How Psychiatry Evolved Into A Religion

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IN THE BEGINNING of the post-World War II era, psychiatrists thrived as outpatient therapists. In fact, many went on to further train as psychoanalysts. But then a series of plagues were visited upon them, which inflicted great hardships and threatened their livelihood as psychotherapists.

First was the increasing ridicule of their profession. Freud’s theories fell into disrepute, the 1973 Rosenhan Experiment1 showed that mental health professionals couldn’t distinguish ‘ill’ from ‘healthy’ people, and psychiatrists were being called ‘quacks’ who didn’t practice real medicine.

Second was an anti-psychiatry movement that started with Thomas Szasz’s The Myth of Mental Illness.2 Psychiatry was also attacked for committing cruel, coercive, inhumane acts like ECT, lobotomy, and commitment, as epitomized in the 1975 film One Flew Over the Cuckoo’s Nest.

Third was the closure of most state hospitals from the 1960s to 1990s. Many of their psychiatrists had to transition to outpatient therapy. This increased competition among psychiatrists for clients.

Fourth was the closure of many private psych hospitals during this time as well, due to difficulty obtaining insurance reimbursement. This added to the growing competition among psychiatrists.

Fifth was increasing competition from less expensive social workers and psychologists becoming therapists (most clients self-paid at that time). Their ranks rose 700% from 1950-1980, leading to their outnumbering psychiatrists by more than 12:1.3 And back then, clients often resolved their issues via therapy and thus were able to terminate, so therapists needed to regularly replace them.

Due to trouble finding enough paying clients, psychiatrists now needed to focus on billing health insurance companies. But they had to show that they provided specific ‘treatment’ of well-defined discrete conditions in order to get paid by them. The 1980 DSM addressed this by abandoning its prior focus on the environmental/psychological causes of outward ‘symptoms,’ and switching to a focus on the symptoms themselves. These were arbitrarily classified into newly-invented, serious-sounding ‘illnesses’ with easy-to-meet ‘diagnostic criteria.’

This DSM did not suggest that these ‘illnesses’ were biologically caused. In fact, it had a section called ‘Organic Brain Disorders’ for real physical illnesses like stroke and dementia. Its goal was mainly that the methods used to define and describe physical illnesses now also be used for ‘mental’ ones. The term medical model at that time conveyed that though ‘mental illnesses’ weren’t physical, the DSM had devised a model (replica) which allowed psychiatry to label and bill its clients’ problems somewhat methodically and systematically, as if they were real diseases. Insurance payments did improve in response, so psychiatry seemed to have been saved.

But then a sixth plague came: Insurance companies began limiting the number of psychotherapy (but not ‘medication management’) visits that they would pay for. They did so because weekly, lengthy therapy sessions are more costly than monthly, brief ‘medication check-ups.’

The seventh plague quickly followed: Insurance companies hired managed care companies; they made psychiatrists do many long, time-consuming outpatient treatment reports to prove the need for ongoing therapy. Such treatment reports weren’t required for the cheaper monthly ‘med visits.’

Psychiatrists adapted to these relentless plagues by totally abandoning their therapy niche and reinventing themselves as psychopharmacologists. To convince the public of the value of this role, they teamed up with Big Pharma to develop and promote what is now meant by the term “medical model” — faith in the DSM’s randomly-created categories as literally real, biologically caused, ‘medically-treatable brain diseases.’ Life was divinely breathed into these conceptualized labels.

The DSM became a sacred book (bible). Psychiatrists were now the authorities (priests) of a new religion that promises “symptom relief” (salvation) via miracle pills. Many of these are placebos, so any benefit is from trust (faith) in them rather than the pills themselves. You obey one doctor’s order (commandment): “Thou shalt take thy daily meds.” They proclaim (preach): “No problems are upsetting you. You’re just sad due to a chemical imbalance (an evil force that is ruling over you). But the miracle of modern science (a new god) has given us the power to fix your brain chemicals. You’ll be rewarded with heavenly bliss, just like the zoloft commercial.” Clients are also excused from guilt for their problems or their kids’ problems (offered absolution), since ‘bad genes’ are responsible.

