And what if the cease-fire agreed to last week does not hold? Israel managed to open its public schools on time on Monday, but it also adjusted its programs. Schools closest to Gaza, where camps, beaches and pools were closed and children spent much of the summer inside bomb shelters amid barrages of rockets, have extra counselors on hand and plan therapy using crafts, drama, dance and music.
Among the 72 Israelis killed in the war was a 4-year-old boy felled by a mortar shell on a kibbutz. In Gaza, the first order of business is for classrooms to be cleaned. He was part of a crew of 11 clearing trash, fixing toilets, replacing broken windows and repainting walls. A barefoot boy carried out a can of garbage. Desks and chairs also disappeared.
By Tuesday, copies of only 89 of the required textbooks had been printed, in a process that is normally completed by Aug. The United Nations is trying to consolidate about 50, people still in its shelters into 20 buildings, but some will not leave. She was hypothermic, her body temperature having fallen to nearly ninety-four degrees. After two days in a medically induced coma, she woke up in the intensive-care unit. Her sisters and parents watched as she opened her eyes. Now she was weak, dizzy, sweating profusely, and anemic.
Her body ached from a condition called rhabdomyolysis, which results from the release of skeletal-muscle fibres into the bloodstream. She had a black eye from hitting the rock. Nevertheless, within a few days she returned to the mode she adopted among doctors. Another doctor noted that she did not seem to meet the criteria for major depression, despite her attempted suicide. The doctor proposed that she had borderline personality disorder, a condition marked by unstable relationships and self-image and a chronic sense of emptiness.
According to her medical records, Laura agreed. She was started on a new combination of medications: lithium, to stabilize her moods, and Ativan, a benzodiazepine, in addition to the antipsychotic Seroquel, which she had already been taking. Later, a second antipsychotic, Abilify, was added—common practice, though there was limited research justifying the use of antipsychotics in combination.
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Shortly before Laura was discharged, she drafted a letter to the staff on her unit. Laura moved back home to live with her parents in Greenwich and spent her nights drinking with old friends. I am floating. When it was clear that positivity was out of reach, Laura began seeing a new psychiatrist at McLean, who embraced the theory that her underlying problem was borderline personality disorder. In , Laura moved in with her aunt Sara, who lived outside Boston, and attended a day-treatment program for borderline patients.
At her intake interview, she wore stretchy black yoga pants from the Gap, one of the few garments that allowed her to feel invisible. Laura had been content to be bipolar. Laura sometimes drank heavily, and, at the suggestion of a friend, she had begun attending Alcoholics Anonymous meetings.
Laura was heartened by the stories of broken people who had somehow survived. The meetings lacked the self-absorption, the constant turning inward, that she felt at the clinic, where she attended therapy every day. If she were to quit drinking, she wanted to feel that she had done it on her own. She was already taking Effexor an antidepressant , Lamictal, Seroquel, Abilify, Ativan, lithium, and Synthroid, a medication to treat hypothyroidism, a side effect of lithium. The medications made her so sedated that she sometimes slept fourteen hours a night.
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In May, , a few months after entering the borderline clinic, she wandered into a bookstore, though she rarely read anymore. The book tries to make sense of the fact that, as psychopharmacology has become more sophisticated and accessible, the number of Americans disabled by mental illness has risen.
Whitaker argues that psychiatric medications, taken in heavy doses over the course of a lifetime, may be turning some episodic disorders into chronic disabilities. The book has been praised for presenting a hypothesis of potential importance, and criticized for overstating evidence and adopting a crusading tone. Whitaker lived in Boston, and they met for coffee.
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Whitaker told me that Laura reminded him of many young people who had contacted him after reading the book. At her appointments with her pharmacologist, Laura began to raise the idea of coming off her drugs. The doctors at the borderline clinic initially resisted her requests, but they also seemed to recognize that her struggles transcended brain chemistry. A few weeks later, she went off Abilify, the antipsychotic. She began sweating so much that she could wear only black. If she turned her head quickly, she felt woozy. Her body ached, and occasionally she was overwhelmed by waves of nausea.
