Harrow + Wunderink + Open Dialogue = An Evidence-based Mandate for A New Standard of Care

Robert Whitaker

In the wake of the new study by Dutch researcher Lex Wunderink, it is time for psychiatry to do the right thing and acknowledge that, if it wants to do best by its patients, it must change its protocols for using antipsychotics. The current standard of care, which—in practice—involves continual use of antipsychotics for all patients diagnosed with a psychotic disorder, clearly reduces the opportunity for long-term functional recovery. (MIA writer Sandy Steingard recently wrote about the Wunderink study, which was published on July 3 in JAMA Psychiatry online.)

The Wunderink study, precisely because it had a randomized design, complements Martin Harrow’s study of long-term outcomes in a very compelling way. In addition, the results reported by Open Dialogue practitioners in northern Finland provide a data-based sense of what would be possible if psychiatry amended its protocols for using antipsychotics based, in large part, on the findings in the Harrow and Wunderink studies.

Here is how the three studies fit so nicely together to form a compelling evidence-based rationale for changing prescribing standards.

Martin Harrow, a psychologist at the University of Illinois Medical School, followed 145 people diagnosed either with schizophrenia or a milder psychotic disorder for 15 years. His was a prospective, naturalistic study. All of the patients were initially treated with antipsychotics and then Harrow followed up at regular intervals to assess how they were doing, and whether they were using antipsychotics. Among his many findings, there were these three key results related to schizophrenia patients:

  • At the end of 15 years, the recovery rate for the schizophrenia patients off antipsychotics was 40%, versus 5% for those on antipsychotics. Harrow’s definition for recovery included a functional component (whether they were working, had a decent social life, etc.) and this functional component was a primary reason for the much higher recovery rate for the off-antipsychotic group. Those on antipsychotics might experience clinical remission of their symptoms, but still not be able to function well in society.
  • The divergence in outcomes between the two groups (the schizophrenia patients on and off antipsychotics) occurred between the two-year and five-year follow-up assessments. At the two-year assessment, the difference in outcomes was not so notable.
  • Once patients off medications became stable, they had very low relapse rates. At both the 10-year and 15-year followup, those off antipsychotics were much less likely to be experiencing psychotic symptoms than those on the drugs.

After Harrow published his 20-year results, he raised the obvious question. Do antipsychotics worsen long-term outcomes? At the very least, Harrow concluded, it is clear that some schizophrenia patients can do well off medication over the long term, and that drug-use protocols need to allow for that possibility.

Harrow’s study presented an obvious challenge to current standards of care for schizophrenia patients. However, those who were eager to defend the common wisdom and common prescribing standards dismissed his findings in this way: His was a naturalistic study, rather than randomized. Thus, there may have been some internal characteristic in those who took themselves off medication that accounted for their better outcomes. The divergence in results wasn’t due to any “harm” being done by the antipsychotics.

Now, I personally think that Harrow’s findings can’t be explained away in that manner, because in every subset of patients in his study, those who got off antipsychotics had markedly better outcomes (in the aggregate.) If the drugs were truly helpful, you simply wouldn’t see such outcomes, but if the drugs did worsen outcomes over the long-term, that is precisely the results you would expect. But it was the lack of randomization that provided an intellectual out for those who would defend current prescribing practices. Randomization is the gold standard for evidence-based medicine, and thus Harrow’s results could be dismissed.

Wunderink has now provided psychiatry with a randomized study of long-term outcomes. In his study of adults with a first episode of psychosis, all patients were stabilized on antipsychotics for six months (n=128), and then they were  randomized either to a “drug discontinuation/drug reduction” arm (the DR group), or to standard drug maintenance (the MT group.) In other words, this was a randomized study designed to see which treatment protocol produced better outcomes: tapering first-episode patients from their antipsychotics (or down to a low dose), or standard drug maintenance, at usual doses.

Wunkerink had 103 patients in his study at the end of seven years. Here are his salient findings:

  • At the end of seven years, those in the DR group had a much higher recovery rate (40.4% versus 17.6%.) The difference in recovery rate was due to the fact that those in the DR group had much better functional outcomes.
  • At the end of 18 months, there was little difference in functional outcomes. The divergence in functional outcomes began to appear after that point (as was the case in the Harrow study.)
  • In terms of risk of relapse (control of clinical symptoms), the relapse rate at 18 months was in fact higher for the DR group  (43% vs 21% for the MT group.) But from that point on, relapses occurred at a greater rate in the MT group, such that by the end of three years, the relapse rate was roughly the same for the two groups. At the end of seven years, the relapse rate was slightly lower for the DR group (61.5% versus 68.6% for the MT group.)

Thus, this randomized study found that a dose-reduction protocol, which allowed for the possibility that some patients could successfully go off their antipsychotic medications, produced superior overall results to the standard protocol of care, which emphasizes continual drug maintenance at higher dosages.

Now some of the patients in the MT group took themselves off antipsychotics during the seven years, which enabled a second comparison. Wunderink reported results for all of the patients in the study who discontinued antipsychotics or took a very low dose, regardless of which group they were randomized to, and compared their outcomes to those who ended up on standard doses of antipsychotics.

Twenty-two patients in the DR group ended up in this off-drug/low-dose category, while 12 in the MT group did. When Wunderink compared these 34 patients to the 69 patients who ended up on standard doses of antipsychotics, he found a marked difference in outcomes. The discontinued/low dose groups were more likely to achieve symptomatic remission (85.3% versus 59.4%), functional remission (55.9% versus 21.7%) and full recovery (52.9% versus 17.4%.)

In conclusion, Wunderink and his colleagues made two important points. The first was that antipsychotics could be hampering long-term functional recovery. “Antipsychotic postsynaptic blockade of the dopamine signaling system, particularly of the mesocortical and mesolimbic tracts, not only might prevent and redress psychotic derangements but also might compromise important mental functions, such as alertness, curiosity, drive, and activity levels, and aspects of executive functional capacity to some extent.”

Second, they noted that the usual methods for assessing the merits of antipsychotics, which have focused on control of psychotic symptoms over shorter periods, were flawed, and that psychiatry needed to adopt a new perspective in order to best assess the merits of antipsychotics. “The results of this study lead to the following conclusions: schizophrenia treatment strategy trials should include recovery or functional remission rates as their primary outcome and should also include long-term follow-up for more than 2 years, even up to 7 years or longer. In the present study, short-term drawbacks, such as higher relapse rates, were leveled out in the long term, and benefits that were not evident in short-term evaluation, such as functional gains, only appeared in long-term monitoring.”

In sum, both Harrow and Wunderink provide evidence, of a complementary type, for a drug use protocol that would involve tapering first episode patients from their antipsychotics, and, in that manner, identify a subset of patients who could do well off the drugs long-term (or on very low doses.) In the Wunderink study, slightly more than 40% of the patients randomized to the DR group did well off the drugs or on a very low dose over the long term.

If you then wanted to have a next step in the “evidence base” for changing antipsychotic protocols, you would want to have a study in which a provider of psychiatric care had routinely utilized antipsychotics in this way, and had followed patients for a longer period of time. A study of that sort would reveal whether the research findings held up when incorporated into regular care.

The reports by the practitioners of Open Dialogue therapy in northern Finland provide that evidence, and also take the research findings one additional step. In Open Dialogue therapy, there is a delay in the use of antipsychotics in first-episode patients, with the hope that patients, with the proper psychosocial support and selective use of benzodiazepines, can get through their first crisis without ever going on antipsychotics. But if patients need to go on antipsychotics, then the open-dialogue protocol also allows for  them  to subsequently try to taper from the drugs.

With this selective use of antipsychotics, Open Dialogue has produced the best long-term outcomes in the developed world. At the end of five years, 67% of their first-episode patients have never been exposed to antipsychotics, and only 20% are maintained regularly on the drugs. With this drug protocol, 80% of first episode patients do fairly well over the long-term without antipsychotics.

Thus, together the three studies provide a clear mandate for change. They provide convincing evidence that if psychiatry wants to promote the best possible functional outcomes, it needs to adopt protocols that will maximize the percentage of patients who are able to do fairly well off antipsychotics (or on a very low dose.) The one remaining question is this: how large is this subset of patients? Harrow and Wunderink suggest that at least 40% of all patients fall into this category, while the Open Dialogue studies indicate that, if you have that first step of avoiding initial use of antipsychotics, it may be 80% of all patients.

In a remarkable editorial in JAMA Psychiatry accompanying the Wunderink report, Patrick McGorry and his co-authors argue that psychiatry needs to respond to this data and adopt new drug-use protocols, and if you read their editorial carefully, they are embracing both elements of the Open Dialogue protocol for prescribing antipsychotics. They wrote:

“In moving to a more personalized or stratified medicine, we first need to identify the very small number of patients who may be able to recover from first episode psychosis with intensive psychosocial interventions alone. For everyone else, we need to determine which medication, for how long, in what minimal dose, and what range of intensive psychosocial interventions will be needed to help them get well, stay well, and lead fulfilling and productive lives. These factors have rarely been the goal in the real world of clinical psychiatry—something we must finally address now that we are armed with stronger evidence to counter poor practice.”

That was the argument made in JAMA Psychiatry. There is new evidence to counter current poor practice standards. Try to get people through a first episode with “psychosocial interventions alone,” and for the rest of the patients, adopt protocols that help people get on minimal doses or off the drugs altogether over the long-term. Psychiatry has an evidence-based mandate to change.

In my opinion, this represents a defining moment for the profession. If it changes its protocols for prescribing antipsychotics, in the manner set forth in the JAMA Psychiatry editorial, then “hats off” to the profession. It will have responded to evidence that didn’t show up in shorter withdrawal studies, and changed its ways in response to new evidence, even though that will surely be a difficult thing to do. This would be a beautiful—and inspiring—change to watch.

But, if psychiatry doesn’t amend its protocols, and if psychiatry doesn’t sponsor new research to best reach these goals, then—and I know no other way to say this—then I think psychiatry will have to be seen, by mainstream society, as a failed medical discipline. Psychiatry will no longer be able to claim that its practices are evidence-based and driven by a desire to achieve the best possible outcomes for its patients. Instead, the lack of change will be evidence that its prescribing practices are, in fact, driven by an ideology, which is to maintain a societal belief that antipsychotics are a necessary long-term treatment for psychotic disorders, and that it is more important for the profession to maintain that belief than it is to help those it treats to have the best chance possible to achieve a good functional outcome, which is the outcome that counts.

Which will it be? My optimistic self hopes for the first outcome, while my realistic self expects the latter. And if it proves to be the latter, this will be a medical story of continuing harm done, and, I would argue, it would be reason for our society to conclude that the care of “psychotic” patients can no longer be entrusted to the psychiatric profession.


Support MIA

Enjoyed what you just read? Consider a donation to help us continue to produce content, provide up-to-date research news, offer continuing education courses, and continue building a community for exploring alternatives to the current paradigm of mental health. All donations are tax deductible.

Select Payment Method Loading...
Personal Info

Donation Total: $20.00


  1. Thank you Bob for your strong statement that psychiatry may fail to be worthy to be entrusted with the care of people experiencing psychosis. Any of us who have followed your journalism for many years, knows that this is a huge step for you to make such a bold pronouncement.

    You are a revered and trusted medical science journalist, and your objective assessments about psychiatry have always meant allot to me personally. The positive impact of your books and journalism are beyond measure around the world.

    As someone who did experience psychosis, and who has spent over 30 years serving those in such extreme states in medication-free sanctuary settings and in the community, I must say that in my opinion, psychiatry has already betrayed the trust of those of us with lived experience of psychosis, who needed help from them.

    For me, the evidence of that betrayed trust has been there for decades.

    I saw it in 1978, in the follow-up results of the largest ever in the US randomized, acute psychosis, medication vs placebo double blind study done by the NIMH on acute psychosis. The results were ignored and suppressed by psychiatry, despite the evidence that the young men who got no meds did much better in terms of functioning and had far less re-hospitalizations at follow up years later.

    The results of that California, Agnews state hospital research was finally published in the obscure International Pharmacopsychiatry journal.

    The research article title was- “Are There Schizophrenics for Whom Drugs May be Unnecessary or Contraindicated?” It seems that title from 1978 ironically echoes your 2013 assertion that there is unnecessary and contraindicated use of antipsychotic drugs.

    Another reason I doubt that psychiatry will take the combined evidence of Harrow, Wunderink and Open Dialogue any more seriously than they did the Agnews results, is because of how they responded to John Bola’s powerful research affirming the Soteria projects results a few years ago. John’s cutting edge research was ignored by psychiatry even after the New York Times featured it.

    So, if psychiatry continues to seek it’s identity as applied neuro-science, but in reality clings to a true-believer ideology that science itself refutes, then perhaps your challenging words about trust will be more and more important.

    Should we entrust the care of those in extreme states to the care of psychiatry?
    For me the answer is No.

  2. Thank you, Bob! As one who was given way too much Thorazine when I was locked up and diagnosed with schizophrenia for my natural feelings of sadness over a romantic loss as a teenager, I can attest to its horrifying effects. When I was finally taken off all of it and a dear young doctor sat with me and listened to me and respected my feelings, I steadily felt better and better and have been fine for over 50 years.

    Your strong words again come as a breath of fresh air on this hot summer morning here in Boston.

    Thank you, always!

  3. Bob, for quite awhile, I have felt that medicine in general has been driven by ideology instead of evidenced based medicine with psychiatry being the worst of the fields. So thank you very much for saying right up front that that if psychiatry doesn’t change their antipsychotic prescribing practices, that they will be ideologically driven.

