Benzodiazepines: Dangerous Drugs

Philip Hickey, PhD
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On February 25, Kristina Fiore published an article on MedPage today.  It’s titled Killing Pain: Xanax Tops Charts

The article is based on a study conducted by Jann M et al, and published in the February 2014 issue of the Journal of Pharmacy Practice.  The study is titled Benzodiazepines: a major component in unintentional prescription drug overdoses with opioid analgesics.  Here’s a quote:

“During 2003 to 2009, the 2 prescriptions drugs with the highest increase in death rates were oxycodone 264.6% and alprazolam 233.8%. Therefore, benzodiazepines have a significant impact on prescription drug unintentional overdoses second only to the opioid analgesics. The combination prescribing of benzodiazepines and opioid analgesics commonly takes place. The pharmacokinetic drug interactions between benzodiazepines and opioid analgesics are complex. The pharmacodynamic actions of these agents differ as their combined effects produce significant respiratory depression.”

Alprazolam is a benzodiazepine.  It was marketed as Xanax in 1981, and has been available in generic form since 1993.  It is used by psychiatrists as an anti-anxiety agent.

When the benzodiazepines were first introduced, it was widely claimed, both by psychiatrists and by pharma, that they were non-addictive.  This claim was subsequently abandoned in the face of overwhelming evidence to the contrary, and the addictive potential of these products is now recognized and generally accepted. 

Incidentally, you can find some interesting history on the promotion of tranquilizers, including benzos, on a Medpage timeline published last month.  The timeline presents ads gathered from the New England Journal of Medicine and from the Journal of the American Medical Association.  It’s tawdry stuff.  Thanks to Laura Delano for the link.

Back to Ms. Fiore’s article.

“When a patient comes in with complaints about anxiety, it’s easy to write a prescription for Xanax, Jann said.  Like other benzodiazepines, it’s cheap and it’s perceived to be safe.”

She also quotes Daniel Carlat, MD, professor of psychiatry at Tufts:

“Xanax really is a tried and true medication…When patients take it, they feel its effect quickly.”

 And

 “It also goes to work fast, which may be a reason why patients show a preference for it…”

 Miss Fiore has also interviewed Allen Frances, MD, former psychiatric chair at Duke and architect of DSM-IV:

“And the drug is an easy solution for primary care doctors who are pressed for time, said Allen Frances, MD, a professor emeritus and former chair of psychiatry at Duke University.

Indeed, the majority of benzodiazepine prescriptions in 2013 were written by family practice or internal medicine doctors, totaling some 44 million prescriptions. That’s vastly more than the 13 million written by psychiatrists.

Frances said that if the FDA were to conduct a thorough review of Xanax, it might not be so widely prescribed.

‘The effects of Xanax are much more subtle and dangerous,’ he said. ‘In combination it can be deadly, and for many people it creates an addiction problem that’s worse than the original condition.’

‘I think if there was a careful review of its risks and benefits, it would be taken off the market,’ he added, ‘or it would at least have much more restricted use.'”

Dr. Frances has reinvented himself in recent years as an outspoken critic of DSM-5 and of psychiatric excesses generally.  His points are usually cogent and well made, but he remains unreceptive to the fact that his own brainchild, DSM-IV, was an integral step in psychiatry’s spurious and self-serving medicalization of non-medical problems.

The fact is that anxiety is not an illness, and drugs that dissipate anxiety are not medications – they are drugs.

Benzodiazepines have a legitimate use in general medicine, and in that context are indeed medicines in the proper sense of the term.  But when prescribed for anxiety on a routine, daily basis, they are drugs.  They fall into the class of drugs that addictionologists call sedative-hypnotics, and are similar in their general effects to alcohol and opiates.  I worked in the chemical dependency field in the late 80’s – early 90’s, and even then we were admitting large numbers of people addicted to benzos.  It was, and is, an extremely difficult addiction to overcome.  Withdrawals are typically difficult, protracted, and sometimes dangerous.  Monica’s Cassani’s website Beyond Meds goes into this in great detail.

Dr. Frances makes the point – undoubtedly true – that general practitioners prescribe more benzodiazepines than psychiatrists.  This is a common cry from psychiatry when confronted with the damage that their products are causing.  But the argument is specious, because no practitioners could prescribe these drugs as a daily “treatment” for anxiety if psychiatry had not, in the first place, promoted the false message that anxiety is an illness.  No doctor could prescribe these products for these purposes if psychiatry had not invented, packaged, and sold their various anxiety “diagnoses.”  When psychiatry embarked on its great mission to medicalize every conceivable human problem, they basically drove the bus off the cliff .  Mental health today is still in a state of uncontrolled free fall.  And every time we hit an outcropping, or the bus turns end over end, psychiatry says: “Oh dear!  How did that happen?”  Well it happened because organized psychiatry put money and prestige above intellectual and moral integrity.  The damage this has done, and continues to do, is beyond reckoning. 

Psychiatry has damaged and killed human beings who came to them for help.  They have routinely disempowered people, and have spuriously equated all human distress to their confidently-touted, but fictitious, chemical imbalances, and, more recently to the twitching of aberrant neural circuits.  They have arrogantly promoted themselves as the arbiters of normalcy and the healers of emotional pain.  They have systematically undermined the notion of self-improvement through effort, and through natural social support networks.  They have enslaved millions to their toxic psychotropic chemicals.  And we haven’t hit bottom yet.

Anxiety is not an illness.  It is a normal human response to ambiguous or potentially challenging or dangerous situations.  I’ve written more on this in my post Anxiety Disorders.  Modern life is fraught with anxiety-arousing situations.    If psychiatry had had the slightest interest in truly helping people, it would have focused on this reality, and developed genuinely helpful concepts and practices in this area.  But there isn’t much money in that.

So instead, intoxicated by its customary delusion of infallibility, it did what it always does:  issued the self-serving decree that anxiety is an illness best treated by “medications.”

Dr. Frances is correct:  benzodiazepines should be taken off the market – not only because they are dangerous, but also because the notion of washing away people’s anxieties and concerns in a drug-induced haze of semi-euphoria is fundamentally disempowering, and makes a mockery of the practice of medicine.  The only possible honest response from a physician who is asked to treat anxiety, is to point out that anxiety is not a medical matter.

People who take these drugs as a routine measure to insulate themselves from life’s multi-variate challenges and vicissitudes are not medicated.  They are stoned.

And the great irony here is that everybody knows this.  The individuals know it; their family members know it; their friends and co-workers know it; the psychiatrists themselves know it.  And the street pushers who obtain benzos illegally know it.

But the great fiction has to be maintained.  Here’s a quote from Benzodiazepines:  A versatile clinical tool, by Bostwick et al in Current Psychiatry, April 2012

“Since the discovery of chlordiazepoxide [Librium] in the 1950s, benzodiazepines have revolutionized the treatment of anxiety and insomnia, largely because of their improved safety profile compared with barbiturates, formerly the preferred sedative-hypnotic.”

And psychiatry and pharma go on making a killing.  According to the Kristina Fiore article mentioned earlier, there were 94 million prescriptions for benzos written in the US in 2013.  Psychiatry is out of control.

29 COMMENTS

  1. The combination of a benzo with a potent narcotic is the beginning of a good general anesthetic without the safety of a medical professional monitoring airway and oxygen. Many fatalities probably occur due to airway obstruction along with respiratory depression. They are “narcotized”.
    I believe that Valium was introduced as being safe with little or no dependence potential which encouraged family docs to write scripts. Panic disorder was the doorway to Xanax addiction for many. An old-time detox MD said that alcohol and benzos were the 2 most dangerous drugs to come off of.
    I knew a psychiatrist who would discharge benzo addicts on Klonopin claiming that it was unsafe for them to be totally removed from benzos. I believe he cited Mark Gold research.

  2. Benzodiazepines *almost* killed me. I’m in my 3rd year and 5th month of withdrawal from them- with no signs of the tortuous HELL that is “withdrawal” from them letting up. I put withdrawal in quotes because the drug is long gone- it’s been “out of my system” after a barabaric cold-turkey, followed by a reinstatement and a lengthy taper. Now, I’m just dealing with a completely disabled and down-regulated brain and central nervous system from taking them AS PRESCRIBED BY MY DOCTOR for 5 years. I’m told I’ll recover…we’ll see.

