Robert Whitaker

JuliusCaesar

anyone going to see Robert Whitaker, who is doing a little tour of Ireland?

Here's an abstract from one of his works:

Although the standard of care in developed countries is to maintain schizophrenia patients on neuroleptics, this practice is not supported by the 50-year research record for the drugs. A critical review reveals that this paradigm of care worsens long-term outcomes, at least in the aggregate, and that 40% or more of all schizophrenia patients would fare better if they were not so medicated. Evidence-based care would require the selective use of antipsychotics, based on two principles: (a) no immediate neuroleptisation of first-episode patients; (b) every patient stabilized on neuroleptics should be given an opportunity to gradually withdraw from them. This model would dramatically increase recovery rates and decrease the percentage of patients who become chronically ill.

Should be of interest.

hotspur

Wish I could make the Dublin one. Though I suppose any of these videos of him will contain the same info:
http://www.google.ie/search?client=firefox-a&rls=org.mozilla%3Aen-US%3Aofficial&channel=s&hl=en&source=hp&biw=1280&bih=606&q=Robert+Whitaker&btnG=Google+Search#q=Robert+Whitaker&hl=en&client=firefox-a&hs=J0z&rls=org.mozilla:en-US:official&channel=s&biw=1280&bih=606&tbs=vid:1,dur:l&prmd=ivnso&source=lnt&sa=X&ei=OsRnTaebH9OzhAfBm6GfDw&ved=0CAwQpwUoAw&fp=13293ef39de36c03

Speaking of talks, Barbara Dowds is doing an interesting looking lecture on neuroscience in psychotherapy next month. I find the areas of interpersonal neurobiology and the intersection of neuroscience and psychotherapy fascinating. Here's a link:
http://courses.pcicollege.ie/CPD_Lecture_Neuroscience_for_Psychotherapists/151/

nesf

Out of curiosity Julius, what does he argue on the relapse side of things? From what I've read (which hasn't been extensive) monotreatment not involving medication results in higher relapse rates for schizophrenics.

Other question/point: can one actually look at medication of schizophrenics over the past 50 years as a single bloc? I mean modern drugs are very different to those from the 50s and 60s with kinder side effect profiles, better results on negative symptoms and cognitive symptoms etc.

Final question: Surely he's only talking about maintenance treatment here? Or is he actually arguing you can treat acute psychotic episodes with talking therapies? I mean from personal experience, I was no where near lucid enough or insightful enough the last time I had a psychotic break to get any benefit from psychological therapies.

JuliusCaesar

This is his page on his latest book. There's a sidebar with all the studies on antipsychotics, antidepressants etc. The last one is I think called "Solutions" which details studies promoting psychosocial treatments which seem to show shorter episodes of first-time psychosis with less relapse and better recovery rates. IIRC, two-thirds of people got on well with this approach. (Still leaves a third who required medication.)

It's not my field, but Chlorpromazine (Thorazine) was the antipsychotic; I know that there are some different ones now -Risperdal?- but this is still used under its various tradenames.

I thought he was very balanced. He certainly wasn't anti-medication, he was just challenging the orthodoxy that medication is necessary in all cases and that medication is a boon and a necessity, and he backed his assertions with some rigorous studies, which may not have received the attention they deserved.

nesf

Read the initial chapters of the book. His methodology and use of proxies for things make me cringe a bit to be honest. Too many years studying stats etc have left me very wary about drawing conclusions like he did at the start (though the book may get better going into it).

His argument went like this: More Disability cheques = More schizophrenic patients = An increasing epidemic of schizophrenia. This is a really shaky argument to be honest. So, so many factors involved here to make this just wrong and he didn't seem to consider the possibility that the initial number of cheques might be an underestimate of the level of illness in the 1950s and other things like this. Him not being a scientist and not having the critical nature of a scientist (i.e. suggest a theory, and then do everything you can to prove it wrong before even considering that it might be true etc) really stands out in the beginning of the book.

Valmont

[QUOTE=nesf;71148454More Disability cheques = More schizophrenic patients = An increasing epidemic of schizophrenia. This is a really shaky argument to be honest. [/QUOTE]
Do you (or the author) mean as in a disability payment of some sort?

nesf

Valmont wrote: »

Do you (or the author) mean as in a disability payment of some sort?

He does.

JuliusCaesar

I think he was using levels of disability as a method of counting people - in fact because numbers are hard to come by, I did the same myself here about ten years ago. At that time there were more people on Disability due to mental illness, than there were unemployed.

In fact it's because the definition/diagnosis of schizophrenia has changed over time, and hence figures are hard to come by, that he used this way of collecting figures.

Anyway, I referred you to the original studies in the sidebar of his website. He is a journalist, not a psychologist or psychiatrist. He did an investigation which was really worthwhile, as it challenged the orthodoxy of ideas - and we often need an outsider to challenge what seem to us to be self-evident truths.

nesf, are you calling psychosocial interventions "monotreatment"?

and lastly, nobody is calling for talking therapy in the acute stages of psychosis. Although in CBT for psychosis, we do talk with people who are actively delusional or paranoid. And we talk about the subject of their delusion.

nesf

JuliusCaesar wrote: »

nesf, are you calling psychosocial interventions "monotreatment"?

No, just the use of only psychosocial intervention or psychiatric drugs monotherapy. From what I've read, a combination of the two works better than either alone but also, drug therapy on its own seems to have better outcomes than psychosocial intervention on its own. Though I have not read extensively in this area.

JuliusCaesar wrote: »

and lastly, nobody is calling for talking therapy in the acute stages of psychosis. Although in CBT for psychosis, we do talk with people who are actively delusional or paranoid. And we talk about the subject of their delusion.

Some unfortunately do argue for just non-drug therapy even in acute stages of illness and this is what makes me nervous about where I see psychosocial (or any other) interventions lauded without reference to them being as part of a combination of therapies. I have read good things about CBT and Personal Therapy (no idea if that's the official term) and schizophrenia, so I'm not against psychosocial intervention for schizophrenia, just against completely non-drug approaches unless they are backed up by a sizeable amount of evidence.




I agree with the whole problem of counting but that in itself should make someone extremely wary of using very positive language about any conclusions. I suppose my problem with his book so far is that he's just not trained to think scientifically and sceptically enough about these things and is presenting conclusions in language that is far too strong for the underlying evidence/method of analysis. Doesn't mean his work is not valuable but I dislike what he's doing because someone who is naive about the area could be easily mislead about the strength of his conclusions from the language he uses.