I didn’t set out to shape the field of psychiatry. I was just a copywriter working in pharmaceutical advertising. But over time, I found myself at the center of a campaign that would help transform how mental illness—and its treatment—are understood in the U.S. This is the story of how we marketed one drug, Risperdal, and how that effort helped turn atypical antipsychotics into a multi-billion-dollar industry.

If you’ve ever wondered how this powerful class of drugs ended up being prescribed for everything from adolescent mood swings to agitated nursing home patients, you’re not alone. The rise of atypical antipsychotics was a business and marketing phenomenon—driven in part by a wave of pharmaceutical mergers in the 1990s. First introduced for schizophrenia, atypical antipsychotics were promoted as more effective and safer than older drugs like Haldol or Thorazine.

While journalists and regulators have addressed this issue, I want to share my memories of marketing Risperdal—the first widely prescribed atypical antipsychotic. This is the story of how we promoted Risperdal not just as a medication, but as a revolution in psychiatric care. It’s also the story of how we redefined schizophrenia, rewrote the safety narrative of antipsychotics, and helped drive one of the most successful (and concerning) pharmaceutical launches in history.

It was also my first realization of the immense power marketers have to shape their version of the truth—and how I eventually came to question the very system I helped build.

The Pressure Cooker: Launching Risperdal in Midtown Manhattan

In the mid-1990s, I stepped into the kind of job people in pharmaceutical advertising dream about: co-creative director and lead copywriter on the industry’s next big blockbuster. The agency was in Midtown Manhattan. The client was Johnson & Johnson. The drug was Risperdal. From day one, it was a pressure cooker.

Risperdal was our agency’s biggest account, so demanding that one colleague warned me the creative team was burned out, and one of the senior writers was threatening to quit. The problem? J&J had acquired two companies during the merger frenzy of the mid-1990s: McNeil, which marketed aging Haldol, and Janssen, which made the newer Risperdal.

When Haldol Failed, the Stakes Shifted to Risperdal

McNeil hoped to maintain Haldol revenues by filing for a new indication—dementia-related agitation. But the FDA denied approval; and the ad campaign we’d spent six months developing was shelved. I can still recall it 30 years later: photographs of elderly patients holding flowers with the headline “Fragile: Handle with Haldol.” A clever, emotionally resonant ad campaign suggesting parents could age at home instead of a nursing home, thanks to Haldol—and all gone in an instant.

We were stunned and disappointed, including the head of the CNS (central nervous system, or psychiatric drugs) franchise at J&J. Without patent protection, generic competition would cause Haldol’s price to drop precipitously. The FDA denial meant that Risperdal would have to carry the entire CNS portfolio.

The ultimate challenge facing us was this: how to convince psychiatrists to substitute a drug that costs ten times more (Risperdal) for a widely accepted and effective drug (Haldol). We would need to justify Risperdal’s premium price tag by positioning it as the next generation option for schizophrenia. But that would require a full reframing of what schizophrenia even was—and a redefinition of Risperdal’s role in treating it.

Many people don’t realize that a drug’s marketing story begins long before FDA approval. Today, drug and device business strategy and planning is backed by an army of researchers, communication companies, and consultants. Often, these strategies are covert and secretive, so much so that those involved at different stages of the drug’s life cycle may be unaware of the corporation’s ultimate marketing intent.

The remainder of this blog will illustrate the various strategies—such as clinical trial design, physician and consumer education, patient advocacy, and market access—used to create a so-called breakthrough therapy for mental health.

Promoting the PANSS Rating Scale: Risperdal’s Rise, Haldol’s Fall

Janssen didn’t just market a new drug—we needed to aggressively differentiate Risperdal from older agents by promoting a new framework for thinking about schizophrenia. And at the center of it all was the PANSS (Positive and Negative Syndrome Scale) rating scale.

In psychiatry, there’s no blood test or brain scan that confirms a diagnosis or proves a drug is working. Instead, clinicians and researchers use rating scales that convert subjective symptoms into numbers. The choice of scale isn’t neutral. Companies choose the one that is most likely to portray their product in a favorable light. That choice shapes trial results, positioning, marketing claims, and how the product is perceived compared to its competitors.

Janssen chose the PANSS for many of Risperdal’s Phase 3 trials. PANSS broke schizophrenia symptoms into two categories: positive (hallucinations, delusions) and negative (emotional withdrawal, apathy). While older drugs like Haldol primarily treated positive symptoms, we said that Risperdal could also target the harder-to-treat negative symptoms. That positioning didn’t just help Risperdal—it helped usher in the entire atypical antipsychotic era by shifting psychiatry’s focus toward chronic, cognitively framed symptoms as targets for pharmaceutical treatment.

The Rise of Atypical Off-Label Use

This growing awareness of negative symptoms opened the door to something even more consequential: the off-label use of atypical antipsychotics. And it didn’t grow through overt promotional tactics—it grew quietly, through a redefinition of what counted as treatable.

Once doctors viewed Risperdal as a tool to improve cognition, motivation, or emotional balance—not just control hallucinations—atypicals expanded into broader psychiatric markets. It made sense to use them for conditions like ADHD, dementia, and conduct disorder. The perception of superior safety over Haldol—and that Risperdal appeared to lack virtually any side effects—only accelerated the trend.

This expansion may not have been the original plan, but it’s how atypicals started being prescribed for behaviors only loosely related to schizophrenia.

The $1 Million Immersive Exhibit: Selling Negative Symptoms to Doctors

How could we make cognitive symptoms—ones that older drugs like Haldol didn’t seem to touch—feel real to psychiatrists? Academic thought leaders had helped legitimize the PANSS through articles and lectures. But we needed something more visceral.

What followed was one of the most elaborate marketing tools I ever worked on: a jaw-dropping $1 million immersive exhibit at the 1998 APA (American Psychiatric Association) meeting in Toronto.

The idea started at an expensive lunch in New York. We were sitting in a four-star restaurant, brainstorming ways to make Janssen’s exhibit booth stand out at the upcoming APA conference. Someone sketched a concept on a napkin: simulate schizophrenia—specifically, the internal voices patients often describe. If we could make psychiatrists feel what their patients experienced, maybe they’d take negative symptoms more seriously.

By the time of the conference in Toronto, that napkin sketch had evolved into a soundproof booth simulating a high-stakes job interview. I suggested we make it a medical residency interview—something psychiatrists would find relatable. The goal was to make the experience feel real.

A consulting psychologist who supervised the exhibit created a script using self-critical, emotionally harsh dialogue—designed to mirror the negative symptoms of schizophrenia.

I always imagined auditory hallucinations as overtly psychotic—like a voice insisting the government had implanted a tracking device in your skull. But these were different: quieter, crueler, more internal. The kinds of voices that chip away at motivation, confidence, and cognition.

I sat across from psychiatrists as they struggled to answer basic interview questions while those voices whispered in their ears. I adjusted the volume as they squirmed—raising or lowering it depending on their discomfort. Some broke into visible sweat. More than one asked to end the simulation early. The line to try the experience wrapped around the exhibit hall.

We tricked ourselves into thinking it was about empathy. I’m embarrassed to say I didn’t see anything wrong with it at the time. The ultimate goal: to implant the belief that negative symptoms were real and debilitating, and that Risperdal could treat them.

The Risperdal Safety Story–Part Fabrication, Part Truth
Walking the regulatory tightrope

Alongside efficacy in negative symptoms, safety was the second pillar of our campaign—specifically, Risperdal’s purported lower risk of extrapyramidal symptoms (EPS) compared to Haldol. EPS includes movement disorders like akathisia (restlessness), tremors, rigidity, and tardive dyskinesia. These were the most dreaded side effects of the older-generation antipsychotics.

Risperdal appeared to cause fewer EPS in early trials compared to Haldol—but those clinical study results were skewed because Haldol was dosed at unusually high doses, almost ensuring worse side effects. The comparison wasn’t just unfair—it seemed deliberately manipulated to make Risperdal seem dramatically better than Haldol in terms of safety. In various trials, Haldol was routinely dosed at very high levels—often above 12 mg/day—well past the point of added benefit. Studies show that once haloperidol exceeds approximately 5 mg/day, the risk of EPS increases steadily, while efficacy plateaus; in other words, EPS is dose-dependent.

One important thing to note is that when the FDA approved Risperdal in December 1993, the agency stated that it would consider any advertising or promotion suggesting that Risperdal was superior to Haldol to be false and misleading. This restriction meant we couldn’t make direct claims of superiority in promotional materials. Paid thought leaders could mention “fewer EPS than Haldol” in speaker programs and publications, but we couldn’t make clinical comparisons in ads or sales aids.

Since the FDA had made its position clear, our advertising copywriters learned to imply superiority without explicitly stating it. Through carefully chosen language, we crafted a message that stayed within regulatory boundaries without crossing them.

Leveraging Pharmacological Pseudo-Science

One of the ways we skirted regulatory limits in promotion was by using a receptor binding story—a pharmacological narrative that hinted at superiority without explicitly stating it. Because we couldn’t claim that Risperdal was safer or more effective than Haldol, we contrasted differences in how the newer atypicals and the older antipsychotics interacted with brain receptors.

Specifically:

  • We emphasized Risperdal’s balanced blockade of dopamine D₂ and serotonin 5-HT₂A receptors, the hallmark of its “atypical” profile.
  • We contrasted this with Haldol’s high-potency, nearly exclusive blockade of D₂ receptors.
  • We linked strong D₂ blockade to movement-related side effects, such as EPS, while suggesting that serotonin-D₂ balance might reduce these risks.

This allowed us to tell a compelling, science-based story without stepping over regulatory lines. Risperdal thought leaders, however, could link the receptor narrative to clinical advantages in abstracts, journal articles, and sponsored CME programs.

I personally wrote an advertorial in a leading medical journal suggesting that 5-HT₂A antagonism seen with atypicals “might be associated” with enhanced cognitive function or reduced negative symptoms. In promotional materials, we were very cautious, referring to Risperdal’s “loose binding” to D₂ receptors. The wording was vague enough to pass regulatory review—but the implication was clear.

Most doctors lack the time to scrutinize every scientific claim made in advertising, at CME programs, or in published articles. If you gave them a plausible story, they’ll fill in the rest.

Market Access Strategy: The Linchpin of Risperdal’s Success

Convincing doctors to prescribe Risperdal wasn’t enough. Someone needed to pay for it. Since most patients with schizophrenia didn’t have private insurance, government programs would be footing the bill.

I was impressed when Janssen provided our ad agency with a white paper highlighting the bureaucratic obstacles families face in accessing mental health services. It was created by a major healthcare consulting firm. Janssen then asked me to turn it into a practical, consumer-friendly brochure which we titled “The Informed Consumer: A Practical Guide to Paying for Mental Healthcare.” The brochure was distributed in doctors’ offices, handed out to psych nurses, and to patients enrolled in the Janssen Pathways Program.

At first, I believed this was an altruistic effort—helping families navigate the complexities of healthcare insurance. At the time, I felt proud of it. We were doing something good for vulnerable people seeking mental health coverage.

But over time, I saw the intent more clearly. The brochure’s underlying message was clear: start the Medicaid and Medicare enrollment process immediately after a psychotic episode. On the surface, it sounded like public health advice. In reality, it was designed to ensure the individual was enrolled in Medicaid, so that their outpatient Risperdal prescriptions would be paid for after being released from the hospital. Janssen’s profits were dependent on reimbursement from public health insurers, including Medicaid, Medicare, the VA, and the Department of Corrections.

