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Drs Alexander and Wyatt make appropriate points. My essay was not a treatise on therapy. Let me assure them that the patient underwent a comprehensive medical evaluation and that there was no organic basis for his paranoid schizophrenia. Pharmacotherapy was considered and rejected by my attending psychiatrist and by the patient on many occasions during and after discharge from the hospital. Such discussions, however, did not lend themselves to the short essay form.As a nonpsychiatrist it is not for me to argue about whether such patients should in fact receive pharmacotherapy, but I will note that I have received telephone calls and letters from other psychiatrists applauding the way this patient was treated. There was no intent in this essay to "turn one's back on the last 30 years of progress."I personally believe that this patient's treatment was appropriate and the outcome unfortunate. It serves to
Kardos GG. Messages From Afar-Reply. JAMA. 1988;260(1):34. doi:10.1001/jama.1988.03410010041028