Rejecting the “Medications for Schizophrenia” Narrative: Part II

Matt Stevenson
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In the first article in this series, I contested the framing of delusions, hallucinations, paranoia, and inability to function as a brain disease called “schizophrenia,” while rejecting the euphemistic label of “medications” for tranquilizing drugs which do not treat a specific illness process. I recounted my story of recovering from extreme states, which I achieved partly by rejecting the “medications for schizophrenia” approach. And I discussed alternative models which explain severe psychosis in terms of suffering expressed through biology and genes, rather than as a discrete illness caused by dopamine imbalances or faulty genes.

In this second article, I will further analyze the reasons why the unevidenced biological-illness approach to “schizophrenia” has become so entrenched in our society. To explore this question, one must take a unflinching look at who benefits from the “illness like any other” approach to “schizophrenia.”

And most importantly, I will discuss hopeful alternatives. These approaches offer psychotic people alternative pathways for understanding their problems and for returning to emotional wellbeing. Psychotic people and their families deserve better than what mainstream psychiatry has to offer, and with real alternatives now available, suffering people have new choices about how to conceptualize their distress and how to get help.

What Do Psychiatrists Stand to Gain from the Bio-Genetic Approach to “Schizophrenia”?

In the debate about causes of psychotic experience, mainstream psychiatrists have tended to give lip service to environmental stress as a factor in triggering the supposed illness, while focusing their explanations of psychotic suffering around unproven notions of faulty genes and chemical imbalances causing the psychotic person’s “brain disease.”

This bio-genetic focus is understandable when one considers that primarily bio-genetic explanations of psychosis have numerous “advantages” for the psychiatric profession, in that they:

1) Support the illusion that psychiatrists are treating well-defined brain diseases in their privileged role as medical doctors;
2) Justify the use of tranquilizers, euphemistically named “medications,” to treat the supposed illness;
3) Protect psychiatrists and allied mental health workers from having to get to know psychotic people intimately as individuals, a process which often involves encountering uncomfortably large amounts of confusion, terror, rage, and despair;
4) Allow for shorter sessions and more profit per hour worked – it is much easier and more lucrative to give someone a pill after a 15-minute evaluation, than to sit and talk to them for an hour;
5) Allegedly protect parents from being “blamed” for contributing to their child’s psychosis despite the fact that biological models actually encourage prognostic pessimism, and obscure the obviously uncomfortable fact that not all, but many parents of psychotic individuals have abused and neglected their children, as pointed to by the studies connecting trauma and psychosis in part 1 of this series.

(Parental abuse of psychotic-children-to-be is something which usually occurs not because such parents are “bad” or “evil,” but because they are under serious stress from a multitude of other factors such as poverty, discrimination, abuse and neglect by their own parents/grandparents, etc. This was the case in the physical abuse in my own family, which acted as a precursor to my psychosis. My parents did not want to harm me, but due to their own fear and anger they were unable to control themselves. Fortunately I now have a much better relationship with my own parents, and being able to discuss the past, including the abusive parts, was ultimately therapeutic and cathartic.)

Regarding #5, the problem with using primarily biological models of psychosis is not only that they are unevidenced, but that (not unlike antipsychotic drugs) such models can have serious “side effects.” These include:

  • Harsher judgments from people who believe “the mentally ill” have biological brain diseases.
  • More prognostic pessimism from both laypeople and professionals endorsing biological models.
  • Increased stigma and less ability to regulate mood in those told they have a chemical imbalance.
  • Less motivation to explore what one can do to change problems in those given “mental illness” labels.
  • Worse outcomes for so-called “mental illnesses” compared to outcomes of physical diseases.
  • Greater fear of people given mental diagnoses (and interestingly, as this talk shows, the majority of the public rejects psychiatry’s narratives about a primarily biogenetic cause of mental health problems in most countries outside the United States).

Pies and Pierre Cling to a Reductionist Model of “Schizophrenia”

Returning to Pies and Pierre’s articles, the authors repeatedly describe psychotic people with statements such as: “the degree of incapacity and suffering the patient has endured, as a consequence of having schizophrenia…” They describe “the chronic debilitating symptoms of schizophrenia.” They speak about “the ravages of… the illness” and its “human tragedy,” but do not go any further in discussing the causal factors in their clients’ lives which may have contributed to their becoming psychotic.

It is fascinating that in psychiatric discussions of how to “treat schizophrenia,” as exemplified in many editorials on the schizophrenia website Ronald Pies is associated with, adverse environmental factors and the subjective experiences of psychotic people are rarely discussed – or if they are, it is as adjuncts to the experience of having a supposedly symptom-producing illness. What is going on interpersonally in the lives of psychotic people is obliterated by the assumption that they “have schizophrenia” and the belief that “medications treat the disease.”

By largely omitting the stories of the people they serve, Pies’ statements regarding “schizophrenia” inadvertently reinforce the unevidenced biological model: this is done as simply as by Pies and Pierre saying that “having schizophrenia” causes incapacity and suffering, as if “schizophrenia” were an autonomous entity that does things to people. To his credit, Pies occasionally makes remarks such as “People with schizophrenia have lives beyond their symptoms,” but these qualifications come across as footnotes set against the larger goal of pushing for drug use.

As Whitaker recounted in Psychiatry Under the Influence, the psychiatric field, guided by the APA, set out in the late 1970s to push public opinion toward equating emotional distress with physical disease. This initiative was pushed forward despite the lack of any evidence that psychosis and other states of severe emotional distress work like a physical disease.

Additionally, the use of the word “patient,” while customary, implies a person with a medical disease. This usage is accepted despite the fact that the existence of a discrete medical illness called schizophrenia has not been established. The use of the word “patient” to describe psychotic people is another element in the discussion by Pies and Whitaker that inadvertently medicalizes psychotic people. (There are alternatives – consider that the British psychiatric system now calls people “service users” rather than “patients”).

