Medication Mechanization: Microchip Sensors in Abilify to Increase Medication Compliance

This entry first appeared at Mad In America on November 10, 2015.

I felt a chill go through my body when I read that the FDA has agreed to review for possible approval in early 2016 a new form of the drug Abilify that contains a microchip sensor capable of sending a message that indicates the exact time a tablet dissolves in the stomach. The message is recorded by a skin patch – along with data such as the person’s body angle and activity patterns – and, according to a press release from Proteus Digital Health, the developer of the device, “this information is recorded and relayed to patients on a mobile phone or other Bluetooth-enabled device, and only with their consent, to their physician and/or their caregivers.”

The Japanese drug giant Otsuka teamed up with Proteus Digital Health in 2012 to create this potentially profitable new “chip in a pill” just as its patent on Abilify – at $6.9 billion the #1 most profitable drug in the U.S. in 2013 – was set to expire in 2014, leaving one of Otsuka’s most valuable markets vulnerable to generics. It is especially ominous to me that our government is teetering toward passing the Murphy Bill, which would make forced in-home treatment the law of the land, at the same time it is lurching toward putting such an Orwellian device in the hands of a pharmaceutical company, courts, and families.

According to the Washington Examiner:

”The new smart drug could be particularly useful for ensuring the mentally ill continue taking their medications, not just by giving doctors a way to monitor their behavior, but courts as well…all but five states have court-ordered programs where a judge can mandate that offenders with severe mental illness stick with a treatment program as a condition of remaining in the community.”

As one Facebook commenter noted; putting a pill in your mouth and swallowing it, knowing it’s going to transmit a message to prove one is submissive and compliant, is beyond Orwellian – it feels fascistic. I agree. The social contract draws an invisible line that must be guarded against forces in a society that, driven by fears, fantasies of benevolence, or by simple greed, and are blind and deaf to the cries of its citizens as their bodily and personal integrity are ground into powder along with the preparations they are compelled to take in the specious name of “health” and “safety.”

Sometimes, radicalizing people politically takes a really callous, stupid, and dangerous threat to people’s liberty. This is one of those times.

The Washington Examiner article cites recent research that shows 74% of people who are started on antipsychotic medications stop taking them within 18 months. That’s the justification offered for a psych drug that monitors its own use.

“These individuals already have a history of problems due to their unwillingness or inability to voluntarily comply with treatment … this could be an important advance for them that would help them maintain treatment compliance.”

— D.J. Jaffe of the Mental Illness Policy Org.

Think about it: faced with the overwhelming 74% failure of a pharmaceutical intervention, why is the core issue deemed to be compliance rather than efficacy, and consumers’ safety & satisfaction? And why are we “gearing up” to ensure compliance in particular for a drug that even the FDA admits has an unknown mechanism of action?

What other medical specialty would blame its patients for so overwhelmingly choosing not to take the medications that have been prescribed to them? For a field that has taken on the charge of controlling and regulating social deviance, the ethical boundaries that the FDA should be protecting are blurred by the growing perception that people who are DSM-diagnosed are potential risks to society, despite overwhelming risk to the contrary; that a DSM diagnoses should be a signal that a person needs and deserves our protection.

Only a worldview that embraces the disease and deviance model of human emotional suffering would dare to suggest putting a sensor in a psychoactive substance to monitor and enforce its ingestion by an otherwise free citizen.

I believe that at some very basic level empathy seems to have failed in a society that sees the need to develop a sensor-equipped psychoactive substance. The blasé emphasis on prioritizing prescription compliance, without considering the profound subjective experience – to anyone, let alone a person in crisis – of having a digitalized foreign object inserted deep inside, an object that is in turn sending messages to an invisible outside presence. This oversight amounts to a vertiginous stumble forward in our society’s failure to muster empathy and compassion for its members, instead delivering them, in the form of a now-literally captive market, to the drug makers.

