Slow Psychiatry: Integrating Need-Adapted Approaches with Drug-Centered Pharmacology



For the past four years, I have been deconstructing my views of my profession.  My focus has been primarily on two areas: the efficacy and safety of the drugs I prescribe and so-called “alternative” approaches (in this I include many things such as Open Dialogue, Hearing Voices groups, and Intentional Peer Support to name a few). I have shared much of this in the blogs I wrote during this time. I am also interested in how we can improve and reform the public mental health system since this is not only where I work but where most people seek services and help. I have wondered where – if anywhere – psychiatrists fit in to a reformed system. I choose to post on a website that is filled with deep criticism of my profession. I take it in and ponder in an Hamletian way if it is ethical to continue to practice given the serious  problems in my field. I have come to an idea about how we can use our medical expertise to contribute something meaningful while acknowledging the value of non-medical thinking and remaining honest about the profound limitations of our knowledge. What follows is an attempt to articulate these ideas.

This discussion is divided into three parts. It begins with a review of Joanna Moncrieff’s ideas about a drug-centered vs. disease-centered approach to psychoactive compounds. In part II, I discuss these in the context of two classes of drugs: the neuroleptics and the psychostimulants. In the final section, I discuss need-adapted approaches and conclude with the proposition that the integration of a drug-centered pharmacology with a need-adapted approach might reclaim psychiatry – a slow psychiatry – as a more humble, humane, and honest endeavor.

Reflections on the Medicalization of Mental Health Care

Psychiatry in 2015 is the field of medicine that specializes in prescribing psychoactive drugs to people who we have identified as having psychiatric disorders. This is not to say that is all we do, and practice patterns vary. But at least where I work — within the community mental health care system in the U.S. — psychiatrists constitute  a small but expensive proportion of the overall work force and one of our core functions consists of categorizing symptom clusters as specific disorders and recommending drugs to treat those putative conditions.

Although this may have begun as a well-intentioned effort to reduce suffering, it has run into a variety of problems.  There has been an ever-expanding tendency to characterize a vast array of human behavior as medical disorders. It is this definition of problems-as-medical-conditions that brings them under the purview of the medical specialty of psychiatry. (Hugh Middleton addresses this in his recent post.) While characterizing a problem in medical terms is not synonymous with stating the problem requires a drug treatment, there has clearly been an increasing use of psychoactive drugs to treat an increasing array of problems in the past few decades. The beginning part of this post focuses on the drugs but the latter part will address why a medical approach to understanding many kinds of problems – as a general principle — is often unhelpful, regardless of whether or not drugs are prescribed.

Regardless of one’s particular inclination towards using drugs to relieve mental suffering, it seems likely that people have and will seek out drugs to alter mental state and mood.  I have argued, and continue to believe, that it is a good idea to have a field of medicine that specializes in understanding how to best use these drugs.  But I think the current model of psychiatry has failed us.

The Drug-Centered Approach

Joanna Moncrieff has made the distinction between a drug-centered and disease-centered approach (1) to thinking about psychoactive substances. In a disease-centered approach one assumes that drugs correct abnormal brain chemistry that is responsible for the condition being treated, they are considered medical treatments, and the beneficial effects of drugs are derived from their effect on a presumed disease process.  A drug-centered approach  posits that the drugs create a state different from the one that existed before the drug was administered but do not correct a specific abnormality or defect; drugs are considered psychoactive substances that alter the expression of psychiatric problems through the superimposition of drug-induced effects.

In a disease-centered approach, one thinks about main effects — those directed at a specific disease state and side effects — versus unwanted effects that are incidental annoyances. In a drug-centered approach, one understands that most drugs have broad effects that may be useful in some contexts. In a disease-centered approach, one is more likely to consider long-term poor outcomes as a consequence of the natural course of an underlying disease state and when symptoms recur after drugs are stopped to consider that a recurrence of illness. In a drug-centered approach, one is more likely to recognize that drugs can have long-term impacts and when the drugs are stopped one understands that some form of withdrawal is expected.

Many psychoactive drugs were first introduced in the 1950s and 1960s and at that time they were thought about and studied in a drug-centered way. Drugs were classified broadly as tranquilizers and stimulants. Drugs were marketed for a wide variety of indications. Combination drugs were popular. In that era, stimulants, for example, were marketed to treat depression as well as over-eating. A popular drug called Dexamyl contained a barbiturate and a stimulant.  It was marketed to treat depression, anxiety, overweight, and fatigue among housewives.

This began to change in the 1960s. In 1962 in the US, an amendment was passed to the Food and Drug Act in response to the discovery that the drug thalidomide caused severe birth defects. Going forward, drug makers were required to demonstrate that a drug approved for the market was not only safe but also effective in treating a specific condition. During that same era, recreational drug use became more common in the US and, as concern about this grew, laws were passed in the 1970s to restrict the prescription use of stimulants. At the same time, psychiatrists had a need to distinguish their concept of drugs as medicine from  recreational users’ concept of drugs as, well, recreation.

Coincident with these forces were struggles within psychiatry.  The psychoanalysts led many major academic psychiatry departments from the 1950s through the 1970s, but a growing group of psychiatrists wished to restore psychiatry to what they considered a more scientific and medical approach. They included those from the Washington University School of Medicine who were the leaders in restoring fidelity to psychiatric diagnosis.  Known as the neo-Kraepelinians, they were the driving force behind the emergence of the modern diagnostic manual, the DSM-III, which was published in 1980.

The neo-Kraepelinians wanted an approach to diagnosis that would allow researchers to use modern methodologies to finally figure out the underlying etiologies and pathophysiologies of psychiatric disorders. This required a consistent and systematic approach to classification so that people who were given the label of schizophrenia, for example, were more likely to bear relevant similarities to one another, despite where and by whom their diagnoses were assigned.

The 1962 Food and Drug Act (2) made this system critical for the ongoing drug development that proliferated over the next few decades because diagnostic categories – disease targets — were required by the law. The publication of the DSM III, which addressed the aspirations of both the neo-Kraepelinians and the drug companies, was the final stage in the transformation of psychiatry’s  approach to understanding psychoactive drugs from a drug-centered to a disease-centered one.

But to this day, we have a big problem.  Despite the promise heralded by the Washington University group and their many adherents, the etiologies of these disorders remain murky at best; there is no clear pathophysiology for any of the disorders in the DSM.

There is now overwhelming evidence of the damage caused by the diseased-centered approach to psychopharmacotherapy.  In many ways, one can consider Anatomy of an Epidemic a treatise on these harms. We promoted these drugs based on their short-term effects. When the drugs are discontinued, we have come to consider all consequent problems to be re-emergences of putative underlying disease processes. This has led to the recommendation that many of the people who began taking these drugs remain on them indefinitely. We failed  to reckon fully with the consequences of drug discontinuation.  Some of the emergent problems people experienced on these drugs were considered evidence of the presence of an additional disorder and this led to an increased use of polypharmacy.


In this section, I apply the construct of the drug-centered versus disease-centered approach to psychopharmacotherapy to two classes of drugs: the neuroleptics and the psychostimulants.

I chose the neuroleptics in part because reconsidering their use has been a focus of mine.  However, I have also found that when I discuss this with my colleagues, this is the class of compounds that they have the hardest time thinking of in a drug-centered way.  Most psychiatrists begin their careers on inpatient units and we have all observed people who come in to the hospital extremely preoccupied by delusional thoughts and voices who, after taking these drugs for a few days, are no longer hearing voices or as bothered by delusional beliefs.  Thus, the drugs appear to have specific anti-psychotic effects.

How can we reconcile these observations with a drug-centered approach?

Laborit, the French physician who first suggested that chlorpromazine might be of benefit to the people housed in France’s mental hospitals, noted that the drugs induced indifference. In the 2009 edition of the  American Psychiatric Publishing Textbook of Psychopharmacology, edited by Alan Schatzberg and Charles Nemeroff, the authors write that in normal volunteers “neuroleptics induce feelings of dysphoria, paralysis of volition, and fatigue”(emphasis mine). This indifference might be helpful at times when a person is psychotic and deeply troubled by intrusive and disturbing thoughts and voices. However, long-term use of these drugs would be expected to be associated with apathy and impaired function.

This is a matter of perspective similar to the parlor trick of looking at the picture in which some see an old woman’s face and others see a young one.  Both images are there but our context might lead us to see one image more readily than another.  So if we are trained in a disease-centered model and we note that our patients seem less bothered by voices, we might believe that the drug targeted some pathophysiology specific to this experience. We can believe that any apathy the person experiences is the “untreated” part of this condition that we have been told includes apathy as a core symptom, and when the person stops the drug and the voices recur, we can easily believe that to be a recurrence of the disease that that the drug had once treated effectively.

