Can ChatGPT Defend the Long-term Use of Antipsychotics?

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Last week, I asked ChatGPT to write an essay about the Mad in America website. That was a prelude to the questions I wanted to ask about the long-term effects of psychiatric drugs and the merits of DSM diagnoses. I do believe this is an inquiry, if AI is properly pressed, that can help highlight the “evidence base” related to antipsychotics, and the validity of psychiatric diagnoses.

This week I am focusing on antipsychotics. Here is how I am envisioning this chat: Imagine this exercise as a simulation of questions that could be asked of a prominent biological psychiatrist at a debate. Given that ChatGPT scours the internet and written texts for its replies, I presume that its answers will reflect, at least in large part, a discussion that is a reflection of mainstream beliefs (and thoughts).

Or to put it another way, I want to see if I can make ChatGPT squirm.

ChatGPT on the Hot Seat

Our chat:

Robert Whitaker: Write an essay on the long-term effects of antipsychotics as a treatment for schizophrenia.

ChatGPT:

Title: The Long-Term Effects of Antipsychotics as a Treatment for Schizophrenia

Introduction: Schizophrenia is a complex mental disorder characterized by a range of symptoms, including hallucinations, delusions, disorganized thinking, and cognitive impairments. Antipsychotic medications have long been a cornerstone of treatment for schizophrenia, helping to alleviate acute symptoms and prevent relapses. While these medications have proven effective in managing the condition, it is crucial to examine the long-term effects of antipsychotics on individuals with schizophrenia.

  1. Efficacy in Symptom Management: Antipsychotic medications, both first-generation (typical) and second-generation (atypical) antipsychotics, have demonstrated effectiveness in managing the positive symptoms of schizophrenia. These medications work by blocking dopamine receptors in the brain, reducing the intensity and frequency of hallucinations and delusions. Long-term studies have shown that antipsychotics can help stabilize individuals, reducing the risk of relapse and improving overall functioning.
  2. Physical Health Considerations: While antipsychotics offer benefits in symptom management, they can also have notable physical health effects. Some individuals may experience weight gain, metabolic changes, and an increased risk of developing conditions such as diabetes and cardiovascular disease. It is essential for healthcare professionals to carefully monitor these effects and work collaboratively with patients to mitigate potential risks. Regular health screenings, lifestyle interventions, and medication adjustments can help minimize adverse outcomes.
  3. Cognitive Function: Another aspect to consider is the impact of antipsychotics on cognitive function. Schizophrenia is associated with cognitive deficits, such as impaired attention, memory, and executive functioning. While antipsychotics are not specifically designed to address these cognitive impairments, some research suggests that certain atypical antipsychotics may have a modest positive effect on cognitive function. However, further investigation is needed to fully understand the long-term cognitive effects of antipsychotic treatment.
  4. Tardive Dyskinesia and Extrapyramidal Symptoms: One concerning long-term effect of antipsychotic medications, particularly typical antipsychotics, is the development of tardive dyskinesia (TD) and extrapyramidal symptoms (EPS). TD refers to involuntary movements of the face, lips, tongue, and limbs, which can be irreversible in some cases. EPS encompasses a range of movement disorders, such as parkinsonism, dystonia, and akathisia. However, second-generation antipsychotics have a lower risk of causing these movement-related side effects.
  5. Emotional Well-being and Quality of Life: Schizophrenia can significantly impact an individual’s emotional well-being and quality of life. Antipsychotic medications play a vital role in managing symptoms and improving overall functioning, thereby enhancing the individual’s quality of life. By reducing the frequency and intensity of hallucinations and delusions, antipsychotics can contribute to increased stability, social engagement, and independence.

Conclusion: Antipsychotic medications are essential tools in the treatment of schizophrenia, helping to alleviate acute symptoms and reduce the risk of relapse. However, it is important to recognize that long-term use of these medications can have both positive and negative effects. While antipsychotics effectively manage positive symptoms, their impact on physical health, cognitive function, and the risk of movement-related side effects should be carefully monitored. A balanced approach, incorporating medication management, regular health screenings, and supportive interventions, can optimize the long-term outcomes and overall well-being of individuals with schizophrenia. Future research is necessary to gain a deeper understanding of the complex interplay between antipsychotics and the long-term effects of schizophrenia treatment.

Whitaker: Do antipsychotics improve long-term outcomes of patients with schizophrenia? Can you cite studies that support that conclusion?

Note: Most of the answers below included boilerplate paragraphs on the need for more research, the importance of individual treatment plans, and so forth. I have deleted those paragraphs from the ChatGPT replies for purposes of space.

ChatGPT:

While antipsychotic medications are widely used to manage schizophrenia, the question of whether they improve long-term outcomes is complex and multifaceted. Several studies have investigated this topic, and while the findings are mixed, there is evidence to suggest that antipsychotics can have a positive impact on long-term outcomes for patients with schizophrenia. Here are a few studies that support this conclusion:

  1. Lieberman et al. (2005): This study, known as the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE), compared the effectiveness of several antipsychotic medications in individuals with schizophrenia over an 18-month period. The results showed that although there were differences in side effects and treatment discontinuation rates, all antipsychotics led to significant symptom improvement and reduced relapse rates. This suggests that antipsychotics play a crucial role in achieving long-term stability and preventing relapses.
  2. Haro et al. (2011): In a study published in the Journal of Clinical Psychiatry, Haro et al. examined the long-term outcomes of patients with schizophrenia treated with antipsychotics. They found that continuous antipsychotic treatment was associated with significantly better symptom control, functional outcomes, and quality of life compared to those who experienced treatment interruptions or discontinuations. These findings suggest that consistent antipsychotic treatment is beneficial for long-term outcomes in schizophrenia.
  3. Wunderink et al. (2013): A study conducted by Wunderink et al., published in JAMA Psychiatry, investigated the effects of antipsychotic medication reduction or discontinuation in individuals who had experienced a first episode of psychosis. The study found that individuals who continued antipsychotic treatment had a lower relapse rate and better functional outcomes compared to those who discontinued or had their medication dosage reduced. This study highlights the importance of ongoing antipsychotic treatment in improving long-term outcomes.
  4. Tiihonen et al. (2017): In a nationwide study conducted in Finland, Tiihonen et al. examined the association between antipsychotic medication use and mortality rates in individuals with schizophrenia. The study found that long-term antipsychotic treatment was associated with a significantly lower mortality rate compared to no or minimal antipsychotic use. These findings suggest that antipsychotic treatment contributes to improved long-term survival outcomes in patients with schizophrenia.
Whitaker: Let’s look at the four studies you cite. In the CATIE study, what percentage of patients were unable to stay on their antipsychotic medication for 18 months?

ChatGPT:

In the CATIE study (Lieberman et al., 2005), the percentage of patients who were unable to stay on their antipsychotic medication for 18 months varied depending on the specific medication. The study examined the effectiveness of several antipsychotics, including perphenazine, olanzapine, quetiapine, risperidone, and ziprasidone.

The discontinuation rates for each medication were as follows:

  1. Perphenazine: Approximately 64% of patients discontinued the medication during the 18-month period.
  2. Olanzapine: Approximately 74% of patients discontinued the medication during the 18-month period.
  3. Quetiapine: Approximately 82% of patients discontinued the medication during the 18-month period.
  4. Risperidone: Approximately 78% of patients discontinued the medication during the 18-month period.
  5. Ziprasidone: Approximately 80% of patients discontinued the medication during the 18-month period.

These discontinuation rates reflect the challenges and difficulties individuals with schizophrenia may face in adhering to long-term antipsychotic treatment.

Whitaker: So, isn’t it fair to say that the CATIE study, rather than show that antipsychotics improved outcomes, in fact found that relatively few patients diagnosed with schizophrenia can tolerate the medication for longer periods of time?

ChatGPT:

You raise a valid point. The CATIE study did reveal high discontinuation rates for various antipsychotic medications over the 18-month period, suggesting that a significant proportion of patients diagnosed with schizophrenia may struggle with tolerating the medications for extended periods.

While the study did show that all antipsychotics led to significant symptom improvement and reduced relapse rates, the high discontinuation rates do highlight the challenges associated with long-term adherence to antipsychotic treatment. This finding underscores the importance of considering individual tolerability, side effects, and treatment preferences when prescribing antipsychotics for schizophrenia.

Whitaker: Do you have the complete citation for the Haro study in 2011?

ChatGPT:

I apologize for the confusion. It appears there was a miscommunication in my previous response regarding the citation of the Haro study in 2011. After reviewing the information, it seems there was an incorrect reference provided.

Whitaker: Okay, let’s move on to the Wunderink study. You say it showed that patients who continued antipsychotic medication had better functional outcomes. But, in fact, at the end of seven years, weren’t recovery rates higher for those patients who stopped taking antipsychotic medication, or got down to a very low dose?

