The Washington Post yesterday published an article by MIA blogger Sandra Steingard, titled “A Psychiatrist Thinks Some Patients are Better off Without Antipsychotic Drugs.” In it, she describes reading Robert Whitaker’s Anatomy of an Epidemic, saying “If Whitaker was right, everything I had been doing for 20 years was wrong. I have spent much of my time rereading the articles and studies he cites, looking for others, talking to colleagues and reading as much criticism of his work as I can find. And what I concluded is that Whitaker is probably right.”
© 2024 Mad in America Foundation
Thanks for posting. I am gratified that, thus far, the comments have been generally positive.
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Hi Sandra,
I just read your article but the comment section was closed.
I’ve been off my meds for quite a while now and my relapses haven’t been as traumatic as they were while being on the meds. The side effects were a lot more than my benefits and kept me more numb, though I was still hearing voices and seeing things but couldn’t respond to them.
Thankfully my only support person turned out to be my psychiatrist and the one person I could trust during those periods of relapse given I had substance abuse issues too.
Thank the universe for those like you who see us more than just an object to be flooded with medications and kept locked away.
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“Courage is what it takes to stand up and speak; courage is also what it takes to sit down and listen.” ― Winston Churchill
Thank you, Sandra – for doing *both*.
Duane
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I read your Washington Post article and I love your balanced approach. I know a family where the mother is bipolar but is now stablized on Abilify and several other medications. Her teen daughter had a brief hospitalization and at her mother’s insistence was started on Abilify as well. Mom is convinced her daughter is on her way to becoming bipolar and sees this as helping to prevent the daughter from going through all the pain she went through—until she finally accepted that she was bipolar.
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Excellent article Sandra. Thank you so much for writing this piece for an influential paper like WaPo. One of the interesting things I have just read is that only about half of patients prescribed antipsychotics continue to take them. As a hospital therapist, one of things that concerns me most is seeing people taking heavy doses of these neuroleptics in a hospital setting, only to be discharged with a strong chance that they will stop taking the drugs abruptly. Without tapering, it becomes highly likely that severe symptoms will suddenly erupt, just like if anyone suddenly withdrew from a heavy drug.
I love that you can have detailed informative conversations in your practice. I only wish that this full understanding of the costs and benefits became established practice.
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What I wonder Sandra, is how do other psychiatrist that you know react to your change of heart? Do you ever talk about it with them?
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Hi Jonathan,
First of all, welcome to MIA. I was going to respond to your earlier post and I may do so in a follow up blog but primarily, I wanted to say that I am glad to have your voice here.
The response from my colleagues has been mixed but overall far more positive than negative. I have decided to write for many reasons but one of them is to have a conversation wiht my colleagues, so, yes, I do talk to them about it. I have been invited to speak to my state’s psychiatry group and I recently gave Grand Rounds for the University’s Department of Psychiatry. I think it was well received. It is heartening to know that younger psychiatrists are extremely open. There are some who have been hostile and there may be more who just do not say anything. I think the most troubing response is from people who dismiss what I say without looking carefully at the evidence. I may be wrong and I would like to know where I am making mistakes in my reading but to be dismissed without evidence is frustrating.
Sandy
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Thanks Sandra. I will be reading your updates with a lot of interest.
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Unfortunately, that’s often the way the world works. People, scientists, patients, etc, go to work each day and mostly act by their learned habits, etc. Science doesn’t happen so that one scientist makes a logical claim, other scientists see that as true, then all world sees that as true. Science, medicine, etc, is a lot dirtier, like all social games *snort*. Paul Feyerabend made a point or two about it some years ago. In any case, thanks so much for your very neutral and great article in so prominent a magazine.
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Sandy, Your article came at a very opportune time for me. I’m considering giving a copy to my daughter’s psychiatrist. Thanks so much for your impeccable honesty, pursuit of truth,
compassion and respect for your patients! And man do i resonate with the point you just made in replying to Jonathan, pertaining to those who “dismiss what i say without looking carefully at the evidence”. I, like you, strongly desire dialogue–reasoned, mutually respectful dialogue–and i find the refusal of many to engage in this maddening!
Russ
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Your ability to still care about the research as it changes speaks volumes to me. I still recall a conversation I had with my then 24 y/o son, shortly after his last discharge. Both of his two psych breakdowns necessitated hospitalizations (though with the HELL he endured with each “voluntary” admission in hindsight the MH “system” just heaped more stress and irreparable harm) . “Mom, why isn’t there a doctor I could see who could give me meds if I need them for a short while, but then just do talk therapy the other times like when I meet with the psychologist. How can’t there be such a doctor?” Sadly, the only p-docs (in-pt and out-pt) he encountered (and trust me we did seek out others) solely focused on drugs, and lifelong drugging. The horrific side effects from Zyprexa (55lb wt gain over a 4 month period )on his recovering knee injury suffered shortly before his first break and his complaint his head felt “like I’m in a fog” once psychosis abated he chose to wean off these drugs. I swear my kid was himself again. You know if my son had met a p-doc like you, imagine he, maybe, could have been saved.
