Long-term treatment with antipsychotic drugs is currently considered the standard treatment for patients diagnosed with ‘schizophrenia.’ A new study challenges this practice, however. The results, published this month in Psychological Medicine, reveal that patients who were not taking antipsychotic drugs had significantly higher levels of functioning than medicated patients.
Researchers led by Esther Jung from Philipps-University in Marburg, Germany, examined the symptom severity, functional outcomes, social supports and coping mechanisms in two groups of patients who had been diagnosed with ‘schizophrenia’: those who were currently on antipsychotic medications and those who were not taking these medications. While the two groups did not differ significantly in their symptoms or levels of distress, patients who were not taking antipsychotics had higher levels of general functioning.
While major studies have shown that a large number of patients diagnosed with ‘schizophrenia’ or ‘schizo-affective disorder’ do not take their antipsychotic medications as prescribed (74%) or stop taking these medications completely (26%), there have been relatively few studies comparing the outcomes of these patients on and off of antipsychotics. In one such study, however, Martin Harrow and his colleagues found that the 35% of patients who had stayed off medication for 18 years had significantly higher levels of general and social functioning compared to patients who had continued taking their antipsychotic drugs over this period.
Similarly, a study led by Jani Moilanen in Northern Finland found that non-medicated patients that had been off of their antipsychotics for more than a year had fewer symptoms, better functioning, and were less likely to be on disability or to be readmitted to a psychiatric hospital. The results from these previous studies led researchers to wonder whether or not patients diagnosed with ‘schizophrenia’ who go off of their meds find other tools for living with their symptoms.
“These studies indicate that there are patients who do not take [antipsychotic medications] AM in order to reduce symptoms, but nevertheless, do not seem to be fairing worse in the long run than those who take [antipsychotic drugs] AM,” the researchers write.
“This raises the question, among many others, whether this group of patients compensates for the absence of medication by increasing their use of other potentially helpful strategies.”
To address this question, the present study compared the coping and social support strategies of 48 patients diagnosed with a DSM-IV ‘schizophrenia spectrum disorder’ who were either taking their prescribed antipsychotic (25) or not taking their medication (23). The two groups did not differ significantly in their diagnoses, how long they had been diagnosed, their age, sex, education level or family status, but the medicated group had spent more time overall in psychiatric and psychological inpatient and outpatient treatment facilities.
Of the 23 patients who were currently not on antipsychotic medication, 78% had previously taken the drugs. Five had been off of the drugs for more than ten years, four had been off for 5-10 years, four had been off for 1-5 years, and three participants had only been off of antipsychotics for less than a year.
Patients did not differ significantly in their positive or negative symptoms or feelings of depression depending on whether or not they were on or off of antipsychotics. The non-medicated patients, however, had significantly higher level of general functioning.
The researchers were surprised to find that this increase in functioning was not explained by levels of social support or coping strategies. The only major difference in coping strategies between the two groups was that the medicated patients were more likely to report relying on professionals for help.
“Taking into account the common side effects of [antipsychotics] such as sedation or akinesia (e.g. ‘feeling slowed down’; ‘feeling like a zombie’), an alternative explanation for higher functioning in non-medicated participants is that medication itself impairs functioning in those individuals who experience these restraining side effects,” the researchers write.
They caution, though, that it is also possible that patients with poorer functioning are the ones who self-select to remain on medications.
The results also revealed that participants, within the currently off medication group, who had never taken antipsychotics had significantly lower depression scores than those who had been previously medicated. Whether or not a patient had removed themselves from antipsychotics or had done so with the advice of a physician did not appear to have an impact on patients’ symptoms or other outcomes including hospitalizations, functioning, social support, or coping strategies.
“This is surprising,” they write, “as sudden withdrawal from [antipsychotics] has generally been found to be associated with increased risk of relapse. Our results indicate that there are patients who are able to withdraw responsibly and successfully from medication on their own.”
The researchers also cite MIA founder Robert Whitaker, writing that their study supports his contention that “not taking an antipsychotic is more likely to show advantages over a longer time course than on a short-term basis.”
“In corroboration of previous findings (from Harrow, Jobe, and Moilanen) non-medicated participants revealed a higher level of general functioning than the medicated individuals,” the researchers conclude. “Moreover, we found that the longer a participant had been off medication (in relation to the duration of disorder), the higher his or her level of general functioning was.”
Jung, E., Wiesjahn, M., Wendt, H., Bock, T., Rief, W. and Lincoln, T.M., 2016. Symptoms, functioning and coping strategies in individuals with schizophrenia spectrum disorders who do not take antipsychotic medication: a comparative interview study. Psychological medicine, pp.1-10. (Abstract)
Interesting. The “spin” on these things is always that “the less serious ones self-select to go off “medication.” Yet we’re also told ad nauseum that the mayhem in the community is being caused by people who self-select to go off their “medication.” Can’t really have it both ways, can we?
We now have four major studies (they failed to include Wunderlink) directly supporting that long-term use leads to more disability, as well as the two WHO studies confirming that people living in countries with low use patterns have better outcomes, plus a couple of well-known treatment protocols (Open Dialog, Soteria, etc.) showing that low- or no-use approaches work for the majority of people with “psychotic” experiences. Yet still no energy from the psychiatric community to question their “medicate everyone forever” protocol for “psychotic disorders.” They don’t even pay attention to their own research.