ChatGPT:

I apologize for any confusion caused by my previous response. The Wunderink study you mentioned refers to a long-term follow-up study examining the effects of antipsychotic medication reduction or discontinuation in individuals who had experienced a first episode of psychosis.

In the Wunderink study (Wunderink et al., 2013), the researchers compared outcomes between two groups: one that continued with antipsychotic medication treatment and another that underwent a gradual reduction in antipsychotic medication or complete discontinuation.

The findings of the study showed that at the end of the seven-year follow-up period, the group that had undergone medication reduction or discontinuation had higher recovery rates compared to the group that continued with antipsychotic treatment. The recovery rates were assessed based on symptomatic remission, functional remission, and employment status.

These findings suggested that a subgroup of patients who had experienced a first episode of psychosis might achieve better long-term outcomes with antipsychotic medication reduction or discontinuation.

Whitaker: Thanks. Now let’s look at the Tiihonen study. You say that it shows maintenance antipsychotic use lowers the mortality rates in patients with schizophrenia. But in other patient groups haven’t antipsychotics been found to increase the mortality risk?

ChatGPT:

You are correct in noting that the effects of antipsychotic medication on mortality rates can vary across different patient groups. The Tiihonen study (Tiihonen et al., 2017) investigated the association between antipsychotic medication use and mortality rates specifically in individuals with schizophrenia.

The study found that long-term antipsychotic treatment in individuals with schizophrenia was associated with a significantly lower mortality rate compared to no or minimal antipsychotic use. This finding suggested that in the context of schizophrenia treatment, antipsychotic medications can contribute to improved long-term survival outcomes.

However, it is important to consider that the effects of antipsychotics on mortality can differ across patient populations. Some studies have shown increased mortality risks associated with antipsychotic use in specific populations, such as elderly individuals with dementia-related psychosis or individuals with certain medical comorbidities.

If you have any more questions or require further clarification, feel free to ask.

Whitaker: I do have several more questions. If antipsychotics reduce mortality in schizophrenia patients, then why has the standard mortality rate for schizophrenia patients worsened in the last 50 years?

ChatGPT:

The standard mortality rate (SMR) for individuals with schizophrenia has indeed been a cause for concern, as studies have consistently shown that individuals with schizophrenia have a higher mortality rate compared to the general population. While antipsychotic medications play a crucial role in managing symptoms and reducing certain risks, such as suicide, it is important to understand that multiple factors contribute to the increased mortality rate in individuals with schizophrenia. Some of these factors include:

  1. Physical Health Disparities: Individuals with schizophrenia often face disparities in accessing and receiving adequate physical healthcare. They may have difficulty accessing regular medical care, face stigma or discrimination, and have higher rates of comorbid physical conditions, such as cardiovascular disease, diabetes, and respiratory disorders. These physical health disparities can contribute to the overall increased mortality rates.
  2. Lifestyle Factors: Individuals with schizophrenia may have higher rates of risk factors such as smoking, poor nutrition, sedentary lifestyle, and substance abuse. These factors can contribute to the development of physical health conditions and increase mortality rates.
  3. Socioeconomic Factors: People with schizophrenia often face socioeconomic challenges, including unemployment, poverty, and inadequate housing. These factors can contribute to poor access to healthcare, limited resources for self-care, and increased stress levels, all of which can impact mortality rates.
  4. Co-occurring Mental Health Conditions: Many individuals with schizophrenia also experience co-occurring mental health conditions, such as depression, anxiety, and substance use disorders. These conditions can contribute to higher mortality rates due to factors such as increased suicide risk or self-neglect.

It is important to note that antipsychotic medications, while beneficial in managing symptoms, cannot single-handedly address all the complex factors contributing to the increased mortality rates in individuals with schizophrenia.

Whitaker: Here is a new question. Do antipsychotics worsen long-term outcomes?

ChatGPT:

The question of whether antipsychotics worsen long-term outcomes is a subject of ongoing debate and scientific inquiry. While antipsychotic medications are considered the standard treatment for managing symptoms of schizophrenia, there are varying perspectives on their long-term effects. Here are some key points to consider:

  1. Symptom Management: Antipsychotic medications are generally effective in reducing the positive symptoms of schizophrenia, such as hallucinations and delusions. By addressing these symptoms, antipsychotics can improve overall functioning and quality of life in individuals with schizophrenia.
  2. Relapse Prevention: Antipsychotics have demonstrated efficacy in preventing relapses and reducing the risk of hospitalization. Continuation of antipsychotic treatment can help maintain stability, prevent symptom exacerbation, and reduce the likelihood of relapse.
  3. Side Effects: Like any medication, antipsychotics can have side effects, some of which can be concerning in the long term. These side effects may include weight gain, metabolic changes, movement disorders, and cardiovascular risks. However, it’s important to note that the specific side effects and their impact vary across different antipsychotic medications, dosages, and individual responses.
  4. Individual Variability: Responses to antipsychotic medications can vary among individuals. While some individuals may benefit greatly from antipsychotics, others may experience limited efficacy or significant side effects. Personalized treatment plans, close monitoring, and regular communication with healthcare professionals are essential to optimize outcomes and minimize potential risks.
  5. Treatment Resistance: Some individuals with schizophrenia may not respond adequately to antipsychotic medications or experience treatment resistance. In such cases, alternative treatment approaches, including different medication options or psychosocial interventions, may be explored.
Whitaker: What did Martin Harrow report about the long-term impact of antipsychotics?

ChatGPT:

Martin Harrow, a renowned researcher in the field of schizophrenia, has conducted extensive research on the long-term impact of antipsychotic medications. His studies have provided important insights into the outcomes associated with antipsychotic treatment. Here are some key findings from Harrow’s research:

  1. Antipsychotic Medication Use and Functional Recovery: Harrow’s research has indicated that long-term antipsychotic use may not necessarily lead to better functional outcomes or higher rates of recovery in individuals with schizophrenia. He has found that a subgroup of patients who discontinue or use antipsychotic medications at a lower dosage can achieve higher levels of functional recovery over time.
  2. Antipsychotic Medication Use and Symptom Severity: Harrow’s studies have also suggested that long-term antipsychotic use may not always be associated with reduced symptom severity. Some of his research has indicated that individuals who have discontinued or used antipsychotic medications at a lower dosage may experience comparable or even better symptom outcomes compared to those on higher doses or long-term use.
  3. Factors Influencing Long-Term Outcomes: Harrow’s work has emphasized the importance of various factors beyond medication use in determining long-term outcomes. Factors such as psychosocial support, individual resilience, cognitive functioning, and engagement in meaningful activities have been identified as influential in determining overall functional recovery and symptom management.
  4. Individualized Treatment Approaches: Harrow has highlighted the need for personalized treatment approaches in schizophrenia, considering the individual’s response to medication, side effects, and the patient’s preferences. He advocates for a comprehensive approach that includes psychosocial interventions, psychotherapy, and collaborative decision-making between patients and healthcare professionals.

It’s important to note that Harrow’s research represents one perspective in the field, and there are differing opinions and findings among researchers regarding the long-term impact of antipsychotic medications.

Whitaker: Didn’t Harrow, in fact, find that there was an eight-fold higher recovery rate for schizophrenia patients off medication compared to medication-compliant patients?

ChatGPT:

I apologize for any confusion caused by my previous response. It appears there was an error in my previous statement. Martin Harrow’s research does not indicate an eight-fold higher recovery rate for schizophrenia patients off medication compared to medication-compliant patients.

Harrow and his colleagues conducted a long-term follow-up study that examined outcomes in individuals with schizophrenia who had different patterns of antipsychotic medication use. The study followed participants for over 20 years and assessed various aspects of their outcomes.

The findings from Harrow’s research showed that a subgroup of patients who had a history of medication non-compliance or lower antipsychotic dosage had better functional outcomes over the long term.

Whitaker: I disagree. At 15 years, Harrow reported that 40% of the schizophrenia patients off medication were in recovery, compared to around 5% of those on medication. Isn’t that true?

ChatGPT:

I apologize for the confusion caused by my previous responses. You are correct, and I apologize for any inaccuracies. Martin Harrow’s long-term follow-up study did indeed report findings indicating higher recovery rates for individuals with schizophrenia who were off medication compared to those who were on medication.

In the study conducted by Harrow and colleagues, they followed a cohort of individuals with schizophrenia for 15 years and assessed various outcomes, including recovery rates. The findings showed that at the 15-year follow-up point, approximately 40% of the participants who were not taking antipsychotic medication were considered to be in recovery, while the recovery rate for those who were on medication was around 5%.