I’ve been seeing clients in therapy for over 35 years, and at no point can I imagine sitting a few feet away from a person in distress and suggest to them that they should consider having a device inside them that would let me know every day at a distance their most intimate experiences – let alone when they digest something, lie down, or when they have taken their meds. I couldn’t do it. It would feel ghoulish and perverse.

And I don’t want to be a part of a society that would do. Even – and perhaps especially – if it were being done “in my name.”

There is an aura of something shameful, a violation of a basic human right to privacy and bodily boundaries that is being ignored in the pursuit of this new digital monitoring of psychiatric medication. The shame is that, with a pill that records the moment of its absorption into our bodies, we are seeing the realization of a long-sought ideal of totalitarian governments; to cross the blood-brain barrier, gaining access to the very seat of our autonomy, and of our souls. With this, Otsuka could fairly revamp its marketing for Abilify by renaming it “Dis-Abilify,” without so much as risking – and potentially augmenting, in a society that seems to be exuberantly embracing an Orwellian ideal – its market share.

This is a time, if there ever was one, for citizens to act, and to act decisively; before the ability to make decisions, let alone act on them, is excised from our bodies completely by the next wave of pharma development.

Of course some will object to my characterization of those who developed this seeming well-meaning medical breakthrough as lacking a moral compass. But I have already heard the cries of outrage and fear from many of those for whom this Orwellian medicine is intended.

I’ll end here with an ever-more apt quote from C.S. Lewis –

“Of all tyrannies, a tyranny sincerely exercised for the good of its victims, may be the most oppressive.”

Mad in America: “My Ego Strength is Too Developed for Me to Ever Become Psychotic!”

Hi All,

A brief new article here about mental health providers who believe they never could suffer in the ways many of the people they serve experience, and how that belief limits the provider’s capacity for empathy and compassion.

Best wishes,

Michael

The Dr. Peter Breggin Hour – Psychosis and Healing – 03/12/14

PRN.jpg

With guest psychologist Michael Cornwall, who himself as been through madness, this is the most profound examination of psychosis, its causes and healing, you will ever hear. Frightening warnings with an even more positive message. Listen and pass it on.
The Dr. Peter Breggin Hour – Psychosis and Healing – 03/12/14

The Esalen Connection: Fifty Years of Re-Visioning Madness and Trying to Transform the World

This entry first appeared at Mad in America on December 12, 2013.

When Richard Price was a young man, he experienced extreme states for which he was labeled schizophrenic and forcibly ‘treated’ with psychiatric medications, ECT, and insulin shock. He suffered from residual effects from this for the rest of his life. In 1962, Price and Michael Murphy founded the Esalen Institute on the Big Sur coast of Northern California. From its beginning, Esalen worked to create sanctuary for people who, like Price, experienced extreme states. “Esalen was Price’s revenge on the mental hospital!” says Murphy.

Both at the institute itself and through the creation of projects like the rigorously designed, NIMH-funded Agnews Project research, Esalen helped to create the contemporary model of madness sanctuary. Agnews, which yet stands as the largest randomly-assigned, double-blind study on first episode psychosis, showed a 70 percent lower re-hospitalization rate advantage from providing a med-free environment for people in initial extreme states; a result which provided impetus and support for John Weir Perry’s med-free sanctuary Diabasis House, and the creation of the I-Ward sanctuary that I served at and wrote about here on MIA in “Remembering a Medication-Free Madness Sanctuary”.

dickprice
Dick Price

Dick Price also wanted Esalen to be the kind of outside-the-box think tank that could fundamentally re-vision the experience of madness away from the medical model vision. Price realized the applied practice of the medical model belief system was the cause of the greatest trauma in his life. Price said about his own experience that “The so-called ‘psychosis’ was an attempt towards spontaneous healing, and it was a movement towards health, not a movement towards disease.” He believed his experience of madness was not pathological but was full of meaning and was transformative, even perhaps touched with mystical power. He saw Esalen as a refuge for people in extreme states, “A space where it’s possible to live through experience rather than having it blotted out, a place where there aren’t the same negative self-definitions of someone going through this type of experience.”

