Award-winning researcher and psychiatrist Tim Calton examines studies demonstrating how psychosis can be managed without medication. Such non-drug approaches shoud no longer be ignored, he argues.
Over two hundred years ago medical psychiatry planted its standard within the realm of the human experience of ‘madness’, quickly becoming the dominant paradigm. Other ways of understanding and tending to mental distress were suffocated or retreated to the margins. Psychiatry’s success in creating and disseminating knowledge about those forms of life which get described as ‘madness’, ‘psychosis’, or ‘schizophrenia’, quickly becomes apparent when surveying the first National Institute for Clinical Excellence (NICE) guidelines for the treatment of people diagnosed with schizophrenia…..
…This document, a synopsis of so-called ‘best practice’ in the clinical treatment of ‘schizophrenia’ within the NHS, clearly states that antipsychotic drugs are necessary in the treatment of an acute episode (National Institute for Clinical Excellence, 2002), a mandate not extended to psychosocial interventions….
Although the NICE guidelines carry a powerful political imprimatur they reflect the deep but extremely narrow tradition of biomedical research into madness; research which would have us believe that the only way to ‘get better’ and ‘stay well’ are to take antipsychotic medication, for life if necessary….
….There is certainly a wealth of historical evidence supporting a non-medical approach to madness ranging from Geel, the city in Belgium where the ‘mad’ lived with local families, receiving support and care that allowed them to function in the ‘normal’ social world despite the emotional distress some experienced (Goldstein, 2003), to the so-called Moral Treatment developed at the York Retreat by William Tuke towards the end of the eighteenth century (Digby, 1985), which advocated peace, respect, and dignity in all relationships, and emphasised the importance of maintaining usual social activities, work and exercise. These approaches, predicated as they were on a gentle and humane engagement with the vagaries of human experience at the limits, and invoking respect, dignity, collective responsibility, and an emphasis on interpersonal relationships as guiding principles, have much to tell contemporary biomedical psychiatry…..
….In the modern era, non-medical attempts to understand and tend to ‘psychosis’ have coalesced into a tradition counterposed to the biomedical orthodoxy. The richest seam of evidence within this tradition is that relating to Soteria House , the project developed by Loren Mosher and colleagues in San Francisco during the early 1970s (www.moshersoteria.com). Here, people diagnosed with schizophrenia could live in a suburban house staffed with non-professionals who would spend time ‘being’ with them in an attempt to try and secure shared meanings and understandings of their subjective experience…..
….To conclude then, it seems appropriate, given the evidence, to claim that the human experience of ‘psychosis’ can be helped without recourse to the use of antipsychotic medication. The research cited above does not appear to have been considered in the current NICE guidelines (presumably because of the small number of studies undertaken using minimal or no medication approaches), though may well be incorporated into the next iteration. This should happen because the lack of any meaningful idea of choice with regard to treatment for people diagnosed with ‘psychosis’ / ‘schizophrenia’ in the UK is abundantly apparent; a state of affairs that may not be sustainable given recent pronouncements on patient choice (DoH, 2008).
We must remember, honour and reiterate these alternative traditions of thought and practice if we are to overcome the extant biomedical hegemony. (read the rest)
* Tim Calton is a psychiatrist and winner of the 2005 Royal College of Psychiatrists Research Prize and Bronze Medal. He is a research fellow at the Institute of Mental Health in Nottingham and special lecturer in the department of health psychology at the University of Nottingham.