This post has generated a number of thoughtful responses from readers. In order to avoid misunderstanding I decided to change the title, which was originally “Is “Medication Tapering” The Best Term For Withdrawal?” and make a few clarifying changes to the text. I also am adding a link to my Coming Off Medications Guide:
http://www.willhall.net/comingoffmeds
The long-term dangers of abrupt withdrawal are not talked about enough, and I really agree with the commenters who are using this blog post as forum to push for greater awareness. I deeply appreciate everyone who is working as I am to bring coming off medications into public understanding. I do hope that the textbook chapter I co-wrote helps alert more practitioners to medication dangers: it’s the first time I’ve co-authored with psychiatrists and I did the best I could.
Unfortunately I don’t have the time availability to re-express my point of view in the comments dialogue, but I do encourage people to read the Guide I wrote, which was just revised in a second edition with the input of scores of contributors. I continue to need suggestions for any changes for upcoming editions, as the Guide is based on the input of many people. As I say in the Introduction, the Guide isn’t perfect but I do hope it’s helpful. I really appreciate all the people who have been involved with the making of the Guide happen and gave input that shaped the second edition — including some of the commenters below.
I also want to apologize to anyone who may have been distressed by this dialogue: my intention is to deepen our understanding of how to help each other around coming off medications. Going off too quickly is a huge danger and one of the reasons the Guide was written: at Freedom Center and through Icarus Project we all saw the problems with coming off abruptly. At the same time, one size does not fit all and gradually withdrawal is not alway best and other approaches are sometimes successful. I make this point in the Guide, and based on the feedback I’ve gotten over the years I do believe that honestly recognizing the diversity of medication withdrawal experiences has been more helpful for people to avoid some of the problems of coming off than creating a firm rule or protocol. And I also know the Guide can be improved. It’s an ongoing learning process for all of us — thanks to everyone who’s working on this issue. — WillÂ
The phrase “medication tapering” is being used more and more as the preferred term for the psychiatric medication withdrawal or coming off process. Based on my years of work educating many people around coming off medications — clients, support groups, and in workshops and trainings — I think that term is misleading, and let me explain why.
Gradual withdrawal is a sound guideline supported by a growing body of research literature as well as personal accounts, but should not be elevated to a firm rule: tapering is one possible strategy, but not the only one or even always the best one. Abrupt withdrawal can create severe and even life threatening consequences, but at the same time there are people who do successfully withdraw abruptly, and abrupt withdrawal, even with its risks (including unknown risks), may be a more advisable course of action and better choice in some circumstances.
As I write with Dr. Neil Falk and Dr. Dan Fisher in the upcoming “Textbook of Modern Community Mental Health Work”
While this slow and tapering approach to reduction and discontinuation is generally advisable and has a growing body of research evidence in support of it, in practical settings this is only a guideline. For example, clinicians and clients sometimes face circumstances where abrupt withdrawal is indicated. Medication toxicity such as liver and kidney problems, signs of tardive dyskinesia, rash associated with lamotrigene, neuroleptic malignancy syndrome, serotonin syndrome, or acute reactions such as heart arrhythmia, suicidality, self-injury, or mania call for either immediate withdrawal or transfer to another medication with a different adverse effect profile. In such instances the risks associated with withdrawal are outweighed by the physical danger posed by medication continuation. Abrupt withdrawal should be cautiously considered, however, as some medications, such as benzodiazepines, can be life-threatening during abrupt discontinuation (Ashton, 2005). Clients may also choose abrupt withdrawal when adverse effects are subjectively experienced as intolerable. In these cases, clinicians should ensure that clients are informed about the possible consequences of abrupt withdrawal, while also acknowledging the motivation and concerns behind it, and any difficulties encountered met are treated as a learning process.
Medication withdrawal is not a medical procedure like surgery: it is driven by the subjective meaning of the medications and the human relationships surrounding them. Because of this, there is a lot of diversity in coming off. Though I would never recommend it, I have met people who did just throw their meds away (often just after coming out of the hospital) and reported no withdrawal effects at all. Many people who begin with “I want to come completely off my meds” may, in the process of reduction, discover new usefulness to their medications or face withdrawal obstacles that lead them to rethink their initial goals. Others do better breaking with their prescriber and leading the process on their own (the UK charity MIND did a study of coming off medications and, because it found physicians were so often unhelpful in the process, changed its policy, and now no longer recommends physicians always guide withdrawal). A surprising number of people “just forget” to take a medication, and find this is the starting point for successful withdrawal. And we should remember that “psychiatric drugs” encompasses a vast range of possible medication situations, from the occasional Ambien on trans-atlantic flights to long term life-threatening polypharmacy. We need to understand this diversity and recognize that people have unique life stories just as they have unique relations to medications.
“Medication tapering” implies that like any medical procedure, there is a standard practice for physicians to follow. It’s certainly true that there should be guidelines and protocols around medication withdrawal, as this information is greatly needed and sorely lacking. There needs to be research into the physical risks of medication withdrawal and how to avoid those risks, including understanding drug interaction, supportive therapies like supplements, and the chemistry of different medications in the body. And too often people who have problems with an abrupt withdrawal are told this shows they need to stay on the medications, not try more slowly next time. But assuming that gradual withdrawal is more than a general principle, or that physicians are the ones who should always be making the decisions, risks making the process more difficult and potentially more harmful.
To meet the complexity and unpredictability of medication withdrawal, we need a more flexible approach. Does calling the process “medication tapering” overlook the need for that flexibility?
Will, I’m a huge fan of you and your work. But I’m really concerned about the overarching message you are sending out here, namely that coming off psych drugs rapidly or even cold turkey should be more acceptable. I have spent years on the various Internet withdrawal forums and it is unquestionably the case that the people who suffer the most and for the longest are those who come off their drugs too rapidly. Yes there are some who are lucky and are able to quit cold turkey without a problem, and yes if you are having a life-threatening reaction then you need to stop straightaway. But please also be aware that the people who most often kill themselves because they cannot handle withdrawal – and I come across around one a month – are also almost always those who stop abruptly, and who try to reinstate and find the drug simply does not work the second time around. Once you are in withdrawal hell as a result of a cold turkey or rapid withdrawal there is usually no going back.
I know you are not advocating a swift withdrawal here, but really you should be campaigning for the opposite – that more doctors and professionals ensure that their patients taper very gradually (especially for long-term users), as the real issue is still that so many still do not use this approach. This article therefore strikes me as dissonant given your other work.
I do however think that the term ‘withdrawal’ is inappropriate. Given that in many cases it takes years for the brain to undo the harm of the drug (I am almost in my fifth year of this horror) it is more appropriate to talk about ‘reversible brain damage’. If this was included in the labelling of these drugs (as it should since so many of the symptoms overlap with traumatic brain injury) I wonder how many would start taking them in the first place?
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To those reading these comments: heretohelp wrote “I am almost in my fifth year of this horror”
And he/she is giving advice on how to quit?
Pulling a band aid off fast or quickly is the best analogy for me. I prefer quick and learning to live with whats left.
Quitting smoking , you can continue to smoke a few a day, but what is the best method for quitting smoking?
Is smoking that bad?
Is consuming legal drugs(psychiatric medications) that bad? Only the individual can judge.
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I’m coming up to my fifth year of withdrawal, and have been drug-free for 23 months. Initially I was detoxed off a benzodiazepine, and as a result of this horrific experience I have learned that a cold turkey from benzos and ssris does not work in the same way as for opiates and nicotine. People can be severely disabled for months and often years afterwards.
