Interpreting Harrow’s 20-Year Results: Are the Drugs to Blame?

Robert Whitaker
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Of all the research that has been done in the past 20 years on psychotic disorders, Martin Harrow’s ongoing study of long-term outcomes in such patients is, in my opinion, the most important work. He and his colleagues have now published their 20-year results. Given the 15-year outcomes data he published in 2007, his latest findings should not be surprising. The schizophrenia and schizoaffective patients who took antipsychotics regularly during the 20 years, compared to those who quit taking the medications (usually within the first two years), experienced more psychosis, more anxiety, and markedly fewer periods of “sustained recovery.”  They were also more cognitively impaired.

The same dramatic difference in outcomes was seen in patients diagnosed with a mood disorder with psychotic features:  those who stayed on antipsychotics fared markedly worse over the long-term.

The psychiatric establishment mostly ignored Harrow’s 2007 report, or tried to explain away his findings. But with the publication of the 20-year results, I think the time has come for psychiatry—and our society—to take a close look at his research, and to try to honestly assess what is going on. A full-bodied inquiry is essential for another reason too: We are now prescribing antipsychotics to an ever larger number of children, and to many non-psychotic adults as well, and if antipsychotics are worsening the long-term outcomes of people with a psychotic disorder, which is the obvious concern raised by Harrow’s findings, then we really need to rethink the use of these medications in those other populations.

Here is a review of the study’s design, and the findings from the two papers.

Study Design

From 1975 to 1983, Harrow, who is a psychologist at the University of Illinois, enrolled 200 people with a diagnosis of schizophrenia or a milder psychotic disorder into his NIMH-funded study, recruiting the patients from two Chicago hospitals. One was private and the other public, as this ensured that the patient group would be economically and ethnically diverse. The enrolled patients had a median age of 22.9 years, and for 46%, this was their first hospitalization. Another 21% of the patients had had one previous hospitalization. Thus, this study largely charted long-term outcomes in patients newly diagnosed, or recently diagnosed, with a psychotic disorder. (See chart).

All of the patients were treated conventionally in the hospital, and then Harrow followed them as their lives unfolded, periodically assessing how well they were doing.  Were they symptomatic? In recovery? Employed? Were they taking antipsychotic medications? Or other psychotic medications? He conducted such reviews at 2 years, 4.5 years, 7.5 years, 10 years, 15 years, and 20 years. At the end of 15 years, he had successfully followed 145 of the 200 patients enrolled into the study, and at the end of 20 years, he had outcomes data for 139 patients. For a long-term study, this is a very good retention rate.

The 15-Year Results

In 2007, Harrow published the 15-year results for the 145 people in the study. Of the 145, 64 were diagnosed with schizophrenia, and the remaining 81 with milder psychotic disorders (schizoaffective disorder, bipolar with psychotic features, and unipolar depression with psychotic features.) Here were his findings:

1. Recovery rates in schizophrenia group

At the end of two years, those who had stopped taking antipsychotics were doing slightly better  on a “global assessment scale” than those taking an antipsychotic. Then, over the next 30 months, the collective fates of the two groups began to dramatically diverge. The off-med group began to improve significantly, and by the end of 4.5 years, 39% were in recovery. In contrast, outcomes for the medicated group worsened during this 30-month period. As a group, their global functioning declined slightly, and at the 4.5-year mark, only six percent were in recovery, and few were working.

That stark divergence in outcomes remained for the next ten years. At the 15-year followup, 40 percent of those off antipsychotics (25 of the 64 patients) were in recovery, compared to five percent of those taking antipsychotics. (To be in recovery, a person had to have no positive or negative symptoms; couldn’t have been hospitalized in the previous year; and adequate work and social functioning.) See charts for recovery rates and for global adjustment.

2. Spectrum of outcomes in schizophrenia group

Harrow divided long-term outcomes for the 64 schizophrenia patients into three categories: recovered, fair, and uniformly poor. Of the 25 patients who stopped taking antipsychotics, 10 recovered (40%), 11 had fair outcomes (44%), and 4 (16%) had uniformly poor outcomes. In contrast, only 2 of the 39 patients who stayed on antipsychotics recovered (5%); 18 had fair outcomes (46%), and 19 (49%) had uniformly pair outcomes. (See chart.)  In sum, medicated patients had one-eighth the recovery rate of unmedicated patients, and a threefold higher rate of faring miserably over the long term.

