Taking “Anti-Psychotics”
When You Are Not Psychotic

N.I.,

Is that for Dr. Steingard or myself?

I agree that you make important points here, mjk. As I have read you make in other posts. And I think the concern we have been discussing regarding the potenially detrimental cognitive effects of neuroleptics is underscored by the study just posted on this site today, evidencing that tapering off of certain neuroleptics increases cognitive functioning. See http://schizophreniabulletin.oxfordjournals.org/content/39/5/993.abstract . But my concerns are not limited to cognitive functioning, but extend into emotional and social functioning, which, of course, are both interdependent with each other and with cognitive functioning. The emotional blunting effects, which I can also describe with painfully acute specificity, as well as the decline in social functioning I have experienced (and can recount with similarly horrific detail) are as profound and debilitating as any cognitive effect. Why are these side-effects not acknowledged in the mainstream? The only meaningful discussion of side-effects I can discern in the mainstream are the — likewise very serious — detrimental metabolic effects, such as those described below by aria. Should I conclude that the only reason why those effects are acknowledged is because Big Pharma has been forced to acknowledge them following billions in legal settlements concerning those side effects? Does mainstream science truly believe that cognitive, emotional and social side effects are of limited or no significance? Do scientists and psychiatrists believe that those effects may be adequately explained by evidence that those on neuroleptics satisfy the cognitively/emotionally/socially deficient profile and therefore existing and further research is unimportant, or unimportant when considering the risks of relapse? Setting aside the question of whether people diagnosed within the schizophrenia spectrum can truly be said to be sufferers of “negative symptoms of schizophrenia,” isn’t it clear — as Sandy and others on this thread and elsewhere do and must acknowledge — that neuroleptics are being prescribed to legions of people without that diagnosis (which I acknowledge accept raises many questions — I mean no disrepect to those so labeled)? Does the conventional wisdom also dictate that non-metabolic side-effects of neuroleptics may be explained away by nature or minimalized as unimportant in the face of whatever intended effect — on- or off-label — the drug is supposed to have on a subject?

“And I think the concern we have been discussing regarding the potenially detrimental cognitive effects of neuroleptics is underscored by the study just posted on this site today, evidencing that tapering off of certain neuroleptics increases cognitive functioning.”

BRAIN suppressants, so it makes sense that some functioning will resume once the deadly (DEADLY) drug is stopped (before it’s too late). I’ve got something of a chemical lobotomy (there will be NO recovery for me and I know it).

I am sympathetic with MJK’s point.Not that neuroleptics are not effective in some ways in the short run but that there are always psychological factors that explain why they are helpful to some people, and not to others. As a dissident psychologist I am often criticized in more drug friendly arenas of the Mad movement than MIA because in my recent book I violate what has become a sacred taboo in The Icarus Project: No one has the right to doubt that each patient knows best what drugs are best for her. I argue that all patients would be best if they stayed off “anti-psychotics” http://www.amazon.com/Spiritual-Gift-Madness-Psychiatry-Movement/dp/159477448X/ref=sr_1_1?s=books&ie=UTF8&qid=1379159490&sr=1-1&keywords=farber+gift
This purpose of this taboo was not merely to discourage pro-drug doctors from pushing drugs but to discourage radical psychiatric survivors from disparaging drug-using patients or from implying that the latter were being misled. This became the postmodernist pluralist dogma.

But it is a proscription not an epistemological insight–if it were, there could be no placebo effect. (Most patients who think they are benefiting from SSRIs are experiencing the placebo effect.)When I made this argument in my recent book many in Icarus Project were angry–the fact that I was not a survivor only aggrandized the anger at me. That did not stop me. I was not going to encourage any so called patient to take neuroleptics even subtly by acknowledging that ANYone benefitted from neuroleptics in the long run.AT TIP that IS done.

There were many risks of neuroleptics–many of them are discussed in Bob’s books . I’ll add here another one implied by MJK I think–the internalization of the medical model. I consider it my moral obligation as a dissident psychologist to discourage patients from taking “anti-psychotic” drugs unless they are already addicted. I was using a Moncreiff drug centered approach to argue against neuroleptics for years, in the 1990s. I had not read Moncrieff in the 1990s– I don’t know when she developed her drug centered approach.