Anyone considering this route doesn’t have to take my word for it – just go ask around on the two largest withdrawal support forums paxilprogress.org or benzobuddies,org.
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That is a very important point about benzos. Unlike opiates, abrupt benzo withdrawal can be life threatening. As a general rule gradual withdrawal is best.
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I have experienced intense withdrawal from anti depressants like Effexor and the withdrawal symptom was worse than the condition being treated. That was my clue that another medication was needed because even though the withdrawal was bad, living with chronic depression exacerbated by my years prior of cocaine abuse was not a better outcome in the long run.
I have also seen a person who had finally been able to titrate down to a lower level of psych meds for schizoaffective and lost weight started eating healthy exercised and stopped smoking after twenty years. Then some jocks at the gym convinced him to use suppliments and stop his meds..because that is better to be on nothing right? You may be able to tell by my tone the end result was bad. He became more ill than he had been in years, stopped exercising and became isolated and started smoking again. Not to mention the shame he felt for losing ground with his goals but he had to get back on the higher dose he had come down from again.
As a certifide drug counselor and director of a drug treatment center, and a survivor/ consumer I can testify that withdrawing from illicit drugs like opiates and cocaine are nothing like what one goes through with psych meds. Psych meds are far more complex and reactions are as diverse as there are people. Withdrawal from heroine hapoens almost the same for someone as another who has been on the same amount for a similar time frame. You can pretty much predict the same outcome for both once they kick.
Coming off of psych meds risks returning to a previous mental state that was so distressing it needed to be addressed with some sort of intervention. “cold turkey”
isn’t the right terminology. Cold turkey refers to a return to a normal state of functioning before the drug was introduced. This for many just isn’t so with psych meds.
That’s a destinction I think is worth mentioning. Without the support of friends,family and yes,even professionals many people doing the cold turkey method can return to. baseline of existing that’s intolerable which can lead to substance abuse or in some cases more imminent danger.
The cold turkey method for severe toxicity and other life threatening reactions is almost always supported by the professional who prescribed them or at least that would be the preferred if possible. The toxicity is also a very objective measure something is wrong. Feeling with your instincts can be too subjective to the current emotional and environmental influences around us. That’s why its important to have support from people you trust to give one more objective data to rely upon.
So in conclusion I think terms like withdrawal can be misleading because regular withdrawal is usually returning to the same baseline of functioning that was interfered with by using a drug like heroin. Psych med titrating down is too complex of an experience no matter what the eventual outcome and too unpredictible unlike other drug withdrawal. Whatever the decision having support is absolutely necessary for success.
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terasinc, we substantially agree.
However, I don’t think the terms “withdrawal,” “tapering,” or “cold turkey” imply anything about what happens after the last dose of medication. Sometimes there’s a “return to baseline,” sometimes not.
Yes, the world would be a better place if everyone could find support for coming off. Sadly, many cannot, not from doctors, therapists, family, or friends. The Web support sites are all they have, if they manage to find them.
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“Pulling a band aid off fast or quickly” — not to dismiss your success with this method of withdrawal, markps2, but you were lucky that cold turkey worked for you.
You would be singing quite a different tune if it didn’t.
It’s a fantasy that one can cold-turkey and, at worse, suffer intense symptoms for a short time.
That’s not nearly the worst. The worst is suffering intense symptoms for years, not weeks.
Cold turkey is a risk. You might succeed at it, but you might not. You can’t tell in advance. If it goes bad, there is no cure, other than time, for what you’ve done to yourself.
You may think you’re making a fast jailbreak from the mental health system, you may think you’re going to tough out withdrawal symptoms, but you’ll end up going from one quack to another looking for treatment.
You may end up as one of those people who posts on Web site after Web site, on Yahoo and Topix, begging for help.
Yep, you came through it okay, and I’m glad for you, but your doppelganger just signed up on my support site and sent me a personal message begging me for advice, anything to reduce the withdrawal symptoms.
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“Cold turkey is a risk” yes it is. Continuing to voluntarily drug oneself on the psychiatrists belief you are the diseased one is equally damaging.
I like my brain , imagination and thinking. I presume there is nothing wrong with my brain physically, this fact of physical health defines the psychiatric chemicals as drugs.
If the psychiatric drugs stop brain function the person is incapable of learning, incapable of changing their life, so they are condemned to making the same mistakes over and over thanks to âhelpingâ psychiatry.
“suffering intense symptoms for years” that’s called life.
âDoubt is to certainty as neurosis is to psychosis. The neurotic is in doubt and has fears about persons and things; the psychotic has convictions and makes claims about them. In short, the neurotic has problems, the psychotic has solutions.â wrote T. Szasz
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I’m sorry, markps2, when it comes to âsuffering intense symptoms for yearsâ in withdrawal, you don’t know what you’re talking about.
Tapering is not advocating for staying on drugs.
You were very lucky, I hope you know it.
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I tried abrupt withdrawl, become a thousand times worse, ended up locked up and on forced treatment orders. Would be nice if I could legally be given the support to withdrawl abruptly, fact is I couldn’t. Hence when I was finally free legally I tapered over a period of 16 months, because if I ever become ill again while trying to go off drugs I would have been on forced treatment for life. It was hell, I hated it, although I can also say, that each time the medication dosage lowered, I become more and more alive.
Every persons experience of withdrawl is different, every persons experience of being on drugs is different, as is the combination of the coctails they were on. I was on 5 when I tapered. Try going off 5 drugs cold turkey and tell me you do not need any form of support for that. Simply would not be possible. I did not choose to be on them. Drug addicts are offered specialised detox centres and yes, if I was lucky enough to be offered a detox centre, then sure I could have survived, fact is I wasn’t. I was instead taken in handcuffs by the police to the local psych ward, locked in seclusion and manhandled by security gaurds, while they forcibly treated me. According to you, I chose every bit of that. I hope you have some evidence to support your statement I choose that!???
MOST people I have come across have had many tries at withdrawling and many of them ended up locked up as a result of an abrupt withdrawl, which is why they decided to go slowly when they were finally free.
Haven’t said that, I also agree with Will there are times when abrupt is necessary to save a persons life. I know someone who the psychiatrist admits is dying on the medications they are on. They are locked up and it is all being forcibly admintistered. There solution is to taper them from the medication, before deciding on another one!!!!! Given that this person is in hospital, it is clearly OK to abruptly withdrawl her, but they are not doing that, even though they have admitted it is necessary.
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I have a huge question. I just recently swapped psychiatrist because of medical coverage change. During this process I ran out of medication for a couple of weeks. While I was out of it I began to have serious withdrawal symptoms. My blood pressure alone went to over 200. The first appointment with this new doctor he refused to see me because my blood pressure was so high. Sent me to an ER where I waited for 5 hours (In intense pain because I have spinal cord damage) after 5 hours I could no longer take the pain and had to be wheelchaired out because I could no longer stand or walk. I could not walk more than 5 steps the next week. Doctor will not allow me to do video appointment. I finally get a refill from my old doctor. I had to set up two different appointments with the same company because they had a different address according to them. I start taking the medication again and my blood pressure and everything else goes back to normal. Now this dependancy scared me. I decided that I wanted to swap to a different medicine but I knew I had to do this very very slowly. First appointment comes around and I’ve typed out everything I want to do in that appointment and the doctor barely glances at it. Basically say verbatim what I had typed so the doctor ends up not sending in a prescription for a lower dose or fewer times each day. Nothing. It’s now day 3 and my left side of my chest is aching and my blood pressure is up.