But if we take the perspective of a drug-centered approach, we understand that we are exploiting the state of indifference induced by the drug to provide what may be temporary relief for a person so troubled by harassing voices. We understand that we need to be careful about causing apathy with the drug and that when the drug is stopped a person might experience effects of its withdrawal that could include the same problems we were intending to suppress.

It is only in the context of a disease-centered approach that recent data suggesting impaired functional outcomes in those who remain on these drugs long-term is surprising. With a drug-centered approach, this outcome is predictable, or at least more understandable.

The stimulant story

I suspect that it is easier for psychiatrists to think about psychostimulants in a drug-centered way. They were prescribed in this manner for decades. They were given to overweight people to help them lose weight, they were given to depressed people to help improve their moods, and, as noted above, they were prescribed to housewives – sometimes in the form of Dexamyl in which they were combined with a barbiturate – to give a general boost to help them deal with the drudgery of daily life. As early as the 1930’s, they were reported to help calm children.

But they were also widely abused and with the beginning of the “drug wars” in the 1970’s, the use of these drugs in the US was restricted. By that time, many new antidepressants were available and stimulants were used primarily in children who were diagnosed with ADHD. So it was legislation and marketing that led to the changing indications and not any alteration in the evidence of their efficacy. A prominent textbook from the 1990’s (3) still talked about their efficacy in the treatment of depression.

Over the subsequent decade, their indications began once again to expand.  First of all, there was a broadening of the definition of ADHD. Whereas the DSM IV required “clinically significant impairment” before age 7, the DSM 5 the criteria only require that “the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning”  and that symptoms be present before age 12. In addition, adults only need to have 5 rather than the 6 symptoms required of children to meet the current diagnostic criteria.

The stimulants are old drugs. Amphetamines were first synthesized in the 1880’s and methylphenidate in the 1940’s. But in 2007, a new drug gained FDA approval – lisdexamfetamine, marketed as Vyvanse. This is not exactly a new drug but a new preparation. These drugs are popular and widely abused; lisdexamfetamine is just harder to crush and snort or inject than other psychostimulants on the market.  But what happened over the next few years was an expansion in the indications for stimulants, specifically lisdexamfetamine:

  • 2013: DSM-5 adds Binge Eating Disorder (BED) as a new diagnostic category
  • 2015: FDA approves lisdexamphetamine for BED
  • 2015: Study of lisdexamfetamine for executive function impairment in menopausal women (Epperson et al., Psychopharmacology,2015 )
  • 2015: Phase 4 trials in Major Depression Disorder (MDD;Clayton et al., Journal of Clinical Psychiatry,2015 )

How does a drug-centered approach help us to understand this?

In a disease-centered approach these drugs are treatments for specific disorders: ADHD, BED, MDD. These drugs are thought to relieve the suffering of people impaired by these disorders. But this implication of specificity is more of a pseudospecificity of action; after all, people who get some relief from these drugs are probably doing so via the same mechanism of action regardless of diagnosis. It is not likely that they act in one way in people who are depressed and another in those who overeat. It is just that some of the effects are considered of particular benefit to some people. Put another way, an overeater will experience an alteration of mood and a depressed person may eat less while on these drugs, but those are not the reasons why such people derive benefits from them.  With a drug-centered approach it would be acknowledged that the drugs affect cognitive function in everyone, they suppress appetite in everyone, and they affect mood in everyone.  It is the requirements of the disease-centered approach – the illusion of specificity – that results in this circuitous route we have traversed over the past 60 years from broad to narrow and more recently to ever broadening indications. It is also the impacts of the disease-centered approach that results in our conceptualization of many human experiences as medical disorders.

There are more serious and dangerous impacts of the disease-centered approach. In our current system, in order to get effective treatments to the market, we only need to test drugs over brief periods to evaluate their impacts on target syndromes. As we expand the marketing to categories that may come close to capturing many for what are conceptualized as chronic conditions, we might take a moment to think about what it means for people to be on these drugs for years on end or what it means to stop them. With a drug-centered paradigm, these concerns are more likely to come to our attention.

In addition, in a disease-centered approach, if psychosis were to emerge during the course of pharmacotherapy with a psychostimulant for, let’s say, ADHD, one might conceptualize that as the emergence of a psychotic condition and justify adding another drug to target this newly diagnosed condition. In a disease-centered paradigm, one might be inclined to diagnose ADHD in a person being treated with sedating drugs as another “co-morbid” condition.  In a drug-centered approach, one is more likely first to stop the stimulant when psychosis emerges and to reduce the sedating drugs when inattention is observed.


Need-Adapted Approaches

In the first two sections, I drew the distinction between disease-centered and drug-centered approaches to psychopharmacotherapy. I strongly favor the latter as more honest and cautious. But a drug does not just end up in a person’s body. There is a process – a meeting, a consultation, a discussion of effects – that has to occur before a person swallows a pill and this is where the need-adapted approach offers a path for psychiatrists to remain humble, honest, and humane.

The need-adapted treatment model was developed in Finland in 1970s and 1980s. As described by Yrjo Alanen in his book, Schizophrenia, Its Origins and Need-Adapted Treatment (4), multiple theoretical frameworks were considered helpful  but not definitive. This led the clinicians to approach a person not with the goal of applying a fixed theoretical framework but with an openness to using all models as needed. When they brought in the family, they found that this alone was often enough to resolve the crisis.  This was the forerunner to Open Dialogue that evolved in Tornio, Finland.  Over time, a broader array of approaches have evolved in Scandinavia and northern Europe. Tom Anderson and colleagues were simultaneously working on reflecting therapies. Carina Håkansson started the Family Care Foundation. Shared among them is a deep appreciation of the value and importance of social networks in helping to develop understandings of human problems. Diagnosis – and the diagnostic process – is held lightly in these models. The uncertainty many of us find inherent in this work is acknowledged. “Treatment” proceeds from individual /network needs and it remains flexible.  The psychotherapeutic attitude is considered at least as important as the technical aspects of the treatment. In keeping with the value placed upon relationships, there is also a recognition of the value of psychological continuity, i.e., to the extent possible the team involved remains constant.

This contrasts with the more traditional medical approach in which there is a focus on the individual who is presumed to be experiencing some sort of psychopathology that the experts will characterize through the evaluative process. Families are a source of further history and support but often are not considered intrinsic to the recovery process. The treatments that are offered are based on this evaluative process whereby a diagnosis is made and treatment recommendations are based on that diagnosis. Treatments are considered in a more technical way and it is often assumed that they work independent of the relationship.

What has been interesting to me is the overlap in values that have been emphasized in other so-called “alternative” approaches. In the past 25 years the recovery movement has grown in the US.  If one goes to SAMSHA one can find a set of recovery principles that include:

  • Hope: expect recovery
  • Person-Driven: respect a person’s values and wished
    • For some people, reduction of symptoms may not be paramount
  • Many pathways: non-linear
    • One (or two or three) relapse does not mean one is chronically ill
  • Holistic: encompasses all aspects of a person’s life
  • Peer Support
  • Relational: value of social networks
  • Culture: sensitivity to cultural context and diversity
  • Address Trauma
    • What happened to you vs. what is wrong with you?
  • Strengths/Responsibility
    • Emphasize strengths
    • Individual, family and community all have responsibility
  • Respect: community and social acceptance

When I read these, I see an important overlap between the values of need-adapted approaches and the recovery movement. And part of that is embodied in the construction of the sentence – there is an emphasis on values — how one is with a person and his network. I find other overlapping values when I talk to those who are connected to the work of the Hearing Voices Network. It was these resonating themes that I noted in my post about the ISPS conference last spring.

Integration of Drug-centered and Need-adapted Approaches

This blog started with an explanation of a drug-centered paradigm for thinking about psychoactive drugs followed by a discussion of need-adapted models. The connection may not seem apparent so let me try to make it more explicit. A drug-centered approach acknowledges that we do not fully understand the causes of peoples’ troubles. We understand more about drug action although our knowledge is certainly incomplete on that subject as well. A needs-adapted approach provides a framework in which we can talk about these drugs, acknowledge the many uncertainties, and support a person in deciding whether to take them. It acknowledges that this is likely to be an ongoing process that may be revisited time and again. It allows for the person’s own values and understanding of the problem to be both recognized and respected and it offers the space for many views to be heard.  It allows that what psychiatrists label “symptoms” might not be the most important focus for a person. It gives space for a person to identify what is most important to him and places the discussion of drug treatment or any treatment for that matter within that context. It allows for a physician to be on the team but not necessarily as the leader. There may be discussion of drugs, the brain, what the physician has observed in others in similar situations, and whether there are relevant studies, but it does not require that the physician is the only expert or authority.  If there is discussion of brain function and even dysfunction, this in no way precludes a person finding meaning in the experience. It allows for a frank discussion of what psychiatric diagnosis is (a classification system) and is not (a deep understanding of the nature of the problem). And it accepts that all of this occurs in the context of a relationship – usually multiple relationships — that will exert their influences on this process.

