Recovery From Schizophrenia: Psychiatry And Political Economy

WHAT IS SCHIZOPHRENIA? 27of worth, meaning and belonging. Just as the destinies of all in society are shapedby political and economic forces, so too is the course of schizophrenia.SUMMARY• Schizophrenia, originally termed dementia praecox, is a functional psychosiswith some unifying features but several distinctly different forms.• In defining dementia praecox, Emil Kraepelin saw poor outcome as a centralfeature of the condition.• Although Eugen Bleuler found outcome from the illness to be good in amajority of cases, Kraepelin’s original pessimism has been more widelyaccepted.• Bleuler’s good results may have been a consequence of his enlightenedtreatment approach.• Scandinavian psychiatrists have adopted a narrow diagnostic approach toschizophrenia, emphasizing poor outcome.• Soviet psychiatrists used a broad diagnostic concept that included patients whowould not have been considered psychotic elsewhere.• American psychiatry switched from a similarly broad diagnostic approach to anarrow definition of schizophrenia in 1980.• The course of schizophrenia is quite variable; the outcome can be mild in halfthe cases.• The prevalence of schizophrenia varies widely (partly because of diagnosticdifferences) but it is often close to 1 person with schizophrenia for every 200adults in populations in the industrial world.• Schizophrenia appears to be universally distributed.• Multiple social and biological factors interact to produce a vulnerability toschizophrenia, to trigger an episode of psychosis and to shape the course of theillness.• Genetic predisposition contributes to the vulnerability to schizophrenia butdoes not alone account for its occurrence.• An over-activity in tracts of neurons in which the neurotransmitter is dopaminemay be one of the underlying biochemical deficits in schizophrenia.• Some people with schizophrenia appear to suffer from mild cerebral atrophy.• The underlying functional deficit in schizophrenia may be an inability todiscriminate relevant from irrelevant environmental stimuli.• Theories that suggest that family communication patterns produce avulnerability to schizophrenia remain unverified.• On the other hand, evidence that domestic stresses trigger relapse inschizophrenia is strong.• Political economy refers to the part of the social structure that regulates labor,energy, production and reproduction in groups larger in size than the family.