Recovery From Schizophrenia: Psychiatry And Political Economy

RECOVERY FROM SCHIZOPHRENIA 57categories has been included in Table 3.1 A study is included only if it followed asample of patients selected at the time of admission to treatment; cohorts selectedat the time of hospital discharge do not include those who remained in hospitaland died there. The list is certainly not complete; the German literature aloneprobably contains a great many more suitable studies. The 114 studies that areincluded, however, provide a comprehensive survey giving us a good deal ofinformation about recovery rates for patients admitted in every decade over thecourse of more than a century. 10Recovery rates during various time periods were calculated by the simplemethod of adding all patients who achieved each level of recovery in one timeperiod and calculating what percentage they formed of the total group of patientsfollowed up in that period. A point of detail: patients who were dead at the timeof follow-up, and for whom there was no information about the state of theirillness when they died, could either have been included in the analysis orexcluded. In this survey they were included in the total of patients followed upbut, of course, they never contributed to the proportion of recoveries. This tendsto reduce the calculated recovery rates for the earlier decades of the twentiethcentury, when institutional death rates were substantially higher, and makes the testof the theory that outcome from schizophrenia was good during those years moresevere.PERIODS OF ANALYSISEach study was assigned to a time period according to the median date ofadmission of the group of patients. Unavoidably, several patient groups wereadmitted during one time period and followed up in another. Assigning the groupto the earlier time assumes that the conditions in force earlier in the illness are moreimportant in shaping the ultimate course. This limitation suggests, however, thatthe trends in recovery rates should be analyzed only over rather long periods oftime.The periods of analysis selected were as follows. 1881–1900: The GreatDepression of the late nineteenth century (1873 to 1896 in Britain) ran throughmost of this period and was a time of severe unemployment throughout theindustrial world. Mental institutions were overcrowded and, particularly inGermany, barren and coercive. 11 An aura of pessimism pervaded psychiatry.Kraepelin’s patients were admitted at this time, and since only one other study isavailable for the period, these results are not included in the formal analysis.1901–1920: The period was characterized by improving employment andincluded the First World War. More active psychiatric treatment methods wereestablished and, in the United States, the mental hygiene movement developed.1921–1940: This was a time of severe economic depression, beginning severalyears earlier in Europe than in the United States, with unemployment rising toaround a quarter of the work force throughout the industrial world. Electro-