DSM-5 and The Crisis in Psychiatry – Philip Thomas

Now someone with greater clout than myself saying meds aren’t always the answer…


“the importance of the human elements of care in helping people to recover from conditions like depression and schizophrenia.

Phil Thomas 6

We (Bracken et al, 2012) examined twelve meta-analyses of drug treatments and psychotherapy for depression. For drug treatment, differences in outcome between active drug and placebo groups are minimal (Andrews, 2001; Kirsch & Saperstein, 1998; Kirsch et al, 2008).

Similar findings emerge for psychotherapy. Advocates of CBT argue that it is effective because it specifically rectifies faulty cognitions that are believed to cause depression. Several studies have shown that most of these ‘specific’ elements can be dispensed with without adversely affecting outcome (e.g. Jacobson et al, 1996; Longmore & Worrell, 2007). There is overwhelming evidence that non-specific factors such as the quality of the therapeutic alliance have greater influence on outcome than specific therapeutic elements (Wampold, 2001; Castonguay & Beutler, 2005; Stiles et al, 2008).

The same holds for recovery from schizophrenia. At face value most RCTs suggest that neuroleptics are superior to placebo in the short-term management of the condition.

However, as Joanna Moncrieff (2008) points out, most of these studies last only a few weeks, whereas most episodes of schizophrenia last for years. She identified only three studies since 1967 that followed up acutely psychotic patients for a minimum of one year (May et al, 1981; Rappoport et al, 1978; Schooler et al, 1967). All three found that although active treatment groups improved more rapidly than placebo groups in the early weeks, a year later these differences disappeared.

There is growing evidence that people with the diagnosis of schizophrenia, who avoid long-term treatment with neuroleptics, have better outcomes (Bola & Mosher, 2003; Lehtinen et al, 2000). The most recent evidence from Martin Harrow’s long-term follow-up studies of people with the diagnosis in Chicago show that a substantial proportion have better clinical and social outcomes if they remain off neureolptic medication (Harrow et al, 2007) These benefits persist at twenty years (Harrow et al, 2012). This is vitally important given the evidence that the long-term use of neuroleptics raises the risk of cardiovascular disease and diabetes (Casey et al. 2011), and reduces life expectancy (on average 16 years or more, Wildgust et al 2010; Chang et al 2011).”

recovery network: Toronto

phil thomasWe are delighted today to be able to share the text and slides from the talk given by Phil Thomas at  Now We’re all Crazy- What’s Next? on Mon 8th July as part of Mad Pride Toronto 2013.

Phil Thomas sets out how the focus on technology -the technological or scientific paradigm – has both failed to provide evidence that validates and supports the hypotheses and assumptions upon which it is founded. Not surprisingly, it has also also largely failed those who struggle.

He shows how evidence indicates that the technology used by those who would treat us plays a surprisingly small role in healing:  the non-specific factors, as research calls them, like human relationship between the patient and profesional, and circumstances  play a much bigger role. In which case we need to ask ourselves yput all that time and effort and resources into making sure people comply with the…

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2 responses to “DSM-5 and The Crisis in Psychiatry – Philip Thomas

  • recoverynetwork:Toronto

    Hi Samantha Jane, Nice blog
    Glad you liked this piece and thanks for sharing.
    The event rocked the house even though it was the same day Toronto had 4 inches of rain in an hour,
    Phil Thomas rocks.
    Kwame McKenzie, spoke to his Walrus article “Mind Games” which we featured a few weeks ago here at this link…

    He observed – for previous attempts at classifying psychiatric diagnoses it was clear to understand what they were for – one could disagree with the purpose – with DSM and especially DSM 5 it is really difficult to see what DSM purpose is.

    He also suggested [andthis is not in his article] that since – as Phil Thomas pointed out so much of “mental illness” is down to cultural factors, and since Canada is a distinct culture from US that insists on having its own DSM, that Canada could perhaps drop DSM and develop its own system incorporating different perspectives and different approaches healing..you can imagine this was a popular idea with the audience…

    We don’t have a link but our third speaker was Lana Frado, who allways rocks the house…
    Kevin H

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