Optimal Use of Neuroleptic Drugs: An Introduction

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I have recently put together a talk in which I summarize my current thinking on the optimal use of neuroleptic drugs, primarily focusing on the treatment of individuals who are experiencing psychotic symptoms.  In order to foster conversation on this topic, I will be posting the content of this talk in a series of blogs.

First of all, I stipulate two points:

  • These drugs can be very effective for some people in the short term in reducing symptoms of psychosis.
  • Once someone is started on these drugs, the risk of relapse is much higher when they are stopped than when they are continued.

Current treatment standards suggest that:

  • Antipsychotic medications are critical to the treatment of schizophrenia.
  • Antipsychotic medications should be started ASAP.
  • Long term maintenance medication is recommended.

In addition, current treatment practice is:

  • When a person does not respond, dose is increased.
  • Dose is often increased faster than drugs typically work.
  • Additional medications are added fairly often.
  • An enormous amount of resources are devoted to insuring that patients remain on medications.

These are questions that I want to address:

  • When should we begin/what is risk of waiting?
  • How much drug is needed?
  • Should everyone remain on these drugs indefinitely?
  • Is it appropriate to consider relapse as a uniform phenomenon with uniform risks?

This is the argument I will put forth in future blogs:

  • The impression of short term efficacy tends to be inflated.
  • The impression of long term risk tends to be minimized.
  • The impression about the risks of delaying treatment (Duration of Untreated Psychosis) with antipsychotics is inflated.
  • Although antipsychotics are sometimes remarkably effective in reducing psychotic symptoms, this does not mean that they are always required.
  • Compliance is low despite our recommendations so it is almost impossible to comply with recommended guidelines.
  • Relapse does not carry the same risk for all individuals.
  • In the early 1990’s, there was a growing recognition that only minimal D2 blockade was needed to produce optimal results.  This concept got lost in the years when the newer antipsychotics were highly promoted but concept remains valid.
  • Joe McEvoy and colleagues (Archives of Gen Psychiatry 48:739-745, 1991) conducted a study in which they determined the minimal dose of haloperidol needed to produce very slight extrapyramidal symptoms, i.e., muscle stiffness.  In a carefully controlled study, he found that low doses of haloperidol (on average about 3.5 mg) were just as effective as the higher doses that were commonly used that the time (10-20 mg).  Raising the dose above that was only likely to produce more side effects without further clinical improvement.

I come to the following conclusions:

  • Since many people choose to stop, since some may get better without medications, since some may be able discontinue with slow taper, since relapse is not universally a disaster, we should revise our practice standard to try to wait before starting drugs and consider discontinuation in a controlled manner.
  • Since these drugs are not as effective as most people think, we should approach failure to respond with more judicious use of drugs rather than by adding on more drugs.
  • The current practice of recommending that almost all individuals remain on these drugs indefinitely should be challenged.
  • We need to reconsider what we consider informed consent.

In the next blog, I will provide the data that support these assertions.  I will provide references for specific articles but at the beginning, I want to cite several books which  have had a big impact on my thinking in recent years.  Each of them has informed me in important and sometimes profound ways.

Marcia Angel’s The Truth About the Drug Companies.  In the 1990’s, I began to notice a disconnect between the published data and the perception of the efficacy of the new drugs.  However, I did not have enough data to fully understand this. Dr. Angel who was then the (first female) editor-in-chief of The New England Journal of Medicine began to write about this.  She was in a position to understand how profound the influence of Big Pharma was on the practice of medicine and she tracked this story with a directness that took courage given her position at the time.

Irving Kirsch, The Emperor’s New Drugs.  Dr. Kirsch is a psychologist who has written extensively about the efficacy of the antidepressant drugs. This book reviews not only his own work but also the larger topic of placebo.

Daniel Kahneman’s, Thinking, fast and slow.  Professor Kahneman is a Nobel Laureate in economics. His work is in cognitive psychology. This book elegantly summaries research conducted over the past 50 years and gives us insight into how we think, form opinions, and make decisions.  Humans have remarkable abilities of intuition but these abilities can also lead us astray in ways that are surprising and unsettling.  It seems critical for anyone who ever has to make a decision to understand what Dr. Kahneman has to tell us about ourselves.

David Healy, Pharmageddon.  Dr. Healy is familiar to readers of this website. This work is important in many ways but one critical message in the book is its discussion of the limitations of randomized clinical trials and the ways in which these can be distorted for commercial purposes.

Wendel Potter, Deadly Spin.  Mr. Potter was a high level executive for a major health insurance company. Although, his book’s topic is not directly relevant to this discussion, I found it important because it sheds light on the ways that corporations invests huge resources into spinning their message not for the sake of the public good but to advance the financial interests of the corporations.

Robert Whitaker, Anatomy of an Epidemic.  This needs no further explanation.  This book directly influences this talk and I refer to some of the articles that he cites in his writing and talks.  However, I cover some areas not directly addressed in the book, specifically the short term efficacy of these drugs and the question of the impact of not using drugs to treat psychosis.

I look forward to reading your comments.

 

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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

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160 COMMENTS

  1. Dr. Steingard,

    I’m fairly impressed with what you’re offering here.

    Generally speaking, what you say throughout makes sense.

    Speaking as a former “patient,” who (back in the late 1980’s) was taking such drugs, it all resonates and is in accord, with my own experiences *and* my observations of many others’ experiences. It’s very well done – for what it is.

    But, one or two things are missing, I feel.

    First of all, there’s no mention of *akathisia* (let alone any description of what akathisia is).

    Nor is there any mention that these drugs can create horrible dysphoria.

    As I’ve said elsewhere, if I could recommend just one online article to all psychiatrists (and to others who are keen on recommending these drugs), it would be this one article (“Unravelling Madness”), which briefly describes such effects, as experienced, by Richard Bentall, years ago, in an experiment led by David Healy:

    http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10565099&pnum=0

    [Note: I tend to be extremely critical of Healy, for he promotes ‘shock treatment’ (ECT) and denies the reality of its negative effects; but, he does a good job emphasizing the dysphoric effects of neuroleptics.]

    From the point of view, of knowing, that such effects can result from prescribing such drugs, I wonder: Is it ever ethical to force them on people?

    (I will tell you here, frankly: I don’t believe it is ever ethical to force them on anyone. Such is my conclusion, for I know, first hand, what it feels like, to have them forced on me… into my veins and my nervous system, my brain. They created the sorts of effects that Richard Bentall describes, in that article. I was so deeply disturbed by those effects, I could hardly function; yet, no one would ascribe my distress to those drugs; instead, those effects were interpreted, by everyone, as ‘proof’ that I was supposedly “mentally ill”.)

    Often, there is mention of weight gain and other effects metabolic effects. Sometimes, there’s mention of tardive dyskinesia, which ostensibly develops only after many years of being on these drugs.

    There is virtually never any mention, anywhere, of what extraordinarily *negative* effects these drugs can have on people, when administered by force.

    My experiences with psychiatry led me to realize, that: as soon as they’re forced on a so-called “patient,” these drugs can be torturous; and, those effects put an end to all possible, reasonable objections, to the ‘treatment’ itself.

    So, what you’re saying in this blog is all quite meaningful, and I do appreciate what you’re saying…

    But, in my humble opinion, if you are to cover this subject well, you’ll need to address these further issues, which I’m raising, in your subsequent blogs.

    Respectfully,

    ~Jonah (@BeyondLabeling)

    http://twitter.com/beyondlabeling

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    • Hi Jonah-
      Thanks for your comments. I agree that akathisia is an insidious and horrible side effect of this class of drugs. I also believe it can be missed by the assumption that the experience is due to the condition which the drugs are supposedly treating. I agree that these issues need to taken into account when thinking about forcing these drugs on people but, at least here, I am thinking about when it is OK to suggest them – and what we say when we suggest them – to someone who is willing to try them
      Thank you for these very important comments.
      Sandy

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    • Jonah, thanks for the link to the NZ Herald article. Very interesting.

      I watched this Ted talk two days ago

      https://www.youtube.com/watch?v=L8Bd_p8pbQI

      It’s about an experiment with fruit flies, where they stress the flies with an air puff and look how long it takes the flies to calm down. Then they found a fly that took much longer to calm down than the other flies. They found a mutation on a gene that encodes the dopamine receptor.

      If I understand it correctly it means, that if you block the dopamine receptors, it is very likely that you get some (at least very mild) form of akathisia. Worst case scenario: The psychotic symptoms don’t go away with the neuroleptics and they make you constantly stressed (not calm / hyperaroused / fight or flight state), which makes it even harder to cope with the psychotic experiences.very

      Now there is also the theory that hyperarousal plays a role in the development of psychosis.

      Which doesn’t mean that neuroleptics don’t work for some people, but I find it plausible that they could be psychological very harmful for some others.

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  2. Hi Sandy-
    Thanks for the post. I do remember attending a lecture years ago by Herb Meltzer (who is probably retired by now.) He indicated that antipsychotics don’t achieve reduction of symptoms by sitting on the receptor site. Rather, the pre-synaptic dopaminergic neuron will increase its release of dopamine in response to the antipsychotic occupation of the receptor site. Eventually, the presynaptic neuron exhausts its supply of dopamine. This is the point at which a reduction in symptoms is observed. According to Meltzer, it takes time for this exhaustion process. If the clinician increases the dose, nothing is achieved in terms of symptom amelioration, which is a function of time. Increasing the dose just augments the EPS. Who knows if Meltzer was right?

    I’m wondering about the use of omega-3s (see J.R. Hibbeln on omega-3s for ameliorating all kinds of distress; recall: omega-3s are the only treatment that decreases the emergence of full-blown psychosis in youth at risk.) I’m attaching some notes on N-acetylcysteine, which is pretty benign, and some comments heard at Emory Frontiers in Neuroscience on Zinc. Since none of these interventions are harmful, why not give them a try.

    By the way, omega-3s are anti-inflammatory. There is a huge literature (see Charles Serhan) on how omega-3 are converted into resolvins, which function to curtail an inflammatory response. They also increase vagal tone and PFC function. However, my guess is one can wipe out the beneficial effect of omega-3s by washing them down with inflammatory high-fructose corn syrup, transfats, or foods with a high glycemic index.

    Hope these notes make some sense. If they don’t give me a call. 770-939-7409.

    N-aceytl-cysteine
    Ketamine is known induce both positive and negative symptoms of schizophrenia. Work on animals has determined the mechanism through which ketamine operates. Ketamine influences the behavior of inhibitory interneurons which function to place a break on glutamate releasing neurons. Ketamine will increase the production of superoxide by an enzyme called NADPH oxidase. Both antioxidants (glutathione) and inhibitors of NADPH oxidase will abrogate the impact of ketamine. In terms of the mechanism, superoxide will decrease the function of interneurons and reduce the amount of an enzyme (GAD) which produces GABA (the neurotransmitter released by interneurons). Genes associated with this circuitry (genes producing glutathione) have been linked to occurrence of schizophrenia. All of this explains why N-acetyl-cysteine (an amino acid which gets converted to glutathione) is efficacious in reducing symptoms associated with schizophrenia.

    Behrens, M. M., Ali, S. S., Dao, D.N., Lucero, J., Shekhlman, G., Quick, K. L., Dugan, L. (2007). Ketamine-induced loss of phenotype of fast-spiking interneurons is mediated by NAPH-oxidase. Specific developmental disruption of disrupted-in-schizophrenic-1 functions results in schizophrenia-related phenotypes in mice. Science, December 7, 318, 1645-1647.

    Lecture at Emory-Zn++ will block signaling at NMDA receptor

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    • Thanks, Jill.
      I am familiar with what Meltzer talked about. The idea is that there is an eventual down regulation of pre-synaptic DA. A recent Archives article (I wil refer to it in another post in this series) talks about the “core” problem being one of elevated pre-synaptic DA release. But we already knew empirically that if these drugs work it is usually over days to weeks not hours to days. The rapid increase in dose is driven by insurance not empiricism.
      Did you see the recent article in the Archives on folic acid and B12? The people who benefitted most had impaired absortion of these nutrients. I have been talking to Bonnie Kaplan, a researcher in Calgary who has worked with a group, Nutratek, which has developed a micronutrient compound that has been shown to be of benefit in a variety of situations including extreme states. I am taking it right now to get a sense of it tolerability. I can get you more information on this if you want.
      One challenge – as you know – is that when we talk about something as complex as psychosis – we are not talking about one thing. There are a multitude of problems – both environmental and internal – that may result in psychosis.

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      • Doesn’t it seem odd to you that people who have low B12 and folic acid are being diagnosed with psychiatric disorders and treated with psychiatric drugs instead of B12 and folate?

        That’s what those studies are finding — a fairly significant rate of misdiagnosis of relatively simple B12 and folate deficiencies.

        Psychiatry should be apologizing to those people instead of recommending “adjunct” treatment with B12 and folate!!!

        Bonnie Kaplan has, unfortunately, sullied her reputation by her association with the TrueHope company and their supplement EmpowerPlus, which is nothing but an overpriced ordinary multivitamin for which its manufacturer makes excessive claims.

        (TrueHope’s activities are of great concern to me because it also gives out bad information about tapering off psychiatric drugs — with the help of its supplements, of course.

        This is not to say that nutrients and the lack thereof cannot be involved in producing “psychiatric” symptoms and supplementation may relieve those symptoms.)

        In 2006, I wrote to Bonnie Kaplan, whose research is what TrueHope uses to back up its claims. Here is her response:

        Date: Thu, 16 Feb 2006 12:16:24 -0700
        From: “Bonnie Kaplan”
        Subject: [altostrata]
        To: [altostrata]
        Hello [altostrata],
        I’m glad you are checking on ingredients, because the supplement has
        changed since the list in the 2001 publication. The company was able to
        change the processing to provide a much finer particle size for the
        minerals, which seems to enhance the absorption of the minerals (makes
        sense), and so the quantities of some were reduced by a third. The
        current adult full dose = 15 capsules/day (not 32, as it was in 2001).

        You asked about two ingredients in particular. I believe the current
        level of inositol is just 180 mg (very tiny compared to the literature
        on inositol using it in isolation), and the phenylalanine is 360 mg. You
        could check with the company on their website (truehope.com), or phone
        them.

        I’m not affiliated with the company, and in fact I will paste below a
        prepared message that I use when responding to email queries. There may
        be other information in it that is relevant to you.

        Best of luck to you,
        Bonnie Kaplan

        ————————————————-
        Thank you for inquiring about the University of Calgary research on
        micronutrient supplementation in the treatment of bipolar disorder. The
        supplement we are currently studying is available commercially as
        Empowerplus (a slight modification from its name prior to 2003, which
        was E.M.Power+). Our first peer-reviewed article was published in the
        December 2001 issue of the Journal of Clinical Psychiatry, along with
        an excellent commentary by Dr. Charles Popper from Harvard Medical School and McLean Hospital. A second article has been published in the Journal of Child and Adolescent Psychopharmacology. Additional confirmation of our results has been published in a Letter to the Editor of the Journal of Clinical Psychiatry, by Dr. Miles Simmons, of Maine. Another
        manuscript containing an open label case series in children was
        published in April 2004 in the Journal of Child and Adolescent
        Psychopharmacology.

        A formal placebo-controlled clinical trial has recently begun in
        Calgary, Alberta, Canada: it involves adults with bipolar disorder who live in the Calgary area. It is using the newer version of Empowerplus (as opposed to the one employed in all previous publications). You can read about the current study on its website: http://www.MoodStudy.com. If you would like to be on our mailing list to receive reprints of this and future articles,
        please send me your mailing address.

        The following are some additional facts that may interest you:
        The ingredients of this supplement are mostly ordinary minerals and
        vitamins. They are certainly not unusual or exotic: a normal everyday
        diet includes 34 of the 36 components, though not in such high amounts.
        A full daily dose initially consists of 5 capsules three times/day (=
        15/day). [Note: our publications thus far employed an earlier version,
        containing many more capsules.] Most people decrease that to a maintenance dose after a few months, usually at about 4 capsules twice/day (=8/day). The ingredients are not a secret: they are listed on every bottle, at the Truehope website mentioned below, and in our published articles.

        If you are a physician considering using this supplement for patients
        who are currently taking psychiatric medications, I urge you to read Dr.
        Popper’s commentary carefully.

        To purchase this supplement, the distributor can be reached at the
        toll-free number on the website (www.truehope.com), which is
        1-888-truehope (1-888-878-3467). That is also the phone number to call
        if you just have general questions about the supplement. The Truehope
        people are not medical researchers or even health professionals, and
        you will see that the website is written for the general public. The
        Truehope people have a system in place for talking with you and the relevant physicians about the use of the product. Although they do not have health professionals available to provide guidance, this “friends
        helping friends” system will be able to provide information that might be
        helpful.

        None of the academic researchers benefit financially from the sale of
        this product. None of us ever receives any money from the Truehope
        people.

        Thank you for your interest in our work. If you have any further
        questions about the academic research, feel free to write directly to
        me.

        Bonnie Kaplan


        Bonnie J. Kaplan, PhD
        Professor, Dept of Pediatrics
        Univ of Calgary, Alberta Children’s Hospital
        Phone: 403-943-7363 FAX: 403-543-9100

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        • I just re-read the study. They found that the supplement reduced negative symptoms in the subset of people who had a gene that coded for poorer absorption of folic acid. I do not think they were clincially folate deficient at the outset.
          But I agree with Jill Littrell that it is very hard to do research on something for which there is no money to be made. Folic acid is a cheap generic substance. There may be many other substances that are deficient even in the diets of people who try to eat well given how much big agriculture has led to the depletion of vitamins and minerals in our soils.

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          • I was referring, probably too obliquely, to the Deplin studies.

            Still, that there is a population with folate processing difficulties — or subclinical low B12 — who might display “psychiatric” symptoms suggests we should do a much better job of screening for those conditions before treating with psychiatric drugs, which do absolutely nothing for the vitamin deficiencies.

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      • thanks–I’ll look into this. I also read some of the other comments. To me, this whole conversation screams that making money should have no place in medicine or drug development. The truth would stand a better chance without the sales mentality. I’m also certain that health care would also not be breaking the federal budget.

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    • Speculating about the finer points of receptor tetris for psychopharmacologists would be of interest if the expert psychopharmacologists got higher scores than those new to the game.

      Its this sort of bio-babble that has brought us to the woeful current state of affairs.

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        • Sure. But when you put it like that you make it sound like their is a problem with people not being offered medication. The problem is actually the reverse. To be fair you have addressed that to an extent.

          Where I feel you are off track is highlighted by your use of the word compliance. It speaks to a top down the doctor knows best approach. If you used the word concordance it would at least denote that your approach was to come up with a plan together. But i’m getting the feeling that you use the word compliance because that is exactly what you expect and if you used the word concordance it wouldn’t be accurate anyway as you don’t appear to believe in it.

