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Psychosis and the City: A commentary on urban living and schizophrenia

Ananya Iyer

For exam points


The claim that “sheher tumhe paagal bana dega” (”the city will drive you mad”) is one that has been made cliché by its use casually and clinically, by grandmothers and researchers, alike. The origin of this statement and its validity to a layman seems apparent, it lies in the aesthetic of “hectic”, “crowded” cities as opposed to be “calm”, “serene” villages. In terms of psychology, there have been numerous studies that ascribed causality or aggravation of mental disorders, especially schizophrenia, to cities. However, the factors that contribute to this causality in some cases, prove to be generalized or warped. Since there are a large plethora of elements that can contribute to the onset of psychotic symptoms and schizophrenia, it is understandably difficult for the researcher to control all these elements in a study of schizophrenia, which may then affect that statistics and conclusions of the experiment.
Factors such as migration patterns, and splitting the demographic of the population in question are often not initially considered in a psychological study. A study conducted by Joanne Newbury et al. interviewed twins brought up in urban areas about their psychotic experiences until the age of 18, such as paranoia, intense suspicions, hallucinations, etc . It was found that 18-year-olds raised in urban areas were 67% more likely to have experienced psychotic episodes, than those raised in rural areas. The twins were part of a longer study, hence, then their reports of symptoms were mapped with due consideration of  “potential cofounders such as family socioeconomic status, family psychiatric and adolescent substance problems,” all of which can make an individual vulnerable to schizophrenia, regardless of his/her place of residence. This accounting for related factors brought down the objective risk of cities to 34%. There are certain aspects characteristic  of cities that may cause a rise in the risk of schizophrenia, such as higher rates of social isolation, high neighbor disorder and higher chance of violent crime victimization. If cities especially do cause schizophrenia, it is likely due to attributes like these. However, these are not eternal or standard to and across all urban regions, for example, many studies not that rates of crime against women are much higher in Delhi than they are in Chennai. Also, the chawl system of residence, employed by residents of low socioeconomic class, is said to have excellent social cohesion among residents. Hence, assigning causality to them would be a case of generalization, without producing a wholesome picture.
There are many other studies that theorize on the association between urban residence and psychosis. Many psychiatrists said that one of  the most recurring findings of schizophrenia research is “a higher prevalence of psychosis in cities.” A Danish study assigned causality to city living by demonstrating, in a population cohort of 1.89 million people, that the longer an individual lives in  a city, the higher is the risk of developing schizophrenia. The experiment used a model of 5-level degree of urbanization, and found that “the more years lived in higher the degree of urbanization, the greater the risk.” Individuals living in a higher degree of urbanization than 5 years earlier, showed a 1.40 fold increase in risk of schizophrenia, while individuals living in a lower degree of urbanization than 5 years earlier showed a 0.82 fold degree in risk, in a sort of “dose response.” However, the experimenters themselves agreed that the obtained number of 35% increased risk of schizophrenia in cities could be due to random chance and sample selection. Firstly, according to a study by Amir Sariaslan, there are genetic variants that simultaneously increase the chances of living in a deprived neighborhood (as found in cities) and increases chances of developing psychosis. Also, due to availability of advanced facilities, families with members who are troubled by mental disorders, as well as parents whose children exhibit early signs of psychosis shift to cities. Historically also, immigrants tend to gravitate towards cities, who are at higher risk of developing psychosis, potentially because lack of understanding of local language and culture increases one’s susceptibility to schizophrenia.
Thus, cities seem to attract people vulnerable to schizophrenia rather than cause it. This study also outlines well the difficulties tied with studying human personality disorders, Cities may possess traits that may tip the scales one way or another, however, it goes deeper than just saying “the city will drive you mad.”

Works referenced
https://www.scientificamerican.com/article/does-living-in-a-city-make-you-psychotic/

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