Monday, September 20, 2021

Comments by Paul Baker

Showing 6 of 6 comments.

  • Dirk Corstens, chair of INTERVOICE responds to Allen Frances

    Dear Professor Frances,

    Thank you for your prompt response to the open letter sent to you from Intervoice. I would like to take this opportunity to continue the dialogue by offering some of my own reflections on your recent article.

    You reiterate that people diagnosed with schizophrenia need medication, because you witnessed “dozens of lives ruined” by people coming off it. That is what I also learned during my psychiatric training, something that was systematically confirmed by colleagues. Proceeding with that mind-set, I also saw dozens of people struggling to come off medication, often unsuccessfully – but mostly due to lack of support (e.g., “when you don’t take your medication we stop treatment”).

    After more than 25 years of experience working in clinical and social psychiatry, much reading, and much meeting and collaborating with many voice hearers, like Eleanor, who bravely took their own roads to recovery, I have definitively changed my mind and practice.

    My present mind-set – my most accurate and honest conclusion about psychosis and medication – is that I really don’t know who needs medication and who does not. I now believe it is better to prevent prescribing medication whenever possible.

    Modern psychiatric practice tends to endorse that people with psychotic experiences – or what psychiatrists believe are psychotic experiences – rarely get access to psychological therapies, and almost never as a first-response treatment (despite robust evidence that it works). Without much communication, and almost automatically, antipsychotics are prescribed. As you may know, in some European countries young patients are even prescribed three different medications at a time. Modern psychiatric practice is ruled by a fundamental fear of psychotic experiences and the objectively false premise that antipsychotics eliminate it. There is abundant reason to change this mind-set: communicate, care, and support. Wait, create a safe environment. Wait and listen. Try to make sense of experiences. Only prescribe low doses when necessary and stop when possible.

    The most important reasons:

    – The diagnosis of schizophrenia is scientifically unreliable (see for example Richard Bentall and Mary Boyle – not anti-psychiatrists, but research-psychologists who think in a scientific way) and more stigmatising than helpful. And of course, there are no specific symptoms nor tests that confirm if the diagnosis is accurate or not.

    – It is more and more uncertain that antipsychotics improve the long-term prognosis of psychosis. Many colleagues now state that the prognosis is not better or worse than before chlorpromazine was administered to patients. Functional recovery seems better when people don’t take antipsychotics or only in low doses (e.g., Harrow, Wunderink, Mosher, Ciompi).

    – There is good reason to believe that antipsychotics often do more harm than good (e.g., Breggin, Whitaker, Healy, Moncrieff, Lehmann).

    – There are a lot of promising alternatives: Open Dialogue, Soteria, CBT, psychosocial therapies, hearing voices networks, self-help groups, trauma-informed therapies. These alternatives have existed a long time; are well documented; propagate the cautious and sparse use of medication – and give good results.

    – More and more people who utilise psychiatric services openly state that they prefer a personal approach and need a say in their treatment and choice.

    It is really exciting and rewarding to operate as a psychiatrist from this alternative mind-set with people who report subjective experiences that overwhelm them.

    Eleanor’s story tells us professionals that meeting the person behind the symptoms, communicating about the real personal story, creating a safe environment, and supporting family members and other allies are the most fundamental ingredients of good psychiatric care and cure. She didn’t say what other people should do or not. It is not a story about medication at all – she only tells it didn’t help her, and after taking it for a while came off it. It is a story of struggle and hope. A real and personal story.

    I really don’t understand why you feel the need to censor her.

    Dirk Corstens, consultant psychiatrist

    Chair of Intervoice

    Dirk Corstens
    [email protected]

  • Some more supporters

    Ellen Duff – Psychologist in Clinical Training, Leeds Teaching Hospitals Trust: UK

    Gordon Kay – Senior Social Worker QLD Health; QLD Hearing Voices Project Manager; member of International Society for Psychological and Social Approaches to Psychosis AU; member of the newly formed Hearing Voices Network committee QLD: Australia

    Jenny Turner – voice hearer, Leeds: UK

  • The following have asked (or were accidentally omitted) to be added to the list supporters above:

    Valentina Alexa. Psychologist, Romania.

    Ron Coleman, voice hearer, trainer/consultant, Working To Recovery Ltd, Scotland, UK

    Sentamu Daniel, Facilitator of the Kampala Hearing voices Group, Kampala, Uganda

    Lucy Goldsmith, Doctoral Researcher, University of Manchester, UK

    Roos Korste, psychologist, in2mentalhealth, the Netherlands

    Alison Scarth, Senior Clinical Psychologist, North Community Mental Health, Southern District Health Board, Dunedin: New Zealand

    Dr Claire Seddon, Consultant Clinical Psychologist, Liverpool, UK

    Dr Neil Thomas, Director, Voices Clinic, Monash Alfred Psychiatry Research Centre, and Senior Lecturer in Psychology, Swinburne University, Melbourne, Australia

  • Excellent article Jacqui

    The shame of it is, in spite of the many efforts to connect with Oprah W. on the back of the open letter we sent her following the programme in 2009 about Jani, we got no response.

    We know they knew about our letter, it was even hand delivered to their office, but the influential O.W show didn’t want to know about the alternative story of hope and resolution we offered.

    For me one of the saddest things is the compliance of services and clinicians.

    Jani is still locked into the system, the diagnosis of SZ remains, the meds are still being given to her ….

    Time to relaunch this campaign?

    Maybe updating the open letter and send it to The Guardian would be one step we could take … If anyone would like to add their name in support of the letter please do …