This two-part article comes in response to recent debates about the value of antipsychotic drugs for people labeled as “schizophrenic.” Contributions to the debate included Robert Whitaker’s white paper “The Case Against Antipsychotics” and Ronald Pies and Joseph Pierre’s blog “Quality of Life and the Case for Antipsychotics.”
As a psychiatric survivor who has personally experienced severe psychosis, my responses to these discussions are to emphasize the following points:
- Antipsychotics Are Tranquilizers: We need to be honest about what antipsychotic drugs really are. Most are major tranquilizers – drugs which have a generalized sedating effect and limit the ability to feel emotions strongly. They are not “medications” treating a specific “illness.”
- “Schizophrenia” is a Contested Concept: More clarity will be brought to the drug debate by acknowledging that “schizophrenia” – the supposed target of antipsychotic drugs – is an uncertain, contested concept. Contrary to popular belief, hallucinations, delusions, and inability to function have not been proven to represent a clearly-defined biologically- or genetically-caused illness.
- The Primarily Biological-Genetic Model of “Schizophrenia” is Unproven and Harmful: Research suggests that the predominantly biological model of psychosis taught to psychiatrists leads to pessimism and poorer outcomes. On the other hand, considerable evidence exists to support a predominantly psychosocial model of psychotic states as being expressed through, but not primarily caused by, biology and genes. Viewed in this way, it is apparent that antipsychotic tranquilizers cannot directly address the experiences of trauma, isolation and abuse that often underlie delusions, hallucinations, and paranoia.
- Effective Alternative Approaches Exist: Hope-inspiring and effective approaches for transforming the lives of severely psychotic people are already available, such as the Hearing Voices Network and the Open Dialogue Approach. With such alternatives becoming more widely researched and available, one must question the value of pouring billions of dollars into continued biological research on “schizophrenia” – research which has thus far yielded no measurable improvement in the lives of psychotic people.
My criticisms therefore focus on the relative lack of attention to what psychiatric drugs actually are, and on the uncertain, contested nature of the supposed target of these drugs: “schizophrenia.” I will elaborate on each of these points with references, as well as highlighting alternative approaches to helping psychotic people.
Finally, I will demonstrate the value of giving at least equal importance to the voices of those with lived experience of psychosis. I come to this debate from a perspective that is too rarely heard – that of someone who was once psychotic and took antipsychotic drugs.
From Psychotic To Well: My Story
As a background to my positions, let me briefly recount my own story in relation to “schizophrenia.”
I’m a 31-year-old formerly psychotic man. In my late teens and early 20s, following a childhood of severe physical and emotional abuse, I suffered through many psychotic experiences. These included hearing persecutory voices telling me to kill myself, holding paranoid beliefs about strangers wanting to harm me, feeling unremitting terror for months at a time, and being unable to function in school or work for about two years. During this period, I was quite literally on the edge, suffering through an almost minute-to-minute, second-to-second struggle full of rage, despair, confusion, voice-hearing and paranoia.
Not surprisingly I was psychiatrically hospitalized twice, with one hospitalization occurring after a failed suicide attempt. In the mental health system, I received all the severe psychiatric diagnoses including “schizophrenia.” I took multiple antipsychotic drugs including Seroquel and Zyprexa. Additionally, my father was psychiatrically hospitalized on multiple occasions, labeled “bipolar,” and given ECT and antipsychotic drugs.
The main causes of my psychotic experiences lay in my life story: physical abuse by my father, a lack of trust and security with my parents, the stress of many childhood moves to different countries, having been severely bullied in school, and the pressure of having to function independently as a young adult. The worst of the abuses I experienced included being thrown across rooms onto sharp table edges, having boiling hot drinks poured onto me, and being ridiculed for my skin color and appearance – enough to drive most people crazy! But the worst experience of all was being in a psychic black hole where I felt totally alone and could not trust anyone.
