Timberrr! Psychiatry’s Evidence Base For Antipsychotics Comes Crashing to the Ground

Robert Whitaker
Robert Whitaker

When I wrote Anatomy of an Epidemic, one of my foremost hopes was that it would prompt mainstream researchers to revisit the scientific literature. Was there evidence that any class of psychiatric medications—antipsychotics, antidepressants, stimulants, benzodiazepines, and so forth—provided a long-term benefit? Now epidemiologists at Columbia University and City College of New York have reported that they have done such an investigation about antipsychotics, and their bottom-line finding can be summed up in this way: Psychiatry’s “evidence base” for long-term use of these drugs does not exist.

This is a finding, published in the American Journal of Orthopsychiatry, that profoundly undercuts the societal narrative that has been driving psychiatric care in our society for the past sixty years.

In the conventional narrative of psychiatry’s history, Thorazine, which is remembered today as the first “antipsychotic,” is said to have kicked off a “psychopharmacological revolution” when it arrived in asylum medicine in 1954. Thorazine, wrote Edward Shorter, in his book A History of Psychiatry, “initiated a revolution in psychiatry, comparable to the introduction of penicillin in general medicine.” Soon psychiatry was touting that it had discovered “antidepressants” and “anti-anxiety” agents, and that narrative—of a medical specialty that had developed chemical antidotes to mental disorders—became fixed in the public mind, and drives psychiatric care today.

I once believed that narrative, but by the time I had finished researching Mad in America, which was published in 2002, I was convinced that it was out of sync with the scientific literature. It was, I wrote in one chapter, the “story we told ourselves.” Then, in 2004, I wrote a paper titled “The Case Against Psychiatric Drugs: A 50-year record of doing more harm than good,” which was published in Medical Hypotheses. In Anatomy of an Epidemic, which was published in 2010, I expanded on this argument, as I believe there is a long line of research, stretching across more than five decades, that reveals that antipsychotics worsen outcomes over the long term.

By writing that journal article and that book, I was challenging the conventional narrative, and the evidence for that “counter-narrative” is of many types: retrospective studies, a few randomized studies, cross-cultural studies, long-term naturalistic studies (such as Martin Harrow’s), MRI studies, and animal research into why antipsychotics “fail” over the long-term. It is that collective body of evidence that I find convincing, and in 2015, I updated that argument once more in for a new edition of Anatomy of an Epidemic. The case against antipsychotics grows stronger and stronger.

The paper published in the American Journal of Orthopsychiatry is titled “Weighing the Evidence for Harm from Long-term Treatment with Antipsychotic Medications: A Systematic Review. “ Nancy Sohler, from City College of New York, and a team of five epidemiologists from Columbia University, note that their study was occasioned by my writings on this topic. They wrote:

“Recently, Robert Whitaker advanced a troubling interpretation of the evidence base for long-term use of antipsychotic medication. He reviewed a number of epidemiological and clinical studies and concluded that antipsychotic medications are an iatrogenic cause of chronicity in schizophrenia, and that these medications may lead to the deterioration of patients’ health and well-being over time. His explanation rested on the notion that antipsychotic medication may induce a hypersensitivity to dopamine. We were concerned by Whitaker’s findings and wondered whether a systematic appraisal of published literature would produce the same results.”

So this was the very inquiry that I hoped Anatomy of an Epidemic would provoke. Let mainstream researchers take a trip through the scientific literature, and see what they would conclude.

In their “systematic appraisal of published literature,” Sholer and colleagues searched for studies that met two criteria: they had to be at least two-years in length and they needed to “permit a comparison of patients who were exposed to antipsychotic medications with patients who were not exposed to medications over the 2-year follow-up period.” They identified 18 studies that met this criteria, and then they assessed--in a yes, maybe, or no fashion--whether the reported results supported the hypothesis that antipsychotics worsen long-term outcomes.

Now, in my opinion, the researchers were reluctant to conclude that a study showed harm, even when the researchers themselves drew such a conclusion. For instance, in their assessment of Martin Harrow’s long-term study of psychotic patients, they concluded that his findings were “mixed” in terms of whether they showed long-term harm from drug usage. But in Harrow’s report on their 20-year outcomes, he noted that in every subgroup of patients, outcomes were worse for the medicated group, and when he compared those patients who took antipsychotics throughout this lengthy period, versus those who got off by year two and never took them again, it was the medication-compliant patients who, by far, had worse outcomes, and on every domain of functioning. As Harrow stated in 2008, at the American Psychiatric Association’s annual conference, “I conclude that patients with schizophrenia not on antipsychotic medication for a long period of time have significantly better global functioning than those on antipsychotics.” But these researchers did not find such results a “yes” in terms of their supporting a hypothesis that antipsychotics worsen long-term outcomes.

I also think the “evidence” that can be reviewed in regard to this question is much broader than the studies that Sholer and colleagues selected. Cross-cultural studies, MRI studies, animal models of psychosis, and reviews of serious adverse effects, such as tardive dyskinesia, are also relevant to this question of whether the drugs do more harm than good over the long-term.

But that is not important here. The important result from this study was this: “We found the published data to be inadequate to test this hypothesis.”

This is a stunning admission. Even though psychiatrists have been prescribing these drugs for 60 years and have been telling their patients that they should stay on these medications indefinitely, the profession never spent the necessary effort to assess whether this drug treatment actually benefits patients over the long-term. This conclusion also reveals that psychiatry, when it boasts of its treatments being “evidence-based,” is making a rather hollow boast.

It is important to understand too that in the realm of evidence-based medicine, it is the obligation of the medical specialty to find evidence that its treatments are helpful, and not vice versa. In other words, it is not the responsibility of critics to find evidence showing harm done; the responsibility rests with the profession to show evidence of a treatment benefit.

