Recovery From Schizophrenia: Psychiatry And Political Economy

228 TREATMENTresearchers differentiated good- and poor-prognosis patients by means of thePremorbid Asocial Adjustment Scale. On rating the patients after six weeks oftreatment the investigators found that chlorpromazine was more beneficial for thegood-prognosis than for the poor-prognosis patients.From the standpoint of this analysis, however, the Klein and Rosen study hastwo flaws. In the first place, it is not a follow-up study. It gives only the outcomeof six weeks of treatment and has no bearing on whether drug-induced dopaminesupersensitivity has a detrimental effect on the long-term course of schizophrenia.It therefore stands in contradiction to Goldstein’s short-term studies only, and isunrelated to the findings of the research teams of Rosen and Engelhardt,Rappaport and Carpenter. Secondly, the research design itself was biased againstrecovery in the good-prognosis patients. The research sample was composed ofpatients who were referred to the drug study after they had failed to improve inmilieu (drug-free) treatment and psychotherapy. This selection procedure wouldautomatically weed out the patients who could be expected to do well in drugfreetreatment. 24May and associatesA number of studies may be found in the literature that, while not preciselyfitting the criteria established for this analysis, nevertheless yield usefulinformation. Philip May and his colleagues, for example, in a four-year follow-upof over 200 first-admission patients with schizophrenia showed that 59–79 percent of patients recovered in various drug-free treatments (includingpsychotherapy and electroconvulsive therapy) and that the successes from suchtreatment (presumably good-prognosis patients) did as well in the long term aspatients who were initially treated with antipsychotic drugs. 25Schooler and associatesNina Schooler and her co-workers made a similar finding in another immediateassignment drug study of a large sample of patients with schizophrenia conductedthrough the US National Institute of Mental Health. In a followup of thedischarged patients one year after leaving hospital the researchers were surprised tofind that “patients who received placebo treatment in the drug study were lesslikely to be rehospitalized than those who received any of the three activephenothiazines.” 26Pasamanick and associatesWe should recognize, however, that there is another immediate assignment studythat does not discriminate good-and poor-prognosis patients—BenjaminPasamanick’s comparison of outcome of drug-treated and placebo-treated patientsin home care—and that this report does not show a long-term benefit to placebo