Recovery From Schizophrenia: Psychiatry And Political Economy

THE PERSON WITH SCHIZOPHRENIA IN WESTERN SOCIETY 181time. 66 The seclusion room experience often colors and dominates the patient’sview of his or her illness. When patients at a major US psychiatric hospital wereasked to draw pictures of themselves and their psychosis, over a thirdspontaneously drew a picture of the seclusion room. Even a year after the hospitalstay, the experience of seclusion, with its associated feelings of fear and bitterness,symbolized for many patients the entire psychiatric illness. 67It has also been common for patients to be strapped down to their beds withrestraints in US hospitals. During one month in the 1980s, a quarter of all patientsevaluated in a psychiatric emergency room in Cincinnati, Ohio, were placed inrestraints. 68 Mechanical restraints have frequently been used on psychiatric wards,the commonest reasons being not violence but “non-conformity to communityrules” 69 and “behavior disruptive to the therapeutic environment.” 70 Understaffingand overcrowding may also force the use of such measures. The ColoradoFoundation for Medical Care found that the overuse of both restraints andseclusion at Fort Logan Mental Health Center in Denver, Colorado, in the 1980swas the result of a shortage of staff. At the Colorado State Hospital around thesame time, overcrowding on the forensic unit was so severe that patients weretransferred to the surgical ward and shackled to their beds in order toaccommodate the overflow. 71 Such are the human consequences of cost-cuttingin public psychiatric services.Recent federal regulations have imposed restrictions on the use of restraints andseclusion in psychiatric inpatient units with the result that the use of thesemeasures has been reduced. The regulations have imposed such a burden on theinpatient psychiatrists, however—they are obliged to see a patient within an hourof ordering the use of restraints or seclusion, even in the middle of the night—thatmany have quit doing inpatient work and a staffing crisis has arisen.STIGMAThere is more to the degradation of suffering from schizophrenia in Westernsociety, however, than harsh treatment and inadequate living conditions. As anAmerican woman with schizophrenia explains:Let’s just say I have a case of shame-I really do. When I look at some of thethings I’ve really gone through—some of the things I’ve done, some of thethings I’ve said—my father’s feeling of shame for me does not equal myown.” 72Another patient writes:I have often been fraught with a profound guilt over my diagnosis ofschizophrenia…. I had little idea how dehumanizing and humiliating thehospital would be for me…. I felt that I had partly lost my right to standamong humanity…and that for some people I would be forever-more