Archive - Carolyn Gage

Published on: December 11, 2010

Leeches and Psychotropic Drugs Part Three

I’m blogging my response to Robert Whitaker’s book Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs and the Rise of Mental Illness in America. In Part One, I explored the historical disconnect between popular support for a medical treatment and the fact that this treatment may be ineffective or even dangerous, with no supporting research. Part Two reviewed the statistics for the epidemic.

Today’s subjet is “magic bullets.” Medicine does have some. Antibiotics and insulin are examples. Researchers identified a medical condition, like bacterial infection or insulin deficiency, and then they developed a medicine that would fix it… Antibiotics to kill the bacteria, and insulin to provide insulin.

The “magic bullets” of psychiatric drugs evolved from a very different process. It might be more apt to label them “stray bullets.” For example, Thorzine, the drug that, in the author’s words, kicked off the whole psychopharmaceutical revolution, had its origins in a search for a drug that would be toxic to malarial microbes. That search came to a dead end, but... all was not lost, because it was discovered that one of the compounds might be useful as an antihistamine in surgery.

Unfortunately, the blood-pressure-lowering side effect was causing patients to die, and so the application was discontinued. One doctor, however, discovered that the drug produced a “veritable medicinal lobotomy”—and a magic bullet was born. In the 1950’s, chlorpromazine (Thorzine) began to be administered to psychotic patients, and the drug that was rendering patients quiet and manageable spread like wildfire through the asylums. When a drug treatment becomes so widely prescribed, it is difficult to keep in mind that it is not treating any disease.

Thorzine is considered a major tranquilizer. How about the minor ones? Well, they also began with a search for something else. Scientists were looking for a drug that would kill the bacteria that penicillin couldn’t zap, and to that end, they were isolating a compound found in disinfectants. Research showed that this compound produced temporary paralysis of muscles, but, what was even more interesting, is that the mice who were being experimented on, did not seem to be upset when they found themselves on their backs and unable to move. Their heartrate remained steady. They were not stressed. And, low and behold, meprobonate found its way to the market in 1955 as “Miltown,” and the race for anti-anxiety drugs was on. Four years later, chlordiazepoxide made it to the shelves as “Librium.”

How about the magic bullet for depression? Same story: stray bullets. Hydrazine was developed during World War II as a fuel substitute. After the war, the drug companies snatched up the surplus to test the toxic properties for “magic bullet” potential. Two hydrazine compounds were found effective against the tuberculosis bacillus. Good news, but something interesting was happening to the patients to whom it was administered. They were being energized—dancing on their beds, even. By 1957, in spite of alarming side effects, iproniazid was being recommended for long-term use with depressed patients.

Meanwhile… back at the Amercian Medical Association ranch, things were changing. In the 1950’s the Food and Drug Administration took over the job of licensing and approving drugs, and most drugs became available by prescription only. The AMA was no longer the watchdog, but the exclusive purveyors, and by 1960, pharmaceutical ads in AMA publications were bringing in $10 million in annual revenue. The PR rush was on. And as the miracle stories multiplied, the rhetoric began to shift.

Tranquilizers became “antipsychotics,” and muscle relaxants became “mood normalizers.” The psychic energizers were “anti-depressants.” The public began to view these as antidotes to specific disorders, and scientists were under pressure to come up with a theory about broken brains to support the "magic bullets" that were achieving celebrity status.

Click here to go back to Part One.
Click here to go to Part Four.

Published on: December 7, 2010

Leeches and Psychotropic Drugs Part 2

This is the second part of a series of blogs about the book Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs and the Astonishing Rise of Mental Illness in America by Robert Whitaker.

The book is by a man who founded a publishing company to report on the business aspects of clinical testing of new drugs… an “industry-friendly” enterprise. Baffled by studies suggesting the inefficacy of medications for patients with schizophrenia, he began an investigative journey that resulted in this book.

“Epidemic” is a strong word. How does Whitaker support it?

He starts by looking at the data for 1955, when the disabled mentally ill were primarily cared for in state and county mental hospitals. Today, these folks would typically be receiving SSI (Supplemental Security Income) or SSDI (Social Security Disability Insurance) payment, with many of them living in residential shelters or other subsidized living arrangements.