The Business of Compliance: How Medication Adherence Helped the Bottom Line

After we’d laid the groundwork—proving efficacy, managing safety concerns, and securing reimbursement—the next challenge was keeping patients on Risperdal continuously. Janssen’s solution was a program called “Pathways to Change.” “Pathways” purported to be an educational resource. In reality, it was a sophisticated patient retention strategy.

“Pathways to Change” had multiple components, including brochures for patients, caregivers, and healthcare professionals. But the central message running through all materials was consistent: don’t stop taking your medication. Our medication adherence strategy included a toll-free service, Person-to-Person, which offered families and providers live support for questions about Risperdal treatment and reimbursement issues.

I wrote several handouts with input from the Risperdal Advisory Board—a group of well-known clinical research thought leaders supportive of the drug. Bringing in this respected board lent the materials an authoritative tone. All members were paid, but that didn’t necessarily make them shills. Many were genuinely enthusiastic about Risperdal, which is why they were chosen in the first place. Medical experts with reservations about Risperdal—or who took a more cautious stance—did not have a seat at the table.

One of the patient materials, a brochure titled “Transitions,” was handed out to people being discharged from hospitals after a psychotic episode. It provided relapse prevention tips, including reminders to keep taking medication after leaving the hospital.

I also wrote a piece for psychiatrists titled “The Therapeutic Alliance,” developed in collaboration with our advisory board. Its core premise was simple: medication adherence improves when patients trust their providers. The brochure recommended doctors make Ulysses agreements—where a patient consents in advance to future treatment, including forced hospitalization or medication, during periods of decompensation. Just as Ulysses instructed his crew to ignore his future pleas, these agreements allowed clinicians to override a patient’s objections based on earlier consent.

In hindsight, it was a masterstroke in “messaging”—cast in the language of empathy, but one with a clear marketing objective. By encouraging medication adherence in therapeutic partnership, we extended our influence far beyond the prescription itself—into the relationship between patient and provider.

The NAMI Factor

The final linchpin in our marketing strategy involved aligning with a mental health advocacy group. Risperdal would not have become a household word without NAMI.

In the late 1990s, NAMI—the National Alliance on Mental Illness—was still relatively small, with pharmaceutical funding; that changed quickly. As the creative lead on the Risperdal account, I worked with NAMI and Executive Director Laurie Flynn, whose daughter had schizophrenia. With support from Janssen and other atypical antipsychotic manufacturers, NAMI began advancing a powerful message: schizophrenia wasn’t caused by trauma or poor parenting—it was a biologically-based brain disorder, treatable with medication.

It was a compassionate narrative intended to remove stigma. But it also aligned with Janssen’s commercial goals. If schizophrenia were purely biological, it would require lifelong medication. Risperdal was positioned as essential.

I became close with Ken Steele, Janssen, and NAMI’s most visible spokesperson. Ken had spent much of his life in psychiatric wards, after being locked in his room as a teen by grandparents who believed he was possessed. Ken became Janssen’s unofficial poster boy—traveling the country, giving interviews, and telling the story of how he was “cured” by Risperdal.

I liked Ken a great deal. He was warm, brilliant, and funny. But there’s a tragic footnote to his story: Ken died in 2000 of complications tied to Risperdal—obesity, diabetes, and heart disease.

We never told that part of the story.

The Cracks Start to Show

For a while, the strategy held. We had the talking points, the scientific language, the educational tools, and the belief system to back it all. But belief can only carry a brand so far. Eventually, reality sets in. By the late 1990s, the cracks in Risperdal’s claims started to show.

Early on, we emphasized two key points: Risperdal was more effective than Haldol, and it caused far fewer side effects—especially the tremors and stiffness associated with older antipsychotics. Sales representatives echoed this—as did medical conferences, educational materials, and journal reprints that positioned Risperdal as psychiatry’s future: modern, safer, and better.

However, larger-scale, independent studies began to paint a different picture. Research from Canada and the National Institute of Mental Health’s CATIE trial (2005–2006) suggested that the efficacy differences between atypicals and traditional antipsychotics were not nearly as dramatic as we had originally claimed.

The safety story began to falter as well. While Risperdal had shown fewer EPS in early trials, those studies had used high—and arguably unrealistic—doses of Haldol, virtually guaranteeing worse outcomes for the comparator drug.

Roughly five years after launch, a more serious concern surfaced: metabolic side effects. Risperdal was increasingly associated with significant weight gain, diabetes, and in adolescent boys, gynecomastia—breast development linked to elevated prolactin levels.

What’s telling is that initial warnings to doctors didn’t originate from the FDA or medical watchdogs. Instead, they came from sales representatives—particularly those from Eli Lilly—who were promoting Zyprexa and attempting to undermine Risperdal’s safety profile. This is a detail often overlooked outside the industry: often, doctors hear about a medication’s risks not from regulators or journals, but from drug reps seeking to discredit a rival’s drug.

Restoring Trust in a Broken System

This is the story of how we turned a schizophrenia drug into a mental health blockbuster—and how marketing reshaped mental health practices.

Many believe the loss of trust in medicine began during the pandemic—with government missteps on one side and extremist disinformation on the other. But I don’t think it started there. The truth has been eroding for decades—it just hadn’t been declared dead yet.

We didn’t just promote Risperdal. We helped launch a new era of medical marketing—one where disease education, clinical research, and sales strategy blurred into a single message. And we convinced ourselves it was all in the name of better care.

This marketing approach transformed mental health. Atypical antipsychotics—initially approved for adult schizophrenia—eventually came to dominate the market, accounting for nearly 93.2% of all Medicaid antipsychotic prescriptions by 2021. Much of that use was off-label. In some states, psychiatrists prescribed so many atypicals for children in foster care that state legislators had to intervene.

If we genuinely want to rebuild trust in medicine, we can’t just blame one bad actor or a single scandal. We need comprehensive reform, including transparency in science, independent oversight, stricter control of marketing claims, and government funding for clinical trials. As long as those with financial interests control the design of studies, influence the narratives, and manage the messaging, no one—whether it’s doctors, patients, or the public—can truly know what to believe.

That’s what I learned from working inside the system.

And it’s why I left.

122 COMMENTS

  1. Advertising is literally one of the most evil “professions” on earth because it’s exactly this, it’s a con artist saying literally whatever will make poor vulnerable people give them money. It’s manipulation and it’s coercive and it’s EVIL. NO WAY AROUND IT.

    This is some of the most deeply evil crap I’ve ever seen. Your only redemption is admitting all this, and that’s not redemption to me, I think you’re still deeply evil. Advertisements and everyone who makes them are the real fascists of the world today for exactly this reason.

    Now we have an epidemic of mass poisoning with these drugs, because horrible evil soulless monsters just wanted more money, and they needed some fascists to help push this poison on everyone else. AND PEOPLE GOT PAID FOR IT. They got paid more than teachers or nurses, I’m sure. More than EMS or firefighters.

    Like I can’t even take how messed up the world is. People who work in advertising are all literally evil like this, fascists lying to the masses, selling them an impossibly cruel utopia. Evil manipulators who get all the money in the US that could be feeding starving children, but no, the advertisers need their third vacation yacht.

    Now millions of people writhe in agony trying to get off the poisons you lied to and coerced them into taking.

    ALL ADVERTISING IS FASCIST PROPAGANDA

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    • I asked Lydia to write about her work for MIA, and she did so in collaboration with MIA editors, as we think it illuminates how drug markets have been built and continue to be built. As someone who wrote about the marketing of risperidone, and how Janssen hid the adverse events and misled the public about its efficacy in my first book Mad in America, I understand the anger and sense of betrayal from the advertising of the drug, and of course the sense of lives damaged by the drug. I just want to make it clear that i solicited this contribution from Lydia, and I would ask other commenters to refrain from name-calling, as our standard for comments is to not allow personal attacks on bloggers and writers.

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    • Through my experiences with non-ordinary states of consciousness, I also came to understand how manipulative and even abusive so many systems are — not just advertising, which I agree with — but propaganda with work slogans that are not lived up to, or personal sayings to try to uplift and be positive all the time even though that means the real issue and causes are not addressed. I used the word “insidious” as I grappled with seeing so much of it around me and waking up to its effects.

      Through my experiences, I came up with the phrase, “Forget the hokey-pokey, abuse, manipulation, domination, and control — that’s what it’s all about.” And I have thought many times over the years that I should add “coercion” in there, but that doesn’t roll off the tongue the same way.

      We all are manipulated in so many ways, so many more ways than most of us are conscious of. And for me, coming to that realization was from a very painful process. My experience was in 1998 — before the rise of social media that has so many features designed to be addictive. So that manipulation has gotten much, much worse over the last 27 years.

      And then we wonder why our society isn’t healthy.

      Dead soul — I also noticed the name you used. Through my own experiences, I thought of myself as the “Rubber Soul” from the Beatles album title. My soul was twisted and contorted beyond anything I could have ever imagined or described, and it hurt like hell. I was lucky, I knew people who had ended up on drug cocktails whose lives were not significantly helped, so I rejected that approach.

      I wish for you that your soul can in time find some small spark of life and may heal somehow.

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  2. Your work and the work of your colleagues ruined my daughters chances of living a normal life. There are no words for the depth of pain and anguish t feel knowing that I can do nothing to repair the damage that was done to her. Knowing that people profited from her suffering while she was fraudulently diagnosed with a ‘permanent’ disease, institutiinalized, and forcibly treated with
    risperadone for years and years, while her youth, and hope slipped away. There are no words. She has been damaged, gaslighted, isolated, and segregated from society. I hope your SUV, and your Caribbean vacations, and your granite countertops made it all worthwhile.

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    • I find myself to be thankful for Sarah saying really painful and hard and true things in this and other situations, because it all rings true and I have thought similar things. I don’t know why it is so hard for me to be that honest.
      I thought I never wanted to hurt anyone. I felt a lot of hurt in my life. One exception, is that I used to imagine, before anything psychiatric happened to my girls, that I would run after anybody who ever tried to snatch my girls and I would jump on their back and “go for their eyes” if necessary to stop them.
      Then years later when my girls needed me to be confident and competent to advocate for them, I discovered that I was avoidant and a useless coward, a person who was easily intimidated by authority figures who was not prepared for the techniques that doctors will use to discourage talk or questions or challenges from their patients. Are doctors actually TAUGHT body language to dissuade the patient from being assertive? and the terse response to questions or simply saying that you think a certain diagnosis was a mistake? I always needed more time to sort out my thoughts. So, right now I’m sure I sound like a mugwump sitting on the fence. But, i know want I want very badly in my lifetime, to hear so many truth tellers come forward to expose the lies, that justice will dawn and things will get better, and then I hope I will weep like never before and say how Sorry I am and I wish that I could have done better, and please forgive me.

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      • If it helps you Carol, & I hope it does—I forgave my mother. She was just as coerced as I was. The unwarranted shame I was given by the treatment & the drugs kept me from telling mother the worst of what was done to me in the mental health system so she honestly did not know. I forgave her. I know she loves me. I hope you & she can forgive yourselves. You’ve suffered enough. We all have suffered enough.

        [Duplicate Comment]

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      • If it helps you Carol, & I hope it does—I forgave my mother. She was just as coerced as I was. The unwarranted shame I was given by the treatment & the drugs kept me from telling mother the worst of what was done to me in the mental health system so she honestly did not know. I forgave her. I know she loves me. I hope you & she can forgive yourselves. You’ve suffered enough. We all have suffered enough.

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    • Using Open Dialog, Finnish researchers found 80% of “schizophrenics” could function without psychiatric drugs, only 20% needed them on an ongoing basis. So to say “a few can manage” is not quite borne out by research. That’s not to invalidate your finding value in them. I’m just trying to undermine the myth that recovering with minimal or temporary drug use is not an unrealistic goal, even if one is “diagnosed with schizophrenia.”