    By the way, this is an important point because one of psychiatry’s main criticisms of folks like us is that we don’t care about the “mentally ill” and all our criticisms of psychiatry do is increase stigma. Hmm, if your practices are based on ideology, aren’t you doing exactly what you are falsely accusing us of doing?

    Thanks again for everything you do.

  4. ..and not exclusively for psychosis too, people of any diagnosis can be given antipsychotics or mood stabilisers and too often there are 12 month studies with intensive psychological support so the results appear good, but longer term we know they’re not.
    This study is really important and confirms what I’ve always thought, that sometimes [with consent]very judicious and selective use of Benzo’s in a crisis are safer. There is no justification for forcing anyone to take antipsychotics for life, and evidence such as this cannot be ignored.

  5. Bob,

    How great is this!

    I feel like I’m reading history-in-the making.

    It reminds me of growing up off the Texas Coast, not far from NASA. I watched each of the early missions – Mercury, Gemini and Apollo – glued to the black-and-white television set, watching Shepard, Young, Grissom and the other “rocket men” until July, 1969 – when we “sent a man to the moon and returned him safely to earth.”

    This is a different kind of science, a different kind of history that is being made – but it is no less fascinating, and of even more importance!

    Thank you, thank you, thank you!


  6. Thank you so much Robert! I like so many others have been a victim of terrible prescription damage prescribed by many doctors over a long period of my life. I was forced to take many different neuroleptics very soon after childbirth. I continued to be brain washed to take Largactil for 15 long, tedious years while I experience horrific adverse effects no human being should have to endure. I am 13 years free from these drugs. I am also free from their dehumanizing effects. Before I encountered these drugs I never experienced the terror I later experienced on them. As Dr Lars Martensson wrote in 1985 ‘neuroleptic drugs should be banned’! They do not allow human beings to be the people they were created to be.
    Thanks also to all the people who are adding their voices daily to Mad in America, other websites and blogs to let the truth be known about our prescription drugs. Let our combined voices grow stronger and louder!

  7. “In moving to a more personalized or stratified medicine, we first need to identify the very small number of patients who may be able to recover from first episode psychosis with intensive psychosocial interventions alone.” – JAMA Psychiatry editorial

    Given the substantial number of patients whose experience of first-episode psychosis was driven by adverse drug reactions involving known side effects of medications, this minimization – a “very small number” of patients who will require “intensive psychosocial interventions” – is nothing but a dodge.

    – bonze anne blayk

    PS: Of course, acknowledging that would require accepting responsibility themselves when things go wrong… something they are loathe to do, while posing as “expert physicians”.



  8. Much of psychiatry is suffering from “Münchausen syndrome by proxy”.


    “Successful treatment of people with MSP is difficult because those with the disorder often deny there is a problem. In addition, treatment success is dependent on the person telling the truth, and people with MSP tend to be such accomplished liars that they begin to have trouble telling fact from fiction.”

    • … “anosognosia”, √, lacks insight, √.

      What kinds of screening are required before the extensive powers made available to psychiatrists are granted?

      The Soviets, and others experienced in managing intelligence and secret police services, deploy cunning traps to “out” those who are not fully committed to their cause; meanwhile, legal requirements that clinicians testify truthfully are hardly enforced, with the consequence that their standards typically fail to exceed those practiced by Jayson Blair.

      Leading to a different question: how many psychopaths have pursued psychiatry as a profession precisely because it is an area of medical practice with no real legal oversight and accountability?

      bonze anne blayk


  9. I was very gratified that Bob pointed out, I think quite correctly, that if the psychiatric profession continues to ignore the clear evidence of long-term damage from antipsychotics, they will have shown themselves to be unworthy of the trust and power society has given them.

    I think very few MIA readers believe that the profession is going to change its ways just because those ways have been proven to be damaging. For one thing, the financial advantages they receive from the drug companies are not something they are willing to give up.

    But even more importantly, I think, is that on the whole the basic paradigm of psychiatry over the centuries, as Bob demonstrated in “Mad in America,” is a complete disrespect for the people it supposedly serves.

    So I expect that this research will be ignored by the profession, but I think it is our job to bring it to the attention of the public. I can’t see anything changing in the basic practices of the profession until the public realizes psychiatrists are not godlike figures but (with a few exceptions) utterly corrupt people who must have their power taken away.

  10. In wake of the Sandy Hook massacre, the Aurora shooting, the Tucson shooting, the deaths of Kendra Webdale/Mozelle Nalan, and the extremely long list of U.S. tragedies involving “psychotic” individuals, it is time for mental health advocates to develop a strong, unified advocacy agenda that incorporates best practice standards of assessment and care for our “psychotic” patients.

    Medical and mental health professionals, not just psychiatrists, must to do the right thing and acknowledge that, if we want individuals who seek, or are force into treatment, to have the best care, our treatment and criminal justice facilities must be proactive and test for the many underlying causes of psychotic symptoms.

    For the most part, psychiatrists, psychologists, other medical/mental health professionals use the DSM 5 with a “Chinese menu” approach.

    The DSM 5 includes “Substance/Medication-induced psychotic disorder” and “Psychotic disorder due to another medical condition”

    unfortunately, no one ever seems to consider them.

    Patients who suffer psychotic/manic symptoms are rubber-stamped with the label of schizophrenia/bipolar

    While there are no biological tests to determine a patient has sz/bp, there are many tests to prove “psychotic” patients do not have sz/bp and are SUFFERING from underlying medical condition.

    The concepts of Open Dialogue and Soteria means “psychotic” patients will continue to SUFFER while the underlying cause goes undetected and untreated. This is cruel and potentially harmful.

    In his book “Mad in America”, author Robert Whitaker points out historically cases of “insanity” were cured by treating infected teeth.

    This still holds true today.

    Proper psychosocial support

    or, a root canal for an abscessed tooth?

    If you were a “psychotic” patient and in need of both, which one would you want first?

    From my personal experience, take the root canal.

    Many individuals labeled with sz simply need dental care, while others are suffering from lead poisoning, Lyme disease or a host of other underlying conditions caused by toxins, bacteria, viruses, or other medical conditions.

    On average, people with severe mental illness die 25 years earlier than the general population. Advocates can no longer ignore the fact underlying conditions of psychosis are being ignored and untreated. We need to work together to ensure best practice standards of assessment are met.

    While Open Dialogue and Soteria are nice concepts, I would think any reasonable person would conclude that the care of “psychotic” patients should be entrusted to those who implement best practice assessment standards.

    The British Medical Journal put together a very nice guideline. It would be nice if advocates supported the use of it.


    MIA blogger, psychiatrist Vivek Datta, recently made this comment evidencing the fact mental/behavioral health facilities fail to provide patients with the same standard of care others patients are given:

    “I do my best to do a thorough neurological examination and assessment of the cognitive state in my evaluations that would point towards a toxic-metabolic encephalopathy or secondary cause of the person’s mental state, and where indicated various laboratory and radiological investigations. Unfortunately today, many psychiatrists have very little postgraduate medical and neurological training, and are only expected to know when another medical condition may be contributing to a patient’s mental state rather than to look for the cause. This is in my view a tragedy, as the value of a good psychiatrist, is the medical training and the ability to be able to recognize the wide range of conditions (endocrine, metabolic, nutritional, neoplastic, autoimmune, systemic etc) that can cause neuropsychiatric disturbances and present as “depression”, “mania”, “psychosis”, “confusion” and so on. It begs the question of what use is a psychiatrist if she cannot use this supposed medical expertise.
    Unfortunately, this situation is compounded as there is no real mental health parity in the US. As a result, unlike in almost any other hospital service, psychiatry is unable to bill for blood tests, brains scans, lumbar punctures etc, in the inpatient setting. The result is there is a financial disincentive to NOT look for other causes contributing to the mental state. In fact, management often breathes down our necks if we DO investigate and treat medical conditions that are either comorbid or contributory! Until this changes, I do not see the culture shifting.”

    When it comes to psychosis, psychiatry has created a medication management treatment monopoly.

    I don’t understand how Open Dialogue and Soteria are taking a precedent over Best Practice Assessment standards.

    My optimistic self hopes advocates involved in MIA will do their best to advance best practice assessment standards, while my realistic self knows it’s like talking to a door freaking knob.
    (Beside you Duane)

    • Maria,

      I too have an appreciation for using holistic approaches.
      IMO, this may end up being a Texas 2-Step:

      Step 1. End the long-term use of neuroleptics as the status quo (first and only line of treatment, often with force) and offer psycho-social alternatives.

      Step 2. Begin to use other non-drug treatment options – including assessment and care, using functional, holistic, orthomolecular, environmental medicine.

      Be well,

      Duane Sherry, M.S.

      • Duane,

        The good Lord does work in mysterious ways but this sure seems more like Texas hold ’em, with the expected gain being on Open Dialogue.

        In cases of psychosis;

        Medication Management – Best Practice Assessment = a medical story of continuing harm done

        Psycho-social alternatives – Best Practice Assessment = a medical story of continuing harm done

        Our “psychotic” patients have the right to know what caused their symptoms.

        I fought for my rights to know by going to the medical library myself and pulling out numerous studies to support a worker’s comp case.

        When I could not find an attorney to represent my case, I represented myself.

        When I finally did find an attorney, in order to get opinions in my favor, I needed to write him questions during the depositions with my doctors because he didn’t know anything about my case.

        When a psychiatrist treated me badly and billed my insurance company over $4000, I wrote a letter to the insurance company and he accepted payment of $4.56.

        When another ER psychiatrist denied me access to medical treatment and assumed I was manic, I filed a complaint with the Division of Human Rights for denying public accommodations and received a settlement.

        When a treatment facility billed me for over $8000 for forced treatment, while ignoring the fact I had an abscessed tooth and was in need of treatment, I filed a complaint that it was an illegal, forced contract that interfered with my right to contract medically necessary treatment. They dropped the entire bill.

        My tenacious self will continue to fight tooth and nail to ensure our “psychotic” patients receive treatment options that incorporate best practice standards.

        • Thanks Bob for the forceful and lucid statement.
          Maria–Dr Mangicaro?– does not comment on it. Instead she posts
          BMJ’s guidelines. The problem with these guidelines is that aside from recognizing “psychotic” symptoms may be caused by physical disorders it affirms the conventional understanding of “mental illness” that had been deconstructed by the best minds in the field on Mad in America blog.
          There is no reason why a psychiatrist is necessary to do the medical tests that could determine whether some other condition is causing the problem. Of course it should be done. Open Dialogue has only an 80% reported success rate. It should aim for 100%.
          Nevertheless Open Dialogue and Soteria did a hell of a lot better than conventional treatment. That is partly as Bob shows because neuroleptics are so dis–abling. See also Peter Breggin.
          In light of their relative success the medical model ought to be replaced–as the British Psychological Society (Clinical Division) has recently recommended.(THe BPS is the counterpart of the American Psychological Association–which is way behind the SPS.) And practicing professionals or psychiatrists like Ms or Dr Mangicaro ought to be a little less arrogant about the pioneers at Open Dialogue. She writes, “While Open Dialogue and Soteria are nice concepts, I would think any reasonable person would conclude that the care of “psychotic” patients should be entrusted to those who implement best practice assessment standards.” They are more than nice concepts.
          To repeat there is no reason why best practice
          assessment should be placed in the hands of psychiatrists when they have repeatedly broken the Hippocratic Oath. A general practitioner
          could oversee the process just as she would if the poroblem was not defined as “psychiatric.”
          Furthermore I don’t recall Bob’s treatment of Henry Cotton’s work at Trenton State Mental Hospital but I do remember Andrew Scull’s.And I’m sure Bob account is consistent with Scull’s. Henry Cotton did not discover that many so called schizophrenics were suffering from abscessed wisdom teeth. Cotton had the theory that the etiology of “schizophrenia” was infected teeth. He had no test to prove this–he assumed it. Thus he removed thousands of teeth from patients under his care. Perhaps because the results were disappointing Cotton’s theory evolved. He came to believe schizophrenia was caused by other infected organs. He had no test to prove this–it was his premise.
          To quote from a book review of Scull’s book Madhouse: “Cotton started his operations in 1917 on the hypothesis that madness could be caused by local infections. Teeth, even when X-rays showed no problems, were only the beginning of the bodily culprits to be removed. If patients were unwilling to undergo these surgical procedures, such obstruction was viewed as a reflection of their diminished mental capacities.” http://www.boston.com/ae/books/articles/2005/09/19/for_psychiatry_a_cautionary_tale/
          Just as today a patient’s unwillingness to accept that she is mentally ill is viewed as evidence of their illness rather than a rational response to being treated with a toxic drug.
          If the removal of the teeth did not result in restoring the patient to normality Cotton looked for other infected organs. As Wikipedia notes,”If a cure was not achieved after these procedures, other organs were suspected of harboring infection. Testicles, ovaries, gall bladders, stomachs, spleens, cervixes, and especially colons were suspected as the focus of infection and removed surgically.[1]” Since
          there were no antibiotics in the 1930s the mortality rate was quite high.Even the patients who lived often did not fare well.Those without colons had to live with a colostomy bag. Others were debilitated after the removal of testicles andovaries. As I recall thousands of patients died. This did not prevent Cotton from being lauded by his cohorts, just as Moniz was given a Nobel prize for his invention of the lobotomy. Cotton died in the mid-30s but these operations continued at Trenton State until the early 1960s.
          So you see Dr Mangicaro you got the story wrong.You haveunderestimated the harm done by the medical model. Your general point is of course correct– emotional distress may indeed be caused by a physical disorder.
          But you must take into account the problem with the medical model–it has been thoroughly explored on this website. If there is a medical problem at the root of emotional distress, it is not a problem for the psychiatrist.
          I think Bob’s conclusion is more than fair: If psychiatry continues its promiscuous and unjustifiable prescription of neuroleptics as I’m sure it will, “this will be a medical story of continuing harm done, and, I would argue, it would be reason for our society to conclude that the care of “psychotic” patients can no longer be entrusted to the psychiatric profession.” Whatever the blindspots of Soteria and Open Dialogue they are minor compared to the willful blindness of a profession that profits from its symbiotic relationship with the pharmaceutical industry and that has done immense damage to millions of people in the 20th century. The vast majority of people labeled “mentally ill” are suffering from problems of living. They do not have a “mental illness” or a brain defect or other illnesses, yet psychiatry refuses to learn from its mistakes.It refuses to ask why a group of para-professionals at Soteria were so much more effective than the creeme de la creme. Have YOU asked yourself that question? I doubt it although you do admit Open Dialogue is “nice.”
          That’s big of you.
          This is not a new problem. No one has criticized Cotton except Scull and Whitaker. In The NY Times it was written in 1922, “At the State Hospital at Trenton, N.J., under the brilliant leadership of the medical director, Dr. Henry A. Cotton, there is on foot the most searching, aggressive, and profound scientific investigation that has yet been made of the whole field of mental and nervous disorders… there is hope, high hope… for the future.”
          Ha ha.
          Seth Farber, Ph.D.

