Punishing the Patient: How Psychiatrists Misunderstand and Mistreat Schizophrenia Paperback – March 1, 2001

As an ongoing survivor of some fifteen years, across three states, of the "mental health" system here in Australia, and having been diagnosed with "schizophrenia" at some point in those one and a half decades, I have always been vehemently opposed to the rights violations inherent and primary in being involuntarily sectioned and "treated" in psychiatric wards, as well as afterwards in the community on "treatment orders". I have always seen my "illness" in a combination of psychological/psychic and spiritual terms: as a psycho-spiritual condition. I have always seen medication as objectionable - perhaps even evil - even though, having been originally forced onto it, I then found (and now find) it difficult to avoid and withdraw from, not least of all because, if, in withdrawing, I re-enter a psycho-spiritually fraught state, I then come to the attention of concerned individuals, and inevitably find myself once again incarcerated in a psychiatric prison, and forced back onto medication, typically after having been subjected to electro-convulsive therapy (ECT).

It is, then, very encouraging and gratifying to read this book by Dr Richard Gosden given that it is very much a book of pro-"patient" advocacy, coming from exactly the same perspective as a psychiatric survivor such as myself, but with the added power of fleshing out the case against the psychiatric paradigm with a mind-bogglingly comprehensive and scholarly review of all relevant issues - very surprisingly and commendably given that, apparently, Dr Gosden is not himself a survivor of the system.

Dr Gosden makes the powerful case that the concept of "schizophrenia" is not grounded in anything more than a set of subjective observations which have been evolved by psychiatrists over the course of many decades (more than a century, I think). After thoroughly, and very impressively, reviewing all of the proposed causes for this set of subjective observations (the so-called "illness"), and explaining the deficiencies, failures and/or reasons for having been historically rejected of each of them, including the biological models used to justify "treatment" with anti-psychotic drugs, Dr Gosden plausibly argues that given the absence of a demonstrably singular (especially biological/familial) cause, the unreasonableness of the belief in being able to eventually discover one, and the subjectivity of the diagnostic criteria, the belief in the existence of some actual, singular mental illness, "schizophrenia", as it is currently understood in the psychiatric paradigm, looks very much like an act of faith on the part of psychiatrists.

After perceptively critiquing the broad applicability of the diagnostic criteria for schizophrenia of both the DSM (Diagnostic and Statistical Manual of Mental Disorders) and ICD (International Classification of Diseases), Dr Gosden then goes on to describe several ways in which individuals might fall foul of these criteria in practice. One in particular stands out for me, given that it is my own experience: individuals undergoing a spiritual/mystical emergency. Such individuals, having been diagnosed with "schizophrenia", typically, under the aegis of having their "right to treatment" honoured, have their spiritual/mystical experiences (journey) curtailed through psychiatric intervention, to their ultimate detriment, and in violation of their internationally-recognised rights. I was particularly drawn to the quote and subsequent commentary that Dr Gosden provides in this context:

"In comparing modern schizophrenics with mythological heroes, Joseph Campbell, the great mythologist, summed up his opinion this way: ‘our schizophrenic patient is actually experiencing inadvertently that same beatific ocean deep which the yogi and saint are ever striving to enjoy: except that, whereas they are swimming in it, he is drowning’.6
Swimmers and non-swimmers might both be in the same waters, and their splashing might look the same to an untrained observer, but what is pleasurable exercise to one could be a life-or-death struggle for the other. The modern tragedy, however, for both swimmers and nonswimmers alike, is that all of them are now routinely drowned by the rescue efforts of an over-zealous and incompetent life-guard. This incompetence is largely due to ignorance about the nature of mystics and the mystical experience".

Dr Gosden goes on to discuss in detail, with careful reference to international covenants, exactly how having one's mystical/spiritual experience forcibly and involuntarily overridden by mind-altering substances is a violation of fundamental internationally-protected rights, as well as how these rights are cynically misinterpreted to the exclusion of "mental health patients", and how the supposed human rights watchdogs are not only disinterested in advocating for the rectification of this situation, but are actively hostile towards such a thing.

