Recovery Protocol- Part 2

The Problem of “Treatment Resistance”

Medically defined, “treatment resistance” is acknowledged when, at minimum, at least two or more medications, at a prescribed dose, for a specified diagnosis and duration, have been employed multiple times but are not achieving the desired outcomes. There are five chief reasons for “treatment resistance” on the psychiatric side of the equation as seen through the Citizen Psychiatry lens:

1) poor drug tolerance due to toxic effects
2) low efficacy of medications (poor medication effectiveness)
3) a person’s recovery mindset is not taken into account
4) medication inability to address other bio-impacting players, contributing to the life of the mental illness
5) misdiagnosis leading to prescribing inappropriate medications

For many consumers in treatment, these reasons listed often lead to poor adherence to taking the medication as prescribed or the cessation of drugs altogether. With “The Recovery Protocol Breakthrough”, a high priority is placed on addressing factors 3 and 4, which feed “medication resistance. ” Attending to these two factors alone can give life to pursue a “personal recovery,” especially when one is languishing. As for poor drug tolerance and low efficacy of medications, their impact on a person’s psyche can and does lower the capacity of a person to activate recovery. While this may be the case until the best, least harmful medications are found, the recovery path can still be pursued with “The Recovery Protocol Breakthrough.” This is also the case with misdiagnosis impacting medication returns. The power to recovery lies with the person and not the medication or diagnostic label.

“Treatment Resistance” is Psychiatry’s silent epidemic.”

From, The Journal Molecular Psychiatry, Pub. July 13th 2021, states that in the US, for example, poor treatment response reportedly ranges widely from 20-60 percent of the population receiving psychiatric treatment. Do you feel you belong to this camp?

In the article, The Challenge of Presenting Antidepressant Risks and Benefits, from Mad in America, Science, Psychiatry and Social  Justice, November 7, 2023, the following was reported showing placebo ( belief set) response for depression on average is 35-40% while with antidepressants (chemical response) is only 42-53%, a random chance of change by medication. Can you live with a 50/50 chance, a toss of the die?

From the Journal of Affective Disorders, April 2021, Evaluating Dimensional Approach to Treatment Resistance in Anxiety Disorders: A two-year follow-up study reports that 30-60% of anxiety disorder patients have inadequate treatment response. Where does this leave consumers?

“Pill Taking” as the Savior
While psychiatry has touted the revolutionary impact of medications, it is well known, in their back rooms, institutionally, that psycho-active drugs have marginal efficacy and are relatively no more effective, overall, since coming on the scene in the 1950s, even though there is a plethora of more innovative drugs lining the prescription shelves. As well, the medications generated today are born from a very narrow and thin theory of mental illness. According to psychiatry, the faulty functioning of neural messengers, called neurotransmitters, are the sole and only culprits for the emergence of major mental illnesses like depression and anxiety disorders and their treatment. This thin view, however, flies in the face of other salient psychosocial and biological variables associated with each person’s mental health illness, which keeps the condition strong and influential.

Psychiatry, in adopting the neurotransmitter model in the 1980s, has built the myth that only neurotransmitter dysregulation, whether serotonin (neurotransmitter) impairment connected to depression treated with Prozac or dopamine (neurotransmitter) dysfunction said to be involved with ADHD treated with Ritalin, can account for the biological reasons for the emergence and sustaining of major mental health disorders.  This means that medications involved with “treatment resistance” are missing the mark by not attending to known psychosocial and bio-factors at play, thus inadvertently sustaining the grip, influence, and strength of mental illnesses unnecessarily. With this understanding, the number four factor listed as contributing to “treatment resistance” are addressed by this program.

Currently, “Pill taking” enforced by psychiatry as the sole instrument to produce change is ineffectual in promoting “personal recovery” but can induce a chemical recovery, where the dampening of symptoms may allow a lift to carry on with living, limping or not.

-The institution of psychiatry, as far back as the 1950s, touted the arrival of psychopharmacology drugs to wrestle mental illnesses to the ground. The results are in and not what consumers nor psychiatry expected.

The Launch
The inherent limitation of therapeutic drug response in psychiatry weakens a person’s confidence in “Pill” taking to pull off a “personal recovery.” This resulting impact, seen today, depletes the strength of an individual’s recovery mindset and dims the drive for recovery immensely, especially when a person is experiencing “medication resistance.” This is where “The Recovery Protocol Breakthrough” enters the equation as the ‘x’ factor required to address the impact of diminished recovery returns. For a recovery to take hold, it needs a meaningful personal vision and mission.

-Recovery does not occur in a vacuum. It requires something with meaning and purpose (Deegan, Patricia Ph.D., 2009 lecture)-

The prevailing view held in psychiatric medicine that drug use alone can create a recovery has been rebuffed by recovery research since the 1980s. We find consumers are gravely disappointed with hanging on to psychiatry’s promise with “Pill” taking as the answer. By applying our recovery equation, the promise of making a recovery comes alive once more.

Between the 1950s and the 1960s, the launch of the neurochemistry drug model was hailed as a breakthrough that drug manufacturers saw as a profit-making bonanza until it was adopted in the 1980s. The promise to consumers by psychiatry and drug makers was on how major mental illnesses could finally be wrestled to the ground. What captured everyone’s imagination was the idea of human ingenuity and technology offering a technological breakthrough for solving mental disorders of the mind. And indeed, this was a very exciting time. The value of technology in solving human problems was gaining momentum, especially with the many outstanding achievements at that time, such as the discovery of penicillin and immunizations.

