Welcome to From Insults to Respect. Today we once again take up the controversial topic of the usefulness of the group of drugs referred to by psychiatrists and the pharmaceutical industry as “antipsychotics.” In most of the articles that I have read that have been written by psychiatrists, “antipsychotic” drugs are the first line of treatment for schizophrenia. And yet, a growing number of mental health advocates have been fiercely critical of this. As someone who has given considerable thought to helping people resolve challenging conflicts, I set myself on trying to find out what is going on here. After a review of the scientific research and participating in several debates, I then wrote three blog posts that reported to my readers what I have found.

In the first post, I conclude that the weight of the evidence indicates these drugs are causing far more harm than good. In the second post, I explain how people come to have the illusion that these drugs are helpful. Upon publishing the first two posts, several defenders of the use of these drugs claimed these drugs are worth using because they reduce the risk of early mortality. I, therefore, published a third post that reviews the mortality research studies. As it turns out, some rather weak evidence does exist that appears to support a positive correlation between “antipsychotic” use by those labelled as having schizophrenia and reduced early mortality. However, those studies have significant flaws and more convincing evidence exists suggesting these drugs actually increase the risk of early mortality.

A recent article published in the prestigious medical journal The Lancet, succinctly summarizes much of this research:

[The evidence] “shows that many patients choose to refuse or discontinue their pharmacological treatment…. Patients with psychosis are often ambivalent about taking drugs, ⁶ and evidence suggests that the effectiveness of such drugs has been overestimated, whereas the severity of their adverse effects have been underestimated.⁷ A systematic review concluded that the improvements claimed for antipsychotics are of questionable clinical relevance, ⁸ and a multiple-treatments meta-analysis ⁹ showed that although differences in efficacy between antipsychotics and placebo were noted, they were smaller than those for most of the analysed adverse effects.¹⁰ Research suggests that adverse effects include structural abnormalities in brain volume,¹¹ increased risk of sudden cardiac death,¹² and substantial weight gain induced by antipsychotics,¹³ which is associated with cardiovascular and metabolic risks.”

In addition to the adverse effects and lack of clinically meaningful positive effects, there is an enormous cost to using these drugs, costs that are siphoning off resources that could be better used for more healthy alternatives. The cost for the drug approach is not just confined to the cost of the “antipsychotic” drugs which has been estimated to be in the range of several billions of dollars. Doctors often prescribe a whole cocktail of drugs for these patients, dramatically adding to the cost of the drug approach, while evidence indicates the combination of “antipsychotics” with these other drugs often leads to additional adverse effects. The cost of the doctors’ time for prescribing and monitoring the treatment must be added, as well, as the cost of the revolving door of placement in a hospital, releasing from the hospital, and readmitting to the hospital, which has been the frequent pattern with this drugging approach. Finally, we must add the cost of treating patients for all of the adverse effects of these drugs.

Given all of these problems, what alternatives to “antipsychotic” drug management are out there?

The Alternatives

There are several very promising alternatives, but in most regions they are not yet available. Articles like mine are designed to expand the general population’s knowledge of just how ineffective, harmful, and financially wasteful the drug treatments are, and that there are safer alternatives. This increased awareness campaign has been a major reason for the slow rising tide of advocates demanding that these more healthy alternatives become readily accessible in every community.

With this background, let’s take a look at these more healthy, humane alternatives.

Cognitive Therapy

A study funded by England’s National Institute for Health Research was published in 2014, that carried out a single-blind randomized controlled trial. Participants aged 16–65 years who were labelled as having schizophrenia spectrum disorders, and who had chosen not to take antipsychotic drugs, were randomly assigned to either receive cognitive therapy plus treatment as usual, or just treatment as usual. Outcome assessors were masked to group allocation.

The authors summarized their results as follows:

“Cognitive therapy significantly reduced psychiatric symptoms and seems to be a safe and acceptable alternative for people with schizophrenia spectrum disorders who have chosen not to take antipsychotic drugs. Evidence-based treatments should be available to these individuals. A larger, definitive trial is needed.

