GUEST COLUMN: Do psychotropic medications increase disability rates in Canada?

Wednesday, October 30, 2013 - 23:36

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By Rosemary Barnes and Susan Schellenberg

Advances in medicine are intended to improve life for the ill or injured. So, have advances in medicine improved life for those with mental illness? American journalist and author Robert Whitaker asks this question in relation to psychotropic medication, first introduced in the 1950s and generally described as a significant advance in care of those with mental illness. 

Consider the experiences of Susan Schellenberg, co-author of this article and of the book Committed to the Sane Asylum. A former public health nurse, Susan experienced a psychotic break in 1969 and understood that she was diagnosed with schizophrenia. By 1969, antipsychotic medication was the widely accepted treatment for schizophrenia, and doctors prescribed this treatment for her.

Susan wanted to be a good mother to her young children, so she took antipsychotic medication as directed for the next 10 years. During this time, she was offered no other treatment and developed increasingly severe speech difficulties and tremors that she came to understand to be adverse effects of the medication. After committing to a better life for herself, Susan found a doctor willing to help her to discontinue psychotropic medication and took up various healing activities. By the early 1980s, she was no longer taking medication and was feeling much better. She then tried to return to nursing, but was only able to achieve a mark of 11 per cent in a nursing refresher course. Could Susan’s experience point to a more general problem?  

Citing research from well-known professional journals and highly respected professional authorities, Whitaker argues yes. Using US records for psychiatric hospital admissions and numbers of people receiving disability payments for mental health reasons, he notes that the rates of people disabled by mental illness has increased over the past 50 years—a period during which psychotropic medications have been increasingly prescribed for mental illness.

Whitaker carefully considers the scientific evidence to determine whether psychotropic medications have contributed to increasing levels of disability due to mental illness. For psychosis, as in Susan’s case, antipsychotics do initially alleviate symptoms for patients. Studies with follow-up times of six months or less provide the widely cited scientific evidence for the effectiveness of such treatment. However, after two to five years, individuals who do not take antipsychotic medication are less symptomatic and better functioning than those who do take medication. Although only a few studies investigate such longer-term outcomes, their findings consistently indicate that poorer outcomes are associated with use of antipsychotic medications. As well, World Health Organizations (WHO) studies show that recovery rates for schizophrenia are higher in less developed countries where psychiatric services and psychotropic medication are less available.

Whitaker provides a detailed summary of scientific evidence demonstrating that the brain changes structurally during sustained exposure to psychotropic medication. In the case of psychotic conditions such as Susan’s, the structural brain changes associated with taking antipsychotic medication for an extended period are also associated, unfortunately, with increased risk for recurrence of psychotic symptoms. If one discontinues antipsychotic medication after an extended period, the persistence of structural brain changes means that the risk for recurrence of psychotic symptoms becomes particularly acute.

In short, research on both brain structure and clinical outcomes produces findings that upend conventional wisdom regarding treatment for psychotic reactions. The findings suggest that widespread, long-term use of antipsychotic medication may indeed contribute to the rise in rates of people disabled by psychotic conditions.

Whitaker investigates medication in the treatment of other mental health problems such as depression, anxiety, bipolar disorders, attention deficit/hyperactivity disorders. In each category, he finds a similar pattern of evidence: better short-term outcomes, but poorer long-term outcomes for those treated with psychotropic medications. He summarizes evidence showing how the brain changes structurally when exposed to psychotropic medications for extended periods. Whitaker also addresses the widely accepted belief that mental illnesses must be treated with medication because such illnesses are caused by a biochemical imbalance. After reviewing years of scientific investigation, he concludes that there is simply no evidence that this is the case. He cites leading authorities who confirm that extensive research has failed to show biochemical imbalances exist or are related to mental illness.

Why do we not hear more about these important findings? The answer is a fascinating story of professional and commercial interests converging and colluding to limit both public and professional awareness of the problematic long-term effects of psychotropic medications. Whitaker tells this story in Mad in America (2010) and Anatomy of an Epidemic (2010). 

Are brains in Canada different from brains in the US? Not likely. Recent reports indicate that Canadians are among the world’s largest users of psychotropic medications; women have long been prescribed such medications far more often than men. So, Whitaker’s conclusions point to the need to look carefully at rates of disability related to mental illness in Canada and the relationship of these figures to medication treatment. Even if medication use contributes only in part to diminished function and higher rates of disability related to mental illness, these poor outcomes are enormously painful for the individuals affected and enormously expensive for the insurance companies and governments who fund medication and disability costs. These outcomes are also potentially avoidable through more restrained and judicious use of psychotropic medication.

