Psychiatric Drug Withdrawal
A Guide for Prescribers, Therapists, Patients, and Their FamiliesBy
Peter R. Breggin, MD
(according to the copyright page, although purchased in late 2012)
Reviewed by Mira de Vries
Help! How do I get my child/spouse/parent/sibling/self off of psychiatric drugs? This is the question most often asked by people contacting MeTZelf. It is also the question most often asked of psychiatrist and prolific author Peter Breggin. This is his second book attempting to answer it.
The first book is titled Your Drug May Be Your Problem, How and Why to Stop Taking Psychiatric Medications, written with David Cohen and first published in 1999. There seems to have been at least one revised edition. Most of that book is dedicated to the Why, rather than the How, and so is most of this new book. Breggin is careful to not assume that his reader already knows how damaging these drugs always are.
Previously having written extensively about damage to the brain and central nervous system, he now uses the term chronic brain impairment (CBI). There are two kinds, one which may heal after the drug(s) is/are withdrawn, and the other that will never go away. He explains that
if a patient was prescribed an antipsychotic for a year as a 20-year-old and then again for a year as a 40-year-old, there is a risk that this constitutes a 2-year exposure. ... the clinician should be cautious and assume that the earlier damage will be cumulatively increased by renewed exposure to the drug.This concurs with what I have heard at AA meetings, that when a person resumes drinking even after many years of sobriety, he is immediately back to where he left off. In other words, the damage is never completely undone, but nonetheless the quality of life is greatly improved after safe withdrawal, which can take years. Also, Breggin warns, "some patients have worse adverse reactions and withdrawal reactions to a drug the second time around" so someone who successfully quit before must not assume that s/he will be able to repeat that success as easily.
Whereas Your Drug May Be Your Problem was addressed mainly to the person taking the drugs, this book is addressed mainly to the people helping that person.
Doing it on one's own is not safe, Breggin explains, because of medication spellbinding, a term he introduces instead of his older term, anosognosia. This means that people on these drugs are not aware of what is obvious to everyone around them (except the people putting and keeping them on the drugs), namely how adversely affected their personalities and bodies are. Of the five adults whose case histories Breggin relates in the final chapters, two were alerted to their CBI by their wives, two by their general practitioners, and one by a "clinical social worker" for whom it was "an act of courage and honesty ... to put her patient's interests first in the face of possible censure from the authorities at her clinic." None of the five sought withdrawal at his/her own initiative. The effects of withdrawing the drug(s) are likewise a closed book to the person doing the withdrawing. For instance, the person might become dangerously angry without connecting this rage to drug withdrawal.
The framework which Breggin advises is a collaborative team consisting of:
Even in Breggin's country, the United States, one is unlikely to find a prescriber willing to cooperate with drug withdrawal. In our country, the Netherlands, it is out of the question. Psychiatrists are bound to the directives of their profession. Medical protocol prohibits general practitioners and other physicians from interfering in a specialist's treatment plan. We don't have nurse practitioners with prescription privileges (yet), and if we did, they would be bound to the same protocol. Any prescriber who violates these principles risks losing his license to practice and thus his livelihood. Indeed, in 2012 our Minister of Health used public funds to prosecute a general practitioner who had questioned the utility of flu shots. My own family doctor has told me on different occasions that he simply cannot take the risk of violating medical protocols even when this would be best for his patient.
Likewise, in our country one is unlikely to find a therapist willing and able to help a prescriber monitor withdrawal and assist the person and family through the rough times, which is done mainly by knowing what to say. Even if such a therapist existed and could be found, there would probably be no way to pay him/her. Someone on psychiatric drugs has CBI and is usually unemployed, let alone earns enough to pay a therapist. Our government mandated health insurance covers only being on psychiatric drugs, not withdrawing from them, no matter how beneficial to the person to be withdrawn and profitable for the general economy.
Furthermore, a person on psychiatric drugs would be lucky to have family who cares about him/her and has the time, ability, and wish to assist in withdrawal. Psychiatrized people often find that their families are their worst enemies. Breggin expresses it this way:
Withdrawal may be prohibitively hazardous if the patient is isolated and has no social support network. It is also extremely difficult if not impossible to withdraw a patient who remains dependent on parents or caregivers who will not fully and enthusiastically cooperate with ... the withdrawal process.and elsewhere
When the family of a dependent and heavily medicated patient is unwilling or unable to engage in this kind of family therapy, there is little or no possibility of successfully reducing or stopping medication, especially on an outpatient basis.It sure as anything isn't going to happen on an inpatient basis. Intramural psychiatric drug withdrawal in this country is unthinkable.
Breggin repeats throughout the book that for the program to work, the person withdrawing must be personally responsible. He doesn't say anywhere what he means by that, but he does at one point state, "Even otherwise competent professionals or business-persons may give up personal responsibility when they enter the healthcare professional's office." So apparently to him somebody personally responsible is competent. Yet he also refers to people with cognitive disabilities or old-age dementia benefiting from drug withdrawal. Such people are by definition not competent.
Then there are the people who are court ordered, competent or not:
Under ... complicated circumstances, what is needed is family intervention involving a variety of wraparound services ... [which] is not available for helping long-term patients come off their medications. On the contrary, the community is more likely to force the long-term patient to take drugs through involuntary outpatient commitment. In this newly developing field of psychiatric drug reduction and withdrawal, there are severe situations for which there are at present few, if any, adequate solutions.In other words, the people who need it most might as well forget it.
If the world were populated by professionals like Breggin it could be done, but the tragedy is, it isn't. He describes his own talent as follows:
I began with a great gift in my initial efforts to help some of the most despairing and overwhelmed people on earth [at a state mental hospital]. The gift was . . . that I had no mental health training. (his dots)As a footnote about Peter Breggin, I refer the reader to my review of his 1992 publication Toxic Psychiatry in which I wrote: "The absolute nadir ... is Breggin’s contention that autism is caused by parents treating their children like furniture. ... I ... don't know whether he has since publicly rectified his position on autism." He hasn't. In this book he writes
I suspect that the apathy induced by these drugs in some of the mothers after the delivery of their children may have impaired their bonding with their children and contributed to causing autism.Apparently Breggin thinks that humans bond like goose chicks.
Nonetheless he deserves enormous admiration and gratitude for exposing psychiatry for the false, harmful, and cruel doctrine that it is.