All of my traumas came together to cause terror and rage. These overwhelming emotions in turn led to the use of psychotic defenses to externalize them, including hearing attacking voices (personifications of rage), suspecting other people of harmful thoughts which originated within me, and so on.
Words cannot do justice to how difficult it is to be in terror of being annihilated for most of a several-year period, to have vicious voices ordering you to kill yourself, to have to survive alone in your own mind because you cannot trust others, and to then be told that you have an incurable brain disease and will never fully recover. The latter was the primary contribution of the American mental health system to my distress. This horrifying idea – that my distress represented an incurable brain disease with a poor prognosis – probably represented the biggest obstacle to my recovery, even more so than the other traumas.
Fast forward a decade: I am now quite functional, having worked a steady, professional job for most of the last several years, as well as being socially active. I no longer have significant levels of psychotic experience, no longer hear voices, no longer feel paranoid about strangers harming me. I am often calm now, and I feel quite alive and enjoy what I do. How did this happen?
Well, facing the long emotional war, I never gave up. Through my own research, I eventually found out that the incurable brain disease narrative was wrong. I became a fighter, promising myself that I would get well and do what I wanted to do. The process of working through my psychotic experiences and coming to trust others was extremely difficult, requiring great patience and perseverance, but I gradually accomplished it.
Starting in my early 20s, I derived great benefit from an intensive psychotherapy in which I explored the origin and meaning of my paranoid fears and persecutory voices. In this setting I was able to form a deeply trusting relationship with another person for the first time. As I overcame my fear of trusting and recounted my traumas, I gradually stopped experiencing voices, paranoid suspicions, and extremes of rage and terror.
I was fortunate to encounter a therapist who believed psychotic people could get well, and to have some financial support from my family. I made a couple of friends with whom I could share my story and who supported me no matter what. I found a field of work that I love. And today, having chosen to carefully taper off of them, I no longer take antipsychotic drugs.
While doing therapy, I did extensive research into different historical treatments of problems labeled “schizophrenic.” My research focused especially on those approaches that other psychotic people had used to fully recover, and of which most American mental health professionals remain unaware. I consider this research to have been crucial to my becoming able to function and have hope about recovery from experiences commonly labeled “schizophrenic.”
I learned the most from the writings of Harold Searles, Vamik Volkan, Bryce Boyer, and Silvano Arieti, four experts at helping psychotic people via psychotherapy, whose insights gave me hope. I credit their work with helping me become aware that the biological-disease narrative of “schizophrenia” was fatally flawed.
The Importance of Hearing from the Psychotic Person’s Perspective
With my history, I obviously have much experience with severe psychosis and with antipsychotic drugs, both from the perspective of a sufferer and a family member.
It’s important to note that experiencing psychosis in the first-person – and recovering from it – is a different type of “expertise” about psychosis than one gains from being in medical school, being a journalist, doing psychotherapy with psychotic individuals, or even being a family member. The same point applies to having actually taken antipsychotic drugs, rather than having only prescribed or written about them.
In Western society, we do not often hear from people who were psychotic and recovered. This sad fact is based on many factors, including shame, fear of judgment, fear of job loss, and the fact that our profoundly inadequate mental health system transforms the lives of relatively few individuals. Once the processes of what I call “patientification” (meaning adopting a sick role and believing one has a lifelong brain disease) and “zombification” (meaning taking too many antipsychotics for too long and losing touch with one’s emotions) get underway, it can become increasingly difficult to return to a fulfilling life.
Although rarely heard, the voices of formerly “schizophrenic” people can be particularly important in revealing what experiencing psychosis and taking antipsychotic drugs feels like from the inside. Additionally, one of the most potentially valuable experiences for mental health workers, including psychiatrists, is hearing from once-psychotic people about what helped them to get well.
Keeping this in mind, it concerns me that in the debate about the value of antipsychotic drugs, little has been heard from those who have suffered through psychosis and taken drugs themselves. That is an issue this blog will address, by providing the positions of one formerly psychotic individual regarding antipsychotic drugs and the “schizophrenia” diagnosis.
