The Case for Selective Use of Antipsychotics

January 7, 2013

Robert Whitaker’s keynote presentation in Brighton, England explores the problems of the evidence base at the heart of the medical model, particularly for ‘psychosis’, and discusses the Open Dialogue approach to working with psychosis, which is practiced in northern Finland. In Open Dialogue therapy, only about 1/3 of first episode patients have been exposed to antipsychotics at the end of five years, and only about 20% are taking the drugs on a regular basis at the end of that time. Their reported five-year outcomes are, by far, the best in the Western World.

This presentation is part of an on-going exploration into alternative recovery models by Mad in America.

The Case for Selective Use of Antipsychotics Comments RSS

21 thoughts on “The Case for Selective Use of Antipsychotics

  1. What is really bothersome to me is the fact that all of this information in these studies is now fairly old. Why is it that so few professionals in the mental health system have any knowledge of this information? Are they lying or is the state that I live and work in even more backward and behind than I think it is?

    How can professionals not know this information. And yet every psychiatrist where I work offers only these toxic drugs as treatment. Couldn’t this lack of knowledge be grounds for law suits in the future if the drugs are doing actual harm to people forced to take them?

    • People only know what they want to know. If they do not want to know it they will not know it. Very few psychaitrists have any training at all in any form of therapy, and so any research related to it, is not going to be read by them.

      They do admit that they only have short term studies, but then say that it would be a waste of money to do them for longer as it would stop people from getting the treatment they need. They consider is acceptable in some circumstances to withhold a drug from someone for the 6 week clinical trial, but they consider anything longer than that medical negligence!!!

      For many it is way to scary to admit what is right in front of you. And of course these have not been publised in the major journals, as they would not usually publish them, as it would threaten the drug sponsership they recieve.

    • I’ve been saying that for years. How could psychiatrists not have known? Reading Whitaker’s first book helps to better understand why this is all happening. Psychiatry was never an honest profession and never cared about the so called mentally ill, a group of non-citizens they deem to be contaminating the human gene pool with diseases that amount to social wastage. As long as treatments are damaging they are seen as helpful. When new treatments like Soteria house come up and show the possibility of getting SMI patients back to life in the real world then they are attacked and shut down — the SMI patients must be doped up and sat in a corner somewhere, else they might have children.

      I do strongly hope that one day Whitakers research will be used against the psychiatric profession in a criminal lawsuit. There’s so much evidence going back for decades that psychiatry had no reason to think that it’s drugs were good and every reason to think that they were causing irreversible brain damage. Yet, they gave those same drugs to millions of children and forced many to have to take them, all while ironically supporting a trend in sports and mass media to associate concussions and head injury with serious mental health problems.

  2. Its a great articulation of the “assumption & expectation” in the accidental discovery of the chemical effect, and the wishful hope, that so-called anti-psychotics would be as effective as penicillin and antibiotics. The “needed” acceptance of a disease process within the brain, a further example of our “instinctive-intelliegence,” and its “assumptions & expectations” to ease survival?

    In Robert’s talk, is there an assumption that mental illness is a product of brain dysfunction, in which the body and the nervous system plays no part? Do we assume that because we sense our mind within the our head, and assume that disorder of the mind has to be “all about the brain?”

    Is the assumption & expectation, a simplistic cause & effect logic, and language which does not match the fluid reality of the electro-chemical activity of the human organism’s body/brain/nervous systems?

    Why do we use a “key in a lock,” mechanical metaphor, to describe a chemical reaction? Are we still struggling with an outdated Copernican view of ourselves, a brain that works with cogs & springs? Is our cause & effect logic far to mechanical to capture the essence of our internal reality?

    In our 1st world Christian societies, were people make a living with their mind, is there a restistance to accepting the body’s role in the creation of our subjective experience? A denial of our evolved nature, because the words instinct and animal are considered some kind of betrayal of Jesus & God?

    Why do we keep looking for dysfunction within the brain with a mechanical cause & effect logic, despite our growing understanding of systems theory and its more powerful descriptions of reality, including our own? Do we live in a culture of denial? Please consider;

    “SEEKING Systems & Anticipatory States of the Nervous System:

    Self-Stimulation?

    The Seeking System: Like other emotional systems, arousal of the seeking system has a characteristic feeling tone– a psychic energization that is difficult to describe but is akin to that invigorated feeling of anticipation we experience when actively seeking thrills and other rewards. Clearly this type of feeling contributes to many distinct aspects of our active engagement with the world.

