Anthony (56) argues from his research that neuropsychiatric drugs do not rehabilitate disabilities. Severely ill patients prescribed drugs and psychotherapies in hospitals and clinics show functional improvements only after moving to community-based psychosocial care (57–60). Indeed, CATIE investigators acknowledge that employment, not just antipsychotic drugs, can benefit symptoms (61). Studies may even underestimate the benefits of employment because socioeconomic factors undermine efforts by mentally ill persons to compete in work environments (55–60). As Carpenter and CATIE investigators concede, most people with schizophrenia are investigated and treated in settings that do not offer employment, a psychosocial intervention known to be effective (56–60). Thus, to understand the contributions that drugs can make to patients’ lives—overcoming disabilities, realizing improved quality of life, and reaching personal goals (62, 63)—CTs may need to provide their subjects with the psychosocial and vocational experiences needed for the patient to learn to live in these roles in society. Absent socially and vocationally enriched environments for drug testing, CATIE and similar neuropsychiatric trials may miss the characterizations of drug efficacy needed by clinicians: not just as effectiveness against symptoms but also as support for recovery from remediable disabilities.
