For 14 years, Laura Delano was a “professional mental patient,” as she describes it, after being diagnosed with bipolar disorder when she was a teenager.
Now she wonders whether the standard approach to mental illness in America is actually making us sicker.
She is the author of “Unshrunk: A Story of Psychiatric Treatment Resistance.”
Jan Jekielek: What is wrong with the mental health system in America?
Laura Delano: At the heart of the problem is the fact that we’ve given a monopoly to this medicalized way of understanding ourselves, to this idea of having mental illness or of being mentally healthy. This whole framework, this medicalized framework, has taken on a monolithic status in our culture such that all the other ways that we might make sense of the struggles that come with being human get pushed to the side.
When you’re viewing your struggles through this medicalized lens, you have one logical next step to take, which is to get treatment, which is often pharmaceutical treatment. To me, it’s about how much power, dominance, and ubiquity the mental health industry has over our culture.
Mr. Jekielek: What does the “mental health industry” mean exactly?
Ms. Delano: You could call it a mental health industrial complex if you wanted to. The word “industry” is an important one to use as opposed to “system” because it shines a light on the fact that this is about very powerful corporations: drug companies, the hospital industry, managed care, medical devices, the list goes on and on. This is in large part about corporations who are selling products and services.
Mr. Jekielek: The book is about your journey, with anecdotes and a lot of data and information. It is a fascinating story. Give me a thumbnail.
Ms. Delano: It’s basically the story of my 14-year relationship to the diagnoses, the drugs, the mental health professionals, the hospitals, and then how I decided to end that relationship, and what that looked like, and why I ended it.
Age 13 was my entry into a therapist’s office. I was an angry, intense, despairing, self-injuring teenage girl, and my terrified parents didn’t know what else to do.
They did what so many loving American parents are taught to do. If your kid is struggling, you need to seek professional help, so that began my journey. A year later, I was sent to my first psychiatrist. I received a diagnosis within my first appointment with that psychiatrist. My whole life was basically reduced to what I was told was an incurable mental illness called bipolar disorder.
I was put right on meds and then spent a few years refusing to accept this diagnosis. Something in me knew that the struggles that I was experiencing were actually healthy responses to the environment that I was in, to the pressures I felt on my shoulders at school and with sports. I was this very driven, perfectionistic kid. I knew that was the problem, not anything inside of my brain. But when you’re a kid, you don’t have power. You don’t yet have a solid sense of self.
I eventually lost touch with that and then spent the final 10 years in the mental health industry as a very compliant, obedient, and deferential psychiatric patient.
Mr. Jekielek: There is one chapter in your book which is pivotal. For the first time, you decide not to comply. Please tell us about that.
Ms. Delano: I loved writing that chapter. Prior to that moment, I had been this compliant patient, just so desperate for relief that I basically turned my entire life over to my doctors, and then eventually my seven-person treatment team.
With every passing week, month, year of being this compliant patient, my life kept falling more and more apart. I kept getting physically sicker with chronic health issues. Mentally and emotionally, I kept spinning out.
By 2010, at the age of 27, I had basically become a professional mental patient, as I like to put it. It’s a provocative phrase, and I use it deliberately, because I was the embodiment of a crazy, unhinged, completely non-functioning, barely-there human being.
In February 2010, I was in a program going to the hospital every day from 9-5 for groups and therapy. A psychiatrist caught wind of the fact that I was maybe becoming suicidal, which I was. But I wasn’t actually, in that moment, going to kill myself. He said, “Why don’t you just check yourself in and get taken care of? Go to the short-term unit. You'll feel more rooted.”
I said: “That’s a great idea. I’m just going to go home and get my belongings and come back later this afternoon.”
But he wouldn’t let me leave to do that. Things escalated. I began raising my voice. He called security.
That was the moment that I realized that this system I had been turning to for help through all of these years, through the most formative years of my life—that I had been assuming existed to take care of me and help me feel OK in my skin—was actually a system of control.
I just hadn’t seen it for what it was, because I had never said “no” to it before.
That changed everything for me. It dislodged this faith that I had had through all those years in my doctors, the pills, the hospitals—just this unquestioning faith that these people were going to eventually help me feel OK. Suddenly, in an instant, it just all blew up.
Mr. Jekielek: When people are suicidal, the protocol is to prevent them from going through with it, and they lose some of their ability to exercise their agency for their own good. You had been suicidal before. Doesn’t it make sense that the doctor would recommend this?
Ms. Delano: All these years later, as I now look back, I completely understand his logic. He had no choice but to incarcerate me against my will, because he was legally and ethically mandated to basically keep his patient alive.
In many ways, we’ve put this profound responsibility on the shoulders of psychiatrists and other mental health professionals to prevent death and to see into the future, because if a doctor senses that you are or might in the future become suicidal, they are obligated to put your safety over anything else.
I have to imagine that a lot of psychiatrists—and psychologists who also have this power—if they didn’t feel this terrifying liability issue looming over their shoulders, might actually be willing to hang in there a bit longer with their patients, to ask more questions, to be curious, and to be open to talking about suicide. But they don’t have that opportunity.