Actually they do mention Wunderink. From the article:
“The treatment recommendation in current consensus guidelines for patients with first episode of schizophrenia is an initial treatment with AM for 1–2 years (Buchanan et al. 2010; Barnes & Schizophrenia Consensus Group of British Association for Psychopharmacology, 2011). However, in clinical praxis AM is commonly prolonged for many years (Harrow & Jobe, 2007), which also becomes apparent in our sample, as medicated participants had been taking AM for 6.5 years on average, ranging from 3 months to 21 years. Together with the results of longitudinal trials that find better long-term outcomes in non-medicated compared with medicated patients (Harrow et al. 2012; Moilanen et al. 2013) and the findings on the severe risks of long-term use of AM (e.g. Newcomer & Haupt, 2006; Newcomer, 2007; Daumit et al. 2008;Ray et al. 2009;Ho et al. 2011), findings that show that patients who discontinue medication are doing equally well or better stress the necessity to be more courageous when it comes to discontinuing medication after a first acute phase. This conclusion is also clearly underpinned by the result of Wunderink et al.(2013) who found better long-term recovery rates in a group of first-episode patients with early dose reduction compared with a maintenance group after a 7 year follow-up.”
Coming off drugs is a bit of a moot point (for me) because I wouldn’t have made recovery without psychotherapy. It wasn’t about “love” or my external life either, it was about me finding out what I was doing wrong inside in my own head.
This should be no surprise, as the natural recovery rate from schizophrenia syndrome is around 30% (Bleuler, et.,al.), while the recovery rate for the chronically medicated is around 10%, at best. Under optimum conditions, natural recovery might be as high as 50%, which is around the results the early practitioners of the 19th Century moral treatment used to get.
When I was withdrawing from medication I got talking to a Psychologist and who claimed that Recovery through psychology was possible for 100% of all sufferers. (This was an experienced psychologist and not a “self promoter”).
And the results seen in the WHO intercultural schizophrenia research.
I had just published a blog on the “Case Against Antipscyhotics,” when, a few minutes later, Justin Karter, our news editor, posted a news item about a German study that found better outcomes for schizophrenia patients off medication. The case against antipsychotics just grew stronger.
And yet they’re prescribing them to CHILDREN. Just mind-boggling.
Thanks to Justin for keeping those quotation marks where they belong.
No one profits from selling nothing ( drugs/medicine), both financially and emotionally.
Financially you know billions of dollars are being made. http://www.nytimes.com/2012/09/25/health/a-call-for-caution-in-the-use-of-antipsychotic-drugs.html
The psychiatrist who thinks himself a doctor , gets satisfaction when treating his patient. He is doing his job when prescribing. If/when he has no medicines/drugs to give, what is he to do?
Bloodletting still going on. http://phenomena.nationalgeographic.com/2015/10/27/bloodletting-is-still-happening-despite-centuries-of-harm/
“The prominent doctor Benjamin Rush (a signer of the Declaration of Independence) set off a fury when he began bleeding people dry during the 1793 yellow fever epidemic in Philadelphia. By all accounts, Rush was a bloodletting fanatic”
Dr. Benjamin Rush the “father of American psychiatry” https://www.nlm.nih.gov/hmd/diseases/benjamin.html
Emotional cost of doing “nothing.
“Sometimes The Best Thing To Do Is Nothing At All ” http://getbetterhealth.com/the-benefit-of-doing-nothing/2011.08.02
He wasn’t the only one. There was a rash of that in the late 18th Century. George Washington was a likely victim of that fad, when he was bled twice for pneumonia in 1799. “The operation was a success but the patient died,” as they used to say in 19th Century medicine.
Wow Mad In America does it again, by supporting madness.
So when these schizophrenics don’t take medications and can’t function in society when they lose their jobs from hearing and seeing things that aren’t there, which one of you people will provide them payments for their bills?
You can go away now.
Employed schizophrenics… Right
Do I have delusions I was employed for a number of years?
A person can not be both “schizophrenic” and employed at the same time, according to psychiatry. All reactions and behaviours of schizophrenia is “positive” symptoms and “negative” symptoms, and a person experiencing these symptoms can not work a job.
And psychiatrists believe all who are working mothers, but whose work the psychiatrist has not yet personally seen, need to be drugged. And if you mention that in your spare time you’re also co-chairing a volunteer organization with 250+ volunteers, the psychiatrist just records in his medical records “not believed by doctor” and claims you are “w/o work, content, and talent.” Then when the psychiatrist finally bothers to look at your work, and concludes it is “work of smart female” and “insightful,” you finally get weaned off the drugs that made you “psychotic” in the first place. liberalminority, the antipsychotics make people “psychotic” via a neuroleptic induced “chemical imbalance in the brain,” called anticholinergic toxidrome.
And the UN stated in 2013 that “forced psychiatric treatment is torture” because the antipsychotics are torture drugs. Ever tried them? This is why “non-medicated participants revealed a higher level of general functioning than the medicated individuals.” As to, “an alternative explanation for higher functioning in non-medicated participants is that medication itself impairs functioning in those individuals who experience these restraining side effects,” the term “side” effects is misleading. Calling tardive diskenesia, tardive akathisia, tardive psychosis, gynecomastia, anticholinergic toxidrome, neuroleptic malignant syndrome, or any of the plethora of other adverse effects of the antipsychotics “side effects” is wrong, these are the known adverse effects of the neuroleptic drugs. The antipsychotics were torture drugs in Russia decades ago, and they are torture drugs in the US today.
Lots of people who ride the bus to work with me each and every work day would dispute this with the psychiatrists! They obviously have “issues” and see and hear things in an alternate reality that is not consensual, but they are going to work each and every day. And they’re bringing paychecks home. It’s always interesting to deal with them.
Perhaps you didn’t read the article. The ones who DIDN’T take medications functioned BETTER in society and were MORE likely to have a job. I know this goes against what you have been told and apparently really want to believe, but this is a scientific study with controls, and they are simply reporting on their findings. The findings happen to contradict what you have been taught and/or want to believe is true.
