Filmmakers Lynn Cunningham and Wendy Ractliffe
What happened to Bill H4062, featured early in the film? What is informed consent?
An early scene in Medicating Normal, shot in 2017 at the Massachusetts Statehouse, features lawmakers voting on a Bill H4062 requiring informed consent for a class of drugs known as benzodiazepines. While there are some who take these drugs successfully, there are significant numbers who, having taken them as prescribed, end up physically dependent and/or severely injured. In this scene, Dave Cope describes how, as a result of being prescribed Ativan six years earlier as a graduate student at MIT, he eventually experienced such severe adverse effects and withdrawal that he lost his career as an officer in the Navy.
True informed consent requires that doctors provide comprehensive information about the risks of these drugs before prescribing them to unwitting patients. The bill H4062 was eventually rejected after several doctors complained that requiring a warning about the adverse effects of these drugs would deter patients who might otherwise benefit. Unwilling to appear on camera, these doctors described decades of experience prescribing benzodiazepines, during which they claimed to never have witnessed a patient struggling with physical dependence or adverse effects. Knowing there would be a full day of testimony, those same doctors left the hearing immediately after testifying early in the day. The doctors missed eight hours of detailed anecdotal data relayed by injured patients who had flown in from all over the country.
In the Fall of 2020, the FDA required an updated black box warning on all prescriptions for benzodiazepines about their potential for physiological dependence, withdrawal, and other serious risks. Nonetheless, after five years, the Massachusetts bill has not yet passed. Now called HD.285/ SD.1370, it is currently under review for the fourth time by Massuchusetts lawmakers.
When interviewing the hundreds of individuals for this film, what were you looking for and what types of questions would you ask them? What did you learn from them?
We interviewed hundreds of individuals with lived experience taking psychiatric drugs-- in particular, we wanted to learn how they felt taking the drugs and coming off of them. Most reached out to us in response to a query about the impact of psychiatric drugs on people’s lives and well-being posted in several highly-frequented online groups.
Some questions we asked were:
- What caused you to seek help in the first place? Were you seeking psychiatric drugs or were they offered to you?
- Describe your experience in the doctor’s office. How much of your background were you able to convey? How long was the visit? How well do you feel your doctor got to know you as a person and patient?
- What drugs were prescribed? Did your doctor discuss with you their potential benefits and risks? Was there any mention of how/when you’d eventually discontinue them?
- Tell us about your experience taking psychiatric drugs. What happened after starting drug treatment? Did the drugs help you? If so, for how long?
- Did you experience adverse effects? If so, what were they? Did you report them to your doctor? Then what?
- After your initial prescription, were more drugs ever prescribed? If so, what were you told about why?
- If you decided to discontinue the drugs, what medical guidance was provided? What kinds of symptoms did you experience? Were you able to find doctors who knew how to help you taper safely?
- How are you now? Looking back, what would you have done differently, if anything?
The more people we interviewed, the more we realized that a pattern was emerging. Often, we found that prescribed psychiatric drugs either didn’t help or helped only periodically. Also, many drugs caused serious adverse effects over time as well as disabling withdrawal symptoms after attempts to stop. Many had lost their homes, their careers, and their families. To make matters worse, very few had doctors who believed their suffering was caused by prescribed psychiatric drugs. Adverse effects were often attributed to a new and emerging “disorder,” a comorbidity that also needed to be treated. Often, the only help they could find was in online support communities containing thousands of others also suffering from prescribed psychiatric drug harm. We realized that this was a groundbreaking story that must be told.
How did Lynn and Wendy meet and what prompted them to work on this topic of mental health and medicine?
Lynn had a family member-- a high-functioning Ivy League graduate and star athlete-- who was diagnosed with mental illness in her 20s. Lynn’s family consulted with the best psychiatrists, resulting in a steady stream of doctors dispensing different diagnoses and an ever-increasing regimen of meds. What started as one drug became ten, and years later she was on disability unable to hold down a job. Were these powerful meds really helping her or was there another better way? These questions led to the research that ultimately unveiled a new unreported reality.