In 1955, 1 out of every 468 Americans was hospitalized from mental illness. In 1987, 1 out of 184 Americans were receiving SSI or SSDI payment for disabling psychiatric conditions. The author concedes that this is an apples-to-oranges comparison, because the increase could be a result of the lowering of social taboos for seeking treatment for mental illness… but, the argument could also go the other way—that the 1987 statistics could be conservative, because they only include folks younger than 65 (older disabled patients are on Medicare and Social Security.) Okay… apples-to-oranges, because SSI and SSDI did not exist in 1955.

So let’s look at a more meaningful comparison, apples-to-apples. Let’s compare the number of folks on SSI and SSDI in 1987 to those in 2007. Why 1987? Because that’s the year that Prozac was approved by the FDA. Twenty years later, the rate for folks disabled by mental illness was 1 in 76 Americans. That’s more than double the rate in 1987.

Whitaker asks us to go deeper. In 1955, comparatively few of the people disabled by mental illness were diagnosed with major depression or bipolar illness. By 2006, 46 percent of young people (18-26 years old) on psychiatric disability were diagnosed with an affective illness, and 8 percent with anxiety disorder.

What about children? In 1987, pre-Prozac, only 5.5 percent of disabled children were diagnosed with psychiatric conditions. Twenty years later, that figure had changed to 50 percent. Today, mental illness is the leading cause of disability in children. And here’s an interesting statistic: Between 1996 and 2007, the number of children on SSI for other reasons (cancer, developmental disorders) declined, while the number on SSI for mental illness more than doubled. In other words, doctors seemed to be making progress in the treatment of other conditions, but losing some serious ground in combating mental illness.

Looking at these statistics, and especially those dating from the entry of Prozac into the marketplace, the author has the temerity to ask about the emperor’s new psychiatric clothes:

Could the current drug-based paradigm of care be causing this epidemic? In other words, is this epidemic iatrogenic in nature? (Etymology: Greek. iatros—physician, genein—to produce.) Is the theory of the “broken brain” actually a broken theory? Are the two decades of psychiatric drugging analogous to the two millennia of bloodletting—a pseudo-scientific practice rooted in the vulnerabilities of human nature, not medical science?

So here was Whitaker’s thinking: Since the general consensus is that millions of people are living better lives because of psychiatric medication, then surely the scientific literature should support this consensus with research into the biological disorders being treated and legions of studies reflecting the success of the new drugs.

In fact, the scientific literature tells an opposite story.

Click here to go back to Part 1.
Click here to read Part 3.

Published on: December 5, 2010

Leeches and Psychotropic Drugs Part One

Did you know that bloodletting was the most common medical practice from the first century AD until the nineteenth century—nearly two thousand years!—even though, in the majority of cases, the practice was harmful and even fatal to patients?

Wow.

Wouldn’t you think that in two millennia, people might have noticed that folks losing pints of blood got worse instead of better?

Actually, I’m sure they did. They would definitely notice when the patient died. So why the extraordinary longevity of such an obviously pernicious therapy?

The answer is simple: human nature. We are emotional, not rational creatures. And we are creatures of habit; our traditions die hard. And we are social animals; shunning by the herd will bring most of us back into line.

Bloodletting was the accepted practice. The patient who challenged it, would be accused of malingering. The parent who refused it for their child would be perceived as negligent, or even malicious. The story is so strong, so rooted in human nature that it hijacks the narrative: The patient who gets worse after bloodletting would have been even sicker without the procedure. The patient who eventually dies from loss of blood was going to die anyway, and the bloodletting came too late to save her.

Who needs science when there is a story as powerful as the story of blood gone bad, blood carrying humors which must be expelled? It is a graphic and compelling story—blood being such a dramatic metaphor for life. Blood is present at the birthing, present on the battlefield, emblematic of the transition to womanhood, and also emblematic of the manhood rite of wounding. Blood ties of kinship, blood feuds to the death. Blood as giver and as taker of life.

And then there is that human tendency to believe that it is better to do something than nothing. And bloodletting had the additional advantage of being quantifiable. Specific amounts of blood could be let at specific intervals. These could be recorded, charted, studied. There could be right ways and wrong ways for the letting-of-blood. Various techniques were developed, each with its own theory. But best of all, everyone has blood.

