In recent decades the understanding of the core physiology giving rise to schizophrenia has advanced markedly. Current pharmacological interventions fail to target the core problems in schizophrenia. Several important outcome studies call into question whether current medications actually make long term outcomes worse. These new studies follow the recognized negative side effect of anti-psychotic drugs. The implication of these findings for social workers who work with the seriously mentally ill are discussed. Alternatives to current pharmacological treatments which are more targeted toward the core physiology of schizophrenia are reviewed.