          When you say compliance I can only assume that not taking medication long term is actually off the table. I don’t mean to be rude at all but your language doesn’t really stack up. How does one be non compliant with a recommendation not to take medication? Of course that rhetorical question needs no answer because recommendations not to take medication just doesn’t exist in practice.

          You probably tell i’m struggling to find a polite way to say that I find what you have written is rather disingenuous. I apologize if that seems a personal attack but I can’t find any other way to address the issue of compliance vs concordance and the mindset that each implies.

          The rest of the medical profession has long come to terms with the fact that “compliance” is a myth anyway. Medicine cabinets all over the western world stuffed with untaken pills are testament to that. It’s only professionals in the mental health world who go into bed wetting mode when their patients decide taking medication long term is not worth the candle.

          My other point is that the medical profession already knows long term use isn’t worth the candle. The reason they go on recommending them is nothing to do with patients though. It’s simply that it provides a legal defense if anything goes wrong. You can defend an action in court no matter what the outcome, inaction lays the doctor wide open. So the drugs are not for the patient. They are for the doctor. This simple fact needs no research. It’s a plain as the nose on my face.

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          • You make a good point about the use of the term compliance. This is a talk I will be giving to physicians and I used the term employed in medical settings. I am arguing for a more conservative use of these drugs and the context in which I am using that term is to point out what you are saying – people frequently do not take the drugs physicians prescribe. I will be elaborating on this more in future posts.

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          • I think you have a great point here Poet. Concordance (agreement) seems a fine term to be used between two equals who have agreed to something. So, in this case, if the physician and person involved with services agree that medication is something worth trying, what’s the best way to describe that, after beginning the medication, the person is taking the medication as directed? Surely we can do better than ‘compliance’

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    • Hi Jill,

      I always appreciate your intelligent comments on many issues of interest to those challenging biopsychiatry.

      However, your above response citing genes linked to schizophrenia is appalling to me based on all the junk science psychiatry has produced so far with a zillion different theories at about one new one per week to justify their bogus disorders invented and VOTED IN by the white old boy network of psychiatry in bed with BIG PHARMA to push the latest lethal drugs, ECT and other tortures on patent. Books like PSEUDOSCIENCE IN BIOPSYCHIATRY and books/articles by Dr. Mary Doyle make it all too clear that schizophrenia is a bogus stigma with no reliability or validity. She and other experts also make clear that symptoms attributed to schizophrenia or now bipolar, psychiatry’s latest “sacred symbol” per Dr. Thomas Szasz, are mostly if not completely environmental. Books like THE PROTEST PSYCHOSIS make psychiatry’s nefarious goals in creating such stigmas with varying symptoms and targets like young angry black men depending on the perceived need for increased social control all too clear.

      Anyway, Dr. Jay Joseph has written some great posts on this site recently and other great articles and books like THE MISSING GENE and THE GENE ILLUSION among many others to totally debunk any claim for genes causing bogus stigmas for the junk science DSM billing bible, which Dr. Loren Mosher exposed as far more political than medical.

      I find it offensive that you would post such THEORIES about schizophrenia when NONE have been replicated or proven!

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    • Omega-3s are good, but it’s also important to lower omega-6 intake. The amount of omega-6s in the normal diet is inflammatory. Better to replace oil high in PUFA (polyunsaturated fatty acids) with oil high in in monounsaturated fats or saturated fats. Especially avoid sunflower, soy and corn oil.

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  3. I am quite sure the rate of relapse after discontinuation of any psychiatric drug is inflated by the almost universal misdiagnosis of withdrawal symptoms as relapse.

    There are virtually no guidelines for tapering; we can be sure some of those who were observed to be relapsed in studies were discontinued too fast for their individual tolerances.

    In addition, of all the hundreds of clinical trials that involved observation (lasting only weeks) after discontinuation, I’ve seen exactly one that included a protocol to distinguish withdrawal symptoms from relapse. All the others — 99%+ of studies — use psychopathology scales for assessment. Any symptomology at all is going to be reported as a psychiatric condition rather than withdrawal symptom.

    The statistics for relapse are likely all incorrect. I would like to see some reporting based on slow discontinuation and careful observation of withdrawal symptoms during the process, and observation for at least 6 months post-discontinuation.

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    • I would like to see that too. But for now, when I discuss this with people, I think I am obligated to point out that relapse appears to be higher when the drugs are stopped. In my own protocal, the individuals who “relapsed”, appeared to have psychotic symptoms and this happened occured at least a couple of months after the most recent dose reduction. In two cases, it took weeks to see improvement after the drugs were re-started. I do not think I am following closely enough to get the information you would like to see. What do you think the time frame would be for seeing withdrawal symptoms after a reduction of 25% of the dose?

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      • Sandy, in my opinion, a dosage reduction of 25% is going to be too much for some of your people. If you observe them for a month, the most sensitive will become apparent — and they will be suffering a lot.

        However, for a middle group, withdrawal symptoms sometimes don’t show up for months. If by the second month you’ve decreased by another 25% or 50%, you’re putting those people in jeopardy of withdrawal symptoms after the final dose.

        To minimize withdrawal symptoms, I suggest a reduction of 10% the first month and another 10% for a second month. With 2 months’ observation, you will be able to tell who can reduce faster, by 10% every 2-3 weeks, and most of those who need to reduce slower.

        If this seems like a pain in the *ss, well, yeah, it is. That’s what the physical dependency incurred by these drugs does — puts those who are more neurologically vulnerable at risk for withdrawal symptoms.

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        • I am just not hearing about this. I concede that there is a tendency to not see what you do not think you will see and I will look harder but I am not getting many comnplaints about this. Are you shaving pills or compounding? I admit my rate of decrease is heavily influenced by the size of the pills.

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          • When you say not hearing about this, do you mean from your patients or other physicians?

            (If physicians — no surprise there. Most could not recognize a withdrawal symptom if it jumped up and bit them.)

            If patients, how are they doing after the second 25% reduction?

            We’re seeing people often can get about half-way down before further decreases cause withdrawal symptoms. My guess is because there’s a lot of excess capacity in common dosing levels.

            Also — people with no prior history of “psychotic” symptoms who are reducing antidepressants or benzos sometimes report psychosis-like withdrawal symptoms, such as hallucinations or depersonalization.

            I suggest this is indicative of withdrawal-induced nervous system instability. A person with a history of “psychotic” symptoms whose nervous system has accommodated to a drug may become similarly destabilized upon withdrawal. More gradual tapering would maintain the stability achieved on medication.

            Sleep disturbance during tapering is an indication of destabilization.

            There are many ways to reduce dosage by amounts smaller than the tablets supplied by drug companies. People use the liquid form of the drug, split tablets, weigh fragments with digital scales, open capsules to count out beads, have drugs compounded into liquids and smaller capsules, and make their own liquids with water or the Ora-Plus suspension base. They become expert in the use of oral syringes.

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        • Well put. The whole problem in a nutshell. If you stop taking them and don’t “relapse” then you apparently never had the so called disorder in the first place. So the “misdiagnosis” never comes to light unless you refuse to take the advice and stop taking the medication. Which as we have seen is a very very difficult thing to do.

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  4. “Once someone is started on these drugs, the risk of relapse is much higher when they are stopped than when they are continued.”

    Trouble is EVERYONE gets started on the drugs. Of course some people are more vulnerable to being screwed up by them than others. Any study is only going to discern that some people will be more or less screwed up by them. Not who should never have been started on them in the first place. That should be the focus.

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  5. Sandra,

    Welcome back. You know I don’t agree with stigmatizing people with bogus DSM VOTED IN labels that do a huge amount of harm or subjecting people to toxic drugs and other types of lobotomy that damage their brains, make them far worse in the short and long run and destroy their lives in countless other ways.

    At the same time, I give you a great deal of credit for continuing to engage in the learning process along with us at this site and doing your best to help people as much as you can while doing the least amount of harm given the less than ideal environment in which you work. Richard Lewis helped me to understand that many patients at Community Mental Health Centers may be poor, on Medicaid, under a great deal of stress and have few options. I apologize if I have misunderstood your situation, but I realize at times one has to do the best they can under the circumstances.

    I think you may have been misunderstood in one post in that it appears that you are stating what the current standard practice or protocol of mainstream psychiatry is and you are challenging some of that based on your own experience, research and increased knowledge including the fraud of BIG PHARMA now exposed by many experts like the brave, honorable Dr. Marcia Angell in books and articles.

    One of the problems that doesn’t get addressed enough here especially is those MISDIAGNOSED with bipolar for abuse related trauma, bullying and other crises for very nefarious reasons like drug company profits and higher incomes. People so stigmatized do not have psychosis or delusions though they can be falsely accused of having them and others due to their stress and trauma per Dr. Carole Warshaw and many other abuse/trauma experts with horrible consequences to women and children especially. Does that happen much in Community Health Centers? Do you deal with domestic/work/school abuse/violence/bullying issues in your work? If so, how are they handled?

    Obviously, anything like giving lesser stigmas, smaller doses of toxic drugs and tapering people off them as soon as possible, considering nutritional and better substitutes for drugs and other changes based on your increased knowledge is very beneficial to your clients.

    Did you ever get around to checking out Dr. Mark Hyman’s books and/or web sites like THE BLOOD SUGAR SOLUTION and the functional medicine approach he and others advocate that I suggested in an earlier email to you? He also has many good videos on the web where he suggests holistic and nutritional approaches to maintain a healthy mind, body and spirit. I highly recommend his approach.

    Sandy, You are a brave woman too!

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    • Hi Donna,
      Thanks for your comments. I did purchase Dr. Hyman’s book. I have not read it all yet (I have a large pile of “to be read”, may suggested by people on this website.)
      I think it is very important to pay attention to the foods we eat. In an attempt to practice to some extent what I preach, I recently cut out added sugar from my diet. Although I do not feel too different, I find it very helpful in managing my life long tendency to eat more than my body needs.
      Perhaps I was not clear in this post. When I talk about current practice standards – I am referring to what is the currently accepted practice by psychiatrists. I then go on to challenge that. In future posts, I will present the data in support of my views. I thought I had too much information for one blog. I will try to put this up weekly. I think it will take two more posts.
      Yes, I work in a busy community mental health center and most of the people with whom I meet receive Medicaid and Social Security disability. I have learned of some innovative treatment approaches but they often are very expensive. My personal focus is on helping to improve the care of people whose only option is the community mental health system. This is where most people in the US who have experienced extreme states will be able to get help.
      Regarding the distinction between labels such as Bipolar Disorder and labels such as PTSD, I agree with you that these distinctions are often not very helpful. People who have been traumatized can have a wide vareity of “symptoms” not just the ones found in DSM. In addition, the experience of having an extreme state can be traumatizing so it is very complex.
      But in the spirit of honest discourse, I admit that I still struggle with how to best help someone in an extreme state. Some of the people I see have gotten themselves into trouble when in these states, for instance, loosing a place to live, rupturing important relationships. It is heartbreaking. I still find that some of these drugs when used judiciously can be of benefit and I am still not satisfied that there are always other viable and effective alternatives although I continue to study and to be open to what others have to say.
      We do agree that Marica Angel is brave and honorable! As for me, I am just another human being trying to make it through the next day.
      Sandy

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      • I gained over 20 kg during the few years of my treatment. Less than a year ago I not only quit added sugar, I went on low carb diet. I eat just a little bit of rice or potatoes with meal, otherwise I try to eat plenty of vegetables, fish, chicken, etc. Now I’ve lost all those 20 kg I gained during the treatment and I feel great, and I don’t even feel like I want to eat any extra carbs anymore, the desire has dropped off.

        I can’t say how much this diet has changed my mood exactly, I’ve done plenty of other changes as well. For instance, after I get home after work, I try to go to woods for an hour or so of hiking. After that, I also do 30 minutes of zen meditation which is quite hard mental practice. (I don’t recommend zen for those very ill, it may be too hard and hardcore.) And other changes. But even besides all of this has been my own striving to understand how I can change my life, the pathways in my brain, I’ve been trying to understand this for 15 years already and I think I now have a good grip of the things that I can do to change my mind, body or brain without the help of shrinks at all.

        I mean, I think I have now found a good foundation for me, but it is not a general purpose system which will work for other people. But I think there are some things that are general. For instance, the effect of prolonged stress/inflammation/etc on the brain and maybe on neuroplasticity, for instance prolonged stress and bad health may deplete the brain from BDNF and other growth factors. Maybe, for instance, SSRI helps one group of severely depressed patients just because it, besides all its other unhelpful actions, it in one way or other reduces stress or increases BDNF or whatever so that the severely depressed patient can create more positive pathways to his brain. That is, in those cases where the drug works a little bit, maybe a subgroup of severely depressed patients, even in them the help doesn’t come directly from the drug but from the drug somehow allowing more BDNF, or whatever, and then at the same time kind of rewiring his brain networks or mind.

        There’s a recent study that anti-inflammation drugs can drastically reduce the effectiveness of SSRIs. Many sites nowadays say that SSRI may be anti-inflammatory, but if anti-inflammation drugs reduce the effectiveness of SSRI, it doesn’t sound so simple. SSRI has also been shown to increase cytokines related to inflammation in frontal lobes but now in the body in general, these cytokines can cause more release of BDNF, anti-inflammation drugs block these cytokines.

        I don’t claim this is the right way to think about the mechanism of SSRI, but it’s a good example of what some of the current neuroscientists are proposing. If you know the actual mechanism behind these drugs, it may give other ideas of whether it was a good idea to prescribe them in the first place, especially after a longer time.

        Do you know what is a good way to increase BDNF? Regular aerobic exercise. What is an efficient way to rewire the brain after you have your body in shape and all those good growth proteins abide in your brain? Zen meditation, self-determination, etc, etc. Donna said that something to the effect that people should become their own doctors. Sometimes it may be useful to go and see a specialist and ask questions about things you don’t know yet, maybe it would take too much time to figure it out and it’s more efficient to ask a specialist about the issue. But this shouldn’t be an authoritative system with psychiatrists trying to control their patients who won’t obey their orders, the patient and the doctor should be on a same level, the patient comes to his office and asks for objective information about the drugs and then the doctor tells what is known, and then then patient decides if he should try to the drug.

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        • Hermes, When I said something to the effect of so called patients needing to be their own doctors, I meant something like what you are saying in that anyone with certain illnesses should do lots of research/homework about their condition and recommended mainstream and alternative/holistic remedies for any recommended drug or treatment. The reason is obvious if you read about all the bogus BIG PHARMA studies, ghost written articles to tout dangerous drugs in medical journals relying on BIG PHARMA ads, doctors learning about new medicines from BIG PHARMA reps, luncheons or Key Opinion Leaders paid shills to tout these drugs to their fellow doctors, greed, indifference or doctors who may have good intentions but are often misled by BIG PHARMA, the medical profession with huge conflicts of interest, the corrupted FDA, etc.

          From my own experience, I was prescribed a medication for stress related irritable bowel syndrome by a gastroenterologist quite a while ago. Having learned the hard way that neither doctors or medications could be fully trusted for the wide variety of reasons above, I researched this new drug and found that it was for the opposite type of IBS than what I had along with other probable nasty “side effects” and if I took it I could have died. Later, evidence came out of massive organ damage and death from these drugs and they were taken off the market, so I was very grateful I did my homework in this like other cases for myself and family where lives were literally saved. I no longer have IBS since I eliminated certain stressors from my life. That was the real needed cure that doctors lie and deny!!

          Although I am increasingly disgusted with main stream medicine in general, one will probably have to go to a doctor for various nasty symptoms or illnesses, but even if doctors have the best of intentions, they are very busy and under a lot of pressure in so called managed care, the information they have is often corrupted and bogus even in the supposed best medical journals and they lack the time to keep up with the glut of professional information like most professionals. Decent doctors recognize that more of a team approach is needed between them and their patients as the limitations of the current broken medical system become more clear.

          So, I am not saying avoid real doctors (I do say avoid psychiatrists and so called mental health experts at all costs including many posing as holistic doctors), but rather, be prepared to do your own homework on your symptoms and/or condition, get second and even third opinions and research any recommended remedies from your doctor and other known experts with a great deal of credibility.

          Thus, to claim that I say to “be your own doctor” without the above caveats could be dangerous. But, I think you got my point and I like most of what you have said and recommended.

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        • Hermes,

          What is BDNF? I combed your article and missed it, but I admit to being overtired, so I may be missing the obvious. I hate acronyms!

          Claims that SSRI antidepressants reduce inflammation or otherwise improve or protect the brain make me shudder and recall the titles of books about biopsychiaty and SSRI’s in particular like TOXIC PSYCHIATRY and THE EMPEROR’S NEW DRUGS respectively. Also, PROZAC BACKLASH, THE ANTIDEPRESSANT ERA, LET THEM EAT PROZAC, YOUR DRUG MAY BE YOUR PROBLEM, 2nd ed. and the fact that the top 25 drugs causing the most violence published by TIME includes many SSRI drugs known to cause suicide, mania, violence, akathasia and other horrible iatrogenic effects than used to misdiagnose bipolar to create a new lifelong victim for the Psychiatry/BIG PHARMA cartel to destroy another life.

          Also, any claims of genetics causing or related to bogus DSM stigmas have been repeatedly proven bogus and more dangerous ad ploys for the psychopharma pathocracy. Dr. Jay Joseph addresses this fraud on his blog here and in his many articles and books like THE GENE ILLUSION and THE MISSING GENE.

          Given that the mental death profession has produced nothing but evil lies to justify their life destroying bogus DSM stigmas to push lethal psych drugs on patent for greed and profit after selling out to BIG PHARMA, I believe they have even worse credibility than the notorious “boy who cried wolf.”

          We have read about the sham BIG PHARMA ad ploys of chemical imbalances psychiatrists used to deliberately deceive their so called patients and the public to take toxic, useless drugs by their own admission per PSYCHIATRY UNHINGED by DR. Daniel Carlott (sp?) and many others. They have been lying about genes causing their bogus mental illness eugenics/euthanasia fascist agenda for decades that were used by psychiatry to justify gassing to death those they stigmatized as mentally ill in Germany based on American psychiatry before and after Hitler came to power they persuaded him to expand to Jews, gypsies and other “human vermin.” They happily transferred their killing apparatus and “selection process” to the concentration camps. Psychiatry has also been complicit in other modern day “ethnic cleansings” or eugenics projects against blacks and other races.

          All in the guise of genetic research to improve medicine and the health of the nation!!

          So, anything the mental death profession says about genetics should not only be subjected to the greatest scrutiny and many replications and review, but also, should cause the nation and its citizens to tremble with fear as to who will be the next target(s).

          This reminds me of a short story by Shirley Jackson called THE LOTTERY.