Reflecting on the language we use to discuss severely psychotic people, one has to wonder why we, as a society, do not listen to them or place them in a social context. While Robert Whitaker understandably debates psychiatrists on their terms for clarity’s sake, I wonder about the harms of continuing to use the unevidenced assumptions contained in words used by Pies like “medication” and “schizophrenia.”

My Position on Tranquilizers Such as Seroquel, Risperdal, and Zyprexa

The reader might be surprised to hear that I am not absolutely against major tranquilizers (i.e. antipsychotic drugs). I think that using them should be an individual decision. However, I also believe that people experiencing psychotic states should be informed that antipsychotic drugs are not medications treating a specific illness, as well as the fact that the potential long-term side effects, such as tardive dyskinesia and weight gain leading to diabetes, can be extremely severe. And along with whether or not to take drugs in the first place, they should have a choice whether or not to accept the “biological illness” model of “schizophrenia”.

In the short term it can sometimes be useful to tranquilize or numb one’s feelings so that overwhelming terror, rage, or despair – feelings that psychotic people are often tortured by – are less unmanageable. In this way a psychotic person may feel calmed and enabled to talk about what is going on. But importantly, the drugs do not and cannot do anything to resolve the preexisting problems in a person’s life – often including isolation, trauma, abuse, and neglect – that may have led them to become psychotic. Nevertheless, the predominant practice in American psychiatry is to give psychotic people drugs indefinitely, and to talk little if at all to them about their lives.

With regard to the studies that Ronald Pies lists in his recent blog about the supposed value of antipsychotic “medications,” I do not believe these studies to be evidence of anything, given that they were Big Pharma-funded, high-dropout, short-term trials of clients who were abruptly withdrawn from drugs, rather than studies comparing medication-naive placebo-takers with those taking drugs.

And it should be pointed out that, in most fields of medicine, such drugs would only be used long-term if they had an evidence base supporting their efficacy in helping most suffering people get the results they want (which may be different from the results the professionals want). Considering the lack of a long-term evidence base for antipsychotics, to use the drugs in the way that many psychiatrists do today would be considered malpractice in most evidence-based medical fields.

This type of behavior may be one part of what has led the public and non-psychiatric physicians to have such a low opinion of the psychiatric field. To quote John Read, a large part of the reason why the field is regarded so poorly can be traced to, “a rigid adherence to a narrow biogenetic ideology combined with arrogant dismissal of those with broader perspectives.” The “medications for ‘schizophrenia’” narrative appearing throughout psychiatric research stands as a prime example of mainstream psychiatrists’ clinging to such an ideology while ignoring the criticisms of people with lived experience and professionals within and outside their field.

Cui Bono?

Unfortunately, informed consent and honesty about what we do not know related to severe psychosis is rarely seen in American psychiatry. I think the reasons why psychiatrists are not as forthright as they could be about the uncertainty around the terms “medications” and “schizophrenia” are understandable. One only has to ask, cui bono? (To whose benefit? That is, who benefits from disguising tranquilizers as medications treating a brain disease, and how do they do so?).

If psychiatrists were to publicize the fact that the evidence establishing schizophrenia as a brain disease is non-existent, and that the drugs used to numb psychotic people are general tranquilizers, the following consequences might result:

  1. Even less respect for the embattled profession of psychiatry than is currently the case.
  2. Anger from clients and families realizing they were misled by their doctors as to the nature of psychotic distress and the risks of psychiatric drugs.
  3. A reduction in income for psychiatrists and drug companies, as antipsychotic drugs would probably be used less frequently and for shorter periods. This is probably the most important factor driving the “medication” myth and the “schizophrenia is an illness” myth”: the $18+ billion in annual sales of drugs for tranquilizing psychotic people.
  4. Significant loss of financial support for university psychiatric research and psychiatrist-training programs, as drug companies began to direct their funding elsewhere – a process which is already underway.

As Upton Sinclair said in the early 20th century, “It is difficult to get a man to understand that ‘schizophrenia’ is not an illness and that antipsychotic tranquilizers are not ‘medications’, when his salary depends upon his not understanding these facts.”

Or perhaps what Sinclair said was slightly different, but you get the point!

Thus, the continued medicalization of this discourse helps to maintain important economic and social benefits for psychiatrists and drug companies. In other words, selling “schizophrenia” as an illness while presenting tranquilizers as “medications” helps both psychiatrists and drug company executives pay their mortgages, send their kids to good schools, save for retirement, and enhance their status as supposed medical-industrial professionals.

This does not mean psychiatrists are “bad” people, but it does mean that there are strong conflicts of interest between making the most profit while elevating one’s social status, and being totally open about what we know and do not know about psychosis and antipsychotic drugs.

Should Antipsychotic Drugs Feature Front and Center in the Debate about How Best to Help Psychotic People?

I have spent the last 12 years researching effective psychosocial approaches to severe psychosis, and more importantly working through a “curative” process for my own psychosis. Although they are rarely acknowledged within American psychiatry, methods for helping severely psychotic people to become truly well – “cured,” in the reductionistic medical language – already exist. Contrary to what one reads in major newspapers, we do not require billions more dollars of research into biology and genetics to know how to help these people.

This is a larger point I believe is being lost in the debate around drugs: Along with not treating a specific disease, these emotion-numbing tranquilizers are not necessarily needed for many severely psychotic people to become well in the long term, even at the beginning of their psychotic experiences.

If tranquilizers are a useful aid for some on the way to wellbeing, then so much the better for those who choose to use them. But there is limited evidence to suggest that these drugs make a large difference in suppressing distress relative to placebo, and when weighed against their side effect profile, the decision to use them long term becomes more controversial.