Lured in by such deceits, they faithfully trust corrupt Big Pharma, and accept an idea as illogical, unlikely, and unverified as ‘Chemical Imbalance-ism.’ A religious approach to the distressed isn’t new — that’s how things were done from the 1200s-1800s, when such issues were seen as spiritual; moral failings. “The devil made me do it” merely evolved into “It’s due to my chemical imbalance.”

But then an eighth plague descended on psychiatry: Payment per brief ‘med visit’ was less than payment per therapy session, and clients now came only monthly instead of weekly. So to avoid big income reductions, psychiatrists now needed far bigger caseloads. Thus, the next step was to declare ‘mental illnesses’ to be permanent genetic defects that must always be corrected by drugs, so clients never stop attending ‘treatment’ (services). Psychiatrists prophesize: “You’ll always need meds for your lifelong illness, just as diabetics always need insulin for theirs.” To ensure that clients religiously return, MDs push many controlled substances since only a month’s supply is given per visit, their highs are very reinforcing, and once addicted people have awful withdrawals if they stop. Believing/complying with the MD ultimately causes lifelong illness; it’s a self-fulfilling prophecy.

Now psychiatrists’ caseloads would steadily grow as they acquired more and more ‘permanently ill’ — and thus permanently dependent — clients. And since typical ‘medication management’ visits only take ten minutes, psychiatrists who built up their caseloads enough to fill all their open slots in a day could now earn much more money than psychiatrists used to earn as psychotherapists.

But then the ninth plague arrived: As ‘med managers,’ psychiatrists initially attracted few clients, since people used to only take psychiatric drugs for severe emotional or behavioral issues. If all psychiatrists’ caseloads were to be full, then new recruits who previously weren’t considered ‘ill’ had to be convinced that they were, and that they too could benefit from their wonder drugs. This was achieved by successively expanding the criteria for ‘mental illness’ until ultimately all normal unpleasant/unavoidable aspects of life met them. It began with sadness being declared a ‘treatable illness’ with Prozac’s introduction for ‘depression.’ Normal childhood immaturity (‘ADHD’ and ‘bipolar disorder’) was next declared to also be a ‘treatable disease.’ In the latter case, psychiatry stuck its nose into an area that until then was none of its business — raising kids. Those who accept its gospel about ‘defective brain hardwiring’ are tricked into replacing the old way of raising kids via 21 years of hard, slow, devoted work, with daily rituals of sedation by ‘anti-immaturity pills.’

So that brings us to where we are today: Biological psychiatry has managed to stealthily become America’s first state-sponsored religion, by disguising itself as a helpful, scientific medical field. Millions have been led astray by its lies, and enslaved by its labels and drugs, just as the ancient Hebrews were enslaved by Egypt. But it took ten plagues to free them. Psychiatry’s tenth plague has only just begun: It’s the growing numbers of all of us here at Robert Whitaker’s Mad In America who are telling the public the truth. Americans will ultimately hear our warnings, and will be set free as well.

Show 3 footnotes

  1. “On Being Sane in Insane Places.” Rosenhan, D. Science 179 (4070) 19 Jan 1973, 250-8. ↩
  2. The Myth of Mental Illness: Foundations of a Theory of Personal Conduct. Szasz, T. (1974). New York: Harper & Row. ↩
  3. 1980 National Medical Care Utilization and Expenditure Survey, National Center for Health Statistics. ↩

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36 COMMENTS

  4. Bingo. This is beginning to get to the heart of the issue that Szasz understood so clearly. Keep reading Szasz and making his research available to the general public. Have you read his book “The Theology of Medicine”? I highly recommend it, and the rest of his work as well. You can also help Joanna Moncrieff understand Szasz better. Thank you.

    https://psychiatricsurvivors.wordpress.com/2017/01/06/the-theology-of-medicine/

    https://psychiatricsurvivors.wordpress.com/2016/05/10/the-truth-about-psychiatry/

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    • Not only that, we now have more and more penetration of psychologizing, psychotherapy and general psychobabble into physical medicine. In every field from irritable bowel syndrome to end-stage kidney disease (yes, I saw a psychosocial treatment program for the fatigue caused by the latter) physical medicine doctors are now herding patients off for psychotherapy of some form or another, under the banner of the biopsychosocial model.

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      • ^^^^^^^ AMEN!

        We also have the Recovery Movement, another way of shifting blame back on to survivors, and also of breaking down the barrier between church and state, by rebranding the concept of Original Sin.