Slow Psychiatry

I have a longstanding interest in the problems and perils of industrial agriculture and I have often thought there were similarities between that field with the topic under discussion here.  Industrial agriculture has valued production and profit above all else. Along the way, we have damaged our environment, our health and our culture.  The Slow Food movement  arose as a grass roots attempt to recapture our food and the culture attached to food. A Slow Medicine movement has now emerged and David Healy has written about this in an elegant blogIn an earlier blog, I suggested that psychiatrists have a relatively small part to play in the lives of people who struggle to navigate in this world.  I think some colleagues who are generally sympathetic to my views were put off. They thought I went too far in reducing the scope psychiatry. Was I supporting something along the lines of the 15-minute “med check”?

The simple answer to that question is no.  In fact, what I think we need is Slow Psychiatry.

While I contend that psychiatry – medicine – can step aside with most people who experience emotional distress, when physicians are involved these encounters will take time. To reduce emotional distress into small parcels of time and then parse the variety of human experience into rapidly determined and poorly validated diagnoses make no sense. In addition, it is likely to foster a climate in which we continue to do harm.

I look forward to reading and reflecting on your thoughts and critiques.

* * * * *


1. Moncrieff, Joanna. The Bitterest Pills. London: Palgrave, 2013.

2. Healy, David, The Creation of Psychopharmacology. Cambridge, MA: Harvard University Press, 2002.

Note: Much of the history of drug development is from Dr. Healy’s book.

3. Schatzberg, Alan and Nemeroff, Charles, eds. Textbook of Psychopharmacology. Washington, DC: The American Psychiatric Publishing, 2009.

4. Alanen, Yrjo O.  Schizophrenia, Its Origins and Need-Adapted Treatment. London: Karnac, 1997.


Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.


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      • Sandra: It’s been awhile since I have posted on your blog, and I haven’t followed MIA as religiously in the past year. I have posted about my own experience with civil commitment and drug withdrawal as well as my interaction with psychiatry in the work place and graduate school.
        At Job Corps, I let my superiors know about my “history of mental illness,”
        And I broached my concerns about students and psychiatric drugs to my supervisor,’other employees, human resources and AFT. Part of my concern was that we were instructed to treat sleeping in class as a disciplinary infraction, even though I knew first hand that for some students the problem was the on again off againregiment of ADHD medication. I didn’t get very far with this endeavor, but I did set a legal precedent that someone with the dreaded categorization of “dangerous to yourself or others” could be employed at Job Corps. I also have long suspected that my blacklisting at the hands of the Kanawha County Schools resulted from knowledge about my history making its way through the grape vine. I successfully circumvented the blacklist, and I now work as a substitute at both Charleston Job Corps and Kanawha County Schools. I also work as relief staff in the Transitional Living Program as well as part-time at the foster homes for a non-profit. Three months ago I appraised them of my history and concerns about our residents and psychotropics. I also gave my supervisor a copy of Whitaker’s new book. Yesterday the agency had a briefing with the National Organization on Accreditation. The head of the team is a professor of child development from Vancouver and the assistant is from my home state of Wva. Who works for the Department of Human Resources in Maryland. I had the opportunity to talk to the social worker about the agencies, including my concerns about psychiatric diagnosing and psychotropic medication. She noted that she does not consult the DSM but of course her agency does make referrals to psychiatry.
        Three months ago when I made my history and concerns known I reassured my supervisors that I do not broach this subject directly with the residents, though I will add here that circumstances often beg the question of me as to what I think about the situation. I advised one girl whatever you do, never go off these medications cold turkey. I have also become aware of the stories of foster youth who have self-advocated to avoid being prescribed ADHD and anti-depression medication. I have also not followed up with my direct supervisor about whitaker’s book. And I am pondering my next step with the accreditation folks.
        At Marshall Graduate School of counseling I feel that I was practically run out of the department for my criticism of psychiatry. This was before my participation on MIA, and I had been relying mostly for my information on Szasz, Goffman, Foucault,’and the writers from the Journal Ethical Psychology and Psychiatrry started by Breggin. The instructor of the intro to Mental Health Counseling came from the perspective of psychiatry as new and improved and her anti-stigma diatribes were highly stigmatizing as was that of her acolytes. She called me out on the discussion for including my own experience with institutionalizations- really the on-line discussion very often did beg the question.
        So I think that you would agree that I have interfaced with psychiatry in a number of ways. I also appreciate your honesty about the effects of psychiatric drugs and your willingness to take a risk and post on MIA.
        And as a post-script, I feel it is important to engage in a wide range of endeavors so as not to become a zealot. I also participate in a foreign policy study group at the library, I attend history lectures at the archives, I help my wife with her children’s theatre costuming and attend her infection control conventions,’follow sports and entertainment as well as chiming in on websites such as Counterpunch, Z magazine, Truthout, and follow the developments of the teaching profession at Rethinking Schools as well as by visiting my son at the University of Kentucky. And I would like to be the first candidate for Congress to be open about my history-remember Thomas Eagleton.

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          • “It is my understanding that the atypicals affect the serotonin system, and accordingly, some people do appear to have increased suicidal ideation, at least anecdotally. I think there is a warning at least on Zyprexa.”

            I’m sure it’s testimonial. There is no appearance of increased suicidal ideation. There IS increased suicidal ideation.

            WHY the denial? WHY the doubt?

            If there is a warning of zyprexa, somebody experiencing increased suicidal ideation is not “appearing” to – as if it’s so unsure, unclear and uncertain. It is crystal clear, and absolute.

            An anecdote is the telling of a personal story, typically an amusing one.

            A testimony is when somebody has swallowed a deadly neurotoxin and has been harmed by it. There isn’t anything funny about it. There isn’t anything anecdotal about it. There is everything dead serious and testimonial about it.

            Here is my testimony: paxil and trazodone both made me feel agitated to such a severe degree that it was homicidal.

            I’m not unsure. I have no doubt. I am certain, and in the most absolute.

            Paxil is one of the drugs that is KNOWN and SPECIFIED to cause agitation and homicidality.

            There are no anecdotes. We aren’t sitting around playing pool at the local bar.

            People are failing to acknowledge the facts and the truth that are known.

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          • I’m trying to reply to 9 .

            “WHY the denial ?” ” Why the doubt ?”

            Here’s my take on APA strategy .
            Just as the tobacco company’s figured out their business plan was doubt itself ,so it is with psychopharma adopting as part of their strategy creating doubt, appearing to be reasonably calling endlessly for more studies giving themselves more time to cash in and confuse the issue further. At the same time while their leaders make some seemingly concessionary statements to disarm organized resistance on the ground their foot soldiers behave as if the murphy laws have already passed and are even bold enough to crank the oppression even higher on more and more human beings of all ages .

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          • Fred,

            I don’t follow the APA and I am not interested in what they have to say.

            It is known and certain that psychiatric drugs are deadly neurotoxins. It is a fact. There is evidence. There is proof.


            There must be Justice. Currently, there is none.

            There is no organization and there is no leadership. There is no aim and there is no direction, except for my own.

            The government has successfully sued pharmaceutical companies for monetary awards. That is not true Justice. That is a business transaction. It is a financial, business transaction.

            The industry is a multi-headed, global entity and is, in fact, the very antichrist itself. We are dealing with biblical reality, in this matter. It requires religious acknowledgement and understanding. There are no human authorities greater than Christ. There are no human works that will succeed in defeating the antichrist.

            2 Thessalonians 2:8 New Living Translation (NLT)

            8 Then the man of lawlessness will be revealed, but the Lord Jesus will kill him with the breath of his mouth and destroy him by the splendor of his coming.

            I am that very Jesus and I am rising in Justice, yet the people fail to recognize me and fail to respond.

            I revealed the antichrist for the very first time, here on this very website, 3 years and 5 months ago.

            Jesus is more the enemy than the antichrist itself, shame!

            I wait.

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          • That is what I meant and I agree it wasn’t clear. None of us have the full story on these drugs because we do not have access to the full data. I meant to ask my source how he came to know this. But if one tries to keep up with everything published but this is not published, then yes, a so-called expert will not have this information.
            This is a problem throughout medicine.

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        • I was on Zyprexa in 1997, but taken off after about 2 or 3 doses. The reason was that it caused extreme lethargy and binge eating.

