Recovery From Schizophrenia: Psychiatry And Political Economy

26 BACKGROUNDtechnological society. Through such family dynamics as these, political economymay affect the course of schizophrenia.It is also clear that other forms of stress in the lives of people withschizophrenia trigger psychotic relapse and influence the course of the illness. In astudy conducted in London, 46 per cent of a group of people with schizophreniaexperienced a stressful life event that was clearly not a consequence of the illnessin the three-week period preceding a psychotic relapse. By contrast, only 12 percent of a matched group from the general population had experienced such stress.The life events noted included role changes (such as leaving school), change ofliving arrangements, development of illness, and other disappointments and crises.When life events were included that may not have been independent of theindividual’s own actions or illness (events such as job loss), nearly two-thirds ofthe people with schizophrenia reported experiencing such stress compared withless than a fifth of the general population sample. 82Subsequent research, 83 including a nine-country WHO study, 84 has confirmedthat stress, particularly in the preceding two or three weeks, can precipitateepisodes of schizophrenia. The research also shows that severe stress provokesmore intense symptoms of schizophrenia, but that even mild stress can precipitatea relapse. 85 A basic problem in schizophrenia is that sufferers are exquisitelysensitive to anxiety-provoking situations. Major life-event stress is likely toprecipitate relapse in patients who are taking medication, 86 whereas those who arenot using medication are more susceptible to relapse with minor stress.Antipsychotic drugs benefit the patient by raising the threshold of response to allbut major stresses.It is unclear whether stress can create a vulnerability to schizophrenia during anindividual’s development 87 (levels 1 and 2 of Figure 1.2) but it is clear that stressesof various kinds play a part in triggering psychosis in those who are alreadyvulnerable and in shaping the course of a manifest schizophrenic illness (levels 3and 4 of Figure 1.2). At these later stages -influencing the vulnerable individualand those already suffering from the illness—we may also perceive the prominenteffect of political and economic forces. Much that is stressful in life is not coveredby such concepts as family hostility or recent life changes. We all need to have therespect of others, for example. Finding value and meaning in life and having a senseof belonging to one’s own kind and community are omnipresent existentialconcerns. Problems arising from these concerns commonly emerge in the lives ofpeople with schizophrenia—problems (it will be argued here) produced orexacerbated by the political and economic dimensions of the society.The following chapters will attempt to show that political economy assumes ahitherto underemphasized importance in the production and perpetuation ofschizophrenia. Specifically, it not only determines mental health policy andlegislation, it also molds public reaction to mental illness and even shapespsychiatric ideology. Political and economic factors influence the social status,social role and social integration of the person with a psychosis—his or her sense