

For his latest project, Johnston released an album last week entitled Beam Me Up, consisting of three previously unreleased solo tracks and rerecorded versions of familiar Johnston originals (including Syrup of Tears, Devil Town and Walking the Cow) all backed by the eleven piece Dutch orchestra Beam. The fact that he’s released an album in march, having just released one in october speaks to his constant writing and recording. For him, it’s like breathing. I’ve heard a few short samples but have yet to get the album. So far it sounds like fans will love it and most of the rest of the world will wonder what the hell is going on and why anyone would buy it, which is something I’ve always liked about his music. It’s certainly not aimed at appealing to the broader tastes.

As if that wasn’t enough, filmmaker David Miller is working on a movie, an “epic superhero story,” about Daniel johnston — and the role of our hero may be played by Philip Seymour Hoffman, one of the few current actors worthy of the  praise he gets with his wide ranging roles as an indie/offbeat actor. From The Guardian:

“It doesn’t really cover any of the same stuff as The Devil and Daniel Johnston documentary,” …. The director, who is in the midst of pre-production, finishing the screenplay and approaching possible actors, added: “There’s so many people reaching out that are huge Daniel Johnston fans. Philip Seymour Hoffman and John C Reilly for example. Johnny Depp’s a big Daniel Johnston fan, though we’d like him to play the older brother.”

I’m curious to see what it does cover. Yes, his life is full of stories worth telling but they are not all about missteps and failures and they’re not all about his mental health, whatever that means. Maybe this one will tell his story with a little more of the fairness he might hope for. If nothing else, it will be interesting to see Daniel Johnston portrayed in a hero’s light. As anyone familiar with his life and work knows, Daniel Johnston loves a hero.

April 7, 2010 at 9:58 am

Michael Riley Convicted

…and Dr. Kifuji might not be off the hook after all. In a clear case of parents’ drugging of their children that’s gone beyond abusive, first Carolyn and now Michael Riley have been convicted of murdering their four year old daughter. From the Boston Globe:

Capping one of the most unusual child abuse cases in Massachusetts history, a South Shore father was convicted yesterday of first-degree murder for killing his 4-year-old daughter with an overdose of a psychotropic drug, which he and his wife had nicknamed “happy medicine’’ and routinely dispensed to their three children to manage their day-to-day behavior…

Prosecutors said Rebecca’s parents fabricated their children’s behavioral problems, making up reports of hallucinations and violent outbursts, in order to obtain drugs to sedate them and to help them qualify for government benefits for families with disabled children.

To be clear, we’re not talking about a couple of parents who might have overdone it or a child that had a freak response to slightly liberal drugging. The Rileys did all they could to obtain drugs and when they had them, they used them to poison their children into a state of quiet compliance. Rebecca was on psychotropic drugs since she was two, as were her siblings. In addition to the chemical abuse, Michael was also physically abusive and had even been removed from the home when charged with attempted rape, indecent assault, battery and giving pornography to a minor — his stepdaughter. He returned just two weeks before Rebecca died.

When you have a family so abusive, broken and damaged that a father that could do that sort of thing and be welcomed back to the home — with the children and by the mother — what sort of care can we expect them to give to their children’s minds and how could anyone think they would act responsibly with such powerful drugs that should never have been given to them in the first place? One way that at least one part of a host of problems could have been eliminated would have come down to a responsible doctor. There was none. Not only was Dr. Kifuji aware of Michael’s abuses, she was instrumental in his returning to the home.

A Weymouth Housing Authority manager testified that Michael Riley, 37, had been banned since 2005 from spending overnights in the family’s apartment there, the result of pending charges that included providing pornography to a minor. A social worker said the father’s alleged beating of his son in 2006 triggered a renewed child-abuse investigation, and the mother, while remaining devoted to the father, filed a restraining order to protect the boy. A house guest also testified that the Rileys’ three children often seemed “more timid’’ when their father was around…

Kifuji diagnosed at least two of the Riley children, while toddlers, with mental disorders after only a one-hour consultation, did not order appropriate blood work while they were on potent pills, and seemingly ignored input from preschool teachers and other clinicians who said the children seemed weak and overmedicated.

It looks like Kifuji might still have to answer for her beyond liberal dispensing of drugs and her negligent psychiatric “care” after all — and why shouldn’t she? While she may not get the full measure of the law, she may have to start worrying about her status as a psychiatrist. For the sake of the children she’s still seeing at Tufts, one can only hope.

