Recovery From Schizophrenia: Psychiatry And Political Economy

THE POLITICAL ECONOMY OF SCHIZOPHRENIA 137(3) social consensus, or tolerance of the mentally ill.A speculative attempt to illustrate how these components may vary with thebusiness cycle is set out in Table 6.1. At any one time, opposing sets of attitudesmay be encountered, but as the economic climate changes so does the balance ofopinion.It becomes clear from this formulation that psychiatric ideology may beinfluenced by changes in the economy—a notion that implies a rejection of theconventional concept of scientific progress inherent in mainstream medicalhistory. There are certainly grounds for this position. As we have seen, whenrecovery rates and treatment standards declined at the end of the moralmanagementera, and at the onset of the Great Victorian Depression, psychiatricphilosophy became pessimistic and turned from an interest in social causes ofillness to biological and hereditary factors. Kraepelin defined schizophrenia as anincurable disease. Early discharge was considered dangerous. Eugen Bleulerreformulated the concept of schizophrenia as a condition from which manyrecovered without defect in the sunnier economic climate of Switzerland beforethe First World War. At this time, he and his colleagues at Burghölzli Hospital inZurich—Carl Jung and Adolf Meyer-developed psychodynamic theories ofschizophrenia. Bleuler encouraged the early discharge of his patients to avoid thedangers of institutionalism. During the twentieth-century Great Depression,physical treatment methods and psychosurgery were emphasized. Psychosis wasneglected and psychiatry, especially in America, concentrated upon the long-term,dynamic treatment of less severely disturbed, middle-class and upper-class,neurotic patients.Widespread interest in social factors in mental illness, in the understanding ofpsychosis and in community care were not to return until 80 or 90 years aftermoral treatment disappeared—until the boom decades after the Second WorldWar. By contrast, psychiatry in post-revolutionary Russia during the earlytwentieth century pursued a different course—a method of psychological andsocial reintegration that evolved from the work of Ivan Pavlov. 24Ideological views that emerge counter to the mainstream of psychiatric thoughtmake no headway in the face of a contrary political and social consensus. Critics,in the mid-Victorian era, who objected to the expansion of asylums intomammoth institutions where individual treatment was impossible were ignoredby local authorities and a tax-conscious populace concerned to maximize costefficiency.25 Hospital superintendents who attempted to establish open-doorpolicies before the advent of the postwar social psychiatry revolution weredefeated by public opinion. 26 Alfred Adler, in the 1930s, gained little recognitionfor his views on the importance of social factors in psychopathology; and thework of American social scientists in the 1930s on the interaction of culture andmental disorder did not influence psychiatric theory or practice to an appreciabledegree. 27