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If antipsychotics only work for some people with psychosis, then why are they given to everyone?

Richard Bentall, in his book Doctoring the Mind:  Is our current treatment of mental illness really any good? (p. 222) points out that antipsychotics seem to be ineffective in reducing psychotic experiences for something like 1/4 to 1/3 of all those who are given them.  And it is well known that antipsychotics come with many serious risks, including that of increased mortality, permanent movement disorders and others. 

So, given that these two things above are true, why is it that we never encounter anyone who has been told by his or her psychiatrist “well it seems antipsychotics aren’t working for you and since they are dangerous, you may be better off doing without them.”? 

Psychiatry has shown almost no interest in trying to find out who might be better off not being on antipsychotics, either because they are one of those who might be able to recover adequately using healthier alternative methods, or because they are one of those for whom antipsychotics don’t work in the first place.  In other words, while psychiatry claims to be working hard to protect people from risks caused by psychosis, it has been willing to do pretty much no work at all to protect people from the risks of what may be unnecessarily hazardous treatment for a particular individual.   This is a strangely “unbalanced” approach, especially from a profession that claims it is able to balance our minds and balance our biochemistry!

15 comments… add one
  • In fact, psychiatrists often go through a list of antipsychotics, starting with the atypical moving through the typical and often combining them with mood stabilizers and antidepressants. Most patients don’t have a clue what hit them!

  • I’ve heard about people reporting neuroleptics not to work for them at rates as high as 60%. I’ve also heard people say, they stop telling the professionals at one or the other point, because all that happens when they do is that their dosage is upped and/or that they’re put on additional drugs, which means more and additional side effects… The remaining 40 (or whatever else) % I’d attribute to the placebo effect. Personally, I think, these so-called “antipsychotics” don’t work – at least not truly antipsychotic – at a 100% rate. No chemical molecule can distinguish between a “correct” and an “incorrect” thought or emotion, and only if it was able to, it could righteously be said to work antipsychotic. All these substances do is they reduce consciousness, i.e. the ability to be aware of “symptoms”, while the “symptoms” still are there. So, the professionals’ argument that the drugs would be necessary to stop the allegedly brain damaging process of “psychosis”, and “protect the brain”, doesn’t hold. In a situation of acute and extreme distress this may give some relief, and may be an advantage. When it comes to long-term use, I think everybody, especially the professionals, ought to have realized by now that these drugs only make things worse. Strangely unbalanced, yeah, and one wonders what it is that causes this blindness.

    • I agree with Marian and Kris that what usually happens when people point out that a medication isn’t working, is that they get put on higher doses or different or more medications, until they give up hoping for anything better. Of course, while multiple drugs may not be working any good, they may be all working together to cause nasty side effects and health problems.

      I don’t agree with Marian that when antipspychotics do “work” that it is just the placebo effect. Rather, I think psychosis has something to do with people making errors as they think independently, and that antipsychotics reduce independent thinking, and so reduce “psychosis.” Another way of saying this is that antipsychotics reduce anticipation of reward and/or threat, and so if people were making errors around that, it can reduce the “psychosis.” So Marian is correct, the “antipsychotics” don’t discriminate good thoughts from bad thoughts, but they do typically reduce the sort of thinking that tends to lead to psychosis for some, at times (though this is also a very valuable sort of thinking at other times, and so it’s a problem to restrict it by drugs.)

      Actually independent thinking and anticipation of reward and/or threat are also very important in recovery, which helps explain why the these drugs that are at least often effective in reducing psychosis in the short term can actually make things worse in the long run.

      As for Marian’s last question, what causes the blindness – I think Western culture has a bias toward short term solutions and linear explanations, especially when we are feeling stressed and overwhelmed, as many do around the whole topic of “psychosis.” That, and the fact that there are lots of profits to be made….

  • We should be clear on what these “antipsychotic” drugs are. They are neuroleptic tranquilizers…nothing more and nothing less.

    These tranquilizers induce the equivalent of a chemical lobotomy. There is no question that they do not provide a placebo effect. They represent chemical straight jackets.

  • @RonUnger
    I like how you say anti-psychotic reduces independent thinking. That’s exactly why I stopped using them. I felt that I was loosing myself and loosing control over my thinking. I was in a “blur”.. kind of fog. I could not attach my thinking to any of my spontaneous thoughts or emotions. It was kind of a river flowing by. Too bad I listened to my psychiatrist for so long. I have had a meaningless, robotic, 8 years of isolation because of it.