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Thanks for the thoughtful reply to my post. I am with you completely about the importance of getting the message out about gradual vs. abrupt withdrawal. It is a cornerstone of my educational work (I was just at a psychology class at Portland State University and I told the students that this, along with the role of sleep deprivation in psychosis, was the most important message I wanted to get across).
If you read what I say here, and in my Harm Reduction Guide to Coming Off Psychiatric Drugs, I think you’ll find I agree with you. The problem I see it is that by calling the whole process “tapering” people are misunderstanding the complex and diverse nature of coming off.
I work with many people who have prolonged difficulty with medications, and have close friends living the horror stories of medication damage. I work with people all the time who got into trouble with abrupt withdrawal. I always, always warn people around abrupt withdrawal.
And I know firsthand exactly about abrupt withdrawal. I was abrupt withdrawn from both Zooloft and from Navane and had very bad experiences both times. A suicide attempt and hospitalization took place after a Zooloft and benzo abrupt withdrawal and I wonder if the withdrawal played a role. So I wish I had been withdrawn gradually.
I also watched my roommate almost die from Lamictal poisoning. If she hadn’t been withdrawn abruptly, cold turkey, she could have died. What if she went to websites that said “never withdraw abruptly from medications”? Would she be dead now? What if she wanted to come off the Lamictal on instict but decided to stay on to wait until she could withdrawal gradually? Might she have had that poisoning reaction and ended up dying?
Yes people do get into problems after abrupt withdrawal and some of them really regret the process because of the problems it can create. But I have to disagree with your certainty around this. Some people go too slowly or wait to get off meds, or don’t trust their desire to go off, and then staying on the drugs creates problems.
Your point about abrupt withdrawal and then not being able to get relief by going back on is a good one. There are people like this, and you point to an extremely important area for research. But at the same time that doesn’t encompass everyone – others find improvement by going back on or trying different drugs. Again, one group’s experience can’t be generalized to a firm rule.
You say “…yes if you are having a life-threatening reaction then you need to stop straightaway.” The problem here is, When do you know you are going to have a life threatening reaction soon? Getting off quickly is a personal choice and I don’t want to claim I know people are making the wrong choice when there are so many unknowns.
I have a very close friend who was on Lithium for 15 years before coming off. She had a strong instinct she was too damaged to become pregnant, but her holistic doctors, being ignorant, encouraged her to go ahead with the pregnancy. It turned out that her thyroid had been so injured by the lithium that the hormone and thyroid changes in pregnancy almost gave her cardiac arrest, and she had to terminate the pregnancy. People often have very good instincts and intuitions about their bodies and drugs. If someone feels coming off abruptly is the way to go, I simply don’t have the certainty to tell them it is the wrong decision.
Published accounts of withdrawal and the internet forums and email lists tend to omit the stories of people who withdraw successfully and then just leave the whole system — survivors and peers included — behind. I do often meet people who come off medications abruptly and succeed. That’s just honest. We need to recognize they are out there.
Part of the confusion is that there is such a wide diversity of medication experiences. Like I said, 2 weeks into an Effexor prescription is different than 20 years of anti-psychotic and benzo polypharmacy. Again a general principle but not a firm rule: sometimes people are so beaten down and powerless that the desire to come off abruptly, even with bad consequences, is part of an impulse to empowerment and liberation. I don’t want to judge that as wrong.
Where you say “I have spent years on the various Internet withdrawal forums and it is unquestionably the case that the people who suffer the most and for the longest are those who come off their drugs too rapidly.” I would have to say yes absolutely, that is also my experience as well. And also, there are lots of people who stay on the medications too long and that also causes huge problems. One of the problems with the “only gradually” message is the same problem with the “only with a doctor” message: it potentially puts up an obstacle to people and it denies the reality of people who’ve had other experiences. So I think we put a little too much fear into the meds and can inadvertently give them a little too much power. Sometimes movements tend to start to look like what they are opposing.
I think, in our efforts to alert the world about the dangers of psych drugs, we sometimes overstate the case. Psychiatry has erred for so long in favor of meds, we shouldn’t make the opposite mistake by exaggerating the dangers of drugs. That is not to deny that people are killed and seriously damaged by medications, but if we express only these accounts we are distorting a complicated picture.
What I am seeing these days is some people and families read Bob’s work and then think that getting off meds is the solution in and of itself. Often it is, like a magic bullet in reverse. Sometimes it’s not. I fear if we just promote coming off meds as the solution then we are setting up a backlash just like promoting taking meds as the solution creates a backlash. Maybe a smaller backlash, and maybe the overarching message is better, but I’d rather be honest at the outset.
One of the principles of my work is giving people accurate information that matches my experience, so I often get into quite a lot of hot water when I take unpopular positions. That I guess (maybe it’s because I’m an Aquarius) is my role in the world, I’m always going to not quite go along with the majority view wherever I find myself. My position that medication withdrawal is not always best under the guidance of a doctor is one of the reasons I was shut out of the Alternatives conference for so many years and why some people doubted the value of my coming off guide. I think I was right on that, and eventually the culture caught up with me: today peers are more open to getting involved with coming off.
I think we’re going to learn that the reality is that gradual reduction is usually best and a very wise general guideline. But the limited research literature that documents people going off abruptly does not state that 100% had problems and couldn’t withdraw; it just documents a trend that supports the general principle of gradual withdrawal. At the same time it’s definitely not a firm rule, and to treat it like that is dangerous.
Another principle I work with is to accept the ambiguity and uncertainty of life. “Don’t ever go off meds abruptly” is an easy short cut to thinking, but doesn’t get at the diversity of medication experiences out there. I think my principle puts faith in individual relationships, learning, dialogue, and people figuring things out on their own, and that’s my bias about how to contribute to human liberation. I’m just not into programs and monologues about what’s right.
Obviously I am hugely concerned with abrupt withdrawal. I probably would not have written this blog post unless I also had written in greater detail in my Harm Reduction Guide. But I am committed to following my experience and learning with integrity, which is why I am encouraging us to try to use a different term than “medication tapering.”
I am with you that “withdrawal” may not be the best term for coming off medications. I use “a harm reduction approach” because I want to emphasize flexibility of outcome, as the diversity is what we need to be emphasizing here, not a program in advance.
Also your post helps me to understand that, though ‘psychiatric drugs’ is a useful umbrella and the principles of withdrawal do apply in general, there are specific drug classes — like the benzodiazepines — that have very specific profiles around long term addiction. We need more research and education around these differences. I would be much more cautious on abrupt withdrawal in a discussion about benzos for example because of the widely documented sudden death risk and the long term physical risks of abrupt withdrawal. So your information and experience here are really important.
Again thanks for a thoughtful reply.
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Will, of course deciding how you’re going to go off is a personal choice. You make the decision to convey the pill to your mouth.
Before deciding how you’re going to go off, you should know the worst possible case, which is: Push your nervous system far enough, and it will break.
Withdrawal symptoms are not benign. They are signals from your nervous system that something is going wrong. Once you push it into severe withdrawal syndrome, it can take a very long time to recover.
Then you really do have a chronic neuropsychiatric disorder.
Your nervous system is not immaterial, like your soul. It runs everything in your body: Your heartrate, your digestion, your sexual response.
Don’t screw it up if you have a choice.
If you’re having an adverse reaction, you need to weigh the severity of the reaction — which also indicates nervous system distress — against the potential damage you might do with cold turkey.
If the adverse reaction is life-threatening or unbearable, the scales are tilted towards quick exit.