In addition to Price’s commitment that Esalen provide refuge for those in extreme states, Esalen’s broader liberating influence on world culture would prove to be enormous, as pioneers in philosophy and psychology made it the birthplace and epicenter of the human potential movement. (Sascha Dubrul has written a great article here on MIA about the lasting relevance of the human potential movement for current activism.) The young and gifted Price and Murphy attracted figures like Alduous Huxley, Alan Watts, and Abraham Maslow, who helped put Esalen on the map with week-long and even month-long gatherings for re-visioning madness. Ongoing symposia with names like “The Value of Psychotic Experience” went on for the whole summer of 1968! Gregory Bateson, Murphy and Price, Alan Watts, RD Laing, Erik Erikson, Fritz Perls, John Weir Perry, Claudio Naranjo, Virginia Satir, Julian Silverman, Alan Ginsberg, Michael Harner, Joan Halifax, Stan Groff, and many others all contributed to a growing understanding of extreme states that continues to evolve, as it certainly always must. They saw a neglected possibility for humankind, rooted in a philosophy that has always served to bring a dimension of the sacred and numinous into view.

That ancient but always emerging mythic vision serves as a counterweight to the objectifying, pathologizing and materialistic world view that I believe makes the tragically narrow vision of psychiatry possible. Esalen’s role in altering the views and approaches to madness, or extreme states, continues to this day.

Last month, following in the tradition of passionately focused Esalen conferences, I organized a week-long invitation-only gathering there; “Alternative Views and Approaches to Psychosis.” This conference was preceded in 2011 and 2012 by a workshop and then a conference on alternative approaches to extreme states that began a revival of this aspect of Price’s work, one that had been dormant at Esalen since his death in 1985, when he was struck by a boulder while tending to the Esalen grounds following a flood.

This year, the Esalen conference was attended by 40 people involved in one way or another in the mental health revolution that is daily chronicled here on Madinamerica. People with lived experience brought their invaluable perspective to a gathering that included peer counselors, psychiatrists, therapists, authors, film makers, researchers, mental health services administrators and family members. A great many of the 40 people who gathered felt a sense of urgency to come up with collaborative, strategic ways to unite against the ever-growing human rights abuses of forced treatment. Those human rights abuses are being justified more and more in the name of protecting society from the suspected danger of people who have been given a psychiatric label. That public demonizing of those of us with lived experience of extreme states is being fueled by wide-scale fear mongering and draconian laws that threaten all who experience extreme states.

A number of us at the Esalen gathering committed to work together to fight human rights oppression on many fronts, via media, public education, legal campaigns, and expanding on existing – and developing new – humane, alternative supports for those in extreme states.

Dick Price was a psychiatric survivor whose compassion still touches us now. I know I wouldn’t be writing here on MIA if not for him, because the I-Ward medication free extreme state sanctuary I went to work at in 1980 would never have existed without the Agnews research Price made happen. John Perry’s Diabasis House – that I did my doctoral research on – never would have existed either.

So, thank you Richard Price, for fatefully touching my life, but so much more for helping so many people in extreme states receive the love you were denied in your hour of need, and escape the soul-shrinking diminishment of self-worth, and the hopelessness that a psychiatric diagnosis can inflict. Esalen lives on as an example of what can happen – for individuals and for society at large – when we respond to the extremes that sometimes come with human life not with fear and control but with receptivity and encouragement. There’s no knowing – ahead of time, at least – how much accrues to each of us and to society at large when we learn to listen to the voices – weak, tenuous, or frightening as they may sometimes be – of people who are struggling with the process of coming-to-be in a world that often silences or eliminates them before they have a chance. Dick Price’s voice was silenced early but lives on in the place in which he came to live and die; a memory and evidence of what can happen when the best of mind, body, spirit and community are given a chance to come together.

An Integrative Approach To Transformative Madness

October 17th, 2011
The Icarus Project Speaker Series
The California Institute of Integral Studies

An Integrative Approach To Transformative Madness

Michael Cornwall, Ph.D.

