Recovery From Schizophrenia: Psychiatry And Political Economy

140 LABOR, POVERTY AND SCHIZOPHRENIAill that treatment efforts and community integration are discouraged, therebyworsening recovery rates?Like most “chicken and egg” questions, this one is probably unanswerable. Theevents occurring at times of major policy change are so tightly intertwined that noone factor can be recognized as causative. Kathleen Jones, for example, sees threecomponents to the postwar British social psychiatry revolution—the Open-DoorMovement, the introduction of the antipsychotic drugs and legislativedevelopments.From the point of view of the therapy or of public policy, the coincidenceof these three movements was fortunate, since each reinforced the other.From the point of view of social analysis, it was less so, since it made itimpossible to trace cause and effect with any confidence. The three strandsof development crossed and re-crossed, becoming so interwoven that it willprobably never be possible to determine what influence each had. 37Certainly there is no indication, in the case of postwar Britain, that psychiatrists,noting greater success rates, dragged politicians unwillingly along. As early as1948, the National Health Service Act established local authority mental healthdepartments that assumed responsibility for community care for the mentally ill;in 1954 a parliamentary debate pushed for further modernization of mental healthservices and hospitals; and, in the same year, a Royal Commission was formed toconsider legislative reforms that would facilitate community care. 38 All thisoccurred before the widespread introduction of the antipsychotic drugs andcontemporaneous with the earliest moves to open the doors of the psychiatricwards. It seems probable that the political incentive to put into practice advancesin psychiatric care and to increase the rehabilitation of the mentally ill was alreadythere—stimulated by the urgent need for labor.The question of cause and effect has a practical aspect. If it were possibleartificially to maintain employment for the mentally disabled during hard times,would recovery rates improve (and admission rates and treatment costs decline),or would the social and political consensus existing during the depression limit thepotential for improvement in the course of psychosis? It seems quite possible, infact, that the effect of the social and political forces would be to obstruct thedevelopment of preferential employment for mental patients. Since the earliestdays of institutions, workers in the regular labor force have objected to the unfaircompetition of inmates’ labor during periods of unemployment. Charles Dickensillustrates this point by contrasting the prisons of labor-starved America in the1840s with those of Britain, where a surplus of workers existed.America, as a new and not over-populated country, has, in all her prisons,the one great advantage, of being able to find useful and profitable work forthe inmates; whereas, with us, the prejudice against prison labour isnaturally very strong, and almost insurmountable, when honest men who