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Until quite recently, medicine didn't offer much of a chance either. While doctors and drugmakers have made impressive strides in treating other forms of mental illness, including depression and anxiety, progress against schizophrenia has been painfully slow. Fewer than half of America's 2 million to 3 million schizophrenics respond well enough to the standard treatment with Thorazine (chlorpromazine) and similar drugs to avoid further hospital visits. Most who do respond remain somewhat disabled, and about 80% are stuck with serious and humiliating side effects, including dulled emotions, a clumsy gait known as the "Thorazine shuffle," a compulsive foot-tapping restlessness and an irreversible syndrome called tardive dyskinesia, characterized by twitching and jerky movements of the facial muscles and tongue.
Clozapine is not perfect either. In some patients it causes seizures. A few develop a life-threatening blood defect and must be immediately taken off the medication. It is also extremely expensive, costing $4,160 annually for the drug itself and as much as $9,000 more for doctor-monitored treatment. But for some it brings miracles. Of 20,000 American schizophrenics who did not respond well to Thorazine and were given clozapine, more than half have shown significant improvement: they become less withdrawn, and the nagging inner voices grow hushed. One patient in 10 responds to the drug so dramatically that the effect is like being reborn. "You go from hating the sunshine in the mornings to loving it," says Daphne Moss, who after two years of treatment with clozapine is teaching public school part time and living independently. "In 15 years of practice, I've never seen anything like it," says Dr. Samuel Risch, a psychiatrist at Emory University in Atlanta.
The emergence into sunlight comes gradually. "You don't take something and wake up the next morning," cautions Dr. Herbert Y. Meltzer, director of the Biological Psychology Laboratory at Case Western Reserve's affiliated University Hospitals and one of the leading U.S. authorities on clozapine. "You see small, steady changes." Still, the 10% of patients who experience a dramatic awakening can be overwhelmed by the bright glare of reality and by the grief of having lost so much time to mental illness. To help patients with this "Rip Van Winkle syndrome," the Case Western group has learned that each small step forward with clozapine must be carefully nurtured with psychological counseling. Without it, the awakened patients can slip back into mental confusion, and the devilish inner voices may begin harping again.
For doctors, patients and anguished families who have coped for years with schizophrenia, the arrival of a new drug that can dramatically help even a portion of the victims is cause for elation. The nation at large should celebrate as well. According to a 1991 study by the National Institute of Mental Health (NIMH), mental illness costs the country $129 billion annually, and schizophrenia alone steals a disproportionate $50 billion -- roughly equivalent to what the Federal Government spent last year on all Medicaid grants. Drugs and doctor bills, hospital beds and police problems add up to $29 billion; lost income and family crises account for the rest.