My reasoning was that patients like non- patients did not suffer from mental illness but they did suffer from fear, terror and despair. But having witnessed the horrendous effect of neuroleptics–from tardive dsykinesia to emotional blunting (eloquently described by NI above) I could see no reason why a patient who was not indoctrinated would voluntarily take neuroleptics which were compared to
chemical lobotomies by their psychiatrist promoters when they were first introduced in the 1950s.
.
In the first place the “mental patient” who take “anti-psychotics,” too readily draws the conclusions from the temporary relief provided by the drug that she does indeed have a psychotic “illness.” She lives in a culture in which she has heard this since childhood—and is unlikely to have heard of the critics of the medical model. Even the very intellectually gifted leaders of Icarus had not read Szasz or Breggin when I interviewed them in 2009. Sascha DuBrul refused to read them although he devoured Kay Jamison. Why?
I was not able to figure out Sascha’s ambivalence about psychiatric drugs and their critics(I did not have enough information about his personal life) although I tried thus violating the pluralist taboo, and eliciting the anger on many TIPers. (Except for Sascha who does not take criticism personally) NI and Sandra agree that neuroleptics may be helpful because they make patients feel less intensely. NI gives a very insightful non-medical account of why patients sometimes find neuroleptics helpful in the short run, despite its tremendous emotional cost. Sanda agrees.
But again I do not think this justifies the non-medicalist (dissident)psychiatrist’s use of neuroleptics,except as agents of last resort.I do not think any “professional” should make it easy for “patients” to use neuroleptics. They are much worse than most illegal recreational drugs, let alone medicinal marijuana.

Neither NI nor Sandra mention any of Breggin’s books. I changed my naive position on drugs after reading Psychiatric Drugs: Hazards to the Brains and became blacklisted in the public sector just 5 years after getting my PhD. Neuroleptics were hailed when they first came out precisely because they made patients apathetic–and ward management easier.

But neither can we dismiss the placebo effect. MJK is right.
The placebo effect means a patient improves because a drug produces an expectation of improvement. (BTW MJK’s statistics for placebo effect are much too low; they are far lower that the definitive analysis by Irving Kirsch. In fact MJK placebos are arguably AS effective as anti-depressants.) It has been shown that placebo are more effective if the patients has a positive relationship with the psychiatrist dispensing the placebo. As written in No More Diagnoses “ having a good relationship with the prescribing doctor is a stronger predictor of a positive response to an ‘anti-depressant’ than just taking the drug regardless of who prescribes it.” I have observed that this is also true of neuroleptics.This confirms MJK point.

In spite of the harmful and painful side effects many patients trusted the psychiatrists. But, e.g., making a patient more apathetic about her voices is one way of reducing the fear evoked by hearing a voice in a secular society. Giving her a “minor tranquilizer” is another. The latter has many advantages. En-couraging someone is better than making them too dull to care.

Sandra writes: “I will post the results of two years of tapering neuroleptics. About 40% of people choose to stop tapering. The reasons vary. Some people do hear more voices and do not like that. Some people find that they have delusional thoughts and they do not like that. Some people just get frightened about having a recurrence of experiences that they did not like. I can say that they are making these decisions with a psychiatrist who is very supportive of tapering.” But can you say Sandra they have not interpreted the voices or delusional thoughts as symptoms of mental illness? Can you say they are making these decisions in a society and in a setting where altered states of consciousness are not discouraged? Can you say these patients did not choose to stop tapering because they feared heir illnesses were “returning”? Did you assure them there illneses were NOT returning? Or did you take an agnostic position? But we do not live in an agnostic culture. Did you ask the kind of questions to the patients that I am asking now?

I raise this as rhetorical question–I don’t expect you to answer it until you publish your experiment. Even if you did not do this at least you offered some patients the option of getting off the drugs. But my point is not intended as a personal criticism but as a commentary on the System. I would argue despite your good intentions if you treat neuroleptics as legitimate treatments rather than poisons you reinforce the medical model. .

I would like to see this studied with some methodological rigor and with double bind. My own observations is that there is an interaction between the effects of the drugs and the patients’ world views. Yet I have not seen any studies of this. For example take a patient who has been reading Peter Breggin and Bob Whitaker
and give her neuroleptics. I predict the drugs will have a more deleterious effect upon her than someone who had no exposure to psychiatric critics.We know from the recent studies you cited that patients not on neuroleptrics are going to do better in the long run. Throw in Peter Breggin and Bob Whitaker 101—and accounts by people like Laura Delano– and I predict these patients will get better quicker. This is not purely hypothetical: in the late 1980s and 1990s thousands of patients were reading Peter Breggin. Would David Oaks have had no episodes after his breakdown if he had not become a student of Peter Breggin’s work? It did not take 7-15 years for him to recover. Is that a coincidence?. I would hypothesize that those former patients in the movement who read Breggin got better sooner than those I interviewed who were not familiar with Breggin or Szasz or Laing.

Obviously there are some former patients who would have rejected Breggin’s work. They joined NAMI, or became consumers.. One of the variables is a receptivity to the critics of the system. Some patients were by nature more rebellious than others. For example David Oaks had been a long time activist before his breakdown at Harvard. My theory is that reading anti-psychiatric theories will greatly accelerate the speed of recovery. I did not have enough information to explain in my book why Sascha DuBrul felt neuroleptics helped him but I do know he would not read Peter Breggin–although I kept urging him (2007–9) to do so.

