Recovery without medication: choice, not moral superiority

We feel that it is important to provide a response to the commentary by Dr Feeney (Feeney 2009) on our article in the May issue of Advances (Calton 2009) and to make our position absolutely clear. Given the many difficulties associated with use of antipsychotic medication (that Feeney himself readily accepts), we do believe that recovery with minimal or even no medication, where possible, is preferable. However, this does not mean that this is a ‘morally superior’ position, nor indeed, as Feeney implies, that people who take medication are somehow ‘morally inferior’. Far from it. We are fully aware that medication is often necessary, given the context and preferences of the individual. Indeed, we have the utmost respect for people who make an informed decision to take medication and we refute absolutely the suggestion that we would feel otherwise. Dr Feeney should not confuse a personal view relating to the experience of taking powerful psychotropic medication (‘chemical sanitation’) with a moral imposition of these views on others. Our concern, however, is that people often take medication not from a position of informed choice, but because of coercion or a lack of alternatives.

We wonder whether Dr Feeney is being rather disingenuous when he claims that he (and the psychiatric profession as a whole) work holistically with people's ‘informed choices’, when he believes that the effectiveness of medication for treating psychosis is ‘beyond dispute’. This ‘holistic approach’ to the treatment of psychosis appears to be predicated on the presumed necessity of medication. It is hard to see how Feeney and his colleagues do not impose this ‘personal view’ on patients. Therefore, to our minds, this practice does not support the option – and informed choice – of recovery with minimal or no medication. This is because true informed choice is possible only if viable alternatives exist within which to exercise these choices. The purpose of our article was to draw attention to the existence of such alternatives. Such recovery without these facilities (as in the UK at the present time) is currently possible only through luck or the good fortune of having an unusually robust network of support. We – along with large sections of the service user/survivor movement, who have long advocated for non-medical crisis services – do not believe that this is good enough.