Recovery From Schizophrenia: Psychiatry And Political Economy

HEALTH, ILLNESS AND THE ECONOMY 51A second possibility is that financial destitution may lead patients to seek theshelter of hospital as an almshouse. Again, the explanation is not supported by thestatistics. Economically comfortable patients show the same increase in admissionrates during the slump as do marginal patients. Admissions to costly privatehospitals also increase during recessions—an economic burden rather than ameans of support. 141We are left with one likely explanation—economic stress and unemploymentlead to a true increase in symptoms of psychiatric illness. Much of the researchcited in this chapter supports the notion that the economy can lead directly tosuch changes in psychological symptoms. Why should the impact on hospitaladmissions occur more in the recession than in the boom? Perhaps because thosewho are susceptible to serious mental illness are most likely to be functioningmarginally on the job and are most likely to be laid off when the economy takes adownturn. The fact that it is principally working-age men and women who showincreased hospital admissions during declines in the economy favors this idea.Other research has shown that the admission of unemployed patients and thosewith job-related difficulties does, in fact, increase during recessions. 142 Overall,we have strong evidence that the onset of episodes of mental illness increases witheach setback in the economy and with the reduction in the call for labor.Physical and mental diseases, including schizophrenia, are more common in theurban lower classes and their occurrence fluctuates with the economy. The effectsof economic expansion, economic stress, working conditions and unemploymentare involved in the genesis of this ill-health, despair and insanity. In the nextchapter we will examine the extent to which the economy and the labor marketshape the course of schizophrenia and influence whether it emerges as a benign ora malignant condition.SUMMARY• Illness and death rates are higher in the working classes.• Stressful life events are more common in the lower classes and contribute tothe raised prevalence of stress-related physical and mental illness.• A high rate of inequality between the richest and poorest in society isassociated with increased illness and mortality.• Schizophrenia is concentrated in the lower classes in the industrial world andin the upper castes and classes in the Third World—a pattern that only atheory of social causation can explain.• Schizophrenia occurs more frequently in large cities and the incidence of theillness is elevated specifically in the urban lower classes.• Social causation and social drift may operate together to account for the socialclassgradient for schizophrenia in urban-industrial areas.• In large cities, fluctuations in the economy are associated with increasedchanges in people’s lives and with symptoms of psychological distress.