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“Most psychiatric drugs can cause withdrawal reactions, sometimes including life-threatening emotional and physical withdrawal problems… Withdrawal from psychiatric drugs should be done carefully under experienced clinical supervision.” Dr. Peter Breggin

Sep 17, 2013

Recovery and Psychiatry: Dirk Corstens, Chair of Intervoice responds to Allen Frances

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

photo credit here


Unknown said...

Good post, Becky. You hit all the places I would have gone!
After seeing your post, I added my own comment to Allen Frances' piece.
Dr. Frances,

One part of your post that I don't understand is your narrow understanding of what treatment entails. You write "But for most people suffering from the symptoms of schizophrenia, treatment is necessary, even essential." This seems to argue that (1) that alternative treatments are incompatible with conventional drugs and psychotherapy, and (b)alternative treatments are not treatments at all.

Didn't the Hearing Voices group that Eleanor Longden benefited from, "treat" her voices? In my books, she was undergoing treatment. "Treatment" for schizophrenia, to many, means trying different approaches in the hopes that they will increase the overall resiliency that makes one resistance to those troublesome symptoms. Drugs treat symptoms only, psychotherapy can drag on for years with mixed results. No once can call standard treatment for schizophrenia a success story. It is really not up to psychiatry to discourage people from thinking for themselves and looking further afield to find something that helps.

Had I listened to my son's psychiatrist, I would have made sure he never ventured beyond drugs and psychotherapy to treat his "schizophrenia." Had he not ventured further afield, I fear he would be a chronic patient, not the able and promising young man he is today. He has not undergone treatment by Hearing Voices, and it may be unlikely that he will, as his resiliency has been greatly increased by other equally promising treatments. The most profound treatments he received that added to his resiliency were sound therapy which induced out-of body experiences, transcendental meditation, and the Tomatis Method. The Tomatis Method is covered by our insurance, and my son’s psychiatrist did not object. We didn't tell her about the first two treatments. If we lived in South America, he'd probably be doing ayahuasca "treatments."

The common denominator here, (and why others may fail to make breakthroughs), is belief that whatever therapy chosen offers some added value, and consistent and persistent follow-through and support by caring individuals. Many people fail to dream beyond their diagnosis and actually believe the unproven damaged brain/biochemical imbalance theories.

Unknown said...

Thanks so much for your comment---you covered what I missed. I was focused on responding to what I view as Allen Frances's need to correct, censure, diminish the importance of, if not invalidate outright, any message delivered by a person who has been labeled with a psychiatric diagnosis. It is insulting to minimize or otherwise diminish another person's story. It was a mistake for Frances to utilize Huffington' Post's invitation to comment on Eleanor Longren's lived experience by minimizing the singular importance of her personal story, and by extension, others in the Hearing Voices movement, in order to discourage others from thinking or believing full recovery may be possible for them, or someone they love. That Frances found it necessary to minimize the importance of the positive message Eleanor shared; and used it in an attempt to further his personal/ professional agenda is disappointing. It is very telling to me that he states, "I have met with many people in the survivors movement and fully understand its value and successes," but does not share any of what his understanding is...Equally telling, is he did not state he has known anyone to RECOVER because of psychiatric treatment or because they refused psychiatric treatment. I wonder, has Allen Frances seen lives ruined because of psychiatric treatment? I have. I wonder has Allen Frances helped any people who were misdiagnosed, were not helped, or were iatrogenically harmed by psychopharmachological treatment to withdrawal from dangerous teratogenic drugs? If not, I am skeptical that he "fully understands" how it is experienced by patients, former patients or psychiatric survivors...I am not aware of any evidence that Allen Frances supports survivors, although he claims to "fully understand" the survivors movement.

Unknown said...


You are right about Frances.

“It is difficult to get a man to understand something, when his salary depends on his not understanding it.”
― Upton Sinclair, I, Candidate for Governor: And How I Got Licked


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