Welcome to From Insults to Respect. Today, I ask readers to consider a story that raises some questions regarding the practice of psychiatry.
The Story
Cool Steve and three of his fellow high school buddies, Jeff, George, and Cliff, have come to the Coney Island Child Psychiatric Center because Steve’s eight-year old brother, Pete, has been dealing with some serious emotional problems. When Pete was first brought to the center, Doctor Goldwin had prescribed Thorazine, to treat Pete. Upon doing some research about the drug, the boys learned it has some serious, and even life threatening side effects. The boys have now come to the center to discuss this with Dr. Goodwin, and while waiting to see him, another psychiatrist, Dr. William Kolanski, comes by. Here’s how Jeff tells what transpires.
“Excuse me, Dr. Kolanski,” I call out just as he’s shutting his office door behind him.
Dr. Kolanski reopens his door. “Can I help you boys?”
“We’d like to ask you some questions about Thorazine,” says Cliff. “We have some questions about the safety of Thorazine.”
Dr. Kolanski’s forehead crinkles. “Oh, I see,” he says. “I’m afraid I too have some questions about its safety. I’ve seen, personally, a couple of tragedies that have befallen patients who had been placed on Thorazine and related drugs. One just occurred last night.”
As he is speaking, we notice Dr. Goldwin opening his office door and as he begins to listen to Dr. Kolanski, his face begins to turn brick red and suddenly he begins to shout at Dr. Kolanski, “Doctor! Please step into my office!”
Dr. Kolanski gets up and walks into Dr. Goldwin’s office.
“Hurry, Jeff,” whispers George. “You’re the actor. Go over by the secretary and as you’re walking by her, create a commotion. Get her into the hallway with you so she can’t see us. The rest of us will listen at Dr. Goldwin’s door and hear what’s going on.”
“Wait a minute,” whispers Cliff. “If they catch us listening, we’ll be the ones they’ll be injecting with Thorazine.”
I look at Steve who is bending over with his ear close to Cliff’s mouth. He straightens up, turns his back to the secretary so his voice won’t project toward her. I glance over and see the secretary is hard at work typing. She has blond hair, obviously bleached.
“Cliff, you’re free to leave,” whispers Steve.
“If you guys are staying, I’m staying,” whispers Cliff. “But we’re nuts!”
Then Steve turns to me. “Go ahead, Jeff,” he whispers. “Do what George said. Hurry.”
What kind of commotion can I make? I think to myself as I head toward the secretary. As I walk by her, suddenly I scream and grab my leg, falling to the floor.
“God! Oh God! Miss! Miss!” I shout to the secretary, pretending to be in agony. She leaps up. “Shall I call for a doctor?” she asks, very concerned.
“No! No! It’s just a cramp. If you could just come over here for a second and help me up. I get them from time to time. I just need to walk it off.” My hand stretches out to her as my face contorts, and I let out a wrenching–“O-h-h-h!”
She hurries around her desk and helps me up. I limp, with her support, leading her down the hall. Halfway down I feign another cramp attack. I moan and groan, fall to the floor and clutch my leg. “I’ll be okay. All I need is some help to walk it off. It’ll be okay in a second or two. Just help me up again. Oh-h-h-h!”
I lead her further away from her desk. By the main doorway, I begin to ask her about being a secretary to psychiatrists, while still acting like I’m in distress. Once she gets to talking, she starts to get lost in what she’s saying for a few minutes.
I begin limping slowly when the hallway elevator doors open. An orderly steps out and turns down the hallway toward the chamber where my friends are listening at Dr. Goldwin’s door.
I have to act fast. I begin yelling, “Orderly! Orderly!”
I have no idea what I will say to him, but he stops, turns, and says, “Yes?”
I explain to him about my leg cramp, and that although the secretary is helping me by holding my left arm, if he could take the other one just until I can get back to the waiting room where my friends can take over to help me.
I limp, with this assistance, toward the waiting area; and when we’re six feet or so from being able to see into the chamber off to the left, I call out, “Steve! Cliff! George! Could you guys come help me?”
I pray my warning cries are heard. When the orderly, the secretary, and I enter the chamber, there are the three spies innocently sitting on the waiting area couch.
* * *
As we jump into a taxi, I ask, “What did you find out?”
