DIFFERENCES IN 'I'HE INCIDENCE OF SCHIZOPHRENIA "

AS SHOWN BY FIRST ADMISSIONS TO

MENTAL HOSPITALS IN THE. STATE OF
MICHIGAN

Thai: for I110 Dam of M. A.
MICHIGAN STATE UNIVERSITY
Henry Holstege
I958

THESIS

DIFFERLHCJS IE TAB INCIDSQUE OF SCJIZOrdfiEfiIA AS saown BY FIRST

ADEISSIONS TO mLNTnL AOSEITALS IN THE STATE OF LICHIGAN

by
Henry Holstege

AW ABSTRACT

Submitted to the College of Science and Arts
Michigan State University of Agriculture and
Applied Science in partial fulfillment of

the requirements for the degree of

MASTER OF ARTS

Department of Sociology and Anthropology

 

1958
Approved ;{;[Xfifiumpflincrlz/

y

HELRY HOLSTEGE ABSTRACT

In order to investigate the distribution of schiz0phrenia

in Michigan, first admission schiZOphrenics to all the State
Mental Hospitals in Michigan, the Veterans Administration Hos-
pital at Battle Creek, and the two largest private hospitals
in hichigan for the years 1949, 1950, and 1951 were studied.
These data were coded and punched on IBM cards and analyzed
by machine methods. The two major hypotheses stated were:
(1) there is a direct relationship between urbanity and the
rate of schizophrenia and (2) that the incidence of schizo—
phrenia is not random throughout the po ulation in regard to
marital status, nativity, sex, and age.

The state of michigan was divided into three separate
areas; Standard Metropolitan areas, counties contiguous to
Standard MetrOpolitan Areas, and counties not contiguous to
Standard LetrOpolitan Areas. It was assumed that these three
areas were in different stages of urbanization. The result of
the study showed that the Standard Metropolitan Areas had the
highest rate of schizophrenia, counties not contiguous to Stan-
dard Metropolitan Areas had the next highest rate of schizo-
phrenia, while counties contiguous to Standard Metropolitan
Areas had the lowest rate of schizophrenia. Therefore, it was
concluded that in Michigan there is no direct relationship

between urbanity per se and the rate of schizophrenia.

2

HENRY HOLSTEGE ABSTRACT

The rate of sch1z0phrenia was also determined for age,
sex, nativity, and marital status.

The population of the state of Michigan was grouped into
ten year age groupings. It was found that the rate of schizo-
phrenia was highest in the age group 25-54, and that there was
a real difference in the rates between all the age groupings.
The schiz0phrenic rate declined steadily after the 25-34 age
group, with every subsequent age group having a lower rate of
schizophrenia than the one preceding it.

The pOpulation of the state of Michigan was also separated
by sex and the rate of schizophrenia for each sex computed.
The difference in the rate of schiz0phrenia was found to be so
slight that it was not considered to be a real difference.

Separate schizOphrenic rates were also computed of the
population of Michigan on the basis of nativity. It was found
that there was a real difference in the foreign and native born
rates and that the foreign born had a lower rate of schizo-
phrenia than the native born.

Schizophrenic rates by marital status were obtained. The
results show that there is a real difference among the various
marital status groups and that the divorced had the highest

rate, followed by the separated, single, widowed, and married.

3

HARRY MQLSTLGE ABSTdaCT

In general, the findings of this study Should indicate
those groups in society which are particularly susceptible

to schizophrenia.

DIFEBREhCaS IR T43 INCIDEHCE CF SCHIZClfiREhIA AS SHOWN BY FIRST

ADMISSICES TO LENTnL HOSrlTAIS IN TnE STATE OF MICHIGAN

by

Henry Holstege

A’THESIS

Submitted to the College of Science and Arts
Michigan State University of Agriculture and
Applied Science in partial fulfillment of
the requirements for the degree of

MASTER OF ARTS

Department of Sociology and Anthropology

1958

ACKECJLEDGHHNTS

The author wishes to eXpress his appreciation to
Dr. J. Allan Beegle for his patient understanding and
valuable supervision which was responsible, to a great
extent, for this study. He also wishes to extend thanks
to Dr. Charles R. Hoffer, acting Head of the Department
of Sociology and Anthropology, and to all other members
of the department who, in ways too numerous to mention,
contributed to this project.

Sincere thanks and appreciation are extended to Gwen
Andrew, chief of the research section of the hichigan State
Department of Mental Health, and her staff, for valuable
and congenial assistance in obtaining the necessary data.
To Dr. George Tokuhata, research sociologist with the
hichigan State Department of Mental Health, go my heartfelt
thanks for the many hours spent in teaching the author the
demographic techniques necessary for the completion of this
study. To David Fitch, chief of the statistics section of
the Michigan State Department of Mental Health, the author
is indebted for help in the compilation of his data.

The author also wishes to express his gratitude and
general indebtedness to his wife, Lois Veltkamp Holstege,
without whose patience, and at times forbearance, this study

could not have been completed.

CHAPTER
I. I

II. RE

III. Ah

IV. SU

TABLE OF COHTENTS

IETRODUCTIOII o o o o o o 0

Nature and Description of Troblem.

Source of Data and Mode of

Summary. . . . . . . . .

VIEJ OF LITERATURE . . .

Urban-Rural Differentials.

marital Differentials. .
Age Differentials . . .
llativity Differentials .

Socio-Economic Class Differentials

mental Disorders in Urban Places

Sociological Theories of
of SchiZOphrenia . . .

ALYSIS OF DATA . . . . .
age. . . . . . . . . . .
Sex. . . . . . . . . . .
Nativity . . . . . . . .
Marital Status . . . . .
Urban—Rural areas. . . .

anaar aJD CONCLUSIONS. .

BlBLIOGRJLIIIY o o o o o o o o o o

APlEEDIX

Analysis.
the Etiology

VI.

VII.

LIST OF TABLSS

Crude Schizo hrenic Rate by Age in the State
of Lichigan 1949, 1950, and l951 . . . . .

Schizophrenic Rates by Sex in the State of
hichigan 1949, 1950, and l95l. . . . . . .

Schiz0phrenic Rates by Nativity in the State
Of I--iCIIiE§8.n 1949,1950, wa 1951 o o o o o

Schizopnrenic Rates by marital Status in the
State of hichigan 1949, 1950, and 1951 . .

Schizophrenic Rates by Area in the State of
hicnigan 1949, 1950, and 1951. . . . . . .

harital Status btandardized Rates by Area in
the State of hichigan 1949, 1950, and 1951

Sex Standardized Rates by Area in the State
of hicnigan 1949, 1950, and 1951 . . . . .

TAGE

49

55

55

57

65

67

68

CHAPTER I
INTRODUCTION

The purpose of this thesis is to study the distribution
of schiZOphrenia in Michigan, with emphasis upon urban—
rural incidence. The assumption is made that schizophrenia
is a disease entity. It is further assumed that the content
and etiology of schiz0phrenia are social psychological or
psychiatric in nature. Ihe assumption is also made, how-
ever, that this disease entity is greater in one group
than in another and that the differing characteristics of
these groups may be regarded as a sociological question.
Thus, it is assumed that social factors, if not the primary
cause of schizophrenia, are at least precipitating factors.
The major hypotheses may be stated as follows:

1. 1'he incidence of schizophrenia varies according

to urban and rural residence.

a. The rate of schizophrenia in Michigan will be
higher in Standard metropolitan Areas than
outside such areas.

b. The rate of schizophrenia in Michigan will be
higher in counties contiguous to Standard
hetropolitan Areas than in those counties
not contiguous to Standard Metropolitan Areas.

