should be the enactment of legislation of the type passed by the State of Illinois ten years ago which specified that no elderly person was to be committed to a mental institution simply for the mental frailties which commonly accompany old age.12 The noncommitment of elderly persons to mental hospitals is not however sufficient. The usual alternative is admittance to a nursing home, many of which are excellent, and provide outstanding care, but at least half the time this is not the 13 A great number of homes have assumed the basic character of mental hospitals in their use of mind-altering drugs to quiet the disruptive, difficult-tomanage, or just plain nonconforming elderly resident. In such instances the person is for all practical purposes in a mental hospital but has, in a manner of speaking, been farmed out to a satellite facility.

case.

In many homes the use of tranquilizing drugs is rampant. According to 1971 data, the most recent available, $60 million was spent on these drugs, with an expenditure of more than $30 million for Thorazine and Mellaril alone, two highly potent and extremely dangerous antipsychotic agents.14 Data from the National Nursing Home Survey, conducted in 1973, indicate that more than 44 percent of all nursing home residents receive tardive-dyskinesia 15 -inducing drugs like these or so-called anti-anxiety medications like Valium or Librium.

The total number administered mind-altering drugs of whatever type (antipsychotic, antidepressant, anti-anxiety, antimanic, etc.) is greater yet.

In nursing homes, and mental hospitals in particular, psychotropic medication is much more than mind altering, it is mind-controlling:

"A common and vivid memory for anyone who see numbers of older people in nursing homes, mental hospitals and psychiatric wards is the image of overmedicated, zombie-like persons only dimly aware of the world around them."16

It is impossible to pinpoint who was the very first person to suggest drugging the elderly for the senile condition, but Dr. Winfred Overholser, who at the time was Superintendent of St. Elizabeth's Hospital in Washington, D.C. and Professor of Psychiatry at George Washington University School of Medicine, was certainly among the first. In 1955 at a chlopromazine (Thorazine) symposium sponsored by the pharmaceutical company, Smith, Kline and French, he briefly dealt with the "need" to do something about senility:

66* *

*If we can do something about cutting down the irritability of our senile patients, we shall be doing a great deal. I look on the problem of senility as one of the most serious ones that face our mental hospitals."17

Administering chlorpromazine or any other psychotropic drug to cut down on "the irritability of our senile patients" involves a process which Drs. Henry Lennard, Leon Epstein, and Donald Bransom of the Department of Psychiatry of the University of California (San Francisco) School of Medicine have labelled mystification. They define this process thus:

66* *

*the definition of issues and situations in such a way as to obscure their most basic and important features The act of mystification, by definition, tends to induce a mystified or confused state... this concept of mystification involves the communication of false and misleading explanations of events and experiences in place of accurate ones, explanations which serve one party at another party's expense."

"18

Mystification, as it applies to drug usage, is the casting of personal and social problems as medical problems. Colored in this way, medical intervention (in the form of drug prescription) is then justified for these problems. In this approach, depression among the elderly does not derive from having been shunted out of the mainstream of life into a dreary, purposeless, waiting-for-death routing, but is instead a woe best soothed by antidepressant medication. It is a problem with a medical but no social aspect. But in what direction does an approach such as this lead and who are the beneficiaries? It leads in the direction of a society in which psychoactive drugs are the staples of control and the elderly are among the hapless victims:

12 News Briefs: Hospital and Community Psychiatry, v. 21, January, 1970.

13 Drugs in Nursing Homes: Misuse, High Čosts, and Kickbacks, Šubcommittee on Long-Term Care of the Special Committee on Aging, United States Senate, p. xiv, January, 1975. 14 Ibid., p. 246.

15 Tardive Dyskinesia-A drug-induced neuromuscular disorder, usually irreversible among the elderly which consists of involuntary, rhythmical movements of the mouth, tongue, nose, lips, jaws, and depending upon severity, other body parts.

