Category Archives: Psychiatry

The Art of Psychiatry

By Dr David Laing Dawson

The Eyes, ahh, the Eyes.

Some years ago a psychiatrist asked me to see one of his patients on the ward of the mental hospital. She had been admitted in a state of psychosis; he had prescribed appropriate medication, and then later increased that medication, and now she sat alone all day, communicating with no one. Was the dose too high? Had he made her toxic? Should he stop the medication?

In her room the woman sat fully clothed on the side of her bed staring straight ahead. I introduced myself and talked with her. I sat beside her on the bed and talked to her. I received no answer, verbal or non-verbal. I looked closely at her eyes.

I left her room and talked with her doctor. Increase her medication I told him. He raised his eyebrows. No, I said, I’m sure.

He did so and the patient recovered, first in small ways, acknowledging the presence of others, and then talking, engaging, and plans for discharge were made.

Her eyes told me she was in a state of high arousal, not drugged at all, but rather in turmoil, flooded by fears and anxieties to the point of immobility. Her eyes were alive but focused internally.

It is easier to be a poet than a scientist when it comes to eyes. A nurse might say to me about a patient, “The lights are on but nobody’s home.” It is an apt phrase, so accurately describing a state of dementia. In early dementia the right image, phrase or music might bring that person back home for a while, but then she will leave home again, and, eventually, not return.

And then there is the stare of the true believer, aroused and focused, all knowing, all seeing. They are the same eyes one sees in delusional states. Perhaps they are daring one to challenge them. They send no signal of welcome, no invitation for discourse, no flicker of doubt. They are the easiest to imitate.

Boys on the ASD spectrum avoid eye contact, and when they are coaxed into making such “contact”, the eyes quickly touch and then slip away, as we do when we glance at the sun.

The girls, the ASD girls sometimes stare fixedly, unblinking. They make “good” eye contact we notice, but the dance is wrong, the movement static, the intent unreadable; my smile goes unanswered by her eyes.

The eyes of the man with schizophrenia are similar, but often flit from certainty to perplexity and back again, as if they are trying to decipher a very difficult passage in an ancient text.

Depression is always present in the eyes. The light is dimmed, the person home, but slow to answer the door. Sometimes they are hooded and dull, but other times, in agitated depression, fearful and searching.

And then mania. If it is an angry mania I sit low in my chair and make only fleeting eye contact, for fear of adding fuel to the blazing fire within my patient’s eyes. If it is a grandiose mania, I watch the eyes of delusion and true belief and wait for a moment of doubt, a shadow to cross those eyes, before I offer a comforting smile and some medication.

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Drugs and Violence

By Dr David Laing Dawson

In medicine, when we find something that works we overuse it. That is as true of antibiotics, anti-inflammatories, and blood pressure drugs as it is for psychiatric drugs.

And this means that some people who really didn’t need the drug in the first place may be suffering unnecessary side-effects. Over time medicine usually corrects with broad studies and new guidelines.

(Although it is as difficult for doctors to convince a patient that he needs to exercise rather than take Prozac, as it is to convince a mother that her child’s cold and earache will run its course with or without antibiotics.)

But to blame psychiatric drugs for violence and murder is patently ridiculous.

In fact, if one extrapolates from the murder rate trends around the world, or just within large Canadian cities, one could make a case for the wide prescription of anti-depressant and anti-psychotic medication being the source of less violence in our societies.

Murder rates in the middle ages were shockingly high by all estimates. Similarly throughout the 1800’s.

In Toronto and Montreal the murder rates climbed from 1900 into the 1960’s, peaking in the mid 70’s and then declining ever since.

The powerful psychiatric drugs were introduced in the 60’s but mostly used within hospitals and outpatient clinics of hospitals. Wider use developed in line with the reduction of psychiatric hospital beds and the introduction of newer drugs in the 1970’s and 1980’s: the so-called atypical anti-psychotics (Risperdal, Seroquel eg) and the SSRI’s for anxiety and depression (Prozac onward).

The increasing use of these drugs within the community and less ill population, when charted, is a reverse image of the declining murder/homicide rates.

Many other factors are at play as well, of course, so I cannot make a case for these drugs specifically being responsible for the declining rate of homicides, but I can from this data be confident that wide-spread use of these medications is NOT increasing the homicide rate.