There are several lines of evidence in support of the contention that antipsychotic drugs should be presented as one option among many for handling severe distress. The first is that recent research by Sohler et al has concluded that antipsychotic tranquilizers lack a solid evidence base supporting their use beyond one year (one should be clear that the “evidence” of “efficacy” is usually defined as dumbing down psychotic distress, i.e. numbing a person’s ability to feel, rather than feeling or functioning well in the long term).

Secondly, the Open Dialogue approach has demonstrated through multiple longitudinal studies (see also here) that an approach using no drugs, or limited-term low doses of drugs, can lead to excellent functional and experiential results for around 80% of psychotic people. Given this success, one has to ponder the reasons why drug companies and governments are so reluctant to fund further studies of intervention for psychosis using limited or no drugs.

Thirdly, the largest meta-analysis of psychotherapy for psychosis by William Gottdiener, which covered 37 studies of psychotherapy comprising 2,642 psychotic people receiving therapy for an average of 20 months, and which also tracked drug use, concluded the following regarding “medication”:

“It is surprising that the proportion of (“schizophrenia”) patients that were likely to improve without conjoint medication, is similar to the proportion of patients that were likely to improve with a combination of individual psychotherapy and antipsychotic medication. This finding is contrary to most therapists’ clinical expectations… it suggests that individual psychotherapy alone might be a viable treatment option for some patients who do not improve from treatment with antipsychotic medications, for some patients who refuse to take medications, or for patients who are treated by therapists that choose to use little or no adjunctive medication.”

These data suggest that recovery from severe psychosis without drugs, or with low-dose, short-term use of drugs, is a real possibility for many, perhaps most psychotic people. Perhaps a large proportion of people who are delusional and hallucinating may not need to be tranquilized (the reader is probably noticing, by this point, how much less flattering it sounds when one discusses “tranquilizing” psychotic people, as opposed to giving them “medication”). If given sufficient social and psychological support, many profoundly distressed people might recover without being tranquilized and without the risk of severe side effects. (And notice how different this language is than saying, “What proportion of people who have schizophrenia require antipsychotic medication?”)

The Disturbing Reality of Outcomes for People Labeled “Schizophrenic”

At this point, let’s take a look at how people labeled “schizophrenic” are doing in terms of outcomes over the past several decades, focusing especially on whether the proportion becoming functional is increasing.

In 2013, Erika Jaaskelainen completed a large meta-analysis of about 9,000 people labeled “schizophrenic” who were followed up for various outcome lengths ranging from two to more than 20 years. The meta-analysis comprised 50 individual studies spanning several decades, including a number from before the advent of tranquilizing drugs in the mid-20th century. About the functional and “symptomatic” outcomes for people labeled “schizophrenic,” Jaaskelainen states:

“Consistent with the previous systematic reviews, we found no evidence to suggest that recovery outcomes (for people labeled “schizophrenic”) have improved over time… Indeed recent decades had lower numerical proportions of subjects who met our recovery criteria. This is a sobering finding – despite major changes in the delivery of care to people with schizophrenia (e.g. deinstitutionalization, antipsychotic medications, psychosocial interventions, and early psychosis services), the proportion of those who met recovery criteria has not improved over time… We found no evidence to suggest that we are getting better at getting our patients better.”

This is sobering indeed. While the meta-analysis did not directly measure the effects of treatment, its breadth and length suggests that the advent of first and second generation antipsychotics – which were being used with the large majority of the cohorts in the study – failed to increase the proportion of severely psychotic people achieving long-term functionality and wellbeing.

This meta-analytic data runs directly counter to the unevidenced suggestions by Jeffrey Lieberman and other leading psychiatrists that antipsychotics are “miracle medications” that have led to greatly improved outcomes. Not only has the miracle of long-term outcomes dramatically improving due to “medications” not occurred, but “schizophrenia” outcomes have been gradually worsening for decades.

Effective Approaches to Helping Psychosis Already Exist, With or Without Drugs

I believe it is vital not only to criticize psychiatry’s approach to “schizophrenia”, but to offer better competing alternatives. Considering that mainstream psychiatry has failed to help so many people labeled “schizophrenic”, there are a number of promising approaches to helping psychotic people that do not center on the use of antipsychotics.

The aforementioned Open Dialogue Program has shown that an approach using only short-term drugging in a minority of cases can be extremely effective in helping psychotic people to recover functionality and become emotionally well. This program not only has robust research supporting its original version in Finland, but is also being actively researched in a number of other countries.

The 388 Program in Quebec, Canada, is another primarily non-drug approach that has been successfully helping young psychotic people to recover for over 30 years. View its Ted-Talk here.

And the Hearing Voices Network, while young, has dozens of groups meeting in different countries, including over 80 groups meeting in the United States and over 90 in the United Kingdom. These groups, which provide psychotic people with an alternative, more hopeful way of understanding their suffering and getting help.

In the psychosis-intervention group I’m a part of, The International Society for Psychological and Social Approaches to Psychosis, we have many therapists who have spoken and published about how the work of helping psychotic people to transform their lives may be accomplished both with and without the use of drugs.

Members of the ISPS group have written books that teach an individualized approach to exploring stresses which contribute to a person becoming delusional, paranoid, and/or hallucinatory. When the resources for developing long-term relationships with psychotic people are available – which in America is far too rarely – these therapeutic approaches can yield great improvement and even full recovery. In “depth approaches” to helping psychotic people, antipsychotic drugs are sometimes used but usually on a short-term, decreasing basis. The focus of the therapeutic relationship is on the individual thoughts and feelings of the psychotic person, what they have experienced, and their hopes and dreams for becoming well. There is never the presumption that a psychotic person has an incurable brain disease that requires drugging for life.

