Could the Glass Be Half Full?

Many of the words published by Mad in America are critical of organised mental health services, conduct of the pharmaceutical industry, the motives of involved healthcare practitioners, and the hidden agendas of those committed to “research”. I would say Amen to all that, but something has happened recently in the UK that suggests many of these concerns might be better considered signs of a glass half full rather than one half empty.

We have just seen publication of “The Abandoned Illness, A Report by the Schizophrenia Commission”, and it has enjoyed significant national media attention.

The Schizophrenia Commission is an independent body which has been supported by the mental health charity, Rethink. The commission was established in November 2011 in order to review how the outcomes for people with schizophrenia and psychosis could be improved. It has gathered evidence from a wide range of sources which include people who have lived with schizophrenia or psychosis, their family members and carers as well as from health and social care practitioners and researchers, and some 2,500 individuals who responded to an online survey. It was chaired by an eminent member of the UK psychiatry establishment, Professor Sir Robin Murray FRS, and included Dr. Clare Gerada, Chair of the Royal College of General Practitioners, Professor Martin Knapp of the London School of Economics and Professor David Taylor, Professor of Psychopharmacology at King’s College, London, amongst others. Their criticisms of current provision for people with schizophrenia or psychosis are outspoken:

“The inadequate care that many people with psychosis receive adds greatly to their distress and worsens the outcomes for what can already be a devastating illness. Most have a period in a psychiatric hospital unit but too many of these wards have become frightening places where the overwhelmed nurses are unable to provide basic care and support. The pressure on staff for increased “throughput” means that medication is prioritised at the expense of the psychological interventions and social rehabilitation which are also necessary. Furthermore, some wards are so anti-therapeutic that when people relapse and are in need of a period of care and respite, they are unwilling to be admitted voluntarily; so compulsion rates rise.

The problems are not just in the wards. People with psychosis rarely have the chance to choose their psychiatrist and families are not treated as partners in care but have to battle for basic services. People diagnosed as having schizophrenia have poor access to general practitioners and general hospital care; their physical health suffers and their life is shortened by 15 to 20 years. The fragmentation of services means that people who have a recurrence of their psychosis lose the established relationships with professionals they trust, and instead feel shuttled from one team to another as if on a factory production line.”

The Commission’s “prescription” is equally compelling:

“Good care delivered by kind, compassionate practitioners can make all the difference. Being given hope is central to recovery too – gaining control and being empowered to build self confidence and self esteem. Time and time again we heard of a transformation whereby an apparently downward course was reversed by nurse, doctor, peer or therapist who took the time to listen and understand.”

These are not the views of narrow minded biomedical scientists and practitioners determined to impose a medical approach to mental health difficulties upon policy and practice, as they maintain hegemony at others’ expense. Nevertheless they are the published views of conventionally authoritative opinion leaders. As a result, they will have to be heeded unless darker forces seek to suppress them. Under Robin Murray’s leadership the Commission acknowledges that our researched understanding of schizophrenia and psychosis is still very patchy, and that there is just as much justification for considering them from a psychosocial perspective as there for viewing them bio-medically. This is significant, coming as it does from one who made his own academic reputation in conventional psychiatric research circles and was considered the third most influential psychosis researcher during the decade 1997 – 2007 (Science Watch).

All this is not to say that the world has turned. The report uses the word ”illness” some 140 times … in an 87 page document, and it is clear that the authors still see schizophrenia and psychosis as afflictions to be “treated” by specialists using professional skills. However it is equally clear that the commission recognises that those specialists need not be medical doctors, and that the skills involved are by no means necessarily psycho-pharmaceutical.

“Abandoned Illness” can be found in full at http://www.schizophreniacommission.org.uk/the-report/. Given its origins and authorship, its publication might well suggest to those concerned with change in mental health circles that here in the UK, at least, the glass might be half full rather than half empty. That doesn’t suggest any more wine, but it does suggest a more hopeful prospect and some movement of a door that until recently has seemed firmly shut.

17 COMMENTS

  1. Today we have Ordeal of Antipsychotic
    The “schizophrenic” must magically overcome the effects of antipsychotics on his/her brain.

