Why I don’t like the idea that mental disorder is a disease

I have been too busy organising the RADAR programme recently to have much time for blogging, but at the moment I am preparing to give a talk at the conference of the American Association for Philosophy and Psychiatry in May. The title of this talk is: Many ways of being human: challenging the medical view of mental disorders and the implications for psychiatry.

This is the first of a series of short blogs in which I set out my thinking behind this title.

The title is taken from a book by British psychiatrist, Alec Jenner, and three Portugese colleagues entitled: Schizophrenia: a disease or some ways of being human? The book sketches out an approach to the understanding of schizophrenia that challenges the idea that schizophrenia is understandable using the cause and effect paradigm of the natural sciences.

Whether some, or all, mental disorders are diseases in the medical sense is both a philosophical and empirical matter. I will address both of these areas in future blogs, looking in particular at the work of Thomas Szasz, but first I want to set out what I don’t like about the idea that mental disorders are diseases ‘just like any other’.

If mental illness is a brain disease, then the behaviour it is manifested in is irrelevant and uninteresting. It has nothing to do with being human in a general sense. There is no lesson to be learnt from it, and we may as well just eliminate it in whatever way we can. Indeed, we have an obligation under this way of thinking to liberate the ‘normal’ person that is buried somewhere behind the illness. The behaviours and experiences (or symptoms) have nothing to do with that person as a person, they are just an aberrant part of their physical body. Nothing is to be lost, no inherent cost incurred, by eradicating the condition without trace.

What attracted me to psychiatry, and I believe many others, is not that the symptoms of mental illness are bizarre curiosities arising from brain irregularities. If this was the case, I could have gone into neurology. What attracted me to psychiatry, and what still interests me, is the intuition that mental disorder has something profound to teach us about the nature of being human. And it does this not by reflecting brain abnormalities, but by consisting of extreme, bizarre, usually dysfunctional and sometimes unfathomable manifestations of human agency.

The title of the talk is also meant to emphasise that mental disorders need to be understood in the same way that we understand other sorts of human behaviour. There is not a categorical distinction between normal behaviour and emotions, and what we might call mental disorder. This is not the same as saying that all mental disorder is on a continuum with normality. Depression and anxiety may be familiar to all of us to some degree, but despite the research saying we all hear voices, I think that true psychotic experiences are rare, and most people probably only get a glimmer of what these might be like when they are very tired, or have taken certain mind-altering drugs. Therefore I do not think it makes sense to suggest that psychosis is on a continuum with normal experience. However, it is not a different sort of thing either. As Luc Ciompi, founder of the Swiss Soteria project commented (as cited in Jenner and colleagues’ book), psychotic states, like that sometimes referred to as ‘schizophrenia,’ are better thought of as a life process than an illness.

As another Swiss psychiatrist, Manfred Bleuler, said (also cited in Jenner et al) people with ‘schizophrenia’ “flounder under the same difficulties with which all of us struggle all of our lives.”

What we need to try and understand these extreme and unusual states of being are not the specialised methods of natural science. In contrast, it is the ways in which we understand ordinary, everyday behaviour that can, if anything, help to reveal the nature and meaning of madness. Madness is an unusual way of being human, but a way of being human nonetheless!


35 thoughts on “Why I don’t like the idea that mental disorder is a disease

  1. I can certainly respect what you’re trying to do here Dr Moncrieff, but I don’t really think pursuing the semantic question of whether schizophrenia is a disease or not is likely to be fruitful. And I think trying to stake out what it means to be human would be completely futile were it not so dangerous.

    As Humpty Dumpty famously said, “When I use a word it means just what I choose it to mean—neither more nor less.” That’s especially the case when you’re speaking in the technical jargon employed by a particular in-group. Heck, according to Laing life itself is a (sexually transmitted) disease.

    I can think of plenty of ways to challenge the notion schizophrenia is a disease from within the dominant paradigm of medicine (e.g. if symptom clusters define a disease then ‘flu-like symptoms’ are a disease) but questions of what is human or a ‘normal person’ aren’t medical ones and, IMHO, can’t shed light on whether it’s valid to call schizophrenia a disease. By suggesting they can be engaged with from within the paradigm of scientific medicine is to encourage exactly the kind of ontological and epistemological overreach that characterises so much of contemporary psychiatry (and neurology).

