Antipsychotics (APs) are widely prescribed as a first-line treatment for psychosis despite research suggesting that they can lead to worse outcomes in first-episode psychosis and carry serious long-term risks, including increased susceptibility to dementia and structural brain changes. A new article published in the Community Mental Health Journal sheds light on a less acknowledged consequence of antipsychotics: their impact on identity and sense of self.
The interdisciplinary team, led by Maev Conneely of University College London, explored how being prescribed, taking, or discontinuing antipsychotics influences identity. The authors write:
“Qualitative research indicates the relationship between taking APs and identity is multilayered and changeable. Taking APs can restore people to their earlier, pre-symptom sense of self. Being prescribed and taking APs can also, on the other hand, be experienced as damaging, erasing, and dulling people’s sense of who they are. This complexity deserves exploration in clinical practice, which we believe is currently not done routinely. More work is needed to understand whether, and how, the relationship between identity and APs is being addressed.”
This study highlights how treatment can shape, constrain, or even erase a person’s sense of self. While psychiatric discourse often focuses on symptom reduction, it rarely considers how interventions—especially long-term medication use—impact identity, agency, and belonging. The implications go beyond individual experiences, raising larger questions about the nature of mental health treatment, the authority of medical narratives over lived experience, and the role of coercion—whether overt or subtle—in shaping self-perception.
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Although antipsychotics are typically the go-to treatment when addressing psychosis, research has shown that they are often prescribed without informed consent. Unsurprisingly, then, less than 10% of people take them as prescribed. It is common for individuals to skip or alter doses, take breaks, or stop taking the drug entirely. Adverse side effects, such as feelings of numbness or lack of feeling, lead people to stop taking the medication. Lack of adherence to
Antipsychotics and psychotic disorders themselves are also highly stigmatized, with stigmatization of psychotic disorders increasing in recent years. This, in turn, can result in self-stigmatization, where the individual experiences stigma for both taking the drug or not taking the drug when prescribed.
While there are rating scales that measure both the benefits and adverse effects of antipsychotics, sense of self and identity are not usually addressed in them. It is also not typically taken into consideration as far as factors contributing to discontinuation.
The authors’ work aims to fill in the gaps in their exploration of how identity, both personally and socially, is affected by antipsychotics. Their understanding of identity is drawn from recovery-oriented mental health care that is person-centered, views the “patient” as the expert on their own experience, and emphasizes shared decision-making regarding treatment.
In their review of available research on identity and antipsychotics, the authors found a range of experiences. While some patients described their experience of taking antipsychotics as “restoring the self,” others discussed how the numbness that can come along with antipsychotics leaves people feeling disconnected from themselves or not feeling like themselves.
One participant in a Danish tapering study who recently discontinued their medication describes their experience:
“I feel like I’m coming home to myself. It’s impossible to navigate life when you can’t feel the small signals in the body. That’s what I feel the medicine took away from me. Waking up to a life that doesn’t fit me at all or that I like. But grateful and happy that I have come back.”
In addition to causing a sense of disconnection, antipsychotics have also been found to affect a person’s sense of agency as well as how individuals see themselves – such as being “lesser,” “weird,” or holding an “unwanted and stigmatized identity as a chronic psychiatric patient.”
In the dialogues between patient and provider, discussing the effects of antipsychotics on the emotional and psychological life of the patient is critical to gaining insight into how they may be impacting identity and sense of belongingness. They emphasize that having a space to talk openly about experiences with antipsychotics is critical and describe how therapists may shy away from such conversations due to their lack of prescribing power but argue that these are the very individuals who may best be suited to open up these conversations.
The authors point to shared decision-making as a potential solution to the problem of identity, which, at baseline, requires open discussion and information shared between clients and their treatment team.
Incorporating an understanding of identity and antipsychotics into psychiatry faces two significant barriers.
- The first barrier is psychiatry’s focus on symptom reduction in research studies, which is what psychiatry relies on for decision-making and understanding. As such, increasing the scope of research to include adverse effects related to identity is key.
