Conflict between treatment and science on a research ward investigating schizophrenia.

Abstract

The biological aspects of schizophrenia have been under study at the Lafayette Clinic since 1956. Previous publications described the isolation of a factor in the plasma of schizophrenic patients. The factor is identified using a chicken-cell lactate-pyruvate (L/P) ratio method. Studies have shown that schizophrenic patients can be significantly differentiated from non-schizophrenic subjects. Work has continued on the identification of the factor and on the regulation of the factor. Attempts are being made at relating behavioural attributes to some aspects of the biochemical measures. A sizeable population of subjects for these studies has been required, as well as a hospital ward. Northville State Hospital made available an adequate ward and an area sufficient for the research laboratory. The hospital ward is described. Criteria for the selection of schizophrenic patients are outlined as follows: sex, age, weight, central nervous system factors, intelligence potential, disease factors, drug factors, somatic treatment factors, duration and characteristics of illness. The selection of control subjects has always posed a problem; and at one stage of investigation, ‘trusties’, obtained through the Michigan State Department of Corrections, were utilized. The management of patients and controls is described. Discussion deals with the more serious problems encountered in the administration of this ward, including: 1) evidence of friction between staffs of a state hospital and a research clinic; 2) difficulties in obtaining a satisfactory ward physician who could willingly co-operate with both staffs; 3) feelings of nursing staff regarding patient care; 4) the unexpected difficulties encountered in the management of ‘trusties’ used as control subjects; and 5) additional efforts to help the members of the state hospital staff concerned feel that they are definitely essential for the success of the project.