After the verdict, Plymouth District Attorney Timothy J. Cruz said he plans to ask the Board of Registration of Medicine to reopen its investigation of Kifuji, who he has said turned a blind eye to the numerous signs that the parents were troubled and reckless in dispensing drugs.

“Dr. Kifuji is unfit to have a medical license,’’ he said. “If what Dr. Kifuji did in this case is the acceptable standard of care for children in Massachusetts, then there is something very wrong in this state.’’

Kifuji testified in both cases, but only after being granted immunity from prosecution.

Cruz said he plans to assemble the transcripts of her testimony, among other things, to present to the licensing board. That information, prosecutors said, showed negligence in how she assessed and followed patients, not just that she subscribes to the controversial belief — as do some other prominent psychiatrists — that toddlers can be diagnosed with bipolar disorder.

The Rileys are certainly near the end of the spectrum of child drugging and the severity of this case makes it seem like a singular event. It is not. Instead of just focusing on the severity of this one instance, we should question the culture of drugs and control that has allowed us, even in much milder and seemingly harmless instances, to use drugs to turn off the part of children that makes them children. In so many instances, we’ve gone well past the point of not letting kids be kids to not letting kids be human

This is an extreme and terrible case with the Riley children being drugged, one of them to death, in order to keep them under control from the time they were toddlers — not for acting out, not for being out of control kids but for being children. In the end Rebecca Riley was given a lethal dose of Clonidine, a blood pressure medication used off label to treat withdrawal from narcotics and alcohol, for crying out for her mother while she struggled with pneumonia.This is tragic and disgusting every way you look at it.

March 27, 2010 at 10:12 am 4 comments

Violence Prevention Medication?

This morning, I stumbled upon an opinion piece for the Buffalo News pushing for Kendra’s Law to be made permanent. Kendra’s Law is an attempt to prevent violent crime by essentially treating people diagnosed as mentally ill like some sort of pre-criminals. On paper it’s also supposed to be for the safety of the “patient” too but when it’s time to push for support, it’s almost always about protecting “us” from “them.” (As I’ve said before, fear sells when facts fail.) Advocates of Kendra’s Law and similar attempts to criminalize extreme states of mind use phrases like assisted outpatient treatment (AOT) instead of the more truthful involuntary or forced outpatient treatment.  These are the types of laws that allow for forced drugging, electroshock and hospital confinement — all based on the unfounded idea of biological mental illness but the idea is just the packaging. It’s essentially a way to keep people under control out of fear of what they might do. This thinking has no basis in fact regarding mental illness and certainly no place in the arena of human rights or a constitutional America. The article is a fine example of fearmongering but that’s the current state of media. Somehow factmongering never caught on.

As with most battles for thought and opinion, this one is very much centered on carefully crafted words and phrases — not unlike much of the current mental health industry. As with force being rephrased as assistance, drugs are renamed and recategorized, some officially and some in the minds and words of the public. (Neuroleptics have come to be called antipsychotics which are now being called antidepressants.) Sometimes words with no previous connection are paired and when spoken with some authority or when used to speak to people’s fear these words become inseparable, creating a false choice scenario. The latest I’ve seen, in the aforementioned article, is “violence prevention medication.” Of course, there is no such thing but it’s another step in grooming the vernacular.

Kendra’s Law—designed to keep people who really need it on their violence-prevention medication—was passed about 10 years ago. It’s up for renewal, again. Just make it permanent…

The law allows judges to order certain mentally ill people to remain on violence-prevention medication as a condition of release and, if that doesn’t work, to order involuntary committal to mental hospitals if shown to be a danger to themselves or others.

The author creates a connection between violence prevention and drugs. Simply by accepting the phrasing, you’d be accept the idea as truth. And if that’s the truth, you are either in favor of forced drugging or you don’t care if innocent children are slaughtered at the hands of madmen. Facts be damned, that’s your choice. Somehow, when I picture people being tackled to the ground, restrained by undue force, faces pressed against a cold hospital floor and forcibly injected with drugs — powerful mind and body altering drugs — it’s hard to see it as “violence prevention.” We are transferring violence at best and at worst and in truth, causing it.

