Thursday, March 23, 2023

Comments by Robb3

Showing 43 of 43 comments.

  • This is heartening news, I hope it is another step towards a more cautious and judicious use of antipsychotic drugs.

    I think the difficulty is having a culture where reducing dosage of antipsychotic drugs is acceptable. Such a culture can be achieved through the framework of using approaches such as Soteria houses, Open Dialogue and other non-drug ways of supporting a person in psychosis. The important aspect for better outcomes seems to be lesser use, specifically, of antipsychotic drugs. It is very important to support professionals to feel ok about using less antipsychotic drugs for shorter periods.

  • This is a top article, thanks Sharna.
    Epigenetics explores changing genetic expression and this surely provides hope for treatments and understanding at a deeper level of the person and their environment? I believe that much is possible through this understanding, including non-drug therapies that may show the impact of change on genetic expression. Epigenetics may also provide explanations as to the impact on genetic expression from current drug treatments for mental health conditions. I want to learn more about this and I look forward to reading “The Science and Pseudoscience of Children’s Mental Health”.

  • Thanks Phil,

    You’ve really made excellent comment on an important report. For me power is at the heart of “psychosis” and much is summed up in your sentence below.

    “There is a strong case to be made for the view that if we place the individual’s cultural heritage and identity at the centre of our attempts to help people who experience psychosis and distress, then we will end up with systems of help and support that are fair and equitable for all people, not just the 86% white majority.”

  • I know people on CTOs have the right to an IMHA (specialist advocate), I am sure there is variation in the quality of worker available. I think people are not necessarily told about this right until they are on a CTO. I think people should be given access to an IMHA at the time of discussion around the CTO and the conditions being considered.

  • It is true that the only mandatory conditions for a CTO (in the UK) are relating to the patient being available for examination. However other conditions are put on by the Responsible Clinician and may state to take medications as prescribed. If a person breaks a condition of a CTO they can be recalled to hospital and even treated in hospital, a CTO has this power of recall. CTOs do not give any authority to treat a person against their will in the community, but there is a big threat over people on them and I think the Octet study showed this to be so.

  • Ron I very much agree with your statement

    ‘….. I believe both disability and long term psychosis could be reduced dramatically if we also very dramatically reduce use of the so-called “antipsychotics.”’

    There is too much pressure to continue on “antipsychotics” and I think this is driven by fear that a person will become “unwell” once off them. In the UK there is pressure to take “antipsychotics” for two years continuously following an episode of psychosis. I ask myself what good evidence there is for such an approach and can’t really see anything compelling. I bet when people reach the two year mark and then try to taper of an “antipsychotic” it is very difficult to get to zero drugs, I bet most people are persuaded to remain on the drugs.

    I think the best approach, at least when looking at a first episode of psychosis, it to avoid neuroleptic drugs if at all possible and if they are used to use in lower doses than usual and as soon as a person is no longer psychotic to look at carefully withdrawing the antipsychotic drug (if one was used). We should reframe how they are used and be fearful of long term use of them.

  • Another great article.

    Psychiatry has become really good at dealing with criticism, it has had lots of practice. Certainly it is great at influencing the thinking of clinicians and consumers. That said I really don’t understand how it can be acceptable for supporters of psychiatry to insist that any criticism of its treatments (even those that have irrefutable proof of causing neurological damage) must carry the caveat, “but let’s not forgot some people are helped”. Perhaps when it is said that we mustn’t forget some people are helped we need ask the question, “is the cure worth it?” and insist of the caveat that such help comes at the expense of neurological damage.

  • I appreciate that psychiatry is different to other areas of medicine, and in fact rather than “quasi” middle ground it often accedes a position of real and solid legal power.

    When I talk about holding psychiatry to higher standards I am not accepting that such standards are necessarily in place but rather that they should be, and that through raising the issues perhaps in fora such as here and other online media it is one way of if not raising the standard then exposing the problem.

    You are right that there is lots of legislation to protect the state and I accept that the states interests are safeguarded, why would we expect different? I do think we need more to help safeguard individuals ( a great deal more) and one way is perhaps through promoting treatments and programmes that not only work but that may also allow a person real choice, even choice to say no to neuroleptic drugs.