Otherwise, you will want to protect your nervous system by going off gradually to minimize withdrawal symptoms.
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those drugs not only damage your brain, they also damage your endocrine system: your thyroid, your sexual functions, your liver, your pancreas as well as your heart and it can take years to get your body back to normal. I think, you definitely need some medical supervision and backing if coming off abruptly of psychiatric drugs.
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Wow, I wish there was medical supervision and backing for coming off psychiatric drugs. If you know of any doctors knowledgeable in this field, please send me mail at survivingads at comcast dot net
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It’s all fine and well to say that people need the help of psychiatrists to come off these toxic drugs but the reality is that none of the psychiatrists that I know, and I know a few since I work in a psych hsopital, are willing to even consider helping people accomplish this. They take people to court and have them locked up for 45 or 180 days so that they can force people back onto the drugs. They are totally non-supportive of helping people with this. Some of them state that even if they were favorable to people getting off the drugs, they themselves do not know much about getting people off. I myself went to my pharmacist and asked for his help in walking me through what to do and he was very helpful. My psychiatrist was not helpful at all. So, my question is, where do we go and who do we turn to to facilitate this process?
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Clearly if someone is experiencing neuroleptic malignant syndrome or other life-threatening effects of psych drugs, they must stop abrubtly. But I agree with hereto help’s comments, above, that the message that going cold turkey is perfectly OK in general is problematic. Many of us know people whose abrupt withdrawl led either to extreme physical health risks or so-called “rebound psychosis” that got them put forcibly back into the mental health system. Of course, I also know people who successfully stopped abruptly, but it feels like playing russian roulette to me. There is certainly a lack of psychiatrists who are knowledgeable about this and are willing to help people come off psych drugs, and there is a crying need for more such practitioners. Peter Breggin has a new book,Psychiatric Drug Withdrawal, which I haven’t seen yet – I’m wondering if others have seen it and have an opinion about it?
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Hi Darby, I’m with you 100% that “that the message that going cold turkey is perfectly OK in general is problematic.” I would never agree with that. The point of my post is that by calling the whole process “tapering” and not coming up with a better term, we miss instances where abrupt withdrawal can work.
Yes abrupt withdrawal may be like russian roulette, the problem is that staying on the drugs may be like russian roulette too.
I have read Breggin’s new book and it is an extremely useful contribution to everyone’s learning. I agree we need more prescribers who can guide people in the process, I just think we also need to learn from people who did it without — or despite — their prescribers.
– Will
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Will, you know I know that you know tapering is the preferable way to go off psychiatric drugs, and I strongly support you in the efforts you’ve made to communicate that.
But — I wonder if you titled this piece and slanted it for no other reason than to be provocative.
I don’t think anyone ever opposed the idea of precipitous withdrawal in the case of unbearable adverse effects, so that’s a straw man argument (or as I prefer, a non-sexist straw dog argument).
So few people are savvy about tapering — and so many are foolish about coming off — that I can’t believe you think tapering has been over-emphasized.
(If anything, I personally wish contributors to MIA would at least be consistent in recommending tapering to get off psychiatric drugs, advice that I believe cannot be repeated enough.)
If the process is called “medication tapering” (which I’ve never heard as a formal term), I say that’s a vast improvement over medicine’s profound cluelessness about getting people off drugs — at least it includes the word “tapering.”
Now all we need to do is explain to doctors what “tapering” means.
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Hi again Altostrata, I don’t know why you think I have written this piece to be provocative, my work is already plenty provocative without me making any extra effort. I have changed the title however because I seem to have really upset you and I do value your work and opinion and I want to overcome misunderstanding.
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I’ve managed my own coming off psychiatric drugs and did so in 1978 and 1984 with chlorpromazine then in 2003 with venlafaxine and lithium. The psychiatrists didn’t support me in this and thought I should be on them for longer or for life, in the most recent episode saying that I had a lifelong mental illness. Of course I didn’t believe them and never have done. We live in Scotland.
This year I stood with my son as he came off haloperidol, in 5 months, from 25mgs injected forcibly at the beginning, then on to pills when taken voluntarily, reducing by small amounts every 3wks. It’s what he wanted and I supported him in it. It wasn’t easy, but it was easier than staying on the drug which had difficult side effects.
We think the older drug was easier to deal with and come off than the newer anti-psychotics eg risperidone. Not sure why. My son’s fine now, no effects from coming off. And he’s got nothing to do with the psychiatric system now, they weren’t much use anyway, the community psychiatric nurses who seem to keep people dependent on them.
He wanted talking therapies rather than psych drugs when in the psych hospital but didn’t get what he wanted, psych drugs being the only choice and forced upon him. The system is still barbaric in my opinion, the use of force unacceptable in this day and age.
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Hi Chris, I am glad to hear about your son. I have heard reports that the newer anti-psychotics can be harder to get off than the older ones as well; one suggestion is that newer drugs affect a broader range of neurotransmitters. – Will
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I had an intern psychiatrist as well as an attending psychiatrist while I was in the hospital. I was lucky in that the intern eagerly jumped at my request for talk therapy. we worked in partnership every afternoon for a month. He told me that psychiatry has become so dependent on the toxic drugs that they no longer learn how to do talk therapy while in medical school. Therefore, most of them running around out there today don’t have the slightest idea how to do anything but push pills on people. This young man is obviously not the typical psychiatrist because he also despises the DSM and has no use for it. But, he is obviously not the average psychiatrist in practice, unfortunately.
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I agree VERY STRONGLY with those above who caution against suggesting cold turkey as just another way to go off psychiatric drugs.
I also agree with Will that in situations where a drug (other than a benzo) is causing unbearable adverse effects, a quick exit may be justified.
HOWEVER, people need very little in the way of permission to cold-turkey off psychiatric drugs. Despite consistent warnings against it, they do it all the time.
Although they know psychiatry is lying in everything else, they want to believe withdrawal symptoms are mild and last only a couple of weeks. Or, they think anyone who complains about withdrawal symptoms is, you know, a little funny in the head.
Given there’s a range of withdrawal reactions, some get away with cold turkey. Others get over withdrawal symptoms within 6 months.
But others win the bad luck lottery. If you’ve ever experienced withdrawal syndrome, or if you know someone who has, you would never, ever suggest cold turkey is as good a way to go off psychiatric drugs as tapering.
Let me tell you, the horror of withdrawal symptoms is unimaginable. Our language can not express what they’re like or how bad they can be. Depression? Anxiety? Don’t make me laugh.
You have no idea until you’ve experienced it.
And — here’s the deal — other than time, THERE IS NO CURE for severe withdrawal symptoms. If you’re very lucky, reinstatement of the drug will alleviate them, but that doesn’t always work.
If you don’t know what withdrawal syndrome is like, or don’t believe it exists, I suggest you visit http://tinyurl.com/3o4k3j5 and read a few of the stories.
I speak as one who has had Paxil withdrawal syndrome for 8 long years, counseled hundreds of people with psychiatric drug withdrawal syndrome, and run a support site for tapering and withdrawal syndrome.
Believe me, if there was an easy way to go off these drugs, I’d be happy to promote it and close my site. But there’s not, and we have to accept the reality that too-fast withdrawal is yet another danger of these damned drugs.
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Altostrata is absolutely right. The question of whether medication tapering is the right term is a red herring. The real issue is that far too many people still choose to cold turkey or do a rapid taper, mostly through lack of awareness. I fear that Wills article will serve as support for those who – in spite all the evidence – still propose this as an acceptable protocol. Hopefully his detailed reply as well as the other posts will serve as a warning of the severe dangers.
