Is Society or Psychiatry to Blame for

the 'Seriously Mentally Ill' Dying 25

Years Prematurely?

Photo Credit: shutterstock.com

By Bruce E. Levine / AlterNet-November

15, 2016
Adults in the U.S. living with serious mental illness die on
average 25 years earlier than others, largely due to treatable
medical conditions, according to the National Alliance on Mental

Illness. This is not controversial, as establishment psychiatry and

its critics agree.
What is controversial is who is to blamesociety, psychiatry, or
the victims themselves? And what is too taboo for the mainstream
media to even discuss is whether many of us, privately, dont care
or may even want this population to disappear.
If we could admit that our societys entire way of thinking about
people diagnosed with serious mental illness has failed, we
might become curious about other societies that view this
population very differentlyand have gotten very different
results.
Who Is to Blame?
In 2011, the director of the National Institute of Mental Health
(NIMH) reportedthat still another major study found, on average,
Americans with major mental illness die 14 to 32 years earlier
than the general population, and he then attempted to explain it:
Disorders such as schizophrenia, major depression, and bipolar
disorder are risk factors for suicide, but most people with SMI
[serious mental illness] do not die by suicide. Rather, the 5
percent of Americans who have SMI die of the same things that
the rest of the population experiencescancer, heart disease,
stroke, pulmonary disease, and diabetes. They are more likely to
suffer chronic diseases associated with addiction (especially
nicotine), obesity (sometimes associated with antipsychotic
medication), and poverty (with its attendant poor nutrition and
health care) and they may suffer the adverse health
consequences earlier.

Antipsychotic medications association with obesity, as noted by

the NIMH director, is part of the explanation for premature deaths;
and according to the American Family Physician, antipsychotic
drugs life-shortening adverse effects include diabetes, postural
hypotension (especially deadly for patients with fall risk), cardiac
arrhythmia, and sudden cardiac death.
Psychiatrist Grace Jackson, critic of her profession and author
of Rethinking Psychiatric Drugs, believes that establishment
psychiatry minimizes the deadly effects of antipsychotic drugs.
Jackson observes, From the perspective of a physician, I agree
that the causes of ill health are multifactorial and include poverty,
poor diet, and homelessness, but even with proper diet, safe
lodging, loving friends, and meaningful employment, psychiatric
drugs end lives prematurely. It would be a tremendous disservice
to patients to ignore the toxic effects of these drugs.
The NIMH director also lists cigarette smoking as a major cause of
premature death, noting, People with a mental illness are more
than twice as likely to smoke cigarettes. However, blaming
patients irresponsible cigarette smoking is an unfair blaming the
victim, as antipsychotic drugs actually increase the desire for
nicotine.
Specifically, a 2009 report, Smoking and Schizophrenia, states
that, Smoking may be an attempt by schizophrenic patients to
alleviate cognitive deficits and to reduce extrapyramidal sideeffects induced by antipsychotic medication. Cigarette smoking
enhances dopaminergic activity, which is especially craved by
people using dopamine-diminishing antipsychotic drugs.
According to the report, cigarette smoking can increase the
clearance of antipsychotic drugs, and thus may be a way for
antipsychotic drug users to lessen the adverse effects of these
drugs.

Antipsychotic drugs are the primaryand routinely the only

treatment by establishment psychiatry for people diagnosed with
schizophrenia and other serious mental illnesses. However, in
addition to these drugs direct deadly adverse effects as well as
increasing the desire for cigarettes, psychiatrys primary
treatment also contributes to the premature death rate because
of its general ineffectiveness resulting in financial poverty.
Investigative reporter Robert Whitaker in The Case Against
Antipsychotics: A Review of Their Long-Term Effects offers
extensive research to back up his conclusion that:
Antipsychotics, on the whole, worsen long-term outcomes. While
for some individuals, Whitaker notes, these drugs may provide a
short-term benefit, there is a long line of research showing that
antipsychotic drugs, as he states, Impair functioning over the
long-term.
Impairing functioning over the long-term is obviously going to
result in increased unemployment and poverty. And poverty,
caused by any means, is well established as being associated with
premature death.
The stigma of mental illness can result in unemployment, poverty,
social isolation and also diagnostic overshadowinga
stigmatization in medical care in which the physical symptoms of
people diagnosed with serious mental illness are falsely attributed
to mental illness, resulting in not receiving treatment for very real
medical conditionsanother cause of premature death.
While establishment psychiatry rails against the stigma of mental
illness, they have actually exacerbated it through their brain
disease explanations. In Myth: Reframing Mental Illness as a
Brain Disease Reduces Stigma, the Canadian Health Services

Research Foundation (CHSRF), reported in 2012: Despite good

intentions, evidence actually shows that anti-stigma campaigns
emphasizing the biological nature of mental illness have not been
effective, and have often made the problem worse. A 2010 study
in Psychiatry Research reported that for the general public, the
acceptance of the brain disease or biogenetic model of mental
illness was associated with a desire for a greater social distance
from the mentally ill.
The CHSRF concludes, Biological explanations can also instill an
us vs. them attitude, defining individuals with mental illness as
fundamentally different. Especially maddening, psychiatrys
highly promulgated biological explanation of the biochemical
brain imbalance theory of mental illness has long
been scientifically disproventhis recently announced even by
establishment psychiatry.
Alternately, the CHSRF concludes, Presenting mental illness in
the context of . . . psychological and social stressors normalizes
symptoms, creating a healthier public perception of mental
illness. Trauma is the psychological-social stressor that is likely
the most critical variable (see articles: Trauma and
Psychosis; Trauma, Psychosis, and Dissociation; and Childhood
Trauma and PsychosisWhat is the Evidence?).
Even more helpful in reducing the stigma of serious mental
illness is eliminating this term serious mental illness, and
instead using terms such as altered state or extreme
emotional state. While these states can be frightening for
society, family, and those experiencing them, depathologizing
these states is one of the best ways to eliminate stigma.
Depathologizing these altered and extreme emotional states,
debunking brain-disease reductionism, and advocating for
psychological-social approaches are among the goals of