    If we set aside problematic terms such as ‘schizophrenia’ and just focus on its most definitive symptom, psychosis, then I can wholeheartedly agree – from my interpretation of my own psychotic experiences – it can teach us something profound. However I sure wouldn’t be so presumptuous as to claim I know anything about ‘the nature of being human’. After all, my sample size for what it is to be human is n=1 and if a word or phrase is to have any meaning at all it must be arrived at by consensus, not by fiat.

    Nor am I inclined to believe psychosis has a specific etiology, course or prognosis. I have little doubt diseases, substances, traumas, genetic predispositions, belief systems, spiritual emergencies and many other things can be significant proximate causes of psychotic episodes, but unless the term ‘psychosis’ is made far more exclusive than it currently is, to try to give it a specific ‘meaning’ (in the broader sense – not merely ‘definition’) is to delegitimise the experiences – and often the suffering – of many of those who have experienced it.

    I can think of one way of framing psychosis that might enable fairly broad consensus as to whether or not it’s a disease symptom. According to Joseph Campbell “The psychotic drowns in the same waters in which the mystic swims with delight.” . If you’re drowning in your psychosis, if it’s an experience you can’t integrate into your notion of self (or non-self), if it’s causing harm or distress that you can’t use to find insight or promote personal growth, then it’s a problem. It may not be a disease as such but it could well be indicative of one. In any case, it becomes a valid target for medical research and, perhaps, intervention. Whether or not current or future medical therapies are more likely to help or harm is a separate question.

    • “Nor am I inclined to believe psychosis has a specific etiology, course or prognosis.”

      You might not be aware of Anti-NMDA Receptor Encephalitis or that Bromine intoxication can be wrongly diagnosed as schizophrenia and of-course we have the psychiatric drug induced problem… including anxiety depression psychosis suicide homicide… an epidemic of doctors/drug companies who can’t see the wood for the trees, and refuse to even look.

      Well done on the RADAR programme !

  2. Thank you for your inspiring article! To me a state of psychosis always has been a question of trying to understand the meaning behind the sometimes bizarre messages they bring. This is a way of thinking that has never occurred to me concerning a somatic illness. This in itself means to me, and many others, that the psychosis is much more than an illness. It is a sort of a language. Often difficult, sometimes impossible for me to understand, but nevertheless a language. This means that to me you are absolutely right! It is really a strange way of thinking but not a disease, not an illness.

  3. First, a discaimer: I write as a carer, not as a medical professional. However, I still feel entitled to take a view because the terminology helps to shape the way we (carers and ‘service users’) respond to the advice we are given by professionals and how we try to support recovery.

    My understanding is that the chemical imbalance theory of mental illness has been subject to considerable criticism in recent years and is gradually being displaced in the academic literature by the view that mental disorders are the consequence of trauma which goes beyond the (genetically determined) resiliance threshold of the individual. If that is right, it suggests to me that instead of ‘mental illness’ perhaps there is value in thinking in terms of over-use injuries, i.e. the mental equivalent of the strains and stress fractures that athletes suffer from if increases in their training load or the trauma of competition exceeds their tolerance level. The analogy holds up reasonably well because, like mental health patients, some athletes are genetically more injury-prone than others.

    In turn, this suggests that recovery is not just a matter of handing out medication, but also of identifying what caused the over-use injury and carefully managing the return to normal life, in much the same way that a good coach will help an athlete get back to training and competition after injury.

    • What a wonderful analogy John. Thank you. This makes a lot of sense. We have known for over a 100yrs that trauma in childhood can cause various developmental problems regarding coping with subsequent life stressors. What we seem to really struggle with is doing something sufficient to help people have a better life. It is easier to label them as mentally ill, drug them, or even CBT them, and send them on their way – cured? – unfortunately not. Most of our “solutions” are limited in application (up to 45% effective response) and most of those revert to problems in the coming years as life kicks back in.

      Is the “hearing voices” etc of psychosis merely a normal life experience about which some people have an attribution error (these voices are not mine)?

      Joanna states that while symptoms are not on a “normal” continuum, they are not different either. This is very confusing to me. Either they are a manifestation of a wide and varied normal human response to an varied world, or they are not. If you have two people who miraculously have the same mother, are conceived at the same time, nurtured in the same womb, with exactly the same genetic make-up, born at the same time, experience the exact same life stressors while growing through childhood, infancy, adolescence, adulthood, meet the exact same people who treat them the same way – will we not see exactly the same responses and problems (as well as functional solutions) from both individuals?

