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Many people reading this book are seeing physicians or psychotherapists who are urging them to start or to stay on psychiatric drugs. If you are being pressured to use drugs, you may find it helpful to understand your doctor or therapist as a human being with his or her own concerns, fears, and conflicts about your desire to be drug-free.
You may not have intended to take psychiatric drugs when you first sought help. After a few therapy sessions, your therapist may have raised the issue. Or perhaps, when therapy wasn't progressing as well as you hoped, you wondered about trying drugs. One way or another, your therapist made a referral to a psychiatrist and, after a fifteen- to thirty- minute visit with the doctor, you were started on drugs.
You may have had mixed feelings about starting on drugs. If your therapist suggested it, you may have concluded, "I must be worse off than I thought. Even my therapist can't help me. Maybe I do have a biochemical imbalance. Maybe it is genetic."
Even if it was your own idea to seek medication, you may have had reservations or questions. Was it all your fault that therapy wasn't progressing so well? Maybe your therapist was on the wrong track. Maybe you could benefit more from a different therapist or another kind of therapy. Possibly you wondered about changing therapists, using herbs and other alternative healing methods, going to a holistic healing center, or trying to make it on your own without professional help. Maybe you wished your therapist had said, "Don't give up on yourself and don't give up on your therapy. We can do it without drugs!"
Your suspicion may have been correct: If you were not doing as well as you hoped in therapy it may not have been your fault. Therapy is a relationship, and there are innumerable reasons why relationships fail to fulfill their promise. There may be a lack of congeniality between the participants, a clash of personalities or values, conflicting viewpoints, a lack of mutual understanding. Maybe the relationship got off on the wrong foot and never recovered. Perhaps neither of you feels comfortable with the other. Your therapist may remind you too much of your father or mother, or your child; or you may remind your therapist too much of his mother or father, or child. Maybe your therapist has problems similar to yours and never solved them. Maybe your therapist is going through a difficult time in his or her own life, or simply doesn't know how to do therapy well. In short, the sources of difficulty in therapy are as numerous as the causes of difficulty in any relationship.
Finding the right therapist is comparable in difficulty to finding and cultivating a best friend. Both friendship and a good therapeutic relationship require persistence, luck, patience, hard work, and perhaps a blessing.
Unfortunately some therapists automatically blame the client for any lack of success in therapy. They may justify themselves by saying, "I did not recommend medication until it was obvious that therapy by itself wasn't working." But this assertion - "therapy ... wasn't working" - holds many unexamined assumptions. Therapy isn't a thing, like a dentist's drilling machine, that works or doesn't work. It isn't something that comes in fixed closes with specific effects, such as 250 mg of penicillin. Rather, therapy is a relationship. And the failure of the relationship can as readily be caused by the therapist as by the client. Commonly both contribute to this outcome.
Each client possesses unique ideas about the aims of therapy one client wants relief from anxiety or depression, another wants to get at the roots of personal problems from childhood, still another is focused on finding a more liberated approach to living. Some clients have no stated aims, others have many.
Parents often seek help in regard to their children from very divergent perspectives. Some parents see themselves as part of the problem; they want guidance in resolving conflicts with their offspring. Other parents see the difficulty as residing in their children; they expect the children to be diagnosed and treated. Therapists also have specific ideas about the aims of therapy. They identify themselves by numerous different "schools" with descriptive phrases such as cognitive therapy, behavioral therapy, existential therapy, phenomenological therapy, insight therapy, relationship therapy, supportive therapy, rational-emotive therapy, psychoanalytic therapy, psychodynamic therapy, experiential therapy, biofeedback, noetic therapy, psychospiritual therapy, psychoeducational therapy, client-centered counseling, neurolinguistic programming, and more. When children are involved, the number of approaches expands to include play therapy and a variety of parent training approaches.