- Another barrier is psychiatry’s reliance on understandings of identity that are grounded in Western philosophies. Opening up other ways of understanding the self, such as inclusive and decolonized models of identity, are also needed in the field to conceptualize identity in a new, more dynamic way.
Others have discussed steps to be taken that can improve shared decision-making in the treatment of psychosis, highlighting increased collaboration between patient and provider as being a significant factor. Recent research has also revealed that when antipsychotics are discontinued, patients experience better long-term outcomes in terms of social functioning and overall quality of life.
Tapering off of antipsychotics has also been shown to be empowering for individuals. In fact, non-pharmacological interventions, such as the peer support group Hearing Voices, have been shown to have numerous benefits for individuals experiencing psychosis, such as allowing for meaningful understanding of their experiences and building a social support network.
The findings of this study reinforce a growing call to rethink how psychiatry approaches treatment. Beyond symptom management, mental health care must address how interventions impact selfhood, autonomy, and social identity. Antipsychotics may suppress psychotic symptoms, but if they also suppress an individual’s sense of self, can they truly be considered a solution?
By incorporating identity into treatment conversations, expanding research beyond symptom reduction, and embracing non-medical and decolonized understandings of selfhood, psychiatry could take a significant step toward a more human-centered and ethical approach to care.
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Conneely, M., Roe, D., Hasson-Ohayon, I., Pijnenborg, G. H. M., van der Meer, L., Speyer, H. (2025). Antipsychotics and identity: The adverse effect no one is talking about. Community Mental Health Journal, 61, 228-233. https://doi.org/10.1007/s10597-024-01255-w (Link)
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This is very confused stuff, because you are using these phrases such as ‘the shaping of one’s identity’ or of one’s sense of self or their selfhood without interrogating what you actually mean when you use these words, and if you were to interrogate these concepts you would realize that they are merely conceptual constructions that don’t correspond to anything actual. What is the self? There is thinking which calls itself me and I, and the idea of me which is based on past experience and self image. But moving the movement of thoughts are certain drives or instincts – emotions, feelings and impulses or energies of consciousness and action, and the more energy there is in this layer the more dynamic and active can be the false self constructed by thought. But identity is who we think we are, i.e. how we identify ourselves and what we identify with – I am a doctor, nurse, a person who is mentally ill or black or a mother or a lesbian or gay man etc. And you confuse identity with one’s sense of self precisely because the false merely thought-based, conceptual self IS based on false concetpual identities, so to affirm this false self by treating identity as something actual just shows how little you and these researchers understand what they are studying, and ought to give you some measure of the absolute poverty and worthlessness of this research, this article, and all our absolutely empty, non-factual notions of self. The true understanding of self comes about through direct and unprejudiced observation of the phenomena we call self which is what the Eastern philosophers and sages always did and what many of the Western philosophers did in order to come to understand themselves (admittedly they often ruined their analysis through conceptual abstractions like we see here but there were exceptions: David Hume, Kant, even Descartes though his most famous statement ‘I think there for I am’ is obviously confused because he posits the I without saying what it is, but implicitly he is identifying with thought as the I, but what is the I besides thought? And he should have said ‘there is awareness of thinking, seeing, hearing, sensing etc therefore awareness or consciousness definitely is’: that was the real insight garbled by his social conditioning). Believe it or not it’s quite easy to have definitive perceptions about all this stuff simply with ever more penetrating, curious and extensive perceptions of the phenomena of one’s own consciousness and this is the true expertise superior to all the bullshit psychiatric and psychological theories of the Western intellect. It only sounds arrogant to those who live in the field of arrogance and humility, i.e. in the intellect, but what I say is what every bird or blade of grass knows. What is is that which is, nothing besides, least of all a bunch of socially invented concepts and words about what is. Perhaps you need to go back to class taught by grass or beetles teaching. They are far more intelligent things then any human teacher, but so are we. We are not the thought machine but the exquisite intelligence which bares it for reasons that go beyond the common understanding of human beings.
