Recovery From Schizophrenia: Psychiatry And Political Economy

146 LABOR, POVERTY AND SCHIZOPHRENIAthan four months during the two-year follow-up period. By the samestandardized follow-up criteria, only slightly more than a third of the patients inthe centers in Britain, America and Denmark showed as great a degree of overallimprovement. Substantially fewer of the Russian patients, further-more, were inthe worst outcome category at follow-up. 68 The superior recovery rates forpeople with schizophrenia in Moscow may have been an artifact of the broaderdiagnostic approach there; yet a similarly inclusive diagnostic concept inWashington, DC, does not seen to have led to better outcome for the Americanswith schizophrenia.Recovery from schizophrenia in the WHO study was, however, no better inPrague (Czechoslovakia) than in the West, despite a labor shortage in Prague atthat time. This difference between outcome in Moscow and Prague is difficult toexplain. It may have been a result of the broader Russian diagnostic approach toschizophrenia. The year these patients were admitted to the study (1968) is thesame year that the Warsaw Pact countries occupied Czechoslovakia, but it is notclear that this had an impact on the rehabilitation of people with schizophrenia.We can only say that the data so far available from full-employment societies areambiguous, but that there is some evidence that such societies benefit from amore benign course to schizophrenia than is found in industrial nations withsignificant levels of unemployment.We have gone a long way towards demonstrating that socio-economicconditions shape the course of schizophrenia. Outcome data on schizophrenia inthe Depression, in the two sexes, in different social classes and in differentpolitical-economic systems all tend to support the notion that the effects of thelabor market and, possibly, economic hardship are critical. In all of these instancesthe observed differences in the course of schizophrenia may be explained by botha direct effect of unemployment on the individual suffering from psychosis or bythe influence of the demand for labor on rehabilitative and reintegrative efforts. Inall these instances except one—the difference in recovery patterns for men andwomen—economic hardship may also be an important stress leading to relapse orpoor outcome.One further prediction remains to be examined—that if labor-marketconditions can adversely affect the course of schizophrenia, the illness should bemore benign in non-wage-labor settings. In the next chapter we will examinethis possibility and, also, use the opportunity to study how major differences inpolitical and domestic economy may affect the person with schizophrenia.SUMMARY• Spending on psychiatric hospital care increased during the Great Depression.• Spending on mental health services in Britain did not decline in the latetwentieth-century economic downturn when outcome from schizophreniawas worsening.