Recovery From Schizophrenia: Psychiatry And Political Economy

THE POLITICAL ECONOMY OF SCHIZOPHRENIA 133He may be unable to cope with…the complex demands of welfaredepartments. 5Although many of these “negative” features of schizophrenia are known to bemade worse by the social deprivation of institutional care, they are neverthelessseen by psychiatrists as inherent aspects of the illness. (Hence the emphasis on thebiological concept of “anergy” rather than the psychological attribute of“apathy”) Mental health professionals become frustrated by, and sometimes criticalof, their patients’ dependency, incompetence and unreliability. To label suchproblems as biological deficits helps the professional cope with his or herfrustrations, but it also increases the pessimism regarding treatment and the stigmathat attaches to the patient. That such deficits are, to an extent, socially inducedbecomes apparent, however, when we read the words of this unemployed (nonpsychotic)teenager:“I feel outside of it…[unemployment] just makes me feel different. I reallyadmire these guys who can get up and shave, and have breakfast, and makea journey to work, and come home again, and have meals-guys who can doall that in one day! I don’t know how they can manage it. When I’ve got tosign on, or anything like that, just do the one thing, it bugs me all day…. Orif I’ve got anything to do…say to catch a bus to go somewhere, it’s a realdrag. We can’t seem to get with it.” 6The similarity in the emotional reactions of the unemployed and of people withpsychosis was highlighted by a study conducted in the Great Depression. Thelevel of negativity and pessimism about the future in large samples of the Scottishand Lancashire unemployed was found to be greater than that of groups ofpatients with psychotic depression and schizophrenia. 7 If the unemployed are asdistressed as hospitalized people suffering from psychosis, how can we hope thatthe unemployed people with psychosis will return to normal during hard times?In fact we may ask, as did the author of the study of the Scottish and Lancashirejobless, “why mentally distressed unemployed …do not become psychotic.” 8The answer is, of course, they may well do so. Brenner found that it wasprecisely that segment of the population that suffers the greatest relative economicloss during a depression—young and middle-aged males with moderate levels ofeducation—that showed the greatest increase in rates of admission to New Yorkmental hospitals for functional psychosis during an economic downturn.Prominent among these patients were people admitted for the first time withschizophrenia. 9 We saw in Chapter 2 that the likeliest explanation for this effectwas a true increase in the occurrence of psychosis secondary to the stresses of theeconomic recession and unemployment. In Chapter 9 we shall explore in moredetail whether labor dynamics significantly affect the rate of occurrence ofschizophrenia. Here we shall concentrate on how far the labor market influencesthe course and outcome of the illness.