The Patient’s Dilemma: Other Evidence on the Effects of Antipsychotics

Abstract

By the beginning of the 1980s the data from randomised controlled trials and the dopamine hypothesis of schizophrenia had come together to form the foundations of a view that antipsychotic drugs were effective and specific treatments for schizophrenia. Tardive dyskinesia and other ‘side effects’ were considered, in most cases, a price worth paying for a treatment that was assumed to work on the biochemical mechanism that constituted the condition itself, whether this was the abnormality suggested by the dopamine hypothesis, or a more complex situation involving other neurotransmitters. The drug-centred understanding of the nature and action of these drugs had been well and truly buried, and descriptions of the mental and physical alterations they produced disappeared from the literature. The very idea that psychiatric drugs, like recreational drugs, exert psychoactive effects—alter mental functioning and the nature of consciousness—was banished from mainstream thinking. Research was dominated by the view that these drug-induced alterations were incidental and therefore essentially uninteresting, and could be readily distinguished from the really significant effects of the drugs on the underlying disease. The dopamine hypothesis of schizophrenia ensured that the majority of attention focused on how the drugs reversed this presumed disease, and not how they modified normal brain function.