In sum, this study shoots one more arrow into the conventional narrative that drives societal thinking today. In that narrative, the antipsychotics occupy a central role. These are the drugs that kicked off the psychopharmacological revolution and made it possible to empty the mental hospitals. These are the drugs that are presented to the public as an absolute necessity for psychotic patients. Read Jeffrey Lieberman’s book Shrinks, and you see this conventional narrative on display. But this study reveals that it’s a narrative woven from a profession’s own desire to tell a narrative of progress, to itself and to the public, rather than a narrative grounded in science.

As for a referendum on Anatomy of an Epidemic, I think this review helps advance the discussion. The researchers didn’t find, in their review of studies that met a certain criteria, evidence that allowed any conclusion to be drawn about the long-term merits of antipsychotics. What is needed now is to broaden the evidence reviewed, so that it includes the MRI research (showing drug-induced brain shrinkage), the cross-cultural evidence, the animal evidence, and a chalking up of all the adverse events from antipsychotics. At that point, researchers might conclude that the pieces of the evidence puzzle all fit together, and they paint a consistent picture of harm done.

Robert Whitaker

In the News: A journalist’s review of reports in medical journals and the media on psychiatric disorders and treatments.

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52 thoughts on “Timberrr! Psychiatry’s Evidence Base For Antipsychotics Comes Crashing to the Ground

  1. One comment I would add is that one of the studies they cite as not supporting your hypothesis was the Crowe study from 1986. This was a study of people who had experienced a first episode of psychosis, were treated with neuroleptics for one month, randomized to drug vs placebo and then followed for two years. They found a higher relapse rate in the group on placebo. However, this group published a second paper in 1990 in which they looked at functional outcomes and found that the group on drug had worse functional outcomes. I would at the very least record this study as mixed. I have sent an email to the authors and will write more when I hear from them.
    Also, the group on drug continues to have relapses through the two years but the group on placebo has more relapses early on and then the rate of relapse plateaus. We now have other studies that suggest if you were to follow the groups long enough, the rate of relapses might eventually be quite similar.
    But I agree that this is an important and helpful study and the failure to find support for the benefits of long term treatment (on average) is as important as their main finding. It is also important, as you point out, that the narrative we followed limited the kinds of questions we were asking.

    • wow thanks for this additional information Sandra…it is interesting (and upsetting and scary) to me that differences in functional outcomes are noted after only one month on neuroleptics.

  2. Is it completely naive of me to hope that this could finally start to make enough people realize that having a system which allows forcing people to take antipsychotics is unethical.

    Will this “new” information feature at all in the argument against AOT ? It has been so bizarre to me to listen to or read otherwise ethical people discuss how ‘further research’ is needed to prove antipsychotic medication is NOT harmful (rather than the burden of proof being on whether the treatment is helpful!)

  3. Sing it, Robert, “It’s going down, I’m yelling timber. You better move, you better dance….” 😉 In all seriousness, thank you for speaking out against the harm being done to humans by the psycho / pharmaceutical industries.

    And despite the fact, “it is not the responsibility of critics to find evidence showing harm done.” I would like to point out that the antipsychotics, all by themselves and in the short run, are known to create both the negative and positive symptoms of “schizophrenia,” because the psychiatrists in practice seem completely ignorant, or in denial, of this fact.

    The negative symptoms of “schizophrenia” are created via neuroleptic induced deficit syndrome, which is a medically known syndrome resulting from adverse antipsychotic effects.

    http://www.ncbi.nlm.nih.gov/pubmed/7914056
    http://www.ncbi.nlm.nih.gov/pubmed/8866773

    “Neuroleptic induced deficit syndrome is principally characterized by the same symptoms that constitute the negative symptoms of schizophrenia—emotional blunting, apathy, hypobulia, difficulty in thinking, difficulty or total inability in concentrating, attention deficits, and desocialization. This can easily lead to misdiagnosis and mistreatment. Instead of decreasing the antipsychotic, the doctor may increase their dose to try to ‘improve’ what he perceives to be negative symptoms of schizophrenia, rather than antipsychotic side effects.”

    And the positive symptoms of “schizophrenia” can be created by increasing the dose of antipsychotics via anticholinergic toxidrome, aka anticholinergic intoxication syndrome. These are the central symptoms of anticholinergic intoxication syndrome, according to a drugs.com interaction checker on Zyprexa and Geodon, two antipsychotics:

    “Central symptoms may include memory loss, disorientation, incoherence, hallucinations, psychosis, delirium, hyperactivity, twitching or jerking movements, stereotypy, and seizures.”

    The only difference between the central symptoms of anticholinergic toxidrome and the positive symptoms of “schizophrenia” are “hyperactivity” vs. “inactivity.” And especially since this known way to create “psychosis,” with the psychiatric drugs, is not included in the DSM, it’s no doubt always misdiagnosed as one of the billable “psychotic” “mental illnesses.”

    The drugs known to cause anticholinergic toxidrome are “the four ‘anti’s of antihistamines, antipsychotics, antidepressants, and antiparkinsonian drugs[3] as well as atropine, benztropine, datura, and scopolamine.”

    And this strikes me as a potentially very serious problem, especially given today’s “gold standard” treatment recommendations for “bipolar,” since these poly pharmacy drug recommendations include combining the antidepressants and antipsychotics. And also since the DSM5 now recommends diagnosing the adverse effects of antidepressants as “bipolar,” which would result in adding an antipsychotic to an antidepressant.

    “The bigger they are, the harder they fall … I’m yelling timber, You better move, You better dance. Let’s make a night, You won’t remember. I’ll be the one You won’t forget.”

      • I know how to make ’em dance, put ’em on antipsychotics, then wean ’em off them. They will then suffer from a drug withdrawal induced super sensitivity manic psychosis that will make ’em so incredibly manic they’ll have to dance, just to get the energy out. “Antipsychotics [increase] the biological vulnerability to psychosis.”