My experience – and I believe Altostrata’s – is centred around benzos and SSRIs. It seems that these classes of drugs pose particular problems in relation to rapid withdrawal, and that – as Will says – we should be careful of generalising. It does appear that rapid opiate detox, for example, runs few of the same risks. And this is almost certainly why some doctors and clinics promote detox for all drugs – they see it work in one area and assume it will work across the board.
We should therefore do all we can to flag the very significant differences, and to highlight that cold turkey of SSRIs and/or benzos can lead to years of unimaginable suffering.
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Hi again, the discussion seems to be devolving into misunderstanding and misattribution. Nowhere would I ever claim abrupt withdrawal is “just another way to go off psychiatric drugs.”
As I write in the beginning of the essay, readers can please refer to my Coming Off Guide for my views, informed by collaboration with more that 50 contributors. – Will
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I have experience of coming off psychiatric drugs on 3 occasions, anti-psychotics the first two times, then again anti-psychotics plus anti-depressants and a mood stabiliser the final time, in 2003/4. Each time I managed to get off the drugs by doing so gradually and successfully. I did this under my own guidance.
I have also supported my 3 sons in coming off anti-psychotics which they managed OK. It was our experience that there were more side effects and problems being on the psychiatric drugs than coming off them or staying off them. I think therefore that it will be up to the individual if they want to come off the drugs and how they feel while doing it and what coping strategies they might use.
Everyone is different, we are all individuals with different past experiences that might have similarities. I believe that everyone’s story is important and makes sense of the whole. I suggest therefore that if someone is considering coming off psychiatric drugs then they look at the evidence, consider the different stories, decide on a way forward and take responsibility for it. But this is only my opinion and is not prescriptive.
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However, elsewhere, Chrys, you’ve said you believe people who complain about post-discontinuation withdrawal symptoms have a psychiatric (psychosomatic) disorder. Would you care to explain that?
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I have said no such thing Altostrata.
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In the context of a post by Duncan Double at http://criticalpsychiatry.blogspot.com/2012/09/what-does-it-mean-to-say-that.html , in which he claimed antidepressant withdrawal symptoms were psychosomatic (the drugs causing psychological dependency)
Chrys Muirhead said (6 October 2012 07:56)…
“Anonymous you may be right about anti-d’s being addictive for some. I’m not sure.
It may be more about what a person thinks about the pill they’re taking and the power it has. Eg if they think it made them feel better then they might be fearful of coming off it, for then they could become unwell again.
For me, I didn’t think the anti-d worked so had no problem in coming off it….”
Your position being: It’s one’s belief about the drug that causes withdrawal symptoms, an “all in your head” argument.
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Altostrata – I’ve looked back at this blog and the context of my response which was to do with coming off the drug rather than the effects of coming off. Here is the rest of my response which you don’t mention:
“The anti-psychotic did seem to take me out of the psychosis but it was a harsh bringing back to reality and gave me low mood. However it may have been the hospitalisation that brought me out of the psychosis, I don’t know, for no-one gave me any time to try and get out of the psychosis by myself.
Psychiatry is a rough treatment. I describe it like taking a skelf (sliver of wood) out of your finger with a sledgehammer. Wrong tools for the job. More damage done than what you went in for. And the skelf probably just came out by itself after the battering the finger got.”
Therefore you are quoting me out of context and misrepresenting my position.
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Not at all, Chrys. Like markps2, you haven’t suffered post-discontinuation withdrawal symptoms and you are attributing them to psychological causes.
“I didnât think the anti-d worked so had no problem in coming off it…” is the nut of your misconception. You imply belief in the drug is what causes others to experience withdrawal difficulty.
(The rest of your quoted post is not relevant to that opinion.)
Those of us who have experienced those withdrawal symptoms are not speechless lab animals. We can tell you and markps2 (and Duncan Double) that your speculations about what we feel are wrong.
I would think that as a patient advocate or psychiatric activist, you would respect that.
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I can only reiterate Altostrata that my comment about anti-depressants not working was to do with my deciding to come off them, and wasn’t to do with effects. At that point I didn’t know if I would experience any negative effects from coming off venlafaxine. What I did know was that being on the drug was very negative for me.
What I did have was experience of coming off the anti-psychotic chlorpromazine, which I came off without any lasting side effects.
I do not think you are a “lab animal” and I am not saying that your “post-discontinuation withdrawal symptoms” are due to psychological causes.
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for interest Altostrata – here’s a post on David Healy’s blog site ‘Monicaâs story: the aftermath of polypsychopharmacology’ that speaks about withdrawal syndrome and is a very powerful testimony:
http://wp.rxisk.org/monicas-story-the-aftermath-of-polypsychopharmacology/
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Thank you, Chrys. I wish we could have worked this out on Twitter.
Yes, Monica Cassini has written a very fine article.
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Will, this blog post is so uncharacteristic of you. The point is muddled, the argument is weak, and it seems to have a politically motivated hidden agenda to please the cold-turkey faction.
Point by point, my apologies for the length:
1) Straw dog #1: The groundless protest against somebodies using the term “medication tapering.” I don’t know of anyone who thinks “withdrawal” and “tapering” are synonymous. As I understand English usage, “withdrawal” is the general and “tapering” and “cold turkey” are subsets.
I don’t understand why you pasted this onto the top of your article, unless your intention was to claim yours is only a semantic argument, which it most certainly is not.
2) Your second paragraph is a Trojan horse, where you introduce cold turkey as a reasonable withdrawal technique.
3) You then refer to your upcoming âTextbook of Modern Community Mental Health Work.” All well and good. The advice about abrupt withdrawal in serious adverse events conforms to medical guidelines (and I’ve read, many, many medical guidelines about withdrawal). As I’ve said above, no one would argue with that.
Please post the section of your book describing “the possible consequences of abrupt withdrawal” for the clinicians who are the audience for your book.
Or do you assume they know? They don’t.
(Note: “Lamotrigine” is misspelled. The last sentence of the selection runs on and needs to be rewritten: What the heck does “and any difficulties encountered met are treated as a learning process” mean? This seems rather important, as it would deal with post-discontinuation withdrawal syndrome.)
4) The next paragraph moves further into “cold turkey as a withdrawal technique” territory, defending it as an aspect of diversity.
Diversity, please. This plays on the general human inability to assess probabilities. I’m sure you understand distribution of response, even though the faction this is intended for might not.
You don’t know which way cold turkey will go for you until you do it. It’s like Russian roulette. Five chambers are empty, but the sixth contains a bullet. Do you like those odds?
5) Your last paragraph and close are a waffle. Did you say what you just did? Or maybe you didn’t mean it? Disingenuity alert!
Can you please tell me when this “research into the physical risks of medication withdrawal and how to avoid those risks” might be done? The scientific literature on withdrawal (maybe 500 papers) has been calling for this for 30 years.
6) Straw dog #2: On November 10, 2012 at 3:44 pm in a lengthy comment, you claimed, hypothetically, your roommate might have been killed by warnings against cold turkey she might have read on a peer support tapering Web site.
I’m glad your roommate went right off lamotrigine and her life saved (by a doctor? another roommate?).
Allow me to point out: No Web site threatened your roommate’s life. It was endangered by a doctor who prescribed an excessive dosage of Lamictal and, probably, ignored the danger signs for too long.
You cannot pin your roommate’s endangerment on tapering Web sites and advice not to cold turkey. The problem is not “medication tapering” but medicine’s focus on “maintenance” despite the patient’s deterioration.