        It all changes when we can organize and start taking actions, instead of seeking Healing and Recovery.

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    • Frank:

      Thanks. Yes, free will and biological psychiatry are enemies. How so many people voluntarily submit themselves (and their children!) to chemical “treatment” by a field that is well-known for subjugating people through forced commitment, zombifying drugs, ECT, lobotomy, insulin shock, etc., can only be explainable as religious zeal.

      Lawrence

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  8. we have everyday problems being psychiatrised in the UK too, but with an NHS.

    I read a bit of propaganda recently from a particularly bad anti-stigma campaign that said, “We all have mental health.”

    Yuk is my response. We all have states of mind but why bring medicine into it?

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    • John:

      Maybe the belief in “chemical imbalance-ism” is spreading around the world since classic religions are waning in importance in people’s lives, and people still long to have faith in some higher power. Psychiatry is stepping in to parasitically capitalize on that need, by playing the role of an “all-knowing” clergy through whom the power of miracle-working science flows through.

      Lawrence

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      • Wouldn’t that imply the psychiatrists have “god complexes”? And, ironically, the psychiatrists believe merely questioning a dream implying one may be “moved by the Holy Spirit” is a “delusion of grandeur” and a “life long incurable genetic mental illness,” requiring a life time of forced drugging. So a real “god complex,” as the psychiatrists suffer from, must require a life time of defamation and torture for them as well. Treat others as you’d like to be treated, right?

        “But it took ten plagues to free them. Psychiatry’s tenth plague has only just begun: It’s the growing numbers of all of us here at Robert Whitaker’s Mad In America who are telling the public the truth. Americans will ultimately hear our warnings, and will be set free as well.” I pray that’s the truth, to the real God, who is NOT a psychiatrist. Thanks for speaking the truth.

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  9. Just my usual note whenever anyone uses the phrase “biological” psychiatry, that this is redundant and implies that there’s some “other” form of psychiatry that’s better; there isn’t.

    Another miscalculation is that simply “learning the truth” will set us free from psychiatry, which neglects the role of coercion and the fact that psychiatry is not a branch of medicine but a system of social and political repression disguised in the trappings of such. So we still will have to fight to be free of it.

    Good article though.

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    • We also underestimate human stupidity and refusal to learn anything. Most people who believe psychiatry’s claims are functional illiterates and get all their education off the tube. (I exclude psychiatric professionals. For them it’s more vested interest and self deception than lack of knowledge.)

      “Evil will always defeat Good, because Good is stupid.” Dark Helmet from Spaceballs.

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  10. All true except that part “Clients are also excused from guilt for their problems or their kids’ problems (offered absolution), since ‘bad genes’ are responsible.”.
    In fact the “clients” are blamed for everything, they’re especially blamed for the result of bad treatment. One therapist in a mental hospital said the treatment isn’t working because I didn’t believe in it, and she mad at me because of it.
    If the meds and treatment don’t work, the all MH system gets mad and hostile, and blames you. It’s like they think you’re doing it on purpose. Maybe it’s because it’s like an affront to their religion and they can’t think rationally about it.
    The ” untreatable client” is some kind of sacrilegious profanity that they loath.
    Another example is an article I’ve read about how some clients don’t like generic ssri meds, and claim they don’t work like the original ones.
    The doctor in the article, said that the important thing about treating depression is consistency and how important it is to continue taking your meds, and he said these ppl stopped taking their meds consistency and that’s why they stopped working when they were switched to generic. Even though there is reason to think they did, he blamed them!
    And these are depressed ppl, not “schizophrenic”. The “non compliance” and blame the patient propaganda are spreading.
    The most obvious reason generic meds don’t work is that the meds are only placebo, and ppl perceive generic meds differently so they don’t have the placebo effect.
    But the doc instead chose an explanation that blames e patients.

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  11. Dr. Kelmenson has made another interesting analogy. His construction of this article using parallel references to Religious beliefs is refreshing and enlightening. It’s amazing how the system works. Dedication is lost to the power of the almighty dollar. Therapy based Psychiatrists are far and few between. The ones who stay the course, like Dr. Kelmenson, will eventually help to set “ the public free”.

