Schizophrenia; evaluation of sociocultural factors.

Question 1

Evaluation; Urbanicity, urban environment, and comparison with rural environment.

Answer 1

• We cannot be sure that living in an urban environment increases the social stress of the individual, as compared to living in a rural environment.
• In a seeming paradox, general health is normally considered to be better in urban rather than rural areas because of easier access to healthcare, higher employment rate and better educational levels.
• In addition, those living in an urban area may experience higher levels of social capital - features of social life and environment that enable people to act effectively with each other.
• Kwame Mckenzie et al 2002 proposed that higher levels of social capital may actually protect us from stress. Therefore it is unclear exactly how the mechanism that underlies urbanicity seems to work; it may just be social stress or it may be more complex interplay of other possible factors such as pollution.

Question 2

Which comes first?

Answer 2

• Does living in an urban environment lead to a greater risk of schizophrenia, or does having schizophrenia mean you are more likely to live in an urban environment?
• The social drift hypothesis proposes that once diagnosed with a mental disorder like schizophrenia, individuals demonstrate a decline in their socioeconomic status (because they find it less easy to maintain employment) and as such may move to less salubrious areas, which tend to be in the inner city.
• As such, this gives a false impression of urbanicity being a cause of disorders such as schizophrenia whereas it may be an effect.
• However, Carsten Pedersen and Preben Mortensen (2001) reported that those individuals who had a high risk of psychotic disorders (like schizophrenia) reduced the likelihood of developing schizophrenia if they moved to a more rural environment.
• Although it cannot definitely be inferred that living in an urban environment causes schizophrenia, this evidence does clearly suggest a link.

Question 3

Social Isolation may be cause or effect?

Answer 3

• Social isolation may also be questioned as a cause or an effect. Much research suggests support for the causal role of social interaction. For example Jim Van Os et al (2000) claimed that single people who lived in neighbourhoods with few other single people were at a greater risk of developing schizophrenia, arguably because this increased the individuals isolation and loneliness.
• This suggests that social isolation is a valid explanation as a cause of schizophrenia.
• HOWEVER, one weakness in this argument is that we really cannot ascertain if the apparent social isolation is a cause of schizophrenia or if it is just an early indicator of psychosis.
• Although prospective studies, like those reported by JOnes et al are helpful it will not be until we are able to implement some form of intervention strategy such as a befriending group, in a controlled setting that we will be able to ascertain the role of social isolation as a cause of schizophrenia.

Question 4

Ethnicity or Discrimination may be the causal factor

Answer 4

• It is important to find out whether it is the ethnicity of the individual that places them at higher risk of schizophrenia or if the manifestation of symptoms is the product of prejudice and discrimination in psychiatric services
• On the one hand, some believe ethnic minorities may appear to be suspicious and mistrustful of the psychiatrists because of previous negative encounters with authority figures.
• The psychiatrists label this behaviour as paranoia, making the diagnosis of schizophrenia more likely, even though the mistrustful behaviour may have in the past been adaptive to the individual.
• On the other hand, Jane Boydell et al (2001) note that incidence rates of schizophrenia increased in ethnic minorities as the proportion of ethnic minorities in the locality fell, suggesting that social experience (isolation, discrimination, etc) contributed to development of the illness.
• These pieces of research imply that is unlikely that we will really be able to assess the impact of ethnicity and discrimination until we live in a society that is free of prejudice and bigotry.