It doesn't have to be like this

Jim Read wants a drug-free mental health service

Openmind 127, May-June 2004

Psychiatric drugs come in for a lot of justified criticism - for not helping, for having horrible and sometimes dangerous effects, and for creating dependence and difficulty in withdrawal. Their critics call for more regulation, better prescribing practice and more access to alternatives, such as talking treatments.

Meanwhile, there has been a massive increase in the number of children being medicated, and prescriptions of antidepressants go up every year. Psychiatric drugs are the dominant treatment, and their position is reinforced as new diagnoses are invented and we are threatened with new powers to enforce compliance.

It doesn't have to be like this. There is plenty of evidence that the overall impact of psychiatric drugs has been negative. If we want a mental health service that is safer, more effective and evidence based - to use some current Department of Health buzzwords - there is a good case for getting rid of them.

There are some basic problems with psychiatric drugs. For a start, they don't cure anything. Furthermore, they induce passivity. Dealing with your life crisis becomes a matter of waiting for them to take effect, rather than engaging your mind and enlisting the support of other people in a quest to find solutions. Quite often, they don't even take away distressing symptoms, in which case the patient is labelled 'treatment resistant' and there is rarely a plan B.

A review of 50 years of research into neuroleptics (the drugs used on people diagnosed with 'schizophrenia' [1]) concluded that the practice of maintaining people on these drugs does more harm than good. Contrary to popular myth, long-term use actually increases the likelihood of relapse.

In contrast, psychological (or talking) treatments can enhance people's capacity to take charge of their minds and their lives. And there is plenty of evidence to show that they work, that they are more popular with recipients than drugs, and are far less likely to be rated as harmful.

But the range of safe and effective alternatives to medication goes way beyond the use of talking treatments. It embraces 'all the resources that life offers us' [2]. We have a literature of inspiring accounts by people who have found ways, beyond the psychiatric system, of creating great lives from the most unpromising circumstances [3]. And we should never undervalue the role of community projects that support people to maximise their income, mix with others, find meaningful occupation and somewhere safe and secure to live.

Within the constraints of the current mental health system, there are people who obtain symptom relief from psychiatric drugs and haven't found anything better. It would be wrong to take their drugs away. Instead, I propose a 15-year programme for creating a new mental health service that is drug free for all people having their first mental health crisis. The stark alternative is for current trends to continue, so that we find ourselves living in a society that can only function if millions are drugged.

Not convinced? Think about this. How would the government's plans for compulsory treatment in the community look if we got rid of psychiatric drugs?

1. R. Whitaker (2004) 'The case against antipsychotic drugs: A 50-year record of doing more harm than good', Medical Hypotheses, 62(1). (Available at www.sciencedirect.com)

2. P. Breggin and D. Cohen (1999) Your Drug May Be Your Problem, Perseus Books.

3. See for example, P. Barker, P. Campbell and B. Davidson (eds) (1999) From the Ashes of Experience: Reflections on Madness, Survival and Growth, Whurr Publishers; and Mental Health Foundation (2001) Something Inside So Strong: Strategies for Surviving Mental Distress.