Further, I am writing this under my real name. In this way I am asserting that one does not have to be scared or ashamed of speaking publicly about having been severely psychotic. Given enough stress, especially severe stresses occurring in childhood and young adulthood, anyone can break down and lose their mind.
Finally, I am not speaking from the perspective of “being in remission from a schizophrenic illness.” I reject the disease model of “schizophrenia,” so I am speaking from my own experience of having been severely psychotic, but without accepting that I had a brain disease. If rejecting the brain disease narrative makes me have “anosognosia” – i.e. a biologically determined inability to agree with professionals’ beliefs about the nature of psychotic experience – then so be it. But if I have anosognosia, then I am one unusually sane and functional ansognosiac.
Contesting Whether Antipsychotic Drugs Are “Medications”
Let us return now to the recent debates between Whitaker and Pies about the value of antipsychotic drugs. My first problem with these dialogues are certain presumptions about the nature of “antipsychotic medications,” presumptions which I believe are based on unproven hypotheses and on circular logic related to the schizophrenia diagnosis.
First, it is important to note that most antipsychotic “medications” are essentially tranquilizers. As authors such as Grace Jackson, Joanna Moncrieff, and Robert Whitaker have documented, the primary effect of these drugs is to chemically numb the brain and limit the ability to feel emotions. They do not treat any specific biologically-caused illness process, nor fix any chemical imbalance underlying such a process. The repeated use of the term “medication” and “illness” in writings by Ronald Pies and other psychiatrists makes it appear as if a valid, discrete brain disease called “schizophrenia” (and supposed symptoms flowing from it) exists as the target of these drugs. But this is not a settled fact.
I would like to clarify here that what I contest is not the reality of psychotic people’s suffering – having gone through what I have, personally and with my family, there can hardly be any doubt about that. What I am contesting are assumptions underlying our use of terms like “medication” and “schizophrenic.”
Regarding the mechanisms by which antipsychotic drugs “work,” the specific action of the drugs on the brain is poorly understood, but what is known is that they mostly damp down the normal chemical functioning of the brain in a generalized way, primarily blocking dopamine receptors. As discussed by Lucy Johnstone, the effects reported by many psychotic individuals include a sense of profound emotional numbness among other serious side effects. From one vantage point, all the effects of the drugs could be viewed as “side effects” in that they interfere with normal reactions of the brain to the environment. Grace Jackson has written powerfully about the dangers of these drugs, the long-term use of which is implicated in lifestyle diseases which contribute to psychotic people dying 20-30 years younger than people not given these labels.
Contrary to popular belief, we do not know that these drugs act in any way similar to how insulin addresses diabetes or how penicillin targets an infection. And yet it is commonly believed that antipsychotic drugs target specific disease processes in the brains of psychotic people. The NIMH even states, on its public webpage about “schizophrenia”:
“Scientists think that an imbalance in the complex, interrelated chemical reactions of the brain involving the neurotransmitters (substances that brain cells use to communicate with each other) dopamine and glutamate, and possibly others, plays a role in schizophrenia.” (emphasis mine)
This vaguely worded statement implies that a disease caused by faulty brain chemistry underlies psychotic experience. But as has been made clear by the authors to be discussed below such as Richard Bentall and John Read, no such disease process has ever been discovered.
Thus, calling the antipsychotic drugs that tranquilize people “medications,” as psychiatrists like Ronald Pies do in their blogs, and as journalists like Robert Whitaker do in responding to them, reinforces a myth. “Medication” is a word commonly used to refer to a chemical compound treating a specific disease process. For example, the Oxford dictionary defines “medication” as “a drug or other form of medicine that is used to treat or prevent disease.” But if we are not sure that tranquilizing agents such as Seroquel and Zyprexa act upon biological disease processes, then perhaps we should not call them “medications.”