Thanks for your reflection and your humanity, Sandra. I have met another p-doc (out-of-state) who I had review my son’s 170 pgs medical records of his last 10 day locked hospitalization. I now believe there are two p-docs that truly seem to care about helping people , like my son, who had two emotional breaks in an 18 month period. Healthy and “normal” for 23 yrs, nothing in our family history or my son’s beautiful life could have predicted the hell that followed. I don’t believe my son should have died. I believe the MH “system” should have helped him understand the complexities why young brains get altered from (IMO) a sea of stressors plus the psychactive THC in the cannabis he used (increasingly) after his injury. I see the hope you offer your patients by such honest dialogue. Doesn’t ever person who befalls such a crisis deserve nothing less?
My son willingly took what the system dictated, but with only the mantra “meds for life, bipolar for life” he only returned for a few months after discharge to the out-pt p-doc, as he felt “the system” offered him no hope despite he recovered. I’m grateful to see you are the p-doc that my son suggested we find. Sadly, I couldn’t find any in time.
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Dear Larmac,
I am so sorry for your loss. I do not know if I would have done better but I am a mom, too. I can not really imagine a greater kind of pain.
Sandy
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Dear Larmac,
My condolences on the loss of your son. There is no greater loss than the loss of a child. My heart goes out to you and your family. I appreciate the fact you speaking out about your son’s experience and are striving to prevent others from suffering the same loss.
I was blessed to be “normal” for 33 years of my life before suffering spontaneous “mental illness” and rubber-stamped with the label of manic-depressive with psychotic features.
In my lifetime I have known a number of individuals, including people I have cared deeply for, who have taken their own life after suffering from symptoms that are considered “mental illness”.
I can honestly say that before living through the mental and physical hell of an encephalopic condition, I did not understand how any human could possibly harm themselves or others.
After experiencing first hand the torment brought on by illnesses that cause delusions, hallucinations and psychotic symptoms, along with disabling side effects of psych meds that included severe parkinsonslike syndrome, tardive dyskinesia, suicidal thinking and weight gain of 85lbs in 6 months while taking Zyprexa, I have made it a priority in my life to advocate for medical and mental health professionals to adhere to best practice standards of care.
The British Medical Journal published a very comprehensive guideline for doctors to follow when assessing patients who are clearly suffering from a psychotic state. Here is a link:
http://psychoticdisorders.wordpress.com/bmj-best-practice-assessment-of-psychosis/
The colossal failure in our medical and mental health care system begins when we fail to ensure our doctors are adhering to this Best Practice standard of care. This lack of accountability reflects poorly on advocates and members of our society who speak out on the treatment of psychotic disorders.
Our society has allowed main stream psychiatry to develop a medication management monopoly which is supported by a strong advocacy agenda promoted by NAMI and other advocacy organizations.
Our current health care system allows our doctors to assess patients using the DSM 5 with a flawed “Chinese menu” approach.
This unethical practice results in patients being rubber-stamped with stigmatizing labels that do in fact accurately describe a person’s pattern of behavior, emotions and moods but completely disregard and fails to test for and treat the broad-range of underlying causation factors.
These factors include, but are not limited to, undetected viruses, bacteria, toxins, injury, trauma, disease, or combination of such.
Patients with many different underlying conditions that manifest as similar psychiatric symptoms are simply categorized and treated with a magic bullet pharmacological approach.
Because medical doctors are among the most respected individuals in our society, the practice of psychiatry has developed into an unregulated power-base of authority in our society. Unlike any other business, our mental health consumers can be legally forced to contract poor quality, ineffective care from providers and facilities.
In order to ensure patients suffering from symptoms of psychosis and mania are given an optimal chance at recovery without being dependent on the long-term use of dangerous antipsychotic medications, mental health advocates, regardless of affiliations, should strive to ensure our doctors are using Best Practice Assessment standards.
Mental health patients should not be forced into purchasing sub-standard, unethical care and ineffective, potentially lethal products.
While I appreciate Dr. Steingard’s support of Robert Whitaker’s work, I do not believe it is in his best interest to breaking down the information presented in Mad in America and Anatomy of an Epidemic as there is a right way and a wrong way, especially considering the death of a young woman at the Soteria House in Alaska.
http://www.adn.com/2011/07/20/1976804_after-shooting-death-at-assisted.html
NAMI advocates who fear alternatives and read “Whitaker is probably right” can twist Dr. Steingard’s meaning into respected mental health advocates like author Pete Earley are probably wrong.