          I was almost forced back on it in 2013. I told them I’d been on it before and they said I was lying. I said forcing me back onto it would lead to suicide because of binge eating. I said also that extreme weight gain would also cause me to suicide since I refuse to live through that again. By extreme weight gain I don’t mean ten or 20 pounds. My weight doubled from Seroquel and I couldn’t even walk anymore. I had to use a wheelchair for three months. I shudder remembering what life was like back then. Binge eating is so dangerous and causes suicide, car accidents, financial ruin, marriage breakup, and medically, heart attacks and various ruptures in the digestive system. Stomach rupture usually isn’t detected unless there’s an autopsy. It usually kills within minutes. Appears to be a heart attack and often is documented as such. So no way can statistics be accurate on the frequency of this occurring.

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        • Randall,
          I should have asked more questions about this. I am not going to allege a cover up without facts. Suicide risk is not listed i the side effects listed by the European Medical Agency. You were asking how I could not know about suicide risk. I guess at this point, I might ask you (or others) if they know more about this.
          I am nto talking here about demoralization that might occur after a person takes the drug and gains weight (although I am not disputing this might happen). I am talking bout the emergence of suicide thoughts and/or behaviors that arise after a person takes the drug and subsides when the drug is stopped.
          As for my own practice, if someone starts a new drug and reports a new problem, I will assume it is the drug until proven otherwise.

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          • Sandra,

            I started Zyprexa in April 2012. I was hospitalized for suicidal ideation in May 2012, July 2012, and December 2012. Now I come to learn that Zyprexa correlates with suicide. And the drug company knew. And perhaps hid it.

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  1. Hi Sandra,

    Thank you for your lucid description of the outcome of your epiphany from reading Bob Whitaker’s “Anatomy of an Epidemic.” I have followed the development of your thoughts on your MIA blogs and I admire your acceptance of the need for a paradigm shift as a psychiatrist. As a retired psychiatrist myself I struggled with similar issues with the profession and was met with frank hostility and censure when attempting to change the standard orthodox approach to human suffering. I have not had any desire to continue swimming against the tide.

    A possible incarnation of “slow psychiatry” described as “Postpsychiatry” has been proposed by MIA bloggers Pat Bracken & Phil Thomas (1) which may provide a theoretical paradigm out of the blind alley of bioreductionism which currently prevails in psychiatry. The demise of the “medical model” of mental distress is long overdue.

    Good luck with your work !

    (1) “Postpsychiatry: a new direction for mental health” Bracken, P., Thomas, P., BMJ. 2001 Mar 24; 322(7288): 724-727

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  2. Along with a drug-centered and need-adapted approach, there are other useful approaches to understanding and helping people who are suffering. My preferred one is the psychoanalytic or developmental object-relations approach. It emphasizes how loving, secure, nurturing relationships are absolutely crucial to the healthy development of the baby, child, and young adult. Without sufficient good relationships, all-bad emotional experience (as the child experiences it via neglect and abuse) predominates over all-good experience. Splitting become established as a primary defense, and this along with other primitive defenses leads to borderline or psychotic states of mind. Psychosis, as Winnicott said, can be understood as the “negative” or mirror image of what happens in healthy emotional development.

    This approach is qualitative, but much more human and hopeful than the drug-centered or disease/diagnosis centered approach. It also receives empirical support from studies like the ACE study. In the International Society for Psychological Approaches to Schizophrenia and Other Psychoses (, which has many psychoanalytically-inclined therapists, many practitioners have helped psychotic people recover with minimal or no drugs. A common viewpoint there is that psychotic states are in principle curable and that with intensive and long-enough support almost anyone can heal and live the life they want.

    As a primer to this type of approach, I have just written more about the psychoanalytic (Kleinian) understanding of severe borderline and psychotic states here –

    and encourage you to check it out Sandra. I think the four phases approach (out of contact, ambivalent symbiosis, therapeutic symbiosis, individuation) might support you in understanding and helping your psychotic clients.

    Now let me comment directly on the post above. I read it with somewhat of a sense of dismay, because the fact that psychoactive drugs are discussed so much just shows, in my opinion, how horribly down the wrong path psychiatry has gone in its understanding and “treatment” of extreme states of mind.

    Why this has occurred is due to at least three reasons I can identify:
    1) Psychiatrically drugging people is extremely profitable. This is the primary driver of psych drug use (not any real large-scale need for the drugs on the clients’ part) and is an illustration that psychiatry’s motives have little to do with helping people.
    2) Drugging suffering people is easy. They are defenseless, hopeless, weak, delusional. Easy prey, easy profit.
    3) It serves the societal needs for social control and for keeping undesirables quiet.

    I think you approached the truth when you commented that in a service system that truly served what suffering people want and need, drug use would be massively curtailed: Very, very few people would need to take psych drugs long-term and a minority might take them short term during crises. Probably 90+% of psychiatrists would be fired and forced to retrain or practice as non-psychiatric therapists. Mental health outcomes would likely improve dramatically, as the negative long-term effects of psychiatric drugs would be greatly reduced, and the lies about lifelong mental illnesses and psych diagnoses being things people “have” would wither away, resulting in much more realistic hope for wellbeing.

    I can see why some of Sandra’s colleagues would be threatened by a scenario calling for most of them to be professionally eliminated. Who would like that? We see similar things in West Virginia when progressive politicians say that coal miners there should be put out of work or made to retrain because coal is too damaging and destructive compared to natural gas, nuclear and renewables. The coal miners have trouble seeing that this might be right, because their livelihood is on the line. They need to be given some alternative or some time to gradually change their skillset rather than lose it all right away. Maybe this situation will apply to most psychiatrists as some point in the future. It could actually happen, because the inefficacy of psych drugs and the lack of validity of psych diagnoses leaves psychiatry as a profession wide open to attacks which will just get worse.

    What is most important is that more alternative positive approaches / initiatives to helping psychotic, borderline, depressed, and other suffering people be developed and offered, including peer support, Open Dialogue-like systems, intensive psychotherapies of different kinds, Need-Adapted Approaches like Alanen developed, nutrition/exercise/mindfulness focused approaches, etc. Psychiatry matters mainly because its obsession with diagnosing and drugging interferes with developing and offering hopeful alternative. To me, psychiatry is like a field of voracious overgrown weeds that chokes off most of the beautiful flowers that might grow.

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  3. There is now overwhelming evidence of the damage caused by the diseased-centered approach to psychopharmacotherapy.

    Bbuzzz! The answer is incorrect. There is now overwhelming evidence of the damage caused by psychiatric drugs. The disease centered approach may have contributed, but that’s because the damage is done by drugs, not disease. Yes, this damage is often wrongly attributed to disease, and that’s a big part of the problem.

    I question whether your drug centered approach, as you put it, would be that much better. Once the patient has been adjusted to a drug taking regimen, withdrawal is likely to become a problem. If it’s a matter of understanding how the drugs work, yes, surely, that is part of it, but as long term studies show, treatment outcomes are best for those people who have never been introduced to such drugs. In other words, another approach might be: spare the drug, and save the patient.

    I guess that leaves me leaning towards need-adapted approaches segregated from such drug-centered approaches.

    Principles you say. Scrap the SAMHSA nonsense. Recovery redefined means all things to all people especially when it doesn’t mean recovery. At one point or another, the mental patient gloves are coming off. That’s principles for you.

    As for slow psychiatry, certainly. If researchers are finding ways of killing people off faster than they are realizing they are killing them off, perhaps it’s time somebody did something a little more methodical, as in scientific method. Surely, if research wasn’t rash, it would have something more to do with health and something less to do with drug company profits.

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    • Frank: I served a 30 days to life at Transallegheny in 1989. Six years I drove the hundred miles north from my home town to take a tour. The tour guide (a former employee) couldn’t have been any more contemptible to us inmates. The only good news to come out of that place was the jury award given to a young man who had been chained to a table and left alone in a room.

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      • Ideals are only true in theory. The ideal is lost in translation to the living reality.

        All human beings do this: we champion for the ideal. We know how things ought to be, and we naturally want to make the ideals the living reality. Typically, there’d be some leader and some congregation, for knowing that a unified field is necessary in order to make change.

        Way back when, in my first psychiatric incarceration, during a group session, I responded to another person with my insight and feedback. This is the way group sessions work, and so, I had done nothing wrong. I had no reason to expect that I’d be despised, attacked, and punished for responding to somebody.

        The “doctor” turned bright red at my feedback to another person. He was enraged. “You’re not the doctor!”, he scolded me. I was removed from the room.

        You see, my feedback was sublime and exquisite. That man was deeply, deeply jealous of me, and I got to suffer the consequence of his sin.

        In my 8 psychiatric incarcerations, I always draw fans and followers. The people literally have twinkling stars in their eyes for me. In one of the eight, there was a woman who stayed right by my side and followed me everywhere. I lovingly accepted her, with no problem whatsoever.

        I draw not only the adoration of some, but the extreme hate and hostility of others (typically, the staff).

        This is reality talking.