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          • Donna, BDNF is short for brain-defined neurotrophic factor. It is a protein which may help neurons to grow new axons, connections, etc. According to these latest theories about how SSRI help some group of depressed people a bit just because of these. For example, a neuroscientist from Helsinki uni, not a psychiatrist, called Henry Castren is now saying that people use the SSRI meds in a wrong way. He says that they may increase the BDNF in some people which may help their growth of new neurons. No, in fact he claims with his rat studies and his theory that SSRI meds are used in a wrong way.

            His theory is that SSRI meds may cause in some unknown way this BDNF protein to increase. But his point that he has been driving is that if you just use SSRI, it may cause an increase in BDNF or whatever, but it will not itself cause any relief. It will at most kind of open a window of new learning in some of the patients, but even that won’t help just because there’s more BDNF. That merely enables or helps the brain to learn more connections, but just enabling is it enough, the brain also needs to learn those new connections. Castren also says in his studies that a rat who got a running wheel and otherwise a good environment grew new connections in his visual cortex like the rat in a dark room or whatever with fluoxetine, that is, it was just useful to give the rat a running wheel than it was to give him fluoxetine? They were closing the other eye of a rat, then testing how much his visual cortex will change, etc.

            Their point is that in their theory, because maybe of the growth of this protein called BDNF, or some other factor they do not yet know, depression meds may open a window of new learning in some specific patients who perhaps lack this type of growth factors. It may be in a way true. But it does not really even help of you increase the serotonin or SSRI or BDNF or whatever, you also need to give internal/external stimulus that creates the new better connections. That is, at max. it may create a new ‘window of learning’ in some patients, but even that window is useless if you don’t use it.

            My additional point was that, if these new theories about the SSRI, window of learning, BDNF, inflammation, etc, actually there is not a single theory … Well, one of my points is that if all this reasoning about opening the window of learning and increasing BDNF in some patients is in fact true, it may be, the mechanism through which it does that increase of BDNF may be a sick one indeed and not a good idea in long term. The basic idea: SSRIs increase inflammation or a process like that and that increases the molecules involved in inflammation and that increases BDNF and that may just kind of enable some of the worst patients maybe to learn to break out of the negative loop of thoughts. I don’t know if this kind of reasoning is true or not and I know it sounds like a crackpot thing after you’ve heard years and years about the serotonin theory. But still, or even less in my opinion it sounds like a good idea to eat SSRI especially long term, maybe in some specific cases it might help a bit with concurrent other new stimulation/training in cases where the patient just can’t learn to a better kind of thinking despite continuous efforts.

            There are actually many different points in what I wrote about. One of the final points is that if all that reasoning about why SSRI and other similar antidepressants help with patients, that mechanism may be a sick indeed. Those chemicals actually cause kind of an inflammation in the brain and that will cause in the end the release of BDNF and other growth factors. This sounds like a crazy theory to many and there is no theory about it, but why do the studies suggest that it is so?

            And my bigger point was not to suggest the BDNF theory or the other reasoning, just to point that when you figure out another way how the drugs may actually work, it may instantly change the whole way of thinking about how/when/why to use these drugs. I have found my own way of reasoning, which is also kind of based on these later reasonings of some neuroscientists and psychatrists, which also doesn’t at all depend on meds or any know therapy and which in the end works better for me.

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          • There’s again no reply button present under altostrata’s message, so I have to reply to some other message.

            ‘Other neurologists view the increase in BDNF supposedly spurred by SSRIs as a response to injury, and not a good sign.’

            That is just part of what I was trying to suggest. That the good part in the ‘responding’ phase of the treatment in those severely depressed was because of in one way or other they ‘enabled’ the brain/mind to grow more positive connections or learn more positive thinking. Castren just found out an idea of window of learning and said that just enabling the window of learning is not sufficient for a better kind of thinking, you also need to grow those better connections with exercise or therapy or whatever.

            My additional point was that maybe the way SSRI and other amine antidepressants relieve depression in some of the patients is not a good idea to relieve the depression, at least in long term. The point is the same as what those neurologists say. My suggestion was that SSRI and other amine antidepressants maybe cause an inflammation kind of an effect in the brains of some of those people in who SSRI initially helps! And that effect also required some other internal/external therapy. A persisting inflammation caused by meds doesn’t sound like a good idea. I dont know if this reasoning is true idea, but maybe it is. No one explains why it isn’t a good idea, and I mean [i]theory[/i] and not practice, I already know that in practice the meds weren’t a good idea for me.

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          • Hermes,

            Thanks for the explanation. I have heard theories like this about SSRI’s supposedly being beneficial to the brain and even protective of he brain, but as far as I know such theories have been debunked as the usual junk sign. Also, it is typical of psychiatry to put a positive spin on a negative as you suggest in certain ways about inflammation as does Altostrata below.

            Since the scam of SSRI’s has been increasingly exposed in studies and books like THE EMPEROR’S NEW DRUGS: EXPLODING THE MYTH OF ANTIDEPRESSANTS that show that these toxic drugs are pretty useless and no better than placebo, psychiatry has been either fighting these facts with junk science articles/studies trying to negate them or posing alternative benefits of these dangerous drugs.

            Given the history of psychiatry and biopsychiatry in bed with BIG PHARMA, I won’t believe any of their great claims for their drug efficacy or safety any time soon especially for known toxic, useless drugs after all their lies and fraud that have harmed millions of people including children no less.

            You did a great job explaining BDNF, making a pretty complicated theory quite understandable. I learned a lot from your explanation too, which I appreciate.

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          • Hermes, this is an endless discussion, and off-topic attached to Sandy’s blog post, but I would challenge that antidepressants have any magical effect on depression specifically.

            Rather, like amphetamines and other psychoactive substances, they are stimulating or cause other neurological noise (such as emotional anesthesia) that some people report as relieving symptoms of “depression” (whatever that is). Others report effects that they feel as adverse, including — quite commonly — overstimulation.

            Antidepressants don’t “work” for depression any more than, say, LSD “works” for depression.

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          • altostrata: “Hermes, this is an endless discussion, and off-topic attached to Sandy’s blog post, but I would challenge that antidepressants have any magical effect on depression specifically.”

            I don’t think what I’m saying is an endless discussion or that what I’m saying is off-topic, well it may be off-topic in some reader’s view but directly related to the posts that Sandra made just before. Maybe that makes it somehow bad or off-topic.

            If you read what I actually wrote above, maybe you’ll also get the idea that maybe SSRI or monoamine antidepressants are maybe not a good idea in long term.

            [quite]
            Rather, like amphetamines and other psychoactive substances, they are stimulating or cause other neurological noise (such as emotional anesthesia) that some people report as relieving symptoms of “depression” (whatever that is). Others report effects that they feel as adverse, including — quite commonly — overstimulation.
            [/quote]

            Yes, and I just tried to explain why they may cause a little bit of actual relief from one group of the severely depressed people.

            [quote]Antidepressants don’t “work” for depression any more than, say, LSD “works” for depression.[/quote]

            Actually I think that LSD or magic mushrooms or ecstasy may be a good thing in rewriring the brain in just one session, just if it’s given in a therapeutical context, not in a getting fucked up context. They may work just after one session. Actually I think LSD may have much potential for curing depression if it’s used in a proper manner.

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          • Again, the reply button is gone and there’s no way to modify one’s broken reply. But I need to add one more point. 🙂

            altostrata: “Hermes, this is an endless discussion, and off-topic attached to Sandy’s blog post, but I would challenge that antidepressants have any magical effect on depression specifically.”

            I want to add one final point, and that is that it may be that using a chemical at one point to a some brain may be sometimes useful. I think that there’s some proof that it may be be in more severely depressed patients more beneficial to take SSRI in at least short term than placebo. I agree we don’t know if it’s a good idea for them to take it in a long term and it may be that the drug doesn’t work even short term for the mid or low depressed patient. But I don’t think it’s an a priori wrong idea that some chemicals may help some persons in some way if used in a right way. The important questions are such things as what they actually do in the brain, in what way they may help some people, etc.

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    • Sandy,

      Thanks for your response. Unfortunately, you totally misunderstood me when I pointed out the huge harm by psychiatry to abused women and children by giving them bogus bipolar and other misdiagnoses for their all too normal stress reactions to abnormal, abusive, often psychopathic, narcissistic, misogynist men with psychiatry having far more than their share of them.

      This reference source, THE ENCYLOPEDIA OF DOMESTIC VIOLENCE, is one of many sources exposing the huge harm psychiatry does when invalidating the victims while aiding and abetting the abusers with bogus psychiatric stigmas with the worst and most common fraud being bipolar now.

      Although PTSD was added to the DSM to acknowledge combat and domestic violence related stress and trauma as normal reactions to abnormal events, many psychiatrists are publishing bogus data about many being predisposed to PTSD so they can blame the victims and deny them any justice, safety, military benefits, etc. I think this is despicable and all too common for the top dogs of psychiatry to collude with the power elite, BIG PHARMA and other self serving interests as you have acknowledged to your dismay, which adds all the more to the victims’ suffering when those who are supposed to help cause the most harm. Dr. Aphrodite Matsakis exposes the shock and misery created by such betrayal by so called legal, medical and other “professionals” who retraumatize trauma survivors.

      Here is an excerpt from THE ENCYLOPEDIA OF DOMESTIC VIOLENCE showing the harm of bogus bipolar and other stigmas for abused women and children, which is all too common:

      http://books.google.com/books?id=OcDBZ0uNNVIC&pg=PA694&lpg=PA694&dq=abused+women+misdiagnosed+by+psychiatry&source=bl&ots=6zZ4YwmNLv&sig=7NlV1qkNScLARf7N5H6NmMl1XMw&hl=en&sa=X&ei=CjVIT4zjCePq0gGMp6yzDg&sqi=2&ved=0CC4Q6AEwAg#v=onepage&q=abused%20women%20misdiagnosed%20by%20psychiatry&f=false

      I am not sure what you mean by extreme states. Abused women and children are not psychotic, delusional, paranoid or making things up in any way, shape or form. They will show signs of great PHYSICAL and emotional stress while being INVALIDATED and falsely accused of being crazy (bipolar) is certainly crazymaking at best and plays right into the hands of her abuser that can include family, community and other bystanders in a patriarchal world.

      So, I will let Dr. Carole Warshaw, Psychiatrist, and nationally recognized Domestic Violence expert speak on the huge harm done to abused women and children by psychiatry out of ignorance, malice, fear or indifference:

      Psychiatric News | July 19, 2002
      Volume 37 Number 14 page 8-8

      Psychiatrists Urged to Ask About Domestic Violence

      Carole_Worshaw.jpeg

      Carole Warshaw, M.D.: “We are trained to diagnose psychiatric disorders without looking at the social context that might have generated the patient’s symptoms.”

      In addition, she noted, research shows that 43 percent of women seen in outpatient mental health settings were sexually abused as children, and 35 percent were otherwise physically abused.

      The psychiatric impact of domestic violence is great. Women with a history of childhood abuse are more likely to be abused as adults than women without that history, said Warshaw. “Rates of posttraumatic stress disorder are also higher in adults with childhood abuse than without childhood abuse,” said Warshaw.

      However, symptoms of severe childhood trauma including flashbacks, dissociation, mood fluctuations, and impulsive behavior are often misdiagnosed as hallucinations, psychosis, and bipolar disorder, leading to treatment that doesn’t address the underlying issues, she said.

      Warshaw directs the Domestic Violence and Mental Health Policy Initiative at Cook County Hospital in Chicago, which brings together more than 70 domestic violence, social service, and mental health agencies in a collaborative partnership to identify common goals, barriers to services, and gaps in services to improve and provide integrated services for victims of domestic violence and their children, according to Warshaw.

      Domestic violence survivors who participated in a 2000 survey conducted by the Domestic Violence and Mental Health Policy Initiative reported feelings of sadness, loss, despair, depression, loneliness, shame, isolation, confusion, guilt, loss of identity, fear, anxiety, stress, insecurity about their capabilities, and somatic symptoms, said Warshaw.

      Moreover, studies of women victims in shelters and clinical settings have reported that about 60 percent had PTSD, 50 percent had depression, and 20 percent had suicidal thoughts or had attempted suicide, said Warshaw.

      “PTSD increases the risk that a victim will develop major depression and diminishes her ability to seek help, make decisions, and mobilize her resources to leave the abuser. It also increases her risk of being isolated and controlled by the abuser,” said Warshaw.

      Missed Opportunities

      Psychiatrists may be unaware that abuse can precipitate a patient’s psychiatric symptoms. “We are trained to diagnose psychiatric disorders without looking at the social context that might have generated the patient’s symptoms,” said Warshaw.

      Psychiatrists fail to ask about abuse because they don’t think it is prevalent among their patients, don’t have the time, and don’t know what to do if they identify it. They may also find it difficult to tolerate the pain and helplessness they feel when patients talk about their experiences of abuse or when their own traumatic experiences are evoked, said Warshaw.

      In the eyes of domestic violence survivors and victim advocates, labeling survival strategies as psychiatric disorders is a barrier to mental health care. “It is important to acknowledge to survivors that dissociation, self-medication, appearing passive and compliant, and self-blame are understandable responses to terror and entrapment,” said Warshaw.

      Additional concerns regarding mental health care identified by domestic violence survivors and advocates in the 2000 survey were not receiving comprehensive mental health services, the abuser’s controlling the victim’s health insurance, initiating couples counseling before knowing the risk to the victim, and not informing the victim that psychiatric diagnoses can work against him or her in child custody battles, said Warshaw.

      Screening and Documentation

      Psychiatrists often find it awkward to raise the topic of abuse, especially when there are no obvious signs. Warshaw recommended asking abuse-related questions routinely and framing them in a way that shows interest and acknowledges that it is a common experience, said Warshaw.

      A sample statement is “I don’t know if this has happened to you, but because so many women experience abuse and violence in their lives, it’s something I always ask about,” she said.

      Warshaw cautioned against asking a patient about abuse in the presence of a potential perpetrator and to be aware if a perpetrator seems “psychologically healthier than the victim. Abusers know how to manipulate the mental health system to further control the victim,” she said.

      If a woman says she is being abused, Warshaw suggested asking her about specific acts of abuse and documenting as many facts as possible, including when and where the abuse happened. She also recommended asking detailed questions about patterns of abuse, tactics of control and intimidation, level of fear and entrapment, sexual coercion, and the impact of the abuse on the woman and any children.

      “Documentation is critical for women seeking legal protection, redress, or custody and provides a safe opportunity to examine the ongoing nature of abuse and its impact,” said Warshaw.

      In addition to obtaining a history of abuse, a causal relationship between domestic violence and mental health issues or diagnosis should be established, said Warshaw. She also recommended documenting the patient’s strengths, coping strategies, and ability to care for and protect her children.

      The patient should also be informed about the limits of confidentiality and the risk that her medical records could be subpoenaed in a court case involving child custody, said Warshaw.

      Assessing the patient’s safety is a critical part of treatment planning, said Warshaw. These are some questions that psychiatrists can ask their patients:

      • Is the abuser present or likely to return to the clinical setting?

      • Is the victim afraid to go home?

      • Is the abuse escalating?

      • Are there weapons present?

      • Is substance abuse a problem?

      • Is the victim planning to leave?

      Warshaw urged psychiatrists treating victims of domestic violence to give them information about domestic violence and local advocacy resources, including shelters, support groups, and national advocacy resources.

      “Victims may need to call a local domestic violence program, the National Domestic Violence Hotline [(800) 779-SAFE], or develop a safety plan before leaving the clinical setting,” said Warshaw.

      A list of state domestic violence coalitions and their telephone numbers is posted on the Web site of the National Domestic Violence Hotline at http://www.ndvh.org/helpstate.html. The Domestic Violence and Mental Health Policy Initiative Web site at http://www.dvmhpi.org should be live in the next month, according to Warshaw. Posted items will include “Recommendations for Addressing Domestic Violence in Mental Health Settings.” ▪

      Sandy, With all due respect, you really didn’t answer my question about how much you encounter domestic/work/community violence and bullying and the fate of the victims. Whether the victim is validated as Dr. Warshaw and other domestic violence experts recommend while avoiding harmful, bogus labels like bipolar or if she is just callously given a bogus stigma with lethal drugs that will hinder her ability to focus and create an escape plan for herself and children is a matter of life and death. Although it is taken for granted that domestic violence takes place in lower income groups, the book, NOT TO PEOPLE LIKE US: HIDDEN ABUSE IN UPSCALE MARRIAGES, shows that such violence against women is alive and well at all income levels with those in higher income marriages the most invalidated of all.

      Again, though I don’t agree with all of what you do and say, if I HAD to be under the care of a psychiatrist, I would hope to get someone like you who tries her best to first do no harm or at least minimize the harm as much as possible when one is faced with people causing great harm or being subjected to great harm themselves. And I hope you see that giving an abused woman a bipolar stigma plays into the hands of the abuser while robbing the woman of her children while further endangering them, her fair share of the home and assets, career, friends, community and all else she holds dear, which is totally unconscionable if one considers these horrific consequences.

      I’m glad you are checking out Dr. Hyman’s book, which can be helpful to your own health and well being too. You might find it quicker and easier to check out his online videos. I’m sure you know a great deal of this by now anyway, but I was very impressed with an example Dr. Hyman provided online of functional medicine being applied to find the causes of symptoms given the bogus ADHD stigma.

      You are making a wise choice eliminating sugar because many doctors/experts are exposing sugar is poison and sadly, corporations covered up this dangerous fact exposed by courageous scientists in the past just as they do with toxic drugs, pollution and junk food today. We must all be our own “doctors” in the sense we need to do lots of homework before automatically trusting someone just because they claim to be experts, doctors or scientists who may have huge conflicts of interest that don’t include our interests at all.

      Again, I give you a great deal of credit for struggling with such difficult issues for the best interests of your patients and society while I won’t deny that some day I hope psychiatry as it now exists with life destroying stigmas and lethal treatments will be replaced by a type of holistic treatment for mind, body and spirit that enhances health rather than destroying it.

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        • Sandy,

          I think it is obvious I was asking you to address far more than whether you deal with “victims of abuse” when you already said you did in another post. I was asking about women and children subjected to domestic and other violence in particular since they are the most frequent victims of violence in our sexist society. This is true despite the supposed “men’s movement” of abusers who frequently seek child custody they don’t even want to rob their victims of all marital and other assets and to destroy their lives in general along with those of their children. Dr. Peter Breggin addresses this issue in TOXIC PSYCHIATRY and elsewhere too. Lundy Bancroft’s books like WHY DOES HE DO THAT and others also describe the problem quite well. Dr. Frank Ochberg, Psychiatrist, also addresses the abuses of psychiatry with regard to abused women in books and his web site, THE GIFT WITHIN as does Dr. Judith Herman in her classic work, TRAUMA AND RECOVERY. Dr. Herman points out in this book that abused women used to get the insult stigma of borderline personality disorder ensuring she would be treated with contempt and disbelief. So, women entering into the landmines of psychiatry are in for a nasty surprise when one considers Dr. Phyllis Chesler’s WOMAN’S INHUMANITY TO WOMAN and other shocking betrayals.