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      • It’s highly complex – firstly & most importantly comprehensive integral approaches need to be fully available from first episode psychosis, & there needs to be ongoing help & support. It requires a totally different society / system. Secondly open dialogue works with all services & agencies including psychiatry & pharmacology.

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      • How I wish Open Dialogue had been around when my family member had been hit full force in college with what was wrongly diagnosed as schizophrenia…and mismedicaþed. We went deep into
        the heart of evil and finally our beloved relative was killed by zyprexa- dying of profound hyperglycemia. No one involved was ever held to account. Fines and lawsuits are not punishment.

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    • Please see my comment regarding the “schizophrenia” symptoms – and what can actually cause them – below, Marc. Now, of course iatrogenesis is not the only cause of the “schizophrenia” symptoms, but it may be the most common … not to dismiss your perspective, Marc … but I thought you should have that information.

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    • Only if the “treatment” is 100% voluntary and based in 100% fully informed consent!! Additionally, there is no such thing as a true definition of “schizophrenia” so how can the 1% of people who are labeled with it “really have it?”

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  5. Thank you for your expose. I confess that I ‘m commenting before thoroughly reading it, because the topic of Risperdal is stressful. Your expose is an answer to prayer and hopefully the beginning of many more exposes.
    Risperadol was a terrible drug for two daughters. It’s hard to even divulge that I had two daughters who were entrapped in psychiatry, which wouldn’t have been so likely to happen in a Functional Holistic paradigm of health care, a system that would have helped me to understand the needs of myself , then my children, so I could be proactive to help them to have a better trajectory.

    The local teaching hospital repressed information and was possibly using patients in clinical trials for risperdal and other A.P.s. Risperdal lowers progesterone which puts the female at risk for catatonia, as happened to my younger daughter who was already traumatized and put at risk from how she saw her older sister suffering from risperdal, or at other times from levels of Seroquel that were too high, that did not address underlying medical issues.
    Risperdal caused terrible akathisia, unless it was mania, in the older daughter, but she was forced to endure it for months in hospital, and left with permanent health damage. For what purpose? For clinical trial observations? Most likely because she was being used.

    My whole family , formerly very happy to do life together, was traumatized by what happened to the sisters. Never, Never, did I imagine such a thing would happen to us. Is this how we find purpose in life, to undergo heartbreaking abuse and tragedies?

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  7. Robert and Lydia, yes this is important and not at surprising . The anger is also not surprising. And when one is I. trauma anger flashback mode it has to expected in this type of venue. And I truly appreciate your truth telling and one way to help you cope. I hope you can find other ways . Listening to the anger when appropriately channeled but hard as Gabe Mate ( I know another professional survivors! I live in many worlds) described in his latest video M . Hasssn- you know your anger on the very margin but hard to stop. It takes time to learn how to deal with the moral injury all survivors have experienced.
    And again not know the territory !!!!! Sales and advertising / public relations should spend at least one year talking to all involved with the product the supporters the nay sayers abd the people directly involved. And even then so many of support people were bamboozled when all this better living through chemistry came out. I had to go inside the system to fully realize the horror of what was done to people.
    One line you wrote about the APA folks going fir bio stuff instead of trauma or environmental concerns!!!!! That is worthy of volumes and a book series. Name each element of the periodic table and how it impacts the earth and the role of psychiatry in the impact of marketing with the one pill slices it all marketing campaign. You stated the discussion from your side so thank you.
    I hope you won’t be a lone voice so being civil at this point here helpful. I scream and curse in my car my Get Smart Cone of Silence.
    Robert you need to configure a place for folks to express emotions without making writers flee. And always an issue but say allow for three vicious comments and tell the authors this is trauma and expect three very emotional comments. And behind every angry angry comment a whole universe of hurt and pain and damn these folks are alive!
    There has to be some creative uniqueness to do this.
    Similar to the parents who allow there children to do the infamous I hate you. There are developmental milestones when okay fits and then the okay there are better ways to express the emotions. So it is an ongoing dialogue to those families with the ability to do that. So many families entangled in trauma and environmental hurts and harms this dialogue never allowed to happen. And when a parent complained of this I would say well good your kid feels age enough to let go. May not be appropriate but your are safe do use that and teach and dialogue like whatever we would discuss.

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    • I don’t like your analogy, of children saying ‘ I hate you!” Suggesting adults with righteous anger must be tolerated like naughty children. How patronizing. My comment reflects my bitterness that people who create wealth through deceipt, lies, and corruption have the freedom and privilege of simply walking away. Too many wait for retirement before they speak out against the social ills of a vocation they chose rather than risk censure in their profession. I don’t hate people in the industry but I do identify with Jesus’ anger
      when he overturned the tables of the money changers at the temple. There is too much idolotry our society, people worshiping the Almighty dollar.

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  8. I understand the anger and rage of other commenters. I haven’t had enough emotional strength to write yet everything I could about the professionals who profited from complicity and actual direction of our daughters’ psychiatric capture and abusive, outdated treatment. I have wondered what kind of people they are and why don’t they ever do anything heroic to buck the system.
    There is also the urge to blame or punish parents which is very palpable, especially if you are considered to be a conservative. The urge to punish and to shame is a real thing, but we need professionals to take the risk of coming forward. We NEED these people.

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  9. The antipsychotics can create the positive symptoms of “schizophrenia,” via anticholinergic toxidrome. And they can create the negative symptoms of “schizophrenia,” via neuroleptic induced deficit syndrome.

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

    All doctors are supposedly taught this in med school.

    Since false advertising is illegal, and given the magnitude of harm done with the antipsychotics, the anger is justified.

    But thank you for your confession, Lydia.

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  10. Lydia, I watched your TEDx Talk. I note that the publicly disclosed adverse effects of risperdal need to be updated because they do omit important adverse effects; that is consistent with the third tactic you described for increasing the consumer base. The evidence for further harm can be found in a broad reading of the psychiatric literature which includes risperdal in a list of antipsychotics that decrease progesterone; this is very important because a metabolite of progesterone is needed to PREVENT catatonia.

    When risperdal’s adverse effect of lowered progesterone results in the development of a form of catatonia then the psychiatrist will be quick to file a petition to force Electro Convulsive “Therapy” on the patient, which is also very dangerous. Just as the drug industry coached you to omit harm in your write-ups , the industry has deceived you. This dynamic is to be expected. The industry knows it is harming patients and deceiving the courts that are used to force risperdal, then ECT and/or clozaril on patients.

    The drug industry evidently repressed the connection between risperdal and clozaril during the marketing of clozaril which is euphemistically called the Gold Standard of antipsychotics. Marketing for clozaril claimed that it does NOT reduce the key metabolite of progesterone that prevents catatonia. However, clozaril is very toxic; a well trained psychiatrist confirmed the toxicity that we saw for ourselves in the health problems that my girls developed.

    Non-marketing literature describes the serious and fatal health problems caused by clozaril. The fact that both of my daughters were forced to use risperdal , but at different doses, and then were eventually forced to take clozaril which had devastating effects on both of them is consistent with the probability that my daughters were valued for clinical trial purposes; they were exploited callously and cruelly despite the smiling faces and soft voices. Our daughters should have never been forced to take risperdal, because that’s when their challenges were first compounded.

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  11. Lydia, I have a question of clarification. Was your entire career devoted to the marketing of just risperdal? Does the industry keep the copy writers ignorant of the relationship between the different drugs so as to prevent then from discovering the magnitude of the harms?

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  12. Carol, thank you for your kind comments. I didn’t work exclusively on psychiatric drugs—over the years, I worked on medicines for many different conditions. This article covers two years when I was assigned solely to Risperdal. I appreciate you sharing your thoughts. I won’t be commenting further here, but I will be writing another piece to address the broader reactions to my article, which I have been reading closely, and to reflect more fully on the issues and concerns raised.

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    • Lydia, thank you for speaking out. I personally believe in restorative justice and redemption, and this is how one does it. From what a quick Google search shows, you are doing good work. And frankly, pieces like this hit much harder when they are coming from someone on the inside of the “enemy” machinations. Those of us who’ve suffered harms from psych drugs can and do yell about it until we’re given more drugs, but it doesn’t have the same impact. I appreciate that in your articles and presentations you don’t apologize, ask for forgiveness, defer criticism, or make it about you in any way. You simply tell us what you learned, and in the process open yourself up to a great deal of hostility. To me, that is way more valuable than an apology. When you had your road-to-Damascus moment or whatever motivated you to get out of that work, you could have just slunk off into another line of work and a peaceful life where no one calls you an evil monster. That, I’d be angry about. So, thanks for deciding to no longer participate in profit-driven evil *and* for stepping up to say what you’ve seen and done. You’re doing pretty much the only thing a good person *can* do when they realize they’ve been doing wrong.

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  13. Registering immense appreciation for this article and the ensuing discussion. In the late 70’s, early 80’s, I had a low level job at a nationally famous retailer whose products were propelled by advertising. Even promoting lingerie that way bothered me: too many claims over the top! I never would have lasted in the medical merchandising of America. This system has Got to go. Let’s start (again) with banning TV ads.

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  14. My heart breaks again. I knew about the false advertising. Exposes have been emerging over the years, especially in the early 2000s. But this one elegantly and objectively details the explicit rot that is the mental health system – that advertising created – that doctors believed in – that the system is built on – that greed made. I think the gut punch was reading about Ken’s death and so clearly understanding the exact way he was used. And then to be used here again? What does confession mean without taking responsibility? I am not sure that the author is fully cognizant of the ramifications of what she has written. I am not sure the author fully grasps the cost in human lives, in hopes, dreams, aspirations. I am not sure she fully realizes the agony of forced medication and restraints and locked doors when one says “I refuse. The medication is making me sicker.” I was the first project manage for the GA Certified Peer Specialist Project, hired in 2000 by Larry Fricks. I was taught by Ike Powell and in turn we were co-trainers for the Project. This work saved my life. Peer supporters undid so much of the damage advertising created to keep people disabled and dependent on their doctors and meds. I carry Larry and Ike’s message today: We are not disabled by illness, but by beliefs. At least I can say that after reading this article most people will now understand where those beliefs about disability come from. Finally, let me say, this article needed to be written with profound and authentic empathy and I am so, so heartbroken to be clobbered over the head with its truth.

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  16. Ms. Green,
    Thanks for the article.
    I know Risperdal.

    I hope you reach a much wider readership than MIA…. not just former, damaged targets.

    Publicly addressing your participation in the horror-show that is Pharma/APA power is appreciated, necessary…and so far, futile

    You have the bona fides to be effective in (this) messaging.

    As you know, Pharma plays the omni-directional, long-game strategy

    I hope you bring commitment & stamina.
    So far it’s been like bringing (metaphoric) guns to a nuclear holocaust.

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  17. I could but I no longer pretend I am not angry, when I am angry. I am angry at all the characters who used deception to further their own agendas and thus contributed to the destruction of innocent lives—like my own.
    I also though find it helpful to discover through reading insider confessions how it happened. So I thank you Lydia. It’s the least you can do but it is also a great deal!
    I would also find it very very healing to hear an apology. It would mean so much to me. I know it’s too much to hope for. But I do not think it is out of bounds to ASK for an apology from people who have hurt you, even if they didn’t mean to hurt you. I’m not asking anyone to ruin their lives like mine was ruined—just a simple, “I’m sorry”.

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    • I’ve been doing a lot of research lately into narcissism, which does describe most of my former “mental health professionals,” and their pastor and bishop “partners.”

      And I will say, don’t bother waiting for an apology from the systemic narcissists. Since even if it ever does come, which it likely will not, it won’t be a genuine and sincerely given apology.

