Recovery From Schizophrenia: Psychiatry And Political Economy

16 BACKGROUNDcommon. 30 The form and basic features of schizophrenia, nevertheless, are similararound the world, as the WHO Pilot Study shows.WHAT CAUSES SCHIZOPHRENIA?Tuberculosis is the result of an infection by a bacillus. In the early decades of thetwentieth century, however, when the disease was widespread, although a hugeproportion of the population became infected with the organism, only a relativelysmall number went on to develop clinically recognizable evidence of the disease.What caused the manifest symptoms of the illness to appear in those few, in somecases years after the initial infection? Poor social conditions were known toincrease the susceptibility to the illness, and improvements in diet and housing werelinked to a decline in the death rate from tuberculosis long before effective drugtreatment was introduced. The irritant effects of coal dust on miners, pregnancyin women and the debilitating influence of secondary illnesses, all could reduce anindividual’s resistance to the disease. What, then, is the cause of tuberculosis? Thetubercle bacillus? Overcrowding? Poor diet? The stresses of lower-class living? Orany of the other environmental, occupational or constitutional factors thatincrease the individual’s susceptibility? Clearly any and all of these factors may beconsidered contributory, and the reduction in the prevalence of the illness had asmuch to do with elimination of some of the social causes and with the increase inthe resistance of the population by vaccination as with the direct attack on theinfective organism by chemotherapy.The same principles apply to schizophrenia. We do not know with certainty ofa specific organic defect or infective agent that is critical in the development ofschizophrenia (although there are a number of theories and there has been anexpansion of knowledge in this area). We do know, however, of several factorsthat increase the susceptibility to this illness and that may provoke its appearance.To grasp how these factors may influence the development and the course ofschizophrenia we need to use an interactive conceptual model such as the oneproposed by American psychiatrists John Strauss and William Carpenter.An adaptation of the conceptual scheme offered by these authors 31 is given inFigure 1.2. An interactional model allows for various types of explanation toassume importance at different stages in the individual’s development. Thegenetic contribution, damaging intrauterine effects and birth trauma might eachplay a part in forming the newborn infant’s predisposition to developingschizophrenia. The vulnerability to the illness might theoretically be heightenedduring childhood development by brain damage, for example, or by unusualfamily communication patterns.Whether or not the illness becomes manifest in later life is likely to dependupon the extent of the vulnerability and the subsequent exposure to a variety ofstresses. Precipitating stresses may be biological in nature (such as hallucinogenicdrug abuse), or psychosocial. In the latter category are life events (such as startingwork, leaving home or bereavement), environmental influences (criticism or