This and other research shows that “schizophrenics” do better when the drugs are used sparingly or not at all. The point of scientific research is to minimize confirmation bias and untested assumptions. If you have a scientific worldview, this research should, as the author suggests, give you pause to wonder whether your current set of assumptions as to what helps people having psychotic experiences is actually true or perhaps needs to be modified.
Sorry, Steve. I was replying to our kept liberal.
So was I!
Provide them with proper treatment so they can pay their own bills. If it were done right the first time, you wouldn’t have this mess. What you and many of the MIA guys consider medical psychiatry isn’t medical, but a muddle of medical, moral and impaired models of “mental” diseases, which seems to have ignored physical diseases that affect mental functioning since niacin took the pellagrins out of institutions and penicillin did the same for neurosyphilitics.
According to St David Healy, it was psychiatry that discovered Niacin for Pellaga and Penicillin for Syphylis!
Being delusional is much more common than psychiatrists think. The dietary treatment for pellagra was discovered by a US Public Health Service physician named Goldberger; the chief individual to use niacin, starting in 1939, was a specialist whose specialty doesn’t exist anymore- a pellagrologist named Tom Spies (MD), and disappeared from the land after assorted biochemists figured out how to add niacinamide to white flour without altering the flour’s taste.
Penicillin was first used on scale by the US and British militaries during World War II, eventually for a variety of infections, being first released for civilian use around 1950. Soldiers being what they are, I’d expect military medicos to be using it for syphilis before the end of the war (they knew enough about the issue to make sure Al Capone didn’t get any).
Several years ago, I heard a voice, was in terror, was paranoid, and couldn’t function.
But now I work full-time, don’t have these symptoms, live independently, and I don’t take any drugs.
No one pays for me, liberalminority.
Further, you provided no argument for your contentions. The whole point of these studies is that being on the drugs longer correlates with less ability to function. The opposite of what you said…
I am currently stuck in Mental Health, Inc. I’m planning a gradual, graceful, quiet exit. In the meantime…
…I can tell you, as a tranquilized “patient,” that these drugs aren’t so great, especially once all the intense, initial problems have calmed down (which can happen for a lot of us with or without meds). For all the talk of “recovery” and such, the treatment for more severe diagnoses is still….meds. Meds. Occasional counseling…to encourage you to stay on your meds.
I think part of the non-medicated peoples’ success is due to stopping the neuroleptics (obviously), but I do wonder if maybe the non-medicated also found other forms of support, possibly outside Mental Health, Inc.
To be fair, in the US we have very poor psychosocial programs in most places…plus, the hyper-individualistic culture denies that “illness” occurs in a social context, because in the US…we don’t believe in “society” so much as we tend to emphasize individuals who just happen to live near each other. If you lose it to the point that you can’t bring home the $$$, then you’re given the cruel compassion of “Schizophrenia” and this “illness” is to be aggressively treated, blah blah blah. I’m just sayin’…I don’t think its just Big Pharma or what have you, I think US culture lends itself well to labeling and destroying society’s “rejects.” Problem there is…the way things are going, more and more people are going off the rails, falling into the hands of Mental Health, Inc. and/or the criminal justice system.
I do think more people could recover with no meds, fewer meds, a shorter duration of use of the neuroleptics, etc. I think the tranquilizers can help some people, for a season, get things together, but…long term use, especially at standard-to-high doses, causes lots of problems. Having said that…creating the sorts of programs that will facilitate long term, genuine recovery+healing with (far) less reliance on heavy meds will require a change in how society deals with low status, stigmatized people.
A number of them are on various nutrient programs, or are treated for other physical diseases that masquerade as mental illnesses, or have various diets that rely on real, not plastic, foods, or shun environmental chemicals that are bad for them, or, a combination thereof.
The `talk therapies’ could include some psychoanalytic approaches,though they’re currently discredited. I wonder if that’s because hardly any psychiatrists can do it and very few psychologist want to because it takes a long time, a lot of emotional investment (if you’re serious), so you don’t get paid much if you make it affordable to clients. But there is a body of evidence that showed quite spectacular results on occasion.
There is no study that shows particularly spectacular results from psychoanalysis. What the literature shows is that therapy with any orientation is very helpful(as is peer support) is the therapist expects the client to get better and forms a good relationship. THe only analysts I know who got “spectacular” results were Bertram Karom, and those trained by him—for the reasons I mention –not because FReudian theory is superior. To what “body of evidence”
do you refer???
The fact is for all of its history vpsychoanalysts –with a few exceptions–took the position that schizophrenia” was incurable, and that all that could be achieved was better ability to cope. But to love and experience intimacy? No– according to Freud and Freudians (with the few exceptions)– that was impossible . It was not even allowed to offer analysis to “schizophrenics.” Freudians have a disgraceful record, and they do not deserve your praise.
Your sanguine view of Freudianism is unwarranted. Read Final Analysis by Jeffrey Masson, an apostate from psychoanalytic faith, famous for his expose of Freud. I discuss some of the successful approaches in my last book.
Seth Farber, Ph.D., THe Spiritual Gift of Madness
Its nice to see you again.
Do you think its possible to be “schizophrenic”
without being anxious? Are not all the other compulsions and symptoms of “schizophrenia” just anxiety in a different form.
I agree that psychotic states are predicated on deep severe anxiety. Karon, in his book Psychotherapy of Schizophrenia: Treatment of Choice, wrote about how severe terror lay at the core of psychotic mental states. Also, Vamik Volkan did this in his book The Infantile Psychotic Self and Its Fates.