2. The incidence of schizophrenia is not random

throughout the population in regard to marital

status, nativity, sex, and age.
a. Married people in Michigan will have a lower
rate of schIZOphrenia than widowed, single,
or divorced persons.
b. Widowed persons will have a lower rate of
schizophrenia than divorced or single persons.
0. Single persons will have a lower rate of schizo-
phrenia than the divorced.
d. Eemales in Michigan will have a higher rate of
schizophrenia than males.
e. Foreign born persons will have a higher rate of
schiz0phrenia in Michigan than native born.
f. The schizophrenic rate in Michigan will vary in
a non-random pattern by ten year age break-downs.
This study is concerned with the incidence, not the
prevalence, of schiZOphrenia. first admission schiz0phrenics
to priVate, state, and federal (Veterans Administration)
hospitals in Michigan for the years 1949-1950-1951
will be used. These three years were chosen so that the
pOpulation base of the 1950 census can be used in comput-
ing rates. The prevalence rate, based on cases obtained
on one census date, is a function of annual incidence,
duration and intensity of illness, modes of onset, and quality

of treatment. Thus, chronic cases obtaining custodial

care in state hospitals are more likely to be included
in prevalence studies than cases obtaining acute, short—
term treatment. Thus, cases are not weighted equally.
Incidence could actually be edual in two groups with
markedly different prevalence. Just because there are
schizophrenics not hospitalized as found in mental
disease surveys does not mean that they will not be hos—
pitalized in the future, and if they are hospitalized

in the future then first admissions will be an adequate
criterion of the schizophrenic rate. The point is not how
many schizophrenics are about in the population at a
given period of time but how many never are institu-
tionalized.

"known," not "true"

Of course, by incidence is meant
incidence. Because of the excellent COOperation of the
private, state, and federal hospitals, and because of
the nature of the disease itself, this writer believes
that at most only a very small fraction of known schiz-
cphrenics could have escaped his net.

It would have been desirable to take into account
also the cases which are not hospitalized at all but
are cared for in their own homes. However, it seems

unlikely that the number could be large in proportion

to the hospitalized cases, or that they would be dis—

tributed in the population in a different ratio than
the hospitalized cases. Besides, schizophrenic patients
are so markedly mentally ill at the tihe of commitment
that they can hardly be cared for at home, even if the
members of the family desired to do so.1

Every effort is made by the hichigan State Depart-
ment of hental Health to differentiate between first
admissions and readmissions, and it is unlikely that
an appreciable number of readmissions could be classi-
fied as first admissions. The records of the private
and federal hOSpitals were personally scynned by the
writer to make certain that only first admissions would
be included in the study. The writer checked every entrance
record for the years 1949-50-51 and set aside the record
of every person that had evidence of a previous com-
mittal for schiz0phrenia at any institution at any time.
He accepted only the records of those persons who were
diagnosed as first admission schiZOphrenics. As stated
above, the state hospital records were sorted automatically
on the basis of first admission schizophrenia. hence any
error in tabulating at the hospital level, if any, must

have been slight.

 

1a a . a -4 .. .. .
hobert h. L. Fans and d. warren Uunham, mental Disorders
in Urban Areas, Chicago: University of Chicago Press,

T939.

Schizophrenia was especially chosen from the range
of diagnostic categories because it is considered by many
psychiatrists as one of those psychoses which has such
definite clinical symptoms that it will sooner or later
necessitate hospitalization.2 According to kline3
schiz0phrenia is an actual disease concept, and the
concept includes sympto;:ns which occur only and always
in schIZOphrenia. He also states that accessory symptoms
may vary and the subtypes may pass over into one
another without altering the essence of the disease.
Besides, apart from the disorders of advanced age, schizo-
phrenia is the most common disorder, it lasts longer,
has fewer recoveries, and is the most difficult for the
patient, his relatives, and his friends to understand.4
As long as a patient ultimately goes to the hospital
it does not matter very much from the statistical point

of view how long this step may be delayed.5

 

2%. fidegaard, "A Statistical Investigation of the
Incidence of Mental Disorder in Norway," Psychiatric
quarterly, July, 1946 pp. 382-585.

 

3Nathan Kline, Synopsis of Eugene Bleuler' s Dementia
Praecox or the Group of Uchizophrenics, hew York:
International Universities Press, 1952.

 

 

4Carney Landis and M. harjorie Bolles, Textbook gf
Abnormal Psychology, New York: macmillan Co. 1950.

 

5Christopher Tietze, P. Lemkau, and m. Cooper, "Schizo-
phrenia, Manic-Depressive Psychoses and Social-Economic Status,"
American Journal 3; Sociology, Vol. 47, September 1941, pp. 167-
175.

 

The study of the causes of schizophrenia has been
made from various points of view. Uauses have been sought
in heredity, germ diseases, glandular disorders, blood
chemistry, brain defects and other constitutional traits.
It is safe to state that no conclusive findings have
resulted from any of these approaches.6 The writer agrees
with those who state the hypothesis that the cause of
schiz0phrenia can be sought in the social experiences
of the individual. It may be that in the nature of these
experiences, and the type of social relations or the la0k
of social relations, the explanation lies.7 The writer
is aware of the work done on the hereditary and physical
aspects of schiZOphrenia. Such work on the blood chemistry
of schiz0phrenics as that of the Swedish biochemist btig
Akerfeldt, the work of the American neuropsycniatrist,
hicholas Bercel, and the class1cal study by hallman
on the genetics of schizophrenia are examples. lt should be
emphasized that the writer in no way wishes to minimize the
contribution of hereditary factors in the etiology of schizo-

phrenia, however unknown the specific nature of these hereditary

 

6Robert S. L. raris, "Cultural Isolation and the Schizo-
phrenic Tersonality," American Journal gf Sociology, oept.1954
p. 155.

7Ibid., p. 169.

 

 

7
forces may be. He does however agree with Nicholas Pastore
who wrote in the lsychological Bulletin of 19498 that no
knowledge to date of the physical aspects of schiz0phrenia
can preclude an environmental component. It soon becomes
apparent to any person who has read many case histories
of schiz0phrenics that there are both psychogenic and
sociogenic disturbances in the life history of persons
who later develop a "functional" mental disorder. The crucial
question is, however, whether these mental and social
distrubances are causal in the mental derangement or
only symptomatic of underlying constitutional tendencies.

The success that some hospitals seem to have with the
so-called "tranquilizers” does not mean that the etiOIOgy
of the disease is a physical one. It is quite possible
that a phenomenon may be induced socially and removed
organically and vice versa.9
The symptomatology of schizophrenia is varied but
certain symptoms appear to be somewhat common to all
forms. The textbooks of psychiatry generally include the
following symptom : apathy and indifference, lack of

contact with reality, disharmony between mood and thought,

 

8 . . .

Nicholas Pastore, "The Genetics of bch1z0phren1a: A
Special Review," rsychological Bulletin, Vol. 46, July, 1949,
pp. 285-302.

9

 

Faris and Dunham o . cit. . xiv.
9 ____ 7

stereotyped attitudes, ideas of reference, delusions,

illusions, hallucinations, impaired judgement, lack of

attention, generally intact memory, lack of insight,

defects of interest, seclusive makeup, hypochondriacal

notions, and negativism.lo The instructions followed

in the private, state, and federal (Veterans Administration)

hospitals in Michigan in classifying schizophrenics are

those recommended by the american Isychiatric Association.

