I don’t know of any studies that show psychosis alone to cause brain damage, but I imagine it’s surely possible. But I don’t think any amount of psychosis could cause the kind of damage that would result in an 8-11% drop in brain weight, which is how much is lost by taking a neuroleptic for 18-27 months according to a study done on monkeys.
As far as weighing the cost benefit of taking a neuroleptic, I don’t know how long I would be willing to put up with voices to stay away from a neuroleptic, but I know this: even with the good that a neuro can do, I believe that most times, the drug should be tapered off as soon as the hallucinations go away. I believe that once the hallucinations go away the brain is able to reset itself, and I can be pulled away from the drug without the hallucinations coming back. In other words, I believe that neuroleptics should ever be used a maintenance medication unless there’s just no other way, such as with perhaps a head trauma.
When I hallucinate badly I have ended up in the hospital and not by appointment. But after I’m out of that hospital my first order of business is to taper down and get rid of the drug. I go for years hallucinating only mildly at times, and that is way better than being on a neuroleptic. I have had several good years with no neuros and that’s several years that were totally worth it. Putting neuroleptics in your brain is a dangerous game. I sit the bench as often as I can and just be quiet as a churchmouse.