      But as one who is a stickler for justice, who is supposed to be a “judge,” according to 40 hours of unbiased psychological career testing, I do most definitely understand your frustration, Blu.

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    • I am also a huge fan of apologies, specifically sincere ones. They can help a lot, but as you mention, they don’t happen nearly enough. I think a big reason for that is that apologies indicate some level of responsibility which opens people up to lawsuits, specifically corporations.

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  18. Once again, I read about the deceit of drug companies, but more importantly, the greed of psychiatrists who prescribe dangerous drugs. I try my best to inform clients who are considering seeing a psychiatrist for help, but frankly, the power of the white coat and advertising wins almost all the time.

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  19. Thank you, Lydia. I know from the personal experience of sharing a short testimony about the death of our youngest daughter that the reactions here can be surprising and difficult and unjust when an ignorant critic wants to satisfy their own “lust for blood”. How hypocritical.
    However, the passionate replies to your testimony arise from the legitimate NEED for justice. As you know, we can’t pretend our children haven’t endured living nightmares or died unjustly due to the power imbalances, and yes, that includes a parent’s regrettable mistake which engages the ratchet-like psychiatric system that “won’t let go”. Thank you, for your intention to wrestle with this terrible reality, come what may. It is noble to “unearth” the truth.

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  21. Thank you for your honesty and vulnerability. I fell into a corporate raider, ruthless environment in the 1990’s-2000’s and can relate. What strikes me is the doctors that were so anxious to get into the booth at that conference; in a way, it’s abusive, self-harm! Physician, heal thyself!?

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  23. Corruption in the advertising industry shouldn’t surprise anyone.

    What surprises me is how easy it is to mislead the majority of psychiatrists.

    But then I remind myself that anyone fluent in medicalese can fool just about anyone.

    And really, what else can you expect from a group that relies on DSM, which, in the final analysis, is where accountability actually belongs.

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  25. Enlighten me why Risperdal isn’t a banned drug?
    It was developed to replace Hadol to become the go to drug for so-called schizophrenia, a very misunderstood personal experience.
    Instead it branched out to be the first approved drug for young autistic kids and for the new ginned up pharma induced bipolar child.
    How is it that all of a sudden it’s deemed to treat behavioral problems, psychological issues, and developmental disorders?
    Really, how is that possible? Sounds like a miracle drug that every parent should have their medicine cabinet.
    But far from it as many have found out the hard way.
    How many people are willing to spend the time absorbing this expose or are they still stuck in magical thinking that a pill will fix their kid?
    I would hope by now most would know psychiatric interventions are laden with dangerous lies and false promises.
    Lastly, how come psychiatrists don’t show up and start their day correcting societies common misunderstandings that have been marketed to them? Isn’t it within their profession to be the ones responsible?
    First do no harm!
    How upsetting to personally watch this play out 2+ decades later and still no safeguards or policies to keep their patients up to date and protected!
    The American Psychiatric Association ‘guild’ continues to be tight and impenetrable!
    Enter at your own risk!

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    • It is extremely disingenuous for psychiatrists to blame patients’ misconceptions about drugs and “diagnoses” on the pharmaceutical industry. They’ve been foursquare walking together the entire time since the DSM III in 1980. As for Risperdal, the “off-label” use of these drugs is rampant, for kids, the elderly, and even as an (PLEASE!) adjunct for “antidepressants!” Off label use is legal but needs to be reined in, as far as I’m concerned. It’s dangerous!

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      • I think the industry knows that they can run circles around everyone. They are not interested in humanity. Trying to be a parent and trying to understand all the subterfuge at the same time was a losing battle. I know this is simplistic. We shouldn’t have to fight these forces alone. One psychiatrist asked me why I thought the system seemed adversarial. What a faker.

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  26. Reading the way Risperdal was aggressively marketed in the early-mid nineties reminds me of how spellbound I once was by psychiatry’s drugs and charismatic salespeople, i.e., psychiatrists.

    It was in 1994 when a one of my areas “most esteemed” psychiatrists sold me on trying what I think was Risperdal. Never mind the fact that I had no meaningful history of psychosis.

    I recall being amazed at her failure to comprehend the post-traumatic effects of my having recently endured a torturous 6+ years of severe Tardive Dyskinesia from the inappropriate prescription of Thorazine for what was just a lot of post traumatic stress/anxiety from having survived a serious auto accident I now attribute to the Thorazine I was taking at the time.

    The understandable anger at having lived through an severe case of
    TD, and essentially left to deal with on my own, made absolutely no impression on her whatsoever; she was truly bewildered.

    In the brief span of the next 3-6 months, my weight ballooned to almost 200 pounds from the Risperdal. And when I told her that I was sure it was the Risperdal that caused it, all I got from her was a pat denial as she quickly made a show of flipping through the DSM.

    Not long after that, I saw my GP, who thankfully was honest enough to say to me, “You’re right, it’s the Risperdal that’s made you put on all that weight. You can lose it if you go off it, but it will take a long time.”

    This goes to show the incredible power psychiatric spell-binding.

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    • Correction:

      I recall being amazed at her failure to comprehend the post-traumatic effects (outrage, despondency, (so-called “depression”) of my having recently endured 6+ years of severe Tardive Dyskinesia from the inappropriate prescription of Thorazine for what the psychiatrist didn’t realize was actually just post-traumatic grief/anxiety/stress from my having survived a serious auto accident I now attribute to the Haldol I was also inappropriately prescribed by another psychiatrist for what was also a lot of anxiety from my having been involuntarily hospitalized for the psychotic depression that I NOW KNOW FOR SURE was brought on by birth control pills prescribed to me in my late teens for excruciatingly painful menstrual cramps.

      “How birth control pills affect the brain”, by Zara Abrams, APA.org

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        • Thank you, Carol. It sounds like a very interesting book. I think there are many critically important differences between the sexes based on the difference in hormones. I see them as secret elixers to life in that they control metabolism, which is everything, really, the very process that keeps the human body and mind functioning optimally, or not.

          My run in with gynecology taught me more than I needed to know, namely that my familiarity with my own hormonal fluctutions were a much better source of information that what the doctors knew at the time.

          I would be interested in talking to you as well, but my information is mostly based on my experiences, meaning I’m not the scholar you seem to be. I just wanted you tell you how much I identify with what you and Catherine went through together because my mother and I experienced something similar.

          Mostly I just wanted to reach out to you and let you know how much I feel for you as her mother.

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  27. To those expressing anger towards Lydia: your anger is misplaced. Lydia is currently using her advertising skills to promote public health. I direct PharmedOut, a project that promotes rational prescribing, and Lydia has done some work for us, mostly on a volunteer basis. We rely on whistleblowers to expose corporate misdeeds; they serve a vital role for all of us. Whistleblowers are brave people who often lose their former colleagues, who feel betrayed. Lydia should be celebrated, not attacked!

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  28. Wow, Lydia. Thank you for this article and expose. There is so much to say about this. I first came across this yesterday and briefly skimmed it. Even just skimming it made me think about it all afternoon. Then I read it.

    I was already planning on sharing it on social media — with some small selections from the article — so that people can read my post and get some key nuggets even if they don’t read the article.

    For me, this will be a very useful tool to share with people who use the phrase, “Follow the science.” And it is obvious that many of those people believe that what they have learned from mass media is tied to science.

    Over the last few years, I have often said that the science they are following isn’t nearly as scientific as they would like to believe, but of course, that often gets dismissed.

    Do I believe that we should “follow the science?” Yes. But that means truly listening to what the data is trying to tell us. I have a master’s degree in statistics and have often used the phrase, “Too often we use statistics the way a drunk uses a lightpost, for support rather than for light.”

    When I first skimmed the article, I paused at the section about NAMI and the sentence: “With support from Janssen and other atypical antipsychotic manufacturers, NAMI began advancing a powerful message: schizophrenia wasn’t caused by trauma or poor parenting—it was a biologically-based brain disorder, treatable with medication.”

    While I believe that the immediate response of “blaming the parents” of people diagnosed with schizophrenia is not appropriate (or so-called bipolar or schizoaffective or psychosis), dismissing trauma as a major contributing factor and how that trauma is stored in a person’s system is exceptionally problematic. And that trauma *may* be related to parents or the family dynamic.

    In other words, I understand why parents involved with NAMI wanted a better model, but the biomedical model and “illness-based” model wasn’t it.

    Thanks again. I see this article as a valuable tool. I am reminded of something my high school physics teacher said in one of the first classes at the start of the school year. “One of the hardest things to do is to ‘uneducate’ someone so that you can re-educate them.” That is, it is very difficult to retrain someone who thinks they have been trained properly to begin with.

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    • I like your nuanced approach and your background in statistics. I hope that you continue to write and apply your multi-factorial approach to tempering the discussions having trigger words that seem to be too-often generalized, rather than nuanced, and misapplied. I think we could have more impact if we would handle the hot button words and phrases more carefully, with more context. We need to assume that many of us have gaps in our understanding, different amounts of ignorance and knowledge, and memories like swiss-cheese, yet we can still be useful to spread awareness and garner support to reduce psychiatric harm, however that is accomplished.

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      • Thank you, Carol. I’ll just say that sometimes I am more nuanced than other times. 🙂 But I try to use it for effect depending on who I am talking to and the environment I am in. At some point I want to pull together the multiple ways that statistics and math concepts are violated and ignored. For example, the biomedical model is so ridiculously overly-simplified and ignores potentially important factors, including past trauma (s) — including birth trauma, current environments (social, family, work, etc), intergenerational trauma. That should be criminal. In fact, I could argue that it is a “crime against humanity” to ignore key factors just because they are inconvenient to deal with.

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  30. I completely agree with you. That’s a good idea to begin that review of how the statistics are misused. Dr. Peter Gotzsche has written a lot about that and also recently in MIA. You can search his name on the homepage of this madinamerica.com and his articles should pop-up. I hope you stay involved.

    Trauma is huge and should be considered along with the other experiences of everyday living such as stress loads, medical issues, and everything that goes in the body , whether consumed, breathed , absorbed or injected.

    Why does the word “medical” trigger people so much? Where is the nuance? Example: In addition to trauma , psychosis can be caused by: viruses, parasitic infections, antibiotics , the cancer-fighting drug interferon, an ovarian teratoma, vitamin deficiencies, bacteria of which STDs were said to account for most psychiatric hospitalizations before the advent of antibiotics according to a Dr. Guttmacher, and from metabolic diseases and vulnerabilities which I hate to say are related to genetic problems. One such genetic vulnerability causes a higher risk for stress and/ or infections of any sort to trigger a psychotic mania due to cortisol fluctuations that perturb the HPA axis.

    If medical causal factors are not identified, the patient will suffer longer and be harmed by the dangerous use of antipsychotics as First Line Treatment. This happens all the time and no one is keeping track of this. This medical neglect has been observed by members of the Family Alliance for Mental Health Recovery, by members of the Mad In America Family Support Group and by countless numbers undoubtedly.

    The psychotic mania should be treated with the best treatment available to resolve the underlying medical issue in a supportive environment with appropriate safeguards, I believe. What should we substitute for antipsychotics to prevent the powerful psychotic patient from hurting self or others? What is the alternative to antipsychotics when the propensity for harm to self or others persists? Who should determine the risk for harm, how, and where/in what setting?

    We need to be painfully honest with ourselves first about how to make progress in this fight to humanize the societal response to those suffering with psychosis or mania, in order to be taken seriously by all the stake holders and the power-holders.

    I have always assumed that a Functional-Holistic paradigm of care would include A History of Trauma in the Differential Diagnosis. Any patient may have multiple factors of etiology such that healing and recovery would also require multiple therapeutic factors.