    This harmoniously operating neurochemical system drives and energizes many mental complexities that humans experience as persistent feelings of interest, curiosity, sensation seeking, and in the presence of a sufficiently complex cortex, the search for higher meaning. Although this brain state, like all other basic emotional states, is initially without intrinsic cognitive content, it gradually helps cement the perception of causal connections in the world and thereby creates ideas. It appears to translate correlations in environmental events into perceptions of causality, and it may be a major source of “confirmation bias,” the tendency to selectively seek evidence for our hypotheses.

    When this seeking system is manipulated by electrical impulse in other mammals, they will eagerly continue to “Self-Stimulate” for extended periods, until physical exhaustion and collapse set in. There are powerful descending components, probably glutametergic in part, that remain to be functionally characterized, but they may be important for the generation of self-stimulating behaviors. When these descending systems are fully characterized, they may have powerful implications for understanding such psychiatric disorders as schizophrenia.

    1, The underlying circuits are genetically prewired and designed to respond unconditionally to stimuli arising from major life-challenging circumstances. 2, The circuits organize behavior by activating or inhibiting motor sub-routines (and concurrent autonomic-hormonal changes) that have proved adaptive in the face of life-challenging circumstances during the evolutionary history of our species. 3, Emotive circuits change the sensitivities of sensory systems relevant for the behavior sequences that have been aroused. 4, Neural activity of emotive systems outlasts the precipitating circumstances. 5, Emotive circuits come under the control of neutral environmental stimuli. 6, Emotional circuits have reciprocal interactions with brain mechanisms that elaborate higher decision-making processes and consciousness.

    It is remarkable how long it has taken psycho-biologists to begin to properly conceptualize the function of the self-stimulation system, in the governance of behavior. The history of this field highlights how an environmental-behavioral bias (world out there), with no conception of internal brain functions, has impeded the development of compelling psycho-behavioral conceptions of self-stimulation. One of the most fascinating phenomena ever discovered, yet still largely ignored by mainstream psychology.

    The prevailing intellectual zeitgeist is not conducive to conceptualizing this process in psychological terms. This would involve discussion of the inner neurodynamic aspects of the “mind” and the nature of intentionality and subjective experience. A neurophysiological understanding of such brain systems can explain how we spontaneously generate solutions to environmental challenges. And how this type of spontaneous associative ability characterizes normal human thinking, as well as the delusional excesses of schizophrenic thinking.

    Arousal of the seeking system spontaneously constructs causal “insights” from the perception of correlated events. Some of the relationships may be true, but others are delusional. Indeed, all forms of inductive thought, including that which energizes scientific pursuits, proceed by this type of logically flawed thinking. An intrinsic tendency for “confirmation bias” appears to be a natural function of the human mind.

    The seeking system can promote many distinct motivational behaviors, and the underlying neural system is prepared to jump to the conclusion that related environmental events reflect causal relationships. It is easy to appreciate how this may yield a consensual understanding of the world when the underlying memory reinforcement processes are operating normally ( i.e, yielding a reality that most of the social group accepts). It is also easy to understand how it might yield delusional conclusions about the world. If this self-stimulating system is chronically overactive, it may be less constrained by rational modes of reality testing.

    The fact that the system is especially responsive to stress could explain why paranoid thinking emerges more easily during stressful periods, and why stress may promote schizophrenic thinking patterns. If the normal function of this system is to mobilize the organism for seeking out resources in the world, then we can begin to appreciate how the seeking system might also generate delusional thoughts. Apparently when this emotional system is over-taxed and becomes free-running (self-stimulation), it can generate arbitrary ideas about how world events relate to internal events.

    Is delusional thinking truly related to the unconstrained operation of spontaneously active associative networks of a self-stimulating, seeking system? If so, we may have a great deal more to learn about schizophrenia from a study of the SEEKING circuits that mediate self-stimulating behavior? Through a study of this system, we can also begin to understand the natural eagerness that makes us the emotionally vibrant creatures we are.

    One might also predict that there is an intimate relationship between self-stimulation and dreaming. REM deprivation leads to increased “sensitivity” in the self-stimulation system It is noteworthy that schizophrenics fail to exhibit compensatory elevations of REM sleep following imposed periods of REM deprivation. There appears to be a fundamental relationship between the schizophrenic process and the emotional discharge that occurs during both REM sleep and the seeking system discharge of self-stimulation. These findings suggest that there may yet be considerable substance to psychodynamic theories that relate dreaming mechanisms to symbol-&-reality-creating mechanisms of the brain.

