Robert Whitaker: The Rising Non-Pharmaceutical Paradigm for “Psychosis”


From ISPS-US: “In this talk, Robert Whitaker reviews the science that calls for a radical change or evidence-based paradigm shift in psychiatric care, and describes pilot projects that tell of a new way.

Starting in the 1980s, our society organized its thinking and systems of care around a ‘disease model’ narrative that was promoted by the American Psychiatric Association and the pharmaceutical industry. That narrative has collapsed . . . the diagnoses in the DSM have not been validated as discrete illnesses; the burden of ‘mental illness’ in our society has risen; and there is an increasing body of evidence that tells of how psychiatric drugs, over the long-term, increase the chronicity of psychiatric disorders.

The collapse of that paradigm provides an opportunity for radical change. In Norway, the health ministry has ordered that ‘medication-free’ treatment be made available to psychiatric patients in hospital settings. A private hospital in Norway has opened that seeks to help chronic patients taper from their psychiatric drugs, or to be treated without the use of such drugs. In Israel, a number of ‘Soteria’ houses have sprung up, which provide residential treatment to psychotic patients and minimize the use of antipsychotics in such settings. Research into Hearing Voices Networks is providing evidence of their ‘efficacy’ for helping people recover. Open Dialogue treatment, which was developed in northern Finland and involved minimizing use of antipsychotics, is being adopted in many settings in the United States and abroad.”

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  1. A sound waves flows. I am always pleased with everything you say. I don’t want to disturb your great passion. Long may you continue in this enormously significant endeavour.

    As a schizophrenic I am sometimes alarmed at the glib way people who have never felt one iota of schizophrenic symptoms can “speak for me”. What I like about you is you try not to do this. Sometimes I feel like my schizophrenia is the hushed up black woman of the campaign for ending discrimination of all other mental conditions. What I like about you is you give your observations of what you feel may help schizophrenics, like you have in this video. But at no point do you demand that a schizophrenic should not be a schizophrenic. My father was an asthmatic. Nobody demanded that he should not be an asthmatic. Yes, I know there is the assumption that schizophrenia exists, or the assumption that it does not exist, since the brain is a mush, and people can poke it all day and say “tis too” or “tis not”. Clearly there is “something” that is “an ill sensation” in a person. I care not whether my schizophrenia resides in my humerous bone or my appendix.There seems a fine line between genuinely helping someone find dignified healing options, on the one hand, and on the other hand “announcing” to them “the way”.

    I see the image of a delapidated hospital and out of its doors pour crowds of people with a dizzying array of conditions or traumas or ills. Some have shattered bones, some have botched cosmetic surgery, some have tropical worms, some have cleft palates, some have twisted ankles, some have cancer. All decide something else should take the place of the hospital. All agree this is a wondrful inspiring change. So a person jots a list of everyone’s notion of what would make each person feel better. A treatment alternative. A squabble ensues. Everyone hollers to the black woman with cancer to get her to say what she would prefer, but her voice is soon drowned out in the cacophany of shouting. Infact she is frowned at for even defining herself as a black woman with cancer, since cancer doesnt exist. And so she cannot speak of her experience.

    At times it feels as if people are wanting to muffle the experience of hellish schizophrenia by clubbing it together with all sorts of less agonizing conditions, as if schizophrenia is a useful battering ram to storm the Bastile of psychiatry. “Look what you did to this poor schizophrenic peasant!” goes the crowd roar. Actually, the schizophrenic can speak for herself. And if she cannot, or is ostracised for doing so, then its just another kind of treatment. A political lobotomy rather than an ice pick psychiatric lobotomy. What I love, yes love, about you Robert, is you are eager to listen. You are all ears in a deaf world.

    It’s the most courageous thing to be ears. That may be why Vincent Van Gogh cut his off.

    (The sunflower painting coward!)

    • I would never invalidate anyone’s suffering or problems and I full well know that they are very real and can be severe, disabling and create situations of urgency, no matter what label(s) they have. But I will always speak out against psychiatric labelling. People like to compare psych. labels to asthma, diabetes, heart disease etc. and I can understand why. But those things have nothing to do with a person’s thoughts, character or conduct. All psychiatric labels do, and they sometimes have a devastating impact on people. Of course, people can label themselves whatever they want. But I would never give it credence. Failing to have a career can make you depressed and agitated (which falls under the purview of psychiatry), but it won’t cause cancer or asthma. These are some important differences.

  2. Bob,
    thank you as always for your thoughtful work and analysis of things.

    The very last question you answered in this interview had to do about family. I strongly believe the tipping point for this movement will come when we train and empower the significant others, family and friends to walk with their loved ones who are in distress whether from ‘psychosis’ or any of the many, other, varied extreme states that come from trauma and dissociation. I’m glad you recognized that it doesn’t take a ‘peer’ to be empathetic, and it is usually only family and SO’s who are around long enough to effect true healing for that 30% who weren’t helped in the studies you cited. For me and my wife, it’s year 13 or 14: it’s been so long at this point that I’m losing count, but we are still drug free and moving forward, even if it’s not at the pace we had hoped when we first started.

    I wish you the best as you continue to spearhead this movement to treat others as any of us would want to be treated instead of ‘othering’ them. For me it’s just part of the Golden Rule.