        But one can heal from a drug withdrawal induced “manic psychosis,” if they keep the faith.

        “Promise me that you’ll give faith a fighting chance, And when you get the choice to sit it out or dance. I hope you dance….I hope you dance … Give the heavens above more than just a passing glance, And when you get the choice to sit it out or dance. I hope you dance….I hope you dance. I hope you dance….I hope you dance.”

        A drug withdrawal induced “manic psychosis” makes one dance, and dance, and dance.

  4. Congratulations and thank you so much Bob! This landmark research that cannot show the justification for widespread anti-psychotic treatment never would have happened without your sustained efforts going back to 2002 with the release of Mad In America. The researchers come right out and say that your journalism challenged them to do this landmark study.
    I can’t help but smile when I think of how this world class academic study that was prompted by your work, is being digested by your critics like former APA president, Dr. Lieberman- who publicly called you “a menace to society”- and referred to people who challenge psychiatry as- “Idealogues who are spreading scientific anarchy.”
    I’m so grateful to you and Kermit Cole and all the crew at MIA for hanging in there all these years. This is truly a day of vindication and celebration!
    Best wishes, Michael

  5. Nice to see you writing again Robert.

    No surprise with these results. The signs have been there in the “collective” evidence from the wide variety of sources you discussed.

    It seems wrong that the authors didn’t include the Harrow study among the results against antipsychotics. The Harrow outcome results were far, far worse for people staying on the drugs.

    This article’s finding is related to, and strengthens, what I said in other posts… that patients and families should have recourse to lawsuits against psychiatrists who prescribe antipsychotics long-term without giving appropriate disclosure of risks/lack of evidence to their clients. Psychiatrists are routinely telling clients they should stay on these drugs for years when there exists no reliable evidence supporting the long-term use of these drugs. In areas of real medicine, which psychiatry is not, such practices would result in malpractice lawsuits.

    It can be easily predicted that psychiatrists / the mainstream will try to deny, ignore, and avoid these results, just like the tobacco companies did decades ago when their product was exposed as harmful. This is why I think public outrage, holding people’s feet to the fire, and strategies that hit psychiatrists where it hurts, i.e. lawsuits / money, are important.

    Here’s another interesting comment on drugs from Gottdiener’s major metaanalysis of psychotherapy for schizophrenia. This was the metaanalysis in which he assessed 37 studies, about half randomized and half not randomized, concerning 2,642 total “schizophrenic” individuals given an average of 1.5 sessions per week of psychotherapy for an average of 20 months’ duration.

    Here’s a quote from the essay:

    “There is a long-standing controversy about the use of conjoint medication in the psychotherapy of people with schizophrenia… since at least the 1960s most therapists that treat people with schizophrenia have used antipsychotic medication in conjunction with psychotherapy. Most therapists think it is indispensable. However, between 40% and 75% of patients do not take their medication (Perkins, 1999) and there are many for whom medications fail to work (see above Hegarty et al., 1994). For these patients and for therapists who choose to offer treatment with little or no adjunctive medication, it would be important to know if such treatments work.

    When antipsychotic medication was used with individual psychotherapy the mean effect size was r = .31 (95% CI + .19 to .42). When antipsychotic medications were not administered with individual psychotherapy the mean effect size was also r = .31 (95% CI + .12 to .48). The corrected effect size and BESD results for psychotherapy with medication and without medication was the same. The corrected effect size was r = .36 and the BESD results showed that improvement rate increased from 35% to 66%…

    It is surprising that the proportion of patients that were likely to improve without conjoint medication, is similar to the proportion of patients that were likely to improve with a combination of individual psychotherapy and antipsychotic medication. This finding is contrary to most therapists’ clinical expectations. The finding that individual psychotherapy can be effective without medication is not new (see Karon & VandenBos, 1981). However, it is important because it suggests that individual psychotherapy alone might be a viable treatment option for some patients who do not improve from treatment with antipsychotic medications, for some patients who refuse to take medications, or for patients who are treated by therapists that choose to use little or no adjunctive medication. ”

    Of course, psychotherapy without neuroleptics, or human help of any form without neuroleptics, is a viable and probably more effective long-term support to psychotic people than either drugs alone or drugs/therapy. Psychiatrists don’t want to explore this question because it would obviate the need for these anti-doctors, de-elevate them from their false standing as medical experts on non-existent diagnoses, and threaten their ability to charge 200 or 300 bucks for a 15 minute “session” where they lazily give the person a pill likely to make them worse over the long term.

  6. I join in the congratulations & won’t take up much space. I think the next big story to be prompted by this one will be about the mechanisms employed by the psychiatric establishment to suppress it and dismiss its significance. So everybody take notes.

    • My same thoughts too Oldhead! There will no doubt be those efforts to suppress and dismiss this research- especially since it was prompted by Bob’s work. But some of the researchers are epidemiologists from Columbia where Dr. Lieberman is chair of the dept. of psychiatry- how could the study easily be dismissed that was done by his colleagues at Columbia?
      It’s going to be interesting to watch the fallout from the research and Bob’s article here- especially when Torrey and Jaffe and NAMI leaders weigh in.
      Best wishes, Michael