Susan never returned to work as a nurse, and instead committed to wellness and devoted herself to learning how to heal. She kept a written and painted record of her dreams, began visualization, yoga, and tai chi practices, saw a naturopath for help with diet and life style, engaged in shiatsu dream and psychodrama therapies, and learned a method of dream interpretation that she found very helpful. When unable to determine where Susan might fit in the work world, a kindly YWCA career counsellor advised her, “Say ‘Yes’ to every opportunity.”  Susan found that the more often she said “Yes,” the more her inner psychic strength and outer sense of self grew.    

Without conscious planning, Susan adopted a recovery approach of the kind that has been long favoured by many non-medical professionals (See list of resources at the end of the article). The tasks of recovery include renewing hope and commitment, redefining self, incorporating illness, being involved in meaningful activities, overcoming stigma, assuming control, becoming empowered, exercising citizenship, managing symptoms and being supported by others. Susan’s experiences illustrate a few of the many activities and professional services that can be helpful to an individual who has experienced emotional disturbance and is focusing on recovery. The recovery approach requires mental health professionals to adopt an expanded vision of the nature and purpose of care, of what is considered possible for an individual with emotional disturbance and of the individual’s own role in pursuing those possibilities. This expanded vision emphasizes the individual reclaiming a life in the community rather than waiting to find a treatment that eliminates symptoms. The recovery approach was chosen as a central focus for national mental health strategy by the Mental Health Commission of Canada.

Organizations such as the Hearing Voices Network, Sistering in Toronto and the Canadian Mental Health Association encourage recovery through groups meeting in the community to provide peer support, family support, and education that includes people with lived experience as well as community members. Whitaker explains how the Open Dialogue approach developed in Finland has been successful in encouraging recovery in individuals and families living with psychosis or schizophrenia. A video and professional articles on Open Dialogue can be accessed through the MindFreedom website.

Using a recovery approach, Susan became, in time, an artist and writer, a process described more fully in Committed to the Sane Asylum. Importantly, Susan’s experience of recovery from serious mental illness is not unique: There is much evidence of the good outcomes that result from recovery approaches. The problems with psychoactive medication use that Whitaker explains, together with Susan’s story and those of the many others committed to wellness and recovery indicate that we can do more to reduce disability related to mental illness in Canada.

Psychologist Dr. Rosemary Barnes has worked at Toronto General and Women’s College Hospitals and been affiliated with the University of Toronto, York University and the Ontario Institute for Studies in Education. She has published on suicide, HIV conditions, residential schools, approaches to mental wellness, and forensic assessment. She has provided expert opinion in legal cases relating to lesbian/gay issues and trauma, and is currently in independent practice.

Artist and writer Susan Schellenberg began her career as a public nurse. In 1980, Susan committed to healing from a 1969 psychosis and ten years of antipsychotic drugs and to keeping an art and written record of her dreams and inner journey as her mind healed. She co-authored Committed to the Sane Asylum: Narratives on Mental Wellness and Healing, a 2009 finalist in Foreword Magazine’s, Book of the Year Awards, psychology category. Her Shedding Skins dream art and text is on permanent exhibit in the main lobby at the Centre for Addiction and Mental Health, Toronto and can also be viewed online: www.susanschellenberg.com 

Additional resources:

Davidson, L., O’Connell, M., Tondora, J., Styron, T., & Kangas, K. (2006) The top ten concerns about recovery encountered in mental health system transformation.

Farkas, M. (2013). Introduction to psychiatric/psychosocial rehabilitation (PSR): History and foundations. Current Psychiatry Reviews, 9, 177-187. Retrieved on October 24, 2013 at

Schellenberg, S., Barnes, R. (2009) Committed to the Sane Asylum: Narratives on Mental Wellness and Healing. Waterloo, Ontario: Wilfrid Laurier University Press.

Weekes, J., Rehm, J. & Mugford, R. (2007) Prescription drug abuse FAQs.

Whitaker, R. (2010) Anatomy of an Epidemic. New York: Broadway Paperbacks.

Whitaker, R. (2010) Mad in America, revised. New York: Basic Books.