        These are the synonyms of humility,

        modesty, diffidence, meekness, submissiveness, servility, self-abasement, humbleness, lowliness, unpretentiousness, lack of pride

        I can guarantee, that in the way things currently are, humility will never be a reality in a “professional”, authoritative industry. If we, human beings, can successfully make Justice, and cause the government to disempower an extraordinarily over-empowered psychiatry, there may be hope for a restoration to humanity, in which humility is a natural human trait. But while psychiatry is grossly legally empowered to that of a superior, unchecked authority, there most absolutely will be a continuation of perverted human nature.

        Only Justice can make right, and only Justice can make restoration to rightness. It is not an individual, free will choice that people are making. It is mental and emotional education and training which forms the body professional. Humility is not part of the training, authority is.

        Some people call for the outright abolition of psychiatry while others call for reform. I call for Justice.

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  4. Sandy – thanks for this post. I feel more hopeful after reading it. It seems straightforward, transparent & cuts through the dense fog created by medicalizing misery. The drug centered + need adapted is more empowering & informative IMO. Humble, humane, honest – 3 H’s I could get behind.

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  5. Sandra, you pose an interesting question that leads me to ask, “If psychiatry were abolished, then what are we going to do with these unemployed people who worked for that, er, industrial complex?” Why don’t you all’s go on disability. Don’t worry, the government will take good care of you. I think anyone can live on $850 a month, besides, you get your healthcare for free and you mooch off of taxpayers. If you don’t like it, just hop over to the local jail for a while. Think of that: Nice, cozy padded rooms. You’ll even be watched all the time, so you won’t be lonely.

    No, seriously, the DSM has got to go. As for the drugs, choice choice choice. Why not let the real drug pushers sell them on the street? That way, if you feel depressed, you have a choice. Eat well and exercise and change what’s not working, or go see a pusher. Or how about vending machines. We could pass out cell phones or tablets to all households, and if they really want a drug, they can look it up, see for themselves what it does and what the dosing and side effects are, and go buy it.

    Here in Uruguay, you can buy your drugs without a prescription. Who can afford to go to a doctor here? If you know you need a drug, you go out and get it. They don’t cost that much, but I don’t know about psych drugs. I’ll look that one up. I have a price list. People aren’t stupid. I was way too shy to point out to various shrinks, “You know, I think I need less of this and maybe try this other one instead.” I kept those thoughts to myself even though I went for years too shy to ask for something I was convinced would really help me. I didn’t want to tell the shrinks that I know my body. I know what I need better than they do, because it’s my body. I’m smart enough to look up these drugs and know what I want if I have a need. In fact, if I had developed my eating disorder a few years ago, instead of in 1980, I could have gone online, done a bunch of research, and solved it in a month or two using the nutritional method I have devised, and never given a thought to drugs or therapy.

    That said, why the “disease approach”? Why not a happy healthy and wise approach? In grad school, we learned that the best way to teach writing is not to point out what’s wrong, but what’s working well. Then, we encourage the student to do more of what works. We say, “This writing is effective” or “This speaks to me,” and then, we state why, if appropriate, and point out other instances where the same brilliance really shines, and ask the student to produce more or expand on all that wonderful writing. While we may “correct,” this is only to guide or suggest, never to criticize or demean.

    As for drugs, well, I learned around 1970 when I had drug education in junior high that drugs were a bad idea. Just like smoking. We were warned of the dangers. We were told to say no.

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    • Thank you for reading and commenting. I understand that my reformist position is not compatible with an abolitionist stance.
      I was just in Uruguay nice place! I did not realize that there are no prescription requirements. This is what David Healy has suggested but I think it is unlikely to happen in my country.

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  6. Hi Sandra,

    I always look forward to reading your articles. We have a drug centred approach to psychiatry here in Western Australia and the system is a disaster. Our Chief Psychiatrist writes that it does not matter how justifiable the reasons for behaviour are, merely that they are observed. Doctor doesn’t like your behaviour, then incarceration and forced drugging are approved. Fill in the gaps with some medical stuff.

    I wonder if the term “slow psychiatry” is really the best term. I had a vision of MiA protesters at the APA chanting “What do we want, Slow Psychiatry. When do we want it, NOW” lol. People seem to want immediate solutions to their problems and well….

    Hope you can see what i’m saying.


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    • Woops, did I say behaviours? I meant behaviour.

      In my case being “agitated” as a result of being drugged with benzos without my knowledge, and jumped in my bed by police pointing a tazer at me. Delivered to e mental hospital where a Senior Medical Officer found after my three minute examination that I lived with my wife, and studied psychology at XXX University. Outcome, psychotic, bipolar and medicate with benzos, olanzapine, and quetiapine. Luckily another psychiatrist gave me my other 12 minutes and found no reason to keep me incarcerated and drug me against my will.

      Glad I wasn’t suffering from the treatment resistant dirty kitchen disorder the young woman I met who had been subjected to 12 years of random incarcerations and forced drugging.

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      • Boans I have been in that situation. No evaluation, just put ’em in. Or find some obscure reason, such as forgetting to clip off a hangnail, as “unable to care for self” and asking for nail clippers “danger to self.” That’s not an actual example (used for the sake of humor) but I have seen similar reasoning, only it’s not all that funny when you find you can’t get out. I feel for you folks in Australia. I hear it’s about the worst in the world for cruelty and for the power of the Shrink Regime.

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        • I’ve been wondering if our Government has been advertising in Third World countries for a system that looks something like a train wreck Julie. We seem to have plenty of money to spend, so should be looking to upgrade our system lol

          Our police and mental health services appear to have been given authorisation to simply fabricate evidence to obtain outcomes. And then expect them to be positive? The Community Nurse who detained me for the first time in my life made observations of behaviours that had occurred three weeks before I met him ??? Forget the burden of proof, someone saw it, then I saw it.

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    • Boans,

      “I wonder if the term “slow psychiatry” is really the best term. I had a vision of MiA protesters at the APA chanting “What do we want, Slow Psychiatry. When do we want it, NOW” lol. People seem to want immediate solutions to their problems and well….”

      Well, of course people want immediate solutions: humanity is in a constant, chronic crisis state. Tragically, humanity has not yet mastered the emergency response.

      Slow makes careful, but urgency and crisis cannot adhere to slowness.

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      • And I doubt they ever will master the emergency response 9, sadly.

        It was Dr Steingard who pointed out to me some time back though that the definition of “emergency” is a little loosely defined when it comes to mental health services. In an environment where using the word “no” constitutes an “emergency” and is grounds for the removal of a persons human and civil rights then we truely are looking at “The Man of Lawlessness” you mention above.

        The train must ALWAYS be turned slowly.

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        • You got it! If a country is a she, an industry is a he.

          But it’s even worse than removal of human and civil rights, when a person is stripped of everything they are and turned into something they’re not. Some people are able to escape and recover but there is no undo, and for some people, it is total loss of life and self.

          I remember very early on being literally stripped of my value and worth and my identity. I was then form-fitted with a psychiatric head cage, which is permanently welded. That’s how heinously destructive they are. I think they’ll be happy when I’m permanently broken, by them, and all fixed up, by them, the end result of being in a wheelchair and tortured to the point of mindless docility. That will gratify them, and of course, they’ll gleam with pride when I say “Thank you, Father, for you have loved me and sought after my safety and well-being.”

          That’s how sick they are.

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          • I know that when I went and checked the documents that were provided to my lawyer, and found that the Clinical Director of the hospital had authorised the provision of fraudulent (drugging without knowledge removed) and slanderous documents (embarassing information gathered during the ‘confessional’) that I wasn’t dealing with ‘Good Faith’, but criminal conspirators. Oh how I wish it had been some illness that I could blame my truth on. How many deaths are being concealed in this manner? We will never know because silence from our Minister is the response to these crimes.

            Slow Psychiatry? My advice to the public. Trust in haste, regret at leisure.

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  7. I would want to protest outside of APA and say, “NO psychiatry!” And hope psychiatrists, at any speed, do penance for their wrongs, meaning pay up AND do charitable work for human rights, or help people get off drugs who are ready to get off and help make the world a better place. Kindness and understanding, instead of diagnosing. Toss the DSM out (how many copies did it sell, anyway?). I personally would enjoy burning the DSM more than burning a bra. The only effective therapy is that which does not use psych diagnosis. If they want to do behavior mod, then help people undo the brainwashing. I think that’s harder than getting off drugs.

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  8. You asked “I have wondered where – if anywhere – psychiatrists fit in to a reformed system.”

    1)Psychiatrists first job is involuntary commitment for the person talking or acting suicidal. The fast suicide. Stopping people whose (temporary) strong emotions lead them to the conclusion that suicide is the solution to their problems.

