Recovery rates under moral treatment
During the early 19th century, a form of care was practiced, known as moral treatment, that emphasized treating the "insane" with kindness and empathy. It was believed that a supportive environment could help heal people who were mentally disturbed. Historians who have reviewed records from the early moral-treatment asylums have concluded that it was surprisingly effective. More than 50% of the "newly insane" recovered within a year's time, and many remained well the rest of their lives. The best long-term study of the time found that only one-third of newly insane patients who received moral treatment became chronically ill; nearly all the others recovered at some point and fared fairly well over the long term.
American eugenics and the mentally ill
The history of 20th century medical treatments for the severely mentally ill in America cannot be understood without first understanding the societal attitudes toward the mentally ill that arose in the first half of the 20th century. The eugenics movement devalued the mentally ill, and it was this devaluation that set the stage for the use of "brain-damaging" therapeutics in the 1930s and 1940s, a legacy that continued with the introduction of "anti-psychotic" drugs in the 1950s.
In addition to citations given in Mad In America, the following sources detail this link between Germany and American eugenicists.
Neuroleptics and Chronic Illness
There is a clear trail of studies in the research literature documenting the fact that neuroleptics increased the likelihood that people would become chronically ill. See the book, Mad In America for an explication of why this body of research was ignored.
For further information on chronic illness and neuroleptics, see The WHO Studies.
Brain Damage and Neuroleptics
It is well known that standard neuroleptics cause tardive dyskinesia (TD). However, TD is usually thought of as a disorder that is limited to motor dysfunction. The citations below are simply a sampling of studies which have found that standard neuroleptics induce brain changes that lead to a more global decline.
Early Death and Neuroleptics
Standard neuroleptics may cause early death in a number of ways. At first administration, sudden death and neuroleptic malignant syndrome are recognized risks. Over the long term, neuroleptics increase the risk of dying from cardiovascular disease, diabetes and a global decline in physical health. These long-term risks arise, in large part, because people put on standard neuroleptics tend to put on weight, to become lethargic, and to smoke. Reports that detail some of these risks include:
The WHO Studies
The evidence of an association between use of neuroleptics and poor long-term outcomes can be seen most clearly in studies by the World Health Organization. A long-term outcomes study by researchers at Harvard Medical School similarly found poor long-term outcomes in the era of neuroleptics.
The Dopamine Theory
Mad In America provides a detailed look at two decades of U.S. research into the dopamine hypothesis of schizophrenia, and shows how the public was misled about those research findings. (The researchers found that there was no good evidence that patients diagnosed with schizophrenia suffered from hyperactive dopamine systems prior to being treated with neuroleptics. Three additional studies by French, Swedish, and Finnish investigators, which were not covered in the book, support this same conclusion.)
A Timeline to Failure