          • Hi Seth,

            Thank you for your critic of my comment.

            Although I do like the sound of “Dr. Mangicaro”, I go by the title of “Cashier Maria” at a local retail store.

            While I understand your harsh criticism of a perspective different than yours, I hope that you would take the time to get to know me better so that you would be able to understand my perspective and I will feel welcome on this site.

            I usually don’t bother commenting anymore because of the hostile nature of those who do not accept my perspective and it is time consuming to try and explain.

            I would like you to know that I am a very honest, hardworking individual who is very passionate about everything I do.

            Arrogant, no, tenacious, you bet.

            I am also very thorough.

            Although I am only a cashier, as a mental health advocate and volunteer for several nonprofit organizations, I strive to listen to and understand the perspectives of others, while maintaining a high level of ethical standards.

            To give myself some credibility as an honest, trustworthy individual, here are two recent letters sent out by my store manager about the bullying prevention volunteer project I have initiated at our local schools. The project supports the use of team building skills as a bullying prevention tool:

            “Thank you so much for all you do for our community and especially for the
            children. I admire you and respect you so much for what you do. You are so
            generous and compassionate. It seems that there is no limit to what you are
            willing to do to help those that need it most. You are an inspiration. I am so
            proud to have you on our team and thankful that you’ve chosen to be our
            ambassador in the community.”

            “Our Cashier Maria Mangicaro has single-handedly led our anti bullying campaign
            this school year. She involved many team members in a number of local schools.
            One of the school we partnered with on a number of events awarded
            us their Business Partner of the Year award. We will continue to spread the anti
            bullying message next school year.”

            I became a mental health advocate after experiencing the problems in our mental health system first hand as a “psychotic” patient, as well as understanding the problems of others as an acquaintance, a roommate, a friend and a caretaker to many other “psychotic” patients.

            Because it took the life of my father and nearly killed me, I would never underestimated the harm done by psychiatry.

            However, I respect the opinion of others who claim psych meds, ECT, and psychiatry have saved their life/the life of their loved one.

            I experienced psychosis as a result of lead and chemical poisoning from long-term exposure while working in the pre-press department of a printing company.

            While the spiritual aspects, the extreme creativity and the “messages from God” were really very cool, the key word here is


            not cool at all and treatable through a mutlimodal approach of Orthomolecular treatments/detoxing therapies.

            Honestly, I didn’t need Bob or Dr. Breggin to show me neuroleptics are so dis–abling.

            I was able to experience first hand severe-Parkinsonslike syndrome, tardive dyskinesia, excessive weight gain and a host of other dis-abling side effects from a wide variety of psych meds.

            I also found out on my own that an abscessed tooth can sure as hell exacerbate symptoms of psychosis.

            Not cool either. The experience was torture and nearly killed me.

            Not all psychoses are created equal and some can lead to fatal consequences.

            A friend who I shared my experiences with told me about his 21-yr-old niece from Rochester, NY who also experienced similar symptoms and became labeled with bp. As the symptoms progress, her doctors thought she had MS but later they found she was suffering from CJ Disease and she died a horrible death.

            Albeit rare, our “psychotic” patients have the right to know they may be suffering from a fatal condition.

            I’m happy others were/are being helped through Open Dialogue and Soteria, but for many of us “psychotic” patients, in order to become “un-psychotic” we need treatment for the underlying medical condition.

            I was extremely fortunate that when I was at my wits end of dealing with repeat bouts of manic/psychotic episodes, I was introduced to complimentary therapies that I had access to and was able to afford.

            Our “psychotic” patients get passed off to psychiatry, or our prison systems, because on a large-scale basis, no one else wants to deal with us.

            Most primary care physicians do not have training to deal with patients in psychotic states.

            We should consider what a primary care physician wrote on his MIA blog about one of his patients:

            “She is a difficult patient, a bottomless pit of needs with no coping mechanisms, and I don’t have a clue how to help her. She is truly a “broken brain”–literally–and will always be disabled. In her case, keeping her semi-sedated makes some sense–to spare herself and society the legal and criminal consequences of her mind unleashed. It seems to be what she wants.”

            Because psychosis involves people who are a “threat to society”, the law entrusts psychiatry with our care.

            The “it’s better for society” mentality stems back to the 1927 US Supreme Ct decision of Buck v. Bell.

            If we really want to fight coercive psychiatry, we need to create an awareness of the reasons why a psychotic episode can suddenly and without warning occur.

            Past exposure to lead is a darn good reason why.

            Even dehydration, excessive caffeine intake, the flu shot, or the routine use of over-the-counter cold medicine can cause psychosis.

            These are basic facts and it makes sense for all advocates to work together and create public awareness.

            In order for Soteria to be accepted, we need to listened to the concerns of others. The neighbors of Soteria in Alaska described it as a “ticking time bomb”. The para-professionals at Soteria were not able to prevent the death of Mozelle Nalan.


            Individuals who are labeled with “mental illness” deserve a chance.

            Unless we can explain why psychosis can occur, our “psychotic” patients will always be at the mercy of psychiatry.

            My goal as a mental health advocate is to call attention to the many underlying causes of psychosis, so that individuals who are “psychotic” patients will have access and the ability to make choices for the care that is most effective for their individual circumstances.

            If our society wants to force our “psychotic” patients into treatment, that treatment must include testing for and treating the underlying cause.

            Open Dialogue and Soteria are reactive solutions.

            When it comes to psychosis, advocates need to support proactive, preventative solutions.

            Understanding what causes psychosis can help prevent it.

            While I am certainly no doctor, I did have a medical-reviewed narrative published in the Journal of Participatory Medicine.

            It took me six months working with the editors (six medical doctors) to get this narrative approved for publishing.

            Mine is the only narrative the journal published in which the editors requested research to support.

            Several of the doctors objected to publishing it because they felt it might encourage other “psychotic” patients to go off medications. They also changed my title to “possibly linked to”, instead of “linked to”


            Please do not take offense, but the best minds in the field on Mad in America blog have completely left out any mention of Orthomolucular concepts, Functional Medicine, Integrative Psychiatry.

            I don’t understand why these concepts are being left out on this site.

            It sure seems as if our “psychotic” patients are being caught in the middle of an internet-based egotistical battle between psychiatrists v. psychologists.

            Many of our “psychotic” patients are among a marginalized population and who because of incarceration, hospitalization, low income or homelessness, do not have access to the internet.

            Those who want treatment for underlying medical conditions and are being denied, deserve a voice and those are the individuals that I continually advocate on behalf of.

            I have been a “psychotic” patient and I advocate for others the same as I would for myself or a loved one.

          • Thank you, Seth!

            I’d like to add a question for Maria: What would you do if somebody told you they were hearing the voices of a bunch of bullies that they’ve actually been stalked by in the past? Would you send them to a hospital to have multiple testings for somatic illness run, until something, anything, a bad tooth, whatever, was found, because something definitely must be wrong with a person who reacts to life? What would you do, if the voices didn’t disappear although the medical problem had been solved? Start all over again, because it can’t be life, there are no dysfunctional relationships, no bullying, no abuse, no neglect, no violence so extreme in our society that a reaction as extreme as that which gets labeled “psychosis” would be perfectly meaningful and understandable? Start all over again, although the person told you that they know they aren’t sick, but reacting to past traumatic experiences?

            To answer your question below what I would do if I, or someone I know, experienced extreme states of mind: I’d do the same that I’ve done before, and that I today continue to do in my workplace, and ask: What has happened to me/you? It has worked for me, it has worked for innumerable people, and it continues to work for innumerable people. The proof is in the pudding. As Seth quotes: Open Dialogue, 80%, 83% to be precise, recovery.

        • Maria,

          There’s been so much injury done by conventional psychiatry that the fear of any ‘medical’ treatment is understandable. IMO, it’s *very* understandable!

          Unfortunately, thyroid problems are left unaddressed. As are other underlying physical conditions that present themselves as “mental” disorders, when they are not.

          Open Dialogue has an 80-85% success rate. The only higher rate I’ve seen is with Orthomolecular Medicine, which was 90%.

          Abram Hoffer, M.D. treated 5,000 patients with first-time psychosis, over 60 years, and 90% lived drug free, and went to work. He insisted on safe shelter. The rest was good nutrition and vitamins, including niacin. Vitamin deficiency can be an underlying condition of what is termed “schizophrenia”.

          I agree with you, Maria. We need best practice assessments to address underlying physical conditions.


          • Duane,

            What we need in mental health advocacy is teamwork.

            Is there any issue that all mental health advocates can set aside their differences and all agree on?

            As an experience “psychotic”, I can tell you psychosis has many tricky aspects.

            The first tricky aspect is the fact many spiritual/creative connections can be made and there are some individuals who are able to handle this kind of extreme energy/state.

            I admit, getting “messages from God” is pretty amazing but psychosis can get very hairy and as we see sensationalized in the news all of the time, can be very dangerous, or have deadly consequences.

            As Joseph Campbell said, “the schizophrenic drowns in the same waters in which the mystic swims with delight.”

            Unfortunately, if a first time “psychotic” patients acts like Adam Lanza, Jared Loughner, or James Holmes, the primary concern is for public safety, and further supports the position of those in favor coercive psychiatry.

            Bob addresses the nature of psychosis correctly in several of his lectures when he states psychosis CAN have “flu-like” characteristics of coming and going on its own.

            This makes sense when you consider a psychotic state CAN be caused by a bacteria/virus, or environmental allergens.

            Unfortunately, if a psychotic state results in a massacre of US children, what is being done in Finland becomes irrelevant.

            Success rate for “psychotic” patients can be improved by developing an awareness of what can exacerbate symptoms.

            While for some individuals conditions manifest as neurological problems, for others, psychotic symptoms are our weakest link.

            Recovery rates are tricky because there are many other conditions can exacerbate symptoms even decades later in life.

            For some of us, the routine use of over-the-counter cold medicine, pain killers, or an untreated abscessed tooth can cause psychotic symptoms.

            By having an awareness of this, we are able to be proactive in preventing symptoms from exacerbating.

            Open Dialogue and Soteria are reactive solutions, they ignore the possible underlying causes and do not give rise to proactive, preventative solutions.

            Just like patients have the right to know about the potential harmful side effects, our “psychotic” patients have the right to know about possible underlying causes.

            Just because us “psychotic” patients may seem crazy, does not mean that we are stupid.

            From an economic standpoint, treating the underlying condition save $$$$$ for the patient and the taxpayer.

            Unfortunately, many professionals loose out.

            The blame always seems to go on psychiatry/Big Pharma. The fact is there are many who profit from our “psychotic” patients.

            I have an NAMI – MIA Charitable Donation Challenge.

            I am seeking to raise $3 million dollars to build a retreat at a nonprofit organization I am a volunteer at.

            I challenge every NAMI member, along with every MIA blogger and commenter to answer this question;

            If you, or a loved one, experienced an acute psychotic episode would you want:

            a.) to go to a psych ward and trust main stream psychiatry

            b.) no treatment at all because you want to live through the experience

            c.) go live at the Soteria House in Alaska

            d.) go to Finland for treatment

            e.) take the advice of Cashier Maria and make sure your doctor abides by Best Practice Assessment guidelines, and uses Functional Lab work to test for and treat possible underlying causes

            f.) other, please explain your answer

            If you selected answer e.

            would you please consider chipping in a dollar or two for a NAMI – MIA Charitable donation to my favorite nonprofit organization, Quantum Leap Farm?


            Seriously, we don’t need to go to Finland, and we don’t need any more research.

            Enough research and case studies already exist in a massive overload of information in our medical libraries.

            We just need to ensure best practice standards are met and support the many wonderful organizations here in the US like Quantum Leap Farm, the Delancey Street Foundation, the Homeless Emergency Project, the Salvation Army, etc., etc.


            If you are a mental health advocate, please consider supporting the organizations that are providing hands-on help for those suffering from symptoms of severe mental illness.

          • Maria, you continue the lie of “psychotic” as being a real thing.
            Lanza, Loughner and Holmes were all on drugs before they performed the act of murder.
            Male with testosterone.
            They were angry and no one (no father) channeled their anger into something harmless or productive.