And, finally, there is an exchange of some sort going on. The bloodletter is receiving payment. The bloodletter is invested in promoting the practice, and the patient and the patient’s family have a disincentive in understanding that they have been hoodwinked… or that they might be responsible for enabling the harm or death of the one they loved. And then, of course, there is the lucrative cottage industry of leech-farming/ leech-harvesting.

Why am I telling you this? Because it might make it easier to swallow the fact that millions of people today are receiving a medically prescribed treatment that is making the majority of them much sicker, shortening their lives, and sometimes killing them… and there is absolutely no research to support the theory upon which these treatments are based.

In this case, the practice is only a few decades old instead of millennia, but the principle behind it is the same: human nature.

This blog is my response to reading Anatomy of an Epidemic by Robert Whitaker. The subtitle is “Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America."

The first thing that impressed me about this book was the story of the author’s involvement with the subject. He was not a counter-culture type guy. In fact, he had co-founded a publishing company to report on the business aspects of the clinical testing of new drugs. In his own words, “we wrote about this enterprise in an industry-friendly way.” Clearly Anatomy of an Epidemic is not “industry-friendly.” What changed?

Whitaker stumbled across a story about the abuse of patients in a research setting. He did a series of articles on the subject for the Boston Globe. In one of the stories, he reported on a study which had involved withdrawing schizophrenic patients from anti-psychotic medications. Since the medication for this disorder is likened to “insulin for diabetics,” the author questioned the ethics of a study that would deprive the patient of a medication supposedly known to be essential for their health.

In the course of researching this article, Whitaker ran across two findings that nagged at his conscience:

1) In 1994, Harvard researchers announced that outcomes for schizophrenia patients has worsened since 1974 and were no better than they had been a century earlier… as in 1894.

2) Two separate studies by the World Health Organization which found that schizophrenia outcomes were much better in poor countries like India and Nigeria, where only 16% of the patients were maintained on anti-psychotic medications.

The point of all this is that the author of the book was a solid believer in the conventional wisdom of modern psychiatry. He believed that psychiatric researchers had discovered biological causes for mental illness and that their findings had led to the development of a new generation of psychiatric drugs to “balance” brain chemistry. He was to discover that none of these assumptions were true.

Anatomy of an Epidemic is the story of his awakening.

Click here for Part 2.

Published on: October 5, 2010

Born That Way... NOT!

“Homosexuals are born that way. It’s not a choice. Who would choose to be gay?” If you are one of the folks who is saying that, please stop.

It makes you look ignorant. It really does.

I understand that it seems to be a great argument, especially to counter the Religious Wrong. It puts the problem back on God’s doorstep: Blame Him. He made us this way

I understand how framing homosexuality as some kind of unfortunate accident of birth might seem strategically savvy, because it takes advantage of some of the (limited) progress this country has made in responding appropriately to people with disability.

And maybe you do believe that God made you that way, and maybe you do wish you weren’t gay, and maybe you experience your homosexuality as some kind of birth defect. Okay, if that’s your truth, then you should say, “I was born that way. I didn’t choose it. I wish I had been straight.”

But stop saying that all of us were born that way. It shows your lack of understanding of half of the human race, including half the population of homosexuals, as well as an abysmal ignorance of global, political, social, spiritual, biological, and economic realities.

I am, of course, talking about the women. Many lesbians do experience our lesbianism as a choice. Many lesbians have grounds to wonder who in their right minds would choose heterosexuality. And many of us find it problematic to make any assumptions about any women being “born heterosexual.”

Yes, believe it or not, the lesbian experience is not just the gay male experience with a bow on its head, like Minnie Mouse. It’s more like Alice’s trip through the looking glass.

So… is it a choice?

Here in the US, until the last century, women could not practice heterosexuality outside of marriage without extremely severe consequences. I am talking about the stigma of the notorious “fallen” or tragically “ruined” woman, with the searing rejection of out-of-wedlock children—often relinquished for adoption under economic, or religious, or social, or all-three pressures.