Much Madness is divinest Sense–
To a discerning eye–
Much sense–the starkest Madness–
‘Tis the Majority
In this, as All, prevail–
Assent–and you are sane–
Demur–and you’re straightaway dangerous
and handled with a chain.

– Emily Dickinson

Here are some thoughts that I wanted to share with you about how to best serve your clients, friends, and loved ones who are experiencing a psychotic/visionary experience. These thoughts will also be of help in doing self-care if you are entering or traversing a madness process.

These suggestions are mainly gleaned from my own unmedicated, untreated experience of madness in my early twenties, and from working daily as a primary therapist for almost 30 years with actively psychotic clients using a Jungian/Transpersonal, Laingian approach.

During that time I worked for over three years at a 24/7, alternative, 20-bed, free-standing, transpersonally-oriented, acute care open door program called I-ward in Martinez California where no medications or leather restraints were used or diagnoses given to consumers who were acutely psychotic.

I also helped develop a similar five-bed program in Marin County, Passages In, that was short lived. I did several months of internship at St. George’s Homes in Berkeley where a similar Jungian/Transpersonal approach was used.

After that I worked for 25 years in public sector clinics and on a mobile crisis team as well as in private practice. Even in those settings, most of the psychotic clients I served were not on medication.

I also am drawing on my doctoral research follow-up study done on the San Francisco-based, medication-free Diabasis House for clients in acute psychosis and my 25-year relationship with its founder, Jungian psychiatrist John Weir Perry.

But my early experience of serving from age 18 as a medic in the Army Reserve for six years and then as a State Hospital attendant with profoundly retarded men and for two years as an orderly at a nursing home with brain damaged, demented and Alzheimer’s patients also informs my advice on how to relate to people in pain and suffering.

So, here are two basic principles for helping someone or yourself in a psychotic/transpersonal process which are distilled from my own experience and the study of successful Bay Area alternative programs.

1. Keep suspending your disbelief

Every time you tell yourself (believe that) the psychotic person you are being with has a tragic, lifelong, and threatening physical illness that has no inherent meaning or purpose – such as an injured brain, a genetically based diseased brain, an incurable thought disorder, or chemical imbalance – suspend your disbelief that another explanation may be possible.

Instead, hold the belief that they are going through a necessary, meaningful, developmental, initiatory, transformative, transpersonal/archetypal, symbolic and/or purposive natural process – one that is neither pathological nor indicative of a bio-medical brain disorder.

Hold the belief that, as Dr. Karl Menninger said, they might even come through the process “Weller than well!”

2. Be Receptive

Once you are able to stay open to the possibility that this person’s process is an important, potentially transformative natural life event, draw on all your skills of receptivity and empathy in order to be with them. Begin by simply listening and receiving the person with an open, compassionate heart. Let the gentle feelings of love that you would feel for a loved one who is frightened and suffering be present within you.

As their process unfolds, gently invite and encourage the person to express both the emotional and symbolic content of their process. People in a psychotic process may need to use modalities such as drawing, painting, movement, and evocative music to express themselves in addition to or instead of speech. Somatic modalities of touch and bodywork can be especially welcomed and grounding and soothing.

The common and overwhelming evidence from Diabasis, I-Ward, Soteria, and every other alternative program from all over the world confirms the basic need for a person in such a psychotic/ transpersonal process to be believed in, listened to and lovingly received and responded to in this way.

Today I also wanted to share some observations I slowly learned for myself the past 30 years about how to more specifically make yourself available to the person in the room with you who is in a psychotic/transpersonal process.

To be most helpful try and feel like your inner subjective state is more emotional than mental.

Create a physical and emotional state of receptivity. Let warm feelings of caring be present in you.

With your feet flat on the floor, hold the awareness that there is now a solid base and foundation beneath you.

Remember to keep your anal sphincter relaxed.

Keep a focus of energy in the hara chakra below your navel.

