Recovery From Schizophrenia: Psychiatry And Political Economy

HEALTH, ILLNESS AND THE ECONOMY 31alcohol to relieve distress. 14 Class status may thus mold personality, copingstrategies, emotional symptoms, and alcohol use and indirectly influence physicalhealth.INCOME INEQUALITYIt is not just low social status, but also the extent of inequality between the richestand the poorest in a society, that is associated with increased mortality andmorbidity. Over 15 independent studies in recent years have demonstrated that,in developed and developing countries, the greater the gulf between the rich andthe poor, the higher the mortality rate from a variety of causes, even after takinginto account such factors as cigarette smoking and obstetric risks. 15 There is astrong correlation, for example, between the level of income inequality in each ofthe 50 US states and the age-adjusted mortality of residents of the state. 16Similarly, in districts across Britain, the death rate is associated not just with theabsolute level of the index of social deprivation but also with the range ofvariability of the index within each area. 17Various explanations have been promoted to explain how income inequalityleads to ill-health and death. Many researchers have concluded that variousaspects of psychosocial life, such as the sense of control over one’s future, socialaffiliations and support, self-esteem, stressful events and job security have animpact on health through the effects of stress. 18 Some of this thinking is capturedin the concept of “social capital”—those features of social organization, like socialnetworks, reciprocity, and trust in others, that facilitate cooperation betweencitizens for mutual benefit. 19 High income differences in a community, it isargued, undermine the possibility of such positive communal interaction.Involvement in community life through active group membership and a sense ofpower in one’s local community are lessened by the presence of marked socialdisparities, impeding individual pathways to health.SOCIAL CLASS AND MENTAL ILLNESSThe evidence is strong that stresses are greater among the lower classes, especiallywhere disparity of income with the more affluent is evident, and that increased illhealth and emotional distress are, to a certain extent, a consequence of thesestresses. It is also clear that schizophrenia and other mental disorders are morecommon in the lower classes. In the Great Depression of the 1930s, sociologistsRobert Faris and Warren Dunham found that the highest rates for treatedschizophrenia were concentrated in Chicago’s slum areas. From a rate of over 7cases per 1,000 adults in these central districts the prevalence of treatedschizophrenia declined gradually through the more prosperous sections of the cityto the lowest rates of below 2.5 per 1,000 adults in the most affluent areas. 20Following the publication of this pioneer work, a number of otherepidemiological studies confirmed that high rates of mental disorder, particularly