Interview with Peter Stastny, M. D.
The Psychiatric-Pharmaceutical Complex and Its Critics
There are literally only a few psychiatrists in the United States who are critical of psychiatry. The two most well-known are octogenarian Thomas Szasz*8 (see chapter 4) and Peter Breggin.†9 Dr. Breggin was probably the first authority to document the harmful effects—particularly the brain-damaging and “brain-disabling” effects‡10—of psychiatric drugs. He began to become popular after an appearance on Oprah Winfrey in the late 1980s. He was also the first psychiatrist to warn of the creation of a psychiatric-pharmaceutical industrial complex (he called it, less clearly, the “psycho-pharmaceutical complex”) which began to develop in a barely perceptible way in the late 1970s when the American Psychiatric Association made a decision to accept drug company money.1
Dr. Breggin still believes that the alternative to psychiatric treatment (drugging) is psychotherapy. As a trained therapist myself, I have had the opportunity to learn and apply some of the alternative therapies that became popular in the 1970s and 1980s, including various kinds of family therapy as well as hypnotherapy. I do not doubt the efficacy of therapy, although unlike Dr. Breggin I am critical of the dependence on individual therapy (or I was in the 1980s before psychiatric drugs replaced everything else). However, the innovative therapies are rarely available today to persons in the public sector, where the emphasis lies always on psychiatric “medication,” which, once commenced, is presumed to continue until the patient’s death.
Therapy is merely an adjunct often not offered or not covered by Medicaid. Thus the most innovative therapies are only accessible to those able to afford to hire a therapist in the private sector. Despite my success with clients, in the late 1980s I was forced to resign from two clinics successively for encouraging clients to wean themselves off of psychiatric drugs. When I wrote my first book in the early 1990s2 I believed that the mental patients’ liberation movement could successfully apply pressure to the mental health system to force it to offer “alternative” treatments in the public sector. Today I believe that the only feasible alternative to Psychiatry in America is self-help associations created and run by patients themselves—and not funded by the drug companies. Since the death in 2004 of psychiatrist Loren Mosher (see chapter 2), Dr. Peter Stastny has been the leading psychiatric spokesperson for the patient self-help movement. He was a founding member in 2005 of the International Network Toward Alternatives and Recovery (INTAR). The book he coedited with Peter Lehmann,*11Alternatives beyond Psychiatry,3 is an indispensable resource for all activists in the Mad Pride movement.
Peter Stastny was born in Vienna, Austria, where he graduated from medical school in 1976. He moved to New York in 1978, where today he is a practicing psychiatrist and author and/or editor of several books critical of mainstream psychiatry. He is an associate professor of Psychiatry at the Albert Einstein School of Medicine. As mentioned, the views in this interview are his own and are not necessarily representative of INTAR.
Description of INTAR
The International Network Toward Alternatives and Recovery is an international summit of world-renowned survivor leaders, psychiatrists, psychologists, family members, and other mental health professionals who meet annually to counter the belief that people with diagnoses such as schizophrenia or bipolar disorder can never completely recover.
INTAR believes that the dignity and autonomy of the person in crisis are of the utmost importance, that full recovery from distressing/altered mental states is possible, and that these two convictions should shape the social response. For these reasons, we find established psychiatry and public mental health systems in which many of us work, seek (or have been forced to seek) treatment (for ourselves or our loved ones) and do research, to be deficient. Instead, we seek, and some of us provide, alternative settings where people in crisis can find the care, connectedness, respect, and interventions they need and elect to use.
Our backgrounds range widely, from peer/user organizing to biomedicine and psychoanalytic training to Eastern meditative disciplines to family advocacy to academic research. But we are, each of us, committed to building safe spaces and positive relationships, wherein the ordeal presented by extreme states of mind can be met with preventive tools and seasoned presence. This includes people who have been through it before and know how to offer the steadfast support needed. As an international network, we undertake to document the effectiveness of such alternatives, to refine and expand their use, and to make them more accessible to people who need them.4
Farber: One of the things that’s distinctive about INTAR was the belief that full recovery from extreme mental states, including so-called schizophrenia, is possible. This is heresy right now in the mental health field.