Here are three examples of such psychotherapy, one from a San Francisco psychiatrist who believes American psychiatry has lost its way when it comes to helping psychotic people, another from a person with lived experience of psychosis who is now a therapist, and a third from a leading British psychoanalyst who has successfully worked with acutely and chronically psychotic people in intensive therapy for decades:

Treating the Untreatable: Healing in the Realms of Madness by Ira Steinman (personal website)

Rethinking Madness: Towards a Paradigm Shift in Our Understanding and Treatment of Psychosis (full book downloadable for free) by Paris Williams (personal website)

When the Sun Bursts: The Enigma of Schizophrenia by Christopher Bollas

The 25+ case studies of “schizophrenic” people in these books are powerful affirmation of the human potential for recovery even from the most severe psychosis.

Beyond these books, there are many people in ISPS with lived experience who have spoken out powerfully about their recovery, including Eleanor Longden, Rachel Waddingham, Olga Runciman, Daniel Fisher, and Jacqui Dillon. In the way they understand having been psychotic, each of these individuals presents a dramatic contrast with the primarily biological-illness model promoted by Ronald Pies and most American psychiatrists.

Conclusion: Affirming Psychotic Individuals As Human Beings Not So Different From the Rest of Us

I believe we should make a societal shift toward focusing on psychotic individuals and their stories, without presuming that we know that their distress – however severe it is at a given time – constitutes a disease called “schizophrenia.” In this model, drugs might be useful for some people for varying periods, but would not be seen as “medications” which are always needed to treat a phantom disease.

By unquestioningly accepting the disease model of “schizophrenia”, far too many psychiatrists are able to reach for their pill box, switch off emotionally, and view the person in front of them as an illness to be drugged rather than a person to be understood.

Psychiatrists are subject to a huge amount of pressures, such as pressure from health insurance systems which disallow non-drug approaches, from poor training programs that eschew depth psychotherapy, from drug companies which pressure them to accept a primarily bio-genetic model, and from fear of offending family members with social explanations. But they, and we, can do better.

If one actually listens to and seeks to form a relationship with a psychotic person, one gradually finds out what Harry Stack Sullivan said: “We are all much more simply human than otherwise.” Although they are often distant, distrustful, and terrified, most psychotic people desperately want human support and understanding. And there is no tranquilizer that can substitute for a healing relationship. As one of the world’s leading therapists of psychosis, Gaetano Benedetti said, healing interpersonal relationships are the “alpha and the omega” of recovering from severe psychosis.

Many years ago, I was told I had an incurable brain disease and would always need to be on drugs. At that time I believed that due to having an incurable illness, I would never be able to work, have satisfying relationships, or feel truly alive.

But gradually, I found out that this entire illness narrative was wrong. It turned out that a discrete brain disease called “schizophrenia” does not exist, that psychotic experiences are more strongly linked to adverse social experiences than to biology, and that through establishing trusting relationships, psychotic people can become non-psychotic and well.

I am glad I did not believe what psychiatrists told me about “schizophrenia” and came to trust my own instincts, because otherwise I might have ended up nonfunctional, imprisoned, or even dead.

To conclude, psychotic people and their families deserve to hear more sides to the debate about “schizophrenia” beyond simply the biological “illness” treated by “medications” narrative. With more people with lived experience speaking out, as well as with programs like the Hearing Voices Network and Open Dialogue offering alternative models, psychotic people now have more options beyond accepting they have a “schizophrenic illness” and that they inevitably need “medications” to treat this supposed disease.

* * * * *

References:

A Large Current Meta-Analytic Review of “Schizophrenia” Outcomes

Jaaskelainen, Erika et al. (2013). “A Systematic Review and Meta-Analysis of Recovery in Schizophrenia.” In Schizophrenia Bulletin. Retrieved from https://www.yellowbrickprogram.com/ArticlePDF/Jaaskelainen-2013-A-systematic-review-Bull.pdf

John Read’s Criticisms of Psychiatry and its Approach to “Schizophrenia”

Read, John. (2014). “Saving psychiatry from itself: will young psychiatrists choose authoritative power or authoritative respect?” Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/acps.12355/full

Read, John. (2015). “In search of an evidence-based role for psychiatry.” Retrieved from http://www.future-science.com/doi/pdf/10.4155/fsoa-2015-0011

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 https://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/

Research Supporting a De-emphasis of Antipsychotic Drugs in relation to “Schizophrenia”

Gottdiener, William. (2002). “The Benefits of Individual Psychotherapy for People Diagnosed with Schizophrenia: A Meta-Analytic Review.” In Ethical Human Sciences and Services. Retrieved from http://psychrights.org/Research/Digest/Effective/BGSchizophreniaMeta-Analysis.htm

Sohler, Nancy et al. (2015). Weighing the Evidence for Harm From Long-Term Treatment With Antipsychotic Medications: A Systematic Review. American Journal of Orthopsychiatry.  http://psycnet.apa.org/index.cfm?fa=buy.optionToBuy&id=2015-55825-001 (Abstract)

Seikkula, Jaakko et al. (2006). “Five-year experience of first-episode nonaffective psychosis in open-dialogue approach: Treatment principles, follow-up outcomes, and two case studies.” In Psychotherapy Research. Retrieved from http://psychrights.org/Research/Digest/Effective/fiveyarocpsychotherapyresearch.pdf

Seikkula, Jaakko et al. (2006). “Open Dialogue in Psychosis II: A Comparison of Good and Poor Outcome Cases.” In Journal of Constructivist Psychology. Retrieved from http://psychrights.org/Research/Digest/Effective/OpenDialoguejoconstrudial2.pdf

Alternative Psychosocial Approaches to Supporting Psychotic People

Bergeron, Danielle. (2012). “A new perspective for treating psychosis.” TED Talk. Retrieved from https://www.youtube.com/watch?v=mmqT-4W4Cvg

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/

Hearing Voices Network United Kingdom. Website. http://www.hearing-voices.org/hearing-voices-groups/find-a-group/

Hearing Voices Network USA. Website. http://www.hearingvoicesusa.org/find-a-group

International Society for Psychological and Social Approaches to Psychosis. Website. http://isps.org/
Transformative Psychotherapeutic Approaches to Healing “Schizophrenia”

Benedetti, Gaetano. (1993). Psychotherapy of Schizophrenia: Master Work Series. New York, NY: Jason Aronson.