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The first group of antidepressants were introduced in the 1950’s, again primarily in hospitals, outpatient clinics and for severe depression. (Imipramine, Amitriptyline)

Prozac, the first SSRI antidepressant was introduced in 1989. Currently 86 people per 1000 in Canada take an antidepressant, usually an SSRI or NSRI medication.

(note both the highest suicide rate and the lowest consumption of antidepressants falls to South Korea)

Similarly the first antipsychotics (Chlorpromazine etc.) were introduced in the late 1950’s/early 60’s and were used primarily within the mental hospital population. The second generation only became available in the 1980’s. Currently a little over 1% of the American population takes anti-psychotic medication.

If one considers the percentage of the population that suffers from severe mood disorders it is reasonable to say that the antidepressants are being somewhat over prescribed.

On the other hand if one considers the percentage of the population suffering from a psychotic disorder (schizophrenia, bipolar disorder, psychotic depression, autism with psychosis) the anti-psychotic medications are being underutilized.

But, either way, to blame these medications for violence or homicide in 2018 is ridiculous, as the data clearly demonstrate.

 

The Danforth Shooting – Violence and Mental Illness

By Dr David Laing Dawson

In the wake of the Danforth shooting a couple of my colleagues have been quick to point out that the association between mental illness and violence is small, that most people suffering from mental illness are more likely to be victims of violence than perpetrators of violence. They are worried about the stigma of violence attaching itself to mental illness. And of course they are right. Though one of them goes on to use those horrible euphemisms of “mental health issues” and “mental health challenges”.

Language is important as are the questions we ask.

If we expand the problem to “mental health issues” then I am sure I can rightly say that all acts of physical violence by one human against another are the products of “mental health issues”. Otherwise we will have to expand our concepts of normal and healthy to include physical violence.

And the use of such ill defined euphemisms plus our worry about stigma cause us to ask the wrong questions. Did he suffer from “mental health challenges” and “issues”? Of course he did. Is a circle round?

These are the better questions to be asked:

1. Did treatable mental illness play a role in the Danforth shooting?

(I have just read that the man in question “repeatedly cut into his face with a pencil sharpener blade” and talked of hearing voices – both symptoms of a treatable mental illness, a psychosis, probably schizophrenia)

2. If he did have such an illness why was it not being adequately treated?

(Not “supported”, “counselled”, “accommodated”, but treated)

And finally, because question 2 will always lead to imperfect answers, 3. How did he get a gun?

I have to add that while many people suffering from delusions never act on those delusions, especially if they are being treated, a very specific sign that a psychotic and delusional person will act upon a delusion (that is, attack his imagined torturers) is self injury to face or genitals.

How Science Tries to Understand Mental Processes

By Dr David Laing Dawson

When science tries to understand human behaviour it can develop methodologies to look at multiple levels of our organization. These levels could range from subatomic particles to the behaviour of tribes, nations, the population of the entire world.

Within the medical sciences we are interested in the behaviour of cells, of neurochemistry, and, at the other end of this chain, the experiences and behaviour of individual humans.

Behaviour can be observed, and observed within different contexts, and under specified situations. Internal experiences require self reporting within a social context, and self reporting is notoriously unreliable. (Imagine asking Donald Trump what he is thinking and feeling, and why he is having these thoughts and feelings, and whether he has written many books.)

Until quite recently the behaviour of brain cells, of neurochemistry, could only be studied by measuring the rise and fall of various metabolites in blood and urine.

And between these extremes (human behaviour and the rise and fall of metabolites in blood and urine) there existed an enormous black box containing the interaction of chemistry, cells, neurons, organs within the brain, systems of arousal and perception, systems of neural organization, complex biochemical and electrical feedback systems….

With EEGs, CT Scans, MRI’s, Pet scans, molecular biology, genome mapping, our new ability to at least see which parts of the brain are active (metabolizing, using glucose and oxygen) and which are dormant when we talk, listen to music and/or hallucinate, that Black Box has shrunk. But it is still there.

Behaviour is a visible product of a long complex chain of events from cell activity, neurohormone production, arousal and filtering systems, inhibiting and stimulating feedback loops.

Ritalin is a stimulant. Yet when given to a boy with ADHD it usually slows him down. So my best guess here is that with ADHD our stimulant is stimulating an inhibitory mechanism.

Like many medications, the power of Chlorpromazine (Largactil) to quell psychosis was discovered by accident. This time in France. Heinz Lehmann brought it to Canada to use in a trial at The Douglas Hospital. It worked dramatically, but why and how it worked is another question. Following the methodologies mentioned above it was first determined that chlorpromazine and drugs developed within the same family affected the neurochemical, neurotransmitter, dopamine. From this arose the dopamine hypothesis of schizophrenia.

