Recovery From Schizophrenia: Psychiatry And Political Economy

IntroductionDoes the way we make our living or the level of economic development of ourcountry affect whether or not we become mentally ill? Does social class or thestate of the economy influence whether people with schizophrenia recover fromtheir illness? Has industrial development affected the number of people withschizophrenia who become permanently and severely disabled—lost to theirfamilies, costly to the community and leading lives of emptiness and degradation?These questions are at the heart of this book.My original intent was to uncover what the natural course of schizophrenia hadbeen before the antipsychotic drugs were introduced, but this simple goal led tothe realization that some current beliefs about the illness, widely accepted inpsychiatry, are not accurate. We may well have been too pessimistic about thecourse of untreated schizophrenia and overconfident about the benefits of moderntreatment. The antipsychotic drugs, it emerges, have not appreciably improvedthe long-term outcome from the illness; these drugs alone did not unlock the doorsof our mental institutions and make possible the community treatment of peoplewith psychosis. Despite a massive annual investment in the treatment ofschizophrenia, the outcome from the illness in modern industrial society is nobetter than in the Third World.Each change in our treatment approach to schizophrenia, moreover, is notnecessarily an advance. A treatment method of demonstrated effectiveness—moral management—was laid to rest in the mid-nineteenth century only to beresurrected in a similar form nearly a hundred years later. Much of what today iscalled community treatment is, in fact, the antithesis of treatment; peoplesuffering from psychosis are consigned to a sordid, impoverished existence inwhich even basic needs, such as food and shelter, are not met. To understand howsuch aberrations and misconceptions have come about, to appreciate what hasshaped the course and occurrence of schizophrenia, and to see what has moldedpsychiatric ideology and the social response to the person with schizophrenia, weneed to step outside psychiatry. We have to venture into the territory of thesociologist, the anthropologist and the historian; we must enter the province ofepidemiologists, social psychologists, economists and political scientists.