    BTW, speaking of Etiology and Differential Diagnosis, genetic information appears to have both helped my family and hurt my family, depending on WHO was providing the care. Any tool can be used for good or evil. A hospital dismissed our genetic testing results, but later may have exploited the data, which they would not openly endorse, for their own research agenda.

    By comparison, the out-patient Holistic-Integrative psychiatrist of my younger daughter convinced me of her benign intentions. I found out about the genetic testing five years after the Trial and Error method of toxic psychiatric drugging almost killed my older daughter via Neuroleptic Malignancy.

    Speaking of trauma, it was very traumatic for my younger daughter and the rest of the family to witness how her older sister suffered from the dangerous, outdated, medically neglectful, damaging paradigm of toxic allopathic care.

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      • “What should we substitute for antipsychotics to prevent the powerful psychotic patient from hurting self or others? What is the alternative to antipsychotics when the propensity for harm to self or others persists? Who should determine the risk for harm, how, and where/in what setting?”

        Films by Daniel Mackler on Recovery from Psychosis/Schizophrenia:

        1) “Coming Off Psych Drugs: A Meeting of the Minds”

        2) “Open Dialogue: An Alternative, Finnish Approach in Healing Psychosis”

        3) “Take These Broken Wings: Recovery from Schizophrenia Without Medication”

        4) “Healing Homes: An Alternative, Swedish Approach for Healing Psychosis”

        Blogs from MIA’s Reimaging Healthcare:

        1) “Berlin Manifesto for Humane Psychiatry Released”

        2) “Open Dialogue Approach Reduces Future Need for Mental Health Services”

        3) “The Struggles and Promise of Open Dialogue in U.S. Mental Health Care

        4) “Intentional Peer Support: Creating Relationships, Creating Change”

        5) “Prescripticide: A Proposal for Action and a Request for Your Help”

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    • Carol, Thanks for your indirect encouragement to write an article for MIA. Statistically-speaking the biomedical model is so ridiculous, it’s hard to believe it is so dominant, though part of that is because at first glance, it is so “reasonable.”

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    • “Why does the word “medical” trigger people so much? Where is the nuance? Example: in addition to trauma, psychosis can be triggered by: viruses, parasitic infections, antibiotics, the cancer-fighting drug interferon, an ovarian teratoma, vitamin deficiencies, bacteria of which STDs were said to account for most psychiatric hospitalizations before the advent of antibiotics according to a Dr. Guttmacher, and from metabolic diseases and vulnerabilities which I hate to say are related to genetic problems. One such genetic vulnerability causes a higher risk for stress and/or infections of any sort to trigger a psychotic mania due to cortisol fluctuations that perturb the HPA axis.”

      If medical factors are not identified, the patient will suffer longer and be harmed by the dangerous use of antipsychotics as First Line Treatment. This happens all the time and no one is keeping track of this.”

      Carol, I’m very much appreciate you’re mentioning these things because I think it’s an area that’s seriously overlooked in today’s medical practice. And as for why the word “medical” is so triggering… from my perspective it’s very complicated.

      I remember the way life was before the advent of “bio-psychiatry”. Back then, pediatricians, family physicians, general practitioners, internists, gynecologists and the rest weren’t primed to diagnose people with psychiatric “disorders” via checklist and then scribble prescriptions for psychiatric “medications”. They would ask questions about your life and would usually only suggest a psychologist if the patient asked for a referral. The last thing most would do is send you to a psychiatrist. Then 1980 rolled around and everything changed.

      The reason I get so freaked out whenever I hear the word “medical” is because it’s so badly mis-used, which paradoxically—and tragically—takes away from the extremely important medical information you so eloquently bring attention to.

      Simply put, I object to the way the meaning of the word “medical” has been so badly misconstrued that most medical doctors have no idea they’re brainwashed to believe that psychiatric diagnoses are real diseases “treatable” with drugs they believe are harmless.

      I think the emotions and the physical body influence each other in incredibly subtle ways. I also think people know this intuitively but are trained to bypass the signals we get from each. I think variations, and even periodic “imbalances” are entirely normal, like blood pressure, heartbeat, body temperature, blood sugar and hormone levels, etc.

      You poignantly ask, “Where’s the nuance?” Well, it seems to have left the traditional doctor’s examining room, that’s for sure. Between insurance companies that no longer reimburse for longer consultations and the drugs reps’ sales pitch, it seems that the truly medical has left medicine.

      My father had type 1 Diabetes. Every so often he would fly into psychotic rages that absolutely terrifying. My gut told me his diabetes were part of the cause. With a glance I was able sense it was about to happen. The rest of my family was caught off guard. The other reason for his outburst I knew were caused by him taking handfuls of pain killers we had on hand in our home from the samples he had in his office where he worked as a psychiatrist.

      As a teen, my moods very affected by my monthly cycle that gave me intolerable pain for which birth control pills were prescribed, which took away the pain, but made me very depressed. But I refused to see a psychiatrist as the GP had suggested because I knew it was from the artificial hormones coursing through my body. Not one doctor believed me. But I’m sure this is where my odyssey in the psychiatric system began.

      I hope nothing I’ve said in this post has triggered you in any way, but I’m very sorry if it does. You have suffered a loss impossible to imagine.

      Mental health is such a confusing combination of factors. But I’m sure it’s correct to at least say that we live in an age of extremes. All I’m really trying to say is how sorry I am for detracting in any way from how crucially informative the word “medical’ can be when used in the right way the way you have done.

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    • … and I have since learned the following about Type 1 Diabetes:

      “It can contribute to episodes that resemble psychotic rages, though it’s not typically classified as a direct cause of psychosis. Here’s how it can happen:

      Blood Sugar Fluctuations and Behavior:

      * Hypoglycemia (low blood sugar) can impair brain function, leading to confusion, agitation, impulsivity and even aggression

      * Hyperglycemia: (high blood sugar) can also affect mood and cognition, sometimes causing irritability and poor decision-making

      * These fluctuations can result in what some call “diabetic rage”, where a person may act irrationally or aggressively due to impaired self-control

      * The stress of managing a chronic illness, especially one as demanding as type 1 diabetes can lead to diabetes distress, which is linked to emotional dysregulation and heightened negative emotional experiences.

      IMPORTANT DISTINCTIONS:

      * While psychotic rage is not a standard medical term, extreme emotional outbursts or aggressive behavior can occur due to neurological effects of blood sugar imbalance.

      * These episodes are typically temporary and reversable with proper blood sugar management

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    • Carol, When I responded earlier, for some reason, I didn’t see your full comment. As I read it just now, I chuckled because in a way, you answered your own question without realizing it.

      I am copying the top part of your comment here and adding some comments to it:

      C: Why does the word “medical” trigger people so much? Where is the nuance? Example: In addition to trauma , psychosis can be caused by: viruses, parasitic infections, antibiotics , the cancer-fighting drug interferon, an ovarian teratoma, vitamin deficiencies, bacteria of which STDs were said to account for most psychiatric hospitalizations before the advent of antibiotics according to a Dr. Guttmacher, and from metabolic diseases and vulnerabilities which I hate to say are related to genetic problems.

      P: What you describe is how evaluations *should* be made. Yet as I mentioned in an article I wrote a couple of years ago, I was diagnosed as having bipolar “which has no cure” based primarily on behavior and speech patterns without any consideration of personal history and past trauma, work environment,, etc. And too often, that is how diagnoses are made — without adequate consideration of multiple factors. The initial reaction is too often to reach for the prescription pad first, which is why I call professionals who do that “professional drug pushers” — and that behavior is directly related to the activities described in this article.

      Too often the “medical” approach isn’t about curiosity as to what the person is experiencing and how they got into that state. It is rather about analyzing behavior (per the DSM, which is also not scientific in nature — James Davies book “Cracked” addressed that) and then slapping a “disoder” label on the person involved in order to fit that person into the model that the professional believes in — rather than looking for the cultural, trauma, or social “disorder” that a person has been dealing with.

      C: If medical causal factors are not identified, the patient will suffer longer and be harmed by the dangerous use of antipsychotics as First Line Treatment. This happens all the time and no one is keeping track of this. This medical neglect has been observed by members of the Family Alliance for Mental Health Recovery, by members of the Mad In America Family Support Group and by countless numbers undoubtedly.

      P: Yep, this answers your question. Medical neglect much too common which is why a “medical” approach triggers people.

      C: The psychotic mania should be treated with the best treatment available to resolve the underlying medical issue in a supportive environment with appropriate safeguards, I believe.

      P: Though what you call “psychotic mania,” which carries significant stigma, could be described in mystical terms as well related to “spiritual awakening” or “spiritual emergency,” what you state is true. Unfortunately, as I mentioned above, people too often reach for that prescription pad without any curiosity about the person’s experiences that often accumulate over time.

      C: What should we substitute for antipsychotics to prevent the powerful psychotic patient from hurting self or others? What is the alternative to antipsychotics when the propensity for harm to self or others persists? Who should determine the risk for harm, how, and where/in what setting?

      P: From this comment, I would guess that you haven’t read the book “Mad in America” which describes several different approaches related to compassionate care, including Soteria houses and so on.

      One thing I want to mention here, though, is while your question is fair, too often people experirencing “psychotic mania” as you describe it are NOT a danger to themselves or others. There is a propensity for family members or others to *assume* they are. That is paranoia, but not the paranoia of the person in crisis, it is paranoia by the people around them. This ties with polyvagal theory and disregulated nervous systems, not just of the person struggling but with dysregulated nervous systems of the people around them.

      I launched a YouTube channel a couple years ago (Bob Whitaker agreed to be my first guest, for which I am VERY thankful.) I also had a chance to speak with Phil Borges who created the documentary “Crazywise” — which I recommend if you haven’t seen it.

      In speaking with Phil, I forget if it is in the video or if it was after I stopped recording — though I think it is in the video, that he mentioned that for one of the people the film follows, the man’s mother was highly fearful of what her son was facing and what he was doing.

      In the video, at one point, he says “Fear is the enemy of the process.” He nailed it. A person in that broken open state (which I call a collapsed and fractured ego) is even *more* sensitive to energies around them — and fear doesn’t help. The point in the video is at https://www.youtube.com/watch?v=av63-7hAQHU&t=1766s.

      As mentioned above, I have had a few articles published with MIA. Here is my author page:

      https://www.madinamerica.com/author/pkolpin/

      The article on burnout is worth taking a look at. That is what led to the breakdown I endured. And initially it was a breakdown — sure, a severe one, but how poorly that was handled led to much worse states of consciousness for me to endure — much worse. And that should be criminal.

      There are plenty of people out there who have not only survived such an ordeal, but have actually *thrived* afterwards. Those folks should be asked what helped and what hurt.

      Instead, the general public is led — misled — to believe that all such experiences are to be pathologized as diseases and illnesses rather than breaking out of past trauma or unhealthy situations.

      As I say in my ebook “Musings from a Kintsukouried Mind” — “The people who make the journey are in the best place to define the landscape and terrain.” Too often, those people who struggle with non-ordinary states of consciousness have their experiences dismissed entirely and are left to their own devices, which *can* (but also many not) lead to more dangerous results. In addition, a better understanding of these types of journeys and what is likely to help and what is likely to harm is not achieved.

      All of this actually ties in with another statistical concept — the massive amount and sources of variability to try to deal with — variability of the experiences, variability in how people are trained in dealing with non-ordinary states, and also variability in people’s beliefs about such experiences.

      Just my take, of course.

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        • And yet one thing I learned a few years ago is that you cannot go from dorsal vagal (the shut down or “freeze” mode) directly to ventral vagal (the “good” and functional mode that is related to regulated). You have to go through the sympathetic mode of the “fight” which I consider the kind of emotional and “power” stage. And from what I experienced in 1998, there is so much more power tied to that state as the energy trapped in the shadow released and even the energy tied to the ego structured collapsed.

