Friday, January 11, 2008

Interesting view on the WHO schizophrenia study

Washington Post reporter Shankar Vedantam wrote that family support determines recovery. The anti-psychiatry movement uses the World Health Organization findings to say that drugs don't work, while Mr. Vedantam says that the difference lies in the way schizophrenics are treated.
Decades of research have supported the WHO findings, but they have met with stony silence in the United States, in part because anti-psychiatry groups have argued erroneously that the studies prove that drugs and doctors are useless. Most U.S. psychiatrists see schizophrenia as an organic brain disorder, whose origins and outcome depend on genes and brain chemistry. They acknowledge the psychosocial aspects of disease, but the challenges of connecting patients with jobs, schooling and social networks are neglected -- often because they fall outside the bounds of traditional medicine. Drug manufacturers, too, are focused elsewhere. "Pharmaceutical companies, which control the scientific production of research at universities, are not interested in saying, 'Social factors are more important than my drug,' " said Jose Bertolote, a WHO psychiatrist. "I'm not against the use of medication, but it's a question of imbalance."

Thara argues that patient-doctor relationships in India are fundamentally different from those in America: The relationships may be paternalistic, but the benefits are lower costs and less fragmentation. On an annual budget of $67,000, SCARF treats 1,200 patients, dispenses free drugs, runs three residential facilities for 150 patients and offers vocational training each day for 100 patients.

Social connectedness for patients is seen as so important that the psychiatrists tell families to secretly give money to employers so that patients can be given fake jobs, work regular hours and have the satisfaction of getting "paid" -- practices that would be unethical, even illegal, in the United States.

Prince George's County outside Washington was one of the sites of the pioneering WHO study -- William Carpenter helped treat about 90 schizophrenia patients at three hospitals. That experience brought home to him the fact that medications primarily control patients' delusions and hallucinations, not the "negative" symptoms that cause patients to disappear into silent, inner worlds.

"The bias has always been in the direction of reducing psychosis," said Carpenter, director of the Maryland Psychiatric Research Center. "Psychosis is public and bothersome. . . . Negative symptoms bother you if it's your child, but it doesn't create a public disturbance."

Anti-psychotic drugs that help quell the outward symptoms may actually exacerbate social withdrawal, he said: "While we treat one part of the illness, we potentially complicate another part of the illness."

New medicines are being aimed at the negative symptoms. But Carpenter and other experts said it is clear that drugs cannot replace social supports.

When people are presented with ambiguous information, they often interpret it to support their established beliefs. When people are presented with unambiguous information that contradicts their beliefs, they tend to pay close attention to it, scrutinize it, and either invent a way of discounting it as unreliable, or redefine it to be less damaging than it really is.


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