Recovery From Schizophrenia: Psychiatry And Political Economy

134 LABOR, POVERTY AND SCHIZOPHRENIAUnemployment may exert an indirect influence on some people suffering frompsychosis in the community. One stress factor known to be associated with pooroutcome in schizophrenia is the effect of living with hostile, critical oremotionally over-involved relatives. The greater the proportion of time a personwith schizophrenia spends in the company of such a relative, the greater is his orher chance of relapse. 10 During an economic depression, both the relative and thepatient are more likely to be unemployed and at home together. For the minorityof people with schizophrenia who live with such a relative, this may be a seriousstress. A successful treatment program that has been developed to reduce the highrisk of relapse for such patients uses as one of its techniques efforts to increase theseparation of patient and relative by getting one of them out of the house and atwork. 11On the other hand, the home environment for the unemployed patient may betoo under-stimulating. It was found in one five-year follow-up study of peoplewith schizophrenia in London that for patients who were unemployed and livingat home, the length of time spent doing absolutely nothing was similar to that ofpatients in backward asylums. 12 Such poverty of daily existence is known to beclosely allied to the clinical poverty of institutionalism and the negative features ofschizophrenia. 13To emphasize, thus, the stresses of unemployment for people withschizophrenia is not to overlook the fact that, for many of these individuals, thestress of employment is also a major difficulty. People with schizophreniaexperience severe problems, argues psychiatrist Hans Huessy, as a consequence ofthe “fabulously highly developed division of labor in industrial society.” 14 Workrelatedstress is certainly important for these patients. In one group of people withschizophrenia, for example, 60 per cent had experienced a stressful life event inthe three weeks before their psychotic breakdown; of these, the stress for onethirdhad been related to stopping or starting work, completing job training orchanging hours of employment. 15 Starting work, however, is an acute stress that,if weathered, may lead the person with psychosis to higher functioning.Unemployment, on the other hand, brings the chronic strain of low status andpurposelessness, which may prevent recovery. Whichever part of the picture westudy, nevertheless, it seems likely that the labor market is closely involved in thesocial production and perpetuation of psychosis.THE INDUSTRIAL RESERVE ARMYUnemployment, argued Friedrich Engels, is not an aberration but an unavoidablecomponent of capitalist production.It is clear that English manufacture must have at all times save the briefperiods of highest prosperity, an unemployed reserve army of workers, inorder to be able to produce the masses of goods required by the market inthe liveliest months. 16