    That said, this was a great article to read. My only qualm is that we need to start using proper terminology. Dependence and addiction are NOT the same thing. Yes, people can and do abuse benzos. However, for the most part, the people I have met in the “benzo trap” are victims of IATROGENIC (caused by a doctor) DEPENDENCY. We were made dependent on the benzodiazepines against our will by our doctors. Had we had informed consent about the dangers of these drugs, most or all of us would’ve refused to take them. We never abused them. We took them as prescribed, thinking we were being compliant patients. The compliance- taking them everyday as we were TOLD by our medical doctors to do with no warnings about dependence or withdrawal- is what caused the dependence. It is truly involuntary intoxication, which is discussed more by Dr. Breggin here: http://breggin.com/index.php?option=com_docman&task=doc_details&gid=121&Itemid=99999999

    Thank you for telling the truth about these evil drugs which cause a suffering that is so far beyond the realm of human experience, that I can’t even begin to describe it in words. But it’s beyond bad. It’s beyond hell. It trumps everything I’d ever considered to be a “worst nightmare” and takes it to a whole other level. Psychiatry kills and so do the general practitioners who prescribe the psychiatric drugs that psychiatry is responsible for promoting and bringing to fruition.

  3. Philip

    Another great posting that is very timely given the rising number of opiate deaths in this country. Most of the recent news about overdoses in the New England area has focus on fentanyl as the dangerous added ingredient causing a spike in fatalities. Flying way under the radar is the far more dangerous problem related to the proliferation of benzo prescriptions.

    Despite numerous warnings in the literature and from some experts, doctors still recklessly prescribe these drugs in a true Dr. Feelgood fashion. This is also a huge problem in the UK despite the fact that in 2004 the Chief Medical Officer ( the UK equivalent of the U.S.’s Surgeon General) put out a warning to all doctors that benzos should not be prescribed for more that 2-4 weeks.

    Your blog stated: “Benzodiazepines have a legitimate use in general medicine, and in that context are indeed medicines in the proper sense of the term.”

    I believe a better way to state that point would be to say the following: In a hospital or other controlled medical setting, benzodiazapines have some very important and legitimate uses in medicine. Outside of a hospital setting benzos are perhaps the most dangerous and abused drugs in the world and should rarely, if ever, be prescribed for more than 2 weeks; and certainly never prescribed to a person with a history of addiction.

    Richard

  4. Like Dr Hickey I am strongly against the medical model– more aptly termed the” disease model” (see Sarbin and Mancuso).
    But it is in large part because I am against the disease model that I believe the benzo’s—Valium, Xanax, Klonapin etc– are valuable drugs in our era and can play a critical role in helping persons to avoid being caught by the system, put on neuroleptics and becoming chronic mental patients.

    Hickey’s cautionary note is appropriate but he overlooks the value of this class of drugs: Benzo’s do have the risks he mentions, but their risks are less than the risk of “anti-psychotics” and the harm they inflict upon the body and mind is much less (unless used recklessly) than those of “anti-psychotics”–Risperadol, Zyprexa, Haldol. (The latter as Whitaker notes include cardio-vascular problems, obesity, diabetes, sexual dysfunction, tardive dyskinesia–resulting in life span 25 years less than average.) We know now that regular use of neuroleptics doom clients to become chronic life long “mental patients.”

    Persons who have “hallucinations” etc do not suffer from “schizophrenia,” No one does. But they might suffer from anxiety, dread and sleeplessness–just as “normal” people do. We have the right to have access to drugs that alleviate these unwanted states. Hickey’s call to ban benzo’s is misguided– it compromises his eloquent denunciation of the medical model. His impassioned and astute argument against the disease model is weakened by his moralistic disapproval of “drugs” per se, of getting “high”– his Calvinistic tone leads him to overlook the value of the benzo’s when used carefully.

    In fact cautious use of benzo’s enable many psychiatric survivors to avoid the anxiety and sleeplessness that might bring them to the attention of psychiatrists who are inclined to define them as psychotic and force them to take drugs that maintain them in a condition of chronic patienthood. Of course if one takes benzo’s frequently one’s tolerance will increase, and the drugs’ efficacy will wane. That is one of the problems of this class of drugs that a drug centered approach like Dr Moncrieff’s would address with the client.

    But that is not a reason to never take these drugs. Certainly not in days like these when shrinks are pushing far more destructive drugs and out patient commitment hangs over every survivor like an incubus.

    Yes the disease model is bogus. Dr Moncrieff’s formulation of a drug centered approach to psychiatry is the only non-ideological approach. Such an approach would not exclude non-drug modalities.
    For example a person who is labeled “schizophrenic” may hear voices or have delusions. But so do many “normal” people, so do people undergoing spiritual transformation. She may be undergoing a spiritual awakening. The problem is not the voices, or even the delusions per se. It is the anxiety that sometimes accompanies non-ordinary states. A responsible psychiatrist might recommend the following to an anxious client: meditation, running, making more friends and cautious use of benzo’s . That is she might recommend they not be used every day and the ultimate goal ought to be to develop one’s own inner resources, the capacity to control one’s feelings or moods so one does not need any drugs. But a psychiatric survivor in a fragile state might wisely choose to use benzo’s because her primary goal during this phase of her life might be alleviate anxiety while avoiding neuroleptics and avoiding getting caught by psychiatrists who insist that all schizophrenics or bipolars take neuroleptics.

    Being subjected to years of Court ordered out patient treatment –forced drugging– which resulted in complete debilitation and tardive dyskinesia is a hellish nightmare that has befallen many fragile survivors I have known. It is still happening today. I have seen or heard over the years thousands of people whose lives have been ruined by “anti-psychotics.” I have spoken to others who claimed being on benzo’s was hell. (They were on high doses) But I have known more people who felt that without benzo’s as sleeping pills they would have become captives of Psychiatry long ago. To take these drugs away from them would be to throw them to the psychiatric wolves.
    No drugs can be compared to neuroleptics— they destroy persons’ capacity to have a fully human life. Lars Martenssen knows that.

    I personally would like to see all neuroleptics banned, but this won’t happen. But any critical psychiatrist living in the US or UK in the current era would want to make sure his client did not get captured by the psychiatric system. Once that occurs the person faces the risk of Court ordered treatment– a life-time career as a chronic and iatrogenically disabled “mentally ill “person.

    Dr Hickey makes a powerful argument against the medical model, but his Calvinistic attitude leads him to make recommendations that would undermine psychiatric survivors’ chances of escaping from the system. Of course Valium is not as bad as Zyprexa. Valium was given to normal people. Up un til recently neuroleptics were restricted to “mental patients”–the lowest caste, the “sacred symbol of psychiatry.” The inventor of the first ‘anti-psychotic, Thorazine, boasted it was a “chemical substitute for a lobotomy.” As Dr Peter Breggin said about neuroleptics,”My personal feeling is that if these drugs were given to anyone but mental patients
    they would have been banned long ago.”

    Dr Hickey claims that patients have no right to use drugs to alter their consciousness. But no doctor has a right to deny patients’ the rights to used drugs to alleviate anxiety, terror. There may be better ways to alleviate emotional anguish or sleeplessness but drugs (benzo.s) should be one option, and in some emergency situations it might be the best. (In fact pace Hickey persons even have a right to use drugs to get high, or to expand their consciousness.)

    Every survivor I know who uses benzo’s does so because he/she is afraid of being forced to take neuroleptics–and each of them has found that sometimes they need benzo’s to get to sleep. No mental health professional has the right to tell patients what drugs to take. The only responsible position is one that supports the right of informed consent–which means that patients must be told of the awful damage done by neuroleptics.
    Seth Farber, Ph.D.
    http://www.amazon.com/Spiritual-Gift-Madness-Psychiatry-Movement/dp/159477448X/ref=sr_1_1?s=books&ie=UTF8&qid=1394707384&sr=1-1&keywords=farber+gift

    • What? The best argument to keep benzos on the market is because they help individuals come off another class of medications that should come off the market? Crazy.