Dr. Stastny: It might be a little less heretical now—everybody talks about recovery nowadays, but I’m not sure what they all mean by it. I don’t personally like to talk too much about recovery, because the term has been bandied about so much that it’s becoming pretty much meaningless as far as I’m concerned.
Farber: Do you object on philosophical terms?
Dr. Stastny: No. I think the mental health industry has corrupted the term and is now using it to say everything is really going well; we all believe in recovery. I think it’s a problematic term. In terms of the name INTAR I think the emphasis is really on alternative and recovery. Recovery is in there because (a), it makes a good acronym and (b), it’s necessary to talk about. Primarily, we’re interested in just a different way for people to get help.
Farber: Someone could object on Szaszian grounds, but that’s not what you meant right? Szasz would say there’s no mental illness so there’s nothing to recover from.
Dr. Stastny: On Szaszian grounds, we could call it discovery or rediscovery rather than recovery, but I mean we’re telling people the system is bad and it’s hurting people and they’re saying, “But what are we gonna do?” You have to have something to offer. Sure there are people like Dr. Szasz who say, “Oh well, just don’t be crazy,” or “Don’t go to a shrink.” But that’s not good enough as far as I’m concerned.
Farber: The people in the mental health system who use the term recovery—do they imply that you can recover but only if you stay on so-called meds?
Dr. Stastny: Yes, I mean I haven’t heard too many people talking about getting off medication at all. Whatever I’m saying shouldn’t be taken as representing INTAR.
Farber: When was INTAR founded?
Dr. Stastny: Exactly five years ago. My main emphasis was people shouldn’t be put on psychiatric drugs to begin with, because getting off of drugs is a much more complicated proposition than not getting on them in the first place.
Farber: I’ve seen so many people—they call me—whose lives have been ruined. A couple of women I’m thinking of in particular: they were put on meds when they were young and attractive, and now they weigh 300 pounds—and all these years they never had a love life, not since they were young. Now they’re in their forties and are humiliated by the ways their bodies look. The drugs not only make them fat but oddly misshapen. So they just resigned themselves to being alone—and essentially having no life except going to day treatment or groups run by the psychiatric system.
Dr. Stastny: I worked with a woman who was hospitalized once, it was her first time, she was put on a bunch of drugs, and she came out not really recognizable to herself. This was only a short period of time, she was on drugs for maybe three or four months. She had gained a huge amount of weight, and she was completely destroyed. If people come off of drugs early they have a better chance of making it.
Farber: Yes, I’d like to get that message across to readers. Get off the drugs early—but gradually of course. The people I know who have been on the drugs for over ten years, even if they want to get off, it seems they can’t.
Dr. Stastny: It’s hard, very hard, but some people make it though. Peter Lehmann has collected a bunch of reports by people who have successfully come off drugs, but it also depends which drugs. Some drugs are easier to come off than others.
Farber: The antipsychotics are the most difficult, aren’t they?
Dr. Stastny: Yes, but the SSRIs, or the selective serotonin reuptake inhibitors like Prozac, Effexor, the drugs used for depression are also very difficult to come off.
Farber: There was a report in The New York Times Magazine a year or so ago (2006–2007) about the guy who had a difficult time getting off of an SSRI. Did you see that?
Dr. Stastny: I saw a thing by a doctor that all of a sudden he’s finding in his practice he has ten to twenty people who started out on SSRIs when they were adolescents and they’re still on them fifteen years later. He doesn’t know what to do with them because there’s no research at all that talks about how to get them off. Psychiatrists are told that patients should just keep taking it for the rest of their lives. There’s no protocol within the field on how to get off once someone has been on that stuff for a bunch of years.
Farber: Did you happen to know the story of Gianna Kali, who got off of drugs after fifteen years?
Dr. Stastny: I happen to know her story, yes.
Farber: She posted on her blog she was able to get off of them without going psychotic or being emotionally overwhelmed but she has no energy. She has a hard time doing things; of course she’s only been completely off for a few months. It makes it harder to get off now, doesn’t it? They put patients on a cocktail of drugs rather than one or two. When a young person has a breakdown and hears voices or whatever, in America they’re told they have a disease and they’ll need to be on the drugs for the rest of their life. Isn’t that almost always the case?