16 Robert Butler, "Why Survive? Being Old in America," p. 198.

17 Winfred Overholser in Address before Symposium on chlorpromazine and mental health, Chlorpromazine and Mental Health, Lea & Febiger, p. 185, 1955.

18 Henry L. Lennard et al, Mystification and Drug Misuse, p. 11, 1971.

They dampen, sedate, diminish and dehumanize social interaction and, when directed at old people, women, problem children, prisoners and disturbing people of all kinds, they can become instruments for social control and management.

9119

The beneficiaries are primarily two: the pharmaceutical industry and the medical profession. They share a common purpose:

"The relationship between the pharmaceutical industry and the medical profession is a very close one . It is in the interest of both of these groups to maintain large numbers of persons on drugs, and it is especially important for the manufacturers to recruit new groups to drug use and to find new uses for their product. It is, moreover, in the interest of both groups to define more and more problems as medical in order to justify both the medical model and the intervention with drugs."20

Psychiatry as a whole is not at all given to accepting the idea of mystification. It is a renegade concept. Nor is drugging the senile elderly considered an example of it. "Senility" itself is a term which puristic psychiatrists are loath to use. It is a lay, not a medical term. It is a mental condition in which the aged person is to varying degrees forgetful, confused, irritable, childish, overtalkative, and restless at night, careless in personal habits, and inclined to wander. It is not an inevitable byproduct of aging. But when it does occur it is often the starting point for accelerated physical and mental deterioration through psychotropic medication:

* *

* instead of tolerating a grandparent's irascibility with a little forbearance; it is diagnosed as agitated depression with paranoid features, and “specific”, often multiple, drug therapy is initiated. This fails to recognize that he just wants more involvement in family life, and ensures that he sits quietly in his chair all day. Here he is withdrawn, drowsy, ataxic 21 on standing and so falls frequently, becomes careless in his personal hygiene and finally needs to be placed in a nursing home where he can be given "proper" attention."22

Psychiatric jargon categorizes the so-called mental disorders of age as either functional or organic. A functional disorder consists of aberrant mental behavior for which there is no physical or organic cause such as a brain tumor or stroke. Included here are paranoid schizophrenia, schizoaffective schizophrenia, involutional melancholia, circular manic-depressive illness, and a host of other meaningless and worthless classifications.

Organic disorder subdivides into two types: acute brain syndrome and chronic brain syndrome. Acute or reversible brain syndrome may be characterized by confusion, memory loss, visual hallucinations, disorientation, restlessness, aggressiveness, or anxiety. It is caused by such factors as malnutrition, infection, liver failure, heart attacks, strokes, brain tumors, and drugs. Acute brain syndrome is not peculiar to the aged; it occurs among younger people also. The aged are simply more vulnerable to physical debility and its taxing effects upon mental faculties. In other words, acute brain syndrome is not a psychiatric disorder at all. Its origin is physical and to the extent the physical aspect is handled the disorder clears. There is no "mental treatment" per se required, no psychiatrist needed, just a good medical doctor. Chronic or irreversible brain syndrome is that complex of symptoms usually considered senility. It breaks down into two types: senile dementia and arteriosclerotic psychosis. Senile dementia (also called senile brain disease) is claimed to result from a death of brain cells. There is, however, no proven correlation between this process and the mental symptoms of senility:

"Because of the observable brain damage found in senile and arteriosclerotic brain syndromes, it was widely believed that such damage was the only cause of mental symptoms. However, later research found generally poor correlation between the degree of deterioration and neuropathological changes

* *

* *

Even normal elderly individuals can have brain changes which appear as marked as those in individuals with clinically obvious senile or arteriosclerotic disorders." 23

Arteriosclerotic psychosis is a disorder which occurs as a result of insufficient oxygen and nutrients reaching the brain because of narrowed and hardened blood vessels in the brain. Again, the mental symptoms are those usually thought of as

19 Arnold Bernstein and Henry Lennard, "The American Way of Drugging-Drugs, Doctors and Junkies," Society, v. 10, No. 4, p. 20, May/June 1973.

