Recovery From Schizophrenia: Psychiatry And Political Economy

82 DEINSTITUTIONALIZATIONMichael Shepherd and his colleagues, after studying the discharge rate from StJohn’s Hospital in Stone, Buckinghamshire, between 1954 and 1957, concludedthat the introduction of drug treatment after 1954 had made no significant change. 4Their net release-rate figures (discharges expressed as a proportion of the averagenumber of patients in residence) for schizophrenia were as follows:At Mapperley Hospital in Nottingham, the patient population began to declineas early as 1948, from 1,310 patients in that year to 1,060 in 1956, and continuedto drop at a similar pace after drugs were brought into use. 5Similar examples for the United States are harder to find. The number ofpatients resident in Massachusetts mental hospitals was already declining in 1954,before chlorpromazine was in use; 6 and at Vermont State Hospital the dischargerate for schizophrenia increased steadily after 1948. 7 Looking only at firstadmission,white males with schizophrenia entering California state hospitals,psychiatrist Leon Epstein found that the discharge rate for such patients wasalready increasing between 1951 and 1954 (the year when drug treatment wasintroduced). Furthermore, patients with schizophrenia first admitted in 1956 and1957 who were treated with the new drugs showed a lower discharge rate thanthose who were treated without drugs. The discharge rate for this group of patientsas a whole (drug-treated and drug-free) nevertheless continued to increase. 8Erwin Linn demonstrated that the same phenomenon occurred at St Elizabeth’sHospital in Washington, DC. Although the discharge rate for patients withfunctional psychosis increased at this hospital between 1953 and 1956, the releaserate for those treated with drugs was again lower than for those treated withoutdrugs. 9 (Such a result, however, would theoretically occur if only the patientswith the worst prognosis were given drug treatment.) Overall it seems probablethat some other influence besides a purely pharmacological effect was operating tostimulate American deinstitutionalization.Much more influential than these studies, however, were the figures for NewYork State mental hospitals presented by Henry Brill and Robert Patton. They