Journalists, Medical Research and Medical Practice

As a medical writer and as someone who works in the daily trenches of serious mental illness in my own family, I find people like Robert Whitaker dangerous. For those who aren’t familiar with him, he is a medical journalist from Boston who is highly critical of the long term use of medication for schizophrenia even though he is neither a scientific researcher nor clinician.

My earlier criticisms of his work appeared in the Huffington Post as Journalists are not medical experts and Leave the schizophrenia diagnosis to the experts please.

One of Whitaker’s key criticisms is that the long term use of antipsychotics in the treatment of schizophrenia makes people worse not better. A group of researchers in New York set out to see if they could replicate what they called his “troubling interpretation” and published their results in a recent issue of the American Journal of Orthopsychiatry.

Their hypothesis was what Whitaker contended that the long term use of antipsychotics resulted in worse outcomes than people who are not treated. They wondered if a systematic appraisal of all the literature would produce the same results as claimed by Whitaker. They looked at 18 studies which included the four that Whitaker used. They pointed out that Whitaker used an additional 6 studies to come to his conclusion but they did not include them because they were review articles that did not report separated data on the exposure groups or were ecological studies which did not report on individual level data.

Of the 18 studies they looked at, only 3 supported the hypothesis that long term treatment with medication causes harm to patients. 8 studies found the opposite and 7 were mixed. These researchers, however, also did not find that long term treatment resulted in greater benefits than harm which is, frankly, not surprising. Some recent studies show that some people with schizophrenia can manage well without long term drug use which Whitaker likes to cite. But there is also no way to predict who can actually achieve that. That is a caveat in all those studies and a fact that Whitaker seems to ignore. (see my post on leave the diagnosis to experts).

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Very much like this post. While there is plenty of viable research questioning both the effectiveness and safety of anti-depressants, the considerable research questioning the effectiveness and safety of anti-psychotics. weighs in far more on the side of using them despite the side effects. And the developmental history of anti-Ps is far from over. Digitization of genetic research suggests that time will work in favor of ever-better-targeted anti-Ps.

BUT – and this is a very big but – medication is unlikely to ever reach a degree of “tailoring” that will make it is effective by itself as it is in combination with patient commitment to the following psychotherapies, especially when the PTSD so often seen along with sz is factored in:

REBT – https://en.wikipedia.org/wiki/Rational_emotive_behavior_therapy
Schematherapy – https://en.wikipedia.org/wiki/Schema_Therapy
Learned Optimism – https://en.wikipedia.org/wiki/Learned_optimism
Standard CBT – https://www.nami.org/Learn-More/Treatment/Psychotherapy & scroll down
DBT – http://behavioraltech.org/resources/whatisdbt.cfm
MBSR – http://www.mindfullivingprograms.com/whatMBSR.php
MBCT - http://www.ncbi.nlm.nih.gov/pubmed/22340145
ACT – https://contextualscience.org/act
10 StEP – http://pairadocks.blogspot.com/2015/04/the-10-steps-of-emotion-processing.html
MBBT – https://www.newharbinger.com/blog/introduction-mind-body-bridging-i-system
SEPT – https://en.wikipedia.org/wiki/Somatic_Experiencing
SMPT – https://en.wikipedia.org/wiki/Sensorimotor_psychotherapy

I think less is more when it comes to medications…but to always advocate against meds is narrowminded, ignorant and idealistic (at best).

If Robert Whitaker cared about people with serious mental illness, he would address the myriad problems actually faced by people who are debilitated by SMI and become disabled, homeless, or imprisoned.

Nowhere in any of his writing does he outline effective treatments for people in severe crisis or who have become disabled by SMI. If it were up to him, there would be no medicine, no hospitals, no programs to help people with disabilities get food, housing, or any other basic need.

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I think Whitaker and MIA in general speaks for the more well/good prognosis end of the severe mental illness spectrum.

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Just ignore him. He’s crazier than we are suffering from an illness called “stupidity”. I’ve worked in audio engineering for 16 years including professionally and I still have idiots come up to me trying to argue with my opinions with their baseless opinions they formed from 30 seconds of pseudo experience with the topic at hand. I don’t even ■■■■■■■ tell these people they have to follow my opinions of what I say to do specifically because if they can find a way that works better for them then great and what I’m telling them is just what has always worked best for me.

Everyone is always wanting to throw their opinions around like they’re fact even when they have zero personal experience, observations or knowledge on the topic at hand and this guy will eventually be forgotten as a crackpot if stupid people don’t end up taking over everything.

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People wonder why I get so mad about people being ignorant. I finally got fed up with having to crack Microsoft Office every other day to keep using it so I went to go see how much it costs and I’m going to have to shell out $150 for it. This wouldn’t be the case today because Microsoft used to bundle most of its programs like this with Windows for free but because a bunch of morons, who after I read into the lawsuit details didn’t really have a grasp of reality anyway, beat their chests and screamed like Tarzan and a translation expert somehow figured out it was a case against Microsoft as a monopoly, now I have to waste $150 if I want to realistically use something I use often when that could be better spent on bills.

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Wow, Thats big talk coming from a medical journalist. Why didn’t he mentioned the other students from other articles and post. I’m studying to become a journalist and I haven’t heard of anyone not mentioning people from other articles and stuff. And as far as he knows we need our medication. IF we don’t have it. They world would be really in trouble. Not marking us as some type of beast when we go out of it. We need our meds. That doesn’t take rocket science to invent a hypothesis on that.

My psychiatrist must be following this guy’s ideas. He wants to taper me off! He does so even after I’ve had my uncle die at 63 with Sz!

I don’t have a direct opinion of Whitaker or the other voices speaking up in defense of AP’s. I don’t like taking them. I made my peace with medication years ago. Each psychiatrist is different. Our needs change as we grow older. New drugs are always coming out, most of them much like the previous ones, with some exceptions. Unfortunately, we are given the onerous burden of finding out which ones work best for us, on an individual basis. This task gets burdensome after a long lifetime of illness. Unfortunately, it never is right, only sort of or kind of. I would NOT go off them. Occasionally, there is a loud voice supposedly speaking up in behalf of "us’. Thomas Szasz was one such voice. The message is very attractive and quite alluring. It’s hard to not be taken in by such stuff. I had such doctor in 1980. I went off my Haloperidol and ended up in the hospital when he died.

What passes for “journalism” these days is too often not. (My BA was in journalism, btw.)

that’s just wrong. Journalism has gotten sorry.