“Schizophrenia” is An Emperor with No Clothes
While the debate around the value of antipsychotics to treat “schizophrenia” continues, it should be couched in the admission that we do not know exactly what “schizophrenia” is, or if there is even one such entity. This is my second response to the debate – to observe that judging the value of antipsychotic drugs on such a moving target is unlikely to yield reliable, generalizable results. This is the case no matter how many different studies are done based on an invalid label.
Why is “schizophrenia” invalid? For an answer, we can begin by listening to the leaders of American psychiatry speaking about the validity of DSM diagnoses, of which “schizophrenia” is among the most prominent.
In 2013, discussing psychiatric diagnosis, the psychiatrist and former National Institute of Mental Health director Steven Hyman stated:
“The underlying science remains immature…The molecular and cellular underpinnings of psychiatric disorders remain unknown… psychiatric diagnoses seem arbitrary and lack objective tests; and there are no validated biomarkers with which to judge the success of clinical trials.” (emphasis mine)
Hyman went on to call the DSM model of diagnosis, which includes labels like “schizophrenia,” “Totally wrong… an absolute scientific nightmare.”
Hyman’s successor at NIMH, psychiatrist Thomas Insel, followed up this criticism by saying:
“At best, [the DSM is] a dictionary, creating a set of labels and defining each. The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever.” (emphasis mine)
David Kupfer, the DSM 5 chair, while trying to defend the new DSM, admitted that the discovery of biomarkers for supposed illnesses like schizophrenia remains “(D)isappointingly distant… unable to serve us in the here and now.”
And former DSM-IV head Allen Frances went so far as saying, “There is no definition of a mental disorder. It’s bullshit… these concepts are virtually impossible to define precisely.”
To say the least, these admissions by the leading lights of American psychiatry do not inspire confidence in the validity and usefulness of labels such as “schizophrenia.” And while psychiatrists have promised that new brain research will uncover a biological or genetic basis for the elusive “schizophrenia,” no progress on this elusive goal has been forthcoming.
Given the fact that leaders of the psychiatric profession have spoken openly about the lack of validity behind labels such as “schizophrenia,” it is fascinating that psychiatrists continue to use the term as if it referred to a valid, reliable illness entity.
As an example, the actual uncertainty around “schizophrenia” runs counter to the way that Ronald Pies writes. In a recent article, Pies described “patients suffering the debilitating, chronic symptoms of schizophrenia.” This description is clearly a biological illness approach, one which assumes that people (labeled “patients”) “have” a disease (called “schizophrenia”), as well as medicalizing their experiences as “symptoms”. But if we are not sure that such a unitary condition exists, something that Pies appears to tentatively acknowledge in footnotes, then it would be better to write about people’s suffering in a less certain way.
Pies also appears to assume – mistakenly, in my view – that just because many psychotic people he has treated or heard about experience chronic distress, that this is the normal, lifelong, and “chronic” experience to be expected for most people given the schizophrenia label. Chronic psychosis is actually not the long-term outcome for a large proportion of people given the “schizophrenia” label, as shown in this article on the World Health Organization studies, a book on the WHO research and in several longitudinal studies by Bleuler, Ciompi, Harding, and others.
The lack of validity and reliability of “schizophrenia” might also explain why billions of research dollars poured into searching for the holy grail – a genetic or biological basis for “schizophrenia” – have yielded not one iota of functional or emotional improvement for psychotic people.
The Long History of Opposition to Schizophrenia’s Validity
Let us return to the core validity question, which is important when considering if psychiatric studies about antipsychotic drugs say anything reliable or generalizable about what best treats “schizophrenia.” A long line of critics, including Mary Boyle, Richard Bentall, Jeffrey Poland, Stuart Kirk, Richard Mancuso, Colin Ross, Gary Greenberg, John Read, and Thomas Szasz, have questioned the validity of the schizophrenia label through books and articles.
They have variously pointed out the following:
- “Schizophrenia” does not refer to a coherent disease entity which can be reliably identified from the behavior of individuals.
- People with no “symptoms” in common can be given the same “schizophrenia” diagnosis.