Bollas, Christopher. (2015). When the Sun Bursts: The Enigma of Schizophrenia. New Haven, CT: Yale University Press.

Steinman, Ira. (2009). Treating the Untreatable: Healing in the Realms of Madness. London: Karnac.

Sullivan, Harry Stack. (1974). “Schizophrenia as a Human Process.” New York, NY: W.W. Norton.

Williams, Paris. (2012). Rethinking Madness: Towards a Paradigm Shift in Our Understanding and Treatment of Psychosis. Retrieved from http://www.rethinkingmadness.com/download/i/mark_dl/u/4007924736/4629448798/Rethinking_Madness_complete.pdf

Formerly “Schizophrenic” Psychiatric Survivors Speaking About Their Recovery

Dillon, Jacqui. “Biography.” Webpage. http://www.jacquidillon.org/biography/

Fisher, Daniel. (2012). “A New Understanding of ‘Psychosis’.” Retrieved from https://www.madinamerica.com/2012/08/a-new-understanding-of-psychosis/

Longden, Eleanor. (2013). “The Voices in my Head.” TED Talk. Retrieved from https://www.youtube.com/watch?v=syjEN3peCJw

Runciman, Olga. Mad in America Articles. Available at https://www.madinamerica.com/author/orunciman/

Waddingham, Rachel (2016). “My Story.” Webpage. http://www.behindthelabel.co.uk/about/

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 and Joseph Pierre. (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). “Confessions of a Trespasser.” Blog entry. Retrieved from https://www.madinamerica.com/2016/09/confessions-of-a-trespasser/

61 COMMENTS

    • Sorry did not mean to flag
      The joys of everlasting side effects
      Thanks for taking the time to reply and check out the story
      Just found out article that says psych docs vote Democratic
      Jeez no wonder Al Franken is clueless
      They have their own voting block!

  1. Thanks again for all of your hard work
    One might want to delve into more history after this
    The Yellow Wallpaper is a short story by Charolotte
    Perkins Gilman fictionilized fact based story on female hysteria
    This was once again a form of trauma that was medical used and the treatment a form of abuse in and of itself
    This was in the end of the Victorian era when women were beginning to – heaven forbid – be uppity
    This parallels the female suffergent movement and it made a good living for docs
    Another era is the Soviet dissatent years of imprisionment and forced medication
    Whenever there is fear of truth in reality the modern world seems to use and find the Denzions of the devil to help surpress it
    and for some psychiatry has been all to willing to land a hand
    Female hysteria is no longer an issue
    One would hope that in the future this will be true of the DSM and many if not all of its catagories
    More work for research for you and others

  2. Matt, I think you make a thorough and persuasive argument that what they offer is not only not working to help people heal, but it’s only making matters way worse, to a tragic degree. And, you illustrate that there are a plethora of avenues to healing that are sound, natural, and heart- and human-centered. Yes, they exist and people are seeking and using them. The ‘alternative-to-the-mental-health-industrial-complex’ is here, on Earth, and ready to be utilized, for those who want it.

    Thanks to the dense and widespread stigma caused by these “diagnoses,” clinicians don’t see the person, they merely perceive a distortion, coming from their own inner reality. Has nothing to do with the client. It’s a delusion, projected aggressively and abusively, and carries the potential for doing incredible long-term harm to the client, because of the disorientation and chronic inner struggle which this inevitably causes, until one can come back in synch with who they really are, over and beyond some shadow projection from a clinician or social worker.

    “Many years ago, I was told I had an incurable brain disease and would always need to be on drugs.”

    Yes, me too, and nothing could have been further from the truth. That is a dead-end version of someone else’s reality in which I don’t care at all to participate any longer. I lived with that delusion for 20 years, then finally woke up and changed my beliefs and healing process, which worked to completion for me. I’ve never been as vital and healthy as I am now, totally fulfilled in my endeavors. Still boggles my mind how they could have been soooo wrong, to the point of it nearly destroying my life, and that of my partner, from their wildly damning prognosis–all stigma-based, pure fiction.

    I think “chronic illness that requires a lifetime of drugs” is the most harmful delusion of all, because it sets one on a path of despair and self-destruction, eventually. But of course, it is what keeps business booming.

    People need hope, encouragement, validation for who they are, and to know that they are not broken individuals, but more so, are seeking connection, sense of self, heart healing, clarity, and direction. That is human. Parents often do not deliver here, and instead, we pick up anxiety, confusion, and mixed-to-negative messages, from which we seek to disentangle. Life is wounding for all of us, that is the nature of being alive. We get hurt, and we heal. From that, we manifest our lives as we go along.

    Really good stuff, Matt, thanks!

  3. Matt, it is good that you are educating yourself and forming your own views.

    I see most of it a bit differently than you do. Clinical schizophrenia is a product of the mental health system, the talk therapy and the drugs. They are both intended to be self-alienating. We only have the drugs because they are a cheaper, faster, and surer acting way of doing the same things to people which talk therapy does.

    Always the objective is to make you believe that your yourself are the problem. Therapy, Recovery, Healing, that it what it is.