March 17, 2010 at 7:42 pm

Big Press Questions the New DSM

I don’t know if this coverage, questioning bordering on critical, is an anomaly or the beginning of the backlash but I hope it continues. It’s an unfortunate fact that television shapes the way millions think. Getting people to question whether human behavior needs a diagnosis can’t be a bad thing and it’s good to see the mainstream media casting even a shadow of doubt on the whole charade as it usually turns a blind eye in the name of its sponsors in pharma. Maybe the medical model has finally jumped the shark with the DSM-V.

February 15, 2010 at 1:13 pm

Jurors Speak Up with Hands Tied

In a break from the typical dismissive response to death by psych drugs, which is to assume everybody did their best and a bad but faultless thing happened, jurors in the Carolyn Riley case are outraged at the conduct of Dr. Kayoko Kifuji. Rightly so. Kifuji diagnosed children as mentally ill for exhibiting the defining behaviors of childhood. She Diagnosed a three year old child with pediatric bipolar disorder (which was absent from the DSM draft released the day after the conviction). She passed out cocktails of serious drugs to two year old children like they were Flintstone’s vitamins — drugs that aren’t approved for use in children and are usually used judiciously even in adults. She let the parents experiment on all of their kids with these drugs and, following their lead, prescribed per those experiments — so yes, the jury was outraged.

From the Boston Globe:

“Every one of us was very angry,’’ said one juror, who requested anonymity to avoid retaliation for her role in Tuesday’s second-degree murder conviction of Carolyn Riley. “Dr. Kifuji should be sitting in the defendant’s chair, too.’’

Another juror said that while the 12-member panel found that the 35-year-old mother was primarily responsible for Rebecca’s death, many jurors were “off the wall’’ when they heard the testimony of Dr. Kayoko Kifuji of Tufts Medical Center. She said they were struck by how quickly Kifuji diagnosed Rebecca with bipolar and hyperactivity disorders, as well as how little the doctor seemed to supervise the mother’s dispensing of medications.

“It blew me away,’’ said that juror, who asked to remain unidentified for fear of reprisals.

Rebecca’s psychiatrist was the focus of some of the most powerful reactions from the jurors after a three-week trial that left them emotionally and physically exhausted.

Not only has she not been convicted of a crime, she will go undisciplined by courts and the medical establishment even outside of the criminal trials surrounding the Rebecca Riley case which can only add to the frustrated outrage of the jurors.

Other than the nationwide publicity given to the Riley case, in which Kifuji is mentioned repeatedly, the only overt sign that Kifuji had potentially questionable conduct is on the Board of Registration of Medicine’s website…Still, when asked if the board’s investigation concluded that Kifuji acted within acceptable medical standards, spokesman Russell Aims responded by saying that the board “closed the complaint against Dr. Kifuji without discipline.’’ He said the board, however, “reserves the right to reopen a case if new information comes to light.’’

The psychiatrist will not face criminal prosecution. A grand jury last summer declined to indict her, and Kifuji testified in Carolyn Riley’s trial only after being granted immunity from prosecution.

Prosecutors contend the Rileys “duped” Kifuji into authorizing the drugs but that doesn’t say much for her as a doctor does it? “Duped” doesn’t begin to explain diagnosing toddlers as bipolar, her cavalier approach to diagnosing and prescribing in general or her indifference to the misuse of drugs like depakote and clonidine. Kifuji had access to Rebecca herself, providing ample opportunity to make her own assessments. She chose instead to go on the word of the parents in brief and drug centered visits. She admitted that she found the Rileys’ actions unsettling. Maybe they were just not unsettling enough to interfere with business. While the prosecution and Kifuji’s lawyers tried to paint her as the good and upstanding doctor who got fooled, in the end she comes out looking like the prime example of psychiatrist-as-drug-dealer — not unlike the physician in every town that addicts know to visit for his liberal dispensing of narcotics — and the Rileys were repeat business. If you’re going to hand out drugs that easily, without concern for how they’re being used and on whom, you don’t get to claim ignorance.

In a country where a gun manufacturer or salesperson can be held responsible for the crimes of someone who legally buys or even steals a handgun (which I’m against), it’s shocking that Kifuji is able to walk away from this without penalty. She is a doctor and with that paycheck and perceived authority comes an obligation to think past the drugs that keep you in business and consider the well being of the people in your care. I sincerely hope her other child patients fare better but it doesn’t seem likely. The only things that seem to have changed for Kifuji since Rebecca’s death are the amount of attention she’s received and a new sense of impunity.

February 13, 2010 at 9:48 am 1 comment

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