      To say a mental illness is not a disease process is perhaps largely correct (although the brain is an organ like any other organ and can malfunction in many ways, with disastrous consequences), but to say that mental health symptoms (even severe ones) are part of being human has major serious consequences, both for the individual, and for the family and society in which they live. We may even come to think of ourselves as products of our environment and seek redress through the courts for the years of abuse, poverty and neglect, and subsequent horrific consequences we have been forced to live with.

      Given we know the causes, if we as a society choose to do little, nothing, or not enough, to ameliorate, or eradicate, these causes, then are we not all culpable of a dereliction of a basic duty of care? Should we not all be held to account for either the abuses and/or the BystanderEffect mentality (which is basically cowardice)? It should be said, loud and clear, that mental illness is a perfectly normal response to an imperfectly normal world populated and managed by imperfectly normal people. I believe that greed and self-love (in excess) directly cause all mental illnesses.

      I also believe that, when we start vocalising the fact that mental illness is not a disease process then we open wide the door to many who would subsequently seek to blame the patient/client/sufferer/victim/service-user/person. If it’s not a disease, about which they have no control, then it must be a behavioural choice, about which they do have control. We can then seek to either limit treatment or actively punish those who refuse to conform to our image of normality in our society. Use of the term “treatment resistant” already implies a moral culpability of the vulnerable client.

      An adult, with severe and/or chronic mental health symptoms is incapable of functioning in any other way unless they receive significant (or “good enough”) prolonged therapy. To do otherwise is akin to compelling the man with the broken leg to apply his own “cast” and then immediately run a marathon, on the basis that running is a normal function for a leg and brief time-limited leg therapy will be sufficient (whether or not it actually is). It’s crazy.

      Most of this is driven, I suspect, by both the need to cut costs and to provide psychologists with the primary power status in our society that they feel they deserve (currently occupied by psychiatrists). The argument that rages in our society rarely addresses the environmental causes of mental illness; those who argue rarely seek to effect changes to the causes themselves (prevention) – perhaps because societies problems ensure that the professionals will have a steady cohort of patients for the duration of their career?

      • I’m not sure if you’re suggesting the voices are just a variation of the usual inner monologue but misattributed, but I can tell you for sure that mine are of an entirely different quality.

        Firstly, there’s no sense the voices are just sub-vocal articulation of conscious thought processes. They’re generally completely off-topic from anything I’m aware of turning my attention to and often ‘tell me’ something very unexpected that I’m not aware of knowing. Their expressed emotions aren’t mine at the time either. They also have distinct pitch, tone, timbre and, often, gender that is in no way consistent with my own speaking voice. They sound like separate people and display distinct personalities and vocal habits. Generally there’s more than one and they’re just as likely to ‘speak’ to each other as address me. Sometimes they seem to ’emerge’ from background noise in the environment at first – especially white noise – though they soon distinguish themselves from it. Other times they just come out of nowhere.

        I’m a long time, fairly diligent practitioner of vipassana and think I’m somewhat skilled at perceiving the arising of my conscious thoughts from non-conscious origins but I sure can’t track my voices that way. They seem to arrive spontaneously and fully formed.

        They’re more like the voices of characters in my dreams than my usual waking inner monologue, except that, unlike the voices, my dreams are usually of real people I know or have known. The closest ‘normal’ waking experience I have to them are transformative ear-worms; when a song is stuck in my head and over time the lyrics spontaneously change into something else.

        I have no opinion as to whether the voices are ‘me’ or distinct entities. I think the notions we have of ourselves as separate individuals are incoherent and subject to fluctuation anyway, so I feel neither the urge nor the capacity to pin them down as part of me or something outside me.

        I also believe that, when we start vocalising the fact that mental illness is not a disease process then we open wide the door to many who would subsequently seek to blame the patient/client/sufferer/victim/service-user/person.

        There’s now a substantial body of research showing that those who see ‘mental illness’ as a brain disease are more likely to blame the sufferer than those who attribute it to other causes. This is particularly the case with clinicians. Hardly surprising really, as the notion is largely predicated on a physicalist ontology that equates the mind/self with the brain. You are your brain, so you are the disease. One reason the ‘brain disease’ model is so popular with groups like NAMI is because it offers a handy escape from alternatives that shift the blame onto family members – especially mothers.

        The problem isn’t the model, it’s the knee-jerk practice of ‘blaming’ itself.

