Recovery From Schizophrenia: Psychiatry And Political Economy

206 THE INCIDENCE OF SCHIZOPHRENIAIMMIGRANTSInformation about the occurrence of schizophrenia in immigrants provides a testof the theory that obstetric complications arising from social change affect the ratesof the illness. Immigrants to the industrial world from less developed parts of theglobe have a higher incidence of schizophrenia than native-born citizens. Somestudies demonstrate that the high rates of the illness are also greater than in theimmigrants’ countries of origin. The common explanations for these observationsare that (a) there is a selective tendency for individuals to emigrate who areconstitutionally predisposed to develop schizophrenia and (b) the stress ofmigration or living in an alien culture increases the risk of developing theillness. 44Another possibility is that the pattern of occurrence is a response to the samefactors that appear to explain the fluctuation in occurrence with the advance ofindustrialization—immigrants from poorer countries entering the DevelopedWorld encounter greater obstetric difficulties due to changes in nutrition buttheir infants receive better perinatal care, resulting in the survival of increasednumbers of offspring with increased risk for schizophrenia. If this explanation isaccurate:• The frequency of schizophrenia will be elevated only in immigrants fromcountries where nutrition and perinatal care are worse than in the newcountry.• The incidence of schizophrenia will be greater in immigrants than in thepopulation of their country of origin.• The rate of obstetric complications will be elevated among immigrants butneonatal survival rates will also be high.• The incidence of the illness will be greater in second-generation immigrantsthan the first generation.There is no shortage of evidence to demonstrate that immigrants from poorcountries to rich show high rates of schizophrenia; the data on this point areclear. In the United States and Canada, numerous studies have shown thatsuccessive waves of poor migrants in the first half of the twentieth century, manyof them fleeing starvation at home, exhibited first-admission rates forschizophrenia considerably higher than those of the general population—theseincluded Greeks, Poles, Irish, Russians and Swedes. 45 Refugees entering Norwaywere ten times more likely than the native population to suffer from psychosis. 46Afro-Caribbean immigrants living in the London boroughs of Lambeth andCamberwell in 1961 were three times more likely (after a correction for the agedistribution of the population) than native-born residents to be admitted tohospital with schizophrenia, 47 and many studies since that time have confirmed thatthe Afro-Caribbean rate of the illness is substantially elevated in Britain. 48Hospital statistics for England and Wales show that Afro-Caribbean immigrants