Recovery from "schizophrenia" and other "psychotic disorders"

 Many of you have probably been aware of two prior World Health Organization (WHO) studies that showed almost twice the recovery rates from “schizophrenia” in developing countries as in developed countries.  While critics of current psychiatric practice attributed the better outcome in developing countries to the fact that most were not on medication, others suggested that cultural factors were mostly responsible for the better outcomes.

A new study though, that looked only at people on medication in a wide variety of countries, found little difference in outcome between developing and developed countries.  While not noted in the article, this apparently provides new backing for those who would maintain that it was the greater use of antipsychotic medication in developed countries that resulted in the greatly reduced recovery rates in those first two studies. 

For those who want to know more about the assertion that long term use of antipsychotics is highly detrimental to real recovery and contributes to long term disability, this issue is covered in depth in Robert Whitaker’s new book, Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America

As I pointed out at a recent mental health system meeting in my county, people with mental health problems face two kinds of risks. 

The first sort of risk is from the mental health problem itself.  Unless the person finds effective treatment, mental health problems can often cause high distress, disability, and even result in death, such as from suicide.

The second sort of risk, however, is the possibility that the person may receive an unnecessarily hazardous treatment.  For example, some people recover from psychosis without antipsychotics, and some people aren’t helped by antipsychotics, and some are helped but not enough to justify the hazards, and some could be better helped by less hazardous methods if such methods were made available.  So when antipsychotics are used routinely for everyone with psychosis, it follows that many people will be exposed to a treatment which will be unnecessarily hazardous to them.  This treatment itself can often cause high distress, disability, and even result in death.

(Some argue that most psychiatric treatment offers more risk than help:  for a good summary of those arguments, see Robert Whitaker’s new book, Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America  If you click this link you can both find out more about the book as well as get many of the main points and the supporting data on the website.)

The mental health system is organized to prevent the first kind of risk, the risk from the mental problem itself.   Billions are spent to address this risk.

Strangely enough though, the second kind of risk is usually not even discussed within a mental health system.  At the meeting in which I was talking, we wanted a document on guidelines for treatment to mention this sort of risk, but our attempt to get it simply mentioned was labeled as “inflammatory” and was being denied.  Why? More »

Richard Bentall, in his book Doctoring the Mind: Is our current treatment of mental illness really any good? describes how researchers first noticed and tested the properties of the medications that later became known as “antipsychotic.”  The procedure was fairly simple.  They first exposed rats to an electric shock applied to the floor of their cage, accompanied by a sound.  The rats quickly learned to climb a rope to get away from the floor of the cage whenever they heard the sound:  this is what is called “conditioned avoidance.”  Then they gave the rats the new medications, and noticed that the medicated rats no longer showed the conditioned avoidance – that is, they no longer climbed the rope in response to the sound.

That this effect exists is not surprising given what we now know about the function of dopamine in the brain, and the role of antipsychotic medication in blocking dopamine.  Dopamine nerve cells are involved in anticipating threats, and that animals that have been repeatedly exposed to threats show increased sensitization of their dopamine system (in other words, their dopamine system is more reactive).  And since antipsychotic medications block dopamine, it follows that they reduce threat anticipation.

People who are diagnosed with psychosis are often misperceiving people or events as threatening when they are not.  Often, such misperceptions cause chaos in a person’s life (especially if the person takes action to fight off threats that are unreal, actions which may create real threats.)  So, medications that reduce “conditioned avoidance” reduce reactivity to perceived threats, and this is helpful at least some of the time.  But isn’t it also possible that such reduced anticipation of threat can go too far, and result in people on medication being less likely to protect themselves from many real threats that may exist? More »

I have written elsewhere about links between creativity and psychosis.  In a recent blog entry, Gianna Kali of “BeyondMeds” links to an article describing how teachers in schools all say they seek to encourage creativity, yet their favorite students all tend to be those who show traits incompatible with creativity – those who are good at agreeing, following rules, etc.  Why the discrepancy?  And what does it mean for mental health?

Creativity is extremely valuable, but it can also have high costs.  One of the costs is that people who are attempting to be creative will sometimes make errors, and their attempted improvements will sometimes make things worse.  But if we are to become a society that truly values creativity, we need to recognize that we benefit from those who live more “on the edge” and who sometimes fall off the edge:  instead of stigmatizing them or labeling them as forever ill, we might better collaborate with them in helping them figure out where they might have gone wrong while also staying open to the possibility they have a lot to teach us.

I really wonder how much creative talent is currently buried under high doses of antipsychotic medications……

In the attempt to convince people to take medications, the hazards of such medications are often minimized or overlooked. While many people may truly be better off taking some medications, at least for awhile, the danger in hiding the hazards of the drugs is that rational decisions about how long to stay on medications, at what dosage, and how hard to try to find alternatives, become impossible. Instead, an illusion is created that the only rational approach is to stay on medications indefinitely, because only an irrational person would risk the return of a destructive psychosis.

If we really allowed ourselves to face all the facts however, we would see that these decisions are much more complex. For example, while the effects of being caught up in psychosis can be terrible, the effects of the antipsychotic medications can be terrible as well. These medications significantly increase the risk of death, due to causing things like heart problems, metabolic syndrome, obesity, diabetes etc. And, while most of psychiatry is still in denial about it, it appears that antipsychotic medications have a tendency to shrink brains. (For those of you unfamiliar with the evidence for this effect, I include some references and other information at the end of this post.)

Some people might think that if antipsychotic medications will shrink the consumer’s brain and then possibly kill them, then the obvious decision is to just get off the medications as quickly as possible. However, the problem is that it appears that uncontrolled psychosis, and its associated distress, will also shrink a person’s brain and very possibly kill them (besides making a total mess of their life in other ways.) More »