Excerpt From Anatomy of an Epidemic

(Below is an example of just one of the long-term mental health outcome studies reviewed by author Mark Whitaker in his new book, Anatomy of an Epidemic. It is just one of 16 major outcome studies conducted and reported in the scientific literature from 1990 to 2008. These and dozens more appear in his book going back to 1950. This abstracted piece below was prepared by William R. Benedict and he is responsible for any errors or mistakes in this summary.)


Fifteen Year Long-term Schizophrenia Outcome Study
by Martin Harrow at the University of Illinois College of Medicine
From 1975-1983 Harrow enrolled 64 young schizophrenics in a long-term study
Funded by the National Institute of Mental Health.

In 2007 Dr. Harrow published a report on the patients’ fifteen-year outcomes in the Journal of Nervous and Mental Disease, and he has further updated this review in his presentation at the APA’s 2008 meeting.

In order to have an economically diverse sample he recruited his patients from two Chicago hospitals. One was private and the other public. Ever since then he has regularly assessed how well they are doing.

Are they symptomatic?
Are they in recovery?
Employed?
Do they take antipsychotic medications?

His results provide an up-to-date look at how schizophrenic patients in the United States are faring.

Hypothesis – If the conventional wisdom is to be believed, then those who stayed on antipsychotics should have had better outcomes. Conversely, if the scientific literature reviewed in Whitaker’s work is to be believed, then it should be the reverse.

Here are Dr. Harrow’s findings which were published on his fifteen-year outcomes in the Journal of Nervous and Mental Disease, and further updated in 2008 at the APA’s annual meeting.

Findings at the end of two years:

The non-antipsychotic group were doing slightly better on a global assessment scale than the group on the drugs.

Findings at the end of two and half more years or at 4.5 years - the group not on antipsychotics were now doing dramatically diverging from the group still on drugs. Now the off-med group began to improve significantly, and now 39 percent of this group were in “recovery” and more than 69 percent were working.

In contrast, outcomes for the medication group worsened during this same period. As a group their global functioning declined slightly, and at the 4.5-year mark, only 6 percent were in recovery and few were working.

Stark divergence in outcomes remained for the next ten years.

Findings at the fifteen-year follow-up - 40 percent of those off drugs were in recovery, more than half were working, and only 28 percent suffered from psychotic symptoms.

In contrast, only 5 percent of those taking antipsychotic were in recovery, and 64 percent were actively psychotic.

Dr. Harrow’s conclusions were:

“I conclude that patients with schizophrenia not on antipsychotic medication for a long period of time have significantly better global functioning than thus on antipsychotics,” Harrow told the APA audience in 2008.

Analysis of the findings – Indeed, it wasn’t just that there were more recoveries in the un-medicated group. There were also fewer terrible outcomes in this group. There was a shift in the entire spectrum of outcomes. Ten of the twenty-five patients who stopped taking antipsychotics recovered, eleven had so-so outcomes, and only four (16 percent) had a “uniformly poor” outcome. In contrast, only two of the thirty-nine patients who stayed on antipsychotics recovered, eighteen had so-so outcomes, and nineteen (49%) fell into the “uniformly poor” camp.

Medicated patients had one-eighth the recovery rate of un-medicated patients, and a threefold higher rate of faring miserably over the long term.

This outcome's picture is revealed in an NIMH-funded study, the most up-to-date one we have today. It also provides us with insight into how long it takes for the better outcomes for non-medicated patients, as a group, to become apparent. Although this difference began to show up at the end of two years, it wasn’t until the 4.5 year mark that it became evident that the non-medicated group., as whole, was doing much better.

Furthermore, through Harrow’s rigorous tracking of patients, he discovered why psychiatrists remain blind to this fact. Those who got off their anti-psychotic medications left the system, he said. They stopped going to day program they stopped seeing, therapists, they stopped telling people they had ever been diagnosed with schizophrenia, and they disappeared into society.