          Above were comments related to having a safe place to express that anger. I thought of John Weir Perry’s effort with Diabasis back in I think the 1970s. It was an efffort much like Soteria, but it had a specific “rage room.”

          In chapter 12 (entited “A Philosophy and Method of Therapy”) of Perry’s book, “The Far Side of Madness,” he describes “there should be a room on the service of creative expression.” He also mentions the value of music and specifically dance. He then says “The service should also have a room for withdrawal and quiet solitude” so an individual can concentrate on his “inner process.”

          And then he says, “There must be a room, too, for the free expression of rage, in which neither staff nor resident Individuals need fear the consequences of destructiveness as would be the case if the rage were expressed o nthe general service itself.” An attendant “could be present to relate to the Individual’s rage permissively without undue alarm and consequent suppression, and without applying the traumatic seclusion routine.” Some of that rage might very well be tied to what Carl Jung called the “collective unconscious” and “collective shadow.” That is what I hit and had to deal with in my own journey, and it was not at all easy. And the failures of the mental health system pushed me deeper into that quagmire.

          Ultimately, before polyvagal theory was a thing, psychiatrists like John Weir Perry understood there was a process involved and that the nervous system was involved. That book was published in 1974.

          He has another book that I have not yet read — “The Self in Psychotic Process: Its Symbolization in Schizophrenia.” That was republished in 2011. The original was from 1953 — long before the hijacking of 1980 with DSM 3.

          When I came across Perry’s work and that of Stan Grof and how that tied with Carl Jung and even Joseph Campbell, it was hard to not get angry — because they were “getting it done” with regard to trying to understand what people go through and developing comprehensive models related to those experiences.

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          • Thank you, Penni. You know so much!

            I know very little of The Polyvagal Theory, but I have heard of it, maybe from one of your articles.

            Yesterday I asked AI to explain it to me in a way I could understand. It was a lightbulb moment because it makes so much more sense than psychiatry’s focus on drugs.

            I think you are so right in that you can’t go directly from dorsal vagal to ventral vagal, that you have to go through the sympathetic mode of “fight”. Emotions (rage) needs to be felt and processed to get to the other side of it. Carl Jung and Joseph Campbell knew what they were talking about. I love the language Jung gave it: shadow, collective unconscious. It is a spiritual breakthrough.

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          • Also, from polyvagal, co-regulation is very important. I am pretty sure that is why efforts like Open Dialogue and Soteria Houses and Diabasis and also peer support programs can be quite effective. The person in distress is not being *forced* into specific actions, and to my understanding are not judged and coerced, which prevents co-regulation. Co-regulation allows the nervous system to feel “safe” (i.e. not judged, not “disordered,” not “manic,” not “psychotic,” etc.

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          • That makes so much sense. Not feeling safe puts anyone one edge, especially when it’s from another person in a position to judge or force you to do something. Just thinking about being judged or forced to do something makes me on edge, feeling the adrenaline flooding my system. It’s the way I always felt when I was in therapy, ALL THE TIME, and as soon as I said “screw this” my whole body started to relaxed in a way it hadn’t in years.

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  31. I appreciate the information here about the negative symptoms/positive symptoms scale. I hadn’t questioned this particular aspect of the picture and had been taught it as well as the ‘dopaminergic drugs cause more extrapyramidal effects’ lie in a psychopharmacology class in college. In retrospect there wasn’t a single piece of ‘science’ in that class that didn’t turn out to be a marketing campaign that was later revealed as hocus pocus to sell more pills and create lifetime customers, with and without consent. It all bumped with what I was being taught in neuroscience classes and you can understand why, the whole discipline in psychiatry is curated narrative construction that has almost nothing to do with science. I am also unsurprised by parents’ enthusiasm for a purely biological narrative. When something horrible is going on with your child the ONE thing you don’t want to believe is that it is somehow because of you, and the more fragile your ego the more vehemently you will cling to something that gets you off the hook. I saw it with my own mother, for whom biological psychiatry became something of a religion for which she was an avowed evangelist (as an aside she was also prescribed antidepressants—but off label to assuage the burden of dealing with her CHILDREN’S biological diseases!).

    But I am heartened by the parents on here who can see that the drug paradigm harmed their children and that their needs were in fact more complex, and who wanted to understand how to better show up for their child—though they got only deceit instead. My parents responded to each drug-related, coercion-related worsening by doubling down on the paradigm: if the worsening was endemic to the child and not iatrogenic it was only a shame that psychiatry had not ‘progressed far enough’ to help. With an attitude like that — and I am sure it is the defining attitude of parents who do not WANT to see the truth — there is no stopping the trajectory of progressive iatrogenic deterioration with no accountability.

    But this article illustrates brilliantly that ‘progress’ in psychiatry is not a real phenomenon, the progress of psychiatry is the ascendency of another prefabricated advertising narrative. And even the fall of one narrative is merely the rise of a competitor company’s narrative!

    As a very distant aside, I believe I am seeing something similar occurring with ozempic. Its uses are broadening out because ‘craving’ has been progressively redefined such that almost any behavior that one struggles with can be cast in terms of it, and ozempic can be prescribed. Not just that but it is a core part of the messaging that the cravings come back when the drug is stopped, so the drug has to be taken — you guessed it — forever!

    I can only watch as this similar looking horror show unfolds. I don’t know how prevalent this is but I’m sure ozempic will begin to be prescribed to children and adolescents with ‘craving related behaviors’ on and off label, ad Infinitum interminably, and a drug with such a profound effect on the body can’t help but cause long term developmental harms that can only be guessed at.

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    • Ryan, I didn’t consider Ozempic specifically, but I have shared this article with several friends or spoke with them about it. I pointed out that this article deals with one specific drug and the overall strategy involved throughout the whole process to promote and lead people to what the team wanted. I.e. statements like “Our next step was ____” or something similar.

      Then I point out that this describes what happened with that single drug. Think of all the drugs out there and how often this type of approach is used across the different drug companies — and that this has been going on for decades.

      I consider this whole “hijacking of science” in this way to be a “crime against humanity,” — and I know Peter Goetzsche has used that phrase before in interviews as well. A number of people have known for years how data is cherry-picked or experiments are designed to be favorable to the drug of interest.

      What struck me about this article was how methodical that strategy was executed — at least that is how it struck me based on how this article is structured and written. It lays out that first, they did this, then they needed to address this, next was addressing this other element. It is astounding.

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      • Yeah, remember Vioxx? Caused strokes and heart disease, literally killed people, but the drug company buried the data until they’d made billions of dollars on this blockbuster drug. No one went to prison for this, either. Not even sure they were fined. It’s not a rare thing.

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        • Wow — hadn’t thought of Vioxx in quite a while. I was even thinking of Zyprexa, which is mentioned in the article, and of course ties with Jim Gottstein’s work.

          I read “The Zyprexa Papers” a couple of years ago. A week later, someone I have known for more than thirty years called me fairly early in the morning, which wasn’t all that common. She had been diagnosed with schizophrenia back in the 1980s. She called to tell me that she had “the diabetes.” The timing of when she called struck me given that I had just finished the book a few days earlier.

          Yep. Crimes against humanity. Tragic there is no real accountability.

          And I forgot to mention that it is a result of what I have come to call “predatory capitalism.” I get that some may say that capitalism is automatically predatory, though I like to throw in the concepts of “predatory capitalism” and “responsible capitalism” at least as something to think about.

          And personally, I always love when the conversation turns toward money. After all, my name is Penni / penny.

          Steve, do you have a resource of how many drugs were taken off the market due to deaths, adverse side effects, etc? As I recall, there were others as well. This is stuff that the general public is not aware of. Just curious.

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          • I don’t know how many, but it’s not a trivial number. And of course many should never have been approved in the first place but are still in use today. That’s why truly informed consent matters so much these days. Even the doctors don’t seem to know all the adverse effects that are acknowledged, and of course the drug companies only publish the ones they are forced to by the FDA. We are really on our own when it comes to protecting ourselves against dangerous drugs, but most people don’t realize that until something bad happens, and sometimes it’s too late!

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          • And it gets even more dangerous when multiple drugs get prescribed so that interactions become something to be concerned about.

            That’s why I have told people that this article is very important, yet in the big picture, what was done specifically with Risperdal wasn’t even the tip of the iceberg. It was a snow clod on the tip of the iceberg.

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  32. Lydia, There have been comments saying any anger harmed patients feel towards you personally is misplaced or that our angry words are undeserved. I would like to know how YOU feel & think about anger harmed patients feel towards you directly.
    Do you feel it’s misplaced? Do you feel it’s inappropriate?
    When I hurt others I feel uncomfortable, ashamed, regretful and also defensive. That doesn’t mean their anger is misplaced or inappropriate. It could. Or some of it could.
    I’d like to know what you feel. And how you deal with these feelings.
    I am assuming writing these blogs and giving talks is how you deal. And that you don’t think our anger is misplaced or inappropriate. But I think I’d like to hear that from you. Either way. Instead of assuming.

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    • Blu, Robert Whitaker has asked me to write an article responding to several themes that have come up in the comments section of my Risperdal article: the sharp criticisms of my years in pharmaceutical advertising, and also the stories from members who trusted psychiatry only to feel betrayed. In my upcoming article, I’ll address people’s questions, comments, and concerns, as well as share more of my personal story, along with thoughts on how members of the MIA community could work strategically for change. I will not, however, be responding to each comment here individually, as mentioned in a previous post from Carol.

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  33. I find the comment about who is to decide how to protect psychotic people ‘from themselves and others’ irksome. If I want to harm myself that is my business, I have autonomy over my own body. If you are scared I want to harm you it’s on you to protect yourself against me and there are means of doing that. But you don’t get to take away my autonomy over my body and my being because you’re AFRAID I MIGHT harm myself or you. And if I DO harm you, then that is what the legal system is for. Foucault talks about how the whole mad category was originally about people who ‘resemble their crime BEFORE it is committed.’ So you see, that is what a comment like that is about: how to preemptively punish and restrain. It is clothed in terms of care but it is really a way of legitimizing CONTROL over a PERSON you fear. So it is about empowering you to constrain other humans because of your own uncertainty. And it is experienced by those other humans in this way — as an intrusive, humiliating, terrifying loss of autonomy over their own being, and they experience it in that way not because they are delusional but because that is the NORMAL and ACCURATE way of perceiving it.

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  36. Ryan, i appreciate that you are being open that you feel irked. I have skin in the game, too. The questions I asked affect everyone and they need to be addressed as humanely as possible. I do not like being misrepresented in a straw man argument.

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    • Carol, you’re probably right that I’m oversimplifying. My parents robbed me of my autonomy and set up a system of surveillance, claiming the ‘right’ to delimit and control what kind of care I could receive, and even submit me to it coercively. Whenever my mother was worried, the strategy was the same: invade my relationships and life without my consent, and leverage any way I was dependent on them in an attempt to achieve maximal control over my behaviors in order to assuage her fears.

      Perhaps, sometimes, her fears were reasonable ones that many parents share. Some of my behaviors were alarming and self-destructive it was legitimate to worry about the possibility of adverse outcomes. But the interventions were always about disempowering me and empowering her to control me in order to allay those worries. This lead to a cycle of humiliation, terror, and feeling despairing and trapped on my end. Seeing the lack of improvement under those circumstances always lead her to more of the same.

      I haven’t spoken to them for five years, and most of my problems are now gone. I have a compassionate trauma therapist who has seen me through all of the struggles my parents would’ve disempowered me to gain control over without doing so, and the result has been increasing freedom and functionality for me.

