Recovery From Schizophrenia: Psychiatry And Political Economy

THE POLITICAL ECONOMY OF SCHIZOPHRENIA 131Figure 6.4 Annual per capita National Health Service expenditure on mental illness (before1987) and mental health services (after 1987) in England and Wales (first series) andEngland (last three series) in constant (1998) poundsSource: The raw data were gathered from health service publications by Gyles Glover,University of Durham, and subsequently adjusted for annual inflation and populationgrowth.As in the case of the Great Depression, decreasing government spending onmental health care does not explain the deterioration in outcome fromschizophrenia. What does?ECONOMIC STRESS AND UNEMPLOYMENTStress may provoke a psychotic relapse in someone with schizophrenia (asdiscussed in Chapter 1). Both the boom and bust parts of the business cycle bringtheir own varieties of stress. In the depression they include loss of status, selfworthand independence for the unemployed, a sense of failure for those who slipdown the social ladder, and economic hardship for many. People withschizophrenia living in the community are exposed to all these possible stressesand those with marginal levels of functioning are particularly at risk when jobs arein short supply.Clinical experience shows us that economic uncertainty is a serious stress formany patients. As social security regulations were tightened during the earlyyears of the Reagan administration, for example, many people with a stablepsychotic disorder whose disability payments were abruptly terminated sufferedrelapses of their illness. The mental condition of many people with psychosissimilarly becomes worse when their most basic needs are not provided for. In theUnited States, homeless male patients with schizophrenia are frequently admittedto hospital, hungry, dirty, sleepless and floridly psychotic. When, after some mealsand a good night’s sleep, their mental state dramatically improves, hospital staffmay claim that the patient has “manipulated” his way into free board andaccommodation. More benign observers argue that the patient’s improvement isevidence of the efficacy of the dose of the antipsychotic medication that hereceived on admission. In fact, such patients often improve as readily without