Recovery From Schizophrenia: Psychiatry And Political Economy

234 TREATMENTtheir usual drugs or to placebo substitution. Staff and patients were not evenaware that a drug study was in process. After four months the drug-withdrawnpatients were doing equally as well as those on drugs (initially, in fact, the drugwithdrawnpatients had responded more rapidly to the treatment program). 43 Bythe end of the six-year experimental program, 85 per cent of the people withschizophrenia in psychosocial treatment were still off drugs. 44 Why was drugwithdrawalsupersensitivity psychosis not a problem with these patients? Perhapsbecause, in this instance, they were generally taking only moderate to low doses ofmedication before withdrawal.Research cited earlier in this chapter—William Carpenter’s study at the NationalInstitute of Mental Health, Loren Mosher’s Soteria House, Luc Ciompi’s SoteriaBerne and Lehtinen’s Finnish study—has demonstrated that the same observationholds true for many young people with acute psychosis. Active, individualized,psychosocial treatment programs render antipsychotic drugs therapy less necessaryfor a substantial number of patients.One prominent study might be seen as conflicting with the general trend ofthis research. The study, by Solomon Goldberg with his associates in the NIMHCollaborative Study Group, found that the relapse rate of people withschizophrenia withdrawn from antipsychotic drugs was greater than that ofpatients who continued the drug treatment. At the time of discharge fromhospital these patients were randomly allocated to either routine outpatient careor to a more intensive program of sociotherapy—major role therapy, acombination of social casework and vocational counseling. The researchers foundthat, overall, the intensive sociotherapy was ineffective. This was because thetherapy helped some patients and hindered others. Mildly ill patients benefitedand more severely ill patients relapsed sooner if they were receiving intensivesociotherapy. 45 Patients taking antipsychotic drugs responded well, but thosetaking placebos had a worse community adjustment if they were in major roletherapy. 46At first glance it appears that these results contradict the evidence for thebenefits of psychosocial treatment in schizophrenia, but on closer examinationthis does not prove to be the case. The psychosocial treatment programs inGordon Paul’s study or on William Carpenter’s research ward or at Soteria Houseor at Soteria Berne were comprehensive attempts to shape a total therapeuticresidential environment in such a way as to maximize the psychotic patients’chances of recovery. Major role therapy, on the other hand, consisted ofoutpatient treatment delivered to people with schizophrenia living in any one of anumber of community locations. The patients in this “intensive” therapy programwere seen, on average, only twice a month. 47 The main thrust of the therapy wasto urge “the patient to become more respon sible and to expand his horizons.” 48The authors appropriately conclude that the major role therapy was probably toointrusive and stressful for the marginally functioning patients and that its toxiceffect was similar to the influence of the critical and over-involved relatives in the