Rejecting the “Medications for Schizophrenia” Narrative: Part II

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 20^th 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-20^th 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 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/

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/