Dr. Stastny: I don’t think they’re always explicitly told they have to be on the drugs for the rest of their life, but if they have a breakdown like that, they’re probably told they should just stay on them until further notice: But no further notice ever comes. So that’s why some people just take themselves off it.
Farber: What you are saying is unusual if not unique for a psychiatrist—that people don’t need to be on these drugs.
Dr. Stastny: What I’m saying is that people who find themselves in trouble emotionally—or because people tell them they are in trouble—they have to have different options. It’s not just the drugs that are damaging; it’s the hospitals and the clinics that prescribe the drugs. I find the hospitals equally if not more problematic. It’s a package deal that happens when people flip out or become very despondent or wonder if they should continue to live. All these things put people at risk for this package they’re being offered, especially in this country, which means: emergency room, admission to a hospital—half the time involuntarily and the other half the time you’re being tricked or you don’t know what else to do or your family puts pressure on you. When patients agree to stay in the hospital they don’t even know what they’re agreeing to, they don’t know what to expect. They have no idea that once they’ve entered the hospital, it’s not a one-time thing. There are a lot of times people are quickly turned into mental patients; it happens very fast. I can speak about one person who unfortunately died. Mimi Kravitz, who recently gave an interview, eloquently described how quickly it happens that you’re turned from a college student to a mental patient with a few gestures on the part of the doctor you know. You’re told that you’re sick: you have to wear pajamas all day, you have one bar of soap, you get a diagnosis, and there you are among the other mental patients. Presto! You are a mental patient. That happens so fast that it seems to me the medication alone is not as problematic as the package, including the often-terrifying responses of the doctors in the emergency rooms—not to mention the fact that no attention gets paid to what people actually are suffering and experiencing, why they ended up there in the first place.
Farber: Oh yes. Good point. The original problem is left unresolved; it doesn’t even exist for psychiatrists who see everything as aberrant biochemistry. I was trained as a family therapist with Salvador Minuchin and then with Jay Haley.*12 That whole family therapy field has also been co-opted; they don’t do real family therapy anymore. The original methods of course were based on the idea that if one person is acting crazy, the entire family is dysfunctional; so there is really nothing wrong inside the person who becomes the “identified patient.” Now family therapy in the clinics has been turned into the so-called psycho-educational model where the family sits together and talks with the therapist about how they’re going to make or help Johnny—the identified patient—to accept his illness, his identity as a patient, and take his meds. It’s the opposite of the original family therapy model, but it’s now been adopted by almost all so-called family therapists. So, the family problems do not get addressed because the therapist joins in scapegoating the so-called patient. Johnny is locked forever into the sick role, and the drug companies and the psychiatrists—the pimps for the drug companies—are happy.
I believe this family therapy movement could have brought about a “revolution in mental health”—just like David Oaks advocates, and it appeared to be heading that way in the mid-1980s. The marginalization or co-optation of family therapy demonstrated that the agenda for the development of the “helping professions” was set by the pharmaceutical corporations and had nothing to with the needs of clients. Family therapists bear responsibility for distorting the ideas of innovators like Minuchin and Haley in order to be compatible with the dominant biopsychiatric theory that problems in living were the result of aberrant biochemistry, not family problems.
Dr. Stastny: Right. That has happened ever since the families in groups like NAMI*13, 5 have lobbied to be taken “off the hook.” It’s a lame excuse by the family movement to say, “Oh we’ve been accused of causing mental illness and therefore now we’re just turning things around—and putting the blame on the illness.” That’s what they’ve done, and they oppose any kind of systemic therapy. For example, there is this movement in Finland that’s called open dialogue, and it’s a very different approach to families and to people. You go in to meet with a family, basically you become one team, and there’s no separate team of therapists—you don’t go back and discuss what’s going on behind the family’s back—it’s an open dialogue and everything gets discussed openly. They’ve actually done research on that and found that has really great results. Most people who are seen by the therapists (and these are so-called psychotics) don’t end up in the hospital, and a great number of people don’t end up on medication.
Farber: Now one of the things that’s so detrimental about the hospitalization is the powerful impact of being treated like a patient—people end up believing they’re chronically mentally ill.
