You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
This book was originally published in the USA in 1985 in hardback, and was hailed as a substantial contribution to the social psychiatry of schizophrenia. Its success has led to this paperback edition. The author is an English-trained psychiatrist working in the United States.
It is a masterly review of the whole field of schizophrenia: its history, aetiology, treatment, and particularly the vexed issue of recovery, and what factors seem to
determine recovery. The book's subtitle, ‘Psychiatry and Political Economy’, hints at where the author believes the key to understanding the poor outcome of schizophrenia lies. He believes that unemployment and the state of the economy have a profound effect on the prevalence and outcome of the disease. During economic recessions there is an increase in incidence of the disease and a reduction in recovery rates. Warner is not saying that there is a simple causal link, but that such factors mould the course of the disease and influence its outcome substantially; and that this factor is all too often neglected by the psychiatric profession in favour of biological, genetic, or psychological factors. He quotes many substantial studies to support this view.
Warner draws our attention to the importance of remembering that between twenty-five and forty per cent of schizophrenics have a potentially good prognosis, and that social, community, and labour factors will determine whether this group will do well or not. Cross-cultural studies show convincing evidence that despite the multi-billion-dollar investment in the treatment of schizophrenia in the West, outcome is better in the Third World, and this is with negligible expenditure. He argues that this is to do with the support offered by extended-family networks and the less intense pressure of the wage economy.
Warner also shows some interesting studies that support the view that in good-prognosis schizophrenia, anti-psychotic medication can worsen the prognosis. His model for the rehab