On the other hand, the socially sanctioned expression of heterosexuality—marriage—was a dangerous and degrading institution for women. In an era before birth control, women could not deny their husbands sex, and this could mean serial pregnancies for two decades or more… with the attendant toll on both psychological and physical health. It often meant too many children to protect or provide for. The rates for infant mortality were nearly as high as the rates for death in childbirth. Wives could be raped and beaten with impunity, could not inherit money, could not own their own wages, vote, serve on juries (critical factor in rape trials), could not own their children. Husbands could have insubordinate wives incarcerated indefinitely in mental asylums. This was still true through the middle of the twentieth century. It goes without saying she was expected to do the most low-paid and menial work.

The woman with enough self-esteem to insist on control of her body; the woman with dreams of creative, entrepreneurial, or intellectual work; and the woman whose childhood experiences of male sexuality were traumatic enough to preclude her fulfilling the obligations of the marriage bed had two choices: celibacy or lesbianism. Many women chose lesbianism. And many of these, not surprisingly, were women of achievement. Scratch around under the surface of these thousands of exceptional, historical spinsters, and you will usually find the lesbianism.

Women have always historically experienced lesbianism as a viable choice, because it has offered intimacy with emotional support, families without childbearing, and the potential for egalitarian, mutual, companionate partnerships, because both parties had equal rights—that is, equal disenfranchisement—under the law.

Many women have rarely, and still rarely, experience heterosexuality as a choice. It is instituted more as a regime, and a compulsory one at that. It is impossible to know whether or not women are really born heterosexual, since all women’s primary socialization for intimacy is same-sex, i.e. with our mothers; and then we are weaned away from that orientation by a never-ending barrage of aggressive narratives and images teaching us to desire men, even if they are animals (Beauty and the Beast), even if they live in an environment that is hostile to us (The Little Mermaid), and even if they have historically enslaved and exploited us (see above). This lifelong avalanche of propaganda is accompanied by sanctions against lesbianism that play out at all levels, from social censure to execution and incarceration. It is impossible to know if women are born heterosexual, or even if we choose it, when we might just be choosing a living wage, acceptance by our families, membership in our church, a career in the military, custody of our children, or having the career of our dreams. In many countries, women who sleep with men might just be choosing to stay alive.

There have always been women with pride, high moral principles, dignity, ambition, courage, and vision who chose and who still choose same-sex intimacy, because it is an empowering choice in a patriarchal culture.

The world has improved for women in the West… in some ways. In others, it has become a nightmare. Trafficking, pornography, prostitution are billion-dollar industries resulting in the exploitation and literal enslavement of millions of women and children. The entire culture has become inundated with pornography, so much so that stripper poles are used for aerobic exercise, popular music glorifies pimping, and girls’ fashions mimic clothing worn for soliciting sex.

Men in the US still make one-third more money than women. Men still rape and batter. Men still harass in the workplace. Men still outnumber women in media images five to one. Women are wildly underrepresented at all levels of government. It’s still very much a man’s world, at the expense of women’s safety, dignity, and independence.

Lesbianism is a proud and strategic choice for many of us, and we want people to understand that. We want women to know they have options. They can exercise choice over their desire. They don’t have accept their programming. And we want men to know that their violence against us is backfiring, that it is generating a spirit and a community of resistance and solidarity among women.

Published on: July 27, 2010

The Bechdel Test, the Lesbian Litmus, and the Gage Gauge

Lesbian cartoonist and brilliant graphic memoirist Alison Bechdel articulated what has come to be known as the Bechdel Test. It's from her brilliant and long-running cartoon strip "Dykes to Watch Out For." Two lesbians are on their way to the movies, and one of them says, "I have this rule, see.... I only go to a movie if it satisfies three basic requirements. One, it has to have at least two women in it... who, two, talk to each other about, three, something besides a man."

There is actually a website, where folks can rate movies according to their ranking on the Bechdel Test.

Well, the recent release of a lesbian-themed Hollywood movie, The Kids Are All Right, has inspired me to propose a lesbian adjunct to the Bechdel Test. Let’s call it the Lesbian Litmus…

Okay, here goes... To pass the Lesbian Litmus, a film about lesbians must have:

1) Butch parity. For every lesbian femme character there is a lesbian butch. Not a transgender male. Not a butchy femme. A lesbian butch. This was an ongoing struggle for "The L-Word."