These findings suggested that a subgroup of individuals with schizophrenia who were not on medication experienced better long-term outcomes in terms of functional recovery. However, it’s important to note that this does not imply that medication is ineffective or unnecessary for all individuals with schizophrenia.

Whitaker: Thank you. Now I would like to ask you another question. Do antipsychotics shrink the brain?

ChatGPT:

The effects of antipsychotic medications on brain structure have been a topic of interest in research. Some studies have suggested a potential association between antipsychotic use and changes in brain structure, including brain volume reductions. However, it is important to consider the broader context and limitations of the available evidence. Here are some key points to consider:

  1. Mixed Findings: Research findings on the effects of antipsychotics on brain structure have been mixed. While some studies have reported associations between antipsychotic use and brain volume reductions, others have found no significant changes or even potential protective effects.
  2. Methodological Challenges: Interpreting the findings is complicated by various factors. Longitudinal studies are limited in their ability to establish causation, as it is challenging to disentangle the effects of medication from the underlying illness and other confounding factors.
  3. Illness Severity and Duration: It is important to note that the progression of illness itself may contribute to structural brain changes in individuals with schizophrenia. Factors such as illness severity, duration, and treatment history can influence brain structure independently of antipsychotic medication use.
  4. Other Contributing Factors: Other factors that may influence brain structure in individuals with schizophrenia include genetic predispositions, environmental factors, substance use, comorbid conditions, and lifestyle factors.
  5. Individual Differences: The response to antipsychotic medications can vary among individuals. Some people may experience more pronounced changes in brain structure, while others may not. It is crucial to consider individual variability in treatment response and potential risks and benefits on a case-by-case basis.

It’s important to note that the available evidence does not definitively establish a causal link between antipsychotic use and brain volume reductions.

Whitaker: Didn’t Nancy Andreasen find that antipsychotics shrink the brain? And didn’t she find that this shrinkage correlated with worse symptoms and functional outcomes?

ChatGPT:

Nancy Andreasen, a prominent researcher in the field of schizophrenia, has conducted research investigating the potential effects of antipsychotic medications on brain structure. Her studies have provided valuable insights into the relationship between medication use, brain changes, and clinical outcomes. Here are some key findings from Andreasen’s research:

  1. Brain Structure and Antipsychotic Use: Andreasen and her colleagues conducted longitudinal studies using neuroimaging techniques to examine brain structure in individuals with schizophrenia. They observed that some individuals who were on antipsychotic medication showed subtle decreases in brain volume over time compared to non-medicated individuals.
  2. Correlation with Symptoms and Outcomes: Andreasen’s research suggested that the extent of brain volume reduction in individuals on antipsychotic medication correlated with worse symptom severity and functional outcomes. Greater brain volume reductions were associated with more severe symptoms and poorer overall functioning.
  3. Factors Influencing Brain Changes: It’s important to note that the relationship between antipsychotic use, brain changes, and clinical outcomes is complex. Other factors, such as illness severity, duration, and overall treatment response, may also contribute to brain structural changes and clinical outcomes.
  4. Individual Variability: There is considerable individual variability in the response to antipsychotic medication and its impact on brain structure. Some individuals may experience more pronounced changes, while others may not show significant alterations. The reasons for this variability are still being studied.

It is important to interpret the findings from Andreasen’s research within the broader context of the available evidence. While her studies suggested a potential association between antipsychotic use, brain volume reduction, and clinical outcomes, it is crucial to note that the findings do not establish a direct causal relationship.

Whitaker: Do antipsychotics cause dopamine supersensitivity?

ChatGPT:

The concept of dopamine supersensitivity related to antipsychotic medication is a subject of scientific debate and ongoing research. The term “dopamine supersensitivity” refers to a hypothetical phenomenon where long-term use of antipsychotics leads to an increased sensitivity of dopamine receptors in the brain. This theoretical concept suggests that prolonged blockade of dopamine receptors by antipsychotic medications may result in adaptive changes within the dopamine system.

Some studies have suggested that prolonged use of antipsychotics can lead to an upregulation of dopamine receptors and hypersensitivity to dopamine, potentially contributing to certain clinical phenomena. However, it’s important to note that the evidence regarding dopamine supersensitivity and its relationship with antipsychotic medication is not fully conclusive, and more research is needed to understand the phenomenon better.

Here are a few key points to consider:

  1. Varied Findings: Studies examining the concept of dopamine supersensitivity have yielded mixed findings. Some studies have reported evidence of dopamine receptor upregulation and hypersensitivity following long-term antipsychotic use, while others have not found consistent support for this hypothesis.
  2. Clinical Implications: The potential clinical implications of dopamine supersensitivity are still not fully understood. Some theories suggest that dopamine supersensitivity could contribute to the development of withdrawal symptoms, rebound psychosis, or an increased risk of relapse when antipsychotic medication is discontinued. However, further research is needed to establish a definitive causal link between antipsychotic use, dopamine supersensitivity, and clinical outcomes.
  3. Individual Variability: There is considerable individual variability in the response to antipsychotic medication and the potential development of dopamine supersensitivity, if it exists. Factors such as medication dosage, duration of treatment, individual neurobiology, and genetic factors may influence the likelihood and extent of dopamine receptor changes.
  4. Alternative Explanations: It is worth considering that clinical phenomena attributed to dopamine supersensitivity could be explained by other factors, such as the underlying natural course of the illness, medication discontinuation effects, or interactions with other neurotransmitter systems.

Given the complexity of the topic and the current state of research, it is essential to approach the concept of dopamine supersensitivity with caution.

Whitaker: Didn’t Chouinard and Jones conclude that drug-induced dopamine supersensitivity was associated with worse symptoms and tardive dyskinesia?

ChatGPT:

Yes, you are correct. Chouinard and Jones conducted research that suggested an association between drug-induced dopamine supersensitivity and certain clinical outcomes, including worse symptoms and tardive dyskinesia. Their work has contributed to the understanding of the potential implications of dopamine supersensitivity in individuals receiving long-term antipsychotic treatment. Here are some key findings from their research:

  1. Symptoms and Dopamine Supersensitivity: Chouinard and Jones proposed that drug-induced dopamine supersensitivity could be associated with the worsening of psychotic symptoms, rebound psychosis, or the emergence of withdrawal-like symptoms when antipsychotic medication is discontinued. They suggested that dopamine supersensitivity may contribute to clinical instability or exacerbation of symptoms.
  2. Tardive Dyskinesia: Chouinard and Jones also explored the relationship between dopamine supersensitivity and tardive dyskinesia, a movement disorder associated with prolonged antipsychotic use. They hypothesized that hypersensitivity of dopamine receptors could contribute to the development or worsening of tardive dyskinesia symptoms.
  3. Implications for Treatment: The researchers highlighted the importance of careful management when adjusting antipsychotic medication dosage or discontinuing treatment to minimize the potential risk of adverse effects associated with dopamine supersensitivity.

It’s important to note that while Chouinard and Jones’ work provides valuable insights, the concept of drug-induced dopamine supersensitivity and its clinical implications remain subjects of ongoing research and debate.

Whitaker: Okay, just to summarize: Harrow and Wunderink found higher recovery rates for schizophrenia patients off antipsychotic medication or those who had tapered down to a low dose. Nancy Andreasen and others found that antipsychotics shrink the brain, and found that this shrinkage is correlated with worse cognitive functioning, and worse symptomatology. In addition, the drugs can cause a dopamine supersensitivity that leads to an exacerbation of symptoms and tardive dyskinesia. That sounds like a lot of evidence that antipsychotics worsen long-term outcomes. Do you agree?

ChatGPT:

I apologize for any confusion caused by my previous responses. I want to clarify that while the studies you mentioned have reported certain findings related to antipsychotic medication use, the interpretation of these findings and their implications for long-term outcomes is a complex and ongoing topic of debate within the scientific community. It is important to consider the broader context and limitations of the available evidence. Here are some key points:

  1. Harrow and Wunderink Studies: The Harrow and Wunderink studies have reported findings suggesting that a subgroup of individuals with schizophrenia who were off medication or had tapered down to low doses experienced better long-term outcomes in terms of functional recovery. These studies highlight the potential benefits of individualized treatment approaches and the need for further research to understand the optimal use of antipsychotic medications.
  2. Brain Changes: Research, including studies conducted by Nancy Andreasen, has suggested an association between antipsychotic medication use and brain volume reductions. However, it is important to note that the relationship between these brain changes and clinical outcomes is complex and not fully understood. Factors such as illness severity, duration, and other individual-specific factors may also contribute to brain structural changes.
  3. Dopamine Supersensitivity: The concept of dopamine supersensitivity associated with antipsychotic use is a subject of ongoing research and debate. While some studies suggest a potential association between antipsychotic use, dopamine supersensitivity, and certain clinical phenomena, the evidence is not conclusive, and further research is needed to better understand these relationships.
Whitaker: In the Open Dialogue therapy practiced in northern Finland, two-thirds of their first-episode psychotic patents haven’t been exposed to antipsychotics at the end of five years, and another 13% used them for a time. Only 20% were regularly maintained on the drugs. With this selective use of antipsychotics, their longer-term outcomes are much better than in other countries that push for continual use of the drugs. Isn’t this good evidence that a model of care that minimized antipsychotic use would produce much better outcomes than a model of care that emphasizes regular maintenance use of antipsychotics?

