Could the treatment regimes be as much responsible for the difference in prognosis between schizophrenia, schizoaffective and bipolar as the conditions themselves?

Initially Kraeplin codified two distinct types: schizophrenia (dementia
praecox) and manic depression. After a while he saw these two types as
not distinct but perhaps the same type and as two extremes at the end of
a spectrum of the type. The type may be analogous as schizotaxia (which
really means a genetic predisposition for a person to exist on the
schizophrenia spectrum) and current genetic evidence is pointing to a
commonality between bipolar and schizophrenia rather than two distinct
types.

However evidence also shows that there are 3 identifiable prognoses
associated with schizophrenia, schizoaffective and manic depression. I
think the lead author is Tsuang if I remember right. It is assumed these
are a result of the expressed type (through the biopsychosocial model of
cause).

But what if a larger factor is treatment and treatment experiences?
Tsuang's research was done on data from the modern time of
psychopharmaceuticals as the primary way to suppress the human types.

Manic depression is treated with mood stabilisers to limit mood or cease
the feeling of emotion entirely. The side effects of these meications
are milder than the effect of drugs for schizophrenics. The major
tranquiliser is a horrible drug, at least the ones currently used and
abused by doctors. The side effects are horrible as are the effects.
Much more of the individual is taken away and it is much harder for the
individual to continue to function when shackled by these strong drugs
which tranquilise without putting the individual to sleep.

The question which is the title of this blog post could be asked even
better perhaps: how much of the negative outcomes are caused by
medication, treatment and treatment experiences versus the problems
experienced by valid human types in a dysfunctional society which
disadvantages them?

It is a question some psychiatrists might prefer not answered but it is
relevant to the lives of those who live with severe mental illness. They
suffer so much because of their treatment in the hope that it genuinely
makes their life better rather than harms them. The suppression of the
individual has been shown to be less effective than living in less
malformed societies, certainly from the IPSS results from the World
Health Organisation. Psychiatry has always focused itself on the
individual - a result of the biomedical training perhaps - but this may
be doing harm rather than good.