      • There are many “wrong” paths to take. One “wrong” path leads to what is called “mental illness”, only it isn’t “illness” really, it’s a “wrong” path. Another “wrong” path is the path of psychiatry that sees instead of a “wrong” path, an “illness”, where no literal (i.e. physical) “illness” has been shown to exist. I wish I could be excited about this new research, but we know the only reasons many psychiatrists have for research is new drug development. Their panacea is still a panacea as far as people who want the problem in problem people suppressed, even if at the expense of this particular human or that. I figure, in the main, psychiatry is going to ignore most research that conflicts with its own biases. It has done so in the past, and it will continue to do so. Its not bad that this research is out there, its just if anything new sinks in, it’s going to take it a long time to do so. They’ve got their own studies showing schizophrenics deteriorate personality-wise. Cautiously optimistic, my optimism is checked by the absurdity of what is going on. Point to these long term studies as more proof, yay, and what are you likely to get from the profession as a response? Psychiatry’s ongoing hunt for bio-markers to “mental illness” and the mad genome. What is the driving force behind psychiatry’s hunt for bio-markers and the mad genome? Drug research and development, the multi-billion dollar pharmaceutical industry. Deception feeds deception, and it is the truth that has long been a casualty of this situation. Given the popularity of the fictions, I just don’t think we have the emergency crew available to salvage the facts. The facts, given the nature of the problem, are just what people don’t want to hear. I have a little hope, but just a little. If you remember, hope was the one plague that didn’t escape Pandora’s Box.

  7. Bob,

    Your tireless efforts and research and the work of this entire community are making a growing difference. People, including researchers, are listening and responding to your questions and ours. Thank you. We have an exciting and challenging road ahead.

  8. I read your book Anatomy of an Epidemic shortly after my first of several psychotic breaks and hospitalizations and it, along with your subsequent posts on this website, certainly encouraged me to decide for myself to reduce my dosages and have periods of time (6-8 months) doing well with no medication. Currently I’m on a pretty low dose for a while. I just try to respond to symptoms and evaluate my condition objectively. There are people who are not capable of doing this for themselves without running into serious trouble. I’m willing to venture that antipsychotics are not the only thing that can induce deleterious brain changes or atrophy. Maybe stress can also affect similarly negative changes. Being psychotic is quite stressful and taxing. Certainly (via Dr. Greger’s nutritionfacts.org website) there’s a good deal of evidence correlating diet with measurable brain changes, supposedly beneficial or detrimental depending on the diet. I know from reading and watching everything you’ve had to say on the subject that you are focused on solutions rather than demonizing all psychiatry, but honestly this does not always come across (I’m only pointing out that reading some of your posts would tend to make a person in the grips of psychiatry all the more irate at their predicament). We would all like to see a better solution to the problem of what to do with people experiencing and susceptible to psychosis and want to know what will give the best possible outcome. I greatly appreciate your work at uncovering for all of us, the particular corruption that has been present in the out-of-control business of psychiatry. I can only count my blessings that I am not in a situation where I feel especially victimized by this business. I think you’ve made a fair point elsewhere about John Nash and the NAMI/pharma white-washing of reality to suit their own agenda in that case. There is this idea being promoted in the NYT for example that people who do well with “schizophrenia” are maintained by their “psych meds” (to use what I suspect is intended as a palatable term to be gobbled up by the dumb masses). But anyway, I’m referring specifically to this idea as being promoted by Elyn Saks, herself suffering from this condition and who supposedly has set out and found many successful people also so diagnosed most of whom apparently regard maintenance on some level of anti-psychotic as necessary for them. This is the sort of information that we as patients do need and need to be able to evaluate fairly in order to make informed decisions. It would be nice if this topic saw some coverage here on MIA. It is dismaying that hardly any effort has been made to assemble such information (NIMH?, my tax dollars not working for me), but hopefully we are headed in that direction, maybe.

    • chris12345-
      I wanted to say that I appreciate your comments and your perspective. I am thinking of also posting on this study and you have inspired me to do this. What you bring up is that there is no right way and the study basically said there is no conclusive evidence on either side. My own impression is that there is such heterogeneity among those who experience what we call psychosis that we will never have a one size fits all approach.
      I wish you the best in your journey.

  9. Thank you for all these comments.

    Sandy, you pointed out the Crowe study to me some time ago, and as you say, it showed better functional outcomes at the end of two years for the unmedicated group, and yet this study was cited as “negative” by the researchers, meaning it didn’t support the hypothesis that antipsychotics worsened outcomes. These researchers seemed hesitant to conclude that studies were “maybes” or yeses in terms of supporting the hypothesis.

    The Carpenter study is another example of where these researchers listed a finding as negative, even though in the Carpenter study, in a comparison of 49 patients who received psychotherapy, the off meds group had a slightly lower relapse rate at end of one year, and suffered less from depression (and there were other observations on how they were doing better.) This led Carpenter to wonder whether antipsychotics increased the biological vulnerability to psychosis. I would think such a finding would deserve at least a mixed rating, not a negative one. It makes me wonder whether this study was done with the expectation to disprove the hypothesis (that antipsychotics worsened outcomes). But the important finding remains; this group couldn’t find any quality evidence, from its review of studies, that antipsychotics improved long-term outcomes.

    Axqi; in 2015, Crown issued an updated edition of Anatomy. The updated edition has a new foreword and a new afterword, which provides a 5500-word update on research since the first edition was published.

    Chris12345. There is the question of how antipsychotics affect outcomes in the aggregate, and then there is the question of how individuals may be affected by medication use. We currently have a one-size-fits all approach, but as I wrote in Anatomy, I think a nuanced investigation of the research literature shows that there should be a selective use model, which would involve trying to get people through first episodes of psychosis without putting them immediately on antipsychotics, and then if the drugs are eventually used, trying to minimize long-term use. This was the open-dialogue model: a selective use model that found that some people could get through an episode without being put on antipsychotics, that some people benefitted from a short term use of the medications, and then there were some who benefitted from their use over a longer term. That selective use model produces better overall aggregate outcomes, whereas a one-size all model promotes worse overall aggregate outcomes.

    I like to think that MIA, as a webzine, promotes that nuanced vision of antipsychotics. As for our not championing the stories that Saks is interested in promoting, there is a whole industry out there promoting that story, and so it’s not missing from the public conversation. What MIA is doing is providing a forum for telling the untold story, so to speak: which is of research that doesn’t support the one-size-fits all model, and research that shows that these drugs can cause harm (to many), and to provide a forum for these experiences too.

