Recovery From Schizophrenia: Psychiatry And Political Economy

72 THE POLITICAL ECONOMY OF SCHIZOPHRENIAintroduced, the proportion of patients out of hospital continued to increase to 85per cent between 1956 and 1975 and to more than 90 per cent after 1975. Onepoint stands out with regard to this trend towards community treatment; whereasthe decrease in hospital use in the postwar years before 1955 was associated withan improvement in the recovery rates for people with schizophrenia, after theadvent of drug treatment deinstitutionalization did not bring any improvement inthe symptoms or social functioning for these patients.Despite the popular view in psychiatry, the antipsychotic drugs have notproved to be a critical factor in either emptying mental hospitals or achievingmodern recovery rates in schizophrenia. Other probable causes of thedeinstitutionalization movement will be presented in Chapter 4, and political,economic and social explanations for the variations in recovery fromschizophrenia will be offered in Chapters 5, 6, 7 and 8. The reasons for thepoor showing of the antipsychotic drugs will be discussed in Chapter 10. It willbe argued that, rather than psychiatric treatment having a big impact onschizophrenia, both the course of the illness and the development of psychiatryitself are governed by political economy.Before going on to this analysis, however, we should see if there are reasons todoubt the accuracy of the findings of the survey of outcome studies ofschizophrenia.DIFFERENCES IN DIAGNOSISCould differences in the diagnosis of schizophrenia between one country or onetime period and another have produced these results? We know, for example,that Scandinavian psychiatrists have a narrow concept of schizophrenia thatexcludes brief illnesses and emphasizes poor outcome. American psychiatry, onthe other hand, until the 1970s, employed a broad concept of schizophrenia thatincluded much of what European psychiatrists call manicdepressive illness and alsosome conditions that would not be considered psychoses elsewhere (seeChapter 1). If the sample of outcome studies included proportionally moreScandinavian studies and fewer American studies during the Great Depression,then this bias might account for the low recovery rates found for that time