“Get this,” says Cliff, obviously annoyed. “I agree to stay with these nuts, and I didn’t even get to listen at the door. Steve tells me I gotta watch down the hallway to see if anyone was coming!”
“I wanted him to stand guard,” says Steve, defending his actions.
“Well, at least Cliff, you must of felt relaxed knowing no one would surprise you,” I say.
“Get out of here!” Cliff responds. “There are three doors in the waiting area–Dr. Goldwin’s office, Dr. Kolanski’s, and some other guy’s. At any second someone might have popped out of any of the doors.”
“Well, anyway, you didn’t get caught,” I say. “What’d you find out?”
“First of all,” says George, “Dr. Goldwin is going to try to get Pete committed to the hospital and to force him to take Thorazine. There’s a meeting in a Judge Kaplan’s chambers at 2:00 today.”
“What else did you hear? I ask.
“Dr. Goldwin,” says Steve, “was yelling at Dr. Kolanski, saying,” ‘What the hell do you think you were doing out there?’ “Then Dr. Kolanski said,” ‘We don’t know what we’re doing with this Thorazine, yet. Just last night one of the patients on it became very sick. We need to back up, re-evaluate.’
“Dr. Goldwin said, ‘Bill, you’re going to have to learn to take a clinically detached view of these cases. Now pull yourself together. I want you to go out there and tell those boys you thought they were talking about some other medication–Reserpine. Tell them you thought they were talking about Reserpine.’
“Dr. Kolanski said, ‘I can’t do that, Robert.’
“Dr. Goldwin said, ‘Let me make myself clearer, I’m ordering you to do it.’
“Dr. Kolanski said, ‘You’re ordering me to do something unethical and immoral.’
“Dr. Goldwin replied, ‘I’m telling you that if you ever want to work as a psychiatrist again, you’ll get out there now and do what I just told you!’
“Dr. Kolanski said, ‘Robert, Pete’s mother has a right to make an informed and completely voluntary decision concerning treatment for her son. I intend…’
“Dr. Goldwin interrupts, hollering, ‘Informed consent–what crap. You know what kind of patients we deal with. You think their parents are any better…’
“Dr. Kolanski then said, ‘Under the law, parents are presumed competent. You presume incompetence. If you think the parent is incompetent to be the boy’s legal guardian, pursue the case in a court of law. At least there she’ll be entitled to due process.’
“Dr. Goldwin then said, ‘Who the hell do you think you’re talking to? Who the hell… you want us to get rid of drugs, do you? What are we supposed to do, talk to the patient? That’s what the social workers and psychologists do. You know what they get paid around here? Do you know what I paid for my brownstone on 57th Street? You’re fired, Dr. Kolanski.'”
Discussion
This story raises some important questions. For example, do you respect Dr. Kolanski for seeking to be honest with Steve and his friends? Did Dr. Goldwin do the right thing by firing Dr. Kolanski? How do readers feel about Dr. Goldwin raising the issue of having a much higher salary than social workers and psychologists because of his prescription privileges?
I encourage readers to chime in on these questions and comment in any other way that comes to mind.
My Best.
Jeff
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Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional intelligence. To begin at the very first post you can click HERE
Back in 2019, I criticized the use of “antipsychotics” and on Facebook someone criticized what I had written saying, “all of the research clearly indicates that the “antipsychotics,” when used by people diagnosed as having schizophrenia, decrease the risk of dying.” I then, very respectfully, asked that he supply me with the references that he is relying on to make his assertion, and within a very brief period, he did just that.
Mental health services have advanced in many parts of the world during the past few decades. Apart from a different mix of community-based care, the introduction of the second-generation antipsychotic medications [also referred to as atypical antipsychotics] in the early 1990s was initially found to be associated with better quality of life and reduced risk of relapse.
I don’t know where this person obtained his list, but it appeared to me, as I began to study it, that it was probably made by a pharmaceutical industry salesperson who goes to doctors’ offices to convince them to prescribe their drugs. I say this because there are articles on the list that had titles that sounded like they were relevant, but when reading them, they were not. For example, the first study on my critic’s list was published in The Lancet in 2018, and titled “
However, if you read just the abstract of the article, as many practitioners do because time reading research studies is not billable, you would find no mention of this statistically significant finding, a finding that could have life saving implications.