  • It is easy to have views that seem polarised when considering psychiatry.

    I agree with much that Phil and Sandra have written.

    One thing that I believe we should be mindful of when comparing psychiatry to other branches of medicine is that psychiatry does have an emphasis of coercion and force that other areas of medicine do not. Therefore I feel that high standards of scientific validity and scrutiny are not unreasonable to be applied as way of safeguarding the interests of those treated. Open discussion is a way forward.

  • This post has really grabbed my attention.

    Many times I have witnessed people complaining about being worse off of neuroleptic drugs and I have witnessed a dismissive response from psychiatrists and other mental health workers in the psychiatric field. I can think of one guy who stated how sedated, unable to think, unable to move properly, unable to recall properly, and actually he was still holding unusual beliefs that were deemed delusions (despite being on an “anti-psychotic” and other drugs). The psychiatrist listened very carefully and responded by saying that it was a case of balancing the benefits against the negative effects of medication and that he would recommend continuation of treatment as the man in his view was getting well. I would agree that the man in question was more manageable, though I don’t know if he was really getting well.

  • Psychiatry knows well the power of the media and must be stunned that Professor Gøtzsche and the Council for Evidence-based Psychiatry have had their evidence and arguments in the mainstream media.

    If psychiatry could accept and take responsibility for the problems it has within then it may be possible to have civilised debate in an honest fashion.

  • Shire, dissatisfied with the success – but not “resounding success” – of its amphetamine/amino acid combination Vyvanse, is developing the drug (which recently failed trials as an antidepressant) as a treatment for binge-eating

    Yeah, well they could sell it alongside olanzapine, now there’s a market!

  • For me it is despairing to read the same old, “just look at all them mentally ill schizophrenic homeless, if only they just took their meds”, in the review, it’s just cheap and trashy. Is Paul Videbech really E Fuller Torrey? I have a theory that many of those that may be considered mentally ill and are homeless would have been far better off if they had never in the first place been given neuroleptic drugs. Oh yeah, that’s the point!

  • What is this antipsychiatry movement? Does it really actually exist? If so who is part of it? Is antipsychiatry just an insult? Is antipsychiatry a way forward or a cul-de-sac?

    An interesting point for me regarding Michael’s article, as well as giving thought to the inconsistences and complexities of Liang, was giving thought to the antipsychiatry movement and of Szasz somehow being portrayed as being part of it by virtue of his writing the Myth of Mental Illness and of being critical of Laing.

    While Szasz never wanted the term applied to him Laing did take on this mantle, at least for a time before denouncing it. I find it fascinating that those whom reject the labeling of others and themselves, by diagnoses as an example, have no problem at all of labeling Szasz an antipsychiatrist. In fact I wonder if people may at times even label me an antipsychiatrist, the cheek of them.

    I too enjoyed Michael’s article and the comments that have flowed from it, but it does not mean I agreed with all he wrote. It has certainly generated thought and comment. There have been excellent points put forward around the aspect of forced treatment, when is it necessary, who decides, what treatments are best, is force always bad, do we need it? None of these issues are simple, all require being open and able to consider the views of others as meaningful, rather than being dismissive.

  • “I will never forget when Thomas Szasz, the author of The Myth of Mental Illness, accused Laing in the 1970s of betraying the cause of anti-psychiatry by continuing to engage in treating the mentally ill, though Laing himself condemned the psychiatric community for the way they conducted this practice”

    This seems a bit wrong to me, surely Thomas Szasz had no problem with anybody receiving treatment, providing it was in the context of a consenting relationship. No Thomas Szasz was critical of Ronnie Laing doing exactly what psychiatry did and does, forcing treatment on people not consenting. Just as happened when Clancy Sigal was pursued by Laing and others and forcibly injected with chlorpromazine, yeah love and peace man, love and peace.

  • Psych drug withdrawal is tough, at least I found it so, but fulfilling too.

    I managed to stop neuroleptic drugs, I had three “failed” attempts where I had to go back on the drug in question and this was hard to deal with as I was having problems on the drug. It took me ages to come off the drug, eighteen months perhaps.

