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!)

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    • 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.

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      • Hmm, Im insomnia has bedraggled me so I can only do a short response for now.

        My uncle had a deadly brain tumour and I can tell you that many of his character traits were turned into completely opposite character traits. Stick an axe through someone’s skull and I am sure the same thing would happen. Brains are physical as well as being portals to the emotional. Remove someone’s brain entirely and they probably stop being emotional about anything. I do not buy that an oxygen starved brain or a malnourished brain or a concussed brain or a psychedelic drugged brain or a post natal hormonally deranged brain and so on wont cause character alteratons. The bit about hunting for a magical brain chemical, like hunting for truffles, with any arrogant confidence, which is what psychiatry does, and which is a gross violaton of trust, is where I agree with Robert Whitaker, as I agree with him on many things. The brain is not just a bag of neuro chemicals it is also waste removal of dud refuse chemicals via its wash cycles of CSF and it is, as brittish singer Gary Newman sang of his friends, rather “electric” whether we like it or not. Loads of other stuff can go skew wiff in the brain. As we all know from gargling antipsychotics that “give” us chemical imbalances of schizophrenia. I am not going to call my brain a fluffy cuddly toy, one that cannot kill me, just because someone refutes that anything can go a bit nutty in there.

        As for labels I feel that at times the pack mentality of it comes over as mockery. I feel that peoples need to mock labels is wrong. We often mock what frightens us. Robert Whitaker never mocks anyone. He just presents his oeuvre and allows even his staunchest pie eating critic to come to his own conclusions. Mocking anyone, least of all some kid with autism, over a stupid arbitrary word choice, is like hitting a Tahitian for not saying “meet and greet” properly. I understand your warm humourous encouragement of others to do as you believe is right for you and drop the label. Warmth and humour are fine. It is when an “us and them” tiresome personal back biting mockery kicks off that I think the thing goes way way too far, and in terms of welcoming people of all sorts of illnesses in to this website it is a sub campaign that more often than not turns people away and therefore just shoots itself in the foot.

        Anyone can deride anyone’s term for themselves as a label. At the turn of the century a prostitute would have called herself a tart. Someone would have saved her and told her she was a sexual goddess while still using her. A century later she would call herself a street worker, or a bar room pole technician, or body healer or god knows. The point is the label is maybe the least of her concerns. Yet it is the easiest for the moral to pick away at. As such, focusing on the label is a narrow way to skirt past the actual crimes of actual abuse.

        But, this response is probably shite. So have your way with it with free abandon. I care not. I am trying not to do screen time at the moment as it sets off my migraines with the flashing vjsuals and dare I say it…oh go on…….yes…no….yes…. character changes.

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        • Naturally brain injuries would change the way one behaves or even remove all behaviour at all and put one in a coma. They can even paralyse a person physically (like in a stroke) or even end life itself.

          But if we’re going down the path where we say that all unwanted or distressing thoughts/behaviours=injured brains, then the brain of anyone who is a problem to themselves or someone else or feels distress is an “injured brain”. The brains of people who are defiant of authority are injured, those who are addicted to video games are injured and the list goes on.

          If you become sad due to a traumatic occurrence or become agitated because you get bullied, I don’t think you’d call that sadness a result of a brain injury.

          If we went down that path, every time a person gets mugged on the street, he should not go to a police station but to a neurologist because his perception of the mugging is in his brain. If he’s hungry because he cannot afford food, he should not go to a queue where food is being offered for the homeless, but to a neurologist because the feeling of hunger is perceived by the brain. Hell, you could drug someone into a stupor and make them forget all their miseries.

          This is how you pathologise problems, how it turns into brain-blaming and gene-blaming with devastating consequences.

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          • Do you not trust the owner of the brain to tell you where their distress is from? Do you have to impose your exterior judgement of why they are distressed? Because if you go down that path then you are swapping one lot of external “experts” for your kind of “expert”.
            I am for every one telling you why they feel they are distressed and having you respect that they are not some convenient “mascot victim” but are a fully autonomous human being with a unique way of discerning their own bodily and mental condition and an ability to tell you what they would like in terms of support. If someone feels their distress is from an injured or upset brain why would that mean anything to someone else? Every brain is unique. If I go shopping and injure my foot and say I am distressed because I have an injured foot why would that undermine the multifarious ways other shoppers might feel distressed? My understanding of my body is sacrosant and not up for academic inspection…If I believe I am pregnant and it is only a phantom pregnancy who are you to bulldoze my happy understanding of my body and impose your cruel logic upon it?

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  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.

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  3. Dear Robert,

    I can’t call you Bob, it’s too quick.

    This may seem like a frivilous footnote here but it is coming from a heart of wholesome sincerity…it is of something only an eagle eyed schizophrenic or bipolar sufferer might spot…but I just want to say I keep feeling that the visual design on your graph….the one depicting the extraordinary upward curve of recoverers who came off antipsychotics…is a thing of beauty. I feel it would make a very fine interstellar looking silver necklace. An award, or an incentivizer to those who want a talisman to help them make it past the initial arduous two years.

    The two comparative lines, if formed of delicate silver bands, could even have gems in them.

    Jewelers forge a crucifix, an ank, what’s that polynesian pendant? Signs of hope.

    Your necklace would be…

    “A Symbol of “Life”.

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