The central features of this treatment for this group of patients involve normalization and evaluation of the appraisals that people make, helping them to test such appraisals with use of behavioral experiments, and helping them to identify and modify unhelpful cognitive and behavioral responses. Additionally, it aimed to provide warm, empathic, and non-judgmental face-to-face contact, supportive listening, signposting to appropriate local services for unmet needs, and crisis management when needed.

Humanistic Approaches

A recent issue of the Journal Of Humanistic Psychology (JHP) is devoted to the humanistic perspective on understanding and responding to extreme states. There you will find several non-antipsychotic approaches for addressing psychological concerns that are labelled as schizophrenia by psychiatrists.

In one of the articles, Yana Jacobs, who once worked as a staff member at Soteria House, tells us about its approach. Funded by the National Institute of Mental Health, Soteria House provided a place to live for people who fit the criteria for schizophrenia and having their first episode. These patients were given the choice of staying at the hospital where they had first been labelled, or coming to Soteria, where “antipsychotics” usually would not be used. As Yana describes the program,

“All six residents were given their own private room and had the freedom to do what they felt like. This might include staying in their bedroom, sleeping all day, or hanging out in a living room and listening to music or chatting with whomever was around. Relationships developed naturally, and we all got to know one another to various degrees, no different than how we develop friendships. This was not a therapist-patient relationship but rather a sort of social relationship. As a staff member I had some responsibilities—going to the market and preparing dinner. Everyone was on their own for breakfast and lunch and could help themselves to whatever they might like. Grocery shopping was often an outing to the market. Usually, one or two residents would accompany me to the store. When we returned, I would ask for help prepping the meal. It was quite informal. The house was often a bit of a mess, but then, we’d all get together and decide it was time for a quick house cleaning and again, whoever wanted to join would do so.”

For those who have come to believe that without the use of “antipsychotics” all hell would break out and the world would pretty much come to an end, consider Yana’s experience:

“I never felt like I was ‘working,’ and honestly, I loved being at Soteria so much that it wasn’t till the end of my employment that I even took note of how much I was being paid. There’s something about being with people when they are going through a difficult time that is such a privilege and truly an honor to be part of this intimate journey.”

Yana explains that there were times when someone was going through deep pain, tears, screaming, throwing things, and sleeplessness, “but always something would emerge and calm would eventually arrive, you really had to have faith in the process.”

Since the original Soteria House opened and funding ran out, several other programs based on a similar model took its place. Berne, Switzerland has had a Soteria House since 1984, and Soteria houses in Vermont and Israel recently opened.

Soteria House programs are designed to help people through an original episode of an extreme experience typically labeled as schizophrenia. The stay at one of these houses lasts for just a few months.

Another approach well described in the JHP special issue is written by Charles Knapp. The Windhorse therapeutic perspective has a Tibetan Buddhist orientation that offers meditation, and spiritual teachings, along with a supportive, empathetic staff. Unlike the Soteria House approach, which aims to support people through a recovery process over a few months, the Windhorse approach recognizes that individual recovery periods are highly variable, and it is not uncommon for people to stay in their programs for eighteen months and even longer.

There are several other approaches described in the JHP special issue, all worth while to think about. All have had their share of success in helping to provide support for people experiencing extreme states.

That said, I would be negligent if I didn’t say that no approach currently available manages to avoid having some disappointing results. This is true for the standard medical model which urges all people labelled as having schizophrenia to immediately take “antipsychotics,” and it is also true for all of the alternative approaches discussed above. However, those alternatives lead to far fewer people eventually choosing to take “antipsychotics,” thus decreasing the chances of people experiencing the various adverse effects associated with consuming “antipsychotics.”

Beyond the decreased risk of “antipsychotic” adverse effects, available research can not say for sure that these alternatives lead to additional improved life outcomes. Nevertheless, results have been very encouraging, and it is high time that these alternatives become far more accessible while high quality ongoing research better assesses what works well, and what needs to be modified.

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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 intelligence. To begin at the very first post you can click HERE.

Alternative treatments for psychosisAntipsychotics