Reflections on the RADAR Study

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After decades of prescribing antipsychotic drugs, I seem to know less about them at the end of my career than I did (or thought I did) at the beginning. Nevertheless, I arrived at an approach to practice that was based on both my understanding of the literature and experience working with and listening to people who took these drugs. Early in my career, leading academic psychiatrists were promoting the idea that many people were on higher doses than was required to control symptoms and reduce the risk of relapse.

Through the 1990s, I was dismayed that the influence of pharmaceutical marketing had seemed to suppress that idea, as polypharmacy and use of higher doses of drugs became part of accepted practice. In the past decade, after critically re-evaluating the existing literature, I was persuaded that there was enough evidence that antipsychotic drugs might hinder social and functional recovery that one needed to be, at the very least, concerned about that possible risk.

Prescription pills and red bottle on Rx form

I can summarize my approach as follows:

  1. It is important to try to establish the minimally effective dose (MED). Regardless of whether one accepts the hypothesis that these drugs worsen long-term social functioning, there are other complications that are not controversial and are often dose dependent (tardive dyskinesia, sedation). Arguments regarding the utility of these drugs too often focus on whether they are good or bad in a binary sense. I have tended to focus on dose—my goal is to try to reduce to a point where the long- and short-term negative effects of the drugs are minimized while retaining their suppressing effects on not only unpleasant or disruptive psychotic experiences but also on relapse risk.
  2. The rationale for long-term use of the drugs is to reduce the risk of relapse. People are often started on them during inpatient hospitalizations and there are many reasons to believe that the dose a person is on at discharge is not the MED. Hospital stays are brief and doses are increased rapidly. Often, in the midst of an acute psychotic episode, the drugs are targeting lack of sleep and agitation, in addition to psychosis.
  3. Most treatment guidelines prioritize the goal of reducing relapse rate. This discourages dose reduction—the APA guidelines do not mention drug discontinuation—because, in the effort to establish a MED, one is inevitably increasing the risk of relapse; it is difficult to establish an MED without observing some emergence or worsening of psychotic experiences.
  4. The challenge of integrating study data—which are, after all, presenting averaged data from a group of people—into daily practice is that there are so many variables. For instance, the risk posed by a relapse varies from person to person, family to family, community to community.
  5. It is easier to make a decision to taper when a person has significant side effects from the drug, is on a relatively high dose, or is intent on decreasing. It is harder to make a suggestion to reduce dose with someone who is not complaining about the drug, even if one has reason to believe they could do well on a lower dose.
  6. I try to establish the history of the current drug regimen. Some have advocated for a “start low, go slow” approach to using these drugs by which a person would be started at a low dose which would be slowly increased until they appear to obtain the benefit sought. This would mitigate the need to reduce the dose later on. Unfortunately, this rarely happens. So I try to learn why changes were made, how quickly they were made, and the nature of the setting in which the change was made. This helps to determine whether the person is currently on the MED.
RADAR Study

RADAR replicates earlier studies in which, over a two-year period, individuals who reduce their doses are at higher risk of relapse than those who do not reduce. Moncrieff has discussed the findings in a blog post. What distinguishes RADAR from other studies is that drug tapers were done at a much slower rate than in earlier studies; the researchers hypothesized this would reduce the risk of relapse. They found that, despite the slower taper, there was still a higher risk of relapse in the taper group than in the maintenance group. However, the study also replicated the finding that most people who reduce their doses do not relapse.

The qualitative study suggests that many people value the opportunity to reduce their doses and this was true even among those who experienced relapse. The secondary hypothesis was that there would be improved social functioning in the taper group and this was not confirmed. I was also surprised that those who reduced their doses did not report experiencing fewer side effects.

How does this new study inform my practice?

I continue to think there are important reasons to offer dose reductions. Although they did not find that the slow taper reduced the risk of relapse, they replicated an important finding of all of the dose reduction studies, namely, most people do not relapse. Because so many people are started on a drug and the dose is escalated quickly, we lose the opportunity to learn if a lower dose would have been as effective. Our only way of determining this is to reduce the dose at some later point.

We still do not have adequate data to guide us on how to best reduce relapse risk; however, I think there are reasons to taper slowly, probably even more slowly than was done in the RADAR study. While RADAR was constrained by a two-year time line, in clinical practice, one can taper over years. If the dose is reduced and maintained without relapse for some period of time (3 months? 6 months? 1 year?), then one can assume a new MED was established. If a relapse occurs, we can resume the most recent dose that seemed effective.

I have observed that when a person is admitted to a hospital after a taper, the drug is resumed at the initial dose or higher. It helps to be able to inform inpatient teams that the person had been stable for a considerable period of time on a lower dose (say, if the relapse occurs at 30% of the initial dose and the person had been stable for an extended period of time on 50% of initial dose, they might avoid being put back on the initial dose).

In a collaborative process that includes the individual taking the drug and others who are concerned (family, friends), one shares the knowns and unknowns. Yes, relapse risk is increased but most do not relapse; the longer the interval between changes, the stronger our evidence that we have established a new MED. Even if one decides to wait 1-2 years between dose reductions, we can over time make substantial changes. Many people are started on these drugs when they are quite young; if it takes a decade to establish a new MED, we are then allowing this person to be on this lower dose possibly for several more decades.

People change over time. Working in one clinic for close to thirty years, I have had the opportunity to know people who seemed to require the medications for extended periods of time, but then are able to reduce the dose safely at some later point. This observation is difficult to verify in a controlled study.

An accompanying commentary by Leucht and colleagues was revealing in that it illuminates what has become accepted knowledge among leading and highly respected academic researchers. The article begins with an acknowledgement that the average dose required for both acute and long-term treatment is 5 mg risperidone equivalents (for a chart of antipsychotic dose equivalents see here.) This is equivalent to 10 mg of olanzapine and 80 mg of ziprasidone, to name a couple of other commonly prescribed antipsychotic compounds. I am arguing for a goal to try to establish a MED.

While Leucht notes that there is variability of dosing requirements, I sometimes draw an analogy to the old radio show, “A Prairie Home Companion.” It was set in the fictional town of Lake Wobegon where among other things, “all the children are above average.” There is reason to believe that many clinicians think their patients are all above average in their requirements of antipsychotic drug doses.

A notable aspect of RADAR is that the doses in both groups were, at the outset of the study, relatively modest. This might be due to the work Moncrieff and others have already done in influencing practice in the UK. But there is evidence to suggest that in common practice, at least in the US, many people are maintained on higher doses than what Leucht is recommending (For example, in a study of people experiencing a first episode of psychosis, many were already on higher doses than what is recommended at entry to the study.)

Leucht’s recommendations are based primarily on the risks that a relapse can entail for some people (“whether their job is at risk … if there were danger to others or suicidality”). I am fully aware of these risks. However, in my experience, other factors are invoked to recommend long-term use of antipsychotic drugs, in particular, that a relapse would harm the brain in such a way as to interfere with long-term recovery. It is important to note that while social functioning was not improved in the taper group, it was also not worse and this is despite the increased rate of relapse and hospitalization.

Leucht also advocates for slow tapers: “[A]ny dose reductions should be done very slowly, thinking in months rather than weeks, to allow the brain to readapt after stopping dopamine receptor blockade.” This conclusion reflects the work that Moncrieff and Whitaker have done. I do not think the notion of needing “the brain to readapt” was particularly prominent a decade ago (and I am still not sure it is widely acknowledged, let alone accepted).

We need to understand more about drug tapering. I look forward to following the ongoing work of Moncrieff’s team. At the same time, I anticipate that is difficult to collect the kind of data needed to provide definitive answers. We may complain that most drug studies only follow people for six weeks but there are understandable reasons for that; besides being more expensive, it is just hard. People change their minds or move away. There are long-term studies in psychiatry but they are all critiqued for their limitations; most of those limitations are related to the practical difficulty of having people engage in research over long stretches of time.

As Moncrieff has written, this was a difficult study both to fund and implement. I am so deeply grateful for the work this team has done and continues to do.

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50 COMMENTS

  1. I’m sorry, but immediately I can’t agree with the whole concept “psychosis.” Here: ” I have tended to focus on dose—my goal is to try to reduce to a point where the long- and short-term negative effects of the drugs are minimized while retaining their suppressing effects on not only unpleasant or disruptive psychotic experiences but also on relapse risk.”

    It’s all to easy and supported in this society to call psychotic experiences unpleasant or disruptive. You only have to look at corporate media, what it makes out to be normal, what we are allowed to say, or think, or feel without being assaulted by a barrage from the mob do we not fit with their programming. More than half my life I have been regularly harassed because it’s convenient for people to call something “psychotic,” and start acting as if EXACTLY those to “qualities” are going on, that’s it’s unpleasant, or disruptive, and the next step is to make out this shows a person could become violent, and excuse the backing up of violent method to force a person on such “medications.” Before that I was just different, had difficulties, but that AGAIN was labeled as unpleasant, disruptive, not what to even acknowledge.