Dr. Stastny: Yes. A lot of people believe that, and they believe the diagnosis. Nowadays, people will tell you that they’re quote-unquote schizophrenic-bipolar. People walk around and I meet them and I say, “Well, what have you been told?” They say, “Well, I’m schizophrenic-bipolar.” It’s like one word, bipolar-schizophrenic: people just buy that, and that explains why they take four different medications.
Farber: This completely undermines their sense of self-esteem, what Laing used to call the rituals of invalidation, of degradation, that take place in the hospital.
Dr. Stastny: To be honest, occasionally hospitals do work for people to some extent. I worked with a guy who had taken himself off psychiatric drugs and was experiencing weird stuff all the time. He had nowhere else to go. He was hearing voices so he thought that meant he had schizophrenia—the term itself should really be abolished because it’s a delusion that the term schizophrenia denotes some kind of a common thing. To give people those psychiatric terms is very counterproductive. Psychiatry has not spent any effort in coming up with terminology that could actually be helpful to people. The voice-hearing movement6 has been very interesting in this regard. In England, in Holland, in Europe, they’ve opened up the possibility that voice-hearing happens to many people, people who are otherwise “normal.” It turns out it’s not restricted to any diagnosis or any illness. It can be associated with being high on drugs, it can be associated with Wilson’s disease (which is a disorder of copper metabolism), or it can be associated with nothing other than being very religious. So the Hearing Voices Network has been very helpful because it’s offered people a lot more room to say, “I had something unusual happen to me, and I have my own explanation for it. Other people might have different explanations for it, so don’t cubbyhole me.” This movement has revolutionized in Europe what it means to be a voice-hearer.
Farber: So it’s a form of Mad Pride? Instead of being ashamed people are proud.
Dr. Stastny: Exactly. It lets people breathe and live and be themselves without submitting to this medical identity.
Farber: Reading about England, many of them actually don’t feel they’re inferior anymore.
Dr. Stastny: Not at all, these people used to be very superior—in the time of the prophets everybody heard voices. That was the qualification to become a prophet.
Farber: It cannot happen in the United States. It’s too much of a threat to the drug companies, and the psychiatrists won’t allow it. They’d all lose millions of dollars. People would stop taking drugs and stop going to psychiatrists. I was reading in some article that the hearing-voices movement has had a major impact in England. They have self-help groups all over, and it’s a substitute for psychiatrists and even therapists. I haven’t met anyone in America who’s been involved. I interviewed two people (see chapters 6 and 7) from the Freedom Center, and they were completely “cured” from so-called bipolar symptoms or so-called schizophrenia—and of all anxiety and depression—by a support group of other patients, most of whom do not take psych drugs. But Freedom Center is a one-of-a-kind thing in America.
Dr. Stastny: It’s very interesting: in America, the Hearing Voices Network has not really taken off. Pat Deegan, a psychologist and ex-patient, is one person who has been promoting it. But it certainly has not taken off like it has in Europe. I was going to try to find out why. I don’t really have the answer, but one answer is that I think the fear of the stigma of being labeled psychotic in America is more severe than in lots of other places. I tried to start a group of voice-hearers in the Bronx, and people don’t want to come out and identify themselves like that. The genius thing that happened in Europe—and that never happened here—is that Marius Romme, this Dutch psychiatrist, went on TV in Holland with one of his patients, and they said, “Look, we don’t know what we’re doing here, we have no clue how to help this person, but let’s hear from our audience about their experiences with voices and how they’re dealing with it.” To their surprise, lots of people contacted them, and they found that there are lots of people dealing with voices who have never even talked to a psychiatrist. That made a huge difference, and that kind of a thing has never been done in this country.
Farber: And it also couldn’t be done on TV here because of the power of the pharmaceutical companies, no?
Dr. Stastny: Well, I don’t know, do we even have this kind of call-in show in America? Maybe on radio but not TV so much. I think that was interesting how that happened on this Dutch TV show: immediately they had a movement, and people were willing to stay connected, and then it started groups all over. In this country some people tried it on the Internet, but it didn’t happen.