No correction can be made for diagnostic disagreement in

the present study. 1'he probable existence of bias does

not preclude statistical analysis which, in fact,

sometimes uncovers other bias not previously suspected.

A slight margin of error in the basic data emphasizes,

the need for caution but does not prevent drawing proper

inferences and conclusions. (If it did, the efforts of

statisticians in many areas would be futile indeed, even

those of the physicists). ll
Schiz0phrenia was not broken down into its several

subtypes, namely, simple, hebephrenic, catatonic, and paranoid.

 

lOFaris and Uunham, 22. cit., p. 58.

ll . . 1 . w. . .
q Bengamin malzoerg and Alfred Lee, migration and hental
Disease, New York: Social Science Research Council, 1956.

 

The belief is held among the staffs of many hospitals
that the difficulty in accurately distinguishing the
subtypes of schiZOphrenia makes it not worth attempting
since it is practically impossible to find agreement
as to the characteristics of the various types. In
fact, not all institutions even attempt to classify
this category of mental disorder into subtypes.12
SOURCE OF DATA kHD MODh OF ANALYSIS

The data for this study consist of 3,881 first
admission schizophrenics to the two largest private hospitals
in Michigan, and The Reuropsychiatric Institute at Ann
Arbor, l'he Veterans Administration hospital at Fort Custer,
and all the btate mental hospitals including Wayne
Uounty ueneral, now called Eloise.
The data were collected by county and then the
counties grouped into the following three groups: (1) the
sparsely populated northern part of the state, that is,
north of the so—called Bay Uity-huskegon line. This
group of counties is characterized by a mixed economic
base of resort trade, mining, fishing, marginal forestry
and farming; (2) the Standard Metropolitan Areas con-
sisting of the urban—industrial counties of Southern

Michigan; and (5) the Southern agricultural counties contiguous

 

12Faris and Dunnam, gp. cit., p. 82.

10
to the btandard hetropolitan Areas.
Ten year age break-downs have been made as follows:
15—24
25-34
55-44
45-54
55-64
654
The above age break down is used because it is the
one most readily available from the State mental hospitals

13

and is similar to the age break down used by fidegaard,

i4 9 in their studies. Schizophrenia

Dayton, and halzbergi
below the age of fifteen is numerically insignificant

and hence is not included. The ten year age break downs
stopped at the age 65 because of the paucity of cases

at this and higher age levels.

Comparisons will be based on age standardized rates;
crude rates will not be used as it is the aim of this study
to control as many as possible of the factors known to be
important in the incidence of schizophrenia. The limitations
of hospital and census data are such that only nativity, sex,

age, and marital status can be controlled. These, however,

are among the most important factors affecting comparisons

 

l4Benjamin Malzberg, "Social and Biological Aspects 2f
Mental Disease," Utica New York: State Hospital Press, 1940.

15Neil A. Dayton, New Facts 22 Mental Disorders, Spring-
field, Ill: Charles C. Thomas Co. 1949.

 

 

 

 

ll

of rates of schizophrenia in different pOpulations.l6
In computing each rate the numerator has been the

number of first admissions for the area under discussion

to all hospitals for mental disease, and the denominator

l7 Dy applying

has been the corresponding base population.
the specific rates of first admissions of the various
areas to a common standard, namely, the population of
the State of Michigan age 15 years and over, as shown
by the Federal census of april 1, 1950 we get the stan-

dardized rate.18

 

16

l7Admittedly as Jaffe has pointed out, this produces
somewhat of an unavoidable bias because the proper denom-
inator for rates of first admission is not the total pop-
ulation but the pOpulation that has not previously been
admitted as schizophrenics to hospitals for mental disease.
See U. S. Bureau of the Uensus, Handbook 2; Statistical
hethods for Demographers, A. J. Jaffe, l951, p. 50.)

18The statistical technique of standardization used in
this study is the Direct Standardization which is expressed
in the following mathematical formula devised by Dr.
George Tokuhata of the michigan Department of mental

Malzberg and Lee, 92, cit.

 

 

 

 

 

 

Health. Dxnx 1,000 Pyn H
rxn Dxn fyn
Standardized Rate 1,000 1,000 Pxn 1,000
Eyn Pyn

Py . . . . Number of peOple in nth age group of stan-
dard population.

12

The writer is congnizant that the data are not close
enough to the phenomena of schiz0phrenia to establish
any clear cut case for the operation of definite causa-
tive faCtors. The method employed only enables one to
view the data quantitatively in the community setting
in which it occured. However, the ecological material
and the relationship found between schiZOphrenia does
enable the research worker to raise significant questions.
As is well known in the public health field, the epi-
demiological study of a physical disease has often been

the forerunner of control and eventual prevention of that

 

8 .
continued

Pxn . . . . Number of people in nth age group of sample
population.
-Dxn . . . . Number of schizophrenics in nth age group of
sample pOpulation.
Pyn . . . Total number of people in standard population.

n . . . . . Number of age groups in a pOpulation.

The 1950 pOpulation of hichigan is used as the stan-
dard pOpulation. The actual operation of this method involves
two processes: first, to compute the age specific schizophrenic
rates for a sample population and, second to apply then
to the standard pOpulation to obtain the number of hypo-
thetical schizophrenics in the standard pOpulation. This
implies that if a sample population being studied had the
same age composition as the standard population, while
retaining its observed age specific rates, the summarized
figures Istandardized rate) would represent the frequency
with whicn schizophrenia would have occurred.

l3
l9

disease. Not many would quarrel with the general pro-
position that the social setting in which men live and the
things that they believe are correlated with many of the
symptoms of mental pathology. Even a superficial review

of hospital, police, and census reports shows that human
groups differ widely in their observed rates of mental

and personality disorders. Ihere is far less agreement

about what these variations mean. The question of why and

how mental disorders are related to cultural pressures,
therefore, requires intensive investigation. Even a

partial answer might lead to insights that could result

in improvements of presently inadequate methods of pre-
vention, treatment, and cure. Mental disorders are definitely
not distributed at random throughout the human race. If

more can be learned about the precise nature of these pop-
ulation differences, plausible and experimentally testable
hypotheses are likely to emerge which can put scientists

on the trail of new knowledge in a field now enveloped in

mystery and obscurity.2O

 

19H. Warren Dunham, "Some Persistent Problems in the Epid-
demiology of mental Disorders," American Journal 2: fsychiatry,

20Joseph W. Eaton and Robert J. Weil, "The Mental Health
of the dutterites," in Arnold M. Rose, Mental Health and Mental
Disorder: {fl Sociological Approach, New York: W. W. Norton Co.,
19559 PP. 224-225.

 

 

 

 

14

In the early years of this century the great psychia-

trist, Adolf heyer, then associated with the mental hospitals
of New York State, directed attention to the influence of
social conditions in generating mental disorders. He found
that some counties in the state had much higher rates of
admissions to mental hospitals than others, and he attri-
buted the differences to variations in social conditions.

The question to be answered, of course, is what are the social
conditions that produce a high rate of mental disease.21
This type of study has been used for the following

purposes:

1. To use distribution patterns of schizophrenia
as certain kinds of evidence for a study of a
.community itself;

2. to utilize such studies as an aid in solving
problems that administrations face in the handl-
ing of public health issues as they may be related
to mental disease;

3. to develop certain hypotheses concerning the role
of social factors in the development of various
kinds of mental disorders;

4. and finally to use such studies as a basis for the

development of preventive programs.

 

21Ernest M. Gruenberg, "The Epidemiology of Mental
Disease," Scientific American, (march 1954) pp. 38—42.

