Recovery From Schizophrenia: Psychiatry And Political Economy

232 TREATMENTDrug treatment and social treatments are not alternatives but must be usedto complement each other. The better the environmental conditions, theless the need for medication: the poorer the social milieu, the greater theneed (or at least the use) of drugs. 36A number of pieces of research support this point of view.A series of projects conducted through the Medical Research Council SocialPsychiatry Unit in London has shown that the relapse rate is higher in peoplewith schizophrenia who return home to live with critical or over-involvedrelatives than in those (the majority) whose relatives are more supportive and lesssmothering. The relapse rate in the patients living in the more stressful householdsis reduced by two factors: (a) restricting the contact between patient and relativesto less than 35 hours a week and (b) using antipsychotic drugs. For patients livingin the low-stress families, however, the relapse rate was found to be lowregardless of whether the patients were taking medicine or not. Figure 10.2illustrates the nine-month relapse rates for 128 people with schizophrenia (71 fromlow-stress homes and 57 from high-stress families)—the combined subject groupsfrom the two studies. 37 The rate of relapse among patients living in low-stresshouseholds and taking no medication can be seen to be several times lower thanthe rate for those who are exposed to a high-stress environment for much of thetime even when these patients are protected by medication.In a later (two-year) follow-up of one of these groups of patients, psychiatristJulian Leff and psychologist Christine Vaughn found that drug treatment dideventually appear to be of some benefit to the patients in low-stress homes. Theresearchers speculated that the drugs were of value in protecting these patientsagainst additional sources of life-event stress (e.g., job loss) to which they wereexposed independent of the fact that their home environments were warm andsupportive. 38 Dr Leff and Dr Vaughn had demonstrated in an earlier piece ofresearch that relapse was unavoidably common in people with schizophrenialiving in high-stress homes but that relapse in patients in low-stress homes wasonly likely to occur if they were subjected to additional independent stressfulevents. 39 One may conclude from these findings that antipsychotic drugs are lessnecessary for people with schizophrenia living in environments that are bothsupportive and also somewhat protective in warding off unpredictable stresses.The therapeutic effect of a warm and non-critical relative has beendemonstrated in two further studies carried out by the same group of researchers.Heart rate and skin conductance tests showed that people with schizophrenia hada higher level of arousal than healthy individuals, irrespective of whether thepatients were living in high-stress or low-stress households. This heightened levelof arousal dropped to normal in a person with schizophrenia when in thecompany of a non-stressful relative but continued at an elevated rate when in thecompany of a critical, over-involved relative. The finding held true for bothpatients in acute psychosis 40 and those in remission. 41 The neuroleptic drugssimilarly are known to decrease the level of arousal in people with schizophrenia