Recovery From Schizophrenia: Psychiatry And Political Economy

136 LABOR, POVERTY AND SCHIZOPHRENIAREHABILITATION AND REINTEGRATIONMarx’s analysis suggests that the treatment of the great majority of the mentally illwill reflect the condition of the poorest classes of society. In the absence of apowerful political counter-force the outlook in schizophrenia is unlikely to getbetter. Despite the fact that an improvement in conditions of living andemployment for people with psychotic disorders may yield higher rates ofrecovery, this consideration will remain secondary. Significant treatment effortswill only be expended on those skilled workers who are acutely mentally ill andwhose disappearance from the work force involves the loss of a substantialinvestment in training. Efforts to rehabilitate and reintegrate the chronicallymentally ill will only be seen at times of extreme shortage of labor (such as in theboom years of the late 1990s in the US)—after the other battalions of theindustrial reserve army have been mobilized. At other times, the primaryemphasis will be one of social control. The rate of recovery of those who have an“incapacity for adaptation” will, then, be a barometer of the extent of generalunemployment.There is evidence to support this interpretation. In an earlier chapter, forexample, we have seen that successful rehabilitation and social reintegration of thementally ill are related to the demand for labor and, in many instances, thissuccess appears to be a reflection of the intensity of the rehabilitative efforts. Torecapitulate:• Rehabilitation of the mentally and physically disabled is more successful inwartime and during periods of labor shortage.• Deinstitutionalization began, before the introduction of the antipsychoticdrugs, in those northern European countries that had low unemploymentrates.• The number of mental hospital beds provided in the industrial nations in 1965was related to the national unemployment rate.• The proportion of people with schizophrenia confined to hospital at follow-upincreased during the Great Depression.• Discharge and recovery rates in labor-starved, early nineteenth-centuryAmerica may have been higher because of the availability of moral treatmentin the public asylums.• Recovery rates and treatment efforts declined as pauperism and unemploymentbecame more common in the new republic.Just how does the labor market influence approaches to the mentally ill?Rehabilitative and reintegrative efforts for psychiatric patients are comprised ofthree inter-related elements:(1) political consensus, or state mental health policy;(2) professional consensus, or psychiatric ideology; and