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Question:
In an article called "Mental Illness May Be Damaging to Your Brain" (Journal of Clinical Psychiatry, July 1997), Dr. Stephen Stahl cites evidence that the long-term administration of anti-psychotic drugs may serve a "rescue role" for the patient by limiting neuronal damage caused by the acute phases of the illness: "For example, the ability of anti-psychotics to prevent future psychotic breaks appears to arrest the downhill course of schizophrenia."

Conversely, panelist Robert Whitaker has cited evidence that the continued use of anti-psychotic medications may actually be harmful to the brain, making a patient's long-term prospects worse. My question is the one that Mr. Whitaker himself posed in his USA Today article: "Do the medications we use to treat schizophrenia promote long-term recovery -- or hinder it?"

David Jeffreys
State College, Pennsylvania


Answered by Robert Whitaker:
This is the question that I've explored in other forums (my book Mad in America, and the USA Today column), and there is not much I can add here to what I wrote in those places, in terms of trying to answer it. But I do believe that this is a question that we desperately need to investigate and study with an honest, open mind.

The World Health Organization twice found that outcomes in developing countries, where drugs are much less frequently used, were much better than in the U.S. and other developed countries. That is an incredible failure, and it seems to me that as we go forward we have two choices: We can ignore this failure, and simply keep on telling ourselves that we have made great progress in understanding the "biology" of schizophrenia, and how we are developing ever better medical treatments for it. Or we can try to understand this failure, and try to understand how our medical paradigm for treating schizophrenia -- constant medication for all people so diagnosed -- may have contributed to it. And if we take this second path, then hopefully we could make changes in our care that would lead to an improvement in outcomes, such that recovery rates here equalled those in India, Nigeria, and Colombia. That is a goal that I would think we would all want to achieve.

[For more on the World Health Organization studies and opinions on the efficacy of anti-psychotic medications, browse related questions and answers in this forum.]


Robert Whitaker


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