Fiachra, I wonder if you would be interested in being an ISPS member (see http://www.isps.org) . You might like the listserv of ISPS. I like your comments here and think you would add a lot to the discussion in other places . I encourage you to check it out!
To respond to Seth, there are some analysts who like Karon have had much encouraging success with psychotic people, including Gustav Schulman, Bryce Boyer, Vamik Volkan, and Gaetano Benedetti. They have written about their work in books that are available on Amazon. Just because results aren’t written about in an academic sounding paper with university letterhead, doesn’t mean they aren’t real..
I agree with what you say Seth about the quality of the relationship and therapy of almost any orientation being helpful at a group level, as Duncan’s research shows.
“..g Gustav Schulman, Bryce Boyer, Vamik Volkan, and Gaetano Benedetti. They have written about their work in books that are available on Amazon. Just because results aren’t written about in an academic sounding paper with university letterhead, doesn’t mean they aren’t real..”
I don’t know where you got that idea–as if I gave a damn or even read academic journals regularly. I was a psychoanalyst in grad school. I became an apostate because of reasons I mentioned. THus I stopped reading analysts in mid 1980s. Probably the persons you mentioned were writing in mid–1980s to 1990s–by which time I’d lost interest in FReudianism. I wrote 2 books in 1990s that critiqued FReud and object relations theory which I espoused in early 1980s> but I based my critique on theorists who were popular in clinic in early 1980s. By the 1990s psychoanalysts were replaced in public sector by bio-psychiatrists….
I was influenced by people like Laing and John Weir Perry.
Anyway I was still optimistic in 1990s about reforming mental health system. Now it’s merged with pharmaceuticl industry…
Just saying that academic studies should not be privileged above qualitative / case-based reports all the time. Thousands of academic studies of “schizophrenia” have gotten us pretty much nowhere in helping these people. Working to process difficult feelings and gradually forming a trusting relationship is where it’s at in psychotherapy of psychosis, as the authors I mentioned discuss in their work…
I will check your suggestion out. I appreciate your comments and opinions as well – and I appreciate your balanced perspective.
You know I’ve made that point, or similar point before. I don’t think people suffer from “schizophrenia.” I think they suffer from fear, despair, terror, grief, sorrow etc. Therefore a therapist or helper should not be trying to suppress
“schizophrenia” or altered states of consciousness, but rather help the mad person feel less anxious., or help them cope with grief. Do you agree?? It’s like an LSD trip–it can be good or bad. ASC are not bad in themselves(See Laing and John Perry, fdiscussed in my last book-2012)
Your other point is more dubious–all negative emotions or behaviors are manifestation of fear or anxiety. No I think loss creates grief which is different than fear? If e.g.you lose someone you lover you will feel grief. Do you really think fear and grief are the same?
I get you Seth.
Yes. Some of the adrenalin derivatives suspected of inducing “schizophrenic” perceptual distortions have anti-anxiety properties when used on volunteers who don’t normally have such distortions.
Ever read “The Assault on Truth”? I found it enlightening, and infuriating, and so worth reading!
Yes. YOu should also read Masson’s Final Analysis since it gives a good sense of what analysts were like in 1980. I did not attend analytic clinic but the elitism permeated the entire public sector.”Schizophrenics” were tyhe untouchables—the lowest caste.
I’m sorry, I didn’t say I supported Freudianism, though of course that was the basis of psychoanalysis. My mistake, I was referring to the long term intense therapy that was used at times for psychosis by people like Frieda Fromm-Reichmann and Harry Stack Sullivan. Whether it was in practice, in the room, strictly Freudian, or even analysis, I don’t know.
I absolutely agree that the relationship is the core factor, but why should such a relationship not occur during psychoanalysis any less often than with any other type of therapy. Surely this would depend on the individual therapist’s performance and whilst, as you say, many analysts have a lot to answer for, maybe some did a good job, at least from time to time. The answer must lie with what the client got out of it. That is the only way success and failure in the `talk’ therapies can be judged.
I was working in the 1970s when Freud was being very thoroughly de-frocked, and our approach was eclectic to put it mildly – I’m not even sure we bothered much about labeling our `techniques’ at all – it was `just whatever helped’. The `body of evidence’ was the wrong way of putting it, I agree. I was really referring to mostly personal anecdotal testimony, God forbid that should be a `body’ of anything, but I understand that a few analysts DID support psychotherapy for psychosis, or, unlike today’s genetic/organic paradigm, looked at it as a maladjustment due to psychological issues.
I was speaking to my own psychologist a few years ago wondering if I had ever done any good for all the people I saw, and he replied that the best any of us can hope for is that we don’t do too much harm.
But perhaps I was too simplistic, I just think that we need any `port in a storm’ and that means we don’t shut anything out.
The Sullivan school had nothing to do with Freud. It was considered to be “interpersonal.”
Sullivan himself had a “schizophrenic” break as a young man from which he recovered.
THe FReudians were so rarely helpful to “schizophrenics”: because schizophrenia was said to be a severe disorder, a result of maternal deprivation during the “oral” phase that made one incapable of having intimater relationship.
I was told this over and over when working on my PhD in late 70s and early 1980s. By promulgating this dogma Freudians did a considerable amount of harm to “schizophrenics.”THe field was Freudian and everyone followed their lead.
Yes “psychotherapy” was for the purpose of preventing people from getting worse. Freudians said only an elect was capable of benefitting from “psychoanalysis” which was supposedly curative.
The secular Augustinianism of Freudianism claimed “schizophrenics” were “predestined”
to eternal loneliness, not able to form intimate relationships. So the secular Priesthood condemned the mad to eternal hell and blamed it on their parents–on secular analogue of original sin
Seth Farber, PhD.
