MiA blogger Sandra Steingard’s Washington Post article “A Psychiatrist Thinks Some Patients are Better off Without Antipsychotic Drugs” is getting wider play, reprinted yesterday in GulfNews.com.
Great to see how you have these conversations with your clients. I so wish more psychiatrists had your point of view….hopefully they too will question what they have believed for so long.
Dear Dr Sandra
What’s the difference between the ‘young man’ that sleeps and watches television all day due to the drugs, and negative schizophrenia.
If you look closely at the psychiatric outrages, there’s always some other factor included: like starting medication, abruptly stopping medication, unsuitable medication or something else. Most sufferers are shy, so why are the outrages so dramatic and out of character?
This is a very important question. There has been a tendency to ascribe negative outcomes to the “underlying” condition and good outcomes to the drugs. We would need to go back to a time when the drugs were not used to understand the extent to which these problems occurred in people who were psychotic. I remember a time when I heard discussions and read papers in which psychiatrists went a round and around about ways to distinguish these things (depression vs side effects, negative symptoms vs side effects). It is all predicated on an assumption that there is an underlying “illness” and the drugs are targeting it.
I have written this before but Joanna Moncrieff’s articulation of a drug centered vs a disease centered model has been the single most important conceptualization for me.
I highly recommend her most recent book, “The Bitterest Pills”. In my own words, what she is slaying is that we need to evaluate these drugs as psychoactive drugs that have impacts on all humans (drug centered) rather than as drugs that are targeting to treat specific disease states in some humans (disease centered).
Once one does this, one no longer makes distinctions between effects and side effects. One looks at what the drug does. Then one can consider if the effects might be helpful for particular person’s problems.
So benzodiazepines (Valium and many others) will make most people feel sleepy. This may be helpful for someone who can not sleep but its effects are not only observed in those who can not sleep.
Nueroleptics dampen drive. They dampen attachment and intensity of attachment to thoughts. This may be helpful for a person who is highly agitated and it may be helpful for someone who is extremely attached to an idea that may not comport to consensual reality and is highly disturbing for the person. But at the same time, it may dampen drive in other areas such as looking for a job or feeling a connection to other people.
This makes sense to me and helps me think about these drugs in a different – and I think more helpful and honest way. I may suggest a drug – for a time – not by saying that the drug will treat a “disease” but that the drug might help the person feel more comfortable. At the same time, we will both be on the look out for ways the drugs may interfere with the person getting on with his life.
Dr. Moncrieff blogs here. I hope I am not misrepresenting her. I recommend her blogs and books to all!
“There has been a tendency to ascribe negative outcomes to the “underlying” condition and good outcomes to the drugs.” Heads I win, tails you lose.
Dear Dr Sandra,
As regards agitation. I think the problem is attachment (full stop).
Once a person loses attachment they see things with equanimity. This is the best position to operate from. But this can be achieved without drugs. Your local Buddhist Centre (if they are genuine Buddhists) could tell you this for free.
The ‘young man’ is not just unattached he is physically disabled, even if he wanted to, he would be incapable of functioning. This is the exact same as Negative Schizophrenia, and its drug induced.
I understand that there are non-drug ways to engage. I agree that those should be considered. Once one begins to view the drugs in a drug centered way, then they become just another thing that can be offered (as opposed to the thing that MUST be offered to treat the underlying “disease”.
You describe attachment brilliantly. Both the fear based and the idea based. I think that’s the crux.
This is why basic understandable psychotherapy is what works.
Hi Dr Sandra,
In your article you mention The lady that says the government is transmitting data to her brain – This is (a form of) anxiety.
Anxiety is a preoccupation that has its own logic. Its not possible to let go of anxiety at will. But its possible to let go very gradually. Detaching is not essy – but, when preoccupations soften normal logic takes over.
I do know what I’m talking about, even though I’ve forgotten how bad it was.
Dear Dr Sandra
The illness model and the drugs treatment is what’s disabling people and costing a fortune. Its also a denial of reality.
From my own experience, its possible to deal with high anxiety in the same way as normal anxiety: Through non drug basic help, the same principles work.
Have you noticed that the terrible tragedies we read about in the media tend to always have the same component – medical psychoactive drugs.