But we have since learned that each mental illness is the product of long, complicated pathways from neuron to dendrite to neuron to behaviour (sometimes through long chains and multiple pathways), and that different medications can affect the final behavioural outcome by affecting different parts of that chain, sometimes by stimulating production of a neurohormone, sometimes by emulating a neurohormone, sometimes by inhibiting a neurohormone, sometimes by blocking the transmission of a neurohormone, and sometimes by inhibiting the degradation of a neurohormone (hence the SSRI’s – Selective Serotonin Reuptake Inhibitors)

With the modern technologies we can describe with accuracy what exactly each drug does at a neuronal, biochemical level. But there remains a black box between that level and the actual observed behaviour. Though it is getting smaller and smaller and easily bridged with hypotheses.

But psychosis is not simply too much dopamine, nor depression inadequate serotonin. Although medically altering those two neurochemicals (neurotransmitters) does affect (usually) the chain of electrical/molecular events that leads to psychosis and depression.

RIP Dr Fred Frese

By Marvin Ross

The world just lost another advocate for serious mental illness. Dr Fred Frese was a psychologist with schizophrenia and an active promoter of better care for the seriously mentally ill. He had been a board member of the National Alliance on Mental Illness and one of the founders (along with Dr E Fuller Torrey) of the Treatment Advocacy Center.

I met Fred, and his wife Penny, when they gave a talk at the Hamilton Program for Schizophrenia in the late 1990s and did a profile of them for one of the medical papers that I wrote for. Both of them were incredible speakers. Fred first got sick when he was an officer in the US Marine Corps guarding the largest repository of nuclear weapons in the US.

He became quite paranoid and was eventually transferred to Walter Reed Hospital in Washington where, he said, may of his fellow psychiatric inmates were high ranking officers. While a patient there and elsewhere, he pursued his education and obtained a PhD in psychology. He joked that he went from being an involuntary patient in one hospital in Ohio to becoming its chief psychologist years later.

He commented that he continued to study because people with mental illness simply cannot find work. His sense of humour was evident when he talked about dating his wife. They had gone for a long walk in the woods and it was then that he decided to tell her that he had paranoid schizophrenia. Not the best place to do that, he commented. She did not run off screaming, they married and had four children.

Dr Frese has always been a strong supporter of involuntary treatment when it is necessary (as it often is) and for the fair treatment of those who are ill.

He explains his position in this presentation below:

As he said in the video clip below, he refuses to be ashamed of his illness and that he is not recovered (despite all his credentials) but is in recovery.

I should also mention that Fred was very generous with his time and was an active supporter of the late Dr Carolyn Dobbins (another psychologist with schizophrenia) and was gracious enough to write a very good blurb for Katherine Flannery Dering’s book, Shot in the Head.

Those of us who advocate for improved services for the mentally ill will have to step up our efforts to make up for Fred’s loss.

Blue Dreams – the Story of Psychiatric Drugs

By Marvin Ross

I’ve just finished reading Blue Dreams The Science and the Story of the Drugs That Changed Our Minds and it is the most balanced accounting of psychiatric meds that I’ve ever read. Lauren Slater is a psychologist and someone who has taken psychotropic medication for bipolar depression for most of her life. She has been in and out of hospitals many times so she speaks from both experience and academic awareness.

She starts out with a very detailed account of how chlorpromazine, the first anti-psychotic, came to be and gradually made inroads against the psychoanalysis that was prevalent at the time. What surprised me was that there were psychoanalytic neurologists who considered Parkinson’s to be the result of psychology and not brain chemistry. She then moves on to give the history of the first anti-depressant, imipramine.

As a political aside, both of those drugs were first used in North America by Dr Heinz Lehmann in Quebec. He came to Canada as a refugee fleeing Hitler. His colleagues arranged a ski vacation for him to Quebec as a ruse so he left Germany with his skis and all his luggage. A lesson for the Donald on the value of refugees.

Her discussion of lithium is quite interesting as its use goes back many years for all manner of ailments but it was slow to be accepted by medicine for psychiatry because there cannot be a patent on a naturally occurring substance. No money can be made and so, to this day, no one has ever bothered to try to find out what it does to the brain or how it works. A sad condemnation of science and of the profit motive in drug development.

