Psychosis, the Medical Model and Recovery Philip Thomas Professor of Philosophy Diversity & Mental Health Institute for Philosophy Diversity & Mental Health Centre for Ethnicity & Health University of Central Lancashire Preston PR1 2HE Lancashire

Outline What does ‘Recovery’ mean? Schizophrenia and the medical model –the concept of ‘deterioration’ and ‘degeneracy’ What is the prognosis of schizophrenia? Deconstructing Psychosis and the Silencing of ‘Schizophrenics’

Caveat Critiques of the medical model should not be interpreted as an attack on those who find medical accounts of their distress helpful. Whatever their chosen framework, individuals have the right to have their understandings of their distress respected, whether medical, social, political, or spiritual.

What does ‘recovery’ mean? Shorter Oxford English Dictionary: –Recovery from illness (medical) –Recovery of something that was lost (narrative) –Recovery of something that rightly belonged to me (moral)

‘Recovery’ as recovery from illness Biomedical model –Disturbances in bodily function, pathology, physiology, biochemistry –Treatment, drugs or somatic therapies –Restoration of ‘normal’ function –Loss of symptoms = recovery (of health)

Schizophrenia: Origins ‘Dementia praecox consists of a series of clinical states which have as their common characteristic a peculiar destruction of the internal connections of the psychic personality with the most marked damage of the emotional life and volition.’ Emil Kraepelin, 1913

‘Recovery’, Schizophrenia, and the Medical Model ‘Defect states’, ‘deterioration’ and poor outcome Duration of untreated psychosis and early intervention services Medication for life Lower your expectations

All hope abandon ye who enter here

Outcome of schizophrenia in the West Kraepelin reported only 13% of his patients recovered. Author(s)Number of Subjects Follow-up (years) % Improved Bleuler (1978) Huber (1979)> Ciompi (1980) Harding (1987)

Outcome of schizophrenia in the West Richard Warner (1994) 1.The outcome for schizophrenia has remained relatively constant in the West, despite the introduction of new technologies – drugs, therapies and services. 2.The state of the economy is the single most important factor influencing the outcome of schizophrenia.

Outcome of schizophrenia in non- Western cultures 1.WHO IPSS 1973 – schizophrenia had better outcome in economically disadvantaged countries than industrialised nations. 2.Kua et al (2003) two thirds of patients in their study in Singapore had good or fair outcome at 20 years 3.Thara et al (2004) in Madras – only 5 out of 61 patients followed up over 20 years had been continuously ill. 76% of men in the study were in employment

Four ways that psychiatry silences schizophrenia Individual – narrative loss, loss of personhood and madness (McCabe et al, 2002) Institutional - meaninglessness of psychosis in psychiatry (Bracken, P. & Thomas, P., 2005) Social – stigma and social distance lead to isolation and powerlessness (Read et al, 2006) Political – the power of psychiatry to speak about madness (Foucault)

For the survivor movement recovery involves speaking out, the act of reclaiming language, or, as Coleman (1999) has put it, having a voice. The single most important barrier to recovery is the diagnosis of schizophrenia.

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