Viewed with the outlook that these

Viewed with the outlook that these indices tap a certain type of inner strength or a tendency to be less vulnerable to major psychopathology, the data on premorbid functioning and the prognostic data indicate one prominent factor is that the unmedicated patients were more likely to be more resilient patients with better prognostic potential, better develop- mental achievements, and more internal resources. The prospectively collected data in Figures 4 and 5 support the view
that the patients who were no longer medicated were different on these premorbid factors from those on antipsychotics. Although prognostic factors and premorbid developmental achievements are important influences on outcome, and were the strongest predictors, multiple other factors also are involved because the off-medication patients showed better global outcomes than the on antipsychotic patients, even when sub- groups with similar prognostic status were compared. With regard to the other type of earlier influence we studied, the data indicate the value of constructive attitudinal and personality characteristics present years earlier before the 15-year follow-ups. Thus, the data indicate that patients with schizophrenia who were unmedicated at the 15-year follow- ups were more likely, over 10 years earlier, to have been patients who had (a) more internal attitudes on an LOC scale concerning the importance of their own efforts toward better functioning and (b) better self-esteem or better selfimages. It is probable that for patients with a more internal attitude and better self-images at the 4.5-year follow-ups, some initial success in functioning contributed to their beliefs that their improved functioning was due to their own efforts and talents rather than to chance. This, in turn, could encourage and reinforce a more internal LOC, leading to increased personal efforts when faced with subsequent challenges, with the constructive attitudes and positive functioning exerting recip- rocal positive influences on each other. Patients who are internally orientated and have better self-esteem are the types of patients who are more likely, if their functioning improves, to urge that they try functioning without medications and/or to choose to try functioning without any treatment at all. These data would fit with some reports and empirical studies on consumers who believe that schizophrenia patients who feel they have recovered are more likely to be those who have “taken responsibility for their lives” (Tooth et al., 2003, p 76).