      Still, I’ve often lamented that my daughter didn’t receive the right kind of support when she tried to come off anti psychotic medications. She came tantalizingly close. So heartbreakingly close. I developed a tolerance for her sleep disturbances, shouting, paranoia, etc. when she was coming off anti-psychiatics because I am deeply concerned about the long term effects of anti psychotics and I believe there is a good chance that that her brain’s dopamine regulation system has been damaged, so I expect her brain to ‘push back’. I don’t see her withdrawal symptoms as signs of the original illness but rather, as a complex combination of drug withdrawal (such as the kind individuals who are withdrawing from street drugs experience), compounded by unresolved emotional and mental issues that led her to help in the beginning, compounded by PTSD from psychiatric harm and abuse.

      but I am only one person and the other people around her didn’t have tolerance, or are not likely to develop tolerance especially the staff members of the group homes where she has been forced to live for the past three years, where compliance and convenience are everything, not long term prognosis.

      When young, smart people who are court ordered to receive the standard treatment for psychosis valiantly try to get off their toxic drug combo’s, and they resist psychiatic tyranny, the most difficult barrier to success is finding an MD or a psychiatrist who is willing to put his/her neck out to help the patient such as by prescribing benzos to provide calming relief during the dangerous withdrawal period.

      My daughter has the support of nearly our entire family behind her attempts to live a med lifestyle but families like ours have no respite from the 24-7 demands of carefully shielding an individual through the withdrawal stage. It is a taxing job to balance jobs, and careers, and running a household when a loved one is behaving in a strange, dangerous, or unpleasant way. We have long since ceased to care about what friends and neighbors think. We’ve scaled back our work ambitions to the minimum needed to survive, but still we will need, at critical juncture, the help of a professional.

      We need a prescriber who can garner our daughter’s trust and help her achieve her goals by prescribing wisely to get her through the horrific anti psychotic withdrawal stage with the minimal social damage. Trust is key. Once an individual undergoing psychosis has been strapped down and forcibly injected by a medical ‘doctor’ people like my daughter are not likely to trust another MD again, or any caregiver for that matter.

      Families like us need help to undo the damage done by psychiatry, institutionalization, social isolation of a loved one. WE need a community of support and not a virtual community like MIA. Sorry, but the internet has limits.

      Benzo’s will probably play a role in the recovery of thousands, if not millions of people who have been deeply wounded by medical ‘science’. Ironic but true. Now, where are the professionals willing to prescribe benzos for this judicious purpose? The yellow pages are not exactly packed with brave professionals and I noticed that most of the alternative directories such as MindFreedom, MIA, etc aren’t exactly overflowing with providers, averaging about one MD per state.

      It is easier to find an abortion doctor who is willing to provide a third trimester abortion than it is to find an MD who is willing to help a psychotic individual come off their toxic, mind numbing medications, especially if they are court ordered.

      • Since your argument Madmon amplifies mine, however reluctantly, I want to highlight a few points before I respond to Dr Lewis. First of all I am arguing that arguments like Dr Hickey are insufficiently insensitive to the needs of so-called psychotic people.

        Let me reiterate my opposition to the disease model. Thomas Szasz wrote the Foreword to my first book in 1993(Madness, Heresy and the Rumor of Angels) on the battle of “schizophrenics” to maintain their integrity under the assault of the mental death system. Unlike Tom I thibk Laing also made an important contribution.

        As you say Madmom it is virtually impossible to find a psychiatrist who is willing to help “psychotics” withdraw from neuroleptics. I pointed this out in my first response which I lost when my computer went off. So I’ll repeat. Here in NYC there are several non-medicalist (as I call it) psychiatrists. Most of them don’t take clients or they do but will not prescribe drugs–thus they are no help to patients who needs to wean herself off. There is another doctor here who is “holistic.” She gives vitamins instead of drugs. She may prescribe drugs temporarily (until the patient gets off) but since she insists on weekly sessions and charges $425 a session what good is she for the thousands labeled “schizophrenic” or “bipolar”? And this is NYC!

        So patients face a daunting task. Anyone who has ever been locked up is in danger of being locked up again. These are the conditions of those former captives who live under the regime of psychiatric slavery. Certainly they live in fear, and they have every right to take drugs that mitigate their fear–alcohol, marijuana or benzo’s. They have no trouble getting neuroleptics because an army of psychiatric vulture swarm about them waiting for the opportunity to force neuroleptics on them. Neuroleptics is in a class by itself–both in terms of the risks entailed and the harm that will inevitably be incurred. I listed the common afflictions above. Psychologically ingesting “anti-psychotics” convey the message that the client has a disease. Taking a Valium conveys a different message–that the client suffers from anxiety. In fact that IS what people suffer from–whether normal or mad. THey also suffer from sleeplessness. If they do not get enough sleep they might do something unwise and be caught and Court ordered to spend years taking brain-damaging neuroleptics that
        will almost inevitably result in them developing tardive dyskinesia, and minimizing the chances that they will be able to escape from the condition of chronic patienthood. Whitaker has shown that. I have witnessed it repeatedly.

        If a former patient can get access to benzo’s she can often avoid being caught by the mind-police–usually with the help of peers or non-psychiatric therapists. It is one part of a regimen of practices and drugs that enable one to deal with the problems of living. It is irresponsible to maintain all psychiatric drugs are equally harmful. They are not. Nor are they equally useful or useless. This is pure dogma.

        Madmom writes: “Benzo’s will probably play a role in the recovery of thousands, if not millions of people who have been deeply wounded by medical ‘science’. Ironic but true.” For many patients it is their ONLY chance of escaping from chronic patienthood. For those of us who made it a priority to get persons off of neuroleptics and Lithium the prospect of banning drugs like Valium is a move that disempowers those who are victims of the Therapeutic State.
        Seth Farber, Ph.D.
        http://www.sethHfarber.com

    • Seth,

      Thanks for coming in.

      Your essential point – if I understand you correctly – is that benzos should be prescribed by physicians to help people deal with damage done by neuroleptics, and to help them avoid being put on neuroleptics in the first place.  In other words – benzos are the lesser evil.  Obviously this is a huge topic.  It is also the argument that is routinely used by psychiatrists to justify all their interventions – including their prescribing of neuroleptics – i.e. that the benefits outweigh the risks.  I think that once we start down that road, it becomes a very steep slope.

      With regards to the availability of drugs generally, my position is anything but Calvinistic.  I believe that all drugs should be available and legal, but marketed with certain safeguards.  This is not because I think drugs are good for people, but simply because I don’t believe that governments have the right to tell people what they may or may not ingest, and also because the war on drugs has in my view done more harm than good.  In numerous places on my website, I have stated that my issue is not with people choosing to use psycho-pharmaceutical products, but rather with the psychiatric fiction that these products are medications being prescribed by psychiatrists to treat illnesses.  I have never stated that people “have no right to use drugs to alter their consciousness.”  Indeed, in my post Do Psycho-Pharma Drugs Have Any Legitimate Function? I state unambiguously “Let me be clear.  I’m not saying that people shouldn’t take these products.  If they choose to take them, let them take them.  What I’m saying is that we need to stop pretending that they are medications, and that they are being used to treat an illness.”

      You refer to my “call to ban benzos,” and I will concede that my wording in that paragraph was careless.  What I had intended to say, and which I think is implied in the rest of the paragraph, is that marketing benzos as medicine should be banned – if for no other reason than that it constitutes false advertizing.

      You mention Joanna Moncrieff’s idea of drug-centered treatment, and you express the belief that this is “the only non-ideological approach.”  I don’t agree with this characterization, in that, regardless of what the physician says, the fact that the pills are prescribed by a physician inevitably entails the implication that they are medications and are being prescribed to treat an illness.  Actions speak more loudly and more convincingly than words.  Indeed, Dr. Moncrieff herself touches on this topic in one of her blog posts:

      “This raises all sorts of thorny questions, of course, about why some psychoactive drugs are legal and others illegal, about what sort of drug use society approves of and what it doesn’t, and why the legal dispensation of many drugs is restricted to doctors: subjects for many future blogs!” [Emphasis added]

      Your assertion to the effect that Joanna Moncrieff’s model is the “only non-ideological approach” also contains, I think, the implication that a non-ideological approach is to be preferred over its opposite, and that you consider my (Calvinistic?) approach to fall into the latter category.  “Ideological” is a complex term.  I suggest that Dr. Moncrieff’s approach is actually very ideological.  In The Myth of The Chemical Cure, in which she developed this concept, it is clear that the approach is based on the values of honesty, genuinely shared decision-making, and ethical objections to the routine dishonesty and destructiveness of psychiatric practices.

      It is my fundamental position that psychiatry is spurious, destructive, and unself-critical, and I believe that an ideological (i.e. value-driven) response is appropriate.

