Welcome to From Insults To Respect.

Last year I published a post titled “Are Antipsychotics Beneficial?” (see HERE).

Robert Whitaker

Although I had personally reviewed the research, I relied on my method of presenting this information to readers by summarizing a free PDF written by the highly regarded science writer, Robert Whitaker, titled, “The Case Against Antipsychotics: A Review of Their Long-term Effects.” By clicking on the blue title, you can read all of his arguments.

Whitaker’s most recent book, Anatomy of an Epidemic, provides an in-depth exploration of medical studies, and concludes that there are serious problems with the conventional wisdom of treating those labeled as mentally ill with drugs.

Toward the end of my post on antipsychotics, I provided the following quote from Whitaker’s free PDF:

“The drugs are supposed to provide the benefit of reducing psychotic symptoms. But the research reveals that, over the long term, this benefit turns into a negative, and so, over the long-term, there are only negatives to be chalked up: the increased chronicity of psychotic symptoms, the impaired functional outcomes, the worse cognitive functioning, and, of course, a broad range of “side effects,” such as tardive dyskinesia, metabolic problems, sexual dysfunction, and so forth. Such is the bottom-line arithmetic that makes the case against antipsychotics.”

In my post, I ended up supporting Whitaker’s conclusions.
Consequently, some of my readers showered me with praise for having the courage to stand up to the powerful pharmaceutical-psychiatric institutions, while others showered me with the most disrespectful insults known to the human race. And then there were those who disagreed with me but did so in a respectful manner. I believe it is my responsibility to now provide them a respectful response.

Those disagreers who remained respectful put forth basically two types of arguments. The most common of these were from people who personally know a family member or friend who has been “diagnosed” as having schizophrenia and from their observations the “antipsychotic” drug treatment appears to be helpful.  Others had seen some research that has convinced them that the drugs reduced the risk of death.

My post today will focus on the first of these arguments. I review the evidence regarding whether or not these drugs reduce the risk of death HERE.

The Apparent Helpfulness of Antipsychotic Treatment

Any pill prescribed by a doctor will lead many to experience a placebo effect, which can be, for a period of time, helpful. I hasten to point out that a person can get a placebo effect with non-drug treatment approaches as well, and this would avoid the various harms associated with this type of drug.

In addition to a placebo effect, the perception of helpfulness of a drug can come about when a patient in an agitated state first comes to the attention of a psychiatrist. These drugs are not only known as “antipsychotics,” but also “major tranquilizers,” because they sometimes do appear to calm someone in distress.

Unfortunately, once someone begins to take these drugs to help with agitation, when they try to come off of the drug, they are left with drug withdrawal experiences that have been described as awful. I hasten to point out that there are other ways to help someone to calm down that need not rely on these types of drugs. I have worked on many occasions with people who are agitated, and without the aid of a drug prescription I listened in a caring way, and in time the person eventually calmed down. If, however, you give someone a drug that calms the person down, it is sometimes much easier, and less time consuming. For people who witness someone they care about in high distress drift into a calmer state upon taking an “antipsychotic,” this can seem enormously helpful.

Moreover, for a period of several months, the person who had been experiencing some mental health concern might, after taking these types of drugs and being a bit calmer, may begin to function better in several ways, such as sleeping more soundly, or having friendlier relationships.

Some of them would have recovered in a fairly short period without the drug, but because they recovered while taking the drug, they, and their loved ones, attribute the improvement to the effectiveness of the drug. If the person tries to see whether the improvement was due to the drug or the natural recovery process, he or she may try to stop ingesting the drug.
However, the withdrawal from the drug, as I mentioned above, often causes a nasty physiological reaction which, in some ways, is similar to someone who is a coffee drinker who suddenly decides to stop, cold turkey. However, the “antipsychotic” physiological withdrawal reaction can be experienced as much worse. When people who care about this person see the downward spiral that occurs from the physiological withdrawal reactions, they may come to attribute it to the person’s “mental illness” returning, and thus, the illusion of long term effectiveness is now deeply entrenched.