20 Henry L. Lennard, op. cit., p. 38.

21 Ataxic-Ataxia is a physical condition in which there is inability to produce coordinated movement wth the muscles of the body.

22 Brian M. Learoyd, "Psychotropic Drugs-Are they Justified?" The Medical Journal of Australia, v. 1, p. 475, 1974.

23 Robert Butler and Myrna Lewis, Aging and Mental Health, Positive Psychosocial Approaches, p. 75, 1973.

representing senility. Arteriosclerotic psychosis is a disorder which is purely physical in origin, requiring good medical treatment. There is nothing wrong with the person's mind as such.

In the past the word "senility" earned itself a bad name because it become a wastebasket classification of mental ills through which the proper diagnosis of many physical conditions was missed. The tendency today is to discard it in favor of more "rigorous" and "meaningful" psychiatric terminology. This tact has helped produce the mystification that depression from loneliness or loss or purposelessness, or forgetfulnes, confusion, and irritability from the fraility of mind that accompanies aging is a medical problem requiring intervention and control on a massive scale with mind-altering drugs.

Treatment of this kind has produced in nursing homes the phenonemon of "snowing" where residents are drugged to lessen the workload of the staff. That this practice takes place was born out through testimony and research conducted by the Subcommittee on Long-Term Care of the Special Committee on Aging of the United States Senate. Regarding the question of whether tranquilizers were being "administered indiscriminately, to make it easier on the staff," it concluded:

"The data assembled by the subcommittee suggests the answer is affirmative. Given the shortcomings in control of nursing home drugs and the fact that unlicensed and untrained personnel have wide access to nursing home drugs, it could hardly be otherwise. The present system of drug distribution provides a ready supply of all drugs, tranquilizers in particular, which are paid for by the Government. Nursing personnel are not adverse to borrowing drugs from one patient for another. Neither physicians nor registered nurses are present in sufficient numbers to prevent this practice * unlicensed aides and orderlies have ready access to the medication and narcotics in many nursing homes. Nursing home personnel in their testimony reported indiscriminate tranquilization of patients to keep them quiet." 24

* *

Testimony before the Subcommittee provided evidence also that reimbursement schedules may be formulated in such a way as to encourage drugging and the confining of nursing home patients to bed:

"For the beleaguered nurse's aide, tranquilizers are a happy solution. If patients are sedated, they cause the staff few problems. The administrator is happy, too, because bedbound patients bring the highest rate of reimbursement." 25

The theme of "making it easier on the staff" is not something which just accidentally developed in nursing homes throughout the country. There has been a certain amount of deliberate orchestration in bringing this condition into existence. One party which certainly bears culpability in this area is the pharmaceutical industry. In drug advertising placed in medical journals and other professional publications the pacification of elderly patients through mind-altering drugs has been plainly suggested:

"Sandoz Pharmaceuticals, in their advertisements for the tranquilizer Mellaril, claims that the 'far-reaching' effects of this drug will benefit the staff who will 'find their load greatly lightened as patient demands are replaced by a spirit of self-help and self-interest.' 11 26

The patient pictured in the advertisement mentioned above is a rather aged woman in a bathrobe sitting in a wheelchair. It is a bit much to believe that a drug, Mellaril, with its numbing effects, is going to instill in anyone a feeling of "self-help and self-interest."

The warehousing of elderly persons through drug pacification is a relatively undeveloped "scientific technology." That which the future holds makes all that currently exists crude and unrefined by comparison. In 1967, the American College of Neuropsychopharmacology, a fraternity of "the most active and most expert investigators studying psychotropic drugs in the United States * and the National Institute of Mental Health sponsored a study group on the likely nature of psychotropic drugs in the year 2000. None of what was presented by the participants was intended as an "exercise in science fiction." To the contrary, "conservatism" prevailed:

"In considering the present volume it is our hope that the reader will not believe this to be an exercise in science fiction * * *. Îf anything, as a criticism of the meeting, it would be our impression that the scientists were far too conservative in their ideas, as is usually the case at meetings of experts." 27

27 Wayne O. Evans and Nathan S. Kline, PreFace, Psychotropic Drugs in the Year 2000-Use By Normal Humans edited by Evans and Kline, p. xiv, 1971.