    With perspective, I think it shows that simply getting to know what psychosis is expressing, what the symbolism, what hidden insecurity or anxiety is underneath it that might get a person to gravitate towards the escape and make them so anxious they can’t think things through anymore, but remain in a reality that’s more objective than the physical, as it relates to responses, reflexes, and the subconscious machinery that evokes these, and those the future, which is not something you can put under a microscope… that THAT is the honest way to go that works.

    The repeated and constant going on regarding this is annoying, this is unpleasant, this is disruptive, this doesn’t fit with statistical based norms or consensual reality deportment; as an excuse to not be challenged to gain the ability to understand what’s going on, regardless of how unpleasant it is to people wanting to fit in, or simply unpleasant because it requires a challenge to with our inner machinery…..

    I can’t say this is the solution, when the beginning wasn’t seeing it as a normal response to what needs to be looked at not used as an excuse to destabilize the brain interfering with natural functions, while confusing the populace of the planet saying this is treating a chemical imbalance while it is causing one. And an epidemic….

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      • You sound very committed to the idea that “there is only one reality” that is unaffected by any of our personal narratives. Can you submit some scientific studies that prove your contention to be true? Or is it simply a matter of faith, based on… your personal narrative?

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      • I already explained this quite clearly, and it becomes overloading when one has to repeat things confronted with indoctrinated responses rather than understanding of what already was explained clearly enough for others, regardless of titles present:

        So, here goes:

        When someone has had trauma, has had to experience something they weren’t allowed to actually call for what it: the emotions involved, when push comes to shove, may start expressing the trauma in an arena that remains free of physical reality, for the very reason that they weren’t allowed to communicate what was going on when traumatized, in the physical. That mental state, using the ability the mind has to create an inner reality, expresses what was going on in a way that might be safe for the person to begin to relate to, and uncover the trauma. Very much the same as what’s called fiction, which also can do the same thing. Or plays, or the rest of the arts. It allows for a processing of emotions in order to allow a person to gain insight into what’s going on, why they respond the way they do, to gain perspective. That involves how a person responds to life, that opens up a potential future with understand of their trauma so they can let go of it, and move on. This is how healing can take place; and so it can be seen, very simply, as being more objective than physical reality being that it determines the future, and that simply isn’t something you can do with the physical, it’s your mind that makes the difference. The understanding of one’s responses, and yes one’s personal narrative.

        Dr. Baudrillard said: “There is only one reality, and your personal narrative does not change or affect that.” If someone is say scared of dogs, because of trauma from their youth, and they learn to understand that fear, rather than taking say some “medication,” and start to understand what otherwise would seem irrational or psychotic to them, they not only let go of trauma that was affecting them without them knowing it, they, in shedding their fear of dogs, also have the benefit of having a canine friend, and that does change their future. That wouldn’t have happened had they not understood what someone else would just call paranoia, psychosis, what have you.

        And no, I don’t believe that anyone not believing in one reality, and only that, and that their narrative doesn’t effect it, that they then are psychotic. In fact, to avoid the adjective psychotic, that dismisses all of our actions, beliefs, responses, desires, dreams etc. having anything to do with making a difference, and all would be delusional junk……as non reality based thinking goes, even when used for indoctrination…..

        I’m assuming that that statement was made seriously in belief, not as a joke or in an attempt to wind someone up or get under their skin. And I had already explained what I meant by something more objective than the physical.

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      • You seem to be commiting a falacy of equivocation, you asume you both use the same concept/definition of reality the comment at reference.

        ” objective reality
        the external world of physical objects, events, and forces that can be observed, measured, and tested. See reality.”

        from :

        https://dictionary.apa.org/objective-reality

        Implying there is another reality not external, maybe internal.

        And at the same time you seem to being able to observe into someone’s elses internal reality, which is not only self-contradictory, it’s ludicrous, since your peering into would be in itself subjective. Lacking severely objectivity even if same thinking folks would agree with you. That’s intersubjectivity.

        ” intersubjectivity
        n. the sharing of subjective experience between two or more people. Intersubjectivity is seen as essential to language and the production of social meaning. The term is often applied to the relationship between a therapist and a client. —intersubjective adj. ”

        from :

        https://dictionary.apa.org/intersubjectivity

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  2. “3. Most treatment guidelines prioritize the goal of reducing relapse rate. This discourages dose reduction—the APA guidelines do not mention drug discontinuation—because, in the effort to establish a MED, one is inevitably increasing the risk of relapse; it is difficult to establish an MED without observing some emergence or worsening of psychotic experiences.” this is actually not necessarily true, that is, it is FALSE. Since reducing the dose of neuroleptics can in and of itself produce symptoms and signs that are not relapse, but are diagnosed as relapse. It is a false claim, a false statement.

    Since psychosis symptoms, agitation and insomnia after tappering are not necessarily due to relapse. They could be withdrawal effects.

    Since necessarily true is true, is always true. Not true is false, and not necessarily true therefore is false.

    Falsity perhaps explained by the use of emergence OR worsening, emergence is relapse?. Is worsening relapse?. So when neuroleptics cause psychosis it is in fact drug induced relapse?. Sounds like a synecdoche as used in at least claim 3.

    “4. The challenge of integrating study data—which are, after all, presenting averaged data from a group of people—into daily practice is that there are so many variables. For instance, the risk posed by a relapse varies from person to person, family to family, community to community.” And apparently from ignorance: from practitioner to practitioner.

    It is my impression from casual reading of neuroleptic studies, and outside that field, that studies do not provide information, sometimes at all, to tailor treatment.

    I am wrong at least on that one in the case of neuroleptics?. If I am, can you explain?. Since the fourth statement is vague to me. But I could interpret that at least the person variables, family variables and community variables can’t be used to tailor treatment. The too many variables statement sounds a red-herring.

    That leaves, as argued partially at MIA, that the only variables tailoring treatment is the practitioner ones. And that is authoritarian, and based on ignorance: on the lack of knowledge of how to use the other variables.

    And on second look, since those 4, four, variables are dependent on each other, even the practitioner variables use sounds severily self-centered, can’t use the other variables to exert it’s unique, alone, autority and judgement.

    So it would be a null judgement, a blind judgement, an ignorant judgement and an authoritarian judgement.

    “They found that, despite the slower taper, there was still a higher risk of relapse in the taper group than in the maintenance group.” not necessarily true, i.e. FALSE if, at least, emergence is not relapse. Same for worsening. Sounds like emergence and worsening are equivocations of relapse.

    Could you explain how emergence, worsening and relapse are related as words?.

    Two unaddressed questions also in this post:

    1.- What about the FATALITY/DEMISE risk when attempting to tapper?.

    2.- What was the cumulative dose for both groups of the RADAR study?.

    I got the impression fatality risk was DOUBLE when attempting to tapper, since there was TWICE as many deaths.

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    • There is an implicit bias in the use of the concepts psychosis, relapse and recovery. That reflects a lack of understanding in the psychiatric world:

      You have to be recovered to relapse, and if the motto, the dogma is that psychosis can’t be recovered, what psychiatrical practice is doing can be formulated thus:

      ===”If you want to decrease the number of people relapsing just make no one recover.”-==

      Which in mathematical terms it’s called a trivial solution. So the solution of psychiatry for psychosis is not about recovery, and when they use the word if at all, in practice they might work so NO ONE RECOVERS, thereby reducing relapse.

      Inspired from the omega parameter in:

      https://pubmed.ncbi.nlm.nih.gov/35237877/

      Which almost to the end of the papae says they will try to avoid doing that: decreasing recovery to decrease relapses… i.e. avoid a trivial solution that is contrary to the utility of the mathematical model.

      But, it’s real science: mathematics. Not pseudoscientific, ill-willed human professions.

      That’s why I love logic and mathematics, it cuts through the crap.

      And not trying to sound callous, but the four, 4. extra humans that died, out of 126/7 trying to withdraw, i.e. to “recover”, won’t count as relapses in the next phase of the study, if there is one.

      But in this case, it diminishes relapses by getting rid of potential relapsers, recovered humans.

      QED…

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  3. This one sentence in Moncrieff’s blogpost referred to just about spills the beans as to why there was 25% relapsing in those tapering off, and only 15% in those not: “The RADAR trial did not provide any specific additional support to people who were randomised to reduce their antipsychotic medication except for more frequent monitoring by their psychiatrists (because we did not have the resources to do this). ”

    It still remains that those never put on antipsychotics have more recovery, or in the long run past those two years as well when tapering off. As Moncrieff states:” It was only at the 7-year follow-up that social functioning was better in people who had originally been randomised to reduction, and that relapses had evened out (Wunderink et al, 2013).”

