Recovery From Schizophrenia: Psychiatry And Political Economy

142 LABOR, POVERTY AND SCHIZOPHRENIA• If one social class is more affected by the rigors of the labor market, that classshould experience poorer outcome in schizophrenia.• Outcome from schizophrenia will be better in industrial nations withcontinuous full employment unaffected by cyclical changes.• The course of schizophrenia will be more benign in non-industrial societieswhere wage labor and unemployment are uncommon.These predictions allow us to discriminate, to a certain extent, between the effectsof the labor market and of economic hardship—only in some of these instancescan we expect economic hardship to produce the same direction of change in thecourse of schizophrenia. Let us see how accurate are these predictions.GENDER DIFFERENCES IN RECOVERY FROMSCHIZOPHRENIADespite the fact that the level of female unemployment is often higher than formales in the United States, for most of the past century men have suffered morefrom the fluctuations of the labor market than have women. In general, substantiallyfewer women have been involved in wage work than men, and One could arguethat patients who return to an assured role as a homemaker will experience lessdifficulty than those who must re-enter the competitive women are more likelyto have a valued social role when not earning a wage. labor market. Furthermore,as Brenner 41 has pointed out, men are more adversely influenced by a recessionthan women. During the Great Depression and subsequent business downturns,male unemployment increased more than female unemployment and oftensurpassed it. From this, one might reasonably predict that the course ofschizophrenia in women in Western industrial society will be milder than in men.“That the probability of recovery is greater in women than in men…may nowbe regarded as established,” 42 wrote Dr Thurnam in his Observations and Essays onthe Statistics of Insanity, as early as 1845. His analysis showed that the proportion ofpatients discharged as recovered from the asylums of his day was consistentlyhigher for female than for male admissions. In more recent times ProfessorÖdegard, in studying all first admissions to Norwegian psychiatric hospitals from1936 to 1945, found a higher early discharge rate for females with schizophreniathan for males. 43 Two follow-up studies of patients with schizophrenia whoentered hospital in Finland in the 1960s showed that women patients were morelikely to be symptom-free, working and functioning independently. 44 PsychiatristJames Beck has noted that outcome studies often demonstrate that males sufferingfrom schizophrenia do worse than females but that women are never found tofare worse than men. 45 Similarly, in two different WHO international follow-upstudies of schizophrenia, proportionally fewer women subjects were in the worstoutcome group at follow-up, and more were in the best outcome category. In theindustrial countries, in particular, women tended to have shorter episodes ofschizophrenic psychosis. 46 In addition, Brenner’s data show that female patients