Recovery From Schizophrenia: Psychiatry And Political Economy

THE POLITICAL ECONOMY OF SCHIZOPHRENIA 143with functional psychosis are less likely than men to be admitted or readmitted topsychiatric hospital when unemployment increases. 47 These gender differencesconfirm the impression that labor dynamics may influence outcome inschizophrenia, though other factors, such as the neuroprotective effect of femalehormones, may also contribute to the observed findings. 48SOCIAL CLASSSome social scientists have argued that the social groups that suffer the most stressduring the depression are those which suffer the greatest relative decline in status—the unemployed amongst the middle classes, for example. 49 On this basis Brennerhas explained the particularly heavy impact of the depression on the mentalhospital admission rate of more highly educated male patients. 50 This is as may be;but the business cycle aside, the social classes that come off worst in thecompetition for jobs are, clearly, the poorest. Black unemployment in the UnitedStates, for example, is regularly twice that of whites, in good times or bad.Unskilled workers in the secondary labor force have the least job security of anygroup, and the lowest status. Their work is often casual, menial, highly routineand, always, poorly paid. Alienation from the creative process is greatest, ingeneral, in the working class. Clearly, if any group were to experience constantdifficulty in gaining and holding wage work and in deriving self-esteem andgratification from their employment it would be those in the lowest social classes.It comes as no surprise to find that recovery from psychosis is worst in thelower socio-economic groups. Admission rates were higher for pauper lunatics inVictorian Britain and, as we saw in Chapter 5, their recovery rates were lower.Similarly, in modern times, not only is the incidence of serious mental disordergreater in the lower classes (as we saw in Chapter 2), but the outcome frompsychosis is distinctly worse. A study conducted in Bristol, England, of males withschizophrenia first admitted in the early 1950s found that patients from the lowersocial classes had longer hospital stays, were much less likely to be improved orrecovered at the time of discharge, were liable to be readmitted earlier and werevery much more likely to become chronically institutionalized than were upperclasspatients. The lower-class patients in the community, moreover, were lesslikely to be employed and showed worse overall social adjustment. 51 The authorof this study, Dr B.Cooper, concludes:It seems most likely that clinical condition and economic status are mutuallyrelated and interacting, and that the patient who fails to return to usefulwork is more prone to schizophrenic relapses. 52Other investigations have produced similar results. Another British study of maleswith schizophrenia from the 1950s found that lower-class patients had longeradmissions. 53 In New Haven, Connecticut, August Hollingshead and FrederickRedlich in the 1950s showed that lower-class patients spent longer in hospital and