Ten years ago Robert Whitaker lambasted psychiatry in a best seller of the year, “Mad in America”. He reviewed a history of chaining lunatics, lobotomies, sterilisation and the Nazi solution of eugenics. He brought the sorry tale to its culmination in the current “story fashioned by drug companies” (p.158), which leads psychiatrists to find “the image of their own expectations”. They see non-existent benefits that the drug companies tell them their products will achieve. Even worse, what the drugs do achieve becomes the standard of reality for them. Now the image of schizophrenia has become the patient drugged to the eyeballs with neuroleptics.

Despite the wide acclaim of his polemic, his message seems to have fallen on deaf ears. Perhaps that is why he tried again two years ago (see “Anatomy of an Epidemic”), but still without awakening enough widespread indignation to reform organised psychiatry. Or perhaps it is working very slowly. Since 2002 organised psychiatry has tried to restrict the influence of Big Pharma (see “Pill Pushing”) on the prescribing habits of psychiatrists. So far its efforts have proven sadly ineffective. Psychiatrists continue to prescribe very high dosages of the latest and most expensive psychotropic drugs, not just singly but in the toxic combinations of polypharmacy (see “Pill Pushing”). Very few exercise the precautions needed for drugs that have a long-term harmful influence.

Whitaker documented a more insidious menace. He reviewed the success of Soteria houses, small residential treatment units which concentrate on sociotherapy and use a minimum of drugs for as short an interval as possible. Many years of experience establish that Soteria achieves better results than conventional therapy for appreciably less cost. An obvious threat to the profits of Big Pharma, they were disbanded in the USA by the same government agency that created them. For justification it used the arguments of a few critics, disregarding the evidence of benefit. Fortunately, all is not lost. Soteria continues to spread in Europe, where psychiatrists have prescribed drugs more cautiously. The evidence that giving the least possible medication brings about better long-term results steadily accumulates (see JAMA Psychiatry).