Some therapists are eclectic, tailoring several different techniques to their clients; others have one particular approach that they use for everyone. Many therapists work with anyone who comes to their office; others specialize. Some therapists work one-to-one, others work with families or groups. Similarly therapists can vary in their goals for therapy. One therapist, for example, may recommend relief from anxiety or depression through drugs along with psychotherapy, another may offer a behavioral or cognitive program for learning new ways of acting and thinking, still another may try to liberate the individual from early trauma or misguided lessons learned in childhood. Some therapists have very clear-cut aims for their patients even before they enter the office; others try to tailor the therapy to the unique goals of the client as they unfold.
Some therapists take a warm and caring approach, and share some of their own feelings and experiences; other therapists are more distant and reserved, sharing almost nothing of themselves. Some try to build a relationship of equality and mutual respect, whereas others are authoritarian and controlling.
Some address their patients by their first name but expect to be called "doctor". Some rarely call their clients by any name. The method of addressing clients, and of being addressed by them, often reflects basic attitudes regarding authority and control.
Many therapists explore client's problems without any formal approach at all; others have definite routines and programs. Some set no time limit at all on therapy; others offer a specific number of sessions. Some therapists work in medical surroundings similar to a surgeons consulting room; others work in home offices that express their unique personalities and family life.
A therapy that meets one person's needs may seem futile, frightening, or even ludicrous to another person. For that matter, even a single individuals response to one or another kind of therapy may vary over time. Some people take to therapy with ease and gusto; others find it painful and even alien.
Given the broad spectrum of attitudes and approaches among clients and therapists, as well as the infinite differences in personality; it is absurd to think that anyone should be put on drugs because one or another therapy "didn't work".
If you aren't doing well in therapy it's not because there is something wrong with you. Rather, it's because the relationship isn't achieving the desired aims of one or both of the participants. And when desired aims aren't being achieved, it certainly isn't going to help if one of the participants starts drugging the other.
Given the infinite number of therapeutic relationships that might potentially be formed, searching for the right therapy makes a lot more sense than turning to drugs after the failure of one, two, or even three of these relationships. Consider experiencing a number of different therapies and therapists if you don't find a perfect match on the first try.
On the other hand, you might feel too insecure or shaky to stop therapy before finding an alternative. Remember, it's your right to keep working with one therapist while you check out another. Optimally, you should be able to tell your therapist that you're seeking additional or alternative help; but if you feel uncomfortable doing so, you don't have to inform your therapist that you are considering a change.
Choosing between drug therapy and psychotherapy or deciding on a combination of the two, often has more to do with faith than with science or reason. In modern times, many sophisticated people feel uncomfortable with their need for faith. They deny it and end up having distorted, unspoken, or covert faith in material things. People used to have faith in their employers, but that is rarely the case today. They may instead try to have faith in their own intelligence and, especially in their training, education, and experience in the workplace. They may also turn to money earning lots of it as a form of security. They have faith in money.
When we grow up, we do not stop being children - we simply disguise that fact. We continue to have all the same basic needs for security, love, and faith.
Children begin by having faith in their parents. Later they may develop faith in other people around them, as well as in people they have never met, from movie stars to sports heroes. As they mature, adults tend to evolve and find new kinds of faith, including their own particular ethics, values, and religion. In order to develop healthy adult relationships, they must learn to have faith in individual people. In short, they must learn to trust.
A person's ultimate faith can be defined in terms of where he or she turns when feeling frightened, self-doubting, desperately depressed or anxious, hopeless, or shaken to the core. Nowadays many people turn to mental health professionals as their ultimate source of security and hope. They have faith that these professionals can make them psychologically or spiritually well. Without realizing it, they are placing themselves in the hands of healthcare specialists who may have little psychological or spiritual awareness - people who have put their faith in medical diagnoses, biological explanations, and drugs.
But isn't psychiatry science? Isn't faith in psychiatry based on facts? On research? Can't we "trust in research"?
