Recovery From Schizophrenia: Psychiatry And Political Economy

58 THE POLITICAL ECONOMY OF SCHIZOPHRENIAconvulsive therapy, insulin coma and psychosurgery were introduced in thetreatment of psychosis.1941–1955: This period saw the Second World War and, particularly innorthern Europe, postwar full employment. A postwar social revolution inpsychiatric treatment occurred in Northern Europe, resulting in increasedrehabilitative efforts for patients with psychosis.1956–1975: Declining employment and “stagflation” characterized theeconomies in most industrial countries. The neuroleptic drugs were introducedinto widespread use at the beginning of this period and US community mentalhealth centers began to be established in the mid-1960s.1976–1995: Major industrial countries experienced an economic recessionthroughout much of this period, with unemployment in Britain rising tosubstantially greater heights than in the USA. New community treatment models,such as the psychosocial clubhouse and assertive community treatment, diffusedacross North America and, to a lesser extent, Europe and Australia. The first ofthe novel antipsychotic agents, clozapine, was introduced towards the end of thisperiod.RESULTSThe results of the analysis are shown in Figure 3.1 (p. 78). Average figures forunemployment in the United States and the United Kingdom for each timeperiod are also drawn in (inverted) to allow comparison. 12 The figures from thetwo outcome studies on patients admitted before 1901 are sketched in dottedlines to emphasize that they are not reliable but merely indicative of the generaltrend.The picture that emerges is in conflict with some widely held beliefs inpsychiatry. In the first place, recovery rates from schizophrenia were not significantlybetter at the end of the twentieth century than they were at the beginning. The arrival ofthe antipsychotic drugs shortly before 1955 appears to have had little effect onlong-term outcome. At the end of the century complete recovery rates remainedaround 20 per cent and about35–45 per cent of people withschizophrenia were socially recovered at follow-up.Second, the state of the economy appears to be linked to outcome in schizophrenia.During the Great Depression of the 1920s and 1930s, the rate of completerecovery was halved at 12 per cent; social recovery fell to less than 30 per cent.During the recession of the 1980s and early 1990s, social recovery declined againto 33 per cent. An analysis of variance shows that these changes are greater thanwould be expected by chance. The little information available for patientsadmitted during the Great Depression of the late nineteenth century shows thesame trend toward low recovery rates. There is a significant correlation betweenchanges in the recovery rates and US and UK average unemployment over thefive time periods after 1900 (see Table 3.2). The more important finding is thecorrelation of complete, symptomatic recovery with unemployment; social