22H. W. hunham, op. cit., pp. 567-575.

 

15

SULhARY

It is assumed that a statistical analysis of schizo-
phrenic data is meaningful. In many instances certain
information is lacking. Some cases of schizophrenia
doubtless have been concealed. On the other hand,as previously
stated, it is not felt that these factors will drastically
affect the conclusions reached in the present study.

Various factors which may contribute to schiZOphrenia
will be iSOlated and the schiz0phrenic rate for each
isolated group will be determined. lndices such as sex,
age, marital status, nativity, and eCOlogical area
will be utilized to indicate the relative effects of
the various factors on the schiz0phrenic rate.

It is recognized that no absolute etiology can
result from this study. The level of abstraction is above
that of the indiVidual case history level. If any complete
etiology is to be developed, the individual case must
be analyzed. However, an indication of the type of condi—
tions 'hich foster schizophrenic tendencies will be of
great aid to the psychologist wno attempts to analyze
individual cases.

This study will contribute to our understanding
of the subject in at least three ways. First, it will

indicate the extent of the phenomenon in Michigan. Second,

16
it will indicate those groups in society which are parti-
cularly susceptible to schiz0phrenia. Third, by utiliz-
ing the data on several Variables, those kinds of condi-
tions which, whether primary or not in the promotion
of schizophrenia, are at least underlying predisposing

23

and precipitating factors, may be inferred.

23Wyidick W. Schroeder, "Suicide Differentials in
Michigan," Unpublished m.A. Thesis, Michigan State University,
1951.

CHAPTER II 17

REVIEW OF LITERATURE

The majority of the studies concerning the distribu—
tion of mental disease in the United States have been con-
ducted in urban communities. Almost all of the studies
have been conducted in cities, counties, and health dis—
tricts within cities, and nearly all of these have been
in only one type of city, the commercial-industrial.

Not all studies of mental disorder have standardized
or adjusted their rates for such significant variables as
age and sex. Some psychiatric surveys offer only a gen-
eral description of findings, presenting total numbers,
percentages, or rates in terms of some specified popu-
lation base, as if these data "speak for themselves".
Whether or not rate differentials are "true" differences,
and are not due to the probability of chance, cannot
be determined from a mere description of the research
findings. Furthermore, many studies have omitted cases
obtaining private treatment, thus running a risk of
serious bias in the results. The conditions that
influence patients seeking privately rather than
publicly supported psychiatric care and treatment can
reasonably be expected to vary considerably in differ-

ent locales within a society as complex as the United

18

States.1

Hence to avoid some of the sources of error listed
above, this study will attempt to take into account not only
areas within large commercial-industrial cities but will
also take into account areas outside of urban areas. This
study will also state explicitly how the mental disease
rates were obtained and the rates will be standardized for
the important variables of age, sex, marital status, and
nativity.

Industrialization and consequent urbanization have
often been held as conditions related to an increase
in the rate of mental disease.2 As early as 1896 Franklin
H. Giddings wrote that,

The isolated farmer and his family have begun to
be affected by the strain of modern life in a deplorable
way. They are no longer ignorant of the luxuries of the
towns, and a simple manner of life no longer satisfies
them. The home must be remodeled and refurnished, the
table must be varied; clothing must be in style; and
the horses, carriages and harnesses must be more costly.
The impossibility of maintaining this rate of expense
under existing agricultural conditions embitters life 3
and finally in many cases destroys the mental balance.

Giddings however did not present any standardized

statistics that showed just what the rural rates of

mental disease were as compared with the urban rate.

 

1E. Gartly Jaco, "Social Factors in Mental Disorders
in Texas," Social Problems, Vol. 1, April 1957, pp. 322—328.

2

 

Ibido , pp. 322-3280

3Franklin H. Giddings, Principles pf Sociology, (New
York: Macmillan 00., 1896) p. 349.

 

 

19

The question of urban-rural mental disease differentials
to this day is not clear. There are very few compre-
hensive studies of urban-rural mental disease differ-
entials that include patients in priv te hospitals and
that include standardized data. 0f the few that meet such
specifications, there is not agreement as to the nature
of the differences, as will be explained below.

The first authoritative statistical analysis of
the environmental distribution of patients with mental

disease may be found in the Bulletin pp the Insane

 

 

and Feebleminded ip Institutions, 1910, published by
the Bureau of the Census. In this report, communities
with a population of less than 2,500 were considered
rural; those with a pOpulation of 2,500 or more were
regarded as urban. 0n the basis of total admissions

to hOSpitals for the insane in the United States in
1910, it was shown that the rural rate was 41.4 per
100,000 corresponding pOpulation, compared with a rate
of 86.0 in urban communities.4 These rates included

all mental diseases, among them schiZOphrenia. It must

also be borne in mind that use of the simplified

 

4Benjamin Malzberg, Social and Biological Aspects of
mental Disease, (Utica: New York State Hospital Bress, I940).

20
definition leaves much to be desired, as the Census Bureau
recognized in 1950 in changing the definition of urban
to a more comprehensive definition.

These general results were confirmed by the next
census of the insane by the Bureau of the Census, which
included data for 1922. An analysis of the place of
residence of first admissions in 1922 showed that the
urban population had a mental disease rate of 78.8 per
100,000 population compared with a rate of 41.1 for
the rural population.5

In commenting upon the results of the 1922 census
of the insane, the report stated:

In general, these statistics indicate that there
is relatively more insanity in cities than in county
districts and in large cities than in small cities,
although to some extent the differences may be accounted
for by differences between city and county as regards
the tendency to place cases of insanity under institu-
tional care. The figures may also be affected in some
degree by the agcident of location of the hospitals
for the insane.

Studies made in New York State in the 1930's show
that the prOportion of admissions from a county in which

a hospital is located is always greater than from other

counties and that the proportion decreases with the

 

5Malzberg, op. cit., p. 83.

6Bulletin on the Insane and Feebleminded in Institu-
tions, lublished by the Bureau of the Uensus, 1923.

 

 

 

21
distance from the hospitals. Malzberg claims that the
influence of this factor upon the comparison between
city and country, however, would not everywhere be
uniform. He goes on to say that probably it does not
go very far toward explaining the higher ratio of admissions
from the urban population. Malzberg claims that it is
undoubtedly true that the proximity of a hospital tends
to affect the admission rate, but with the continued
growth of hospital accomodations, the greater ease of
transportation, and the establishment of hospital
districts, the force of such environmental selection
is weakened.7 Today, it might be concluded that modern
transportation and communication is such that dis—
tance from a mental hospital is rather meaningless
in the determination of rates. In a study conducted in
Texas in 1958, Jaco found an insignificant correlation
between the incidence rates and number of psychiatric
beds for the sub-regions. Consequently, he claims that
the pattern of distribution of schizophrenic rates
cannot be adequately explained by the availability

of psychiatric facilities in different parts of the

 

7Mala-berg, pp. cit., p. 84.

22

state.8

In 1930 in the state of New York the average annual
rate of first admissions with dementia praecox was 19.0
per 100,000 with a minimum of 9.8 in rural areas and
a maximum of 22.6 in New York City. A partial explanation,
of the variations, according to Malzberg undoubtedly re-
sides in the greater ease with which certain types of
mental patients may be cared for at home in rural
sections and in some smaller cities.9 However, he presents
this statement as a fact, but gives no empirical proof
to support his statement. One could just as readily state
that mental patients can escape detection and hospitali-
zation better by residing in a big city slum area, than
by living in a rural community where everyone is instantly
aware of any unusual activity on the part of an individual.

many authors have stated various reasons why they
believe that the urban mental disease rate, and in
particular the schiZOphrenic rate, is higher in the urban
areas than in the rural areas.