      I’ve given your thesis on the putative benefits of benzos a great deal of thought, but I still baulk at the notion that one can help people, in any meaningful sense of the term, by giving them neurotoxic chemicals.  You’re probably correct in saying that the benzos are less destructive than the neuroleptics, but that’s cold comfort to a person who has become strongly dependent on benzos.  In your defense of benzos, you state that “…the harm they inflict…is much less (unless used recklessly) than those of ‘anti-psychotics’…”  I’m not sure who is the intended target of the term “reckless” – the client or the prescriber – but either way, I think the concept is problematic.  Benzos have very high addictive potential, and even people who take them “only as directed” can become extremely dependent – a fact which usually only comes to light when they try to taper or discontinue.  By which time, of course, the damage is done.

      Ultimately, on the central issue, we may have to simply agree to differ.  I have grave reservations about distributing, under medical aegis, dangerous psychoactive chemicals on the grounds that they might potentially save the individual from a worse fate.  I think our energies would be better spent in directly challenging the use of the major tranquilizers.

      Anyway, thanks again for coming in.  I’m sorry for any ambiguities in my writing, and for any ensuing misunderstanding.  Do have a look at the posts that I mentioned, and feel free to come back with questions, thoughts, commentary, challenges, etc…  I welcome dialogue.

      Best wishes.

      • Philip,
        I was pleased to see that regardless of your “Calvinist” attitude toward drugs, you support patients’ right to make their own choice.

        You write, ” I’m not saying that people shouldn’t take these products. If they choose to take them, let them take them. What I’m saying is that we need to stop pretending that they are medications, and that they are being used to treat an illness: “, ” I have stated that my issue is not with people choosing to use psycho-pharmaceutical products, but rather with the psychiatric fiction that these products are medications being prescribed by psychiatrists to treat illnesses. ”

        I completely agree with this position–although I still think you have a prejudice against the use of drugs to alter consciousness, but contrary to my suppositions you make it clear at any rate that you support people’s right to make these decisions. And your target is Psychiatry and its use of the medical model to maintain its hegemony and to augment its growth and relationship with the drug industry .

        I was using the term “ideological” in a different sense, as is typically used by anarchists or Marxists to denote a process of mystification. I describe Moncrieff’s drug-centered approach as non-ideological, meaning transparent as opposed to the mystifications of the medical model. (I was not contrasting it to your position because I thought you were opposing the use of drugs. )So I agree with you characterization of Moncrieff’s position. It is the only honest approach to the use of drugs. But unlike Breggin I believe drugs can have positive functions and persons have to weigh their assets against their risks. Although you praise Moncrieff your position is really Breggin’s. You regard all drug as neuro-toxins that should be avoided. Ironically I had a dispute with Moncrieff because of her defense of neuroleptics in some cases. However I agree with her about other drugs.

        Years ago I saw a “schizophrenic” who had not spoken in at least 10 years become passionately involved in a conversation with another resident after he had a glass of champagne(This was an unusual half-way house in the Bay Area.) I don’t know of anyone who has explored its potential to foster social interaction among withdrawn patients but we do know many of the great American writers attributed their inspiration to alcohol. Of course for the most part they used alcohol self-destructively but as any shaman knows one has to learn to master a drug lest one become its slave.

        Moncrieff provides an alternative to Breggin anti-drug approach. A drug-centered approach would weight the pros and cons of every drug. For example, any psychiatrist using this approach would warn clients of the dangers, as you have, of combining Valium and opiates. She would also warn clients that benzos have “a very high addictive potential.” I would be inclined to explain and qualify this characterization. I think their high addictive potential is in large part because they make people feel good as opposed to neuroleptics which make people feel awful.

        I do not believe based on observation of friends and clients who were survivors (and my own occasional use–I had a back injury that required muscle relaxants) that they are any more addictive than neuroleptics –that is I do not believe they are harder to withdraw from, although psychiatrists will repeatedly warn “schizophrenics” of how addictive benzos are. So if you are implying that Valium has a higher addictive potential than Risperdal, I am skeptical.(Valium, for some reason is virtually never prescribed. It has been replaced by more addictive benzos like Ativan.) Is this not
        a mystifying way of saying patients like benzos better and thus are more inclined to abuse them, rather than that they have more intense withdrawal effects allow to moderate levels? And if so how is this relevant to individuals who are not inclined to abuse drugs?

        I want to point out to you that what I am doing here is applying a drug centered model like Moncrieff’s to the problems of living.

        Benzos would admittedly be problematic for clients who have a tendency to take drugs to get high. Those are the clients who use them “recklessly.” I had a friend who was an alcohol abuser and a crack fiend–sadly she died at 42. If she had access to Valium she would take them in handfuls. She was an extreme but the more inclined one is to abuse drugs with a “highness potential” the poorer a candidate one would be for benzos. Persons like these might find themselves in a living hell. Obviously there are psychiatrists who recklessly prescribe benzos

        These drugs have value when they are used cautiously to alleviate anxiety or panic. They have a low threshold for tolerance so the less frequently they are taken the more effective they will be. Most “psychotics” are not inclined to abuse benzos.

        ” Addictive” is a word used to scare “patients.” Thus I have never heard of a psychiatrist who warned patients of the “addictive” nature of neuroleptics. Never.
        Psychiatrists are threatened by mad persons use of benzos. Successful use of benzos by “psychotics” undermines the claim that they suffer from a disease, not from anxiety. The efforts to pathologize anxiety has not been successful: Almost every one knows that anxiety is a feature of life in the modern world. And most people feel they sometimes “need” a few beers, a little wine or a joint to take the edge off. If the mad start learning to function without “anti-psychotics” the “sacred symbol of psychiatry” is going to lose it bedrock reality.

        Certainly with benzos there is a low threshold for tolerance. That is an argument for using them carefully. One might avoid taking them every day. In my opinion it is not an argument in favor of the use of neuroleptics.It is an argument for using meditation or music as an alternative but these do not always work. Of course medicalists (my word for adherents to the medical model) will urge “schizophrenics” or “bipolar 2’s” to take neuroleptics, not benzos. As a non-medicalist I believe persons suffer from anxiety, not from “schizophrenia” and not from “anxiety disorder.”

        When I interviewed people for my first book I discovered that everyone of these people who rejected the medical model and repudiated their diagnosis of “schizophrenia” (this was before “bipolar” became popular) had a terrible reaction to neuroleptics the first time they were given it. It was not tranquilizing for them, it was sickening.It sedated them in the same way as a bad flu does. For all of them neuroleptics were a hellish experience.
        After they were on it for more than a few days they began to develop the zombie effect–they became emotionally indifferent to everything.The shrinks always told them they would need to take it for their entire lives.

        While I argue that most of the suffering of “mental patients” is iatrogenic it is true that many first break patients were in a state of panic even before they were apprehended, before they were hospitalized. The humane thing to do is to offer such patients some sort of real tranquilizer, Benzos are effective. So are other drugs Lewis mentions like Neurontin. Maybe you do not have a Calvinist approach but many in our camp do. They feel the “patient” should tough it out on her own– that is the “purer” more “holistic” way. Breggin is opposed to all drugs since he believes they all, including alcohol, cause brain damage. He believes every drug is neuro-toxic. In Breggin’s ideal world no one would ever drink wine. But Moncrieff’s approach is different than Breggin’s.

        You have not understood what Madmom and Hermes and I have been saying.
        We live under a regime of psychiatric slavery. Any mad person not on neuroleptics risks being picked up and taken before a judge and ordered to go to out patient trreat3ntake “anti-psychotics”. I know people who have been cheated out of a life. One cannot function on neuroleptics.

        The best solution for a “psychotic crisis would be inexpensive housing, a rich support network etc etc. A support network for people who say strange things is very hard to find outside of virtual reality–but that is not the same.
        As far as housing Psychiatry and the State give the mad a restricted array of options–but they all involve being looked over by mental health professionals. Perhaps it’s different in Colorado but patients here are fortunate if they can stay off neuroleptics–that requires finding the right kind of housing and the kind of psychiatrist who does not exist. I had a friend who was an activist against the system for years. When her mother died she was unable to find a place to live. After 35 years of fighting the system she ended up in a halfway house. She developed tardive dyskinesia in one year. When I saw her I was shocked: She looked like a patient with a bad case of Parkinson’s.