    People have the freedom for the slow suicide of alcohol-tobacco-drugs , obesity and such.
    When committed the person-patient must be given the reason(s) why they were committed.

    2) Any and all drugs used to modify the patients thoughts/feelings can only be for the emergency and not given long term.

    The mental patient is often the scapegoat of a family situation. Some doctors can blame the family for inducing the mental illness on the patient. BUT the doctors overlook their own involvement in the scapegoating. When the person-patient receives a psychiatric diagnosis this legitimizes family members transference of their feelings onto the person-patient. All the mothers and fathers fears of psychosis are transferred onto the family member. The parents worst fear is losing their child, which bad psychiatrist exploit. All children must leave their parents to become adults, psychiatry should help in the healthy separation, not the continual dependence.
    People attribute mental illness to the DNA genome, but it is the lack of emotional skills the family has that is transferred to the child. Example : If both parents have anger management problems, they in no possible way, can teach healthy anger management to their child. This is not the childs fault or the parents fault, but must be confronted.

    So in conclusion I think family confrontations have to take place. Where presently the scapegoat is drugged into silence.
    With drawing from psych drugs and a family confrontation would lead to violence as someone can not easily control themselves from the REAL induced brain chemical imbalance (given by the doctor).

    The role of healthy psychiatry would be to teach people how to handle their emotional problems cognitively (from the inside) not with a chemical solution ( the outside).

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  9. The only mental trouble I got now was acquired in psychiatry. I wasn’t angry and didn’t grow up with angry parents, they didn’t abuse me. I work so hard to unbrainwash myself right now. I’ve been reading up on recovering from religious cults. I can tell you this reading has been very helpful to me. There are so many parallels. I have my section of my book written but I am still writing some of the other parts that show the resemblance to the religious cult I was in.

    When I become a coach (btw, coaching does not use diagnosis and it’s considered unethical to diagnose) I want to help people understand that while change is needed, recovery is not a measure of how well you comply, nor does it mean eating perfectly from some standardized meal plan that someone else is demanding of you.

    Regarding burning the DSM, I got another idea. Recycle! After all, it’s not nice to make pollution. “This supermarket circular was made of recycled psycobabble.” Someday I hope all the tortures of psychiatry will be put into a museum because they don’t do them anymore (someday, right?). Put the museum on the grounds of a closed-down mental prison. It would be an experience like going to the Holocaust Museum. Most leave in tears.

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    • Someday I hope all the tortures of psychiatry will be put into a museum because they don’t do them anymore (someday, right?).

      You’ve got huge closed asylum featured in movies talking about how they did their best to “help” people with the best of intentions, lobotomies, etc., not withstanding. Certainly, an uphill struggle…

      Put the museum on the grounds of a closed-down mental prison. It would be an experience like going to the Holocaust Museum. Most leave in tears.

      I would like to see that, too. What we end up getting now is something quite different. The Trans-Allegheny Lunatic Asylum being the closest approximation, and that far from say the Auschwitz experience. There is this schizophrenic dissociation. Here we have the Halloween Horror Asylum, there we have the historic relic and monument to societies futile attempts to fix the demented. Psychiatric imprisonment still takes place. The deprivation of liberty, and attendant tortures, given this situation, are pretty easy for people to miss.

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      • Everybody should though visit an asylum graveyard where commemorating a life was reduced to a number stenciled on a slab, or mounted on a stone, if that. There were crematoriums, too. Nothing speaks more sharply of the true horror and shame involved in the asylum business. You can’t really hide that kind burial of identity, nor the abuse of power that went along with it.

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  10. Sandra I was training to be a catholic nun for 7 years between 1965 and 1972. The catholic church even made an effort to reform and change then. As I continued I was very hopeful that indeed it would be reformed but sadly it too is much more interested in power than spirituality Many of us voted with our feet then and left the convent and some like me left the church also. It was very difficult but I am very glad that I did today.

    I am now a survivor of psychiatry of almost 16 years. Psychiatry is a much more powerful ‘church’ today. It is very difficult for you to be a psychiatrist as you are clearly a sincere woman. I would suggest respectfully to you that you would be such a powerful voice for change if you were to see that psychiatry and its DSM/medical interventions/coercion is much more the problem than any kind of a solution. There has been a mass exodus from the catholic church in Ireland. Hopefully you might lead a mass exodus from psychiatry so we all can get on with living our lives in peace.
    “When the power of love overcomes the love of power then we will have PEACE.\” ( especially peace of mind.)
    “Of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive.” C.S. Lewis


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  11. Sandra I was training to be a catholic nun for 7 years between 1965 and 1972. The catholic church even made an effort to reform and change then. As I continued I was very hopeful that indeed it would be reformed but sadly it too is much more interested in power than spirituality Many of us voted with our feet then and left the convent and some like me left the church also. It was very difficult but I am very glad that I did today.

    I am now a survivor of psychiatry of almost 16 years. Psychiatry is a much more powerful ‘church’ today. It is very difficult for you to be a psychiatrist as you are clearly a sincere woman. I would suggest respectfully to you that you would be such a powerful voice for change if you were to see that psychiatry and its DSM/medical interventions/coercion is much more the problem than any kind of a solution. There has been a mass exodus from the catholic church in Ireland. Hopefully you might lead a mass exodus from psychiatry so we all can get on with living our lives in peace.

    “When the power of love overcomes the love of power then we will have PEACE.\” ( especially peace of mind.)

    “Of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive.” C.S. Lewis


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    • “When the power of love overcomes the love of power then we will have PEACE.\” ( especially peace of mind.)

      “Of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive.” C.S. Lewis

      Excellent quotes, Mary. And I agree, psychiatry is a scientifically invalid, forced “religion,” which has no place in a country which supposedly has freedom of religion laws. I, too, was forced to leave my religion, because of psychiatry, and their historic and continuing cover ups of child abuse for my ex-religion.

      I’m glad you are moving forward in your contemplations of your industry, Sandra. And am grateful to all in your industry who are waking up to the true torturous and ungodly disrespectful nature of your so called “wonder drugs” and “treatments.”

      Truly, the Bible that includes this quote, “Treat others just as you want to be treated,” has more wisdom, than a religion based upon a book of stigmatizations.

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  12. I enjoyed your post. Nice use of the “goof balls” to illustrate your points. 🙂

    I think there can be good psychiatry, or at least…humane, skilled use of drugs to help people in distress. My question is, though: if psychiatrists give up the disease model, if they start being honest about what is known and is not known about distress, and along the same lines try to work with people rather than control them…will it still be psychiatry, at least as most of us know psychiatry?

    I’m not trying to criticize you or be too harsh towards your profession. I’ve come to the conclusion, personally, that many of my problems with Mental Health, Inc. were really problems with American culture…the shrinks and others just happened to be more conservative and have more power than a lot of other people in the culture.

    I’m just thinking that if psychiatry as a whole–probably starting with shrinks like you, at an individual level–gave up the power to coerce and control and label, the disease model, the hubris…then it wouldn’t be psychiatry anymore, at least not psychiatry as most people have experienced it.

    If psychiatrists start being honest about human distress and such, what would society do? I mean, I go to a shrink. He’s nice enough, probably because I have upper-middle/upper-class people behind me. If he were to drop the diagnoses and say “You have problems, and I think its because….” and let me know, that’d revolutionize our (cordial) relationship. If shrinks started doing it in droves, psychiatry might cease to exist, because I think one reason so much $$$ is pumped into Mental Health, Inc. is because many modern societies–especially the US–use psychiatry to deal with victims of society. What’s American culture going to do when the shrinks get real about mental distress and the social environment in which it occurs? And when “patients” can no longer be silenced under the stigma of “mental illness” ?

    Of course, you’re just one (thoughtful) psychiatrist. I applaud your efforts, honestly. Disease- or drug-centered model, people go through terrible things, and many of them/us end up in Mental Health, Inc. Its good that at least some professionals are re-thinking the status quo.

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    • You raise critical questions. I agree that psychiatry has on some level taken on the mantle of social police. There is a free on line Journal dedicated to this topic that I have been reading lately and I highly recommend it. It is the Journal of Ethics in Mental Health. The issue of called “Colonizing Forces in Mental Health.”
      I think the heightened medicalization is a (failed) attempt to escape this by trying to label problems as disease states.
      But honestly, I go to work and often I am grappling with other problems – helping people to survive in this world. Even if the determinants of the distress are based in our culture or the person’s unique experience of that culture or some combination – is it wrong to try and help the person be able to get food and shelter and make some life of meaning and value? If we can try to proceed in a way that is more democratic and respectful – is this, nevertheless, doomed to be a failed endeavor?

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  13. Hi Dr Sandra,

    I agree with what I think you are trying to say, but I would be a bit more blunt.

