Recovery From Schizophrenia: Psychiatry And Political Economy

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WHAT IS SCHIZOPHRENIA? 15Figure 1.1 The long-term course of schizophrenia in 228 patientsSource: Ciompi, L, “Catamnestic long-term study on the course of life and aging ofschizophrenics,” <strong>Schizophrenia</strong> Bulletin, 6:606–18, 1980.studies analyzed in that chapter indicate that in many industrial world settings theprevalence of schizophrenia is close to one in every 200 adults.<strong>Schizophrenia</strong> is found in every culture. The content of the patient’shallucinations and delusions varies from one social group to another—thedelusions of villagers living in the north of Ghana are associated with the localfetish system, for example, but among the city dwellers of Accra in the south ofthat country ideas of influence and control by electricity and radio are more
16 BACKGROUNDcommon. 30 The form and basic features of schizophrenia, nevertheless, are similararound the world, as the WHO Pilot Study shows.WHAT CAUSES SCHIZOPHRENIA?Tuberculosis is the result of an infection by a bacillus. In the early decades of thetwentieth century, however, when the disease was widespread, although a hugeproportion of the population became infected with the organism, only a relativelysmall number went on to develop clinically recognizable evidence of the disease.What caused the manifest symptoms of the illness to appear in those few, in somecases years after the initial infection? Poor social conditions were known toincrease the susceptibility to the illness, and improvements in diet and housing werelinked to a decline in the death rate from tuberculosis long before effective drugtreatment was introduced. The irritant effects of coal dust on miners, pregnancyin women and the debilitating influence of secondary illnesses, all could reduce anindividual’s resistance to the disease. What, then, is the cause of tuberculosis? Thetubercle bacillus? Overcrowding? Poor diet? The stresses of lower-class living? Orany of the other environmental, occupational or constitutional factors thatincrease the individual’s susceptibility? Clearly any and all of these factors may beconsidered contributory, and the reduction in the prevalence of the illness had asmuch to do with elimination of some of the social causes and with the increase inthe resistance of the population by vaccination as with the direct attack on theinfective organism by chemotherapy.The same principles apply to schizophrenia. We do not know with certainty ofa specific organic defect or infective agent that is critical in the development ofschizophrenia (although there are a number of theories and there has been anexpansion of knowledge in this area). We do know, however, of several factorsthat increase the susceptibility to this illness and that may provoke its appearance.To grasp how these factors may influence the development and the course ofschizophrenia we need to use an interactive conceptual model such as the oneproposed by American psychiatrists John Strauss and William Carpenter.An adaptation of the conceptual scheme offered by these authors 31 is given inFigure 1.2. An interactional model allows for various types of explanation toassume importance at different stages in the individual’s development. Thegenetic contribution, damaging intrauterine effects and birth trauma might eachplay a part in forming the newborn infant’s predisposition to developingschizophrenia. The vulnerability to the illness might theoretically be heightenedduring childhood development by brain damage, for example, or by unusualfamily communication patterns.Whether or not the illness becomes manifest in later life is likely to dependupon the extent of the vulnerability and the subsequent exposure to a variety ofstresses. Precipitating stresses may be biological in nature (such as hallucinogenicdrug abuse), or psychosocial. In the latter category are life events (such as startingwork, leaving home or bereavement), environmental influences (criticism or
Page 2 and 3: Recovery from SchizophreniaRecovery
Page 4 and 5: First edition published 1985by Rout
Page 6 and 7: ContentsAcknowledgments viIntroduct
Page 8 and 9: devotion to excellence in creating
Page 10 and 11: ixA NOTE ON THEORYThe materialist t
Page 12 and 13: Part IBackground
Page 14 and 15: WHAT IS SCHIZOPHRENIA? 3WHAT IS SCH
Page 16 and 17: WHAT IS SCHIZOPHRENIA? 5syphilis, n
Page 18 and 19: WHAT IS SCHIZOPHRENIA? 7Table 1.1-c
Page 20 and 21: WHAT IS SCHIZOPHRENIA? 9complete sy
Page 22 and 23: WHAT IS SCHIZOPHRENIA? 11patients w
Page 24 and 25: WHAT IS SCHIZOPHRENIA? 13publicatio
Page 28 and 29: WHAT IS SCHIZOPHRENIA? 17intrusiven
Page 30 and 31: WHAT IS SCHIZOPHRENIA? 19Figure 1.3
Page 32 and 33: WHAT IS SCHIZOPHRENIA? 21Brain stru
Page 34 and 35: WHAT IS SCHIZOPHRENIA? 23system. Th
Page 36 and 37: WHAT IS SCHIZOPHRENIA? 25One thing
Page 38 and 39: WHAT IS SCHIZOPHRENIA? 27of worth,
Page 40 and 41: Chapter 2Health, illness and the ec
Page 42 and 43: HEALTH, ILLNESS AND THE ECONOMY 31a
Page 44 and 45: HEALTH, ILLNESS AND THE ECONOMY 33i
Page 46 and 47: HEALTH, ILLNESS AND THE ECONOMY 35B
Page 48 and 49: HEALTH, ILLNESS AND THE ECONOMY 37s
Page 50 and 51: HEALTH, ILLNESS AND THE ECONOMY 39d
Page 52 and 53: HEALTH, ILLNESS AND THE ECONOMY 41F
Page 54 and 55: HEALTH, ILLNESS AND THE ECONOMY 43o
Page 56 and 57: HEALTH, ILLNESS AND THE ECONOMY 45T
Page 58 and 59: HEALTH, ILLNESS AND THE ECONOMY 47b
Page 60 and 61: HEALTH, ILLNESS AND THE ECONOMY 49F
Page 62 and 63: HEALTH, ILLNESS AND THE ECONOMY 51A
Page 64 and 65: Part IIThe political economy of sch
Page 66 and 67: RECOVERY FROM SCHIZOPHRENIA 55impro
Page 68 and 69: RECOVERY FROM SCHIZOPHRENIA 57categ
Page 70 and 71: RECOVERY FROM SCHIZOPHRENIA 59Table
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Page 74 and 75: Table 3.1 -continuedRECOVERY FROM S
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Table 3.1 -continuedRECOVERY FROM S
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RECOVERY FROM SCHIZOPHRENIA 71Table
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RECOVERY FROM SCHIZOPHRENIA 73Figur
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Table 3.3 Recovery rates in the USA
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RECOVERY FROM SCHIZOPHRENIA 77the l
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RECOVERY FROM SCHIZOPHRENIA 79Table
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THE POLITICAL ECONOMY OF SCHIZOPHRE
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MADNESS AND THE INDUSTRIAL REVOLUTI
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25 patients, and on the more distur
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Chapter 6Labor, poverty and schizop
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THE PERSON WITH SCHIZOPHRENIA IN WE
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Chapter 9The incidence of schizophr
