Drug refusal in schizophrenia and the wish to be crazy

The extremes of drug compliance were studied in two groups of schizophrenics: 29 habitual drug-refusers who invariably discontinued medication only to be readmitted several months later, and 30 drug-complier patients who habitually came in for their refills or injections of antipsychotic medication. The drug-refusers experienced the resurgence of an ego-syntonic grandiose psychosis after they discontinued medication. The habitual compliers, in contrast, developed decompensations characterized by such dysphoric affects as depression, anxiety, virtual absence of grandiosity, and some awareness of illness. The refusal of these chronic schizophrenics to take their medication could not be attributed to social isolation, paranoid diagnosis, or secondary gain. A discriminant function analysis showed grandiosity to be the most powerful discriminating variable between the two groups. We interpret these findings to mean that some schizophrenics may prefer an ego-syntonic grandiose psychosis to a relative drug-induced normality.