Recovery From Schizophrenia: Psychiatry And Political Economy

56 THE POLITICAL ECONOMY OF SCHIZOPHRENIAtheir first psychotic break or more chronically ill, or selected by any other criteriathe researcher chooses. Any of these factors may affect the course of thepsychosis. The patients may be followed for any period of time: one year, tenyears or until death. If the illness is progressive, this factor could clearly affect theresults. These follow-up studies are obviously not strictly comparable. Anyattempt to get useful information from them, then, makes the assumption that thedifferences between the studies balance out when a large number of them arecollected into groups. If significant changes in outcome are uncovered, it will benecessary to calculate whether the variations may be due to differences indiagnosis, patient characteristics or follow-up methods between the groups.MEASURES OF RECOVERYOne of the crucial variables in these studies is how the researcher chooses tomeasure the patients’ condition at the time of follow-up. The investigator may bemost concerned about whether symptoms of the illness are still present but couldfocus on either psychotic features, such as hallucinations or delusions, on neuroticsymptoms, such as anxiety, or on behavior problems like withdrawal or eccentrichabits. The proportion of patients considered to have recovered will depend onhow rigorously recovery is defined. If outcome is measured in terms of socialfunctioning, the investigator may look at any combination of a range of featuresincluding the following: working ability, capacity to care for basic needs,abnormal behavior causing distress to others, criminal activity, number of friends,or sexual functioning. Social functioning measures are particularly hard tostandardize. A fairly unambiguous measure is whether the patient is in or out ofhospital at follow-up; but this is not necessarily, as we shall see, a reliable measureof social functioning.To impose some consistency on the follow-up results, information has beengathered from studies according to predetermined definitions of terms that havebeen in use throughout the twentieth century:• Complete recovery: Loss of psychotic symptoms and return to the preillness levelof functioning.• Social recovery: Economic and residential independence and low socialdisruption. This means working adequately to provide for oneself and notbeing dependent on others for basic needs or housing. This term is the onemost open to variations in measurement. Since an important part of thedefinition is employment status, we run a risk of tautological reasoning incorrelating social recovery with the unemployment rate.• Hospitalization: In a psychiatric hospital at the time of follow-up.Every Developed World follow-up study of patients admitted during thehundred-year period beginning in 1885 that was uncovered during a lengthyperiod of library research and that provided information on one or more of these