- The bias and subjective judgment of psychiatrists is central to the labeling process (marking the difference between a “schizophrenia” label and illness diagnoses in real fields of medicine).
- No biological or genetic test can confirm the supposed diagnosis.
- Labels such as “schizophrenia” provide little to no ability to predict outcomes.
Establishment psychiatrists have historically been unable to refute such assertions that the “schizophrenia” label is unreliable, arbitrary, and scientifically invalid. For the most part they have ignored these critics and doubled down on using “schizophrenia” as if it were a valid diagnosis. It is almost as if they believe that by simply asserting that schizophrenia is a valid, discrete illness over and over again in journals and textbooks, by starting each article with “schizophrenia is a chronic, severe brain disease,” that this magically makes it so.
As Richard Bentall said, the more relevant question may be “not whether to replace schizophrenia, but what to replace it with.”
The Rise of Alternative Definitions of “Schizophrenia” and Psychosis
Now, additional voices seeking to (re)define “schizophrenia” have entered the mix, including the Hearing Voices Network, the British Psychological Society, Mad In America authors, and psychiatrists such as Jim Van Os. Each group has proposed alternative non-medical conceptualizations of severe psychosis that do not presume a biological or genetic cause, nor necessarily presume that a singular illness called “schizophrenia” exists.
These novel approaches include the BPS’s Understanding Psychosis, which redefines psychosis as often representing an understandable reaction to stress or trauma; the HVN’s positions on how voice hearing may have personal meaning and not always requiring drugging; and Van Os’ “Schizophrenia Does Not Exist” website, which contends that psychosis is part of a continuum of serious distress fading into less severe problems of thinking, feeling, and behaving.
These alternatives represent a significant challenge to establishment psychiatry’s illness narrative of “schizophrenia.” With the broad reach of the internet promoting awareness of these alternative views, people experiencing psychosis and their families have new choices about how to understand their suffering. As the New York Times states, “An alternative form of mental healthcare is taking root that is very much anti-mainstream.”
It should be noted that these alternative groups acknowledge that psychotic experiences such as voice-hearing, paranoia, delusions, severe apathy and so on are real and expressed in brain chemistry. They are not saying that “mental illness doesn’t exist” in the sense of saying that severe psychotic experience is not real or extremely painful (the latter being a simplistic trope commonly trotted out by biological-model advocates to defend against critics). Rather, these alternative groups have their own competing models of severe psychoses – models which acknowledge the expression of distress via biology and genes, but do not necessarily view them as central causes of suffering.
Lastly, before moving on, I would like to highlight an innovative new model for the relationship of genes, environment, and psychotic experience put forward by Brian Koehler, a wonderful therapist of psychotic people at New York University. This model provides a much-expanded role for adverse experiences such as loneliness, stress, trauma, and abuse in modifying biology and genes which together lead to psychotic experience. Of this approach, Koehler says, “I have derived a theory which will make a much stronger case for socio-environmental influences in what was previously thought of in classically genetic terms.”
A More Evolved Model of Psychosis – The Psychosis Spectrum Syndrome
Although they rarely speak publicly about it, I believe that an increasing number of psychiatrists are becoming open to the idea that the suffering which has previously been labeled “schizophrenia” may be better conceptualized as a syndromal continuum of psychotic states with complex individualized causes, often including socio-environmental ones. For example, Dutch psychiatrist Jim Van Os recently published a paper entitled “Psychosis as a Trandiagnostic and Extended Phenotype in the General Population.”
Referring back to the Whitaker-Pies debate, I believe Pies is aware of the difficulty in defining psychosis, but he nevertheless writes about “schizophrenia” as if it were a monolithic medical disease which people “have,” while rarely if ever referring to the adverse experiential and relational factors in people’s lives which may have led them to become psychotic.
This leads to a third point – that the “schizophrenia” label tends to blind us to asking what has happened to psychotic people that may have caused them to become so distressed. To the degree that Pies does not acknowledge trauma and abuse as a major contributor to psychotic states, he is either not up to date on recent research into psychosis and adverse social experience, or he may have other reasons for clinging to an impersonal disease model of “schizophrenia.”
