Recovery From Schizophrenia: Psychiatry And Political Economy

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WHAT IS SCHIZOPHRENIA? 7Table 1.1-continuedSource: Kraepelin, E., Dementia Praecox and Paraphrenia, Edinburgh: Livingstone, 1919.
8 BACKGROUNDEUGEN BLEULERTwelve per cent of Emil Kraepelin’s patients with dementia praecox recoveredmore or less completely—few enough, but a sufficient number to cause concernabout the central diagnostic criterion being poor outcome. In the more prosperousyears of the early twentieth century in Switzerland and in the therapeuticallyprogressive atmosphere of the renowned Burghölzli Hospital, psychiatrist EugenBleuler presented a more optimistic view of the outcome from the illness.Stimulated by the psychoanalytic theories of his assistant, Carl Jung, Dr Bleulerformulated a new unifying concept for the condition and gave it a new name. ToDr Bleuler the identifying characteristic of the illness was not poor outcome but aspecific psychological picture—a lack of continuity in the associations betweenthe patient’s thoughts and a restricted or incongruous expression of emotion.Other symptoms that he regarded as fundamental were ambivalence and autism (apreoccupation with the inner world leading to detachment from reality). <strong>From</strong>the fragmentation of thinking and feeling, Eugen Bleuler derived the termschizophrenia—split mind. The hallucinations and delusions that were commonlypart of the psychotic picture, Dr Bleuler considered to be merely secondary to themore fundamental defects. 7Dr Bleuler’s 1911 monograph, Dementia Praecox or the Group of <strong>Schizophrenia</strong>s,contains many examples of patients who fail to show Kraepelin’s progressivedeterioration and who often recover a high level of functioning.A young farm girl, age seventeen, has been catatonic for a period of twoyears. Then she became a nursing attendant. Two years later she wasreleased. She then became a midwife. She married, her husband had adifficult time with her. For example, she would not permit him to singwhile he worked. She formed strong unfounded sympathies andantipathies. At the age of thirty-eight, she was again mildly catatonic forsome six months. Since then she has been working for eight years outsidethe hospital, but not as a midwife. 8Another of Bleuler’s examples:Physician: Neurasthenia at twenty-nine. Then at thirty-one after typhoidfever, catatonic. At forty-seven, apparently “cured”. He then resumes hispractice, marries. Has been well for the past two years. 9Bleuler’s impression was that few, if any, of his patients with schizophreniacompletely recovered without some vestige of their illness remaining. Farreachingimprovement, however, was common. Fully 60 per cent of his patientsrecovered sufficiently from their first schizophrenic episode to return to work andsupport themselves. 10 Such “social recoveries” cannot be directly compared withKraepelin’s 12 per cent of patients, who may well have shown signs of more
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 16 and 17: WHAT IS SCHIZOPHRENIA? 5syphilis, n
Page 20 and 21: WHAT IS SCHIZOPHRENIA? 9complete sy
Page 22 and 23: WHAT IS SCHIZOPHRENIA? 11patients w
Page 24 and 25: WHAT IS SCHIZOPHRENIA? 13publicatio
Page 26 and 27: WHAT IS SCHIZOPHRENIA? 15Figure 1.1
Page 28 and 29: WHAT IS SCHIZOPHRENIA? 17intrusiven
Page 30 and 31: WHAT IS SCHIZOPHRENIA? 19Figure 1.3
Page 32 and 33: WHAT IS SCHIZOPHRENIA? 21Brain stru
Page 34 and 35: WHAT IS SCHIZOPHRENIA? 23system. Th
Page 36 and 37: WHAT IS SCHIZOPHRENIA? 25One thing
Page 38 and 39: WHAT IS SCHIZOPHRENIA? 27of worth,
Page 40 and 41: Chapter 2Health, illness and the ec
Page 42 and 43: HEALTH, ILLNESS AND THE ECONOMY 31a
Page 44 and 45: HEALTH, ILLNESS AND THE ECONOMY 33i
Page 46 and 47: HEALTH, ILLNESS AND THE ECONOMY 35B
Page 48 and 49: HEALTH, ILLNESS AND THE ECONOMY 37s
Page 50 and 51: HEALTH, ILLNESS AND THE ECONOMY 39d
Page 52 and 53: HEALTH, ILLNESS AND THE ECONOMY 41F
Page 54 and 55: HEALTH, ILLNESS AND THE ECONOMY 43o
Page 56 and 57: HEALTH, ILLNESS AND THE ECONOMY 45T
Page 58 and 59: HEALTH, ILLNESS AND THE ECONOMY 47b
Page 60 and 61: HEALTH, ILLNESS AND THE ECONOMY 49F
Page 62 and 63: HEALTH, ILLNESS AND THE ECONOMY 51A
Page 64 and 65: Part IIThe political economy of sch
Page 66 and 67: 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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