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New Guide: A Sane Approach to Psychiatric Drugs

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Millions of people believe that psychiatric medications have saved their lives, while millions of others report that their psychiatric medications were unhelpful or made things worse. All this can result in mutual disrespect for different choices. I can think of no better antidote for this polarization than the recently revised, second edition Harm Reduction Guide to Coming Off Psychiatric Drugs. This 52-page guide, published by the Icarus Project and Freedom Center, is now available free online in English as well as in Spanish, German, and Greek.

Harm reduction is pragmatic and recognizes that there is no single solution for every person. Instead, as the guide states, "Harm reduction accepts where people are at and educates them to make informed choices and calculated trade-offs that reduce risk and increase wellness." Harm reduction is about providing information, options, resources and support so that people can make choices that fit their situation and who they are.

I wish the Harm Reduction Guide to Coming Off Psychiatric Drugs had been in existence for my entire career as a clinical psychologist. It would have been especially helpful for one particular couple whom I saw several years ago for marital counseling. Cathy and Jim (not their real names) met during their psychiatric hospitalization, both having been diagnosed with serious psychiatric illnesses. After their hospitalization, they dated, moved in together, and married.

Cathy told me, "Jim is an intellectual, smarter than anyone I have ever met in my life," to which Jim blushed and responded, "Bruce, sometimes it's good to have a wife who is a little delusional." Jim then told me that "Cathy is the most beautiful woman in the world," to which Cathy laughed and said, "Sometimes I worry that Jim is hallucinating about another woman."

After a year of marriage, their marital bliss began to erode over the issue of psychiatric medications. One day, Jim quit taking his antipsychotic Zyprexa. Cathy, who continued to take her antipsychotic Risperdal, was worried that Jim, without Zyprexa, would become agitated, do something "crazy," and would be forced to return to the hospital. Jim said, "Even if Cathy is right that I am increasing my chances of going nuts again -- and I don't know that she is right here -- the reality is that with Zyprexa I can't take a decent crap and I can't concentrate when I read, and books -- besides Cathy -- are the most important thing in the world to me." And then Jim added that he was worried about the short-term and long-term adverse effects of Risperdal on Cathy, and that he wished she would stop taking it.

Ultimately, and quite beautifully, both Cathy and Jim came to see that risk in life was unavoidable, and they learned to respect each other's choices and risks with respect to psychiatric medications. Both would have appreciated the Harm Reduction Guide to Coming Off Psychiatric Drugs, which is all about informed choice that allows one to take the risks that make most sense given one's situation.

Will Hall, the primary author of the guide, is a former psychiatric patient and is passionate about informed choice when it comes to psychiatric medications. Hall, no anti-drug ideologue, begins by pointing out that in U.S. society there are confusing messages about drugs, and this results in a great deal of fear:

Drugs become demons or angels. We need to stay on them at all costs, or get off them at all costs. We look only at the risks, or we're too frightened to look at the risks at all. There is no compromise: It's black and white, all or nothing. It's easy to fall into absolutist thinking when it comes to psychiatric drugs. Pro-drug advocates focus on the risks of extreme emotional states, while anti-drug advocates focus on the risks of taking drugs. But it is the belief of this guide, and the philosophy of our pro-choice work at the Freedom Center and the Icarus Project, that either-or thinking around drugs is a big part of the problem.

Hall's serious emotional suffering included "multiple suicide attempts, hearing persecutory voices, extreme mistrust, bizarre experiences, hiding alone in my apartment, unable to take care of myself." The psychotherapy that he received hadn't worked, and no one provided him with any other options besides medication. Hall writes, "I was under pressure to see my problems as 'biologi¬cally based' and 'needing' medication, instead of looking at medication as one option among many."

After spending a great deal of time in hospitals, residential facilities, and homeless shelters (where he lived for nearly a year), Hall began to believe that so-called "expert authorities" had failed him and started his own investigating, "I started judging my options more carefully." That process led Hall to co-found, along with Oryx Cohen, the Freedom Center, a support community in western Massachusetts that brings together people asking similar questions. From all of this came the Harm Reduction Guide to Coming Off Psychiatric Drugs.

For Hall:

This is a guide I wish I had when I was taking psychiatric drugs. Prozac helped me for a while, then made me manic and suicidal. I was sick for days after coming off Zoloft, with counselors telling me I was faking it. Nurses who drew blood samples for my lithium levels never explained it was to check for drug toxicity, and I was told the Navane and other antipsychotics I took to calm my wild mental states were necessary because of faulty brain chemistry.

Hall used many different psychiatric drugs over several years, but he tells us, Tthe medical professionals who prescribed them never made me feel empowered or informed. They didn't explain how the drugs work, honestly discuss the risks involved, offer alternatives, or help me withdraw when I wanted to stop taking them." Hall wrote this guide because, "Information I needed was missing, incomplete, or inaccurate."

"Making harm reduction decisions," says Hall, "means looking honestly at all sides of the equation: how drugs might help a life that feels out of control, how risky those same drugs might be, and the role of options and alternatives. Any decisions involve a process of experimentation and learning, including learning from your own mistakes and changing your goals along the way."

Below are titles of several of the short chapters offered in the Harm Reduction Guide to Coming Off Psychiatric Drugs:
  • Why Do People Find Psychiatric Drugs Helpful?
  • How Do Psychiatric Drugs Work?
  • Do Psychiatric Drugs Correct Your Chemistry?
  • Who's to Blame? Yourself? Your Biology? Neither?
  • How Do Psychiatric Drugs Affect the Brain?
  • Facts You May Not Know About Psychiatric Drugs
  • Health Risks of Psychiatric Drugs
  • How Withdrawal Affects Your Brain and Body
  • Why Do People Want to Stop Using Psychiatric Drugs?
  • How Difficult Is Coming Off Psychiatric Drugs?
  • Staying On Medications and Harm Reduction
  • Intermittent Use: Taking Psychiatric Drugs From Time to Time
  • What are the Alternatives to Using Psychiatric Drugs?
  • Coming Off: Step by Step

In the sometimes silly, routinely hypocritical, and often disrespectful psychiatric drug debate, the Harm Reduction Guide to Coming Off Psychiatric Drugs is an oasis of wisdom and compassion. And the fact that Will Hall, the Icarus Project, and Freedom Center are providing the guide free is an antidote to cynicism -- yes, there are some people who are actually more passionate about helping emotional sufferers than making a buck off of them.

Bruce E. Levine, a practicing clinical psychologist, writes and speaks about how society, culture, politics and psychology intersect. His latest book is Get Up, Stand Up: Uniting Populists, Energizing the Defeated, and Battling the Corporate Elite. His Web site is www.brucelevine.net.

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