    And what all of this is predicated on is the Middle-Class Family and how Capitalism and the State depend upon this to maintain order and compliance. The middle-class family is different from anything else which has ever existed in a number of ways:

    1. Has children by choice, in order to increase social status of parents.
    2. Reads pedagogy and child development manuals to enhance the social status gain.
    3. All societies inscribe upon both children and adults, but with the middle-class family, the parents are living in Bad Faith, not admitting that they have choices, not living up to their own values. And this is the source of most parent v child conflict, the child recognizes that the adults are not being honest.
    4. Has converted children into private property, rather like how it used to be with slave ownership.

    So our future Einsteins, Mozarts, and Andy Warhols, get denigrated and denigrated in the name of the Self-Reliance Ethic, and get turned into Homer Simpsons.

    And then sometimes things go a bit wrong, but we have Psychotherapists and Psychiatrists who step in then and continue the abuses that the parents started.

    Nothing will ever change until we the Survivors of the Middle-Class Family organize and reject Therapy, Recovery, and Healing, and the Self-Reliance Ethic too, and start taking political and legal actions, and also start setting up some of our own institutions.

    Our Own Bill To Counter Murphy, Please Join:
    http://freedomtoexpress.freeforums.org/our-own-bill-to-counter-murphy-t359.html

    I would suggest R. D. Laing’s “Politics of Experience”, and with Aaron Estherson, “Sanity Madness and the Family”, and Deleuze and Guattari’s “Anti-Oedipus”, along with Jeffrey Masson’s “Against Therapy”, and Alice Miller’s “For Your Own Good” and “Thou Shalt Not Be Aware”.

    Nomadic

  4. Once nabbed by the “mental health” authorities, one has the right to treatment, but not the right to refuse treatment. This is why I’m not an advocate for patient rights, I’m an advocate for human rights instead. Those supposed “inalienable” rights the Declaration of Independence goes on about were based on ‘natural rights’, the ‘natural rights’ accorded human beings. One “alternative’ that you neglected to mention was “the right to refuse treatment”. This is a right that we don’t have by law, given the loophole of mental health law, but it is a right that I feel we should have.

    This right to treatment has been used as both an excuse to lock people up, and as a legal ruse to get people released from the imprisonment of custodial “care”/neglect. That neuroleptics have been referred to as chemical restraints is no accident. The drugs make patients more lethargic, and manageable, that is to say, they make it more difficult for patients to be non-compliant and resistant. First, you have the restraint of a locked door. Second, you have the restraint of a spirit subduing chemical. What I see as the problem, in both instances, is the deprivation of liberty involved.

    Of course, we know, too, that psychiatric drugs have a very negative impact on physical health. This is another right that is violated as well, security of person. On top of those rights violated, the deprivation of liberty that forced treatment entails requires a lapse of due process. It is seen as a civil matter, and thus lacking the burden of proof required in criminal cases. None of this could have been perpetuated without that loophole in the law, mental health law, that allows certain human beings to be treated as if they were sub or non-human beings. Calling human beings is “sick” is the way treating them as sub or non-humans is rationalized, and I think that is what we really need to be dealing with here.

    • Excuse me. “Calling human beings “sick” is the way treating them as sub or non-humans is rationalized, and I think that is what we really need to be dealing with here.

      Before psych-drugs were introduced, lobotomy was growing in popularity. Lobotomy was a way to keep people out of the hospital. Now we know better…not. Psych-drugs gained acceptance as the “chemical lobotomy”. I think we have to deal with the fact that physical treatments for non-physical conditions end up being harmful. ECT, now growing in popularity, was also bigger back then when it came to dealing with people on the wards. Weaning people off drugs is the way to go, but the basis for having people take them is less a matter of doctors finding some miracle cure than they’d give out.

      Lobotomy and ECT came out of the pre-WW II eugenics era; psych-drugs, the post-WW II negenics eras. Bio-psychiatry is in large measure the problem, but it’s not a problem that began with, nor will end with, psych-drug management. You’ve got, in both instances, research driven by bias. It all harks back to the big problem of incarcerating people on medical pretenses. You don’t arrest people, unless they’ve been given a psych diagnosis, for their “sicknesses”. It is this intolerant control attitude that is the problem. We know now, at least some of us do, that the problem is not a matter of people of non-northern European ancestry sharing space with people who did come from northern Europe. Next question, what do you do with people who don’t placidly serve the status quo with their obedient compliance? Take a wild guess.

  5. Matt, thanks for an incredibly passionate and well-researched article. The truth is out there, but unfortunately, too many people don’t want to hear it. I’m sure glad you figured it out, and have given others the chance to look the truth straight in the eye!

    —- Steve

  6. Sorry but no cigar.

    You still don’t seem to get that putting “schizophrenia” in quotes doesn’t change anything. If you believe that there is “something,” though perhaps mislabeled, which constitutes a genuine category of existence other than “human,” you are still missing the point. There is no category, period. Or maybe I should repeat an earlier illustration: broken glass, hypodermic needles and jelly fish do not constitute a scientific category just because you can get hurt stepping on them at the beach.

    I’m afraid you’re currently so caught up in some notion of being an “alternative psychologist” that it may inconvenient to acknowledge any of this, as without “something” to point out and analyze there’s nothing to be an expert on, alternative or otherwise.

    To have an anti-psychiatry perspective it’s necessary to realize that fighting psychiatry, as well as the endless misery it is responsible for masking, means fighting the prison system, of which institutional “mental health” is one wing, and the entire imperialist empire and the destructive lifestyles which reflect it. One can endlessly mystify and “solve” the vicissitudes of individual responses to oppression, but the point is to end the oppression, not convince people to respond to it in a “positive” way. As long as you talk about “schizophrenia” or “psychosis,” quotes or no, as something that “we know what we mean when we say it” there’s nothing much to discuss, as they are in fact terms with no meaning.