For the primary causal factors leading to psychotic experiences, we have to look at individuals in relation to their past experiences and significant relationships, particularly negative and traumatic ones. The contributions of these adverse social experiences to the distress of many psychotic people reminds us that antipsychotic tranquilizers cannot address the root causes of their suffering.
Trauma, Abuse, Stress, and Breakdowns in Trust as Causing “Schizophrenia”
While reading this section, I ask the reader to keep in mind the possible psychological effects of receiving tranquilizing drugs for people who have been seriously abused and traumatized. One can ponder the effect of presenting these drugs to clients as “medications” that supposedly treat a symptom-causing illness, rather than as tranquilizers numbing the ability to feel one’s rage and fear after a lifetime of adverse social experiences. Perhaps the awareness that this is a misleading presentation by professionals is one reason underlying the fact that up to 75% of psychotic people stop taking their tranquilizers within two years – an issue of “failed compliance” that pharmaceutical corporations apparently have a plan to stop.
In the model of severe psychosis I favor, adverse environmental experiences are frequently (although not always) involved in leading to psychotic breakdowns. In support of this position, a number of psychologists and psychiatrists, such as John Read, Colin Ross, and Richard Bentall, have done research showing a powerful link between being labeled “schizophrenic” and having experienced physical, emotional, and sexual abuse.
An article by Noel Hunter reviews this research and provides references to the literature:
“Read et al. concluded in 2005 that child abuse is a causal factor in “schizophrenia.” Read et al., after identifying similarities in the brains of traumatized children and adults who were diagnosed with schizophrenia, demonstrated the neurodevelopmental pathways through which childhood adversity may cause psychosis. In 2004, Janssen et al. established a strong dose-response relationship between childhood abuse and psychosis after following 4045 individuals from the general population for two years. Bentall et al. also found a dose-response relationship between childhood abuse and psychosis (meaning that the greater number of adverse experiences and/or the higher the severity, the greater the risk), wherein those who had a high-severity of childhood abuse were 48.4 times more likely to develop psychosis as an adult. When specificity and dose-response relationships are demonstrated, a causal relationship is strongly probable. In fact, Bentall et al. stated that “experiencing multiple childhood traumas appears to give approximately the same risk of developing psychosis as smoking does for developing lung cancer.” And, lastly, in the same month as the Sekar study was released (January 2016), so too was a nationwide cohort study out of Denmark and Sweden which found that experiencing the death of a first-degree relative before 18 years of age, especially from suicide or accident, resulted in a 39% increased risk of being diagnosed with schizophrenia.”
The recent Adverse Childhood Experiences study, in which thousands of people were assessed to see how trauma, abuse, and neglect in childhood related to later severe psychiatric diagnoses in adulthood, further reinforced the connection.
This research does not mean that everyone who gets labeled “schizophrenic” has these adverse social experiences; these studies are based on averages. But they strongly suggest that most people who are labeled “schizophrenic” experience severe traumas, abuse, and/or neglect leading up to their psychoses.
For those who doubt this link, I recommend viewing one of John Read’s provocative Youtube presentations on the issue, including “Who Is Right About the Causes of Psychosis…Psychiatrists or their Patients?” and “Childhood Adversity and Psychosis, From Heresy to Certainty.”
The powerful association between trauma and “schizophrenia” calls into question the model of a schizophrenia arising primarily from within an individual due to a brain chemical imbalance or faulty genes. It may also help to explain why, according to a recent meta analysis of schizophrenia outcomes by Erika Jaaskelainen, antipsychotic drugs have not resulted in increased long-term recovery rates since the mid-20th century.
In my view, tranquilizing people with Seroquel, Zyprexa, Risperdal etc may help contain their distress in the short term, but does little or nothing to make them functional or connected to others in the long term. When one reflects upon the love and support one needs to recover from being poor, unloved, abused, and traumatized, one can better appreciate why being tranquilized alone may not help very much.