The Web is full of good and terrible information. Your Googling roommate might have ended up taking advice from a naturopath, for example, and embarked on liver cleansing instead of quitting Lamictal.
If people are Googling and seeking advice from other non-doctors on the Web, what it demonstrates is they don’t trust the advice they get from doctors. As we all know, the level of knowledge in medicine about adverse effects is abysmal and about withdrawal, even lower.
Peer support sites for tapering and withdrawal exist because people can’t get this help from doctors. It’s not there. Nada. Zero. A VACUUM.
Anyone, including Peter Breggin, who kicks the can of getting people off drugs to medical professionals is living in an alternate reality, not of this Earth.
No, peers don’t offer the level of care you might get from a knowledgeable physician, if you were able to find one, and you should assess all peer advice accordingly.
But your accusation that such tapering advice is destructive and, I gather, an affront to withdrawal “diversity,” is a gratuitous drive-by slur on peer support sites, one of which I run.
Everybody has a vested interest in believing withdrawal is a lot safer than it is, particularly a faction of psychiatric activists who think tapering is a plot against the God-given right to cold turkey.
And — allow me to close with this. Proponents of cold turkey never, ever show up to clean up the mess. If you think cold turkey is as good way a way as any to go off psychiatric medications, here’s an offer for you:
Send e-mail to me at survivingads at comcast dot net and I’ll make you a guest moderator on my site. You can counsel the people who’ve cold-turkeyed. Maybe you can explain to them their intractable suffering is merely withdrawal “diversity.”
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Alto, you are coming off as a bit obsessive here on this post. You don’t own the subject of coming off of psych drugs just because you host a different site regarding such.
Will’s revolutionary idea here and elsewhere is for psych patients to learn to trust their own inner voice and spirit, and by doing so, learn better coping mechanisms to take care of themselves beyond a blanket acceptance of meds doing all the work.
He is about self-determination and listening to individual narratives. I think you are wholly missing the point. Will would never contradict your personal experience, but likewise he won’t generalize it for others. We could all stand to learn from his respectful position.
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Emily, every day someone comes to my site who’s cold-turkeyed and suffering terribly, and begs for a solution.
If they’re very lucky, they can reinstate the drug. This does not always work. The person then is in for many months, maybe years, of recovery from withdrawal syndrome.
These situations are heartbreaking. They could have been avoided. But, for one foolish reason or another, these people have asserted their “right” to cold turkey.
Unlike other peer support sites (such as paxilprogress.org), which discourage such members because, gosh, they’re just too darn depressing, I’ve committed to support people with prolonged withdrawal syndrome.
Doing support of this kind is hard, hard work. Misguided recommendations to cold turkey if you feel like it only makes it more difficult.
I can hardly wait to see how Will, Dr. Falk, and Dr. Fisher describe the downside of cold turkey in their forthcoming book, so people who consider this option will be fully informed.
Maybe “You break it, you own it, you take it home” could be a chapter title.
If you’d like to share my reality, Emily, you might read a few of the stories at http://tinyurl.com/3o4k3j5 Would you like to be a guest moderator and support these folks?
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Alto, I applaud you for your good and faithful service to our community of persons who have been deceived and harmed by psych meds. Yup, there are many of us with gut-wrenchingly depressing stories out there that could use some help that is currently not being offered by professionals. Nope, I don’t want your job.
But you didn’t write the booklet on coming off of psych drugs– Will Hall did. He has provided something of invaluable help to many when nothing out there existed like it. He is a pioneer who has been there and done that in the alternatives mental health field for over a decade. His blog deserves more consideration than you are presently giving. His point on diversity is very salient and very sincere.
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I’ve always had nothing but respect for Will, his work, and his writing.
I also have done a great deal of writing about withdrawal. I consider Will a peer.
I understand the concept of diversity and I completely support that, too.
But cold turkey is like unsafe sex with strangers. You might say unsafe sex is part of the diversity of sexual practice. A lot of people are still attracted to it.
Many people get away with unsafe sex, but some do not.
Fortunately, infection with an STD or HIV is not the death sentence it was, but there is no cure or treatment for severe and prolonged withdrawal syndrome, or medical care, or even, as you can see in this discussion, recognition among psychiatric survivors or activists.
So what kind of choice is “cold turkey” for people on psychiatric drugs? If you want to get out of the system, you risk being trapped in withdrawal syndrome and lacking self-determination for a very long time.
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Bravo, Emily! I agree with you. I don’t quite understand why Will is being taken to task so grievously here. What he said makes perfect sense to me and I don’t hear him advocating everyone who is on these toxic drugs quit taking them today.
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Adding to my list above:
7) Will — please explain how your Textbook of Modern Community Mental Health Work will explain reinstatement of medication if withdrawal symptoms appear.
This is the only way known to diminish withdrawal symptoms, aside from prescribing benzos, which is what many doctors do, of course leading (if they work) to dependency and withdrawal issues of their own.
However, reinstatement sometimes does not work, and benzos sometimes cause paradoxical reactions, making unbearable withdrawal symptoms even worse. In these situations, doctors will often diagnose relapse or emergence of a new psychiatric disorder and throw the kitchen sink, drug-wise, at it.
So you have a person who maybe went off one drug too fast, gets withdrawal symptoms, and ends up trapped on polypharmacy with an escalated but phony diagnosis.
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Alto,
As one who tapered very slowly off of a 4 med psych cocktail, I greatly applaud your post.
Frankly, as a big fan of Will’s, I was shocked at his post. But due to brain fog for non related psych med issues, I just couldn’t make a coherent response to express my views. You just did. Thank you.
AA
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Will,
I printed your last opus on paper in addition to saving it on my computer-a rarity for me since I have not much storage space.
If you will allow me a disgression:
âExercise more and eat less â equal obesity fighting message to teenagers and parents of obese children.
This doesnât mean that âExercise more and eat less.â is not the behavior in many an anorexia nervosa sufferer teenager.
âExercise more and eat lessâ should still be the prevalent message to send around because anorectic persons will not need this message to stop eating enough and exercise a lot.
I believe , to go back to the subject of your post , that it depends on who you want to educate. For the many people ingesting SSRIs, using tapering off as a synonym for getting rid of medication is just safer on health ground. It is another matter when you provide education for health workers.
Thanks for your work. All the best to you.
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Hi Ivana, thanks for your comment. I understand your point – we need a simple clear message. I just disagree that coming off medications can be made so simple. It’s just not like exercising and eating right.
Especially with complicated topics like coming off medications, the role of doctors is to provide useful, complete, and honest information to empower patients. Oversimplifying can imply patients are incapable of thinking for themselves.
I often emphasize very strongly the importance of gradual withdrawal in my workshops and talks, and I try to make things as simple as possible, but I don’t think we can get around really educating people.
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We have one-in-five adults in this country on psychiatric drugs and only a *handful* of resources to help people get *off* of them.
Only psychiatry (and its partners in crime, pharma and the federal government)could have created a situation like this…
What a mess!
Duane
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Duane,
The surest way to get many people convinced that they needed the drugs in the first place is to let them see a friend suffering from the most horrendous withdrawal symptoms going “cold turkey” often cause.
France is a very different country -and this will be my last comment since I do not feel at ease discussing a situation I do not know engough about in practice but in France and in England many people want their pills and a quick fix -not talking therapy,no exercise, and the psychiatrists sometimes have to accept not to be too paternalistic about it.
