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Attitudes toward, and results with, the treatment of chronic psychosis, and schizophrenia in particular, have varied considerably at different times. Stephens’1 review of 38 long-term follow-up studies, which divides outcomes into “recovered,” “improved” and “unimproved” categories, cites “recovered” percentages ranging between 6% and 53%, and “unimproved” percentages ranging between 18% and 83%. Roff's2 1975 follow-up, after a mean of 22 years, which means that treatment was stopped for the most part before the use of tranquilizers started (about 1955), presents a recovery rate of 44%, with only 18% unimproved.
Study of recidivism rates in schizophrenia suggests that treatment results may indeed have worsened since the advent of tranquilizers. Anthony et al.'s3 survey of 45 analyses of recidivism (readmission) rates within specified periods after discharge from hospital presents rates of 67%, 70%, 70% and 75% in the four studies conducted after five years-all carried out in the mid-1960s, after the psychopharmacological “revolution”-whereas Hillside's four-year follow-up4 of its 1950 predrug cohort revealed only a 48% recidivism rate. A five-year follow-up study5 of the entire New York State Hospital system 1943-1944 first-admitted schizophrenic cohort (N-2,941) revealed a recidivism rate (percentage of those discharged who required rehospitalization) of 28%. This latter figure is, of course, flawed by the fact that so many of the original cohort remained in hospital for the full five-year period without ever being discharged; yet, even when these are fully taken into account, the failure rate (retentions plus readmissions) still becomes only 56%. Neither earlier study is, incidentally, mentioned either by Stephens or the Anthony group.
The notion that schizophrenics can get better, even though obscured by