Recovery From Schizophrenia: Psychiatry And Political Economy

ixA NOTE ON THEORYThe materialist theoretical approach I have used throughout this book is notcommonly applied to questions in psychiatry. The central premise of the approachis that in order to understand human thought and behavior it is essential to beginwith the material conditions of mankind’s existence and productive processes.The origins of philosophical and social change, the materialist argues, are likely tobe found in changes in technology. Values, attitudes and ideology are likely to beshaped by political and domestic economy (for example, family patterns, socialstratification and political organization); and these aspects of society, in turn, tendto be molded by the forces of production and reproduction, by the technology ofsubsistence and population control and by labor requirements. 1A materialist research strategy, for example, allows us to generate thehypothesis that social attitudes towards the mentally ill partly reflect the usefulnessof the person with psychosis in the productive process; that psychiatric ideology isinfluenced by economic conditions; that the course of schizophrenia is influencedby class status, sex roles and labor dynamics; or that variations in the occurrenceof the illness may reflect differences in the circumstances of different classes andcastes under different modes of subsistence and production. Such hypotheses, ofcourse, must be tested against alternative explanations, and that is what this booksets out to do.I do not wish to suggest that material conditions create schizophrenia in anysimple, deterministic way, but rather that they mold the course and outcome ofthe illness and influence, along with other factors, its incidence. Psychiatricideology is obviously not wholly determined by the economy, but it could besignificantly affected by such factors. The materialist perspective allows for theoperation of any number of causes besides technological, environmental andproduction-related forces. People in similar environmental settings will not alldevelop schizophrenia; biology must be crucial in determining who develops apsychosis. Inbreeding could produce isolated populations with an increasedgenetic predisposition to schizophrenia. Individual psychology is also relevant; thepsychotic or pre-psychotic person’s behavior or response to circumstances maysometimes create the stresses that precipitate or worsen his or her illness. Thematerialist researcher would expect, however, that if we look at a large number ofinstances we will often find material forces to be important. It is not onlybiological, genetic or psychological factors that determine the distribution andcourse of schizophrenia. We should be prepared to expand our concern withsocial factors beyond family dynamics and socio-economic status. It is in therelationship between all of these potential causes and the economic, technologicaland environmental facts of our existence that we may gain the broadestunderstanding of why some people become schizophrenic and why some of themnever recover.