Christian had been diagnosed with
schizophrenia. Two days before, in a haze of paranoia, he had punched
a colleague of mine at a day centre. So Christian was sectioned
and medicated, heavily, with neuroleptics. Most, on seeing Christian
would have described him as being so whacked out he was a dribbling
wreck. Treatment-advisory body, the National Institute of Health
and Clinical Excellence (Nice) would say the neuroleptics had successfully
“calmed” Christian, in preparation for treating the
“underlying psychiatric condition”.
Neuroleptics – such as Clozapine,
Olanzapine, Risperidone and Seroquel – are the “primary
treatment” for psychosis, particularly schizophrenia. Indeed,
98-100 per cent of people diagnosed with schizophrenia inside our
psychiatric units – and 90% living in the community –
are on neuroleptics, also called anti-psychotics. “There is
well established evidence for the efficacy of anti-psychotic drugs”,
Nice told mental health professionals in its guidelines
for the treatment of schizophrenia.
Nice claims a similar efficacy for
the widely-prescribed SSRI anti-depressants in treating depression.
Some researchers disagree. A recent widely-publicised meta-analysis
asserted that SSRIs are no more clinically beneficial than placebo
for mild and moderate depression. London NHS psychiatrist Joanna
Moncrieff is one such dissenting researcher. But she has conducted
a far wider examination of psychiatric drugs, and has endeavoured
to expose the “myth” of anti-psychotics. She claims
there is no sufficient evidence to support their long-term use and
they cause brain damage, a fact which is being "fatally”
overlooked. Plus, because of a cocktail of vicious side-effects,
anti-psychotics almost triple a person’s risk of dying prematurely.
Moncrieff, also a senior lecturer
at University College London, particularly strikes out at her own
profession, psychiatry, claiming it is ignoring the negative evidence
for anti-psychotics. In her book, The
Myth of The Chemical Cure, Moncrieff argues the increasing prescribing
of these drugs is unleashing an epidemic of drug-induced problems.
She argues, effectively, that psychiatry is guilty of gross scientific
Having scrutinised decades
of clinical trials, Moncrieff's first point is that once variables
such as placebo and drug withdrawal effects are accounted for, there
is no concrete evidence for antipsychotic long-term effectiveness.Moncrieff’s
interpretation of the relevant meta-analyses and trials is radically
different to Nice which arrived at an opposite conclusion for antipsychotic
At the heart of dissent against psychiatry through the ages has
been its use of drugs, particularly anti-psychotics, to treat distress.
Do such drugs actually target any “psychiatric condition”.
Or are they chemical control, a socially-useful reduction of the
paranoid, deluded, distressed, bizarre and odd into semi-vegetative
zombies? Historically, whatever dissenters thought has been largely
ignored. So, it appears, have new studies which indicate anti-psychotics
are not effective long-term. For example, a US study last year in
of Nervous and Mental Disease reported that people diagnosed
with schizophrenia and not taking anti-psychotics are more likely
to recover than those on the drugs. The study was on 145 patients,
and researchers reported that, after 15 years, 65 per cent of patients
on anti-psychotics were psychotic, whereas only 28% of those not
on medication were psychotic. An intriguing finding, surely? So
what about the mainstream media headlines of “breakthrough
in schizophrenia treatment”? Afterall, broadsheets react positively
to the plethora of alleged genetic "breakthroughs"
in schizophrenia, even when it comes to genetically-engineered schizophrenic
mice. But there wasn't a squeak.
Interestingly, the researchers of the Journal
of Nervous and Mental Disease paper hypothesised that it
was patients with "inner strength”, “better self
esteem” and “inner resources” who were more likely
to recover long-term without neuroleptics. However, not one peer-reviewed
study examining the necessary individual characteristics and support
networks to live through psychosis without drugs has, in the last
48 years, appeared in The British Journal of Psychiatry, the publication
that each month drops through the letter box of every psychiatrist
in the land.
The “psychological factors”
of, for example, inner strength, are, perhaps more the terrain for
clinical psychologists. Such as Rufus May who was compulsory treated
with anti-psychotics when diagnosed with schizophrenia as an 18-year-old.