Okay Seth. I think you’ve established you know far more about Freudianism than I do. I don’t have a doctorate, I never had years of theoretical discussion before finding myself in front of terribly distressed people, armed with a few books and a whole lot of colleagues telling me you couldn’t talk to “schizos”, just drug “em and hand them over to the social worker. I found you could talk to “schizos” and a lot of what they said made sense.
But here I was guilty of using a label, “Analysis”, to describe something without really knowing all the details – a common failing in psychiatry I think – so I thank you for pointing that out, as well as clarifying your position, and educating me on Freudianism, What I really meant was intensive, one to one, long term psychotherapy as a possibility pathway for people diagnosed with “schizophrenia”. It would not be an option for everyone, or even suitable for everyone, but maybe for some. (Thanks also for the update on Sullivan – some of that was forgotten knowledge and again I was careless.)
As for the blaming of parents, as I saw it in the late 60s that was the basis for the rise of bio-psychiatry. All those upset parents saying, “but I loved him/her, so don’t blame me,” got to the doctors who maybe had issues of their own, and it all became, “of course it’s not your fault, it’s the `chemical imbalance and`in the genes”. So it was easy to expand that because the people wanted to hear it.
Mt experience in talking to the “sick” one and their families, was that very often it WAS the parents, and we seem to be returning to that, at least to some degree. The issue now seems to be how to blame, not whether to blame. We are the product of our childhoods after all so maybe they got that right.
Indeed, were they worse than the alternative which has condemned “the mad to the eternal hell” of being at the mercy of their genes and brain chemicals, and being forced to take crippling drugs, face early death and a hopelessness so profound that it makes “not being able to form intimate relationships” look like a good outcome? The Freudians may have confirmed the “predestined” nature of “schizophrenia” but didn’t they essentially leave them alone? This at least allowed about half of them to get better. Today’s “treatment” stops them getting better. So now we have a “predestined” condition which is iatrogenically exacerbated by the “treatment”.
As I’ve said, those who did embark on long term, one on one, intensive psychotherapy may or may not have considered themselves Freudian, but what they actually said and did inside their sessions could be labelled anything – as we agreed, the relationship is the vital element.
I was not trying to establish I know more about Freudianism than you–I did not know until now how much you knew. I knew quite a lot because I was steeped in it. I went to school at the end of the Freudian era.
Yes FReudians, psychoanalysts wanted as little to do with “schizophrenics” as possible. AS soon as they put in time in public hospitals or clinics, they set up restrictive private practices. I don’t see anything admirable about that. Anyway the public clinics were still psychoanalytically oriented. Very low expectations were held for most of the clients. Just as things began to improve a bit psychiatrists teamed up with drug companies. THe APA changed its rules so it could accept drug company money. This deregulation was happening everywhere and its motivating factor was greed–not a capitulation to NAMI’s line, though NAMI helped.
THe mad were being drugged and crippled by drugs and the FReudians raised no objections. They thought the mad were hopeless anyway. And my point was they influenced everyone in the system into regarding the mad as incapable of intimacy..In Valenstein’s book on lobotomies he quotes a critic who said, “Even the therapists who opposed the procedure failed with amazing uniformity to give public utterance to their opposition.” Half of the mad, as you claim, did not get better. Most of them from the discovery of neuroleptics in the mid– 1950s onward were destroyed by the drugs—and the degradation and the ostracism.Maybe that was true in 19th century when moral treatment was still popular.
Freudians’ contempt for the mad influenced everyone in the field, and probably set the stage for lobotomies and “:chemical lobotomies.” I knew these shrinks and I know the disdain and pity with which they regarded “schizophrenics.” If you read R D Laing’s revolutionary book THe Politics of Experience(1967) the shrinks he excoriates were all Freudians. Same with Szasz’s greatest book THe Manufacturer of Madness(1970) These powerful defenses of the mad were written in the Freudian era. The only change is now far more people are put on toxic drugs.
The psychiatric wards’ view of the mad as hopeless cases who must be suppressed with drugs was heavily influenced if not created by the Psychoanalytic priesthood, the sages, the intellectual elite of society.
But what I’m trying to get across is that how shrinks saw themselves DID matter. Freudians, with only a few exceptions, in those days were unequivocal: Schizophrenia was incurable. The best that could be done was to firm up the “schizophrenic’s egos with “supportive psychotherapy” to prevent them from being rehospitalized.(The same was tyrue of so called personality disorders–although Kohut tried yto open up psychoanalysis to wealthy “”narcissistic personality disorders.” But as far as the “psychotics” ” Freudians did not offer :intensive psychotherapy” to enable them to live fulfilling lives. I don’t have time to go into detail about the great harm done by psychoanalysts to the mad. I tried to convey a sense here.You can read more about it in my books.
Today there are numerous methods to help the mad—and to learn from, the mad. What is lacking is the motive to do so. But I do not put the blame on the parents but on mental health professionals who have become pimps for the drug companies. If they were doing their jobs parents could be educated to be “good-enough” (Winnicott’s term)care-givers.
Seth Farber, Ph.D. http://www.sethHfarber.com
Where I worked, Freud was comprehensively defrocked by the few psychiatrists who’d ever read his work by 1970- possibly because few of them had sufficient intellectual skills to actually read it. Many had not read much from any other psychotherapy source either. They dismissed philosophical discussions on just about anything and you didn’t have to be a psychoanalyst to dismiss the patients, everyone did. The drugs were already routine and while there were a few vague gestures made towards “rehabilitation” for “schizophrenia”, it wasn’t taken seriously. The more cynical called these efforts “institutionalisation training”.