Having now spent 15 years on the other side, outside of the mental health industry, and having spent, I couldn’t begin to count the number of hours, with suicidal people, I have found that when someone is in that state, often what they need most is to be heard. They need to be able to talk about all the things that are making it such that they don’t want to be alive anymore. They need to be able to talk about death and why it’s calling to them.
When we shut down that space and basically instantly say, “Panic mode, incarcerate the person, medicate the person,” I think ironically, it ends up making a lot of people more suicidal, because they feel even more alone with their struggles.
Mr. Jekielek: How did you ultimately make this decision to leave the system in all its manifestations?
Ms. Delano: After that forced hospitalization, I had two more encounters with this power that mental health professionals have to force and coerce. One was being made to take a medication that I didn’t want to take, and the other was having the police called on me when I was so tranquilized by that medication that I slept through a therapy appointment.
In that state of questioning and rethinking, I happened upon a book that had this compelling cover with a phrenology illustration on the cover. It was one of those old drawings where the human skull is broken up into different compartments…[but] each compartment had a different psychiatric drug name in it.
I was looking at this cover and thinking, “I’ve been on that drug. I’ve been on that drug. I’ve been on almost all of these drugs. I wonder what this book is about. I’m going to buy it.”
The name of the book was “Anatomy of an Epidemic,” by Robert Whitaker. He set out to answer this curious question he had, which was, “Why do long-term studies of people diagnosed with schizophrenia [show] ... outcomes better in countries that don’t have ubiquitous pharmaceutical treatments? Why are the outcomes worse in the U.S. and other developed countries that have access to all these amazing medications?”
In a nutshell, he realized that the story we’ve been told or sold about the safety and effectiveness of psychiatric drugs when used over the long term is completely lacking in a strong evidence base. If you actually look at outcomes, there’s a strong case to be made that psychiatric drug use over the long term is making us sicker and more disabled.
There I was on five medications. I was declared so sick as to be treatment-resistant, because none of these drugs were helping me. I just kept getting worse. [People said:] “It’s so tragic. Poor Laura’s bipolar disorder is so severe.”
After reading this idea and looking back on my life, I thought to myself, “What if it hasn’t been a treatment-resistant mental illness this whole time? What if it’s been the treatment?”
Mr. Jekielek: What did it mean to leave the mental health system? Coming off the five drugs you were on, that is a very difficult thing to do. People who have gone cold turkey have terrible side effects and then say that their illnesses are relapsing. How did you manage to do that?
Ms. Delano: The issue of coming off psychiatric drugs is a hugely important one.
I’m often accused of being dangerous because I talk about coming off these drugs. I talk about coming off these drugs because I want to help people do it as safely as possible, because it is so dangerous. I completely agree.
What I didn’t know in 2010 when I decided to come off those drugs was that my central nervous system had become completely dependent in a physiological sense (not in the addiction sense, where I had cravings and would seek out the drug despite it causing harm. That’s the conventional definition of addiction). This was purely physiological. My brain had completely reacclimated its structure and how it functioned, as had my body, because of the drugs that had been in my system for so many years.
Coming off of them doesn’t just flip a switch, and then your body goes back to how it was prior to you ever taking them. Coming off of them too quickly actually disrupts the homeostasis that your body has developed to compensate for the presence of these drugs. Someone quitting any psychoactive drug cold turkey, that they’re dependent on, will go through symptoms of withdrawal.
What’s challenging in the case of psychiatric drugs is that withdrawal symptoms mimic the symptoms of the very diagnoses—the reasons why they’re taking these drugs in the first place. So, as you said, withdrawal symptoms often look like a relapse of an illness.
I didn’t know any of this when I came off. I came off basically cold turkey. I came off five drugs in about half a year, which is very fast. I went through unspeakable pain. The struggles that I had on the drugs were just amplified—projectile vomiting, boils breaking out of my skin, debilitating migraines, light sensitivity, panic responses to any kind of stimulus, paranoid racing thoughts, utter fatigue, and then insomnia at night. I could go on and on about how brutal withdrawal was.
It was only as I started to recover from that, which took a lot of time, that it began to click just how unsafely I had come off them.
What also clicked for me was that I was able to survive cold turkey withdrawal in large part because I had a lot of resources at my disposal. I had a family who could take care of me. I didn’t have to work. I didn’t have kids. I didn’t have to pay a mortgage.
That was when I realized some people feel really helped by these medications—I totally respect that—but some people don’t. They should have the right to know how to come off these drugs safely.
Right now, it’s almost unbelievable. There are 65 million American adults and 6 million American children who are currently on psychiatric drugs, and there are zero off-ramps for getting them off these drugs safely within the mental health industry—zero.
Mr. Jekielek: I had a psychiatrist on the show recently who specializes in this tapering process, so it’s not zero.
Ms. Delano: That’s a good point. There are individual practitioners and what might be perceived as fringe resources cropping up around tapering off these drugs. But the official system itself, whether it’s the National Institute of Mental Health, or the American Psychiatric Association, or the American Academy of Child and Adolescent Psychiatry, these official bodies that are looked to for guidance, for guidelines, for protocols, and for establishing a standard of care, there is zero acknowledgement there. There are zero off-ramps there.
