Recovery From Schizophrenia: Psychiatry And Political Economy

THE POLITICAL ECONOMY OF SCHIZOPHRENIA 205Consequently, this first generation of more affluent women will have relativelysmall pelvic dimensions and, when pregnant, will carry large, well-nourishedfetuses. The result will be more difficult deliveries and more brain damage in thenew generation of infants.The result may also be increased infant mortality. As we saw in Chapter 2, eventhough infant mortality has decreased with industrialization, it rises during theboom (see Figure 2.3), confirming that it can be a complication of affluence.Increased obstetric difficulties, then, are likely to lead to increased numbers ofneonatal deaths as well as increasing numbers of surviving brain-damaged infants.If neonatal care improves, the proportion of brain-damaged infants that survivewill increase; infant mortality, however, may continue to be above average.Improvements in neonatal care, in the early phase of industrialization, becomeavailable sooner to the upper classes. This bias increases the tendency for childrenborn with obstetric complications to higher-class women to survive infancy withbrain damage and for similar lower-class children to die earlier in life. Both theincreased rate of brain damage and the increased survival rate could, in turn, leadto higher rates of schizophrenia in the upper classes.In the later phases of industrial development upper-class women with goodnutrition from birth will have relatively large and well-formed pelvic cavities.Further advances in obstetric care, such as Cesarean section, which decrease therisk of fetal brain trauma, are also selectively available to the upper classes; both ofthese factors will eventually lead to lower brain-damage rates and a subsequentdecrease in the incidence of schizophrenia in the upper classes. Lower-classwomen will not realize these benefits as soon. At the present time, for example,low birthweight, an indicator of obstetric complications, is more common inblack infants in the United States than among white newborn infants. 39 Theseinfants are at greater risk for schizophrenia; studies have found that lowbirthweightinfants have more damage around the ventricles of the brain(characteristically found in schizophrenia) 40 and that people with schizophreniatend to have lower birthweights than their healthy siblings. 41 The risk ofschizophrenia in the lower classes is no longer moderated by poor survival rates,moreover. The low-birthweight black infants have higher survival rates thanwhite low-birthweight infants.This analysis helps explain why the recent apparent decrease in the incidence ofschizophrenia has been greatest in the most prosperous regions of the UnitedKingdom, 42 why the districts that show no decrease in schizophrenia have largeimmigrant populations with high rates of poverty 43 and why Westernschizophrenia rates are higher among the poor. Differences in intrauterinedevelopment, delivery and infant survival may contribute to the increased risk ofschizophrenia in the upper classes in the industrializing world and, conversely, tothe high risk in lower social classes and (as we shall see shortly) among thechildren of immigrants in the post-industrial world.