        “I think our energies would be better spent in directly challenging the use of the major tranquilizers.” I think neuroleptics are poisons that no humane doctor would ever prescribe to a patient who was not already on them. But your statement is comparable to a socialist who says, “Our energy would be better spent in challenging capitalism than in trying to get higher wages.” Every day I deal with people who are victims of the psychiatric-pharmaceutical industrial complex–they spend much of their times worrying about how to avoid being caught and subjected to forced outpatient commitment. They’ve been on these drugs before—they knows it would be a death sentence–so they live in fear.One friend of mine will say “delusional” things to the wrong people if she does not get enough sleep. Thus she takes a sleeping pill sometimes on top on benzos. That way she can avoid being forced to take neuroleptics–ie being forced to undergo a chemical lobotomy. “Oh God what are we doing to our visionaries” cried John Weir Perry.

        My recent book discusses these questions in passing. I discuss in greater detail the theories of various critics of psychiatry– with more emphasis on Laing than Szasz because the book is on the Mad Pride movement. It includes interviews with Oaks and DuBrul and a Foreword by Kate Millett. Like Laing in The Politics of Experience, 1967(Laing retreated from this position 2 years later) I argue that the mad are the potential vanguard of a new Great Awakening based upon the propagation of a utopian-messianic vision. But if the mad are going to play this redemptive role they have to protect their minds, they have to find ways to avoid being captured by the mind-police.

        I’m behind schedule–I’ll read the other article of yours you mentioned later
        Thanks.
        Seth Farber, Ph.D.
        http://www.amazon.com/Spiritual-Gift-Madness-Psychiatry-Movement/dp/159477448X/ref=sr_1_1?s=books&ie=UTF8&qid=1394959333&sr=1-1&keywords=farber+gift

    • Dr. Seth Farber, Great point(s)! And your prose is impeccable. Much respect and admiration to you sir. And I totally agree with your position on benzodiazepines. After an unsuccessful taper off, and reinstatement on the antidepressant – Effexor XR, I quit the drug altogether. “Why continue taking it if it’s not working, right?” Now the only drug that I can depend on (unconditionally) to bring me out of bout’s of suicidal despair, is Klonopin. And I’m not using them to “GET HIGH”, but to survive the negative psychological impact that was brought on by the aforementioned AD.

      You mentioned Thomas Szasz. What an invaluable character in the field of psychiatry and, philosophy in general. “All drug’s of any interest to any moderately intelligent person in America are now illegal”, (Thomas Szasz). If that doesn’t tell the world that “psychiatry” is a state/government apparatus, a tool used for social control of the populous, I don’t know which word’s will.

      When I was in prison I read a book called, The Cult of Pharmacology, by Richard DeGrandpre. If you haven’t already, then it’s a “must read” for anyone trying to understand preferential drug treatment, and drug favoritism by the so called, “expert’s.”

      If your interested in my own elaborations on the subject you can go to the blog – Playing the Odds, Antidepressant withdrawal, and the problem of Informed Consent, by Dr. Shipko. To bad this site doesn’t leave you the option to edit and or delete comments, like Youtube. I got pretty “wound up” on the other blog.

      Until next time, if there is a next time, I’ll be purchasing a copy of, Madness, Heresy and the Rumor of Angels. By the way, I’m not a bad guy. I just made a bad mistake. The crime I was incarcerated for was over a drug-deal gone bad. Real bad!

      Dana A. Callicoat

      • Thanks for your comments, Dana,
        Many of the posters here do not have any kind of strategy for preventing psychiatrists from ruining patients” lives by labeling them “psychotic”: and putting them on and keeping them on neuroleptics. Drugs like benzo’s or Neurontin can play an invaluable role.
        If a patent is given only a drug for anxiety it makes it virtually impossible to OTHER-IZE them. THeir problem is defined as fear, anxiety—not schizophrenia. Of course long term use of benzo’s can be harmful. But it attenuates the line between the worried walking and dreaded “schizophrenics.” Plus benzos rarely trurn people into zombies. THis is why nursing home inmates are given Zyprexa, not Valium.
        What is missing from this discussion is 1) Patents on benzo’s are less likely to become convinced they suffer from “mental illness” rather than problems of living, THis means they will regard benzo’s as crisis drugs. 2) Patients should have the right to choose less destructive drug. Not to accede to shrinks.
        By evading these issues our posters are not contributing to preventing patients from becoming chronIc patients. By obscuring differences between benzos and neuroleptics, posters are contributing to perpetuating use of psychologically and physiologically most toxic dRUGS In America. Read WhitaKer’s work on drugs.
        What dominates today is neuroleptics–the most dangerous drugs on mArket.
        Chemomonster speaks eloquently–but he is not alone. THe posters have avoided issues raised by others on psychiatric drugs. I submit that the single-most important ISSUE for therapist is preventing the otherizing of patients and getting them off “anti-psychotics.” While the harm inflicted by all psychiatric must be addressed, one must also address: How to get patients off of neuroleptics that ruin their lives. And short term use of benzo’s and other drugs like Neurontin should be offered to patients as alternative to neuoroleptics and Other-izing patIENTS as psychotics.
        I will take a look at The Cult of Pharmacology–It looks impOrtant. THe industrY doMINATES THE whole medical fiELd., I am awaRE that the whole medical field is dominated by big Pharma. THus chemotherapy makes pAtients sicker but it is highly lucrative for doctors and pharm industry, Cancer is lucrative. These issue cannot be addressed in isolation, Read Foucault But of course Psychiatry has nothing to do with medicine–but with problems in living
        . Like cancer, “schizophrenics,” will not be” cured” by therapy or “medicine.” Not when billions of dollars can be made by keeping people sick or unable to function. “Schizophrenia” is a myth, there is no such thing–there are only problems of living. Normals take drugs for anxiety. They are less risky long term treatments but if you get thrown into loony bin you should be able to ask for Valium as alternative to far more toxic stupefying Zyprexa. THe greater advantage is Valium. That way you can’t be labeled “schizophrenic”– you can’t be Other-ized.
        Seth Farber, PhD

      • Thanks for your comments, Dana,
        Many of the posters here do not have any kind of strategy for preventing psychiatrists from ruining patients” lives by labeling them “psychotic”: and putting them on and keeping them on neuroleptics. Drugs like benzo’s or Neurontin can play an invaluable role.
        If a patent is given only a drug for anxiety it makes it virtually impossible to OTHER-IZE them. THeir problem is defined as fear, anxiety—not schizophrenia. Of course long term use of benzo’s can be harmful. But it attenuates the line between the worried walking and dreaded “schizophrenics.” Plus benzos rarely trurn people into zombies. THis is why nursing home inmates are given Zyprexa, not Valium.
        What is missing from this discussion is 1) Patents on benzo’s are less likely to become convinced they suffer from “mental illness” rather than problems of living, THis means they will regard benzo’s as crisis drugs. 2) Patients should have the right to choose less destructive drug. Not to accede to shrinks.
        By evading these issues our posters are not contributing to preventing patients from becoming chronIc patients. By obscuring differences between benzos and neuroleptics, posters are contributing to perpetuating use of psychologically and physiologically most toxic dRUGS In America. Read WhitaKer’s work on drugs.
        What dominates today is neuroleptics–the most dangerous drugs on mArket.
        Chemomonster speaks eloquently–but he is not alone. THe posters have avoided issues raised by others on psychiatric drugs. I submit that the single-most important ISSUE for therapist is preventing the otherizing of patients and getting them off “anti-psychotics.” While the harm inflicted by all psychiatric must be addressed, one must also address: How to get patients off of neuroleptics that ruin their lives. And short term use of benzo’s and other drugs like Neurontin should be offered to patients as alternative to neuoroleptics and Other-izing patIENTS as psychotics.
        I will take a look at The Cult of Pharmacology–It looks impOrtant. THe industrY doMINATES THE whole medical fiELd., I am awaRE that the whole medical field is dominated by big Pharma. THus chemotherapy makes pAtients sicker but it is highly lucrative for doctors and pharm industry, Cancer is lucrative. These issue cannot be addressed in isolation, Read Foucault But of course Psychiatry has nothing to do with medicine–but with problems in living
        . Like cancer, “schizophrenics,” will not be” cured” by therapy or “medicine.” Not when billions of dollars can be made by keeping people sick or unable to function. “Schizophrenia” is a myth, there is no such thing–there are only problems of living. Normals take drugs for anxiety. They are less risky long term treatments but if you get thrown into loony bin you should be able to ask for Valium as alternative to far more toxic stupefying Zyprexa. THe greater advantage is Valium. That way you can’t be labeled “schizophrenic”– you can’t be Other-ized.
        Seth Farber, PhD