Learning more about the potential adverse health implications of these widely-prescribed psychiatric drugs, Lynn felt compelled to action. She reached out to her college roommate, Wendy Ractliffe, who for two decades had been a maverick and an activist promoting the health benefits of organic agriculture and the creation of sustainable communities. At the time, the opioid epidemic was raging, and Lynn and Wendy agreed this overlooked parallel narrative about prescribed psychiatric drug harm was just as alarming. After interviewing hundreds of patients, and scores of experts, Lynn and Wendy selected the subjects for their film and began assembling their filmmaking team.
Describe the evolution of the Medicating Normal Team and its dynamics. How did the team handle such a controversial issue?
When Lynn and Wendy first began assembling the Medicating Normal team, there were few who were open to these radical, new perspectives on mental health treatment. The prevailing mainstream media was saturated with the miracles of modern medicine. Editor David Dawkins immediately embraced the controversial subject matter, having a family member of his own who had been adversely impacted by unnecessary psychiatric drug treatment.
Many injured by prescribed psychiatric drugs felt disbelieved by their doctors. To emphasize the importance of listening to those with lived experiences, Lynn and Wendy chose to portray real stories told by real people without relying on a script or a narrator. To do this they recruited DP Joan Churchhill and her partner Alan Barker, known for their pioneering cinéma vérité style of filmmaking-- in which the viewer is drawn into the subject’s experiences, unaware of the camera’s presence. Many of the film’s most powerful vérité scenes were captured as a result of Joan’s ability to “listen with her camera,” allowing the subjects and their unfolding experiences to drive the film’s narrative.
During the editing phase, Muffie Meyer, a prolific documentary film director and producer, also with a background as a cinéma vérité editor, joined the team. Lynn had worked for Muffie at Middlemarch Films as an assistant editor years before and had always considered her a friend and lifelong mentor. Muffie was initially resistant to the notion that these drugs were causing large-scale harm. Her skepticism soon dissipated as she became engaged with the film’s subjects and their stories and the film’s line up of highly credible experts. Like the rest of the team, the more she learned, the more she realized how little was actually known about the brain. She also recognized early on that the profit motive of the pharmaceutical industry was invested in hiding data and manipulating trials. However, as the team’s staunchest defender of mainstream medicine, Muffie played a valuable role. She urged balance throughout the editing process resulting in a more credible film, one with access to a wider audience.
Differing viewpoints among team members about the costs v. benefits of psychiatric drug use ultimately benefited the film. While editing, the notion that psychiatric drugs can sometimes help was often debated. Some believed that it was simply wrong to say they help anyone, especially in the long term; others felt it was inaccurate to say they never helped. All agreed that by further examining the word “help,” a distinction needed to be made between numbing or tranquilizing effectively with a drug versus getting at the root of a problem by changing one’s life.
In the end, the narrative the film was revealing was strong enough on its own that we did not need to preach absoluteness-- people’s bodies vary and psychiatric drugs impact everyone differently. Some people are helped by them and others are devastated. If we wanted to raise awareness about the very real harm occurring, we knew that we could not deny anyone’s experience, or we’d lose credibility. Nonetheless, everyone on the team agreed that society’s quest for the quick fix had redefined normal human suffering as a medical problem needing a drug, creating an epidemic.
After completion, the film has evolved into an emerging grassroots movement spearheaded by its outreach team, Angie Peacock (a subject in the film) and Nicole Lamberson (an activist in the prescribed harm community). Each has not only lived the experience of psychiatric drug harm, but is also a professional with a foot in both doors-- Angie has a Masters in Social Work from Washington University in St Louis and Nicole is a physician assistant.
Angie began by traveling in an RV across the country, screening the film for veterans and many groups wanting to learn about these issues. Due to the pandemic, the team seamlessly transitioned to virtual screenings, reaching even more people. These community screenings collectively revealed the pervasiveness of this issue. Now recorded for our YouTube channel, panel discussions feature experts and other stakeholders with differing perspectives. The outreach team welcomes everyone to the table-- post-screening discussions provide a safe place where conversations not happening elsewhere are encouraged. It is the dialogue the team values most.
