This week, Mad in America examines three articles published online by the Journal of Humanistic Psychology. These three articles are part of a forthcoming special print issue on first person psychopharmacology (1PPP). The first article details 1PPP as a psychiatric drug trial method that prioritizes the lived experience of psychiatric drug use. The second explores the limitations of the current DSM diagnostic criteria for Major Depressive Disorder, especially its neglect of first-person experience. The third details a first-person experience of depression and antidepressant use under the current psychiatric paradigm.
Proposing First-Person Psychopharmacology as a New Drug Trial Framework
A new article published online in the Journal of Humanistic Psychology outlines the problems with the current paradigm of psychiatric treatment and details how 1PPP can address these gaps. This article, authored by Radslow Stupak and Pesach Lichtenberg from the Cardinal Stefan Wyszyński University in Poland, proposes 1PPP as a new kind of randomized controlled trial for psychiatric drugs that combines the rigor of traditional RCTs with qualitative data on the lived experience of psychiatric drug use.
Psychiatric treatment often relies heavily on symptom scale driven RCTs and reduces complex psychological suffering to biology. This overlooks the lived experience of psychological suffering and psychiatric drug use, depends on arbitrary measures that fail to capture what actually matters to patients and service users, and assumes treatment plans derived from group estimates will translate to individual recovery.
1PPP could address some of the problems with the current psychiatric paradigm. This method would replace diagnosis dependent RCT participant selection with inclusion criteria based on real life problems and situations faced by potential participants. 1PPP trials would last between 36 weeks and one year, significantly longer than the six to 12 week durations typical of current RCTs. This would allow these trial results to reflect real-world psychiatric drug use rather than the effects of the drug over an artificially short period of time before many of the worst negative effects of the drugs would be present. Data collection would primarily involve semi-structured interviews about the drug’s effects alongside a single visual quantitative measure of the positive and negative impacts of the drug.
A 1PPP trial would also use a four-group blinding design. One group would receive the drug from the beginning of the trial, allowing researchers to track the effects of the drug over months of continuous use. A control group would act as a baseline comparison of the natural trajectory of a specific kind of psychological distress during the trial’s conditions. A placebo-to-drug group would start the trial on a placebo, with researchers switching them over to the drug at a predetermined point without their knowledge. As the participants would already be accustomed to taking a pill and speaking to researchers, this would allow researchers to better isolate the drug’s effects from the placebo effect.
Finally, a placebo-drug-placebo group would begin the trial on a placebo, switch to the drug, then back to the placebo without knowledge of these changes. This would allow researchers to differentiate between withdrawal and relapse to some degree as many withdrawal effects would show up more rapidly compared to relapse, which would more commonly show up gradually as the participant was exposed to psychological stressors without the effects of the drug.
The authors describe three key challenges of implementing 1PPP drug trials. This method emphasizes that a drug’s effects are to some extent dependent on users’ environments and mindsets. This would mean 1PPP trials would face significant limitations in generalizability between different cultures, regions, socioeconomic classes, etc. This method would require significant resources for data analysis, including trained interviewers for the frequent semi-structured interviews and researchers for identifying themes in the interview data. This method would also risk researchers interpreting data through their own biases.
DSM-5-TR vs. Lived Experience: Critiquing the Superficiality of Psychiatric Diagnosis
A new article published online in the Journal of Humanistic Psychology examines the tensions between the diagnostic criteria for major depressive disorder presented in the DSM-5-TR and the actual lived experience of people suffering with deep, prolonged sadness. The author, Angelos Sofocleous from the National and Kapodistrian University of Athens in Greece, argues that a mechanical tally of behavioral indicators required by DSM-style diagnosis excludes and undervalues the lived experience of patients and service users.
Checklist-based DSM-style diagnoses primarily evaluate symptoms of depression in terms of severity and duration without considering environmental contexts and life events that act as stressors and triggers. This can result in pathologizing ordinary behaviors. Because the DSM does not differentiate between sadness with a cause and sadness without a cause, psychiatry runs the risk of diagnosing and medicating normal sadness. For example, the DSM-5 removed the bereavement exclusion from depression diagnosis. This exclusion said that clinicians should not diagnose depression within two months of the death of a loved one. This was followed by the creation of “prolonged grief disorder,” a diagnosis separate from depression that limits “normal” grief to one year. With the removal of the bereavement exclusion for depression and the creation of prolonged grief disorder, clinicians may now pathologize the normal grieving process.