In this article, I’ve explored the uncertainty around the medicalized term “schizophrenia”, contested the use of the term “medications” for sedatives not known to address a specific illness, and begun to explore alternative psychosocial models of psychosis. Hopefully I’ve demonstrated that the language used in the Pies-Whitaker debate does not reflect the concepts or terminology for psychosis used or accepted by many helping professionals nor people with lived experience.
In the second article in this series, I will further explore the motivations underlying the usage of these loaded words. I’ll discuss the specific research debated by Pies and Whitaker, discussing when antipsychotic drugs might be valuable. And I’ll present an in-depth look at hopeful alternative approaches to helping psychotic people. These approaches are giving psychotic individuals and their families real choices, beyond the “medication for schizophrenia” approach, both in terms of how to conceptualize suffering and how best to alleviate it.
* * * * *
Articles on Antipsychotics by Ronald Pies and Robert Whitaker
Pies, Ronald. (2016). “How Antipsychotic Medication May Save Lives.” Blog entry. Retrieved from http://www.psychiatrictimes.com/schizophrenia/how-antipsychotic-medication-may-save-lives
Pies, Ronald. (2016). “Quality of Life and the Case for Antipsychotics.” Blog entry. Retrieved from http://www.psychiatrictimes.com/schizophrenia/quality-life-and-case-antipsychotics
Whitaker, Robert. (2016).“The Case Against Antipsychotics.” Blog entry. Retrieved from https://www.madinamerica.com/2016/07/the-case-against-antipsychotics/
Whitaker, Robert. (2016). The Case Against Antipsychotics: A Review of Their Long-term Effects. White paper. Retrieved from http://www.madinamerica.com/wp-content/uploads/2016/07/The-Case-Against-Antipsychotics.pdf
Whitaker, Robert. (2016). “Timberrr! Psychiatry’s Evidence Base for Antipsychotics Comes Crashing to the Ground.” Blog entry. Retrieved from https://www.madinamerica.com/2015/12/timberrr-psychiatrys-evidence-base-for-antipsychotics-comes-crashing-to-the-ground/
Critical Explorations of Antipsychotic Drugs
Bentall, Richard. (2009). Doctoring the Mind: Is Our Current Treatment of Mental Illness Really Any Good? New York, NY: New York University Press.
Healy, David. (2009). Psychiatric Drugs Explained, 5th Ed. New York, NY: Elsevier.
Jackson, Grace. (2005). Rethinking Psychiatric Drugs: A Guide for Informed Consent. Bloomington, IN: Authorhouse.
Moncrieff, Joanna. (2013). The Bitterest Pills: The Troubling Story of Antipsychotic Drugs. New York, NY: Palgrave Mcmillan.
Whitaker, Robert. (2010). Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America. New York, NY: Crown Publishers.
Analyses of the Potential Harms Done by Biogenetic Explanations for “Mental Illness”
Haslam, Nick. (2015). “Blame it on biology: How explanations of mental illness influence treatment.” In The Conversation. Retrieved from https://theconversation.com/blame-it-on-biology-how-explanations-of-mental-illness-influence-treatment-48578
Kemp J., Lickel J., Deacon B. “Effects of a chemical imbalance causal explanation of individuals’ perceptions of their depressive symptoms.” Behavior Research and Therapy 56 (2014) 47-52. Retrieved from http://www.uw-anxietylab.com/uploads/7/6/0/4/7604142/chemical_imbalance_test_brat.pdf
Read J., Haslem N., Sayce L, Davies E. (2006). “Prejudice and schizophrenia; a review of the “mental illness is an illness like any other” approach.” Acta Psychiatrica Scandinavica 2006: 114: 303-318. Retrieved from http://www.freedom-center.org/pdf/read_prejudice_schizophrenia_biol_stigma.pdf
Schultz, William. (2015). “More on Neuroessentialism: Theoretical and Clinical Considerations.” Retrived from http://www.madinamerica.com/2015/12/70079/
Unger, Ron. (2012). “It’s Not Just the Drugs: Misinformation Used to Push Drugs Can Make Mental Problems Worse.” Retrieved from http://recoveryfromschizophrenia.org/2012/07/its-not-just-the-drugs-misinformation-used-to-push-drugs-can-also-make-mental-problems-worse/
Books and Articles Contesting the Validity of Schizophrenia as a Medical Disease
Bentall, Richard.(2005). Madness Explained: Psychosis and Human Nature. New York, NY: Penguin.