    I was fine for a period of two years and then became acutely psychotic (it was right out of the blue) and had a short spell in hospital and back on a neuroleptic, this time Zeprexa and clonazepam. When I got out I managed to stop the drugs, first the clonazepam and then Zeprexa. That was over five years ago and I feel pretty good now, totally drug free, and work full time.

    Everyone stopping or reducing psych drugs takes an individual path. People can manage without psych drugs, and do well.

  • Thanks Ted,

    I don’t know much about the conference and the issues that you have raised here, apart from what is posted. I aim to look more into this.

    Recently I was at a conference where this was presented as part of Jacqui Dillon’s presentation. For me it is important to really keep in mind the points below.

    • The crisis in the profession of psychiatry has been looming for a while, as discussed in a series of articles in the British Journal of Psychiatry.
    • Traditional psychiatric response to threat:
    • Ignore
    • Attack
    • Assimilate 

    (Johnstone, Users and Abusers of Psychiatry, 2000.)

  • I have mixed feelings about the dialogue presented here.

    Sure having better treatment for mental distress would be something I share, however I do wonder what is really on offer when it comes to “advance directives” and less use of force. Does it mean that there would be greater effort to persuade a person to take a drug before they are forced? Does it mean that an advance directive would be drawn up to show how a person would prefer to be treated?

    In the UK an advance directive in respect of mental health treatment is pretty much worthless, due to it having no legal standing. I could draw up an advance decision to refuse medical treatment in respect of physical health conditions but such a right does not extend to mental health conditions. You may be able to get some leeway with some psychiatrists but there is no security that if hospitalized treatment given would be anything other than the “as usual”.

    A big issue for me is the type of treatments that are forced on people who may be deemed psychotic or manic. The treatments are neuroleptic drugs that are damaging and ineffective over the long term. These are drugs that are “recommended” for a long period (years) and they are extremely difficult to stop taking. I appreciate crisis situations exist, and as such I feel a short-term approach with drugs, and not necessarily neuroleptics, is most often the best, especially when dealing with a person at early contact with mental health services.

    Perhaps the “silly bickering” seems more serious when it’s your arse on the wrong side of the hypodermic full of clopixol? Personally I feel the problems with psychiatric drugs, especially those coerced/forced need to be addressed before any moving on can be done.

  • Ted,

    I understand your point about reclaiming a word, it is a difficult task I think as the general public may well equate “antipsychiatry” with anti-scientific.

    I have just started reading Thomas Szasz’s book “Anitpsychiatry: quackery squared”, and from it I learned that “antipsychiatrie” was first coined in 1908 by a German psychiatrist Bernard Beyer, who invented the term “antipsychiatry as a label with which to stigmatize psychiatric criticism .” (Szasz)

    Well we can’t accuse E Fuller Torrey of original thought.

    Torrey stigmatizes any criticism of forced treatment by labelling this valid criticism as “antipsychiatry” and thus prevents scrutiny of the facts. Critics of Torrey are often critical of forced treatment and brutality that he promotes. The evidence is that forced treatment is ineffective, harmful and just plain wrong, and yet criticism is seemingly ignored by the mainstream media.

    Would it help to just ignore Torrey?

  • You’re right that coercion is the big difference and this is really the unassailable issue.

    This quote form Allen does worry me:
    “We both believe that psychiatry done poorly follows a narrow biomedical reductionism, while psychiatry done well benefits from an inclusive and humanitarian model that integrates biological, psychological, and social factors.”
    I worry that psychiatry tries to absorb its opposition but still maintain control. Always psychiatry has room for a model that is inclusive, as long as that model is one that includes the biological. If only taking the pills was a free and informed choice between consenting parties, but it is not.

  • You’re right that coercion is the big difference and this is really the unassailable issue.

    This quote form Allen does worry me:
    “We both believe that psychiatry done poorly follows a narrow biomedical reductionism, while psychiatry done well benefits from an inclusive and humanitarian model that integrates biological, psychological, and social factors.”
    I worry that psychiatry tries to absorb it’s opposition but still maintain control. Always psychiatry has room for a model that is inclusive, as long as that model is one that includes the biological. If only taking the pills was a free and informed choice between consenting parties, but it is not.