    (Panksepp suggests that if we can accept this stress sensitized self-stimulation system as fundamentally a SEEKING system, which requires discharge, new ways of alleviating delusional thinking may be created to provide discharge, while stimulating reality testing, perhaps via computer games for example?)”

    Excerpts from, “Affective Neuroscience: The Foundations of Human and Animal Emotions.” by Jaak Panksepp.

    In my own exploration of psychosis, Panksepp’s description of Self-Stimulation makes perfect sense, once I learned how to understand “sensation” and sense impuse and the “motor act” as the as my mind’s “intentional” foundations. Difficult to accept in our “I think therefore I am,” cultural zeitgeist, I know.

    Yet, “The prevailing intellectual zeitgeist is not conducive to conceptualizing this process in psychological terms. This would involve discussion of the inner neurodynamic aspects of the “mind” and the nature of intentionality and subjective experience.” _Jaak Pansepp.

    Its a telling observation, which we seem scared to explore? Perhaps our instinctul-intelligence holds a double-bind trap in its assumptions & expectations, for ease of self-preservation?

    Best wishes,

    David Bates.

    • When you read the obvious typo’s, can you pause to feel your impulsive need to judge the other?

      Can you feel your own primitive affect/emotion & the ego’s passionate judgements, under which the sensitive soul suffers a fearful psychic pain and disorders of the mind? Please consider;

      “Affects as Passions and Actions:

      The notion that affects are invaders that work against our true nature is expressed in the early modern understanding of “passion” as a pacifying force opposed to action, meaning the activity of the soul. (true-self) Up to and including the seventeenth century, to be the “object” of affects is to be passive in relation to them. Such passive states are contrasted with those in which one is active. Thus, when Spinoza talks of an adequate cause, he means a cause that accounts for actions that take place within us or that follows from our nature. On the other hand, “we are passive when something takes place within us or follows from our nature, of which we are only the partial cause.” Passions may work against actions and actualization.

      Passions and passionate judgments are passive as a result of being “affected by the world around us.” We are not acting to actualize our distinctness, but reacting, and in this sense losing the initiative relative to the things that affect us. Yet it is the peculiar nature of such pacifying affects, that they also “affirm” the ego and individual judgments. The distinctness of our individual judgments depends then on the extent to which we are pacified by various affects, and how far this passification or resistance to it, marks one person as different from another. It also depends on the soul or anima that resists those passions.

      Aquinas tells us, “evil cannot be known simply as evil, for its core is hollow, and can neither be recognized nor defined, save by the surrounding good,” which fits in with Lacan’s psychoanalytic definition of the ego as nothing but “lack.” The notion that pacifying passions work against the soul or form they affect, is also a statement that the essence of the self is something other, something distinct from the affecting passions. “It is this distinctness which comes to be lost.” While passion as passivity and action are retained as key categories, they are recast in a mechanistic worldview which “explains nothing,” Descartes action, rather, is the transfer of motion from oneself to another, and passion is being acted upon.

      With this mechanistic turn, it seems that bodies have a “power to resist change,” as well as the power to impart motion. For Descartes, the soul is not the form that is the body’s affective power, it is the capacity to think. While the soul exists, “it is always thinking,” yet as it thinks it loses more of the physicality it once had. The eighteenth century marks a shift, instead of being reactions to invasions from something external to the self, passions become the very activities of the mind, its own motions.

      The term “feeling” which used to be allied with sensation, has become a victim of our lack of precision in “affective” language. No distinction parallels Aristotle’s between our emotions and sensations. Passions or “affects” now claim to be a class of feeling, rather than something discerned by feeling. They seem to be part of one’s self-contained energetic motivation, and the original understanding of passions or affects as pacifying is lost. (thinking has lost touch with being affected, from both within and without)

      Affect and Ego:

      Lacan dates the era of the ego from the late seventeenth century, while Foucault assigns an intensification of knowledge as the will to power, to the same period. Both are aware how the passion to control the other, causes a person to seek knowledge as a means to control, and that the exercise of such knowledge is aligned with discipline from without, or “objectification.” Taken to its objectifying extreme, this process leads to our present madness, which is the destruction of future life, even our own, for the sake of immediate gratification.

      Yet, to understand this, we need to see how the “negative affects,” cohere as an egoistic constellation, and why judging (diagnosing) or “projecting” affects onto others and the self is fundamental to why that egoistic constellation solidifies in the Western centuries progress. Unconscious affects bear on the ego by repressions and fixations as forms of judgment. Judgments based on images, memories, and fantasies about avoiding pain and increasing pleasure. (p, 106.)

