Recovery From Schizophrenia: Psychiatry And Political Economy

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WHAT IS SCHIZOPHRENIA? 17intrusiveness at home, for example) or existential concerns (loss of a sense ofpurpose or belonging).Once an episode of psychosis has begun, these same stressors and new ones,together with the degree of vulnerability, will determine the subsequent courseand outcome of the illness. Labeling and social stigma may affect the individual’ssense of self-worth, as may his or her success in reintegrating with the socialgroup and in returning to a valued social role. Criticism, rejection, restriction,confinement or idleness might well limit the individual’s capacity for recoveryfrom schizophrenia.The strength of some of these potential causes of vulnerability and precipitantsof psychosis has been better demonstrated than others. On the following pages afew of the more important will be briefly outlined.InheritanceIf inheritance is important in the development of schizophrenia, relatives ofpeople with schizophrenia will have a greater risk of developing the illness thanothers—and they do. One would also expect the risk to be progressively greaterin relatives who are more genetically similar to the schizophrenic person.Epidemiologist Irving Gottesman, drawing data from about 40European studies conducted between 1920 and 1987, compiled a comparison ofthe average lifetime risk of developing schizophrenia for people with differentdegrees of relationship to someone with schizophrenia. His findings, shown inFigure 1.3, indicate that the closer the similarity in genetic make-up, the greaterthe risk. The identical twins of people with schizophrenia, who have precisely thesame genetic constitution, run the greatest risk of developing the illness—nearly50 per cent. The offspring of parents both of whom have schizophrenia have asimilar risk. The rate is less for first-degree relatives such as non-identical siblingsand progressively declines through second-degree and third-degree relatives to thegeneral population risk of around one per cent. 32Studies of people adopted in infancy suggest that the increased risk ofschizophrenia in the relatives of identified cases is related to inheritance ratherthan environment. The children of people with schizophrenia have a similarincreased prevalence of the illness whether they are raised by their biologicalparents or by adoptive parents. Likewise, the family history of people withschizophrenia brought up by adoptive parents reveals an increased prevalence ofthe illness among their biological relatives but not among their relatives byadoption. 33Genetic factors appear to be important in the development of schizophreniabut are not sufficient to explain the entire pattern of occurrence. As we haveseen, although identical twins have exactly the same genetic make-up, the risk ofthe second twin developing schizophrenia is only 50 per cent. One may concludethat genetic factors play a major part in establishing the vulnerability to the illnessbut that environmental factors (including the intrauterine experience) must also
18 BACKGROUNDFigure 1.2 Interactional model for factors possibly affecting the onset, course and outcomeof schizophreniaplay important roles before schizophrenia becomes manifest. Nearly two-thirds ofpeople with schizophrenia, moreover, have no relative at all with the illness. 34 If agenetic vulnerability is always present in schizophrenia it must skip generations;the interaction of more than one gene and environmental factors may benecessary for the illness to become apparent.Studies of twins reveal additional information about the inheritance ofvulnerability to schizophrenia. 35 When one of a pair of identical twins has asevere and deteriorating form of schizophrenia, it is virtually certain that the othertwin will show signs of the illness; but if one identical twin has a mild form of the
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 26 and 27: WHAT IS SCHIZOPHRENIA? 15Figure 1.1
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
Page 72 and 73: RECOVERY FROM SCHIZOPHRENIA 61Table
Page 74 and 75: Table 3.1 -continuedRECOVERY FROM S
Page 76 and 77: Table 3.1 -continuedRECOVERY FROM S
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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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