Recovery From Schizophrenia: Psychiatry And Political Economy

THE POLITICAL ECONOMY OF SCHIZOPHRENIA 139legitimizing the last stages of deinstitutionalization to legitimizing the finalabandonment of the same patients to poverty and neglect in their inner-cityghetto. The story of moral treatment is, here, being repeated under similareconomic conditions. The cause for mounting pessimism appears the same in eachcase—governmental indifference leaves the patients stranded in sordidenvironments, without adequate treatment and without a purpose in life. Thevictims are blamed each time, however; it is, supposedly, the inherently incurablenature of the patients’ condition that indicates that we should not waste time andmoney treating them.SOCIAL TOLERANCECan it be shown that public tolerance of the mentally ill is similarly affected bythe economic climate? In general, discrimination, prejudice and negativestereotyping are known to increase sharply as competition for scarce jobsincreases. Negative attitudes towards ethnic minority groups become morecommon during hard times. 30 But information about the effect of the economyon attitudes towards the mentally ill is limited. In Britain, many observers notedan improvement in public attitudes towards mental patients at the time of thepostwar social psychiatry revolution. 31 As Professor Morris Carstairs wrote in1961: “Few would claim that our current ‘wonder drugs’ exercise more than apalliative influence on psychiatric disorders. The big change has been rather one ofpublic opinion.” 32 In America, in line with the higher unemployment, the lateronset of deinstitutionalization and the less intense rehabilitative and reintegrativethrust of that movement, public attitudes were slower to change. Communitystudies from the 1950s reported that attitudes towards the mentally ill werecharacteristically negative and rejecting. 33 By the 1960s there were indicationsthat the general public was becoming more accepting, 34 but there was nosubsequent demonstrable improvement in the status of the mentally ill during theeconomic stagnation of the 1970s. 35 Not until the improved economic conditionsof the late 1990s do we see a renewed interest in the US in combating the stigmaof schizophrenia. 36REHABILITATION EFFORTS—CAUSE OR EFFECT?Having seen that both recovery rates in schizophrenia and rehabilitative effortsexpended on the mentally ill tend to diminish during the depression, the questionof cause and effect remains to be addressed. Do the patients fail to get betterbecause nobody bothers to treat them, or does nobody bother to treat thembecause they fail to get better? Earlier in this chapter it was suggested thatunemployment has a direct psychological impact on those who are out of work,including the mentally ill, and could thus stand in the way of recovery frompsychosis. Can we rule out the additional possibility, implicit in Marxist theory,that a labor glut so diminishes the political incentive to rehabilitate the mentally