Recovery From Schizophrenia: Psychiatry And Political Economy

TREATMENT 247indicated, unemployment and material factors affect the course of schizophreniaand employment may be important for recovery. Work may often be crucial forthe development of self-esteem and in shaping the social role of the mentally illperson.RESEARCH ON WORK AND SCHIZOPHRENIAUp to this point the evidence presented in support of this position has beenlargely macrostatistical in scale. Such observations have included:• increasing hospital admissions for schizophrenia during economic slumps(Chapter 2);• the worsening outcome for schizophrenia during the Great Depression(Chapter 3);• improved rehabilitative efforts under full-employment conditions (Chapter 4);• high cure rates for insanity during the labor shortage of industrializing America(Chapter 5);• better outcome for higher-class people and females with schizophrenia(Chapter 6); and• superior outcome from schizophrenia in the Third World (Chapter 7).At this juncture it would be valuable to change the level of magnification and tolook for evidence on a smaller scale of the effect of employment andunemployment on individuals with schizophrenia.For much of the postwar half-century relatively little research was conductedon work and mental illness. Until recent years there has been a general lack ofinterest within the psychiatric profession in vocational rehabilitation, 6 but the1990s—years of relatively low unemployment in the US—saw an increase ininterest. In the index to the two large volumes of the 1989 fifth edition of theAmerican Comprehensive Textbook of Psychiatry, for example, there were only 11references to “Work,” “Working,” “Vocational,” etc. This number grew to 30 inthe 2000 seventh edition, but it is still less than a tenth of the number ofreferences to “Sex,” “Sexual” and related items. Psychiatrists appear to have takenseriously only half of Freud’s well-known dictum that the ability to love and towork are central issues in the lives of men and women. 7 The lack of interest inwork has been, in large part, a response to the fact that there is little workavailable for people with schizophrenia. For people with psychotic illness notinvolved in an effective vocational rehabilitation program the rate of employmentin recent decades in the US and Britain has rarely exceeded 15 per cent. 8Consequently, many mental health professionals discount the possibility that theirclients with schizophrenia will be able to work and they underestimate the valueof vocational services. 9In reviewing the research, it is clear that modern vocational rehabilitationmethods are successful in getting people with schizophrenia back to work. It is