@yobluemama2 I do support Intervoice but also support meds when needed. Complementary-no one right way http://t.co/I5HBJIoZVZ
— Allen Frances (@AllenFrancesMD) September 16, 2013
Allen Frances responded to the open letter by writing, "Reconciling Recovery and Psychiatry: Response to Open Letter" for his blog in Psychology Today. I find Allen Frances' criticism of those harmed by psychiatry insulting; frankly, I find his professional posturing in this instance, resembles juvenile bullying. Frances claims his criticism is motivated by concern for people with psychiatric diagnoses; apparently, he is afraid people may believe and be inspired by the hearing voices movement. Why is the idea that people with a diagnosis of schizophrenia may feel hopeful for recovery is something to fear? Frances states he is concerned that "trying to follow Ms Longdon's path might help some, but may harm others."
I, on the other hand, am concerned that Frances did not "cover the waterfront of possibilities" accurately or ethically in his response. The hearing voices method, "could not possibly serve as a model for everyone who hears voices," so Frances claims he wants to prevent people from thinking Eleanor Longden's personal story is "a blanket condemnation of all psychiatric treatment"?! I'm skeptical of the veracity of this claim since Frances is promoting the medical model as "essential," while decrying the harm done by "Big Pharma and the physicians who over prescribe." My skepticism arises from Allen Frances's failure to disclose his collaboration with Big Pharma, the widely disseminated Expert Consensus Guidelines; which are still marketed as treatment standards meant to inform pediatricians, GPs, Internists, etc. to guide how they treat people using current psychiatric standards of care. There's no concern about patients being disabled and killed as a direct result of being diagnosed and treated according to a consensus of expert opinions...
Doctors rely on guidelines to inform treatment decisions believing the guidelines are based on valid evidence of treatment safety and effectiveness; not a drug marketing strategy!
I want to share the comment left by psychiatrist, Dirk Corstens, the Chair of Intervoice, in response to Allen Frances's blog post answering Intervoice's Open Letter:
Recovery and Psychiatry
Submitted by Dirk Corstens on September 17, 2013 - 12:41am.
Dear Professor Frances,
Thank you for your prompt response to the open letter sent to you from Intervoice. I would like to take this opportunity to continue the dialogue by offering some of my own reflections on your recent article.
You reiterate that people diagnosed with schizophrenia need medication, because you witnessed "dozens of lives ruined" by people coming off it. That is what I also learned during my psychiatric training, something that was systematically confirmed by colleagues. Proceeding with that mind-set, I also saw dozens of people struggling to come off medication, often unsuccessfully - but mostly due to lack of support (e.g., "when you don't take your medication we stop treatment").
After more than 25 years of experience working in clinical and social psychiatry, much reading, and much meeting and collaborating with many voice hearers, like Eleanor, who bravely took their own roads to recovery, I have definitively changed my mind and practice.
My present mind-set - my most accurate and honest conclusion about psychosis and medication - is that I really don't know who needs medication and who does not. I now believe it is better to prevent prescribing medication whenever possible.
Modern psychiatric practice tends to endorse that people with psychotic experiences - or what psychiatrists believe are psychotic experiences - rarely get access to psychological therapies, and almost never as a first-response treatment (despite robust evidence that it works). Without much communication, and almost automatically, antipsychotics are prescribed. As you may know, in some European countries young patients are even prescribed three different medications at a time. Modern psychiatric practice is ruled by a fundamental fear of psychotic experiences and the objectively false premise that antipsychotics eliminate it. There is abundant reason to change this mind-set: communicate, care, and support. Wait, create a safe environment. Wait and listen. Try to make sense of experiences. Only prescribe low doses when necessary and stop when possible.
The most important reasons:
- The diagnosis of schizophrenia is scientifically unreliable (see for example Richard Bentall and Mary Boyle - not anti-psychiatrists, but research-psychologists who think in a scientific way) and more stigmatising than helpful. And of course, there are no specific symptoms nor tests that confirm if the diagnosis is accurate or not.
- It is more and more uncertain that antipsychotics improve the long-term prognosis of psychosis. Many colleagues now state that the prognosis is not better or worse than before chlorpromazine was administered to patients. Functional recovery seems better when people don't take antipsychotics or only in low doses (e.g., Harrow, Wunderink, Mosher, Ciompi).
- There is good reason to believe that antipsychotics often do more harm than good (e.g., Breggin, Whitaker, Healy, Moncrieff, Lehmann).
- There are a lot of promising alternatives: Open Dialogue, Soteria, CBT, psychosocial therapies, hearing voices networks, self-help groups, trauma-informed therapies. These alternatives have existed a long time; are well documented; propagate the cautious and sparse use of medication - and give good results.
- More and more people who utilise psychiatric services openly state that they prefer a personal approach and need a say in their treatment and choice.
It is really exciting and rewarding to operate as a psychiatrist from this alternative mind-set with people who report subjective experiences that overwhelm them.
Eleanor's story tells us professionals that meeting the person behind the symptoms, communicating about the real personal story, creating a safe environment, and supporting family members and other allies are the most fundamental ingredients of good psychiatric care and cure. She didn't say what other people should do or not. It is not a story about medication at all - she only tells it didn't help her, and after taking it for a while came off it. It is a story of struggle and hope. A real and personal story.
I really don't understand why you feel the need to censor her.
Dirk Corstens, consultant psychiatrist
Chair of Intervoice
www.intervoiceonline.org
- The diagnosis of schizophrenia is scientifically unreliable (see for example Richard Bentall and Mary Boyle - not anti-psychiatrists, but research-psychologists who think in a scientific way) and more stigmatising than helpful. And of course, there are no specific symptoms nor tests that confirm if the diagnosis is accurate or not.
- It is more and more uncertain that antipsychotics improve the long-term prognosis of psychosis. Many colleagues now state that the prognosis is not better or worse than before chlorpromazine was administered to patients. Functional recovery seems better when people don't take antipsychotics or only in low doses (e.g., Harrow, Wunderink, Mosher, Ciompi).
- There is good reason to believe that antipsychotics often do more harm than good (e.g., Breggin, Whitaker, Healy, Moncrieff, Lehmann).
- There are a lot of promising alternatives: Open Dialogue, Soteria, CBT, psychosocial therapies, hearing voices networks, self-help groups, trauma-informed therapies. These alternatives have existed a long time; are well documented; propagate the cautious and sparse use of medication - and give good results.
- More and more people who utilise psychiatric services openly state that they prefer a personal approach and need a say in their treatment and choice.
It is really exciting and rewarding to operate as a psychiatrist from this alternative mind-set with people who report subjective experiences that overwhelm them.
Eleanor's story tells us professionals that meeting the person behind the symptoms, communicating about the real personal story, creating a safe environment, and supporting family members and other allies are the most fundamental ingredients of good psychiatric care and cure. She didn't say what other people should do or not. It is not a story about medication at all - she only tells it didn't help her, and after taking it for a while came off it. It is a story of struggle and hope. A real and personal story.
I really don't understand why you feel the need to censor her.
Dirk Corstens, consultant psychiatrist
Chair of Intervoice
www.intervoiceonline.org
photo credit here
