Recovery From Schizophrenia: Psychiatry And Political Economy

THE POLITICAL ECONOMY OF SCHIZOPHRENIA 83noted that the residential population of the state hospitals was increasing byaround 2,000 patients each year until 1955. In that year 30,000 cases received thenew type of drug treatment, and in the following year the upward trend wasconverted into an annual decrease in the residential population of the followingapproximate magnitude:The authors concluded that “the abrupt population fall was in material degreedue to introduction of the new drugs” because “no other explanation for thestatistical changes could be found.” 10 They were, however, unable to demonstratea direct cause-and-effect relation between drug treatment and patient dischargealthough, as sociologist Andrew Scull points out, 11 and as Davis’s view at thebeginning of this chapter illustrates, their work is often interpreted as having doneso. The New York experience was so close to the pattern for the country as awhole that the use of antipsychotic drugs is now inextricably linked in the mindsof most American psychiatrists and mental health professionals with thedevelopment of community care for psychotic patients and the radical changesassociated with the advent of the deinstitutionalization era. The data fromnorthern Europe, however, make it plain that increased discharge rates, shorterhospital stays, and community treatment for people with psychosis werebecoming the rule in many areas well before the antipsychotic drugs arrived onthe scene.If not to the new drugs, then to what may we attribute these postwar changesin the management of mental patients?THE SOCIAL PSYCHIATRY REVOLUTIONA revolution in the treatment of people with psychosis was taking place in manyparts of northern Europe before drugs were available—a revolution that wentlargely unnoticed in the United States until it was well under way. Mainstreamopinion in American psychiatry to this day, in fact, has overlooked thesignificance of the European social psychiatry revolution and continues toemphasize the central importance of drug treatment. As expressed by John Davis,the advent of chlorpromazinecreated an atmosphere that emphasized positive treatment and led to thevigorous application of other therapies, such as milieu therapy,psychotherapy, group therapy and occupational therapy. The greater use ofthose social therapies was made possible by the effective treatment, through