Ms Slater began suffering depression at quite a young age and was eventually sent to see a psychiatrist in her early teens. She saw the doctor three times per week. After about 6 years of no progress, her doctor put her on imipramine which had recently become available but it did not help and gave her terrible side effects. When Prozac became available, she was switched to that and she spent 17 years taking it.

This is what she had to say:

“Both before and while I was on imipramine, my emotions were wild and I was whipped between states of utter despair, whirling anxiety and unstable ecstacy that allowed me to pull all-nighters writing lengthy tomes that later, in the sober light of another day, lacked what I felt at the time of composition had been a poetic essence. I was also a revolving-door mental patient in and out of the hospital admitted and discharged five times between the ages of thirteen and twenty-four, with not much hope for a full future……”

“Prozac turned my life around and did it fast, one two.”

“On SSRIs, however, I have been able to stay out of mental hospitals, to write nine books, to bear two babies who are now adolescents with their own keen interests and proclivities to manage with their own interests, to manage a marriage and then a divorce, and, just as important, to nurture a circle of friends.”

Unfortunately, over the years she has had to increase the dose until Prozac became ineffective and she had to switch to other medications. And, the drugs had a severe impact on her health causing her to gain weight and to develop diabetes. But, she said, that was the price she had to pay for sanity.

While she has been helped by pharmaceuticals as have many people, she is very critical of psychiatry and its theories which are quite simplistic. I was surprised to learn that despite the dopamine theory of schizophrenia, it turns out that those with this disease can have a wide range of dopamine levels and the levels are not related to the presence of the disease or its severity. The same applies to serotonin in the case of those with depression. Prescribing is a guessing game and there are doctors who prefer certain drugs and that is what they prescribe based simply on their preferences and not the science of why a certain drug works. However, drugs that dampen or increase levels of these neurotansmitters do help with the symptoms but psychiatry still has no clue about etiology.

This ideological adherence to certain drugs is one that I encountered a number of years ago. I pitched a story to a psychiatry/neurology newspaper on research done comparing the side effect profile of the older anti-psychotics with the new atypicals. The pitch was accepted and I submitted the story which showed that the newer drugs had just as many side effects as the older ones. The editor called and told me the research was preposterous and should never have been accepted as a presentation at a psychiatry conference. They refused to run the story but paid me anyway because they had accepted my pitch (in error I was told).

Of course, we all now know that the research was correct.

One interesting fact she mentions is that even with drugs like Prozac, the rates of depression are increasing. The reported incidences of depression have increased a thousandfold since the introduction of anti-depressants. She suggests that this might be the result of an American society that emphasizes individualism and has very few safety nets like universal health care. Sociological studies have shown that depression increases with isolative societies.

It would be interesting to compare rates of depression over time between the US and other western countries that are less individualistic like Canada and Western Europe.

I was pleased to see that while she references my old opponent, Robert Whitaker, she discounts his views. Yes, anti-depressants do cause changes in the brain as he points out but then, untreated depression (and schizophrenia) cause changes in the brain and the patient when untreated, is not able to manage.

Psychiatry and our knowledge of the brain is still in its infancy and we can only hope that greater progress is coming.

The Failure in Police Reactions to Emergencies – Amended After Toronto

By Dr David Laing Dawson

Within the span of a few days the Hamilton Police demonstrated good judgment and remarkable restraint keeping two unruly mobs apart on Locke Street, saved a little girl’s life with quick compassionate action, and killed a teenager, a boy obviously in the throes of some kind of psychotic episode.

Why do they perform so well, even heroically, in some circumstances, and so poorly, tragically, in others?

I am not asking the question rhetorically, for the question may be worth serious consideration.

The first of these three situations was the most dangerous. It could easily have erupted into violence followed by five years of lawsuits.

The second required quick, focused action despite the horrifying sight of a child being caught under a moving train.

The third required a calm assessment of imminent danger (there was none) and then a calm slow approach.

In the rush to arrive at an unfolding situation each officer will develop heightened arousal. Stress hormones, adrenalin, breathing pattern, heart rate, blood pressure will all be aroused. This is commonly called the fight / flight response, but it is a complex system of brain/body arousal that allows for increased awareness of danger, heightened ability to focus, increased startle response, decreased pain sensation, decreased attention to ‘unimportant’ internal and external stimuli (e.g. time, hunger, thirst, chirping birds, other people), and heightened reflexes.

For the little girl with the severed limb this served her well. The officer reacted quickly and with full focus and efficiency without external distraction.