    I know of quite a few people who on their own simply tapered off of psychiatric drugs, nothing to do with the psychiatrists even knowing. Or at least one person not even taking the medications she was being forced on, although it was thought she had, and then being told how much better she was doing, when all she really did was for an interim stop doing the stuff that THEY were paranoid about. Since I can’t divulge what the situation was when whoever wasn’t compliant, I give a simile to it: As in a woman isn’t supposed to wear pants, or she is sick and has to take said meds, and when she decides not to wear pants for awhile, and gets them to think she’s taking the meds, she told how much better they are making her.

    I really don’t see how a psychiatrist is going to in such a situation create the space to understand the need for what’s been chemically suppressed to emerge, or to deal with withdrawal symptoms., one who has gone to school for years being indoctrinated that psychiatric medications are an integral part of healing, with the whole volume of information regarding how simply dealing with symptoms as an expression of an emotional reality or a normal response to an environment that isn’t encouraged to be acknowledged, and that suppressing such symptoms suppresses the warning signal regarding what needs to be dealt with, whether emotional, environmental, habits taken on that dowse symptoms with self medication or addictions: the whole plethora of stuff that says you can’t deal with this, or when you express this there’s something wrong with you, or you will be punished, or you psychiatrist will decide you’re sick and you might believe it just as psychological relief that something is being done, or you can’t be non compliant, I don’t really see how that [the whole environment a psychiatrist is coming from] isn’t at all contributing to the 25% relapsing.

    And then in the end still there’s quite a bit of recovery MORE than the relapsing, still pointing out the majority get better without the medications, and thus points out to: try something different to begin with besides what correlates once again with recovery when removed from the situation.

    If I would start talking about what went on with me that was labeled as psychotic, that would be quite immense. And the major problem was simply things not being acknowledged, what caused emotional problems. Simply being disturbed. Beyond this simply the place your mind ends up being in, when to compensate even further things beyond the norm occur, beyond what wasn’t acknowledged out of assumption or discrimination. You start entering the environment where stuff happens that society truly thinks is impossible: miracles and community where it isn’t a war between two sides both saying they are hurt to excuse judging, dehumanizing or killing the other. The symptoms, the pain, the emotions express something else. Metaphysical things that if I went into it would sound like I’m investing in impossible stuff, when I wasn’t investing in anything yet, simply experiencing stuff I can’t be brainwashed into believing is impossible, isn’t going on, is fraudulent. But emotions in the end, when not suppressed do that. Even when they are symbolic and seem non reality based, they animate your reflexes, your responses, and yes we are that amazing that we can determine the future with our responses, and so what’s made out to be non reality based might be more objective than physical 3d reality, it might determine the future, might come, what you can’t see but it’s actions you can, like emotions. They are spiritual. There’s also no loss in simply allowing them, giving them legroom to express themselves, and I really mean allowing them rather than suppressing them, and then when what anything does when suppressed, when pressures is increased, and it explodes, say there’s something wrong with it, no I mean giving it room to express itself, which is what art is, or what it’s meant to be beyond “entertainment.” That creates perspective on life, allows one to understand all of life, NOT just the stuff where in the first impulse isn’t to find it disruptive or unpleasant.

    There are a whole community of artists, ones who have nurtured mental well being over the centuries. You can still see their works in museums, read their books, see their plays, hear their music, see their sculptures, read their poetry etc. Funny thing is these exact psychiatrists that were the one acknowledged resource helping people get off of “medications” that scientifically CAUSE chemical imbalance, although they are the source of the prescriptions, and the school trained to implement such a response: that is the one resource listed…… and they also come from this school of thought that has promoted quite extensively how the artists whose works remains, that expresses the beauty in life, what’s left over after everything we think we’re suffering through and won’t go away, still this art shows what’s left over, and was there the whole time, instead psychiatry has gone quite manic trying to pin disorders on just about all of them. Posthumously.

    Maybe, just maybe, there is an environment where there’s help for those otherwise listed as relapsing, but this probably won’t be found with those trained to scientifically cause what correlates with a chemical imbalance in the most grounded scientific way; and then, when those trying to recover from a “medically” induced chemical imbalance start having difficulty with it, offer to maintain the chemical imbalance, rather than……

    There really might have been ways of dealing with this for what is in the beginning if, rather than suppressing the goal was to find out what’s really going on…..

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    • I’m sorry this sentence should have been without the double negative, but it gets to be such a dizzy matrix trying to say ANYTHING “That creates perspective on life, allows one to understand all of life, NOT just the stuff where in the first impulse isn’t to find it disruptive or unpleasant. ” I was of course referring to how the first impulse is to make it out to be the material used to diagnose a disorder, rather than to see it for what it is. When someone needs a respite from life, or a rest in order to heal, to be in a different environment, then that’s appropriate. That’s also what happened in the early asylums, I think of the Amish and the Mennonites. There people would recover, in contrast to present asylums, where the main course is making them addicted to medications they can’t get off of, making them believe that the disabling of the brain to prevent symptoms society doesn’t want to acknowledge is healing (is this any different than Freud with his ridiculous penis envy, because he didn’t want to acknowledge sexual abuse, except he didn’t give his patients a chemical imbalance to disable their mind from expressing the symptoms of sexual abuse, or trauma, just made up ridiculous nonsense as if this explained something). I had enough of this and sarcastically made up something called sparkly envy, that all the countries with brown skinned people, would they express the trauma from the Western invaders, that this would be called sparkle envy, to elucidate how ridiculous this Freudian nonsense was. But no, in the early asylums, were people got good food, and rest, people healed. This isn’t going on with present asylums. If someone has a limp, you diagnose rest, so the muscles can heal. You don’t give them “medications” to disable the muscles from saying: “heh don’t do that yet, we’re healing, that hurts” and then with the consequent damage when a person continues to get in the way of healing, start adding on more who knows what till the communications between their body and their brain is dysfunctional. Then why is this going on with the spiritual, emotional, environmental signals with what’s called mental illness? And what’s being covered up. And WHY are those who have an approach that’s not raking in profits for the drug companies, why are they not even allowed as methods?

      It’s a bit odd when psychiatrists are the ones doling out the medications, and psychiatrists are the ones determining when someone has a diagnosis, or is relapsing or not, and psychiatrists are the only ones that Radar could have for where a person went to when they needed additional support with tapering off of these drugs. I’ve heard the same thing, when talking to the mother of a child, that actually wanted to help her daughter get off of the psychiatric drugs she was forced on, didn’t help her, and was having great difficulty dealing with and getting off of. The mother told me she had looked into help, but one has to be a rich Hollywood star or so, to afford such places. The insurance of course doesn’t offer any such help (also wouldn’t pay for a yoga class, art supplies, a musical instrument or lessons etc.). The daughter ended up committing suicide, after I specifically had told the mother, would she have her daughter committed again that I was scared they would lose her. Afterwards, she actually said that we all thought that…..

      There seems to be a lot behind this paragraph:

      The RADAR trial did not provide any specific additional support to people who were randomised to reduce their antipsychotic medication except for more frequent monitoring by their psychiatrists (because we did not have the resources to do this). Participants in either arm could be referred for psychological therapy or general social support as provided by their local service and we also gave people information about local support groups. However, more specific support may have been beneficial and if I were to do this sort of study again, I would certainly want to provide something of this sort.

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  4. Has the illness that is being medicated been defined to the degree that this experiment/study has any validity? Has “relapse” (which appears to be a critical aspect of the study) been defined? Is everyone involved in the study defining the illness that’s being medicated and the event, “relapse of said illness” the same way?

    There is so much wrong here in terms of “science” or even logic. It’s terrifying. How many are disabled, bedridden, broken by an industry that “thought they knew”, and no one cares? Not only does no one care, those people still get attacked if they speak out.

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      • Hey Sandy: it’s been awhile. We had a back and forth conversation a few years back. I managed to reduce my Zyprexa intake from 2.5 to around 1.0. It wasn’t easy. There were unpleasant side effects, but it did help me to lose weight.
        Unfortunately I find myself back to 5.0-long story. The last psychiatrist I saw swore on a stack of Bibles that the side effects were the disease coming back. I was successful getting my primary care physician to write the prescription. I had dropped your name as a possible prescriber. I tried to find you in Vermont, but you had already flown the coop.
        I reached out to Laura Delano in hopes of finding someone who could help me to titrate.

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      • So, ALL relapses ended in hospitalization that could lead to dying in hospital or a few weeks latter, to be ruled, apparently 50% of the time as “natural causes”?.

        How does trying to withdraw from neuroleptics lead to a 200% increase in fatalities of which 50% are “natural causes”?.

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      • So, ALL relapses ended in hospitalization that could lead to dying in hospital or a few weeks latter, to be ruled, apparently 50% of the time as “natural causes”?.

        How does trying to withdraw from neuroleptics lead to a 100% increase in fatalities of which 50% are “natural causes”?.

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        • Hummm, non-expert biased answer:

          Because treatment of relapse is deadly for some, eough of some, 100% more of some.

          And so natural!. 100% more natural!, if I’m not mistaken…

          Almost casual, like almost Causal.