In my opinion, using Best Practice Assessment of psychosis guidelines is the most ethical standard of care to treat a patient in a psychotic state.
This standard of care should be at the foundation of a unified advocacy agenda as it prevents unnecessary suffering from being misdiagnosed as does the current bad practice of psychiatrists using the DSM with a “Chinese menu” approach.
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Sandra, thank you for writing this article, and I’m glad the Washington Post published it. My former psychiatrists won’t confess to their misdiagnosis of the adverse effects of an antidepressant (“safe smoking cessation med”) as bipolar. And their many (one doc did confess in his medical records only) “Foul ups” with antipsychotics. Antipsychotics do not cure the adverse effects of antidepressants. Which is the reason, I would imagine, the DSM points out that if a person’s initiating issue is adverse effects to another drug, a bipolar diagnosis is wrong.
I hope and pray the psychiatric profession stops committing this type of malpractice soon. I am so heartbroken Biederman’s encouraging this type of psychiatric malpractice has resulted in millions of children being disabled and killed, completely with toxic drugs, by doctors who had promised to “first and foremost, do no harm.” The magnitude of the iatrogenic harm is heart wrenching.
I’m living proof Mr. Whitaker’s concerns are valid and true. Thank you for admitting that what you believed was appropriate treatment for the past twenty years was wrong. You have no idea how insane it was trying to deal with psychiatrists who were so grotesquely misinformed about the actual effects of their drugs, and deluded into believing they were new “wonder” drugs.
I do so hope the psychiatric industry eventually comes to the realization that their DSM “bible” is really nothing more than a listing of the symptoms of the serious mental illnesses their drugs create. And a bunch of medicalizing normal human behavior in order to railroad innocent people onto their toxic drugs for profit. “Money is the root of all evil,” the real bible is still where wisdom and truth can be found at least.
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I am impressed that the comments are so supportive. I think it makes a HUGE impact for a psychiatrist to be publishing these comments in a national news outlet. I also think you have a gift for stating these things in a way that doesn’t feel attacking or humiliating to the current practitioners (at least those with enough ethics to actually care about whether they’re harming their patients or not). Thanks for having the courage to put your voice out there in public. It is a critical part of this movement to get professionals to take these concerns seriously, and both the content and the intent of this article will make it easier for other professionals to “come out” and acknowledge these very real concerns.
Thank you!
— Steve
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Maria, thank you for sharing the BMJ guidelines for the Best Practice Std of Care. I was not familiar and find this very relevant. This is one of the reasons I feel so indebted to Bob Whitaker and the MIA crowd, professionals like Sandra, and the psych survivors, as well as the families, like mine, as we can all learn from each other. (I work in Nephrology and my patients often share some interesting research they inquire about that peaks my interest and follow-up.) I love that the MIA crowd helps one other, we can all gain so much insight into the intricate web of the human brain. Again, thank you so much for sharing this info.
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Dear Larmac,
I am glad to know that you find value in the BMJ’s publication of Best Practice assessment of psychosis.
My employment background includes working in professions that involve adhering to strict deadlines, pleasing a demanding clientele in highly competitive environments, and in some cases, very limited profit margins.
In many such industries, error mean loss of profit and jeopardizes sustainability.
The application of the risk management process leads to process improvements, development of benchmark-best practice standards and a profitable, sustainable business operation.
This is what the BMJ has done for our health care system. They have created a benchmark-best practice standard based on root cause analysis of evidenced-based causation factors that can create a psychotic state of mind.
Unfortunately, for the masses who may enter into a psychotic state, our health care and criminal justice system’s lack of responsibility allows for error and for misdiagnosis.
These systems profit from our “Mad in America”.
The use of “Bad Science, Bad Medicine” and “Magic Bullets” that results in the “Enduring Mistreatment of the Mentally Ill”, is a profitable and sustainable business for many professionals.
Implementing Best Practice Standards would erode the need for many services.
Sad but true, one man’s continued suffering is another man’s job security.
In Kindness, Maria
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For the past six years I have been a volunteer for the International Society for Ethical Psychology and Psychiatry (ISEPP) and maintain their website, blogs and social network accounts.
Robert Whitaker presented at the ISEPP 2013 conference and is highly respected among our members.