    I appreciate all the comments here.

  10. Bob thank you so much for your work. Though many in the field have argued against your views, it will be much much harder to ignore this study. I am also very interested to see how Torrey, Jaffe and Lieberman respond to this.

    On a deeper note, in my work as a private practice therapist with young people going through a “first break”, I often work with people who are choosing not to take medications. I support that decision in large part because of the longitudinal studies that show worse prognosis. But I am often very much alone in my field and I really hope that this view becomes mainstream soon.

    It is much much harder when I work with people who have started down the road of long term neuroleptic usage. If they are looking at trying to reduce or come off meds, it can become much more challenging, especially if there is large dose polypharmacy- as you well know.

    My hope is that this information is disseminated to anyone who is going through a “first break” so that they can have adequate informed consent before deciding to embark on taking neuroleptics long term.

    • But this is the huge problem, the elephant sitting smack dab in the very middle of the room that no one will talk about. I work in a state hospital and no patient there gets informed consent. They’re simply told that they must comply with taking the drugs, no matter what. They’re not told about all the effects that the drugs produce. There is no informed consent and no choice.

      • Yes Stephen. Agreed that it is the elephant in the room. Ground zero for this is the hospital setting where “first break” folks invariably go. They then will almost always be prescribed neuroleptics, often at high doses and often multiple drugs.

        That is where this has to change and where true “evidenced based practice” needs to occur. And that means full information that includes the meta study Whitaker referenced.

        Until then, a whole new generation of young folks will be ushered down the same path that can be very challenging to walk away from.

        I recently helped somebody get out of a court commitment. They were going through an extreme state and were then prescribed a combination of high dose haldol cogent in. Klonopin and Prozac. This was a young underweight person who then had horrible reactions and felt a million times worse. There was no discussion. No communication with family members and no listening to the needs of the patient.

        We were able to get this person out quickly enough and the person stopped all meds and quickly recovered.

        We need a sea change in our approach to crisis states.

    • Jonathan,

      I am one of the people who was “started down the road of long term neuroleptic usage.” Who was then weaned “off meds, it” did “become much more challenging,” because of the prior “large dose polypharmacy.” But I did largely recover.

      I did, however first, suffer from two drug withdrawal induced super sensitivity manic psychoses, which were of course misdiagnosed as a return of the doctors’ theorized “life long incurable, genetic, mental illness.” But these drug withdrawal induced “psychoses” were more like happy and loving “psychoses,” not the evil and hatred filled “large dose polypharmacy,” anticholinergic toxidrome induced “psychosis.”

      My point in mentioning this is that I hope “mental health professionals” will learn that there can be hope for those who were previously majorly tranquillized with “large dose poly pharmacy.”

      And I will say the way I recovered was getting off the drugs, maintaining my freedom (from medical oppression) as much as possible, and with lots of manic dancing, painting, gardening, “chasing cars” (driving around and mentally coming to grips with the medical and religious betrayal I’d dealt with), and lots of “manic” biking. In other words, the opposite of what today’s “mental health industry” believes is the “cure” of a drug withdrawal induced mania.

      • Yes indeed there is hope and indeed there are many people here who can attest to recovering without meds after polypharmacy treatment. Great to hear that you were able to successfully wean off.

        I have worked with a number of people who are deeply challenged when tapering and feel understandably extremely angry at being trapped by having to take meds to avoid relapse into worsening mental health due to iatrogenic nervous system disregulation.

        It would be so much easier to not go down that road at all if at all possible, especially in light of this meta study which repeats the idea that long term recovery and prognosis is likely worse on meds than off.

  11. All I know is that I went to the doctor with a complaint of insomnia and that snowballed into ADD bipolar bla bla bla bla and I ended up on all the pills ssris benzos stimulants and that evil Zyprexa that really messed me up and I started going to hospitals with anxiety attacks and getting admitted to psych. An 8 year nightmare that only ended when I discovered this “anti psychiatry” stuff learned the truth and said no more and took my life back.

    Long journey and I met alot of people along the way and most of them just got worse and worse as they piled on more. I was not an exception, I was the norm.

    I wouldn’t take part in websites like this if I was just unlucky and lots of other people were helped. All they do for most people long term is keep them sick and in cases like mine make them sick.

    I just don’t get why it continues. Scary.

    • If you were put on the SSRIs, benzos, and antipsychotics you did not suffer from ADD, bipolar, or any of the other DSM disorders. You suffered from anticholinergic toxidrome. These are the drugs that are known to cause this drug induced toxidrome:

      “the four ‘anti’s of antihistamines, antipsychotics, antidepressants, and antiparkinsonian drugs[3] as well as atropine, benztropine, datura, and scopolamine.”

      And these are the central symptoms of anticholinergic intoxication syndrome:

      “Central symptoms may include memory loss, disorientation, incoherence, hallucinations, psychosis, delirium, hyperactivity, twitching or jerking movements, stereotypy, and seizures.”

      My doctor called me “one in a million” since I was able to medically explain this to him. And I want lots of patients to be able to medically explain this type of iatrogenesis to their doctors in the future.

      And what’s great about knowing one suffered from the drug induced anticholinergic toxidrome, rather than one of the DSM disorders, is that anticholinergic toxidrome is curable, while the DSM disorders supposedly are not. Thus there is hope.

      • Re: “suffer from ADD, bipolar”

        No I didn’t “suffer” from it.

        All I wanted was a pill I could take and goto bed early. I didn’t even know WTF bipolar or ADD was and never ever considered myself “mentally ill” in any way.

        I had no idea the door I opened the day I went to that doctor for a sleep pill. “Insomnia is a symptom of depression….” and “low serotonin”. I completely fell for the scam, I had no clue at all.