Panic is a common symptom of “psychosis”–that is it often accompanies voices or other unusual experiences. We know that in the few experiments done Valium was as effective as neuroleptics in sedating “psychotics.” Why? What is it we want to accomplish?. In my recent book I interviewed 7 former patients. Paul Levy and Ed Whitney agreed with me that what the shrink calls bipolar or schizophrenia is often a spiritual awakening. (I would argue it is never a disease.) Let’s say the patient is having a distressing hallucination. If we give a patient a Xanax –or a glass of wine (as Henry Stack Sullivan did in the 1940s) –you might mitigate the fear without producing a state of apathy. More than apathy the shrinks hailed Thorazine when it was discovered in 1956 because it produced a state of “emotional indifference.” Patients were described as acting and feeling like “zombies.” Benzodiazapines do not produce that effect. Shrinks had rationalizations for avoiding benzos. Is it because benzos are more addictive or simply more pleasurable? The withdrawal effects of neuroleptics are no less intense than those benzos that have a longer half life, but the latter do not produce the same emotional indifference, or the other pernicious side effects.)The ingestion of a neuroleptic in a psych ward is a medical ritual that convinces the patient she has a medical problem.
But assume as I do that for example the voice hearing patient is not suffering from an illness. But she may be very frightened. If the psychiatrist gives the patient a Xanax or a Klonapin the former is implicitly defining the problem as anxiety–she is underrming the medical model. She is giving the patient a drug which “mentally healthy” people use to take the edge off (unless they are addicts).Bruce Levine argues that cocaine and SSRIs are equally effective in the short run for despair––he disputes that either are helpful in the long run. My point is we are dealing with propaganda in the one case—“anti-psychotics” or “anti-depressants.
You are going to tell me that benzos are not without risks. Yes if the patients has a tendency to use drugs excessively Valium may indeed be more dangerous. But my point is that psychiatrists like yourself Sandra should use neuroleptics as a last resort and prescribe them with the same trepidation with which you would prescribe morphine.
Seth Farber, Ph.D.
http://www.sethHfarber.com

Seth,

Thank you for your informative post and links. My concerns about autonomy and choice are not epistemological either, but evidence-based. I have read Breggin and Whitaker and others — with great interest and eyes wide open. Their work is what brought me to this site and gave me the courage and sense of urgency to wean off of Seroquel. Nor have I discounted the significance of the placebo effect in psychiatric care, and I acknowledged in my previous post that the judgments of some are not fully informed or carried out with sufficient capacity. But I have observed first hand my own patently false and sensorily impaired (i.e. objectively inaccurate and subjectively tactless) beliefs and actions on them, well before I ever trusted or even saw a psychiatrist. These beliefs and actions are evidence to me that my brain was not functioning properly. This to me is uncontroversial and without question, and the conclusion is mine to not question. Others are free to and will disagree with me. As for treatment, this is much more thorny. As a person who has experienced what I observed in my own mind as dysfunction, I face a dilemma. I want to believe that the psychiatric medications I’m on are ineffective, or at the very least any benefits are far outweighed by detrimental effects, which would enable me to to believe that I can avoid that dysfunction, as well as dysfunction referred to in psychiatry as depression, without resort to harmful medications. But the risk of being wrong is simply too consequential for me to embrace, without scientific or medical training, scientific and medical conclusions beyond the scope of my knowledge and skill. Nor would I trust my own independent research, lacking the training to be able to arrive at reliable and fully informed conclusions. I’m left with having to face choices on whom to believe. This to me is not easy, and cannot, be based upon empirical assessment with sufficient reliability to warrant taking such high stake risks. Your distinction between addicts and non-addicts, the former of whom you’ve not said should under no circumstances be on neuroleptics (as I understood you), is an important one. As an addict seeking to free myself of Seroquel, and I accept “addict” as a fair characterization of my condition — , I live in a way as an inverse junkie. I want desperately to wean off of Seroquel because of the benefits of reducing, and trying to eliminate, side effects. But, for me, perhaps unlike the conditions of many others, my life is in a very good place, and so the lure of drug-freedom, in some ways like the lure of recreational drug use, is fraught with peril. And so I must take my own Hippocratic Oath and vow not to do myself harm by changing my brain in a way that could undo the gains I have made since last being unstable (i.e. when I tried to switch to another neuroleptic in 2010, and prior to that, before being on any neuroleptic). Whether my stability was in part due to a placebo effect — I don’t discount this possibility though it would only be a partial explanation — I am nevertheless stable. This is an unequivocal fact, because I do get to decide what stability and happiness mean to me, and I am extremely well educated, self-knowing and skeptically minded. Given this calculus, I am of the view that Sandy’s efforts — and those of others displaying similar courage and integrity as medical practitioners and researchers — to help people like me — people who are fully informed and want help — critically important. And I am not the only one in this position. I believe I can take this position and still agree with much of what is said by folks with different views than mind. I don’t see it as a binary choice, but a more nuanced one. We can be allies with each other and with psychiatrists like Sandy without a you’re with us or against us directive.