Meyerson, writing in the American Journal of Psy-

 

chiatry, states that mental disorders appear to be more

 

8Gartly E. Jaco, "Incidence of Psychoses in Texas
1952-1953," Texas State Journal of Medicine, February, 1957,
pp. 86-910

9

 

Malzberg, oo. cit., p. 85.

__-L.

23
prevelant where the population is mobile and heterogeneous
than where it is stable and homogeneous, and where life-
conditions are complex and precarious rather than simple
and secure. Hence, because the urban areas are composed
of a mobile, heterogeneous, and complex society the

,. . 10
mental disease rate is higher.

Lantz, in an article entitled "Population Density
and lsychiatric Diagnosis," states that the mental
disease rate is always higher in densely settled regions
than in sparsely settled regions and hence the rural
. — .5 . . . ._ 11
rate is lower than that found in urban areas.

In his discussion of differences between rural
and urban mental disease rates, Lemert argues that there
can be little doubt but that the greater familism of
rural peOple and the tendency of smaller communities

12

to handle problems informally is involved here.

There may be Some validity for this statement where mild

 

loAbraham Meyerson, "Review of Mental Disorders in
Urban Areas", American Journal 2f rsychiatry, Vol. 96,
march, 1940, pp. 995—997.

llHerman R. Lantz, "ropulation Density and Psychi-
atric Diagnosis," Sociology and Social flesearch, Vol. 97,
Janua y-February, 1955, pp. 522-526.

12 - 1‘ ‘ " o 1 F‘ ' --.
EdWin m. Lemert, "Legal Vommitment and SOCial Control,"
Sociology and Social Research, hay-June 1946.

 

 

 

24
forms of senile psycnoses are involved. However, it is
necessary to reiterate the statement of Dunham and Faris13
that schizophrenic patients are so markedly mentally ill
at the time of commitment that they can hardly be cared
for at home, even if the members of the family desired to
do so. To state that the greater familism of rural people
and the tendency of smaller communities to handle problems
informally explains the differences in rural-urban mental
disease rates, if there is a difference, is in the Opinion
of the writer an hypothesis for which there is no proof.
Besides there is a tremendous difference in saying that
the greater familism of rural areas might make a slight
reduction in the schiz0phrenic rate than stating, as
Demert does, that the greater familism of rural areas
explains the difference. The former position might be
tenuously held while the latter can hardly be seriously
defended.

In the journal, Social froblems, Burgess writes

 

that the growth of cities has resulted in a number of
changes in our institutions and social relations which
would seem to exert an adverse influence on the mental
health of the population, and hence produce a higher
rate of mental disease. He claims that the effects

of urbanization can be most readily perceived by con-

trasting life in the city with the rural neighborhood.

 

13Faris and Dunham, 22. cit.

25
The change has been from low to high population density,
from simple to complex and complicated social relations,
from face-to-face intimacy to impersonal contacts,
from primary to secondary social control, from a family
centered economy to employment often in a gigantic
industry, from a stable to an unstable home life, from
the predominance of sacred to the growth of secular
values. All these and other changes appear to have
increased the stress and strain of adjustments in the
city as compared with rural living. Burgess further
says that certain aspects of urbanization, specifically,
the greater complexity of living, the increasing
instability of the family, the decline of the neighbor-
hood, the growth of impersonal relations, loneliness and
isolation, the slums of the city, the increasing tempo
of city life, and the growing intensity of the struggle
for success and the maximization of stimulus, seem to be
related to the problems of individual adjustment and
to a higher urban mental disease rate.14 This point of view
is in essential agreement with Wirth's "Urbanism as a Way
Life" written in 1958. Neither Wirth, nor Burgess
present statistics showing differences in the urban-rural

mental disease rate. They both seem to assume a priori

 

14Ernest W. Burgess, "Social Eactors in the Etiology
and Irevention of Mental Disorders," Social rroblems,
Vol. 1, 1953-54, pp. 53-56.

 

26
that these differences do exist between the rural-urban
areas and that these differences of necessity do cause
a higher mental disease rate in the urban areas.

faris and Dunham, on the other hand, state that a
relationship between urbanism and social disorganization
and mental disease has long been recognized and demon-
strated. fhey say that crude rural-urban comparisons
of rates of dependency, crime, divorce and desertion,
suicide, vice, and mental disease have shown these
problems to be more severe in the cities, and espe—
cially in the large rapidly expanding industrial cities.15
However, they produce no statistics from valid research
to prove their contentions, at least in regard to
mental disease. At best they should underline "crude
rates."

There have been a few studies that have produced
different results. Lemert found that the urbanized in-
dustrial counties in hichigan had lower rates of

16

schizophrenia than many non-urbanized counties.

Schroeder and Beegle found that the farmers in michigan

 

I?

lbliobert u. L. Paris and H. warren Dunham, Mental
Disorders in Urban Areas, (Chicago: University of Chicago
Bress, 193§T.
16g . , ,q av_ w __, , a.
h. m. Lemert, "AA haploratory study of mental Uls-
orders in a Rural rroblem Area," Aural bociology, Vol. 15,
October, l948, pp. 548-554.

 

 

 

27
had higher rates of suicide than peOple with city
occupations.l7

nouser and Beegle have suggested that the nigh
suicide rate of rural males is derived from the frus-
tration and personal disorganization which have resulted
from the conflict in the rural and urban values. They
offer the hypothesis that the frustration and personal
disorganization which have resulted from the conflict in
the rural and urban values have been most among farmers
where the rural way of life had been most satisfying,
and consequently the most idealized.l8 However, as
Earner states, suicide might be avoided by a psychosis
or a neurosis.19 If this is true than the above state—
ment of Houser and Beegle would be just as aprOpos to
schizophrenia as to suicide and hence one would expect

a high rate of rural schiZOphrenia.

 

17Widick W. Schroeder and J. Allan Beegle "Suicide:
An Instance of high Kural Rates," Rural Sociology,
March 1953, pp. 45-52.

18Schroeder and Beegle, gp. cit., pp. 45-52.

19William L. Warner, "The Society, The Individual and
His Mental Disorders," AmeriCan Journal g£_Psychiatry,
V01. 97, 1937, PP. 275-284-

 

 

28

20 conclude

Mangus and Seeley in their study in Ohio
that personality disorders occur as often among farm
people as they do among non-farm residents, and per-
haps more often. They claim that from the point of
view of mental health, farm residence is probably
an advantage for younger children, but that the
advantage is lost with increasing age. They argue that
this might be due in part to migration of disproportionately
large numbers of better adjusted youths away from farms
and from farm occupations.
Loomis and Beegle in their book, Rural Sociology:

The Strategy 2f_§hgggg, state that the incidence of mental

 

ailment in rural areas is equal to or greater than that
of urban areas, which is in essential agreement with the
findings of Lemert.

Lemert,22 in contrast to many of the studies done on
rural-urban distribution, found relatively high rates in
the predominately rural, sparsely populated Upper Tenni-

sula of michigan. This finding contradicts Lantz's contention

 

20A. R. Hangus and John R. Seely, "Mental Health Needs
in a Rural and Semi-Rural Area of Ohio," in Arnold M. Rose,

 

 

Mental Health and Rental Disorder: A Sciological Approach, .
New York, (N. w. Horton & Co., 19557 Pp. 205-214.
21

Charles P. boomis and J. Allan Beegle, Rural Sociology:
The Strategy 3; Change, (Englewood Cliffs, N. J., Prentice-
Hall, Inc., 1957 p. 351.