2) If there is lesbian sex, then it must be for and about lesbians. Not lesbian sex for straight men to get off on. No Windchime Treatment. This is named for Steven Spielberg’s notoriously homophobic treatment of Celie’s initiation into lesbian sex in his film adaptation of Alice Walker's dazzlingly lesbian and feminist and womanist novel The Color Purple.

In the book, of course, there is this amazing scene with mirrors, where the sophisticated Shug shows Celie her genitals, and the lesbian sex is framed as a healing alternative to both women’s experiences of violation by men. In Speilberg’s version, there are some chaste kisses on the cheek, and then, just as Celie moves in for the lips, the camera cuts away to hands being placed on shoulders... Oh, come on! Seriously? SHOULDERS? But even that is too much for Spielberg, and the camera cuts away again to a tinkling little Japanese windchime. Fadeout. So now we can just imagine all the fragile, exotic, tinkling little sex that follows… (Footnote: I remember reading somewhere that Tina Turner had been considered for the role of Shug instead of Margaret Avery. I have a feeling she would have ripped Spielberg a new one… as in “What’s windchimes got to do with it?”)

But, as I was saying, lesbian sex for and about lesbians.

3)    No “all she needs is a good man.” (The Fox, The Kids Are All Right, The Children’s Hour, Chasing Amy, Kissing Jessica Stein) No “give me a baby” sex. (French Twist) And, help me if I’m forgetting any.

4)    No killing off of the lesbian to make it okay (Boys on the Side, The Fox, The Killing of Sister George, original ending of Maedchen in Uniform, Thelma and Louise... who can only justify their lesbian kiss with the fact they are going to be ruptured and shattered cadavers seconds after.)

5) It shouldn't be necessary for the women to be drunk/high. The lesbianism shouldn't be accidental or dismissable because of having been drunk, but clearly chosen. (Claire of the Moon) (Thank you, Karen Escovitz!)

6) The lesbian sex scenes should not be outnumbered or outclassed by heterosex scenes (The Kids Are All Right) (Thanks, again, Karen!)

7)    AND NO SEX SCENES WRITTEN OR DIRECTED BY SOME IDIOT WHO STILL CAN’T ACCEPT OR IMAGINE THAT WE DO JUST FINE WITHOUT A PENIS, WITHOUT MALE PORNOGRAPHY, WITHOUT WINDCHIMES, WITHOUT VAMPIRES, WITHOUT INEBRIATION, WITHOUT SUICIDE, AND ESPECIALLY WITHOUT PANDERING TO SOME INTERNALIZED MALE PORNOGRAPHIC GAZE. OKAY?

So that’s my proposed “Lesbian Litmus.”

The Bechdel Test seems to eliminate about half of the big studio films. The Lesbian Litmus looks to me like it will take out about half of the lesbian films. The more assertive lesbians and feminists become the more rarified the cinematic atmosphere…

And now I am going to suggest The Gage Gauge:

The lesbians who are in a primary relationship express an understanding that their intimacy poses a tremendous threat to male dominant institutions, and they derive both pleasure and energy from this understanding and, because of this, seek out opportunities to maximize the radical potential of their lesbianism.

Now, surely, somewhere there must be a lesbian film that ranks on the Gage Gauge…? If not, may I suggest any number of Gage plays for future filmmaking projects? www.carolyngage.com

Published on: July 21, 2010

Witnessing for Lindsay

I want to say something serious about Lindsay Lohan.

She tried to be in a public lesbian relationship at the same time that Hollywood was claiming her as a heterosexual sex goddess. Nobody has ever done that before. And she pulled off one of the most remarkable portrayals of an incest victim ever seen on screen.

She was trashed and ridiculed for the lesbian relationship. Her girlfriend was given insulting nicknames by gossip columnists. Her father expressed his homophobia openly to the press. And while she was going through all this, she was struggling very publicly with drug and alcohol addiction. The gossip-mongers reveled in every careless crotch shot, every drunken stumble. She was called “Lindsanity” and “Fire Crotch” and “LOLhan.” Her girlfriend’s admirable loyalty to her, even after the breakup, through DUI's, rehab, and up to the current jail sentence has been treated as a joke.

The film about incest was trashed by the critics and buried as quickly as it opened. The press was far more interested in Lohan’s unpredictable behavior on the set, which very closely mirrored Marilyn Monroe’s behaviors on the set of her last picture, The Misfits… and probably for the same reason: Both actresses were playing very close to home, bringing a dangerous level of integrity to their roles as violated women fighting for their lives in real-life environments that offered inadequate support.