          It appears that you do not wish to address these issues here though the bipolar and other bogus stigmas that lead to neuroleptic and other toxic drugs for such victims of domestic violence are highly inappropriate and cause great harm to them in the long run as the above resources I cited make all too clear.

          It seems that the “kindest” thing to do would be to steer them away from the “mental health” profession and to local domestic violence experts, shelters and hotlines since psychiatry really has no way to deal with such victims as Dr. Carole Warshaw and others in the profession expose all to clearly. Yet, as Dr. Peter Breggin exposes, once biopsychiatry came on the scene, “the most dangerous thing one can do is visit a psychiatrist,” and this is most apt for abused women and children.

          I won’t pursue the topic further, but I must say that I am very disappointed with your response given that a vast majority of those targeted for bipolar and other harmful stigmas that result in lethal drug cocktails including neuroleptic drugs are abused women and children who are not psychotic, delusional or otherwise the supposed candidates for such “treatment.” I’m sure that other people just experiencing normal life stressors or crises fall into this category too and I think it would be great if that was addressed on this web site too. You and others seem to limit your entire approach to those with psychosis or similar symptoms when those stigmatized with bipolar especially now include a vast number of pretty normal people caught in psychiatry’s ever widening net.

          But, women and their children especially have frequently been the main targets of psychiatry along with many other abuses of power.

          I rest my case.

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          • Hi Donna,
            Sorry to disappoint you. I have tried to stay, in these blogs, in areas in which I feel I have something to say. I have concerns about the broadening of the diagnosis of Bipolar Disorder and maybe someday, I will address that in a way that is less disappointing for you but for now, you are correct, that I am choosing to not address your concerns in detail.

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          • Sandy, I have to respond here because there is no button under your answer.

            During this exchange, it occurred to me to wonder if you have any background in family systems therapy approaches, work/school bullying and mobbing, domestic violence and other toxic environmental stressors that can cause extreme emotional distress or trauma symptoms. Or is your only expertise in DSM labels and so called psychopharmacology as is true of most psychiatrists today?

            The reason I ask this is that I have done a great deal of research on both of the above topics and as Dr. Carole Warshaw exposes, psychiatry is very ill equipped to deal with domestic violence or any severe environmental stressors. She laments the fact that psychiatrists are trained to focus only on symptoms and not any environmental stressors that contribute to the extreme states you mention, which fuels the many bipolar and other misdiagnoses. Obviously, the focus on the symptoms is done to match them with very harmful psychiatric diagnoses to justify using drugs that are mostly useless while having very toxic effects.

            When you say these drugs “help” people that seems to be from your perspective as a psychiatrist and those in the victim’s environment. It may be that those wanting to stigmatize and drug the victim may be the real villains subjecting the victim to group, work or family violence and oppression the victim is brainwashed to believe they deserve. Family systems therapy speaks of the “identified patient” while knowing the whole family or system is the sick patient that needs to become more functional as a whole rather than scapegoating the person acting out the family drama. This may have been part of the approach of OPEN DIALOG. Such great books as STALKING THE SOUL by a French psychiatrist deal with perverse abusers who have a huge negative impact on those they subject to their psychological terror and torture in homes, work places or any place they are able to find new victims. The author admits psychiatrists tend to wash their hands of such cases because even they don’t want to deal with the perverse abuser!! Unreal!

            Does it ever occur to you that the so called extreme states you encounter are due to toxic environments and relationships that would best be escaped rather than stigmatizing and drugging the victim into submission thus ensuring their being stuck in a deadening, deadly environment of despair as is the case with domestic violence and work/school bullying/mobbing? It is also true that someone subjected to such abuse for a long time can get very angry indeed often used against the victim as well.

            Toxic, dysfunctional, narcissistic families per many experts are known to enforce rigid roles of a golden child, scapegoat, clown, lost child and others that enforce a sick environment that ensures problems cannot be discussed and the status quo is rigidly maintained. Perhaps those you encounter in extreme states are family scapegoats suffering through intolerable no win situations. If you stigmatize and drug them into submission, you end up enabling and reinforcing the toxic family dynamics that the victim should be escaping rather than accepting such a destructive, miserable existence.

            Anyway, I realize you said you don’t wish to address these issues here and now, but the truth is if you aren’t familiar with these issues and don’t address them, I don’t see how you can really properly assess the problems of the people you encounter or truly help them to cope other than giving them life destroying stigmas and toxic drugs. Such stigmas and torturous drugs will certainly shut the patient up because they know they are being punished, invalidated, blamed, scapegoated, tortured and destroyed, so they are unlikely to resist given their situations and the power of psychiatry to increase dosages, inflict even worse treatments and otherwise abuse their power whether they realize it or not.

            Anyway, I hope you will give such issues some thought since I think they are at least as important as DSM labels and toxic psychiatric drugs.

            Thank you for your honest answer.

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      • Donna, thanks for the awesome post! The quotes from the “encyclopedia of domestic violence” were particularly good. I had never heard of that book, despite my working in the field of social work. And it’s good to know that this stuff does get published in mainstream journals, even though I don’t see anyone in the psychiatric field paying much attention to it.

        — Steve

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        • Steve,

          Thanks so much for the validation and encouragement. I do feel quite alone and unsupported expressing these critical views by very caring psychiatrists and mental health experts who actually address the victims’ toxic environments, the real cause of severe emotional distress that is falsely attributed to bogus claims of “mental illness” to fuel the biopsychiatry global money machine for the power elite at the huge expense and harm to the majority.

          And to be honest, it takes a great deal of hard work and time to ferret out this information, but fortunately I have degrees and lots of experience in research areas that have been a great asset in this long term endeavor of seeking the truth about many things I learned that I had been grossly misled about in my youth. Dr. Thomas Szasz warns that it is our responsibility to learn about such social institutions as psychiatry to avoid harm. I have found out that is also true of the legal profession, government in general, main stream medicine, corporations and other institutions I naively trusted before they proved they were totally unworthy of such trust as a whole.

          That does not mean that everyone is included in such a critique. The problem is that those controlling main stream medicine and psychiatry in power structures like the AMA and APA and other professions make decisions they force on the rest of the profession that are not in the best interests of patients or consumers since they exist to gain more money and power for their profession and not on behalf of their clients. Though the majority do go along to get along, fortunately, there are always those mavericks who act as whistleblowers for the rest of us and I am eternally grateful for them. Society owes a huge debt for those who take risks to protect the rest of us. I greatly admire Dr. Carole Warshaw, Psychiatrist, who is a domestic violence expert and the subject of an article I posted above. I tout the huge contributions of Dr. Peter Breggin frequently too since he has been a lifesaver for many.

          Thanks again for your comment. It made my day.

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          • I also want to express my appreciation for your contributions to the conversation, Donna. I can assure you that the trauma-informed perspective is more than welcome here. I keep an active eye out for trauma-informed research that is pertinent to the MIA mission, as a means to encourage that dialogue. I am more than grateful for your perspective and knowledge base.

            The MIA mission is a delicate one, as I see it; to work from within the psychiatric theory and research. Robert Whitaker has accomplished what he has by doing this scrupulously; avoiding stands on what “psychosis” or what-have-you is or is not, and looking at outcomes. Within that framework, yours and others’ perspectives on the implications are welcome and necessary.

            I see Sandy’s reserve on the subject as appropriate. Within what she is saying there is room for discussion of alternate perspectives. More than that; alternate perspectives are called for, and we are all the beneficiaries of yours.

            You are every bit as essential and integral a participant in this website’s mission as is Sandy, Bob or myself. Thank you for staying engaged.

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  6. When I stopped all the psychiatric drugs I was put on cold turkey (at the time it was a cocktail clomipramine/sertraline but I had been in the past on Zyprexa, Risperdal, Dextroamphetamine and Lorazepam that I had previously stopped with supervision) I felt terrible for a couple of weeks. Terrible as in “brain zaps”, nausea, general bad feeling. So bad that I even thought about going back to them. Fortunately, I was able to resist the temptation, encouraged by testimony of people who had gone through the same process who said that eventually those withdrawal symptoms go away. They do go away, and with them the extra pounds, the skyrocketing cholesterol levels and the kidney/liver malfunction. It’s been a long time that I have been off drugs and I doing great.

    I was diagnosed with OCD, a diagnosis that I consider as fake as all DSM diagnoses. Yet I was put on all kinds of drugs of the psychiatric arsenal: antidepressants, antipsychotics, anxiolytic and stimulant. Because my cholesterol level skyrocketed my psychiatrist wanted me to be put on cholesterol drugs as well (but I refused). So!

    I think that psychiatric drugs should be banned, period. Psychiatry should be declassified as a medical specialty and be given the same legal status as astrology or homeopathy. Period.

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      • Thank you as well for clarifying that you believe in coercion and force when your demands are not met as evidenced by your use of the word compliance instead of concordance.

        For your information compliance is not the word used by all medical professionals so I can only imagine you are speaking to a rather backward thinking group of doctors.

        It’s not the existence of the drugs that is the problem it is that they are forced on people. It’s the people who use that force that need to be dealt with. It is they who are the problem, not the drugs.

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      • Sandra,

        Although I appreciate the evolution you’ve made during the past year, I still find your defense of coercion in “some cases” troublesome. The late Thomas Szasz gave a delightful talk 10 years ago at the CATO institute debunking that concept http://www.cato.org/multimedia/events/libertarian-principles-psychiatric-practices-are-they-compatible . In his view, which I share completely, on the matter of coercive measures, there is no middle ground, one has to be an absolutist. He criticizes psychiatrists like Peter Breggin for their willingness to accommodate the psychiatric establishment as the slave owners who were “nice” to their slaves. The real problem is coercion. Abolishing it is a noble a goal as the abolition of slavery, or the battle against racial segregation were. I will not be satisfied until that goal has been accomplished. In his talk he very accurately, from a historical point of view, traces the emergence of coercive psychiatry as a replacement of institutions such as the inquisition.

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        • I respect your point of view and agree that this is a big problem for which I do not pretend to have the best answers. I support you in your goal. I would love to get some help on developing safe alternatives for people who are in extreme states who are not able to be helped within our current system of care.
          Even in Vermont some of the alternative programs do not accept people who are aggressive. They get sent to the emergency room where I sometime work. They are sent to the jails where I sometimes consult. I would love some help – that goes beyond saying this is a bad thing – to figure out an alternative.

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          • The answer is found in the Constitution.
            14th Amendment
            “Due Process” clause

            The right to a trial with an attorney.
            Want to lock someone up, and/or force them to take drugs?
            *Prove* the case in court.

            Otherwise, set the person free.

            We make this stuff so complicated.
            It really isn’t.
            The *complication* is due to the feelings of those in the mental health system that they must do *something*.

            Really?
            And what happens if you do *nothing*?
            If *something* causes more harm than good.
            Then do *nothing*.

            I find it interesting that conservatives and libertarians are so often dismissed – theirs are the views that are the most *radical*, the most *revolutionary* – the most *truly* “progressive”!

            In short, unless you have permission to “treat” someone, leave them alone!

            Duane

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          • I agree with Duane. If you give a serious thought at what you are defending it comes down to this:

            – One system for everybody who has not been labelled “mentally ill” in which you cannot be deprived of your freedom unless you commit a crime (and to be deprived of your freedom you have to be shown to be guilty beyond the “reasonable doubt” standard, which is as tough as it gets, in a court of law).

            – Another system for those who have been labelled “mentally ill” in which you can be deprived of your freedom because some psychiatrist thinks so. In the US we are lucky that there is SCOTUS case law that limits that further so that a psychiatrist needs to show “dangerousness”, but still, this idea that a psychiatrist can lock you in without you having committed any crime whatsoever and without a trial is troublesome. In the European country where I was committed, and in fact in most of the European Union, the situation is even worse. There a psychiatrist only needs to show “need for treatment”, which is a vague standard that gives psychiatrists power to basically commit anybody they want, and ruin their lives in the process, as they did with me.

            Your coming to the good side will not be fully completed until you renounce psychiatric coercive measures.

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          • “Of all tyrannies, a tyranny exercised for the good of its victims may be the most oppressive. It may be better to live under robber barons than under omnipotent moral busybodies. The robber baron’s cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end, for they do so with the approval of their own conscience.” – C.S. Lewis

            I LOVE these words!

            Duane

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        • Thanks for this Szasz link cannotsay.
          At about the 31 minute point, Dr. Szasz makes a good point, one of many, that may have some bearing here. With the emergence of “Right to Treatment” there has come this belief by the State that it has a right to use coercion and violate your civil liberties. Szasz makes the point that this is due, in part, because we’re not talking about voluntary contracts between two people where money is exchanged for goods and services. So, if we insist on a “Right to Treatment” and the person doesn’t have the ability to pay for that treatment thru a voluntary contract, the State seems more than happy to treat, but under its own terms which include coercion. So how do we go about reforming this when there are many individuals who just can’t afford “treatment” via private contracts? Some States have piloted programs when State subsidy funding are giving to individuals for treatment “of their own choice” But these projects always have stipulations that prevent true freedom of choice. It’s a thorny but important topic.

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          • Thanks. I believe that Thomas Szasz was an intellectual giant. While it’s unfortunate that he associated himself for a while with Scientology (although by the time he made that speech he had already distanced himself from them), there is no doubt in my mind that we in the psychiatric survivor movement have been all catching up to the ideas he introduced in 1960 http://psychclassics.yorku.ca/Szasz/myth.htm . What he said there was as true than as it is now.

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        • Dear cannotsay2013,

          I feel bad to see Dr. Peter Breggin bashed from time to time on this web site. Many people like me owe Dr. Breggin a huge debt because thanks to his books like TOXIC PSYCHIATRY he wrote many years ago when psychiatry sold out to BIG PHARMA in the 1980’s, he helped me to see through the lies/fraud of biological psychiatry and rescue loved ones from having their lives totally destroyed based on his excellent advice. Many psychiatric survivors also greatly benefited from Dr. Breggin’s work and they respect him very much including David Oaks and many Mind Freedom members.

          I totally disagree with you that Dr. Breggin accommodates the psychiatric establishment in any way. In fact, he refuses to use DSM stigmas in his own empathic therapy and also refuses to drug or commit anyone.

          Other critics complain that he charges huge hourly fees and doesn’t provide free therapy to the poor.

          I find these criticisms very unjustified because over a period of many years, whenever psychiatry came out with some new dangerous, fraudulent claim or practice, Dr. Breggin was right there to write articles and speak to Congress to alert the public and fight against them usually alone and unsupported while being attacked by the top dogs of the APA and BIG PHARMA in bed with each other. He exposed that certain high level psychiatrists plotted to prey on black children with a prejudicial racist supposed treatment program for youth violence that he was able to nip in the bud. He wrote about this in his book, THE WAR AGAINST CHILDREN OF COLOR.

          In recent times, he has exposed and fought against the great comeback of brain damaging ECT and the permanent amnesia and loss of one’s capabilities incurred from this barbaric treatment while psychiatrists with vested conflicts of interests have promoted it as very safe and effective just as they have done with toxic psychiatric drugs he has exposed also in his many books like YOUR DRUG MAY BE YOUR PROBLEM, 2nd ed. and many others.

          Please cite specific examples of how and when Dr. Breggin accommodated the psychiatric establishment. Did Dr. Szasz specifically cite Dr. Breggin? I find that very hard to believe since I have been following Dr. Breggin and his fine work as the conscience of psychiatry for many years and am familiar with most of his writings and work.

          I am sure it costs Dr. Breggin plenty of time and money to constantly write articles about the latest frauds perpetrated by psychiatry like comebacks of lobotomy and to appear before Congress frequently to protest such critical issues like the psychiatric drugging driving our soldiers to suicide and disability, psychiatry’s predation on children and many others.

          I have never read about or seen one instance where he sold out to the psychiatric establishment in the many years I have followed Dr. Breggin.

          I would trust Dr. Breggin any day of the week with my loved ones and myself.

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          • Donna,

            Breggin is mentioned indirectly by Szasz as an answer to a question (somebody asked Szasz about a few psychiatrist who were trying to work from within, Breggin was one of them, but Szasz said that none of those mentioned had done much to expose psychiatry or something along those lines) . Bear in mind that Szasz had little patience with those seeking accommodation. I think that Breggin has done a lot of great things for our case. Yet, I find myself increasingly in agreement with Thomas Szasz that in the matter of coercive psychiatry there cannot be middle ground or “third way”. It’ really black and white. Either you are OK with coercive psychiatry or you are not. Anybody who is for some kind of middle ground is in fact justifying evil, even if it’s in “a few extreme cases” whatever that means.

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          • Hi cannotsay2013,

            I totally disagree with this interpretation of what Dr. Szasz said knowing what I know about him and Dr. Peter Breggin, which is quite a bit. Dr. Szasz was not against voluntary relationships between patients/clients and psychiatrists for therapy or trying to improve one’s life by trying to solve life problems with outside help. He felt that’s all that psychiatry was dealing with: life problems or crises that people might be experiencing for which they might seek outside qualified help or advice, which he advocated as long as the relationship was totally voluntary without government interference. Dr. Szasz exposed that the problems came when psychiatry and the state joined forces and psychiatry became a hidden police force to rob certain annoying or inconvenient people who had not broken the law of all their civil, democratic rights in the guise of mental health with forced commitment, drugging and other abuses of power that Dr. Szasz called THE THERAPEUTIC STATE, the title of one of his many books. He showed how psychiatry like the Catholic Church it replaced had become a tool for government to engage in the latest inquisitions and witch hunts to destroy any heretics who might be political dissidents or those inconvenient to those in power, family members, etc. This was all done supposedly for the good and safety of the so called mental patient and society, a total fraud and abuse of power by the state/psychiatry alliance as Dr. Szasz exposed as did Dr. Breggin.

            Dr. Peter Breggin has not worked within the psychiatric establishment in the least bit in that he has attacked bogus DSM stigmas, toxic psychiatric drugs, ECT, lobotomy, forced drugging, racist treatment agendas, sexism and forced commitment and every other abusive mainstream practice in his many articles, books, web sites and appearances in the media and before Congress and on and on that brought on constant attacks by
            mainstream psychiatry and BIG PHARMA.