3. Psychotic symptoms in the schizophrenia group

At the 10-year follow-up, 23% of the patients off antipsychotics were experiencing psychotic symptoms, versus 79% of those still on the drugs. At the 15-year followup, 28% of those off antipsychotics had psychotic symptoms, versus 64% of those on the medications. (See chart).

4. Global adjustment of those with milder psychotic disorders

At the end of two years, those with milder psychotic disorders who got off antipsychotics were doing somewhat better than those on the drugs. This difference in global outcomes became pronounced by the end of 4.5 years, with those off medications doing markedly better, and remained so throughout the 15 years. (See chart.)

5. Global outcomes of all 145 patients

Harrow provided global adjustment data for all four groups in his study: schizophrenia on meds, schizophrenia off psychiatric medications, milder disorders on psychiatric meds, milder disorders off. At the end of 15 years, the global outcomes for the four groups lined up like this, from best to worst: Milder disorders off meds, schizophrenia off meds, milder disorders on meds, and schizophrenia on meds. (See chart.)

6. Global outcomes for schizophrenia patients by prognostic type.

At the start of the study, Harrow grouped his schizophrenia patients into two subgroups: those with a good prognosis and those with a bad prognosis. Although he didn’t provide the global data for these two subtypes, he did report this finding: “In addition, global outcome for the group of patients with schizophrenia who were on antipsychotics were compared with the off-medication schizophrenia patients with similar prognostic status. Starting with the 4.5-year followup and extending to the 15-year follow-up, the off-medication subgroup tended to show better global outcomes at each follow-up.”

Interpreting the 15-year findings: Harrow’s explanation

In his discussion, Harrow noted that it was those with a good prognosis (which was characterized by a stronger internal sense of self,) who were more likely to stop taking antipsychotics, and thus stated that his study had simply identified a subset of schizophrenia patients who could fare well off medication. He did not attribute the poor outcomes in the medicated patients to possible iatrogenic effects of antipsychotics.

Another possibility: The drugs are to blame.

In order to explore whether the antipsychotics may be to blame for the poor outcomes, these questions need to be examined:

a) Is there evidence in the scientific literature that antipsychotics might increase a person’s biological vulnerability to psychosis over the long-term? (The dopamine supersensitivity theory.) If so, is this problem seen in the data that shows the medicated patients were much more likely to still be psychotic at the 10-year and 15-year follow-ups?

b) Nancy Andreasen has reported that antipsychotic usage is associated with a decrease in brain volumes over time, and that this decrease in brain volumes is associated with an increase in negative symptoms and cognitive impairment. Is this effect of antipsychotics showing up in the poor recovery rates for the medicated patients over the long-term? Is this why so few worked?

c) Those with milder psychotic disorders could be expected to have a better long-term course than those diagnosed with schizophrenia. Yet, the schizophrenia patients off meds fared better over the long-term than those with milder disorders on the medications.  If the drugs have long-term iatrogenic effects, wouldn’t that explain this surprising outcome?

d) In the study, there are several subsets of patients that can be identified, including good-prognosis and bad-prognosis schizophrenia patients. Why, in every case, did the off-med group have better global outcomes over the 15-year followup?

The 20-Year  Results

In his current paper in Psychological Medicine (published online), Harrow has grouped his patients in a slightly different manner. He grouped those with a schizoaffective diagnosis, who in the 15-year study had been in the “other psychotic disorders category,” with the schizophrenia patients. There are 70 in this SZ (schizophrenia spectrum) category in his new paper, and 69 now in a “mood disorders with psychotic features” diagnostic group.

Here are the relevant findings from his 20-year report:

1. Psychotic symptoms in SZ group

At the two-year follow-up, about 35% of the SZ group were off antipsychotics, and that percentage remained fairly stable throughout the next 15 years. There was no significant differences in severity of psychotic symptoms between the on-med and off-med groups at two years, but starting with the 4.5-year followup and continuing through year 20, those “who were not on antipsychotic medications were significantly less psychotic than those on antipsychotics.”