You might also find of interest information from some of our other past conferences:
Psychiatrist, Dr. Grace Jackson and her lecture on Brain Repair
his presentation has four goals:
1) to describe the health problems of the mentally ill
2) to explain problems associated with pharmaceutical use in the USA
3) to provide a brief overview of brain damage due to psychiatric drugs
4) to introduce possible methods for brain repair
http://www.psychintegrity.org/gracejacksonmdlecture.php
Child psychiatrist, Dr. Scott Shannon on Functional Medicine
http://isepp.wordpress.com/2011/08/24/the-ecology-of-the-child-a-new-view-of-pediatric-mental-health/
Gary Kohls MD on the dangers of psychotropic drugs
http://isepp.wordpress.com/2012/04/27/dr-gary-kohls-on-psychotropic-drugs-the-hidden-dangers/
Charles Gant, MD is not a member of ISEPP but he is the MD who helped me and many other patients.
http://www.youtube.com/watch?v=MDQPb6cV8Jw
In Kindness, Maria
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Maria,
The info you shared is powerful. I was aware of the facts, such as the oxidative stress and mitichondrial damage from certain drugs. It’s one of the many reasons, once my son’s psychosis abated, I didn’t argue when he was determined ( and successfully did) wean himself off Depakote and Zypexa. Sadly, returning to using the same drug, cannabis, he was using at the time of his 1st break, it once again ( IMO) fueled a 2nd break. There was a 18 month window b/t psych breaks that this young man of mine seemed 100% ” normal” beyond any doubt. There is no question, in my mind, the very bi-products formed from psychotropic drugs must be similar to “recreational” drugs, like cannabis and other ones with psychoactive ingredients ( in those with vulnerable young brains< 25 yrs old) which harm the brain cells. Listening to the video (2009) with Dr. Gary Kohls is heartbreaking that if my family and I had not taken our son to the psych hospital, in the throes of his breakdown, good chance as in the 3rd world nations (without access to health care), he would likely have recovered, in time, from his FEP. This exact scenario happened to a client's cousin, twenty yrs ago. The family took the then 20+ y/o male, who had been substance abusing, to Mexico watching over his care in a one room shack where the cousin was given shelter, food, love and compassion NO meds, NO hospitalization. The family kept him out of harm's way, one month later his psychosis resolved. This man is alive, functional, and thriving decades later.
My son made a grave mistake assuming the substance, cannabis, others around him did especially in todays culture of common pot use. But I still can't comprehend what I have learned since, and certainly the many studies about the psychosis-cannabis link, even in 2009 (which I was waving at the " experts") was ignored and denied. A functional young man, age 23, who had just married 2 months prior, with a hx of NO severe MI, would be boxed into a lifelong, genetic disorder of "bipolar for life, meds for life". I have never viewed society in the sad light I do now. How could my son have been so irreparably harmed? I never believed the lies he was told, not ever. I just couldn't put it together in time.
I just hope p-docs like Sandra Steingard, who obviously care, are mad as hell now the truth is being exposed. Surely, with the knowledge available, how tainted the current MH system is, some influential souls couldn't empower like-minded politicians to divert MH funds into alternative ( more cost efficient – always a buzz word) models of mental health care? These alternative programs already exist in the U.S.
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Dear Larmac,
It’s very sickening to know the truth.
Exposing the truth in the tainted MH system is like pealing an onion, there are many layers and it really stinks the facts continue to be shoved under the rug.
Number one on my list is lead poisoning.
Good God, why is this being ignored?????
Past exposure to lead was one of the key factors in my own situation and corrected with Chelation Therapy which has been around for over 60 years.
Another factor linked to psychosis, and something I have experienced personallly, is revealed in Bob’s book Mad in America. Simply suffering from an abscessed tooth can be an underlying cause of psychosis. Treat the abscessed tooth and the psychosis goes away.
If we want to improve mental health care, we need to improve dental care.
Here is a link to a narrative I wrote that was published in the Journal of Participatory Medicine:
http://www.jopm.org/perspective/narratives/2011/03/28/psychosis-possibly-linked-to-an-occupational-disease-an-e-patient%E2%80%99s-participatory-approach-to-consideration-of-etiologic-factors/
To be honest with you, at this point I believe the only way to clean up our tainted mental health care system is for mad-as-hell patients to start suing their p-docs.
A Florida attorney posted a success care for Failure to timely diagnose and treat encephalitis with a $25,000,000 verdict.
Here is another interesting case
http://nypost.com/2009/10/04/my-mysterious-lost-month-of-madness/
Najjar estimates that nearly 90 percent of those suffering from autoimmune encephalitis go undiagnosed.
“It’s a death sentence when you’re still alive,” Najjar told me. “Many are wasting away in a psych ward or a nursing home.”
I was the first person in NYU Medical Center’s history to be diagnosed with NMDAR encephalitis.
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