67-680 0-80--8

Dr. Heinz Lehmann, who today is a member of the Canadian Psychiatric Association, a visiting professor at the University of Cincinnati, a professor of psychiatry at McGill University, and a 30-year member of the American Psychiatric Association dealt with how life might be for the elderly in future years. He treated the subject of how it is necessary for them to feel needed and experience a sense of achievement. His approach though had a slightly different twist. Rather than operating off the premise that life itself can be therapeutic and that achievement is the product of a certain amount of honest work, he suggested that agents might be found that could drug a person into thinking he had accomplished something whether or not he really had:

*

"Instead of honors, receiving one honorable mention after another which they may put on the walls of their room, old persons need a feeling of achievement We will have to find positions for senior people, and roles where they are needed and can find achievements *

**

"But perhaps we should, in addition, find drugs that would at least give them a fantasy or an artificial sense of achievement. The sense of achievement, i.e., the gut feeling I have done something quite well,' is an experience which can probably be induced by pharmacological means." 28

And he goes on to state that if the minds of our senior citizens should offer evidence of having become a bit "jaded" in their latter years then the "blackboard" will have to be cleaned to once again invigorate them with a "feeling of newness," and for this task the amnesia of electroconvulsive shock treatment is well suited: ** what will have to be done is to produce some sort of 'cleaning of the blackboard,' to produce once more a temporary feeling of newness in the aged person and wipe away the feeling that everything is forever familiar and unexciting. Perhaps someday, somebody will even have the courage to give electroconvulsive therapy (ECT) to a person who is getting old but has remained well preserved except for a complaint of early memory loss. It would take quite a lot of courage because, as is well known, the ECT procedure by itself produces temporary memory impairment. Yet the disinhibiting effect of ECT might well outweigh its amnesiaproducing effect. A temporary radical amnesia might have a salutary effect on the aging person suffering from insidious slight memory loss. If then exposed to all kinds of entirely new experiences for a few weeks, he might regain his zest for living because he regained the exciting feeling of unfamiliarity of his youth and with it perhaps some of his old enthusiasm." 29

If it is a bit difficult to follow Lehmann's "reasoning" that radical amnesia can have a beneficial effect upon slight memory loss, it is because one must become acquainted with the fact that psychiatry holds such harmful effects as this to be of possible therapeutic value.

Among the drugs he recommends for use are marijuana and LSD. He states that "disinhibiting" drugs are needed for the elderly and marijuana just might serve this purpose well:

"We also need disinhibiting drugs for the elderly so that they may, under controlled conditions, regress; but we need something better than alcohol, something that does not produce a hangover and liver cirrhosis. In other words we need a better alcohol, a shorter acting one, which would allow an aged person for an hour or two to get 'drunk,' if he wants to, and then recover promptly. The potential of marijuana for this purpose should be seriously considered." 30

As for LSD, the most vicious of drugs, Lehmann offers that it might be used to combat the loneliness of old age, perhaps in a group therapy session where everyone gets stoned:

"Yes, I think that should be thought of on the days when there is nobody visiting, nobody to take them out for a drive, nothing to do. On such bleak days, if they are not asleep, there might be an LSD experience, perhaps in a group controlled situation-at any rate, something to look forward to, because to have nothing to look forward to is the most terrible thing for an older person-or for any person." But these LSD sessions would probably take place only on those days when the elderly person is not drugged into somnolence and stowed out of sight:

31

"Since an old person is beset by so many hazards and liabilities and since he has become socially disengaged but at the same time needs greater involvement with and greater acceptance by society-why not have an old person sleep under drugs three to five days a week? During this time he could be easily supervised by a Public Health nurse or by his relatives who would just go and feed him small

28 Ibid. p. 61.

29 Ibid., p. 62-63.

30 lbid., p. 65.

