Hi Carol,

I don’t want to speak in generalizations because opinions vary within the critical psychiatry community as to how best to approach treatment for conditions like schizophrenia. I stay pretty far away from authors and works that are so fundamentalist in their thinking that they think all psychiatric medication ought to be rejected or abolished. That type of extremist attitude tends to be shared mostly by the scientology wing of antipsychiatry, one I have no interest in defending, nor one that I take very seriously.

The primary motivating factor behind critical psychiatry is harm reduction. Everyone’s goal, including psychiatrists, is to help people. Where we diverge is in our understanding of what it really means for people to get “better” and what “help” amounts to. In cases such as the ones you describe, where hallucinations and delusions became distressing to all involved, if there aren’t any good alternatives to antipsychotic medications that work in restoring the patient’s ability to live a fulfilling and normal life, then of course, all else being equal, medication ought to be continued.

The argument isn’t so much centered around whether medication should never or always be used, but rather the concern is that the psychiatric profession typically uses antipsychotic medication as the first line of treatment for conditions such as schizophrenia, while ignoring or outsourcing helpful alternatives like cognitive behavioral therapy and other forms of psychotherapy specifically modified for use in such cases.

A further worry is that, all too often, patients are simply not informed of the risks and serious side effects of medications as powerful as those prescribed for schizophrenic patients. If we’re serious about harm reduction, and if we truly value the autonomy of patients and want to promote transparency and honesty as much as possible, we shouldn’t prescribe medications with side effects as serious as those in antipsychotics without informing that patient of the risks.

I can’t give you a general answer about what critics of psychiatry in general tend to think about treatment for schizophrenia, because doing so would require I qualify each and every attribution I make such that I do not misrepresent their views, and those qualifications would simply take far too much time if I want to do justice to them. I can point you in some general directions though. Here’s a paper by Joanna Moncrieff on the topic. You’ll see that her position is shaped by the guiding principle of harm reduction, with a specific emphasis on our lack of data regarding the effects of long-term antipsychotic treatment, which is usually the norm for schizophrenic patients. Note:

In my view antipsychotic drugs can be useful in suppressing psychotic symptoms, and sometimes, when people are beset by these symptoms on a continual basis, life on long-term drug treatment, even with all its drawbacks, might be preferable to life without it. But most people who experience a psychotic breakdown recover. In this situation, antipsychotics are recommended not on the basis that they provide relief from severe symptoms, but because they are said to reduce the risk of relapse.

There are two problems here. First, the studies that provide evidence that antipsychotic treatment reduces relapse are flawed in a number of ways. They do not consist of a comparison between people who are started on long-term treatment and those who are not, but of a comparison between people who are withdrawn from long-term antipsychotics, usually abruptly, and those who continue to take them. Hence these studies are likely to be influenced by the fact that people who stop drug treatment, especially after being on it for some time, are likely to experience withdrawal-related effects, which we know include agitation, insomnia and occasional psychotic symptoms (sometimes known as supersensitivity psychosis). The difference in relapse rates is almost certainly exaggerated in these studies, therefore, especially since relapse is often defined only in terms of a modest deterioration in general condition or symptoms. Moreover the studies rarely last beyond six months, and in fact studies that last longer than a year show an evening up of relapse rates between people on maintenance treatment and those whose antipsychotics are discontinued (3).

Thank you for the thoughtful question. I hope this at least provides a starting point from which to read more on the varied perspectives out there!