Daniel Mackler, another filmmaker and former social worker, has edited hundreds of valuable, information-laden clips from the outtakes of the film, also housed on the film’s YouTube channel. The team administrates various social media accounts, releasing pertinent and relevant information and articles about mental health to its growing audience of followers. Leading experts in the field, both medical and non-medical, and those with lived experience are interviewed live on Medicating Normal’s Facebook page.
What is this film about and why is it important?
The film focuses on the overuse and harmful impact of commonly prescribed psychiatric medications. To tell this story, Medicating Normal follows the journeys of five ordinary people whose doctors prescribed psychiatric drugs to help with issues such as stress, mild depression, sleeplessness and grief. As a result, they experience serious physical and mental side-effects, as well as lasting neurological damage.
The film is important because so many people are impacted. One in five Americans take regularly prescribed psychiatric drugs on a daily basis. David Cohen, Professor of Social Welfare at UCLA and an expert in the film, estimates that of those who regularly take these drugs about 30 to 35% experience harm and/or are made worse by them. Over-represented in these statistics are vulnerable segments of our society, including the elderly, the underprivileged, veterans, children in foster care and young people in general. It is a human rights issue that needs to be acknowledged by our larger society.
The film is not anti-medication, it’s pro-informed consent-- meaning patients and medical practitioners deserve to be made aware of these potential harms. Medicating Normal offers insight into why psychiatric drugs are so prevalent today. Driven by profit, pharmaceutical companies have hidden -- from both doctors and patients -- the dangers and long-term harm that these drugs can cause. Therefore, it is critical to expose all people, especially health professionals in training, to the issues raised in the film.
Due to escalating prescriptions during the pandemic, the problem is even more widespread than ever. Pervasive in all media and throughout college campuses, mainstream “mental health” slogans are hurled at unsuspecting people, conditioning them into believing they need medication. On the surface, these messages appear benign, proactive and preventative-- “Stop the stigma,” “Get help” and “Take your meds”-- and yet no one questions their meaning or underlying motivation. Medicating Normal challenges viewers to consider the implications of expanding drug treatment to so many people.
Regarding Robert Whitaker, how did his book, Anatomy of an Epidemic, impact the creation of this film and lead you to select him as an expert?
Early in the research phase of the film, Lynn and Wendy were inspired by Robert Whitaker’s scrupulously researched book, Anatomy of an Epidemic, in which he defines the disease model of psychiatry. He explains how, since the 1980s, a medical mystery has emerged-- increasing numbers of people are being diagnosed with mental disorders and treated with psychiatric drugs, and yet disability rates due to mental illness are rising. If these were physical illnesses, he posits, wouldn’t the disease rate be going down because more people are receiving treatment? Whitaker began to suspect that this increase in mental illness was caused by the very drugs that were supposed to be helping people.
Whitaker also examines long term research that compares treated versus untreated patients: the untreated patients do better. He exposes actual trials illustrating manipulated data that make the drugs look better than they actually perform. His book also follows countless patients who have been harmed by the drugs they took and whose health eventually improves after getting off the drugs.
Whitaker’s message is chilling, but in its clarity, it also gives hope by encouraging education about these drugs. We wanted to make a film that would compel consumers and would-be consumers of psychiatric drugs to learn more about them. Whitaker’s understanding and ability to interpret the science behind these drugs provided a solid, irrefutable rationale for the controversial viewpoint of the film. Furthermore, by reporting in Anatomy of an Epidemic on the personal experiences of so many harmed individuals, Whitaker demonstrated that you cannot accurately portray this story without including the people who have lived it.
In the film, Dr. Vieten explains to Angie that cultural conditioning causes people to seek psychiatric help. How do you think this depiction of mental health affects people?
In a conversation with Angie, a veteran who has suffered trauma, Dr. Vieten, a board-certified clinical psychologist, explains our society’s cultural conditioning that leads to psychiatric overmedication: “One of the things that's happened in our culture is that normal has been confused by marketers of all kinds with comfortable. So if you're in a normal state you must also be in a comfortable state. And if you're uncomfortable in any way there's something wrong, you're abnormal.”
The title of the film, Medicating Normal, encapsulates this notion that society has medicalized behaviors and feelings once considered part of the normal range of human emotional experience. Your boyfriend breaks up with you and you are of course devastated. You have a stressful job and you feel overwhelmed. But these days, too many people go to a doctor complaining of these feelings and walk out with a prescription. We have forgotten that these emotions, while they may be extremely uncomfortable, often resolve with time.