The sad truth is that, in the field of psychiatry it is impossible to "trust in research"147. Nearly all of the research in this field is paid for by drug companies and conducted by people who will "deliver" in the best way possible for those companies. Even if the particular research project isn't drug company-sponsored, the researcher is bound to have strong ties with drug companies that control the research field, finance most of the conferences and meetings involved, and provide other perks such as consulting jobs. In addition, the drug companies and the drug researchers share a common belief in drugs. They also share a set of values about the kinds of statistical manipulations that can be tolerated, about the kinds of data that can be accepted or rejected, and about the standards for success. Almost always, if any kind of statistically significant numbers can be wrung out of the data - regardless of their real meaning - the clinical trial will be touted as "proof" of the safety and efficacy of the drug in question. Indeed, it is almost impossible to collect data in such experiments without coming up with "significant" correlations and "positive" results.
Sadly even well-informed people too often put their faith in psychiatry and psychiatric research. It is the same as putting their faith in a drug company.
Many psychiatrists nowadays have no faith in psychotherapy; others simply don't know how to do it. They are medically trained and rely on medical methods, and they believe that aberrant genes and biochemicals are the most significant causes of psychological suffering. Still other psychiatrists may continue to believe in talking therapy but feel pressured to give medication by colleagues as well as by patients and their families.
Even many nonmedical psychotherapists - mental health professionals who specialize in talking therapies - feel coerced into going along with the latest fads in psychiatric diagnoses and medication. HMOs, PPOs, and other insurers often pressure therapists and clients alike to seek treatment with drugs. And psychotherapists, including clinical psychologists, counselors, and social workers, are being trained to believe that medication must be used in any situation that seems difficult. The end result: Therapists have begun to lose confidence in themselves.
If your therapy isn't progressing well or if you appear to be in a crisis, your therapist may feel "out on limb" and insist on your taking a drug. Therapists have emotional vulnerabilities exactly like anyone else. Your emotional crisis can turn into an emotional crisis for your therapist.
Even caring, experienced, ethical therapists may find that their personal concerns get in the way of encouraging you to work with them without drugs. They may worry about how you will do without the drugs, but they may also fear what will happen to them if you "get worse" without drugs. Instead of being focused on what you want and need, your therapist may become more worried about his or her professional image, about criticism from colleagues for not giving drugs, even about a lawsuit from your family if you do poorly without drugs.
Organized psychiatry has fueled the fears of therapists by making threats and, in one well-publicized instance, by asserting that a private psychiatric hospital "lost a malpractice suit" because it didn't prescribe drugs for a patient. In fact, the hospital settled the lawsuit out of court in a rather cowardly manner. Furthermore, this particular suit was a rarity.
Psychiatrists who prescribe drugs and electroshock are the ones who are most regularly sued in the mental health field. And innumerable malpractice suits are threatened or brought each year against medical doctors, including psychiatrists, as a result of damage done by their prescription of psychiatric drugs and electroshock. Meanwhile, very few psychotherapists are sued by patients or their families for any reason. Many psychiatrists have multiple lawsuits brought against them, few psychotherapists have any. As proof of this point, the malpractice insurance premiums paid by psychiatrists are much higher than those paid by psychotherapists.
More specifically there have been very few malpractice suits brought against therapists for failing to recommend medication. But therapist's fear of being sued is exaggerated by biological psychiatry as yet one more method of intimidation. Although such lawsuits are possible, they are not likely especially among therapists who take the time to explain their views and to contrast them with the prevailing opinions expressed by psychiatrists.
If we do not hold drugs in reserve as a last resort, then we are faced with relying on ourselves - our own personal resources - including our capacity to be empathic, to understand, to help in the creation of new and better solutions. This is true whether we are trying to help ourselves, friends, family members, or patients without encouraging the use of drugs.
When you and your therapist reject medication as an alternative, you in effect declare, "Working together, we have the personal resources to lick this problem." Many professionals are afraid to take such a stand. They lack confidence. They hope for a greater power to rely on beyond themselves, their clients, and other mere mortals. Nowadays the ultimate Higher Power is medication. It is especially frightening to reject this "power" because drug companies and biological psychiatry have convinced a large segment of the population that drugs are the answer, perhaps even the only answer.
When we decide not to turn to medical interventions to ease our distress or to solve our crises or suffering, we define ourselves, and other human beings, as the ultimate resource. We communicate to ourselves or to a client or friend, "You and I together, and with the help of other people, possess the necessary resources to solve or transform your suffering and this crisis for the better."