    Btw I think you are overstepping some kind of line when you “advise” people about drugs. By doing so you implicitly support people taking them. Also you’re not a doctor. 🙂

    • psychotic people and their families deserve to hear more sides to the debate about “schizophrenia” beyond simply the biological “illness” treated by “medications” narrative

      How about “deplorable” people instead of “”psychotic,” that’s a fashionable insult this fall.

    • the “schizophrenia is an illness” myth

      What’s the “myth”? If schizophrenia existed it would be an illness; “it” is dictionary-defined as an illness. But it does not exist. It is not “misunderstood,” it does not exist — as it is impossible to have a “mental illness.”

  7. Thank you, Matt, for an interesting and well written article. Certainly those who experience psychosis need to be listened to and respected. Oftentimes they are dismissed because in their distress some can be very angry, not make logical sense and be socially withdrawn. This certainly elicits our own worst fears not just for “psychiatrist and allied mental health workers” but society in general. One sees someone on a street talking to oneself, wandering the streets, in dirty clothes and it can evoke all sorts of feelings. Compassion, fear, confusion and anger/rage. I think of parents and family members as doing the best they can to understand their family member so I caution against going back to any “blame” model, i.e. “schizophrenic mother” of the past. Having anyone who is ill affects the whole family system. “The identified patient” as we call the person experiencing the symptoms often feels scapegoated, but truly I see as a therapist and social worker the effects it has on the whole family. In addition society does look at those with psychosis in a fearful, misunderstood manner which then reinforces the feelings of shame that the person experiencing the symptoms and their families already may have. I agree with that medications are not the sole answer. The anti psychotics certainly work short term during crisis periods, but I see the long lasting effects of health problems as a serious issue as well as ignoring the root causes which can be childhood trauma and abuse but not always. Substance use can also bring on psychotic episodes and certainly continued use creates greater problems.

    • Knowledgeispower, as a family member, I want to thank you so much, for your comment; and I completely agree with what both you and Matt say.

      I think the open dialogue model is so powerful as it doesn’t presuppose any particular cause. Instead, as least how I understand it, issues and factors come forth through the discussion of the person with their community. If the decision making power is in the hands of the individual, then hopefully his/her community could also exclude any relationships that the person felt were too abusive to include. If the way forward with healing comes from the indivudual circumstances of the person, like in Open Dialogue, then the community is protected from ‘theory driven’ therapies (e.g. the schizophrenic mother as you describe above) that can so severely damage the individual and his community.

      I often think of going into psychosis ( from my simple ‘family member’ perspective) as being a result of two continuums. One is ‘vulnerability’ to psychosis (which would include all the possible medical, genetic , hormonal, diet, physical environmental toxins, a person’s individual body ‘response’ to stress, etc., etc, which may or may not be turn out to be things that can contribute to psychosis). The other continuum would be all the adverse ‘psychological’ events that a person may experience (jtrauma, abuse, social issues, bullying, things happening at critical developmental times etc.) If you have enough of ‘one’ continuum (eg. drug toxicity as described in Katinka’s article about the `drugs that steal`), you don`t necessarily need anything from the other continuum to make you go into psychosis. If you are a person who suffered severe abuse or trauma, it is amazing if you don`t go into psychosis.

      As a family member I look back at the pre-psychosis time, and think that there were certainly ways I could have been different (if I had understood more ) to better support the extremely sensitive, ethical and creative soul I had been entrusted with. However, more heart breaking for me, is how I reacted during the time of the break down. The way my loved one was being, was so exactly similar to the adolescent angst that èveryone`talks about. I had no idea that the depths of the suffering might have been much greater. Then, extreme anxiety set in as I did not want my love one to have the symptoms that could be so hurtful to them, and that are so full of stigma in our society (..spoiler alert …if you try to ignore or suppress them – they don`t go away). (Just as an aside – I was anxious about how the stigma would affect my loved one’s life- not about any concern about stigma for me as a family member.) Finally Rossa Forbes has spoken so eloquently about how a family`s treatment of a loved one can change as a result of the way a person in psychosis starts to act and be towards others. Those early days when I tried to ‘criticize or cry`in order to reach my loved one, and to bring them back to be the person I thought I knew so well, will also be always burned into my memory.

      Imagine if I had instead being enveloped into a supportive, accepting community which could have guided me through my reactions to my loved one`s extreme distress. Imagine what a better support I could have been and what a difference that might have made to my loved one.

      • “The anti psychotics certainly work short term during crisis periods”…I was reading over my response and just wanted to add that although anti psychotics are reported to to help some people in the short term, in our case I truly believe that is what set things off on a much more serious course for our loved one. I can’t stress enough how important I think it is to ‘WAIT” (for at least 6 months if not a year) after a first episode before even considering drugs because of this possibility, and in order to try and figure out ‘what’s what’ in terms of the ‘2 continuums’ model. I think Sandra Steingard’s ‘slow psychiatry’ speaks to this by saying ‘hold off for as long as possible with drugs.

  8. Matt: Thanks for references for further reading (Jaakelainen, Benedetti, ISPS, etc). Without doubt mainstream psychiatrists dismiss any possibility of the relevance of environmental stress. The ones that lament about “stigma” seem clueless that declaring someone has an incurable brain disease increases stigma. And their criteria for “improvement” is how manageable & “in control” the patient’s behaviour is. I’m relieved to no longer count myself as a “mental health worker”. My job became a nightmare. When you begin to have doubts about the biogenetic model, your previously collegial relationship with co-workers evaporates; you enter a no-man’s land, neither staff nor patient. You are helping me get a perspective.

  9. Matt, reading your article again and then the discussion so far, I’m reminded of one of the most moving and profoundly simple and clear comments I’ve read on MIA, I believe a few months back, by Bonnie Bustrow–and I’m paraphrasing because I don’t see “comment history” any longer so it would be a needle in a haystack–but something to the effect of, “We’re trying to understand what it means to be human.” I think, in the end, that’s what it boils down to.