          And relapse treatmen being similar or identical to first time psychosis, I can, tentatively on RADAR alone, non-expertly and biasedly, but not ill-willed, conclude that:

          First time psychosis treatment similar enough to relapse is deadly too. Perhaps way too deadly.

          Abolish psychaitry!.

          Long live Thomas Szasz!

          Thomas Szasz! Thomas Szasz! Thomas Szasz! Thomas Szasz! Thomas Szasz!…

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    • Kate had asked quite clearly whether the way the illness is diagnosed is valid. Then whether relapse has been defined, and then whether a different outlook is included. What is included [AGAIN for the umpeenth time, see the statement attributed to Einstein’s about what’s crazy: “Insanity is doing the same thing over and over and expecting different results.” as in it’s GOT TO be a chemical imbalance, although we haven’t really found that to be the case, but treat it as if it is, and suppress or deny that science tells use we are causing one] the diagnosis used to force people on drugs that cause chemical imbalance is valid while according to science (which she also points out is missing as well as logic) what’s included again is the system where they CAUSE chemical imbalance. That they are thrown back into the same system that caused the chemical imbalance when attempting to re-balance their brain hardly is a scientific statement as to how many are “relapsing,” it’s a statement that the help they need to recover and have a healthy brain was not there. Rebalancing would mean allowing what was brought out of balance INCLUDING the understanding of what was labeled as symptoms, and to allow what was labeled as symptoms to be there without discrimination, phobia, labels of this is disruptive, unpleasant, not understood, difficult, etc., labels al usedl to excuse what isn’t understood to be suppressed causing a chemical imbalance while saying one is treating one.

      Again, what was already stated, that the first sentence of this blog becomes quite terrifying and brings one to the point of abusrdity: “After decades of prescribing antipsychotic drugs, I seem to know less about them at the end of my career than I did (or thought I did) at the beginning. ”

      Who is it that has gone through these processes? Who isn’t listening or knowing how to deal with something a healthy brain expresses, and instead disables it, as if this is treating what it causes (a chemical imbalance)?

      I think at the beginning it was known to those who were open enough to it that antipsychotic drugs cause chemical imbalance [to many people not indoctrinated simple observation as to the effects, what they saw in the community, what kind of a state people forced on these “solutions” ended up in was enough for them to see this], at what point does this become a bargaining table for playing game theory that there’s a loss to actually be scientific? And what is this supposed loss, that one has to admit the drug companies aren’t the solution, that one has to look at one’s indoctrination, one’s comfortable process (aka statistical based norms consensual reality deportment)?

      To state: “In the study, the researchers compared the number of people in each group who were admitted to hospital.” says that people were thrown back in the same system that caused a scientifically verifiable disease, and were treated as if the cause of the chemical imbalance was how you fix it.This means they are accused of relapsing rather than it’s not really acknowledged what’s going on. To conclude that there’s not enough help for them to regain a balanced brain that would be science. Whether there are methods that correlate with recovery, they would have to be there present and available, and acknowledged, and funded, and offered. Instead they aren’t acknowledged or allowed, there’s discrimination against them, they are disqualified because they aren’t “medical” which means they don’t cause a chemical imbalance while saying that heal it. That people can’t get off highly addictive drugs isn’t a statement that the drugs are a healing agent, not even if they end up in the same place that coerced, seduced or forced them on such agents making them out to be what they don’t correlate with statistically or scientifically.

      To meet very pertinent questions, that Kate asked with……..

      It’s real easy to once again make statements reiterating the problem of people not going one step further to gain perspective by repeating what lacks it [perspective]. It amounts to: “When you don’t conform to the ideology present, even though non conforming points out stuff that needs attention but is suppressed, then you could get arrested, found socially incompatible, discriminated against, have the mob against you…….” And voila, you’re relapsing, you’re a heretic, you’re…..

      This stuff is overloading enough, when needing perspective we don’t need to have our head again pointed to what someone else didn’t understand, and still doesn’t, despite…..

      Kate already said it, it’s horrifying what’s going on, whole swaths of society chemically disabled, while society becomes more and more paranoid of any symptoms that the answers might be where they aren’t going to get points for being compliant to the mob….. People looking for help, their lives falling apart treated by people who thought they knew… and to say something about this no one cares, or you get the same devised responses that avoid perspective…..and empathy…….and courage…….. and then you get attacked for speaking out at all, punished when frustrating people with having to look twice

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      • I wanted to fill this in a bit: “they are disqualified because they aren’t “medical” which means they don’t cause a chemical imbalance while saying that heal it.” In reference to alternative methods, which I mentioned in an earlier post.

        The premise or ideology is that when the brain is disabled, when “medications” or rather drugs are used to disable the brain then a chemical imbalance has been addressed: That then is made out to be medical because it’s observed that the patient is no longer exhibiting “symptoms.” It’s then also pushed to the side that there are environments and methods that give room to the symptoms to be understood, dealt with as healthy functions of the brain, have the brain left intact, and the person “recovers.” But there’s supposed to be a loss that nothing “medical” has been done.

        And I’m sorry, but the whole immense riff between what’s going on and a true reality that’s more objective than the physical or linear time, because it resonates with the themes in life, the same as fiction would, or the rest of the arts. What’s always been part of any true civilization. And remains. You know, the artists that have left beauty for us to enjoy, to see what’s left over from other time, just as difficult, or more so than ours, and yet life is worthwhile? The ones exploited by psychiatry to make out that know now how to improve their lives, posthumously? I have to start mentioning things that sound crazy. And I don’t know where to start.

        I will say that when I was the most made out to be psychotic, a supposed danger, it was really me picking up themes from non linear time, I could go into what some would call past lifetime stuff recycling, but there is no past in non linear time. An issue with a spirit friend of mine, who had to put a medium into a trance that was relaying information that she said he was doubting, and thus had to open this portal, with the medium. I have to add that the medium started acting somewhat like Lord Voldemoort, because I was told he was blown away by the love between me and my spirit friend. I didn’t really like having to deal with the medium, afterwards, and spouted off about it years later, just in my mind, and she (my spirit friend) finally responded regarding this issue. I recognized it resonating with others who were around during the time referred to regarding this issue, and who were around then, when I asked about it as well, and because such a matrix of timeless poetry isn’t something one becomes familiar in these times, not even with the medium and those making out they’re familiar, I was overloaded, and for one day was just picking up harmonics of the situation. You can’t even try to communicate this stuff to some people. The next day already, when I was simply trying to hone in to what was going on, I was made to be psychotic, and having dealt with such discrimination for years, when such is thus labeled, I could only think I was off, and had no ability to see what the poetry was. But then to see the amount of delusional misinterpretations of my behavior, anything I did could have been misinterpreted, as “Determined” has stated in her post. In fact just about everything was, and then lies added, that’s if the person, a social worker who fortunately I had nothing to do with but was taking a parks and recreation yoga class from, that she wasn’t herself harshly not seeing what was going on at all (and was this anti-depressant or another psychiatric drug regime related. Because SHE was on such?). I had NEVER encountered such absolute brainwashed behavior. When she could diagnose anything as psychotic, she could misinterpret what she pleased, and then add stuff that hadn’t even happened. It seriously was extremely spooky. I did get away from that, she got a restraining order with her paranoia and lies, and other people’s paranoia and robotic behavior; I could challenge the restraining order, which I did just because there was so much wrong in her reports, and then the following happened. I have to first mention that another spirit friend, where there’s quite interesting stories regarding as well, and was involved with the harmonics, that he had actually spoken to me quite clearly there in one of the classes, telling me to not even talk to her, not even ask questions, valid question regarding the yoga poses (or even any interactions), but I knew there really was no concern, I wasn’t doing anything, and so I didn’t heed this “voice.” So then in the situation with a judge, she props herself up pretentiously in her chair, and says: “I know, he’s doesn’t hear voices, he sees things that aren’t there, it’s non-reality based.” WHAT is one supposed to do with this!? And what I saw that was supposedly non-reality based, that was regarding these themes in life, what life actually is about, in a novel you might call them themes. It was about investments. I didn’t know that about ten years later I would meet the person that it really was regarding, although this “yoga teacher social worker” was involved with it, if for nothing else because she WAS investing in the wrong stuff, and then beyond linear time is where it first popped into my head, from the issue my spiritual friend had brought up (from “1724” is that crazy enough, although I won’t go into what exactly right now)….. I was working on a metaphysical or miraculous healing, which did occur, and the x-rays showed that, and it was just to remind this other person, and me that one can invest in such, that life has meaning, and something gives it form. Someone who in the past had invested in the wrong, but would be reminded there are other investments, such as miracles. Miracles collapse time, when we have been able to take in what something is about, in life, the lesson, the gift doesn’t have to repeat itself.

        I could go into explicit detail more, but that would be pages…… that’s also just my story, everyone has their own, their own instincts beyond fear, where evolution blossoms. It also doesn’t have to be about anything labeled as a miracle, or conceptually breaking limitations that would startle people. Simple not dismissing what’s labeled as psychosis to see if it’s depicting an emotional wound that when allowed to come to the surface can be let go of, and a person is liberated, that could be enough.