            Though I greatly admire Dr. Szasz for his brilliant mind and enlightening books, I think Dr. Breggin made a far greater contribution to the survivor movement especially with his first book, TOXIC PSYCHIATRY, that warned the public of the dangers and sham of the new biological psychiatry in a very practical way. He also gave great advice to expose the fraud of psychiatric diagnoses and escape the system, which worked very well at least back then. I don’t see how anyone could be more of an outsider than that since most psychiatrists fear making the slightest criticism of mainstream psychiatry since they know it might damage their careers. Dr. Breggin and his wife like Dr. Szasz and other critics of psychiatry were accused of being Scientologists and both were subjected to many professional attacks, ostracism and attempts to marginalize them as quacks, which is the typical approach of the APA and the psychiatry top establishment for those who dare to challenge or question them. That’s because power corrupts and absolute power corrupts absolutely.

            Given what we know now, both Dr. Szasz and Dr. Breggin have been more than validated for their brave stance exposing the harm of the “new” biological psychiatry. Robert Whitaker exposes how this new paradigm came about, which was far from scientific, noble or ethical, but rather, to save the ailing profession of psychiatry by selling out to BIG PHARMA.

            Anyway, either Dr. Szasz misunderstood Dr. Breggin or you misunderstood Dr. Szasz in my opinion since there is no way Dr. Breggin could ever be associated with mainstream psychiatry. I’d suggest you read his books, his many articles and web sites in order to be fair to him.

            One thing that may have caused this misunderstanding is that Dr. Breggin like Dr. Mosher worked as therapists in the psychiatry paradigm that existed before the APA created the new DSM biopsychiatry paradigm by selling out to BIG PHARMA. Both Dr. Mosher and Dr. Breggin were already using new and unusual approaches like Dr. Mosher’s Soteria project while they could be said to be insiders in a certain sense before the new biopsychiatry. But, it was their insider status that made them invaluable as whistleblowers exposing the sham behind the new biopsychiatry paradigm, which is true of any whistleblower since most people don’t know enough to even understand such systems never mind expose and criticize their shortcomings. But, Dr. Szasz was an insider until he was shunned and ordered not to teach any longer just as Dr. Mosher and Dr. Breggin lost government positions due to their unique views.

            Again, I am very indebted to Dr. Breggin and I will always be grateful for the huge risks he took on behalf of potential psychiatric victims since his great courage and advice helped me save loved ones from great long term harm.

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        • I was myself committed to a psychiatric hospital and spent there more than a month, but I am shocked by the comparison made between such an experience and slavery. Anyone who believes that such a comparison is justifiable should read (or re-read), for instance, Frederick Douglass’s “Narrative”. I do believe that such a comparison is highly offensive to the memory of enslaved people.

          In fact – and I realize that it might seem outrageous to some – in spite of my very critical attitude towards mainstream psychiatry I am now glad that I was committed to a hospital when I was acutely psychotic.

          I was then frequently having terrifying auditory hallucinations. They made me often so afraid of my own relatives that at some point I even conceived a plan to travel in secret to some other city, without informing anyone about my whereabouts … I prefer not to even imagine what my family members would have felt if I had realized that plan.

          Some of my experiences at the hospital were very distressing (especially the side effects from one of the drugs, the fact that I was unable to go outdoors for a month and the aggressive behaviour of some of the other patients), but – apart from being expected to obediently take drugs – I did not experience any violence or abuse from psychiatrists and other staff at the hospital.

          I was able to see my loved ones as often as I wished and talk to the head doctor as often as I wished. I was able to spend most of the day reading and listening to music. I knew that I would spend at the most 3 months at the hospital. I would never, never compare my experiences to those of an enslaved African.

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          • Joanna,

            When Dr. Thomas Szasz, eminent psychiatrist and psychiatric survivors compare biopsychiatry to slavery, they are talking about forced psychiatry, forced commitment, forced drugging and many other horrors committed by psychiatry that feel like rape to most if not all of its victims due to the fear, force and fraud involved. The type of ill gotten power that allows a psychiatrist to hijack your life at any time and torture and abuse you against your will is quite comparable to the lack of freedom and choice of slavery for the many subjected to psychiatric violence.

            Dr. Szasz and psychiatric survivors don’t interfere with people having voluntary relationships with psychiatry though they believe the lack of true informed consent is abusive and dangerous not to mention the very idea of “mental illness” is a total sham. Dr. Szasz makes this clear when he says that psychiatry is to real medicine what spring fever is to rheumatic fever or heart break is to heart attack. The first words are metaphors using medical words to describe nonmedical things as is the case with the term “mental illness” since the mind can’t be ill since no disease or lesion can be found there while the other terms refer to real medical illnesses using similar words. So, the whole idea of so called mental illness is twisted clever ploy invented by psychiatrists who literally wanted to hijack countries and infiltrate them as a fifth column to force their evil, pernicious values on everyone where the concept of good and evil would no longer exist and all social institutions like family, church, schools, courts, medicine and all others would come under the thumb of psychiatry. You can find this psychiatric agenda of the 1930’s and 1940’s on the web. They have succeeded beyond their wildest malignant dreams and it is all too clear they have also created a chaotic, alienated, isolated, miserable, violent, more poverty stricken, unequal, totalitarian, fascist existence for a vast majority of people so they can by more easily controlled by psychiatry and the government/corporation pathocracy, the true goal of such evil.

            Unfortunately, once one is given a bogus DSM stigma, one is at risk for forced commitment and drugging from psychiatry for the rest of their lives from abusive relatives, spouses, coworkers, bosses or anyone who wishes to further harm, destroy and otherwise discredit and eliminate the victim.

            When we are young, we are taught not to accept candy from real friendly strangers since adults know that psycho child predators often lurk underneath those nice gestures and superficial charm. Somebody asked why we as adults often fail to take this advice ourselves to our great peril?!!

            CAVEAT EMPTOR!!

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          • No one is comparing your experiences to those of an enslaved african. They are comparing two institutions. The experiences of many American chattel slaves wasn’t neccessarily that brutal compared to what many psychiatric patients have suffered over the past two hundred years, but the former are still slaves, regardless of the suffering involved, which has little bearing on whether or not one is a slave, hence the existence of happy slaves throughout history.

            I have read many histories of slavery, and am under no illusions that some of the worst crimes of lese-humanite have been committed by slavemasters towards those whom they oppressed. I am also aware, from reading histories of chattel slavery in America, that lots of enslaved peoples were extremely happy with the system, and were in no way tortured by their masters, and can make no greater a claim on our sympathy than many psychiatric patients who, likewise, have no wish to throw off the yoke and break free, and at least claim that they don’t suffer.

            You cannot efface the continuities between two institutions on the grounds on which you defend your own opinions. A person can be a slave regardless of whether they have undergone the most extreme suffering.

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          • No offence, but your story is meaningless in this regards, contrary to what Sandy seems to be saying, just like the stories of chattel slaves who supported the system are meaningless in deciding whether or not they were slaves. Sorry if that sounds brutal, but it’s just the truth.

            The points of congruency between psychiatric slavemaster (that is the psychiatrist who subjugates his patient, a subjugation achieved through a variety of channels) and other slavemasters, between psychiatric slavery and chattel slavery are many.

            Regarding the former, the most obvious is that common thoughout the history of both is the subjugation of the subject through force, violence and degradation. The weapons and means employed differ, but this in no way should detract from the similarity.

            Another similarity is the imposition of an invidious status to deprive the individual of citizenship and the entitlement to the rights such a legal status implies, the freedom of both being narrowly circumscibed within the limits imposed by their masters, who view (views enshrined in the statute books, albeit in terms more flattering) their subjects as inferior people, to whom the rights (such as the right to be let alone) and liberties of the citizen do not extend.

            In both cases, the justification for the inequities and imbalance of power inherent in the relationship is justified on the grounds that the psychiatrist/slavemaster is the custodian of his subject (deemed unworthy of liberty) and the arbiter of his true interests.

            This is my dad’s computer, so I don’t get to use it much, so time does not permit me to further elucidate and enumerate the similarities between involunatry psychiatry and involuntary servitude, yet I think what I have written is sufficient to give you at least the embryo of an understanding into why I believe it is a species of slavery.

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          • As Donna already pointed out, it’s the coercive aspect that I have a problem with. If psychiatry had the same legal status as other pseudoscientific endeavors astrology or homeopathy, I would not be spending my time here because I would not have been committed.
            Alas, psychiatry ruined my life because of its coercive methods and that has to be denounced in the strongest terms.

            You might not have felt like an slaved African. I did. My freedom was taken away for an arbitrary reason without having committed any crimes whatsoever. I was left at the mercy of a few shrinks with whom I was forced to share my most intimate life details if I wanted to get out of there. I was forced into medications that almost damaged my kidneys and liver irreparably. I have nothing but absolute contempt for those psychiatrists and for every psychiatrist that supports coercive psychiatry.

            Because of my commitment there are things that I will not be able to do during the rest of my life. I will not be able to legally own guns -not that I wanted to own one but there is a difference between not wanting and being banned from it. I will not be able to run for political office or take any public role that would expose my life to scrutiny. I will not be able to apply for government or industry jobs that require security clearances. In short, I have been stigmatized for the rest of my life as if I was a dangerous criminal convicted of a horrendous crime.

            So if you think you liked the experience, fine. I did not. So don’t speak in my name. And now that you mention slavery, back in the day drapetomania was the label that psychiatry used for those slaves who wanted freedom. I am pretty sure there were many slaves with Stockholm syndrome who agreed with the drapetomania diagnosis. Psychiatry has a peculiar way of annihilating its victims’ willpower.

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    • CannotSay,

      What if I need a psych med to resolve being able to stay asleep on my apap machine?

      Just so folks know, I have suffered months of insomnia that was most likely due to undiagnosed sleep apnea made worse by being on psych meds. Unfortunately, I feel that being on them. has made me hypersensitive to being able to tolerate the treatment that I need.

      I intend to explore many other avenues before I resort to taking a med. But I may have no choice as I can’t function on little sleep on a daily basis. No one can.

      Sorry, it may seem like I am getting off topic but in a way this relates because Sandy’s point is that antipsychotics do benefit some people and Bob has said the same thing. They just don’t benefit as many people as psychiatry thinks they do.

      But still, to deny even a small percentage of people something that would benefit them them simply because we hate psychiatry for legitimate reasons would be wrong.

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      • As I said, I have no problem with voluntary relationships. It’s the coercive aspect that I find despicable. I also think that psychiatry is, for the most part, as nonsensical as astrology or homeopathy but I have nothing against people who voluntarily use their services. Imagine for a second how our life would be if astrology had the power of preemptively locking in an individual because some astrologer looking at the natal chart of said individual believed that there is 75% chance that said individual would become violent tomorrow. There would be an understandable outrage against such power. Yet, that is the power that psychiatry has here in America today (75% is equivalent to “clear and convincing evidence” which is the standard required by the courts to commit people). We know that psychiatry has no ability to predict who’s likely to become violent (several studies attest to that), yet our society gives psychiatry the power to preemptively locking people based on the assumption that it can do so.

        If I were an astrologer, I would sue the government for discrimination: a psychiatrist and an astrologer practice the same type of nonsense, yet the first is given a lot of legal power while the second is ostracized.

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        • Hi Can’t Say,

          Thanks for clarifying.

          Actually, I would be using a regular doctor as I have no intention of ever setting foot in a psychiatrist’s office again. No disrespect to Sandy and the ones who post here by the way.

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          • :D. I advise you to stay as far as you possibly can from a psychiatrist. They will only bring hell to your life. If you need some drug of the psychiatric arsenal, get it from your GP.

            See, I am a very strong defender of individual freedom, which is why I feel so strongly on the matter of coercion. Some people don’t value their freedoms as much and see no big deal in getting locked in for “medical” purposes. I do.

            If one day I have the resources, I will support any astrologer who wants to sue the government for discrimination :D.

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      • I support letting people choose whatever treatment they want, AS LONG AS THEY’VE BEEN GIVEN TRUE INFORMED CONSENT. The problem with these toxic drugs is that it’s the rare psychiatrist or GP who truly informs the person about the effects of the drugs and whether the benefits of taking the drugs outweighs the problems that they cause. People in state hospitals are essentially forced into taking the drugs before the psychiatrists even consider discharging them. If you don’t comply with the drugs you don’t get loose, plain and simple. Many times people are taken to court and have their time extended, against their will. This is done as an effort to force them into taking the drugs.

        So, if you want to take them by all means do so, but no one should be forced to consume them against their will and they should be informed as to what will happen to them if they take the drugs.

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        • Stephen, absolutely no arguments whatsoever as you’re preaching to the choir. Long before the UN labeled forced drugging as torture, I called it that on the Shrink Rap Blog. I am sure they weren’t happy about that.

          Can’t Say, we agree about psychiatry. But be careful about assuming that GPs can’t do any harm with psych meds. I saw a story yesterday on NPR about one giving an 80 year man an AD because he was upset about cognitive issues. He tragically committed suicide with a gun which I feel was the result of a reaction to the med even though obviously, I can’t prove it.

          I know I am getting off topic but needless to say, I was quite disgusted since NPR as usual didn’t ask the tough questions and just automatically made it about guns and suicide. I derisively call them National Psychiatric Radio.

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          • National Psychiatric Radio! That’s hilarious. I’m a daily listener, and have often heard they are funded in part by the Robert Wood Johnson Foundation. I hear that’s related to Johnson&Johnson, the drug maker. This new joke name may beat the one, “National Propaganda Radio.” It’s funded somewhat by individual donations, but not entirely! Still, I like hearing how the information is being presented. That’s information in itself.

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  7. Duane, the issue isn’t that Alto is against alternative med. It is that just because they aren’t mainstream psychiatry, doesn’t mean you should be any less skeptical. Sadly, while there are good folks out there, there are also some scam artists who can also be quite harmful. True, they can’t force you into treatment against your will but they can still cause alot of harm.

    Sandy, I tapered at the 10% rate using a compound pharmacy. When that got to be too expensive, I used a digital measuring scale, empty gel caps, and a pill crusher, to measure out my doses. Yes, it is a pia big time but it was the only way for me to safely get off of my meds.

    Not sure how that would work for your patients so perhaps finding a compound pharmacist you could work with might be your best bet. But I definitely agree with Alto that tapering them by 25% of current dose is way too fast, particularly for antipsychotics that are quite powerful. In fact, some of your patients might find they need to taper at 2.5 to 5% of current dose every 4-8 weeks.

    Yes, it will take them a long time to get off the drugs at that rate but better they increase their chances of success and maintain their quality of live vs. a fast taper that will most likely cause a relapse and set them up for failure.

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    • I reduced my meds approximately every 4 to 6 weeks.

      Totally agree that compounding is expensive. But if that isn’t an option, somehow you have to figure a way for people to taper slowly because for alot of folks, that is their only chance of success.

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      • Thanks. I am using longer intervals (3-6 months). The data from the relapse stuides suggest that recurrence of symptoms after dose reduction can occur many months after the reduction. I worry that if something happens and the person ends up in the hospital, the dose will be increased, often dramatically. If I can establish that someone has done well on, let’s say 50% of the initial dose, but then has a recurrence of symptoms on a lower dose, I will try to put the person back to the 50% dose rather than the intial dose. This is a form of harm reduction.

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  8. In some circumstances the question comes down to: what is better the padded cell or a tranquellizer when a person who has “completely lost it” and is trying to kill himself or somebody else, arrives in A&E. I am talking about my son here. I am glad they coerced him into taking Haloperidol at the time; what I object to though is that the psychiatrists continued to tranquellize him against his will afterwards instead of talking to him and helping him to solve his psychological and emotional problems that brought him to his knees in the first place.I think that people break down for a good reason and psychiatry is ignoring this. I am looking forward in reading more of what you have to say.

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  9. Hi, Sandra,
    I’m going to jump in on this discussion with anecdotal information re my son’s tapering. I think you are doing an excellent job of keeping track of the complexity of the situation and reminding us that no two people are alike. My husband and I hired an well-qualified holistic psychiatrist to very slowly taper my son off the two low dose meds he was on. The taper was supplemented with all kinds of vitamins, minerals, immunity boosters, etc. And, he was getting psychotherapy twice a week from a different psychiatrist. Surely, I thought, he would not relapse given all the support (physical, mental, emotional) he was getting. Wrong. Within a couple of months of finally getting off them, he was showing signs of psychosis. We delayed putting him back on the drugs until it became clear that he may not survive crossing a street. We tried again two years later, after different holistic therapies had been used and twice weekly psychotherapy. Same ending. Slow taper, but soon showing signs of psychosis. These drugs, as much as I dislike them and see how crude they are, were invented for a reason, and that reason was to stop psychosis. I’ve chased all kinds of interventions, and, while my son is really on an excellent path now because of these interventions, I wish we could find out what his particular medical problem is that keeps him dependent on the meds for the time being. It could be his immune system (that’s my latest thinking)but where are the answers? “Science” hasn’t bothered looking too hard past the dopamine theory until fairly recently and I don’t want a drug in 10 years time, I want a natural remedy now. This is my long-winded way of saying, yes, it’s complex. Sometimes I fear that people now believe that relapse is only because the med tapering was too quick. Also, it is well known that as a person gets older, the symptoms tend to diminish or disappear, so a lot may be explained by the age of the patient.
    Best regards,
    Rossa

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    • Thanks, Rossa. This is an important perspecitve. I, too, do not think all “relapse” is withdrawal but at the same time I am not going to dismiss other experiences or perspectives just as I hope others will not dismiss yours.
      I would change one thing. You write, these drugs were “invented for a reason, and that reason is to stop psychosis.” This my be minor but these drugs were found serendipitously to be of help in reducing psychotic symptoms. It was only after this discovery that we walked it back to develop a hypothesis to match their effects on people. That hypotheisis – and the hype attached to these drugs – has held us back from exploring other possible explanations. I suspect we agree on this.

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    • Hi Rossa, it’s very complex indeed. If there is an illness that causes the psychotic symptoms, than it’s quite possible that the symptoms return, after tapered off the drug that suppressed the symptoms (on the other hands there are people who had a psychological crisis that was caused by social circumstances, who where put an psychiatric medication and they were ill just because of the medication and become well after withdrawal).

      I have no medical education, but there is more and more evidence, that the immune system and autoimmune responses play a role in mental disorders. I never had any psychotic experience, but after I went on a gluten-free diet my anxiety dropped to a normal level and nightly panic attacks just disappeared.

      Many of the non-neuroleptic (experimental) treatments are linked to the immune system:

      Omega-3 supplements (reduction of omega-6 in the diet)
      Probiotics
      Vitamin B12 / Folate
      Vitamin D
      NAC
      Gluten-free / casein-free diet
      Mindfulness based stress reduction / yoga

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      • I have had good results with all the supplements Oli suggests (except NAC, which tends to upset stomachs), plus magnesium citrate, taurate, or glycinate.

        I suggest omega-3 be supplemented to at least 3,000mg EPA plus DHA per day — usually about 6 capsules of good-quality fish oil.

