Recovery From Schizophrenia: Psychiatry And Political Economy

THE POLITICAL ECONOMY OF SCHIZOPHRENIA 159Many clinicians in the West have noticed that the demands of a 40-hour week areoften overly taxing for patients suffering from psychosis. In huntergatherer andpeasant societies, the distinction between work and non-work may be hard tomake (in some cultures it is not linguistically possible to differentiate “work” from“ritual” or from “play” 42 ), but the demands of subsistence are unlikely to beburdensome. !Kung Bushmen work no more than two to three (six-hour) days aweek in hunting and food-gathering for themselves and their dependants, andabout two hours further each day is spent on food preparation and“housework.” 43 Slash-and-burn agriculture, for example among the Bemba ofnorth Zimbabwe or the Toupouri of north Cameroon, calls for only three or four(five-hour) working days a week. 44 Plough agriculture commonly requires a 30–35-hour work week. 45 Estimates of labor requirements for irrigation agriculturevary. In Yunnan Province in pre-revolutionary China, the working day wasseldom longer than seven to eight hours, including frequent rest periods, even atthe busiest time of year; during the slack months, there was virtually no farmwork to be done. Elsewhere a demanding 50–70-hour work week has beenrecorded, but both of these examples of irrigation agriculture involve marketproduction, not just local subsistence needs. 46 Where production is for use and notfor exchange, labor needs tend to be low. 47In each setting there is wide individual variation. In pre-revolutionary Russia,for example, peasant farmers in Volokolamsk worked between 79 days a year inthe least industrious households and 216 in the most industrious. 48 This compareswith an expectation of around 230 to 240 working days a year for employees inmodern industrial society. Work demands in many cultures are particularly low foryoung, unmarried adults 49 (who may be at higher risk for developingschizophrenia), but whatever the usual pattern, workload expectations are morereadily adjusted to meet the capacities of the marginally functional individual in avillage setting than in the industrial labor market. There can be little doubt that itis simpler for a person with schizophrenia to return to a productive role in a nonindustrialcommunity than in the industrial world. The merits of tribal andpeasant labor systems are apparent. As in the West during a period of laborshortage, it is easier for family and community members to reintegrate the sickperson into the society, and the sufferer is better able to retain his or her selfesteem.The result may well be not only better social functioning of the sickperson but also more complete remission of the symptoms of the illness.OCCUPATION AND OUTCOMEIn searching for predictors of good outcome in schizophrenia, the WHO PilotStudy examined a number of patient characteristics. We may look at these datafor evidence of an association between occupation and outcome in schizophreniabut, in so doing, we encounter difficulties presented by the variety andcomplexity of work and subsistence patterns in the developing world. Poverty canbe extreme in the urban slums of the Third World, where many eke out an