So, in sum, as an addict, and survivor and past sufferer (subjectively) of brain dysfunction, I feel little choice — given my responsibilities to my family — but to and rely upon the best of psychiatry as a conservative with a “little c.” Knowing that any scientific knowledge (admittedly, even by many psychiatrists, little) is in its infancy, and knowing that had I not started on the drugs in the first place (which might not have occurred without prior use of cannibis), I might not need to engage in the caution I do now. But I must engage in it, and it would be irresponsible for me to assume that the effect of Seroquel on my stability (short or long term) is necessarily and entirely a fabrication of my mind or that of my psychiatrist.

Seth,

In my view we don’t have adequate responses to the requests for help of many who seek relief from experiences they view as destructive in their lives — experiences that psychiatry refers to as hallucinations, delusions and psychosis. Where you and I may agree is that it appears to me increasingly plausible (you require no more convincing) that the relief neuroleptics cause in the short and long term are unscientific in nature. Likewise, because of their quite possibly unscientfic mechanism of action, the effects of neuroleptics (and getting off of them) do not in themselves evidence that the person suffers from any brain dysfunction. This especially if people, for instance, suffer from psychosis when they get off of them yet never were psychotic to begin with (they used it as a sleep aid or to treat non-psychotic depression for example), or if people are psychotic in the first place due to use of hallucinogens such as cannibis and PCP. Additionally, I suspect that, with full information on what we know and don’t know, many would choose not to take neuroleptics at all, ever, on the view that the relief is outweighed by the addictive, metabolic, cognitive, emotional and other problems associated with those drugs. Those people might instead seek relief for their psychosis in other ways, or might try to wait it out (even given the costs and risks of doing so). We also agree I suspect that, at least for some people addicted to neuroleptics, it is unwise to abruptly discontinue taking the drugs due to the withdrawal effects, perhaps caused by supersensitivity psychosis, and it may be the case that these addicts cannot safely get off of the drugs at all (at least not entirely). If this is so, we might also agree, at least in some respects, that there’s a role for the best of the world’s psychiatrists to help people wean off of antipsychotics. You would disagree with my view, however, that it is ethical and wouldn’t amount to medical malpractice were a psychiatrist to prescribe a neuroleptic to a person not already on them. But to me, if that patient is fully informed of all known risks, alternative approaches to treatment, and some basic facts about the limits of medical knowledge in this area (and our hopes to find better treatments, medical and other), and if there is a solemn commitment to try to wean the person off once they’ve been stabilized, the psychiatrist can properly prescribe a neuroleptic to provide the short and long term relief desired.

Where we might disagree more, and this is only a little off-topic, is in relation to other psychiatric drugs. Are you an absolutist on the issue of whether *any* drug currently on the market that are FDA approved for use to treat a DSM-diagnoses and regarding which there has long been a consensus among mainstream medical professionals regarding the safety and efficacy of those drugs for those uses? (No need to preach to the choir about the corruption and limited authoritativeness of the FDA) Let’s take two examples: Lithium and (self-servingly), Lamictal, for their purported use as “mood stabilizers.” Do you think psychiatry’s claims of their benefits and tolerable side-effects is a sham, and a sham to such an extent as to warrant an absolute bar on the use of these drugs on people, whatever their conditions and history? Are there *any* drugs that pass muster, e.g. anti-depressants? This is not a rhetorical question; I value your opinion.

And Seth, in case you do want to reply, I want to be clear that my question is not whether the perceived relief experienced after taking antipsychotics, anti-depressants or mood stabilizers evidences the existence of brain or psychological dysfunction. I also accept that we will likely disagree on whether the experiences referred to in psychiatry as depression and mania are forms of brain psychological dysfunction. The narrow question is that, do you understand that mood stabilizers and antidepressants do not as chemical agents provide *any* beneficial effect, or relief, other than a placebo effect misinterpreted as relief from symptoms caused by the drug. I think I understand your conclusion to be that that the only effects that anti-depressants have on the brain are the harmful side-effects, withdrawal-effects, and the induction of mania, and any depression-lifting benefit is purely a placebo? Is that correct and what about so called mood stabilizers? Is your position absolute that there can be no beneficial effect whatsoever other than placebo for any DSM/FDA approved psychiatric drug?