Recovery From Schizophrenia: Psychiatry And Political Economy

248 WORKless clear to what extent being employed improves the symptoms and course ofthe illness. Before the recent era of randomized controlled studies of vocationalservices, several studies demonstrated that people with schizophrenia who wereworking fared better, but it was unclear whether employment had led to clinicalimprovement or whether higher functioning had made employment possible.Psychologist Leon Cohen, for example, studied 114 people with chronicschizophrenia discharged from a Veterans Administration hospital before 1955.He found that patients who had a job to go to or a definite vocational plan atdischarge and those who found employment after discharge were able to stay outof hospital longer. That work was the important element leading to the patients’success is suggested by his additional finding that the severity of the patient’spsychosis at discharge was in no way related to the likelihood ofrehospitalization. 10A British study published in 1958 reported very similar findings. Medicalsociologist George Brown and his colleagues followed for a year 229 malepatients (mostly diagnosed with schizophrenia) discharged from seven Londonareamental hospitals. Over 40 per cent of these patients worked for six months ormore and of these nearly all (97 per cent) succeeded in staying out of hospital.Another 43 per cent of the patients never worked at all, and of these fewer than half(46 per cent) succeeded in avoiding rehospitalization. Again there is a suggestionthat work was more important than clinical status in determining success, for afull third of the patients who worked for most of the year were rated asmoderately or severely disturbed and many more had residual symptoms. 11In 1963 Howard Freeman and Ozzie Simmons published The Mental PatientComes Home, a comprehensive report on the fate of 649 patients with psychoticillness discharged in 1959 from nine US state hospitals and three VeteransAdministration hospitals. Like the researchers before them, they found thatpatients who were successful in staying out of hospital were substantially morelikely to have been employed than those who were rehospitalized. They alsofound only a moderate degree of correlation between the patient’s working abilityand the severity of his or her psychotic symptoms. 12Psychologist George Fairweather became well known in the 1960s for devisinga model community program in which psychiatric patients lived together incommunity lodges and worked together in teams as independent businessesproviding various needed services to the community. A follow-up study ofpatients in the lodge program showed that they realized substantial benefits whencompared with a matched control group of patients who entered typicalpsychiatric aftercare programs. Patients in the lodge program had assuredemployment and those in routine aftercare, almost to the last person, were unableto find full-time work. Residents of the lodge spent five or six times as muchtime out of hospital as patients in the control group. Lodge patients were moresatisfied with their lives in the community, but very little difference was foundbetween the level of symptoms manifested by the two groups of patients. 13 Wecannot conclude from this study that employment alone led to the patients’