Sofocleous argues that identifying depression by the presence of “depressed mood” is circular and far too broad. The DSM-style checklist for depressed mood reduces an entire spectrum of sadness to a binary “feels sad” or “does not feel sad” distinction. This clumsy way of categorizing sadness misses the nuance of the lived experience of “depressed mood.” According to the author, first person testimonies reveal that what the DSM would label as “depressed mood” could correspond to a number of real-life experiences such as loss of meaning, fatigue, intense overthinking, and feelings of detachment from one’s own mind or body. By neglecting the lived experience of “depressed mood,” current psychiatric paradigms threaten to flatten these different experiences into a single “sad,” “not sad” binary.
The author also points to problems in how the DSM deals with psychomotor disruption related to depression. Currently, the DSM-5-TR recognizes psychomotor retardation (slumped posture, slowed speech, difficulty performing daily self-care tasks, etc.) and psychomotor agitation (constant fidgeting, pacing, etc.) as symptoms of depression only if they are recognizable by outside observers. This ignores and invalidates invisible bodily and existential distress because it does not manifest in a way that can be observed.
Ignoring and excluding lived-experience significantly limits DSM-style diagnosis and psychiatric treatments based on those diagnoses. The author calls for a transition towards a more person-centered and collaborative approach in psychiatry where lived experience takes precedence over superficial symptom tallies to allow for a better understanding of how depression, and psychiatric drugs to treat it, truly affect patients and service users.
Lived Experience of Depression and Antidepressant Drug Use
A new article published online in the Journal of Humanistic Psychology reports one service users lived experience of depression and antidepressant drug use. Author Adele Framer, founder of the Psychotropic Deprescribing Council Inc. in the US, details her experience of normal psychiatric care for depression and provides insights into the history, marketing, and clinical practices of psychopharmacology.
Framer describes her childhood growing up in a dysfunctional, neglectful, and abusive family. Her parents had an antagonistic relationship and her home life was marked by financial anxiety. By the age of 10, she writes that “thinking of suicide was my security blanket.” It was around this time that Framer describes her first experience with psychiatric drugs when her mother struggled with withdrawal from Librium, an early benzodiazapine marketed as “mother’s little helpers.” The author traces the root of her issues with depression to her early troubled family life rather than “intrinsic flaws in my genetics or neurobiology,” which is largely the focus of normal psychiatric treatment.
The author was first exposed to antidepressants after reporting feelings of loneliness, anxiety, and isolation to her gynecologist. Her doctor labeled her experience as Premenstrual Dysphoric Disorder, a condition largely popularized by pharma industry marketing in an effort to increase sales of Prozac. She was prescribed Prozac, which she calls a gateway drug, and began to experience hypomania, an unusually elevated mood. She later experienced emotional complacency and sexual dysfunction as a result of the Prozac which ended her serious relationship. She continued taking Prozac for about two years until she tapered herself off without much difficulty over several weeks.
At the age of 50, Framer visited a doctor with complaints of social anxiety. She was prescribed Paxil, an antidepressant that had been heavily marketed as a treatment for social anxiety. After experiencing emotional blunting, complete loss of libido, lethargy, and apathy, she visited her doctor again with these concerns. After mocking her suggestion that Paxil could be causing these issues, her doctor agreed to switch her to Lexapro but did not suggest a cross-taper. This resulted in withdrawal and serotonergic overdose, a potentially life threatening condition when the body has too much serotonin. Framer reports feeling nervous, disoriented, dizzy, shaky, and sweaty. When she complained to her doctor, who she later discovered was fraudulently billing her insurance for psychotherapy, she was kicked out of his office. She found another doctor that again prescribed Paxil and decided to discontinue her antidepressant use after a year of emotional blunting and sexual dysfunction.
Her attempt at discontinuation led to protracted withdrawal syndrome that lasted for 11 years. Her symptoms included “brain zaps,” depersonalization, derealization, extreme terror, severe ear-ringing, sexual dysfunction, emotional blunting, memory loss, and the loss of the ability to form mental imagery. Her doctors dismissed her concerns of withdrawal, even when presented with medical journal articles, framing her symptoms as relapse. Framer notes that overall, she lost 14 of her most productive years to active psychotropic drug treatment and protracted withdrawal.
As she could not find help through mainstream medical institutions, Framer immersed herself in scientific literature related to psychopharmacology and withdrawal. She began authoring major publications on psychiatric drug tapering and protracted withdrawal syndrome and founded the Psychotropic Drug Deprescribing Council in 2023.
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Framer, A. (2025). First-person psychopharmacology: This Is Normal Care. Journal of Humanistic Psychology. (Link)
Sofocleous, A. (2025). Major depressive disorder: From accurate diagnosis to effective treatment. Journal of Humanistic Psychology. (Link)
Stupak, R., & Lichtenberg, P. (2026). First-person psychopharmacology (1PPP): A new way forward for Clinical Trials. Journal of Humanistic Psychology. (Link)
