From inside a locked ward to drug-free living

In part one of this series, we featured the medication-free ward at the Asgard Psychiatric Hospital in Norway, where the staff have been implementing a new way of treating people with severe emotional health problems, including psychosis, mania, and depression, without coercing them to take medication. In 2015, the Norwegian Health Minister ordered the country’s health authorities to create non-drug options; Asgard is just one of several hospitals where patients are given such choices.

Pro-Choice and Pro-Life

Another pro-choice hospital is Blakstad Psychiatric Hospital, located on the banks of a fjord in southeast Norway, near the border with Sweden. Blakstad was a pioneer of a different mental health approach, introducing what it calls Basal Exposure Therapy (BET) in the year 2000.

Dr. Didrik Heggdal, who created the BET model, calls it an “alternative to coercion and control in suicide prevention,” and the unit at Blakstad has not shied away from taking the most vulnerable patients and treating them without mind-numbing medication. Many of those admitted to the BET program have been in and out of psychiatric hospitals for years and have taken multiple psychiatric drugs, without any apparent benefit (and with plenty of harm done). Robert Whitaker, who visited Blakstad, notes that the BET program has primarily been used by people categorized as “treatment resistant” and that Blakstad offers them what many see as their last shot at achieving a measure of normal life.

Many have exceeded expectations. One of them is Caroline, 30 years old and in the “psychiatric system” since the age of 10. Over the ensuing 20 years she experienced admissions to psychiatric wards, dozens of different drugs (antipsychotics, antidepressants, and benzodiazepines) and their adverse effects, and made multiple suicide attempts.

At Blakstad, Caroline realized that the message she had always been given, that “emotions were not allowed,” was not only wrong but extremely damaging. Today, she is moving toward a life that is alive, full of feelings, and absent of drugs.

I have just one goal, and that is to not merely exist. It is to live with everything that being alive involves, with every emotion. I want to be able to experience these emotions, and be a whole human being.

Caroline is still tapering off her drugs and, more critically, as Whitaker notes, “learning to confront her many existential fears.”

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Learning how to exist without fear

Basal Exposure Therapy, along with the support of Blakstad staff, is what has enabled Caroline to make such great strides. BET is based on the concept that serious emotional disturbances are “sustained by avoidance behavior,” as Heggdal describes it. He pays little heed to formal diagnosis and instead focuses on the source of anxiety and ways to overcome it.

The people he helps feel under near-constant threat of “existential catastrophe,” Heggdal says. They have learned to avoid certain situations or environments, fearing that they could become “engulfed by total emptiness or stuck in eternal pain.” Over time, their lives become more restricted due to their fears, and they simultaneously become more consumed by anxiety, spiraling downward in a self-reinforcing loop of avoidant behavior.

BET, by treating these patterns as phobias, counters the feedback loop with gradual and repeated exposure. Over time — treatment usually takes around 6 months — patients learn that they can actually survive the dreaded encounters and that their anxieties about disintegrating into nothingness “are not real.” This is how lasting healing begins.

Using a drug-free regimen, or as near to one as possible, is a critical part of the process, because the drugs numb feelings and suppress the phobic sensations that patients have spent years of their lives running away from. At Blakstad, patients are helped to taper down the drugs they have been taking, and those who want to stop entirely are also helped to achieve this goal.

Treating the ‘treatment-resistant’

As at Asgard, the Blakstad unit believes in granting a large measure of freedom to those being treated. However, their patients are almost all extremely suicidal with severely disturbed behavior patterns, and therefore a locked ward is necessary for their protection. Within the ward, however, control over the patients’ lives is kept to a minimum. Restraints are never used and drug treatment is never coerced.

Heggdal stresses how important this is for giving people back their sense of agency, especially considering that these are largely people who have been controlled by psychiatrists and psychiatric drugs for much of their lives.