    This is how your well-thought article–and I guess, the series, on the whole–is speaking to me now. Whatever we call ourselves and others, however we address the trials and tribulations of our lives–and we all have them, no exception–however we choose to grow, gain clarity, and to feel love, that is how we are human. Can’t think of where I’d want to go from there, other than wondering how to best utilize my humanity. I imagine that would be different for all of us, based on our own beliefs, personality, and life experiences.

    Kudos for using your humanity, full-bodied, to bring clarity to others around extremely challenging and personal issues, and to offer compassionately alternative ways of thinking. I think anything at all in life has its challenges and rewards, including being a pioneer. We are what we are, and we make the best of it.

  10. Current treatments for Schizophrenia are based on dopamine imbalance hypothesis.
    Schizophrenia is by 21st century science standards,still phenomenon.They only add
    glutamat imbalance hypothesis.This is on wikipedia,impossible that such fraud
    don’t get public attention.But sadly my brethren,we act as phenomenon,as well.
    Despite all evil of mental health system against us,very few have courage to say
    anything against them.In Europe,there isn’t state control-outpatient commitment,
    over me.This is very first thing,which you have to change.This is in fact,against any
    values and laws of real democracy.You are victims of Mental Health system regime.

  11. Interesting Blog and Comments . Certainly the dominant narrative in so many areas besides and in effect supportive of psychiatry is so extensive that we have virtually an entire country criss crossed with dominant houses of cards . All the false pseudo scientific prominent and dominant houses of cards together require multifaceted oppressive coercive enforcement policies to drive the people to compliance. Finding something you enjoy doing can take your mind off of what is happening to so many all around you and enough money in addition can help cultivate an illusion of freedom and grow capitalism further as more jobs are sent out of the country and more jobs related to control and compliance are created. Real medicine like the AMA , give me a break .

  12. Hi Matt, thanks very much for the 2nd half.

    From the article:
    https://www.madinamerica.com/2012/08/a-new-understanding-of-psychosis/

    In this Link Daniel Fisher describes an ‘Open Dialogue’ idea of a person in crisis being ‘stuck in their heads’ and ‘getting back together’ through positive human interaction.
    I became disturbed when I stopped taking strong tranquillizing drugs.

    At the same time I discovered a CBT approach :- that if I was able to put my thinking to one side for long enough, I would eventually come out of my Catastrophy – and then my problems would become manageable. This difficult process is what I’ve used for the last 30 years (and it’s worked for me).

    But 30 years ago I was told by a psychologist in Ireland that Full Recovery through the Talking Treatments was available for everyone.

    Mental Illness is very expensive to the Tax Payer and I think one of the problems is the profit made from the “new drugs” in the last 30 years. A large part of this profit has gone into Universities (through Research) and influenced Professional Opinion.

    The University Professionals have gone on to influence Policy within Medical Bodies and Governments and medicalised ‘Mental Health’ further.

    The new expensive drugs were a Disaster. They damaged Health and shortened Life Expectancy (and were no better than the old drugs). But nobody wants to rock the boat and talk out, on account of the risk of being “excluded”.

    In my own case Psychiatric drugs caused exactly what they were supposed to prevent – the risk of “Acting Out”:- I attempted suicide twice on these drugs

  13. Matt
    Don’t frightened your own crazy kind.They are enough scared of Mental institutions.Certainly
    you didn’t meet slavic primal maniac,as I am.And no-one order me around.I doubt,that is case
    for you.Because if you are part of any organisation,you still have a boss.You can’t think,with your
    free mind on your own.MIA mistake is,that doesn’t as official leader someone,who is clinical
    insane by standards of psychology and psychiatry.Someone who is very controversial and
    who will offend psychology and psychiatry.And normal people as well.This sure not be very
    welcomed by many here,but indeed public attention is all what matters.Even angry one.
    There are hundreds of forbidden topics in USA,which aren’t excepted by normal population.

  14. To paraphrase Graham Young (The Young Poisoner’s Handbook).

    http://www.imdb.com/title/tt0115033/trivia?tab=qt&ref_=tt_trv_qu

    ‘In order to be a Great poisoner requires remaining undetected. To be a Famous one requires getting caught’ They eventually caught Mengele, and I assume some of those remaining undetected at this point in time will eventually have their status changed to Famous.

    How interesting that one of Youngs methods was to have his mother take Antimony Sulphide and Thalium in the false belief that it was ‘medicine’ for her illness.

    And with no National Standard as to what constitutes a ‘chemical restraint’, doctors (or those posing as doctors) are free to make people sick and invoke the provisions of the MHA based on the sickness they have caused.

    Thanks for pointing out the great lie Matt.

  15. As the mother of a person with a “label” I am very angry that “treatment”(joke)… in Australia consists solely of massive amounts of drugs …when my son came out of hospital he could not walk without falling over but this was cheap treatment ….my problem was “that i was anti psychiatry well actually I am proud to be anti over paid indifferent cruelty ..

  16. Matt,
    I’d be very interested in your response to two things–Dr. Jeffrey Leiberman on 60 Minutes showing a brain scan of degeneration of the brain, here at 3:30 sec. https://www.youtube.com/watch?v=WU7X9Vl0j7c
    and the fact pointed out in your article that insurance companies won’t pay for anything but drugs for “treatment”. Insurance companies want to SAVE money, so they only reimburse for “effective” treatments.

    Your response?

    • Since Lieberman and other psychiatrists refuse to scan the brains of “treatment naive” people these scans deserve to be taken with a truckload of salt.

      Why shouldn’t drugs that override a person’s natural brain processes and alter the brain’s chemistry change the shape of the brain and cause damage? Heroin abuse can cause brains to degenerate. Does this mean the abuser’s brain was bad to begin with?