organizations such as the International Society for Ethical

Psychology and Psychiatry; the National Empowerment Center;
and MindFreedom.
So Why Do We Allow Psychiatry to Stay in Charge?
Given the horrific premature death rate and research such as a
2003 study in Psychiatry Research that reported: "On long-term
prospective evaluation, risk for death in schizophrenia was
doubled on a background of enduring engagement in psychiatric
care, the question is: Why do we allow psychiatry to stay in
charge?
Its difficult to imagine society allowing an authority with such
horrible results to stay in charge of a population that a society
actually cared about. Would professional sports team owners
allow orthopedic surgeons to remain in charge of treating their
injured star players if these surgeons results consisted of, on
average, increased impaired functioning and premature death?
Team owners and fans care about these star athletes and would
not accept the litany of excuses for failure that most of us accept
from psychiatry.
So, why dont enough of us care about the population diagnosed
with serious mental illness?
One answer is that altered and extreme emotional states of
people diagnosed with serious mental illness can create havoc for
families and society within our economic systeman economic
system that obliterates genuine community and creates
extremely stressed families already struggling to find enough
hours in the day to survive. And so families are vulnerable to

resenting those in altered and extreme emotional states who

need a great deal of attention, support, and time.
In many indigenous and tribal societies that have genuine
community, people experiencing altered and extreme emotional
states do not create havoc but are seen in a positive light.
In Psychosis or Spiritual Awakening, filmmaker and photographer
Phil Borges, who has been documenting indigenous and tribal
cultures for over 25 years, investigated 40 shamans from all over
the world. He observes that shamans in a community are
routinely identified with the call going through a psychological
crisis in their teens when they hear voices, have hallucinations,
and exhibit other behaviors that are seen by psychiatrists in our
society as symptoms of psychosis. In contrast to our society, in
many indigenous and tribal societies, people who experience
these altered states are viewed as having a gift and a talent,
and so their behavior is seen positively. Instead of working with a
psychiatrist and being viewed as mentally ill, they work with a
mentor who has similarly experienced such a state and who is in
the best positon to reduce anxiety and fine-tune their gift to be
helpful to the community.
The late ethnobotanist Terence McKenna, who also studied
indigenous and tribal societies, concluded similarly with Borges:
In a traditional society, if you exhibited schizophrenic
tendencies, you are immediately drawn out of the pack and put
under the care and tutelage of master shamans. You are told:
You are special. Your abilities are very central to the health of our
society. You will cure. You will prophesy. You will guide our society
in its most fundamental decisions. Contrast this with what a
person exhibiting schizophrenic activity in our society is told.
Theyre told: You dont fit in. You are becoming a problem. You
dont pull your own weight. You are not of equal worth to the rest
of us. You are sick. You have to go to the hospital. You have to be

locked up. You are on a par with prisoners and lost dogs in our
society. So that treatment of schizophrenia makes it incurable.
Prior to modernity and not just in indigenous cultures and tribal
society, when people experienced altered or extreme emotional
statessuch as being seriously suicidalthere was a very
different reaction than the one of our current society. Abraham
Lincoln biographer Joshua Wolf Shenk, in Lincolns Melancholy,
recounts Lincolns friends suicide watch over him; and Shenk
describes how Lincolns extreme dark emotional states seemed
not a matter of shame but an intriguing aspect of his character,
and indeed an aspect of his grand nature, which rather than
stigmatizing Lincoln actually drew people toward him.
The key to a community truly helping people experiencing altered
and extreme emotional states is for that community to believe
that these states have meaning and value for the community.
Once a society diseases and pathologizes these states as mere
illness and defect without meaning or value, those people
experiencing these states are seen as burdens on society.
When people get treated as unwelcome burdens, they can
become angry and agitated or, depending on their temperament,
become passively dysfunctional.
The more a society demands machine-like efficiency and
productivity, the more people experiencing altered and extreme
emotional states are seen as monkey-wrenches and burdens.
When a society becomes so fanatical about machine-like
efficiency and productivity that ethical injunctions against murder
are thrown out the window, societies like Nazi Germany emerge.

In Nazi Germanys T4 Program, involving virtually all of German

psychiatry, Hitler created a mandate to kill anyone deemed to
have a life unworthy of living, which certainly included people
diagnosed with serious mental illness. Lack of economic
productivity was the major criterion for inclusion in T4, and the
Nazis referred to the programs victims as having burdensome
lives.
To be clear, modern American society is not Nazi-German society,
as it would be taboo in present American society to actually
euthanize those diagnosed with serious mental illness. But in the
United States in the earlier part of the twentieth century, there
was widespread compulsory sterilization of those diagnosed with
serious mental illness; and in current American society,
apparently it is acceptable for this population to die, on average,
25 years prematurely without seriously challenging the authorities
in charge of treating them.
Among societies that prioritize economic efficiency and
productivity over life and all of lifes varieties, there are certainly
differences in how they treat those who experience altered and
extreme emotional states; but are these difference really a
difference of kind or merely a difference of degree?
In any society that prioritizes economic efficiency and productivity
over all else, people in altered and extreme emotional states will
be seen as burdens, without meaning or value. And while such a
society might have a taboo against euthanizing this population,
most of that societys members will not care enough to seriously
challenge the authority in charge of treating this population
despite that authority having a record of dismal failure.
Posted by Thavam