Consistent with the principle that therapists are people, too, they may respond with many fears if you reject the suggestion of drugs or show an interest in discontinuing them. Therapists, like the general public, have been bombarded with prodrug propaganda. During their training as psychologists, counselors, or social workers, they may have been required to attend prodrug lectures by biological psychiatrists. Many mental health professionals feel dependent on psychiatrists for referrals or for jobs, and tend to accept what they advocate. They may fear criticism from their colleagues or from psychiatrists if they don't "go along with the program" - and nowadays drugs are the program.
If you are depressed, your therapist may become concerned about your potential to hurt yourself or to commit suicide. Therapists have been led to believe that antidepressant drugs can help to prevent suicide. Few of them realize that there is no convincing evidence that any psychiatric drug can reduce the suicide rate, but that there is evidence that many drugs, including antidepressants, increase the suicide rate148. As reviewed in Peter Breggin's introduction, the FDA now warns doctors and users of the capacity of antidepressants to increase suicidal thinking and behavior.
If you can honestly do so, you should allay your therapist's fears by making an agreement that you won't harm yourself and that you will instead talk about any self-destructive tendencies you might have. Also consider making contingency plans in advance-agreeing, for example, to always phone or wait until the next session rather than doing anything drastic. Your therapist will feel much more comfortable about supporting your nonuse of drugs if you make clear your willingness to work together and to take responsibility for not harming yourself or anyone else.
Some individuals take the position that "it's my own business if I hurt myself". But when a person attempts or commits suicide, a tidal wave of suffering results. Therapists are not immune to this. Faced with a client's suicide, they feel not only guilt and remorse, as well as loss; they feel that they have failed. They may also fear for their reputations or worry about their legal vulnerability to a lawsuit brought by the family or by you, if you survive.
Nowadays, therapists often fear being sued. They do not know that mental health professionals are rarely sued for not giving drugs. By contrast, it is common for psychiatrists and other physicians to be sued by their patients because of adverse drug reactions.
Above all, therapists need to understand that the best guarantee against getting sued is to have good relationships with their clients. It is very rare for patients to sue doctors or therapists when they feel that they have been treated in a thoughtful, considerate, informed, and caring manner. Patients and clients, as well as their families, can almost always accept honest mistakes. What they resent is indifference, manipulation, and callous disregard for their well-being.
Let your therapist know that you appreciate his or her concerns about your desire not to take psychiatric medication, and promise not to hold your therapist responsible for any risks that you choose to take in regard to rejecting or withdrawing from medication. You might even suggest signing a form in which you acknowledge that nonuse of drugs is your decision and that you are following through on it after having been fully warned about the potentially negative consequences.
Your therapist has probably been taught that psychiatric medications have positive long-term effects and that many patients should stay on them for a lifetime. Thus, if you have been taking drugs for years, your therapist may feel that you are assuming too big a risk by trying to "do without them". He or she probably has no idea that few, if any psychiatric drugs have been proven to bring about long-term beneficial effects, even by the standards of researchers who favor drugs149.
There are no lifetime studies of drug efficacy. As described in Chapter 2, most studies of psychiatric drugs last four to six weeks and often have to be statistically juggled to make them look positive. Even when researched over the longer term, these drugs tend to be associated with increasingly adverse effects and no evidence of efficacy. It may be useful for your therapist to read this book and others150 in order to learn that there is little scientific basis to most claims for the efficacy of psychiatric drugs even over the short term, and almost no evidence for their value over the long term. There is simply no justification whatsoever for the commonly made claim that some people need to take psychiatric drugs for the rest of their lives.
In fact, most of the difficulties involved in "doing without drugs" are the result of drug withdrawal. Patients most often have trouble stopping drugs not because they are useful but because they create dependency.