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Good article, but it’s just one more that fails to address the true motivation underlying psychiatry: the unconscious wish to suppress uncomfortable feelings; in other words, the wish to deny what it means to be fully human.
P.S. The concept of “shared decision making” is utter bullshit, a false interaction crafted to give the appearance of open-mindedness when in reality all it really does is give practitioners the opportunity to think up ways of defending continued use of anti-psychotics.
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That one should have to SUGGEST “shared decision making” as if the PRACTITIONER gets to decide whether or not to “share” their power says a hell of a lot about the “diagnostic” and “treatment” process!
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That’s for sure. Just shows how far most practitioners’ heads are up their own asses.
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I read that 10% with psychosis what ever prognosis take prescribed antipsychotics regularly. I take a very low dose of clozapin as forced forensic treatment punishment treatment resistant related violence when under forced treatment locked up. I don’t think schizophrenia is my problem, but still rehab means coming back to life while stopped abilify 7 years ago cold turkey then immediately picked up and tortured with restraints and forced treatment. For me antipsychotics 1990 – 2025 could be discussed here, If you please?
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Claus,
Try politely telling your psychiatrist that you mean no disrespect, but you’ve become an independent psychopharmacology researcher, thus critical psychiatry person. When I was trying to help a loved one in extreme distress, this did result in a young hospital psychiatrist agreeing that he, too, was a critical psychiatry person.
Then politely request to avoid altogether, the anticholinergic drugs (a drug class which includes the antipsychotics) – or be safely weaned off of them – whatever your particular case might involve. Since, if you’re dealing with the “positive symptoms of schizophrenia,” those symptoms can be created with the antipsychotics and/or antidepressants, via anticholinergic toxidrome.
https://en.wikipedia.org/wiki/Toxidrome
And if you’re dealing with the “negative symptoms of schizophrenia,” those symptoms can be created with the antipsychotics / neuroleptics, via neuroleptic induced deficit syndrome, as well.
https://en.wikipedia.org/wiki/Neuroleptic-induced_deficit_syndrome
I’m not familiar with your exact situation, Claus. However I hope my decades of research, and experience helping myself and a loved one, may help you too.
But do be forewarned about the fact that withdrawal from the anticholinergic drugs can also cause a drug withdrawal induced “super sensitivity manic psychosis.” So a personalized, slow, hyperbolic, taper is likely best.
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I read about anticholinerg drugs. Clozapin blocks acetylcholinerg neurotransmitters, the eyesight, hearing and parasympathetic nerves to the body. Well that’s about what I feel when I watch TV, that I can’t seem to listen well.
The cold tyrkey abilify was already in 2016. Now I wanted to edit the text above that you answered. Abilify has a strong d2- antagonist effect which I really hate. For many years, I couldn’t be 100% sure, if a important problem was about the drugs or which, but after stopping with Abilify some seizures disappeared. There were no words for it and my contact nurse wrote in her files about me, that they were senses amplified/ positive symptoms. Back then I also took some clozapin besides abilify. I tried to take clozapin in different doses at different times. Taking 25 mg could sometimes help a little on the seizures so why would it be the medicine? There was no help. What I didn’t know before 2017 and later was, which of the drugs caused the seizures. But it was the antipsychotic effect, saying this is primarily d2 receptor blocking = the dopamine hypothesis in cortex.
But I have a complaint going at the officials of Danish psychiatry. Now I was in hospital for 6 days again, got out last tuesday 25th. These people are awful treating people badly. And it was stressful. I could tell you stuff nobody believes. But I had to give them a message about a very critical problem in my life that much gets in the way of so-called psychiatric treatment.
Well, I just had to point out everything to these authorities and tell them about my personal opinions and lived experience or else it would be forced treatment forever. Gotta do it by the book, and I am more a researcher of theoretical physics than medicine. Of course that got a me a huge problem after that cold turkey 2016, some crack cocaine shortly after. It all sent me to work and think up something much simpler into modern physics.
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By the way, thanks a lot for your answer. Especially about not being disrespectful and the meaning of clozapine as an anti-cholinerg drug.