Another contributing element to the perpetuation of this messaging is the labeling of these feelings as “disorders,” specific biological illnesses requiring medication for life. These diagnostic labels follow a person forever. To sell more drugs, the pharmaceutical companies happily promote the message that it’s “OK” to have one of these conditions. Increasingly, many people embrace their psychiatric label as their identity. For example they say, “I have PTSD” instead of “I have experienced trauma.”
In a post-screening panel discussion, Dr. Anna Lembke, a psychiatrist from Stanford University, illustrates this point in a story about meeting with a group of young student leaders at a local highschool. She describes how they introduce themselves-- not only with their names, but also with their disorder labels. She describes this experience as “stunning” because in her own youth such self incrimination would be unheard of. While she acknowledges that we’ve come a long way in destigmatizing mental illness, she is also very concerned that it has now become a part of people’s identities, causing them to sometimes surrender a little bit of their own competence and undermine their own self-efficacy.
The description of benzodiazepines as having ‘short-term usefulness and long-term risk’ sat heavy in this film. Why do you think it is important for ALL people, including health care professionals, to learn more about psychiatric drugs and their potential harms?
Often psychiatric drugs are helpful in the short term. This isn’t surprising as most pharmaceutical trials last 4 to 6 weeks on average. The issue is that, often, the longer a drug is used, the more it can cause significant adverse effects. This can result in what’s called a prescribing cascade, a process whereby the side effects of drugs are misdiagnosed as symptoms of another problem, resulting in additional prescriptions. Polypharmacy (being prescribed multiple drugs) can then result in even more adverse effects and/or drug interactions that again lead to further misdiagnosis and long term harm. No one studies the impact of different combinations of polypharmacy on the body.
Comprehensive knowledge about the short- and long-term effects of psychiatric drugs is critical and is the bedrock of informed consent. In order to make a truly informed decision about whether to begin any treatment, including psychiatric drugs, a consumer needs a complete picture to weigh the risks versus the benefits of said treatment. All healthcare professionals, including first responders, need awareness and accurate information to be able to identify presenting adverse effects in order to avoid misdiagnosis and additional harm. Everyone else in our society must also develop basic health literacy about the adverse and withdrawal effects of psychiatric drugs because they are so pervasive.
Lynn - You had a personal experience that drove you to make this film. What would you recommend to those who are in the same situation as you, to help or be present for their loved ones?
What began as a personal journey to help a struggling family member became a mission to tell an untold story. Our family was uninformed about the possible long term impact of psychiatric drugs. We did not consider alternatives nor did we educate ourselves adequately by reading all the published material, both pro and con. Like many families, we relinquished total control of our relative’s care to her doctors. She had attempted suicide and, understandably, our fear led us blindly into believing that her suffering was caused by a so-called lifetime “chemical imbalance.” It wasn’t until I began researching for the film that I learned that scientists had already disproved this theory, yet it was still used by drug companies as a marketing ploy, and by doctors as an oversimplified rationale, explaining to patients the purpose of drug treatment.
Years later, our family discovered that my relative had indeed experienced trauma—something they never even thought to consider as a root cause. Today it is known that for trauma these drugs are often not effective, and sometimes even contraindicated.
Obviously, hindsight is 20/20-- so, my advice, and the advice of every member of our team, is to avoid the mistakes my family made by:
- first and foremost, listening to your loved one’s reported symptoms—it is their body;
- making sure that a chosen doctor is collaborative and knows, or is willing to learn, how to taper someone off these drugs;
- researching, learning, reading as much as possible;
- thinking critically by including alternative viewpoints in your decision-making process;
- employing healthy skepticism for any treatment when presented with “scientific” rationale (for example, find out who funded a drug study, or how long the study lasted);
- considering potential root causes and/or exacerbating factors (family dynamics, environment, socioeconomic stresses, trauma, other medical conditions, etc.);
- investigating and trying alternatives before more invasive and higher-risk options;
- weighing pros and cons of drug treatment (for example, are the symptoms severe enough that it's worth the risk of any potential side effects which may prove to be more severe than the current condition?);
- expanding health literacy so as to be adequately prepared to not only question medical authority, which isn’t always right, but also to assist the doctor in the plan of care;
- seeking advice from those who have already navigated similar symptoms, diagnoses, and treatments.