      For Lacan, the interlocking of self and other, is an imaginary space, which is imaginary in that fantasies (assumptions) interlock within it. Yet by the power bodily affects, these interlocking fantasies are also physical, just as the force of the imagination is physical. In this respect, they can be something the self does to the self, energetically speaking, or something directed towards the self by another’s goal-seeking aggressive projections. (p, 109.)

      For the ego, comparison is effected by and mediated through images of others and fantasies concerning them. The history of an imaginary slight–in envy or wounded narcissism–can be built into a fantasy or psychical memory, and that history can be conjured in an instant together with its affective associations. This is why we can speak of these “affective” states as passionate judgments. The passionate judgment is what gives the other or the self a negative image, embodying the objectification of narcissism or the contempt of envy. These judgments are at odds with the soul, or actualization drive. (p, 110.)

      Excerpts from “The Transmission of Affect” by Teresa Brennan, PhD.

    • One time in the past, I with a previous history of “schizophrenia” went to my local hospital seeking help. I had insomnia and could not endure the pain of the insomnia. I was told to wait in the emergency department. I did wait for hours in the emergency department, did what was asked of me. When I discovered I could not leave and I could not wait any longer ,I became angry-violent by punching a plexiglass wall separator to receive some attention. I was then given some drugs that I wanted-needed to lose consciousness. Why did it have to come to that?

      • Dear Mark,

        I have had similar experiences. On one occassion I drove myself to the hospital requesting to consult the neurologist I was under the care of. For several nights I woke up with sudden severe headaches. It progressed to numbness going down my left arm, loss of cognitive functioning (I could not understand what people were saying to me) loss of peripheral vision and feeling like I was going into a coma.

        Because I had a history of “bipolar disorder” the ER doctor ordered a psych consult. A young psychiatrist told me that I could only be admitted to the psych ward for mania.

        I refused “treatment” and told him I was leaving.

        He told me to wait a few minutes because his shift was over and he would walk me to my car because it was late at night and he was worried about me.

        Assuming I was “manic” he acted inappropriately, which he later regretted as I filed a complaint with the Division of Human Rights for failure to provide public accomodations and was awarded a settlement (without an attorney)

        My prior EKGs were normal. After that episode they indicate a myocardial infarction.

        Is it any wonder the life expectancy of our mental health patients is 25 years less than the rest of society?

        Esmin Green’s death is an example of how the label of “mental illness” negatively impacts medical treatment.

        http://articles.cnn.com/2008-07-01/us/waiting.room.death_1_hospital-staff-hospital-employee-kings-county-hospital-center?_s=PM:US

        • Hi Maria,

          Good for for filing a complaint. Your experience sounded like a nightmare.

          As one who was on psych meds for 15 years before getting off of them, I have a question about medical records. Since I was never hospitalized and if god forbid I ended up in an ER, would my chances of being subjected to similar experiences as you were be as great or not?

          I guess my question is how did the ER know your mental health history? Had you been a patient at that hospital or what exactly happened? Of course, share as much as you are comfortable discussing.

          Thanks!

          • I live in MI and if you go to the hospital here they will have your medical records automatically if you’re subscribed to a health plan that the hospital participates in. If not they’ll get your medical records from wherever they are electronically and it will not take them long. Doctors fear treating people without their medical records because they could get sued if they do something that needlessly aggravates a pre-existing condition.

            Years ago I went to a hospital cause of a severe abdominal pain that made me think I might be having pancreatitis. I had also been drunk earlier in the day and didn’t look very good. After they took my clothes and gave me a robe they had me sit in the hallway on a gurney. The pain went away so I went about trying to get my clothes back and it was at that point I was told that I had threatened to kill myself (I hadn’t) and that I was being committed to the psych ward. This was my first encounter with psychiatry as an adult. I was 24 years old and had celebratorily walked away from state mandated psych treatment when I turned 18.

            Since then I’ve found another hospital not too far from here that doesn’t have a psych unit, although somebody I asked there said they could always just call an ambulance to transfer me if they wanted. It seems that as long as psych wards and 72 hour holds and involuntary commitment exist, former mental patients will get caught back up in the system when they go in for real medical care.

          • AA,

            Yes, I had been a patient at that hospital before and they had access to my medical records.

            I had initiated a worker’s compensation claim for the diagnosis of toxic encephalopathy but was still under the care of a psychiatrist.

