Recovery From Schizophrenia: Psychiatry And Political Economy

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). Fromthe 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 Schizophrenias,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