Another way in which the illusion of the long term effectiveness of the drugs can occur has to do with the fact that even when the “diagnosed” person is not functioning well on a drug treatment regimen, human beings can always imagine that the patient would be doing even worse without taking the drug. And of course, when the patient does try to go off the drug, the raging physiological withdrawal process occurs. So, in this way, the combination of the belief that the patient could be doing worse, and upon becoming worse when trying to do without the drug, it convinces people that the drug treatment is helpful.

Finally, oftentimes family members are the ones who had advocated that the distressed person go to a psychiatrist and comply with the drug treatment. Once they take that position, and tell others what they had done, information that comes their way in the form of the distressed person having bad side-effects, or hearing from people who take the position that the drugs may be more harmful than helpful, a psychological phenomenon known as cognitive dissonance occurs. The principle of cognitive dissonance states that human beings strive for internal psychological consistency. When they experience internal inconsistency they become psychologically uncomfortable and a major way that they try to reduce the discomfort is by avoiding circumstances and contradictory information likely to increase the magnitude of the cognitive dissonance.

So, in summary, the five ways that people may get the false impression that over the long term the drugs are effective are:

1. The placebo effect,
2. The initial calming effect of the drug,
3. Attributing observed improvement as being due to the drug rather than to the natural course of the experience,
4. Whenever the drug taker is not doing well, it is easy to imagine he or she would be doing even worse if he or she was not taking the drug,
5. Cognitive dissonance.

(By the way, upon reading this, if some of you who have been taking these types of drugs decide that you want to try to wean yourself off, a good resource to help can be accessed HERE.)

Maybe I’m the One Suffering From Cognitive Dissonance

I have publicly supported the argument that these drugs cause more harm than good. Therefore it can be argued, it is I who suffer from cognitive dissonance whenever evidence comes my way that might support the idea that these drugs are helpful in the long run.

This point is worth considering. What I have done to avoid falling into this trap is to thoroughly review the research regardless of whether or not it supports my position. Here’s a partial description of what I found.

By the late 1990s, investigators had reported that antipsychotics caused basal ganglion structures and the thalamus to swell, and the frontal lobes to shrink, with these changes in brain volumes “dose related.” Then, in 1998, Raquel Gur, from the University of Pennsylvania, reported that the swelling of the basal ganglia and thalamus was “associated with greater severity of symptoms.”

Soon Nancy Andreasen, who was then editor-in-chief of the American Journal of Psychiatry, reported on her findings from a study of 500 schizophrenia patients. In 2003, she reported that their frontal lobes shrank over time, and that this shrinkage was associated with a worsening of symptoms and functional impairment, and after five years, with a worsening of cognitive abilities.

While Andreasen initially attributed this shrinkage of the frontal lobes to what she referred to as the schizophrenia disease process, in 2011 she announced that long-term use of the old standard antipsychotics, the new antipsychotics, and clozapine were all “associated with smaller brain tissue volumes.” She found that this brain shrinkage was dose related; the more drug a person was given, the greater the association “with smaller grey matter volumes.” A loss in white matter volume was also “most evident among patients who received more antipsychotic treatment.” Illness severity and substance abuse had “minimal or no effects” on brain volumes, she concluded.

Numerous studies have now reported that antipsychotics induce changes in brain volumes, which, German investigators concluded in 2014, “exert adverse effects on neurocognition, symptoms and psychosocial functioning.”

The MRI studies provide objective evidence that antipsychotics cause changes in brain volumes that are associated with a worsening of symptoms, and a worsening of functional impairment.

So, with all due respect to my critics, I respectfully submit the above argument that the belief that antipsychotics are helpful in the long run is an illusion.

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Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional and social intelligence. To begin at the very first post you can click HERE.

antipsychotic drugsHarmful effects of antipsychoticspsychiatryRobert WhitakerSchizophrenia