22Edwin H. Lemert, "An Exploratory Study of Mental Uis-
orders in a mural froblem Area,"Rural bociology, Vol. l3,
October, 1948, pp. 548—554.

 

 

29
that the mental disease rate is always higher in densely
settled regions than in sparsely settled regions. These
non-industrial, non-urbanized counties had higher rates
than the Standard hetropolitan areas of the lower penn-
isula. However, this writer believes that there are
inaccuracies in Lemert's data that would change his
results. hemert writes that he did not include the
first admissions to the Veterans Administration hos-
pitals because he included these men when they were admitted
to the state hospitals. He forgot to add, however, that
Veterans Administration patients are rarely admitted
by the state authorities to state hospitals. Hence
several hundred patients were omitted from Lemert's
study and almost all of these, according to the
writer's statistics, came from Standard metropoli-
tan Areas in the southern part of the state.

Hence one can readily observe that the information
on rural-urban mental disease differences are contra-
dictory and much more research in this particular
area is needed. One can state from the information at
hand that at this time no sweeping generalizations concern—

ing differences can be made.

30
MARITAL DIFFERENTIALS

Several studies have been done on the distribution
of mental disease among the various marital groups; that
is, differentials between married, separated, divorced,
single, and widowed.

Jaco23 found in Texas that the rates for both sexes
were highest for the divorced, followed in order by the
separated, single, widowed, and married.

halzberg24 in his study of New York found that
the married had the minimum standardized schizophrenic
rate of 15.4, and the single had the maximum rate of
55.4, the latter being in excess at the ratio of 5.6 to
1. The divorced in his study had the high rate of 51.5,
which did not differ significantly from that of the
single. He found that the widowed population had an
intermediate rate.

In his study on mental disease and schizophrenia
in particular, Dayton25 found that the married have the
least chance of developing mental disorders of any
marital group. The widowed, the single and the divorced,
in increasing order, show a higher incidence of

mental disorder.

 

23Gartly E. Jaco, "Incidence of Psychoses in Texas
1952—1955," Texas State Journal pf medicine, February, 1957,
pp. 86-910

24Malzberg, 2p, cit.
25Neil A. Dayton, New Facts 2Q Mental Disorders,
(Springfield, Ill. C. C. Thomas 00.,419407.

 

 

31

The evidence from various sources seems clear
that the married pOpulation had much lower rates of
schizophrenia than any of the other marital groups.

Jaco believes that the fact that the divorced,
separated, single, and widowed had higher rates than
married persons lends support to Durkheim's concept of
anomie. In psychiatric terms, the psychotic reaction
to anomie can be described essentially as a loss or
confusion of personal identity. EJuch a condition can
feasibly, according to Jaco, be regarded as related
to mental aberration as much as to such other symptoms
of disorganization as suicide.26 The inference is that
married peOple would not fall into a state of anomie
as rapidly as the other marital groups.

I-'.;owrer,27 on the other hand, writes that the fact
that the rate for single persons is higher than that
for the married does not necessarily mean tlat marriage
tends to prevent mental disease. It may mean only that
less stable personalities tend to remain unmarried.

He claims that this interpretation seems all the more

plausible when one observes that the divorced have the

 

26Gartly E. Jaco, "Social Factors in Mental Disorders
in Texas," Social lroblems, April, 1957, Pp. 522-528.

27Ernest Mowrer, Disorganization—Tersonal and Social,
(New York: J. D. bippincott Co. 19427.

32
highest rate, suggesting that when the unstable person—
alities marry, they tend to get divorces, personality
disorganization being an important factor in domestic
discord.

The widows and widowers in all the studies had
a rate of schizophrenia between that found for the married
and the single and divorced. halzberg28 thought it a
matter of significance that widows and widowers had
higher rates of mental diseases than the married.
Since, according to malzberg, both groups had similar
mental characteristics to begin with, the differences
in rates of mental disease must be due to the sorrows and
tribulations consequent upon the death of a closely
related individual, and to the subsequent difficulties
of economic readjustment on the part of the widows.

29

Jaco writes that widows and widowers have higher
rates of schiZOphrenia because the husband or wife is
no longer there to act as the buffer between the
incipient mental condition and the prying eyes of a

curious and unfeeling world. he also thinks that the

psychoses might be precipitated by the shock of the

 

28

halzberg, 2p. cit.
29‘, ‘ :I "(V '- "n‘ ' 7’ .l "‘
bartly h. Jaco, ooc1al cactors in mental Disorders
in Texas," Social rroolems, april, 1357, pp. 322-945.

 

33

death of a loved one. He also adds that often the necessity
of living alone, the struggle of depending on oneself
exclusively, and the many economic difficulties constituted
too great a load to permit the preservation of mental
balance. He states that in some cases, the strain
imposed upon the spouse by the mental disorder in
the patient was actually the cause of the widowhood.
host of the studies found that the divorced had
'the highest rate of schizophrenia. It is possible that
certain of these patients carried an incipient mental
disorder into marriage and that the developing mental
symptoms were the basic cause of the divorce. A second
possibility involves persons who have been on the bor—
derline of mental disease but who have been protected
for years by the Spouse and when the spouse leaves
with a divorce, the mental disease is brought out
into the open. In a third group one might possibly
find that the emotional disturbances incident to the
divorce proceedings precipitated the psychoses. A
fourth possibility is that the train of events follow—
ing the divorce acted as a causative factor. Probably
the majority of cases are combinations of the four

situations.

34
While it is possible that a pre-psycnotic person
may also be one who is likely to get divorced or remain
single, it is equally possible that the marital situation
may precipitate a predisposed individual into mental
stress or conflict. This is a "chicken—or—the-egg”
question. There is no need to seek a single cause,
nor are multiple etiological answers necessarily
invalid.30
In most of the studies on the distribution of schizo—
phrenia the single persons had the second highest rate
with only the divorced having a higher rate. However those
who remain single throughout life have undoubtedly gone
through a certain selective process, and hence a differ-
ent rate is to be anticipated. One could hardly expect the
single and married mental disease rates to be similar.

AGE DIFFERBETIALS

 

In the comprehensive studies done on the distribution

of schiszhrenia, age was found to be a very important

31

characteristic. Among those less than 15 years of

 

DOGartly E. Jaco, "Social Factors in Mental Disorders
in Texas," Social Problems, April, 1957, pp. 322-328.

 

51See especially Neil L. Dayton, New Facts 2n Mental
Disorders, (Springfield, Ill. C. C. Thomas 00., 19445
Benjamin Malzberg, Social and Biological Aspects of hental
Disease, (Utica, N. Y: State Hospital Press, 194077

 

 

 

35
age schiz0phrenia is almost non-existent. Hence very few
studies report on the incidence of schiZOphrenia below
the age of 15. In the interval 15 to 24 Years of age,
schizophrenia was the leading mental disease. It contin-
ued to grow in frequency in the next higher age group 25-34.
After 35 years of age the rate of schizOphrenia declines in
frequency until the rate becomes very low after the 60th
year and almost becomes non-existent in the older age
groups of 604. In this particular area, age distribution
of schiz0phrenia, the research reports have been consis-
tent with one another and have reported the distribution
as stated above.32 Hence we see that age is an important
variable and any studies that do not standardize for age
differences can be very misleading.