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  12. Excellent blog as always. But I couldn’t but notice the omission of the Rosenhan experiment-being sane in insane place’s I believe it was called? I’m inclined to believe this study was more impactful to the profession of psychiatry than One Flew over the cuckoo’s Nest; though I’m equally inclined to believe the movie more of an impact on the social and cultural consciousness than the study was.

    I hope I’m not nit-picking here, and apologize if I’ve done so.

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    • plebtocracy:

      I did include the Rosenhan experiment, in the second paragraph, and if you click on the citations at the end it is cited there. I agree that it was an important reason for psychiatry’s evolution into the path it took. How amazing that the public has forgotten about it, and about psychiatry’s social-control role as portrayed in “One Flew over the Cuckoo’s Nest”. I guess people are able to ignore the facts so that they can believe what they want to believe is true, especially when so many other people are doing it.

      Lawrence

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  13. Thank you, Lawrence, for another in your series of thoughtful and important articles. I won’t recount the great many things that seem to me right about what you’ve written but rather, in a constructive spirit, point to a few things that might warrant further thought and refinement.

    The first is perhaps somewhat rhetorical, but I think at this historical juncture important, namely that there are other state-sponsored religions, in addition to the rather awful one you describe. Capitalism, for instance–and of course that is intimately connected with what you describe here via the pharma-medical-industrial complex. There must be profits…

    The other relates to what in social-science jargon is called functionalism. Some years ago, in defending my dissertation, I was rightly challenged for saying that certain things “must happen” within the context of a certain social system, in the sense that there appears to be a certain systemic logic (or “functional requirement” of the system) that almost magically leads consistently to certain outcomes, outcomes that seem to satisfy what the system demands. (This problem was not new to me. I should have known better! But I fell into a functionalist trap, which is a very easy thing to do when you work with a narrative or a system that has great power.)

    So, as one example in your case, the DSM “had to be” invented to keep psychiatrists employed. I think there are risks with stating it this way. One is that something appears inevitable when perhaps it was not. Was the DSM the only option, or were there others that were discarded?

    The other is that it takes our attention away from specific people, interests, decisions, and uses of power. Was it “necessary” because ALL psychiatrists are manipulative creeps and colluded to make it happen? Or because they are indoctrinated into a system of belief and so are not aware, or not fully aware, of other options or the effects of what they do or simply of their own responsibility? In which case causation is at a higher level, but then it begs the question of whether someone made the decisions to set things up this way (i.e., in our medical-education system) or whether it’s truly at a “system level” and no one actually made a conscious decision to make all this happen. All of this, of course, matters both in terms of who’s responsible for this god-awful mess, and also in terms of what we need to do to get out of it.

    So basically, I think it could help to disaggregate, to look more closely at WHY it seemed inevitable and at specifically who did what, when, and why. Otherwise we risk assuming that either all psychiatrists are inherently selfish jerks intentionally harming their patients or that “the system” simply required things to happen this way, and the psychiatrists are just doing what they were trained to do. I think most often it’s somewhere in between those two, such that the system does tend to indoctrinate people and require certain sorts of outcomes, but also that certain people are in positions to make decisions, and to abuse power–and that last, of course, is a key point of leverage if we want to change things.

    Another reason I think this is worth considering is that, while I find your account compelling and know others here do also, it has a bit of a ring of conspiracy theory, and that may raise credibility issues for the wider audience you so rightly suggest we are hoping to reach through MIA. I think the more specific we can be, and the more careful about assigning responsibility and blame, the higher the credibility with people outside our circle here.

    I hope it doesn’t seem like I’m taking shots at your work, which I really do find important and inspiring–and especially so coming from a physician. Like you and so many others, I am angry as hell about this business and am fully in support of greatly appreciate your work.

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    • Daniel:

      I appreciate your feedback. I can see how the article may have come across as conspiracy-theorizing, and I agree that this would hurt our credibility. In the title I used the word “evolved” to connote that psychiatry’s changing approaches were the result of some approaches turning out to be much more financially “fit to survive” than others, and thus out-proliferating the less “fit” approaches. But in the article itself, I failed to bring out this point, so I can see how it may have seemed that I was implying that all these changes were planned out.
      Over the course of my career I witnessed this evolution myself – Many psychiatrists who thought like me retired earlier than they had planned to (died out like the dinosaurs), due to an unwillingness to adapt by telling lies and pushing drugs. But many others were excited by the chance to make huge amounts of money and be treated like “real” doctors, and they flourished, while also setting examples for incoming psychiatrists who were hoping for similar prestige/riches, to follow.

