Off-Label

Once a drug has received approval in the USA by the FDA (or equivalent body elsewhere) to be prescribed for a particular use, doctors have the discretion to prescribe it for other, hitherto unapproved, uses, known as 'off-label' indications. The marketing strategies employed by pharmaceutical companies to exploit this are well known.

However, when I first heard the expression, it seemed like the psychiatric equivalent of 'in remission'; in which the patient one day fails to meet the criteria for a particular diagnosis s/he once received, and thus goes 'off-label.' Or perhaps there is no formal reassessment, but that the patient has simply moved out of the mental health system, by elopement or ejection or something in between, and gradually loses the self-perception and attendant habits of being 'sick'.

I fall into the second category. I 'fell' into the system at 15 - you could say I both jumped and was pushed. A cocktail of post-traumatic symptoms, boredom and standard romantic notions of going 'mad', combined with an abusive and unsupportive family and a social and educational milieu that regarded with deep suspicion teenage girls more interested in science and literature than boys, clothes and sport, made my descent almost inevitable. What followed were four years of diagnoses, hospitalisations, medications and humiliations which turned a troubled but basically normal kid into a... raving nutcase (I'm not sure how else I can put it).

I got out, but it nearly cost me my life. For many years I thought it necessary to try to forget about it in order to get on with my life, but the ongoing effect it has had on me and, as a consequence, on those close to me, has forced me to abandon that coping strategy and to begin reconsidering my experience. My initial conclusion is that I copped a double-whammy - suffering from the usual consequences of extreme physical abuse as a child (dissociative episodes, lowered mood, and preoccupation with the past), I entered the mental health system with the expectation that these issues would be addressed, only to be re-traumatised by unnecessary hospitalisations, inappropriate (and sometimes outrageous) behaviour on the part of those who were supposed to be 'treating' me and the unquestioned assumption that my problem was strictly biological. I was given many drugs that these days can only be prescribed to adults, and involved in a variety of drug trials and experiments. The ethical dubiousness of this hardly needs to be stated.

I've no doubt that my experience is far from unique, but having long dissociated myself from the 'system', I don't really know anyone who was put through the wringer to the extent that I was, and who could help me understand what happened and why. Hence this blog.

What it is:

- An exploration of some of the ethical and philosophical issues posed by the discipline of psychiatry, and
- Hopefully a forum for sharing and understanding experiences, both positive and negative, with the mental health system.


What it isn't:

- Dedicated to proselytising or damning any particular treatment or approach
- A source of unbiased information or opinion
- A support group for people in crisis, and
- A front for the Church of Scientology!

Iatrogenic Identity Disorder

According to a recent conversation with one of the many psychiatrists I saw as a teenager, I'm a different person to whom I used to be. I must have looked somewhat sceptical when he said this, so he reiterated his point: "No, really, compared to the way you were ten years ago, it's like chalk and cheese!"

So, what's going on here? A multiple personality? Routine BPD instability? No, he's just got it wrong: I'm the same person, in a different situation. If we really need a diagnosis for insurance purposes, let's call it Iatrogenic Identity Disorder.

It seems to me that a crucial part of coming to terms with your own experience is to own it: I am the chalk and the cheese. In my worst and most obnoxious moments, I wasn't a different person, depersonalised and excused by some sickness, but merely my younger self, responding to extreme and relentless provocation in an extreme and typically adolescent fashion.

Casting me as "a different person" clearly both reflects and ratifies the notion that the 'mentally ill', i.e. people subject to extreme, unusual or maladaptive emotional and/or perceptual experiences, form a group which is essentially distinct from the so-called 'normal' population. It's not difficult to see how this essentialist thinking contributes to the continuing stigmatisation of the 'mentally ill'.