In June 1962, I had just finished a year of active duty in the Air Force (actually 9 months) and was looking for a job until I went back to medical school in September. I had been pulled out when the reserves were called up by Kennedy in the wake of the Berlin Wall, built by the Russians in August.
I found an ad in the LA Times for medical students to work at the VA hospital in west Los Angeles. I was a medical student although I had had only one month of medical school. I had, however, been a corpsman in the Air Force so had a little more clinical experience than many first year medical students.
I applied and was accepted. I learned the job was to do annual physical exams on 200 chronic schizophrenics since the psychiatry residents, in the grip of the psychoanalytic phase of psychiatry, did not want to do so. I started about the 15th of June and soon met my boss, a professor of psychiatry at UCLA named George L Harrington.
He was a striking individual, a big man who walked with a pronounced limp from a previous femur fracture. The effect of this combination was powerful on the chronic schizophrenics of Building 206 at the Sawtelle VA Hospital.
Harrington was one of the two or three most impressive men I ever met in medicine. He had trained as an analyst and his father was one of the first lay analysts, a former Baptist minister. Harrington had met Sigmund Freud and actually sat on his knee as a child. He grew up near the Menninger Clinic in Kansas and went to Kansas Medical School. He told me that one of his first summers in medical school, he got a job at the state mental hospital and tried his psychoanalytic theories out on chronic psychotic patients. They didn’t work. When summer was over and the state psychiatrists returned from vacation, they treated one depressed female patient with shock therapy. Harrington had spent the summer trying analysis on her with no success. With one ECT session she was much improved. That was enough to convince him that analysis did not work, no matter that the psychoanalytic school of psychiatry had taken over the specialty and the departments of all the medical schools.
Harrington was sure this was all wrong and was convinced that schizophrenia was an organic disease. He told me that it might even be a deficiency of an unknown vitamin. It wasn’t so many years since beri-beri and pellagra had been discovered to be vitamin deficiencies. I have previously referred to this experience, and I am convinced that he was on the right track when most psychiatrists were wrong.
Unfortunately, the psychiatry profession held on to psychoanalytic thinking far too long. A friend of mine from medical school is an analyst and has made a good living from it in Malibu. That is a good choice of location since analysis works best on rich mildly neurotic patients. Psychotics tend to be poor and difficult to work with. Now, with huge advances in neurobiology there is more hope but the public is still reluctant to trust psychiatrists with any authority. I am afraid that the profession is still suspect from the years of the Freudian blind alley.
A fellow named Clayton Cramer, who has a schizophrenic brother named Ron, has written an excellent book about the legal history of the deinstitutionalization movement that emptied the mental hospitals since 1960. On his blog, he posts that the shooter in Connecticut may have been taking Fanapt, an antipsychotic drug that is prescribed for schizophrenia. A rather hysterical post on what looks like an anti-treatment site alleges that SSRIs, a class of drug that is unrelated to anti-psychotics, are responsible for mass shooting incidents. It is this sort of misinformation that muddies the waters around the issue of violence and mental illness. The drug, iloperidone is an “atypical anti-psychotic” which means it is a serotonin receptor antagonist. It was nothing to do with SSRIs, which are selective serotonin reuptake inhibitors. The effects are very different as are the mechanism.
The battle for intelligent treatment of schizophrenics goes on.
A summary of treatment options does not mention the most serious problem. That is that schizophrenics commonly stop taking the drug, either because they feel fine and believe they no longer need it, or because they have no insight into their condition and refuse the drugs unless coerced. This is the reason why commitment, even outpatient commitment which involves supervision of the drug taking, is desirable.