I recently read Rachel Waddingham’s excellent post (Me & the Meds: The Story of a Dysfunctional Relationship) on how she eventually managed to get off meds and take control of her hallucinations. This particular piece struck home with me because it illustrates that the biggest problem with the direction psychiatry has taken in the past fifty years is not the meds (acknowledging that meds are a big problem) but the refusal to deal with the obvious: Hallucinations. You don’t get a label of “schizophrenia,” which Thomas Szasz referred to as “The Sacred Symbol of Psychiatry,” unless you have some form of hallucination. Schizophrenia is the hallucination.
And how is psychiatry treating its sacred symbol of the hallucination? Through a habitual pattern of avoidance behavior. It uses the drugs to evade the personal responsibility of having to deal with nasty, frightening hallucinations. Hallucinations are the real problem holding most people with the label back from enjoying life to the fullest. Rachel Waddingham is a case in point. Like many people, she could get herself off the drugs, but she still had to contend with the hallucinations, which is why many people are chronic patients. The hallucinatory anxiety pre-exists the “need” for the drugs. It is always there, watching, waiting, ready to pounce when you think you are finally free.
Hallucinations are where psychiatrists abandon ship.
My thirty year old son is also a case in point. No matter how slowly and conscientiously he has tried to get off the medications, it’s the hallucinations that get him in the end. That is why he is, to my regret, still on a medication. His psychiatrist, a dedicated person who my son has been “dating” twice a week for about a bazillion years (to use Rachel’s “my chemical romance” analogy) can’t deal with the hallucinations. She hasn’t been trained to do so, and I suspect, she, like most psychiatrists, wouldn’t want to take on this enormous and life sucking task, otherwise she’d have chosen to be a social worker. To be fair to her, a few years ago she respected our request to not put “Chris” back on the meds. Six months later, my husband and I couldn’t deal with the psychosis any longer in our homemade Soteria, and back Chris went to the hospital, and back on the meds.
We could have used some help. The meds weren’t the problem since Chris wasn’t on them; the psychosis was the problem, the thing that psychiatry does its best to avoid at all costs by administering antipsychotics. Chris’s psychiatrist has done a great job of helping him grow, become a thoughtful, expressive person, and rebuild his confidence. All this matters for naught when, very occasionally he becomes floridly psychotic and begins to think he’s the Messiah. Everything she and he have painstakingly worked on goes flying out the window, making a mockery of the years of psychotherapy. Not knowing how to deal with hallucinations means that, in the blink of an eye, hard won classes, jobs, and relationships are in grave danger of being lost.
Learning to overcome the hallucinations without resorting to chemicals is where many people would like help. You can do all the trauma based therapy in the world, having many thoughtful discussions with your psychiatrist, but it’s the hallucinations that demarcate the zone between life long patient and functioning individual. What psychiatrist wants to take on this dirty job? It is far nicer to see tranquillized patients for fifty minutes during which you can discuss art and literature, childhood trauma, and make references in passing to the horror of hallucinations. These chats can stretch on for years without ever getting around to helping the person with what really scares him, the hallucinations. You need to have patients exhibiting hallucinations in order to address them, and psychiatry would prefer not to see them.
My son attended a two year hospital run day program and I vividly remember how the professionals on staff dealt with the subject of hallucinations: To avoid having the patients talk about them. Needless to say, that program is still thriving because not many are getting well. I guess that’s the point of the program (she cynically remarked).
It is interesting that Rachel was a manager of the London Hearing Voices Project while still on meds. This should lay to rest the criticism of some that Hearing Voices exists to part people from their meds. Later, despite the fact that she presumably knew all there was to know about how to manage her voices, the big test came when she had to go it alone without the help of her psychiatrist.
What, I repeat, does psychiatry exist for, if not to deal with the central tenet of the profession, the hallucination? I guess that’s the whole point: NOT to deal with it. Better to ensure a steady stream of patients!