      • An adult, with severe and/or chronic mental health symptoms is incapable of functioning in any other way unless they receive significant (or “good enough”) prolonged therapy.

        That’s circular reasoning at best. Nonsense at worst.

        I’d suggest one reason MI diagnosis is on the rise – setting aside DSM bloat – is because the consensus definition of ‘functioning’ is changing as greater demands are placed on individuals to ‘fit’ into increasingly dysfunctional societies and – especially – workplaces. If you internalise those demands and fail to meet them you will come to see yourself as deficient or defective – possibly mentally ill. One strand of CBT is to help the patient change their notion of what ‘functioning’ is.

        People often spontaneously recover from even severe mental illness without ‘therapeutic’ intervention. In fact there’s a strong argument to be made that recovery is more likely that way.

  4. I’m very much interested in hearing your thoughts as you move through the study because I just do not agree with the way mental illness is dealt with at all and I have personal experience that refutes so much of it so keep posting
    M zurcher

  5. Anti NMDA Receptor Encephalitis is often misdiagnosed as psychosis, about 1 in 4 not diagnosed correctly will die, so I wouldn’t recommend it. Susannah Cahalan wrote a book on her experience: Brain on Fire. When we get past all these other problems that cause what looks like mental illness.. “mental disorders need to be understood in the same way that we understand other sorts of human behaviour” I agree with that and that it needs to be debated.

    • mental disorders need to be understood in the same way that we understand other sorts of human behaviour

      I don’t really agree. I’m no Skinnerite. Mental disorders need to be understood in the same way we understand other sorts of human suffering. The Buddha composed a sutta about it. The Fire Sermon. If it ain’t suffering it ain’t a disorder – regardless of the behaviour it may engender. What’s to debate about compassion?

      • Okey dokey, this is why – and one example – I think the social context of other sorts of human behaviour is relevant. Jennifer Weist of the German group Jennifer Rostock sings Du du du ….du willst mir an die Wäsche literal translation.. You you you..you want to get into my laundry, so you can work out the real UK translation. So why is this stuff relevant to these problem’s, well first off the young women in the audience totally identify with what she is singing about… it amounts to female sexuality and male attitudes and is thousands of years old with her story set in a cinema, she references classic films and has a personal dialog going with some unknown man that only he and she will relate to. But the young women get the inferences. (don’t worry no bad language in it) But it’s the intensity of input, that’s the key thing. It is mostly young people 18 -24 who suffer psychosis. If a person is already suffering hyper-mania, first off.. they probably will not know that it’s an issue… they feel absolutely great, on top of the world, faster than everyone else, sharper, alert, clear. However this kind of intense input is what pushes young people into full blown mania and psychosis. My view is that we should go on to their ground…. YouTube and talk about this. What’s the point on here….I’m talking to a people who know this stuff. Jennifer Rostock have 8 million views. Now I would be a total hypocrite if I just said: look, despite the good intention, this stuff aint no good for you, but I do believe in informing people:

  6. BTW, Dr Moncrieff, did you notice Sir Robin Murray’s citation of your work in his mea culpa, which concludes “Furthermore, the syndrome is already beginning to breakdown, for example, into those cases caused by copy number variations, drug abuse,
    social adversity, etc. Presumably this process will accelerate, and the term schizophrenia will be confined to history, like “dropsy.””

    Hopefully he’s right and the question of whether schizophrenia is a disease will soon be moot.

  7. Thanks for all your interesting comments and for your encouragement for the Radar programme.

    In reply to Cabrogal, I think that what we call things does have a significant influence on how things are viewed. Calling something a disease has implications about lack of agency and autonomy, for example.
    I agree with you that working out what consitutes being human is not the remit of medicine. But I don’t agree that just because something is a problem it is necessarily a legitimate target of medical research. Many problems that beset human beings and groups are not best understood using the language of medicine and natural science, and if you don’t understand the problem correctly and fully, you are unlikely to be able to find useful interventions.
    Thanks to dagernet for the comments on psychosis being a language- this is a really interesting thought.
    Thank you John and Crow for your comments on the role of trauma. ‘Helping people to have a better life’ in a general sense is, I agree, the way to prevent and reduce mental health problems. Just to clarify, it is the term ‘continuum’ that I have problems with. I agree that psychotic symptoms are part of the ‘wide and varied’ human response to the world, but I don’t think they are something you can measure on a scale that most people have a little of and psychotic people a lot of.
    And Chris, I am not sure I fully understood your point, but I enjoyed the video!

