Recovery From Schizophrenia: Psychiatry And Political Economy

THE PERSON WITH SCHIZOPHRENIA IN WESTERN SOCIETY 191husbands’ illness with only a select few friends or relatives. 122 Although there is amarked tendency for family members to deny the stigma, their concealment andwithdrawal point to an underlying sense of shame and lead them into socialisolation. 123In a survey of relatives of people with schizophrenia in Washington, DC, AgnesHatfield observed “a picture of unremittingly disturbed family life marked byalmost constant stress” 124 as the consequence of caring for a patient at home. Shenoted that marital disruption, blame, grief and helplessness were common results.In a study of British families in which a person with schizophrenia was living athome, half of the family members reported severe or very severe impairment oftheir own health as a consequence of their relative’s psychiatric condition. 125All of the parents of the mentally ill in a discussion group at the Mas-sachusettsMental Health Center “to a greater or lesser extent saw themselves and the othersas ogres responsible for the misfortune that befell their children.” 126 The burdenof guilt that such relatives carry is the result of the popular conception that mentalillness is a product of faulty upbringing. Mental health professionals, adopting thissame attitude, may see the family members as adversaries and add to theirestrangement. Carried to its logical extreme the notion of the“schizophrenogenic” family led to the bizarre occurrence in a Colorado court ofa 24-year-old man, with the support of his psychiatrist, suing his parents for“malpractice” that supposedly caused his schizophrenia. 127The stigma perceived by families is not decreasing. American researchers foundconcealment among family members in 1982 to be higher than in a similar studyconducted in 1961. 128 Half of the family members of hospitalized psychiatricpatients in a more recent US study reported some degree of concealment, morefrequently when the family member was well-educated. 129 Perceived stigma andmisconceptions among family members can influence the course of the illness.Isolated and guilt-ridden as they are, it is not surprising that the families of peoplewith schizophrenia sometimes become over-involved with their sick relatives. 130Seeing this interaction, mental health professionals may try to separate them,encouraging the patient to move away from home and minimize contact with hisor her relatives. This step completes a process of social disintegration; the patientis separated from almost everyone except other stigmatized patients; the familymembers are socially isolated and feel banished not only from the socialmainstream but also from their affected relatives.ALIENATIONWhere pre-industrial cultures offer social reintegration with maintenance of socialstatus and provision of a valued social role for many of those suffering frompsychosis, Western society leaves people with schizophrenia in a state of socialdisintegration with pariah status and a disabled role. In the non-industrial world,communal healing processes operate within a social consensus that predictsrecovery and minimizes blame, guilt and stigma; whereas in Western society