Does the City Drive Us Mad?

1. Does the City Drive Us Mad? The Effect of High Density Living www.psychlotron.org.uk

2. Where would you rather live? And why?

3. Urban Living and Mental Illness • What is the nature of the relationship? • Cause or effect? • What is the mechanism?

4. Urbanicity and Schizophrenia • Pedersen & Mortensen (2001) • As population density rises, so does prevalence of schizophrenia • Risk in inner city more than twice that in rural area

5. Urbanicity and Schizophrenia • Higher density living is associated with increased risk of mental illness • Primarily schizophrenia, but also depression and anxiety • These data are correlational

6. Causation Hypothesis Something to do with the urban environment causes or triggers schizophrenia Migration Hypothesis People with schizophrenia move towards urban areas Access to services, cheaper housing etc. Cause or Effect?

7. Cause or Effect? • Pedersen & Mortensen (2001) • Moving into or out of a city affects a person’s risk of schizophrenia

8. Cause or Effect? • Pedersen & Mortensen (2001) • Dose-response relationship between urban living and schizophrenia • More exposure in childhood leads to greater risk

9. Cause or Effect? • Relationship between urbanicity and schizophrenia cannot be explained solely by migration • Urban living plays a causal role in onset of schizophrenia • So what is the mechanism?

10. Physical Stress e.g. noise, pollution Social Stress e.g. lack of support Biological risk factor e.g. viral infection What is the Mechanism? Urban Living Schizophrenia

11. Crowding Viral infection Daily life stress Social isolation & fragmentation Pollution Social inequality What is the Mechanism? Less evidence More evidence Based on Freeman (1994); Pedersen & Mortensen (2001); van Os (2004)

12. Conclusions • People living in urban environments run a greater risk of developing schizophrenia • This is not due to migration of schizophrenics to inner cities • This may be due to infection or environmental stress (noise, pollution) • More likely due to the social conditions that accompany high density living

13. What would you choose? Why?

14. The Environmental Breeder Social drift Social adversity

15. Environmental Breeder hypothesis • All social explanations look at factors in society that result in schizophrenia. This is because there is a higher incidence of schizophrenia in lower classes, the unemployed and those living in deprived areas. The Social Drift idea says that those with schizophrenia become lower class (social movement) because of the difficulties that arise from having schizophrenia. The idea of Social Adversity says that characteristics associated with living in urban areas (declining inner-city areas with social deprivation, unemployment, poor housing and low social status) lead to schizophrenia. Features in the environment that might affect the development of schizophrenia seem to be adversity in adult life, unemployment and poverty, social isolation, living in inner-city areas with poor housing and overcrowding, high levels of crime and drug use, and separation from parents as a child.

16. Social Adversity: • There is a higher record of schizophrenia compared to rural ones. Studies in Chicago, London and Stockholm have shown above average incidences of schizophrenia. • Hjem et al (2004) conducted a study in Sweden that showed that social adversity in childhood lead to schizophrenia later in life. (Longitudinal study research method: lots of detail).

17. Social Drift: • One study to support compared the social class of schizophrenia men with their fathers’ social class, using official statistics, found that though schizophrenic men were in the lower classes, their fathers generally were not. Those who developed schizophrenia didn’t achieve well in their education as children, had problems in adolescence and difficulty keeping their job.

18. What do you think is the cause? And why?

19. Social causation explanation • Describe one explanation for schizophrenia. (4 marks) • Social causation • This suggests that those from lower social classes are more at risk of developing schizophrenia/eq; • Being in a lower social class increases the stress factors for a person/eq; • This increased level of stress can trigger the disorder/eq; • So families of low social class will, according to this, have a higher incidence of schizophrenics/eq;

20. Evaluate the explanation for schizophrenia you have given • Social causation • Research by e.g. Dohrenwend et al (1992) showed the incidence of schizophrenia in lower classes is significantly greater than in higher classes/eq; • However subsequent research has questioned a causal link, though an association does occur/eq; • One possibility is that lower class families are exposed to more risk factors such as infection levels and stress/eq; • Evidence of the level of schizophrenia in immigrant groups provides evidence as such people are invariably in a lower class situation in the host country, compared to the same groups in their home countries where schizophrenia is lower/eq; • However there is still uncertainty whether such features are diagnostic as non-schizophrenics are not screened/eq; • The higher level of schizophrenics in poorer areas could be a result of social drift as they are drawn into such areas/eq;

21. There are many explanations for schizophrenia including biological ones. Describe one explanation for schizophrenia and compare this with one other explanation. Comparisons include considering similarities and/or differences. (12 marks)