Farber: People are told the only answer is the so-called antipsychotic drugs, which really ruin their life. They can’t have any romantic or sexual life when they’re on these antipsychotic drugs; they basically sit in their room, and the only interactions they have are in psychiatric groups with patients and doctors.
Dr. Stastny: Well, I wouldn’t be so general about it. I think there are people who manage to make it, to do something and are able to have sex and relationships too, but it’s a minority of people.
Farber: A minority, yes. But when I find someone on antipsychotics who seems to have some kind of real social life—and not just in psychiatric facilities—it turns out they are on lower dosages. This minority you speak of—haven’t they lowered the dosage of the psychiatric drugs they’re taking?
Dr. Stastny: Yes, that’s absolutely true. When I first got into psychiatry in the late seventies or early eighties, it was a time when the dosages of drugs were drastically reduced. People had realized that giving someone seventy or eighty or one hundred milligrams of Haldol basically lobotomizes them; this was before the new antipsychotics in the early 1990s. So, they had all these people that were half-dead zombies, and the perspective of psychiatrists at that time was very simple: “We gotta get people on low dosages.” Lo and behold people started to wake up, because instead of giving sixty or seventy milligrams of Haldol, people were taking three or five or six milligrams, and it made a huge difference to the quality of their life.
That has been reversed today, ever since the new atypical anti-psychotics have replaced the older drugs. Now the dosages and combinations of drugs have increased to a point of madness, especially in hospitals. I work with people who come out of hospitals, and it usually takes me a year or half a year to get people off of these incredible combinations and dosages. This is what I call the third phase in the so-called drug revolution, which is, “Let’s throw everything and the kitchen sink at people and let them fend for themselves without any therapy or support.” The 1980s were a better time, because people were really on low dosages, and they were able to do a lot more.
The first phase was during the first forty years after they started using antipsychotics, and they used megadoses until the 1980s because all of a sudden people were talking about how Haldol causes terrible nerve diseases like tardive dyskinesia. Now it’s back to the way it was. The same psychiatrists who talk about recovery from psychosis and self-help, they drug people to the gills.
Farber: There have been a number of articles in the New York Times; there was one that had the statistics from Minnesota (where the law requires them to keep statistics), and over one-third of the psychiatrists in 2005 (probably more today) were getting consultation fees from the drug companies, and the ones that got the consultation fees—even though they claimed they were objective—prescribed many more drugs, even to kids.*14, 7
Dr. Stastny: Robert Whitaker [the author of Mad in America] would agree; he’s going to come out with another book soon.
Farber: So what you are saying is that the so-called revolution with atypical drugs that was supposed to be a move forward—because they claim these drugs are less harmful than the older antipsychotics—was actually a move backward because the psychiatrists are putting people on higher dosages of these drugs?
Dr. Stastny: Absolutely. They’re putting people on higher dosages, and they’re putting people on multiple drugs [instead of one or two]. What seems to have happened in the past twenty or twenty-five years is that the pharmaceutical industry has completely gone out of control. This is what’s happening in terms of health care reform also. These people have realized they can make huge amounts of money by pushing the drugs. The new drugs were incredibly lucrative for the drug companies: they recommended high dosages, and also they realized they can make more money by not competing with the other companies.
Farber: What do you mean by not competing?
Dr. Stastny: I’ll give you an example. I once had a drug rep say to me, “Don’t change anyone’s drug regime, just add our drug.” “Just add,” they kept saying, “just add this and that.” And this “just add” is exactly what’s going on all the time nowadays, and it’s horrifying. Take Risperdal: when it first came out people were usually on eight to twelve milligrams; the fact is one fourth of that amount is equally effective and has way fewer side effects. Now they’re lowering Risperdal, but it’s taken fifteen years to reverse that trend. I’m very frustrated with the way things are going. It’s not about reforming the system anymore: to me the place to start is really with all those people that enter the system freshly. There are so many thousands every single day that enter the system. For example, a student in college may be going through some existential crisis and starting to feel suicidal, and that person could end up in the hospital, which could be a terrible experience. Occasionally it could be helpful to treat someone in a residence if you have a really nice place and you can talk and chill out and relax—and not be put on medication. Those places don’t exist in America today; insurance won’t pay for them. If you’re in a hospital and you don’t get put on medication, the insurance is going to say, “You are not sick and should not be in the hospital.” It’s a package deal, and that’s what I’d like to change. I’d like to see people being treated differently from the get-go: that would be less expensive for the public because the person would not become a lifelong patient, as you show in this book.