2. High anxiety in SZ group

At the two-year followup, about 50% of those on antipsychotics and a similar percentage of those off medications were experiencing “high anxiety.” However, over the next 30 months, high anxiety symptoms soared in the on-antipsychotics group, such that nearly 75% were experiencing this disress by year 4.5%, whereas anxiety markedly declined for those off antipsychotics, such that only about 20% were experiencing this distress by year 4.5.  This dramatic difference in anxiety symptoms remained throughout the 15 years, with more than half of those on antipsychotics still suffering from high anxiety at the end of 20 years.

3) Cognitive function in the SZ group

The researchers assessed cognitive function at each followup, with one test assessing ability to access general information, and the other abstract thinking. At three of the six follow-ups, those off antipsychotics showed significantly better cognitive functioning, and in the other three follow-ups, there was a general trend favoring those off antipsychotics.

 4)  Relapse rates in the SZ group

Harrow and his colleagues assessed whether patients who were not psychotic at a followup then relapsed in the next study interval. The relapse rate was much higher in each instance for the medicated patients. Between the 7.5 and 10-year assessments, the relapse rate was 33% for those on medications, 0% for those off the drugs.  Between 10 and 15 years, the relapse rate was 67% for the medicated group and 0% for those off medication. Between 15 and 20 years, it was 25% for those on antipsychotics and 11% for those off medication. This finding revealed that those who remitted off medication were very likely to stay well.

5) Sustained periods of recovery in the SZ group

Of the 70 SZ patients, 24 remained continuously on antipsychotics throughout the 20 years. This was the patient group that were fully medication compliant, yet only 4 of the 24 patients (17%) “ever entered into a period meeting the operational definition of recovery during any of the six follow-ups.” The reasons they failed to do so was either because they were psychotic or not working, Harrow noted.

In contrast, there were 15 in the group of 70 who were off antipsychotics by the two-year follow-up and remained off the drugs throughout the remaining 18 years. Thirteen of these 15 patients (87%) “experienced two or more periods of recovery,” which meant they were both asymptomatic and working more than 50% of the time.

Outcomes in the mood disorders group

At every follow-up, significantly more of the unmedicated patients than those on antipsychotics experienced a period of recovery. Those with mood disorders who stayed on antipsychotics had poor long-term functioning, which was “consistent with the data on the poorer long-term functioning of the schizophrenia (group) who were on antipsychotic medications,” Harrow wrote.

Is it the Drugs?

Thus, we see in these two reports, which arise from the best longitudinal study we have today of long-term outcomes of schizophrenia patients, a consistent story: At every turn, those on medications—as a group–have worse long-term results. They suffer more psychotic symptoms, they are more anxious, they relapse more, they don’t do as well on cognitive tests, and very few enjoy a period of recovery (when the definition of recovery includes returning to work at least part-time.)

This is outcomes data that needs to be closely examined. As we do so, we need to ask whether we should continue with our current paradigm of care, which emphasizes continual use of antipsychotics, or whether that paradigm of care needs to be rethought. Indeed, in this new paper, Harrow and his co-authors do broach the essential question: “Is very long-term treatment with antipsychotic medications undesirable?”

To address that question, we need to look at other research that bears on this question. Is there reason to believe that antipsychotics induce a dopamine supersensitivity, that leads to more chronic symptoms over the long-term? If antipsychotics are associated with a shrinkage of brain volumes, and if studies have shown that as this shrinkage occurs, there is an increase in negative symptoms and cognitive impairment, does this explain why patients on the drugs have poor long-term functional outcomes? We need to assess whether this larger body science tells us that Harrow’s findings are to be expected, as they are consistent with what we have learned about the long-term effects of antipsychotics, or whether there is another plausible explanation—other than the drugs are to blame—for the markedly worse outcomes in the medicated patients.

And I would think that this is a question, given our society’s current widespread use of antipsychotics, of extreme moral urgency.

 

 

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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

30 COMMENTS

  2. Thank you Bob for addressing this landmark study so quickly and for raising the question- “Are the drugs to blame.”

    You importantly point to other research on brain volume and dopamine that gives that question validity.

    Wouldn’t John Bola’s research on un-medicated first episode psychosis efficacy results, especially the randomly selected, double blind NIMH Agnew’s Project results, also have relevance to Harrow’s long term study, since it also shows significant higher functioning at follow up for the subjects who didn’t get anti-psychotics?