Mr. Jekielek: What are psychiatrists saying about coming off of large amounts of medication? You’re saying they don’t think about it at all?
Ms. Delano: It’s another almost unfair position that we’ve put psychiatrists in. If I put myself in the shoes of a psychiatrist who’s seeing his patient once a month, very possibly just for 15 minutes—maybe an hour, but that’s pretty rare—then that person who I see once a month comes in and she’s on four medications or five medications and she says, “Doc, I want to come off these.” Of course, that psychiatrist is going to instantly freak out and say, “What do you mean?” Because that psychiatrist is set up to fail here.
That psychiatrist doesn’t have the time to properly support that person, has the liability risks of operating outside the standard of care, and doesn’t know the patient enough to even really know what their support system looks like, what their nutrition is like, what kinds of stressors are on their plate. So I get why psychiatrists are so terrified of helping their patients come off.
Another piece is that psychiatrists often have in their mind the previous times their patients tried to come off and it didn’t go well, which is usually cold turkey or rapid withdrawal. People think slow means a few weeks, a few months, or that maybe even a year is very slow. Actually, a year is fast for a lot of people, however shocking that sounds. With doctors, it’s a combination of fear and then just how ill-equipped they are. It’s no fault of their own that the system around them has set them up to fail in this way.
That’s why the nonprofit that I founded in 2018, Inner Compass Initiative, has a mission to help people make more informed choices about psychiatric drugs, about psychiatric diagnoses, and about safer tapering off these drugs. Our hope is that we are seen by the psychiatric profession as a relief, as a resource, as a partner, as a collaborator in this.
It takes a lot to come off of a psychiatric drug. A certain percentage of people don’t have problems. It’s a mystery who is going to have an easy experience and who isn’t. For the people who have a hard time coming off, it might take years. How many people have the resources and support to do that successfully? Not many.
Mr. Jekielek: Since you came out with your book, one criticism is that you’re promoting hesitancy to use drugs which help people and make a real difference in people’s lives, and as a result, people may be harmed. How do you react to that?
Ms. Delano: I am sharing my own personal story, and I’m sharing some basic facts that I learned for myself too, after not knowing them for many years. People hear that as me pushing an agenda that people should stop their meds and not take these drugs. That speaks to the understandable fear of unknown terrain beyond the quick fix of pharmaceuticals that are so ubiquitous in our society. I get why people are threatened by my story.
I wrote this book to start a conversation. I knew it would scare people, because I would have been scared of it too. My only agenda here is around informed choice.
My story is a story of what happens when you do not have the information you need to make a meaningful choice for yourself about whether and how to engage with the mental health industry. I want people to have all of that information so that they can make whatever choice is right for them, which indeed might be to take these drugs. I am not against antipsychotic drugs. I have friends who feel helped by these drugs. I think they can be helpful.
It’s about the stories that we tell ourselves about why these drugs are helpful that distort our ability to make true choices about them. These drugs are not medications treating diseases. They are psychoactive drugs that are disrupting brain function. That disruption might feel helpful for you.
Joanna Moncrieff is a British psychiatrist who gets called anti-medication all the time, but she’s not. I remember when I found her work many years ago, it helped me click right into the nuanced understanding that we need to have about these drugs.
This is not about being pro or anti. This is about using straightforward, honest language to talk about what these drugs are, to talk about our limits of knowledge around what these drugs are, how they actually affect us, and then to let people make their own decisions from there based on their own life circumstances. If they decide they don’t want to take these drugs, they should have the right to not take them, and they should have options. If they decide they do, I completely support that.
Mr. Jekielek: What is the most important information to have when considering medication?
Ms. Delano: When it comes to the drugs, what I was not told, what my parents were not told, is that these drugs are approved by the FDA on the basis of very short-term trials, six to eight weeks on average. There is zero evidence base for polypharmacy. Their safety and efficacy have never been studied in combination with each other.
Every single psychiatric drug across all the different drug classes is dependence-forming, meaning that if you take this drug for any length of time, your body may well completely alter itself to accommodate the presence of the drugs. If you want to come off it one day, you might have a really hard time doing that, and you might need years of tapering.
Especially for girls and women who are teenagers or entering into their young adulthood or childbearing years, it should be a legal requirement that doctors tell us before we start these drugs that if you want to have a child one day, you need to build in a long-term exit strategy here, so that you don’t find yourself in a situation where you need to stop this drug abruptly and potentially cause significant harm to yourself. A lot of it is about just the straightforward facts about the evidence based upon which all of these drugs are prescribed.
Part of my outrage is fueled by how in the dark so many of us are about what we actually know about these drugs. And what is wild is that it’s all available right now. Don’t take my word for anything I just said. You can go to the FDA website right now. Just Google, Drugs/FDA, and you will be taken to the website where you can search for the drug label of any psychiatric drug that you’re on. You can read the whole thing. You can see the two or three trials that were used to approve the drug. You can see how long it lasted. You can see what they called “effective,” which you may or may not be surprised to know is often quite small.
Then from there, you can decide what you want to do.
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