Recovery From Schizophrenia: Psychiatry And Political Economy

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WHAT IS SCHIZOPHRENIA? 5syphilis, no specific cause of the condition could be identified; in contrast to thepsychogenic psychoses, dementia praecox did not appear to be an acute responseto stress; and it was to be distinguished from manicdepressive insanity by itsprogressive deteriorating course and by the absence of clear-cut mood swings fromelation to melancholia.Emil Kraepelin’s description of dementia praecox continues to serve us well,with some exceptions, as a picture of modern-day schizophrenia. Some of thecharacteristic features that he identified are listed in Table 1.1. Where hisobservations no longer appear relevant is in his description of the symptomsassociated with catatonic schizophrenia—automatic obedience, stereotypicmovements, waxy flexibility, echolalia and echopraxia (see Table 1.1). Kraepelin’streatise on dementia praecox is illustrated with photographs of catatonic patientssitting and standing rigidly in bizarre and contorted postures, preserving poses intowhich they were set by the photographer. It was not unusual for Kraepelin’spatients to repeat involuntarily the words and movements of those around them orto stand or kneel for days or longer in the same spot. 5 Patients with such featurescould still be seen on the wards of old-style institutions after the Second WorldWar, but they are now very rarely seen in the industrial world. Catatonicschizophrenia, however, is still one of the commonest forms of the disorder in theThird World.It is possible, as social psychiatrist Julian Leff argues, that these catatonicsymptoms are a somatic expression of delusions of influence, symbolic thinkingand pathological fear, much as the bodily symptoms of hysteria are a somaticconversion of anxiety. Both hysteria and catatonic symptoms have receded in theWest, Dr Leff suggests, as the population has developed a capacity for expressingemotions in verbal and psychological terms rather than as somatic symptoms. 6 Itmay also be true that the harsh and regressive conditions of asylums around thebeginning of the twentieth century tended to provoke and worsen catatonicsymptoms, which persisted as a physical expression of the patient’s dependentstatus and barren existence.Even more probable, these same asylum conditions may have brought aboutthe deteriorating course that Kraepelin saw as central to his concept of the illness.Therapeutic nihilism, extended hospital stays and coercive management withinthe asylum walls, and poverty and unemployment beyond them, during theseyears of the late nineteenth-century Great Depression combined to limit thechances of recovery from dementia praecox. Few psychiatrists since Kraepelin, aswe shall see in Chapter 3, have found the course of schizophrenia to be asmalignant as originally portrayed. As Kraepelin’s classification was adopted aroundthe world, nevertheless, so was the impression that the illness was inevitablyprogressive and incurable. To varying degrees the same view holds sway today—that without treatment the outlook is hopeless—despite considerable evidence tothe contrary.
6 BACKGROUNDTable 1.1 3.1 Features of dementia praecox identified by Emil Kraepelin
Page 2 and 3: Recovery from SchizophreniaRecovery
Page 4 and 5: First edition published 1985by Rout
Page 6 and 7: ContentsAcknowledgments viIntroduct
Page 8 and 9: devotion to excellence in creating
Page 10 and 11: ixA NOTE ON THEORYThe materialist t
Page 12 and 13: Part IBackground
Page 14 and 15: WHAT IS SCHIZOPHRENIA? 3WHAT IS SCH
Page 18 and 19: WHAT IS SCHIZOPHRENIA? 7Table 1.1-c
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Page 28 and 29: WHAT IS SCHIZOPHRENIA? 17intrusiven
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Page 32 and 33: WHAT IS SCHIZOPHRENIA? 21Brain stru
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Page 40 and 41: Chapter 2Health, illness and the ec
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Page 62 and 63: HEALTH, ILLNESS AND THE ECONOMY 51A
Page 64 and 65: Part IIThe political economy of sch
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RECOVERY FROM SCHIZOPHRENIA 55impro
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RECOVERY FROM SCHIZOPHRENIA 57categ
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RECOVERY FROM SCHIZOPHRENIA 59Table
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Table 3.1 -continuedRECOVERY FROM S
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RECOVERY FROM SCHIZOPHRENIA 73Figur
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Table 3.3 Recovery rates in the USA
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RECOVERY FROM SCHIZOPHRENIA 77the l
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THE POLITICAL ECONOMY OF SCHIZOPHRE
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MADNESS AND THE INDUSTRIAL REVOLUTI
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25 patients, and on the more distur
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Chapter 6Labor, poverty and schizop
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THE PERSON WITH SCHIZOPHRENIA IN WE
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Chapter 9The incidence of schizophr
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Part IIITreatment
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ANTIPSYCHOTIC DRUGS: USE, ABUSE AND
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TREATMENT 247indicated, unemploymen
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TREATMENT 249success, for the lodge
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TREATMENT 251vocational programming
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TREATMENT 253the job is permanent.