Farber: Of course, in the seventies there were a few alternative residences for psychotics, and they were funded by the government. Nowadays they can’t get any funding if they’re not going to push psychiatric drugs.
Dr. Stastny: No, they cannot. Some of the more progressive psychiatrists are trying to introduce a waiting period of three days between the time a person gets admitted and when they get started on drugs. Even that is not acceptable—not even three days! I would propose at least three weeks without drugs as a normal waiting period.
Farber: Mosher [Loren Mosher, the psychiatrist who cofounded the Soteria Project] used to use small amounts of Valium when people were in a state of psychotic panic or couldn’t sleep—on a temporary basis. He would not use antipsychotics.
Dr. Stastny: I’m a big believer that the benzodiazepines are the least noxious of the drugs. I once years ago came up with the hierarchy of the least toxic alternatives.
Farber: The psychiatric establishment acts like Valium is heroin nowadays.
Dr. Stastny: Klonopin is pretty widespread; it’s less habit-forming than Valium, although both are far better than the antipsychotics. I personally think it’s not a bad drug; some people use it like others use red wine. If you drink too much wine over a period of time, it’s probably going to harm your liver or your brain, but Klonopin—it seems—is not really toxic to the system.
Farber: You know Henry Stack Sullivan used to use wine or some kind of alcohol to relax schizophrenics when they came into his hospital in Chestnut Lodge.
Dr. Stastny: Some people believe certain dosages of marijuana are helpful to certain people.
Farber: There is evidence for that with physical problems. What was your hierarchy?
Dr. Stastny: Neuroleptics, of course, are the most toxic. Some of the antiseizure drugs like Depakote and lithium are up there too, but probably the second-most toxic should be the SSRIs. Following them are the anticonvulsants, and at the bottom—the least toxic—are the benzodiazepines. Yes, I would say that they’re the least toxic. Psychiatrists are so scared of causing people to become addicted to benzodiazepines, but then patients get dependent on neuroleptics and antidepressants instead.
Farber: One of the reasons people stay on the drugs is that hospitalization is such a traumatizing experience that they become terrified of having to go back. They’re afraid if they don’t keep taking these drugs they’re going to end up back in the hospital again. Let me ask another question: to me, you seem to differ from psychiatrist Peter Breggin. Dr. Breggin seems to put all drugs in the same category, or at least his position is to never use any psychiatric drugs except to get off gradually.
Dr. Stastny: Yes, I do differ. Again certain benzodiazepines have been very helpful to people. I have met people who have been having a terrible time coming off Klonopin; addiction does happen; I think it’s a minority though. I think it is really important that patients understand how the drug works for them. The whole business of maintenance medication is extremely problematic. I don’t know how I feel about certain mood stabilizers; I know Depakote is a pretty terrible drug, and it’s usually prescribed at way too high a dosage. I know a woman who goes through these states where she becomes really dysfunctional, she can’t speak, she is almost catatonic, she just can’t do anything, and she feels very down at the same time. It seems like for her taking a little Depakote even for a short period of time makes a difference. That’s an odd thing, and we would never know that if she hadn’t experimented with it. We figured it out together that even taking a little bit for a short period of time makes a difference. So, the unconventional uses of medications are more interesting to me than the sort of, “Why don’t you keep taking this combination for the rest of your life?”
Farber: What do you advise someone to do who is stuck in Iowa—or even New York City—who does not want to be put on drugs? If they are in Massachusetts they can go to the Freedom Center, but anywhere else it’s almost impossible to find a psychiatrist who is not a drug pusher. So what could you advise persons reading this who are constantly being told they’re chronically mentally ill? How can they find help?
