Intoxication Anosognosia: The Spellbinding Effect of Psychiatric Drugs

Article excerpt

Why do so many individuals persist in taking psychoactive substances, including psychiatric drugs, after adverse mental and behavioral effects have become severe and even disabling? The author has previously proposed the brain-disabling principle of psychiatric treatment that all somatic psychiatric treatments impair the function of the brain and mind. Intoxication anosognosia (medication spellbinding) is an expression of this drug-induced mental disability. Intoxication anosognosia causes the victim to underestimate the degree of drug-induced mental impairment, to deny the harmful role that the drug plays in the person's altered state, and in many cases compel the individual to mistakenly believe that he or she is functioning better. In the extreme, the individual displays out-of-character compulsively destructive behaviors, including violence toward self and others.

Keywords: adverse drug effects; psychiatric medications; drug-induced cognitive deficits; toxicology; substance abuse

Anosognosia is defined as unawareness or denial of a neurological deficit or, more broadly, ignorance of the presence of disease. The concept originated in the observation that individuals with nondominant parietal lobe lesions (e.g., stroke) sometimes fail to recognize an associated paralysis on the other side of the body. In an enlightening essay, Fisher (1989) enlarged the concept of anosognosia and described it, along with memory dysfunction, as one of the constant features of brain damage and dysfunction.

Defining anosognosia as "the capacity of brain damage to cause denial of lost function," I have previously used the concept to explain aspects of the brain-disabling principle of psychiatric drugs-that all physical treatments in psychiatry work by causing brain dysfunction and disability (Breggin, 1997, p. 10). In this article I want to examine a specific brain-disabling effect that I have labeled medication spellbinding or intoxication anosognosia.

THE IMPORTANCE OF MEDICATION SPELLBINDING

A huge percentage of the population uses legal recreational drugs such as caffeine, nicotine, and alcohol despite considerable public health efforts to warn about their harmful effects. Another large percentage uses illegal drugs such as marijuana, methamphetamine, cocaine, and heroin despite concerted efforts to alert the public about their dangers. Finally, another significant percentage of the population uses psychiatric drugs-including stimulants and antidepressants-whose safety and efficacy have become increasingly controversial and subject to Food and Drug Administration (FDA) review.

Why do so many people take psychoactive medications, even in the face of obviously harmful effects and often despite questionable benefits? There are of course many potential explanations why human beings have such a strong tendency to use drugs that impair the function of their brains and minds. Here I want to focus on one specific biological mechanism that encourages and even at times seems to compel drug taking.

If all psychoactive drugs possess qualities that tend to encourage, facilitate, or compel usage, then it may help to explain the widespread use of psychiatric drugs as well as recreational drugs. In the past, most warnings about the beguiling or seductive effects of drugs have focused on recreational and illegal substances-but can the same or similar effects be found in the action of all psychoactive agents, including prescribed psychiatric medications?

Some psychiatric drugs, such as the stimulants and benzodiazepines, cause changes in the brain that lead to dependency and withdrawal problems. There is increasing evidence that most or all psychiatric drugs cause sufficient withdrawal problems to interfere with efforts to stop taking them (Breggin, 1997; Breggin & Cohen, 1999). Dependence and withdrawal problems in themselves, however, do not fully account for the widespread use of a broad array of psychoactive agents, including nonaddictive psychiatric drugs, such as the antidepressants, lithium, and neuroleptics. …