            The psychiatrist had recently resigned as head of the department of psychiatry but he still had admitting rights.

            I remained under the care of a psychiatrist because the insomnia was very difficult to control.

            He knew I was having cognitive problems and was the one who made the referral to the head of neurology at the same hospital.

            I made it clear to the ER doctor that I was a patient of both doctors as I had nothing to hide and I brought along the MSDS sheets from the chemicals I worked around to aid in the evaluation process.

            For my worker’s comp case I obtained all of my medical records.

            I would recommend to all psychiatric patients to obtain their records.

            Lab work indicated abnormalities from day one that were never disclosed to me.

            Below is a case from the same hospital I was treated at of a young girl who was misdiagnosed for two years with bipolar disorder.

            As a mental health advocate I support a movement that promotes accurate assessment of symptoms of psychosis/mania to rule out underlying medical/substance-induced conditions before labeling individuals with bipolar/schizophrenia.

            The Soteria Model and Open Dialogue fail to consider this critical aspect.

            http://psychoticdisorders.wordpress.com/2012/11/25/neuropsychiatric-systemic-lupus-erythematosus-presenting-as-bipolar-i-disorder-with-catatonic-features/

            Neuropsychiatric systemic lupus erythematosus presenting as bipolar I disorder with catatonic features.

            OBJECTIVE:

            The authors describe a 15-year-old African American young woman with a family history positive for bipolar I disorder and schizophrenia, who presented with symptoms consistent with an affective disorder.

            METHOD:

            The patient was diagnosed with Bipolar I disorder with catatonic features and required multiple hospitalizations for mood disturbance. Two years after her initial presentation, the patient was noted to have a malar rash and subsequently underwent a full rheumatologic work-up, which revealed cerebral vasculitis.

            RESULTS:

            NPSLE was diagnosed and, after treatment with steroids, the patient improved substantially and no longer required further psychiatric medication or therapy.

            CONCLUSION:

            Given the especially high prevalence of NPSLE in pediatric patients with lupus, it is important for clinicians to recognize that neuropsychiatric symptoms in an adolescent patient may indeed be the initial manifestations of SLE, as opposed to a primary affective disorder.

  3. Great presentation, Robert. Look forward to meeting you in Belgium in March.

    Re Stephen’s post re “why so few professionals in the mental health system have any knowledge of this information”, the first reason is that they are no longer taught anything but the neurobiological paradigm of psychosis. For instance I recently attended a presentation about the history of schizophrenia in which trauma as one cause of psychosis was not even mentioned. The second is the ascendency of Big Pharma, which has set the agenda for most research in the field, and which pays leaders in the profession to carry out research and promote antipsychotic drugs, not as cures for psychosis, but as “stabilisers” – forever.

    Re Markps2′s comment: You are quite right that in many cases, antipsychotic drugs are forced on the service user, not “given”. If they complain or resist, depot medication is “given’, often indefinitely. Sometimes, especially if the service user has been using amphetamines, it is hard to treat a psychosis without a major tranquiliser, though i agree with Robert that benzos are being used more frequently in acute situations. What I don’t agree with is long-term compulsory treatment – and in my experience, very few who are forced to take medication are able to work. Also, virtually no-one is told that it is possible to be drug-free, although there are now recovery programmes starting up in many parts of the world.

    Very few clinicians explain the side-effects of these drugs – and antipsychotics are now being given to children, which in my view has serious medicolegal ramifications.

    I’d like your reference, Robert, re the possible relationship of side-effects (eg akithesia, obesity, diabetes, liver damage, sun sensitivity) to suicidality in some patients.

    Best regards

  4. Enlightenment is man’s emergence from his self-incurred immaturity. Immanuel Kant

    Dear Robert Whitaker,

    This talk is a talk of enlightenment. My many thanks for your exposition of the more complexe neuro-physiolocigal interrelations mediating the biochemical molecules knows as neuroleptics/anti-psychotics.
    Having been inpatient with a psychotic diagnosis in Germany in 2007, I questioned and refused taking neuroleptics because I did not wanted an uncontrollolable quantification of receptors at the post-synaptic side. I refered to the known biological mechanism of “repair of insult” which the brain activates as response to regular (street)drug intake – leading to severe forms of supersensitivity and addiction/craving as well as the acknowledged vegetative and cogito-emotional thuderstorms upon withdrawel of (street) drugs. The psychiatrists on the ward first attacked my naive misunderstandings of neurophysiology and threatened me with a prospect of loss of brain matter if I refused medication. Thus I role-played the compliant patient for being able to leave hospital. My research, in my view, seemed to confirm my conceptions – however NOT A SINGLE PSYCHIATRIST I saw would allow or be able to discuss these complexe projections and loopings (meso – limbic with basal ganglia – and neocortical feedback/forward projections and loops).