        I had help along the way. Despite the mental health system in more ways than one. This man who got the Russian Cosmonaut medal for healings that happened when he was a conduit, he tells his story, his true story of being a child where such healing happened, and how he was put in an asylum by a priest, and given shock therapy for a year, because the priest thought he had been given special gifts by the devil, who would supposedly not like the shock therapy and loosen his grip on the boy. 2005 before the personal experience I related above, he helped me shed something that would have to be classified as a miracle, but it’s simply a natural part of the Universe, not some high falutin phenomenon. https://youtu.be/g9edB02jWP0?si=dQzeY6IIRWTCHqkS

        The first healer I went to (I really had to get away from these “mediums”), afterward I thought he had added 20 years to my life. But at that time I didn’t know that’s the amount taken OUT of a person’s life when they’re put on anti-psychotics. I think that simply knowing what was part of his environment existed, that simply knowing this was there on the earth, not in “Heaven” somewhere, who knows what you have to do to be “worthy,” but HERE on the earth, that that allowed me to know what was there, and somehow not be predated on by the mental health system and forced on medications. How his healing resonated in my life is quite a story, involving more impossible things, and the other spirit friend who voice I did hear…….

        If I started going into all of that, it’s books. It’s not “easy” getting used to, that’s how easy it is, you don’t have to fit in anywhere, and that form of “easy” just follow the “rules.” The world’s way just doesn’t work there. There are no such limitations. Everything I used to do becoming frantic because I never was really encouraged to become comfortable with such stuff, and thus didn’t really know what it was yet to calm down and relate to it. All the frantic reflexes….. that’s all calmed down, but even that stuff only really disinhibited me so something else could be there beyond my programming….beyond fear…..

        There IS something else there. This story that you have an illness, and if you don’t have your brain disabled for the rest of your life, touted with the not so innocent lie that this disabling isn’t disabling but treating a chemical imbalance, when in reality it’s causing one, thus the suppression of “symptoms”…..this might just be stuff that’s inconvenient for the psychological idea of safety when everything is “normal,”

        “Normal” is a setting on a washing machine. There’s also “delicate,” “permanent press,” “spin,” “fast cycle,” “heavy duty.”

        Miracles can close the circle, it’s part of what goes into giving life meaning, because it’s about something. And being about something, it is not some random occurrence of who knows what we have to protect ourselves from. Miracles are just part of the ingredients. And I’m sorry, but it’s become quite an odd word the way it’s marketed socially. It’s more normal than that. It’s maybe like when you start heading for the answer, then all the other stuff you might have ventured into, that drops out of the timeline, that time collapses, it’s not linear. But you do have to want to see the poetry, not just find is impossible, crazy or delusional.

        Everything that life points out that you can’t put into a bottle, make tangible and then sell as the answer, it just wouldn’t work that way, things here don’t really last, how could that be objective reality?

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    • As some other MIAer would have said: Like her ego jumped first and said “I thought”, just to kowtow to the MIA community and say: “or I thought I did”.

      That’s my impression from my fellow mexican medical trainees and practitioners: ill prepared, bad effort, big confidence, lack of remorse. And apparently it’s not just Mexico.

      And yet, she could have written with at least enough sense of humility.

      Given that by now, she should be fully aware all the damage over the decades, she caused prescribing neuroleptics according to the psychiatry’s creed.

      Just the numbers, hundreds?, thousands? medicated with neuroleptics per year over at least 30 years, and at a 5% false positive rate.

      At 500 new neuroleptized per year, newly hooked per year, over 30yrs, at 5% false positive rate is 750 people prescribed neuroleptics without psychosis/schizophrenia, with the outcomes of Ms. Montcrieffs study IF attempting to withdraw.

      The death rate in the withdrawal group is 8/126, or around 0.064, that multiplied by 750 is 48 dead humans, trying to withdraw when falsily diagnosed with schizo…

      Forty eight dead humans, dead, around 50yrs of age. With no psychosis, no schizophrenia, just a false diagnosis, in TWO, 2 years, not every year.

      Forty eight over 30yrs, that’s around 3 every two years. Each human life in dollars amout per year of life was around $50,000dlls, unadjusted, conservatively now. That’s $60,000,000, sixty million dollars doing the neoliberal equivalence of money per year of human life.

      Sixty million!, I am not being insensitive, just maybe for some practitioners 48 human lives sounds meeeh against all the lives they think they saved!.

      But 60 million dollars is more than even Mr. Lieberman could have made in his own life!, let alone PAY for them. If it were a HOUSE, he would have to earn at least around 200 million dollars in his WHOLE LIFE! just to buy the house in a SINGLE payment, without interest…

      On just a conservative fraction of false diagnoses. 5% is what a confidence interval would have given me, the real rate? what? 10-20-30 to 75%?.

      And yet, no sincere admission of humility: I was wrong. I am sorry. This is what happened. This is what I, I, did wrong, and this is what I, I, can do to TRY to amend it.

      And none of those “progressive”, radical, “post”, whatever psychiatrists have done that.

      Where is the honesty expected from a physician?. A carer? A healer?. A HUMAN?.

      Let alone, the integrity to do the math, and calculate how many people my wrongness killed in the course of my practice.

      I knew, instead I thought I knew. Sitll don’t know…

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  5. One foreign brand name for Thorazine is Hibernal, as in the pills cause cns hibernation states. The new drugs are arguably better tolerated by many than equivalent doses of the older drugs but are otherwise similar. And so…

    The insulation and hibernation effects of the neuroleptics are arguably their core effects. As a result of these effects those in authority can establish chemically based behavioral control over the drugged individuals. An additional benefit for those in power over the individuals is using the drugs and additional drugs as tools for punishment and reward. Good behavior can result in lower doses of the neuroleptics and perhaps something pleasant such as a benzodiazepine. Bad behavior could mean the less noxious pills are taken away or that the toxic major tranquilizers are increased.

    I’m thankful that some psychiatrists are looking into less toxic ways of helping some people under their control achieve some of their goals. My problem is that standard treatment in psychiatry at least from what I’ve seen is slavery just as Szasz describes.

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  6. Dont know if my comment is note worthy but not everyone needs such medications.Althow after facing a traumatic life expĂ©rience i am still slowly tapering. Seeking help and understandig.Dr’s do not have a clue and either suggest other medications to help withdrawl symptom or just simply leave you cold turkey, and on your own to suffer and often consider death as a really unwanted option, so very cruel…

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  7. The people who conduct these studies should keep in mind, anti-psychotics are not only prescribed to people diagnosed with schizophrenia. They are used across the board to “treat” anything from bipolar dx people to those on antidepressants (as an “adjunct”) to people diagnosed with borderline personality.

    I remember, the IOP psychiatrist who put me on Abilify while I was there for DBT gave a presentation about how Abilify “healed the thing in a person’s brain that makes them borderline”. I remember, I had undiagnosed akathisia from the first dose. I didn’t know what akathisia was at the time, so I was unable to advocate for myself (also was still suffering from ECT brain damage) and was kept on Abilify for years

    The last conversation I ever had with that psychiatrist, she said she was going to write me a refill for Abilify (I was being discharged from the IOP) and she asked, “What dose of Abilify do you find is most helpful?”. She listed three dose sizes.

    I said I didn’t know how to answer that question, because I had never found Abilify to be helpful.

    She said, “I’ve seen you off Abilify. I’m prescribing the highest dose.”

    I hated her for that.

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  8. I think this is a great article. Finally looking at some nuances of a difficult situation. I tapered off antipsychotics but relapsed multiple times. Although I don’t like the drugs they are the lesser of two evils for me as I don’t like psychosis and the disruptive effects it has on my life. I was prescribed the standard “dose you left hospital on” for life but recently went down to half that and feel okay (time will tell). The positive effects on my life in terms of less sedation alone are huge and could make the world of difference for me. I want to commend the author for actually considering this as most docs are more interested in getting you on the depot and disability pension so you are stable and not creating more problems for them. I hate the idea of the depot as it takes away the important property of autonomy and you as a human deciding what is best for you. It gives so much control to the system, but can completely flatten someone so they are obedient and stable but not really able to participate in life. The other thing is these trials for the level required prioritize societies focus on “zero psychosis at all costs” as opposed to the patients desire for optimum (not perfect) health.

    I’d love to be psychosis free without the pills but for me living at 70% with medication light is so much more meaningful than at 20% but with a higher dose of anti psychotics. So many doctors are too burnt out, blindly formally trained and disconnected from common sense to be able to have an intelligent nuanced conversation about life on lower doses or off meds if that is the person’s preference.

    Thank you for the good work.