    I have been off anti-psychotics now for 4 months, and started a process of being able to feel again. My emotions are still in an “anaesthetic mode”.. I can’t feel much except anxiety, but I have had some slow progress. My thoughts are becoming “my own” again. I’m glad I have found a psychologist who is sceptical to psychiatric drugs and to the different diagnose labels that psychiatrist are fond of using.

    I have had four different psychiatrist that has given me four different diagnosis (and medication that come along with it). One believed I was schizophrenic, the other one bipolar, the third diagnosed me with acute psychosis, and the fourth was a professor in psychiatry who had developed his own kind of research. He labelled me “stemmning menneske” (Norwegian) it means a person who easily are emotionally effected by the environment.

    “Chemical straight jackets, and chemical lobotomy”.. you hit the nail :). well said.

    I believe that current medicines and treatments are a joke, and that it’s like throwing a dice. It’s like my former psychiatrist said: “psychology and psychiatry is no science at all. It’s just professional guessing game from subjective viewpoints (the ones that treat you that is)”. Well I certainly agree with him. They look for different signs and guess using useless medications.

    Neuro science and different brain implants are showing great promise though. In 10-30 years much will be done. Today’s medicines are totally primitive and barbaric.

  • Are antipsychotics like a chemical straightjacket, as Alan asserts? I think that’s partly true, though I think it’s important to avoid seeing it in too black and white a manner. Some people, such as Elyn Saks, accomplish some pretty interesting things while taking antipsychotics, so the drugs at times are not all that debilitating – they just restrain people from “going overboard” in some ways, to keep them on track. Of course, for others, they really are very debilitating, at least in the doses given. And in any case, it is better to learn self restraint if that is possible, because self restraint can be much more selective.

    As for Steffen’s hope for neuro science and brain implants, I am skeptical. They may be useful in offsetting some sorts of injuries, but not in correcting more subtle problems, I would guess. And then there’s that other problem with brain implants: once they really know how to do brain implants that influence people in various ways, how will we ever know for sure if we ourselves have one that is controlling us?

  • We already know how to do brain implants that influence people greatly. It’s still in an early age but it’s improving fast. Take a look at this documentary: <a href=""link. I think it’s a good documentary, but for the implants skip to about 4 minutes of part 5 and continue with part 6.

    In many ways I believe Alan is correct. At least in my own experience. How others feel and react I don’t know.

  • Hi Steffen, Thanks for the link! It was fun – but more optimistic than I would be about how well high tech implants would work! Especially for paranoid people who might wonder what all those computers and implants are up to – and especially when we have human corruption that affects everything. I can just read the headlines – does that new Eli Lilly implant that makes you smarter and cooler also contain programming that give you strange cravings for Eli Lilly products? Are your clothes not just communicating to your doctor when you are having a health problem, but also to your psychiatrist when you might be getting overexcited about something, or……

  • Im glad you liked it!

    I think there is no way to stop this development in any way. It’s coming. Which implants and how it is integrated is another question. I hope it will be regulated by an international independent organ of scientists and scientists only, so corporations and governments don’t get free boundaries to fill it up with all kinds of spyware and junk. I doubt it though. When they go wireless (which they will) security issues regarding hackers and other curious folks will be very important. These implants are not just for people with mental issues, but it will be something for everyone that can afford it. Imagine an implant rising your IQ with a 100, or 500… if one refuses to buy or accept such an implant one would guaranteed be left out or considered primitive and ignored by those who do. I don’t think psychiatrists at that stage will be occupied with persons getting overexcited or not.. the software in the implant will handle it and adjust it automatically or maybe be regulated by a remote system that monitors all brainwaves connected to it. It’s scary if this power gets loose unregulated or in the wrong hands, but also very exciting if done correctly. Like most technologies I think it will be somewhere in the middle. It will be abused but also used and enjoyed.

    People will be very concerned about this. At least I will. Paranoia will flourish. One solution to this problem is to have the operating system running the implants be open source.. like Linux. It would be safer, more reliable, and most important it would be visible to all. I will stop now im just rambling.

  • Steffen: If you’re right, and I fear you might be, in one way or the other, and unless humanity manages to destroy itself (and the rest of nature with it) before it reaches to make your vision come true (oh well, wouldn’t that, too, be a kind of destruction of human nature, transforming human beings into cyborgs?), I only hope, there will be some sort of Malpais to escape to! I can’t imagine anything more enjoyable than being a human being. And I think, that no technology, however advanced, ever can come up to the human experience, never mind surpass it.