To my mind, it is a heuristic error to think that it is so different here from medicine or surgery in general: many people want a back surgery even when their GP is agaisnt it -and rightly so- in many casesetc… A French medical student, I know well and trust to be a good person – was hurt recently by the sobering experience she recently had in her cardiology shift: she listened to clients refusing any lifestyle changes the cardiologits proposed and wanting instead pills for moderate high blood pressure levels when losing weight might have been a safer option, etc…and other insisting to get pills they just did not need according to the consultant in charge.
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Dr. Fulli,
You make some very good points that I feel are ‘universal’ – particularly in regard to finding a ‘quick-fix’. I hope you come back to this site with your input and expertise.
Duane
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This is an important point which I address in my Coming Off Guide. Prescription is not simply a patient choice, it also involves the prescribers ethical duty to do no harm.
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Hi Will,
I am not a paternalistic psychiatrist at all – -at least for a psychiatrist based in France.
This decision of mine -not being a paternalistic psychiatrist- honestly, leave me unable to imagine how one can use the doctors(or whomever in the USA) ‘s prescription priviledge to refuse a prescription to an informed individual.
(Actually, in my own special case, I would write an introductory letter to a colleague or a GP.)
This after one has tried to respect your idea about information and education of the client as when you wrote- in answer to my begging you to maintain a clear and simple first ligne of information using tapering off as a synonym for getting free of drugs:
//Especially with complicated topics like coming off medications, the role of doctors is to provide useful, complete, and honest information to empower patients. Oversimplifying can imply patients are incapable of thinking for themselves.//
If they are capable of thinbking by themselves about “going cold turkey” they should be allowed to judge by themselves about taking Pharma drugs at a time were we-doctors- are still so ignorant. Shouldn’t they?
All the best to you Will and thanks for your comprehensive opus much needed and also the modification of your title.
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Duane,
Regular doctors are just as guilty since non psychiatrists prescribe 75% of psych meds. In fact, a former doctor I saw tried to bully me into taking a psych med when I wanted no part of it. I am not joking.
Sorry, I don’t mean to get off topic but you had believe that if the concept of tapering is foreign to psychiatrist, getting off of them under a regular doctor’s supervision would be even worse.
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AA,
A great point, and reminder. In fact, as psychiatrists disappear from ‘medicine’ (half are approaching retirement age in the U.S.), we will see more GP’s prescribing these drugs.
Thanks for making a much-needed point.
Duane
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Will and everyone–Thanks of the discussion. Unfortunately, this topic is is systematically ignored, for the most part, in education and practice. I’m currently in a psychiatric nurse practitioner program which teaches us– from day three–about the merits of psychiatric drugs, and how to prescribe them, but says nothing about how to taper people off. We are being trained to do half of a job. This negligence is not only a reflection of current inadequate practices but also sets us up for negligent future practice. It’s time for this to change.
The elephant in the room here is the fact that we–peers and people with lived experience–are filling a huge gap. That practitioners and pharmaceutical companies are, on the whole, are either unaware of or ignoring how devastating withdrawal can be, and so don’t have the tools to effectively help people come off. They don’t know how to ‘taper’ (which I do believe is a responsible goal, though not always going to fit with a person’s needs or wishes) people off psych drugs because they made a decision not to study the long term effects of these drugs, or the tapering/withdrawal process. This post, online sites, manuals, all of our voices– we’re scrambling to make sense of a system that is ignoring the real needs of the community it is paid to serve. Leaving this fact out of the story paints an incomplete picture of the issue at hand.
The idea that everyone has a different experience with psychiatric drugs, and that some people can come off without much trouble, says nothing about their individual case, and so makes the success rate seem totally random. In fact, there may be good reason why some are able to come off, while others are not. I want to know: Which drugs were they on, how many different classes of drugs, and for how long? What kind of resources did they have in place to support them through the withdrawal process? If we got funding to do research (!!) my guess is we’d see that those who were very sick in the withdrawal process shared some circumstances in common: length of ‘treatment’, class of medication, number of medications, financial resources. In this way we’d have a clearer picture of the risks of these drugs, and professionals might have a better idea of how to support people (who are looking for assistance) to come off of them in a way that will be least harmful.
Vanessa
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Vanessa, there is no evidence that withdrawal syndrome is predictable.
My guess is it has to do with — yep — neurological diversity, but characteristics so complex and subtle we will never be able to identify them for predictive purposes.
It has to do with the way the drugs latch on to the individual nervous system.
People who are on drugs shorter than 2 months seem less at risk, but some still suffer withdrawal after cold turkey.
A few drugs, such as buproprion, seem less likely to produce withdrawal symptoms, but some get them anyway.
Medicine has a strong belief that lamotrigine has no withdrawal syndrome, but many have found this is a joke.
I agree with you, research that might predict who would get withdrawal symptoms might be very valuable. As I’ve said, researchers have been calling for this for 30 years.
In the meantime, millions are on drugs, and I personally want them to get off safely and get as far away as pharmapsychiatry as they can. My conclusion is that tapering is worth the inconvenience and cold turkey is an unacceptable risk.
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Vanessa they do not believe they are only doing half the job. They believe that there is scientific research to prove that these people need to be on these drugs for life, just like insulin for diabetes. No one studies how to withdrawl a person from insulin, so why bother learning how to withdrawl from these substances.
Problem is they have nothing to support what they say, but what they think and believe is why they are teaching what they are.
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Yes Belinda It is a real problem. I’m under no delusions about the field right now. Well meaning people have no idea how harmful these drugs and labels can be, or how complicated the withdrawal process is for so many people.
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Which poses the question, are the intentions of those in the field, in the majority of cases, quite so unimpeachably pure and noble? A lot of people seem all too willing to take comfort in thought-terminating insipidities about how “most psychiatrists and nurses are well meaning” and about how they mean well etc.
It was Montaigne who once said, to paraphrase, that nothing is believed in so firmly as that which is least known. How do we know that they are well meaning, where are these good intentions that people talk about so much?
We would do well to remeber that intentions are abstract nouns, ergo we can’t verify properly whether the intentions are good or not, yet anyone who claims that maybe, just maybe, bad intentions are in the ascendency in psychiatry, is usually dismissed as paranoid, although society in general rarely appeals to good intentions when it discusses child abusers, scientologists, rogue tradesman or burglars, because psychiatrists have the power to define the situation in terms most amenable to themselves, unlike the aforementioned, and it is one of the marks of power that the powerful define, and the powerless are defined.
Don’t get me wrong, when I use the term “bad intentions”, this shouldn’t be seen as synonymous with malice or evil, but what about greed and a careeristic drive for seniority within your own profession to the detriment of the patient; a will to consolidate the power the profession exerts; prejudice; indifference and lack of empathy (the latter two both reinforced by an ideology that corrupts the thinking of those who are exposed to it)? Or are some people under the missapprehension that these can be subsumed under the rubric of “good intentions”?
Whenever I hear mention of “good intentions” in relation to psychiatrists, much like with politicians who sanction illegal wars, I ask myself the question, who profits from this? Psychiatrists, politicians and other assorted morally irresponsible yet powerful people, that’s who.
Well, I disagree with these well-meaning people who say that psychiatrists are mostly well-meaning.
Many say, that psychiatrists and their lackeys are ignorant of the truth, they lack insight. Pish! A person who believes in the afterlife doesn’t merely believe in it independent of will and motivation, au contraire, he believes it because he wants to believe it, because he is terrified of eternal death. I would say that the same applies to at least most people in psychiatry. They are not merely ignorant, oh no, they are the agents of their own ignorance, and they must be judged.