Both of the authors of this book have been active in several professional arenas, giving us the opportunity to compare the characteristics and personal styles typical of the various professions. Psychiatrists as a group are much more controlling, authoritarian, and emotionally distant than other nonmedical mental health professionals. Now that the profession is dominated by it's biological wing, it attracts doctors who feel more comfortable writing prescriptions than relating to people. These tendencies, in turn, are reinforced by their training in clinics and mental hospitals, where they are taught to exert power and authority over patients and other professionals and where they learned to lock up people against their will, to administer electroshock, to write orders for solitary confinement and restraint, to control every aspect of the patients daily routine, to prescribe toxic drugs while denying their devastating adverse effects, and to generally maintain an authoritarian and distant relationship with their patients.
As a result, psychiatrists tend to seek power not only on the hospital ward and in the office but in administration and politics as well. They frequently become powerful leaders in the health field. In politics, they are extraordinarily effective. The mental health lobby funded by drug companies and led by organized psychiatry is one of the most powerful in the nations history.
Biological psychiatrists - who comprise the majority of today's psychiatrists - tend to react in a very suppressive manner to those who oppose them, including dissidents in their field. They ostracize their critics and have been known to drive them from their positions in schools or other institutions. This behavior is consistent with the authoritarian and controlling approaches they are taught during their training.
In our experience, nonmedical psychotherapists tend to be less authoritarian, less controlling, and less remote than medical doctors and especially psychiatrists. Doing psychotherapy day-in and day-out tends to promote acceptance of the inevitable autonomy of clients or patients. Therapists tend to learn to respect their own limits and to focus on strengthening the people they are trying to help. When doing their jobs correctly they exert their influence through empathy, understanding, and wisdom - not manipulation and control.
Psychotherapists, by nature, are not very political or bureaucratic. They tend to be private souls, feeling most comfortable in the settings in which they have chosen to work - intimate, secluded, well-protected spaces. Focused on understanding and helping individuals, they often lack concern or insight into the economic and political forces that drive the mental health profession and society. Barely do they participate actively in the major controversies within the mental health field.
Unlike biological psychiatrists, "talking doctors" have no source of funding or power in large industries, private foundations, or the government. They have no massive lobbying group in Washington. Even psychiatrists who practice psychotherapy have little or no influence at the National Institute of Mental Health (NIMH) or the American Psychiatric Association, both of which are dominated by their biologically oriented colleagues.
Not only do psychotherapists lack a broader economic power base, but their personal incomes tend to lag far behind those of psychiatrists who prescribe drugs, perform shock treatment, and confine people in hospitals. Organizations that represent psychotherapists, such as the American Academy of Psychotherapists, are also economically and politically weak. By contrast, organized psychiatry as exemplified by the American Psychiatric Association, has gained enormous wealth, and hence influence, through it's funding by the drug industry.
Organized psychiatry - with it's natural tendencies toward accumulation of power and it's funding from drug companies - now dominates the field of mental health, whereas psychotherapeutically oriented practitioners can rarely achieve positions of professional influence. Many hold precariously onto whatever positions they can get on journals and in clinics, professional schools, and national organizations. It is no exaggeration to say that they live in fear. To gain the enmity of a biological psychiatrist in a professional institution - such as an association, university hospital, clinic, professional journal, or government agency - is to risk ones job and career.
You and your therapist may find it encouraging to learn that there is an organization of professionals that speaks truth to power in the field of psychiatry. The International Center for the Study of Psychiatry and Psychology (ICSPP), in Bethesda, Maryland, was founded in the early 1970s in part to resist the growing power of biological psychiatry (see Appendix C). It provides a network of mutual support and shared information for professionals and concerned laypersons. It also sponsors a peer-reviewed journal, Ethical Human Sciences and Services, that is devoted to scientific research and analysis unsullied by professional and economic interests. Each year the ICSPP holds an international conference devoted to the principle of helping people in psychological distress without resort to drugs.
If you are a client or patient who wishes to stop or to reject psychiatric medication, it is extremely important that you understand your therapist's or doctor's fears and concerns, and are able to offer rational reassurance that you will take responsibility for your decision and personal conduct.
The next chapter offers suggestions for therapists who wish to favor psychotherapy over psychiatric medication as a treatment for their patients or clients. If you are in therapy you may find it useful to share these suggestions with your therapist.