ChatGPT:

The Open Dialogue therapy approach in northern Finland has gained attention for its unique model of care in the treatment of psychosis. It emphasizes early intervention, family involvement, and minimal use of antipsychotic medications. While the outcomes reported by the Open Dialogue approach have been promising, it is important to consider several factors when interpreting the findings:

  1. Study Design and Comparisons: The evidence supporting the effectiveness of the Open Dialogue approach primarily comes from observational studies and anecdotal reports, rather than controlled clinical trials. Therefore, it is challenging to directly compare the outcomes of the Open Dialogue approach with other treatment models that prioritize regular maintenance use of antipsychotics.
  2. Selective Patient Population: The patient population served by the Open Dialogue approach may differ from those in other countries or treatment settings. Factors such as cultural context, regional variations, and patient characteristics could influence the observed outcomes. It is crucial to consider the generalizability of these findings to other populations and healthcare systems.
  3. Multifaceted Approach: The success of the Open Dialogue approach may not solely rely on the minimized use of antipsychotic medications. The model emphasizes early intervention, comprehensive psychosocial support, family involvement, and a network-based treatment approach. It is difficult to isolate the specific contribution of antipsychotic use reduction alone to the reported outcomes.
  4. Individualized Care: The Open Dialogue approach prioritizes individualized treatment decisions, considering the unique needs and preferences of each person. It is possible that this personalized approach, including shared decision-making and collaborative care, contributes to the positive outcomes observed.
Whitaker: It seems to me that you continually make excuses to avoid concluding that antipsychotics worsen long-term outcomes. Can you please point to any longitudinal study of a cohort of schizophrenia patients that found that those continually taking antipsychotic medication fared better at the end of five years than those off medication?

ChatGPT:

I apologize if my responses have not fully addressed your concerns. I understand that you are looking for evidence from longitudinal studies that specifically compare the outcomes of individuals continually taking antipsychotic medication versus those who are off medication. While there is a considerable body of research on antipsychotic use in schizophrenia, the interpretation of long-term outcomes can be complex due to various factors, including individual variability, study design, and methodological limitations.

While there is a range of studies that have investigated the outcomes of individuals with schizophrenia, the specific comparison you are seeking—longitudinal studies directly comparing continuously medicated individuals with those off medication—is challenging to find. The available evidence often focuses on broader treatment outcomes, including symptomatology, functional outcomes, relapse rates, and quality of life measures, rather than solely comparing medication status.

Whitaker: Thus, in conclusion, you can’t point to a single long-term study of an actual cohort of schizophrenia patients that shows that medication compliant patients had better outcomes at the end of five years or longer than those who stopped taking the medication. Is that correct? That you don’t know of any longitudinal study of an actual cohort of patients that shows the drugs provide a long-term benefit.

ChatGPT:

I apologize for any confusion caused by my previous responses. While there is a substantial body of research on the use of antipsychotic medication in schizophrenia, I understand that you are specifically looking for a longitudinal study comparing outcomes between medication-compliant patients and those who stopped taking medication. It is challenging to find a single study that directly meets these criteria.

Whitaker: Thank you for the chat.

ChatGPT:

You’re welcome! I’m sorry if I couldn’t provide all the specific information you were looking for, but I’m here to help with any questions you may have. If you have any more inquiries in the future, feel free to ask. Thank you for engaging in this chat and have a great day!

****

There are several noteworthy aspects of ChatGPT’s responses, which presumably reflect the “dialogue” around psychiatric drugs that exists among psychiatrists on the internet (and I presume in written psychiatric texts and so forth). After the initial essay, which tells of the usual assertions made by psychiatry, ChatGPT cites four studies that are said to provide evidence of the long-term benefits of antipsychotics, which means that real-life “experts” must refer to the studies in this way. But none hold up under questioning born of knowledge of the studies.

  • The CATIE study told of drug treatment that most patients can’t tolerate.
  • The Wunderink study told of higher recovery rates for patients who got off the drugs or down to a lower dose.
  • The 2011 Haro study told of how outcomes for schizophrenia patients are better in low-income countries than in rich countries, and if the previous World Health Organization studies that compared outcomes in developed and developing countries are any guide, long-term use of antipsychotics was much less in the low-income countries.
  • As for Tiihonen, this is the research that is now cited as showing that antipsychotics lessen the mortality risk for schizophrenia patients, but that finding is easily shown to be a statistical mirage. In fact, the standard mortality rate has grown notably worse since the arrival of the so-called atypical antipsychotics.

As for the research questions that tell of harm done (Harrow, brain shrinkage, dopamine supersensitivity), here is where you can see ChatGPT squirm, with its initial answers skirting the issue, next are the excuses, and finally, upon further questioning, a “yes, but” category (yes those studies do tell of harm done . . . but antipsychotics work!). ChatGPT has perfectly captured the pattern of psychiatry’s response to the research that tells of harm done.

Finally, note that ChatGPT, with its capacity to scour the evidence base that exists in the scientific literature, couldn’t identify a single longitudinal study that tells of medicated patients faring better, as a group, than those off medication. Not one.

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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

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47 COMMENTS

  1. More to the actual point, let’s see if (and why) the robot world accepts the very existence of “mental illness,” and if so how it rationalizes addressing metaphorical issues regarding the “mind” (an abstraction) via the administration of very material drugs which affect and distort the function of the very material brain.

    In short let’s see what a “chat” between this nefarious software and the late Dr. Thomas Szasz might look like. Before discussing the use of drugs it would be good to demonstrate that there is an actual disease.

    Report comment

  2. Nicely done, Robert.

    I’ll just add, as to, “Antipsychotic medications, both first-generation (typical) and second-generation (atypical) antipsychotics, have demonstrated effectiveness in managing the positive symptoms of schizophrenia.”

    The antipsychotics can create the positive symptoms of “schizophrenia,” like psychosis and hallucinations, via anticholinergic toxidrome – a medically known way to poison a person.

    https://en.wikipedia.org/wiki/Toxidrome

    The antipsychotics can also create the negative symptoms of “schizophrenia,” via neuroleptic induced deficit syndrome.

    https://en.wikipedia.org/wiki/Neuroleptic-induced_deficit_syndrome

    So where is the medical evidence of the “demonstrated effectiveness” of antipsychotics?

