Recovery From Schizophrenia: Psychiatry And Political Economy

86 DEINSTITUTIONALIZATIONcompetitive in the industrial market place. Industrial therapy in the United States,meanwhile, lagged a long way behind. 16Such radical changes, in several areas pre-dating the introductionof chlorpromazine, explain why drug treatment appeared to have little effect inmany hospitals. Professor Ödegard demonstrated that of the 17 mental hospitals inNorway, those which had previously had a poor discharge record showed themost benefit from the introduction of the antipsychotic drugs; those whichalready had a higher discharge rate, and were presumably more advanced in socialtherapeutic techniques, showed no increase in the number of patients dischargedand maintained in the community after drugs became available (see Table 4.1).Dr Ödegard concludes that for hospitals where social milieu therapy was not welldeveloped “the drugs were a real blessing,” but thatin the more privileged institutions the drugs simply meant that one form oftherapy was replaced by another and equally efficient one. 17Similarly, Dr N.H.Rathod, a psychiatrist at Cane Hill Hospital in Surrey,demonstrated that the effects of the new “tranquillizers” were very limited onwards where particular attention was paid to the creation of a therapeuticenvironment. 18Antipsychotic drugs, then, appear to be more effective for the patient withpsychosis who is living in an inadequate setting, and to be less valuable where theenvironment is designed for his or her wellbeing. This is an important point andone that we will return to later in the book. It is a point that is not readilyapparent to mental health professionals who were not practicing before theantipsychotic drugs were in use; and because of the peculiarities ofdeinstitutionalization in the United States, it is a point scarcely recognized inAmerican psychiatry. In practice, drug treatment is all too often used as asubstitute for adequate psychosocial care. As concern grows over the harmful sideeffects of the antipsychotic drugs and over the social plight of large numbers ofpoverty-stricken people with psychotic disorders in the community, this becomesan issue of some consequence.DEINSTITUTIONALIZATION IN THE UNITEDSTATESThe antipsychotic drugs had a more revolutionary impact in the United States,where there were relatively more backward asylums in 1955, than in those parts ofnorthern Europe where social therapy prevailed. The subsequent course ofdeinstitutionalization in America also differed from that in northern Europe.Despite the development in the United States of a network of community mentalhealth centers after 1965, the welfare of the chronically and severely mentally illwas, for decades, largely overlooked. A substantial proportion of those discharged