Recovery From Schizophrenia: Psychiatry And Political Economy

300 DESEGREGATING SCHIZOPHRENIACONCLUSIONWe have far to go before the person with schizophrenia is welcome in Westernsociety and before he or she can view himself or herself as an equal and usefulmember of society. Until that time schizophrenia is likely to continue to be amalignant condition.We have the knowledge, nevertheless, to render the illness benign. We wouldneed to:• treat the acute phase of the illness in small, domestic, non-coercive settingsthat reflect the humane principles of moral treatment;• ensure adequate psychological and clinical support in the community,including a full range of independent and supervised, non-institutionalaccommodation;• give recognition and support for the care offered by the family of the person withschizophrenia, and provide family education and counseling;• provide a variety of work opportunities for the mentally disabled—work thatis neither too demeaning nor too stressful;• establish economic incentives to work by increasing the earnings disregard indisability pension schemes or by providing wage subsidies for the severelyhandicapped;• encourage economic and social advancement through consumer-cooperativebusinesses, housing and services;• fight for the rights of people with schizophrenia and their families toparticipate as fully integrated members of society, through local action andcoordinated efforts to counter the misrepresentations generated by the newsand entertainment media;• use the antipsychotic drugs as a supplement to these measures, not as asubstitute for them.Parts of this plan would be expensive but it may cost little more than our current,vast expenditure on the treatment and support of people with schizophrenia andon the associated disruption, crime and imprisonment that result from inadequatecare. Our society is inherently unequal, however, and to provide such a quality oflife for the person with schizophrenia is difficult because such a large proportion ofthe population—including armies of unemployed, homeless and incarceratedpeople—would be left in worse circumstances. To render schizophrenia benign wemay, in essence, have to restructure our provisions for all of the poor.