Don’t get me wrong, I’m not having a go at anyone, I am merely making a general comment, but psychiatrists aren’t the victims here, the patients are. In the main, I think they believe what they want to believe.
For example, when they claim that one of the patients on the ward is “psychotically aggressive”, making the fundamental attribution error of attributing to the individual what is occasioned by the violence-promoting environment they are in (violence begets violence, although most of the violence on the psychiatric ward, which is committed by the staff, is mystified by the idiom and imagery of medicine, treatment and the hospital), they may originally be the victim of the ideology, but their unwillingness to think critically about these ideological phrasings is why they continue to believe it, and human beings hate to think critically about things they benefit from, hence why the powerful know so little in general about the role of power in human affairs, and why its victims know so much.
The same applies to society in general. Society believes that the “pharmacological revolution” actually has happened, not because it doesn’t know the truth, but because it doesn’t want to know the truth, which should engender a lot of pessimism about the possibility of reform within the field of psychiatry, because psychiatry is litle more than a weathervane blown by the winds of popular opinion and prejudice, and can only be reformed if society and its attitudes towards dissidents and undesirables are reformed.
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Cledwyn–I am not saying good intentions are enough, or that one’s ignorance should be excused. Good intentions took 17 years of my own life.
I don’t make this point to offset or minimize the problem. I make this point– that many psychiatrists are well-meaning– to demonstrate exactly how extremely dangerous bio-psychiatry is– it’s harm hiding beneath the veil of medicine and good will.
Vanessa
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âNever ascribe to malice that which is adequately explained by incompetence.â – ascribed to Napoleon Bonaparte
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Hi Vanessa, I am with you on the huge need for more research to shed light on the questions you are asking. And it’s great you are in the nursing program, we need more professionals with integrity and vision like yourself. – Will
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By the way, my site, http://survivingantidepressants.org , was hacked last night.
If anyone here gets pleasure from this, allow me to point out it’s taken away the sole source of emotional support for a whole lot of suffering people who have been injured by psychiatric drugs.
They are part of your spectrum of diversity, though you might not want to embrace them.
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I’m sorry your site was hacked. I would hope that no one here in MIA is responsible. Call me naive but we’re all in this together fighting an unresponsive and uncaring system that is determined to keep us quiet and compliant. WE may not always agree with one another on everything, but I can’t see anyone here attacking someone else over a disagreement.
People who hack do it for the enjoyment of destroying period, they often don’t care what the subject of the site is, they just go around attacking sites for the sheer joy of it. They attempt it to see if they can get away with it. This is not the attitude that I find in people who post here, thank goodness. I may be wrong, but I suspect this is random attack.
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I keep coming back to your post. Call me slow, but I just want to say thank you for reaching out to the people that you do. Your work is important. I also care about the people you reach out to and want to work to make sure that their diversity is included in all of this. I work in a state hospital where there are people who have been irrepairibly damaged by the toxic drugs that they’ve been forced to take. I often worry that they will be left behind in our movement because they will experience a greater difficulty in gaining their lives back; perhaps they will never regain them. But I refuse to turn my back on them, no matter what. So, in some small way our work does share some common ground. Hang in there.
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Thank you, Stephen, I agree. (My site is back online now.)
Unfortunately, people who are injured by too-fast tapering and cold turkey — people who have prolonged withdrawal syndrome — find support only among others who have suffered similarly.
Few doctors even recognize the condition; only one or two in the world even attempt to treat it.
Doctors, family, friends, therapists — they all tell people who are suffering from withdrawal syndrome that it’s “all in their heads” or they’ve relapsed or developed some new, exotic psychiatric disorder that doesn’t match any known symptom pattern (they’ll call it bipolar NOS or conversion disorder or PTSD or psychosis — anything to justify throwing a bucketload of drugs at it).
As I mentioned before, there is also a faction of psychiatric activists who deny, minimize, or ridicule withdrawal syndrome because it doesn’t fit into an ideology of “throw aside your crutches and be cured.”
Yes, you can get beyond the crutches, but there’s nothing easy or safe about these drugs, including exit.
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Alto,
“only one or two in the world even attempt to treat it.”
I cannot tell for the USA but for the world at large, i do not think that I have only another fellow psychiatrist trying to help people tapering off from benzos and SSRI!
I did my MD thesis on two personal cases of pseudoneurosurgicaldiseases induced by benzodiazepine I received being oncall as a neurosurgery registrar for only
months at la SalpĂ©triĂšre Hospital in Paris in the early 80s and at that time- in the early 80s as a psychiatry registrar, I used to prescribe a switch to a “long acting” BZ decresing dosage and then Chloral to help in-patients to get rid of benzodiazĂ©pines as a sleep prescription and I used a long acting BZ at decreasing posologies plus low doses of imipraminic antidepressants to get rid of benzodiazepines anxiety treatments…
In 2008, I even tried to open an homeopathy and psychotherapy only psychiatrist ‘s private practice in Paris telling the medical Gestapo thant my intention was to work for people not really in need of allopathic drugs to overcome life difficulties. It was not to be for several reasons- one being that the president of the Paris medical board thought that homeopathy was dangerous and my having previously in 2001 having been declared incompetent and dangerous by a very very old psychoanalyst because I had ask a psychiatrist examination of a son of his who sexually assaulted a girl at a high school depriving her of her beautiful long hair because she refused his sexual advances.
Please, Alto, I appreciate youy a lot and have respect for your good work but cannot let it pass when you show – in good faith- an ignorance of the fact that more than 1 or 2 doctors in the entire world are helping tapering off -when the client agree that is…
Thanks again, Will and Alto, for all your good work.
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Ivana, many doctors know something about tapering, though they are still too few and very difficult for people to find.
As I said before, only one or two doctors in the world treat POST-DISCONTINUATION WITHDRAWAL SYNDROME. If you know of any others, I would like to hear of them at survivingads at comcast dot net
If tapering is too fast, after the last dose withdrawal syndrome can continue, intensify, and last for many months or years. That is the PROLONGED WITHDRAWAL SYNDROME of which I spoke.
It is widespread nervous system or autonomic dysregulation, usually invisible on any tests.
(Prolonged withdrawal syndrome may also occur after benzo withdrawal.)
Some doctors, illogically, think withdrawal symptoms only occur during tapering. This is untrue. After discontinuation, withdrawal symptoms may persist and get worse, coalescing into prolonged withdrawal syndrome.
Tapering should be conducted to minimize withdrawal symptoms throughout the process, lessening the risk of prolonged withdrawal syndrome when tapering is over.
Thank you for this opportunity to clarify the concept of prolonged withdrawal syndrome.
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Will: Thank you once again for the invaluable work you have done to help people safely withdrawl from psychiatric medications. I just wanted to let you know that Neil Falk was my psychiatrist for about a year at Cascadia, and I had some bad experiences with him related to my psychiatric medications. When I saw him, I was prescribed 1200 mg of Seroquel, a dose that another doctor had put me on, but a dose so high it should be illegal and I believe it is in some states. He took away all of my psych medications overnight one time to teach me a lesson about losing them, and I went 5 days in a terrible state of insomnia and extreme psychosis because of this. He instructed local Portland hospitals not to let me in during this time. I did manage to reduce my dosage of Seroquel as a result of this 5 day ordeal, and he approved that. But I am still on 600 mg a day of Seroquel, and it is so wired into my neurological system and connected to my sleep that it will take years to taper off that high of a dose. My experience in working with Neil Falk with regard to psychiatric medications was not a good one, overall, and I just thought you should know this since apparently you are working on a project with him that you mention here. Best regards, Julia
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