  12. I’d really like to hear that “Timber” among medics and the general community here.

    I think that the best news to me is the new edition of “Anatomy” that has come out. This is very important. Thanks.

  13. This is great to hear. I sincerely hope this snowballs into a new level of truth and awareness for the public at large, on a variety of levels. I imagine, at the very least, that the legal implication for the APA (for starters) could be devastating, and rightly so. Eager to see what happens next…

  14. This is good news. Some people do better on neuroleptics, at least for a season. Some don’t do well, but find themselves coerced or straight up forced to take them (sometimes by injection) for a season. My own limited experience tells me that even for people who respond favorably to neuroleptics, there are probably other drugs that could ease threm through a rough time w/ far fewer problems (and probably lower drug acquisition costs, too). I seem to recall reading some small studies that showed “schizophrenics” benefitting from diazepam and other flavors of benzodiazepines. Not ideal, but I’d rather be on Valium than on Haldol…far more humane.

    Its funny to me…lately, “Narcissism” has been the It disorder. Shrinks are all over the media talking about NPD, writing books, etc. Perhaps…they should start by developing some humility as a profession (?). There’s so much that is not known about severe distress and how to deal with it, different kinds of distress, what “recovery” is and what it involves, so on and so forth. I’m not looking for the shrinks to give up their prescribing privileges and find different jobs, but some honesty and human decency would be most appreciated.

  15. If I steal a cookie and then feel guilty it would never occur to me that I need psychiatric medication! And yet for some people this connection between actions and feelings must be very obscure. The idea that a state of mind is best resolved by a drug is behind excessive alcohol use, illegal drug use and other powerful agencies like pornography. Probably regarding the human body as a vast and intricate chemical activity leads nicely to the conclusion that emotions are simply chemicals and neurons. For those who go to medical school what could be more transparent than that a chemical from without will do the job and mend the pattern. This begins metaphysically or philosophically with empiricism and ultimately with materialism–you and I are composed of matter and nothing more. All conditions are material conditions. Someone with a different metaphysics would never rest with a merely chemical solution to a mental problem. They would want to know the why, the origin of the problem, and view it in terms of consciousness. However, there is so much money to made by the material solution and much less with a more human approach. It is of the same ilk as war to solve a problem between nations rather than diplomacy.

  16. Thank you Robert for your tremendously relevant work, definitely worthy of the Pulitzer Prize for Public Service.

    I stumbled upon Anatomy unfortunately only after getting profound iatrogenic damage and seeing my life shattered to pieces after 1 decade exposure to one SSRI.

    As unipolar depression & TRD (a good % of it arguably tardive dysphoria) classic treatment algorithm proposes augmentation with the family of atypical anti-psychotics, and although this recommendation seems to orbit around the studies by Lilly on fluoxetine+olanzapine combination (a marriage made in heaven), and Abilify+SSRIs, I wonder if the long term outcome in this clinical application would yield at least mixed results as well, specially considering the serious life threatening risks of this augmentation agents.

    Although TRD algorithm recommends non-systemic approaches when augmentation agents like atypical APs fail, only a very tiny fraction of the patient population will have access to them. Probably more than 99.9% of cases of TRD (at least in Europe) will get indefinite treatment with a revolving door of medication attempts, many of which use anti-psychotics. The vast majority of patients are stuck in this hamster’s wheel, and the low response rate in the clinical trial makes one expect that most of them are dealing with permanent treatment inefficacy and intolerance which doesn’t do much more than keeping them sedated, in the absence of a better treatment approach.

    I wonder if metadata could be derived from existing studies on the long term impact of depression treatment augmentation with atypical anti-psychotics as the patient population is dramatically higher than in schizophrenia.

    And if the oppositional tolerance hypothesis proves correct on this class of meds, maybe it’s legitimate to suspect on increased chances of having induced tardive-psychosis at comparable rates to tardive-dyskinesia.

    The widespread use of atypical-antipsychotics in hard-to-treat depression management could probably deserve some closer investigation, considering the big piece of the pie it gets from this increasing patient population.

    I hope you can come across metadata in this realm in the future although this article and study conclusions alone are good predictors of what the answer for that question might be.

    Never let your thirst for truth fade away. You are already a living legend.

    Heartful cumpliments from Portugal,
    Joao Gaspar

    • As I mentioned above, it is medically known that combining the antidepressants and antipsychotics is unwise, since combining these drug classes is known to cause anticholinergic toxidrome. These drug classes cause this drug induced toxidrome:

      “the four ‘anti’s of antihistamines, antipsychotics, antidepressants, and antiparkinsonian drugs[3] as well as atropine, benztropine, datura, and scopolamine.”

      And these are the central symptoms of anticholinergic intoxication syndrome:

      “Central symptoms may include memory loss, disorientation, incoherence, hallucinations, psychosis, delirium, hyperactivity, twitching or jerking movements, stereotypy, and seizures.”

      So, absolutely, “depression treatment augmentation with atypical anti-psychotics” is unwise, and may very likely result in “psychosis,” via anticholinergic toxidrome.

      • I will also point out that since this psychiatric drug induced toxidrome is not included within the DSM, as a possible cause of “psychosis,” that it will almost always be misdiagnosed by doctors as one of the billable DSM disorders.

  17. Psychiatry is a technical occupation. The best psychiatrist is the one that choses the “right” drug and dosage and does so quickly. He need not be particularly compassionate. The best auto mechanic may be rather a grumpy man but he does keep your vehicle running smoothly. Neither the psychiatrist nor the car mechanic need to be alturistic; both may claim they are in it for the money and that is okay as long as they have the necessary expertise. Most psychiatrists bereft of the drugs would flounder; they might give talk therapy a go but then compassion and other feely things would become essential. And they are schooled to view human beings as machines with chemical imbalances, with misguided neurons, etc. Even regular medicine has gone too far into medication as the universal panacea. And again all the tests and drugs cost money and more money; this is what the scientific age has to offer. It is hard not to reach out and take it.

