‘Harm Reduction’ and Psychotropics: A GoodTherapy.org Review

Pills spill out of medicine bottle lying on sideIn an era of partisanship, much of the mental health community is divided on the issue of psychotropic medication. Is psychiatry’s magic bullet following the curve of overprescribed antibiotics or painkillers (i.e., opiates)? Should we consider treating mental health conditions more like sinus infections and less like diabetes? The emotional nature and visceral responses to these queries are often born out of personal experience and monetary investments.

Many of us have taken or are taking psychiatric drugs to make it through the day or, at the very least, know people who are literally and figuratively dependent on a doctor’s prescription pad. However, Will Hall has managed to both thread the needle and address the great division this topic ensues. The free, downloadable Harm Reduction Guide to Coming Off Psychiatric Drugs, published by The Icarus Project and the Freedom Center, is the clearest articulation of both sides of the pharmaceutical coin I have come across.

The Icarus Project represents a support network and education project “by and for people who experience the world in ways that are often diagnosed as mental illness” or who are, in the words of Emily Martin (2007), “living under the description” of such a label. The project aims to “advance social justice by fostering mutual aid practices that reconnect healing and collective liberation. We transform ourselves through transforming the world around us.”

The Icarus Project, open to anyone, is known for offering support to people who wish to express their unhappiness over treatment with psychotropic drugs and find relief in alternative ways (Martin, 2010). In the guidebook, Hall offers philosophical, historic, and practical understandings of the body and pragmatic instruction on exploring one’s relationship to the fated chemical cure:

“Psychiatric drugs do not change the underlying causes of emotional distress. They are best understood as tools or coping mechanisms that sometimes alleviate symptoms and pave the way for change—but with significant risks for anyone who takes them.” (p. 14)

The authors are weary of false dichotomies:

“It’s not an either-or choice between taking psychiatric drugs or doing nothing. There are many alternatives you can try. In fact, some problems that are called symptoms of ‘mental disorders’ might turn out to be caused by the drugs people are taking.” (p. 26)

The guidebook takes aim at over-arching biological explanations of suffering: “Believing these claims can reinforce a sense of being a helpless victim of biology, and leave people feeling there are no options other than medications” (p. 15). This represents the attuned nature of the text as it taps into the defeatist American attitude while at the same time smoothly transitioning from complex issues such as neuroplasticity and epigenetics:

“Epigenetics shows that instead of a ‘genetic blueprint,’ the environment interacts to turn genes on and off. Using genetic science to oversimplify the diversity of human behavior is a throwback to the discredited concepts of social Darwinism and eugenics. It portrays some people as destined to be inferior, defective, and less than fully human.” (p. 16)

The guidebook is an empowerment tool emphasizing that the decision to take medications ultimately resides in the hands of the afflicted regardless of the etiology of their experience (i.e., genetic, biological, interpersonal). It does echo Thomas Szasz’s (1974) views on the metaphors behind psychiatry and the moral injustice of involuntary commitments. His ethical understanding of psychological dysfunction remains tacitly alive in this handbook minus the hyperbolic and grossly intellectual approach Szasz used to explain it:

Sometimes spiritual states of consciousness, nonconformist beliefs, conflicts with family members, or trauma are called ‘lack of insight,’ but they deserve to be listened to, not made into illnesses.” (p. 43)

We must remember that there is always an existential element to a person’s suffering in the same way there is always a biological trail to every experience (i.e., mania, learning to play the violin, studying a new language, meditation, falling in love). Emphasizing one side of the coin (the biology or the brain) relieves us of the responsibility to consider habitual patterns and ethical conflicts.

This is a summons to Joel and Ian Gold’s sentiments on psychosis and culture as well as a smelling salt to the post-World War conscience of Viktor Frankl, who searched for significance as a means to psychological resilience.

Szasz (1974) understood cultural terrain and the way clearings are paved to fulfill “the roles of helplessness, hopelessness, weakness, and often of bodily illness.” What most refer to as diagnoses of “mental illness” are actually shifting roles that “pertain to frustrations, unhappinesses, and perplexities due to interpersonal, social, and ethical conflicts” (Szasz, 1974; p. 246).