Today we once again take up the controversial topic of the usefulness of the group of drugs referred to by psychiatrists and the pharmaceutical industry as “antipsychotics.” In most of the articles that I have read that have been written by psychiatrists, “antipsychotic” drugs are the first line of treatment for schizophrenia. And yet, a growing number of mental health advocates have been fiercely critical of this. As someone who has given considerable thought to helping people resolve challenging conflicts, I set myself on trying to find out what is going on here. 
After a review of the scientific research and participating in several debates, I then wrote three blog posts that reported to my readers what I have found.
Upon publishing the first two posts, several defenders of the use of these drugs claimed these drugs are worth using because they reduce the risk of early mortality. I, therefore, published a third 
The cost for the drug approach is not just confined to the cost of the “antipsychotic” drugs which has been estimated to be in the range of several billions of dollars. Doctors often prescribe a whole cocktail of drugs for these patients, dramatically adding to the cost of the drug approach, while evidence indicates the combination of “antipsychotics” with these other drugs often leads to additional adverse effects. The cost of the doctors’ time for prescribing and monitoring the treatment must be added, as well, as the cost of the revolving door of placement in a hospital, releasing from the hospital, and readmitting to the hospital, which has been the frequent pattern with this drugging approach. Finally, we must add the cost of treating patients for all of the adverse effects of these drugs.
There are several very promising alternatives, but in most regions they are not yet available. Articles like mine are designed to expand the general population’s knowledge of just how ineffective, harmful, and financially wasteful the drug treatments are, and that there are safer alternatives. This increased awareness campaign has been a major reason for the slow rising tide of advocates demanding that these more healthy alternatives become readily accessible in every community.
A 
The central features of this treatment for this group of patients involve normalization and evaluation of the appraisals that people make, helping them to test such appraisals with use of behavioral experiments, and helping them to identify and modify unhelpful cognitive and behavioral responses. Additionally, it aimed to provide warm, empathic, and non-judgmental face-to-face contact, supportive listening, signposting to appropriate local services for unmet needs, and crisis management when needed.
Relationships developed naturally, and we all got to know one another to various degrees, no different than how we develop friendships. This was not a therapist-patient relationship but rather a sort of social relationship. As a staff member I had some responsibilities—going to the market and preparing dinner. Everyone was on their own for breakfast and lunch and could help themselves to whatever they might like. Grocery shopping was often an outing to the market. Usually, one or two residents would accompany me to the store. When we returned, I would ask for help prepping the meal. It was quite informal. The house was often a bit of a mess, but then, we’d all get together and decide it was time for a quick house cleaning and again, whoever wanted to join would do so.”
Another approach well described in the JHP special issue is written by Charles Knapp. The Windhorse therapeutic perspective has a Tibetan Buddhist orientation that offers meditation, and spiritual teachings, along with a supportive, empathetic staff. Unlike the Soteria House approach, which aims to support people through a recovery process over a few months, the Windhorse approach recognizes that individual recovery periods are highly variable, and it is not uncommon for people to stay in their programs for eighteen months and even longer.
There are several other approaches described in the JHP special issue, all worth while to think about. All have had their share of success in helping to provide support for people experiencing extreme states.
But the research reveals that, over the long term, this benefit turns into a negative, and so, over the long-term, there are only negatives to be chalked up: the increased chronicity of psychotic symptoms, the impaired functional outcomes, the worse cognitive functioning, and, of course, a broad range of “side effects,” such as tardive dyskinesia, metabolic problems, sexual dysfunction, and so forth. Such is the bottom-line arithmetic that makes the case against antipsychotics.”
Consequently, some of my readers showered me with praise for having the courage to stand up to the powerful pharmaceutical-psychiatric institutions, while others showered me with the most disrespectful insults known to the human race. 
And then there were those who disagreed with me but did so in a respectful manner. I believe it is my responsibility to now provide them a respectful response.
Any pill prescribed by a doctor will lead many to experience a placebo effect, which can be, for a period of time, helpful. I hasten to point out that a person can get a placebo effect with non-drug treatment approaches as well, and this would avoid the various harms associated with this type of drug.
These drugs are not only known as “antipsychotics,” but also “major tranquilizers,” because they sometimes do appear to calm someone in distress.