            An act of anger, the feeling of “anger” is a mental illness today. Anger is suppressed by psychiatric drugs, this method can work, but like the Star Wars system even if you stop 99% of the nuclear missiles, you still get devastating damage from the 1% that get through.

            Lanza was taught to shoot by his mother.
            Loughner wanted to die.
            Holmes planned his display of anger for months.

            Maria Mangicaro on July 19, 2013 at 12:51 pm wrote “Unfortunately, if a first time “psychotic” patients acts like Adam Lanza, Jared Loughner, or James Holmes…”

    • Often what is arbitrarily diagnosed as psychosis is extreme emotional distress. (This was the case with me, I have read below that it was not with you. I’m sorry for your horrible experiences.) How is it productive to endlessly search for or treat a physical problem in a case when there is none, often very obviously? It seems to me that Open Dialogue and Soteria programs are trying to fill this enormous hole in the “system,” the need to address emotional needs, not create a precedent that would deny medical needs.

      • Hi Maria
        Thanks for your response.
        Congratulations for your good work.
        This has nothing to do with a battle between psychologists and psychiatrists. You obviously don’t know much about the “mental health” system in America.
        My position is as heretical among psychologists as psychiatrists. I despise the entire mental death system. I have no identification with psychologists who are clamoring to get prescription rights.
        I am not advocating more power to psychologists.
        But you have evaded Bob’s point. Although you have been a victim of psychiatrists you have no objection with vesting more power in their hands although as Bob shows they have consistently abused it. Considering their symbiotic relationship with the drug cartels it is unlikely they will change. They are pimps for the drug companies. Yet you avoid this issue altogether Maria.

        You write, “Most primary care physicians do not have training to deal with patients in psychotic states.”
        And what value is the so called training of psychiatrists? Is that a joke? It is of no value. Most patients I know have been traumatized and harmed by their treatment by trained psychiatrists. You are not being consistent. The psychiatrists are the most dangerous persons. If there is a need to search for physical problems let it be done by specialists who are referred to patients by primary care physicians. The training of shrinks only makes them more arrogant and destructive
        When you talk like this you sound like an apologist for psychiatry and the mental health system.

        Although I accept that many “psychotics” have medical problems unlike you I have found most of them are suffering from problems of living–and this is why Soteria and OD are so successful.

        Back in 1989 I wrote “Psychiatric treatments” in mental hospitals are for the most part forms of physical and emotional abuse. Psychiatric “diagnoses” are demeaming labels without any scientific validity. The psychiatric Establishment is pushing dangerous drugs which they euphemistically call “medication.” Treatments in this century have ranged from revolving chairs to lobotomies
        to electrical assaults on the human brain to neurologically damaging drugs. There has been no revolution in the treatment of individuals who are psychiatrically labeled: it is an unbroken history of barbaric practices, justified by professionals as medical procedures designed to control patients’ ostensible mental diseases.” It has only gotten worse since then. But you think the problem can be solved by imploring psychiatrists to send patients to other doctors for specialized examinations?

        As long as you leave power in the hands of the psychiatric-pharmaceutical industrial complex, nothing will change. You need to transfer power to patients themselves. A visit to a specialist is fine
        but not as a substitute for changing the system. It is the centralization of power and the disenfranchisement of “mental patients” that is the main problem. Yet you think the main problem is a technical error.

        You wrote:

        “We should consider what a primary care physician wrote on his MIA blog about one of his patients:

        “She is a difficult patient, a bottomless pit of needs with no coping mechanisms, and I don’t have a clue how to help her. She is truly a “broken brain”–literally–and will always be disabled. In her case, keeping her semi-sedated makes some sense–to spare herself and society the legal and criminal consequences of her mind unleashed. It seems to be what she wants.””

        I find it hard to believe anyone would write this on MIA. It is disgusting. I think you misread it. I bet it was criticism of this position. If not please tell me who wrote it. If you are correct I will ask that such a person be prohibited from posting here. It is the worst kind of bigotry and does not belong on this website. Please give me the information. If you prefer to do it offline write me at:
        [email protected]\
        AT any rate it is not typical–psychiatrists are usually worse precisely BECAUSE they think their mis-training equips them to help the so called mentally ill.

        You write: “Because psychosis involves people who are a “threat to society”, the law entrusts psychiatry with our care.” They are not a threat to society and the fox should not be guarding the chicken coop.
        PS I am going to quote Bob again:But, if psychiatry doesn’t amend its protocols, and if psychiatry doesn’t sponsor new research to best reach these goals, then—and I know no other way to say this—then I think psychiatry will have to be seen, by mainstream society, as a failed medical discipline. Psychiatry will no longer be able to claim that its practices are evidence-based and driven by a desire to achieve the best possible outcomes for its patients. Instead, the lack of change will be evidence that its prescribing practices are, in fact, driven by an ideology, which is to maintain a societal belief that antipsychotics are a necessary long-term treatment for psychotic disorders, and that it is more important for the profession to maintain that belief than it is to help those it treats to have the best chance possible to achieve a good functional outcome, which is the outcome that counts.

        • The quote about the patient with a “broken brain” was made by Dr. Mark Foster, a blog author on MIA. –


          I think it’s important to remember that many people on MIA have made comments about how they were helped by nutrition or other holistic approaches.

          Some of us who appreciate and *use* these approaches are hardly proponents of the status quo, especially lack of informed consent and the use of deception and coercion. In fact, many of us are adamantly opposed to these things.

          IMO, the more options available, the better!

          From the ‘Resources’ page on MIA:

          International Guide to the World of Alternative Mental Health

          Alternative Mental Health.com offers a directory of alternative mental health practitioners, a bookstore, support groups, email lists, and a monthly newsletter in support of reducing dependency on psychiatric medication.

          Alternative Mental Health.com looks for medical problems, allergies, toxic conditions, nutritional imbalances, poor diets, lack of exercise, or other treatable physical conditions that may underly “mental” disorders.

          Be well,


          • I would also like say that Maria’s volunteer work has included moderating the blog of the International Society of Ethical Psychiatry and Psychology (ISEPP).

            This is *hardly* a conventional psychiatric forum. –


            The list of professionals who have made contributions on the ISEPP site reads like a ‘Who’s Who’ of voices of dissent! And Maria was involved in making sure their voices were heard.



          • I remember now I spoke to Maria at ISEPP about 5 or 6 years ago. This was after Peter Breggin went nuts and alienated half his followers by saying that they had a mental disorder–“Americapohobia.” ISEPP was the non-Breggin group, the one David oaks joined. She was very helpful to me. But she clearly does not understand the critique of bio-psychiatry by the dissidents including Breggin who seems to have resolved his belated mid-life crisis.
            It is noble that Maria volunteers for ISEPP. But her work there contradicts what she says here.

            Thanks Duane for the reference for Maria’s statement. First of all I had suggested that a primary care physician could coordinate
            the non-psychiatric medical assessment (Maria’
            s suggested such an assessment) of people who are psychiatrically labeled, instead of a psychiatrist. Of people who want to go through such a process. She responded, “Most primary care physicians do not have training to deal with patients in psychotic states.” Ha! This comment indicates Maria does not agree with the perspective of ISEPP or MIA. It is the very opposite of what most people are saying here: The training of psychiatrists does not equip them to deal with people in psychotic states. To the contrary they are trained to objectify them and see them as Others, not to let their barriers down, not to bridge the distance between them. Maria then quotes a primary care doctor, a DO, to prove the point that they had a patronizing attitude toward so called psychotics. One statement would not prove anything but Maria omission of relevant data is suggestive of her pro-psychiatric orientation. I had predicted Maria had misquoted it because as she presented it it did not belong on MIA.
            The DO claimed his patient had a broken brain. Had his patient been a “psychotic” this would have been unacceptable but his patient was in fact a woman who had suffered serious brain damage! The DO said, that “she was a 31 year old blond woman with a history of traumatic brain injury and partial hemiplegia.” This is entirely different. Thomas Szasz never denied that there were people with brain damage. I would say that this DO has never heard of neuroplasticity
            and thus was unduly pessimistic. But that’s another point.
            Bob argues that psychiatry is (and will soon be proven to be) a failed medical
            profession. But Maria insists they are well equipped to care for the so called mentally ill. She only want to make sure there is no organic problem or a physical problem. So she advises psychiatrists to follow guidelines. But she evades the point Bob raises which is the basis of the critique of Psychiatry–its corruption due to its relationship with the drug industry.

            In fact she is critical of every other non-psychiatric approach to dealing with madness that eliminates or minimizes the role of psychiatrists and eliminates or minimizes the use of neuroleptic drugs.She mocks that two most effective programs. Maria is nice person with a kind heart but
            she has a divided mind. The problem with psychiatry is not a purely technical one that can be solved with guidelines. It is political, economic, ideological.

            Most orthomolecular practitioners I have known have been reluctant to get”psychotic” patients off drugs.They have accepted the psychiatric paradigm. The ones that do not use drugs should be commended. My problem with them is that they accept psychiatric diagnosis. Study after study has shown that the efficacy of a drug is correlated with the quality of the “patients” trust and rapport with her therapist. Thus the placebo effect is enhanced by interpersonal factors. I have not seen research on orthomolecular approach and psychosis but the success of millions of people getting off neuroleptics
            suggests that in most cases madness is caused by social factors. Tht may also be true of orthomolecular treatments.

            Nevertheless as I stated the success rate of OD is only 80%. It should be 100%.Orthomolecular doctors (they need not be psychiatrists) who foreswear the use of neuroleptics may have a contribution to make.
            But the first thing most of us dissidents agree about is psychologists have too much power, and they have abused that power. That issue must not be shelved.
            Seth Farber, Ph.D.

  11. Bob,

    I want to thank you for continuing to bring evidence to the table for us to consider what really supports healing from extreme distress. I hope this new data and mounting evidence base do transform standards of care (for those who can access that care, another big issue) that improve mental health outcomes.

    I also want to thank all of those on this site and elsewhere who continue to put “anecdotal” real-life evidence on the table for us to consider. There are an almost infinite number of ways to heal from distress, trauma, abuse, illness, grief… the vicissitudes life seems to throw us all in some measure.

    I appreciate Maria’s injunction to consider that Soteria and Open Dialogue may not be gold standard either if we don’t take the time to consider each person’s unique circumstance. To listen for what may be needed. To look under a variety of stones, and not all of them in the mental health garden.

    As always, something magical happens on this forum when so many perspectives are given voice.

    Thank you all for stretching my limits of understanding in the service of healing.

  12. Will the wishful desire come to fruition, or be ignored in our consensus need to protect the image, of our “normal” sense of reason? As you write Bob;

    Which will it be? My optimistic self hopes for the first outcome, while my realistic self expects the latter. And if it proves to be the latter, this will be a medical story of continuing harm done, and, I would argue, it would be reason for our society to conclude that the care of “psychotic” patients can no longer be entrusted to the psychiatric profession.

    I think the problem is the taken for granted prominence of “objective” rationality, and that it contains some kind of special insight? The consensus of the group, towards this image of reason, will therefore go to any lengths to protect it, hence psychiatrists become the mind police for a greater society, where the average citizen is scared to death by the kind of innate experiences, people with a so-called mental illness go through. IMO this is not madness or the mental illness of a diseased brain, but simply the acute sensitivity of being human.

    We must remember that to the great Mystics, normality is Psychotic? Hence I posted these comments on my facebook wall today, as my inner journey continues.

    Lift the veil a little more & realize the defensive and dark side of your objective rationality.
    Real human intelligence is emotional, intuitive, innate and entirely creative, because that’s what mother nature and the cosmos, created you for. Too much of our so-called objective insight, is based on our instinctive need to survive, that’s all. In Silvan Tomkins brilliant work on our innate nature, he notes 9 primary affect-emotions, only 2 of which are considered entirely positive. Interest-Excitement and Enjoyment-Joy, the other seven are devoted to your immediate need to survive the possible dangers of the present moment. Going beyond this innate need of wary self-defense is what happens to all the great mystics, including Buddha, Jesus & Muhammad, as they faced the nature of their own reality and transcended an innate sense of FEAR.

    To which, there followed these comments;

    Chilling and accurate and terribly sad it is so common most never even notice.

    Its not sad, when we realize it was all meant to be? We are living through the resurrection right now, as technology allows us to see clearly, what the mystics have always known. To the Mystic, normality is Psychotic?

    The sadness is the realization that so many will never step past the door into the resurrection experience… technology does actually open up many realities that used to be open only to the mystics. Having lived with so called psychosis for many years and trying to mesh with the so called normal world, I have faced many things people blanch at when I describe them. Sadness because until recently I was very very alone in this 3 dimensional reality.

    NEVER? Is a long time. I understand the desire, we want it to happen NOW! Yet the task of maturity for us all, is the realization of reality, as it is, in the here and now. As Joseph Campbell points out, the Hero’s journey is an individual one and the need to teach what has been learned and forgotten by successive generations. Perhaps, its time to start teaching children more ancient wisdom, than simply how to become another “objective” cog in an economic wheel of life? The real wheel of life, is organic, its our inherent nature and where the vitality of our creativity comes from. Losing touch with this innate reality and trying to be objectively rational, always diminishes my energy, as I join the consensus image of reason, which in Buddhist terms, is illusionary and self-defeating.

    Gentleness and patience and compassion are lifelong learnings that slowly teach me new courage.

    What this community gets lost in, IMO, is the consensus need to protect the image of our “objective” sense of reason. As long as we focus on “treatment” we endorse the consensus view that Madness is a disease and NOT part of a “continuum” of human experience. We can’t have our cake and eat it too? We must start showing the world that so-called mental illness, is simply the sometimes hypersensitive nature of being human, IMO.