Dr. Stastny: With people who’ve been in the system for a long time, it’s a more difficult problem than the people entering the system, because for those who are already on drugs there is a big risk that the brain has been irreversibly altered. If you want to improve your chances of succeeding in getting off the drugs, you have to have support, you have to read the literature—whether it’s the Coming Off Drugs guide or something like it—and also have a different way of dealing with whatever problems might come out. In the book Peter Lehmann and I did,8 there’s a woman from Germany—Regina Bellion—who talks about how she arranges to have several of her friends take turns sitting on her for a few days instead of taking drugs. They call it a Ulysses contract; they prefer to be tied down than to be drugged.
Farber: Yes, they had to tie Ulysses to the mast. There are not enough of the alternative mad patient groups. I mean if you’re in Oregon you can go to David Oaks’s Mind Freedom, if you’re in Northampton you can go to the Freedom Center, but these places don’t exist across the country except in virtual reality on the Internet.
Dr. Stastny: The Internet in the end doesn’t really help people enough. You’re going to find it takes a group of very committed and courageous people that are willing to spend a couple of days and nights with someone who is in a really bad way. What’s amazing is that it really helps, but it is something not many people are prepared to do, or even trained to do. We need places like Soteria for the person who is going crazy or flipping out. Hopefully your book will encourage more people to put effort into creating self-help alternatives.
Farber: They can get more specific ideas from reading your book Alternatives beyond Psychiatry. What’s amazing to me is that if you do that in the beginning you can deflect the person from being inducted into what would have been a lifelong career (to quote Erving Goffman) as a chronic mental patient—just by a strong intervention. By strong I mean sometimes just by telling them, “Look do not let the psychiatrists and your parents convince you that you’re mentally ill. You’ll be okay. You need to gradually get off the drugs.” Often that was enough. I’ve experienced this before: I was blacklisted in mental health clinics because I often deflected persons from getting entangled in the system.
Dr. Stastny: I’ve heard many stories like that where people in the beginning are deflected. In Vienna, I worked once in a pediatric adolescent medicine ward where kids would come for a variety of reasons—including some kids who were sent there from a poison center where they were detoxed after they had taken an overdose. Instead of sending them to the mental hospital up the hill they sent them to us. So basically, they were not put on medication and instead given some therapy—individual and family—and they didn’t become labeled. They didn’t have to be associated with other people who were labeled as mentally ill, and they did very well. One woman is grateful to me till this day that I spared her admission to a psychiatric hospital at the age of fifteen. I don’t know what would have happened to her if she had a different experience.
We do the opposite here in America; we send kids to hospitals so easily, and the children’s hospitals are generally worse than adult hospitals. I see kids coming out of there, and some of them are really damaged, but others throw all their pills away, and they sort of become basically normal five or six years or ten years later—and they were labeled with every freaking diagnosis in the book. It would be very interesting to do a study on people who have been through this, just like the study that Courtney Harding did in Vermont. She found after thirty years a whole bunch of people were living happily without medication. We might find that same thing with these kids you know, the ones who escaped, so to speak.
Farber: Can you say a little about Soteria?
Dr. Stastny: There are Soteria houses based on the original model right now only in Switzerland, and Alaska has a recently opened one. There might be a small one in Germany, and in Scandinavia there’s a small one. Basically, it’s a place where people can go when they’re having an acute “psychotic” episode where they’re really not in touch with reality or they’re scared or maybe hallucinating and whatever. There’s a small community of people who work there, and some of them might have had similar experiences in the past. It’s an intense environment where people are supported through these experiences and usually come out of them within a matter of days without medication, although sometimes they don’t.
The interesting thing about the original Soteria is that they weren’t doing any therapy. It’s not a therapeutic model; it’s a community that functions as a community because people need to eat, they need to use the bathroom, they need to clean up, they need to live, and they want to come back from wherever they are in these states of whatever you want to call it—madness, craziness, or freak-out. The original Soteria was a study for people who would have been diagnosed with first episode of schizophrenia. It turns out—we know this from follow-ups—that many of those people later on no longer met those criteria.9
Farber: You’re referring to the research they did which was published, which of course is revolutionary because psychiatrists claim schizophrenia is incurable and that the patient will deteriorate without “medication.” No one’s done any studies like that since then. It was pretty conclusive, was it not?
Dr. Stastny: Yeah, I mean if you read John Boles’s work, he’s published several articles of meta-analysis. It’s very powerful and very definitive that it’s basically safe to withhold medication from people for a period of several weeks.
