Recovery From Schizophrenia: Psychiatry And Political Economy

THE POLITICAL ECONOMY OF SCHIZOPHRENIA 207and (to a lesser degree) Asian immigrants from India and Pakistan had higher ratesof admission for schizophrenia than the general population. 49Reports of immigrant groups from more affluent countries stand in contrast.British immigrants to Victoria, Australia, in 1959 and 1960, for example,demonstrated an incidence of treated schizophrenia that was similar to the nativebornrate but only a quarter of the incidence among immigrants from southernand eastern Europe. 50 European Jews settling in Israel in the 1950s had a lowerincidence of schizophrenia than Jewish immigrants from the Middle East. 51American-born residents of England and Wales experienced rates ofhospitalization for schizophrenia in 1971 that were lower than those for mostother immigrants and close to those for native-born residents. 52 English-bornimmigrants to New York State between 1949 and 1951 exhibited a strikingly lowerfirst-admission rate for schizophrenia than immigrants from other nations or evennative-born, white Amerieans. 53Immigrants were not over-represented in one sample of Canadians withschizophrenia unless they were coming from Eastern Europe and entering adisadvantaged minority population. 54 When Irish-born patients admitted totreatment from Camberwell in 1966–7 and in 1970 were compared with a classmatchedgroup of English-born patients the prevalence of schizophrenia wasfound to be no greater in the Irish. 55 These observations confirm the impressionthat the occurrence of schizophrenia among immigrants from countries withsimilar nutritional and health care standards is not elevated.Many of these studies may be faulted for their use of hospital statistics as themeasure of incidence. More low-class immigrants might be admitted to publichealth facilities than affluent citizens, leading to a statistical bias. Communitysurveys that distinguish immigrants from non-immigrants would theoretically bemore accurate, but such studies are rare.Many researchers have emphasized that the elevated incidence of schizophreniaamong immigrants from poor countries is greater than among the population oftheir countries of origin. Psychiatrist Silvano Arieti points out that in 1949 thetreated incidence rate among Italian immigrants to New York was three timesgreater than the highest incidence in Italy. 56 (Diagnostic variations may accountfor part of this difference.) Örnulv Ödegard found that treated schizophreniaamong Norwegian immigrants to Minnesota, prior to the 1930s, was twice ascommon as among native-born Americans or among the general population ofNorway. 57 A series of studies have demonstrated that the incidence ofschizophrenia in Jamaica, Trinidad and Barbados is substantially lower than amongAfro-Caribbeans in Britain. 58 On the other hand, immigrants to London fromIreland, where nutrition and obstetric care are no worse, do not show anincreased prevalence of illness when compared to the Irish who remain in Eire. 59If obstetric complications account for the elevated incidence of schizophreniaamong poor immigrants, we should expect to find high rates of thesecomplications of pregnancy and delivery among immigrant women. This is, infact, the case. Afro-Caribbean and Asian women in England and Wales are much