A rant on the poor medical practice, bad understanding of evidence and the problem of psychiatrists treating psychosis

There is a problem that most psychiatrists have never had any
experience of psychosis. All they know about it is what they read. They
spend their first years training in physical medicine too so end up too
biomedical.

Psychosis can only be understood from the inside. A library of books is
nothing compared to lived experience.

The stuff that people like Rufus, Intervoice and the HVN are doing is
essential to help people get better. Psychiatry thinks drugs are a first
resort but they really should be the last. People should be able to get
help to learn to self-manage. It's what I've had to do.

I went through psychosis untreated and managed to hold down a part time
job while I thought people could read my thoughts and all sorts of other
possible hallucinations. I was self-harming and parasuiicdal. I didn't
want medication so had to stay away from the NHS who would have
sectioned me and forced medication on me.. I sucked myself in to a
withdrawn state so I could keep working even while the computer 'talked'
to me. Luckily I was in the right environment so when I did have a blow
out and swore at someone and accused her of knowing my thoughts I didn't
lose my job.

Now I survive and I'm trying to thrive. It's possible but psychiatrists
don't seem to believe it is possible. They talk about recovery in their
Fair Deal manifesto but I don't think they really understand what's
necessary to achieve that.

The most extraordinary thing is NICE only recommended CBT for
schizophrenia (and arts therapy and family therapy) in 2009. They
recommended against social skills training, supportive psychotherapy and
counselling. They didn't recommend support groups. And the NHS still
aren't providing CBT - only 50% of people with sz have received it.
They're meant to be the top scientists on this but they produce poor
clinical guidelines. Compare it to the depression guidelines which are
significantly better. I know depression's bad but it's a lot better than
psychosis. People with sz have a completed suicide lifetime prevalence
between 5 and 10%.

We have a ridiculous situation in the UK where people with psychotic
disorders are excluded from treatment from the £173 million a year
Improved Access to Psychological Therapies program. So people with
common mental disorders can get treatment easily but those with real
psychiatric 'illnesses' that can tear apart a person's life just get
drugged up.

The drugs themselves are dangerous and don't actually treat psychosis.
It's one of the great lies of antipsychotic medication. They're major
tranquillisers. They're designed to chill people out without putting
them to sleep. Even the most dangerous drug clozapine, a drug so
dangerous it was voluntarily withdrawn by the manufacturers but the
psychiatrists got it relicensed, doesn't reduce the delusions in
everyone like an antipsychotic should (and some people do want to be rid
of the experience). The effect of diminishing the supposed
hallucinations and delusions may be achieved primarily through the
placebo effect.

The measures they use in studies, like PANSS, are designed to be
sensitive to medication. It's not surprising therapy doesn't do well on
measures that are designed to be medication sensitive. I bet that if
they looked at GHQ or PHQ scores rather than PANSS scores they might
find many therapies do work to help people's distress. They may also
find that support groups are effective too.