Recovery From Schizophrenia: Psychiatry And Political Economy

34 BACKGROUNDDanish island of Samsö, although mental disorder in general was more frequentamong the lower social classes, the prevalence of psychosis in particular wasunrelated to class. 42In fact, it emerges that the occurrence of schizophrenia is substantially greaterin urban areas compared to rural areas. So we have to ask ourselves why theincidence of schizophrenia is elevated specifically in the urban lower classes.As early as 1852, Isaac Ray noted that insanity was more common inmanufacturing and mercantile communities in Massachusetts than in farmingareas. 43 In 1903, William White reported that the distribution of insanity acrossthe United States paralleled the proportion of the population living in cities of 8,000 or more. He concluded that insanity was a result of “the stresses incident toactive competition.” 44 A series of studies conducted in New York state between1915 and 1935 reported that the first-admission rate for dementia praecox and,later, schizophrenia was two to three times greater in large cities than in ruralareas. 45 Other studies revealed an incidence of schizophrenia that was twice ashigh or more in the cities than the rural areas of Ohio, Texas and Maryland. 46Psychiatrist Fuller Torrey examined the geographical distribution in the UnitedStates of insanity or, more recently, schizophrenia for nine different years between1880 and 1963 and concluded that, throughout the period, there was a consistentregional correlation between the extent of urbanization and the prevalence ofthese conditions. 47 Studies in Sweden and Britain also show an associationbetween the occurrence of schizophrenia and city living, 48 and a recent Danishstudy found urban birth to be the most important factor determining a person’srisk of developing schizophrenia; being born in Copenhagen rather than a Danishvillage accounted for a third of the risk of developing the illness. 49What could cause this increase in the occurrence of schizophrenia among theurban working class? The social-drift theory offers the solution that people withschizophrenia or pre-schizophrenic symptoms migrate from the country to thecity. This effect, however, cannot explain the Danish finding of a higher risk ofschizophrenia among people born in urban areas. Other possible explanations areincreased exposure to infections during pregnancy and childhood due to morecrowded living conditions in the city, nutritional differences between the urbanand the rural poor, and a greater risk of poor obstetric care and perinatalcomplications among the urban lower classes. It is also possible that the socialconditions of rural working-class life are less likely to create a vulnerability forschizophrenia than urban lower-class existence. We shall see shortly, when welook at the effects of the business cycle, that there is a rural-urban difference inthe effect of fluctuations in the economy on symptoms of mental disorder, just asthere is a rural-urban variation in the influence of social class on the occurrenceof schizophrenia. The effect might be similar in each case.This, then, may be a convenient point to begin to examine the effects of thebusiness cycle on health, illness and mortality.