      Lawrence

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      • Yes, I can totally see how it would play out as you describe. And it goes that way in so many fields.

        So, in academia, for instance, it’s often the people who focus on grant-writing and commercial applications who do well and stick with it, whereas many who really care about teaching publish less, and do less flashy or commodifiable research, end up as low-paid adjuncts, and eventually give up.

        Or, to take another example more germane to this discussion, and very personal for me, my father was the VP of marketing for Smith, Kline, and French (before it was SmithKline Glaxo) and was forced to retire, i.e. fired. Many years later he told me he “wasn’t up to it,” but I at least like to think he actually was too decent a man to get fired up about selling drugs. He might otherwise have ended up the guy in charge of marketing Paxil. Maybe he’d have seen how rotten things were, but more likely, I suspect, he would have been too enmeshed in the whole thing to see it clearly. So, thankfully (!), he was fired.

        Anyway, I think this sort of thing happens in many fields. It would be interesting to do interviews with psychiatrists who took different paths with this and try to tease out what caused some to maintain critical thinking and others to hop on board with the drugs.

        Thanks again, Lawrence, please keep writing!

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  14. Thank you, Dr. Kelmenson, for another great article. In community mental health psychiatrists are taking hundreds of clients on their caseloads. There just was no way that they could know these seriously and chronically mentally and physically disabled patients well.

    I do feel for some of them who are truly in it to help and heal but find out quickly when they start working the reality of how psychiatry is actually practiced. In meetings I remember in a busy community mental health agency where I was a director one second career psychiatrist who was just starting working was trying to get to know her clients in more depth. She wanted to get to know her patients better and had long meetings with her patients and direct care staff. She was quickly burning out though as she was falling behind on seeing the required number of patients a day, the 15-minute standard. Though I complimented her to her supervisor, the medical director, about her dedication to her patients; I was met with anger by the medical director who said she needed to focus on completing her billing and notes. The agency could not financially survive without this. Reimbursement rates from the state health insurance continue to be very low.

    Ironically it was the lowest paid employees, the residential staff and case managers who actually knew the patients the best in group homes. The master level clinicians who were very underpaid did not stay long, just long enough to get their license and find better paying positions. Peer specialists also were terribly paid and what I saw not well treated and respected. The ones that stayed were nurses and psychiatrists who were the better paid. The individuals in these programs needed the most care and time but got improperly trained staff with huge turnover, and psychiatrists who did not have the time to do anything but bill and were not aware of their patients deeper lives and activities. Patients stayed on the same psychiatric drugs because it was easier to do and paid the bills. Shameful system that does not serve the interest of the individual needing help.

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  15. Truly enjoyed the article Dr. K. Especially, the 10 plague countdown analogy. The theory here should be move and adjust, move and adjust. Sounds like the military on an military operation.

    In the end, it comes down to adaption as you read the evolution by psychiatrists to adapt and overcome the situation in order to get paid. Driven by insurance companies, additional reports and the simple way out, Big Pharma, thus the evolution and the next round of plague.
    Perpetual motion would be a good way to describe the evolution of this whole process. Dr. K. does a wonderful job outlying the evolution from the beginning.

    In the end, it’s all about psychiatrists getting paid and finding the easiest way to do so (evolution). Insurance companies requirements led to extra work and less profit, therefore Big Pharma became a quick and simple fix to recover income (adaption). As pointed out by Dr. K. “Due to trouble finding enough paying clients, psychiatrists now needed to focus on billing health insurance companies. But they had to show that they provided specific ‘treatment’ of well-defined discrete conditions in order to get paid by them”. More work, less profit, in essence, a serious no go.

    The whole world changed in the 80’s to off shore manufacturing, off shore banking etc. More profits, way less costs and as Dr. K pointed out in this article, it’s affecting this field in a major way as well as many other fields. Cultures adapt, the rich want to get richer regardless of who it hurts or effects. Quick fix to more profits, Big Pharma and reduced time per client. Who suffers, you do as a patient as the insurance companies dictate what treatments your allowed (# of visits) and what medications that you can have. Imagine that, insurance companies dictate (are they doctors?), they are only interested in their 35% profit margins for who other then the share holders.