    However, these slowing down in part of the interconnected neurological sub-systems with agitation in other parts or diminished activity/later substance-degradation in again other parts are demonstrated by both: 1/ “side” effects of the neuroleptics (drugs can’t read pharma notice and introduce changes, never “side” effects) 2/ adequate behaviour which would correspond to a natural situation in which the person and its CNS interact – as this is mimicked by the introduction of neuroleptics.

    Robert Whitaker, you are the first person who demonstrates the more complex and more wholelife-biologically understandable neurophysiological interactions – be it as a sociobiological response – be it via the introduction of neuroleptics (monoamine-interfering molecules mostly). How often did I ask: how comes medical doctors do not think with the proper neurological prsocesses they have studied at Uni? This is where my basic knowledge in neurophysiology comes from: I have had the pleasure to study with one of the meading brain-AND-behavior researchers at a medical university in Germany, Prof Rehkämper. We students were asked to struggle to understand the intelligency in the complexity of neurophysiology in a socially interactive mammal subject. This saved me from taking drugs because I would be able to recuse the destructive dummy-models of reductionist pseudo-science.

    I am dancing with joy and brightness about your research and clear thinking which is the responsable use of an intelligent man’s capacities and calls for emergence of reductionist psychiatrists self-induced immaturity. Instead of complex and dialectic understanding of embodied neurophysiology the dummy-scientists construe tiny little brick-models of the intelligency of kids in the kindergarden. But the qualities of good European enlightenment thinking and the liberal qualities of responsible and challenging journalism as Your work demonstrates should introduce a “Kopernic turn” in medical research and medical treatment with the necessary combination of neurophysiology and social interaction.

    My bright joyous happiness and empowering support taken from your work, all of it!, is the most vital thank I wish to render to you!

    Ute
    (from Germany, currently studying at the Institute of Psychiatry at King’s College London, UK)

    • I wouldn’t go so far as to stay out of the ER in an emergency. It shouldn’t matter how you look or behave when you’re in crisis, but unfortunately it does. My advice would be that if you’re worried that there may be a diagnosis of serious mental illness on your chart then just don’t go in dishevelled and upset.

  5. “Another Case for Selective Use of Antipsychotics”

    Dear Bob,

    The mass shootings in the US have brought the topics of “mental illness”, the treatment of psychosis and our flawed mental health care system to the forefront of concerns in our country.

    Mental health care involves a large-scale, complex system.

    The interaction between our mental health care and criminal justice systems contributes to the unregulated power-base of psychiatric authority in our country.

    Unlike physical illness, individuals who are precieved and labeled “mentally ill” are of a class of people who can be deprived liberty and legally forced to contract treatment services/consume potentially lethal products without treatment/product options.

    Individuals labeled “mentally ill” are in critical need of a strong, ethical and uniform advocacy agenda founded in evidence-based, best-practice standards of care.

    I realize that you do not want to consider yourself a mental health advocate, but if you consider the definition of the word “advocate” is:

    “A person who publicly supports or recommends a particular cause or policy.”

    - listening to this video, you are acting in the capacity of an advocate for the Soteria Model and Open Dialogue.

    Your journalistic perspective has taken on an authoritative position challenging the main stream paradigm of care for the treatment of psychotic symptoms.

    If anything, you should at least consider yourself a public advisor for the treatment of psychotic symptoms.

    The paradigm of care that you are promoting is one that fails to consider testing for and treating underlying medical conditions and substances that are known to induce psychotic/manic behavior.

    This is an unethical standard of care.

    It might come to a surprise to you, but many individuals who experience acute psychosis are individuals who are socially well-adjusted, educated, employed, home owners who have loving family and friends and do not need a Soteria Home, a Healing Farm House or Open Dialogue approach.

    They need medical assessment and medical treatment for medical conditions that manifest as abnormal behavior.

    As an individual who has been in our mental health care system and treated for psychosis on numerous occasions, what I benefited from the most is Functional Medicine/Integrative Psychiatry/Orthomolecular approach, Chelation therapy, vitamins, minerals, nutrients and detoxing treatments.

    I recognize psychosis as being caused by a virus, bacteria, toxin (including medications and not just psych meds) physical injury/disease.

