Recovery From Schizophrenia: Psychiatry And Political Economy

210 THE INCIDENCE OF SCHIZOPHRENIAper 1,000 (ranging from 0.9 to 8.0 per 1,000) compared to an average of 6.3 per1,000 (1.3 to 17.4 per 1,000) in Europe and North America. 77 The incidence ofschizophrenia, however, is not lower in the Third World.The recently published WHO study of the incidence of schizophreniaconducted at twelve sites in ten different countries was described in Chapter 7.The findings of the study are quite striking. The rate of occurrence of narrowlydefined “core” schizophrenia, it emerges, is extremely similar at all the sitesstudied, varying from a low figure of 0.07 per 1,000 in Aarhus, Denmark, to ahigh of 0.14 in Nottingham, England. More variation is apparent when a broaderdiagnostic approach is used, from 0.16 per 1,000 in Honolulu, Hawaii, to 0.42per 1,000 in the rural area around Chandigarh, India. 78 Even so, this range ofvariation is far less than would be expected based on the earlier, non-standardizedprevalence studies. The gradient of occurrencefrom the highest rate in a ruralThird World setting to the lowest rate in a large American city—is the exactopposite of what would be expected if labor market stress directly influenced theoccurrence of schizophrenia.Other studies conducted in Ireland 79 and Germany 80 using the samestandardized approach applied in the WHO study, have found narrowly definedschizophrenia to occur with incidence rates that are very close to those identifiedin the WHO report. It is difficult to explain why new cases of schizophrenia shouldoccur at such similar rates around the world. One thing is clear, however—thatthe wide range in prevalence rates identified in the earlier studies is probably notdue to variations in the rate of development of the disorder; it is better explainedby differences in case finding, diagnostic approaches, research methodology anddeath and recovery rates of people with schizophrenia. The apparently lowerprevalence of schizophrenia in the Third World is almost certainly due to the factthat people suffering from schizophrenia are more likely to recover quickly or todie young in developing countries than they are in the Developed World.DOES LABOR MARKET STRESS TRIGGER THEONSET OF SCHIZOPHRENIA?It seems unlikely that the stresses of the labor market directly affect the rate ofoccurrence of schizophrenia. If such stress affects the timing of onset ofschizophrenia, however, we would predict:• First-time admissions to hospital for schizophrenia will increase in times ofhigh unemployment.• The age of onset of the illness will be earlier in the sex that is most adverselyaffected by the labor market.The first of these predictions has been shown to be true—the evidence waspresented towards the end of Chapter 2—so we may examine the issue of genderdifferences.