After examining two long-term studies on schizophrenia and psychoses, Insel came to what was previously considered a radical conclusion: in the long-term, some individuals with a history of psychosis do better off medication.
Insel finally recognized what mental health treatment reform activists and investigative reporter Robert Whitaker have been talking about for years–the research shows that American psychiatry’s standard treatment protocol has hurt many people who could have been helped by a more selective and limited use of drugs, and a more diverse approach such as the one used in Finland, which has produced the best long-term outcomes in the developed world.
Like many treatment reform activists and Whitaker, Insel does not completely reject the use of medications, but instead called for a more judicious use of them. Insel concluded:
Antipsychotic medication, which seemed so important in the early phase of psychosis, appeared to worsen prospects for recovery over the long-term….
It appears that what we currently call “schizophrenia” may comprise disorders with quite different trajectories. For some people, remaining on medication long-term might impede a full return to wellness. For others, discontinuing medication can be disastrous.
What is amazing about this recent conclusion by the NIMH director is that it means less money for drug companies, which in the past, have heavily influenced psychiatric treatment through their financial clout. Big Pharma has profited enormously from the current standard treatment protocol that calls for lifetime antipsychotic medication after a single psychotic episode. Because of this treatment protocol and the increasing use of antipsychotic drugs for nonpsychotic conditions, antipsychotics grossed over $18 billion a year in the United States by 2011. The antipsychotic Abilify became the highest grossing of all drugs in the first quarter of 2013, and it is on track to gross $6 billion this year (entire corporations that only grossed approximately $5 billion last year include Facebook and Yahoo).
How Did This Activist Victory Happen?
For several decades, a small group of mental health treatment reform activists, comprised of dissident mental health professionals and “psychiatric survivors” (who themselves had received nonproductive and counterproductive treatments) have been engaged in an uphill battle for truly informed choice, including multiple options which reflect the diversity of the population diagnosed with schizophrenia and other psychoses.
Dissident psychologists, psychiatrists and other mental health professionals at the International Society for Ethical Psychology and Psychiatry, patient and ex-patient activists at MindFreedom International, and patients’ rights advocates at National Association for Rights, Protection and Advocacy have not received attention from the mental health establishment or from most of the mainstream media. But they aroused the curiosity of investigative reporter Robert Whitaker.
In 1998, Whitaker co-wrote a series on psychiatric research for the Boston Globe that was a finalist for the Pulitzer Prize for Public Service. The more Whitaker dug, the more he uncovered glaring problems in standard psychiatric treatment. He found a dramatic rise in U.S. mental illness disability rates; research revealing the failure of standard psychiatric treatment protocols; World Health Organization findings that schizophrenia outcomes are much better in India and Nigeria than in the United States; WHO findings of an association between good outcomes and not remaining continuously on psychiatric drugs; and treatment options that were far more effective than American psychiatry’s standard of care. His book Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill was published in 2001.