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      • And as per Peter Gotszche and an “insider” they cause sudden death not reported in the clinical trials, just by “being sitting on a park bench”. You know, buttock pressure, lymphatic drainage, etc…

        Outside the hospital, away from liability for practitioners that care so much, and with so “professional” care…

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  9. Because there are legitimate science people reading this topic:

    I was subjected to about 15 years of antipsychotics. I haven’t taken any psychotropic drugs for about 7 years. In my case, my original “crime” was a hormonal migraine that went on everyday for 12 years. The headache went away when I passed through menopause (now – 17 years ago). I guess the docs thought I had imaginary pain? They never discussed it with me.

    How can you do science when there are such subjective concepts as psychosis or relapse or withdrawal?

    I want to offer a legitimate side effect of being subjected to the mental health system. No one in that system believes a word any patient says. They have a notion in their minds that anything you say is bogus – and that you must take their drugs.

    2 weeks ago, I was exiting the elevator on my floor, when a dog raced in and bit me (did not break the skin). In all fairness to the dog – I was the new guy, not the dog. I had only been in my apartment 3 weeks. I called the Landlord. After 5 days of non responsiveness – I filed a police report. I don’t know what all happened, but I moved and I had to pay 1 month termination fee. All’s well, that end’s well.

    I was terrified “they” wouldn’t believe me. All the dog owner had to do was deny their dog did that. I am terrified of the police (nothing good has ever come of that). The landlord? Apparently, it’s not their liability (it’s the dog owners). I carried in my hand, a can of pepper spray, to protect me from the dog, during the 2 weeks it took for me to move. (Screams – danger to others … as it should!) You try carrying a can of pepper spray in one hand and a lamp in the other! Not easy.

    All they have to do is tie police databases to psyche databases and no psyche patient (or former patient ) will ever have anything resembling full citizenship. Even in the case of dog bite.

    My point is the drugs deliberately “snow” you (how in the world is a person supposed to take care of themselves, when they cannot think at all), and 15 years of disbelief has life altering consequences. I am 68 and on my own. This is the “U.S.A.

    It worked out okay.
    No one knew of my internalized fear. My new apartment has a private entrance.
    I guess a person does what they have too to survive.

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    • This is a great comment. This has been my experience as well — never returning to full citizenship. Reading what you went through, and how you solved it, it strikes me that many of us who have been labeled and then forced to problem solve, alone, without the benefit of authorities backing us up in asserting our rights, have developed a particular set of skills that sets us apart from those who have many people and systems that they can rely on.

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      • Sorry I have to laugh a bit here: “that sets us apart from those who have many people and systems that they can rely on”

        Rely on for what, and get assimilated for it? Maybe we’re better of being sort of lacking in that department…..

        There might not even be loss……

        That’s one box I don’t really miss having to fit into……

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          • I don’t want to belittle what either you or Determined have been through. I know this myself, you become an object, something for people to project all their compromises in life on, anything you do can be misinterpreted as soon as you’re labeled as having a diagnosis.

            People can be extremely abusive, unprofessional, even exhibit criminal behavior, but as soon as your behavior can be pinned with some psychiatric diagnosis that’s all overlooked, not even questioned. Psychiatric detention is against human rights, the UN even has stated that.

            I have my own stories, and it’s shocking, mind boggling, it’s like a method of overloading a person akin to the mind control method called confusion technique. The amount of robotic, brainwashed, phobic, and delusional responses is astounding. Simply astounding. People that don’t know how discriminatory they are in their evaluations of others, don’t know how their “treatments” are causing what they say it’s healing (a chemical imbalance), people that offer “psychological” comfort to the masses akin to tell people that because they sacrificed a virgin God favors them and the crops will be good next year (if not, more virgin sacrifices)….and they are deciding who is non reality based in their thinking, or shows signs of depression!? (just tell certain, how many of them?, you don’t believe them, and see how they respond, whether this is showing signs of depression, mania, what have you, ODD, mood swings….), and when they with violent coercion physically imprison you, and force treatments on you that have been proven to cause damage, that don’t in the long run correlate with recovery, even what’s allowed to be doled out in the media, stories where the sources are so loaded with conflicts of Interest the APA has to announce that the normal rules for such don’t apply to them, and exactly WHO is prone to get violent!? The loss of life, of liberty, of ability to function, the way people are lied to and controlled by fear, the paranoia made against normal responses to life necessary to understand what’s going on in society, the propping up of Institutions putting money and population control over understanding or even nurturing human nature….

            It’s quite astounding, even Stephen Fry, who dares to expult the truth about the Catholic Church here: https://fb.watch/nJcbEijvmm/?mibextid=HSR2mg this same man promotes the mental health system. Apparently they got him by the you know what’s, could it be “relapsing” and what’s going on in reality, is that because of withdrawal symptoms? As we have here again another story of how things are covered up, not being able to get off of highly addictive “medications” when there’s not really support to help other than those that forced, coerced, lied to, conned or maybe even violently injected those trying to get off it, and when this isn’t happening 25 percent of the time (without proper support), then…….. even though for the rest (75%), they are fine without what they were told they would need for the rest of their life….. this mean keep prescribing it!?

            But what kind of a society is that that allows such? Why want to be part of it? What’s the loss in letting go of it, or even not be allowed to join such ranks?

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          • Just to clarify, when I used the word “systems”, I was thinking more about the legal system. Without getting into the whole saga, I’ve been in a few situations where my rights were violated (once, by a corrupt landlord, and another situation where neighbors made a false report resulting in 2 cops coming into my apartment and interrogating me about a fictional crime). In those situations, it’s always nice to have the privilege of being seen as an upstanding member of society (i.e. someone with no psychiatric record), or to have enough money and clout to have a personal lawyer to step in, or a relative who’s a judge or a cop or a lawyer who can turn the situation around with a quick phone call.

            Alas, that is not my life, and it bothers me, a lot sometimes. But I also feel that I’m stronger for it, that I’ve had to learn how to navigate these situations alone. It’s given me confidence in my ability to survive, if not thrive.

            As far as the mental health system…I have no need for it and hope to get through the remainder of my life without having any more contact with it.

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          • I found that people who supposedly are whatever they are called: dysfunctional, crazy, permanently disabled (that again makes me laugh cuz disabled from what, no I’m not going to believe all the programming no)… As I steer myself away from going on another diatribe about how amazingly full of fabricated devised untrue stuff people can be it’s just…. I found that the people called dysfunctional, crazy whatever is wrong with them that they are not being able to be part of the system well they have an ability to listen, they don’t immediately censor your story, they’ve been through it so they don’t judge other people’s behavior etc. They are real people they haven’t been manufactured by some societal factory given rewards for. . .. people can be incredibly resentful and paranoid if you’re not supporting all their compromises in Life or they think you’re crazy. Somebody studying social work or something to that accord shared that in one of the classes they were given the right to do something that’s going to like bother other people. They got permission to go to the mall and spend the whole day going up and down the elevator, and if somebody complained then the security guard would come along and take them to the next floor and then just leave and not do anything about it. Just leaving the elevator to annoy people by just going up and down the elevator doing nothing else. This was so they would learn how people respond when somebody just is doing something outside of statistical based norms or consensual reality department or whatever it is called: “beyond the status quo?” The only thing I remember being shared was that somebody would face the wall and just go “some people!?” I know I’ve been in the same situation without even trying to and the perplexity of people’s responses is just like what do they want to be humans or some fabrication of social based norms? I think we have instincts when liberated that you can’t instill people with, you have to allow them. That would be an interesting experiment to replicate though. A bunch of people from Mad in America just sitting somewhere in the Town square talking gibberish on purpose. Of course you’d have to have got permission from the police…. And explain it’s a social experiment. There was a show on TV with a supposed to demonstration of somebody who is schizophrenic. And the one thing is I remember is that the lady mentioned how many people were talking about her. This was supposed to be a sign of schizophrenia, but even if she exaggerated it a bit or modulated it into another scenario it’s simply going to be true that statistically she is the one people are going to be talking about and that happens in general just because she ever did something that nobody wanted to understand and there was no support to gain perspective on whatever it represented…. I was riding the bus once and the bus driver who other than that seem to be really nice lady she actually proceeded to entertain the whole bus by saying all there was a girl that she came to the downtown Transit center she took all her clothes off. The whole bus, I mean the whole complete bus started guffawing snickering and loudly laughing with outbursts as if this was oh yeah some kind of sensation to find this person crazy, were upon follows a whole list of other behaviors that basically probably would be non-violent in contrast to how she was treated. This is how people entertain themselves socially: so and so is crazy, aren’t we just so sane and knowledgeable and with it. Numerous other stories also at the same Transit center. It’s simple Dadaism: the people that started an art form after world war I showing that chaos has more Harmony than all the rules people were supposed to follow that started world war I…..

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      • For all of us (and KateL, who stated this exactly – further below in this thread) …
        My “privilege” was showing.

        For starters, I believed that a dog shouldn’t bite me between my parked car and my doorstep. I’m just guessing, but I am pretty sure lots of people could read this and just laugh (because it happens all the time – or worse, where they live).

