Recovery From Schizophrenia: Psychiatry And Political Economy

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RECOVERY FROM SCHIZOPHRENIA 79Table 3.4 <strong>Recovery</strong> rates for good-prognosis patients designated as “first admission,” “early,” “acute” or “selected” among 114 outcomestudies of schizophrenia. The proportion of total subjects with these good-prognosis designations is also shown
Chapter 4DeinstitutionalizationWhat accounts for the finding arrived at in the previous chapter, that theproportion of patients with schizophrenia found to be in hospital at follow-updeclined dramatically before the advent of the antipsychotic drugs? A widely heldbelief about modern mental health care is that these drugs, introduced in themid-1950s, brought a new dawn to psychiatry, making possible effectivetreatment and community care for psychotic patients. Chlorpromazine, the firstof the antipsychotic drugs, initiated a “therapeutic revolution” in the hospital andcommunity treatment of schizophrenia, argued psychiatrist John Davis in theComprehensive Textbook of <strong>Psychiatry</strong>. He continued:Those changes have resulted in a massive reduction in the number ofhospitalized schizophrenic patients, a finding all the more remarkable since,up to the introduction of the new drugs, there had been a steady increase inthe number of hospitalized mental patients. The shift in the fate of mentalpatients is the most convincing proof of the efficacy of those agents. 1Dr Davis illustrated the point with a graph showing the rise and fall in thenumber of residents of US state and county mental hospitals during this century.His graph is essentially similar to the broken line in Figure 4.1, with the additionof the letters CPZ and an arrow pointing to the peak of the graph in themid-1950s indicating the time chlorpromazine began to be widely used. Theobservation that the antipsychotic drugs made deinstitutionalization possible hasbecome a truism of modern psychiatric practice. But how accurate is it?A moment’s reflection discloses that the figures relevant to this issue are not theabsolute numbers of mental hospital residents, but the numbers as a proportion of thegeneral population. A graph of the rate of mental hospitalization—the continuousline in Figure 4.1—reveals a different picture. Whereas the absolute number ofmental hospital residents peaked in 1955, the rate of hospital use peaked in 1945and never climbed as high again.Although there has been a marked decline in the population of mental hospitalssince the introduction of the antipsychotic drugs, it is clear that something elsewas happening in the first postwar decade to alter patterns of psychiatric hospitaluse.
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Recovery from SchizophreniaRecovery
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First edition published 1985by Rout
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ContentsAcknowledgments viIntroduct
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devotion to excellence in creating
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ixA NOTE ON THEORYThe materialist t
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Part IBackground
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WHAT IS SCHIZOPHRENIA? 3WHAT IS SCH
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WHAT IS SCHIZOPHRENIA? 5syphilis, n
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WHAT IS SCHIZOPHRENIA? 7Table 1.1-c
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WHAT IS SCHIZOPHRENIA? 9complete sy
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WHAT IS SCHIZOPHRENIA? 11patients w
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WHAT IS SCHIZOPHRENIA? 13publicatio
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WHAT IS SCHIZOPHRENIA? 15Figure 1.1
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WHAT IS SCHIZOPHRENIA? 17intrusiven
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WHAT IS SCHIZOPHRENIA? 19Figure 1.3
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WHAT IS SCHIZOPHRENIA? 21Brain stru
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WHAT IS SCHIZOPHRENIA? 23system. Th
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WHAT IS SCHIZOPHRENIA? 25One thing
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WHAT IS SCHIZOPHRENIA? 27of worth,
Page 40 and 41: Chapter 2Health, illness and the ec
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Page 50 and 51: HEALTH, ILLNESS AND THE ECONOMY 39d
Page 52 and 53: HEALTH, ILLNESS AND THE ECONOMY 41F
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Page 62 and 63: HEALTH, ILLNESS AND THE ECONOMY 51A
Page 64 and 65: Part IIThe political economy of sch
Page 66 and 67: RECOVERY FROM SCHIZOPHRENIA 55impro
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Page 70 and 71: RECOVERY FROM SCHIZOPHRENIA 59Table
Page 74 and 75: Table 3.1 -continuedRECOVERY FROM S
Page 84 and 85: RECOVERY FROM SCHIZOPHRENIA 73Figur
Page 86 and 87: Table 3.3 Recovery rates in the USA
Page 88 and 89: RECOVERY FROM SCHIZOPHRENIA 77the l
Page 92 and 93: THE POLITICAL ECONOMY OF SCHIZOPHRE
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Page 138 and 139: Chapter 6Labor, poverty and schizop
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THE POLITICAL ECONOMY OF SCHIZOPHRE
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THE PERSON WITH SCHIZOPHRENIA IN WE
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Chapter 9The incidence of schizophr
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Part IIITreatment
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ANTIPSYCHOTIC DRUGS: USE, ABUSE AND
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TREATMENT 247indicated, unemploymen
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TREATMENT 249success, for the lodge
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TREATMENT 251vocational programming
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TREATMENT 253the job is permanent.