      However, I don’t see anywhere in your post that you are advocating engaging in anything like this. When I hear ‘protecting’ I hear ‘controlling’ but this is due to my own experience, and I can become quite defensive because of how awful and entrapping that experience was, and in an effort to quiet the part of my own psyche that still believes I need that kind of ‘care.’ Not all parents mean it that way or act on it that way, and it’s not fair for me to assume you’re talking about doing anything like what my parents did.

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      • Ryan, I saw your comment a couple of days ago but didn’t have time to create a thought out response at the time. I drafted something before I saw this comment, which clarifies things considerably. I thought I would go ahead and post it, though.

        In my own experiences, I found that some people around me were more “paranoid” about my state than I was. This included the people in the Employee’s Assistance Program where I worked began coercion tactics and threats of termination in an effort to shove me back into the same role that broke me open to begin with. They threatened to fire me from a job that contributed significantly to “driving me crazy.” Make sense of that.

        I went through four months of sheer hell due to the incompetence and bullying. At the time, I didn’t know what the DSM was or the biomedical model, so their tactics made no sense. To me, it was obvious my mind collapsed or imploded due to accumulated stress and increasing stress continuing to build. Yet their heavy-handed approach not only wasn’t helpful, it was harmful. After three months of that, I realized “This is why a person could go and harm other people. They ground me into the dirt.”

        Many people react out of fear and then project the worst case scenario onto a person who is distressed or even in crisis — which of course is only likely to worsen the situation for that person.

        A few years after the breakdown, my mom and I were talking and she asked me, “So, Penni, why didn’t you take a gun and go shoot a bunch of people?”

        I thought it was a fair question — a weird question, but a fair one. Someone later criticized her for even asking that, which I thought was ridiculous. I told her, “Well, for whatever reason, I don’t believe I have the right to take someone else’s life — aside from a situation of self defense. Yet I do reserve to take one life if I so choose and that would be my own.” I told her I wasn’t suicidal, but I reserved that right.

        With regard to actual threats to others, in my opinion, that is more murky.

        It’s one thing for someone to perceive a threat due to behavior, but where there is no actual threat. That is, a person might be loud or disruptive, but that person made no statement to someone nearby or interacted with them. Sure, an observer may be disturbed or fearful, but there was no actual threat. That is where I would say the observer — stranger, family member, or someone else is a bit “paranoid” themselves. I think that is what you meant by another person just being afraid that you *might* harm yourself or another. There is no real indication of that, it is merely the other person’s fear and then projection.

        However, if some type of threat behavior or statements are made — stalking, verbal threats of harm, etc — then, yes, that is where a person has the right to report that, call the police or take whatever action. That is where some type of threatening statement or behavior is involved, not just general fear due to behavior not involving the observer.

        However, the statement “if I DO harm you, that is what the legal system is for” is problematic for me. If some type of threatening behavior has been made, I am not going to just wait for someone to actually harm me, such as physically assault me, before taking action.

        And then there are tragedies.

        On August 1, in Anaconda, Montana, a man shot and killed four people in a bar. The story made national news. A week later he was captured.

        In a case like that, clearly waiting for someone to DO something that causes harm is too late for the people harmed — whether it is a shooting or even some type of physical or sexual assault.

        What is especially tragic in that case is that a few days after the shooting, the man’s niece told the media that members of the family wanted to get help for him, but they were turned away from the VA and the state mental hospital.

        From the article: https://www.msn.com/en-us/news/us/niece-says-montana-bar-shooting-suspect-was-turned-away-from-mental-health-treatment/ar-AA1K2GRf?ocid=BingNewsSerp

        “The VA turned us away stating that they weren’t able to help. The Montana state Hospital turned us away because they only accept patients who are court ordered which could not happen unless ‘He becomes a harm to self or others.’”

        “The system failed,” Boyle said. “We as people failed.”

        When I learned of that, though, I wasn’t convinced that the system would know how to truly help the man. Would there have been a trauma approach or a chemical approach? I feel that the niece had more faith in the system to be helpful that what many people experience. Especially since the man had been diagnosed with schizophrenia. Many people don’t realize that psychotic processes can also be tied closely with trauma and / or stressful factors.

        And yet now, four people are dead. And the rest of his life is forever altered. He is 45 years old. Five lives were ruined.

        Apparently, the man wasn’t a threat to himself or others, until something happened and then he was.

        I think a big part of the problem is the ridiculous biomedical model that focuses way too much on biochemistry without taking into account trauma history, current stress in life, grief and other factors that can overwhelm people. That overwhelm can lead to a severe stress breakdown like I had, but that is then treated as a permanent condition instead of a temporary period.

        I was glad to read that you have a trauma counselor. I wish more people knew to look for people trained in dealing with trauma. That doesn’t mean it’s always successful, but usually a person who has issues to work through is not medicalized as readily as when working with someone who focuses more on biochemical imbalance.

        With so many people trained to focus on behavior as related to biochemistry, temporary yet possibly debilitating conditions are not handled well.

        I wish the system were not so focused on labeling people as having “disorders” but instead looks at what is going on and has gone on in a person’s life. A trauma approach might have served the man in Anaconda reasonably well.

        A day or so after I came across this article, I saw an interview with Rob Wipond in my feed. His book is “Your Consent is Not Required.” One of the interviews I found interesting was with the folks at Medicating Normal — https://www.youtube.com/watch?v=VhqcABn1P3s. He has a YouTube channel and book about forced “treatment” and incarceration which ties in with the “threat to yourself or others.”

        Sorry to horn in on the conversation, but since I had drafted the content, I thought I would go ahead and share.

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        • Hi Penni,

          Thanks for your comment I agree most of this, and like your take on the polyvagal theory as well. People find certain behaviors distressing and imagine worst case scenarios and then react as if those were sure things, usually in ways that make the situation dramatically worse, because they don’t address the actual problem of the person who is suffering but merely empower themselves to control the sufferer’s behavior, which the sufferer usually finds to be terrifying and humiliating — precisely the kind of emotions that drive something like a psychotic break. This is why I say that a reaction like that is designed to allay the onlooker’s fears. The outcomes the onlooker is afraid of may or may not be likely but the disempowering response is still never helpful. And the outcomes are certainly not a sure thing, as cases like yours and mine prove: I and presumably you are no longer in crisis, and I achieved that by removing myself from people who probably had themselves convinced that their crisis-deepening reactions were saving me from crisis. There are ways to support people who are suffering without controlling them in ways that harm them, so that the suffering becomes a part of a broader development and the reactions build trust and safety. It simply involves admitting that you CANNOT control the other person and seeking to meet them where they’re at without losing your OWN shit.

          I think if we were honest we’d phrase things how I’ve been doing: the aim of controlling behaviors is to control another person’s body who’s behavior is distressing to you. We’re overestimating our own certainty if we claim the outcomes we’re afraid of are a sure thing, and also not being honest about the fact that we are trying to regulate our own anxiety by taking the autonomy of another. Then the harms of doing so are usually rationalized away: ‘I had to or you would have . . . .’ But surely we know enough now to say these rationalizations are not reality-based, given that coercive practices increase the very outcomes they’re ostensibly aimed to prevent.

          Still the story you relay about the man who actually did do harm to others and himself isn’t to be explained away. It’s true that there IS an increased RISK — which is different from certainty — when a person is in extreme states. Then the question becomes, how do we help such a person? If the states were fine for them and others the question wouldn’t be raised. It’s the same as teenage alcohol use: there are RISKS, so the behavior becomes a concern. Then again the question is, how do we address the concern? If the answer is to take away the person’s autonomy and control their body I still and will always maintain that is not ‘helping’ and is more about the needs of the person doing the controlling.

          As an aside, the treatments I was coerced into were always biomedical, and I mentioned trauma from day one to my parents. Not even from them: my brother was actively making attempts on my life as early as elementary school and I grew up in the presence of what I described to my child therapist as a ‘ticking timebomb.’ Is it any wonder I felt unsafe in my body given that was the situation I developed in? However, my parents always punished me verbally for bringing up trauma, and told me I was just making excuses and looking to blame them (even before I ever mentioned the trauma THEY caused through THEIR abuse). That is why when I hear and see parents downplaying the role of trauma and getting defensive when it’s mentioned, what I see is my own parents’ denial: denial that kept me trapped in a system to ‘help’ me — fix my broken brain or behaviors — that erased my experience to protect my parents from accountability or, even more I believe, the shame of confronting what they already knew deep down to be the case. I was only able to access trauma informed care because my grandma died and left me enough money to break free of my dependence on my parents and resist their control over what kind of treatment I got. So it’s worth asking, I think, even though yes my experience isn’t necessarily the rule: how much of the biomedical hegemony actually exists BECAUSE family members generally have the power over the vulnerable individual, and reject treatment that shines a light on their influence, and seek treatments that get them off the hook? Surely there are many reasons the hegemony of this approach exists, and parents are not responsible for the APA wanting to consolidate influence by ‘putting on the white coat’ or pharmaceutical companies lying for profit. But at least in my case the paradigms I had access to were a direct result of my parent’s denial.

          Heck, they even had a child psychologist explain to them that I was an anxious kid because I was being abused! At which point they fired him and took me to a biopsychiatrist! Who incidentally became a biopsychiatrist because his daughter became ‘mentally ill’ and he knew it ‘had to be biological because he was a great parent!’

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        • I’ll also add just to round out the comment, it’s human to get defensive when you feel you’re being blamed for something both when you do and don’t share in the responsibility for it, and I’m not saying every case of mental illness is a product of trauma and that every trauma is a product of certain ways of parenting. But it is also true I believe that abusive people will both downplay and deny their responsibility, and defend the necessity and even benevolence of their actions, and the current paradigm is very user friendly for such a person—or, in your case, a workplace. So I am saying that its dominance is likely at least SOMEWHAT a product of that.

          And to echo Carol, these kinds of issues aren’t ubiquitously non-biological. Here’s just a snapshot of the medical issues it turned out I was dealing with: hypoglycemia; adrenal fatigue; sleep apnea; mold toxicity; a vestibular imbalance from childhood concussions (from abuse). But the simple act of disease-ifying my ‘symptoms’ and behaviors was enough for my parents: they weren’t looking for these kinds of causes and didn’t have the patience for it anyway. They just funneled me into one quick fix coercive drug and behavior modification program after another, all of which only served to make all of these things worse. But doing so helped THEM cope with their anxiety by making them FEEL more in control and helped THEM cope with their shame by pathologizing me and gettin them off the hook entirely, not to mention erasing the trauma of the very interventions they were putting me thru.

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          • Thank you, Ryan for providing that extra information of how you were suffering before the toxic drugging….
            It is really sad and tragic how parents make mistakes or selfish decisions that hurt their children.
            I’m not trying to excuse the bad actions of parents, but I would also say that there are many “realms” of modern life that engender wrong decisions that cause heartbreak and cruelty.

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          • RE: : they weren’t looking for these kinds of causes and didn’t have the patience for it anyway. ” Regarding Patience, A Dr. J. Pentz lamented the “the rush to treat” with toxic drugs. Safer, evidence-based treatments and methods do exist and it should be mandatory to require their use to reduce the use of antipsychotics. Patients need protections from conflicts of interest.

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          • Hi Ryan, I scanned through your response to my comment a few days ago and wanted to reread it before replying. Thanks for taking so much time and effort to respond. There is so much additional material I could respond with, but I will try to keep it short.

            1. Yes, the effort to control the person’s behavior is highly problematic. Too often it causes more turmoil to the person involved or at least adds to the underlying subconscious material that is trying to erupt.