I was thinking about a good nurse I talked to last monday while lying on my back. Why she poked my hand and there was no reaction. When the doctor on the first day noticed a small reaction while using the rubber hammer. I am traumatized. Only 300 mg and weighing 105 kg, 171 cm, often constipation, a slow gut system. A lot of harassment.
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Forced treatment only. The diagnosis is a lie. I don’t expect help until 2027. Maybe it will be possible to break away then
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Look closely and you’ll find what truly motivates psychiatry (and its assorted minions): an unconscious fear of uncomfortable feelings; in other words, the fear of facing what it means to be fully human.
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Also, in BOTH psychiatry & the priesthood, they COVER-UP various sexual abuses. It’s the “dirty little secret” of psychiatry. Several women I have known over the years, were sexually molested when they were girls, by their Fathers. When the girls got older, Daddy took them to a shrink, who “diagnosed” & DRUGGED the girls. Result, “Oh, you can’t believe anything she says. She lies. She makes stuff up. She has mental illness. She sees a psychiatrist, and takes psych drugs”…..See how the SCAM works? Ah, psychiatry…..
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One dirty hand washes the other.
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Problem IS, they keep “washing” their hands in the same ole MUD….LOL!….
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Sad but true.
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Very true, Bill. Covering up abuse or sexual assault is the number one actual function of the psych industries, I think.
https://www.indybay.org/newsitems/2019/01/23/18820633.php?fbclid=IwAR2-cgZPcEvbz7yFqMuUwneIuaqGleGiOzackY4N2sPeVXolwmEga5iKxdo
https://www.madinamerica.com/2016/04/heal-for-life/
And it’s all by DSM design.
https://www.psychologytoday.com/us/blog/your-child-does-not-have-bipolar-disorder/201402/dsm-5-and-child-neglect-and-abuse-1
And you are right, covering up child abuse is also a problem for the religious leaders, I had to leave my ex-religion because of their systemic child abuse covering up “partnership” with the “mental health” workers.
Ethical pastors of a different religion confessed this systemic criminal behavior is known as “the dirty little secret of the two original educated professions.”
“… And the ones we hail
Are the worst of all …”
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“what truly motivates psychiatry (and its assorted minions):” aside from money, “an unconscious fear of” what they can’t bill for, which I guess gets us back to the avarice issues of the so called “mental health professions.”
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Psychiatric drugging means one thing: enabling people to sleepwalk through life.
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My time under the thumb of psychiatry was, at best, a LIVING NIGHTMARE…..hardly “sleepwalking”!, LOL!….
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Mine too, come to think of it.
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In 2013, I forced the Medicaid clinic’s Director to withdraw me from 9 years/every 24-hrs- prescribed antipsychotic, anticonvulsant, & benzo addiction…my ‘punishment’ as a lab-dog, for having $ worries/insomnia following a business closure in 2004.
As I had immediately rejoined the workforce with excellent insurance, I was an irresistible target for the psychiatrist during the ‘bipolar gold-rush’ years following the now disgraced DSM-IV. She was later listed in Propublica’s “Dollars for Docs” as reaping $65K+ annually from Pharma-her largest ‘donor’ made the gateway- drug she drenched me in…Seroquel (Astra Zeneca)…introducing me to the now familiar ‘complaint’ of suicidal ideation.
After reporting that to her-she doubled down on the dosage.
Thanks Anjali.
Following the 2.5 years of withdrawal & the attendant horrors, I stepped into a new life- ‘phase’ of ‘Re-entry’ in 2016.
I didn’t see it coming…and it was tortuous. It was in addition to the following 3 years of ‘seizure-like’ events.
The exit-doc had left me with these parting words…”Don’t dwell on this. Let it go”…as if the next morning would bring rainbows & butterflies into my world.
I was gobsmacked at his arrogance…and self-forgiveness for his participation.
Starting a new life after grand-scale betrayal & addiction, causing documented heart-failure, nervous system collapse, brain lesion, snuffing-out my identity, & now seizures…was a big job.
Who was I supposed to see about that?
