Don’t Get Schizophrenia in the US

 Jack Caputo

26 Feb 2026

HST401

I pledge my Honor that I have abided by the Stevens Honor System

Don’t Get Schizophrenia in the US

I recognize that I am truly fortunate to not have any sort of psycho-condition, nor have anyone close to me who has one. With the prevalence of schizophrenia being between 0.25-0.64% [1], this is not the case for a considerable amount of Americans, around 850 thousand to 2.2 million. And because of the nature of schizophrenia, the condition affects not only the diagnosed but also their family, friends, potential coworkers – really everyone in their life.

 

Reading the account of Prof. Elyn Saks [2], a successful academic and author with a PhD in psychoanalysis who also happens to have schizophrenia, exposed me to how the condition actually manifests in a person's life. I had the conception that schizophrenia was all about being out of touch with reality, seeing people and hearing voices, unable to distinguish what was real and fabricated. There was some of that, but psychoactive episodes were not the norm for her. Her narrative foremost proved how those with schizophrenia can be very high functioning and lead normal lives with successful careers and relationships. Yet it was not all sunshine and rainbows – the somewhat visceral account showed how schizophrenia makes its way into every part of a person’s life.

One point that stuck with me was her acknowledgement that her case was very special. Having family, friends, employment/a sense of purpose, plus excellent medical insurance and healthy finances, meant she could repeatedly get help throughout the years. This is not the case for many others diagnosed with schizophrenia.

A striking guest piece by psychotherapist Madeline Till in the New York Times [3] illustrates this very well – almost too well. It is a story of how she and the rest of her family became powerless to help her son with schizophrenia after he turned 18, becoming a legal adult and leaving home shortly after. Because he did not perceive his illness, a very common symptom of the condition called anosognosia, he was not legally eligible for care. He would not accept help from the family, but also could not help himself due to his condition. As saddening as this account is, it is not unique among affected families. One response to Till’s essay that stuck with me was that of Jeffrey A. Lieberman, a professor of psychiatry at Columbia University, who writes that Till’s story “is not a personal tragedy but national crisis and moral failure” [4]. This crisis and failure started with the new approach to mental illness in the US after the closure of psych wards.

They were most certainly abusive and horrific: patients would be forced into treatments and therapies, many with dubious scientific justifications. Psychoactive episodes would be dealt with through restraining and sedatives. A reform was necessary, but it seems we went too far in the opposite direction. In advocating so intently on autonomy, says Lieberman, we discard our ethical obligations of caring for, protecting, and preventing suffering for those who can’t care for themselves: “neglect has been recast as freedom and abandonment as compassion”.

What exactly does this neglect and abandonment look like? Till briefly explains how, after the downfall of the psych wards, society was left with no other alternative of care for those with mental illness. Thus, many get stuck in a cycle in which they are homeless or in otherwise deplorable conditions, wherein authorities (police, social services) can act only in severe situations – if the lives of themself or others are in danger – in which they get, say, admitted to a hospital. After they are treated and labelled as “stable”, they are discharged – but to where? What home? No, only back to the streets, with no support systems to keep them afloat.

The for-profit healthcare system in the US encourages this cycle, Till says, by rewarding “brief stabilization over comprehensive long-term treatment”. Insurance companies love actionable items and numbers, even if they are not effective: by prescribing drugs, doing wellness questionnaires, sending social workers to check in, we feel like we’re helping. But this is just a thin veil of bureaucracy. Under scrutiny, the problem increasingly looks like a failure of basic humanity, predicated on the systematic oppression – intentional or unintentional – of those who are least in the position to be able to deal with it.

I mentioned drugs. Well, what about the drugs? Surely, antipsychotic medication works, if we prescribe so much of it. The incredible, concise summary of the state of antipsychotics from Mad in America [5] unfortunately disagrees. In the short term, only around 20% of patients benefit from antipsychotic prescriptions, while the remaining 80% see no benefit – yet still risk getting the side effects of the drug. A landmark study in 1992 showed that developing countries had significantly better outcomes for remission, psychotic episodes, and social function than developed countries, which prescribed 4x as many antipsychotics. Fifteen years later, in 2007, a different study showed that those not on antipsychotics routinely scored better in long-term recovery: less psychotic symptoms, lower relapse rates, higher cognitive function, and higher employment rates.