For the containment of the two mobs there had been enough planning, preparation, structure, and organization that each officer was able to quell or override their fight/flight response and diffuse the potential for violence.

Not so in the third example. The officers arrived in fully aroused state and entered the situation with heightened reflexes and heightened fear. Guns were drawn, triggers pulled.

Each circumstance is different. But in all the unnecessary police shootings of the past few years there has been one consistency: Police arrive in a rush on a call labeled as dangerous in some way. They are in a state of heightened arousal. They do not pause. They do not collect their thoughts or information. They do not pause in safety to slow heart rate, breathing, to scan the environment. They are hyper focused. They push forward. There is no thought of backing up.

In this state a cell phone can be seen as a gun. Awkward movements and slow response to commands can feel dangerous and threatening. The fact that no third party is at imminent risk does not register.

In a recent police shooting in the U.S. you can hear the heightened arousal, the full fight/flight response in the voices and breathing of the officers.

I have to conclude that some things are missing from police training. The first would be a pause upon arrival at the scene to determine if there is indeed a truly imminent threat to a third party. (Not a suicide threat, refusals, waving of arms, bizarre behavior, bad language, verbal threats – but a truly imminent threat to a third party. Is there anyone else on the street car, in the back yard, nearby in the field, nearby in the park, in the arrival lounge?). The second is the option to hold, rest, backup, breathe, take the time to dampen the state of arousal one is in at that moment, and then and only then proceed in a sane, calm, safe fashion.

And all that I suggest was done by the Toronto police officer when he confronted the driver of the van that had just wreaked havoc on Yonge St killing 10 and injuring many others. When the officer arrived, no one was in imminent danger. He even had the presence of mind to return to his cruiser and turn off the siren as it was distracting and preventing the officer and the subject from hearing one another. That also gave  him time to calm his nerves. At times, he backed away and, presumably when he realized that he was not in danger himself, he advanced and the suspect gave up.

We can only hope that this incident will serve as a training tool for others who might find themselves in a similar situation.

More on The Continuing Proof of the Efficacy of Anti-Psychotics

By Dr David Laing Dawson

The narratives from the proponents of Open Dialogue remind me of the narratives arising from the psychoanalysts working in private psychiatric hospitals in the United States in the 1950’s and 1960’s. Many case studies were available and even books written on the subject.

In the late 1960’s we were unlocking the doors of the mental hospital in Vancouver and applying therapeutic community principles. The principles and ideas of the therapeutic community can be found in the activities of the Open Dialogue program. And before that they can be found in the practices of small hospitals from the Moral Treatment Era of the 1850’s to 1890’s, and again, briefly, in some mental hospital reforms shortly after WW1 and before the Great Depression, albeit, in each case, within the language and pervasive philosophies of the time.

In the late 1960’s we had already discovered how wonderfully effective chlorpromazine could be in containing mania and reducing the psychotic symptoms of schizophrenia.

So in this context, knowing the evidence, the clear evidence of chlorpromazine being the first and only actually effective treatment for psychosis, and lithium for mania (beyond containment, sedation, shelter, kindness, protection, food, routine grounding activities, time and care) it behooved us to look closely at the claims of the psychotherapists who were writing such elegant and positive case studies from the American private hospitals.

So I read them.

They were interesting reading, detailing the relationship of therapist and psychotic patient, interpreting the content of the psychosis, and the painstaking time consuming process of building a relationship, working to help the patient view the world in a different manner, and always, through the pages of these reports, it was said great progress was being made. And they all ended with something like (this is the one I remember best) “Unfortunately, despite showing so much progress, patient X assaulted a nurse and had to be transferred to the State facility.” Curiously, as with many “studies” I read today, despite the obviously bad outcome, a paragraph is added at the end extolling the progress made (before the unfortunate outcome) and recommending we stay the course.

There are many interesting explanations for the continuing anti-medication (for mental illness) philosophies. (Note that almost nobody objects to taking medication for other kinds of suffering and illness). Marvin and I have written about a few – the preciousness of the sense of self, the wish that there be an immortal mind that can outlive a brain, the fear of being controlled, distrust of Big Pharma, professional jealousies, and turf wars. But writing the above reminds me of another reason this irrationality persists.

It was clearer to me then (1960’s/1970’s) than it is now, because we really wanted to find ways of helping without medication: It is much more ego gratifying to mental health workers of all stripes when our patients get better simply because of our presence, our words, our care, ourselves, than if we just happen to prescribe the right medication.