A psychologist, a psychiatrist…a Life Coach (joke)? My primary wanted me to stop talking about it (my MEDICAL history!).
It was up to me to salvage, treat, and rebuild a new life, a new personality..and boy, I had changed…completely.
Being intentionally bought, sold, disabled, and passed around has formed my core into a new hybrid of being. And I had never been shy. I had simply trusted the wrong cultural authority-MEDICINE.
It began right away. I ‘observed’ my compulsion to flex righteous power, with fascination. I was re-establishing my brain-function effectiveness (complex problem-solving) AND re-establishing my power in the world. I was compelled to quietly, effectively flex over everything that interfered with my recovery, new life, and had taken advantage of me when I was weak and sick (side effects).
It was the ULTIMATE CBT workbook-with a great big smirk.
I was compelled, while healing my brain and body, to push-back and extract an appropriate -toll for interfering-inappropriately…with me.
I started immediately with small, but easy rip-offs…my cable company coughed up $2000 for past transgressions…followed by other service providers sloppy lies. I then tore a big hole in the Board of Directors at my HOA who were lying, stealing, and threatening me for saying so (with evidence). It cost them $20,000…& then I moved.
I organized and traveled 2500 miles across the country, bought a condo on the water, & continue the ‘work’ of re-building.
The biggest plumbing company in S Florida tried to change the contract-AFTER the kitchen work was done, bullying me in my living room. I literally paid them to leave for my safety-I would fight them starting the next day.
The Florida Attn’y General’s office retreived my $1200 for me.
A new neighbor flooded my bathroom and sent her ‘manly’ nephew to threaten me-“don’t complain”. I almost laughed. He is banished and she was fined AND paid for all damages.
A man ‘interfered’ with me 3 times in my new community. I had him removed-engaging the HOA and Sherrif to do the heavy lifting.
I have a PhD on engaging with bullies, bullsh#tters, & thugs, thanks to Psychiatry.
Psychiatry taught me how to use the ‘process’ to effectively push back…& extract a cold-blooded toll.
It became the foundation of my re-birth. I was back. Appropriately.
I have a profound, rock-solid understanding of ‘appropriate”-in ALL its contexts- now.
And I know who the danger is.
“Revenge is a dish best served cold”.
.
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I love that this is being addressed. In my own experience, both ADs and APs wipe out all the negative voices, emotions, but also all the positive, all sense of who I am, all sense of meaning and purpose, any interest in life and engagement, loss of will etc etc. Thus, I choose to live with the “demons”, which is really difficult, honestly, in order to not lose “sense of self” and purpose and higher levels of conscious awareness. I am also ADHD and Autistic, and I’ve heard professional lectures saying that neurodivergent people respond paradoxically negatively to these meds because they further depress the part of the brain that already functions differently, and this may address why people have such opposite experiences. He said specifically with ADHD these meds further depress the areas associated with Executive Function etc, and I found that to be true. I’d be happy to give personal feedback for your research if that would be helpful.
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I can’t start to express how heartbreaking all of this is. The amount of friends, people vulnerably human, that I have watched the psychiatric system and these “medications” turn into beggars terrified of their own humanity. Like the ones you see on the street corners getting a scrap here and there, when there are whole dumpsters and empty houses filled with what they would need, but it’s all locked up. Where does all this money go, for example that the insurance companies pay out, Government sponsored programs, grants, research, academics, donations to help “mental health,” etc. etc.!!!!!?
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I learned how to push back on bullies & danger in the conventional world from Psych Gladiator School…and it helped restore a certain confidence…to a point.
I know how quickly a life can be locked in a closet and forgotten…for decades.
Beneath my fragile joy at remaining alive & upright, a hypervigilant tension is a constant presence in every.single.interaction.
I feel I must always be ready to defend my freedom, my existance…
That daily, quiet foreboding is the knowledge of the true malevolence and profound indifference for anyone at all, at any time… lacking massive resources.
I can still find joy and innocence in gardening and my pets, a beautiful day and a good meal…but I know what’s out there.
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