Recovery From Schizophrenia: Psychiatry And Political Economy

244 TREATMENTthe patient’s illness and guidance as to reasonable expectations for his or herperformance. If the patient’s household is found to be highly stressful, familytherapy should aim to reduce the relatives’ intrusiveness or hostility, and plansmay be made to reduce contact between patient and family or to devise analternate living arrangement.Therapists’ respect for the patient’s individuality and strengths will help meethis or her need for status and independence. Using an unlocked communityfacility encourages staff to find non-coercive ways to protect the patient andothers from hazards arising from psychotic thinking and behavior and poorjudgment. These measures may include increased personal contact rather thanrestraint and distracting recreational activity instead of seclusion. Such methodsmaintain the patient’s own reliance on self-control. Increasing levels ofresponsibility and involvement in the management of the household and concernfor the welfare of other residents gives the patient a useful social role and a senseof personal value to others.In short, aside from a lessened emphasis on stern paternalism and an increasedemphasis on family relations, these treatment approaches attempt to recreate theprinciples of moral management as practiced at the York Retreat.SUMMARY• Antipsychotic drug treatment may have a negative long-term effect on peoplewith a good-prognosis form of schizophrenia.• Long-term treatment with the standard antipsychotic drugs creates dopaminereceptor supersensitivity, worsening the dopamine dysregulation which is anunderlying biochemical deficit of schizophrenia.• Withdrawal of the standard antipsychotic drugs may cause a rebound ofsymptoms of schizophrenia to a higher level than would have been the casewithout treatment.• Drug-withdrawal studies, consequently, may have given an over-optimisticimpression of the benefits of the standard antipsychotic drugs in schizophrenia.• The majority of non-withdrawal studies indicate that people with goodprognosisschizophrenia-like disorders do as well or better withoutantipsychotic drugs treatment.• Stress precipitates psychotic relapse in people with schizophrenia and drugtreatment is less necessary for patients in low-stress settings.• The revolving-door patient has been created by the use of drug treatmentcoupled with a neglect of the psychosocial needs of the person with apsychotic illness.• The new generation of antipsychotic drugs has increased the range of treatmentoptions for people with schizophrenia, but bring new side effects and healthhazards.