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      • Thanks, Oli, for your taking the time to respond. I confess that I am quite jaded now about medications, vitamins, psychotherapy, and mindfulness, even though I am giving more thought to the immune system. My son, at one point, was swallowing 35 vitamin and mineral supplements a day, taking into account all the supplements you listed, and he still relapsed after going off the meds. I guess I was looking for a quicker fix than was actually the case. It is a hard slog for the “correctly diagnosed.” By “correctly diagnosed,” I mean, people in the traditional age groups (15 to 25 for men, 25 to 35 for women) who are NOT at the mercy of nurse practitioners and doctors who actually believe that there is a compelling need to medicate children showing signs of mental illness. My humble opinion, based mainly on extensive reading personal experience and other people’s testimonies, indicates that people outside of this age range are the most likely to be “misdiagnosed” as bipolar or schizophrenic. “Correct” diagnosis doesn’t mean much, since the diagnosis has no verifiable scientific underpinning, but it does mean that if you exhibit certain behaviour and beliefs within these age ranges, you’ll get the label that reflects the behaviour. I do believe, however, that an all encompassing approach to treatment, that does not rely on meds exclusively, gets wonderful results over time. I have always noticed improvement in my son, with each new intervention tried, and these improvements are cumulative.

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  10. Duane,

    Why the anger when people like Alto and I express concern about alternative medicine practices?

    Essentially, my message is that when dealing with mainstream and alternative health professionals, you need to be very cautious. That is just common sense and has nothing to with any agenda.

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    • AA,

      I have experienced unspeakable trauma in my life.
      Two saving graces were Neurofeedback and Cranial Osteopathy. They helped *much more* than “talk therapy”.

      We have injured soldiers who would greatly benefit from Hyperbaric Oxygen Therapy – for both “PTSD” and TBI.

      Re: Being “very cautious”

      Water soluble vitamins are extraordinarily safe.
      So is neurofeedback.
      So is deep breathing and relaxation.
      So are *many* non-drug approaches.

      I can understand being *cautious*, but *very cautious*?

      Are you comparing using a neuroleptic to having an osteopathic physician perform a cranial adjustment? Taking antidepressants to learning to pray and meditate?

      Is there *some* inherent risk involved in these approaches?
      Sure.
      But a pretty strong argument could be made that there is *significant risk* involved in psychotherapy – not the least of which is that most folks who reveal their souls to these folks know *nothing* about their therapist – including their beliefs and values.

      Re: Alto
      Let Alto speak for Alto.

      Duane

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  11. While some “alternative medicine” has significant side effect risks, as a rule, most are less than those of conventional medicine, which is used with so little consideration. The concern for the use of any “unproven” remedy should be proportionate to the risk. For instance, certain herbs can have significant and even deadly side effects if used in high dosages. Folic acid, however, has almost no risk, as excess B vitamins are excreted in the urine easily. As another example, homeopathy may be seen by many as hokey and unscientific, but the side effects are essentially nothing more than a very temporary discomfort at the very worst, and the costs are minimal. If someone wants to try it out, why not?

    We ought not to be viewing “alternative medicine” as a monolith, but should look at each intervention with an eye to cost-benefit analysis, just as we ought to be doing with conventional medicine. Most of the time, doing that analysis honestly brings “alternative medicine” out on top, mostly because the risks, as a general rule, tend to be so much smaller, even if the benefits may be inconsistent or difficult to determine.

    —- Steve

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    • I agree that, by and large, taking a supplement is a lot less dangerous than taking a psychiatric drug. (However, I’ve got a couple of cases of people having difficulty withdrawing from SAM-e….hmmmm….)

      I get outraged about any kind of dishonesty in health treatment, alternative or allopathic.

      Some people just don’t have the money to waste on misrepresented treatments. For example, many naturopaths will order urine tests that purport to measure neurotransmitter balance from a company called NeuroScience. The lab reports come complete with recommendations for NeuroScience’s pricey supplements formulated to correct whatever neurotransmitter imbalances are found. How could this possibly be valid?

      I wish now I had the several hundred dollars I wasted on that bogus testing and those supplements when I was much more naive.

      (Many people have adverse reactions to NeuroScience supplements, which contain various neuroactive ingredients.)

      Like TrueHope’s EmpowerPlus, Immunocal is another supplement for which the manufacturer, Immunotec, generated studies and a lot of scientific-sounding blather supporting its use. Immunotec also got Immunocal approved as a prescription “medical food” reimbursable by Medicare. Immunocal is a whey protein isolate. Unlike other whey protein isolates, supplement composition for Immunocal is held secret.

      From what I can glean, Immunocal is roughly equivalent to NOW Whey Protein Isolate, which lists its composition on its label and is available without prescription. The difference: Immunocal is 15 times more expensive. You (or Medicare) pay $85.00-$99.00 for 300 grams of Immunocal; for the same amount of money, you can get 4536 grams of NOW Whey Protein Isolate.

      Beyond cost, there are real dangers in supplement manufacturer misrepresentations. Neurocritic discusses TrueHope’s liabilities in this post http://neurocritic.blogspot.co.uk/2012/07/empowered-to-kill.html , which includes some very interesting transcripts of TrueHope support calls with people desperate for solutions to their health problems.

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  12. Hello Sandra,

    great post. Just some additional points I find important:

    – It is thought that delaying treatment with neuroleptics is harmful. As far as I know there is no proof this assumption.

    – It is still argued that loss of brain tissue over the years is mainly caused by the illness, but we know that antipsychotic treatment is associated with brain tissue loss.

    – Side effects of neuroleptic drugs are often battled with additional drugs, which can be harmful too.

    – Patients should always be tested for B12 and vitamin D deficiencies. They should also be tested for gluten and casein sensitivity.

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    • Hi Oli-
      Thanks for the comment. This part one of what I anticpate will be a 3 part series. I plan to address the delay in treatment question in more detail as well as the loss of brain tissue. It would have been a very long post so this is my intro and my conclusion. The middle portion is to follow.
      Your point about the added effects of medications used to treat side effects is an important one that I do not address directly. With antipsychotics, if one avoids higher doses, one can avoid some of these side effects. Wiht the neuroleptic threshold study that I cite above, McEvoy established that one does not need to use drugs to treat the neurologic side effects. If someone develops them, then he is on too much drug. This study was done with haloperidol but the principle applies to many of the newer drugs as well.
      People here do not like to talk about dopamine but these drugs block dopamine receptors. If you block ~70% of the receptors, you get as much symptoms reduction as you will get with more blockade. However, with more blockade, you see much more neurologic effects. So just checking – carefully – for neurologic side effects is a pretty easy way to assess whether the person is on too much drug. Before the newer drugs were introduced in the early 1990’s, academic psychiatrists were recommending a conservative approach to pharmacotherapy for psychosis. That message got lost in the hype over the newer drugs which were incorrectly marketed – and this was supported by some of those same academic psychiatrists! – as safer and more effective.
      One crux of my argument is that if one prescribes these drugs, tread lightly.

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    • Oli – I spent at least two years kicking myself for not getting my son on medication because I believed (wrongly) the pharmaceutical hype that it was important to get people on medication right away “to protect the brain.” However, delaying treatment has its very severe side effects if the person is exhibiting behavior that increasingly puts their lives at risk. My son got grazed by a car on one occasion, and barely avoided getting beaten up by strangers on another. So, while I agree that the brain isn’t going to stop functioning by delaying treatment, the other side of it is the non-drug risk.

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  13. It is so difficult for a psychiatrist to make sense of the conflicting information about what drugs are supposed to do and what we see them do. Medicine is basically a team sport, and any time a doctor disagrees with the ‘standard of care’ then it is an uphill and often career trashing experience.

    I want to praise Dr. Steingard for having the motivation and energy to express her individual opinions, which run counter to the way that psychiatry is practiced. The big problem is that the antipsychotics do clearly help some people, so taking a total antidrug position is simplistic. Unfortunately when a psychiatrist opens up an honest dialogue about antipsychotics, they are quickly marginalized and labelled an antipsychiatrist. Absent a meaningful scientific literature on the risks and benefits of the drugs, there is probably no better source of information than an honest clinician who can draw their own conclusions. I look forward to reading the next two installments.

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  14. Dr. Steingard, Thanks for the concise, highly readable article. Would patients’ families be open to using the Open Dialogue approach that is so effective in Finland, as it harmonizes social situations and minimizes drug use? Also, how about using technology that gets real-time feedback on how well-balanced brainwaves are with less medication? When the amplitude of brainwaves is balanced (lobe-to-lobe, left-to-right), the whole brain harmonizes and symptoms of many mental disorders are relieved, pretty much for good. Recent Webinars on this technology mentioned that the objective computer analysis shows that drugs often disrupt the brain’s ability to balance itself. Wouldn’t this provide proof to back a doctor up in choosing to minimize drugs if it enables more mental balance? The unbalance caused by drugs was mentioned in minutes 5 and 7 of the Webinar with “Special Guest Dr. Cronin” and in minutes 12 and 58-59 of “A Conversation with Lee.” They’re under the “Ask Lee Library” at http://brainstatetech.com/webinars I share this unpaid, because I want unnecessary suffering alleviated!

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    • It does appear that in Finland, they are able to use less medications in the context of the other supports they offer. It seems to be largely influenced by a context in which they do not believe drugs are always needed or are the core element of effective treatment.
      I am not sure we know enough about brain waves to translate that information into something that would accurately inform drug choice. But in my personal commitment to not dismiss something about which I know very litte, I will take a look at this.
      Thanks for your comments.
      Sandy

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      • Thanks for your openness. There’s data from over 50,000 clients showing that balanced brainwaves correlates with symptom relief. My mind’s energy was measured in a different way, which showed I have lots of highly ordered intuition; it weaves together information, telling me brainwave balancing is the way to go. It’s really taking off in the last few years. It’s clear just by watching the Brain State guys that their minds are highly balanced.

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  15. Dear Sandra Steingard, M.D.

    From your tapering post
    “I suggested that we taper by 25% of the initial dose at intervals of every 3 to 6 months”

    May I ask please. Does this mean that you are tapering people off of anti psychotics in the following stages: 100%->75%->50%->25%->0

    Tapering by 25% of the “initial” dose suggests that to me. I’d really appreciate it if you could clarify please?

    Thank you.

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    • It is a guideline that varies from person to person. It depends in part of what size pills I can get and on the patience of the person with whom I am working. I am also beginning to gather anecdotal evidence that as the dose gets lower, we should go slower so I try to stick wiht 25% of the current dose not the initial dose.

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  16. Dear Sandra, as a fellow clinician I welcome this and your proposed future posts as I think many psychiatrists who adopt a critical approach are honestly trying to work out how best to use drugs in a way that benefits their patuients while minimising harm. I currently work in Finland and can I say, that sadly it is not all open Dialogue here. Indeed I have seen some of the most terrible polypharmacy I’ve ever witnessed in my clinical life. At the moment I am in a rehab post and nearly every patient I try lowering the dose a bit. Unfortunetely my other colleagues are not of the same mind, saying things like, well if the patient is stable why rock the boat. that is why this sort of guidance for sensible and judicous use of meds is required right now. There are however many thorny issues to tease out. I notice you miss out of your reading list joanna Moncrieff who has written a number of very thoughtful books about psychiatric medication, their history, pharmacaology etc. Worth a read.

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  17. Hi Jeremy,
    Thank you so much for reading and commenting. Thank you also for brining attention to Dr. Moncrieff and her work. I have one of her books on my “to read” list and I have read some of her papers. I agree that she derserves credit – along with the whole UK Critical Psychiatry group – for bringing attention and scholoarship to this topic.
    I have also heard that outside of Tornio, psychiatry is practiced in a manner similar to how it is practiced in the US. Do you have any thoughts about why that is the case? I have been curious about this. My speculation – as an outsider – is that it is because there were psychiatrists who were open to what they were trying to do up there and this helped to create a narrative about psychosis that was different from what was being created elsewhere.
    Thanks for reading and sharing your thoughts.
    Sandy

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    • I have met Jakko Seikkula, he is a lovely gentle man, and I have asked him about this issue, namely why dooes the rest of Finland seem to ignore these excellent results. Indeed a country like Finland which leads the way with education, mobile technolgy, socail care etc, with a small, coherent population is well placed to lead the world in psychosis care. Unfortunately, my guess is that, Big Pharma have bought the Finnish government and lobby powerfully for biomedical approaches. It is said that when jakko Seikkula presented his findings at a conference people told him the Tornio Group were being unethical for witholding meduication or that his results were too good to be true. This is of course heresay. Anyway it is all rather sad. Methinks Mad in America and anatomy of epidemic need a Finnish tranlation as I am not sure one exists. Finnish patients need to know that there are some alternatives, and to hold their government and medical proffessionals to account, to demand better, more humane, patient centred care. E.g. at the recent Finnish psychiatrists Association annual meet up I noticed a talk which I didn’t attend called, ‘ect as yet a still underused form of treatment’ I mean I ask you where is this all heading?

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    • I wanted to make a brief point and surprisingly many of the points have been made.
      Let me focus it here.
      I was also going to mention Joanne Moncrieff’s brilliant book–The Myth of the Chemical Cure
      and for this reason: she is against the medical model but unlike Peter Breggin she is not
      completely against drugs. Breggin is against licit and illicit drugs–any drugs that affect mood. (In theory I would want to defend some drugs, say wine, or consciousness-expanding drugs or sleeping pills. (Peter’s position on drugs has become puritanical, like Scientologists’) Moncrieff’s provides another rationale for careful use of drugs–while strongly repudiating the disease model as Breggin does..

      Sandy perhaps carelessly you called neuroleptics “anti-psychotics.” I think you might agree: That term is psychiatric propaganda.
      From my POV I do not recognize the term “psychotic.” I don’t pathologize states outside the ontological mainstream. But from any angle neuroleptics are not anti-psychotics. As Breggin points out, if they “work” it is because they reduce the charge of everything, the excitement….

      You correctly responded above:

      You have got that partly right–they were discovered after the fact. But Sandy as pointed out by others here neuroleptics were hailed by their promoters as “chemical lobotomies.” THeir effects are pernicious. They did have a purpose– to make patients more docile and easier to warehouse in the 1950s’ state mental hospitals. Why should a drug with such a nefarious history be promoted today by psychiatric reformers?
      I think primarily because of the vestigal influence of the medical model.

      What MIGHT be a legitimate purpose of a drug prescribed by a psychiatrist? To make people feel better. For example, to mitigate anxiety or panic.
      In the 1950s Henry Stack Sullivan gave a glass of wine to new residents in his asylum who were suffering from “psychotic panic”.
      Wine also tends to make patients more sociable, not more withdrawn as neuroleptics do.
      A far more humane treatment. If wine is impractical–as is opium (which someone else mentioned) why not benzo’s? (Not SSRIs–Healy has argued that one.)
      David Cohen points out as others did that studies show that benzos are just as effective in short term effects (which is what they re needed for) as neuroleptics––w/o the negative side effects including risks of akathisia even in short term. The longer term effects are horrific. 65% of persons who stay on them 20 yrs will get tardive dyskineia. Why use these chemical lobotomies?
      See also Lars Martensson MD.There are many other drugs–that help one sleep, which is important.

      Psychiatrists want to save the medical model. Thus they insist they need to use anti-psychotics for “psychosis.” Psychosis, if not schizophrenia, is still the sacred symbol of psychiatry. If we don’t want to save the medical model, there IS no justification for such awful drugs as neuroleptics.
      Why get anyone STARTED on neuroleptics?
      (The only justification is for people who have already become addicted.)
      But psychiatric reformers should be phasing out neuroleptics.
      Seth
      Seth Farber, Ph.D.
      http://www.sethHfarber.com

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      • Part of my response dematerialized for some reason.
        I reinsert the missing sentences and reiterate the paragraph that followed

        You correctly responded above:
        “You write, these drugs were “invented for a reason, and that reason is to stop psychosis.” This may be minor but these drugs were found serendipitously to be of help in reducing psychotic symptoms. It was only after this discovery that we walked it back to develop a hypothesis to match their effects on people.”“

        You have got that partly right–they were discovered after the fact. But Sandy as pointed out by others here neuroleptics were hailed by their promoters as “chemical lobotomies.” THeir effects are pernicious. They did have a purpose– to make patients more docile and easier to warehouse in the 1950s’ state mental hospitals. Why should a drug with such a nefarious history be promoted today by psychiatric reformers?
        I think primarily because of the vestigal influence of the medical model.

        Seth

        http://www.sethHfarber.com

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        • Hi Seth-
          Thanks for you comments and careful reading. You get no argument from me on the labeling of this class of drugs but old habits die hard.
          You ask, “Why should a drug with such a nefarious history be promoted today by psychiatric reformers?”
          That is the question. Although I would not say I am promoting them, I am just trying to reckon with the various data out there to form my own opinion about when and if these drugs should be used. We may come to different conclusions on this.
          Sandy

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        • Hi Seth,
          From this thread it is not clear to me what your position on neuroleptic use is. Would you ban their use under any circumstances?
          The comparison of alcohol and neuroleptics is interesting. I enjoy a glass of wine or two with dinner, not only for the taste but also for the warm, relaxing feeling. Now, in a purely hypothetical situation, if a psychiatrist prescribed an amount of alcohol that would make me pass out on a daily basis and he informed me that I needed it for the rest of my life, I’d tell him to go take a hike. In a very real situation that’s exactly what I did to the head of adolescent psychiatry at an Ivy League school when he told me that my son would have to take neuroleptics indefinitely. At the time my son had been on Abilify for more than a year, gained 100 lbs, developed metabolic syndrome, was in clear cognitive decline and still hearing voices.
          Another story about my son is when he had his first and only major psychotic break – excuse the term, I know you don’t approve. The best way I can describe his state was that of a raging wild beast, cornered and poised to attack. He didn’t recognize who I was. With the police watching, the ambulance took him to the ER, where they injected ativan and haldol. I would have tried to prevent the intervention had I known at the time that I was in my right to do so, he hadn’t actually attacked or threatened anybody. I was so ignorant then. After a few hours he woke up, embraced me, told me how much he loved me and how ashamed he felt. I don’t know if it was the ativan, the haldol or if his state would have passed fairly quickly without the drugs; I’ll probably never know.
          With my son’s case in mind, I ask if using a benzo for a few days is a bad thing. Though, from what I read, the risks of dependency and the subsequent complications of withdrawal become an issue after only a few weeks. Likewise, for how long and in what amounts is neuroleptic use by any given individual dangerous? What are the risks of dependency and of withdrawal? What are the chances of metabolic disorders? Will pertinent research convince even some of the ardent critics that a course of a couple months does not pose unacceptable risks? I think that there aren’t many easy answers and that the discussion is important. That is Sandy’s point. Personally, I’d regulate neuroleptic use so much as to make even some hard core liberal progressives wonder…
          I am interested in your reaction to my questions.