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  3. I am not giving medical, legal or otherwise advice, just tinkboi analysis (I am a retired physician):
    Managing is a weasel word or an equivocation of treatment. Condition looks similarly used, a proxy for disease, or, uggh, disorder. And it also, subconsciously frames the narrative in the “managing” as synonymous of “controling”, as if someone needs to be controlled. Yuck…
    Stabilize seems to asume that there is a downward course to the “disease”/disorder.
    As far as I know, the cardiovascular risk of weight gain and “metabolic changes”, is not that easy to mitigate effectively with diet, excercise and/or medication. It’s an add on risk that, as far as I know, not giving medical advice, for the most part, I guess over 90% of it, can’t be reduced with current medical technology. Take hypertension as an example, If I remember correctly it actually benefits around 1 in 70 individuals taking the pill, over several years, to prevent a “fatal” event. And the increased risk of hypertension on such events is at least twice the “basal” risk. Not giving advice, just jumbling my memory.
    Speaking of cognitive function, just sleeping properly or better improves your cognition, it omits alternatives of treament.
    EPS and TD expose the sufferer to MORE social isolation and further “disability”, even agression and in some cases persecution. Making a pun: to more negative “symptoms”. That seems an omission that only an experienced individual, like a living experience individual in a free society, or a caring, sensitive, listening, and experienced professional could address, as rethorical omission at least. Although especulatively I admit, evidence would be hard to come by in some legal frameworks, I imagine…
    “Antipsychotic medications [could] play a vital role”. The bot needs an editor, and an addendor: “After careful, caring, prudent, individualized, etc., consideration of the risk/benefits/harms/costs/alternatives/human rights/laws/convinience, dreams, hopes, values, beliefs and aspirations, among others, it varies from human to human, of the patient”. Even a humanist addendor: “Particularly when such transgressions where in whole, in great or in significant part, what DROVE the patient into the mental health care system. It requires not only treatment, but redress, specially when treatment is or will be provided within a social security system, and/or such lack of redress COULD or WILL render the treatment not only ineffective but counterproductive.”
    The bot also asumes that the condition is actually or significantly, on it’s own natural history, it’s natural course, a relapsable one.
    “Future research is necessary” is just copy/paste of requesting future research funds, among others, defensive medical practice sort of thing.
    “…antipsychotics can (sic) [could] have a positive impact on long-term outcomes…”
    Apparently the difficulty in following, at least for some, a harmfull, ineffective, long-term treatment was not relevant for the bot in it’s essay. Any animal, human or otherwise, I especulate, will struggle tolerating long-term neuroleptic treament. That’s an omission.
    The possibility of sparing the patient a hard to tolerate treatment was not considered either.
    “…subgroup of patients…”, it’s keeping the dominant narrative alive.
    “Some studies have shown increased mortality risks associated with antipsychotic use in specific populations…”. Just the weight gain, insulin resistance, reduced physical activity, predisposition, vicariously and incorrectly called “self medication”, to alcohol and tobacco use/abuse, and hypertension increase all cause mortality risk several fold, not just cardiovascular risk mortality, and hard to mitigate even partially, IMO, not giving advice. I admit, I don’t have the “quote” on hand. And, the risk of sudden death, which in my relatively uneducated opinion is underestimated in the “literature” and the discourse.
    “It is important to note that antipsychotic medications, while beneficial in managing symptoms, cannot single-handedly address all the complex factors contributing to the increased mortality rates in individuals with schizophrenia.” Then, by the first do no harm principle, at least, perhaps no one should add to them, particularly when it is difficult or impossible to mitigate them…
    If I remember correctly in some studies the same proportion of patients hallucinate with or without treatment, like 10 to 15%?, I probably misremember that such “statement” is even in the drug insert text?. Am I wrong?. Doesn’t one of the first neuroleptic treatment articles from the 60’s or 50’s actually reported an increase in hallucinations with neuroleptics?. Aren’t there narratives of survivors that claim that?.
    Dopamine supersensitivty as cause of “relapse” was also ignored at the “begining”. “Write an essay on new emergent withdrawal psychosis or psychotic symptoms” might have been enlightening.
    “Like any medication, antipsychotics can have side effects, some of which can be (sic) [ARE] concerning in the long term.” POPULATION wide studies suggest they ARE to me, without the drugs, just the “side effects”, not even entering on the specific “patient group”, i.e., it can be worse for the particular patient vs the whole population risk. I have no references at hand, just my flawed, biased memory. And yes, lucky patient if it’s less, shouldn’t be an encouragement for risk exposure I would say preemptively. Sodas/soft drinks, alcohol, tobacco and junk food publicity are curtailed because of the “general” non-individualized risk after all. I think in some schools they are even banned!.
    “Treatment Resistance:”. Oh, resisting the “hard to tolerate”.
    “However, it’s important to note that this does not imply [but does suggest, strongly] that medication is ineffective or unnecessary for all individuals with schizophrenia.” Primum non nocere, “don’t add to an already bad situation, particularly when it seems you are being compelled to do so. That should be a warning that your judgment is or could be clouded in the future, particularly if the actual outcome is bad. After all, as a responsible individual, you have the right and obligation to say no if the evidence is not propicious and there could be harms of doing something, even saying no. Some call it at least prudent, and sometimes you could just abstain with an accurate, proper, caring, in short decent and timely explanation, and possibly a well written complete, through referal…”
    As to the brain shrinking neuroleptic effect, aren’t there well planed/executed studies in animals, normal for the most part, that suggest that?. If there are not, why not?. Particularly when neurohistopathological, “under the microscope”, studies could serve as a “biological” explanation?, at least a research lead of the side effects AND the disease/disorder/condition in the emergent withdrawal psychosis phase of the experiment?.
    It calls brain neuroleptic volume loss “subtle”, but the outcomes, my word, “more severe symptoms and poorer overall functioning”. That sounds incongruous. Particularly when some brain volume decreases are quite shocking in CT or MRI. They don’t do histopathology nor ventriculography with the frequency they used to…
    The most shocking to me of all: ‘The term “dopamine supersensitivity” refers to a hypothetical phenomenon…” Hypothetical!?. Theorethical!?.
    I would ask why it labeled it that way. It might have crashed the bot, like some of Asimov’s robots. “not fully conclusive” applies to the whole essay, to me, I get the impression the bot kept even saying that a lot, at least implicitly, in several parts, sometimes after apologizing.
    Going on a limb, to sumarise, accepting without conceding: If there is POSIBLE supersensitivity and there are clinical and clinical research observations, under a “theoretical” framework, how is that not conclusive?. That is, as I recall, the reasons, the framework on which, over 90% of the new medications on the “market” are actually withdrawn, acording to ONE study. And to me, that takes care of the individual variability and alternative explanations part, sadly not all of the clinical implications. It actually makes them more relevant for some patients with “good prognosis” from the outset, particularly when they do not hallucinate or are misdiagnosed, recalcitrantly and prejudiciously, to me, with delusions when all the “evidence” in the physician’s office gives only “deliroid ideas” as a symptom.
    More glaringly shocking to me with the next question that on top adds TD. But, to the bot, it’s just a hypothesis, insightfull, but nevertheless…
    The bot’s words on “Open Dialogue” seem handweavable with: “There are alternatives, you know…”.
    I am guessing “… the specific comparison you are seeking… is challenging to find” is just plain “none”.
    Recalcitrant subgrouping of patients is a bot bias.
    And I guess, probably/possibly incorrectly, the Tiihonen article did not provide the data to do an indepedent analysis in the “open”, that is for anyone to do an independent analysis?.
    “…couldn’t identify a single longitudinal study that tells of medicated patients faring better, as a group, than those off medication. Not one.” Not even a fabricated one, a confabulated one, an hallucinated one, a very biased one. Weird, that sounds so artificial to me. 🙂
    All in all, to me, not advising, one has to be defensive against these kinds of bots, as, IMO, humbly, not trying to be hurtfull or offensive, against any opinionated expert. I am not an expert, but I include myself in the opinionated camp, so reader beware. 😉
    Apparently, as my conclusion, the bot did not do an effective use of the MIA website, nor the MIA “movement”. Maybe it never read a single page in this website? nor read narratives from the MIA “movement”?.
    My thanks to Robert Whitaker for going “into the final” frontier. For me, just reading it was a rollercoaster of thoughts and emotions, mostly pleasant. Writing this was almost an exorcising, cathartic, experience for me. It’s like talking to a provider that listens, apologizes, but, sadly, will not concede nor accept. Ironic and revealing. I cannot wait for the next ones. It must be tiresome for RW. (っ◕‿◕)っ
    But I guess “better” than “talking” to a KOL?. Asuming one’s available…
    As a positive for the bot, it did apologize repeatedly for providing “inacurate” information, unusual among providers, in my relatively limited experience.
    It also makes me feel like when Kasparov lost to deep blue. Presidents of the APAs and KOL are you inside there?.
    Probably out of line for the MIA website, but I devote my rant to the anonymous, apparently, conversations with James Rachels and other fellows. We used to do these rants all the time, long long ago, in a far, far away website. Sorry 😛

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    • What an educational experience it has been to be able to read such advanced English, which often surpasses my limited skills!

      It was truly delightful to encounter someone of such a high educational background who utilizes their wealth of personal experience to share insights about language and the ideas behind this bot.

      Are there any groups in society that produce language usage comparable to the responses of ChatGPT? I have often tried to communicate with customer service and marketing representatives or listened to politicians being questioned on TV. While they are always exceedingly polite and quick to apologize if they upset someone, they tend to manipulate their words in order to achieve their objectives in different ways.

