Recovery From Schizophrenia: Psychiatry And Political Economy

THE PERSON WITH SCHIZOPHRENIA IN WESTERN SOCIETY 193the same active ingredients that proved successful in reversing the institutionalsyndrome—normalizing the environment and engaging the patient in his or herown treatment—are also effective in relieving the effect of the existentialneurosis.ORIGINS OF ALIENATIONThe person with schizophrenia, it appears, is among the most alienated ofindustrial society, and it is in this condition that one may perceive the causes ofthe malignancy of the illness. Looking beyond this, the origins of the mentally illperson’s alienation are to be found in the political and economic structure ofsociety—in the division of labor and development of wage work. For it is theseaspects of production that have rendered the person with schizophrenia—with hisor her limited ability to withstand stress, limited productive capacity and limiteddrive—marginal to the industrial work force, marginal members of (whatanthropologist Jules Henry terms) “the driven society.” 137Caste systems do not perpetuate themselves. Continued enforcement ofdiscriminatory economic and physical sanctions is necessary to maintain theexistence of a pariah group. 138 Similar political and economic pressures arenecessary to restrict the interclass mobility of members of US ethnic minoritygroups. 139 The same is true of the low status of the mentally ill in the West. Thepostwar drive to influence public opinion and increase the community acceptanceof mental patients was equivalent to earnest attempts to adjust the status of a caste.The political motivation at that time, in some areas, was to bring the mentally illinto the work force, in other areas, to transfer the responsibility for their care fromthe state to the community. These efforts decreased as the political motivationreceded. The recent growth in strength and solidarity of advocacy groups for thementally ill, such as the National Alliance of the Mentally Ill, however, has led toa resurgence of interest in combating the stigma of schizophrenia (seeChapter 12). It takes a power differential to erect the barriers of stigma anddiscrimination and it takes the creation of a power bloc to knock them down.SUMMARY• A third of the people with schizophrenia in the US are living in boardinghomes or nursing homes, in hospital, on Skid Row or in jail or prison.• The stigma of mental illness in Western society continues to be great.• A combination of labeling theory and cognitive dissonance theory allows us toexplain how the stigma of mental illness can lead to poor outcome frompsychosis.• People with schizophrenia in Western society have restricted social networksand they and their families become relatively estranged from society.