New PsychOdyssey OpEd: Response to “Definition of Insanity”

Wall Street JournalOn Tuesday, April 1, The Wall Street Journal published an editorial criticizing the Substance Abuse and Mental Health Services Administration. (To view a copy of the editorial, click here.) PsychoOdyssey’s Tom Pyle wrote the following letter in response:

As father of a son with schizophrenia, I found the Journal’s editorial about SAMHSA partly right. Yes, SAMHSA is a bloated bureaucracy not primarily addressing serious mental illness. Yes, SAMHSA supports some aspects of the consumer/survivor movement. Yes, SAMHSA sometimes seems hostile to traditional psychiatrists like Dr. Torrey who espouse medications first and foremost.

But, no, not all roads to recovery run exclusively through heavy anti-psychotic medication and hospitalization. Solid science increasingly shows that heavy anti-psychotic use over long periods may retard recovery 1, cause extreme weight gain2, induce metabolic syndrome 3-5, or cause brain shrinkage 6. No wonder ex-patients like Dr. Fisher, himself a psychiatrist with schizophrenia, feel like “survivors”. consistent with the federal government’s 2003 National Consensus Statement on Recovery7, several non-medical therapies like the Hearing Voices Network are worthy psychosocial adjuncts to medication (or even no medication).8-13

Recovery is a mental health concept without a consensus.7,14-21 Depending on one’s view, it can be an outcome, a process, or an ideal—or, optimally, all three. Sadly, paradigm partisans too often hijack the term for their own narrow purposes. In fact, recovery has three components. The medical component (Dr. Torrey) is about hospitals, doctors, and medications for short term and enduring symptom stabilization as governed by the science of psychiatry. The empowerment component (Dr. Fisher) is about self-help, individual choice, peer support, and hope as governed by science of psychology. The third component, rehabilitation, is about providing skills and supports to advance community integration and reduce stigma as governed by the science of psychiatric rehabilitation22-28. No one component is sufficient. All are needed for integrated, holistic treatment. Thus recovery discussions must be pluralistic. All voices should be represented, especially those with psychiatric disabilities of whatever ilk or ideology who  personally must endure the mental illness maelstrom.

Thomas H. Pyle, MBA, MS (PsyR), CPRP

Princeton, NJ

Mr. Pyle is an appointed family representative member of the New Jersey Mental Health Planning Council


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7.         Substance Abuse and Mental Health Services Administration. National consensus statement on mental health recovery. In: Substance Abuse and Mental Health Services Administration, ed. Washington, DC. : U. S. Department of Health and Human Services. Retrieved from; 2004.

8.         Romme MA, Honig A, Noorthoorn EO, Escher AD. Coping with hearing voices: an emancipatory approach. The British Journal of Psychiatry. July 1, 1992 1992;161(1):99-103.

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