      • Thanks for your comments, Dana,
        Many of the posters here do not have any kind of strategy for preventing psychiatrists from ruining patients” lives by labeling them “psychotic”: and putting them on and keeping them on neuroleptics. Drugs like benzo’s or Neurontin can play an invaluable role.
        If a patent is given only a drug for anxiety it makes it virtually impossible to OTHER-IZE them. THeir problem is defined as fear, anxiety—not schizophrenia. Of course long term use of benzo’s can be harmful. But it attenuates the line between the worried walking and dreaded “schizophrenics.” Plus benzos rarely trurn people into zombies. THis is why nursing home inmates are given Zyprexa, not Valium.
        What is missing from this discussion is 1) Patents on benzo’s are less likely to become convinced they suffer from “mental illness” rather than problems of living, THis means they will regard benzo’s as crisis drugs. 2) Patients should have the right to choose less destructive drug. Not to accede to shrinks.
        By evading these issues our posters are not contributing to preventing patients from becoming chronIc patients. By obscuring differences between benzos and neuroleptics, posters are contributing to perpetuating use of psychologically and physiologically most toxic dRUGS In America. Read WhitaKer’s work on drugs.
        What dominates today is neuroleptics–the most dangerous drugs on mArket.
        Chemomonster speaks eloquently–but he is not alone. THe posters have avoided issues raised by others on psychiatric drugs. I submit that the single-most important ISSUE for therapist is preventing the otherizing of patients and getting them off “anti-psychotics.” While the harm inflicted by all psychiatric must be addressed, one must also address: How to get patients off of neuroleptics that ruin their lives. And short term use of benzo’s and other drugs like Neurontin should be offered to patients as alternative to neuoroleptics and Other-izing patIENTS as psychotics.
        I will take a look at The Cult of Pharmacology–It looks impOrtant. THe industrY doMINATES THE whole medical fiELd., I am awaRE that the whole medical field is dominated by big Pharma. THus chemotherapy makes pAtients sicker but it is highly lucrative for doctors and pharm industry, Cancer is lucrative. These issue cannot be addressed in isolation, Read Foucault But of course Psychiatry has nothing to do with medicine–but with problems in living
        . Like cancer, “schizophrenics,” will not be” cured” by therapy or “medicine.” Not when billions of dollars can be made by keeping people sick or unable to function. “Schizophrenia” is a myth, there is no such thing–there are only problems of living. Normals take drugs for anxiety. They are less risky long term treatments but if you get thrown into loony bin you should be able to ask for Valium as alternative to far more toxic stupefying Zyprexa. THe greater advantage is Valium. That way you can’t be labeled “schizophrenic”– you can’t be Other-ized.
        Seth Farber, PhD

  5. Philip:

    By the way, GREAT WORK on this article. It is the best article I’ve read on this issue and I’m considering forwarding it to the members of my extended family who are either on benzos or who are prescribing benzos. I pick and choose my battles closely with extended family members and this article could definitely ruffle a few feathers!!

  6. Seth

    Some of your points made above are misguided and unfair to the author Philip Hickey.

    It is one thing for you to raise some questions regarding the possible use of Benzos in certain cases to help someone in extreme states of psychological distress, but to jump to characterizations such as “…his Calvinistic attitude leads him to make recommendations that would undermine psychiatric survivors’ chances of escaping from the system.” is a leap into critical arrogance.

    The focus of this article was on the overall dangers of Benzos and how their use is justified by Biological Psychiatry’s medical model. He did not address secondary issues related to those survivors who still may still be stuck on Benzos or in some stage of a long term withdrawal or their possible rare substitute replacement for neuroleptics. Out of the 94 million prescriptions for benzodiazapines it is safe to say that at least 93 million represent irresponsible and potentially dangerous prescribing. That is a point worth making here.

    You stated: “…I believe the benzo’s—Valium, Xanax, Klonapin etc– are valuable drugs in our era and can play a critical role in helping persons to avoid being caught by the system, put on neuroleptics and becoming chronic mental patients.”

    I believe this is an extreme position going in the other direction. Some pharmaceuticl CEOs who currently fear for a loss in revenue might seize on this statement to seek out a new niche for their cash cows that are increasing coming under critical evaluation. Benzos are clearly not the savior or antidote for neuroleptics. Seth, I know you did not exactly say this, but your emphasis in the above statement way over exaggerates their importance and minimizes their dangers. Yes, they may have a role to play, but once again, anything beyond a few weeks, in almost all cases is getting into addiction territory and long term dependency. MIA and other survivor stories on the Web have featured hundreds of pages of testimony about the hell of Benzo addiction and withdrawal.

    You said: “Dr Hickey claims that patients have no right to use drugs to alter their consciousness. But no doctor has a right to deny patients’ the rights to used drugs to alleviate anxiety, terror.”

    Philip Hickey made no such claim in his blog. Why don’t you ask him his position on this question?

    You said: “The only responsible position is one that supports the right of informed consent–which means that patients must be told of the awful damage done by neuroleptics.”

    A doctor has responsibility way beyond “Informed Consent.” Doctors must also be completely aware of their power and prestige in the therapeutic relationship. They must also be aware that in our culture of addiction and demand for quick fixes that vulnerable patients might be willing to take risks that doctors need to protect them from. The case of antibiotics is a good example where this guidance is essential in overriding the desire and demands of a patient.

    Philip Hickey did make an error when he stated that: “Dr. Frances is correct: benzodiazepines should be taken off the market …”

    I believe Dr. Allen Francis in his recent statements only advocates that Xanax be removed from the market, not ALL benzodiazapines.

    I hope Philip and others at MIA will join in on this discussion to clarify exactly what role Benzos have to play in both survivor misery and possible forms of relief from extreme states of psychological distress.

    Richard

  7. Richard, Phil
    I said that I agree with Phil Hickey’s “impassioned and astute argument against the disease model” and of the medicalization of the problems of living. However I feel it is my responsibility to bring up an issue that is virtually always ignored here. Any argument against drugs will meet an enthusiastic reception because it accords with the general anti-drug orientation of most readers. You may accuse me of “arrogance” but I think Madmom’s reluctant confirmation of my point is an indication that I am raising an issue that will be ignored if I don’t make my point with vehemence. Manmom’s bemusement– “crazy,” “ironic” — confirms that I am
    ,stating something unfamiliar, taboo–because it’s just not said. Let me remind you that conventional shrinks never talk about the option of putting schizophrenics on “MINOR tranquilizers” instead of neuroleptics. And here it’s not cool to advocate any drugs.

    You may be right about the statistics but I don’t consider my point secondary. Most of the people for whom I advocate are “psychotics” and most survivors (including most posters here) have been locked up and labeled bi-polar or schizophrenics–these groups are the vanguard in the movement. All of my books are attacks on the psychiatric-pharmaceutical complex. So I took the opportunity to raise points that are not discussed here at MIA, instead of reaffirming the points where I agreed.

    Let me bring up 2 fundamental premises of yours and Hickey’s that are antithetical to my beliefs.
    Hickey writes
    “The fact is that anxiety is not an illness, and drugs that dissipate anxiety are not medications – they are drugs.” That’s right. But Hickey implies that the use of drugs is illegitimate, while the use of medication is justified. (I expressed myself ambiguously because the computer deleted my first response–and I was rushing. I will try to be clearer) My sense is that you and Hickey share the culture’s double standard re licit and illicit drugs. This is the “Calvinism” that leads the two of you to speak of “drugs” with such disdain. I support the responsible use of alcohol to alleviate social anxieties and facilitate social intercourse. I support the use of LSD to “expand” consciousness.” I support the use of drugs. They are as “legitimate” to me as medications.

    My objection is to medicalization of the problems of living, to the alliance of the drug companies and “mental health” professions and to the campaign of misinformation that leads people to take SSRIs despite their inefficacy and risks and neuroleptics which in my opinion are no better than chemical lobotomies. I can’t elaborate here but I think you and I have antithetical premises. One measure upon which we would probably agree is the following– I strongly support re instituting the APA’s pre-1980s ban on accepting money from the drug companies.