I have to say though, we believed that the drugs would help. We thought we were doing the right thing, at least, at first. But from 1973-1975 when I walked away, I worked in a unit where we realised how nasty they were and reduced or withheld them altogether. We also worked with families, social interventions and PSYCHOTHERAPY (the eclectic kind), but were hamstrung by the administration.
As for half the mad getting better, I based that on the 19th century moral treatment records, on WHO’s surveys in Nigeria, Colombia and India, Robert Whitaker’s figures taken from records before neuroleptics 1945-55, Harrow’s and Wunderink’s studies and Open Dialogue records. I think Soteria House predicted similar outcomes. And none of the figures on recovery include those who have had a psychotic break and somehow steered clear of psychiatrists AND psychologists, ((who traditionally don’t want to deal with psychosis either, so pass them on to the system), and recovered by themselves. We just don’t know but figures coming out through Hearing Voices suggest quite large numbers of people who live normal productive lives could fit the criteria for “madness”.
But I don’t think we can blame “madness” on psychiatrists. Something had to go wrong first. That they make it worse and create more of it after the initial events, certainly. I want to go on record that I have absolutely NO TIME for psychiatry, I desperately want to see the entire profession shut down as the amoral, venal, close-minded, pseudoscientific criminal organisation that it is, and would like to see some sort of organised alternative in place.
I wanted to respond to your post July 30,9:58 but I there is no “response” below it. Anyway I don’t tyhink we necessarily disagree.
Of course “schizophrenics” get better if they are left alone. My point was that they weren’t. THus I wrote “Half of the mad, as you claim, did not get better. Most of them from the discovery of neuroleptics in the mid– 1950s onward were destroyed by the drugs—and the degradation and the ostracism.Maybe that was true in 19th century when moral treatment was still popular.” My statement “Maybe THAT is true..” was written quickly. By “that” I meant your claim that 50% got better. And even more when they actually got help.d In the WHO survey those who recovered were actually integrated into communities… in undeveloped world. Same with moral treatment, to a lesser degree..
It does not matter whether your cohorts actually read FReud. THe views on “schizophrenia” were based on psychoanalytic theories that pervaded popular culture. The meme of the chronic severely diseased schizophrenic was taught in all the grad school programs in universities. It is impossible to over-estimate the influence of psychoanalysis throughout most of the 20th century. It has the influence bio-psychiatry does today–plus it had a literary status and social prestige that immunized it from criticism–until the end. It took brilliant intellectuals like Laing and Szasz to begin its deconstruction.
Madness is an ambiguous phenomenon. Psychiatry constructed it as “chronic mental illness” There is no question psychiatry did not create madness but its transformed it into a disease—and above all its treatment made an acute crisis into a CHRONIC life problems. Psychoanalysis lent all its prestige into defining “schizophrenia” as chronic, incurable tragic –original sin. REad THe City of God. Read Calvin. Then read Freudians on schizophrenia. I make the link in my book Eternal Day.
As I wrote in the 1980s.”Yesterday’s shaman is today’s chronic schizophrenic. THe kind of person who in a bygone era would hare been initiated into the vocation of shaman. medicine man, spiritual healer is today inducted into a career as a ‘chronic mental patient’–victim of the most serious mental illness known to mankind”
Seth Farber, PhD
The analysts Bryce Boyer, Vamik Volkan, Harold Searles, Silvano Arieti, and Peter Giovacchini had much success with psychotic clients. Their work is reported here:
The treatment accounts in these books are pretty remarkable, and inspiring…
Psychoanalytically informed psychodynamic therapy is also different from psychoanalysis. That is what these analysts are using in most cases with psychotic clients, not psychoanalysis per se. But again the most important thing is the relationship as perceived by the client…
Another successful analyst with psychotic people would be Murray Jackson, in his book Weathering the Storms –
A more modern therapist of psychosis who uses psychoanalytic principles but is not an analyst is Ira Steinman:
“Recent studies have shown surprising and encouraging evidence that many cases of schizophrenia eventually cure themselves.” New York Times 1986.
They would not listen, they’re not listening still. Perhaps they never will…
We don’t disagree – I was taught everything you were, I just didn’t believe it, ever, any more than you do. I worked with people with “schizophrenia”, to a man with horror stories of their lives, who despite their being drugged to the eyeballs, produced a worthwhile program when nobody believed they could. I watched them flower in the program of theatre and art that I worked in, where they were valued and respected, and I watched 2 of the most talented of them kill themselves when that program stopped. I’ve spent the last 45 years saddened by the fate of the others, many of whom I counted my friends, including one of the most inspiring and courageous young women I have ever met, abandoned to the system to destroy. I will always carry some guilt for that.
I had then and now NO RESPECT whatsoever for psychiatry – it is a brutal, destructive profession come down from the oppression of the patriarchal church and all the underlying savagery that went with that still exists today.
How do we change it?
A saleswoman told me of a woman who walked around the shopping centre. Everyone was afraid of – her stumbling walk, her facial twitches and blank stare and labelled her `mad’, turning, moving away and whispering. The salewoman proudly said she asked her once if she’d like a cup of tea. The woman sat with her and they talked, briefly. She was surprised that the woman seemed quite lucid, `for a sick person.’ I told her that ALL the `mad’ symptoms were almost certainly the results of the drugs the woman was taking. The Parkinson’s walk, expression, the Tardive Dyskinesia, the restlessness, Akathesia. I asked her to judge the woman on her lucid conversation, not her strange looks. She will spread that around the gossip spots. That is how we `get’ psychiatry. Tell people. That is all I can do.
