Recovery From Schizophrenia: Psychiatry And Political Economy

Chapter 9The incidence of schizophreniaDoes political economy influence the rate of occurrence of schizophrenia? Couldindustrialization, migration, social class and caste, or the factors governingproduction and reproduction determine how many people develop thevulnerability to schizophrenia? Could labor conditions, unemployment and othersocioeconomic stresses trigger the onset of the disorder? Up to this point we haveconcentrated upon the course of schizophrenia—recovery from the illness and thelevel of functioning achieved by chronic sufferers. The course of schizophrenia, ithas been argued, is strongly influenced by the utilization of labor, a factor thataffects the social role, status and integration of people suffering from psychosis. Atthis juncture it may be valuable to make a diversion and to examine the frequencyof occurrence of the illness and the extent to which it is affected by social, politicaland economic factors. We will also examine what efforts to prevent schizophreniaare likely to be effective and safe.For social factors to affect a person’s vulnerability to illness or the course of thedisorder there must be a mediating biological mechanism that converts the socialinfluence into a bodily response. Stressful labor dynamics, for example, can havean impact on the course of schizophrenia because increased stress worsens thedopamine supersensitivity that is believed to underlie the disease (see Chapters 1and 10). Influences on the occurrence of schizophrenia are likely to be differentfrom those affecting the course of the illness. If social factors are to have animpact on the individual’s vulnerability to schizophrenia they might do so byinfluencing the development of the fetal brain or the occurrence of brain damagelater in life—they might affect such factors as maternal and fetal nutrition,maternal drug and alcohol use, infections during pregnancy, deliverycomplications and childhood infections and head trauma.INDUSTRIALIZATION AND ILLNESSPatterns of interaction between socio-economic factors and the occurrence ofillness over time can be complex. Some diseases are worsened by affluence andtend to grow in frequency with industrial progress; others are a response topoverty and tend to decrease in incidence with the advance of industrialization. Anumber of diseases associated with Western industrial growth, however, are