Recovery From Schizophrenia: Psychiatry And Political Economy

144 LABOR, POVERTY AND SCHIZOPHRENIAwere more likely to be readmitted. 54 Repeating that study a decade later, JeromeMyers and L.L.Bean also found that lower-class patients were more likely to bekept in hospital and more likely to be readmitted. In the community, the patientof low social class had a worse work record (except for homemakers, where expatientsperformed as well as never-hospitalized women), and was more sociallyisolated and stigmatized. 55 A 1974 follow-up study of people with schizophreniafrom the eastern United States demonstrated that social class was strongly relatedto symptomatic outcome. Lower-class patients had more psychotic symptomswhen interviewed 2–3 years after discharge from hospital. 56 Finally, the WHOinternational follow-up study of schizophrenia found that having a higher-statusoccupation was one of the best predictors of good outcome for patients living incities in the Developed World (London, Moscow, Prague, Washington, DC andAarhus, Denmark). 57Three studies do not show a significantly longer duration of hospital stay forlower-class people with schizophrenia. Two of these, however, were conductedin Britain during the early 1950s, when there was full employment. 58 Under suchconditions, one might expect some improvement in outcome from schizophreniain the lower classes (although Cooper’s contrary findings for people withschizophrenia in Bristol were also from this period). Ödegard’s study ofNorwegian hospital admissions from 1936 to 1945 failed to show a consistentpattern of longer hospital stay for patients from lower-status occupations. Ödegardrecognized that his results did not conform to the usual pattern found in othercountries, and he attributed the findings to the fact that some of the lower-statusoccupations in Norway, such as public service employment, carried bettereconomic job security, which resulted in the unusually high discharge rates forpatients from these groups. 59Overall, it is apparent that the majority of studies, and the more comprehensiveamong them, point to worse outcome in schizophrenia for the lower classes. Anumber of factors might explain this phenomenon—economic hardship, differentlevels of tolerance in the family or in the community, or even, as some Americanresearchers have argued, “more limited and rigid concepts of social reality” andpoorer “drug compliance” in the lower-class patients. 60 In conjunction with theother material in this chapter, however, the finding may be taken as further supportfor a link between labor dynamics and the course of schizophrenia.FULL EMPLOYMENTProfessor Luc Ciompi has argued that the benign course of schizophrenia intwentieth-century Switzerland may have been a result of the “exceptionallyfavorable socioeconomic conditions” that prevailed in that country throughoutmuch of the century. He followed up more than 1,600 people with schizophreniaadmitted throughout the century to the University Psychiatric Clinic in Lausanneuntil they passed the age of 65. Twenty-seven per cent had completely recoveredand a further 22 per cent were only mildly disturbed. Thus, about half of the