Recovery From Schizophrenia: Psychiatry And Political Economy

48 BACKGROUNDmodern labor dynamics can be unhealthy for both employed and unemployedworkers.SUICIDEAnalysis of suicide patterns yields more evidence of the destructive effect of labordynamics and especially of unemployment. All authorities are agreed that suiciderates peak during economic recessions and have done so throughout thecentury. 117 The unemployment index is the strongest predictor of changes in thesuicide rate, having a greater impact on male suicide rates 118 and on older peopleof working age. 119 One researcher, Albert Pierce, asserted that suicide statisticsshow an increase whenever the economy fluctuates up or down, 120 but laterattempts to replicate his work have found unemployment to be more importantthan absolute economic change. 121 The view of Emile Durkheim, the earlyFrench sociologist, that “fortunate crises…affect suicide like economicdisasters” 122 has not been borne out. His claim, however, that work protectsagainst suicide does appear to be supported by the data.Throughout the industrial world suicide is more common in the elderly 123 andis higher in retired men than in working men of the same age. 124 The pattern ofincreasing suicide with age holds true for white Americans; but for blacks andespecially American Indians, who experience high levels of unemployment earlyin life, the suicide rate shows a peak in the young-adult years (see Figure 2.4).The Indian reservations with the highest suicide rates are those with the mostsevere problems of unemployment, alcoholism and traditional familydisintegration. 125 Suicide is more common among those in the lower-income,lower-status jobs where employment is least secure. 126 Economic stress couldaccount for many of these findings, or the absence of a socially endorsed usefulrole (in middle-class whites, a problem most common in late life) could be animportant precipitant of suicide. That the current picture is a response to changesaccompanying the growth of wage work is supported by a study of suicide inHong Kong. Before industrialization, Chinese suicide was more common inyounger adults; industrial development has brought declining prestige, changedroles and a steep rise in suicide to the elderly of the modern city. 127The circumstances of individual suicide victims suggest that joblessness, workproblems and economic difficulties may all be critical stresses. Studies havegenerally found around a quarter to a third or more of suicide victims to beunemployed—a substantially higher rate than in the general population or incontrol groups. 128 For example, a large-scale study of bricklayers and carpenters inDenmark found more unemployment in the recent background of workerssuffering violent deaths from both accident or suicide. 129 In addition, a pattern offrequent job changes, job dissatisfaction and downward mobility can often beuncovered in the history of suicide victims. 130 Which comes first -the emotionalproblems or the work difficulties? Two controlled studies have tried to tackle thisquestion by examining unemployment rates in psychiatric patients who