Cystic acne broke out on her face and her neck.
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Her skin pulsed with a strange kind of energy. A month later, she went off Effexor, the antidepressant. Her fear of people judging her circled her head in permutations that became increasingly invasive. She began to experience emotion that was out of context—it felt simultaneously all-consuming and artificial.
Later, she found a community of people online who were struggling to withdraw from psychiatric medications. The Web forum Surviving Antidepressants, which is visited by thousands of people every week, lists the many varieties of neuro-emotion: neuro-fear, neuro-anger, neuro-guilt, neuro-shame, neuro-regret.
For many people on the forum, it was impossible to put the experience into words. It took Laura five months to withdraw from five drugs, a process that coincided with a burgeoning doubt about a diagnosis that had become a kind of career. When her aunt Sara updated the rest of the family about Laura, the news was the same: they joked that she had become part of the couch. Her family, Laura said, learned to vacuum around her. Others in her situation might have lost their job and, without income, ended up homeless.
It took six months before she felt capable of working part time. Laura had always assumed that depression was caused by a precisely defined chemical imbalance, which her medications were designed to recalibrate. She began reading about the history of psychiatry and realized that this theory, promoted heavily by pharmaceutical companies, is not clearly supported by evidence.
Genetics plays a role in mental disorder, as do environmental influences, but the drugs do not have the specificity to target the causes of an illness.
Wayne Goodman, a former chair of the F. Few studies follow patients who take the medications for more than a year. A decade after the invention of antidepressants, randomized clinical studies emerged as the most trusted form of medical knowledge, supplanting the authority of individual case studies. For adolescents who go on medications when they are still trying to define themselves, they may never know if they have a baseline, or what it is.
Antidepressants are now taken by roughly one in eight adults and adolescents in the U. Industry money often determines the questions posed by pharmacological studies, and research about stopping drugs has never been a priority. Barbiturates, a class of sedatives that helped hundreds of thousands of people to feel calmer, were among the first popular psychiatric drugs. Although leading medical journals asserted that barbiturate addiction was rare, within a few years it was evident that people withdrawing from barbiturates could become more anxious than they were before they began taking the drugs.
They could also hallucinate, have convulsions, and even die. Valium and other benzodiazepines were introduced in the early sixties, as a safer option. By the seventies, one in ten Americans was taking Valium. Selective serotonin reuptake inhibitors, or S. There had been other drugs used as antidepressants, but they had often been prescribed cautiously, because of concerns about their side effects. Concerns about withdrawal symptoms emerged shortly after S.
A third of the patients said they felt suicidal, and four were admitted to a hospital. One had an abortion, because she no longer felt capable of going through with the pregnancy. Internal records of pharmaceutical manufacturers show that the companies have been aware of the withdrawal problem.
At a panel discussion in , Eli Lilly invited seven experts to develop a definition of antidepressant withdrawal.
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Guy Chouinard, a retired professor of psychiatry at McGill and at the University of Montreal, who served as a consultant for Eli Lilly for ten years and did one of the first clinical trials of Prozac, told me that when S. Chouinard is considered one of the founders of psychopharmacology in Canada. When he reinstated their medication, their symptoms began to resolve, usually within two days. Most people who discontinue antidepressants do not suffer from withdrawal symptoms that last longer than a few days.
Some experience none at all. Giovanni Fava, a professor of psychiatry at the University of Buffalo, has devoted much of his career to studying withdrawal and has followed patients suffering from withdrawal symptoms a year after stopping antidepressants. A paper published last month in a journal he edits, Psychotherapy and Psychosomatics , reviewed eighty studies and found that in nearly two-thirds of them patients were taken off their medications in less than two weeks.
To some degree, that makes sense: no one wants to deter people from taking drugs that may save their life or lift them out of disability.