A few years ago, when this madwoman had an episode of psychosis, my doctor doubled the dose of an antipsychotic I took and added another I’d never taken before. With these drugs came the typical, awful side effects—I stumbled, I couldn’t think clearly enough to work or drive, and I had a mouth so dry I could barely speak.
Like most such states, this mad-time resolved. I told my doctor I wanted to taper down. She seemed surprised but suggested a swift decrease. Soon, my brain felt like it was burning in my head. I could feel it, fiery against my skull.
I was caught in a dilemma getting increasing press and little solution: the painful process of going off, or decreasing, psychiatric drugs. Psych meds work by altering the nervous system. Stopping or decreasing too fast is a wrenching physical adjustment that can create the same states the drugs are meant to fix: depression, anxiety, confusion, etc. Even unpleasant feelings in the brain itself.
Is there an alternative? In 1794, a doctor named Philippe Pinel said something revolutionary to his French audience that may be revolutionary to mine. Pinel declared madness curable. By “cure,” Pinel meant an outcome psychiatry still fails to embrace: hope for madness's role in a patient’s life to end.
Pinel tempered the radical nature of what he said with the very French subject of how the mad at his asylum enjoyed good soup.
By “end,” I mean offer help in the best sense of any care—a period of difficulty treated through exploring different methods in such a way that the person returns as much as possible to their previous condition. Not automatic lifelong meds and a glued-on diagnostic label.
Such a cure isn’t always possible. But it should be the desirable, anticipated outcome. Psychiatry needs to begin a hard study of exit strategies.
Though psychiatric medications have existed since the 1950s, the idea of taking them permanently gained ground around the 1980s, as a biological view of mental “illness” replaced a more psychological one. Drugs like Prozac were promoted as correcting the “chemical imbalance” causing depression, an imbalance that would theoretically be lifelong. Pharmaceutical companies, to put it mildly, embraced the idea.
I spoke recently to Laura Delano, who runs the nonprofit Inner Compass Initiative, an organization created to provide information to users of psychiatric drugs. Delano herself withdrew from a cocktail of five psychiatric drugs, and 14 years later, she said she’s “still discovering who I am” without them.
“A shift occurred then from defining [mental states] as episodic, temporary experiences to incurable brain diseases,” Delano told me. Psychiatric language shifted from using terms like "reaction" or "disturbance" to "disorder" and "disease." This was intended in part to reduce stigma. But the shift is striking. Depression that’s a “reaction” or “disturbance" implies not just a limit but an origin, while “disorder” does not—the former terms stress cause over chemicals.
Medications like antipsychotics, anti-anxiety drugs, and antidepressants were in most cases developed for short-term use. Many trials of psychiatric drugs last less than two months, though the length of time spent on a medication increases the difficulty of stopping it.
Despite these problems, “staying on meds” has become not just the likely outcome in psychiatry but a test of virtue. “Good” patients stay on meds. Bad patients don’t, often because they’re “so sick they don’t know they’re sick.” To take meds is to acknowledge there’s something wrong with you; to shun them means something even worse.
Yet drug withdrawal is far slower and harder than most people, including doctors, realize. Its effects are often misread as a return of symptoms.
Recently I took an online depression screening test, one offered by a mental health nonprofit. Questions covered sleep quality, worry about under- or over-eating, low energy, and feelings of poor self-worth. I answered honestly that, within the past two weeks, these feelings had bothered me “several times.”
“Bothered,” as far as I could tell, could mean for a little while or a long one. I gave a flat "no" to any kind of self-harm. Results showed I had “mild depression” and should see my doctor. Though surely these feelings afflict everyone at some time during a period of a few weeks. (All these feelings would “bother” me during any two-week period in which my academic job held one of its routinely awful department meetings.)
Many people taking my test would follow up with a general practitioner, and many of those doctors would prescribe antidepressants. And it’s unlikely the appointment would last long enough for me and my doctor to figure out I could just skip the department meetings.
I believe that at times in my medical history, a short-term course of psychiatric medication made sense. I know I have needed intermittent support. I don’t think I should have been prescribed long-term meds without experiencing what happened if I tapered off slowly and lived without them. Short-term courses of psych meds have in many studies proven either as effective or more effective than longer-term ones.
I trusted doctors who told me I could never live without meds. I imagine they trusted drug literature and the DSM. But all based their beliefs on, as Delano put it, “zero” hard evidence.
Anne Harrington, in Mind Fixers: Psychiatry's Troubled Search for the Biology of Mental Illness, suggested psychiatry "make a virtue of modesty." The choice to shift to a disease model in psychiatry is often justified as necessary to do some version of “bringing the approach of psychiatry in line with other medical disciplines.”
But psychiatry is not like any other discipline. There is nothing inside or outside the body “like” consciousness. Consciousness begs for modesty, even humility. It is the most extraordinary gift any of us will ever get, the one that allows us to appreciate all other gifts. Even good soup. Let's begin there.
References
Harrington, Anne. Mind Fixers: Psychiatry's Troubled Search for the Biology of Mental Illness. W.W. Norton, 2019.
login
who are we?
contact us
qosheapp
Toi Staff
Gideon Levy
Belen Fernandez
Rami G Khouri
Mort Laitner
Rachel Marsden
Donald Low
Bradley Blankenship
Ali Fathollah-Nejad
Nikkei Editorial
Abbas Juma
Michael Kwet
visit website