    It will be very interesting to see the NIMH’s response to Harrow’s 20 year study now, given what you report in “Anatomy of an Epidemic’ about their blackout of his 2007 results-

    “The NIMH issued 89 press releases, many on inconsequential matters. But it did not issue one on Harrow’s findings, even though his was arguably the best study of the long-term outcomes of schizophrenia patients that had ever been done in the United States.”

  3. When we add in the research that has come from Open Diaglouge in Western Lapland in Finland to these results, we can also see what the outcomes can be if we never give people the drugs to begin with. In this group those without medication are not recieving any treatment at all. The ONLY treatment to be recieved in the vast majority of the world is medication. One wonders how the well group would be faring if they had had some real psychological therapy to sort out the issues that resulted in them being in crisis in the first place. Of course it needs to be remembered that a large amount of psychological therapy is not good and many therapists are down right abusive. What this does show though is that doing nothing is significantly better than taking med’s. Which also defeats the argument that the med’s are the best thing we have at the moment, anything else costs too much money, etc. This proves that we are much better off doing absolutely nothing at all.

  4. I really wished you would have mentioned how the argument that the patients who were doing better early on in their treatment would go off the drugs and become those doing better can not possibly be true. You’ve investigated enough on the treatment of mental illness in this country to know that it’s hardly ever a choice for people with that diagnosis. The off-med group in Harrow’s study were NONCOMPLIANT patients. No psychiatrist, no NAMI-minded family, will ever allow someone diagnosed with schizophrenia to go off the drugs, ESPECIALLY if they’re doing better on them. The argument that it was those who had a milder form of illness and got better then went off the drugs can not possibly be true and it’s dishonest for psychiatrists and insiders to try to trick the naive public into thinking that it could be. Only if people with schizophrenia were never forced or coerced to take the drugs could that ever even be a possibility.

  5. I think I should add what should be the obvious point of my last post. That the off-med group in Harrow’s study were simply by chance. They had to have been lucky enough to slip through the cracks and not be forced or coerced to take the drugs, therefor the idea that it was those with milder forms of the illness who could go off the drugs and do better can not possibly be true. Surely there were people in the on-med group who were considered to have mild forms of the illness that might have done better off drugs but who were forced or coerced to take the drugs and those, like Courtney Harding’s “backward” patients, who were terribly ill and expected to never recovered who slipped through the cracks, quit taking the drugs and got better.

  6. One last comment, I want to say that I really do think it’s very important for Whitaker to look into this and address it because it is the #1 argument on that side of the fence. I’ve seen it all over. On blogs, book reviews, youtube comments, it’s EVERYWHERE and not just because this or that guy might have said it but because it’s what most peoples logic seems to lead them to. These people of course don’t know how the drugs are really used in psychiatry, that they are the cornerstone of care, that it’s considered malpractice not to use them on all people diagnosed with psychotic disorders, that they can be forced on patients, ect. Whitaker really needs to destroy that argument.

  7. “The schizophrenia and schizoaffective patients who took antipsychotics regularly during the 20 years, compared to those who quit taking the medications (usually within the first two years), experienced more psychosis, more anxiety, and markedly fewer periods of “sustained recovery.” They were also more cognitively impaired.”

    Well duuuh, of course the worst patients will be on psychiatric drugs and those not ill enough to stay on them will be doing better! If three people have a fever and the person with the highest fever is on aspirin, does that mean aspirin worsened his fever, or wasn’t it because his fever was worse that he was on aspirin? — That is the argument. It’s EVERYWHERE! It’s like a knee-jerk reaction for most people who read of the Harrow study.

  8. Dear Bob,
    I would suggest this hypothesis:
    I believe that the organic psychiatry, before the arrival of the drugs had already discovered the possible organic causes of mental illness. See for instance the work of Pfiffer, Pauling, Hoffer and his amazing results on schizophrenia.
    I suspect that in those years, psychiatry was at a crossroads, in danger of losing its power because it could be confined in neurology.
    The biggest problem is that these scientists seriously threatened the allopathic medicine and the drug industry.

    As I am discovering orthomolecular medicine, I read many people who are being assisted in their recovery from this organic approach.

