I have written above that there are alternatives to using medications to treat psychotic disorders. Medications and placebos do work to some degree, and would be better than not giving anything, so why am I making a fuss?

There are harmful physical effects from the medications, harmful psychological effects from labelling behaviour into illness categories, and harm by limiting the options that are made available to clients.

The Harm

1. Physical Health – education by the government agency I work for revealed that those patients diagnosed with a major psychotic disorder (eg schizophrenia) have a reduced lifespan of approximately 20 years. The reasons would be many and intertwined. The medications would be one factor – medications contribute to obesity, diabetes, heart, kidney and thyroid problems. Such clients tend to smoke more, feel sedated and live a more sedentary lifestyle etc. If therapy can be provided and obviate the need for medications (at least for some), we are a long way forward from where we are.

2. Psychologically there is much harm. Readers will understand the difference between labelling behaviour, and labelling a person. We might notice a person behave in a clever way, and we might generalise and say “s/he is a clever person.”  Generalisations contribute to the formation of that person’s identity (or beliefs about self); in contrast describing or reporting one clever instance is less impactful since it is just one among many.

Being thought of as a clever person (or thinking of oneself in that way) implies it is likely to be frequent and an enduring part of the person’s nature. Since beliefs tend to be self-fulfilling, it encourages more of the behaviour.

If a behaviour is undesirable (eg clumsy) it is kinder to describe a clumsy instance as a behaviour, rather than describe the person as a clumsy person. But with mental health diagnoses, it is so easy for people to form the identity that they are Bipolar or Schizophrenic, which massively shapes their future expectations. There have been suicides where reports from colleagues suggest the persons saw no hope following their diagnosis. The diagnosis is a label, which shapes the person’s identity and thus their beliefs about future potential. Diagnoses can demoralise.

Instead it is helpful if we treat people as having ‘difficulties’ and we then collaborate to find solutions. I recall Michael White (Narrative therapist) say, “We cannot be neutral,” meaning it is not possible to be neutral. If we tell someone they have schizophrenia, we are shaping their mind in a way that is different than saying “the voices” seem troubling. The first is a package of ideas that may shape their identity; the latter is one recurring experience they have mentioned and we can collaborate to find a solution.

If we say, “You need to take medication for the voices,” we are implying a solution is outside their control. If we offer a range of alternatives, we are undermining the paradigm of biological causation and treatment. We are not being neutral, nor is it ever possible. Offering alternatives posits people have capabilities, not limitations. If people have capabilities we can collaborate and build on them. If we view them as limited, we may find ourselves forcing medication onto them via legal orders. If they then comply, have we not already harmed them by communicating a belief they are incapable? This is a belief communicated not just to the patient, but his/her family and the community.

In contrast to this belief, I do recommend watching a British award winning documentary about psychologist, Rufus May. It is a re-enactment and follows him working with a client who hears voices. His approach is unconventional, and would stimulate debate, but it does show his utter belief that the client can manage without antipsychotic medication, which supports the client’s wish. It is available on YouTube in 6 parts (for those with extra time…about 60 minutes.)

3. Parentalism – (It seems to me that “Parentalism” is the modern non-sexist term.)

The biological paradigm is maintained by selecting and promoting certain information to clients and families. Other information which is likely to jeopardise their belief in the paradigm, and their adherence to medication treatment is not highlighted.

For instance, in September 2008 a blog reported Dr Nancy Andreasen’s research findings that antipsychotic medication causes brain shrinkage in patients. Essentially it reports that the larger the dose, and the longer it is taken, the greater the brain shrinkage. I cannot vouch for the veracity of her research. However, I understand she is a psychiatrist and scientist of very high standing.  Among other achievements she served as Editor-in-Chief of the American Journal of Psychiatry for 13 years, a leading journal in the field.

Andreasen said she delayed announcing her findings for 2 years, concerned that patients would not continue on their medications.

Information such as the above is not likely to be shared with patients.  But I would certainly like to know if I was the patient, or a family member. And I would like to know of the alternatives I could consider.


Current day mental health organisations do cause harm, physically and psychologically. If we want to build collaborative relationships with clients, we must be courageous and share our knowledge. With honesty we can find better ways forward.

(Go to essay 8.)