    • In reply to Cabrogal, I think that what we call things does have a significant influence on how things are viewed. Calling something a disease has implications about lack of agency and autonomy, for example.

      That’s not the same as pretending you can change attitudes by changing language. Look at how quickly one generation’s ‘polite euphemism’ for an ethnic minority becomes the next generation’s racial slur.

      There’s a good example in the novel The Curious Incident of the Dog in the Night-Time in which the autistic protagonist is taunted by a group of children chanting “Special needs! Special needs!”.

      It’s our stigmatisation of ‘mental illness’ that drives people to want to externalise it as a ‘disease’, not the other way around.

    • if you don’t understand the problem correctly and fully, you are unlikely to be able to find useful interventions.

      Well, as an ontological anti-realist, I’m sure not holding my breath waiting for any problem to be understood correctly and fully.

      The idea that science progresses in steps made out of robust theory followed by controlled experimentation is largely a myth. Many of the greatest scientific leaps have been the result of ignorance followed by accidents and errors. I think if Kuhn and Popper could agree about anything it would be that failure to understand is a vital part of how science develops. All scientific theories are tentative and prone to falsification, otherwise they ain’t scientific. Maths has proofs (though Godel demonstrated its limits), science does not.

      The problem with psychiatry isn’t that it makes so many blunders but rather its pathological inability to acknowledge them when it does. That’s because psychiatry has very little to do with either medicine or science. As Michel Foucault, Bruce Levine and many, many others have been at pains to point out, the primary aim of psychiatry isn’t medical but political. It’s not about alleviating suffering. It’s about empowering illegitimate authority, stifling dissent, enforcing conformity and displacing social problems onto the individual.

      • Being alone having to deal with the way I think things work in the mental field I have come to your conclusions all by myself untrained as I am and so it is very good to hear coming from somebody who sounds like you know the inns and outs of the system and it just confirms that it is a disaster and it’s very disheartening but it’s good to hear that at least that perhaps I am thinking clearly after all

      • “The problem with psychiatry isn’t that it makes so many blunders but rather its pathological inability to acknowledge them when it does. That’s because psychiatry has very little to do with either medicine or science. As Michel Foucault, Bruce Levine and many, many others have been at pains to point out, the primary aim of psychiatry isn’t medical but political. It’s not about alleviating suffering. It’s about empowering illegitimate authority, stifling dissent, enforcing conformity and displacing social problems onto the individual.”

        Yes indeed and when an individual experiences it..well it hits home on how difficult it will be to change all this vile abuse. One of the reasons I use molecular biology to argue with psychiatrists is because it is very precise and therefore pretty much can not be argued with.

        You may find this interesting :


        For me, the interesting part is that it points to where – if any – one biological problem may be: dysfunction of the AMPA receptor which is a glutamate (major excitatory neurotrasmitter) receptor and responsible for pushing out the gating magnesium irons in the NMDA receptor and hence facilitating normal function (also a glutamate receptor). But here’s the problem… the body doesn’t want anything that is outside of the evolutionary correct nutrients. It changes itself to that end and to the point of damage. The other very interesting thing about this research is that it’s a metabolite and not the drug.

      • Buying into biopsychiatric non-sequiturs just encourages them. When it’s not reverse engineered BS aimed at legitimising pre-existing treatments, such as catecholamine theories of mental illness, it’s woefully feeble chains of inferred causality based on some media-hyped research tool such as fMRI or bioinformatics.

        How many times in an average year does someone loudly ‘discover’ a biomarker for mental illness?
        How many of them pan out? Except for advertisers that is (most people still think depression is caused by serotonin deficiency).

        About the only reason I can think of for buying into molecular biology and neurology based paradigms of mental illness is to show how the exact same data and exact same models can be used to draw diametrically opposite conclusions. It’s usually not difficult.

  8. But I don’t agree that just because something is a problem it is necessarily a legitimate target of medical research.

    That’s true. But just because the DSM is a reeking epistemological swamp doesn’t mean that no mental or emotional distress has a physiological basis or the potential for medical alleviation. For one thing, it looks to me that entheogenic chemicals such as LSD and psilocybin are showing huge promise for the long term alleviation of the existential despair that is so often the most unbearable (and suicide inducing) aspect of major depression. I think the inevitable neurological ‘explanations’ for their mechanisms are laughable, but they still seem to work.