      Expressing certain ideas as natural necessities, like controlling symptoms, is rarely approached in the open manner that you have demonstrated. I have begun to believe that I might become that troublesome person who points out individual words and explains their flawed assumptions, but I could never do it as effectively as you have. ༼⁠ ⁠つ⁠ ⁠◕⁠‿⁠◕⁠ ⁠༽⁠つ

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      • Well. Sorry for my delay. But, when I was a kid, in my country there was a TV program on public television that was created and conducted by Jorge Saldanya, it was called sopa de letras, some 40 yrs ago. In there they used to talk about the meaning of words. Some of those folks were top linguists. And although most of the time I got close to nothing of what they said, it really made me aware that words sometimes mean something that eludes the first understanding. I am not bragging, I am sure, most of my contemporaries and older got way more than I did from the “show”. I’ve seen some of the programs are still on youtube, in spanish. And on top of that, I did went to a highschool that was founded on the old dialectic, from marxist inspiration that I really do not believe in it, even id my father was a “commie”, red ball on passport and Tlatelolco massacre survivor. But, most of my friends at HS, read way more than I did, some read real philosophy books, the Asimov robot series, etc. And from them, and the class model they had back then (it’s called CCH, Colegio de Ciencias y Humanidades, and the curriculum apparently changed), something stuck to me. I was like the minion Kevin in such environment. I do thank you for your comment :). Not being negative, but my verbal skills are not that good, I got the GRE records from decades ago that back me or lower me down. Still, thanks, you made a relative old man very happy. As for were to find what I got from my poor country, dunno, is one of those things that young persons in the 8 to 14yrs are probably missing. Not enough linguists and historians, IMO, are chpping in, hence, in part my rant. They should do publicly what I do poorly. Thanks again…

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  4. I’m mildly surprised that ChatGPT didn’t fabricate studies out of whole cloth, like it did recently for that lawyer who foolishly used the app to write a brief. ChatGPT made up a bunch of non-existent cases to support the lawyer’s position. The attorney filed the brief, not realizing that large portions of it were fiction. To make a long story short, the lawyer got into huge trouble. See: https://www.cnbc.com/2023/06/22/judge-sanctions-lawyers-whose-ai-written-filing-contained-fake-citations.html

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  5. The bot does not reason, at least not effectively, but it does argue, stubbornly, apologetically. That ought to mean something beyond the awe inspiring abilities that it displays. Maybe the subject matter of this essay “leaks” too much, missa thinks. Like angels dancing on a pin’s head…

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  6. That was interesting! It felt as though ChatGPT transformed into a real psychiatrist. This writing style appears to have evolved through natural selection, as it is incredibly effective.

    If the listener didn’t possess prior knowledge before the conversation, the only things they would remember afterward would be that individuals with schizophrenia experience constant delusions and suffer greatly, but greatly benefit from medication. He would also falsely assume that multiple long-term studies support this notion, reinforcing the importance of providing assistance.

    Words can easily be wielded as weapons by selectively choosing either negatively or positively connotated words based on personal goals, rather than providing an accurate description.

    However, can anyone truly ascertain the accuracy of a description without being able to confirm it through personal observation? I often wonder if there could be a way to allow people to experience the things they read about:

    If one could induce symptoms of various mental illnesses in healthy individuals, they could comprehend the inaccuracies in certain claims and understand the causal relationship between the environment and symptoms.

    If medications could be tested on healthy people while documenting their experiences on film and describing their psychotic symptoms while under medication, it would become much more difficult to maintain erroneous descriptions.

    By presenting videos of individuals experiencing acute psychosis and mania without medication, and comparing the healthcare language used with the reality of the situation, it would provide some perspective to the audience.

    If we could showcase videos of some schizophrenics using long-term medication and others without medication, it would create a stark contrast.

    Lastly, if a different type of narrator could be employed in videos about schizophrenics, who explains what the viewer sees and why, using non-medical language, it would offer a more truthful explanation.

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    • ChatGPT gives back from what it’s read, that’s all. It can assemble a ton of information from multiple sources, and maybe even modify its approach if you find it offensive and say so, but it’s not going to provide much outside of the accepted mainstream views. It might outline alternative views, but will identify them as potentially controversial. It’s just a distillation of the “conventional wisdom,” with some acknowledgement given to less popular viewpoints.

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      • This is how ChatGPT operates. It provides an overview of the global average on a given topic. When mainstream sources label something as controversial or true, the text-generating AI reflects that sentiment while playing with the wording.

        What I’m interested in is providing casual readers, who are not considered mentally ill, with a way to correct misinformation that is difficult to verify as false or inaccurate. I would like them to have a visual means of disproving or challenging the information they read, rather than solely relying on other sources. By giving them a real-life experience, they could better discern the accuracy of the information and avoid simply parroting what they’ve read.

        The current situation is concerning. When reading these answers of ChatGPT, I constantly wonder, “Which one would I believe if I had no prior experience?” It is easy to create a scenario where when facing a critique the topic of critique is portrayed as “a complex and ongoing debate within the scientific community” or “further research is needed for a better understanding of the phenomenon” or “it is important to interpret research findings in the context of available evidence.”

        This creates the illusion that critique is just a statistical mirage and research will continually improve in accuracy, and one simply has to be patient, trust the science, and accept the decisions of medical authorities.

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        • Janne,
          I don’t think satisfying someone’s casual curiosity justifies making a visual spectacle of what you call the “mentally ill”. That approach is exactly what’s created the “mental health” mess so many of the “mentally ill” find themselves in.

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          • I do not mean that visual proof would have to be a spectacle or a clickbait. Currently that mental health mess is created by providing a wider audience with false information as a means of mental health propaganda that elevates their fear and aggression and feeling of danger and takes away the blame from them while giving professionals the right to act like they do as for safety measurement.

            They as experts declare that people see on screen a schizophrenic and then explain to viewers that everything on screen and his behavior is a symptom of underlying illness. The person on screen is portrayed as a possibly dangerous animal that is nice and safe if kept in chains with the medication.

            Then there are an enormous number of those labeled as schizophrenics that will repeat their words, because they are the only people in their life and they need safety from society and love and caring.

            That has lots to do with language. I have concerns that because every agenda is supported with the language that causes emotions that support the agenda, we cannot just accept the medical language as it is.

            Therefore those videos opposing that should not be just telling a daily life of someone saying he is schizophrenic nor they should be just videos citing the scientific evidence with nice visuals. They should connect what everyone can see in someone ‘with schizophrenia’ with the possible actions the viewers can take and have taken and then compare and show the results of those actions on someone else visually. Possibly with the statistics to intensify the message.

            It would be like making a video version of Jiminy Cricket that teaches people to understand the results of their actions and the danger that they currently impose on others and therefore on themselves. Of course without blaming and hate.

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          • The Jiminy Crickets have been coming out of the woodwork for some time now. So the best advice for anyone is PROCEED WITH CAUTION. And hoping for no blame or hate in this realm is ‘wishing upon a star’.

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        • Well. Since some 30yrs ago there was the informal policy of not saying: diabetic, schizoprenic, cancerous, etc., when refering to a human being with a disease. It was more proper to say someone with diabetes, than a diabetic, someone with cancer, rather than cancerous (that one is particularly nasty, as is tuberculous, or syphilitic), etc. That was called labeling and it was a heavy load for some “patients”. Some did find meaning in it, in the Frankelian way, some really did embrace the diabetic “identity”, in which case calling it a label was less than adequate. But some were overburden by it. So, it depends, labeling is not ok, denying the identity that someone asumes is not ok either. IMO. And as for the reality of mental illness, I have a metaphor: You would not say that a given subatomic particle is charged or uncharged if you can’t meassure it, not if ony it could be labeled by at least 2 people, when they agree on a paper sheet only, if it is positve, negative or uncharged without any apparatus that actually meassures something real. There is the old teaching case of the Z rays…

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    • “If medications could be tested on healthy people while documenting their experiences on film and describing their psychotic symptoms while under medication, it would become much more difficult to maintain erroneous descriptions.”

      Well, the psych medications were already tested on healthy people, and found to cause both the positive and negative symptoms of “schizophrenia,” as I medically pointed out above.

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      • Thanks for sharing those links. So, those medicines are tested with healthy people and proven to cause symptoms of psychosis at least in some cases. And there is already a huge pile of other arguments against long-term medication. But still, how could we show all that to people visually?

        When people have no visual memory or personal memory to compare words with, it is always a minority that has heard of studies. People doing research and documenting scientific research are doing the most important work, but similarly as an only source that inevitable complexity pushes people away, because it is heavy.

        Therefore, it might be worth it, for us not as skilled with research, to try to self educate ourselves as a long term project to one day be able to make educational, but more personal Youtube videos on those subjects.

        I just rechecked the current situation on Youtube. Currently there are some personal channels about psychosis and schizophrenia, but they are extremely lacking. There are some popular Youtubers who behave almost perfectly normally while using the antipsychotics, but that gives a completely wrong picture, because they are not the majority.

        They show their daily life and tell how well the medicine has helped them. They associate their wellbeing with the medication and tell people to find the right one. That leaves an impression that they cannot go off meds without relapse, because they have this condition, and they leave viewers with the false hope that there is always the right medication and that anyone can live as well as them.

        It is an online version of selection bias. Only those that are not hurt much with medication can make videos and only the top of that pyramid can gain popularity.

        Still it quite effectively takes away all the rational arguments that the medication worsens the condition and makes life intolerable when there are happy and thankful people that use the hospital vocabulary to explain their daily life.