The many forms of psychotherapy offer a promising solution, but are not without their problems. Because we have yet to find the magic bullet for curing schizophrenia, therapy is still very common. Talking over your specific situation, 1-on-1, with somebody who wants to listen, in a format that works for you, is very powerful. Saks herself found, through experience, that the now-prevalent cognitive-behavioral therapy, which works for many others, did not for her; she instead has opted for seeing a psychoanalyst, which has worked very well for her. But this trial-and-error of finding a therapy style and specific therapist that works for you is expensive and time-consuming. It’s difficult, not accessible to everybody who needs it, and can’t be scaled – after all, there’s only so many therapists out there!

Clearly, things need to change. Many people with mental illness, plus their family and friends, are suffering needlessly because of systems which do help them. What are the people in power doing about it now? Earlier this month, our very own Robert F. Kennedy Jr., secretary of health and human services, claimed that a Harvard doctor “has cured schizophrenia using keto diets” [6]. While there is ongoing research in this area, claiming a “cure” has been found is blatantly wrong [7]. Such gross, unscientific claims downplay the seriousness of schizophrenia and the complexity of its treatment. Ironically, spreading such baseless information about diet and exercise actually hurts its reputation for actually being able to improve mental health.

It seems that we’re still not taking matters seriously. We unfortunately may have to wait until changes in the administration before realistic improvements can be made at the governmental level. Our politicians should not be using the problems of people with mental illness for their own gain.

As one commenter posted under Till’s essay, “There is no example of cruelty masquerading as compassion more obvious to me than the refusal to involuntarily treat those whose psychiatric disorders take control of their minds and prevent them from making rational decisions”. Is it more ethical to force treatment upon those who can’t make logical decisions or care for themself, than to let them suffer in the name of freedom? This quickly starts to look like the psych wards of the past, but questions like these inevitably arise in discussions about what we can do, and what we should do. These are, of course, hard questions, with a lot of nuance. But we can certainly do better than we’re doing now.

A good start would be a call for more humane treatment across the board – from hospitals, courts, police, social workers, insurance companies, lawmakers, physicians. Compassion is always potent, especially so for a condition which can uproot the entire life of the affected and their family. 

But there are more tangible solutions out there. The “club house” model, started by Fountain House in NYC, seeks to provide a lifestyle imbued with purpose through community and employment. They educate their members, then support them in finding paid work, all the while maintaining a strongly connected community [8]. Though Saks didn’t participate in a club house, she would agree that community and purpose kept her tethered to reality and reduced her psychoactive symptoms. The Fountain House model is evidence-backed and has been replicated over 300 times, nationally and internationally [9].

Hopefully, smart people who care will continue to develop effective ways to help people with schizophrenia. Perhaps we can reconsider whether we are overmedicating those with mental illness. Maybe, soon, our government will pass influential legislature to reform how we can care for those with mental illnesses. Regardless, something we can all do, starting today, is show a little bit more compassion and humanity, especially to those who are starving for it.

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[1] https://www.nimh.nih.gov/health/statistics/schizophrenia 

[2] https://johnhorgan.org/books/mind-body-problems/chapter-five 

[3] https://www.nytimes.com/2026/01/28/opinion/family-mental-health-homeless-schizophrenia.html 

[4] https://www.nytimes.com/2026/02/14/opinion/mental-illness.html 

[5] https://www.madinamerica.com/drug-info-antipsychotics-schizophrenia/

[6] https://x.com/LeadingReport/status/2019482973016375665 

[7] https://www.nytimes.com/2026/02/11/opinion/kennedy-mental-illness.html 

[8] https://www.fountainhouse.org/about 

[9] https://www.fountainhouse.org/assets/Brief-Summary-of-Evidence-for-Clubhouses_2022.pdf