  9. This may help people understand why people stay on a drug like lithium… the episodes can be terrifying. But I don’t agree with going to a psychiatrist and being drugged for the rest of the patients life, (seems to me she is on either lithium or an anti-psychotic at this time and may-well have been on it since a teenager) for me it must only be used to get through an episode and the least toxic drugs with a cytochrome P450 test being done and the best knowledge on food/herb/spice drug/cyp interaction. The real important thing is HOW a patient comes off a serious drug such as lithium.

  10. I think that if a patient has been long term on antipsychotics or lithium, I mean longer than 5 years it’s going to be very difficult indeed to come off. I was misdiagnosed with treatment resistant depression when it was actually had SSRI induced akathisia after going to my GP with severe anxiety. This was pretty much proved by a Cytochrome P450 test. Ended up 2 years on lithium before working out what to do. Now off lithium for two months after a 6 month tapper and am still not ‘normal’. Before that I had the full works of benzo’s and antipsychotics all because these psychiatrists do not admit that the drugs they prescribe cause akathisia and it is their fault. It’s not an over estimation that discovering and reading Peter Breggin, Joanna and the rest saved my life from these ‘doctors’ Reading Peter Breggin and what he went through over the Joseph T. Wesbecker case gave me the will power to stand up to these people and study in more depth. It’s just incredible what is going on, how history will see this is a going to be a vast crime. Now for some strange reason I’m able to recall all the lyrics to Joni Mitchells album Hijira all night long, I can only surmise that is a result of coming off lithium.

      • The answer is: slowly and with all out determination like a jet thrust vectoring on earth gravity a few feet off the ground and then powering away into the light.

  11. A person who goes through all this can expect to be messed up in ways they would not expect. I was unable to go to my building society and take out money, so I had a relative fill the form in and do it for me. Eventually the building society became suspicious and I had the fraud people knocking on my door asking for my birth certificate and passport. After I proved who I was and many months later was well enough to go to my bank, I found that they had just cancelled my account, refused to reopen it, and would not give a reason why. I tried to open accounts with three other banks none of them would give me an account. So now if I wish to buy anything online I’m dependent on a relative. Thankfully I still have the building society account. And that is very minor, given that I almost died three times under the ‘care’ of a psychiatric hospital.

  12. There is something else I wish to say about all this, and it is important. As well as being on these drugs it is also important when coming off t to consider the common foods, herbs and spices that you eat. This is because certain items block, attenuate and interfere with the liver enzymes that metabolise the drugs. And I learn’t this in a very stark and unpleasant way. One of the common withdrawal problems you will have and pretty much have to expect and prepare for is insomnia. So what did I do, I took a herbal product which has Valerian. Big mistake… I later found out that Valerian blocks the liver enzyme system Cytochrome P450. I also found out that common food stuffs such as black tea, garlic and black pepper also block or interfere with Cytochrome P450. Here is one reference but it can get real technical and a person really needs a
    pharmacist/dietitian trained in all this to advise :


  13. “Are antibodies to neuronal proteins important in psychiatric disorders”

    Angela Vincent

    Sorry, but I really think this is an important question.

  14. OK so my friend Sue – who helped me through the three years of hell – is badgering me to write about what I did to overcome the anxiety worry, and fear of coming off these drugs.

    The first thing is the motivation. And that came from research, however, when you feel utterly horrendous you can not do proper research and read studies. You in-put words and come up with stuff and hang on to words, that’s how I found this site, I put in lithium and read: ‘Lithium is a neurotoxin’ and that was all I could hold on to. Think about it, a psychiatrist is saying that ‘Lithium is a neurotoxin’,but lithium is the favoured drug of psychiatrists. That word: neurotoxin, really is some motivation.

    The second thing – by keeping a record – date, time, amount of drug to be taken – is to slowly reduce the amounts of the drug, with lithium there is only 200mg and 400mg, a usual dose is 800mg so the logical thing to do would be to reduce to 600mg hold that for at least two weeks assess how you feel, if you feel OK reduce to 400mg, if not just hold it until you do feel OK, so you do that until you are at 200mg. If you are on this drug long term you can put that out to 3 or 4 weeks before every reduction. When you get to 200mg you can stretch out the time (hour) at which you take the drug. So I set a time to take the drug, did it for three days bang on time and then on the fourth day I took it an hour later for three days and then another hour later for three days and so on until you are taking the drug at 200mg every other day. You do that for two weeks and then start taking it every other two days, any problems hold on until you feel OK and then proceed to every three days and continue onto 7 days and then stop. But be prepared to start again, first sign of manic behaviour go back to where you felt OK and again continue to reduce slowly.