    • Orthomolecular medicine is an alternative to psych drugs with demonstrated success. Look at Alternatives to Meds in Sedona, AZ. They are having success with moving people off psych drugs with orthomolecular medicine. A family member has had significant reduction of meds that was impossible to achieve without the orthomol help. I wish our family had found this resource years ago. No one in the medical community told us about the success of orthomol with schizophrenia, even though our family member has been subjected to numerous hospitalizations and extended stays at Menninger. And i then found that Dr. Hawkins published his book on Orthomolecular Medicine in the Treatment of Schizophrenia in 1973! why aren’t patients and their families told of this option by the medical community? It certainly begs the question that should be answered.

  9. Any time you are talking about brain shrinkage it can’t be good. Furthermore, i think the time for debate has long passed and these drugs should be banned for use in kids at a minimum. The latest atypical anti-psychotic craze was just the latest batch of poisons aggressively promoted by pharma and subsequently handed out like skittles because they were on patent. The real question is when is establishment psychiatry going to take a hint? Sadly, i do not think they are.

  10. Dear Mr Whitaker,
    I am a 3rd year psychiatric nursing student in the UK. Yesterday I submitted an assignment on the effectiveness of antipsychotics during first episode psychosis. Thanks to your book, Joanna Moncrieff, Bola, and Harrow & Jobe, I was able to argue against their effectiveness. I was able to suggest their propensity to aggravate the chronicity and longevity of psychosis. We are not shown any alternatives to psychiatry as we know it at university. I am so glad I discovered your book although it has made me question wether I want to be a nurse as i do not want to give psychiatric drugs to people in my care. I am hoping that psychiatric care will be revolutionised and soon.

    Kind Regards
    G

      • Persoanlly I would LIKE it if a person who shows this much concern for truth and the REAL wellbeing of ‘patients’ worked in psychiatry. Psychiatry needs to be changed, nurses with a critical attitude might help bring that change about. I know from experience that most nurses and student nurses do not like to use violence against patients.

      • On the contrary, we need Whitaker informed professionals. Like salt, the light of the earth, leaven for bread. God help us all if we chase away professionals who take time to educate themselves. We need you to try to open the eyes of your colleagues. Plus we’ll need lots of people who have a clue about how to help people get off meds.

      • Dear Jennifer

        I wanted/want to be a psychiatric nurse as i wanted/still want/will always want, to help people. I would never, ever, willingly cause anyone any harm, ever. sometimes change can also be initiated from within as well as from the outside. Mavericks do exist within!

        Best Wishes

        Gaynor

        • Hi, Gaynor!

          I am a subversive professional in the mental health field, and have been pretty successful in getting people to look more critically at the use of psych drugs, especially in kids. It’s a slow process, but it is essential to have professionals in the field who voice their opposition, otherwise, the psychiatrists just have their way.

          Good for you for keeping your critical thinking skills intact and maintaining your integrity despite the onslaught of psychiatric indoctrination!

          —- Steve

  11. Hi Bob,

    I have an alternative theory that is testable and may offer a different explanation.

    Is it possible that those who stayed on the drugs remained in active treatment with the system, while those not on the drugs stopped being patients entirely?

    This would mean that those on the drugs would regularly:

    (a) Consider themselves sick with an incurable brain disease;
    (b) Be in a position of being passive recipient of “help”;
    (c) Participate in a relationship of extreme power imbalance, as the inferior party;
    (d) Possibly go in and out of hospital more frequently simply because of the above factors – believing they needed help, their families believing they need more help, coming to see themselves as very sick, etc.
    (e) Have more frequent hospitalizations and power imbalanced encounters, including threats and force, lead to a further deterioration in sense of control over one’s life and belief in one’s own self-efficacy.

    And perhaps the patients NOT on medications:

    (a) Did not view their problems as an illness, possibly even “lacked insight”;
    (b) Took responsibility for their own lives and decided not to remain in an inferior position, tied to the system.
    (c) Looked beyond the obvious “explanation” to deeper places, where they could better understand their own problems.
    (d) Had more positive relationships with people who believed in their abilities and potential.

    Studies have shown, I believe, that those who are most likely to “lack insight” are those with an internal locus of control,
    and also that those with an internal locus of control are psychologically healthier.

    The abstention from medications can be explained simply by cognitive dissonance. If I don’t believe I have an incurable brain disease, and I know these drugs are toxic and dangerous, why should I take them? Similarly, if I DO believe I have a disease and need help, reinforced by an ongoing “therapeutic relationship”, I would be more likely to take “my meds”, right?

