Schizophrenia, Negative Symptoms, and Social Policy

Abstract

Since the end of the Second World War, social policy with regard to the mentally ill has been in a state of change. Some trends are already clear; others seem less so. In the industrialized countries, we have moved away from reliance on the custodial hospital toward a greater or lesser development of largely, but not exclusively, treatment and housing arrangements in the community. In many places this has meant return to the family, particularly in the case of the young mentally ill. In retrospect, we realize that the impact of this change in social policy on the family should have been evaluated and planned for as early as the 1950s. Our failure to do so has meant years of neglect and waste of one of our most important social and rehabilitative resources. In terms of both social and fiscal policy, our current interest in the negative symptoms of schizophrenia and in the role of the family in caring for its mentally ill members might well be termed tardive intervention. In few of the Western industrialized countries is the situation of the mentally ill deemed to be truly satisfactory; almost nowhere have the mentally ill reached the simple goal of relative equality of opportunity with those not burdened by mental illness; in some countries the changes have been equivocal. In addition to the relatively lower priority accorded psychiatric care in comparison with other health sectors, rehabilitation of the mentally ill continues to suffer from a low status. An underlying and continuing problem has been failure of the public and the professions to perceive the mentally ill as disabled and requiring rehabilitation. They use no crutches or canes, and their handicap