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Part IIITreatment
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ANTIPSYCHOTIC DRUGS: USE, ABUSE AND
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TREATMENT 247indicated, unemploymen
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TREATMENT 249success, for the lodge
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TREATMENT 251vocational programming
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TREATMENT 253the job is permanent.
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TREATMENT 255Social enterprises in
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TREATMENT 257pharmacy technicians a
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TREATMENT 259The situation seems to
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TREATMENT 261Though these results a
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TREATMENT 263• raise the minimum
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TREATMENT 265• Social policy inno
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TREATMENT 267Table 12.1 Living situ
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TREATMENT 269A JAIL DIVERSION PROGR
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TREATMENT 271the office work and th
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TREATMENT 273One might imagine that
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TREATMENT 275studies may be the res
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TREATMENT 277established for some o
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TREATMENT 279Another residential pr
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TREATMENT 281interest loans and gra
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TREATMENT 283individual’s goals s
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TREATMENT 285Cognitive therapy, it
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TREATMENT 287Table 12.2 Facts about
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TREATMENT 289consumers and professi
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TREATMENT 291definitively not part
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FIGHTING STIGMAAlthough the mentall
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TREATMENT 295The National Alliance
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TREATMENT 297other medical disorder
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TREATMENT 299when a psychiatrist an
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NotesINTRODUCTION1 Harris, M., Cult
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NOTES 30333 Heston, L.L., “Psychi
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NOTES 30557 Sham, P.C., O’Callagh
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87 Dohrenwend, B. and Egri, G., “
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NOTES 30929 Srole, L., Langner, R.S
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NOTES 311unemployment cause the dea
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NOTES 313107 Warr, P., “Studies o
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138 Dear, M., Clark, G. and Clark,
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NOTES 3178 Epstein, L.J., Morgan, R
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NOTES 31943 Quirk, A. and Lelliott,
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NOTES 32349 Walton, “Pauper lunat
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105 Bockoven, J.S., Moral Treatment
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NOTES 32729 For positive evaluation
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66 Barker, D., “Moscow mayor has
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NOTES 33133 World Health Organizati
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NOTES 33380 Eliade, M., Shamanism:
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NOTES 335homelessness a mental heal
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NOTES 337Academic Press, 1978; Faul
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NOTES 339Washington, DC: House of R
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NOTES 34194 Read, J. and Baker, S.,
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132 Robinson, J.R and Shaver, P.R.,
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NOTES 345“Schizophrenia is not di
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NOTES 34748 Bagley, C., “The soci
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NOTES 34979 ni Nuallain, M., O’Ha
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NOTES 3514 Kapur, S. and Seeman, P.
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NOTES 35327 Pasamanick, B., Scarpet
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NOTES 355Archives of General Psychi
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NOTES 357“Prognostic factors in r
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NOTES 359Chandler, D., Meisel, J.,
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30, 1978; Moffit, R., “The econom
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NOTES 36312 Stein, L.I. and Test, M
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NOTES 36547 Personal communication,
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NOTES 367European Psychiatry, 15:26
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BibliographySTUDIES OF THE OUTCOME
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BIBLIOGRAPHY 371Horowitz, W.A. and
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BIBLIOGRAPHY 373Salokangas, R.K.R.,
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AUTHOR INDEX 375Dunham, Warren 31Du
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AUTHOR INDEX 377Urquhart, M.C. 129n
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SUBJECT INDEX 379atypical 20;compan
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SUBJECT INDEX 381CESP see Carer Edu
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SUBJECT INDEX 383disability pension
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SUBJECT INDEX 385diagnosis of 148;d
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SUBJECT INDEX 387Isle of Wight 33is
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SUBJECT INDEX 389Middlesex, Hanwell
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SUBJECT INDEX 391PACE see Personal
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SUBJECT INDEX 393economic condition
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SUBJECT INDEX 395self-employment 15
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SUBJECT INDEX 397symbolic thinking
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SUBJECT INDEX 399volition disturban
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