Warner – Recovery From Schizophrenia Notes

Richard Warner – Recovery from Schizophrenia: Psychiatry and Political Economy

Chapter Three – Recovery from schizophrenia

• Warner compares tens of studies into recovery from schizophrenia. Findings:

  • Recovery rates from schizophrenia were not significantly better at the end of the C20 than they were at the start

  • The state of the economy appears to be linked to outcome in schizophrenia (p76)

    • During the Great Depression complete recovery halved to 12%, social recovery fell to 30%

    • During the recession of 1980s and 1990s social recovery declined to 33%

    • There is a significant correlation between changes in the recovery rates and average unemployment in the UK and USA

      • This is an especially important finding in the case of complete recovery, since social recovery itself is in part a measure of patient employment

  • People with schizophrenia experienced the impact of deinstitutionalization before the antipsychotic drugs were brought into use (p77)

    • Further, the deinstitutionalization that occurred after the introduction of antipsychotics is not associated with an improvement in recovery rates

Chapter Four – Deinstitutionalization

• Warner cites various hospitals, including in the UK, in which the discharge rate increased before the introduction of antipsychotics (p88)

  • In some comparisons of patients treated with drugs and patients treated without, those treated with the new drugs had a lower discharge rate than those treated without them

    • This could be accounted for if those with the worst prognoses were treated with drugs

• So if not the new drugs, to what may we attribute these changes in the management of mental patients?

  • There was a general postwar movement in psychiatry towards positive treatment, therapies, open door policies etc

    • Some of these advances were facilitated by the new drugs, which helped to ameliorate the most serious psychotic symptoms

    • But in general, the hospitals in which these radical changes occurred did not see general improvements as a result of antipsychotics; the improvements had already come from social psychiatry

      • ‘antipsychotic drugs, then, appear to be more effective for the patient with psychosis who is living in an inadequate setting, and to be less valuable where the environment is designed for his or her wellbeing’ (p.92)

• Why was there a golden era of social and community psychiatry in the immediate postwar years (and in the later 20^th century in the USA)? (p.98)

  • Scull claims it followed from the postwar development of welfare programs that enabled the indigent and the disabled to be maintained more cheaply outside an institution

    • This analysis has merit, but it doesn’t explain variations in timing – e.g. it would appear to predict a late onset for community care in Norway, and simultaneous introduction in UK and US

  • We can identify four possible political motives for a deinstitutional trend. How salient are they for this trend in mental health?

    • Cost savings

      • Yes, clearly important, but don’t explain variation between countries

    • Humanitarian concerns

      • Present but insufficient: such views had previously been ineffective in achieving change, so why were they effective now?

      • Rather it seems probably that the philosophy of care is a secondary phenomenon, shaped by patterns of institutional practice

    • Need to put the buildings to a new purpose

      • Not in the second half of the 20^th...

Buy the full version of these notes or essay plans and more in our 20th Century British psychiatry Notes.