By David Oaks

Any serious debate in 2007 about the topic of involuntary psychiatric procedures ought to include the following fact:

For years, many studies have indicated that long-term high-dosage neuroleptic (also known as antipsychotic) psychiatric drugging may induce structural brain damage. This damage can include actual shrinkage of areas of the brain associated with higher-level functions, what makes us human.

In his commentary, "England's New Mental Health Act Represents Law Catching Up with Science," Anthony Maden demands that "ethical advocates of a change to capacity-based legislation are under an obligation to deal with the science."

However, I note that proponents of involuntary psychiatric procedures seldom explain clearly to colleagues, the public, patients or their families, the full implications of these procedures. It is undeniable that involuntary psychiatric procedures often involve psychiatric drugging, and that neuroleptic psychiatric drugs are often used in such circumstances.

Therefore, the impact, risks and efficacy of neuroleptics are relevant. There are debates about these topics, including that there are effective alternatives other than neuroleptics. However, I wish to focus on one particularly relevant risk.

In the last decade or two, countless medical articles have raised warning flags that long-term high-dosage neuroleptic use is associated with structural brain change. Please understand that I, and the nonprofit organization I direct, MindFreedom International, are pro-choice. Many of our members choose to take prescribed psychiatric drugs, including neuroleptics, others do not.

But we are all united in speaking up for basic human rights, and a fundamental human right for patients, their family and society itself is the right to know. It is a horrible medical catastrophe that knowledge about neuroleptic-induced structural brain damage is today largely confined to the medical field itself. As a human rights activist for the past 31 years, and as an individual who has personally experienced involuntary neuroleptic drugging, I maintain that this disaster amounts to a kind of "Greenhouse effect" of the mind, and some day the public will want to know why they were not informed.

Similar to the controversy about the environmental Greenhouse effect, there are industry defenders who are sowing doubt about the claims here, that long-term high-dosage neuroleptic use is associated with structural brain changes. Even though there are brain scan and autopsy studies showing these changes, some still try to deny these changes by claiming the underlying "mental illness" must be reasonable for the brain changes. This does not explain, however, why medical studies on animals can replicate similar structural brain change. Did these animals all miraculously develop "mental illness"?

Why is neuroleptic-induced structural brain damage so important? Try a simple thought experiment. If any medical authority recommended that thousands of individuals out in the community receive involuntary psychosurgery -- actual surgical destruction of healthy brain tissue to change behavior -- there would be automatic outrage. Why? Because when force is combined with a procedure that is so profoundly intrusive and irreversible and damaging to the core part of our being as psychosurgery, the general public intuitively understands that coercing these procedures would be unethical.

Many Studies Show that Antipsychotic Treatment can Result in Severe Structural Brain Changes

Today, there are many studies showing that long-term high-dosage neuroleptics can actually result in such severe structural brain changes, that these changes can include shrinkage of the parts of our brain associated with high-level cognition. As anyone who is knowledgeable in this field is aware, there are many such studies showing that long-term high-dosage neuroleptics are associated with structural brain change.

I will just mention one such study, because it involves both an older-type neuroleptic and a newer atypical neuroleptic.

In this study, three groups of monkeys each were given haloperidol, olanzapine or sham for a 17 to 27 month period. There was an 8 to 11 percent reduction in mean fresh brain weights in both drug-treated groups compared to sham.

The differences were seen in all major brain regions, especially in the frontal and parietal regions in both gray and white matter. There was a general shrinkage effect of approximately 20% and a highly significant variation in shrinkage across brain region

The Absurd Notion That Psychiatric Drugging is Good for the Brain

When I have raised concerns about studies like this with defenders of coerced psychiatric drugging I have been surprised at the response. One hypothesized that perhaps such brain shrinkage is helpful. Another hypothesized that such shrinkage is not literally "damage." Still another hypothesized the brain would snap back afterwards.

All of these debaters, despite the absurdity of their defense, miss the main point. To repeat, yes, I understand some may still choose to take a neuroleptic despite these risks; if they are fully informed and offered a range of alternatives, that is not the issue here. However, any debate about the ethics of involuntary psychiatric procedures must include a discussion about the fact that long-term high-dosage neuroleptics literally have a similarity to chemical psychosurgery.

The fact that any large library has the information I am discussing on its medical side, but not in the popular media side, is an indictment of the core values and ethics of the entire medical profession. This is a human rights emergency, and calls for immediate attention.

In the 1800's, a medical model was utilized to help consolidate power of those leading the mental health system. It is time now for democracy to get more hands on with the mental health system. We cannot continue to abandon mental health policy to rule by a small group of experts.

There are many other arguments against forced psychiatric procedures, especially on an outpatient basis, but I am focusing upon this central point about neuroleptic structural brain change because it is so important, and is so frequently totally ignored by those defending forced psychiatric drugging.

Patients on the "Sharp End of the Needle" in the Mental Health System are Among the most Silenced, Disempowered, and Oppressed in Society

For decades psychiatry has searched for proof of a "chemical imbalance" for any major psychiatric disorder. While they have not found proof of any chemical imbalance, those of us in the human rights field have discovered an enormous power imbalance. People on the "sharp end of the needle" in the mental health system are among the most silenced, disempowered, and oppressed in society. Due to decades of community organizing among thousands of psychiatric survivors and our allies internationally, the powerless clients are finding ways to speak out.

I applaud the president of the World Psychiatric Association, Dr. Juan Mezzich, who has recently joined with us in calling for open mediated dialogue between organizations representing psychiatric survivors and psychiatric professionals.

We will never be silenced again.

Medical study source: The Influence of Chronic Exposure to Antipsychotic Medications on Brain Size before and after Tissue Fixation: A Comparison of Haloperidol and Olanzapine in Macaque Monkeys, by Dorph-Petersen KA, Pierri JN, et al. from University of Pittsburgh.- Neuropsychopharmacology 9 March 2005

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David W. Oaks, Director, MindFreedom International www.mindfreedom.org More citations: www.mindfreedom.org/kb/psychiatric-drugs/antipsychotics/neuroleptic-brain-damage/