We give the patient freedom. The level of control is extremely low at the ward. We treat the patient as an adult, as an equal and with the respect for a person who is there to work with himself or herself. We are there to assist them in this work with themselves. And when we do this,they mobilize their resources. We shouldn’t be surprised.

Indeed, the results confirm his confidence in the approach. In 2018, Heggdal and colleagues published a study of the first 33 people treated using BET, all of whom had been written off as “treatment resistant” prior to their arrival at Blakstad.

In a comparison o the 16 patients who had ceased all psychiatric medication entirely, with the 17 who were still taking drugs, the 16 who were drug-free were all higher functioning. They also had lower re-hospitalization rates and much higher full-time employment rates — 56 percent versus just 6 percent.

Furthermore, 7 people in the drug-free group had made what the study defined as a full recovery (as opposed to none in the group of those still on medication). Among those who had succeeded in coming off medication were 9 who had been taking antipsychotics and 7 who had been taking “mood stabilizers.”

The researchers concluded:

Former patients who had undergone basal exposure therapy and were drug-free at follow-up at least two years after discharge had significantly better psychosocial functioning and showed a more positive development in terms of their ability to work and live at home unaided than those who continued to use psychotropic drugs. Fewer of those who were drug-free had been readmitted or remained in contact with mental healthcare institutions.

Don’t run from pain — learn from it

Heggdal notes that one of the main obstacles to genuine recovery is a mistaken view of what life should look like. Too many doctors fall into the same trap and think that their job is to rescue their patients from distress — and if that means drugs to numb the pain of life, then they don’t see the problem in that.

The World Health Organization defines health as the “absence of pain,” which is absurd. If you buy that definition, you’ll soon find yourself in a lot of trouble.

Curiously, officials at the WHO actually admire the BET program and have singled it out as an object of emulation on several occasions. In particular, they have praised the fact that it “requires people to take responsibility for their own choices” and they approve of its “non-coercive practices.”

In 2023, the WHO together with the United Nations Office of the Commissioner on Human Rights jointly published a document titled, “Mental Health, Human Rights, and Legislation.” In it, the authors note that,

Coercion can inflict severe pain and suffering on a person, and have long-lasting physical and mental health consequences which can impede recovery and lead to substantial trauma and even death. Moreover, the right to independent living and inclusion in the community is violated when coercive practices result in institutionalization or any other form of marginalization.

Commenting on BET in an evaluation of what the therapy offers, the WHO wrote that,

A growing body of evidence demonstrates that the use of coercion in treatment can be reduced by as much as 97% and that service users’ quality of life and psychological and psychosocial functioning can be significantly improved. A retrospective study from 2017 found individuals who used the [BET] service had fewer admissions to psychiatric and general hospitals in the 12-month period after discharge from BET, compared with the 12-month period before admission.

The WHO also noted that the cost of treatment in a BET unit is between 30 and 40 percent less than in other similar units that use standard models of care. Perhaps most significantly, they point out that “graduates” of BET recover their lives to the extent that they marry and establish families on healthy footings:

One qualitative study of service users at the BET Unit found that participants displayed less symptoms, a significantly improved level of functioning, and re-established connections with their families. Some even started their own families, and were engaged in education or work. Some stopped using medication altogether.

Several users of the BET service have participated in qualitative studies and reported experiencing a normal life. As one service user recounts, "I had been told: ‘You have a serious mental disorder that can’t be cured. You have to rely on medicine for the rest of your life.’ And so, I went to the BET Unit, and got discharged without any diagnosis, with no medication, without anything.”

In the final part of this series, The Gold Report will feature the remaining few medication-free psychiatric wards in Norway and examine why the country is halting this experiment in genuine healing, despite its striking successes.

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The information contained in this article is for educational and information purposes only and is not intended as health, medical, financial or legal advice. Always consult a physician, lawyer or other qualified professional regarding any questions you may have about a medical condition, health objectives or legal or financial issues. ‍If you are struggling with suicidal thoughts, you can call a qualified free mental health helpline or seek help from a qualified therapist.