There was a time when I could engage in philosophical, intellectual discussions with ease, but 87 ECT treatments took care of that. My thinking is far more concrete, less subtle and ordered now compared with how I was before 2000. It took 3 years for me to realise that I could no longer follow an argument for more than a few minutes. Writing is better because I can back-track and see what I’ve said but even then…So I apologise if what I say is simplistic. It is yet another black mark against this `treatment’ that dropped a `gifted’ individual to `high average’, and was the result of an overnight suicidal reaction to Prozac (Rx for stress)- also got 13 years of antipsychotics etc for the bipolar I never had, when I never had a psychotic episode on my life. Now drug and psychiatry free x 3 years.
@ Seth Farber
I couldn’t locate the right place to reply/ I agree with your sentiments but I must draw you out on this romantisation of the shaman malarkey.
the shaman is a quack, and often a dangerous one. in some parts of the world they’ll be advising people to have sex with babies to cure their AIDS or encouraging people imbibe the most ridiculously powerful hallucinogens to connect to the monkey that lives on the moon.
to in one breath rail against psychiatric quackery and in the next breath be lauding shamanic quackery, which is probably worse, seriously undermines all the well-thought out and presented critique that precedes.
You have not read any scholarly books on shamanism–I have no doubt.
And even if some shamans are destructive that doesn’t mean you can dismiss the whole spiritual tradition., YOu are just ethno-centric. Have you read Mircea Eliade’s books on shamanism ? I’m sure you haven’t.
Some think Eliade unfairly disparages use of hallucinogens. Havre you read McKenna’s books? Or Michael Harner’s? I’m not an expert of shamanism. I just know enough to recognize bigotry…
Seth Farber, PhD
They were the ancestors of our present-day doctors, after all.
He hasn’t heard of the Native American Church?
Thank you Mr Seth Farber for that mildly disarming reply of a somewhat snotty tone.
Hey, I’m not a bigot. I disagree with you. I give short shrift to pomposity and pretentiosuness. Imagining that people suffering the world over with what has come to be known as schizophrenia or bipolar are in fact misunderstood shamans that if properly assimilated by society could save the world is…
well, first and foremost for those of a Christian bent, such as yourself, an appeal to false prophecy…
but in a general, rational, logical, humane sense…. just plain out and out delusion.
Yes, Mr Seth Farber I have read one book by McKenna. It wasn’t quite as good as the one I read by Carlos Casteneda.
But you know, shamans don’t get it from books. And they don’t get it from snotty intellectuals. Where do they get it from I wonder?
You didn’t quite read Castaneda. They get it from their teachers.
Also, just out of curiosity, what was the title of your dissertation? Always fascinated to know…
It’s interesting how a legitimate concern about the New age construct of the shaman is dismissed out of hand as ethnocentric and bigoted.
There are shaman in Africa advising men with aids to duck babies to bring about a cure. That’s a fact. All across Africa shaman are performing genital mutilationss as cleansing rituals. And as rituals to gender neutralise in very peculiar ways.
There is no universal shamanism. That is a middle class New age romantic construct.
People would have you believe that a holiday in Peru ingesting hallucinogens in a mud hut puking your guts up can cure you of sadness.
It’s all so very sad and so very pretentious and exploitative.
Ah well. Q uack quack.
There may very well have been a deterioration of shamanism. The deterioration of sacred phenomenon in modern world was one of Mircea Eliade’s themes. But just because there are hustlers–whether pseudo-“shamans” or degenerated shamans– does not mean the phenomenon should be dismissed.
I would be humble dealing with an authority, but you know a little of “shamanism” which you probably picked up in The National Enquirer and you present yourself as an authority–thus potentially leading people to avoid reading about an important spiritual tradition. You probably don’t believe in spiritual traditions anywayr.
Shamanism is not a “New Age” construct!!. It was an integral to native American culture, as well as other indigenous cultures in N and South America and Asia. The renowned author Mircea Eliade (1907-1986), historian of religion and professor at the University of Chicago, started writing on shamanism in the 1950s. Eliade was not influenced by the “New Age.” His main book on the topic Shamanism was written in 1968. The shaman is above all an expert in ascension into the spirit world and a mediator between the natural and supernatural worlds. Eliade called shamanism “one of the archaic techniques of ecstasy ” at once mysticism, magic, and ‘religion’ in the broadest sense of the term.” He wanted to restrict the term ‘shaman’ to those who went into trances and who would address the tribe through a spirit or would visit the spirit world and return.”(https://greencardamom.github.io/BooksAndWriters/eliade.htm) But the shaman is also ” believed to cure, like all doctors, and to perform miracles of the fakir type, like all magicians […] But beyond this, he is a psychopomp, and he may also be a priest, mystic, and poet.”
When thus defined, shamanism tends to occur in its purest forms in hunting and pastoral societies like those of Siberia and Central Asia, which revere a celestial High God “on the way to becoming a deus otiosus”. Eliade takes the shamanism of those regions as his most representative example.
In his examinations of shamanism, Eliade emphasizes the shaman’s attribute of regaining man’s condition before the “Fall” out of sacred time: “The most representative mystical experience of the archaic societies, that of shamanism, betrays the Nostalgia for Paradise, the desire to recover the state of freedom and beatitude before ‘the Fall’.” This concern—which, by itself, is the concern of almost all religious behavior, according to Eliade—manifests itself in specific ways in shamanism.
Anyway there are now many scholarly books out on shamanism–many by participant-observers. I hope people don’t take snide assessments of professional skeptics and religious-atheists(like Bill Mahr) to heart and do their own research.
Seth Farber, PhD http://www.sethHfarber.com
I’m afraid this discussion about shamanism and who is right or who is wrong has deteriorated in to a slanging, one-upmanship that is beneath this site. Rasselas. Redux you are abrasive and insulting and you, Seth, are pompous and insulting, and I doubt you are ever humble. Your ability to put down with a plethora of references assures us that you are well read. Surely you don’t have to continually blind us with your exalted intellect to make your case whilst insulting your critic’s sources.