NATIVITY DIFFERENTIALS
Several writers have found that the foreign born
population has a higher ratio of schiZOphrenia than the

33

native born. Malzberg, in his study in New York,

 

32See especially Neil L. Dayton, New Facts 22 Mental
Disorders, (Springfield, 111: U. C. Thomas 00. 1940
Benjamin Malzberg, Social and Biological Aspects of Mental
Disease, (Utica, N. Y.: State Hospital iress, 19457.

33Malzberg, pp. cit.

36
found that the native born has a standardized rate
of 22.2 per 100,000 population, and the foreign born
had a rate of 32.8. Dayton also found that the foreign
born has a higher rate of schiZOphrenia than the native
born. Both of these studies, however, were made more than
a decade ago and halzberg's almost twenty years ago.
nalzberg and Dayton both used pre-World War II data.
Whether or not we have been having a different type
of immigrant since World War II, who has a different type
of social structure, and consequently a different mental
disease rate, remains to be seen.
SOCIO-ECONOMIC CLASS DIFFERENTIALS

There has been a lot of research in recent years on
the distribution of schizophrenia by social class and
occupation. The most prolific writers in this area
have been Hollingshead and Hedlich who have been doing
their research in New Haven, Conn.

First, Hollingshead and his group of sociologists
delineated the class structure of New Haven; second they
interviewed, as controls, a five percent sample to the com-
munity's population; third the team took a census of
psychiatric patients; fourth, both the sample popu-

lation and the psychiatric patients were classified

37
into five socio-economic strata.34 To delineate the class
structure hollingshead and his fellow sociologists devised
a classification of five social levels, based on three
factors: education, occupation, and the person's place
of residence. a patient in Social Level one, for example
is a person with a college education, holds a top pro-
fessional or executive job, and lives in a well—to-do
residential area. The classification drOps prOportionally
through five groupings so that a patient in Social Level
five is a person with an elementary (or less) education,
is a semi-skilled or unskilled worker, and lives in a
poor section of the community.35

The association between social class and prevalence
of schizophrenia in the community's population was
measured by an Index of Prevalence so constructed
that if the number of patients in a class was proportionate
to the total population of the class in the community
the index would be 100. Instead of an equal distri-

bution of patients by class the following pattern was

found. In class I the index figure was 23, in class II 33,

 

34August B. Hollingshead and Frederick C. Redlich,
"Social Stratification and Schizophrenia," American
Sociological deview, Vol. 19, pp. 302-306.

55"Scniz0phrenia and the Class Structure," Science
Digest, August, 1952, p. 32.

38

in class III 48, in class IV 84, and in class V 246.56
The proportion of schizophrenics is 11 times greater among
patients in Social Level five than among patients in Social
Level I.

One can conclude that Hollingshead and Redlich found
that there are definite connections between particular
types of social environments in which people live,
as measured by their social class rating, and the
emergence of particular kinds of psychiatric disorders,
as measured by psychiatric diagnosis. They found a very
significant inverse relationship between social class
and schizophrenia.37

Hollingshead and Redlich disproved the hypothesis that
the lower social classes have a higher rate of schizophrenia
because of a drift to the lower classes by members
of the higher classes when they become psychotic,
by showing that 91% of the patients in their study were
in the same class as their parental families; further

that there is a much greater mobility upward than downward

 

36August B. Hollingshead and Frederick C. Redlich,
"Schizophrenia and Social Structure," American Journal pf
.Esychiatry, Vol. 110, pp. 695-701.

 

37August B. Hollingshead and Frederick C. Redlich,
"Social Stratification and lsychiatric Disorders," American
§§ociologica1 Review, Vol. 18, pp. 163-169.

39
within the small minority who do change their class
positions. This study clearly shows that few schizo-
phrenics move downward in class level.38 This study also
showed that the lower the class, the greater the tendency
for schiz0phrenic patients to reach the attention of
a psychiatrist through the instrumentality of the
law.39

Tietze, Lemkau, and Cooper in their study of mental
disease and socio-economic status also found that there
is relatively more schizophrenia in the "lower" social-
economic groups. They found that among workers and
farmers schizophrenia is much more common than manic—I
depressive psychosis, whereas in the business and the
professional group more manic-depressive than schizophrenics
are found.40
In a study of 12,168 male first admissions
from Chicago to public and private mental hospitals,

Clark shows that the age adjusted commitment rates by

 

38August B. Hollingshead and Frederick C. Redlich,
"SchiZOphrenia and Social Structure," American Journal 2;
Bsyghiatry, No. 110, pp. 695-701.

 

391bid.

4OChristOp-her Tietze, Paul Lemkau, and harcia Cooper,
”Schiz0phrenia, Manic-Depressive Bsychoses and Docial-Economic
Status," American Journal pf Sociology, Vol. 48, pp. 167-175.

 

 

4o
occupational groups are negatively correlated with the
factors of occupational income and occupational prestige.

He found that there is a real association between high
income and high prestige, on one hand, and low psychosis
rates on the other hand. The findings of Clark, as those
of HOllingshead, medlich, Tietze, Lemkau, and COOper,
indicate that the occupational—psychoses rates fall
into a pattern with an inverse relationship between
psychoses rates and the factors of occupational income
and occupational prestige.41
Jaffe and Sharas in a study done in 1939 subdivided
the population into two economic classes. The one
"class," the term they used, consisted of single-home
and two-flat buildings, with an equivalent median rental
under $50 per month. The other "class" consisted of
single-home and two-flat buildings with an equivalent
median rental over $50 per month. They found that the
poorer person's chance of being admitted to a hospital
for schiZOphrenia was greater than that for the higher

class.42

 

41Robert Clark, "Psychoses, Income and Occupational
Prestige," American Journal 2; Sociology, Vol. 54, 1954,
pp. 433—440.

42A. J. Jaffe and E. Shanas, "Economic Differentials
in.the Probability of Insanity," American Journal 2:
Sociology, Vol. 44, 1944, pp. 534-539.

 

41

hafmli DISOhDFRS IN URBAN PLACES

 

The first comprehensive study on the distribution
of mental disease in an urban place was done by Faris and
Dunham in Chicago.43 They found that "insanity areas"
do exist within a city. One of their major findings was
that the schiZOphrenic cases showed a high degree of con-
centration at the center of the city. They found that there
was an inverse relati nship between distance from the center
of the city and the rate of schizOphrenia. Their work was
duplicated in many other cities. In St. Louis, Milwaukee,
Omaha, Kansas City, and :ecria the same results were ob-
tained. While there is some variation among the cities,
probably to be expected in communities of varying size and
situation, still there is sufficient evidence to support
the conclusion that insanity areas exist within cities.44
SOCIOLOGICAL THBWRIBS ON THE BTIOLOGY OF SCHIZOPHRENIA

Several sociologists have attempted theoritical
formulations to the etiology of mental disease. Read
Bain, a sociologist, speaks of "Our Schizoid Culture,"
and regards irrational contradictory norms of America as

"neurotic and psychotic societal behavior." Other sociologists,

 

43Faris and Dunham, pp. cit.

44Charles W. Schroeder, "Mental Disorders in Cities,"
American Journal Sociology, Vol. 48, 1948, pp. 40-47.