  18. Thank you for your valuable, historic work. Your point is evidenced; medicinal therapy and the medical model is creating an epidemic of problems that they profess to be curing.

    I am glad that they are beginning to research the effects of long-term medicinal therapy but was surprised they consider two years to be a “long-term.” Two years may be a “long-term” to study neuroleptic drugs affecting a biological problem but it seems like a short term for a social welfare problem. Two years is not much time to change the course of unbelievably distressful experiences.

    Best wishes, Steve

  19. Dear Mr. Whitaker:

    In the article you cited, the authors state: “In the case of long-term use of antipsychotic medications, new data may be needed to establish a sufficient evidence base to understand its benefit/risk balance for patients with schizophrenia”

    That statement indirectly challenges researchers to shore up their position to produce ‘new data’ to ‘establish a sufficient evidence base’. With billions of dollars at stake, sociopathic executives will motivated like never before to fabricate long term data to refute the existing data which undermines the long term use of neuroleptics.

    If I were an executive of a major pharmaceutical company, and my plan wasn’t to sell all my shareholdings, I would be calling a general meeting of all the executives of all my competitors to band together to fight any legislation that would allow transparency of data and regulatory oversight of the clinical trials, the exact opposite of what Dr. Healy is proposing. Considering the low standards of journalism in corporate owned media, long term data supporting the long term use of a number of psychiatric drugs could be fabricated and heralded in the press without a means for independent researchers to scrutinize the means by which such data was achieved.

    It seems that the broken clinical trial system and the issue of transparency is where the real battle ahead lies

  20. I wonder if any of these studies controls for the prevalence of antipsychotic nonadherence. I have read that “a review of medication adherence in psychiatric and physical disorders, spanning papers published between 1975 and 1996, reported the mean amount of prescribed medication taken to be 58% for patients prescribed antipsychotics 65% for those prescribed antidepressants, and 76% for those prescribed medication for physical disorders.”

    When I was locked up in a psychiatric hospital I didn’t argue with my doctor over a medication I was prescribed. Arguments like that never go well for patients. I simply kept the pills under my tongue and spit them out later. Then I read in my chart that my doctor said I was improving on the medication!

  21. The ISPS listservs were discussing this paper and I wanted to quote a response from Grace Jackson, MD, for readers on here:

    ———————

    (from Grace Jackson, MD, referring to the current study on antipsychotic treatment)

    I think the title of this article is misleading. the authors allege that they are investigating long term harm but the study is only looking at chronicity of psychosis >>>>>> not the numerous additional harms that may be related to chronic neuroleptization.

    If the authors had expanded their investigation to consider:

    all cause mortality
    rates of EPS
    rates of TD
    rates of diabetes
    rates of heart disease and/or sudden cardiac death
    rates of pneumonia
    rates of stroke
    rates of dementia
    rates of colitis (with or without fatal bowel obstruction)
    rates of cataracts/retinopathy
    rates of DVTs or PEs it would surely have produced a different conclusion.

    I have been lecturing and writing about the extra-mortality and morbidity due to all categories of psychiatric drugs for more than 10 years so I find this latest title absolutely preposterous.

    The elephant in the room is brain damage due to psychiatric drugs >> how many neurons can be killed or damaged before the patient is demented, and is chemical brain injury (CBI is a term I use with my patients)helpful ?

    In the 1950s, the first proponents of thorazine stated overtly that they had found a method of inducing frontal lobotomy >>> without a scalpel, and without voltage.

    It is almost Orwellian to suggest 60+ years later, that the harmful nature of neuroleptics just “has not been proven” because we lack evidence.

    • Might there be significant antipsychotic induced endocrine toxicity/toxicities with their own separate long term sequelae? (Both morbidity and mortality sequelae?).
      For example, risperidone induced hyper-prolactinaemia leads to male and female mammary hyperplasia. What impact might this have on the future development of invasive breast cancer?
      Thyroid hyperplasia et al?
      Thank you.

  22. I thank you for your work Robert Whitaker. The billions spent on mental illness might be more wisely spent to help people get better, not worse. Future generations may thank you as well.

  23. Luke 13:6-9 (New International Version)
    Then he told this parable: “A man had a fig tree, planted in his vineyard, and he went to look for fruit on it, but did not find any. So he said to the man who took care of the vineyard, ‘For three years now I’ve been coming to look for fruit on this fig tree and haven’t found any. Cut it down! Why should it use up the soil?’

    Sir,’ the man replied, ‘leave it alone for one more year, and I’ll dig around it and fertilize it. If it bears fruit next year, fine! If not, then cut it down.’

    From 1939 to 1945 Hitler and “Action T4” attempted to cut down all the presumed genetically defective, but there is no genome for mental illness. Many others were sterilized. Anyone can be a productive citizen.

    No one wants to kill the mentally ill for not producing any work or art, but the mentally ill can not bear fruit if the keeper is poisoning them continually.

    And the keeper gets paid until the tree/mentally ill dies from the poisons.

    The proof that keeping people on drugs is a mistake will help many people have productive lives ( when they are forgiven their mistakes).

  24. The fact is, that mainstream America will never stop the pharmaceutical company-driven prescribing of blockbuster drugs at the expense of the most vulnerable citizens. Most people, will listen to the physicians, the teachers, the people who influence them directly according to their life situation. In the quest to do what is right for their loved ones, being children, siblings,spouses or other– they follow the herd, the money-driven campaigns– only with the education of “buyer beware” will the general public ever get that they– THEY– are a marketing target– and then, I say with much reality infused commentary– they will not think for themselves, as this is a society that does not think for themselves, they follow. Keep on truckin’ Bob.
    S

  25. Yessss!! Another stake through the heart of the psychiatric drug cartel! The next edition of Mad in America should be printed with a cover that reads “Still Saving Lives After All These Years”. Mr. Whitaker, you were robbed of the 1999 Pulitzer. Taking on corporate greed, sanism, and scientific fraud all in one book is the sort of gift to humanity that only a small handful of people, every century or so, will bestow upon us. Thank you for swinging the ax of truth at the poisonous trees in the forest of psychiatry!