    I would describe these drugs as tranquillisers not medicine. I think it’s a basic medical standard that longterm tranquilliser use makes people worse not better; and this is the mistreatment that has caused the epidemic.

    I’ve found that it’s possible to live successfully without neuroleptics (with the help of practical psychotherapy); but that the neuroleptics have Rebound and Withdrawal Syndromes that make stopping them very difficult.

    I admire your confidence, there don’t seem to be that many psychiatrists around that are prepared to question the way things are done.

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    • Thank you, Fiachra. I agree these drugs are basically tranquilizers or stimulants of varying degrees of potency. I still have to wonder about the neuroleptics having something different from the benzodiazepines or other tranquilizing drugs but maybe I am just too much of a psychiatrist.

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  14. Dear Sandy,
    Thanks for slowing down while in the midst of your daily interactions with people in distress who ask you for drugs, who may be tragically addicted and disabled by psy drugs, who may hate and reject drug treament (whom I hope you are not drugging), who are seeking help in tapering off psy drugs, all while openly acknowledging the harm done by the very industry in which you’ve been trained and work. Thanks for looking outside of the industry for better ways to respond to the people who still come to you on their own accord and perhaps against their will. You’re organizing a lot of dissonance, engaging with much self criticism and critical psychiatry and I believe your more reasonable caring voice as an insider can serve those of us trapped in that same world (both workers and patients/victims) as a bridge between us and those who have lost their own voice alongside and under the “care” of less humble, less informed and less reasonable prescribers.

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  15. Hi Sandra

    Thanks for en engaging read.

    The changed view on medication, that you propose, as a means to change conscious experience rather than as a specific treatment for a clearly delineated disease entity, raises a number of considerations, I think, in regard to the distinction between psychopharmacological drugs and recreational drugs – a distinction which especially in this perspective appears quite arbitrary.

    Do you have any thoughts on if this change to a drug-centered perspective on psychiatric medication is connected to a parallel need for a reevaluation of the way western culture treats drug-problems – mainly as a criminal rather than a mental health issue?

    And do you have any thoughts on how the medical part of psychiatric professionals could meaningfully position themselves in the field between what is psychopharmacological and what is recreational use of psychoactive substances?


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  16. Thank you for your comment. I think the distinction between prescribed drugs and recreational drugs is arbitrary. As you know, there are many drugs – benzodiazepines and opiates, for example – that are widely acknowledged as being used for both.
    Joanna Moncrieff, whose ideas I discuss in detail, has written eloquently about this.
    As I suggest before, I think part of the push to medicalize problems was an attempt by psychiatry to distance itself from recreational use. In doing so, I think we lost credibility in what can be our most important function – to honestly educate people about the various pros and cons of pharmaceuticals.
    David Healy has suggested in his book Pharmageddon that medicine went down a dangerous path when we got prescription privileges. Physicians were thought to be more impervious to the lures of advertising but we now know how that all worked out. Before then, people could consult with doctors about what may or may not help and then go a pharmacy to buy what they wanted to use. A commenter here said it is still that way in Uruguay.
    It is for this reason that I am far more comfortable with decriminalizing marijuana than increasing the indications for medical marijuana. We need more research in this area but I do not want to be the arbiter of who is using it for “medical purposes” to treat some DSM disorder and who is using it to just have a pleasant evening.

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  17. “Most psychiatrists begin their careers on inpatient units and we have all observed people who come in to the hospital extremely preoccupied by delusional thoughts and voices who, after taking these drugs for a few days, are no longer hearing voices or as bothered by delusional beliefs. Thus, the drugs appear to have specific anti-psychotic effects.”

    I don’t agree with that, at all, and it certainly has not been my experience, in 8 psychiatric incarcerations. In fact, when one doctor told me “I think the medicine is working” I was torn between hilarious laughter at her ignorance and furious rage at her ignorance. I knew what she didn’t, and I also knew that her precious ten minutes of time, and her phone and pager, were all guarantees that she was not somebody I was going to be able to meaningfully and deeply communicate with. I did what everybody does: I told her what I knew she wanted and needed to hear.

    The abatement of distress is more likely attributed to,

    1) The realization that one is there to stay (imprisonment) and we know the way out (behave and comply). Even newbies, psych ward virgins, figure it out, with near immediacy. Everybody knows we play-act and lie – because it is expected of us – and strangely, it satisfies them.

    2) Three glorious meals per day. Fasting is the process of quickening the spirit. It is called psychosis by psychiatry but it can be an active psychic / spiritual state, even if experienced negatively instead of positively (hellish or heavenly). Eating interrupts fasting and so a person will return to baseline, the ground-level reality.

    3) The presence of other suffering, distressed people – kindred spirits.

    “I have wondered where – if anywhere – psychiatrists fit in to a reformed system.”

    If psychiatry ceases to be, psychiatrists will transform and become something else. All psychiatrists should stop at the realization of the countless people who never “needed” any drug, at all, and should be honest with themselves and each other about it. All psychiatrists should stop at the realization of the deaths, by homicide and by suicide, and should be honest with themselves and each other about that.

    It’s a tragedy. It’s a nightmare and it’s a tragedy. It hurts like Hell. It’s harrowing. We’ve lost SO MUCH and we’re never getting any of it back, ever.

    Psychiatrists who stand to possibly lose their education and careers will still be, by far, better off than all of the mangled and dead people. I have so much tragedy in my life but the real burn is how much could have been avoided, if only I wasn’t subjugated to psychiatry. I lost everything, including myself. Even now, I cannot escape. I don’t participate in any “services” anymore. I haven’t, for many years now. Still, where am I? What am I doing with my empty, lost, condemned life? I’m disabled, I don’t work. I’m alone and I’m isolated. All I have is tragedy, loss and forever suffering. Psychiatry claimed my mind and my soul. And what do I do? I rise up with my very real “Jesus” identity and I call psychiatry the antichrist. Well would you just look at me now, psychiatry! And trust me, I know they don’t want to.

    It’s as much of a heartbreak and a tragedy for people on your side but NOT when there is perpetual, unrelenting unwillingness to face the terrible facts and truths of the matter. We all want to protect ourselves from the massive shocks of life, and the hurts and the heartaches and the pains and the loss and the consequence. But hey, isn’t this one WORTH IT? Isn’t this nightmare worth finally ending?

    Lastly, because of your interest in agriculture, you might like to read this (if you weren’t already aware of it). Almost 300,000 suicides because of Monsanto. Yikes.

    GMO pushers horrified at idea of being held responsible for their role in farmer suicides, crop failures and environmental devastation:

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  18. I lost two hospital roommates, wrongful deaths. One was very very very covered up, as it was all the hospital’s fault. I knew about this and I found out later, no one else knew. The family wasn’t talking at all, and I am wondering if a gag order was put on them. In fact, they weren’t happy that I spoke up, what little I said. I am between a rock and a hard place on this one, to respect the family’s wishes or to assume they’re under court order and in fact want this story out. Plus, lately I have decided that the deceased’s wishes are important. They should not live or die in vain.

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    • I know that in my instance Julie, a little bit of police intimidation was of great assistance in ensuring the truth can not be known.

      I really do find it difficult to look back and understand how these people could possibly claim that anything they did was for the good of my mental health. Conspiring to conceal the drugging? Absolutely poisonous….. still they got drugs and incarceration for that lol.

      Standard operating procedure here to target the family of anyone with evidence of corruption. Proceed with caution if that’s what you decide.

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      • Boans, I agree, same in the States. I once wrote a private email to a higherup about discrimination in my own church. Next thing you knew, a cop and two church higherups came ramming on my door accusing me of planning to murder the church minister. I couldn’t believe my ears. Was this some comical scene that I myself had written now playing itself out? Was I in Wonderland? I said, “I don’t know if I should laugh or cry.” I was naive and had no clue, at that moment, that the last thing you should do is to reach into your pockets. I did so, turning them inside-out to “prove” I had no weapons. Ironically, I’d just come home from my first Justina protest in Boston and was FREEZING, dehydrated, and weak. I was still recovering from severe anorexia and acute renal failure. I am only five foot one. By default they all towered over me, especially the man from church. They shook all over, as if they were terrified I’d “shoot them all.” I’m sure if I really did have a gun and shot it, I’d have missed my target and I would have fallen over in the process. They also said they were not telling the church congregation about this “visit.” Then, they said I was welcome back at church anytime but only if I agreed “not to write.” I concluded that what I had written to the higherup got back to the church and that my email made a large impact, possibly threatening the minister’s job.

        BTW, I mentioned by name several in the church that I felt were clearly being subject to discrimination due to diagnosis. I mentioned incidents I’d witnessed. Cut and dry. One of these people was the late Rachel Klein. I don’t know how she died but I got my ideas. Was discrimination a factor? You bet. She died ten days after I left the USA. No one’s talking.