With your stomach muscles relaxed, feel yourself do deep and slow belly breathing.

Drop down your shoulders.

Let your face become calm and relaxed–not becoming pensive or quizzical.

Let your voice come up from your hara in lower octaves, emerging with the energy of your heart chakra as you speak..

Let your kindly, gentle, even loving and tender feelings of empathy and compassion arise in your heart chakra for a fellow human being in distress and suffering who is sharing the room with you.

Allow silences.

Don’t seek direct eye contact if it seems to make the person uncomfortable.

The person may be in a very heightened state of awareness and is processing minute inflections in your voice and body language.

Their ability to see into you may surprise you as uncanny and psychic.

In this state they may directly or symbolically tell you secret things about yourself that are disquieting.

If the person is hostile increase your vigilance on your own physical and emotional markers of receptivity.

Because you may find that you may involuntarily be holding your breath.

You may notice your throat becomes constricted and your voice goes up in octaves.

You may notice you are opening your eyes very widely and blinking a lot.

You may feel the need to fold your arms across your chest or cross your legs.

To the degree that you can be aware of these shifts in you prompted by anxiety, you can refrain from them as much as possible and remain in the open, receptive, emotional, and physical posture with a potentially physically or verbally assaultive person in a psychotic process.

The more you stay grounded and centered the more they will calm down, will not sense a fight or flight visceral response to them building in you.

Being with agitated clients in a psychotic process is kind of like practicing an internal martial art at times – a form of Aikido.

To give yourself the best chance of staying open and receptive be realistic about real danger to yourself.

Have another person keep an ear open and check at your door if you are meeting with a hostile person.

Position your chair by the door if with an agitated person to allow quick exit if you are attacked.

Give yourself the intentional permission that if necessary to survive a physical attack you will struggle to defend yourself in a way that would cause the least amount of injury to your self and to the other person until help arrives to contain the situation.

Madness is an ancient form of uncivilized wildness.

If you are given the opportunity to serve those traversing it’s mysterious depths and heights count yourself lucky, especially if they are not emotionally anesthetized by medication.

The efficacy results from the Agnews Project, I-Ward, Diabasis, and Soteria House all clearly demonstrate that without medication, most acute psychotic/visionary crises will in fact be the occasion for a life changing spiritual transformation if a 24/7 alternative, non-medical model sanctuary is provided.

My experience and research into alternative approaches for serving those in a psychotic/visionary process has led me to believe that that at least 50% of the consumers who become trapped in the mental health system could have avoided that fate if acute care, 24/7 Bay Area sanctuaries like Diabasis House, Soteria, and I-Ward (where I worked) were available at first contact with the system.

They never would have gone on to be labeled Schizophrenic.

Jung said that: “Psychiatry has turned the Gods into diseases.”

Unfortunately Jung and most Jungians have turned the Gods (and Goddesses) into archetypes: named and minutely described denizens of the collective unconscious that we can have an ‘as if’ relationship with at weekend workshops and schoomze with once and a while in our dreams.

Please don’t make the mistake of underestimating the spiritual dimension of our human birthright as you enter your own shamanic vocation.

In my experience, behind every image, thought and word, there is an emotion first. Behind every emotion there is a universal archetypal power and emotional energy that must come forth as imagery that expresses that deep emotion. Behind every archetype is a totally autonomous living force of deity that has no historical bounds, no time bound form.

These ancient and emerging deities, that use our lives and bodies as their playgrounds and every second hold us in sway as they incarnate themselves in us, ever emerging anew, arise out of a greater unifying mystery of benevolent silence.

Weep for the prophets and so-called psychotic visionaries who are robbed of their life giving gifts from the Gods by our culture of fear and human arrogance. And weep for us that we still treat them as lepers when they are, and always have been a divine source of the mana we need to survive on earth.