Unfortunately, once someone begins to take these drugs to help with agitation, when they try to come off of the drug, they are left with drug withdrawal experiences that have been described as awful. I hasten to point out that there are other ways to help someone to calm down that need not rely on these types of drugs. I have worked on many occasions with people who are agitated, and without the aid of a drug prescription I listened in a caring way, and in time the person eventually calmed down. If, however, you give someone a drug that calms the person down, it is sometimes much easier, and less time consuming. For people who witness someone they care about in high distress drift into a calmer state upon taking an “antipsychotic,” this can seem enormously helpful.
Some of them would have recovered in a fairly short period without the drug, but because they recovered while taking the drug, they, and their loved ones, attribute the improvement to the effectiveness of the drug. If the person tries to see whether the improvement was due to the drug or the natural recovery process, he or she may try to stop ingesting the drug.
However, the withdrawal from the drug, as I mentioned above, often causes a nasty physiological reaction which, in some ways, is similar to someone who is a coffee drinker who suddenly decides to stop, cold turkey. However, the “antipsychotic” physiological withdrawal reaction can be experienced as much worse. When people who care about this person see the downward spiral that occurs from the physiological withdrawal reactions, they may come to attribute it to the person’s “mental illness” returning, and thus, the illusion of long term effectiveness is now deeply entrenched.
Another way in which the illusion of the long term effectiveness of the drugs can occur has to do with the fact that even when the “diagnosed” person is not functioning well on a drug treatment regimen, human beings can always imagine that the patient would be doing even worse without taking the drug. And of course, when the patient does try to go off the drug, the raging physiological withdrawal process occurs. So, in this way, the combination of the belief that the patient could be doing worse, and upon becoming worse when trying to do without the drug, it convinces people that the drug treatment is helpful.
Once they take that position, and tell others what they had done, information that comes their way in the form of the distressed person having bad side-effects, or hearing from people who take the position that the drugs may be more harmful than helpful, a psychological phenomenon known as cognitive dissonance occurs. The principle of cognitive dissonance states that human beings strive for internal psychological consistency. When they experience internal inconsistency they become psychologically uncomfortable and a major way that they try to reduce the discomfort is by avoiding circumstances and contradictory information likely to increase the magnitude of the cognitive dissonance.
I have publicly supported the argument that these drugs cause more harm than good. Therefore it can be argued, it is I who suffer from cognitive dissonance whenever evidence comes my way that might support the idea that these drugs are helpful in the long run.
By the late 1990s, investigators had reported that antipsychotics caused basal ganglion structures and the thalamus to swell, and the frontal lobes to shrink, with these changes in brain volumes “dose related.” Then, in 1998, Raquel Gur, from the University of Pennsylvania, reported that the swelling of the basal ganglia and thalamus was “associated with greater severity of symptoms.”
The MRI studies provide objective evidence that antipsychotics cause changes in brain volumes that are associated with a worsening of symptoms, and a worsening of functional impairment.
Recently I provided a post titled, “
Whitaker was a medical writer at the 
In 2002, 
As Stip noted in his 2002 paper, there is no compelling evidence in the literature that antipsychotics improve long-term outcomes. The relapse studies do not provide such evidence, and there is no other body of research that does. However, as can be seen in this paper, there is a history of science, stretching across six decades, that consistently tells of a medical treatment that, in the aggregate, does more harm than good.
The first long-term study reveals a higher rehospitalization rate for patients treated initially with antipsychotics.
Guy Chouinard and Barry Jones, drawing on an emerging understanding of how antipsychotics change the brain, provide a biological explanation of why that would be so. They then test their hypothesis and find that a significant percentage of medicated patients suffer from drug-induced tardive psychosis. 
MRI studies reveal that antipsychotics induce changes in brain volumes that are associated with a worsening of positive and negative symptoms, and adverse cognitive effects. 
In order to argue that antipsychotics do not worsen long-term outcomes in the aggregate, all of this evidence would have to be explained away. This entire history of science would need to be discounted. In addition, this review has focused on the benefit side of the risk-benefit equation for antipsychotics. The drugs are supposed to provide the benefit of reducing psychotic symptoms. 
But the research reveals that, over the long term, this benefit turns into a negative, and so, over the long-term, there are only negatives to be chalked up: the increased chronicity of psychotic symptoms, the impaired functional outcomes, the worse cognitive functioning, and, of course, a broad range of “side effects,” such as tardive dyskinesia, metabolic problems, sexual dysfunction, and so forth. Such is the bottom-line arithmetic that makes the case against antipsychotics.