        I am not worried about my family members being targeted, Boans. The only one is my dog and we are safely far away.

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        • I miss the good old days Julie where fellow parishioners would bring cakes, not police. When the concern was about how much bible bashing was going to occur, not search and restrain techniques, and ‘treatment’ lol 40 lashes for not attending Friday prayers is looking better all the time.

          I’m wat off topic and won’t make any further comment here but, let us know how Puzzle and you are doing in the forums huh?


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    • Julie

      What may have happened is that the hospital paid the family a set sum of money to not pursue finding anything out. If the family is of low economic status it can be very tempting to go ahead and take the money and promise your silence. This sometimes happens in state “hospitals”. And sometimes families don’t want anyone knowing anything about how their family member died because of the shame that’s attached. They don’t want anyone to know that their family member was in a psych facility.

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      • I believe it was both, Stephen. To this day, I don’t know if this harm occurred at the facility where we were housed or at another facility and then she was transferred to where we met. At the time, I challenged the facility, knowing her medical condition, and they finally admitted she had the condition in question. This is something almost always treatment-induced. The fact that the personnel involved were quite on the defensive, first telling me, ‘That’s your disorder speaking,” but then, when clearly the facts were indisputable, they conceded. Then they claimed to be gods that were going to save her, and demanded that I not question what they were doing. I was scared! Sometimes, I’d walk past her bed (mine being by the window) and get scared she wasn’t breathing! Please don’t die! Please! I discharged myself because of that and other reasons. I was so pissed. I did put up a statement online but it wasn’t something easily accessed. About six months later, she friended me on Facebook. We rarely had any interaction. We were friendly with each other, never any altercation. Suddenly, I found that I was no only unfriended, but blocked by her. I’d say within a year and a half later, she was dead and no one was talking. I believe her heart was so physically damaged and weakened that her will to survive was barely there during that year and a half. One of the known signs is an uncanny apathy that resembles depression. Anyway, when I noticed she wasn’t on Facebook (while I was blocked) I feared she was dead. I tried to look her up any way I could. Finally, I heard she had just died. To my surprise, no one knew what I knew. Someone had something big to hide.

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        • Yes, it’s sad that these kinds of things happen, all under the guise of “good treatment” at the hands of the system.

          At the state “hospital” where I work a young man died from an allergic reaction he had to something he ate. It was known that he had the allergy. He got hold of what he was allergic to without him knowing it since it was in the sauce on the food and not readily apparent. He kept telling people that he didn’t feel right or good and they kept ignoring him, since everyone knows that all “mental patients” manipulate and lie and seek attention all the time. By the time that someone finally paid attention to him it was too late and he died. His death could have been prevented if someone would have just listened to him and checked him out. But they didn’t.

          These kinds of things have to stop.

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  19. I’ve not posted nor followed this site for a long while, but wanted to check in. Sandra, the other bloggers, and the users of this site provide a fantastic public service, and I credit the blog for giving me the courage to taper down from a 300mg dose of Seroqual about 3 years ago to the level I am at now, i.e. hovering at 50mg – 75mg, but still with a 200mg dose of Lamictal. I’ll try not rehash my story too much, other than to say that in 2003 I had hit rock bottom, after plummeting from being a high-powered professional with an elite education to living in my parents’ basement, unemployed as well as both economically and volitionally bankrupt. Between 2003 and 2012 I had managed, on meds (including 400mg-300mg of Seroquel) to rise up to greater heights than previously, as well as get married and have 2 kids. But then, after finding a prominent psychiatrist who was willing to taper me off of Seroquel I began to experience all of the feelings of fury and and joy and conscientization that so many on this site have so eloquently expressed, albeit tempered by a kind of fear and skepticism and conservatism re medication not shared by many of you. I continued to rise, far greater even than previously, and grow back into myself. I was (and remain) alive and looking outward into the future again. But then I reached a stage where my thinking and feeling had become less reliable than it had been for many years (other than during a period when I unsuccessfully tried to switch to Geodon). I found myself again shifting into unmistakable high(er)s and low(er)s, but, with the help of this psychiatrist who served equally as a multidisciplinary talk therapist, this time was able to navigate them successfully without being hospitalized and while retaining the goal of eliminating antipsychotics entirely. I have glimpsed the unwanted (by me) places I could descend or ascend into but then have been able to put on the brakes, in a way that had never before been possible. I find myself mostly as I want to be but sometimes in this precarious place of non-linear emotional and cognitive teetering, but managbly. I attribute this newfound capability primarily to the wisdom I have obtained from experience (most of all) and the help of a highly skilled, independent, fiercely empirical, methodologically and theoretically MacGyver-like medical professional, very much like Sandra has revealed herself to be over the years on this blog. Ambivalently, self-defeatedly and grudgingly but ultimately volitionally I have increased the meds in very small measures for very short periods, in moments when it seemed that what I was doing would not be enough. I chose this route only because, empirically, meds had sometimes been correlated with avoidance of those unwanted places, in the short term and the stakes are astronomical. But my insistence upon continuing to taper, with the psychiatrist’s support and encouragement, made it bearable, and even empowering. Of late I have become uncertain of whether I will ever reduce the dose from the 75/50mg level I have been hovering at because, frankly, I have not enjoyed what has unmistakenly felt like increased instability since around 125mg or so. The fluctuations have not gone unnoticed at work, and I my position there has been adversely affect to a degree, but mostly perceptually rather than substantively. In short, tapering has not taken me as far back into myself as I had hoped, and sometimes it has has correlated with those unwanted place to a significant degree. I also continue to fear greatly the long term cumulative effects of the Seroquel , despite the relatively low dose, as well as the unknowable (given our level of scientific understanding) short and long term effects of anti-seizure /mood-stabilizer drugs. Honestly I don’t know what all of that says about the competing theories and approaches that Sandra and other professionals like her have had the courage to grapple with. All I have is my will to survive and flourish, whatever it takes. By far the best step I have taken toward that end has been to work with that rare professional who is willing and capable of assisting my navigation through all of that, while honoring my directive to limit, and where feasible eliminate, psychiatric medication.

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    • This is very thoughtful and inspiring. The fact that you can, with amazing strength, balance the introspective work that you must do with the responsibilities of family and work is truly awesome. This is, I think, the goal of emotional well being; taking care of self and loved ones but it is, as you know, very difficult to do. I respect and admire your accomplishments and hope that you can make your goals flexible and not too hard on you. You don’t have to reach perfection; just a comfort level with yourself and others. I believe you are closer to that than you think!

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  20. Margaret,

    I appreciate your comments. A few years into this journey now, I find myself having to reckon with the feeling that the professional accomplishments that I have fought so hard to reclaim and redouble on may operate as a kind of ceiling limiting how far I can go with tapering and minimization of psychiatric drugs. Perceived professional accomplishments may be healing and feel vindicating after a long fall, but over time these are diminishing returns insofar as the accompanying burdens of work create conditions that not only require greater use of psychiatric medication in one’s overall approach, but crowd out other life goals. For me, those goals include, yes foremost family, but, overall, the intertwined benefits of joy and health. I’ve found that neuroleptics (at least in higher doses), on balance, undercut both of these goals. And, to a degree unknowable, the evident benefits of the anti-seizure drugs I take, may also be offset by long term harms. Based upon the literature I suspect that, even for me, there may be effective substitutes to mood-stabilizer drugs under the right conditions and with the assistance of a willing MacGyver.

    The further distance of which you speak that I wish to travel (i.e. including further reductions in the medications) may well require a “needs-adapted approach” that addresses needs beyond emotional priming for stressful work conditions. It may be that the “proving them wrong” part of my pursuit of professional goals overestimates their overall value, to the detriment of joy and health. But more challenging of a dilemma (in light of the symbiotic relationship between my meds, my work, and my moods) is how to weigh the goal of eliminating psychiatric drugs with that of building family security, starting from a substantial financial deficit.

    A recurring theme that I have returned to in my posts on this blog has been that I reject the notion that “consensual reality” is a bad thing. As an update, I would say that, while I have no desire to believe things that are not true or see things that are not there, I also do not enthusiastically consent to our culture’s celebration of a relentless pursuit of power and wealth (and perceived respectability) through work, regardless of one’s emotional proclivities (via the combination of nature and nurture).

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  21. Apathy is horrible with Dexedrine sometimes too. It does the same as it did as a kid and Lamictal is the only drug to keep that mood just gone. And there were a group of people who did respond to my seasonal moods. While I take Dexedrine, I maintain great sleep and eating hygiene. I have the classic response to that drug still so I would disrupt my life at this point and it hasn’t been 10 years.

    However even with a small dose of wellbutrin for awhile and maybe 20 Klonopin for a variety of things. My health us better than most but I know what to supplement. I am off antipsychotics.

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