Recovery From Schizophrenia: Psychiatry And Political Economy

202 THE INCIDENCE OF SCHIZOPHRENIACASTE AND CLASSAs with thyrotoxicosis, poliomyelitis, coronary artery disease, and certain otherillnesses, schizophrenia may initially increase in incidence among the upper classesas industrialization progresses and then switch to being predominantly a lowerclassdisease.The evidence for the increased rate of schizophrenia in the lower classes incities of the industrial world was presented in Chapter 2. At that juncture it waspointed out that the social-class gradient for schizophrenia was rarely found inrural areas, a fact which eliminated the likelihood of a selective, genetic cause.The drift of people with schizophrenia or those at increased risk for the illnessinto lower-status occupations might partly explain the concentration ofschizophrenia in the poorer classes, but there is an important observation whichforces the conclusion that some class-specific stress must additionally be at work—the social-class gradient for schizophrenia appears to slope in the reverse directionin peasant cultures and in non-industrialized parts of the world.The province of Lazio in Italy in the early 1950s, for example, although itincluded the city of Rome, sustained a largely rural population many of whomwere peasant farmers. An analysis of all reported cases of mental illness in theprovince between 1951 and 1955 revealed that schizophrenia was mostcommonly reported in the better educated, clerical workers and professionals. 27One must expect, however, significant under-reporting of psychosis in peasantcommunities and this factor may account for the observed findings in Lazio. Asimilar pattern, though, has been noted in other economically underdevelopedareas.Several studies from India have made the observation that schizophrenia ismore common among high-caste members than among the lower castes. Firstadmissions for schizophrenia to the only public mental hospital in Bihar state in1959 and 1960, according to psychologist Sharadamba Rao, were much higheramong the rich Bania merchant caste, the urbanized and upwardly mobileKayasthas (many of whom are in managerial and government jobs) and theeducated Brahmin and Rajput landowners than among the lower-caste peasantswho work the land themselves—the Kurmis, Goalas and Koiris—or among thelow-caste Telis and the untouchable scheduled castes. The incidence of treatedschizophrenia was nearly 50 times greater among the Banias in this study andmore than ten times greater among the Kayasthas than in the lowest castes. 28These differences might be explained by a greater tendency for the moreeducated castes to refer their relatives for Western-style psychiatric treatment.That this explanation is not sufficient is shown by three door-to-door psychiatricsurveys that confirm the greater prevalence of schizophrenia among the highercastes in India. The field survey of villages in West Bengal conducted byD.N.Nandi and his colleagues found the prevalence of schizophrenia amongBrahmins (at 7.2 per 1,000) to be four times greater than among the untouchablescheduled castes (1.8 per 1,000) or the non-stratified Munda and Lodha tribesmen