    Here is another fundamental premise about which we disagree. You write (and I’m sure Hickey agrees): “A doctor has responsibility way beyond “Informed Consent.” Doctors must also be completely aware of their power and prestige in the therapeutic relationship. They must also be aware that in our culture of addiction and demand for quick fixes that vulnerable patients might be willing to take risks that doctors need to protect them from. The case of antibiotics is a good example where this guidance is essential in overriding the desire and demands of a patient.” I agree with much of your eloquent formulation here but not if it is intended to replace informed consent. That is not if it leaves the final choice with the doctor. I strongly believe the final choice should belong to the client. I think you disagree–I think you probably favor benevolent paternalism.

    What I meant to say last time–I think you misunderstood because of my ambiguity –is that psychiatrists do not have the right to deny patients the right to use benzo’s to alleviate anxiety. They are the least harmful tranquilizing drugs and since persons cannot get them without a prescription THE CHOICE SHOULD BE WITH THE CLIENT. I do not think you or Hickey agree. I think you feel the doctor should have the right to make that choice for the client. Is that not right DR Hickey? Is hat NOT your position?

    So you see there are fundamental differences between us.

    How do you get “psychotic” patients off drugs.I support Moincrieff’s drug centered model of psychiatry. But as Madmom and I agreed psychiatrists refuse to .do this. I think the key is building up informal support groups–with the support sometimes of an outside non- medical therapist . That means for many patients being on benzos for more than a few months may be necessary if they can get access to it. And if they do not have .a tendency to abuse drugs. Many patients have realistic anxieties because of the risk of being committed by a relative, neighbor or shrink.

    But you stated, “once again, anything beyond a few weeks, in almost all cases is getting into addiction territory and long term dependency…”: That is too doctrinaire a position. Of course it is true that after a few weeks you get into tolerance territory. Anyone advising the client must take that into account but again I think your puritanical bias against drugs is coloring your assessment. My goal is to get clients and friends off of neuroleptics and keep them out of chronic patienthood. To say that every client becomes addicted is the stuff of Reefer Madness–the film. Benzos are best drugs for alleviating anxiety. Meditation obviously has less side effect but it may take times before clients can master it.
    Seth Farber, Ph.D.
    http://www.sethHfarber.com

    • Seth

      Your arguments are contradictory and you continue to mischaracterize my position, as well as, exaggerate the benefits of Benzos and minimize their potential dangers. I say all this respectfully, because I share many(not all) of your positions that I have followed for some time on this website.

      My position is consistent. I accept the drug centered model and oppose the disease model. I have never stated that certain drugs should never be used; this includes the mislabeled “anti-psychotics.”

      You, on the other hand, do not completely uphold the drug centered model because it appears that you approve of all drugs being prescribed and used (if someone so chooses) except the category of drugs originally called major tranquilizers (mislabeled as ” anti-psychotics”).

      You stated above to Madmom the following: “Psychologically ingesting “anti-psychotics” convey the message that the client has a disease. Taking a Valium conveys a different message–that the client suffers from anxiety. ”

      The message of “disease” you refer to is in the “eye of the beholder.” If some one believes in the disease model, then of course they will see things as you describe. But some one could just as well believe (and be correct in their interpretation of reality) that they are suffering some form of psychosis or other extreme state (which, by the way, may actually be, an extreme form of anxiety) and want those symptoms reduced using a major tranquilizer such as Abilify. For some people this might even work better than a Benzo, and they, as well, should have the right to obtain such a prescription. (this is all qualified by the fact that most psychiatrists don’t know what they are doing when they prescribe these drugs). And with the right support system, in the right environment, and for a recommended short period of time and with a clear exit strategy, the use of this type of drug might help some people. While this is my position, I say all this with extreme reservations as well as being open to amendments. This is truly being consistent with a “drug centered model.”

      For some people taking a Benzo might ALSO “convey the message” that they have a serious addiction to these drugs, in addition to the fact that they may also experience anxiety. And continuing the use of these drugs, instead of safely tapering, may actually be doing far more harm than good in their lives. These are very difficult decisions and choices that many people have to make, especially those who have been damaged by an oppressive psychiatric system.

      Drugs of all kinds have many contradictory functions in human existence. In my first blog publication here at MIA titled “Addiction, Biological Psychiatry, and the Disease Model” I made the following statement:

      “In opposition to the disease model we might find it helpful to conceptualize and understand both addiction and symptoms that get labeled as “mental illness,” more simply as useful coping mechanisms that over time “get stuck in the on position.” Let me explain. Human beings are driven to repeat behaviors that are pleasurable and/or take away pain, and they usually have sound cognitive rationalizations for doing so. These tendencies are very much related to our survival as a species, especially when you look at the drive to eat, drink, and procreate. In other forms of pleasure seeking and pain avoidance most people who use alcohol and other mind altering drugs more often feel very good in the earlier stages of their use. This is especially true when there are generally fewer negative consequences associated with their consumption. Some people have also postulated that human beings are, at times, attracted to altered states of consciousness. This can be a way to avoid boredom through experimentation, or, perhaps more often, become a creative way to escape or rise above the resulting discomfort or trauma experienced in a threatening environment. In the beginning stages of drug use, these substances may provide a temporary pleasurable escape from a harsh reality and/or become a very successful short term coping mechanism that actually prevents more dangerous reactive behaviors (including suicide), or perhaps even helps prevent the person from going “crazy”.”

      In this article I go on to discuss the process whereby these successful coping mechanisms reach a point when they may turn into their opposite and become self defeating and overall harmful to a person’s life. I bring up these quotes to further indicate that you have mischaracterized my position and made incorrect assumptions.

      You say; “psychiatrists do not have the right to deny patients the right to use benzo’s to alleviate anxiety. They are the least harmful tranquilizing drugs and since persons cannot get them without a prescription THE CHOICE SHOULD BE WITH THE CLIENT. I do not think you or Hickey agree. I think you feel the doctor should have the right to make that choice for the client. Is that not right DR Hickey? Is hat NOT your position?”

      Seth, I don’t think that you or anyone else can say with any certainty that” Benzos are the least harmful drugs.” Some people believe they wreak havoc with the brain’s gaba receptors, perhaps even causing permanent damage, or at the very least damage for many years after people stop them. And 30% of all opiate related overdose deaths are connected to Benzos. In fact Benzos may be the critical ingredient that ultimately causes death in these overdoses.

      And Seth, Don’t you believe an ethical doctor has the right and responsibility to “do no harm” by, in some cases, saying to some one that “I can no longer prescribe you this drug anymore in good faith because I believe (based on all my knowledge) I would be causing you far more harm than good. So I am referring you to another doctor for a second opinion.” I believe they have that right and responsibility.

      You say; “Benzos are (the) best drugs for alleviating anxiety. ”

      Seth, can’t we also say,with some science to back it up, that Benzos are the best drugs at INCREASING AND SUSTAINING anxiety in some people over the long haul. For as tolerance develops some people experience increased breakthrough anxiety (with their natural coping mechanisms now suffering from almost total atrophy due to long term dependency) and anxiety now becomes a sustaining factor in their life.

      There are other drugs that are effective with anxiety including alcohol, THC, visteril (an others in that category) and neurotin to name a few. I am not suggesting they are necessarily good choices. You and Hermes may be correct that they should be used more often (in place of neuroleptics) when some one is in emotional crisis in a hospital setting. But for some people Benzos can become horrible drugs, and they may not find out until it becomes a serious problem. I still believe you have overall minimized their dangers and exaggerated their role in survivor recovery/liberation.

      Oh, and BTW Seth, I am not a doctor as you made reference above, I am a Licensed Mental Health Counselor working in a community mental health clinic. You can access every position I’ve taken in every discussion at MIA by clicking on my name at the top of this comment.

      Richard

      • Richard,
        I answered Philip above.

        First of all let’s get this opiate thing off the table. Maybe you and Phil keep know as mentioning it because you work with opiate addicts. The survivors I know as friends comrades or clients have not been opiate users. So I have no reason to even contemplate that point. It’s obviously an important point for those who work with opiate abusers.