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  18. To Donna,
    This is a reply to your question about my training in family systems therapy and my understanding of the relationship between traumatic life experiences and human beahvior.
    When I entered psychiatry, it was with the plan to become a psychoanalyst and I have intensive, albeit long ago, training in that field. After that my training was focoused more on traditional psychiatric diagnostic classification, brain models of psychiatric problems, and pharamcotherapy. My exposure to family treatment was in the form of psychoeducation.
    More recently, I have become intereated in family therapy primarily through my training in diaolgic practices and Open Dialogue.
    However, there has been a strong focus in the past 20 + years on trauma and its multifacted and complex impacts on human behavior. I do not consider myself an expert in the treatment of these problems but in the setting in which I work, I have colleagues who are and I try to coordinate care with them. So I guess I consider myself aware of the impacts of trauma on human behavior and development but not an expert clinician.
    I would add that it is not self evident to me that if a person’s problems are caused by trauma, that this means there is no role for the use of drugs treatments. This is something that can be studied and evaluated.
    I hope this at least in part answers your questions about me.
    Sandy

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    • Hi Sandy,

      Thank you for your response. I am glad to hear about your background in family systems therapy and trauma along with Open Dialogue. Given the emphasis on DSM stigmas and psychiatric drugging as the only treatment for the most part now, it is apparent that the former family and environmental emphasis doesn’t have much if any impact on how people will be treated by psychiatrists today. However, with the type of organization you manage, it may still be possible to get therapy to solve problems rather than life destroying stigmas and toxic drugs that create far more problems? Or referrals to appropriate agencies?

      If you have been following the tragedy of the military and other studies, the evidence shows that psychiatric drugs have not only been useless for trauma for the most part, but very dangerous because military suicides are at record high numbers along with other typical problems with psychiatric drug cocktails. Supposedly, several investigations have or are taking place, but it appears BIG PHARMA has won the day with so called treatment for the military with DSM stigmas and useless, toxic drugs that just make soldiers’ problems much worse. Dr. Paula Caplan has written about this travesty of justice on her web sites and a book on the topic. Bipolar is also alive and well in the military to rob soldiers of any benefits by blaming them for their PTSD. Efforts by biopsychiatry to come up with junk science to “prove” that many who get PTSD had faulty genes in the first place is another way to deny them benefits for war related injuries. So, it is all too clear whose side biopsychiatry/BIG PHARMA is on and it sure isn’t the soldiers or so called patients.

      As exposed in the articles on domestic violence I included above, pushing psych drugs on abused women already struggling to cope makes it all the more difficult for them while psychiatric stigmas cause them much loss and harm when they are already at a huge disadvantage having to face the abuser in court, divorce and in child custody battles per Dr. Carole Warshaw above. The best thing that could be done is to refer them away from psychiatry to domestic violence experts and shelters before they become trapped in a system that aids and abets the abusers to the huge detriment of the woman and any children.

      I guess it is still very difficult for me to accept and keep in focus that current biological psychiatry completely ignores such environmental stressors that cause great emotional distress to people while focusing only on supposed symptoms to justify stigmatizing a person as “mentally ill” with supposed faulty genes and brains to push mostly useless, toxic drugs known to cause dangerous side effects, ill health, disability, loss of relationships and careers/jobs and destroyed lives for the most part with early death by about 25 years probably welcomed after a life destroyed by biopsychiatry. What is really tragic is that such blaming the victims ensures that nasty pathological bullies at work, in homes and in the community/world at large get to continue to abuse with impunity without being targeted by psychiatry while the victims get the double whammy of the original abuser and then being abused and blamed by psychiatry and the community. See Tim Field’s great web site, BULLONLINE and the great work of Dr. Robert Hare, world authority on psychopaths and author of WITHOUT CONSCIENCE and SNAKES IN SUITS: WHEN PSYCHOPATHS GO TO WORK. If you google, psychopaths in the work place, you will find great books like WORKING WITH MONSTERS and other gems about this global menace. But, victims bullied and mobbed by psychopaths and narcissists or plain evil people can become quite ill and traumatized while being falsely accused of being mentally ill while the serial bully goes on to the next victim. I think this is one of the huge harms of current biological psychiatry in that it reinforces a cruel, bullying narcissitic society with no empathy or compassion for the victims. I also recommend the work of Dr. Heinz Leymann, who coined the term “mobbing” to describe how groups can viciously team up against one person at work, in homes and in the community to destroy the person’s reputation, career, relationships, marriage, financial security and often drive them to suicide. His MOBBING ENCYCLOPEDIA describing this evil is on the web and there is a book about this work, MOBBING, by Noa Davenport. There are also many books about bullying at work and school today. What do you think about the fact that psychiatry totally ignores such pernicious environments and stigmatizes and prescribes toxic drugs to the victims of such evil abuse and cruelty as was true in the infamous case of Phoebe Prince you can read about on the web.

      The Adam Lanzas and other young male school/public shooters rarely if ever existed before biopsychiatry started pushing its lethal drugs with most of them in a list of the top 25 drugs causing violence published by TIME. For our government officials to completely ignore the role of psychiatric drugs, especially SSRI’s known to cause suicide and violence, in most if not all public/school shootings shows the corruption and total loss of any moral compass in our government and nation at large. The fact that our government and the psychiatry/BIG PHARMA cartel with the likes of Ralph Torrey are using this latest tragedy to push more forced screening and drugging from cradle to grave is so evil it boggles my mind. It’s pretty obvious Lanza like most school shooters was under “psychiatric care” and on toxic psych drugs and many are fighting to get this information released.

      As I said, I do give you credit for your willingness to read/learn about the huge harm done by biopsychiatry and BIG PHARMA in Robert Whitaker’s books and other sources.

      I also realize that if you wish to practice psychiatry in this day and age now that it has been sold out to BIG PHARMA, you are pretty much forced to give people bogus DSM stigmas along with toxic drugs known to make people’s lives far worse in the short and long run though they might make psychiatrists and others more comfortable once the victim is a drugged, apathetic zombie robbed of all power and independence.

      Obviously, I am very much against this approach, so I guess the only hope for now is for people like you to at least try to minimize the damage for as many people as possible.

      As far as your comment about the role of drugs for trauma, everything I have read has shown they are useless for trauma including articles on this web site and make things far worse per the experts I cited above including domestic violence and military experts. And of course, victim blaming stigmas are especially pernicious for trauma victims and rob them of any justice, compensation, disability or other benefits if needed as in the military. It also destroys trauma victims’ faith in humanity all the more in that being retraumatized by psychiatry, the legal system and other so called helpers is all the more toxic for trauma survivors per Dr. Aphrodite Matsakis in her trauma books like, I CAN’T GET OVER IT.

      With all due respect I sense that you go back and forth on this issue, but in the end are trying to justify the use of neuroleptic drugs in spite of all of the evidence that they destroy countless lives per ANATOMY OF AN EPIDEMIC and many other sources not to mention so called survivors’ horrific experience. Causing somebody to blow up into an obese, ill robot with toxic neuroleptics is not only a death sentence, but further destroys the victims’ self esteem in a weight obsessed culture while making them all the more of a target for public ridicule, loathing, contempt, bullying, ostracism and disgust as if they didn’t have enough problems with being stigmatized, poisoned and robbed of all their human rights.

      Of course, there is always the possibility if enough psychiatrists decide they do not want to engage in TOXIC PSYCHIATRY any more and join together in protest, things could change for the better.

      Anyway, thanks for your responses, but I do feel like I am beating a dead horse here. I think you and your colleagues like all of us have far more to think about and consider than a very narrow focus like how neuroleptic drugs should be used in psychiatry. It’s critical to consider the big picture of how biopsychiatry continues to destroy countless lives while aiding and abetting the many narcissistic, abusive people in power hiding in plain sight that cause their many victims severe emotional distress stigmatized by psychiatry to push toxic drugs in a never ending Kafkaesque vicious merry-go-round until only psychopaths will be able to survive in the end. I guess that’s the idea behind all those TERMINATOR and other movies where humans are fighting robots trying to take over the world when it appears the robots have won.

      Finally, as this stigmatizing and forced drugging creates more and more ill health and disability, the already bloated costs of health care, Social Security Disability, more unemployed people not paying taxes and other overwhelm to a system already struggling with huge debt will probably explode creating all the more social havoc.

      I don’t know about you, but from what I have read, we should all be pretty scared about what the future holds for most of us.

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  19. Sandy,

    As Robert Whitaker says, the point of this web site is to air different views.

    I have cited many experts including psychiatrists with many alternative views than yours, so I believe these views are just as valid as yours, so I don’t see the point of your dismissive responses or ignoring me to avoid these issues, but if that makes you more comfortable that is all right with me. We are talking about the same issues and people, but our views about how these issues and fellow humans should be treated are quite different if not opposite at times.

    Obviously, you are under no obligation to share any information with me about your background, your work or opinions in general though I appreciate your efforts to do so.

    I think you should reserve such power tactics for your practice rather than this web site.

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    • I am sorry you find me dismissive. That is not my intent. You have provided an enormous amount of material and I need some time to digest it all. I just do not have more of a response right now. I guess I may be misinformed about proper blogging etiquette but I do not always have the time to read everything and respond in a cogent manner. I am kind of a slow reader and perhpas an even a slower thinker. So this is more about me and my limitations than it is a reflection of any disrespect I have for your ideas.
      The main point I am trying to make is that I do not dimiss the role of trauma in causing serious and significant problems in people’s lives. I do not think that the diagnostic system we currently use is partiuclarly informative. I am not sure what it is I wrote about in this post that led you to those conclusions about me. I respect and appreciate that you are trying to educate me but it will take me some time to read all of this and absorb it and think about it. When I am responding briefly, I am just trying to convey that I have read what you have written. I thought it would be nice for people who take the time to comment to know their comments have been read but perhaps that was an incorrect assumption.
      For now though, I am having trouble defending a position I do not think I have taken.
      Sandy

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  20. Hi Sandy,

    Thanks a lot for your kind, empathic response. I guess I felt hurt by some of your responses that did seem to me that they were dismissive, so I am relieved when you say that is not the case. I literally felt like I got a slap in the face from your last comment where it seemed you were saying I shouldn’t make any more comments about this topic with which I probably agreed for this particular entry, but I felt that you were angry with me for seeming to push the matter too far. So, perhaps I overreacted because I felt literally dismissed by you to the point I wasn’t going to dare share another comment with you on this post other than to let you know I felt bad reading your last comment.

    I admit that I am very passionate about these issues like many people here. I clarified above that when I make critical comments about mainstream psychiatry that does not include my heroes like Dr. Peter Breggin, Dr. Carole Warshaw and others like you who try to struggle with these issues for more helpful, safe outcomes rather than just maintaining the status quo that can be very harmful to people.

    Any type of communication that doesn’t take place face to face can be easily misunderstood since about 90% of communication is nonverbal, so I don’t think blogging etiquette is the issue.

    Anyway, I have come to like and respect you quite a bit though you knew from the start we disagreed about many things while I also admire you for having an open mind and being receptive to new ideas and practices as I have said before. But, maybe I don’t know enough about you, your work and what you think about such issues as trauma to necessarily assume we disagree on such issues. You mentioned you have more counselors than psychiatrists where you work.

    Also, as I admitted before, you were amazing in your patience for dealing with people like me who made undeserved horrible remarks on your blog about you and main stream psychiatry that has caused many of us great suffering that you took in stride while earning everyone’s respect including mine in spite of us. If you recall, I apologized and told you that although we still didn’t agree on several issues, I do respect your hard efforts to learn new things, to try to do as little harm as possible while dealing with the biopsychiatry paradigm, seeking healthy, holistic, nutritional approaches, reading books like ANATOMY OF AN EPIDEMIC, learning about Open Dialogue and many other
    positive things. So, I have to admit that given the unjustified hard time I gave you when you started blogging here, you owe me some payback. I’m saying this tongue in cheek, but it’s all too true.

    Although it seems we agree that psychiatric diagnoses are not too relevant but just a necessary evil for billing, given the current paradigm, I think there is a huge difference between giving someone a PTSD or related diagnosis as opposed to the life destroying bipolar stigma especially for abused women and children since the former at least validates what they’ve experienced to a certain extent while the latter designates them as severely mentally ill for life and supposedly delusional and psychotic when they try to protect themselves and children from the abuser. The same is true for soldiers suffering PTSD in my opinion.

    I don’t want to push my luck, but I really would like to hear how you and your colleagues deal with trauma in your future blogs if you can fit that into your agenda since experts like Dr. Judith Herman (author of classic, TRAUMA AND RECOVERY) claim that most mental health experts know that most if not all of those they encounter have been abused in some way and/or suffered other traumatic events. And you said above that trauma issues are receiving more focus though I fear from some of my reading that some of the supposed research seems to be another attempt to blame the victims to justify more stigmatizing and drugging. Some experts say the better approach is “What happened to you?” rather than “What’s wrong with you?”

    I am learning from you and I am honored when you say that you might learn some things from me too. I have felt somewhat invalidated when raising abuse/trauma issues on this web site since not everyone caught up in the system is psychotic by any means. So, by focusing on abuse, trauma issues along with psychosis, I think that would expand the usefulness of this web site to many others and attract a greater following. As a matter of fact, I have thought about disengaging from this site for that reason since it doesn’t seem applicable to my life and the many people I’ve known seeking help from psychiatry.
    Anyway, I hope we can be friends and I will try to tone it down in the future.

    Again, I appreciate your compassionate response and I regret if my response felt like an attack on you when it was an expression of my hurt at feeling rejected by you.

    Thanks a lot for clarifying your comments.

    Sincerely,

    Donna

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    • Hi Donna,
      I am so glad that we have developed a mutual respect and understanding. You are so correct about the challenges of communicating electronically(I think that my comment that seemed so harsh was misunderstood becasue I thought I was just echoing what you had said a while back).
      I have very much appreciated our long extended conversation. It just reminds me of how complex but rich human relations can be!
      Warm regards,
      Sandy

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    • Donna, I agree with you that the usefulness of this web site would be expanded to many others by focusing on abuse ,trauma issues (betrayal trauma) along with psychosis.Also that there is no ones posts on this entire web site more important and accurate then your own ,please don’t disengage from this site and please don’t tone it down.Sincerely, Fred

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      • I would like to echo Fred here. I’ve only taken the time to read through this post today (and I don’t have the time to do it today, either, but I’m glad I have). I responded to Donna earlier in the thread, not realizing all the ground that has been covered up until this point since then. It’s very edifying and gratifying to see all this.

        I do not think we have shied away from trauma issues on this site. It is certainly an important part of my perspective, and I seek out research to post that bridges the worlds where I can find it. I am grateful for all that anyone can bring to the discussion.

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        • Thanks Kermit for your encouragement. It’s nice to hear from you. I learned some of the information I posted from your great articles on things like the failed attempts by the military to treat PTSD with psych meds and other important issues of great interest to me. So, I appreciate your contributions too.

          Given what you said about Robert Whitaker’s approach, I worry about focusing on any one drug or treatment as the enemy to be exposed or attacked or even improved for that matter like the “judicious use of neuroleptics.” I think this misses the big picture. Given Bob’s books including MAD IN AMERICA, psychiatry is well known for coming up with never ending ways to damage the brain and perform new types of lobotomies whether chemical, electrical or surgical as so called treatment.

          I think most of the psych drugs being used have gotten some pretty bad press and though many in psychiatry are still fighting to make a last stand, I think some very scary things are happening.

          As you know, there was a great controversy on this web site about ECT known to cause brain damage, permanent memory loss and even death. Experts like Bentall & Read summarized their extensive study by saying that based on their findings, ECT could not be recommended at all. Even lifelong promoters of ECT have come out and admitted the brain damage and permanent amnesia and even death it causes.

          Yet, ECT seems to be making a huge comeback along with cingular lobotomies, brain transcranial stimulation (found useless I believe)(not sure I have the terminology exactly correct here) and other dubious treatments that may be as bad and even worse than the horrible drugs.

          I was appalled that the great Dr. Oz even had a program on ECT recently and I had a fit that his program presented it as a very safe and effective treatment for depression, which all those with huge conflicts of interest pushing it also say because it has been very lucrative. That’s when I had to agree with many people that Dr. Oz is a fraud like the Wizard of Oz. I have seen articles saying the same thing in the media and in so called science publications. So, this nasty practice is being pushed as a great safe substitute for the toxic drugs as Dr. Breggin exposed as well while they obfuscate the brain damage it causes.

          So, the handwriting is on the wall. I think psychiatry is pretending to maintain the status quo while bringing back their old brain damaging “treatments” in “new clothes” or “sheep’s clothing” while inventing new ones since they know they can pretty much get away with anything on the so called “mentally ill” as long as they have the latest junk science and paid shill KOL’s to back it up.

          Although I think Bob Whitaker has made an immense contribution to exposing the huge damage done by biological psychiatry when focusing on individual treatments like the toxic drugs, it appears that a more “big picture” approach is needed to challenge biopsychiatry’s bogus stigmas, constant junk science, fraudulent focus on genes and brain wiring and the huge amounts of wasted tax dollars on this fascist eugenics agenda and whatever brain damaging, life destroying treatments they push now and in the future. Also, the fact that most people caught in the web of psychiatry’s deceit are not psychotic, bipolar of delusional and a danger to themselves and others as psychiatry pretends needs to be exposed too.

          I realize that creates a conflict for Bob and others because of Dr. Healy’s great contribution to exposing the problems with psychiatric drugs that cause brain damage and other life threatening effects. At the same time, Dr. Healy engages in an ECT practice that he advocates in his book and articles and refuses to acknowledge the brain damage and other lethal effects of this horrible assault on patients exposed in many other studies, web sites and the great book Bob Whitaker recommended, DOCTORS OF DECEPTION.

          As you know there was an obviously planned attack on those protesting ECT on Dr. Healy’s blog, which drove many followers of this web site away. I don’t think this problem has ever been addressed, which makes me uncomfortable and wondering where Bob Whitaker and you stand on ECT and similar brain lobotomies of all types making such a great comeback.

          I know this may seem off topic, but I have been pretty discouraged by the news lately with Chrys posting about lobotomy increasing in Scotland and psychiatry gaining all the more power with the latest public/school shootings they probably caused.

          I realize I am bringing up an uncomfortable topic, but I don’t think the ECT war was ever properly or fairly addressed on this web site. I also thought that those like me fighting against ECT lost big time, which drove me away from this web site too for quite a while.

          When all is said and done, Bob Whitaker has contributed enough to help psychiatric survivors that would make 100 people proud to have accomplished the same thing in their whole lifetimes. So, I don’t want to seem ungrateful or that I’m asking the impossible from him. Rather, when I see psychiatry acting like the best of psychopaths when one lie like the “chemical imbalance of the brain claim” is exposed and they smoothly move on to the next lie with no shame, embarrassment, remorse or admission of wrong doing, I think the whole concept of psychiatry’s fraud, fascist powers and assault on humans needs to be addressed along with their gross violation of human and democratic rights.

