A small group of therapists who have been bucking the psychiatric mainstream for almost 40 years is meeting in Philadelphia on Friday to talk about how to help those with mental illnesses without prescribing drugs.
The International Society for Ethical Psychology and Psychiatry opposes the medical or biological model of mental illness that sees medications as a way to combat chemical or structural problems in the brain.
The group sees even the most serious of mental illnesses, maladies like schizophrenia and bipolar disorder, as a reaction to trauma, emotional pain or conflict, said Al Galves, a retired psychologist in New Mexico who is the society's executive director. Symptoms like sadness tell you to pay attention and change. "It's a signal. It's an alarm," he said. "Do something about it."
While he sees signs that its message is being heard, Galves said the group is clearly in the minority. "We're not winning the battle," he said.
Its memberships have held steady for years at about 200 therapists, he said. Compare that to the 137,000 members claimed by the American Psychological Association and 36,000 by the American Psychiatric Association.
ISEPP's two-day meeting, which costs $225 per day or $375 for both days, starts Friday at the Philadelphia Airport Marriott. Speakers will tackle topics like "Transformational Change vs. Symptom Suppression," "Rethinking Madness" and "Recovery from Psychiatry," but not all agree with the group's stance on medication.
Galves said the meeting helps members recharge. "We're really inspiring ourselves," he said.
One prominent speaker is Irving Kirsch, a placebo expert and instructor at Harvard Medical School who wrote "The Emperor's New Drugs: Exploding the Antidepressant Myth." His analysis of studies on antidepressants found they were mostly no better than placebos, or sugar pills. (Placebos are often surprisingly effective in psychological studies.) The real medicines were slightly better than placebos for the ten percent of patients with the most severe depression.
In an interview Thursday, Kirsch said psychotherapy and physical exercise are just as effective as the pills, without any side effects. He said antidepressants do have withdrawal symptoms and increase the likelihood of relapse. He thinks they should only be a "last resort."
Many people with depression really do need help, he said, and he wants more funding to study which treatments are best. Kirsch said he couldn't comment on treatments for other mental illnesses.
After an interview with Kirsch aired in February on the CBS program 60 Minutes, the American Psychiatric Association took the unusual step of issuing a press release that called the piece "irresponsible and dangerous."
Salman Akhtar, a Thomas Jefferson University psychiatrist, will talk at the meeting about the therapist-patient relationship. He thinks medications can help people with schizophrenia and bipolar disorder, but doesn't prescribe drugs for most of his 10 psychotherapy patients. The therapists he supervises prescribe drugs for 80 percent of their patients.
Psychiatric medicines, he said, "are not as bad as some people think and they are not as good as some people think."
Many of the problems that drive patients to seek help - distress about loneliness, divorce or mounting debt - are not "fixable with medication at all," he said.
Akhtar said that therapists' training often focuses on how to talk or listen, but he wants members of the group to think about something else. "What is the attitude we should have before we talk, before we listen?" Therapists need to come to the relationship with a vision of what the patient could be after therapy and with faith that the patient can improve.
Staying grounded and secure can be challenging, he said. "It's not easy to help a human being, especially one who's internally trapped."