    Doctors today don’t really care as long as they get paid and few do go out of their way to help fight what the insurance company allows, and those doctor’s should be honored, however; most of the time, doctor’s don’t because it isn’t worth their time and there is no profit in it. So much for me and you in this case.

    Well written article Dr. K, always enjoy reading your articles.

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  16. The path of the ordered man is beset on all sides by the inequities of schizophrenia and the tyranny of bipolar disorder.

    Blessed is he, who in the name of profit and political will, pathologises the distressed into a cycle of dependence, for he is truly his funder’s keeper and the finder of undiagnosed children.

    And I will prescribeth upon thee with whatever mine favourite poison is, then abruptly withdraw thee!
    And thus proveth via thou latest syndrome t’were of an underlying illness.

    And you will know my name is psychiatry when I lay my diagnosis upon thee.

    Kraepelin* 25:17

    * new testament, revised edition

    (..with all due – and indeed much – respect to insightful psychiatrists, of course, such as the article author)

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  17. Thank you for analysing the history of psychiatry.

    Is it possible to give a rough guess on the long-term harm of antipsychotics on recovery?

    Antipsychotic medications are viewed as cornerstones for both the short-term and long-term treatment of schizophrenia. The evidence for symptom reduction will be critically reviewed. Are there benefits in terms of recovery?
    Leucht et al has 2009 found (How effective are second-generation antipsychotic drugs? A meta-analysis of placebo-controlled trials) the effect NNT(Number Need to Treat)=6 for short time treatment (1). However this was looking at 50% or more reduction of symptoms on the Positive and Negative Syndrome Scale (PANSS).
    Leucht et al 2012 looks at maintenance treatment with antipsychotic drugs. Between 7 to 12 month are covered. Hospitalisation was also reduced NNT=5. “This effect must be weighed against the side effects of antipsychotic drugs. Future studies should focus on outcomes of social participation and clarify the long-term morbidity and mortality associated with these drugs”.
    Bola et al. Cochrane.org 2011 (5) found just 5 studies with real placebo, i. e. RCT (Randomized controlled trial). One of them Rappaport et al 1978 found that umedicated patients managed better, e. g. readmission into hospital. NNH turned out to be 2.9 (NNH= number need to harm).
    The Council of Evidence-based Psychiatry exists to communicate evidence of the potentially harmful effects of psychiatric drugs to the people (3).
    Nancy Sohler et al. gives 2016 this summary: «For many years, this (…)clinicians’ belief in the need for long-term use of antipsychotic medications strong (Lehmann, 1966) that it has been impossible to design a sound observational study to address the question of efficacy or harm … (O)ur study also could not conclusively evaluate whether long-term antipsychotic medication treatment results in better outcomes on average. We believe the pervasive acceptance of this treatment modality has hindered rigorous scientific inquiry that is necessary to ensure evidence-based psychiatric care is being offered.»
    So I understand there are nearly no RCT controlled studies (avoiding «cold turkey» problems) answering my question on recovery.
    Real world outcomes and results