    “Trial by ordeal : Trial by ordeal is a judicial practice by which the guilt or innocence of the accused is determined by subjecting him to an unpleasant, usually dangerous experience. Classically, the test is one of life or death and the proof of innocence is survival. In some cases, the accused is considered innocent if he escapes injury or if his injuries heal.” from wikipedia
    1 Ordeal of fire
    2 Ordeal of water
    2.1 English common law
    2.2 Ordeal of boiling water
    2.3 Ordeal of cold water
    2.4 Witch-hunts
    3 Ordeal of the cross
    4 Ordeal of ingestion
    5 Ordeal of poison
    6 Ordeal of boiling oil

  2. Thanks for posting this Hugh, it’s encouraging and points to the shift in perspectives psychiatrically speaking.

    I think that among the many challenges will be the bringing about of cultural change, in the face-to-face workings with patients, particularly behind closed doors. And in the recognition of damage done by going down the dead-end road of psychiatric drugging to the exclusion of therapeutic treatment.

    • I tend to think that a focus on “cultural change” is laudable. However culture is the result of beliefs, its the faulty beliefs of those who work in services that have to change.

      Always talking about culture obscures this fact and lets everyone off the hook because you end up with a situation where nobody things they are actually part of the problem.

  3. The comission seems to have overlooked one thing in the report: the harm caused by the antipsychotic medication. Patients die early BECAUSE of the antipsychotic medication and if you have some idea of how the antipsychotic medication works, it is not surprising. Patients kill themselves because of the antipsychotic medication, its terrible side effects the doctors don’t take seriously and the withdrawal symptoms some doctors laugh at. My son’s endocrine system was so disturbed by the medication he was forcibly and unnecesseraly fed with that it took two years to get his thyroid function and his testosterone back to normal. he is still traumatises by what happened to him. What the carer had to say nobody took seriously.Certainly nobody tried to work with me. And yes, it all happened in your backyard.

    • I also noticed this. It sounds as if, once again, that they’re strying to say that the reason that people die early is that they aren’t getting the treatment. I think it’s going to be very difficult to ever get them to admit that the one and only treatment that they force people to undergo is actually doing a great deal of terrible harm. They don’t want to face up to it, accept it, or take any responsibility for it. Yes, this is a forward step, but as I’m reading it I’m finding that a lot of the rhetoric is the same old usual stuff when it disucsses the drugs. kAs you point out; the system needs to work in partnership with the caregivers. At least the report does emphasize tat this is important.

      • I have to take back what I said about their rhetoric about the drugs. This document is actually very progressive and calls for people being allowed to try tapering off the antipsychotics under strict guidance. Just a couple of quotes:

        “…While most people who have an acute psychotic episode benefit from antipsychotics in the short term, there is much less certainty about how long people should remain on these medications.”

        “The Commission feels that there should be continuing dialogue about whether it is necessary to keep on taking antipsychotics and in what dose. More help should be provided to those who wish to decrease their dose and if this is successful to try to manage without medication, the latter needs to be done with close monitoring in case it leads to relapse.”

        They talk about shared decision making in regards to the prescribing of the drugs and that patients have a right to request a review of their medications. They are also calling for true informed consent.

  4. I agree it’s a very positive sign that the psychiatric establishment is saying such things – it brings me some level of hope. But the glass is definitely only half full, or maybe only an eighth, as long as they are avoiding the hard facts about the adverse effects of their supposedly helpful medications. Both the long-term impact on mental health (increased chronicity due to messing with the dopamine system) and the long-term impact on physical health (acknowledging that these drugs ACTUALLY KILL PEOPLE who would otherwise live, which partly explains the early deaths) need to be overtly acknowledged before we make real progress.

    Still, it’s an acknowledgement that the current paradigm sucks big time, and for that we have to be appreciative. Gives us something to build on. Thanks for sharing it, and good for jolly old England!