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TREATMENT 255Social enterprises in
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TREATMENT 257pharmacy technicians a
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TREATMENT 259The situation seems to
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TREATMENT 261Though these results a
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TREATMENT 263• raise the minimum
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TREATMENT 265• Social policy inno
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TREATMENT 267Table 12.1 Living situ
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TREATMENT 269A JAIL DIVERSION PROGR
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TREATMENT 271the office work and th
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TREATMENT 273One might imagine that
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TREATMENT 275studies may be the res
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TREATMENT 277established for some o
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TREATMENT 279Another residential pr
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TREATMENT 281interest loans and gra
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TREATMENT 283individual’s goals s
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TREATMENT 285Cognitive therapy, it
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TREATMENT 287Table 12.2 Facts about
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TREATMENT 289consumers and professi
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TREATMENT 291definitively not part
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FIGHTING STIGMAAlthough the mentall
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TREATMENT 295The National Alliance
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TREATMENT 297other medical disorder
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TREATMENT 299when a psychiatrist an
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NotesINTRODUCTION1 Harris, M., Cult
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NOTES 30333 Heston, L.L., “Psychi
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NOTES 30557 Sham, P.C., O’Callagh
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87 Dohrenwend, B. and Egri, G., “
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NOTES 30929 Srole, L., Langner, R.S
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NOTES 311unemployment cause the dea
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NOTES 313107 Warr, P., “Studies o
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138 Dear, M., Clark, G. and Clark,
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NOTES 3178 Epstein, L.J., Morgan, R
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NOTES 31943 Quirk, A. and Lelliott,
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NOTES 32349 Walton, “Pauper lunat
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105 Bockoven, J.S., Moral Treatment
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NOTES 32729 For positive evaluation
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66 Barker, D., “Moscow mayor has
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NOTES 33133 World Health Organizati
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NOTES 33380 Eliade, M., Shamanism:
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NOTES 335homelessness a mental heal
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NOTES 337Academic Press, 1978; Faul
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NOTES 339Washington, DC: House of R
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NOTES 34194 Read, J. and Baker, S.,
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132 Robinson, J.R and Shaver, P.R.,
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NOTES 345“Schizophrenia is not di
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NOTES 34748 Bagley, C., “The soci
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NOTES 34979 ni Nuallain, M., O’Ha
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NOTES 3514 Kapur, S. and Seeman, P.
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NOTES 35327 Pasamanick, B., Scarpet
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NOTES 355Archives of General Psychi
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NOTES 357“Prognostic factors in r
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NOTES 359Chandler, D., Meisel, J.,
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30, 1978; Moffit, R., “The econom
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NOTES 36312 Stein, L.I. and Test, M
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NOTES 36547 Personal communication,
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NOTES 367European Psychiatry, 15:26
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BibliographySTUDIES OF THE OUTCOME
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BIBLIOGRAPHY 371Horowitz, W.A. and
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BIBLIOGRAPHY 373Salokangas, R.K.R.,
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AUTHOR INDEX 375Dunham, Warren 31Du
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AUTHOR INDEX 377Urquhart, M.C. 129n
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SUBJECT INDEX 379atypical 20;compan
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SUBJECT INDEX 381CESP see Carer Edu
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SUBJECT INDEX 383disability pension
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SUBJECT INDEX 385diagnosis of 148;d
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SUBJECT INDEX 387Isle of Wight 33is
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SUBJECT INDEX 389Middlesex, Hanwell
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SUBJECT INDEX 391PACE see Personal
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SUBJECT INDEX 393economic condition
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SUBJECT INDEX 395self-employment 15
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SUBJECT INDEX 397symbolic thinking
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SUBJECT INDEX 399volition disturban
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