September is National Suicide Prevention Awareness Month. And who could argue with that? Suicide rates are higher than they have been at any time since the Second World War. This seems like a good time to talk about the risk factors for suicide, and what we can do about them.
Schizophrenia is the mental health condition that is correlated with the highest risk of suicide . According to the Treatment Advocacy Center, an organization that has long campaigned for the court-mandated drugging of people diagnosed with schizophrenia and other mental illnesses, “The lifetime risk of suicide among individuals with schizophrenia is currently believed to be about 5%.”
That may be true. But what the TAC doesn’t tell you is: It didn’t used to be.
David Healy is a Professor of Psychiatry at Bangor University in Wales and the author of “Pharmageddon.” Dr. Healy and his colleagues examined data for first-time admissions for schizophrenia in north-west Wales for the years 1875-1924 and compared the mortality rate of these patients to those from 1994-2010.
North-west Wales was almost ideal for comparisons of this kind. Between 1875 and 1996, the population of this area changed almost not at all in terms of size, age composition, ethnic composition, poverty or rurality. Moreover, for both periods, there was effectively only one point of access to mental health service users in Wales: Denbigh Asylum for 1875-1924, and the North West Wales District General Hospital Psychiatric Unit for 1994-2010. This is about as close to a controlled experiment as it is possible to get for this sort of thing.
Their findings were nothing short of astounding. In comparison with the general population, patients with schizophrenia in the contemporary cohort were 10 times more likely to be dead at the end of their first year of treatment than their counterparts from a century before. Dr. Healy noted “There is no other illness in medicine where such a statement could be made.”
All the deaths in the contemporary cohort (seven out of a total of 227 patients) were due to suicide. In the first year of treatment, patients hospitalized for schizophrenia now are 100 times more likely to commit suicide than the rest of us. By contrast, only one patient out of 655 in the historical cohort committed suicide.
What is the reason for this change? It was not that those in the historical cohort lacked the means to kill themselves. Asylum patients in Wales in the 19th and early 20th centuries spent almost all their waking hours at liberty in asylum farms, kitchens and sewing rooms, with plenty of sharp objects within reach and ample opportunities to commit suicide.
Dr. Healy and his co-authors argue that the likeliest explanation is the excess of suicides in the modern-day cohort is due to so-called “antipsychotic” drugs, which did not become available until the 1950s. In a previous paper, Dr. Healy analyzed RCT data for the antipsychotics Risperdal, Zyprexa, Seroquel, Serdolect and Geodon. He found the rate of suicidal acts in the treatment arm was almost four times that of the placebo arm. There were no suicides out of 1,351 patients given placebo, whereas the 12,817 patients in the treatment arm included 33 completed suicides.
Or as Dr. Healy put it, graphically and succinctly, “When it comes to dead bodies in current psychotropic trials, there are a greater number of them in the active treatment groups than in the placebo groups. This is quite different from what happens in penicillin trials or trials of drugs that really work.”
Dr. Healy told me “If you look at asylum records both in north Wales and elsewhere, up to about 1950, people with schizophrenia didn’t commit suicide. They just didn’t. This was not an illness that led to people actually going on to kill themselves. It’s the combination of the illness and its treatment that results in people actually committing suicide.”
These are astonishing findings. In what other branch of medicine have outcomes gotten worse since the 19th century?
Patrick D. Hahn is the author of “Madness and Genetic Determinism: Is Mental Illness in Our Genes?” published by Palgrave Macmillan. He can be reached at patrickhahn@hotmail.com.