I remember well a patient, a professional, a few years ago, thanking me for helping him overcome a severe depression. “Nah,” I said, “I just managed to prescribe the right medication for you.” “No, no,” he said. “It was more than that.”

All right. There are a few moments when I can be attentive, thoughtful, kind, and even find the right words. But to try doing that alone while withholding medication for severe mental illness would be malpractice, cruel, egotistical, even sadistic.

 

The Continuing Proof of the Efficacy of Anti-Psychotics

By Marvin Ross

Despite the protestation from the anti-psychiatry advocates, medication for schizophrenia works and another study has just been published to support that position. A new study based on a nationwide data of all patients hospitalized for schizophrenia in Finland from 1972 to 2014 found that the lowest risk of rehospitalization or death was lowest for those who remained on medication for the full length of time.

The risk of death was 174% to 214% higher among patients who never started taking antipsychotics or stopped using them within one year of their first hospitalization in comparison with patients who consistently took medications for up to 16.4 years.

It should be pointed out that this is real life data rather than a clinical trial involving a total of 8,738 people.

What is particularly significant for me in this study is that it is from Finland which is the home in one isolated part of that country (Lapland) to the alternative Open Dialogue espoused by the anti-psychiatry folks including journalist Robert Whitaker of Mad In America fame. Whitaker claims that 80% of those treated with Open Dialogue are cured without need for drugs.

I wrote about Open Dialogue very critically back in 2013 in Huffington Post and pointed out that there is very little research to demonstrate its efficacy. I actually asked a Finish psychiatrist, Kristian Wahlbeck who is a Research Professor at the National Institute for Health and Welfare, Mental Health and Substance Abuse Services, in Helsinki about Open Dialogue.

This was his answer:

“I am familiar with the Open Dialogue programme. It is an attractive approach, but regrettably there has been virtually no high-quality evaluation of the programme. Figures like “80 per cent do well without antipsychotics” are derived from studies which lack control group, blinding and independent assessment of outcomes.”

He went on to say that:

“most mental health professionals in Finland would agree with your view that Open Dialogue has not been proven to be better than standard treatment for schizophrenia. However, it is also a widespread view that the programme is attractive due to its client-centredness and empowerment of the service user, and that good studies are urgently needed to establish the effectiveness of the programme. Before it has been established to be effective, it should be seen as an experimental treatment that should not (yet?) be clinical practise.”

As for the claim that psychiatric hospital beds in Finland have been emptied, he said “in our official statistics, the use of hospital beds for schizophrenia do not differ between the area with the Open Dialogue approach and the rest of the country.”

My blogging associate, Dr David Laing Dawson also wrote about Open Dialogue in this forum with very skeptical view. He stated that the director of the program admitted that about 30% of the patients in Open Dialogue are prescribed medication so arguing that medication is not used is not correct.

At the time my article appeared in Huffington Post, someone on Mad In America agreed with me that there was insufficient evidence on the efficacy of Open Dialogue and said that a US study was set to begin in, I think, Boston. I did find a completed study on Open Dialogue done by Dr Christopher Gordon. His study involved 16 patients and he states at the outset that

“Since this was not a randomized clinical trial and there was no control group, we cannot say that these outcomes were better than standard care, but we can assert that they were solidly in line with what is hoped for and expected in standard care.”

In the paper that is in a legitimate psychiatric publication, he states that of the 16, two dropped out and a further 3 had disappeared at the end of the study so no data is available for them. This is a study of 11 people who completed the one year term.

He then points out that:

“Of note, four individuals had six short-term psychiatric hospitalizations (two involuntary).”

and that:

“three of the six individuals who were not on antipsychotics at program entry started antipsychotics. Of the eight already on antipsychotics, four had no change in their medication, and four elected to stop during the year. Both groups of four had similar outcomes and continued to be followed in treatment. Shared decision making and toleration of uncertainty contributed to these choices.

Hardly the success he suggests if the goal was to help them get well without medication.

But, coming up at the end of May in Toronto we have a conference with Robert Whitaker and others on Shifting the Narrative on Mental Health from the psychiatric disease model to the relational/recovery model, and on the challenges that are stacked against that eventuality.

Now I would say that the challenges against that shift are science but they define it as “The challenges and resistances to progressive change are of an ideological, macro-economic nature guaranteeing a protracted and difficult struggle for recovery advocates.”