I am guessing that, as long as the generally accepted biomedical perspective on voice hearing as a symptom of an underlying illness is predominant, medication is going to be the first "reach for response" in helping to alleviate distress.
And this will be the case for a long time, until we create and present other healing modalities and alternatives to those who struggle with their mental health journey. Then medication can be just one of the tools in the healing toolbox.
And for many people, at least in the short term, the hope that doctors know what is needed to suit any presented situation and have the necessary experience and knowledge around the sensible use of medication, offsets any immediate concerns around long term use and side effects..
For some activists and campaigners, inside and outside the medical professions, there are many questions regarding the efficacy and long term risks of years spent absorbing powerful drugs into the brain and body.
The schizophrenia model, which was shaped by early pioneers like Kraepelin, has been a contentious area for debate for decades and there have been sporadic calls over the years for the label to be scrapped entirely.
But these moments seem to drop away, the medical model reasserts itself and the medical business model reasserts its supremacy, dominating debate and carefully shaping the opinions of medics and the general population.
The strident protests and patient activism of the 1960s and again in the 80s gives way to the the predominant paradigms as the currents of debate and discussion ebb and flow.
For now, and once again, we are generally back in the construct created by the large drug companies, the medical training schools and the guild of doctors who carry out their duties.
So, with that in mind and regardless of your own views on the matter, here are some good questions to ask when medication is offered as a remedy.
1. How effective is this medication?
2. What are the recovery rates?
3. How long do I have to take this for for it to work?
4. What side effects should I look out for?
And finally,
5. How good are you at helping patients get OFF the drug again?
Make your doctor do the work.
It is easy to put people on medication, but how easy is it for an individual to be helped OFF again when the time is right? Once they are in the diagnosis and treatment boat, how long will they have to sail along inside it?
There are some very useful guides for tapering off and eliminating dependency on psychiatric drugs safely and I will include some links here.
Ideally, slow withdrawal strategies should be done in collaboration with medical support teams.
Asking the questions outlined above is a useful exercise. It will focus drug providers on short, medium and long term goals and introduce the concept of non reliance and dependency at a later date, something that, in my twenty years experience working in psychiatric systems, was rarely a matter for consideration.
This is true, especially and understandably, at the first point of contact between a person and "important" health professionals in whom we trust and rely upon to accurately understand our situation and treat our confusing or distressing symptoms.
Where the individual is seeking remedies, advice and support and the medic is under pressure to provide them.
I was present at many "presenting" hospital interviews where doctors had decided on a label of schizophrenia within minutes of meeting the person for the first time.
The danger was obvious to me as a witness, they were time pressured and simply using a "tick box" strategy to determine a diagnosis, missing out on fuller and more thorough readings and narratives regarding the experience of the individual.
And so the rush to judgement.
It is difficult to go back and revise a diagnosis once it is written up in medical notes. Future doctors and nurses will, possibly, read those case notes for explanations and guidance and will accept the earlier decisions made by others in words that, once put down on paper, resonate and have an effect.
My point with all of this?
Getting something as important as a psychiatric diagnosis right is vital.
Empowering people to do their own research on medication is important.
Being informed and able to discuss, debate and present a point of view is liberating for an individual.
Most doctors are open minded and simply wish to help. I saw this many times. I would like them to be confident enough when talking with people to feel comfortable to discuss what they do not know as much as what they do.
And it is here where a problem lies. As a senior psychiatrist in Coventry, England once told me,
"Ah Ivan, but if we did that, we would undermine the confidence that the patient has in our ability.
If we start saying that there are some things we do not know, what then for the trust in our knowledge and expertise, for which we have worked long and hard, making a big investment of money, time and effort, university and medical training and all of that.
And what about our moral authority? Why would patients do what we say and follow our instructions if we indicate that we are NOT fonts of all knowledge relating to psychiatry and medication?
We will slowly do ourselves out of work and render ourselves dispensable. Society might decide that it no longer need us".
So, there we have it. The doctors themselves are imprisoned by their own forms of magical thinking, afraid to acknowledge the imperfections in their system of belief for fear of rendering themselves unnecessary.
I wish it was different. Meantime, everyone must make their own judgements and decisions.
Ideally, mental health teams should work to stabilise a person if the need is an acute one, but I would prefer to see medication as a last resort rather than the first and then, from there, too often the only one.
There are already enough concerns relating to long term use, effects on the body and brain, shortened life spans and the seeming inability of the profession to help people back off these drugs.
But that is where we should be looking and, there are plenty of folk who have struggled and managed to break free of psych-meds and the entanglement with services that this involves.
Here are some interesting links on this subject>
https://willhall.net/comingoffmeds/ offers a guide to harm reduction and safe withdrawal.
You can find Will Hall online and on YouTube and can get free downloads as well as contact him directly.
A very good trainer and consultant who has had the experience of struggling with psych drugs and getting off.
https://withdrawal.theinnercompass.org/page/importance-movement-and-exercise-psychiatric-drug-withdrawal
The consequences and costs of life long dependency on medication need addressing more widely.
For individuals, receiving a schizophrenia diagnosis, with all its attendant negative expectations, has a stifling effect on life chances, expectations and hopes for the future.
Initiating and maintaining emotional and romantic relationships seems so much harder when you may want to disclose that you are being treated for a so called "serious psychotic mental illness.
Employment opportunities may be denied you, side effects may dull your thinking and weight gain make keeping physically fit that much harder.
Socially, the ongoing loss of active and meaningful employment activities carry a fiscal burden to society as a whole and traps a person into potential "victim" roles.
Many attendees at the hearing voices group I facilitated spoke to their imbued sense of shame about being on lifelong state benefits and stuck with stigmatising mental health labels that will not go away.
Finding paid work was just a "pipe dream" for them.
But they had a desire, in many cases, to contribute more fully to society.
Finding life long clients who depend on your products may satisfy shareholders and C.E.Os of the huge pharmaceutical companies, but, in my opinion, satisfies too little by way of enabling full recovery for people.
Many individuals wished to be able to get on with rounded and satisfying lives, lives where they can be free and full participants if the situation and society permitted it.
Below this is an interview with Will Hall, a Scribe document of the harm reduction guide and a talking book version.
Please explore and enjoy, regardless of points of view and beliefs, an open mind is a healthy mind!