Those are my favorite lines from a favorite book [and movie]. They come to mind whenever I watch the news in the evening. It’s a habit I’ve developed to remind me not to get too caught up in the dramatic rhetoric of journalism. And they came to mind reading this article in Mad in America:
Mad In Americaby Robert WhitakerMarch 17, 2016
May 7, 2015
December 29, 2015
January 27, 2016
February 1, 2016
February 16, 2016
February 22, 2016
Psychiatry And Anti-Psychiatry [Frances]February 24, 2016
Robert Whitaker does the same thing most of the bloggers on his site do – he anthropomorphizes psychiatry as a unitary entity that is of a single mind. Psychiatry says… "one size fits all." Psychiatry says… "medications for life." Parenthetically, that notion of psychiatric one-mindedness has made my own discussions with people who are MIA followers quite difficult. And that problem continues here. When Drs. Pies and Frances clarify their positions, and they turn out to be fairly close to Whitaker’s, he sees them as going against this singular psychiatry he apparently thinks of as making universal recommendations.
As a consequence of positive results from numerous short-term [1–2 years] studies, prolonged use of antipsychotic medications over a long period has become the current standard of care in the field. Thus, antipsychotic medications are viewed as the cornerstone of treatment, in both the short-term and the long-term treatments of patients with schizophrenia.
American Psychiatric Association [APA] guidelines suggest clinicians to consider antipsychotic discontinuation for schizophrenia patients who have been symptom free for a year or more. Nevertheless, many clinicians keep schizophrenia patients on antipsychotics indefinitely assuming that the medication is essential for continued stability.Antipsychotics are also viewed by some as leading, over a prolonged period, to eventual recovery for some patients with schizophrenia. A comprehensive review from the World Psychiatric Association section on Pharmacopsychiatry notes “Antipsychotic treatment has a significant impact on the long-term course of schizophrenic illness and can significantly facilitate recovery…”
Originally published in February 2004. This guideline is more than 5 years old and has not yet been updated to ensure that it reflects current knowledge and practice. In accordance with national standards, including those of the Agency for Healthcare Research and Quality’s National Guideline Clearinghouse, this guideline can no longer be assumed to be current.
But, as was seen above, psychiatry’s evidence base for antipsychotics, which states that the drugs are effective over the short term for curbing psychosis and effective for reducing the risk of relapse, does not promote such selective-use prescribing, and, indeed, any survey of 100 people diagnosed with a psychotic disorder in the past 25 years would find that most had been told they needed to take the drugs for life. Frances and Pies, in their blogs, were seeking to defend psychiatry’s prescribing practices and the long-term effectiveness of antipsychotics, but the caveat they expressed — that the drugs are effective for a certain subset of psychotic patients — naturally focuses attention on the drugs’ effects on those who don’t need them long-term, and that leads to a finding of great harm done.
And that finding, in turn, supports a demand, based on Frances and Pies own writings, for a radical rethinking of psychiatry’s use of antipsychotics.In a follow-up blog, I will respond to their review of the “evidence” for the long-term effects of antipsychotics. That provides another an opportunity to watch their minds at work as they sift through the evidence. What studies do they dismiss? What studies do they embrace? This is a review that ultimately leads to this question: Do we see, in their assessment of the scientific literature, evidence of the critical thinking that we want to see present in a medical specialty that has such a large impact on our lives? And if not, what shall we do?
Mad in AmericaBy Robert WhitakerMay 7, 2015
When you write a book, you usually do so in response to a prompt of some type, and in the process of researching and writing the book, you will come to see your subject in a new way. Psychiatry Under the Influence, a book I co-wrote with Lisa Cosgrove, provided that learning experience, and this is what I now know, with a much greater certainty than before: Our citizenry must develop a clear and cogent response to a medical specialty that, over the past 35 years, has displayed an “institutional corruption” that has done great injury to our society. In fact, I think this is one of the great political challenges of our times…
As I noted in the beginning of this post, co-writing this book led me to “see” this subject of psychiatry and its influence on our society in a new way. It puts the focus on society as the injured party, and it is easy to see that the social injury arising from this corruption is vast and profound.The institution of psychiatry, with its disease model, has dramatically changed our society over the past 35 years. It has given us a new philosophy of being, and altered how we view children and teenagers, and their struggles. It has touched every corner of our society, and this societal change has arisen because of a story told to the public that has been shaped by guild and pharmaceutical influences, as opposed to a record of good science. That is the nature of the harm done: our society has organized itself around a “corrupt” narrative…