Recovery From Schizophrenia: Psychiatry And Political Economy

ANTIPSYCHOTIC DRUGS: USE, ABUSE AND NON-USE 229treatment. 27 Why should the placebo-users in Schooler’s NIMH study have had asuperior outcome? One possibility is that there were more good-prognosispatients admitted to that study than to Pasamanick’s. The subjects in the NIMHstudy typically had a number of good prognostic features—the illness was at anearly stage, the onset had been acute and later in life, and many of the patientswere currently or previously married. 28The Soteria ProjectAnother immediate assignment study of treatment in schizophrenia is well worthexamining—the Soteria Project. Under the direction of psychiatrist LorenMosher (at the time Chief of the Center for Studies of Schizophrenia at NIMH)and social worker Alma Menn, this project set out to compare the effectiveness ofa non-medical, psychosocial treatment program for people experiencing their firstepisode of schizophrenia with the drug-oriented treatment of a communitymental health center. Acutely ill patients who had previously had no more thantwo weeks of inpatient psychiatric treatment were arbitrarily assigned totreatment in a short-stay inpatient unit followed by outpatient aftercare or to SoteriaHouse, a home for up to six patients in the community staffed by nonprofessionals.Patients in the standard community mental health center programspent a much shorter time in their initial period of residential (hospital) care—onemonth compared with five-and-a-half months of residential care for Soteriapatients. Whereas all the mental health center patients were initially treated withneuroleptic drugs, only eight per cent of Soteria patients received such therapy.Follow-up, two years after admission, showed that the outcome for Soteriapatients compared quite favorably with that of the people with schizophreniatreated by the community mental health center.The overall levels of psychopathology in the two groups of patients were notsignificantly different at follow-up.“Our data,” suggest Mosher and Menn, “indicate that antipsychotic drugs neednot be used routinely with newly admitted schizophrenics if a nurturant,supportive psychosocial environment can be supplied in their stead.” 29 The