Recovery From Schizophrenia: Psychiatry And Political Economy

236 TREATMENTHere we find another explanation of the failure of the drug-treatment era inpsychiatry to usher in improved outcome in schizophrenia. In the rush to transferpatients to the community—to cut institutional costs regardless of the social costs—some people have been abandoned and, for others, the antipsychotics havebeen used not as an adjunct to psychosocial treatment, as John Wing recommends,but as an alternative to such care. Too often the psychiatrist is called upon towedge the person with schizophrenia into an ill-fitting slot because an appropriatelytherapeutic setting is not available, affordable or even considered feasible. Drugtreatment becomes here an economic and political tool.THE REVOLVING-DOOR PATIENTThe ascendancy of psychopharmacology over psychosocial treatment isepitomized by the revolving-door patient. This creation of the neuroleptic era hasbecome a focus of public concern—the central character, for example, in a seriesof New Yorker articles and the subject of a ground-breaking court decision. SylviaFrumkin’s ten admissions to Creedmoor Hospital, New York City, by age 31,her multiple hospital admissions elsewhere, and her family’s consequent suffering,all documented in the New Yorker, 54 represent nothing unusual. Notuncommonly, several times in one year the same patient will be medicated backto sanity in an American public hospital and discharged to an inadequateenvironment, placed in an unworkable setting or simply released to live on thestreet with the full knowledge that readmission will shortly be necessary.Such a case was Kathy Edmiston. In a hearing concerning her circumstances inthe Probate Court of Denver, Colorado, Judge Wade commented:On virtually innumerable occasions respondent has been certified andinstitutionalized for short periods of time (during which periods hercondition has been stabilized by use of medication in a structured setting).She has then been placed either on out-patient status or in a nursing home.She then becomes sufficiently ill that she is picked up or delivered to theemergency room at Denver General Hospital, placed under certification, andthe process begins again. Without even a minimally adequate treatmentprogram, respondent and others like her will continue to be victims of theirown inadequacies (often including their delusional systems) and will betargets for the influence and exploitation of others. For example, thebehavior of this respondent in the community, which is related to thenature of her mental illness, has made her the victim of physical, sexual, andfinancial exploitation. 55The judge ruled that the next time this patient was certified the mental healthagency must establish a suitable program for her treatment.Since the Edmiston case in 1980, civil rights lawyers have won a court orderrequiring the City of Denver and the state of Colorado to improve services for