    However is it possible to use other studies to evaluate effects based on other studies and real world results?
    WHO Cross-Cultural Studies, 1970s/1980s found (Jablensky, A. 1992, Hopper, K. 2000): 16% of patients in the developing countries were regularly maintained on antipsychotics, versus 61% of the patients in rich countries. 63.7% of the patients in the poor countries were doing fairly well at the end of two years. In contrast, only 36.9% of the patients in the seven developed countries were doing fairly well at the end of two years. In the developing countries, 53% of schizophrenia patients were “never psychotic” anymore, and 73% were employed. In the rich countries, only 37 percent of the patients had good outcomes, and 59 percent had become chronically ill.
    Naturalistic studies of e. g. Harrow, M. & Jobe, T.H. (2012), Harrow et al 2014 (11), Wunderink (4,7) and Wils et al 2017 show that patients do better without long-time antipsychotic medication. Harrow, M. & Jobe, T.H. (2017) concludes in “A 20-Year multi-followup longitudinal study assessing whether antipsychotic medications contribute to work functioning in schizophrenia”:
    “Negative evidence on the long-term efficacy of antipsychotics have emerged from our own longitudinal studies and the longitudinal studies of Wunderink, of Moilanen, Jääskeläinena and colleagues using data from the Northern Finland Birth Cohort Study, by data from the Danish OPUS trials the study of Lincoln and Jung in Germany, and the studies of Bland in Canada,” (Bland R. C. and Orn H. (1978): 14-year outcome in early schizophrenia; Acta. Psychiatrica Scandinavica 58,327-338) the authors write. “These longitudinal studies have not shown positive effects for patients with schizophrenia prescribed antipsychotic for prolonged periods. In addition to the results indicating the rarity of periods of complete recovery for patients with schizophrenia prescribed antipsychotics for prolonged intervals, our research has indicated a significantly higher rate of periods of recovery for patients with schizophrenia who have gone off antipsychotics for prolonged intervals.”
    Jaakko Seikkula et al 2010 (Journal Psychosis Volume 3, 2011 – Issue 3) has reported on long-term outcome of first-episode psychotic patients treated with Open Dialogue Therapy in Western Lapland approx. 80% recovery (6). “Showing the benefit of using not much medication supported by psychosocial care.” 19% were on disability allowance or sick leave with 17% ongoing neuroleptics. Sveberg (2001) reported 62% on disability allowance or sick leave following standard care and 75% ongoing neuroleptics (11). Disability allowance or sick leave goes up more then 40%. Open dialogue reduced the incidents of psychosis from 33 to 2 per 100 000 annually.
    The effect of cognitive therapy (8) and psychotherapy (9) is documented.
    Bjornestad, Jone et al. 2017 reported “Antipsychotic treatment: experiences of fully recovered service users”: “(b)etween 8,1 and 20% of service users with FEP achieve clinical recovery (Jaaskelainen et al., 2013)” under the profession’s current protocols.
    Approx. 60% or so of first-episode patients may recover without the use of antipsychotics (Whitaker 2017).
    In order to maintain the narrative of antipsychotics being “effective” schizophrenia is falsely declared chronic i. e. drug dependence is preferred over recovery.
    Now I know this guess is not exact science, but does it seem that approx. 40% of patients subject to regular medication (e. g. in Norway “National guideline for diagnosis, treatment and follow-up of individuals with psychotic disorders”) loose long-term recovery compared to non-medicated patients?
    Would this be a fair guess of the long-term effect of antipsycotics on recovery?
    Alternatives to medication

    Morrison et al. 2012 (8) concludes «A response rate analysis found that 35% and 50% of participants achieved at least a 50% reduction in PANSS total scores by end of (cognitive) therapy and follow-up respectively» i. e. NNT=2 for «follow-up» with cognitive therapy. Antipsychotic drugs perform NNT=6 according to Leucht et al. 2009. This shows Klingbergs conclusion (9): “In conclusion, psychosis psychotherapy does not have an evidence problem but an implementation problem.”
    Choice

    Patients have a right to know in advance to decide with informed consent the benefit of actual symptom reduction in the beginning at the price of long-term reduction of recovery. Where there is a risk there has to be a choice.
    I would appreciate your answer based on your knowledge of studies. Thank you in advance.

    Follow-up: Jim Gottstein: Schizophrenia Drugs Reduce Recovery Rates from 80% to 5% (Comparison Open dialogue/Harrow results)

