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Structural violence and schizophrenia

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  • Kelly, Brendan D.

Abstract

Despite clear evidence of a substantial biological basis to schizophrenia, there is also evidence that social, economic and political factors have considerable relevance to the clinical features, treatment and outcome of the illness. Individuals from lower socio-economic groups have an earlier age at first presentation and longer durations of untreated illness, both of which are associated with poor outcome. Individuals with schizophrenia are over-represented in the homeless population. Migration is associated with increased rates of mental illness, including schizophrenia, and this relationship appears to be mediated by psycho-social factors, including difficulties establishing social capital in smaller migrant groups. Individuals with schizophrenia are substantially over-represented amongst prison populations, and imprisonment increases the disability and stigma associated with mental illness, and impedes long-term recovery. The adverse effects of these social, economic and societal factors, along with the social stigma of mental illness, constitute a form of 'structural violence' which impairs access to psychiatric and social services and amplifies the effects of schizophrenia in the lives of sufferers. As a result of these over-arching social and economic factors, many individuals with schizophrenia are systematically excluded from full participation in civic and social life, and are constrained to live lives that are shaped by stigma, isolation, homelessness and denial of rights. There are urgent needs for (1) the development of enhanced aetiological models of schizophrenia, which elucidate the interactions between genetic risk and social environment, and can better inform bio-psycho-social approaches to treatment; (2) a renewal of emphasis on the United Nations' "Principles for the Protection of Persons with Mental Illness" and related legislative measures in individual countries; and (3) continued study and examination of the impact of social, economic and political structures on the clinical features and outcome of mental illnesses.

Suggested Citation

  • Kelly, Brendan D., 2005. "Structural violence and schizophrenia," Social Science & Medicine, Elsevier, vol. 61(3), pages 721-730, August.
    • Handle: RePEc:eee:socmed:v:61:y:2005:i:3:p:721-730
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    References listed on IDEAS

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    Cited by:

    1. Espinola-Nadurille Mariana & Delgado Guadalupe, 2009. "Mental Disability and Discriminatory Practices: Effects of Social Representations of the Mexican Population," International Journal of Social Psychiatry, , vol. 55(3), pages 238-246, May.
    2. Hannigan, Ben & Coffey, Michael, 2011. "Where the wicked problems are: The case of mental health," Health Policy, Elsevier, vol. 101(3), pages 220-227, August.
    3. Ian Cummins, 2018. "The Impact of Austerity on Mental Health Service Provision: A UK Perspective," IJERPH, MDPI, vol. 15(6), pages 1-11, June.
    4. DeVerteuil, Geoffrey, 2015. "Conceptualizing violence for health and medical geography," Social Science & Medicine, Elsevier, vol. 133(C), pages 216-222.
    5. Pursch, Benita & Tate, Alexandra & Legido-Quigley, Helena & Howard, Natasha, 2020. "Health for all? A qualitative study of NGO support to migrants affected by structural violence in northern France," Social Science & Medicine, Elsevier, vol. 248(C).
    6. de Silva, M.W. Amarasiri & Albert, Steven M. & Jayasekara, J.M.K.B., 2017. "Structural violence and chronic kidney disease of unknown etiology in Sri Lanka," Social Science & Medicine, Elsevier, vol. 178(C), pages 184-195.
    7. Kelly, Brendan D., 2009. "Health services, psychiatry and citizenship in a globalizing world: A perspective from Ireland," Health Policy, Elsevier, vol. 93(1), pages 48-54, November.
    8. Kelly, Brendan D., 2006. "The power gap: Freedom, power and mental illness," Social Science & Medicine, Elsevier, vol. 63(8), pages 2118-2128, October.

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