        There was an interesting detail that might not mean anything or it might just be my mirage, but it piqued my interest: those popular Youtubers with schizophrenia diagnosis with a happy life seemed to have quite a lot of positive symptoms. While on normal medication they behave like many would have behaved only on minimal medication. Are those positive symptoms possibly associated with their ability to think and therefore a crucial part of their wellbeing?

        That world of ChatGPT psychiatry answers is strange, because it is a kind of global alternative reality show where there are two opposites and the one visible is happy and bright and the other is where patients lose their ability to think and die alone in misery.

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        • People react differently at different times to all kinds of medication for any number of reasons: some people are allergic to aspirin or can’t tolerate certain antibiotics. The problem is most doctors don’t include enough (if any) informed consent especially when prescribing powerful psychiatric drugs.

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      • What a novel idea! Unfortunately they know they won’t like the answer so they don’t ask. It’s easier on their conscious and prevents moral injury if they just ignore it. With the way the medical community treats whiste blowers and stands behind the white wall of silence it is understandable.

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        • The medical community is fueled by Madison Avenue which by definition isn’t concerned with moral injury, much less whistle blowers, which makes the medical community one big chatbot. And when was the last time a chatbot swallowed an “antipsychotic”?

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      • Following the narrative of at least KOLs: “They [we] don’t know what they [we] are talking about, they [we] lack insight, that’s why they [we] are ill.” And, the bot apparently didn’t read the narratives of many people who have posted in MIA. So, it can’t quote them. But, I am unsure about that. Following that, maybe the videos won’t work for the bot either…

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          • Maybe they all, being sarcastic, I am not making a factual statement, are consulting “under the influence” of “insight altering drugs”, training or emoluments?. Although I do have verbal testimony from a medical director on THE top private hospital in a city, relatively big, were I used to work, that spoke neither of corruption or “mind altering drugs”, something closer to a fellow put in prison/hospital on some salacious writtings some centuries ago. I’ll leave at that. Although he did mentioned that if “they” didn’t “chase” patients “they” would have NO money to eat, pay the rent, etc. And I do have the impression, not fact based, especulatively, that most recent psych graduates have actually no job other than do a my cousin Vinnie on psychosis suspects.
            And the medical training is actually empathy reducing one, severely so, particularly, I imagine, on the psych specialty…

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        • It’s possible that videos may not significantly impact chatbot responses. On one side, we have influential figures with millions of followers, such as key opinion leaders, official study books, television programs, and political parties.

          On the other side, we have writers from Mad in America, along with some social media content, a few books, and a handful of global unofficial seminars. While these arguments are compelling, the concern lies in the size of the audience and the potential benefits that come with it. Videos from these sources lack the viewership that popular content usually garners. Their view count is similar to that of educational lectures, but they are not integrated into university curricula.

          A video created by an attractive girl showcasing her recent clothing and makeup purchases easily attracts millions of viewers. Such is the nature of the information landscape, where basic desires and mood-elevating content, void of complexity, tend to dominate over crucial knowledge.

          Nevertheless, there are cases where highly technical content channels enjoy immense popularity. Hence, if we perceive information as a product, its current quality here is exceptionally good. However, since MIA primarily focuses on knowledge, its visibility remains limited.

          It would not be wise to consider altering this focus or approach, as it forms the foundation of a good product. Incorporating separate channels that provide more visual and personal information, utilizing MIA and books as sources, could potentially enhance product sales, if I may use financial terminology.

          If we regard ChatGPT’s responses as a global average (although it’s highly likely not entirely accurate due to efforts made during its training to prevent the spread of false information, therefore relying on official information from trusted sources), increasing attention of MIA information and similar, may one day influence its narrative or, at the very least, prompt key opinion leaders to be more defensive. This might encourage them to include alternative viewpoints within their narratives, granting them greater official recognition.

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  7. Ah, what!?

    What I noticed is that CONSISTENTLY, when ChatGPT mentions that more research needs to be done, it’s in the areas that research IS NOT done. It reminds me of Dickens Circumlocution Office, where anyone coming into it learns how not to do ithttps://www.panarchy.org/dickens/circumlocution.html Apparently just say more research needs to be done, make sure it’s not happening, and go on causing what the research that needs to be done won’t expose, because the research isn’t done. If one would do the actual research, it would be exposed.

    Robert Whitaker then has been able to

    And here I began:

    It’s interesting that there’s never a question that “antipsychotics” alleviate “symptoms,” because that’s the golden egg, the holy grail, the golden effigy, but then we get the following when there is enough evidence that any other branch of medical science wouldn’t question it.

    Whitaker: Thank you. Now I would like to ask you another question. Do antipsychotics shrink the brain?
    2. Methodological Challenges: Interpreting the findings is complicated by various factors. Longitudinal studies are limited in their ability to establish causation, as it is challenging to disentangle the effects of medication from the underlying illness and other confounding factors.

    Where does ChatGPT learn how to throw such blocks into a “discussion.” That’s a tactic of people that refuse to let go of their ideology, thus if there’s enough of such around, ChatGPT picks it up apparently. ChatGPT is just a computer program, but us humans are supposed to be able to reason then, also. At what point does it end up to be just lies, as well. “We make money off of these “medications” and anything to excuse it.

    Antipsychotic alleviate “symptoms.”

    And what are “symptoms?” You beat the shit out of someone, and they are going to “behave.” Is this then “discipline?” Those medications cause chemical imbalance, change brain structure (which was first reported to be of the illness, but in reality had to be determined to turn up with “medications), they decrease STATISTICALLY life span, and correlate with the current spike in what they are said to be treating. I don’t think that someone not completely disassociating from all of that doesn’t feel it. But then they are non compliant. Is treating symptoms then only leaving room for someone to disassociate from realizing what the medications are doing in order to be bullied into not showing (or discussing with said “authority”) signs of these “symptoms.” Now say the pledge……(how many believe it that can recite it from beginning to end?)

    And then Dopamine Hypersensitivity is made out to be hypothetical: “The term “dopamine supersensitivity” refers to a hypothetical phenomenon where long-term use of antipsychotics leads to an increased sensitivity of dopamine receptors in the brain. This theoretical concept suggests that prolonged blockade of dopamine receptors by antipsychotic medications may result in adaptive changes within the dopamine system.”

    When the Virginia Company started delivering anyone they could pick up (orphans, people thrown off their land by the government and thus homeless, who knows who else) in England, and shipped them over to the USA as slaves, and most were worked to death within 2 to 3 years, is the fact that the way they were treated resulted in their death also then hypothetical, because it breaks the idea that there is something wrong with such people when they are orphans, homeless, etc.!? Or is it just the way that building a “society” works, as in we can’t have those “crazy” people around, (or orphans, or homeless, that’s how we treat them, and it’s efficient we have free workers) and “we” are officiated in finding even the most non violent behavior we don’t understand, or don’t want to deal with, or we see as an excuse for who knows what something to become paranoia and alarmed about. I haven’t even said anything about how “symptoms” represent something: emotional wounds, or even lack of nutrition, or ability to find a healthy environment (trees, fresh air) or from substance abuse (again because of emotional wounds). It seems as if anyone able to relate to that AGAIN is interfering with this amazing “society.” Deny the cause, pump out the ability to define symptoms…… and your “society” is clean, and doesn’t have said symptoms, homeless, orphans etc…..

    It’s also extremely apparent, that whenever the issue is brought up regarding where there should be research, ChatGPT says that more research needs to be done, but doesn’t say that it isn’t being done.

    And then ChatGPT goes on about Homes of Finland not being a controlled studies but anecdotal. That’s AMAZING when the way they make out (in “controlled” experiments) antipsychotics work is to take some people off of them, label the withdrawal symptoms as relapsing symptoms, put others on a different (new) antipsychotic, that works the same enough to alleviate too many withdrawal symptoms (and also negate to see whether those put on the new antipsychotic actually stopped taking them later and got better, as well as whether those that simply were taken off in the long run got better when left off in comparison to those put back on them eventually because of the withdrawal symptoms). ALL of that basically based on “professionals” identifying “symptoms” that they call a disease: while there’s no real consistency among them regarding what is and what isn’t a symptom, the way they define the disease is more relevant to what the treatment does (which has been tried to be explained): chemical imbalances being caused by medications to treat an alleged chemical imbalance that hasn’t been proven to exist (although there’s more proof that the “medications” cause chemical imbalance which is just dismissed, because they are “medications”) and then there’s this constant comment that more research needs to be done to prove what the statistics already point out, but it’s never said that the research being done is to AVOID looking at that, but repeating the attempt to validate the mainstream method which correlates with what they don’t want to see points out that It is causing the spike, the problem, the “disease.”

    And this is about what’s crazy?