As with anything technologically new that captivates the imagination of the public, policymakers, government, and institutions, the call to charge ahead was given for medication use as the first line of treatment, even in light of Nobel laureate in chemistry Linus Pauling, in 1968, announcing to the psychiatric community and world, that taking the proper nutrients contained in foods, in optimal amounts, can correct mental illnesses trajectory for the better. However, for psychiatry and drug manufacturers, there is no proprietary and patentable value in nutrients, nor is this discovery considered a technological marvel.

Instead, this complementary pathway, Linus Pauling, called Orthomolecular Psychiatry, now known as Integrative, Functional, or Nutritional Psychiatry today, is considered a fringe discipline outside mainstream institutional practices. Mainstream psychiatry actively disavows to the public and intern training programs the connection between mental illness and diets consumed. However, this program considers nutrients, diets, and eating behaviors as recovery care factors.

The demand for treatment has increased since the 1950s as the machinery of psychiatry touted medication’s effectiveness as the holy grail. However, the results are in, and the data is disappointing. Upon review by researchers, some decades later, the “Pill” revolution can be considered a “whimper” and not the “bang,” as promised. The question that is unanswered to date is why the promise of medications, as the first line of treatment, has not been powerful enough to stem the tide of “treatment resistance?” A clue to this answer came from a set of remarkable studies that, in hindsight, was a premonition to what happens with a continued reliance on medication as a first line of treatment, a “pill first policy.”

Starting in the 1960s, the World Health Organization conducted the most extensive multi-national longitudinal study to assess schizophrenia in both developed and underdeveloped nations. What was an unexpected and startling set of findings led to a most comprehensive examination and follow-up on recovery rates of people living with persistent schizophrenia between industrialized nations holding a drug-first policy and developing nations with low to middle incomes that have the least access to drug treatment. The initial research findings were rebuked and questioned at first. Subsequent findings, however, validated the previous studies. The following journal article highlights some main findings, “What did The WHO Studies Find,” Schizophrenia Bulletin, Volume 34, Issue 2, March 2008, Pages 253–255, Published: 18 January 2008,

While high rates of complete clinical remission were significantly more common in developing country areas (37%) than in developed countries (15.5%), the proportions of continuous unremitting illness (11.1% and 17.4%) did not differ significantly across the two types of setting. Patients in developing countries experienced significantly longer periods of unimpaired functioning in the community, although only 16% of them were on continuous antipsychotic medication (compared with 61% in the developed countries).

In his book, “Magic Bullets, Psychiatric Drugs and The Astonishing Rise of Mental Illness in America,” Robert Whitaker, an investigative journalist, unearthed the facts known in the backroom halls of psychiatry. Whitaker points out that statistically, though more and more people have been getting access to psychiatric treatment in the US, the number of adults on government disability due to mental health disorders has more than tripled since 1987. In essence, reliance on a drug-first strategy for long-term recovery alone is least effective when drugs are only the change agent.

Consider this clue, as well. The steep rising rates of depression over the past several decades are occurring despite the billions of millions of dollars spent on research, volumes of research published, and the plethora of smarter, cheaper anti-depressants now available. The World Health Organization has now considered depression as the single most significant contributor to ill health worldwide.

What has transpired since the 1950s, with the “Pill” culture within the walls of The Treatment Room, is how the oxygen expended is almost entirely taken up by the focus on symptoms, the diagnosis, symptom management, and drug response, which caters to and supports medication as the sole provider of treatment. Here, the “Person” as an agent of change possesses little to no value or airtime as the magic of medications is deemed all one needs. Also, because of the trimming of time consumers have in the clinical room, the opportunity to bring the “Person” into the treatment equation becomes an exception vs the rule. These influential factors benefited the public purse of the state, which saw quicker turnaround times and prescriptions of these drugs, allowing patients to carry their treatment home rather than be housed at taxpayer cost, as was the case before the turn of the 1900s till the 1960s.

However, to continue accommodating the tight timeline within the psychiatrist’s office, the clinical culture with the patient required a one-directional approach to treatment where only one expert in the room mattered, that of the psychiatrist. This removed a) a collaborative approach to treatment- a fundamental recovery principle where two experts are present in the room and 2) what the person brings as an agent of change. This meant the diagnosis reigned in visibility, relegating the person to being seen as a passive recipient of care with nothing to contribute other than being good “Pill” swallowers.  In effect, consumers were not considered agents of change outside of offering feedback, presenting historical information, and becoming well-polished “Pill” takers. As a result, a different form of culture grew within the Treatment Room, where a formulary of interaction became the practiced norm to support the demand for a fast drive-through treatment model. Over the decades, this formulary evolved and became entrenched in supporting a medication-first policy and subsequently found its way into other helping disciplines in mental health, unknowingly.

The Formulary
Over time, with the medications taking center stage, the relational posture and culture of The Treatment Room came to support this movement. This treatment culture influenced the formulary practices of helping disciplines that provide services to consumers struggling with mental health conditions, like psychotherapy and psychology.  Click here to view the Formulary of Care Guidelines.  These formulary standards offer little to no breathing space to massage “Agency” and “Hopefulness” connected to fostering a stronger recovery mindset.

The Framework of Recovery Orientation provides an antidote to those formulary standards. In recovery, when a “recovery person first” position is given life in The Meeting Room, people bring to bear what is working right for them along with their personal resources such as abilities, purposes, skills, values, strengths, connections, community, family, interests, and passions. Recovery research to date has shown that this impact paves the way to greater empowerment tied to making a “personal recovery” a reality. This regenerative work cannot take flight within the existing formulary framework with mainstream service providers.

Continue to The Recovery Protocol Part 3 – Click Here