    To test this hypothesis, one would have to look at whether or not the patients in Harrow’s study remained in an active relationship with the mental health system, whether or not they believed that they had an incurable disease, and how often those who stayed ON meds were hospitalized and otherwise traumatized versus those not on meds.

    Also, it would be very helpful to see if there were any social, esteem, “insight”, relational factors precipitating getting off of the drugs and staying off successfully.

    I do believe that the drugs are extremely impairing, from personal experience, and you can’t rule that out, but there may also be other factors worth considering.

    – S.

    • Hi S.A.,

      You bring up some excellent points that actually are in very close alignment with the results of my own recent research of those who have attained full and lasting recovery after being diagnosed with schizophrenia and/or other psychotic disorders.

      In particular, every participant of all three of my research studies expressed the following factors as being of particular importance in their recovery:

      (1) Finding meaning in life (which essentially means cultivating one or more pursuits that allowed them to channel their passion and energy in an enjoyable and meaningful way)

      (2) Connecting with one’s aliveness (meaning essentially connecting with their feelings, needs, and sense of agency (which includes, as you point out, developing more internal locus of control))

      (3) Finding hope (hope that genuine recovery is possible)

      (4)Arriving at a more hopeful understanding of their psychosis (meaning developing an alternative understanding of their anomalous experiences that is more hopeful than the the prevailing theory that they have a degenerative brain disease. Every one of them was heavily inculcated with the brain disease theory and expressed that leaving the mainstream mental health system was crucial in ridding themselves of this very harmful and unsubstantiated theory.)

      (5) Healthy vs. unhealthy relationships (meaning cultivating healthy relationships with people who believed in them and either distancing from unhealthy relationships or doing the hard work of healing them. This includes distancing themselves from disempowering mental health care professionals).

      (6)…and finally, the one factor that all participants expressed was a hindrance in their recovery was…you guessed it…harm from the psychiatric system (including the use of antipsychotics and the heavy inculcation of the brain disease theory)

      *For anyone who may be interested, I have a book coming out very soon devoted to a systematic challenge to the mainstream understanding of psychosis, providing a number of alternative and more humanistically oriented theories of psychosis that have been presented, and introducing the results of my own recent research. The book’s titled “Rethinking Madness” and the website for the book is http://www.RethinkingMadness.com. I’m sending out free review copies in the next few weeks to anyone willing to write a review for it (either on Amazon or a blog). You can contact me at: [email protected]

      *Also, thanks again to you, Bob, for more outstanding work in highlighting this important research and presenting it in such an accessible manner. You are definitely one of my biggest heroes.

      • Hi Paris, cool to see your comments on this. Like you this struck a cord with me…i think maybe a combination of both is where its at here. And/or depending on the individuals make-up weighted one way or the other (ie towards drugs or personal motivation). I can apply many of those factors talked about here; not being in the ‘system’ , not accepting patient hood etc etc, however for many i think the power of the drugs means a triggering of ‘symptoms’ which they have no way to interpret but through the paradigms that have been imposed on them…its a vicious cycle; but how do we stop it when the predominant mental health ‘system’ is set up in this way ?

  12. Let me see if I can respond to the comments here.

    First, in response to Michael and others, yes, there is other data that is relevant to this question of: Are the drugs to blame. Bola’s work focuses on randomized studies that followed patients for at least a year or so, and his findings shows that the medications–in those randomized studies–do not improve outcomes (and if anything the outcomes favor the unmedicated patients.) Those studies were one to three years, if I remember, and so at least they in a small way support the data showing up in Harrow’s much longer study.

    There is other evidence that can be found, including data from the WHO studies, animal studies, etc. This in fact is why I think the data is so compelling: If you understand this history of research, bringing in all the different types of data you can find, you would expect that the medicated patients would do worse overa 20-year period.

    As for the way Harrow’s data has been attempted to be explained, that this is just a matter of patients with a better prognosis, his own data belies that explanation. As I mentioned, in every subgroup of patients, those who got off did better. Bad prognosis patients off meds did better than bad prognosis on meds; good prognosis off meds did better than good prognosis on meds; those with milder disorders off meds did better than those with milder disorders on meds; and most notably of all, those with schizophrenia off meds did better than milder disorders on meds. So in fact his data shows that those with A WORSE PROGNOSIS at initial entry into the study who then got off antipsychotics had a better outcomes than those with a BETTER PROGNOSIS who stayed on the drugs.