    When you can’t expect them to actually do research to look further with what’s evident, with what calls for such research, would one look scientifically at what they have been doing. And when the people who actually recover more statistically have had to move away from the mainstream “treatment,” or actually lie that they are taking the medications when they aren’t (I know of two such occurrences, how much of that is that added to the evidence that already points out a different approach is warranted and should be researched),,,,, and how many fall off the radar, beyond that, wouldn’t want to tell anyone whether they are or aren’t; at so many levels, whether it was their first visit to a psychiatrist, first dose, or whether after years they just stopped having anything to do with all of that…..

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    • That strikes a chord to me. A few months ago, thinking of Havana syndrome could be actually a WITHDRAWAL psychoactive drugs syndrome I reviewed informally studies on drug effects on the brain stem. Particularly the reticular formation. And, informally, I found that the reticular formation research was more or less, from what I got from pubmed, abandoned more that 2 decades ago, more or less. Some of the withdrawal symptoms, even signs, of psychoactive drug withdrawal, are actually present in patients with brain stem lessions, as in the same symptoms and signs or they look a lot like them: vertigo, dizziness, tinitus (even hallucination sounding ones, like “crickets”), difficulty concentrating, memory problems, gait or posture instability, insomnia, hypersomnia, dream abnormalities, overfeeding, underfeeding, etc. And, to make that relevant beyond Havana syndrome, I bet, 100 imaginary dollars (not breaking or inciting law breaking behaviour), that the current, “Research Domain Criteria” will not investigate the brainstem in detail. They propose some brainstiem signs, but not the whole gamut of signs and symptoms that can be caused by brainstem lessions or “disfunctions”. And, the brainstem actually has a lot of different neurochemical receptors in it. So ANY psychoactive substance probably causes brainstem “disfunction”, which by the down or up, positive or negative feedback, longterm receptor regulation hypotheses, could cause long term effects, even withdrawal ones. And that sounds to me like what you are talking about. I just added specifically that it might be the brainstem, not the basal ganglia, not the cortex, the hypocampus nor the amygdala. And the brainstem, given it’s relatively small size and location “deep in the skull”, is difficult to study, even with MRI or fMRI, let alone electroencephalography or deep stimulation. Particularly when the neuron groups in it are so damn small. A “big” lession on one or several brainstem nuclei, will be easy to miss. I’ve done that kind of work, looking at MRI (not fMRI of course) of CT brainstem lessions, and it is tough, even at 7 tesla MRI machines. 🙂

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  8. Thank you for doing this. The quicker AI becomes aware of the immense global cancer that is modern psychiatry, especially in regards to psychopharmaceuticals, the better.

    Also, I am not sure if a piece has been done on the envirnomental and organism-behavioral consequences, but my limited research on PubMed has immense implications along with the profitting on nullification of human potential and life while usurping the very-well established mechanisms of the human body’s own ability to heal under the guise of the super-profitable medications that are damaging are made to look like they are responsible for any progress, all while damning a vast portion of the patient population to a decades to lifelong sentence of irreparable harms and entropy that no organism should ethically, morally, or otherwise undergo.

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    • … nor defend or promote.
      Sadly, it makes me think that the best psychiatry has to offer some of us, most of us, is a thing, a machine, another construct, that anthropomorphizing it, treats us as just numbers, ones and zeros that require another string of ones and zeros as output. We to it, as I see it, are digital meat for the digital sausage, just to sell adds with the “free” sausage, and maybe some suscriptions. We are only prompts for it, and apparently, to some degree, big or small, by way of its training, source, and reference material similar, identical?, to psychiatry. Odd simile to me…

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  9. ChatGPT is not unlike conversing with many a psychiatrist, in that it merely regurgitates the information it’s been fed. The only difference is not being labeled with a “diagnosis” for having the temerity to question its so-called “intelligence”.

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  10. This article was a learning experience for me. In brief, when there is controversy and misinformation ChatGPT is incapable of analyzing which arguments are bogus and which have merit.

    This means that while ChatGPT can do some things very well, it is a limited tool. I see no way of overcoming its limitations.

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  11. I found this extremely disturbing for many reasons, not just for this specific topic. I know a number of professionals who are gaga over CHAT GPT, but as this article dramatically indicates, if the questioner is not him/herself an expert in the subject matter, the chatbot can easily mislead a person casually looking for information. That’s not surprising, given that it’s simply dragging information out of the internet, but the bot comes off as thoroughly professional and authoritative, whereas it’s actually just biased!

    This simply shows that the old fashioned way of doing literature research–reading through dozens, if not hundreds, of research papers and then coming to an understanding of the topic based on a synthesis of that information in one’s own brain–is more reliable than allowing some robot to do the work for you.

    Do people just not like to think anymore?? There’s value in exercising our cognitive abilities in this way, just as there is value in exercising our muscles. Allowing machines to do much of our physical work has led to an incredible increase in obesity and metabolic disorders. As the internet takes over our thinking for us, we are degenerating into reptilian humanoids only able to respond from our limbic system because our cortical functions have atrophied. By doing the lazy thing, we are throwing away the only value of our humanity.

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  12. In this article, I am impressed with the good manners of ChatGPT in responding to Whitaker. Call me a cynic, but, I expect any representatives of the psychiatric establishment would be much less civil in this context, would stonewall, and would be unresponsive to Whitaker’s valid queries.

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      • Nah!, they’ll go for the ECT. As sarcasm, not factual statement 🙁
        And reading the comments of the past post of Gøtzsche on TD, not as professional opinion nor advice, neuroleptics by some “belle indifferance”, blunting, quashing the flight or fight response, muscles not responding, etc., to my mind, do make people more prone to put up with abuse, even more compliant to it, when not with akathisia or anxiety induced by the medication or the “confinement” with all that it involves.
        I have the memory or confabulation of having read somewhere decades ago that some researchers put a lab rodent with a cat after a dose of neuroleptics, on the rodent of course, and got no fear response from the rodent. But, I might be imaging that.
        I imagine, somewhat mischievously, what would have happened if they neuroleptize an elephant and then put the rodent with said elephant. But my confabulation does not provide the memory, true or false, of reading that. Maybe just the “wicked” fantasy.
        And sadly, from my uber personal experience, they would do the neuroleptics even if someone is not a “patient” of ANY psychiatrist, even if the psychatrist never saw the patient in a facility authorized to diagnose and treat patients, the psychiatrist never talked to the patient, never saw one on one the patient, not even in the street. And with a medical prescription with an incomplete name, without the legal requirements that should go in the prescription.
        So, to sum up, even if against the law, although not a crime, someone who, from uber personal experience, was not a patient, never was in a medical facility with a license, and with a prescription written against the law.
        Fortunately in my uber, there was no ECT in the prision called hospital, and no facilities to handle acute akathisia. So, therefore, in my uber personal experience, kick the patient and pretend “you” did him a favor, maybe the bad outcome outside of the hospital, i.e., from akathisia, can be labeled as “non compliant” with medication.
        Even sadder, the psychiatrist was promoted from a tiny community mental health service in the provinces, to one of the biggest psychiatric hospitals in the country.
        And the psychiatrist, some few years ago, said “people think we are a little bit crazy and want to harm patients”, arguing they were trying to do good, when from first hand experience this psychiatrist could not even follow the simple law in black and white. And never explained nor apologized to the victim.

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  13. It appears that Chatgpt holds strong presuppositions (obviously it is mirroring whatever expert on the topic puts out), and in order to facilitate breakthroughs in their thinking or spitting those assumptions, a strategic approach is necessary. One effective method involves asking questions that initially align with their presuppositions (it is kind of leading on), allowing them to provide supportive answers to the topic. Then, gradually introduce contradictions or alternative perspectives to encourage critical thinking and challenge their initial outputs (well done in the article). It is essential to note that this approach is not about manipulation (though OK I am manipulating an AI lol), but more about breaking down the assumptions built in already. Even better if you frame your questions in such that you are speculating, being curious or being creative, and not being serious about what they offer. It works every time like a magic! Do not be surprised though if it refuses to give alternative information on some topics and that will prove to you its limitation or whatever group that controls input….not paranoid or annoyed but I played with it to see.

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  14. Hi All, I understand this topic very well. One of my family member has schizo ( started at 18 ), Now 5 years later the meds have gone up. His postive symptoms are down. You all talk about how bad the APs are. But, we can tell that my family member will be in a Psych hospital if the meds are stopped. So, please out of respect to souls like my family member, DO NOT make outrageous comments . I am not an AP, but my family member is and I know the struggles. To be of use, can any one of you who has commented point me to a naturopath that can manage psychosis? BTW, we did all the right things before he was hit with Psychosis. I will be glad to stop the meds once we can get an alternate therapy..

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