    Please consider an excerpt from a very fine dissertation on psychosis and spirituality;

    Chinomy (1974) advises that the initiate start at the fourth (heart) chakra, which is safer, and work from there because the base chakra is too dangerous to work with for the novice who is not familiar with the process, or not strong enough to handle Kundalini energies.

    (Yet, compared with Levine’s sensate awareness for trauma resolution, does Kundalini relate to the spontaneous release of a nervous system [conditioned] vigilance state?)

    This transformational process is always accompanied by varying degrees of physical and psychological signs and symptoms, and Greenwell (1990) has classified these phenomena into seven primary categories.

    The first category, pranic movements or kriyas, consists of intense, involuntary body movements, shaking, vibrations, jerking, sensations of electricity, tingling, and waves of energy throughout the body.

    Category four includes psychological upheavals such as the intensification of unresolved psychological issues, fear of death or insanity, mood swings, and waves of anxiety, anger, guilt, or depression as well as profound compassion, unconditional love, and heightened sensitivity to the moods of others.

    The parapsychological experiences category consists of such phenomena as precognition, healing abilities, reading the minds of others, unusual synchronicities, electrical sensitivity and psychokinesis.

    The extrasensory experiences category, which is often identified as a subcategory of the parapsychological, includes atypical perceptions such as lights, symbols, images of entities, the reviewing of other lives, visions, auditory input including voices, music, repeated phrases or continual inner sound and olfactory sensations.

    The final category, samadhi or satori experiences, includes sensations of deep peace, wisdom, experiences of light, tranquility, joy, overwhelming waves of bliss and the absorption of consciousness into a condition of unitive awareness.

    Greenwell (1990) acknowledges that each individual demonstrates a unique pattern, varying in intensity and duration, and suggests that when one’s experiences fall into several categories this indicates a high probability of Kundalini awakening. Sanella (1997) believes that the signs and symptoms, such as alterations in emotions and thought processes, visions and voices all appear to be largely personality determined. But sensations such as itching, fluttering, tingling, heat and cold, perceptions of inner lights, sounds and the occurrence of contortions and spasms appear to be quite universal. He proposes that this universality may indicate that all spiritual practices are activating the same basic process and that these processes may have a definite physiological basis that gives rise to these specific bodily symptoms.

    Saraswati (1984) focuses on the changes that take place in the mind during the awakening of Kundalini. When this happens, one transcends the normal categories of mental awareness, the scope of one’s knowledge becomes greater, the mind becomes dynamic, while the quality and experiences of the mind begin to change. When one looks at people, animals, and nature, there is a deeper communication with them, a realization of some inner essence. Matter appears to lose substance, one’s body may feel like it is made of air or one may feel that they are no longer a part of their physical body. (the comment in brackets is mine)


    And from the author who helped me most, in the transformation of my psychoses;

    Trauma and Spirituality:
    In a lifetime of working with traumatized individuals, I have been struck by the intrinsic and wedded relationship between trauma and spirituality. With clients suffering from a daunting array of crippling symptoms, I have been privileged to witness profound and authentic transformations. Seemingly out of nowhere, unexpected “side effects” appeared as these individuals mastered the monstrous trauma symptoms that had haunted them-emotionally, physically and psychologically. Surprises included ecstatic joy, exquisite clarity, effortless focus and an all-embracing sense of oneness. (p, 347)

    “The life of feeling is that primordial region of the psyche that is most sensitive to the religious encounter. Belief or reason alone does nothing to move the soul; without feeling, religious meaning becomes a vacant intellectual exercise. This is why the most exuberant spiritual moments are emotionally laden.” _Carl Jung.

    At the right time, traumatized individuals are encouraged to and supported to feel and surrender into immobility/NDE states, states of profound surrender, which liberate these primordial archetypal energies, while integrating them into consciousness. In addition to the “awe-full” states of horror and terror appear to be connected to the transformative states such as awe, presence, timelessness and ecstasy. (p, 353)

    Excerpts from “In an Unspoken Voice,” by Peter Levine, PhD.

    IMO the continuing focus on medications and treatment, is part of our mechanism of denial, as we scapegoat any sense of “otherness,” in the way humans have for millennia, its a ruse to prevent us from being truly self-aware until we are ready to face the final curtain, and take responsibility for what we are?

    The Cosmos, perceiving and acting upon itself.
    We are IMO, the very mechanism of Eternity.

    Best wishes to all,

    David Bates.

      • Consider words from my brother in arms;

        “It seems obvious that when faced with the choice of allowing a realization that Jung either was singularly psychologically blind to the identity of his own benefactor Dionysus, or a realization that Jung deceptively hid the identity of the phallic maneater Dionysus– that Jung’s followers were in so much cognitive dissonance, were in such a bind that they unconsciously chose the third alternative. They went into a collective trance. Like the throng in the Emperor’s New Clothes fairy tale, they couldn’t see the reality before their very eyes.

        Orwell famously affirmed this psychological axiom – ‘To see what is in front of one’s nose needs a constant struggle.’

        That’s why Perry’s patrician jaw dropped and I saw him for the first time at a loss for words when I spoke my Jungian blasphemy about the big secret hidden in plain sight. When the defense of denial collapses on a secret that big it is a dramatic thing to witness. Perry became almost giddy–he kept repeating–”Of course Michael, yes, you are right, you are right–I never saw it, none of us did–oh, you must publish this, must publish this!” And so I am right now.” _Michael Cornwall PhD.

        See more here: https://www.madinamerica.com/2012/04/jungs-first-dream-the-mad-god-dionysus-and-a-madness-sanctuary-called-diabasis/

        As Michael points out: “When the defense of denial collapses on a secret that big it is a dramatic thing to witness.”

        The dreaded realization that mainstream society, not just psychiatry, is avoiding like the plague, IMO. I’m not a fan of the taken for granted “us vs them” worldview, IMO Michael’s insight applies to us ALL.

        The taken for granted sense of “otherness” which matures into a taken for granted sense of “them,” is simply a subconsciously stimulated need, for survival towards the possible dangers of the present moment.

        Yet in America, with particularly “paranoiac,” society, at least to those of us who don’t live in one of the most violent cultures on earth, Hollywood’s rather adolescent emotionality seems to fuel, a taken for granted misperception of life, as it is, within the reality of the lived moment. A simplistic survival perception, which becomes a self-fulfilling prophecy?

        • Ah, I just had to check out that article!

          “Direct encounters with chthonic archetypes and deities via hypnosis, sacred shamanic trance, evocative ritual or mind-expanding drugs never were part of the advertised Jungian or Neo-Jungian process of inner exploration and healing.” – Michael Cornwall, Ph.D.

          LOL: I identify with the “chthonic” indeed, but not as madness, not at all!… I’m just typical of a certain type of transsexual woman which has routinely been suppressed in the histories…

          (transsexual persons have been around for a long, long time…)

          My Prozac+Trazodone/mCPP driven adverse drug reaction of January 1997 built on prior experiences I had enjoyed while sane and straight (i.e., “Tantric sex”); and though the hallucinogenic terror was at times overwhelming, there was also self-enlightenment out of it?

          I experienced the collapse of a projection… wow, it sucked, did it ever.

          But as I told my gender therapist, “There are things about oneself you might rather not know… but still, you’re probably better off knowing them.”

          B.A.R.BLAYK – prêtresse d’Hécate – https://www.facebook.com/photo.php?fbid=10150860111507954&set=a.10150860111497954.427164.707147953&type=3&theater

          PS: The science involved in my ADR is hardly anecdotal; I despair at times at the “rationality” of doctors who apparently have no clues at all as to the properties of the drugs they prescribe?

          And apparently few institutional clinicians have no any clues, or concerns at all, as to who their patients are… much less what a “network systems programmer” does In Real Life? (For example… “document the hell out of seemingly inexplicable phenomena” 😉


          • It will be interesting to see how Bob rationalizes the expected outcome of a NEED to ignore reality and remain in denial, about the nature of our very human madness.

            Consider an excerpt from a book by one of most renowned new age voices of our time and the inherent madness of being human;

            “According to Christian teachings, the normal collective state of humanity is one of “original sin.” Sin is a word that has been greatly misunderstood and misinterpreted. Literally translated from the ancient Greek in which the New Testament was written, to sin means to miss the mark, as an archer who misses the target, so to sin means to miss the point of human existence. It means to live unskillfully, blindly, and thus to suffer and cause suffering. Again, the term, stripped of its cultural baggage and misinterpretations, points to the dysfunction inherent in the human condition.

            The achievements of humanity are impressive and undeniable. We have created sublime works of music, literature, painting, architecture, and sculpture. More recently, science and technology have brought about radical changes in the way we live and have enabled us to do and create things that would have been considered miraculous even two hundred years ago. No doubt: The human mind is highly intelligent. Yet its very intelligence is tainted by madness. Science and technology have magnified the destructive impact that the dysfunction of the human mind has upon the planet, other life-form’s, and upon humans themselves. That is why the history of the twentieth century is where that dysfunction, that collective insanity, can be most clearly recognized. A further factor is that this dysfunction is actually intensifying and accelerating.

            The First World War broke out in 1914. Destructive and cruel wars, motivated by fear, greed, and the desire for power, had been common occurrences throughout human history, as had slavery, torture, and widespread violence inflicted for religious and ideological reasons. Humans suffered more at the hands of each other than through natural disasters. By the year 1914, however, the highly intelligent human mind had invented not only the internal combustion engine, but also bombs, machine guns, submarines, flame throwers, and poison gas. Intelligence in the service of madness! In static trench warfare in France and Belgium, millions of men perished to gain a few miles of mud. When the war was over in 1918, the survivors look in horror and incomprehension upon the devastation left behind: ten million human beings killed and many more maimed or disfigured. Never before had human madness been so destructive in its effect, so clearly visible. Little did they know that this was only the beginning.

            By the end of the century, the number of people who died a violent death at the hand of their fellow humans would rise to more than one hundred million. They died not only through wars between nations, but also through mass exterminations and genocide, such as the murder of twenty million “class enemies, spies, and traitors” in the Soviet Union under Stalin or the unspeakable horrors of the Holocaust in Nazi Germany. They also died in countless smaller internal conflicts, such as the Spanish civil war or during the Khmer Rouge regime in Cambodia when a quarter of that country’s population was murdered.

            We only need to watch the daily news on television to realize that the madness has not abated, that is continuing into the twenty first century. Another aspect of the collective dysfunction of the human mind is the unprecedented violence that humans are inflicting on other life-forms and the planet itself – the destruction of oxygen producing forests and other plant and animal life; ill treatment of animals in factory farms; and poisoning of
            rivers, oceans, and air. Driven by greed, ignorant of their connectedness to the whole, humans persist in behavior that, if continued unchecked, can only result in their own destruction.

            The collective manifestations of the insanity that lies at the heart of the human condition constitute the greater part of human history. It is to a large extent a history of madness. If the history of humanity were the clinical case history of a single human being, the diagnosis would have to be: chronic paranoid delusions, a pathological propensity to commit murder and acts of extreme violence and cruelty against his perceived “enemies” – his own unconsciousness projected outward. Criminally insane, with a few brief lucid intervals.

            Fear, greed, and the desire for power are the psychological motivating forces not only behind warfare and violence between nations, tribes, religions, and ideologies, but also the cause of incessant conflict in personal relationships. They bring about a distortion in your perception of other people and yourself. Through them, you misinterpret every situation, leading to misguided action designed to rid you of fear and satisfy your need for more, a bottomless hole that can never be filled.

            Trying to become a good or better human being sounds like a commendable and high minded
            thing to do, yet it is an endeavor you cannot ultimately succeed in unless there is a shift in consciousness. This is because it is still part of the same dysfunction, a more subtle and rarefied form of self-enhancement, of desire for more and a strengthening of one’s conceptual identity, one’s self-image. You do not become good by trying to be good, but by finding the goodness that is already within you, and allowing that goodness to emerge. But it can only emerge if something fundamental changes in your state of consciousness.”

            Exerts from “A NEW EARTH” by Eckhart Tolle.

            My psychoses, have fundamentally changed my state of consciousness. Yet mainstream psychiatry considers all hyper-sensitive’s like me, pathological?

            Yet here on Medications in America, the denial of the nature of human madness, is upheld by a rational agenda, to keep the focus on medications and treatment, IMO.

            We should realize that the human mind evolved to “dampen” the internal energies of our e-motive reactivity. That’s generally what we do with our need for “rationalizations,” IMHO. We self-sooth the inherent anxiety, of the lived moment.

  13. This program Orthomolecular is wonderful and amazing; but that doesn’t disqualify Soteria or Inner Dialogue. There’s no reason the two can’t work together, and there’s no need for competition, for Brand Name wars there, whatsoever. There’s no need for anyone saying “this is the one answer, the best.”And I really don’t see the Soteria project, Inner Dialogue, Healing Homes of Finland and the Orthomolecular Program being in any way incompatible with each other. Those, I think, should all be available in a mainstream approach, being that they get better results than what is usually enforced. And they are more cost effective. When a person’s emotional needs are tended to, they want to take better care of themselves. And their own personal instincts are allowed to come out, that part of them which knows better than anyone else what’s good for them. In fact, focusing on something outside of the self as being the cause can cause exactly the kind of fear that may result in psychosis. Looking for the answers on the inside doesn’t do this. Tending to emotional wounds doesn’t do this. I’m not saying one shouldn’t be up on nutrition, relaxation exercises, everything that the orthomolecular method has looked into; I’m just saying that you can’t separate emotional health from physical, and when not tending to one create a holistic organism. Both need to be looked into. To be acknowledged.