    I acknowledge the selective use of psychiatric medications can help stabelize psychotic/manic symptoms while the body heals itself or an effective treatment is found.

    As a mental health advocate, I believe there is a need for mental health patients to have access to affordable integrated/dental care, alternative therapies/products and concepts that support patient empowerment through the Participatory Medicine movement.

    As an advisor to those considering the treatment of psychosis, could you please give me your opinion of the Best Practice Assessment of Psychosis guidelines published in the British Medical Journal?

    Personally, I think it is pretty comprehensive and I do not understand why it is not the number one consideration for medical and mental health professionals treating psychotic symptoms, as well as mental health advocates concerned with the treatment of psychotic symptoms.

    http://psychoticdisorders.wordpress.com/bmj-best-practice-assessment-of-psychosis/

    I look forward to your opinion.
    Kind Regards,

    Maria Mangicaro

    Posted on Mad in America dot com 01/17/2013

  6. Maria,

    I don’t think the open dialogue model of care, or the Soteria model, in any way precludes looking for environmental causes of psychosis (viruses, toxins, other medications, illicit drugs, etc.) In fact, I believe that good medical care would start by assessing whether such triggers could be present and causing the symptoms, and if triggers were found, then you would incorporate into any treatment plan. The reason that I may seem to be “advocating” for an open dialogue approach is simply because they have the best reported outcomes in the western world, and I would think we could all agree that a paradigm of care that helped a greater percentage of people get back to work and school., and do so in the absence of antipsychotic drugs, with all their possible adverse effects, is one worthy of knowing about.

    There is also no reason that an open dialogue approach would preclude an in-depth physical and assessment for the type of factors you mention. In general medicine, that used to be called taking a case history (which was a starting point for all types of medical care), and then somehow it often got lost in modern psychiatric practice.

    So I surely am not advocating for a paradigm of care that would ignore such assessment, and response to it.

    • Dear Bob,

      If you think the Open Dialogue approach is one worthy of knowing about, then would you

      PLEASE, Please, please,

      consider learning more about the value of an Orthomolecular approach, Functional Medicine and Integrative Psychiatry as well as the successful outcome of cases treated according to best practice assessment standards.

      Two-time Nobel Prize winner, and molecular biologist, Linus Pauling Ph.D.,coined the term “Orthomolecular” in his 1968 article “Orthomolecular Psychiatry” in the journal”Science

      You will find Orthomolucular approaches are based in solid, scientific data.

      http://profiles.nlm.nih.gov/MM/B/B/J/Q/

      As a mental health advocate, I am BEGGING you to PLEASE incorporate the importance of accurate assessment of psychotic symptoms in your presentations.

      In each presentation that you fail to acknowledge organic causes of psychotic symptoms

      - something mainstream psychiatry readily accepts but also fails to acknowledge in order to promote the concepts and treatment of schizophrenia/bipolar disorder –

      you are leaving out a huge piece of the puzzle.

      We are in a critical time period and mental health care patients are in need of critical thinkers who will use due dillegence to consistently focus on best practice standards of care, especially when engineering a new paradigm of care that focuses on psychotic symptoms.

      The best reported outcomes in the Western world will not bring Mozelle Nalan, Kendra Webdale and 20 Sandy Hook Elementary School students back to life.

      When public safety is at risk, advocates and lawmakers in the US will not simply agree on a paradigm of care based on a greater percentage of people get back to work and school. The fear factor of the Sandy Hook massacre is contributing to a zero tolerance mentality.

      Advocates in favor of the Selective Use of Antipsychotics and alternative treatment options need to step up their game plan.

      The obstacle mental health advocates are up against includes the fact we are fighting each other’s agendas without finding common grounds to form a united advocacy agenda.

      The BMJ’s Best Practice Assessment of Psychosis is something all ethical advocacy agendas should consider supporting.

      Many individuals suffering from symptoms of severe mental illness are among a marginalized population, in jails/prison/psych wards/homeless and do not have access to the internet, or a voice in their proposed treatment agenda (something which they may be forced into and forced to pay for without treatment options)

      Anyone who is speaking out on the treatment of psychosis must act to ensure they are promoting treatment standards with both patient best-interest and public safety considerations.

      In some of your talks you describe psychosis as having flu-like characteristics of coming and going on its own.

      From my personal experiences and the fact a psychotic state can be caused by a virus/bacteria (including dental caries, one of the most prevalent chronic diseases of people worldwide and mentioned in Mad in America) you are correct in making this assessment.