“I would be humble dealing with an authority, but you know a little of “shamanism” which you probably picked up in The National Enquirer and you present yourself as an authority–thus potentially leading people to avoid reading about an important spiritual tradition. You probably don’t believe in spiritual traditions anywayr.” This is totally unnecessary and I think, beneath you.
You have fairly successfully alienated me at least.
“. Your ability to put down with a plethora of references assures us that you are well read”
What makes you think I have any desire to assure you or anyone eldse that I am “well-read.” ?
My motive was to quote an astute and renowned scholar to show that Rasselas claim that “shamanism” was a flaKY New Age” construct was not true. And to dismiss an entire spiritual tradition because of a few modern hustlers who call themselves shamans was not a serious way to investigate the phenomenon–as contrasted to the profound commentary and research of the late Professor Mircea Eliade.
It;s clear to me that Rasselas has some sort of peeve, Maybe not ethnocentrism. Maybe he/she is a secular humanist and atheist in the tradition of Richard Dawkins and Chris Hitchens and Bill Mahr who regards all spiritual traditions as bogus. It seemse he/she read Castenada as entertainment.
I quote Eliade because he is profound and astute, and highly respected by those with interesrt in spiritual traditions. It is presumptuous
to claim Deeo that I quote him to show I read him. I did not give a plethora of references . I have not read that much on shamanism. I gave a few references.
Ok you return mainly to the one source, Eliade, but you drop in others, McKenna’s books? Or Michael Harner’s…” all the while suggesting that the other person hasn’t read them or has done it for `entertainment’, and that to disagree with you he/she could be a…then you label, again with references to support your inferences.
Do you think it possible that you are doing exactly what psychiatry does? Pulling out labels to categorise, putting the person into boxes where it is safe to ascribe to them a set of values, behaviours, and beliefs – in this case ethnocentric, secular humanist, atheist, none meant kindly. This would appear to be designed to give far more weight to your position by denigrating the personality and beliefs of the person who disagrees with you. That his/her opinions are less valuable than yours because he/she picked them up in far less erudite publications than you did, e.g. the National Enquirer, and that he/she is somehow lesser – “probably don’t believe in spiritual traditions anyway”. Why you should assume that someone who doesn’t believe in `spiritual traditions’ should be so, I don’t know.
I suspect the two of you are coming from different positions. Rasselas seems to be talking about the reality of Shamans as they function in today’s world, you about the scholarly examination of an ancient phenomenon. As such it is possible that neither of you is right or wrong.
As a person who IS an atheist and not of a spiritual disposition, (my right), it seems to me that so often the `scholarly approach’ to `spirituality’ is often a taking of the high ground in an intellectual justification of a set of beliefs that are, a) not disprovable, and b) exist beyond the on-the-ground experience of the people, and are used to control.
For instance those who questioned the Christian faith were heretics, devil worshippers, witches, blasphemers, idolaters and, yes, atheists, all labels that distanced dissenters from the `good’. I’m not saying this is what you are doing but it does look a bit like it.
I find what you’re saying about Shamanism very interesting, but what jars and annoys me is the way you’re doing it. I once had a similar experience with the editor of the Psychiatric Time who wrote a critique of a movie about a man’s psychological journey to `wellness’ which, interestingly, included a shaman connection. The critique said that the film was well made, then set out to attempt to discredit its content by devaluing the man who made it. The response I got avoided any reference to that and suggested that my comments were because I couldn’t have seen the movie. (A lovely straw man argument.)
Please educate us Seth, but, both of you, keep it cool.
Funny thing, those who went off psych-drugs relied less on mental health professionals, therefore, speculation has it they were better off to begin with. Psych-drugs are so big with mental health system functionaries, I don’t even want to go there.
Other explanations? According to Dr. Peter Breggin psych-drugs work by disabling brain function. Of course, disabled brain function should not be expected to result in better over-all functioning. The brain has been described as the executive organ of the organism. Disable that, and you’re going to get some inadequate responses.
One thing is for certain, these drugs are not going to improve performance on the ball field, in the dance hall, in the classroom, or anywhere else. They will make people more compliant, less expressive, more obedient, emotionally blunted, and more manipulable by other people. The drugs work by making life easier for mental health workers, for patients, not so much.
Concur. The older psychiatric text books are fairly blunt about the effects the neuroleptics. “Patients” lose interest in the “symptoms,” along with life in general. In low doses, the neuroleptics were used, sometimes in combination with other drugs, to treat low mood. ThoraDex, anyone? A lil bit of Thorazine, a lil bit of Dexedrine…a lil bit of apathy, a lil bit of stimulation. Sort of like Prozac, but probably more fun. And faster acting.
At best, I think psychiatric drugs maintain people at a certain level. Some people may function reasonably well, others not so much…the so-called “symptoms” are suppressed, and the person/”patient” is tranquilized into a steady state, neither actively “crazy” nor growing, making progress towards autonomy and such. That’s probably one of the better outcome scenarios. More often, especially with the working class, poor, and minorities and women…the person/”patient” deteriorates over time, physically as well as mentally, and the deterioration is blamed on an underlying “illness.”
Don’t forget the NAMI mommies!
Destroying parts of the brain to “cure” hallucinations or sadness makes about as much sense as gouging out a man’s eyes to get rid of floaters. Yes, it will keep him from seeing those nasty floaters–along with everything else.
The first piece drawing the analogy was by Julian Silverman in American Anthropologist, 1967–“Shamanism and Acute Schizophrenia.”
Also see my 2012 book The Spiritual Gift of Madness for discussion of Laing , Perry etc