The guide asserts the importance of community, relational healing, the power of language and meaning making, as well as the physiological implications of medications within our social conditions. Bessel van der Kolk’s work on trauma and the body comes to mind as the text offers testaments to the fallacies of the disease model for mental health:

“We need a mental health system based on voluntary services, compassion, and patience, not force, control, and paternalism. We also need communities taking more responsibility to care for each other.” (p. 44)

I have referenced the lack of reliability and invalid nature of the mental health diagnoses of the DSM, but this text truly understands that an egocentric view of the self is not the only form of perception:

“Sometimes paranoia is a message about abuse, or reflects sensitivity to nonverbal communication; self-injury is often a useful way to cope with overwhelming trauma; believing the universe is talking to you is shared by many world religions; and manic states can be an escape from impossible circumstances to find deep spiritual truths. Even falling in love often feels like going crazy.” (p. 44)

The jargon-free format is juxtaposed with nuanced political insight into the trends of medicalization: “Children also sometimes become the ‘identified patient’ of a family system that itself needs help to change” (p. 40). As Gary Greenberg (2013) noted, by 2005 antipsychotic use in children and adolescents was up by 73% since the turn of the century. By 2007, half a million children were being prescribed antipsychotic medication—and 20,000 of those were under 6 years old (Greenberg, 2013).

If none of this fits with your worldview, one can still appreciate the breadth of resources compiled here in a seemingly altruistic manner (it is a free guidebook, after all). This includes a plethora of online communities, scholarly articles, and the essential lurking information that is counter to popular psychology culture and social media newsfeeds. In addition, there is sound advice on independent strategies for health that might escape the fast-food, high-deductible, copayment health care we now utilize. The rubber meets the road with this text in the practical application and forthright directives laid out. For example, “Even if you get enough hours, being asleep earlier than 11 p.m. is most restful” (p. 33).

Without sounding like a banal motivational speech by Tony Robbins, the guidebook eases the reader into a new mental paradigm:

“Beginning a medication reduction is like embarking on a trip or journey: the unknown can be an exciting possibility or an intimidating threat. It is important to acknowledge that you may be a very different person now than when you first started taking psychiatric drugs. You may have grown, developed new skills, and gained new understanding. You are handling things differently than when you were first put on medication: past stressors may no longer be present, and life circumstances may have changed. And whatever difficulties you do have aren’t necessarily symptoms of a disorder or signs you need medication.” (p. 30)

We must remember that there is always an existential element to a person’s suffering in the same way there is always a biological trail to every experience (i.e., mania, learning to play the violin, studying a new language, meditation, falling in love). Emphasizing one side of the coin (the biology or the brain) relieves us of the responsibility to consider habitual patterns and ethical conflicts.

This reduction in emotional bandwidth can be brought back online during a detoxification from the pharmaceutical agent. It frequently opens previously boarded-up questions as to how one came to the crisis that led to psychotropic drugs or how one wants their future to look. Fitting with the harm-reduction ideology, the guide does not hold a position for self-actualization:

“Whether it’s coming off completely, reducing your medications to a better level, or just gaining a greater sense of control, celebrate your new empowerment.” (p. 39)

A final note and word of caution: Hall makes clear in the text that it is not intended as medical or professional advice. Nor is this article. As Hall puts it, “While everyone is different, psychiatric drugs are powerful, and coming off—especially suddenly or on your own—can sometimes involve risks greater than remaining on.”

References:

  1. Gold, J., & Gold, I. (2014). Suspicious Minds: How Culture Shapes Madness. Simon & Schuster.
  2. Greenberg, G. (2013). The Book of Woe: The DSM and the Unmaking of Psychiatry. New York, NY: Penguin Group.
  3. Hall, W. (2012). Harm Reduction Guide to Coming Off Psychiatric Drugs, 2nd Ed. Retrieved from http://www.willhall.net/files/ComingOffPsychDrugsHarmReductGuide2Edonline.pdf
  4. Martin, E. (2007). Bipolar expeditions: Mania and depression in American culture. Princeton: Princeton University Press.
  5. Martin, E. (2010). Self-making and the Brain. Subjectivity, Vol. 3(4): 366-381.
  6. The Icarus Project website: http://theicarusproject.net/
  7. van der Kolk, B. A. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. New York, NY: Viking Press.