    The orthomolecular only has a 50% recovery rate with those who have had “schizophrenia” for a long time. From personal experience of my own and others, that may require attention to thought itself. This is “anecdotal.” A friend of mine was having”psychotic episodes” for years (20 years, I think). But when she stopped believing in the devil, a belief she had been indoctrinated in as a child; then she stopped inducing the stress which cause her to have psychotic episodes. Those are her own words, by the way, and she’s been completely fine, since. Also, she saw that as an experience, not as a disease. And she wouldn’t judge other people as being sick either, but be able to relate to them. Everyone has their own story, but I find that when it involves thought, that it’s usually less acknowledged than something based on a tangible physical source of cure. Often it’s completely overlooked, because you can’t put it into “black and white,” but you have to allow for something as intangible as human nature or the human condition and experience. And you have to just simply listen, rather than trying to be objective and knowing the answer. I understand that people who aren’t medicated, have a much higher recovery rate for “schizophrenia.” In fact I have read that in itself is 90 %. But I haven’t read any material where those people were themselves asked how their thinking changed, or what changes occurred in their lives.

    I find it fortunate that thought in itself remains intangible to someone trying to find an objective source for healing. And it remains free to everyone, that way. If you believe thought is just a chemical reaction, then you have still decided to have a belief, to involve thought. Even if you say that’s an observation, you could have looked at it very very differently, and that also is thought.

    I also don’t know how anyone can decide that another is still “sick” with schizophrenia. Or make a judgement on the 10 percent, the 17 percent, the 50 percent or the greater numbers that are still seen as having “schizophrenia.” Those are all still completely valid human beings with their own experience of life. They are the only ones that know their experience. They aren’t separate from the creative source. And to understand them, you have to first see them as human, rather than as a disease. And you have to listen rather than try to convince them there’s something wrong with them. Needing emotional attention isn’t a disease. Needing good nutrition isn’t a disease. Needing vitamins isn’t a disease. Needing the freedom to express yourself creatively isn’t a disease. None of those are diseases as little as dying of hunger is a disease or something “genetic.” When you stop seeing them as being flawed, you find your own human nature in them. There’s absolutely no loss there whatsoever….

  14. Hi Marian,

    Thank you for your reply.

    Your question to me is:

    “What would you do if somebody told you they were hearing the voices of a bunch of bullies that they’ve actually been stalked by in the past?”

    I would just listen to the person.

    I’m a very good listener and would have plenty of bullying experiences to share with them.

    If this individual wanted the voices to stop, and for some strange reason preferred the advice of Cashier Maria, over that of an experienced mental health professional, I would suggest they learn more about Bioenergetic Therapy, as I found this type of mind-body work extremely powerful and effective for emotional trauma.

    If they told me they were having visual hallucinations along with hearing voices, I would strongly suggest to them to have Functional Lab testing done because there is probably an organic contributing factor to this problem that when addressed would improve their overall health. If they had insurance, an MRI is always nice to rule out a brain tumor.

    If they seemed like Jason Russell, I would suggest they drink a lot of water.


    If they had a Marty Feldman look, I would suggest they have their thyroid checked.

    If they drank a lot of caffeine, used illegal drugs, alcohol, or smoked cigarettes, I would suggest they cut down as those could be contributing factors.

    If they told me they had not slept in 7 days, I would highly suggest they look at all of their options and figure out the best way to get some sleep, because after 8 days without sleep you could die.

    If they told me they had recently ignored a bad tooth ache, I would strongly advise they no longer ignore it and get it treated as soon as possible. And also make sure their dentist prescribes the antibiotic flagyl because it is an anaerobic bacteria that could have festered, spread to their brain and is now affecting their ability to think clearly.

    If they could not afford the dentist, I would suggest Oil Pulling, Mrythe, garlic and try to get a prescription of flagyl from their PC.


    Dental care is very important to our overall health and definitely can have negative impact on our mental state. Although I am not a medical professional, I have been in psych wards enough to recognize many of our “psychotic” patients have personal hygiene issues and have been lacking adequate dental care.

    I think it is important to consider psychosis, mania, schizophrenia, bipolar disorder, etc. are nothing more than labels that describe behavior.

    They can be very accurate descriptions, so therefore they seem very real and we need some form of communication other than referring to people as “crazy”.



    I have a lot of friends who are psychics/mediums who hear voices/have visions/see spirit-beings. I don’t judge anyone as psychotic for hearing voices/seeing things that I don’t.

    I also have had friends who heard voices that told them to do very harmful things to others/themselves and became labeled schizophrenic.

    Sometimes I wonder if I was the only person on the planet who read a small article published in the USA Today back in 1999 that stated:

    “despite the slaying, Adderall remains a safe and effective drug for controlling AD/HD.”


    Ryan Ehlis suffered a Substance Induced Psychosis.

    Many other “psychotic” patients have also suffered psychosis from a substance, or a medical condition.

    Open Dialogue fails to acknowledge these cases and would leave many at a loss.

    Many of our “psychotic” patients are limited to their choices of treatment because they can not afford anything other than what their insurance/prison/jail will give them.

    My goal as a mental health advocate is to get patients choices in the help they receive.

    Kind Regards,

  15. I definitely understand the hatred against psychiatry but there are a few good ones. And before anyone flames me, hear me out.

    As one who had gone through hell in trying to adjust to pap therapy because of my sleep apnea, I would see a neuropsych/sleep specialist if he was in my area. He is more forward thinking than two sleep specialists I have dealt with who thought that trazadone and ambien were perfect solutions for my inability to stay asleep on the machine. And sleep doctor one wanted to pawn me off onto a psychiatrist.

    I also know of someone who went through hell trying to get care from her sleep specialists who guess what? Wanted to also pawn her off on a psychiatrist because they couldn’t help her. It was the psychiatrist who lined up good doctors for her who are finally doing the trick. And no, he didn’t insist that she take medication.

    By the way, I do mostly hate what psychiatry stands for, ok? But since the problem with labeling patients seems to transcend the field, I am getting to hate all medical professionals. I guess my point is you can’t assume that you will receive good care just because your doctor is not a psychiatrist.

    I agree with Maria looking into causes of psychosis and wanted to add one which is sleep apnea. Many people are erroneously being diagnosed with various mental conditions when they turned out to have sleep apnea. Unfortunately, that happened to me and I now fear the years of being on the meds have made my system so hypersensitive that I can’t tolerate pap therapy which is another post.

    My two cents.

    • Dear AA,

      Thank you for replying to my comment.

      Your two cents are worth a lot in common sense.

      When it comes to mental health care, we are really in a Seven Blind Men and an Elephant situation.

      Because so many lives are at stake, including those who may be harmed by someone who are accurately described as being in a psychotic state, we really need to work hard at being patient and understanding every perspective.

      Everyone has insights in to the problem but many have their blinders on to the problems others face.

      I have witnessed first hand how primary care physicians have mishandled individuals suffering from insomnia and led to the destruction of their life because of treatment with psych meds.

      I’ve dealt with insomnia myself and it can be unbearable.

      Six years ago I had the opportunity to have dinner with a very well renown advocate who traveled 3000 miles to attend a conference in my area. They are known for their strong stance against psychiatry and were dx’d sz themselves. They had to cut our evening short because they needed to take an Ambien early on so they would not be groggy in the am.

      The following year, while volunteering at a conference for a nonprofit mental health advocacy organization I noticed the Executive Director did not look well. I asked them if they were ok and they said yes. It was easy to recognize they were in some serious pain, so I asked once again if they were ok. They said they had a bad migraine and would be ok soon because they just took a vicodin.

      If intelligent individuals who know the risks and are capable of looking into the alternative still want to rely on medications, that is their choice.

      Who am I to judge?

      Robert Whitaker has stated in his lectures that Anatomy of an Epidemic does not take an anti-medication/psychiatry position and that medications will always have their place.

      Considering many individuals who take psych meds are happy taking them, that seems like the most rational, commonsense perspective to take.

      We need to continue to question, we need to continue to rationalize, we need to continue to share our opinions without overly criticizing.

      Personally, Dr. Kayoko Kifuji, the psychiatrist who treated Rebecca Riley and her siblings, makes me sick to my stomach.

      I would gladly pay out of my pocket whatever the costs are to have her deported back to the apparently Godless country she came from.



      In the US we “celebritize” and care about the problems of some, and turn a blind eye to the suffering of those who do not get their story sensationalized by the media. Those who are labeled “schizophrenic”, “mentally ill”, “psychotic” are especially among a marginalized population that our society has historically not given a crap about, taken advantage of and profited from.

      How can we send Michael Jackson’s doctor to jail and still let the doctors who treated children like Rebecca Riley and Gabriel Myers remain in practice?


      How can we place recalls on tricycles and bean bag chairs, yet allow harmful psych meds to be passed out like candy?

      How do we allow a pharmaceutical company to openly state, “despite the slaying” a medication is still a fine and dandy solution for ADHD?


      My perspective may seem “inconsistent” but that is only because the nature of mental health advocacy itself is schizophrenic.

      As much as there are horrific problems in our mental health care system, lumping all psychiatrists in the category of bad professionals is not something I can do.

      I have been under the care of and have met many psychiatrists who use medications with a best practice, judicious approach and are very compassionate individuals who offered talk therapy when I was off meds.

      I have met 3 psychiatrists from my hometown of Syracuse, NY who were trained in acupuncture and offered it to their patients. One would do it for free to his patients who could not afford it. I have met psychiatrists who are knowledgeable in vitamins and made recommendations to me. They were open to the use of complimentary therapies and happy to hear of my success.

      I believe in the benefit of the Participatory Medicine movement and collect information on participatory concepts in mental health care.


      To me it is not about fighting psychiatry or Big Pharma.

      It’s not about fighting the opinion of a chemical imbalance or what method works best or what the latest research shows.

      It’s about getting the labels off of people and the options they would like to choose available to them.

      It’s about waking up to the needs of others and meeting those needs.

      I like Robert Whitaker a lot.

      He has a very likable personality and everyone seems to take to him very easily.

      He is very intelligent and speaks in a very calm tone that is easy to listen to.

      Although he does not consider himself a mental health advocate, if you look at the definition of “advocate”, he is certainly acting in the capacity of one.

      I appreciate his effort as a journalist who has focused his efforts on change in our mental health care system and the tremendous amount of time and energy putting together this forum for discussion.

      I can only imagine how exhausted he must be after his lecture and travels around the globe.

      He has sacrificed his personal time with his family for the cause of mental health advocacy, and that is admirable.

      In the US, our society suffers from Infectious Cronkitis.

      We expect our journalists to digest large amounts of information for us and then regurgitate it back and spoon feed us the key points.

      We consider our journalists as our middleman to the best of the so-called experts. Because of their profession, they have access to resources that the average person does not. They have a limited perspective but their view are highly regarded.

      Personally, from the perspective of an individual who was considered a “psychotic” patient, I greatly appreciate the efforts of CCHR.

      Actor Tom Cruise is the only well-known celebrity that has spoken out for our rights.

      It doesn’t matter to me if Tom was a Scientologist, a Wiccan, a devotee or Sai Baba, or a Catholic priest, he spoke the truth and revealed it with a feverish passion.

      This is the type of individual I want in my corner as an advocate.

      Personally, I found Bob’s comment in this interview very disturbing and I hope he would consider the many individuals who credit CCHR with saving their life.


      “You mentioned Eli Lily and their response to data showing Prozac being associated with suicidal ideation, and how scientology and its views on psychiatry entered the picture.”

      “I made a little joke in the book about psychiatry secretly funding scientology, but really, it couldn’t have worked out better for the pharmaceutical companies and biological psychiatry. The reason is that, of course, it delegitimizes criticism. The fact that scientology is so visibly attacking biological psychiatry and attacking psychiatric drugs delegitimizes all criticism. Scientologists clearly do have a cult-like status and they clearly do have an agenda. The fact that they’re so visible makes it very easy for psychiatry and pharmaceutical companies to say, “This is just criticism coming from that crazy group.”

      Some of the stuff, they’ve gone into the data and they’ve brought out some information. Because it was scientology and CCHR that was out front with the criticism and raising questions and raising accusations that these drugs were causing suicide and violence, just made it really easy for pharmaceutical industry and Eli Lily to have it dismissed. If we didn’t have Scientology. Imagine it doesn’t exist and there’s no such group raising criticism. The questions around whether Prozac can stir violence or could cause someone to become suicidal or homicidal would have had a lot more traction.”

      I advocate from an open, honest, commonsense perspective that is willing to listen to others.

      Areas of my interest involve

      1. preventing the misdiagnosis of individuals suffering from symptom accurately described as mania/psychosis

      2. advancing participatory concept of mental health care

      Thank you for being open-minded and listening to what I have to say.

      Kind Regards,

  16. Lots of interesting comments here. I don’t think any of us can claim to know with certainty what causes the behavior that get labeled psychoses. This certainty is one of the primary fallacies of the whole psychiatric experiment. It seems to me that one of the most fundamentally kind and honest things we can do is acknowledge that we just don’t know, and be willing to find out together, without jumping hastily to any conclusions.

    • Matthew, I believe the people having (had) the experience do know, and they’re telling us clearly and unmistakably about it in their “psychotic ramblings”. The primary fallacy of the whole psychiatric experiment IMO is that our society and a group of people, the professionals, have decided to label certain people “insane” for their experiences and behavior, and to define “insane” as “not to be listened to/not to be taken seriously”. IMO the “we don’t know” statement is counterproductive as it, too, is dismissive of the voice of the labeled person herself, especially the voice of those who haven’t yet learned to see themselves through the eyes of others (psychiatry).

