In general, the orthodox ‘disease-centred’ view is that psychiatric medications reverse or partially reverse an underlying biological ‘abnormality’. The existing evidence for this has been questioned. It is suggested that, in the absence of clear evidence for targeted actions by psychiatric medications on specific pathologies, an alternative, ‘drug-centred’ model is more valid and useful.
A drug-centred model views drugs as producing characteristic altered states, which vary according to the pharmacological properties of the drug concerned. These effects can alter, suppress or obscure the manifestations of mental health difficulties, and may be experienced as useful for some people with these problems. Within this model, there still remains a role for the careful and judicious prescribing of certain psychiatric drugs in some situations involving mental distress and disturbance.
However, the drug-centred model does entail a different relationship between person and prescriber. Rather than centring the discussion on what intervention is deemed appropriate for a specific diagnosis, people using services and their networks can ask and debate with their doctor about what sort of drug-induced effects might or might not be useful in their specific situation. They can explore by themselves and with others what the benefits of a drug-induced state would be and what negative consequences are likely to flow from that state.
People who are already taking psychiatric drugs might want to reflect on what drug-induced effects they are experiencing, and how these effects might be affecting their lives. They will want to balance any positive effects they feel they obtain against the negative or unpleasant effects and the evidence for long-term harm. People who want to stop their medication, either because they are stable, or because they feel it has not helped, will need information about the nature of the drug they are on before they can decide the best method for coming off it.
The drug-centred model makes the service user the expert in their own drug management. It is up to them to decide whether they find certain effects useful or not (unless drugs are being prescribed against the patient’s wishes for purposes of social control). The model highlights how taking psychiatric drugs is always a delicate balancing act between benefits and harm. The useful effects that drugs have are part and parcel of a drug-induced state, a state of intoxication that is not the same as the ordinary state of the body and mind. Taking psychoactive drugs is likely to impair and suppress aspects of our mental and emotional functioning to a greater or lesser degree. If so, the question is whether that impairment is preferable to the distress that is being experienced.
Although many people are advised to take psychiatric drugs for long periods after their problems have subsided, the evidence for the benefits of long-term treatment is limited and harmful effects accumulate with long-term use. Therefore, deciding to stop taking prescribed drugs long-term can be a logical decision in many situations, and it is important that professionals provide support to people to do this as safely as possible.
Much of the material in this section is a condensed and updated version of material contained in A Straight Talking Introduction to Psychiatric Drugs by Joanna Moncrieff, published by PCCS Books, and used with the publisher’s kind permission.