Recovery From Schizophrenia: Psychiatry And Political Economy

124 THE POLITICAL ECONOMY OF SCHIZOPHRENIAFigure 5.1 Percentage of admissions discharged as “recovered” from Worcester StateHospital over successive decadesNote: Reprinted by permission of the author. From Bockoven, J.S., Moral Treatment inCommunity Mental Health; New York: Springer, 1972, p. 56, © J.Sanbourne Bockoven.fell to 20 per cent in the late Victorian Great Depression and to 10 per cent in the1930s.David Rothman has criticized Dr Bockoven’s work on two counts. Rothmanargues, in the first place, that the revised recovery rates for Dr Woodward’s patients“are considerably lower than the claims for the 1830’s and 1840’s.” HereRothman makes the error of confusing the claimed recovery rates for “recent”(acute) cases (which were over 80 per cent) with general admissions (45 per centrecovery). Secondly, Rothman claims that Bockoven “makes no attempt toquestion just what ‘recovery’ meant in the original records.” 106 But Rothman isincorrect here, also. Bockoven demonstrates exactly what “recovery” meant forWoodward’s patients by presenting the results of Dr Park’s follow-up, 36–60years after discharge, of all of Woodward’s patients who left the hospital,“recovered,” prior to 1847. There were 1,173 such patients, and information wascollected on the condition of 984 of them. This project was both ambitious andsuccessful, and took Dr Park ten years to complete. The study showed that anextraordinary 58 per cent of the patients followed-up never had another relapse inthe rest of their lives or until the time of follow-up. Another eight per cent hadrelapsed but were well at follow-up. Dr Bockoven draws the conclusion that,during the moral-treatment era,the natural history of psychosis in general (including cases due to organicchanges of the central nervous system) was such that a large proportion ofpatients were able to leave the mental hospital, and only a small proportion,perhaps 20–30 per cent, were destined to die in a mental hospital. Favourableoutcome was, of course, even more frequent in the functional psychosesconsidered alone. 107A contemporary of Pliny Earle, Isaac Ray, a psychiatrist of equal stature andexperience, rebutted Earle’s views in 1879. Dr Ray argued that the early statisticalreports were no more biased than recent figures and that recoveries had, in fact,