    References:
    1)Leucht S, Arbter D, Engel RR et al. How effective are second-generation antipsychotic drugs?
    A meta-analysis of placebo-controlled trials. Mol Psychiatry 2009; 14: 429–447
    http://www.nature.com/mp/journal/v14/n4/full/4002136a.html
    2)Leucht S, Tardy M, Komossa K, Heres S, Kissling W, Davis JM.2012 May 16;(5):CD008016. doi: 10.1002/14651858.CD008016.pub2.
    Maintenance treatment with antipsychotic drugs for schizophrenia.
    https://www.ncbi.nlm.nih.gov/pubmed/22592725
    3)Council of Evidence-based Psychiatry
    http://cepuk.org/unrecognised-facts/long-lasting-negative-effects/
    4)Wunderink L, Nieboer RM, Wiersma D, Sytema S, Nienhuis FJ. Recovery in Remitted First-Episode Psychosis at 7 Years of Follow-up of an Early Dose Reduction/Discontinuation or Maintenance Treatment StrategyLong-term Follow-up of a 2-Year Randomized Clinical Trial.
    JAMA Psychiatry. 2013;70(9):913-920. doi:10.1001/jamapsychiatry.2013.19
    http://jamanetwork.com/journals/jamapsychiatry/fullarticle/1707650
    5)Bola JR, Kao D, Soydan H, Adams CE. Antipsychotic medication for early episode schizophrenia. 15 June 2011. http://www.cochrane.org/CD006374/SCHIZ_antipsychotic-medication-early-episode-schizophrenia
    6)Robert Whitaker. Harrow + Wunderink + Open Dialogue = An Evidence-based Mandate for A New Standard of Care:
    http://www.madinamerica.com/2013/07/harrow-wunkerlink-open-dialogue-an-evidence-based-mandate-for-a-new-standard-of-care/
    7)Dr. Lex Wunderink, MD, PHD of the University of Gronigen (Netherlands) speaks about his findings for long-terms use of antipsychotic drugs at the 2015 Yale Symposium: New Data and New Hopes Call for New Practices in Clinical Psychiatry. https://www.youtube.com/watch?v=RKeBjLG-ueY
    8)Morrison AP, Hutton P, Wardle M et al. Psychological Medicine. Volume 42, Issue 5 May 2012, pp. 1049-1056. Cognitive therapy for people with a schizophrenia spectrum diagnosis not taking antipsychotic medication: an exploratory trial. Psychol Med 2012; 42: 1049 – 56
    https://www.ncbi.nlm.nih.gov/pubmed/21914252?dopt=Abstract
    9)Klingberg S, Wittorf A. Evidence­based psychotherapy for schizophrenic psychosis. Nervenarzt 2012; 83: 907-918.
    https://www.ncbi.nlm.nih.gov/labs/articles/22733380/
    10)Harrow M, Jobe TH, Faull RN. Psychol Med. 2014 Oct;44(14):3007-16. doi: 10.1017/S0033291714000610. Epub 2014 Mar 24.
    Does treatment of schizophrenia with antipsychotic medications eliminate or reduce psychosis? A 20-year multi-follow-up study. https://www.ncbi.nlm.nih.gov/pubmed/25066792
    11)Scientific Symposium. Pharmaceuticals – risks and alternatives. The 15th of October 2016 in Gothenburg, Sweden. Jaakko Seikkula, Professor of Psychotherapy, Clinical Psychologist, Finland. Naturalistic study designs for developing the system to reduced medication
    12)Open letter to the Directorate of Health, Knowledge Centre, Public Health, Medicines Agency, Patient Safety Program, Norment, Experience Expertise 12. February 2017:
    Knowledge- and research-based liquidation of current harmful psychiatric medication in favour of evidence-based practice to promote recovery http://home.broadpark.no/~wkeim/files/open_letter_knowledge.html

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  18. Lawrence, you are writing about psychiatry from psychiatry’s point of view. If you focus on the patient’s experience, psychiatry and all of mental health isn’t just a religion, it’s a brainwashing religious CULT. I have been writing on this topic for years in my blog. I did a two-hour radio broadcast on the topic of brainwashing, cults, and the similarities between psych and cults. My station is at blogtalkradio.com/juliemadblogger and if you scroll down the list of shows you will find the one on brainwashing.

    My suggestion has been that psychiatry and often, psychotherapy as well, both brainwash its clientele as a way of keeping them from leaving the cult and continuing to adhere to its illogical practices.

    The essence of brainwashing is to strip a person of his/he current identity and ideology, and then, replace these with a brand new identity and way of thinking.

    Thus, wherever you were at when you came into psych (such as, “I’m a college student and I just want a little help) gets knocked down and replaced with, perhaps, “I am a mental patient, I have a permanent disorder, I’m disabled, I smoke Kools, and I go to a day program and live in a halfway house.”

    It is written that if the brainwashing is successful, the subject will fully embrace the new identity.

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    • Julie:

      I have read some of your witty, insightful blogs and many of your comments. I enjoyed reading them, learned from them, and was greatly influenced by the perspectives you provide from your vantage point. I know that many psychiatrists see themselves as superior, exalted authorities, and like to exert their power over people who are at their mercy, but I try not to be like that. I try to welcome all different points of view, and this has led to my changing my views on some issues since I joined this website. We are all making valuable contributions to an important cause here, and our rising numbers show that we are making progress.

      Lawrence

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