Recovery From Schizophrenia: Psychiatry And Political Economy

126 THE POLITICAL ECONOMY OF SCHIZOPHRENIAprognosis were pessimistic. 113 At this point in history, in the coercive, prison-likeenvironment of a German asylum 114 during the universal, late nineteenth-centuryGreat Depression, dementia praecox was defined as a progressively deterioratingand all but incurable illness.When moral treatment returned, a century and a half after its originalappearance, its objectives and ideology were similar but the locations wereswitched. This time it was in labor-short northern Europe that it served (at leastinitially) a genuinely rehabilitative purpose, but in America it was largely usedmerely to legitimize the deinstitutionalization movement—the transfer of theindigent mentally ill from indoor to outdoor relief, and from state budget tofederal. Both the concept and management of psychosis appear to have beeninfluenced by political and economic factors. Ideology and practice in psychiatry,to a significant extent are at the mercy of material conditions.SUMMARY• Moral treatment was a humane and non-restrictive method of management forpeople with psychosis that came into being simultaneously in several parts ofEurope in reaction to the eighteenth-century concept of madness as bestial.• The origins of moral treatment were also those of the French Revolution andthe English Industrial Revolution—Enlightenment thinking, dramatic changesin population and labor patterns, and the capitalist transformation ofproduction.• The treatment method was inextricably tied to the development of mentalinstitutions, and it helped legitimize the public asylum movement.• A function of the new asylums was to enact the social policy of providing poorrelief to the unemployable in institutions and the cutting back on outdoorrelief to the employable.• Moral treatment was little used in British public asylums except for a brief spellduring the boom years of the 1850s and 1860s when the asylum system wasbeing expanded.• Private patients in Britain enjoyed more humane care and better recovery ratesthan paupers.• The high levels of unemployment in Britain throughout the nineteenthcentury may well have limited rehabilitative efforts for the insane poor.• The labor shortage in early nineteenth-century America was associated withmore intense rehabilitative efforts and higher cure rates, especially in acutemental illness, in public asylums.• Later American psychiatrists attempted to obscure the fact that recovery rateswere higher during the moral-treatment era.