By Dr. David Laing Dawson

Chlorpromazine was first synthesized and used in France in 1951. Before this there existed no effective or successful treatment for the psychoses of schizophrenia or bipolar illness. Hundreds of things were tried through the centuries, from stockades, banishment, exorcism, punishment, to spinning chairs to wet packs to teeth extraction, barbiturates, insulin coma, and, of course, various forms of psychotherapy, work programs, and behavioural modification. None of it worked. None of it worked beyond the small improvements brought about by support, encouragement, hope, and wishful thinking. Of course a kinder, better, more supportive, more understanding environment helps. But it does not change the course of these illnesses.

ECT provided temporary relief. But, for the most part, those residents of mental hospitals trapped in psychosis remained trapped in psychosis prior to the introduction of chlorpromazine. Many of the severe symptoms of those illnesses cannot be found today on our psychiatric wards, but prior to the introduction of chlorpromazine, medical students could be taken to the wards of mental hospitals to see examples of mania, catatonia, bizarre compulsions and the enactment of delusions.

Chlorpromazine was brought to Quebec and North America in the early 1950’s.

By 1967 I was prescribing chlorpromazine for mania and schizophrenia in the emergency ward of a Toronto Hospital . By late 1968 I was treating, on an inpatient ward and in outpatients, people suffering from bipolar illness and schizophrenia.

Chlorpromazine and other new anti-psychotics were amazingly effective in the treatment of acute psychosis. Improvement occurred within days, and full resolution of the psychosis within 4 to 8 weeks.

So, how long should we keep people on these medications? In 1969 it was reasonable to try removing the medication once full recovery had occurred, within, say, 6 months. THIS DID NOT WORK. All relapsed. The next logical step was to try reduction and cessation of anti-psychotic medication after at least a year of recovery. THIS DID NOT WORK. Relapse was not always immediate, but it inevitably occurred.

By the mid 1970’s we knew people who suffered from schizophrenia could only be protected from relapse by remaining on anti-psychotic medication for years, perhaps for life. And we knew that each relapse caused more damage and was more difficult to treat.

We needed better medications with fewer side effects, not anachronistic anti-pharmacology psychiatrists.

Removing patients from a treatment we know works (evidence based and scientifically proven) for experimental purposes is, simply, unethical.