Recovery From Schizophrenia: Psychiatry And Political Economy

THE POLITICAL ECONOMY OF SCHIZOPHRENIA 95unemployed. 68 British and American studies show that the employment of thedevelopmentally disabled increased from around 40 per cent in the GreatDepression to 80–90 per cent during and after the Second World War. 69Vocational rehabilitation activities were also very highly developed in the fullemploymentconditions of the Eastern Bloc countries before the dissolution ofcommunism. 70Recent economic changes in the United States can also illustrate the effect ofthe labor market on the rehabilitation of the mentally ill. When unemploymentdropped to less than two per cent (essentially full employment) in BoulderCounty, Colorado, in 2000, the rate of stable employment of people withpsychotic illness increased from around 15 per cent a few years before to 50 percent. Vocational rehabilitation services for people with mental illness werestepped up to keep pace with the job placement opportunities. 71Labor dynamics, then, may explain many features of the deinstitutionalizationmovement and subsequent developments in community psychiatry. Before theintroduction of the antipsychotic drugs, postwar full employment in northernEurope called for the rehabilitation of the marginally employable mentally ill, andstimulated the development of more therapeutic styles of hospital care and apolicy of early discharge. The move to milieu therapy and community treatmentwas delayed in the United States, where full employment did not generallydevelop. The introduction of disability pension schemes made possible thedischarge of patients in the absence of employment opportunities, and the adventof the antipsychotic drugs allowed the control of symptoms in patients placed ininadequate and stressful settings. These changes, particularly in the United States,led to a different style of community management—the transfer of patients to lowcostplacements, often without genuine attempts at making patients productive,valued and integrated members of society.The steep rise in unemployment in Britain after the 1960s may go a long wayto explain the subsequent stagnation in British psychiatric rehabilitation. Therelatively better-functioning US economy of recent decades, leading to areas oflabor shortage in the 1990s, may explain the successful expansion of Americanpsychiatric community treatment and rehabilitation in the later years of thecentury.INTERNATIONAL COMPARISONSThe countries that led in the postwar revolution in social psychiatry were,according to Maxwell Jones, 72 Britain, the Netherlands, Norway and Switzerland.Table 4.2 lists postwar unemployment statistics for these countries and other partsof Europe and North America; the unemployment figures have been adjusted 73 tomake them reasonably comparable. The four countries that were progressive inpsychiatry at that time are among those with low unemployment rates.Countries, like the United States and Italy, where the rehabilitative movementwas delayed, had higher rates of unemployment. Open-door policies and the