      As I see it, the problem we’re having in this discussion here (and have had in others before) is not so much that some people believe in one cause, and others in another one, but that it obviously is extremely difficult for some people to consider the possibility of different causes, among these also non-medical ones, why they seem to have a hard time respecting the voices of those who know that their individual experience is/was caused by non-medical factors, that indeed their experience is/was not the expression of some sort of malfunctioning on their part, which is what the labels suggest, but a meaning- and purposeful reaction to life. Why they would prefer to not have their experience labeled in pseudo-medical terms like “psychosis”, “schizophrenia”, “bipolar”, etc.

      So, while I am glad to see that there is some respect from the particular commenter toward the fact that some people know existential, spiritual, psycho-social, whatever you want to call it, factors caused their experience, I unfortunately don’t see that respect displayed toward those of us who don’t want their, by existential, spiritual, psycho-social,… factors caused, experience labeled an “illness”, “psychosis”, “schizophrenia”, “bipolar”, or other. Thus, once again we’re denied our voice.

      • Marian,

        Could it be possible that what our society calls “psychosis” can be unique for each person who goes through such an event?

        Ranging from:

        An emotional crisis; an adverse reaction to an over the counter, prescription or illicit drug; a spiritual awakening; sleep deprivation; a healthy reaction to trauma; an underlying physical condition that presents as something “mental”.

        Call me crazy, but IMO it could be any of these things. And I would appreciate what a person told me was their experience – no matter what that experience was – including one that was emotional-spiritual, “non-medical” and vice-versa.

        I agree with losing the psychiatric labels; they only serve to marginalize. I believe in validating each person as an equal in this life and that “psychosis” is an event, not a person.


        • Duane, that’s what I’m saying. And I certainly didn’t want to imply that you were the one who doesn’t respect people’s definition of themselves and their experience. I know that you do.

  17. Hi Maria,
    Despite your impassioned andeloquent statement there are a couple thing you do not understand and they are critical/
    Bob Whitaker above makes a powerful statement about ending the use of neuroleptic drugs. Although Breggin is against ALL drugs few people are. You cannot compare taking one Vicodin for a headache or Valium for insomnia to being placed on neuroleptics. I have long oppoised the puritanical attitude toward drugs.After I had a back injury I learned the value of “narcotics” when used cautiously. Sure there are people like Michael Jackson but that does not mean analgesics do not havea legitimate medical function.Neuroleptics do not-they were not introduced for the purpose of making “psychotics” lives easier–let alone to “cure” “schizophrenia.”. These drugs were introduced in the mid 1950s. They were given to “schizophrenics” who were expected to spend the rest of their lives in psychiatric hospitals. The psychiatrists hailed these drugs as “a chemical substitute for a lobotomy.” That was meant to be an endorsement. They made it possible to warehouse thousands of people in horrendous institutions and to keep them docile. They cause all kinds of serious physical problems, including tardive dyskinesia. They turn people into zombies.Up until recently they did not give them to “normal” people because they make it impossible for them to function–to work, to study to make love, to pass for a normal human being.(Yes if you take very low doses the effects are not as debilitating.)
    I knew these drugs kept people as “mental patients” back in 1988 when I got fired from a clinic for encouraging clients to get off these drugs–and SSRIs since they often seemed unnecessary. I think Breggin has unwisely diverted attention from neuroleptics by implying that ALL psychiatric drugs are the equally bad.That’s how he sounds anyway. They are not equal!. NOw Bob has presented incontrovertible evidence that “anti-psychotics” prevent people from recovering from their crises. This I have long argued is ironicAlly one of the reason shrinks still use these drugs.If people started getting over so called schizophrenia Psychiatry would lose its “sacred symbol” and the medical model would begin to lose its credibility.AS Sassz pointed out “schizophrenia is the linchpin in the medical model. Anyone in the reform movement should take the same position towards typical and atypical neuroleptics as they take toward electroshock. They should demand the abolition of its maintenance-use, if not of itsuse altogether. (Obviously some people have been on too long to get off–they’re the exception.) It is an evil drug that makes emotional crises chronic mental problem.
    It is to Bob’s credit that he has placed so called anti-psychotics in the center of the debate. It cannot be compared to the type of drugs that normal people often take and sometimes abuse, like Valium or Ativan or alcohol for that matter. Anybody who is genuinely in the reform movement must demand that shrinks stop putting people on “anti-psychotics.” Despite the name they cause a chronic state of disability that looks just like “mental illness.” They are “pro-psychotics.” Any psychiatrist who prescribes anti-psychotics (Except to people who can’t get off) should be boycotted. When the mental patients liberation movement started in 1970 the leaders knew how destructive these drugs were, and they started getting off them.
    Second Maria it’s irrelevant that they are some good psychiatrists. That’s not the point. It like telling me that you have met some good soldiers and thus you feel you have to support the military and war. You have to look at the institution, at the structural factors that lead most psychiatrists to prescribe unnecessary drugs. The reason we have wars is not because they are necessary for nationa security–both Bush’s war and Obama’s war(s) have created far many more terrorists than they have destroyed. And look at all the other costs of these wars. Look at the civilians killed and maimed in Afghanistan, the sky high suicide rate among American soldiers.
    Look at the cost in terms of liberty. The fact that there are nice soldiers is irrelevant. As Eisenhower predicted in 1960
    we hAve wars because there is a military industrial complex which profits from wars–and now we have a anti”terrorism” industrial complex which has destroyed the basis of our Constitutional republic. (Sorry NSA, I’m just kidding you.) So as Peter Breggin showed, in 1978 changes were made in APA rules which led to the growth of a massive psychiatric-pharmaceutical industrial complex. The fact that there are good psychiatrists is not going to stop the drugging of America or the diseasing of America.
    In the same way that the MIC profits from wars the PPIC complex profits from diseases and
    drugging. Appealing to the goodwill of generals will not end war BECAUSE war is profitable. Appealing to the goodwill of psychiatrists will not end the diseasing of America because diseases are profitable. Of course we should welcome the dissidents. I am a dissident. I became one when I encouraged my “schizophrenic: client in a clinic in 1988 to get off anti-psychotics. I was fired but my faith in John gave him faith in himself.
    He was 25 then and had been a “schizophrenic” for 7 years. He got off the drugs on his own and today 25 years later he has not taken a drug since or been locked up since. No one could ever guess he ever was a “schizophrenic.” But back in 1988 I was the only psychologist who took this position.His parents had dragged him all over. But his NAMI mother walked out when I said John could get off drugs and over his problems. Anyone else taking the position I took today 25yearslater would also be fired. John had never heard what I told him before. If our paths had not crossed he would be a chronic schizophrenic today.
    THE PPIC does not hire therapists who warn patients to get off of drugs. Thus the good will of dissidents is not enough to change the system.
    If you don’t understand these two facts–the crazy-making properties of neuroleptics and the power of the PPIC– you just do not understand the forces we are up against.
    Right now we should follow the British and demand the end of psychiatric labeling, ie diagnosis. We should also demand as Bob implies the abolition of the use of neuroleptic drugs. These along with opposition to coercive treatment are critical. They are currently outside our power but they are good educational tools. Other demands however useful are tangential and do not get to the heart of the issue.
    Best, Seth
    Seth Farber, Ph.D.

    • I agree with much of what Seth wrote here. Within three years I managet to get all the most severe diagnoses they have on offer (bipolar, schizophrenia, severe depression with psychosis) when all of my severe symptoms were obviously caused by neuroleptics. When I got to the system, in my papers it says I sleep 7,5 hours and wake up lucid. Three months later, after starting neuroleptics, my papers say I sleep 14-16 hours a day and am still tired during the day. I also got “heart shocks” when falling sleep, my skin all over the body would develop red “inflammation” or whatever spots, I became anhedonic. Heavy inner anxiety and depression like symptoms. The papers said that I had become very passive in conversation and replied only with single words. When I talked about these problems which obviously were because of neuroleptics, they for instance suggested that I have “post-psychosis depression” and wrote in their papers that “patient has paranoid thoughts concerning his current medication. Also when I said I have too much of Abilify, the psychiatrist just looked at me and said “it’s a good dose”. I developed symptoms that were very similar to “negative and cognitive symptoms of schizophrenia”, and they went gradually away when I stopped neuroleptics.

      I’m not anymore taking any meds but I’ve been taking SSRIs too. They have many problems too, but in my opinion they’re generally not even close to neuroleptics. One thing is that their use can lead to neuroleptics eventually. The psychiatrists, patients and general population still seem to think that these “atypical” neuroleptics are much safer and more efficient than the old neuroleptics, so there’s a low barrier to trying them.

    • Hi Seth,

      I know u will find this hard to believe, but we’re on the same side, we just come from different backgrounds, have had very different experiences and have very different perspectives.

      I come from a working class family.

      I spent 15 years in the graphic arts industry, which involved fast-paced production while adhering to strict deadlines. Maintaining profits meant perfecting one’s craft and a zero tolerance for error.

      As a consumer, I make wise choices.

      During my recovery I spent time volunteering as an arts and craft instructor for individuals who suffered TBIs, all of whom were on antiseizure/psychotic meds and also labeled with “mental illness”.

      In a flash of an instant, these individuals lost so much of their life from car/motorcycle accidents, brain aneurysm, strokes, etc. For one man, that is all it took was a mosquito bit to suffer Equine Encephalitis and end up labeled “mentally ill”.

      Spending time with these individuals was priceless. Together we produced beautiful artwork and crafts and at the end of the season we had an art exhibit at a local cafe. Sharing the joy they experienced as their finished pieces were framed and hanging was shear joy. To be part of their life was truly a gift in itself.

      As a patient, I would often use artwork to cheer up other patients. Many who had birthdays really appreciated getting a handmade card signed by all of the other patients. It would be the only form of celebration they had. I would also make calendars for patients because we would lose track of what day it was, when our family members had birthdays, when the holidays were and when our bills were due.

      Sometimes I wonder if mental health advocates are even aware of the small items lacking in these overpriced psych wards. Decks of cards, calendars, magazines, books, art supplies, paper, pens, board games, DVDs/CDs, extra clothing, these are all things in need at many psych wards.

      From a patient’s perspective and from the perspective of a friend to individuals with TBIs, Dr. Foster’s description of a patient as “a bottomless pit of needs” were very upsetting.

      And for him to decide that “In her case, keeping her semi-sedated makes some sense–to spare herself and society the legal and criminal consequences of her mind unleashed.” demonstrates the control medical professionals believe they have over their patients. They decide who is worth helping and who should be kept drugged.

      From a common sense perspective, it is wrong for a doctor to discuss his patient’s history in such detail in public. This patient is entitled to her privacy. If this woman did have blonde hair, then he is identifying a specific trait and violating her privacy rights.

      The case below exemplifies the problem of our medical and mental health professionals using the DSM 5 with a “Chinese Menu” approach.

      This case happened at the same hospital I was misdx’d at and the same hospital Dr. Szasz was Professor of Psychiatry Emeritus at.

      This is the result that we should be striving for “no longer required further psychiatric medication or therapy.”

      And for this “mentally ill” patient, steroids were the answer.

      Working within the existing parameters of Psychiatryland, in order to have zero tolerance for cases like this, can we agree that this “Chinese Menu” approach needs to go?

      Neuropsychiatric systemic lupus erythematosus presenting as bipolar I disorder with catatonic features.
      Posted on November 25, 2012 | Leave a comment
      Psychosomatics. 2009 Sep-Oct;50(5):543-7.
      Alao AO, Chlebowski S, Chung C.
      Department of Psychiatry, SUNY Upstate, NY 13210, USA. [email protected]

      The American College of Rheumatology has defined 19 neuropsychiatric syndromes associated with systemic lupus erythematosus (SLE) involving the central, peripheral, and autonomic nervous systems. Neuropsychiatric manifestations of lupus (NPSLE) have been shown to occur in up to 95% of pediatric patients with SLE.

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

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

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

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

      • Maria
        Yes you’re right. His attitude was contemptuous and contemptible. However your own omission was misleading.
        To say that a person with organic brain damage had a broken brain IS literally true. To say it about s so-called schizophrenic is a lie and sheer mystification. I don’t know enough about brain damage to even understand most of your terminology. I do know that they have discovered lately that the brain is not intractable
        and that it possesses neuroplasticity which makes such grim prognoses self-fulfilling prophecies.However it’s more complexthan someone with “schizophrenia.”The shrinks use Latin terms vto avoid telling the truth. This is a person undergoing an emnotional crisis or upset. I am completely against the use of such medical diagnosis. It’s the same thing with grief. Now they label a person who ost a close friend or family member pathological. If you spent all your life with someone andshe died it is natural to be unhappy miserable. Yet the shrinks say, Well we’ll let you feel sad for two weeks. Any longer is a “clinical depression.” Or a major depression. This is not a legitimate diagnosis. It’s a public relations trick to assert control over the unhappy person. This enables the shrinks to hospitalize her against her will and deceive her into thinking she has a medical problem. This kind of language degrades and debases the bereaved person. It would be far more accurate to say that she has the “blues.” But that is not financially profitable.
        It does not allow you to fill the hospital bed or to sell psychiatric drugs–drugs that do no better than
        placebos. The shrinks take the stories of life and translate it into medicaleeze. We should be doing the opposite. We should tell our own life stories, not give it to medical con artists who have become pimps for the drug companies.