      This assessment is true in some cases of psychosis, but not all.

      The diverse array of underlying causes of psychosis contributes to the problem of trying to create a uniform treatment plan that works best for the majority.

      As you have also stated quite factually, antipsychotics do appear to help stabelize a person seeking treatment, or forced into treatment for psychotic symptoms.

      The length of time one suffers from a psychotic state can be reduced when the underlying cause is targeted and treated.

      The length of time antipsychotic medications are used, and the risk of adverse side effects will also be reduced.

      Being aware of what triggers can exacerbate symptoms is the best way of preventing reoccurance.

      Targeting underlying causes of psychosis/mania needs to be recognized for a best-practice standard of care to be established.

      Mainstream psychiatry and the use of anti-psychotic medications will always have the upper hand in a society that does not want people suffering from a temporary bout of psycho-flu purchasing guns.

      The appearance of stabilizing on medications, makes a convincing argument for main stream advocates and law/policy makers to support long-term use and even early intervention.

      Many NAMI advocates are parents who do not want their child to suffer another bout of psycho-flu ever again.

      The mass shootings promote discussion of the “treatment” of psychosis and gun control but the media agenda does not consider the critical aspect of what can cause a psychotic state in the first place.

      The anti-psychiatry/alternatives agendas eagerly to point to the use of psychiatric medications but fail to consider the possibility of a combination of factors such as the interaction of cold medicine/a flu shot/abscessed tooth, etc and the exacerbation of psychotic symptoms.

      What your book Mad in America indicates is that taking a case history for individuals in a psychotic state has never been a standard of care, that is why we ended up locked away, institutionalized, criminalized, ostracized, demonized and contributes to the fact currently our life expectancy is 25 years less than others.

      Before promoting a universal, one-size-fits-all treatment approach for symptoms of psychosis, law/policy makers need to recognize the fact there are many underlying medical conditions and substances that can induce a psychotic state and be misdiagnosed as schizophrenia/bipolar disorder.

      In this presentation you mention that antidepressant medications can cause a “bad reaction” and induce mania, resulting in a person who was originally dx’d with depression being labeled with bipolar disorder.

      The “bad reaction” is a toxic encephalopic response and should be diagnosed as a Drug Induced Mood Disorder (292.84), not bipolar disorder.

      You might be interested in listening to “Expert”, Dr. Ankur Saraiya, explain the same scenario in what psychiatrists “informally” refer to as Bipolar 3

      http://www.howcast.com/videos/498598-Bipolar-Disorder-1-2-and-3-vs-Cyclothymic-Disorder-Mood-Disorders

      In a separate video Dr. Saraiya explains the “Chinese Menu” approach of using the DSM.

      Chinese Menu?????

      Need I say more about a defect in that approach?

      Patients in our mental health care system suffer from the fact medical/mental health professionals and advocates use a rubber-stamp approach of labeling all manic/psychotic behavior as Bipolar/Schizophrenia without understanding the DSM recognizes the variations in causes of psychosis/mania.

      I would urge that you consider breaking away from referring to symptoms of psychosis and schizophrenic behavior as one in the same.

      Clear distinctions are made in the DSM, they should be referred to as such.

      Advocating for a paradigm of care that does not ignore taking a patient’s case history is the main focus of my personal mental health advocacy agenda.

      Thank you for your support.

      292.11 Amphetamine-Induced Psychotic Disorder, With Delusions

      292.11 Cannabis-Induced Psychotic Disorder, With Delusions

      291.3 Alcohol-Induced Psychotic Disorder, With Hallucinations

      293.83 Mood Disorder due to (indicate general medical condition)

      333.90 Medication-Induced Movement Disorder NOS

      310.1 Mental disorder due to medical condition

      296.46 Manic, most recent episode, full remission

      292.12 Drug Induced Psychotic Disorder, With Hallucinations

      292.11 Drug Induced Psychotic Disorder, With Delusions

      292.84 Drug Induced Mood Disorder

      292.89 Drug-Induced Sleep Disorder

      Posted on Mad in America, January 17, 2013

  7. A comparison. In my city of Montreal we have garbage containers for garbage. What you have on hand as a problem is garbage or not garbage. When in truth we have recyclables such as metal, wood and biomass(food/fertilizer) .The city does not give the recycle option. The city, to admit to the second option, would cost money (for a second container), and someone needs to force the city to admit to their error.
    What is psychiatry’s incentive to stop “helping” their patient with antipsychotics?

Leave a Reply