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A Look At . . . Coping With Mental Illness
We've Been Misled by the Drug Industry

By Daniel Fisher, M.D., Ph.D.
The Washington Post, Sunday, August 19, 2001; Page B03

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I have recovered from schizophrenia. If that statement surprises you -- if you think schizophrenia is a lifelong brain disease that cannot be escaped -- you have been misled by a cultural misapprehension that needlessly imprisons millions under the label of mental illness.

In the last 20 years, the pharmaceutical industry has become the major force behind the belief that mental illness is a brain disorder and that its victims need to take medications for the rest of their lives. It's a clever sales strategy: If people believe mental illness is purely biological, they will only treat it with a pill.

Drug companies have virtually bought the psychiatric profession. Their profits fund the research, the journals and the departments of psychiatry. Not surprisingly, many researchers have concluded that medication alone is best for the treatment for mental illness. Despite recent convincing research showing the usefulness of psychotherapy in treating schizophrenia, psychiatric trainees are still told "you can't talk to a disease." This is why psychiatrists today spend more time prescribing drugs than getting to know the people taking them.

I, too, used to believe in the biological model of mental illness. Thirty-one years ago, as a Ph.D biochemist with the National Institute of Mental Health, I researched and wrote papers on neurotransmitters such as serotonin and dopamine. Then I was diagnosed with schizophrenia -- and my experience taught me that our feelings and dreams cannot be analyzed under a microscope.

Despite what many people assume when they hear about my recovery, that original diagnosis was no mistake: It was confirmed by a board of six Navy psychiatrists after my four-month inpatient stay at Bethesda Naval Hospital. I was devastated by being branded a schizophrenic. My life seemed over. Six years later, however, I had defied everyone's expectations and recovered. The most important elements in my recovery were a therapist who believed in me, the support of my family, steadfast friends and meaningful work. And I had a new goal: I wanted to become a psychiatrist. My therapist validated that dream, saying, "I will go to your graduation." (When I received my degree from George Washington University Medical School in 1976, he was there.) Drugs were a tool I used during crises, but I have been completely off medication for 25 years.

I am not an anomaly. Thousands of others have recovered, but are afraid to disclose their past due to the stigma of mental illness. The definitive Vermont Longitudinal Study, led by Courtenay Harding, followed 269 patients diagnosed in the late 1950s with severe schizophrenia. Three decades later, Harding found that two-thirds of them were living and functioning independently; and of those, half were completely recovered and medication-free.

The Swiss psychiatrist Manfred Bleuler -- whose father, Eugen, coined the term schizophrenia in1908 -- obtained similar results. His father had mistakenly concluded that people did not recover from schizophrenia -- because he rarely saw his patients after discharge. Our own research at the National Empowerment Center (NEC), funded by the federal Center for Mental Health Services, shows that the most important factor in recovery from mental illness is people who believe in patients and give them hope: Medications are a less important factor.

But that is not how psychiatrists are being taught; recently I was reminded of how tightly training is controlled. I contacted a colleague at a major West Coast medical school to see if he could get me an invitation to conduct one of their teaching rounds. He apologetically told me that he couldn't: Since he had published a critique of the biological model of mental illness, demonstrating that people could recover from schizophrenia without medication, he himself was no longer allowed to speak to the residents in training -- even though he was on the faculty.

The pharmaceutical industry also controls the public's education. Who can avoid the TV image of the phobic man who needs Paxil to socialize? Industry-funded research and experts have a huge impact on media coverage. Finally, the drug companies have taken advantage of well-intentioned advocacy groups who support the biological model of mental illness -- and they give those groups much-needed financial support.

Schizophrenia is more often due to a loss of dreams than a loss of dopamine. At the NEC, we try to reach out across the chasm of chaos. I know there are many people who feel they have done all they can, have struggled against mental illness to no avail, and we understand their pain. Yet we believe that recovery is eventually possible for everyone -- although it can take a long time to undo the negative messages of past treatments. We can offer hope from first-hand experience.

Addressing the needs of people with mental illness will require a large-scale retraining of mental health workers, decision-makers, families and the public. There will need to be more research into the ways that people recover. There will need to be more jobs, housing, peer support and self-help, for these are the pathways to self-determination and independence. And there needs to be a cultural shift toward people rather than pills to alleviate this form of human suffering.

Daniel Fisher is co-director of the National Empowerment Center, a nonprofit organization run by people who have recovered from mental illness that seeks to help others recover.

2001 The Washington Post Company