  • I am not mentally ill but have been in the mental health system for several years and am currently being forcibly injected with an antipsychotic. In my opinion antipsychotics do not work. Someone here says that “No chemical molecule can distinguish between a “correct” and an “incorrect” thought or emotion”. This is what I believe. Antipsychotics are supposed to overcome delusional thinking, but no chemical will change beliefs/thoughts. Someone else here describes antipsychotics as “chemical straight jackets, and chemical lobotomy” which is correct. One thing is for sure, they don’t leave your brain chemistry as mother nature intended. My experience on these drugs is that they actually cause chemical imbalances in the brain. My blood tests prove this. The result of this is constant malaise (feeling unwell) but in many cases (thousands) people develop serious illness and ultimately there have been many deaths (thousands) attributed to antipsychotics.

    As to why these drugs are pushed so hard a large part of it is because it’s easy money for the drugs companies. The drugs companies pay people to do favorable research which the people are ground level swallow. You also need to realise that the people at the top of the mental health industry have managed to implement a system globally that violates most of the human rights of the victims of the system. Forcibly injecting someone with a poison must be one of the ultimate violations of a person’s human rights. Taken with the way that the alleged mentally ill (there is no scientific test to prove someone has a chemical imbalance in their brain) have been treated since mental illness was discovered (or more likely invented) gives us some idea as to what the individuals who control the industry think of the alleged mentally ill. The system can be used as a system of persecution even in supposedly free countries which has been my experience.

    • Hi Haze,

      Thanks for your thoughtful comments. I especially appreciate your comment that “No chemical molecule can distinguish between a “correct” and an “incorrect” thought or emotion”. I think that is essentially correct. Antipsychotics can slow down a person’s thought process, make it less spontaneous and wild, so if the speed, spontaneity and wildness of the thought process has been seen as a problem, the result may be seen as an improvement, but the drug is not capable of making fine discriminations, and the resulting “drugged state” is indeed an “imbalance” compared with normal brain functioning.

      I think there are really a number of factors that add together into the way these drugs are currently marketed. Certainly the profit motive is one huge factor, but also there is our society’s fear of madness, its desire to believe that mental, emotional and spiritual issues are essentially simple rather than endlessly complex and paradoxical, and the actual desire of families and others to be helpful to mad people (while often lacking insight into how to actually do that) and other factors as well. They all come together to make a “perfect storm” of drug promotion……

  • Yeah its absolutely right..
    They don’t do anything to you.. Theyre not making u smarter or more insightful… They don’t make you aware of your condition..
    They just work by blocking the problems away wich is extremely unhealthy.
    A psychiatrist should see that but they don’t… They just call it a disease when infact it means something and is very real..
    Its just plain arrogance.. Its social control..

    And what about people who are very depressed?
    Antipsychotics makes them even more depressed trust me..
    They don’t make you find the rootcause of your problems..
    Wich is what we really need… Thats why it isn’t a disease. Its a mental state.. And there’s nothing wrong with that..
    I am sick and tired of the psychiatrys endless effort to label EVERYTHING. They can’t even make an proper follow up to their own “discoveries of mental diseases”…

    And it is devastating to the people.. Cause everyone literally thinks that their pills help when infact they don’t.. They don’t even make any relieve from your pain…
    Its annoying as a client and consumer to be so misstreated in a field where they supposes to “help” you…
    And im so tired of people saying that i need medication..
    They really believe that they work.. Its utter nonsense.
    Look what psychiatry have done to the society..
    They tell them lies..

  • Me as a person who sufferes from very deep and serious depression wich is “treatment ressistant” is very unhappy about the options for me..
    When you have lost the desire to look for happiness theres not much to do..
    Not even psychotherapy or any other “therapies”…
    In psychotherapy you have to be wan’t to be treated..
    And if you as me can’t do that.. They can’t do shit.
    I am a lost citizen.. The treatment avaivable doesn’t reach out to people like me…
    And trust me i don’t wanna end up as another psychiatric trash experiment.. Where they without any regrets just stuff pills down your throat so you become physically thin weak and ill and even more crazy…

    • Hi Daniel,

      I hope you do use the internet to find stories of people who have recovered from serious depression, without using the pills that you note haven’t worked for you. There are really lots of different ways people do this, seeing a variety of possible paths might help you get some ideas that would look worth exploring.