        My biggest terror was that no one (the police) would believe me (even 7 years post the mental health world – being treated as I was, has consequences).

        Here is another “nugget” for those that study people formerly on antipsychotics. I stuck to my trajectory in solving the dog bite situation, because I have learned post antipsychotics to “Always, always, always Trust Myself”.

        This landlords insulting indifference was followed by spam. They are refunding me that extra month of rent (for reasons unknown to me – yay), but the phishing email was asking me to go online and pay my final due. That landlord’s computers had leaked my name, email, physical address, and the fact that I had moved.
        This landlord is having organizational troubles (but thanks for the refund).

        This is a perfect example of why to function in the world we have – we have to be able to “trust ourselves” (our instincts). The mental health industry doesn’t believe us, and they are not focused on self confidence – instead they have this nutty notion that we should be “compliant” with whatever they say.

        Compliance is another word for “obedience”. Someone please explain to me why anyone should be obedient to a stranger who doesn’t believe them and has only spoken to them for 5 minutes.

        I solved the dog bite “situation”. I trusted myself.
        Maturity wise – all other humans in this drama were half my age.
        And my “privilege” was showing.

        I am using this situation to illustrate some of the skills needed to get along in life that both the people of the mental health system and the drugs they prescribe have destroyed. It takes courage and self confidence to live in our times. Simply starting or stopping a pharmaceutical is just part of the equation.

        Agitation and insomnia are part of being human. It’s what happens to humans when we are stressed.

        Good luck to all.

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        • I think the way practitioners perceive patients is far worse, their perceptions I think are more correctly as they perceive us as non-people. Not even as animals, but as plants, vegetables.

          Some practitioners even diagnose and treat people without actually seeing them, so that’s non-people perception too.

          Even chatGPT knows better:

          “Since I have no information about your medical history and am unable to perform a physical exam, I recommend that you consult a doctor or healthcare professional for a proper diagnosis and treatment specific to your situation.”

          I have never heard of a psychiatrist doing a physical exam or elaborating a full clinical history.

          I even met one from the US who gave two patients unlabeled out of the box medications. And refused to provide clinical information he had for one patient to actually have a full, relevant clinical history, a physicial exam and lab tests from a qualified competent specialist that he was not.

          To provide a referal to acquire the information he judged as necessay and he could not obtain, because of lack of qualifications and expertise.

          Despite he himself suggested that before diagnosis and treatment it was necessary. He used deception to try to order himself lab tests lacking said information, which is antitethical to medical practice. And treated the patient like an incompetent adult: inventing stories about mind candy, for instance.

          Manipulative behaviour of the infantilizing kind. Which implies spite for the adulthood and what it implies in this individual.

          And I suspect it was because the patient had complications from psychiatric treatment AND he wanted to conceal covert diagnosis and treatment. Which would be somewhat obvious to a competent specialist even outside psychiatry if presented with facts in possession of said psychiatrist, or even just really seeing the patient.

          So, that’s what he might have been trying to avoid: The truth in a way that was helpfull for the patient, law enforcement AND detrimental to his colusion, involvement in harming, not treating a person.

          Well, guess what he did next?. He cajoled the patient to start a medication, despite his previous assessment and claims, and the patient got complications from a single pill of his prescribed medication.

          Guess what happened next?. He unacknowledged the complications from a single pill and insisted, cajoled and manipulated for the treatment to be resumed as he “mandated”.

          What happened next? When the patients asked, as it’s right for a clinical summary of his assessment and interventions, said US trained psychiatrist, still practicing in Mexico, he was a webpage, REFUSED to provide it, with the same techniques: manipulative and deceptive.

          Despite said summary provision was agreed BEFORE starting assessment, as far as the patient knew. Covert practice apparently might have render any explicit agreement moot.

          So summing up this psychiatrist’s practice against this single individual: the psychiatrist harmed the right to health of the patient by dishonest, concealed, manipulative and fraudulent means. In non-legal terms, in the popular dictionary meaning of those words.

          And the recalcitrancy of his behaviour does not point to an erroneous assessment, but to a goal directed conscious effort to harm the health of the patient. It was no mistake, it was a way of working based on decades of experience doing the same to other people.

          Like a predator, for a few pesos and the arrogance, vanity and cruelty that I got the impression he enjoyed from his awfull reproachable and even prosecutable behaviours…

          Similar to many infamous cases now in the media, same way of perceiving others as non-people. With a touch of sadism.

          And then there are several statements by psychiatrists and KOLs that literaly say something like: “You can’t listen to these people because they are mad”. or “Can’t you see they are mad and don’t know what they are talking about?”.

          Without going into the troppe of lack of insight, those are pejorative comments made by so called physicians. So, to me it suggests spite, even hate for some, lots of people under their “care”.

          And from comments of non psychiatrists, spitefull and hatefull coments even encouraged, appreciated and praised in water cooler talks among mental heatlh providers.

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  10. A few days ago MIA published an interview with Charlie Morley: “Embracing the Shadow – Charlie Morley on Lucid Dreaming as Therapy”.

    For a long time I have been wondering what do psychiatrists actually believe dreams are. So far I haven’t found a concrete answer anywhere; a lot of shoulder shrugging and ignorance. It is not interesting for them, because nobody would think of using drugs against dreams. And, what they can’t explain to themselves is ignored.

    I’m pretty sure that human beings are not only composed of a material body, but also of higher frequency energy fields, of which the dream is the best example we all know. In my opinion, the same applies to the “energetic product” of a “psychosis”. The doors to an altered state of consciousness that provides energetic inputs have opened, just as they do during sleep. The only difference is that the doors can no longer be closed so easily, and this altered state of consciousness keeps infiltrating the wake consciousness.

    I am going very far, but perhaps these states could be considered as “normal”, because we are material and energetic beings. How burdensome and unbearable these states of consciousness are, the human being alone can decide.
    The task of the helpers is clearing, clearing these states with the „patient“ and developing ways together to change these impressions or to live with them.

    I don’t know if psychiatry is the right place to stabilize or perhaps change altered states of consciousness. Psychiatry has hijacked the “psychic field” without any knowledge of energetic connections.

    So drugs become only interesting when everything else (life, trauma, the nature of the hallucinations, how the person deals with them, the intention to change, etc.) is clarified and the „patient“ wants them after a true information of possible side effects and consequences. This is a process, sometimes a long process, that requires patience.

    Perhaps then the question of whether much or little of the drug is administered becomes superfluous. A new understanding of human beings is needed, not a self-evident administration of drugs, sometimes more, sometimes less.

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  11. This is in reply to Nijinsky’s comment regarding Stephen Fry.

    Yes, it’s really distressing to me when people who I look up to, and who seem like critical thinkers with well-functioning b.s. meters, turn out to be uncritical supporters of psychiatry.

    A journalist named Michael Shellenberger has some interesting things to say about censorship and fascism (he was one of the journalists who exposed the “Twitter files”).
    Then he said this, repeatedly, with no sense of the irony of buying into psychiatric diagnoses while dissing “hateful elites”:

    “Michael Shellenberger
    @shellenberger
    ·
    Jun 27
    The elite bureaucracies are run by people who exhibit the behaviors of people diagnosed with “Cluster B” personality disorders, including entitlement, grandiosity, black/white thinking, obsessive attention-seeking, impaired sense of reality, and lack of empathy.”

    Now I have cancelled him.

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  12. Hi Sandy,
    I appreciate your work and your integrity and how you are trying to call to account so many who have blindly accepted the status quo with the studies you have released the last couple of years. This is another good example…but I contend ‘psychosis’ is an overused and hackneyed term that too many use to prejudge the experiences and perceptions of others rather than doing the hard work to understand what is really going on internally with another.

    I understand I’m a no one. And my little article that Mad in America graciously published yesterday is ripped out of a much larger chapter as well as the rest of the book that would provide better context for my claims. If you ever had time to read it, perhaps you’d find even one little thing worth discussing with me.
    Sincerely,
    Sam

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    • Hi Sam Ruck,
      I am sorry it has taken me awhile to respond (I will put this in your blog comments, hoping you see it one way or another).
      First of all, you are not a no one. Your experiences – as are the experiences of those who posted other comments here) are important and valid.
      My blog was meant to address the RADAR study and its implications regarding those who have been prescribed antipsychotic drugs as well as to describe my own approach to prescribing them.
      It was not intending, however, to address the full meaning of psychosis. I admittedly used some medical terms but I agree that what falls into the category of psychosis is broad and I also agree that there are other approaches that can be helpful. I also would like to see more people given the option of working through these kinds of extreme states without taking the drugs.
      I wish you, your wife – and everyone here – the best.

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      • So, what about the exponential increase in the fatality rate when continuing taking neuroleptics, antipsychotics in those over 50yrs of age?. Of sudden, non-coronary cardiac deaths…

        Which, by the way, it does seem the average age of the study subjects.