Was there a moment(s) that stuck out during the five-year process of this film and working with this team?
At one screening, a group of mental health professionals, most of whom prescribe the drugs mentioned in our film, unanimously expressed concern: “The film is irresponsible because it will convince people needing these drugs to stop them.” (This did give us pause; yet, we have come to believe that it’s irresponsible not to show the film!) Also, it baffled us that these professionals, without having met the film’s subjects, were unanimously of the opinion that each one of them was in fact mentally ill and needed their prescribed medications. From our perspective, they had missed the whole point of the film. This drove home for us how insufficient data about a patient can so easily be used to justify mental health diagnoses and treatment.
Another screening for a group of college students garnered a completely opposite reaction-- all were very supportive of the film. Equally alarming, however, was the fact that a majority of them were medicated or had friends who were. Still, they recognized the importance of the issues raised and identified with the film’s subjects and their experiences. One student began crying as she described her inability to stop her prescribed antidepressant without significant withdrawal. This group’s professor expressed extreme frustration at University mental health policies. She lamented the mandate that if she noticed a student in distress, she first had to notify the campus mental health system as opposed to consoling the student directly.
Another memorable event-- After the film was complete, Lynn made an appointment to see the doctor who first diagnosed and prescribed drugs for her family member. After all that transpired, Lynn was shocked to learn that the doctor had mostly stopped prescribing and was instead practicing EMDR (Eye Movement Desensitization and Reprocessing), a form of psychotherapy proven effective for trauma. Today, Lynn’s family member is still heavily medicated, although on fewer drugs. She believes her drugs help her and does not want to stop taking them. She loves the film and recognizes it as “an important public service.”
After watching this film, what are some resources you recommend to those who want to research more about mental health and medicine?
Our website hosts research, resources, alternatives, and a reading list: medicatingnormal.com/resources. Our YouTube channel also houses over 100 outtakes from the film as well as recorded post-screening panel discussions and interviews with those who face these issues daily, either personally or professionally.
Talk about some of the reactions of people seeing this film.
Medicating Normal has been featured in 15 film festivals, winning 3 awards for best picture and 2 audience awards. Driven by the urgent need to get the film out there and discussed, the outreach team has organized more than 140 community screenings followed by customized post-screening panels throughout this country and abroad.
At these screenings, audience members frequently express an overflow of emotion and gratitude that, “finally a film has validated my experience!” Many feel betrayed by mainstream medicine and share devastating accounts of their own harm, which are sometimes as impactful as the stories revealed in the film itself. Others believe their drug has saved their life and worry that the film isn’t balanced enough. Some, eager to learn more about an under-publicized topic, are shaken by the potential implications of a highly-medicated society.
Surprisingly, many prescribers have expressed gratitude at being exposed to another viewpoint. After one screening a GP told us, “I’m a family physician. I prescribe these drugs all the time, and I had no idea about the extent of these side effects.” A psychiatrist said that the film made him feel very defensive, but also admitted that he found it helpful, saying, “Drugs can be useful, but we as professionals need to step back and understand that there is truth in the claim that we have been harming some of our patients.” Other prescribers responded with relief that the film corroborated a concern they’d had for years. A retired pediatric nurse practitioner described having nightmares about the impact her prescribing may have had on her young patients.
While we were unable to sit in on the film's debut at Yale Medical School’s Grand Rounds, we know it provoked an almost-2-hour-long discussion. Many doctors who see the film recognize the gross negligence and “bad doctoring” experienced by our subjects. What they fail to understand is that these doctors in the film and their actions represent a standard of care currently accepted by most of medicine and our society at large.
There are countless mental health care professionals who have joined our post-screening panels who began treating patients one way and who are now recognizing the importance of trying alternatives before resorting to a drug. Many still resist the premise of the film and deny that the problem exists. Regardless of the reaction to the film, we always try to remind ourselves that our goal from the beginning has been to raise awareness and start a conversation.