Georgia Rule was the film, and it featured Jane Fonda as the grandmother, Felicity Huffman as the mother, and Lohan as the teenaged daughter. In the film, Lohan’s unruly, sexually promiscuous character has been sent to live with her grandmother, a woman with old-fashioned values and methods of discipline. Turns out the girl is a handful because her stepfather has been raping her, and her mother does not believe her. As many child victims do, the daughter has recanted her accusations, because her mother’s denial of the abuse is more painful than her rejection of her daughter for lying … and, of course, after retraction, the acting out began. The victimized daughter tells the story, as so many of us have done, in ways that make up in drama for what they lack in directness.

The film has an unforgettable scene where Lohan’s character bargains with her rapist for a new car. We watch her as she begins to identify with the Lolita identity the stepfather has forced on her, struggling to locate any avenue of empowerment in an increasingly desperate scenario.

Her mother doesn’t know whom to believe, but Georgia, the grandmother, does. The relationships between the three women are complicated, and honest. And that’ the problem. They're too honest. The critics didn’t know what to make of them. This is about incest, right? How dare it have any humor? How dare it have elements of domestic comedy? Incest… heavy, tragic, filled with monsters and helpless and terrified girls.

No. Incest. American as apple pie. Mundane as mowing the lawn. Incest. Something woven into the fabric of Thanksgiving dinner, family roadtrips, mother-daughter feuds. The critics trashed this film because they could not handle the level of commitment on the part of three seasoned and brilliant women, taking incest in stride and making the audience deal with the banality of it. The critics would have us believe that incest is so tragic, so searing, such a perversion of the dynamics of the nuclear family that anything less than Oedipus Rex is disrespectful to the victim. They take incest so seriously-- or so they would have us believe--they cannot abide a dramedy on the subject.

The truth of the matter is, they cannot handle the truth in women’s lives.

As a playwright and a performer who does a lot of writing and acting on the subject of incest, I have learned a few things. First, it scares the shit out of people. Second, it is nearly always censored. And this censorship always comes down the same way... the way the critics for Georgia Rule made sure the film was killled. The depiction of incest is dismissed on artistic grounds, aesthetic grounds, political grounds. As if there is some blockbuster, politically correct way to treat the subject, but no one has managed to discover it yet... which is why we hardly ever see anything realistic about incest. Just perpetrator-identified crap.

And there is a third thing that I learned the hard way. It takes a lot of recovery and a lot of community support to portray an incest survivor, and especially one who is unrecovered. An actor needs to have evolved just a little beyond her character. It can be very dangerous to play self-destructive confusion from a point of self-destructive confusion. Electrifying for the audience, but too risky for the actor. It can be fatal to play a character who is more evolved than oneself. Lohan’s character in Georgia Rule is, finally, believed. The perpetrator is busted and kicked out. A powerful matriarch steps in and order is restored. The child is protected.

How painful must that have been for Lohan, when her perpetrators continue to be enabled and protected by an industry that is hell-bent on prostituting her? Where is the powerful Lohan matriarch who can stop enabling the behaviors and set the healthy boundaries around a raging addiction? Where is the feminist studio head who has Lohan’s back and who can wash out the mouths of the paparazzi and drive off the cultural pimps who keep offering more and more money for pornographic photo spreads?

It must have been painful to deliver the character to a reunited family of supportive and protective matriarchs, while she, the actor, had to wend her way back her trailer, where her alcohol and her pills were waiting… with her parents whose public feuding over her had become a nightmare.

So now she’s in jail. That means involuntary detox. I wish her well with that. And I understand she has signed to make a film about the late captive and torture survivor Linda Boreman (aka “Linda Lovelace”). Personally, I think that’s a dangerous choice. Boreman escaped. She understood her porn “stardom” to have been a violent ordeal. She understood her first husband to have been a captor and abuser. She became an anti-pornography activist.

If this film follows Boreman’s life through her liberation, Lohan will have two choices: arrive at an understanding of how pornography and a pornographized culture exploit women, or self-destruct.

There is a third option, but it’s one that Lohan would never do: Turn in a bad performance.

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