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TREATMENT 255Social enterprises in
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TREATMENT 257pharmacy technicians a
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TREATMENT 259The situation seems to
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TREATMENT 261Though these results a
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TREATMENT 263• raise the minimum
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TREATMENT 265• Social policy inno
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TREATMENT 267Table 12.1 Living situ
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TREATMENT 269A JAIL DIVERSION PROGR
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TREATMENT 271the office work and th
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TREATMENT 273One might imagine that
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TREATMENT 275studies may be the res
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TREATMENT 277established for some o
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TREATMENT 279Another residential pr
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TREATMENT 281interest loans and gra
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TREATMENT 283individual’s goals s
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TREATMENT 285Cognitive therapy, it
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TREATMENT 287Table 12.2 Facts about
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TREATMENT 289consumers and professi
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TREATMENT 291definitively not part
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FIGHTING STIGMAAlthough the mentall
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TREATMENT 295The National Alliance
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TREATMENT 297other medical disorder
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TREATMENT 299when a psychiatrist an
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NotesINTRODUCTION1 Harris, M., Cult
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NOTES 30333 Heston, L.L., “Psychi
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NOTES 30557 Sham, P.C., O’Callagh
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87 Dohrenwend, B. and Egri, G., “
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NOTES 30929 Srole, L., Langner, R.S
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NOTES 311unemployment cause the dea
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NOTES 313107 Warr, P., “Studies o
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138 Dear, M., Clark, G. and Clark,
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NOTES 3178 Epstein, L.J., Morgan, R
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NOTES 31943 Quirk, A. and Lelliott,
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MADNESS AND THE INDUSTRIAL REVOLUTI
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NOTES 32349 Walton, “Pauper lunat
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105 Bockoven, J.S., Moral Treatment
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NOTES 32729 For positive evaluation
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66 Barker, D., “Moscow mayor has
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NOTES 33133 World Health Organizati
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NOTES 33380 Eliade, M., Shamanism:
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NOTES 335homelessness a mental heal
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NOTES 337Academic Press, 1978; Faul
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NOTES 339Washington, DC: House of R
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NOTES 34194 Read, J. and Baker, S.,
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132 Robinson, J.R and Shaver, P.R.,
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NOTES 345“Schizophrenia is not di
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NOTES 34748 Bagley, C., “The soci
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NOTES 34979 ni Nuallain, M., O’Ha
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NOTES 3514 Kapur, S. and Seeman, P.
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NOTES 35327 Pasamanick, B., Scarpet
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NOTES 355Archives of General Psychi
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NOTES 357“Prognostic factors in r
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NOTES 359Chandler, D., Meisel, J.,
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30, 1978; Moffit, R., “The econom
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NOTES 36312 Stein, L.I. and Test, M
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NOTES 36547 Personal communication,
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NOTES 367European Psychiatry, 15:26
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BibliographySTUDIES OF THE OUTCOME
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BIBLIOGRAPHY 371Horowitz, W.A. and
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BIBLIOGRAPHY 373Salokangas, R.K.R.,
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AUTHOR INDEX 375Dunham, Warren 31Du
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AUTHOR INDEX 377Urquhart, M.C. 129n
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SUBJECT INDEX 379atypical 20;compan
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SUBJECT INDEX 381CESP see Carer Edu
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SUBJECT INDEX 383disability pension
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SUBJECT INDEX 385diagnosis of 148;d
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SUBJECT INDEX 387Isle of Wight 33is
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SUBJECT INDEX 389Middlesex, Hanwell
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SUBJECT INDEX 391PACE see Personal
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SUBJECT INDEX 393economic condition
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SUBJECT INDEX 395self-employment 15
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SUBJECT INDEX 397symbolic thinking
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SUBJECT INDEX 399volition disturban
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