For those of you not familiar with Mad in America (MIA), it is a US organization begun by journalist Robert Whitaker. He is the author of books that are highly critical of modern psychiatry and its reliance on medication particularly for schizophrenia. As they say on their website they “investigate the problems and deficiencies with the current drug-based paradigm of care.”
I happened to come across this announcement on their site: “In World Psychiatry, two Canadian psychiatrists argue that the body of scientific evidence about schizophrenia shows that it is not a progressive illness and therefore we should have much higher expectations of full recoveries than we do.” I was intrigued because one of the authors of this study is Dr Robert Zipurski of McMaster University in Hamilton, Ontario.
Once before, MIA cited a study by him that used quotes selectively. They implied that Dr Zipurski provided proof of the evils of antipsychotic medication. Their website stated “decreases in brain tissue volumes are attributable to antipsychotic medication, substance abuse, and other secondary factors.” But, a careful reading of that paper found that when people discontinue medication early, the relapse rate is up to 78 per cent compared to 0-12 per cent for those who remain on medication.
MIA did not provide its own interpretation of this current paper which Dr Zipurski wrote with Dr Ofer Agid of the Centre for Addiction and Mental Health in Toronto. The two authors continue from the previous paper mentioned above and point out that:
Relapse of psychotic symptoms following a remission from a first episode of schizophrenia is also observed to occur in over 80% of individuals when studied naturalistically. This is largely attributable to discontinuation of antipsychotic medication rather than to the effects of an unrelenting disease process. The risk of symptom recurrence in remitted first episode patients receiving maintenance antipsychotic treatment is estimated to be in the range 0-5% in the first year of follow-up, compared to 78% in the first year off medication and close to 100% after three years off medication.
The authors then go on to wonder why outcomes are so poor if people have the ability to remain in remission. The reasons, they say, are numerous including the lack of services for these people or that they refuse treatment. Then, of those who are treated, about 20-30% are treatment resistant to the available antipsychotic medications. Others are non compliant with medication and so have relapses and re-hospitalizations. For others, their concurrent problems with alcohol, drugs, and other mental illnesses mitigate against retained recovery.
They conclude that while “there is room for debate about how recovery should be defined, it should be clear that most individuals with schizophrenia have the potential to achieve a stable remission of symptoms and substantial levels of satisfaction and happiness.”
That stability, they say, can be achieved with antipsychotic medication. Physicians/scientists/psychiatrists who observed that this dementia praecox or group of schizophrenias appeared to be a progressive disease were observing people with this illness pre 1960 before anti-psychotics were available – they were not wrong or overly pessimistic as there were no effective treatments at the time.
And it does take time for science to recognize that if someone begins antipsychotics at about age 19 and remains on them along with good medical care, that they can get to old age and remain stable or even improve.
It is encouraging to see MIA recognizing the importance of drug treatment by their promotion of this paper.