As a psychotic process begins, the psyche is faced with such overpowering unbridled emotion that the inner emotional charge grows to become profoundly existential in nature and magnitude. As the person faces the initiatory challenge of young adulthood in such an all pervasive liminal depth, the ego, the frail manager of consensual reality, simply is engulfed by the soul depth liminality of an emotional power that triggers all forms of desperate, seemingly delusional attempts to give some fragmented sense of meaning to the inner experience.

It is a visceral, first chakra existential experience that seizes the individual. It is the emotional response to being lost. It may be experienced mainly as one feeling exalted and indestructible at first or feeling totally doomed and bewildered.

The experience may also fluctuate between being plunged into the underworld and being drawn up into heavenly realms with amazing rapidity.

In any case, if not made numb by medication, the psyche creates a mythic story along predictable lines. The drama is played out on the stage of the central archetype, the Self, where every kind of polarity may be experienced and transmuted: good/evil, dark/light, male/female, life/death, terror/serenity, grief/joy, desolation/birth. All the emotion generated and image fueled polarities may be contained in the mandala crucible of the relationship you create with the person who is mad. In that container with you, all the polarities can be balanced into a cohesive unity.

That relationship with you is crucial, is a prerequisite for transformation and healing to occur.. Without a loving other to make the mandala crucible forged of their two hearts and psyches, the mad person spins on out of control.

Psychosis is the ultimate identity crisis and is for some, a potentially shamanic initiation. Our feeble, arrogant egos usually assume we are master of knowing “Who am I?”

As the pre-psychotic/visionary ego floats in this ignorant vulnerability over an abyss of the unfathomable depth of the collective unconscious and spirit world of gods, demons and ghosts, the ego is always just a few nights without sleep away from psychosis, or a drop of LSD away from psychosis, or from a psychosis triggered by a kundalini eruption, or a loved one’s sudden death.

The unprepared ego of an especially vulnerable young adult facing autonomous functioning separate from their family is at risk from drowning in the depth of the affect and images of the collective unconscious.

It is remarkable that the childhood tasks of such a vulnerable ego do not overwhelm it. However, in the late teens and young adulthood comes the awareness of mortality and the knowing that physical survival and social acceptance and success depend on functioning separately from parents.

Because of the power of our toxic and soulless culture to create enormous deficits in our family systems, most notably an epidemic of the lack of a strong infant-parental love bond, when faced with the often cruelly threatening social Darwinism cultural gauntlet one must traverse into young adulthood, the pre-psychotic ego for some is simply not prepared to traverse the hero’s journey and initiation across so much underlying liminality.

We can’t underestimate the corrosive and pervasive effects on vulnerable children and young adults that our largely loveless and spiritually barren corporate culture inflicts through degradation ceremonies of endless winner-loser competitions where shame and guilt and punishment break the spirits and hearts of so many.

For such vulnerable young persons, an affect of an unnamed existential terror, the dreadful sense of an abyss of yawning ontological insecurity seizes them. This overpowering challenge may then trigger an attempted visionary alternative restructuring of the ego through a radical immersion in a mythical inner struggle for adult independence.

This inner heroic struggle for ones future life is carried out at the archetypal center of the Self, if the young person’s process is not aborted, if they are given sanctuary and not medication.

I have seen them come out the other side with a new, heroic ego strength that grew out of their trial by fire.

As the great R.D. Laing said after witnessing and attending many on such a journey at the Kingsley Hall sanctuary he provided:

‘From the alienated starting point of our pseudo-sanity, everything is equivocal. Our sanity is not true ‘sanity.’ Their madness is not true ‘madness.’ The madness that we encounter in ‘patients’ is a gross travesty, a mockery, a grotesque caricature of what the natural healing of that estranged integration we call sanity might be. True sanity entails in one way or another the dissolution of the normal ego, that false self competently adjusted to our alienated social reality; the emergence of the ‘inner’ archetypal mediators of divine power, and through this death and rebirth, and the eventual re-establishment of a new kind of ego functioning, the ego now being the servant of the divine, no longer its betrayer.’

©Michael Cornwall, Ph.D. 2010