          Obviously, it is not for me to say what Bob’s agenda should be and I think his latest talk on ADHD is very helpful to parents, but I am wondering if his time and efforts might be better spent on a more “big picture” agenda as I was trying to describe above.

          I would like to know if Bob Whitaker and/or this web site will have anything to say about the great ECT and lobotomy comebacks that are a growing menace to the public. Unfortunately, silence can be interpreted as condoning certain actions.

          I have also noticed that all those who attacked people like me trying to address the ECT issue on Dr. Healy’s web site for depriving them of commenting on the supposed limited topic of SSRI’s (though Dr. Healy touted ECT in his posts too), have all disappeared from his blog, which mostly attracts no comments.

          I am bringing this up because I stressed the fact that abuse and trauma issues are mostly what comes to the attention of psychiatrists in my posts above per Dr. Judith Herman, trauma expert. When psychiatry sold out to BIG PHARMA with its DSM III and the invention of its bogus brain disorders to push toxic drugs and other torture treatments like ECT, it also colluded to ignore all environmental causes of severe emotional distress like domestic, work and community violence and bullying and other crises known to cause trauma. Though they gave lip service to PTSD to pacify soldiers at the time, most people suffering from traumatic events are given the bipolar fraud or other stigmas to blame and discredit them and deny them any justice, compensation or validation since psychiatry sees its role as serving the power elite as Bruce Levine exposes.

          So, I think the very existence of biopsychiatry is a total menace to every person on this planet and people won’t be free of its predation until and unless the whole evil edifice is exposed and abolished like all types of fascism and slavery.

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      • Fred,

        Thank you for your kind and supportive comments.

        You speak of betrayal trauma. Have you read Dr. Patrick Carnes’ great book, THE BETRAYAL BOND? He goes into all types of abusive relationships that can cause trauma/betrayal bonds to abusive people due to abuses of power in a wide variety of relationships including work, home, school, churches, medical, etc.

        You make some interesting comments too.

        I also appreciate your empathy in your comment when you probably could see I was feeling somewhat discouraged about my participation on this website.

        Donna

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          • Hi Stephen,

            Thanks for your validation. I have read that even psychosis is most often caused by abuse and trauma, so I think it is a critical issue for anyone who has encountered the mental death profession. From what I have read, biopsychiatry knows that people are catching on to the fact that it TOTALLY IGNORES environmental stressors. Therefore, they pretend to address it by fraudulently claiming either that bad genes or some other “blame the victim” flaw rather than the abuse and/or traumatic event(s)is the cause of the PTSD and not the evil situation. Or, as with an article just posted on this web site, they claim after the fact that one’s so called bipolar is far worse due to childhood trauma.

            What is truly evil about such a claim is as Dr. Carole Warshaw, Dr. Judith Herman and other abuse, violence experts expose is that psychiatry does not acknowledge ANY environmental stressors for any of their bogus stigmas for children or adults, but focuses merely on their paper and pencil check lists of normal reactions to life stressors or crises to stigmatize every would be victim they encounter to push the latest lethal drugs and other lucrative tortures on patent while robbing them of any justice, credibility or ability to recover, make a living or survive if they don’t see through and escape this fraud and death trap.

            As now exposed by those like Dr. Warshaw and the ENCYLOPEDIA OF DOMESTIC VIOLENCE ABOVE and many other sources, psychiatry is DELIBERATELY misdiagnosing the abused, bullied/mobbed, traumatized suffering gross injustice and violation of all rights from the original abusers who find themselves scapegoated and stigmatized with the life destroying bipolar stigma so the psychiatry/BIG PHARMA cartel can profit from their suffering while literally killing them by driving them to suicide or early death by about 25 years from the added stress, betrayal, retraumatization and lethal drugs and other so called treatments including constant crazy making bullying invalidation of their reality. Along with the bogus bipolar, the victims of horrific psychological/physical terror, bullying, mobbing and other abuse in homes, work places and the community at large are also subjected to fraudulent claims by the mental death profession that they are delusional, paranoid, hallucinating and other vicious lies to aid and abet their fellow abusers in power. Another bogus ploy is when pushed enough, the mental death expert will admit the person has some trauma as a dual diagnosis with the bipolar fraud stigma. See the work of Dr. Heinz Leymann in THE MOBBING ENCYCLOPEDIA online, BULLYONLINE by Dr. Tim Fields, Dr. Gary Namie’s THE BULLY AT WORK, Dr. Robert Hare’s WITHOUT CONSCIENCE and SNAKES IN SUITS and other sources I cited above along with many others exposing this pernicious collusion of those in power including psychiatry to completely destroy and eliminate anyone targeted by psychopathic, narcissistic serial bullies who are becoming more prevalent in our society every day.

            It is all too clear that psychiatry aids and abets the most powerful, perverse, abusive person, group or entity in every encounter by completely discrediting, silencing, stigmatizing, ostracizing, robbing and destroying anyone who gets in the way of more powerful people including themselves.

            So, helping people see through this evil menace is a first step to escaping this death trap by first unbrainwashing one’s self from all of the lies of psychiatry and their many enablers in power.

            I am glad to hear that others hear want to focus more on the issue of trauma, so maybe it would be helpful if those with such an interest spoke up more and related it to various issues that are brought up here since trauma from abuse and other abnormal events is what lands most people in the mental death system in the first place.

            Again, I have been glad for your many helpful comments and your support when I was feeling alone and discouraged about the trauma and other issues.

            Donna

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  21. Jeremy from Finland mentioned Joanna Moncrieff and she’s often very good read. For instance, here’s her presentation paper about Antipsychotics: myths and realities. She has written a lot of different articles, etc, I’ve also read one of her books.

    http://www.linkbristol.org.uk/assets/files/Issues%20and%20Concerns/Joanna%20Moncrieff%20Presentation.pdf

    And the situation in Finland seems to be more something like that Finland was still somewhat independent and distant from the European trends in the earlier part of the 20th century and there were some experiments here and there, but gradually at least the Western world has become and is becoming more and more alike. Same ways of acting, same drugs, etc. Same problems. The thing that those people are doing in Tornio is not so much some new discovery but kind of remnants or one final remote “island” of Finnish national development from 1960’s or 1970’s. During the 1980’s, the USA/Western thinking and media pushed more and more to Finland and replaced the studies on schizophrenia therapy done by this other group. A small number of people in Finland have since then continued with their studies, and those people in Tornio are a great number of those people who are left from this development.

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  22. Hi Sandy,
    I do not have time to read all the previous comments so I apologize if I’m repeating a point already made. I feel very strongly about this.
    There is a basic fact about neuroleptics – the most important one – which has been established for some time and which, I feel, you are suppressing in your article. It is that neuroleptics destroy the brain. In the 1950’s, psychiatrists called treatment with thorazine the chemical lobotomy. At the time they could only speculate about the physiology; what they could observe were the clinical facts. With good reason they made the analogy. When computed tomography became available they used the technology to longitudinally study the brains of schizophrenics. The most reputed researcher in field, Nancy Andreasen, and the psychiatric establishment at large were soon trumpeting that they had proved the degenerative nature of the disease. In the long term the brain mass of schizophrenics was decreasing alarmingly compared to healthy individuals. Twenty years later, Andreasen admits she now believes the reason her subjects’ brains were wasting were the neuroleptics they were ingesting, not a natural process of the condition. The establishment does not refute this fact, it only suppresses it. Most everyone who is familiar with the site, knows all this – I don’t like try your patience but diminishing the relevance is even worse.
    I disagree with your claim that the short term efficacy of neuroleptics is inflated. A haldol dose for an acute psychotic episode is just as immediate and as effective as lobotomy. All the “major tranquilizers” and their successors are. I look forward to hearing your arguments on this point.
    Though you will argue how the long term risks are minimized – and the risks are grave and plenty – you don’t have an issue with the long term certainties, brain atrophy and significant cognitive impairment being one of them. A risk is an event that has a significant chance of not happening, that’s why I don’t call brain atrophy a risk. I am curious whether in your clinical experience you know of anyone who has continually taken neuroleptics in a mid range therapeutic dose for more than ten years who is not cognitively impaired.
    I disagree that the risks of delaying treatment are inflated, if by that you mean physiological risks and you believe they are made to be bigger than they actually are, because they don’t exist at all. Insomnia is a condition that causes other physiological ailments, psychosis is not. If you mean the risk of violent acts, I agree with you.
    Morphine and chemotherapy for cancer are accepted as effective short term treatments. There are no good arguments that either should be used long term. The science to justify neuroleptics belonging to the same category already exists.

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    • “Though you will argue how the long term risks are minimized – and the risks are grave and plenty – you don’t have an issue with the long term certainties, brain atrophy and significant cognitive impairment being one of them. A risk is an event that has a significant chance of not happening, that’s why I don’t call brain atrophy a risk.”

      PC,
      This is an EXCELLENT POINT (very well put) regarding the so-called “risks” of using these drugs long term.
      In fact, your entire comment is excellent.
      Respectfully,
      ~Jonah

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        • 🙂 PC,

          You’re welcome. I like your comment a lot – for the reason I explained – and, especially, for that one sentence, of yours: “A risk is an event that has a significant chance of not happening, that’s why I don’t call brain atrophy a risk.”

          That’s such a great point you make; I’m committing it to memory! (There’s your second comment on MIA!!)

          Long term use of these drugs leads to measurable brain shrinkage – and will create powerful physiological dependency. Prescribers should explain these facts in no uncertain terms.

          And, about your comparison of prescribing neuroleptics for ‘psychosis’ to prescribing Morphine and chemotherapy for cancer: It’s a fair analogy, in the way you present it…

          (You say, “Morphine and chemotherapy for cancer are accepted as effective short term treatments. There are no good arguments that either should be used long term. The science to justify neuroleptics belonging to the same category already exists.”)

          But, note: I’m not entirely fond of the comparison of ‘psychosis’ to cancer.

          It’s an interesting analogy, in the way you’re using it; there is *wisdom* to be drawn, from such an analogy (in particular, yes, it’s surely a *mistake* to prescribe neuroleptics on a long-term basis).

          But, ‘psychosis’ is a much more *vaguely* defined phenomena than cancer; and, whereas cancer is widely held to be ‘bad’ (and, most people believe that all cancer requires some kind of medicalization), ‘psychosis’ can come in forms, which really should *not* be judged ‘bad’ at all, nor should they be medicalized at all (forms which, when subjected to nurturing environments, will clearly come to reflect a natural outgrowth of developmental processes that are simply bound to *improve* a person’s life, in the long run).

          In fact, many types of cancer exist, but ‘psychosis’ can refer to such a broad array of phenomena, I’d avoid taking any analogy to cancer too far or too literally.

          Respectfully,

          ~Jonah

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          • The analogy of morphine with a neuroleptic is that both can relieve insufferable pain but don’t cure anything. The analogy with chemotherapy is that they both kill cells, one quickly, the other slowly. The commonality is that all of them will lead to premature death if taken in sufficient amounts and for sufficient time. There is absolutely nothing in common between cancer and psychosis. One is an illness and the other is not.

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  23. “Morphine and chemotherapy for cancer are accepted as effective short term treatments. There are no good arguments that either should be used long term. The science to justify neuroleptics belonging to the same category already exists.”

    Moncrieff also says than in some earlier studies, drugs such as benzodiazepines and even opium have been found to be as effective, I suppose short term, then neuroleptics. (I haven’t read these studies though.) But maybe it is not a good idea to start the neuroleptics in the first place even in many of the acute psychosis, given that their use usually or often simply sticks.

    http://www.linkbristol.org.uk/assets/files/Issues%20and%20Concerns/Joanna%20Moncrieff%20Presentation.pdf

    * Barbiturates: 2 early studies showed chlorpromazine superior
    • Opium: 1 study. Opium equal to chlorpromazine for acute psychosis
    • Benzodiazepines: 6 trials: 3 trials AP=BZD; 2 trials BZD>AP; 1 trial CPZ>BZD=HAL

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    • My point is not that a neuroleptic is the best short term treatment for psychotic conditions but that it would be hard to make the case that short term treatment is medical malpractice. As for long term treatment this is what I think: before someone is subjected to neuroleptic treatment, he should have a MRI performed on his brain. If after a few years of neuroleptic treatment the patient’s brain mass has diminished by 5% or the psychiatrist failed to perform the initial MRI, the patient should have an excellent chance of successfully suing his prescribing psychiatrists. Currently his chances are nil. That simple change in legal precedent would have at least as big an impact on global health as the anti-tobacco or anti-asbestos campaigns of the past.

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      • “…it would be hard to make the case that short term treatment is medical malpractice.”

        PC,

        In my first comment, to Dr. Steingard (i.e., in that first comment, directly beneath her blog), I emphasized certain risks inherent in *forcing* these drugs upon so-called “patients”.

        I pointed out, that I believe forcing these drugs on people is always unethical – given the risks involved; indeed, it is always bad practice, given the risks.

        But, generally speaking, it is not malpractice – because it is a form of standard ‘medical’ protocol, throughout the land.

        It is essentially impossible to make the case, that any medical practice, which is standard protocol, is malpractice.

        [Important to bear in mind: “malpractice” is a legal term. Though many highly popular (‘standard’) medical procedures are eventually proved inefficacious – and even harmful; they are *not* considered ‘malpractice’ unless or until they are being practiced *after* that time, at which they have been broadly condemned by the field of medicine.]

        So, while I think it is a good idea to develop a standard protocol, of measuring brain mass before and after long-term use of these drugs, I don’t believe it would lead to legal prosecutions of doctors.

        It could lead to prosecutions of pharmaceutical companies – if/when it’s proved that, in the course of promoting these drugs, they have suppressed findings, that these drugs cause such damage.

        Respectfully,

        ~Jonah

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        • Jonah, I agree with you that forced psychotropic drugging is unethical; it is also enshrined by law. It is the only medical “treatment” that can be forced on patients. I say that long term neuroleptic prescription – whether voluntarily adhered to or not – is not currently considered malpractice but that it should in many circumstances if not most. Historically many human rights abuses from today’s perspective were enshrined by law, among classic examples are slavery, women and gays rights (rather lack thereof). Things eventually change but not without strife. Though I may sound a little harsh on Sandy sometimes, I recognize she is an agent of change and I profoundly respect that.

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      • Hi Sandy,
        I don’t know if in the future you will be engaging any of your patients in long term neuroleptic use but I’m sure you have plenty of colleagues in the Vermont mental health system that will. Would you be willing to urge them to have their patients periodically get a brain MRI? Once a year maybe? Not a bad idea to track their brain mass as a good clinical practice, no?

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  24. Why does a psychiatrist put someone who isn’t psychotic on neuroleptics?

    After all the medical training and feed back from other clients how could the psychiatrist not know the drugs were causing at least some terrible side affects??

    That the client’s changed behavior was due to the drugs he prescribed??

    When he does know this then why wouldn’t he admit it and help taper the client off said drugs??

    These are basic questions that psychiatrists should be aware of because they are essentially gate keepers and responsibly prescribe any mood changing drug very carefully.

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    • Along this line, Sandy, I’d love for your comments on the dramatically increased use of neuroleptics for “aggression” in children and the elderly. These people don’t even meet the questionable and subjective criteria for a psychiatric diagnostic label, and yet they are given drugs simply for their behavior. Where does this kind of thing stop? Can we drug someone for excessive political protest, or for being too upset about the state of the economy?

      I consider this behavior not only unethical, but criminal. Do we give someone antibiotics without evidence of an infection, or blood pressure medication when their blood pressure is normal?

      What do you think of this trend? Should it be stopped, and if so, how? I work with foster kids and this is done all the time, without the slightest consideration for the long-term impact on the children involved. It makes me ill, but I’d love to know how you view it.

      — Steve

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      • Steve,

        It’s good to see you’re pressing these questions.

        I believe no one should be *forced* to take these drugs (made that point, in my first comment), and there should be no way to prescribe them for kids; i.e., doing so should be outlawed.

        Kids who are currently on these drugs should be carefully weaned off them (starting yesterday).

        Of course, I realize that would, at first, seem wholly unfeasible in the eyes of most psychiatrists.

        I recommend they study up, on *behavioral* approaches to parenting seemingly ‘oppositional’ kids.

        There are so many books on that topic!

        Also, I recommend this video,

        “12 year old Testifies in U S Senate Hearing”

        http://www.youtube.com/watch?feature=player_embedded&v=Td7X3yk2UTg

        (Note: At minute 12:30, one piece of advice from 12-year-old Ke’onte Cook… “That meds aren’t gonna help a child with their problems. It’s just gonna sedate them, make them tired, make them forget it for a while, and then it comes back, it happens again. What I learned in therapy is that, when you’re taking therapy, you talk about the deepest thing, it hurts, then it comes back, but you can handle it better.”)

        Respectfully,

        ~Jonah

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  25. What is the cause of this so called mental emotional illness ? Either betrayal trauma or drug poisoning, mostly metal poisoning)chemical poisoning, or a combination of 2 or 3 or 4 considering so many abused ,and that just in the USA 78% of the population has at least some mercury fillings.Plus whose gotton away without being vacinated. Google RussellBlaylockMD Mental Health and watch a video of him being interviewed.Also see A Special Interview with Dr. Christopher Shade at Mercola.com on the mental effects and wide range of mercury poisoning. What do you do about all this instead of just trying to make money off of peoples suffering.You force the government to remove all mercury fillings and replace with ceramic restorations ,remove all root canals,check for cavitations.All according to Hal Huggins Protocols. Treat betrayal trauma with enegy medicine like YuenMethod.Every emergency room should be able to make fresh mostly green vegetable juice(also makes weaning off drugs much easier as well as taking 1000 to 1200 mg.niacin followed by a hot bath with Baththerapy (a mineral Powder)rub body with a luffa ,put on inflatable collor as a precaution against drowning. You’ll fall asleep and wake up feeling great.This is my method to replace ect with a modality that that does no harm. you fall asleep in the tub and wake up feeling great.Traditional Naturapathy and Homeopathy can greatly help if you find experienced people to show you what to do like me.Any questions? Go for it.Their is little use for psychiatrists a vestage of the Spanish Inquisition.

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  26. Sandy, I’d be interested to see what you think of the new article by Martin Harrow and Thomas Jobe http://www.madinamerica.com/2013/03/do-antipsychotics-worsen-long-term-schizophrenia-outcomes-martin-harrow-explores-the-question/

    As quoted by Bob Whitaker, Harrow and Jobe say: “The discontinuation effect includes the potential of medication-generated buildup, prior to discontinuation, of supersensitive dopamine receptors, or the buildup of excess dopamine receptors, or supersensitive psychosis….” which would suggest some “relapse” is a withdrawal effect.

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