Recovery From Schizophrenia: Psychiatry And Political Economy

RECOVERY FROM SCHIZOPHRENIA 55improvements in recovery rates or the long-term benefits of drug treatment. 6Swiss psychiatrist Manfred Bleuler (son of Eugen Bleuler, who coined the term“schizophrenia”) had a particularly interesting perspective. “During the greaterpart of my life,” he wrote, “I have lived in hospitals which cared mostly forsevere cases of schizophrenia, and from babyhood on through my wholechildhood, gravely sick schizophrenics even lived in my parents’ family.” 7 Studyof the course of illness in his patients over several decades led him to conclude, in1968, that little change had occurred in the proportion of patients whodeteriorated or who recovered. “There still exists the sad chronic evolutions tosevere chronic conditions, and it is doubtful whether modern therapy has been ablemuch to increase the number of total, life-long recoveries.” 8 The onlyimprovement Manfred Bleuler could detect was a decrease in the severity ofchronic schizophrenic deterioration as a result of a reduction in the mishandlingand neglect of hospitalized patients that was common earlier in the centuryAlthough not impressed with the results of treatment, Dr Bleuler was lesspessimistic about the natural course of the illness. He wrote:Generations of psychiatrists felt that schizophrenia was a process psychosisprogressing to complete deterioration, if life was long enough to allow theprocess to come to an end…. I am certain today that the contrary is true. 9Dr Bleuler found that many of his chronically disturbed patients improved later inlife, rather than deteriorating, and that another 25–35 per cent of his patients withschizophrenia before the Second World War recovered from their illness afteronly acute episodes of psychosis.Which view is correct: that schizophrenia is an inherently catastrophic illnessfrom which only modern psychiatric treatment can afford relief; or that it is acondition with a considerable, spontaneous recovery rate upon which treatmenthas little long-term effect? The first point of view, without a doubt, is the opinionof the majority of psychiatrists. Taking a deeper look into the storehouse ofinformation on recovery from schizophrenia in the dusty volumes of psychiatricjournals going back to the beginning of the twentieth century may help resolvethis issue. If we analyze this material according to time periods that reflect themajor changes in the state of the economy, we may also throw some light onanother question: to what extent have changes in the economy during thecentury influenced the outlook for people with schizophrenia?FOLLOW-UP STUDIESUnfortunately, there are problems involved in comparing the results of the manylong-term follow-up studies of people with schizophrenia. As we have seen inChapter 1, which patients are labeled as having schizophrenia varies from countryto country, from time to time and from one psychiatrist to another. The patientschosen to be followed may be male or female, adolescent or adult, experiencing