© Copyright 2016 GoodTherapy.org. All rights reserved. Permission to publish granted by Andrew Archer, LICSW, therapist in Mankato, Minnesota

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Eugenie

    Eugenie

    July 4th, 2016 at 9:05 AM

    I suppose that at some point we maybe all saw these kinds of drugs as a cure all, but after seeing how they have impacted my life as well as others, and then reading this, it makes perfect sense that while they may help us cope for a while they never get to the heart of the underlying issue.
    Will anything ever? I am not sure. I know that for me the medications that I take help me function and live better and I think that with a doctors care I will continue with them fro as long as she and i think that they make sense for me. But I would not like to do that at the expense of my health.

  • Joan

    Joan

    July 5th, 2016 at 7:53 AM

    Are you ever worried that studies that suggest it could be the medications causing the symptoms could make the pendulum swing in the other direction and cause those who need help to not seek it out as a result of that kind of information being floated aorund?

  • Francine

    Francine

    July 5th, 2016 at 1:11 PM

    Hmmm my thoughts are that if more doctors would actually listen to their patients and their wants and needs instead of doing only what they think is the best thing for them, then something like the Icarus project wouldn’t even be necessary.

  • Andrew Archer, LCSW

    Andrew Archer, LCSW

    July 5th, 2016 at 1:47 PM

    Thanks for the comment Eugenie. A couple years after Prozac came on the market we were met with “The Decade of the Brain” as well as a lot of optimistic psychopharmacologists in the 1990’s. However, it seems the enthusiasm for ‘cures’ was misguided.

  • Andrew Archer, LCSW

    Andrew Archer, LCSW

    July 5th, 2016 at 2:29 PM

    @Joan: It would take quite a bit for the pendulum to swing. Emily Martin noted in her 2007 book that the market for psychotropic drugs was growing rapidly in the 1990’s. “In the United States, sales reached $2.5 billion in 1990, $6.6 billion in 1995, about $7.6 billion in 1996, and then over $15 billion in 1999.” Sales for antidepressants alone are more than 10 billion per year currently. @Francine: it would be nice if doctors had more time to speak with their patients, but I imagine that their time is very limited with ever shrinking margins.

  • Carley

    Carley

    July 6th, 2016 at 8:10 AM

    I suppose this is a pipe dream but it seems to me that many patients would feel so much better if there was more of an overall consensus within the mental health community as to what treatment will work best with what illness. I know that one does not intend to harm, and opinions are great, but you know, if there would be a little more cohesiveness then that might make some who are waffling about treatment feel just a bit better.

  • Andrew Archer, LCSW

    Andrew Archer, LCSW

    July 6th, 2016 at 12:47 PM

    Thanks for the comment @Carley. One thing to consider with ‘globalized’ approaches to medicine or specifically diagnosis and treatment is that in undermines cultural understandings of illness. For me, it does not seem possible to have a universal understanding of “depression” for example, because one must consider so many factors (e.g., environment, parental upbringing, SES, political climate, age, gender, etc.) that are constantly changing. To your point, historically, this has been the DSM’s aim although one could argue it has missed the mark.

  • Carley

    Carley

    July 7th, 2016 at 12:14 PM

    I get what you are saying but I just can’t help but feel if there were even just some guidelines that could be agreed on then maybe it would even be easier to get more insurance companies to cover treatment. But I guess that is another topic entirely huh?

  • Andrew Archer, LCSW

    Andrew Archer, LCSW

    July 8th, 2016 at 10:01 AM

    @Carley, you hit on a crucial aspect of this which is financing. I imagine the conversations on topic related to diagnosis and treatment vary in places where there is universal health insurance (i.e., less of a reliance on private reimbursements).

  • phillip

    phillip

    July 8th, 2016 at 10:50 AM

    Look, I think that we all have to come to a decision with our provider about what is going to be the appropriate treatment for us. Not what works for another person, but what will work for you. It might be something that other people agree with and then again, it may not be, but if it helps me and I know that and my provider is good with that, then why do I even care what someone else has to say about it?

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