  • It’s odd that benzos have become more and more out of favour the further out of patent they have gotten, what could possibly be the reason? Sure there may be issues with dependency but AD also have issues with dependency as shown by the amount of people that are on them for years and years.

    I have seen loads of people given AD for anxiety and I don’t recall anyone saying they felt much less anxious, at times the opposite in fact. Only the clinicians prescribing seem happy with the change from benzos to AD.

    Indeed AD can cause anxiety, clinical trials at times have used benzos to help people through the trial period with AD.

  • Nancy Andreasen is trying to make the unpalatable somehow palatable, she knows that neuroleptics, even the “atypical” ones cause brain shrinkage, animal studies prove this beyond doubt.

    I am interested as to how many people in the study were actually drug free (i.e. never at any time taking neuroleptic drugs) at the time of their first MRI scans. I recall reading that people in her study had been on neuroleptics prior to the initial scans, albeit for a short period. The only way that it could be tested that “schizophrenia” causes brain shrinkage (and to what degree this may be so) is by studying people that are truly naive with respect to neuroleptic drugs.

  • Should we stop using antipsychotic medication?

    I think we should look at not introducing people to “anitpsychotic” drugs in the first place, and try to assist those already on them to be on the least possible amount (preferably zero). Surely we will look back on these drugs in a similar way to how we now look at lobotomies and that can’t be good.

  • This sort of approach seems similar to the UK’s Community Treatment Orders, CTOs. They were introduced following a change in mental health law with the Mental Health Act 2007, and I think the first patients put on them were in November 2008. Basically this law (through a set of individual conditions) places an obligation on people released from hospital, following their compulsory detention, for them to accept treatment in the community or face being recalled to hospital, with the potential to be assessed and even end up back as a hospital patient.

    The change in the law was primarily brought about by powerful lobbying that made a case for ensuring those with schizophrenia when in the community took their medications. I know one group that was highly successful in terms of lobbying and I recall they, the Zito Trust (now wound up), had financial support through an unrestricted educational grant from Eli Lilly and Co. Ltd. Tragic high profile homicides formed the background to the lobbying.

    Prior to the law change there was much talk of the benefits of CTOs and of how they would reduce violent crime and hospitalizations of those with serious mental illness. It was also put forward that the change in the law would only affect a minority of “revolving door patients”, a figure of 250 per year was initially muted, then a figure of 400 per year was put about. Around 4,000 people in the first year were placed on CTOs. I have no idea how many people are now on them but it will be in the thousands.

    Everyone was told that CTOs would of course be helpful and that it was obvious they would be helpful, this was despite the only research available (albeit from other countries) showing no real benefit. We do now have some research outcomes:

    Lancet. 2013 May 11;381(9878):1627-33. doi: 10.1016/S0140-6736(13)60107-5. Epub 2013 Mar 26.
    Community treatment orders for patients with psychosis (OCTET): a randomised controlled trial

  • Dear Anonymous,

    I am not for the status quo, when I wrote about people feeling challenged and frightened with respect to putting treatments for psychosis under scrutiny I was thinking more of those currently with the power to treat being frightened and challenged by the reporting of the facts.

    When I use the word “psychosis” I know it means many things to many people. For me I consider it descriptive rather than clinical, let’s be clear one person’s “disparate extreme states of mind” may be another person’s spiritual awakening or indeed another’s breakthrough or anything else.

    Believe me when I say I have empathy for anyone forcibly drugged.

  • Dear Bob,

    It’s been difficult reading the recent posts on the Pete Earley article, lots of emotion stemming from unjustified personal attacks. I can appreciate that people may feel challenged and frightened when looking at the treatments for those with psychosis and other mental health issues. I know from experience that when people are prescribed antipsychotic drugs it is often the case that they are not given the full picture about them, and the claims for efficacy and side effect profile are not truthfully portrayed. The rationale given for the lack of accurate information is that the person receiving the drug needs treatment and is unable to make an informed decision (though I know from experience that not all people first given these drugs are in a psychotic state and/or lacking in mental capacity).

    The time has arrived when we have to look honestly at treatments for psychosis, people receiving treatments need to be informed, carers need to be informed. There will be pain and difficulty when looking at these issues, there always has been. This demands being mindful, honest and compassionate and I believe that you are and have been so.