Boyle, Mary. (2002). Schizophrenia: A Scientific Delusion? New York, NY: Taylor & Francis.
Greenberg, Gary. (2014). The Book of Woe: The DSM and the Unmaking of Psychiatry. New York, NY: Penguin.
Kirk, Stuart. (2013). Mad Science: Psychiatric Coercion, Diagnosis, and Drugs. New Brunswick, NJ: Transaction Publishers.
Mancuso, Richard, and Theodore Sarbin. (1980). Schizophrenia: Medical Diagnosis or Moral Verdict? New York, NY: Pergamon Press.
Poland, Jeffrey. (2006). “How to Move Beyond the Concept of Schizophrenia.” Retrieved from http://www.academia.edu/237140/How_to_Move_Beyond_the_Concept_of_Schizophrenia
Poland, Jeffrey. (2006). “Steps Toward a Schizophrenia-Free World.” Retrieved from http://www.academia.edu/237140/How_to_Move_Beyond_the_Concept_of_Schizophrenia
Read, John and Jacqui Dillon, Eds. (2013). Models of Madness: Psychological, Social, and Biological Approaches to Psychosis (The International Society for Psychosocial and Social Approaches to Psychosis Book Series). New York, NY: Routledge.
Ross, Colin. (2004). Schizophrenia: Innovations in Diagnosis and Treatment. New York, NY: Haworth Press.
Szasz, Thomas. (2004). Schizophrenia: The Sacred Symbol of Psychiatry. Syracuse, NY: Syracuse University Press.
Psychodynamic Depth Approaches to Transforming Psychotic States
Arieti, Silvano. (1974). Interpretation of Schizophrenia, 2nd Ed. New York: Basic Books.
Boyer, Bryce. (1983). The Regressed Patient. New York, NY: Jason Aronson.
Searles, Harold. (1965). Collected Papers on Schizophrenia and Related Subjects. New York, NY: Chatto and Windus.
Steinman, Ira. (2009). Treating the “Untreatable”: Healing in the Realms of Madness. London, UK: Karnac.
Volkan, Vamik. (1995). The Infantile Psychotic Self and its Fates: Understanding and Treating Schizophrenics and Other Difficult Patients. New York, NY: Jason Aronson.
Alternative Models of Psychosis
Cole, Kermit. (2016). Love is Dialogical: The Open Dialogue UK International Conference and Training. Retrieved from https://www.madinamerica.com/2016/03/love-is-dialogical-the-open-dialogue-uk-international-conference-and-training/
Cooke, Anne Ed. (2015) Understanding Psychosis and Schizophrenia: Why people sometimes hear voices, believes things that others find strange, or appear out of touch with reality, and what can help. Retrieved from https://www.bps.org.uk/system/files/user-files/Division%20of%20Clinical%20Psychology/public/understanding_psychosis_-_final_19th_nov_2014.pdf
Hearing Voices Position Statement on DSM 5 and Psychiatric Diagnosis. (2016). Webpage. http://www.hearing-voices.org/about-us/position-statement-on-dsm-5/
Koehler, Brian. (2015). The Deeper Genome: New Research Findings in Genomics and Epigenomics. Retrieved from https://www.madinamerica.com/2015/12/the-deeper-genome-new-research-findings-in-genomics-and-epigenomics/
Van Os, Jim. (2016). Schizophrenia Does Not Exist. Website. https://www.schizofreniebestaatniet.nl/english/
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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