Recovery From Schizophrenia: Psychiatry And Political Economy

THE PERSON WITH SCHIZOPHRENIA IN WESTERN SOCIETY 173greatly swollen over the prior 15 years by large numbers of former state hospitalpatients. They reported:By a stroke of grim irony some of these ex-patients had come full circleback to the institution that had originally discharged them—this time forshelter not treatment. 6As the result of a class action suit filed on behalf of the city’s homeless, themunicipal government had been forced to open an empty state hospital buildingon Ward’s Island as an emergency shelter. This time around, though, conditionswere far worse than when the facility had been staffed as a hospital. Now thebuilding was crammed full of cots and there was no type of treatment orrecreational activity. Infestation, disease, violence and fear were pervasive. Inconsequence, staff pushed and prodded the residents with night-sticks to avoidcontact and to maintain order. They dealt with the men in rough language andthrough barked orders. One feature had not changed since the days when thebuilding was a hospital, however—the characteristics of the residents. Eighty-fourper cent of the men seeking shelter there in May 1980 were mentally ill; 60 percent were found to be moderately or severely disturbed—mostly suffering frompsychosis. 7There was little doubt that patients were ending up on the streets because ofthe deficient aftercare planning and services of the mental health system. Nearly aquarter of the patients discharged from New York State psychiatric centers in theearly 1980s were released to “unknown” living arrangements. From one hospital,nearly 60 per cent of patients were released to an “unknown” address. 8This state of affairs was not confined to New York. In a random sample of 50men on Chicago’s Skid Row in the late 1960s, Robert Priest, a Britishpsychiatrist, found 25 per cent to be certainly or probably suffering fromschizophrenia. 9 Only a decade earlier, however, in 1957 and 1958, beforedeinstitutionalization was far advanced, an American researcher, Donald Bogue,found a mere nine per cent of men on Skid Row in the same city to have mentalillness. At that time, Bogue reported, “mentally unsound persons …are picked uprather promptly by the police, and…institutionalized.” 10 A survey conducted inLos Angeles in the early 1980s found half of the 7,000–15,000 people living onSkid Row to be incapacitated by chronic mental illness—40 per cent of the menand 90 per cent of the women. 11 Around the same time, in Philadelphia, 44 percent of the Skid Row homeless, and at least a quarter of the people living on thestreets and in the shelters of Washington, DC, were suffering fromschizophrenia. 12 In Boston, 40 per cent of those staying at an emergency shelterwere suffering from a psychosis in 1983. 13 Forty-seven per cent of the emergencyshelter users in St Louis in the mid 1980s suffered from a functional psychosis. 14In Denver in 1981, the judge who heard most of the cases related to the mentalillness statute remarked that the primary residential care provider for mentalpatients was the city bus company. When they stopped offering free rides on the