            2. And yes, involving the man in Anacondo who did become a harm to others and himself, that should not just be explained away. And yet, the overall process of his case history should definitely be examined and understood as to what didn’t work and how he was not “helped” at earlier stages of the process. Was trauma ever assessed? Was there trauma in his childhood? (he was a war veteran and had PTS — to my understanding). Was he treated biomedically? (I am guessing yes.) If so, what drugs and drug cocktails was he prescribed? And so on. There is much more to the story than what has been reported. And just incarcerating people in so-called “hospitals” isn’t the answer.

            3. Totally agree on the human nature to get defensive — I could even argue that is related to polyvagal in a way in that someone is a threat to the model a person has created for operating in this world.

            I don’t know if you are familiar with intergenerational trauma. I believe that is something that also deserves much more attention with regard to assessing situations and how that contributes to people ending up in crisis.

            I know of a Native American man who has a PhD in psychology, Eduardo Duran, who spoke of how with untreated trauma in families, it will take 7 generations for that to work its way through to resolution.

            One way he put it is that if you don’t deal with trauma in your own life and body, you should generate a family tree and look at your great-great-grandchildren and even later and ask which of them will deal with depression, which of them will deal with so-called “bipolar” or anxiety etc.

            In my own family, I could see the trauma and responses through the generations. One example, how my grandma disowned my dad for marrying my mom and how that drove his desire to be “successful” at his career.

            And the trauma doesn’t have to be within the specific family lines. Such as growing up during the Depression of the 1930s and being a young child during a world war. Children sense the anxiety and fear of the adults around them.

            5. Ultimately what is disgusting is that there were several approaches from the 1960s and 1970s that were more effective for treating “psychotic breaks” than what the biomedical model has provided. Even going back more than 100 years the compassionate care model described in Mad in America was more helpful — and humane.

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      • Thank you, Ryan, for explaining. I noted a while ago that articles often limit their main focus and only make passing reference to related issues. Since I often find my voice to be the only one speaking about the kinds of problems my family encountered, that’s usually where I expend my energy when I write.

        Parents Make Mistakes: I find myself trying to TRIAGE those mistakes given that psychiatry seems ready to catch and keep patients in their outdated paradigm that replaces authentic care with conflicts of interest and toxic drugs. You would hope that in a good care system that parents who were not sure how to help their child could speak with someone about what happened that led up to the present moment and what could be tried in order to prevent hospitalization. But , NO, if your family is already stigmatized, it seems unlikely that you will be allowed to say “No thank you,” and to leave with your child.

        We are familiar with the “catch-22” dilemmas that parents face. What could be more dystopian? Our country spends billions, but there is little interest in funding alternatives for those who may or may not be a danger to self or others. Don’t we need to expose that forcing toxic drugs May CAUSE people to become a danger to self or others? Or, is that strategy likely to be resisted by those at risk for toxic drugging? A transition period to a better way to respond to people is needed. Where should the necessary discussions take place?

        I think the second biggest form of resistance to a better system probably comes from the public’s impression that non-coercion really means “anything goes” , because when “anything goes”, there is societal entropy and services for maintaining a healthy environment break down and then “NOTHING actually Goes”. The poor are usually hurt the most by the economic breakdowns that result. Disease, crime, and fear thrive in areas of total economic collapse; society is left begging for a “Savior” to take over. Having said that, will there be another series of angry posts ? ….We do need the ability to talk with nuance about extremely complicated problems. Nobody wants to be exploited or have their life destroyed by power imbalances.

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        • “…; society is left begging for a ‘Savior’ to take over. Having said that, will there be another series of angry posts ? …. We do need the ability to talk with nuance about extremely complicated problems. Nobody wants to be exploited or have their life destroyed by power imbalances.”

          Carol, I want to be honest: your repeated calls for nuance feel hurtful to me. I understand that you may be trying to encourage thoughtful dialogue, but in this context, it echoes the way survivors are often shut down—especially by those aligned with the Mental Health Industrial Complex.

          When people express legitimate anger about being harmed, they’re frequently told to be more “nuanced” or “balanced”, as if our pain is too disruptive to be heard.

          My anger isn’t reckless or uninformed—it’s too rooted in lived experience, and it deserves space. Asking for nuance in the face of systemic harm feels like a demand for emotional labor that protects the status quo.

          Here’s some nuance you may not have thought of: anger is not the opposite of nuance; it’s often what makes nuance possible.

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          • Birdsong: I don’t mind if you ask me what I meant by nuance. I will try to clarify below, but that doesn’t mean that my words will be ok with everyone. I didn’t object to expressing anger. I empathized with it. When I speak of nuance, I am referring to dialogues that I hope will eventually occur where the mutual concerns can be discussed in a way that honors the needs of everyone so that we are all trying to reduce harm.
            For Example, it won’t work for many to have a stranger suddenly intrude into private space. Over the years , I’ve seen this occur in different types of situations, places, and involving different people. We have a survival instinct that is not wrong; it is how we determine safety or danger.
            If we can’t have some assurance of degree of risk , we will become neurotic. At the same time, If I don’t protect others from MYself, I am in the wrong. In this day and age, evolved wisdom that we usually referred to as common sense is not reliably taught. The most vulnerable and the weaker among us must not be abandoned to the lack of clarity and a void of good sense. A policy that doesn’t protect boundaries will violate the needs and purpose of the so-called “evolutionary nest” that is necessary for peace and for children to be spared from traumatizing events. Especially if we want don’t want to fall prey to psychiatry.
            I know there is a modern philosophy of interpretation of language that asserts that the speaker is responsible for the listener’s subjective interpretation of the message. ( Or something like that) Well, we don’t all subscribe to that philosophy . This is where I think that we have a choice to subscribe to good will and support each other to find our words.
            I think the idea of Emotional CPR is a good idea to promote even in these threads, but there will always be situations for which we are not prepared.
            I also acknowledge the systemic, structural and economic problems that aggravate the competing needs, which is why we need the nuance. We need to detail the problems so we can envision the solutions. We will probably need to allow for different types of solutions, because everyone will never agree. Coercing conformity of belief , thought, speech will still cause problems and suffering. This is just me, talking. I don’t expect everyone to think like me.

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          • I’m angry with all of you. for basically the same reasons. I lost one child. I still have a loved one who has to deal with the system. She has been terribly hurt, life turned upside down, youth stolen, happiest years of life desecrated by suffering from psychiatric coercion of the OUTDATED toxically, allopathic paradigm that thrives on medical neglect. We can be angry to our highest level along with God Almighty , but I am reminded that he has warned me in his word that I have to be careful how I handle my anger. God Almighty is angrier than we know, so I regret my cowardice in times of need and my failure to acknowledge him in the times when I made the wrong decisions because i was hasty due to my fear. That’s another good reason to promote Emotional CPR.

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          • Carol, I’m having trouble following your explanation—it feels a bit unclear to me.

            MIA is a public space, and with that comes a range of voices and expectations.

            I tend to speak plainly and name things as I see them. That works for some people, and not for others—and I’m okay with that.

            I’m open to suggestions, truly—but I need clarity. What you’ve shared feels muddled, and I’m not sure how to engage with it meaningfully.

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  37. This article is enlightening, but as a person harmed by off label prescription of atypical antipsychotics, a child at the time, an apology would honestly be nice. Especially since it sounds like this person was very directly responsible for this widespread harm.

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  38. Thank you for writing this article. I appreciate your taking ownership for your role and making changes when you realized your job did not align with your values. My daughter was prescribed Risperdal for autism when she was 9 years old – when she had no psychotic systems. The initial dose was ineffective. When we increased the dose, she started gaining 10% of her weight per week. I stopped that because I still wasn’t seeing benefits, just bad side effects. In fact, she tried a few psychiatric medicines that produced many side effects and no benefit. Fortunately, we left psychiatry after a terrible year. Imaging my shock when we tried a gluten free diet and I saw a benefit within 2 days and even more benefit with an artificial dye-free, low salicylate diet. Another game changer was adding magnesium glycinate as recommended by the MAPs doctor we found. My frustration is with an industry geared toward profits, not health. The psychiatrists at the practice we went to were so condescending. Psychiatry is based on observations, and they would disagree with my observations even when I showed photographs to make my point. Their livelihood and training was based on the drugs, not health – even if the drugs cause harm. I believe doctors should have accountability for the drugs they prescribe – for doing research before prescribing the drug and keeping track of their patients. My trust in medicine was damaged long before Covid because of harm my family experienced.

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    • Heather, your comment about condescending attitudes is spot on. I have long said “drop the condescension” — people are dealing with things on a daily basis that others cannot truly comprehend. So glad that you recognized it wasn’t working and that you were able to find something that did work better. Sometimes people recognize something isn’t working, but then finding something that dos work can also be problematic.

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    • Dr. Bangen, how would you account for all the terrible results described in the comments here?
      What profile or sub-population of patient in Germany are you describing? Did you actually know the patients who allegedly had great therapeutic results? Did you ask the patients to describe their health and quality of life after receiving risperdal? Were the patients living on their own and free of fear of retaliation for expressing any dissatisfaction with risperdal?
      Are you aware that often patients and even their care takers don’t even know that particular health problems are caused by the drug they are taking?
      Teens want to have healthy bodies. It is traumatizing and cruel for them to be forced to take drugs that make them “feel bad” and distort their bodies.
      I can’t believe you are serious.

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    • Dr. Bangen, I scanned through the page you provided. I must admit, I was a little startled at the description of term “somatic therapies” and including ECT with that. I guess that is technically correct since it does involve the physical body.

      However, these days, at least from what I’ve learned of somatic therapies, they are more about presence, mindfulness, and connecting to the body. This would include breathwork (such as that developed by Stanislav Grof), movement such as exercise and dance, meditation, and even titration of traumatic memories.

      In my experience, untreated burnout progressed to the point of a severe stress breakdown (or ego collapse). Mad in America article: https://www.madinamerica.com/2023/07/how-does-untreated-burnout-manifest/

      And then the lack of help from the mental health industry worsened my condition considerably.

      Since “burnout” isn’t a medical condition in the US, people’s needs are not addressed adequately.

      For my type of experience, assessing how a combination of past trauma AND a toxic work environment AND unhealthy dynamics of the swim team I was coaching would have yielded a better understanding of the burnout I was facing.

      I caught a documentary from DW a few weeks ago about burnout. https://www.youtube.com/watch?v=Q7zF0r0YnM8. In my opinion, much more needs to be done to understand just how stress — especially prolonged and unresolved stress — builds up over time and how it ultimately manifests if not dealt with. Just my take, of course.

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  42. Birdsong: I’m not sure what happened. I don’t have a problem with this space or with you or with Ryan. I think there is a misunderstanding here: I’m not sure what it is. Did you think I meant that I am mad AT everyone? No, not at all. I’m saying that I’m WITH you all in feeling angry about the harm we or our families have experienced. People can have their feelings and express them. I understand the dangers of being locked up just because of stigma and my family has suffered greatly because of it. …..I am hoping something good will result from Lydia Green writing her expose and the information that the survivors here shared with her. I’d like to keep the focus on that.

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    • Thank you, Carol. I’m relieved to know that you don’t have a problem with me.

      I, too, am hoping that good will result from Lydia Green’s expose and the information that the survivors here have shared. And you are right: that’s where our focus should be.

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  43. “we extended our influence far beyond the prescription itself—into the relationship between patient and provider” “provider!?” this is English!? To help the water put out the fire we called the match the provider, and then……

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    • I like the point about the match. I don’t use the word “provider” when it comes to people who get paid in the mental health system. Sometimes I use the term “professional” — but only because it means that they get paid. A friend of mine only uses the term “practitioner” because they are practicing.

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