The Medical Model
The publication in 2010 of The Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America by Robert Whitaker heralded the beginnings of a broader, public and professional, recognition that the medical model was deeply flawed, both theoretically and practically. Whitaker detailed the lack of scientific basis for the claim that schizophrenia was caused by brain, genetic or otherwise biological defects, and demonstrated that treatment of schizophrenia solely or mainly by psychotropic medications, particularly when viewed from a long term treatment perspective, was, too often, not just ineffective, but harmful. (Whitaker, 2010)
Since then, there has been increasing confirmation and amplification of Whitaker’s thesis and factual analysis. For instance, the New York Book Review featured articles (in June and July 2011) by Marcia Angel, former editor of New England Journal of Medicine, which prominently critiqued the medical approach and its claims (Angell, 2011a; Angell 2011b). Another book that delves into the critique of the medical model is Beyond the Brain by Tanya Marie Luhrmann.
These and other works have revealed that there is no scientific basis to claim that schizophrenia is a brain disease. In 90 years of research there are no consistent differences found anatomically or physiologically between people labeled with schizophrenia and those not labeled with schizophrenia. Furthermore, there are no genes definitely linked to schizophrenia (Beck, Rector, Stolar & Grant, 2011). According to one expert, “Schizophrenia is a useful construct—not myth, not disease.” (Frances, 2013).
More importantly, on a practical level, not only is the standard treatment by antipsychotic medication far less effective than claimed, but such medication has many serious detrimental side effects. Below, we will look at the questionable effectiveness as well as the harms of medication.
While the effect of medications on the course of recovery of schizophrenia varies greatly among individuals, the general overall effects of long term antipsychotic medication appears to be detrimental. A recently published study by Lex Wunderink shows that over a long term, seven years, those in a group who had reduced or discontinued medications had a much higher rate of recovery than those who had standard medication doses (40.4% v 17.6%) as well as a somewhat lower rate of relapse (61.5% v 68.6%). Even in the short term, 18 months, those on standard medication doses and those on reduced and discontinued doses had about the same functional outcomes (Insel, 2013; Steingard, 2013; Whitaker, 2013).
The Wunderink finding that long term treatment with medications can impede fundtional recovery, is a confirmation of prior studies. According to a large 20 year study published in 2007, the “schizophrenia and schizoaffective patients who took antipsychotics regularly during the 20 years, compared to those who quit taking the medications (usually within the first two years), experienced more psychosis, more anxiety, and markedly fewer periods of “sustained recovery.” They were also more cognitively impaired.” (Whitaker, 2012). Addutionally, results from the 2012 issue of the British Journal of Psychiatry are consistent with studies by the World Health Organization in the 1970s which showed that the recovery rate of schizophrenic patients in poor developing countries, where use of neuroleptics is not the standard care, is substantially better than the recovery rate in developed countries (Bracken et al., 2012). Whether the better income is attributable to the non use of neuroleptics, or to more supportive social environments in developing countries, or both, is unclear (Read, 2004).
Analyses of studies which purport to demonstrate the effectiveness of antipsychotics for schizophrenia have been proven much exaggerated and false. Professor David Healy, Cardiff University School of Medicine, provides a very detailed critique of false medical claims for antipsychotics. Positive results for medications were twice as likely to be published as negative findings, only half of the studies completed regarding medications presently in use were published, major published studies were found not to be replicable, and industry funded studies were found to be far more likely to find positive results compared to independently funded studies. In a TED talk, Ben Goldacre revealed gross publication bias of medication clinical studies. Considering these issues, a website has been set up where patients can report their own stories on drug side effects.
In 2011, the annual conference on schizophrenia held by a major medical center in New York City abandoned its focus on medications as the panacea. Up to that year, prior conferences held out the promise that new generations of psychotropic medications were each better than the prior, and that a “silver bullet” was just around the corner. In 2011, no such claim was made, and one of the main speeches was the efficacy of yoga as a treatment
Harms of Medication
While the effectiveness of antipsychotic medications is inconclusive, there is an “increasing body of evidence that the adverse effects of treatment are, to put it simply, not worth the candle. The combination of extrapyramidal symptoms, dangers of tardive dyskinesia and the neuromalignant syndrome, weight gain and the metabolic syndrome, sedation, postural hypotension, and interference in sexual function…would need to be offset by massive symptomatic and social functioning improvement to make the benefit/risk ratio positive." Of course, it often is, at least in the short term, but for many the risks outweigh the benefits (Tyrer, 2012).
While the US has 4.5% of the world’s population, it consumes 51% of all the antipsychotic medication consumed in the world. Compared to the general population in 2011, patients who take antipsychotic medications have an increased risk of heart attacks and sudden death (both heart diseases) of 5 times and 2-4 times respectively; stroke of 1.4 to 3.5 times; diabetes 7 times; dementia (of which Alzheimers is the largest category) 6 to 14 times. Takers of antipsychotics have “unexpectedly high rates of tangles and or plaques (major structural abnormalities in brains of Alzheimers patients)! Antidepressants, also not uncommonly administered to schizophrenia patients, increase the risk of dementia by 2 to 5 times (Jackson, 2012). There are numerous studies indicating that use of antipsychotics is related to reductions in brain volume and increases in ventricles (Read, 2012).