    —- Steve

  5. I just went through the schizophrenia report again and it got me thinking. The glass is still half empty, I think, and will stay so until some of these recommendations get implemented. A lot of them were already there when my son got sucked in in the Mental health system in your neck of the woods four years ago but none of the professionals took much notice of them. Did anyone listen to the carer? No, they were shoved to the side and considered a nuisence. Did the psychiatrists listen to the patient when he begged the psychiatrists to get him off the olanzapine because he could not take the side effects any longer? No, they prescribed him more antipsychotics and antidepressants which he wisely put straight in the bin. Did the psychiatrists think that he was a pain in the neck and just pretending that he suffered from side effects? Yes, so they forcibly drugged him and nearly killed him. I think what needs badly doing is changing the training psychiatrists get in Medical School. They are doctors aren’t they? Why then are they unable to recognise side effects of their meds and why don’t they know how those meds work and how they disrupt the whole body? Why are they not taught to look for the root-cause of the problem and just look at the symptoms etc…No therapy was ever offered to anyone during my son’s illness. His CPN was hell bent into brainwashing him into believing that he was suffering from incurable serious mental illnes. Luckily he is well now but it is not thanks to the mental health care system or any of his doctors: psychiatrists and GP were totally useless. He definitely did not get well thanks to the medication. By the way, what is happening to the respite care some people need so badly? The authorities just closed down the respite homes in Newark (Notts). A friend of mine used to recharge her batteries there now and then and, since she has nowhere else to go, she has ended back in hospital being drugged: is that a cheaper option? Did she ever get any counselling or emotional support at home? NO! Did her husband? NO! THE GLASS IS FAR FROM HALF_FULL in your neck of the woods, Dr Middleton: there is still a long way to go.

  6. Let’s get real here. Steve and Alix are absolutely correct to challenge the fanatasy that the “glass is half full” just because one report comes out questioning the current practices of treating schizophrenia.

    There are two types of denial. One is, “we don’t have a problem,” and the other is “our problem is not that big.” Let’s be reminded that Biological Psychiatry is comprised of major established institutions of power backed by major corporations seeking the highest rates of profit by any means necessary. They have successfully brain washed millions of people to believe in their paradigm of treatment. They are not going to pack it in because of a few criticisms and contrary reports.

    Right now we are seeing some main stream followers of Biological Psychiatry questioning some of the more obvious extreme examples of their abuses as they become more exposed. They are getting nervous that this is giving their institution a bad reputation and may threatenen their power. Yes we should support defectors and those willing to question the current paradigm from within, but let’s not get carried away or misunderstand the enormous amount of work and struggle ahead of us.

    Back in 2005 the president of the APA made the following statements in a speech at their annual convention:

    “There is widespread concern of the over medication of mental disorders and over use of medications. Financial incentives and managed care have contributed to the notion of a “quick fix” by taking a pill and reducing the emphasis on psychotherapy and psychosocial treatments. As we address these Big Pharma issues, we must examine the fact that as a profession, we have allowed the bio-psycho-social model to become the bio-bio-bio model. In a time of economic contraint, a “pill and an appointment” has dominated treatment….Drug company representatives bearing gifts are frequent visitors to psychiatrists’ offices and consulting rooms. We should have the wisdom and the distance to call these gifts what they are “kickbacks and bribes”.”

    These sound like radical comments, but what has changed in the APA or in the treatment of people labelled “mentally ill.” We are building the foundation of a very important movement. I am very encouraged by recent struggles that are developing among activists, but we need very sober assessments when we chart our road forward.

    Richard

  7. In the UK this report was covered extensively all day by the BBC and led on the evening news. All good for awareness raising. However….trust me on this…the authors are now concerned about the effect all the negative publicity about their work could impact on staff morale.

    You have to ask, if publishing a pdf doc gets them worrying if they have done the right thing, how likely is that anyone will attempt any real change that might shake those same staff up??

  8. this is better.

    http://www.schizophreniainquiry.org/

    In December 2011 we noted the launch of a project called ‘Schizophrenia Commission’ and saw how it was set up without much discussion with service user/survivor organisations and organisations working with black and minority ethnic communities. It seemed to be dominated by a unit that researches ‘psychosis’ and structured in a narrow medical framework that accepts diagnoses as valid ways of labelling people. We felt that the time was right to launch an inquiry into the ‘schizophrenia’ label. And, when we found that such an inquiry was strongly supported by many organisations and individuals, and that many of them were actually willing to do so publicly by allowing us to include their names on our website, we decided to go ahead, raising funds for our expenses as we went along.

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