BACKGROUND
On March 19 of this year an article by Martin Harrow and Thomas Jobe was published in the Schizophrenia Bulletin: Does Long-Term Treatment of Schizophrenia with Antipsychotic Medications Facilitate Recovery? You can see it here. The term “antipsychotics” embraces drugs such as Haldol, Risperdal, Thorazine, etc… I prefer the term major tranquilizers, because it is more accurate.
Drs. Harrow and Job have conducted a long-term (15-20 year) study of people diagnosed with the condition known as schizophrenia. They found that individuals who had been given “anti-psychotics” continuously for these long periods showed “…considerable psychopathology and few sustained periods of recovery.”
They also noted that the patients who were untreated (i.e. did not receive drugs) for many years “…showed significantly better outcomes than did those on antipsychotics.”
The authors examined the possibility that the individuals who came off the drugs were better risks to begin with, but they found that some of the “good risk” patients who stayed on the drugs did not show favorable outcomes.
The authors also discuss the finding that when people have been on the drugs for a prolonged period, and then come off the drugs, there is a fairly high relapse rate (25%-55%) within the first 6-10 months. This is usually cited as evidence for the efficacy of major tranquilizers and for the widespread insistence within psychiatry that the drugs need to be taken for life.
MAJOR TRANQUILIZER WITHDRAWAL
Drs. Harrow and Jobe point out that this drugs-for-life position is incompatible with their primary finding – that in the long-term the undrugged individuals do better. So they suggest an alternative explanation for the high relapse rate on discontinuation, namely, that the short-term relapses are essentially a reflection of drug withdrawal. The idea is that the dopamine-blocking action of the major tranquilizers would, over the long-term, cause the organism to produce excess dopamine receptors (or supersensitive receptors). Then, when the drugs are stopped, there is an abrupt and large increase in dopamine activity in the brain which would result in extreme cognitive and overt behavior. In other words, while the major tranquilizers are being consumed, the organism is “trying” to normalize its functioning by making maximum use of what dopamine is available. Then when the major tranquilizers are removed, brain activity increases markedly.
This notion is analogous to the familiar phenomenon of delirium tremens sometimes noted in sudden alcohol withdrawal after prolonged heavy drinking.
The authors call for further long-term research on this topic. Robert Whitaker has written a helpful commentary on the article. You can see it here.
SCHIZOPHRENIA IS NOT AN ILLNESS
My own view is that the condition known as schizophrenia is not an illness, and is not even a coherent unified phenomenon. It arises from a profound and continuous sense of failure which in turn stems from an almost limitless number of reasons, including in many cases childhood neglect and abuse. The individuals embraced by this “diagnosis” probably have only one thing in common: the context in which they find themselves is not rewarding, does not bring them the sense of joy and fulfillment that most of us take for granted. So they, very understandably, withdraw into a world of their own making. They sometimes feel anger and disenchantment towards the world – again very understandably – and their expressions of this anger, often expressed incoherently, bring them to the attention of the authorities. Sometimes they feel apathy and despair, again very understandably.
MAJOR TRANQUILIZERS TRANQUILIZE
Major tranquilizers are not medications. They are what the name says: tranquilizers. They reduce psychotic behavior because they reduce all behavior. And they destroy brain cells. Long-term use of these products has been likened to a lobotomy. Almost all clients find these drugs very difficult to tolerate, and many (perhaps most) eventually stop taking them. But if they do it too suddenly, they can precipitate a withdrawal reaction that is often worse then the presenting problem. A graphic description of this is contained in Jean Davison’s book The Dark Threads.
There is only one genuine “treatment” for this non-illness: help the individual to find a sense of fulfillment in the world by helping him come to terms with the past, and acquire the skills he needs to create a meaningful and fulfilling future. This has to be done with patience, compassion, kindness, and a profound respect for the person’s uniqueness.
Giving a person major tranquilizers, with their truly horrendous long-term effects, and abandoning him/her to the disempowering milieu of the clubhouse or sheltered workshop, is not only unhelpful, it is extraordinarily destructive.