Recovery From Schizophrenia: Psychiatry And Political Economy

Chapter 6Labor, poverty and schizophreniaWhy did fewer people with schizophrenia recover during the twentieth-centuryGreat Depression? It is worth examining this question in depth as the answer mayhelp us understand why outcome from schizophrenia deteriorated during therecent, late twentieth-century economic downturn in Britain.It is scarcely surprising that social recovery rates in schizophrenia declinedduring the Great Depression since employment is a large part of the measure ofsocial functioning; but why was there a drop in the rate of complete, symptomfreerecovery at that time (as revealed by the analysis of follow-up studies inChapter 3) from an average of 20 per cent to 12 per cent? Which of the followingpossible explanations is most applicable?• Government spending on psychiatric treatment decreases during hard times,resulting in hospital overcrowding and poor-quality care.• The stresses of the Depression, including economic hardship andunemployment, affected patients and their families and prevented recovery orprecipitated psychotic relapse.• The reduced demand for labor led to diminished rehabilitative and reintegrativeefforts for people with schizophrenia, resulting in changes in mental healthpolicy, psychiatric ideology and social tolerance for people with mental illness.GOVERNMENT SPENDINGMental hospital admissions, especially for people with schizophrenia and otherforms of functional psychosis, increase during an economic recession (as HarveyBrenner’s work, Mental Illness and the Economy, has shown). If legislators cut backon funding during the Great Depression, at a time of increasing demand, theresult would, presumably, have been overcrowding, deteriorating care and nontherapeutichospital conditions. Is this what happened? The evidence suggests it isnot.The annual expenditure on psychiatric hospitals in the state of Colorado, forexample (as can be seen in Figure 6.1), increased considerably between 1913 and1955, even after allowance is made for inflation and state population growth.During the decade of the Great Depression, however, expenditure was