Recovery from Schizophrenia: Psychiatry and Political Economy, 2nd ed.

Richard Warner. Routledge, 29 West 3 Street, New York, NY 10001. 366 pages. Hardcover, $69.95; softcover, $25.00.

The first edition of Recovery from Schizophrenia was acclaimed on publication as a work of major importance. It demonstrated convincingly, but controversially, how political, economic, and labor market forces shape social responses to the mentally ill, mold psychiatric treatment philosophy, and influence the onset and course of one of the most common forms of mental illness. In this revised and fully updated edition, Dr. Warner analyzes the latest research to refine the argument in his original book and to give new answers to such questions as, "Has industrial development affected the number of people who develop schizophrenia?" and "How may we create opportunities for the economic advancement of mentally ill persons?"

The opening chapters of the book establish the background for the subsequent analysis. The first chapter outlines what is known about the factors that promote the appearance of schizophrenia and that shape the course of the illness. The material is presented in such a way that readers who are not already familiar with the facts and features of the illness will learn enough to understand the rest of the book. The next chapter provides details of the ways in which mental and physical health are influenced by the economy, by social class and by the conditions of labor.

The middle section of the book looks at the impact of political economy on schizophrenia. Chapter 3 is an analysis of outcome studies of schizophrenia since the turn of the century and tries to establish whether changes in the long-term course of the illness are linked to large-scale fluctuations in the economy. The extent to which political, economic, and labor market forces shaped the postwar policy of deinstitutionalization is examined in Chapter 4; and the role of similar forces in the development of institutions for the insane in the eighteenth and nineteenth centuries and in molding the treatment philosophy of the period is discussed in the following chapter.

Chapter 6 looks at possible reasons for the link between the economy and outcome from schizophrenia and Chapter 7 attempts to explain why schizophrenia is a less malignant condition in the Third World. The plight of the Western schizophrenic person and the way in which the social role and alienation of the psychotic person shape the course of the illness are examined in Chapter 8. Moving from the course of schizophrenia to its incidence, Chapter 9 analyzes how economic development, social stratification, and birth complications influence the appearance of the illness.

The final section deals with treatment issues. Chapter 10 evaluates the limitations of the antipsychotic drugs and the place of low-dose and drug-free treatment. The importance of work, economic opportunities, consumer involvement, and community support in the management of psychosis is covered in the final two chapters.