Free Anatomy of an Epidemic by Robert Whitaker

During this period, outcomes studies in England, where schizophrenia was more narrowly defined, painted a similarly encouraging picture: Thirty-three percent of the patients enjoyed a “complete recovery,” and another 20 percent a “social recovery,” which meant they could support themselves and live independently. 7
    These studies provide a rather startling view of schizophrenia outcomes during this time. According to the conventional wisdom, it was Thorazine that made it possible for people with schizophrenia to live in the community. But what we find is that the majority of people admitted for a first episode of schizophrenia during the late 1940s and early 1950s recovered to the point that within the first twelve months, they could return to the community. By the end of three years, that was true for 75 percent of the patients. Only a small percentage—20 percent or so—needed to be continuously hospitalized. Moreover, those returning to the community weren’t living in shelters and group homes, as facilities of that sort didn’t yet exist. They were not receiving federal disability payments, as the SSI and SSDI programs had yet to be established. Those discharged from hospitals were mostly returning to their families, and judging by the social recovery data, many were working. All in all, there was reason for people diagnosed with schizophrenia during that postwar period to be optimistic that they could get better and function fairly well in the community.
    It is also important to note that the arrival of Thorazine did not improve discharge rates in the 1950s for people newly diagnosed with schizophrenia, nor did its arrival trigger the release of chronic patients. In 1961, the California Department of Mental Hygiene reported on discharge rates for all 1,413 first-episode schizophrenia patients hospitalized in 1956, and it found that 88 percent of those who weren’t prescribed a neuroleptic were discharged within eighteen months. Those treated with a neuroleptic—about half of the 1,413 patients—had a
lower
discharge rate; only 74 percent were discharged within eighteen months. This is the only large-scale study from the 1950s that compared discharge rates for first-episode patients treated with and without drugs, and the investigators concluded that “drug-treated patients tend to have longer periods of hospitalization…. The untreated patients consistently show a somewhat lower retention rate.” 8
    The discharge of
chronic
schizophrenia patients from state mental hospitals—and thus the beginning of deinstitutionalization—got under way in 1965 with the enactment of Medicare and Medicaid. In 1955, there were 267,000 schizophrenia patients in state and county mental hospitals, and eight years later, this number had barely budged. There were still 253,000 schizophrenics residing in the hospitals. 9 But then the economics of caring for the mentally ill changed. The 1965 Medicare and Medicaid legislation provided federal subsidies for nursing home care but no such subsidy for care in state mental hospitals, and so the states, seeking to save money, naturally began shipping their chronic patients to nursing homes. That was when the census in state mental hospitals began to noticeably drop, rather than in 1955, when Thorazine was introduced. Unfortunately, our societal belief that it was this medication thatemptied the asylums, which is so central to the “psychopharmacology revolution” narrative, is belied by the hospital census data.
Through a Lens Darkly
    In 1955, pharmaceutical companies were not required to prove to the FDA that their new drugs were effective (that requirement was added in 1962), and thus it fell to the NIMH to assess the merits of Thorazine and the other new “wonder drugs” coming to market. Much to its credit, the NIMH organized a conference in September 1956 to “consider carefully the entire psychotropic question,” and ultimately the conversation at the conference focused