May argues withdrawal effects of
anti-psychotics often get wrongly interpreted as “relapse”.
So, he has launched a website
advising people how safely to come off psychiatric drugs. Many patients,
like May (who perhaps had the required "inner strength”),
have successfully come off anti-psychotics and gone on to recover.
The irony is that they frequently have had to do it behind the backs
of their psychiatrists, who fear relapse.
Moncrieff’s second point is
that the psychiatric establishment, underpinned by the pharmaceutical
industry, has glossed over studies showing that anti-psychotics
cause extensive damage, the most startling being permanent brain
atrophy (brain shrinkage) and tardive dyskinesia. As in other neurological
conditions patients suffer involuntary, repetitive movements, mental
impairment, memory loss and behaviour changes. Brain scans show
that anti-psychotics cause atrophy within a year, alerts Moncrieff.
She accuses her colleagues of risking creating an “epidemic
of iatrogenic brain damage”. Moncrieff is a hard-nosed scientist,
so she is respectfully reserved. But her carefully-chosen words
are still alarming. "It is as if the psychiatric community
can not bear to acknowledge its own published findings,” she
How worrying it is, also, that the
Healthcare Commission should report
last year that almost 40 per cent of people with psychosis are on
levels of anti-psychotics exceeding recommended limits. Such levels
cause heart attacks. Indeed the National Patient Safety Agency claims
heart failure from anti-psychotics is a likely cause for some of
the 40 average annual “unexplained”
deaths of patients on British mental health wards. Other effects
of anti-psychotics include massive weight gain (metabolic impairment)
and increased risk of diabetes. Two years ago, The British Journal
of Psychiatry - Britain’s most respected psychiatry journal
- published a study
reporting that people on anti-psychotics were 2.5 times likely to
die prematurely. The researchers warned there was an “urgent
need” to investigate whether this was due to anti-psychotics.
But so engrained is the medication culture in mental health that
many psychiatrists regard that not medicating early with anti-psychotics
amounts to negligence, Moncrieff notes.
Moncrieff does acknowledge
there is evidence for the short-term effectiveness of anti-psychotics.
But again Moncrieff asks psychiatry to be honest. Moncrieff points
out that when anti-psychotics, such as chlorpromazine, were first
used in the fifties they were called “major tranquillisers.”
Why? Because that’s an accurate description of their effect,
particularly short term. They sedate, numb, or tranquillise, the
emotions, so reducing the anxiety of paranoia and delusions. Any
person on anti-psychotics would verify this (Go to askapatient.com).
So, in this respect, they are effective. Nowadays, however, these
drugs are referred to as “anti-psychotics”. For Moncrieff,
this is a wheeze because there’s no evidence that anti-psychotics
act directly on the “symptoms” – paranoia, delusions,
hallucinations – of those diagnosed with psychosis. There’s
nothing anti-psychotic about anti-psychotics.
Embedded in Moncrieff’s thesis
is that, unlike other medical conditions, there is no evidence that
psychiatric illnesses, including schizophrenia, are caused by physical
abnormalities. As clinical psychologist Mary Boyle penned it, schizophrenia
is a "scientific
delusion” which drugs can never cure.
alternatives? Moncrieff - like her fellow psychiatrists in a group
called the Critical
Psychiatry Network - asks services to look seriously at non-drug
approaches, such as the Soteria Network in America. She believes
psychiatrists such as herself should no longer have unparalleled
powers to forcibly detain and treat patients with anti-psychotics.
Instead, they should be “pharmaceutical advisers” engaging
in “democratic drug treatment” with patients. Psychiatrists
should be involved in “shared decision-making” with
patients, and would have to go to civil courts to argue their case
for compulsory treatment. "Psychiatry would be a more modest
enterprise” writes Moncrieff, “no longer claiming to
be able to alter the underlying course of psychological disturbance,
but thereby avoiding some of the damage associated with the untrammeled
use of imaginary chemical cures.”