Dr Gosden mounts a compelling case that these rights violations are maintained by several protagonists: concerned and frightened families, who want only for their suffering family member to return to "normal" and stop suffering; pharmaceutical companies, who have a financial interest in expanding the market for their anti-psychotic drugs; and the State, which has an interest in neutralising "socially disruptive and potentially dangerous" individuals. He appropriately links all of this to the materialistic, mechanistic, isolating, cold, consumerist culture which is coming to subjugate our planet, and argues persuasively that certain cases of "schizophrenics" might actually be carrying valuable remedies against the peril in which we as a global society find ourselves both culturally and existentially, if only they (we) were allowed to work through their (our) madness to the end without intervention, and to emerge whole and wiser.

Along the way, Dr Gosden exposes conflicts of interest (corruption, in my view) in various advocacy organisations that take money and supposedly scholarly publication material from, and even ally themselves with, pharmaceutical companies, making it questionable who's really pulling the strings, and he eloquently and dispassionately argues against what I would refer to as the horrors, and - which Dr Gosden emphasises - utter misguidedness, of "preventive treatment" for youngsters deemed at risk for developing "schizophrenia".

Particularly impressive to me, especially given that, apparently, he has not undergone such an experience himself, Dr Gosden anticipates and rebuts the challenge that if he were to encounter a "real" case of "schizophrenia", in all of its florid paranoia, delusion, confusion and suffering, he would be less inclined to advocate for the "patient's" right to refuse treatment as opposed to the more realistic option of forced psychiatric intervention. Here, Dr Gosden points to the success of such drug- and psychiatric-dogma-free residential facilities as those "modelled along the lines of John Weir Perry’s Diabasis"; successful in that the individuals with the good fortune to pass through them successfully navigated their crises and emerged afterwards with the belief that the experience had, ultimately, been a positive one; one which benefited them. I had not heard of such facilities before, but, having researched a little into them, I am now gobsmacked that such a fantastic model of "madness sanctuaries" has been overrun and rendered defunct by the model of "psychiatric prisons". Such facilities as these are, I am convinced, the way of the future.

Thank you, Dr Gosden, for all of the time and effort you have put into knowledgeably, skilfully and intelligently speaking up on behalf of people like myself: people who, whilst relatively articulate, suffer from the prejudice and stigma attached to a psychiatric diagnosis, making it all too easy for our own advocacy to be presented as either delusional ("lacking insight") or emotionally self-interested and biased. We psychiatric survivors owe you a great debt for writing this very compelling and powerful book.

Dr. Richard Gosden, a researcher in mental health from Australia, has produced a refreshing, easy to read analysis of the diagnosis and treatment of Schizophrenia by modern day psychiatry. This book is must reading for clinicians, be they psychiatrists, psychologists, social workers, or psychiatric nurses. Gosden presents a clear account of the development and problems associated with both the old neuroleptic medications and with the new "atypical" neuroleptics used to `treat' Schizophrenia. He presents a clear and easy to understand account of how these drugs lead cumulatively to both Tardive Dyskinesia and to Neuroleptic Malignant Syndrome. Dr. Gosden debunks the genetic and biological-chemical theories of Schizophrenia and presents an excellent summary of the psychosocial theories. He also presents a remarkable expose of drug research in mental health. The last part of this work describes the problems psychiatry faces with informed consent. Dr. Gosden focuses upon the human rights issues and deprivation of liberty that are usually present as a result of the Schizophrenia diagnosis. The book is clear enough to not only be an asset to mental health professionals, but also is easily understood by the lay public. I highly recommend it.

I have long family history of schizophrenia , so this book really help me to understand the vast medical and non medical aspect of this mysterious decease , and how many phycatrist misunderstood the patient . Instead clinicians this book is of great help for families having schizophrenia patient in them , to understand the right and better treatment. It also helpfull for humsan right activists working towards more human liberty.