        Aware that one of the papers that calculated those exponentially increasing odds, admitting you are the expert, has a fatality rate by non-coronary sudden cardiac death ONE FIFTH, apparently, of the average ALL US, non-coronary sudden cardiac death rate: around 1 in 10,000, instead of the whole US around 1 in 2,000. I.e., not that representative of the US population in THAT regard…

        But you are the expert, so, what do I know, now or ever…

        Oh, Oh, that reminds me:

        Have you met a psy practitioner that does not know the similarities and differences, electrophysiopathologically, between a Torsades des Pointes, a ventricuar tachychardia and a ventricular fibrillation?. Because I did know the difference when in 2nd year med school. And I am from a poor third world country, then…

        Because I have met one who did not, he in the 90s was a biological psychiatrist trained in THE top psychiatric hospital in Mexico and he didn’t. But he rarely asked for an ecg, a Holter or a cardiologist consultation. Granted, he never saw patients under neuroleptics, but he did use trycliclics, this was pre fluoxetine times.

        Can you relate to that?. Do you know more psy practitioners that don’t do that? or don’t know why? that don’t know those disease causing mechanisms? Maybe some researchers that do really cool and praised papers?.

        And I don’t mean potassium channel blocking stuff, I mean the pathology of fatal arrhytmia induction of any kind that gives rise to the EXPRESSION of those ECG identified arrhytmias…

        Because I’ve met radiologists, not the most clinician felllows, that did know that in the Chavez Rivera. But no psychiatrist from the Fray Bernardino. And although I did not really got the hang of them, I have seen the best they can train…

        And I don’t mean to put off radiologists, some are more clinical than some clinicians, particular psy practitioners. Heck!, I’ve met radiological technicians more clinicians than some psy practitioners. Really, I have…

        And obviously a ventricular flutter is irrelevant for neuroleptics, but you are the expert.

        Oh Oh Oh:

        What can your expert opinion tell the MIA readership about non-clozapine neuroleptic induced myocarditis that could explain the fatality rate of the RADAR study?. You know, eosinophils going wild all over the place?.

        Leucocytes AND platelets do have dopamine receptors. Aware the published research said: No problen, we came empty handed.

        Or empty armed, like the empty armed economist Harry Truman wished about, you know, one sided?…

        So, I am not being aggressive, I just think omissions sometimes deserve an appropiate and competent respone. At least in the tendency to be that…

        And I am sorry if that is triggering for you, I know, I suffered the rounds, and at least one time, for a group of braggadocious inflated egos in training, as some may say, at the request of the Top Honcho, the Big Kahuna of my School, I was the hitman to put them in their place.

        And they were the top graders!. Heck topper than me!, One was the valedictorian for the whole class. That oddly, never came to my class. But yeah, she was the top, nonetheless.

        Unlike some patients of the psy disciplines, I did earn their appreciation, and I hope love. And forgiveness for my, my, ill-will. Aware most of them, didn’t even suspected my undercover assignment, I admit I am puffing…

        I hope, I, I, can at least count on your sympathy…

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  13. I’m going to try to go on a limb here, and try to EXPLAIN the omission in this post, and the other RADAR post:

    https://www.madinamerica.com/2023/09/what-the-radar-trial-tells-us-about-antipsychotic-reduction-and-discontinuation/

    About the increase in fatalities when trying to withdrawm, 100% more, 50% of them ruled by “natural causes”.

    Admitting, I’m no insider.

    I think given there was reluctance to do a withdrawal/tappering study by the clinical researchers taking part in RADAR, as I understand from Ms. Montcrieff’s piece and I think this post. And some “common” MIA knowledge, admittedly.

    Suggested or confirmed by her “high praise” among other statements, including some in this MIA piece. Brevity…

    When that reluctance met the increased fatality numbers there might have been recriminations.

    Perhaps acrimonious ones, even with legal implications…

    Particularly because other “good” outcomes, without “spin”, might not look that great. Not worth the fatalities…

    Guilt/culpability and legal liability of psychiatric research, done despite or overcoming objections.

    In my experience as a former practitioner, retired now, one rule of thumb of things NOT to do, is to push a practitioner to do something he or she disagrees with.

    Beyond morality, it sounded common knowledge, implicit empirical knowledge, that patients were more likely to suffer a bad about outcome precisely because the provider disagrees. Easy to make fatal mistakes when holding a grudge…

    The typical don’t push it if the doc says no, it might backfire in ways difficult to prove, but apparent when one sees it enough in the regular course of practice/training. I’m not saying it’s a law, it’s a rule of thumb.

    Legal considerations being absent as in “don’t ask don’t tell, you might get sued”. The apparent omission, the lack of emphasis and then some in the original MIA RADAR post and this one speak to ME, ignorant, of, abstractly:

    Guilt management.

    Shames galore.

    Except that MIA posts are supposed, I imagine, to be informative, not “apparently” deliberately omissive.

    Since that would curtail, impinge, prevent, i.e. will harm, the right of MIA readership to be informed.

    And informing, most definitively is a MIA mission, an obligation, and the omission has to be “cured”, overcomed, by the MIA readership that actually comments.

    Without MIA it’s high a burden as going unassisted in intrepreting original research articles.

    It’s a barrier to information having to curate posts that are omissive enough to pass as dishonest. Puting guilt, shame and legal liability aside.

    So, it puts, to my deluded non lawyer mind, undue burden on the readership, AND it will not have enough corrective effect to align the narrative with the FACTS. Who reads comments anyway?. Particular thrice as long as this one…

    And I think MIA can relate to my implicit expression of impotence, since MIA is also an underdog AND it does not get coverage in the main press.

    A microcosm of the macrocosm that MIA is, and fights against.

    The answer is probably there in the hospitalization fatalities and the mortailty by neuroleptics in high or higher doses pusblished clinical research . But again, it’s too high a burden on the readership…

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  14. Complementing the extensive comments:

    Using neuroleptics in persons above 40-50yrs of age is a very bad idea, the increase in sudden cardian death is expontential with age…

    And it does already occur in general in around 3.5% of the people labeled “schizo” and treated with neuroleptics.

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  15. Thank you, Sandy, for your always thoughtful wording and analysis of difficult issues around medication use, which are always going to be polarizing. Your introspection and humility are a model for us, and your approach w/r/t this particular issue strikes me as very logical, and one that I have tried to emulate with all medications.

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  16. Hyperbolically and satirically:

    It’s midsummer evening in some place, all gathered dressed in togas, the marine breeze runs refreshing the sweaty faces.

    Time for tough choices.

    A Nero look-alike figure addresses a crowd, gathered to hear the good news about antipsychotics and it’s withdrawal:

    Deadly beloved, sorry, dearly beloved (fixing the laurel crown that slided at the slip of the tongue):

    For some significant percentage of you, although insighfull, keeping (sic) taking your antipsychotics will lead to sudden cardiac death, given your age alone.

    Antipsychotics caused overweight, obesity, hypertension and diabetes will add to that.

    Lack of physical activity, smoking and overdrinking, it’s just the dopamine oversearch effect. Don’t self medicate, that will increase the chances of sudden cardiac deaths.

    Equally cherised, for those of you trying to avoid such indignant fate it will lead in similar percentage to an equally indingant outcome of “natural causes” and miscellanous demises.

    We are not entirely clear and forthcoming about the whys.

    I know it sounds like the false choice between lions and crucifixion.

    But fear not, know not, think not, feel not, doubt not, work not, learn not and please don’t mingle.

    We care, and we care A LOT$(sic).

    (Nero’s eyes kind of remembered me of Richy Rich, briefly, something symbolic I am sure, I could not see clearly with my skeptic glasses…)

    Just our careers are always on the line, this side of the line, the normie cis-line.

    We have outstanding education loans, mortgages, tuitions, vacations, expensive hobbies and some of us alimonies.

    And please do not run. You might die of violence otherwise not stated, and unpublished. You won’t even be a statistic.

    It’s the same everywhere you can go.

    Feel for me not either. I, now, KNOW BETTER.

    And, hopefully, if honesty prevails, so WILL you… eventually.

    Just guidance there is not, prevention avoided, but we did cool papers.

    I feel for y’all…

    (I could not help perceiving or imagining a little drool on the left corner of the mouth…)

    *****
    Written to try to take off the burden, not increase it, to point and mock those directly responsible for such false choices.

    My intent was to help, even if I failed, I hope not in a way that causes damage, that causes pain.

    In such case I’ll embrace ridicule over shame and guilt. I hope, the reader can help me accomplish that.

    I apologize before hand if I hurt anyone put in those choices by antipsychotics and to no one else…

    ****
    Although the author, I do claim no copyright to this text. Sounds grandiose wanting it to be shared outside MIA if allowed, but for reasons not to be disclosed, it means a lot to me just writing “no copyright”…

    And I do hope it helps particularly younger generations to see the world, even if a little bit irreverently and without false respect, and question enough claims passed as truth.

    During my life it provided me confort and nurture. I hope for some of you it can do the same, in small doses…

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