    I came off 12 psychiatric drugs like this including three anti-psychotics and 4 benzo’s. The benzo’s are – in my experience – the most difficult, but only psychologically. This is where R. D. Laing comes in handy. Re-frame the problem, you can’t sleep so you are good at not sleeping, you are awake, you can do stuff. Think yourself to a point where you can be awake at 2am 3am 4am in bed and feel OK and accepting about it and thinking: right I’m not putting anything into my body that is going to make me worse… that is going to jack up glutamate and keep me awake, therefore at some point my body is going to re-balance itself. Now this isn’t a one or two month thing it’s likely to go on for a while so be determined,stay focused as much as you can; being stubborn is not so bad with this problem.

    • Hi Chris,
      thanks for posting this advice. It’s really helpful. I get so many enquirires from people who are struggling to come of their meds- this will be helpful to direct them too. I think the main messaage I take from your experiences and those of others is that it can be really hard, but the withdrawal symptoms do get better in the end if you can stick with it.
      Your advice about reframing things in a positive light reminds me of Allen Carr’s approach to stopping smoking, which helped me to quit.

      • What happened to me could happen to anyone. I do not hear any voices, do not have other hallucinations, am not paranoid, not bi polar. Had the kind of anxiety that anyone who sufferers sustained stress would have, no history of being abusive or violent. Before this I had no idea of psychiatric drugs or psychiatry. My GP put me on an SSRI which caused a terrible reaction which I now know is called Akathisia, for anyone who doesn’t know this, it is a toxic build up of drugs, which can potentiate suicide/homicide ideation and completed suicide/homicide…. it is drug induced psychosis. He refused to accept that it was the drug and prescribed more. Then when I had terrible and very real pain from a kidney problem – unknown at the time – and visited the hospital, they would not accept there was a real problem and do a necessary scan… they read what my GP had said decided it was all in my head, probably constipation, did a blood test and discharged me. A week later – in horrific pain – I was admitted and had an emergency operation. After they took my temperature and within a few minutes had loads of medical people around me. I later learned they suspected sepsis.

        When my friend Sue was trying to help me realise it was the drugs, I would say to her: well I am not going to be alive by the end of the week so there is no point in thinking about coming off them, so I might as well take them all at once and get it over with. And this is how it went on for ages. The Sue’s of this world.. they are the unsung hero’s. And then you have the crazy, dangerous psychiatrists and GP’s on their pedestals refusing to take responsibility for all this. And the terrible and dangerous thing is you go along with it, because the drugs remove any caring, so you just don’t care about anything, that’s what antipsychotics do… Peter Breggin calls it spellbinding. Before I operated at a really high level in what I did, now I struggle to write my own name. To quote Thomas Szasz “if you don’t wise up you’re a dead duck”.

      • Dear Chris,

        All too often, when an otherwise “normal” person receives a mental health diagnosis – even as simple as depression or anxiety – they cease to exist as a respectable human being with rights. They be come the silent, ignored, invisible underclass that society wishes to eradicate from its conscience. Even if a violent crime is committed against you, the legal profession will refuse to take the case to court unless there are “normal” witnesses…..if it’s your word against the criminals, then the prosecutor believes that the jury will not believe you because you have a mental health issue. This leaves you in an extremely vulnerable position, without any protection under the law. We really are an unwelcome underclass.

        My advice……..at ALL costs, avoid going to you doctor regarding any emotional or mental health concerns, No matter what you think the cost is right now, it will be greater if you are diagnosed. In addition, the drugs are not just significantly limited in their therapeutic worth, but also harmful in their side-effects. Many of the theory’s that the use of drugs is based upon are currently being called into question by professionals and pharmaceutical company’s alike.

        If you can, talk to a friend, talk to Samaritan’s, talk to the wall or a pillow, BUT try to avoid talking to a doctor. It rarely helps and often harms.

  15. Thank you for that… if there is one regret I have it’s not knowing what you have just said prior to 2013.

    With regards what Joanna is doing. If I had one single experience I would like to really get across it’s the support of someone close to the patient, be it relative partner or friend.. and their qualities. That is – from my experience – critical.

  16. And thank you Joanna, I think it is very important that people come off these drugs and I wish you every success with it.

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