31 Ibid., p. 67.

amounts of food at regular intervals. Then, for one or two days of the week, the old person will be allowed to wake up, and this awakening will be timed in such a way that some special and pleasant events will take place on that day. It will be the one or two days when the old person works, or will go to a party or the opera or the circus or on a short trip, or whatever it is. On these days, he will also be given a special stimulant-perhaps a mild hallucinogen-which will enhance his experiences and will keep him extraordinarily alert." 32

It should be borne in mind that these insane recommendations do not merely represent the offerings of a single man but an entire profession-psychiatry. Neither the National Institute of Mental Health nor the American College of Neuropsychopharmacology, under whose aegis this symposium was conducted, ever issued any condemnation that it was wholly unthinkable to administer LSD or marijuana to an elderly person. On this point, there was nothing more than silence and by this silence agreement that these were perhaps acceptable practices, that they were thinkable thoughts, and that a souless and mechanistic society where one can drug, shock, and lobotomize without the faintest hue and cry from his fellows or the slightest pangs of conscious that he does harm was not something to be sculpted in the future but created now.

Tardive Dyskinesia

There exists a neurological disorder which is nearly rampant among elderly persons administered drugs called antipsychotics (also known as neuroleptics). This disorder, which may be induced by Thorazine, Stellazine, Mellaril, Haldol, or any like agent, is known as tardive dyskinesia. It is quite different from other neuromuscular disorders caused by antipsychotic drugs. What most distinguishes it is that it can be irreversible, permanent. It strongly tends to persist indefinitely; once it is induced an individual might have to endure it for the remainder of his life.

The term "tardive" means late and "dyskinesia" means abnormal movement. Therefore, "late abnormal movement" is a literal rendering. It is a disorder which usually occurs late in the course of treatment, after a protracted period of time; two years of continuous treatment has been reported to be the average amount of time that lapses before it occurs.

33

Unlike the other disorders induced by anti-psychotic drugs which closely mimic idiopathic conditions, tardive dyskinesia is a unique neurological entity, only bearing some resemblance to naturally occurring disease. It is primarily characterized by continuous involuntary, rhythmic movements of the lips, mouth, tongue, nose, and lower jaw. In some cases the arms, legs, trunk, and other body parts may also be affected. The least severe manifestation of tardive dyskinesia involves abnormal facial and tongue movements which are undetectable when the mouth is closed. These movements are amplified in further progressed cases of the disease. In such cases the tongue curls, rolls, or twists, and moves side to side or back and forth in rhythmic fashion, protruding when the mouth opens and producing in some instances what is called "fly-catcher tongue." In those cases in which the individual suffers movements of the tongue but the mouth doesn't open in coordination with them he casts the appearance of an animal chewing its cud as his jaws incessantly chew and his tongue strikes the inside of his cheek.

In the well developed complex of movements that comprise tardive dyskinesia the abnormal motions of the tongue are but a single element of a physically and socially incapacitating condition. The lips are involved in sucking, chewing, smacking, blowing, pursing, and rolling type motions, with puffing of the cheeks. The lower jaw moves side to side, sometimes with grinding of the teeth, and opens and closes as the tongue thrusts out. As the lips, tongue, mouth, and lower jaw go through their ceaseless ritual the lower face grimaces or contorts into bizarre expressions and the eyes close and may be difficult to open. This pattern of activity repeats itself every five to eight seconds.34

32 Ibid., p. 66.

33 Frank J. Ayd, "Persistent Dyskinesia: A Neurologic Complication of Major Tranquilizers," Medical Science, v. 18, p. 34-40 June, 1967.

34 Ibid., p. 35.