    Finally, most of those off meds did in fact leave the system and got no mental health treatment. And it would be interesting to see if that process itself, just getting out of the system, can lead to a positive outcome for some, as the people no longer accept the “patient” role.

    • Thank you Bob for clarifying that in every sub group, bad prognosis didn’t effect the better outcome of those off meds vs those on meds, and even those with a schizophrenia diagnosis did better off meds than those with a milder psychosis diagnosis.

      It seems to me this should be the central finding of Harrow’s study. But again, at 20 years he makes the same attribution that good prognosis was the key to understanding the off meds results, as he did with his 2007 reaults.

      I wonder if he is reluctant to do otherwise because it would perhaps call into question the validity of the underlying diagnostic catagories and their predictive value in accurate prognosis?

    • I wonder if Harrow actually thinks that he can just change the definition of prognosis to embellish his ideology.
      He seems to think that when people are off of the medications, that this in itself is a prognosis – because then they think they don’t need them.

      This would only show how imitatory and inappropriate their use of scientific or statistical procedures or language is.

      Would this make the whole anti-psychiatry movement than valid givers of prognosis, because when a person doesn’t believe they need medications this gives a prognosis with a more positive outcome? Or does it mean that psychiatrists actually never say what they mean, and their objective messages come through telepathically, more in the mystical kinds of ways “Schizophrenia” communicates to people?

      I don’t know, I’m just trying to surmise. Maybe I shouldn’t try to make any sense out of it.

      In the mean time they already have been promoting the fact that their prognosis is based on belief that’s separate from scientific procedure. That causing a chemical imbalance is healing one. Is this then validated because a person giving themselves a “non scientific” prognosis of not needing the medications has a more positive outcome then the also non-scientific chemical imbalance theory: being that they are both non scientific and one works they both do; and this is then science?

      On the complete other “side”: along with dopamine hyperactivity, and shrinkage of the brain – both originally attributed to the “disease” itself, having to be corrected as coming from treatment instead – there’s also another thing that causes stress and leads towards emotional problems. All the side effects of psychiatric medications. And consequently, when an emotional problem has a physical cause because of a physical wound or disease, this may not even looked for. Emotional trauma, physical trauma or the simple need for expression such as in art could all be overlooked because there’s a belief that it’s caused by a chemical imbalance in the brain.

      If believing you don’t need the medications is a prognosis (while having a prognosis of a mental illness, which is allegedly a chemical imbalance needing medications) what does this make all of psychiatrists and their prognosis?

      I wonder if I sound “schizophrenic” and incoherent yet?

    • I’m kind of still trying to work out this prognosis hypothesis.

      If it would actually be a prognosis for people to be told they have schizophrenia (which psychiatry says needs medications), but not take medicines to receive the proper flavoring of the prognosis: for this Monty Python of prognosis science to be made valid; would the psychiatrists then actually have to tell the patients they have schizophrenia, that they should take medications, but they want to find out that if they don’t take the medications believing they don’t need them whether this comes out better. Or how do they sort them in compliant, non-compliant groups: are they TOLD to be compliant or non-compliant and is this free will or not!? Or do they actually have to be medicated but not know they are being medicated; although they are told they don’t have what they are medicated for in order for this prognosis to occur where they have the disease but don’t believe they need treatment? Or should they just be told that they do have the disease but then be conned into not believing the psychiatrist (as in the day after their diagnosis an article appears in the paper that the psychiatrist was found to be fraud and has flown to the ex planet Pluto via a new submarine like water/space vehicle for mythological ex planets).?

  13. I was happy to come across this article and grateful for those professionals who are willing to call into question current practice and promote better, wiser, more humane and more basic treatment. I was also glad to see that orthomolecular medicine was mentioned as an answer. After walking the maze of the psychiatric system for 10 years with a close relative, we finally found the solution with orthomolecular treatment. But even worse than the psychiatric drugs themselves, was the way people in the system related to our relative who was suffering from symptoms – without warmth, kindness, or recognition of this person as intelligent and sensitive.
    When someone suffers from psychosis and related symptoms, he or she cannot survive the system without family members who continue to relate and care for him or her as the real person that he or she is, and advocate for him or her. Without this, I don’t see how anyone can stand a chance of recovering in the present system.
    I hope this research and more like it will bring about the change needed.