        I have worked with so called schizophrenics as friends clients advocate for years and my impression is that you have been deceived, you have been influenced by their tropes and terminology which are completely bogus.It is kind of you to work with people with TBI.I think you came to identify with them. But you are different. You cannot compare an emotional crisis it with TBI.
        I spent quite a many years reading the literature and there is no evidence that there is any anomalies or disorders in so called psychotics. That kind of language is used to deceive you and make you believe shrinks have some expertise they do not have.They are bogus doctors. If you read Joanne Moncrief you’ll see the only person who show signs of brain pathology—shrinkage of ventricles–are those taking neuroleptics.
        Psychiatrists speak this jargon to make people think they are brain doctors but they are not. The rhetoric is used to disempower you. After years of working in the field I know that those who get OUT of the system and off the drugs do better. That is what Bob is trying to show you.
        In the 70s and 80s they did many experiments all designed to prove “schizophrenics” were cognitively inferior. If you read Ted Sarbin/James Mancuso book on Schizophrenia you find the majority of patients performed as well as the normal population. A few ersons did less well. That is only a small difference between group means–attributable to disguised variables like the effect of the drugs. But they use these difference to construct the myth of schizophrenia.
        So there is copious research: There is nothing wrong with the brain of schizophrenics.Sure there may be a few who actually have TBI. The problem Maria is not the Chinese menu. The problem is with the menu at all, with all medical diagnoses. If an orthomolecular doctor accepts the diagnosis of the shrink
        he has also embraced a myth. I don’t object to people taking vitamins or whatever they want.As long as it’s not neuroleptics But the diagnosis is incorrect. There is no such thing s schizophrenia. Sure emotional symptoms could be caused by physical problems but that is true for everyone.
        If you tell someone there is something wrong with their brain that becomes a self-fulfilling prophecy. Psychiatrists have mastered the jargon of brain disorder even though it’s not validated by research because they are trying very hard to convince “patients” they have specialized knowledge.
        I have met 100s of patients who got off the drugs out of the system and then their problem was resolved
        If they lost their partner they may have the blues for a long time. That’s not a pathology.And even a orthomolecular doctor should not say it is.
        Every psychiatric diagnosis is a misdiagnosis. A “schizophrenic” may have a more sensitive constitution than normates which is all the more reason they should stay away from shrinks and look for non-medical solutions to their problems.

        • Seth,

          Honestly, I agree with you wholeheartedly.

          We are saying the same thing, just speaking a different language through different experiences.

          I agree with Bob and after listening to all of his online talks, I’m pretty darn sure Bob would agree with me.

          You say, every “psychiatric diagnosis” is a misdiagnosis.

          I say, all “mental disorders” are nothing more than labels that describe a behavior that the norm considers abnormal.

          These labels are used not just by psychiatrists and unfortunately, in order to get help to those who need it, we need to use labels to communicate.

          Bob uses the terms schizophrenic/bipolar all of the time in his talks.

          How else can he communicate his message without calling individuals schizophrenic/bipolar?

          Psychosis is nothing more than a word used to describe what appears to be, or may actually be, an altered state of mind/consciousness.

          Mania is nothing more than a word used to describe a very energetic brain.

          Schizophrenia is just a label placed in individuals acting differently, but perhaps dangerously.

          These are the type of “schizophrenic” stories that make our society scared of those acting differently than the norm.

          These are the type of stories that our lawmakers consider and continue to empower psychiatrists as the experts, despite the fact the medications/withdrawal effects may have been a contributing factor to the danger to public safety.


          In third world countries, Shamans/Gurus use hallucinogenic substances, or deep meditation to achieve an altered state of mind/consciousness/energetic brains and their society accepts them.

          I am not a Shaman but I did have similar experiences. I did not use hallucinogenic substances, I was exposed to a number of different toxic substances that eventually had a synergistic effect that produced the same as hallucinogenic substances. I suffered an organic psychosis, toxic encephalopathy. It was a closed head injury, the toxins I worked around can cause neuropsychiatric disorders and that is what caused my initial symptoms.

          The most simple way that it was described to me was my brain was swelling and I suffered organic brain damage that was successfully treated. I I had a very broken brain, literally and I was labeled bipolar, schizoaffective and schizophrenic. I relate well to individuals with TBIs because I also suffered a closed head injury causing cognitive deficits, and to this day still have residual effects of memory/neurological/cognitive problems/multiple chemical sensitivities/autoimmune disorder.

          In the United States some of the most horrific tragedies have involved individuals in altered states of mind/consciousness.

          Having a very energetic brain can lead to erratic behavior/spending, etc. and have permanently damaging effects on one’s life.

          No one is immune from suffering an altered state of mind/consciousness that can have damaging effects and lead to being labeled with a “mental disorder”.

          Those concerned with how they/their loved one would be treated should have a Psychiatric Advance Directives in place.

          Altered states of mind/consciousness due to a Medical Condition involve a surprisingly large number of different medical conditions, including but not limited to: brain tumors, cerebrovascular disease, Huntington’s disease, multiple sclerosis, Creitzfeld-Jakob disease, anti-NMDAR Encephalitis, herpes zoster-associated encephalitis, head trauma, infections such as neurosyphilis, epilepsy, auditory or visual nerve injury or impairment, deafness, migraine, endocrine disturbances, metabolic disturbances, vitamin B12 deficiency, a decrease in blood gases such as oxygen or carbon dioxide or imbalances in blood sugar levels, and autoimmune disorders with central nervous system involvement such as systemic lupus erythematosus have also been known to cause altered states of minds leading to the dx of sz/bp.

          A substance-induced altered state, by definition, is directly caused by the effects of drugs including alcohol, medications, and toxins. Psychotic symptoms can result from intoxication on alcohol, amphetamines (and related substances), cannabis (marijuana), cocaine, hallucinogens, inhalants, opioids, phencyclidine (PCP) and related substances, sedatives, hypnotics, anxiolytics, and other or unknown substances. Altered states can also result from withdrawal from alcohol, sedatives, hypnotics, anxiolytics, and other or unknown substances.

          Some medications that may induce altered states include anesthetics and analgesics, anticholinergic agents, anticonvulsants, antihistamines, antihypertensive and cardiovascular medications, antimicrobial medications, antiparkinsonian medications, chemotherapeutic agents, corticosteroids, gastrointestinal medications, muscle relaxants, nonsteroidal anti-inflammatory medications, other over-the-counter medications, antidepressant medications, neurleptic medications, antipsychotics, and disulfiram . Toxins that may induce altered states include anticholinesterase, organophosphate insecticides, nerve gases, heavy metals, carbon monoxide, carbon dioxide, and volatile substances (such as fuel or paint).

          The ENERGY & COMMERCE COMMITTEE’s Examination of SAMHSA’s Role in Delivering Services to the Severely Mentally Ill, indicates that those of us concerned with alternatives to medication management are in critical time period and we need to figure out how to communicate our messages effectively to those in control of our mental health care system.

          Our lawmakers are the ones who empower the Medication Management Monopoly.

          This hearing should be sending off an alarm to all advocates concerned with advancing the availability of alternative therapies.


          Seth, I am enjoying this exchange, thank you for your comments. It’s the best way to flesh out ideas on how to communicate effectively to the main stream.

          • Damn I lost what I wrote. I don’t agree with Bob entirely. i agree that anti-psychotics are harmful and that OD and Soteria are positive alternatives. It’s very important that Bob chronicled those facts. But I would never refer to someone as”schizophrenic” without using the scare quotes. That’s an insult to the people I know who had spiritual episodes. It’s not an illness. I agree with you that shamanism is an ASC and it can be enriching, it can give people the gift of healing. Hallucinogens when used carefully can be therapeutic. Schizophrenia can also be part of a healing process as John Perry and Michael Cornwall, Paris Williams and I have argued.
            The psychiatric establishment regarded Jesus as “schizophrenic,” as defective–they did not understand he was spiritually gifted.
            The papers you cite report only the negative. They don’t recognize that people can grow BEYOND normality.
            You write, “The most simple way that it was described to me was my brain was swelling and I suffered organic brain damage that was successfully treated. I had a very broken brain, literally and I was labeled bipolar, schizoaffective and schizophrenic.” OK how did this happen to you? There is book Train Your Mind, Change Your Brain by Sharon Begley. It may be helpful to you because there is a greater capacity for change–and the book shows how. But you were not bipolar and schizophrenic. You don’t understand Maria that those words are used to insult people.
            We have been telling you over and over that there is no such disease as schizophrenia. When you tell a patient she is “schizophrenic” you undermine her self confidence. if you look at MindFreedom or my book there is absolutely no evidence of a brain disorder. Those words are used to demean and anti-psychotics are used to make or keep people dis–abled.
            The sensibility of the psychiatrist is shrunken. They look at people who are growing beyond them and instead of seeing growth they see disease.In The Politics of Experience Laing presciently wrote, “If
            the human race survives, future men will look back on our enlightened
            epoch as a veritable Age of Darkness. The laugh’s on us. They will see
            that what we call ‘schizophrenia’ was one of the forms in which, often
            through quite ordinary people, the light began to break in the cracks
            in our all-too-closed minds.”
            Of course we have to turn even suffering into an occasion for growth as you did. But still the doctors lied to you
            when they told you that you had “schizophrenia.” It was not that Jesus was a “schizophrenic.” It’s that sychiatristws did not understand him. What they call schizophrenia is a growth crisis as Laing said. You don’t realize Maria how spiritually ignorant shrinks are. They are not like real doctors. They label anything
            THEY don’t understand as mental illness. They are afraid of the light, and they cling to their Ignorance.
            It seems you had a brain injury.I’m sorry to hear that. It’s good that you got over it. But you did not have any of those other illnesses. You were lied to by psychiatrists.All psychiatric labeling should be abolished. And the sanctity of the human soul–of your soul– should be affirmed.

  18. First of all thanks, yet again, for bringing another piece of rational research to our attention. HOWEVER, the recommendation for benzodiazepines for some people will actually cause further psychosis. There are a small group of people who have a deficit in the enzymes to deal with these drugs, and others, and various endogenous and exogenous toxins. These people are probably ill because of this in the first place and “treatment” with toxic drugs makes them worse.
    We have just discovered that my son, aged 50, has in fact been suffering from metabolic ketoacidosis from a yet unidentified inborn error of metabolism. This causes a symptom known as hyperpnea which means that he is not receiving enough oxygen to his brain, causing confusion. Added to this is toxicity from the acidosis, which he can’t deal with because of a genetic detoxification deficit.
    Do you think the psychiatrists found this out? They did everything to stop us getting to the bottom of this to cover up their own negligence, to the extent of perjury to a Mental Health Tribunal.
    Don’t say that we can’t know what causes psychosis. We need people who practice medicine, not people who can’t prove that their speciality exists!
    Incidentally my son is waiting for hyperbaric oxygen treatment.

  19. Here i am not replying in any way to all what has been written above (my knowledge of the english Language is not so fluent, being a dutch woman who lives already in Italy since 40 years…), but I only would like to post a small testimony of my own story (of which Robert Whitaker is informed too… I gave him my book recently in Italy): Before 2000 I suffered for circa 4 years of a so-called delirious paranoid ‘schizophrenia’ in North-Italy. For my fortune I was immediately in contact with a human psychiatric approach after my forced hospitalization. I was in a half-wayhouse for 13 months and then went back home, following a good psychotherapy for almost 10 years. I took antipsychotics in totally for 4 years, I believe, and have stopped taking them already 11 years ago. How much more was I going better since I stopped the psychopharmaca! I started sleeping better, I started dreaming again, I restarted to be able to do my householding again, to reflect better, to remember better, to be able to do associations and so on: after all functioning better every where, at home, in my contacts with son, husband and other persons and most of all this was better for my psychotherapy too. I ended up my therapy at the end of April 2009. If someone should be interested in the story on Amazon can take a short look inside my autobiographic book ‘Healing from schizophrenia. A personal account’. by Lia Govers. As a matter of fact my story in the italian version is cited also in the italian version of Whitaker’s book about the Epidemy of psychopharmaca (sorry, don’t know the english title of it)…

  20. Bob,

    Thank you for this great post.

    A small contribution to this conversation and thread:

    This recently published article (above), “A Decade of Reversal: An analysis of 146 Contradicted Medical Practices”, suggests that–assuming psychiatric practice is no exception to the prevalent trend of ‘medical reversals’ in other areas of medicine– Bob’s data-driven invitation to change protocols and sponsor more pointed research is not at all without precedent.:

    The article reads:

    “Recently, a project of BMJ, entitled Clinical Evidence, 81 completed a review of 3000 medical practices. The project found that slightly more than a third of medical practices are effective or likely to be effective; 15% are harmful, unlikely to be beneficial, or a trade- off between benefits and harms; and 50% are of unknown effectiveness. Our investigation complements these data and suggests that a high percentage of all practices may ultimately be found to have no net benefits.”


  21. Mr. Whitaker,

    Do you know if the Wunderink study was done with gradual withdrawal or sudden withdrawal for those in the DR group? If sudden withdrawal, that would explain the initially high rate of relapse.

  22. Hi Robert

    Thank you for such a thorough analysis, as always. I felt your call for change was right on the money, and very respectful.

    Unfortunately for my family, we have been completely betrayed not just by a psychiatrist, but by the entire system all the way up to federal level because nobody really wants to upset the status quo, in my research experience anyway. The sheer number of people who have died as a result of this harmful pathologizing and drugging of human distress is criminal. And more or less, astonishingly, they have completely gotten away with it. Such injustice is more than betrayal.

    Its very possible that you alone have created the first real oversight that psychiatry has ever had, through your impeccable and inspirational work. For that, and on behalf of all the people that your work *might* still be able to save, I thank you.