Farber: You’re saying he went back and looked at Mosher’s research and confirmed it?
Dr. Stastny: Yes, and he also looked at a lot of the Scandinavian studies, which were based on the Soteria model, and found they worked. The difference between Soteria and what’s done in Scandinavia today is that Soteria was a residence for people to go to live—a building, a community—and now in Scandinavia they mostly have therapists living with the families. They work with people wherever they are, they found they did not need to move people to a different environment. Here in this country we always say, “Let’s find you a place, either a hospital or some other place to stay so you can go through your madness.” In Scandinavia or in England people generally stay with family.10 The families there, I would think, are not as problematic as here, which is interesting.
Farber: Anyway, Mosher showed in the seventies that the Soteria non-drug treatment was actually superior to treatment with drugs—even in terms of less hospitalizations.
Dr. Stastny: Well, it was superior in the long run and it was equal in the short run, which was really interesting, you know. One could argue that if you give psychosocial treatment over a period of time and you do a variety of things, that people will get better. It worked just as well as the hospital in the short run—without giving patients psychiatric drugs and without locking anyone up.
Farber: How did you come to adopt this unconventional point of view? You had conventional psychiatric training, right?
Dr. Stastny: My unconventional point of view began before I had any formal psychiatric training, because I was exposed to the Italian democratic psychiatry movement while I was in medical school. The Italian psychiatrist Franco Basaglia and his group impressed me because whatever I learned about psychiatry, even as a general medical student, seemed to prove to me that institutions were really not about helping people.
I was involved in the anti-institutional movement before I even learned anything about psychiatry. The fact that I became a psychiatrist was a bit of a fluke: I was looking for other medical specializations, like cardiology, but I started to realize that in medicine and cardiology the person is always treated as an object—left out of the equation. That bothered me, and so I figured in psychiatry that would be a place where people are included, since it’s about talking to people. I came here from Germany and did my residency under the leadership of Joel Kovel; he was my director of residency. He was a Marxist and Freudian.
Farber: Joel is a friend of mine, but I did not know that.
Dr. Stastny: He did not want to deal with people with more severe troubles, but still he had a different perspective than most psychiatrists. I was exposed to some pretty interesting people during my training at Einstein,*15 such as people who believed in systemic work and family therapy, as you talked about. After that I actually went to work at Bronx State; today is an interesting day because I have been associated with that hospital for thirty years, and today I finally quit. I resigned after all these years.
Farber: Did you do it for any principle?
Dr. Stastny: No, I resigned because my work doesn’t really mean anything there anymore, and I worked there only four hours a week now. When I went to work there I never wanted to work in an inpatient unit, but they gave me the opportunity to work with the people that were trapped in the hospital—meaning that they had nowhere else to go, they were essentially homeless. I said, “I’ll work under one condition: the doors are open, nobody is forced to do anything, and anybody can leave when they want to.” That was my condition, and they agreed. The funny thing is that when we had the open doors, almost nobody left—as opposed to from the locked ward where people constantly tried to run away. We called the open ward the hotel ward.
We did a lot of stuff that was interesting: we encouraged people to become friends, to make plans together, to get out together, to live together, and to work together. In the process of that atmosphere people felt freer to come up with their own ideas. I learned from the people that were hospitalized that we—the staff—are really secondary: 90 percent of the time we stand in the way of people. So I concluded that what we need to learn is (a), get out of the way and (b), facilitate people’s recovery. I don’t like to call it “recovery.” I prefer to say people’s opportunities in the world. My interest wasn’t in therapy. My interest was very social: it was about giving people opportunities to be creative, to make a living, and to start organizations. I really believe it doesn’t matter what diagnosis people have; what’s important is how people live and what kind of chances they have in life. If you support that, people go beyond the expectations that are created by their “diagnoses.”
Farber: And it actually worked?
Dr. Stastny: We did great stuff. We had a federal grant and we developed the first business run by ex-patients, which started in a state hospital in New York, although you could start it pretty much anywhere.
Farber: Thank you. I think it will be surprising for many who read this book to discover that there are psychiatrists like you in America. And they can go to INTAR’s website at www.intar.org.