  14. Much of Harrow´s research corresponds with my own findings in talking to people online for 5 years, as well as that of transpersonal psychologists Dr.Stanislav Grof and Dr. David Lukoff – who recommend treating some forms of ‘acute psychosis’ as Spiritual Emergencies – Difficult processes which can be worked through with compasssionate support.

    My wife and I are presenting a draft research proposal to São Paulo’s Hospital das Clinicas on Tuesday, May 22, 2012 in order to provide the groundwork and argument for an experimental project within the hospital which will educated people diagnosed with bipolar disorder to the potential for healing. Harrow´s research, (along with Grof´s and Lukoff´s), will be a key part of that proposal.
    Thank you Robert!

    • bipolarorwakingup is a scam, he does not even have Bipolar Disorder and has never taken medication before and has stated this many times and I have proof of it. Please check out this video I made on this topic.

      http://www.youtube.com/watch?v=YOSlDWhp-eY

      He is exploiting Bipolar Disorder to promote spiritual awakening and to buy his book to make more money.

      He exploits it by using the mania of Bipolar Disorder to manipulate people into believing that they do not need medication and that it’s just a spiritual awakening and that Bipolar Disorder does not actually exist.

      I explain everything in detail in this video.

      This makes it harder for people who truly struggle with Bipolar Disorder on the day to day. He is spreading misinformation and exploiting the fact that people who have this disorder sometimes seek a miracle cure to be rid of their mental illness.

      It is wrong, and also potentially dangerous for some individuals as he openly encourages people to go off of their medication, one person just got out of a hospitalization even and he suggested he slowly work his way off meds.

      I do not advocate medication or going off medication, I believe there is no right or wrong way to cope with Bipolar Disorder. There are pros and cons to being off or on meds.

      But what he is doing is wrong. He does not know what Bipolar Disorder is and leading people to believe that it’s all in our head and not a real mental illness, that it’s just a spiritual awakening and is normal.

  15. I love my psychology friends but this study has more holes than swiss cheese. There is absolutely no cause and effect relationship that can be concluded. It is just as likely that people recovering and not having symptoms resulted in there no longer being a need for medication. Or thousands of other con-founders that could have led to these results by bias inherent to this type of study design.

    I am all for treatment other than medication, how about designing a study to demonstrate the effectiveness of other treatment. Simply presenting this misleading data and suggesting no treatment at all is more humane than any treatment is irresponsible, laughable and just plain incorrect.

    Show me some real data to support alternate therapy. I can come up with several medication studies that RANDOMLY select treatment groups and BLIND treatment to both the patients and researchers which show increased hospitalization, worsening symptoms and otherwise decreased quality of life in the group who received placebo.

    • “It is just as likely that people recovering and not having symptoms resulted in there no longer being a need for medication. “

      This would change the whole “prognosis” for “schizophrenia” again, because then it wouldn’t be advertised as a disease based on a chemical imbalance (unproven chemical imbalance) which needs to be “medicated” for life. Any recovery according to mainstream “treatment” remains that if there is recovery it is because of the medications. Simply telling a person they could get off of their medications rather than they need to be on them for life could then point out that this increases recovery. But it still remains that those who aren’t medicated have a higher recovery rate.

      “I am all for treatment other than medication, how about designing a study to demonstrate the effectiveness of other treatment.”

      There have already been many of such studies. Soterio House, Open Dialogue, The Quaker method.

      “I can come up with several medication studies that RANDOMLY select treatment groups and BLIND treatment to both the patients and researchers which show increased hospitalization, worsening symptoms and otherwise decreased quality of life in the group who received placebo.”

      It would be interesting to see these studies. It’s only too easy to surmise what might be going on. Take a group of people who have been diagnosed as being “Schizophrenic,” who already are on medications; and take some of them off of their medications, and you get withdrawal symptoms, as well as the emergence of emotional issues that they need insight into, an insight they most likely wouldn’t be getting from the people that suppressed these issues with brain disabling “medications.” And there – if this is the case – you have these supposed results that non-medicating causes increased hospitalization, worsening symptoms and decreased quality of life in the group who received placebo. If that were the case, it actually points out the same as this trial here which points out that medications cause more difficulty in actually recovering from “schizophrenia.”

      Also this isn’t th only study referred to here. There’s also the results of the WHO….

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