Recovery From Schizophrenia: Psychiatry And Political Economy

THE PERSON WITH SCHIZOPHRENIA IN WESTERN SOCIETY 179of sane offenders—incarceration rates rise during an economic recession (but areunrelated to crime or conviction rates), 52 and jail and prison populations tend tobe greater in those Western industrial nations with the highest rates ofunemployment. 53 The larger the surplus population, the greater the extent ofconfinement and the worse the conditions of the poor—the mentally ill amongthem.WHERE ARE AMERICANS WITHSCHIZOPHRENIA?The plight of the long-term mentally ill discharged from hospital to a barrenexistence in America’s boarding homes and nursing homes during the early yearsof deinstutionalization has been described in Chapter 4. How many people withschizophrenia live in these institutions? A report of a committee of theDepartment of Health and Human Services estimated that some 300,000–400,000people with long-term mental illness were residing in board and care homes inthe United States in 1981, 54 the majority suffering from schizophrenia. 55 ACongressional report estimated that there were nearly a million residents oflicensed and unlicensed board and care homes in the US in 1986, and suggestedthat about half, many of them elderly, were mentally ill. 56 There is no indicationthat the number of mentally ill in board and care homes has decreased since themid-1980s, and if we conservatively estimate that 20 per cent of the residents oflicensed and unlicensed board and care homes suffer from schizophrenia, thennearly 200,000 people with this illness must be housed in these, often squalid,conditions.The living conditions in board and care homes—which often house hundredsof people—have not improved since they were first called into service for exhospitalpatients. The 1986 Congressional Report detailed fraud, exploitation,neglect, physical and sexual abuse, malnutrition, overcrowding andovermedication as being common. 57 A series of front-page articles in the NewYork Times in 2002 described the same conditions as being prevalent forthousands of mentally ill people housed in homes in New York State. In apredatory atmosphere, prostitution and drug abuse are common, rooms are fetid,clothing is dirty, residents are unwashed, and dead cockroaches are found inmedication boxes. Minimum-wage workers beat patients to subdue them andforge treatment records of contact with fake psychiatrists. Premature death ofresidents from illness, suicide, or stifling summer heat is not uncommon, but maypassed unnoticed until the stench of rotting flesh attracts attention. Operators ofthe homes steal from residents and refer them for unnecessary eye and prostatesurgery in return for kickbacks from surgeons. Defending the state supervisorysystem, the health commissioner told lawmakers that her department was “doingmiracles” in its regulation of the homes. 58A 1981 government report indicated that there were 250,000 patients in nursinghomes with a primary diagnosis of mental illness, excluding elderly patients with