Recovery From Schizophrenia: Psychiatry And Political Economy

ANTIPSYCHOTIC DRUGS: USE, ABUSE AND NON-USE 227“Antipsychotic medication is not the treatment of choice, at least for certainpatients, if one is interested in long-term clinical improvement.” 22Carpenter and associatesPatients with good-prognosis schizophrenia, a record of adequate prior work andsocial functioning and a short history of illness were selected for a studyconducted at the US National Institute of Mental Health by William Carpenterand his associates. The 49 patients were treated with or without neurolepticmedication at the discretion of their psychiatrists—the assignment to drugtreatment was fairly arbitrary but not random. The two groups were equivalent intheir prognostic ratings and had similar initial clinical characteristics. At one-yearfollow-up the patients in the drug-free treatment group demonstrated a morebenign course in a number of ways:Patients receiving drug treatment in hospital were also significantly more likelyto suffer a postpsychotic depression.The research team who conducted this studyraise the possibility that antipsychotic medication may make someschizophrenic patients more vulnerable to future relapse than would be thecase in the natural course of their illness. Thus, as with tardive dyskinesia, wemay have a situation where neuroleptics increase the risk of subsequentillness but must be maintained to prevent this risk from becomingmanifest. 23Klein and RosenOne study alone that fits the criteria of (a) immediately assigning patients to adrug-free or drug-treatment category and (b) distinguishing good-prognosispatients, fails to support the picture drawn by the research cited so far. DonaldKlein and Bernard Rosen at the Hillside Hospital, New York, randomly assigned88 inpatients with schizophrenia to chlorpromazine or placebo treatment. The