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Minimal-medication approaches to treating schizophrenia

  • Tim Calton and Helen Spandler
Summary

UK guidelines for treating people diagnosed with schizophrenia currently emphasise the primacy of antipsychotic medication, with or without psychosocially based interventions as circumstances dictate. We now see increasing calls, most notably from mental health service users, for the provision of ‘whole-person-based’, minimal-medication approaches to treating people with this diagnosis. This article is intended to locate the development of such approaches within the history of modern and pre-modern psychiatry and, in doing so, summarise the available evidence base that underpins their efficacy.

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Corresponding author
Dr Tim Calton, c/o Department of Health Psychology, Division of Psychiatry, A Floor, South Block, Queen's Medical Centre, Nottingham NG7 2UH, UK. Email: tim.calton@btinternet.com
Footnotes
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For commentaries on this article see pp. 218–220 and 221–223, this issue.

Declaration of Interest

T.C. and H.S. are acting trustees of the Soteria Network UK.

Footnotes
References
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Minimal-medication approaches to treating schizophrenia

  • Tim Calton and Helen Spandler
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eLetters

Response to Dr Feeney's commentary

Timothy G Calton, Special Lecturer
24 June 2009

We feel that it is important to provide a response to the commentary by Dr. Feeney on our article and to make our position absolutely clear. Given the many difficulties associated with use of anti-psychotic medication (that Feeney himself readily accepts), we do believethat recovery with minimal or even no medication, where possible, is preferable. However, this does not mean this is a ‘morally superior’ position, nor indeed, as Feeney implies, that those people who take medication are somehow ‘morally inferior’. Far from it. We are fully aware that medication is often necessary, given the context and preferences of the individual. Indeed we have the utmost respect for people who make an informed decision to take medication and refute absolutely the suggestion that we would do otherwise. Dr Feeney should notconfuse a personal view relating to the experience of taking powerful psychotropic medication (‘chemical sanitation’) with a moral imposition ofthese views upon others. Our concern, however, is that people often take medication, not from a position of informed choice, but because of coercion or a lack of alternatives.

We wonder if Dr. Feeney is being rather disingenuous when he claims that he (and the psychiatric profession as a whole) work holistically withpeople’s ‘informed choices’, when he believes that the effectiveness of medication for treating psychosis is ‘beyond dispute’. This ‘holistic approach’ to the treatment of psychosis appears to be predicated upon the presumed necessity of medication. It is hard to see how Feeney and his colleagues do not impose this ‘personal view’ on patients. Therefore, in our mind, this practice does not support the option - and informed choice - of recovery with minimal or no medication. This is because true informed choice is only possible if viable alternatives exist within whichto exercise these choices. The purpose of our paper was to draw attention to the existence of such alternatives. Such recovery without facilities like these (as in the UK at the present time) is only currently possible through luck or the good fortune of having an unusually robust network of support. We - along with large sections of the service user/survivor movement, who have long advocated for non-medical crisis services – do notbelieve this is good enough.
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