    • Thank you for swinging the ax of truth at the poisonous trees in the forest of psychiatry!

      Now there’s some metaphor for you! If anyone takes this as literally as some do the term “mental illness” the cops might go looking for RW swinging an axe in a forest full of poisonous trees. :)

  26. Now what?

    How do we better organize a group, or a campaign or a movement the can successfully force psychiatry to confront its malpractice?

    That’s what I want, and that’s what I personally believe is the most important and potentially effective tactic we can utilize. Psychiatry claims that it is a professional discipline, and in particular a medical discipline. As such, it follows that it is bound by the same ethical standards and codes as the rest of medicine.

    If that’s true, then psychiatry has one question above all others that it must answer in order to be taken seriously by anyone: by what ethical or professional standard do you justify long term prescription of medications for which there is no scientific evidence showing their efficacy, and in the face of scientific evidence showing their harm? How does that no violate ethical codes of medicine? When prescribers tell “patients” they are permanently ill and that long term use of antipsychotics are “necessary medical treatment” how are they not committing fraud, malpractice?

    Personally, I want a campaign of malpractice lawsuits against psychiatric prescribers, combined with suits against the FDA directly challenging their approval of drugs with insufficient research, and at times fraudulent research. I feel that this is a tactic that has not really been tried. Sure there have been lawsuits against big pharma, but I think those largely miss the point. Big Pharma can afford to payout a billion dollars as just “the cost of doing business.” You start suing practitioners for malpractice, and the government directly, I think you both get more traction AND do more to gain mainstream media attention.

    Besides, its the biggest question out there: how can long term prescribing of anti-psychotics possibly be justified as ethical and responsible medical practice, according to ethical standards for medicine?

    • I agree with this absolutely. I have been advocating for some time the bringing of malpractice lawsuits against psychiatrists who advise clients to start and stay on antipsychotics for years – especially without informing them of the risks and lack of evidence of efficacy.

      In this way the majority of practicing psychiatrists in the United States become immediate targets for lawsuits.

      Large fines, being banned from practicing their profession, or even prison time for psychiatrists who misled clients would be a strong motivator for psychiatry as a profession to take a hard look at what it is doing.

      The best lawsuit targets would be high-profile psychiatrists who are in the media and/or leading recent published research, such as Jeffrey Lieberman, John Kane and the group of psychiatrists that led the RAISE study. But lesser known psychiatrists are just as valid targets for the same ethical reasons.

      I encourage anyone who talks to a family or individual who has had a psychiatrist act in this way to encourage them to consider legal options against that psychiatrist. I often speak to psychiatric survivors and a few of them are in this situation; I will start to suggest this to them.

      Things may look very different in court with evidence like this recent study admitting that there is no proven basis for long-term use of this drugs. This is especially true if the advice (by a psychiatrists) were given in the next few years after this study comes out… as it surely will be by many of the psychiatrists across the US in 2016-2020… despite it being obvious for years already that there is no solid evidence supporting long-term use of the drugs.

    • I agree about the malpractice, etc. suits but this brings us back to something broached following Tina M’s article: There are precious few lawyers who can argue cases in the ways we they need them to be argued. In this case they would have to not only be competent at demystifying pharmaceutical/psychiatric psychobabble but able to deconstruct the medical model in ways that judges and juries would understand. And from what I see these skills are few and far between. We have some raw data here but to make it useful it needs to be explained in a way those who would make decisions based on it can appreciate. So we need to make reaching out to progressive-minded lawyers a priority, before we find them opposing us in court in the name of “better mental health treatment.”

      • This is a good point Oldhead.

        The basic issues should not be so hard to understand. Many lawsuits are brought against doctors for medical malpractice regarding physical diseases already. The data attacking the validity of psychiatry’s diagnoses and treatments is quite broad and strong, if not well enough known by the public. Some judges and laypeople jurors will be sympathetic to these arguments (aside: how many people really like psychiatry as a profession and want to stand up for it?)

        If people start to bring more cases against psychiatrists for their (mis)treatment of mental nondiseases, some lawyers will start to learn how to contest these cases. If the demand is there it might happen that good lawyers get smart to how to wage these cases… that’s my optimistic view anyway.

        I know one lawyer personally who is very well informed about these type of issues. I’ve gone through one legal case with him… long story. But it was interesting to see how thoroughly a good lawyer researches the history of similar cases and the subject material on the case. I imagine part of the challenge would be the plaintiff educating their own lawyer about the data around psychiatry and its harms/lack of validity. Or, bringing in 3rd party supporters who could do so. So that is another issue, if any of us speak to people who eventually bring lawsuits against psychiatrists or Big Pharma, we can also provide them with ideas about what their lawyer can read.

  27. As someone who has just come off having Zyprexa Olanzapine in their system/body since 1999, I have spent the past few years documenting my experience with the drug, withdrawal, and to make matters even worse, “the prescriber”. I am noticing a variety of posts here talking about malpractice, etc. All I can say is based upon my personal experience, “good luck” with that ever happening.

    You are welcome to browse my videos at the link below. However, pleased be advised some of the material is not exactly pretty, and you should view them at your own discretion. On the legal front in dealing with the prescriber, please pay special attention to the episodes “zyprexa wars: the verdict” as well as “the animated story”.

    Thank you.
    kiwi101

    https://www.youtube.com/user/kiwi101/videos

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