        You write,”You, on the other hand, do not completely uphold the drug centered model because it appears that you approve of all drugs being prescribed and used (if someone so chooses) except the category of drugs originally called major tranquilizers (mislabeled as ” anti-psychotics”).”
        There is no inconsistency there. I’m also against the use of arsenic. My point is that the most harmful drugs are first neuroleptics and second the SSRIs. There are many critical psychiatrists who agree with this. Ron Leifer did–when I interviewed him for my first book, although we did not discuss SSRIs. And Peter Stastny did when I interviewed him recently. Many of these psychiatrists believe benzos should be used in hospital settings rather than neuroleptics.
        Read David Cohen’s articles on the history of neuroleptics. Psychiatrists wanted to make people physically ill as means of sedating them. Furthermore they promoted Thorazine as a chemical substitute for a lobotomy.” Read also about the Russiasn dissidents on these drugs. In the Harrow experiment as I recall 40%
        of non-drugged patients made a full recovery, 5% of those on neuroleptics did.
        The higher the dosage, the more toxic.
        I suggested benzos but you’re right Vistaril, Neurontin are probably also benign means of alleviating anxiety.

        I’m not sure the point you’re making in the middle. That anything can be interpreted in an infinite variety of ways. Yes in theory. But shrinks want to keep patients on “anti-psychotics” and taking these drugs sustains the propaganda.

        You ask if I don’t believe you have the right to say to a client “I can no longer prescribe you this drug anymore in good faith because I believe (based on all my knowledge) I would be causing you far more harm than good” ? Yes I do. I wrote “psychiatrists do not have the right to deny patients the right to use benzo’s to alleviate anxiety. They are the least harmful tranquilizing drugs and since persons cannot get them without a prescription …” I deliberately wrote “psychiatrists.” I did not mean that every psychiatrist has the responsibility to offer benzos to patients. Here in NY I worked recently with several friends to find a psychiatrist who would help them get off drugs, or see them without demanding they take drugs.

        My first friend, Susan, found a pro-drug psychiatrist who said he’d help her decrease Valium. She had been off neuroleptics for months. She postponed getting off Valium because she is under too much pressure, and she feels now is not the time to cut back. None of the MIA psychiatrists were seeing patients except one who charged $425 per hour–every week. The person who wanted to find a psychiatrist who would not force her to take drugs had no luck. I am thinking of advising her to ask him for something less toxic than neuroleptics. Without a psychiatrists she will likely be committed again. A shrink seems to be the only insurance policy.

        I have met those people who say benzos were a living hell for them. Every one I met was taking very high dosages–the equivalent of 30-60 milligrams of Valium a day, or more.

        I do not believe in long term regular use of benzos or any drug for anxiety–I’m not sure I made that clear.I would encourage people to use a variety of non-chemical ways of reducing anxiety. I believe that some people need to have it around for emergencies and sleeplessness, and may need to take benzos or whatever it for patches of time–to avoid being hospitalized, to avoid being subjected to AOTs.. Switching between benzos and the other drugs you mentioned is one way to avoid tolerance.

        You wrote, “Seth, can’t we also say, with some science to back it up, that Benzos are the best drugs at INCREASING AND SUSTAINING anxiety in some people over the long haul. For as tolerance develops some people experience increased breakthrough anxiety (with their natural coping mechanisms now suffering from almost total atrophy due to long term dependency) and anxiety now becomes a sustaining factor in their life.” I am not familiar with this. I have seen tolerance develop and the drug ceases to be effective. My assumption is that this is what happened. I have not read anywhere that “they sustain anxiety over the long haul.” I have no way to assess this. I’ll read the references. I don’t know if you reference that in “Addiction, Biological Psychiatry, and the Disease Model.” I don’t have time to look now but I’ll look later.

        I have to go back to some work
        Thanks
        Seth

  8. I guess I personally agree with Seth’s point. Benzos may be some of the most efficient and safe substances out there if used in a right manner in reducing anxiety and providing sleep. Maybe a safe environment to try them instead of neuroleptics would be in a hospital setting for something like first episode psychosis or related crisis. Maybe if they were used in such settings people wouldn’t get addicted to these drugs. Maybe there wouldn’t be so many chronic “schizophrenia” patients. Etc.

    I don’t think there’s nothing a priori kind of wrong with using drugs.

  9. Seth, when you state “Benzos are (the) best drugs for alleviating anxiety. ” you must be talking about the medical model of the ‘disease’ of anxiety. It seems obvious that the vast majority of the population use alcohol in order to wind down. A couple of beers or glasses of wine in the evening is the choice of millions. Other drugs such as opium and marijuana have also been used for thousands of years by human beings. So when you state that benzos are the best drug – where is your evidence? Of course I believe people have the human right to own their own body and to ingest any substance that they choose if it makes them feel better. Even chocolate. Obviously any overuse will cause issues. Just like salt. So I agree with Phil in the case that he makes which is to say that the promotion of benzos as a ‘medical drug’ akin to say insulin or antibiotics is morally wrong. I think…. …

    • Nick, You’re right. We are discussing THE GREAT TABOO–DRUGS
      You’re right because my formulation was careless. But I never referred to a disease, but to an unwanted feeling. I had in mind something stronger than MILD anxiety. We need a more precise phenomenological language for drugs and unwanted anxiety states. Supposedly the Eskimos have 100 words for snow. So to “wind down,” to mitigate mild anxiety for many if not most people, alcohol or marijuana would be optimum. Many people find marijuana makes them more tense, “paranoid.” So we are dealing with idiosyncratic effects–which is common with drugs.

      Anyone who has been to a party knows alcohol mitigates social anxiety and facilitates social interaction. That is a positive effect. The puritan school opposes all use of drugs (like alcohol) for this purpose, and thus will not admit alcohol’s promotion of social intercourse is an asset . I would prefer to see them–and all drugs– used more carefully.

      When I spoke of benzos for anxiety I had in mind more intense anxiety. I do NOT accept the medical model. That is why I said,e.g., people do not suffer from schizophrenia. They suffer from anxiety. Once you accept this as your premise the patient
      should be offered a choice of a variety of substances to alleviate anxiety. One can use drugs to alter mood. For intense anxiety in a hospital or Soteria type setting a benzo is probably going to be the best option. Richard Lewis pointed out there are other comparable options like Vistaril or neurontin. All of these drugs are better in terms of risk/benefit ratio than neuroleptics.

      The antipsychiatry activists I’ve known all had extremely adverse reaction to neuroleptics—from the start it made them feel awful. Just as it did Soviet dissidents. Patients should be offered benzos and similar drugs as options, not forced to take “anti-psychotics.” You all seem to be missing my point. First, it is humane to offer patients some sort of drug to alleviate unpleasant states ranging from anxiety to panic. Second, even alternative psychiatrists seem to consider neuroleptics the only option albeit on a temporary basis. This makes no sense–it’s inconsistent.

      Conventional psychiatrists are threatened by the use of alternatives to neuroleptics (“anti-psychotics”) because they undermine the premise that what is being treated is psychotic illness, rather than unwanted feelings. People like Phil and Richard are so opposed to the use of drugs they will not even consider benzos or eg neurotin as alternatives to neuroleptics for the management of anxiety. It is a topic that remains unspoken. It is taboo.

      So by default neuroleptics are tolerated even by alternative professionals who are opposed to long term drugging. If this statement is untrue than I ask Mr Lewis or Dr Hickey where on this page or anywhere else have they discussed any kind of positive use of drugs–at least from a harm reduction or lesser evil perspective?

      So what would they advocate for a patient in a state of panic–“schizophrenic”– who ends up on a psychiatric ward? I would advocate their right to take Valium, Klonapin or Neurontin (or nothing) as an alternative to neuroleptics. I agree that benzos are used–prescribed– irresponsibly by psychiatrists. But why is there no discussion about their positive aspects—their use as alternative means of mitigating anxiety???? Let’s be realistic. Sometimes patients are in intolerable states of panic. Do they not have a right to be given a drug to alleviate this panic? Should we not admit benzos then have a potential positive use?
      Seth Farber, Ph.D.
      http://www.sethHfarber.com

  10. Benzos are perhaps the most efficient, safest and patient-comfortable psych-drugs out there when used in a controlled setting and temporarily, such as in temporary “psychosis”. The addiction may get quite bad in long term, so they should maybe used only short term. But still.. I guess there’s a use for them. I’d rather give those first-episode patients admitted to hospitals benzos instead of neuroleptics when possible. Or maybe some OTC drugs such as Benadryl. Just to give some sedation and sleep. Benzos can be most useful drugs when used in a controlled setting. Of course troubles may start out of it.. but still..