 

42
also state the idea that the exposure of an individual
to conflicting or contradictory norms and values renders
him especially prone to schizophrenia. For example,
Green writes, "A consistent view of self is not easy
to maintain when——-as is especially characteristic of our
large cities——-sexual, ethical, family, and community
standards glaringly contrast as one moves from one
group to another. Upon accepting an invitation to dinner
at the home of a new acquaintance, one must often be pre-
pared either to bow one's head while grace is said or
to accept a cocktail and laugh at a smutty story.
A psychic readiness to adapt to ever changing situations
is not for some a source of personality conflict, but
for others it constitutes a painful compromise with

l.45

self. He states that the diversity and inherent contra-

dictions of modern AmeriCan urban culture and productive

of personality conflict, which can result in schizophrenia.46
Of the several hypotheses relating the frequency

of mental disorder to social conditions, none has been

more persistently enunciated, than that which proposes

that schiZOphrenia is the outgrowth of social isolation;

and no one has been as profuse in writing about it as

 

45Arnold W. Green, Sociology, (New York: McGraw—dill
Book 00., 1956) p. 150.

46

 

Ibid., p. 151.

43
R. E. L. Paris.47 more recent statements have suggested
that isolation is a result of incongruent intra—familial
and extra—familial orientations toward the child and
represents a stage in a "typical process" for schizo—
phrenics. This "typical" process for schiZOphrenics
is said to involve the following stages:

Tarental oversolicitude produces the "spoiled
child" type of personality; and leads to a certain isolation
from all but the intimates within the family.

The next stage is persecution, discrimination or
exclusion by children outside the family. The most usual
reaction to this persecution is to feel unhappy but with
no immediate depreciation of establishing friendships.

Often the children try for years to make friends.
Eventually there is a resignation---a withdrawal from a
hopeless goal. From this time ofi'their interest in
sociability declines and they slowly develop the
seclusive personality that is characteristic of the
schiZOphrenic. They confine their social activities
to their own families, or take increased interest in read-

ing, music and art.

 

47Robert E. L. Paris, Social Psychology, (New York:
The Ronald Press, 1952).

 

44

Finally, the symptoms of schiZOphrenia are ascribed
to the lack of social experience in the person so isolated.
Not being experienced in intimate personal contacts with
a larger number of other persons he is deficient in his
understanding of the reaction of others and responds
unconventionally and inappropriately to them. He
mistakes unintentional slights for active persecution.

He interprets his own failure as due to interference
by others.48

One of the most commonly emphasized characteristics
of pre-schiZOphrenic life is a parent (usually the mother)
who is variously characterized as over-protective, domin-
eering, over anxious, over solicitious, inconsistent and
ambivalent toward the patient as a child.

The importance of the "domineering, over-protective
mother," in the etiology of schiZOphrenia does not neces-
sarily rest upon a Freudian conceptualization, however,
and most investigators who have emphasized the mother-
child-relationship in pre-schizophrenia have not done

49

so within a specifically Freudian framework.

 

48Melvin L. Kohn, and John A. Clausen, "Social Iso-
lation and Schizophrenia," American Sociological Review,
Vol. 20, 1955, pp. 405-410.

49William F. Ogburn and Meyer F. Nimkoff, Sociology,
(New York: Houghton hifflin Co., 1950).

 

 

45

However there has been no proof that such frustrations
have a part in the etiology of schizophrenia, nor even that
such frustrations are "associated with" schiZOphrenic
psychosis.SO

The concentration of schizophrenia in the lower
social strata of society is consistent with an hypo-
thesis which emphasizes the frustration of aspiration,
the loss or denial of a complimentary status and the
"self blame" that sometimes accompanies them. Such an
hypothesis is also consistent with some case study
materials and anthropological data.51 Bleuler states
that "... the overt symptomatology certainly represents
the expression of a more or less successful attempt

to find a way out of an intolerable situation...".52

 

O . 4 . .

5 Herbert L. costner, "Differential Rates of hos-
pitalization for schizophrenia in a Aural rcpulation,"
Unpublished ml Thesis, Ind. U., 1956.

51herbert L. Uostner, Ibid.
52'“fi g3 ‘, ° .. 7“. w \

hugene Bleuler, nementia rraecox, 93 the broup
_§ Schizo4hrenias, anglisn edition translated by
Joseph zinken, (New York: lnternational U. Press, 1950)
p. 460.

 

 

 

4o
Emile Durkheim's analysis of suicide statistics
shows that there is social support ot individuals who
undergo severe personal trauma, and that suicide rates
are a function of anomie——-the absence of such social

53 As was stated before Durkheim was able to

support.
demonstrate that certain kinds of suicide (and mental
disorders should be added) were due to the fact that
society itself had partly disintegrated, and the in-
dividual who formerly had a satisfactory adjustment

to the society could no longer adapt himself, even
though he made what had once been the proper responses.
Such an individual "feels like a fish out of water"

and one course of action for him is suicide. However,

54

suicide might be avoided by a psychosis or neurosis.

 

53-

Emile Durkheim, Suicide, Translated by John A.
Spaulding and George Simpson, (Glencoe, Ill: The Free
Press, 1951).

54William L. Warner, "The Society, The Individual
and His Mental Disorders," American Journal 2f_rsychiatry,
Vol. 94. 1937. pp. 275-284.

 

 

ClarTLR IIl

ANALYSIS OF DATA

Five major factors influencing the magnitude and trend
of schizophrenic rates are considered. These factors,
namely, age, sex, marital status, nativity, and area of
residence, are functionally significant in relation to
differential schiZOphrenic rates observed among first
admission patients.

As stated previously the rates for the state of
hichigan are based upon first admission Cases of schizo-
phrenia from the records of the two largest private mental
hospitals, all of the state institutions, and the Veter-
ans Administration Hospital at Battle Creek, for the years
1949, 1950 and 1951. The population of hichigan as reported
by the 1950 census Was multiplied by three to give a

comparable population base.1 The pOpulation was divided

 

1This of course could result in a slight margin of
error as the population thus obtained may not be the exact
population for those three years. However as the figures
dealt with are very large it is assumed that the margin of
error would be too slight to seriously affect the results.
The writer is aware that similar results could have been
obtained by using the 1950 population as the base and then
dividing the result by three. However it is the opinion
of the writer that the former method is more accurate,
even though the rates obtained from both methods do not
vary more than .01 per 100,000 population.

48‘
into the number of schiz0phrenics and then multiplied
by 100,000 to secure the Various rates. Hence the rates
discussed below represent the number of schiZOLhrenics
per 100,000 persons in the state of Michigan.
ggg

in order to obtain a clear indication of the distri-
bution of schiZOphrenia according to age, the population
was divided into six separate age categories (l5-24,
25-54, 55—44, 45—54, 55-64 and 65 and over). Bates were
then computed for each age group.

The hypothesis with respect to age composition is
that the probability of acquiring schizophrenia is not
random throughout the pOpulation. Hence, the hypothesis
would lead us to expect variations in the rate of schizo-
phrenia by age.

The results show that the age group 25-34, with a
rate of 45.00, has the highest incidence of schiZOphrenia.
See Table I. A steady decrease is shown in every sub-
sequent age group, the lowest rate being 7.56 in the
b5 and over age group. The l5-24 age group exhibits the

third highest rate, of 59.68.

49
TABLE I

CRUDE SCHIHOIHRJNIC RATE BY AG; IN THE STnTE OF
MICHIGAN 1949-50-51

 

 

AGE GROUP RATE OF SChIZ. :ER 100,000 POP.
15-24 30.68
25-34 45.00
35-44 53-52
45-54 18.92
55364 11.82
654 7.36

 

Table I shows that there is a very rapid drop in
the rate of schizophrenia after the age of 44. The results
show conclusively that middle age and older people are not
as suceptable to schiZOphrenia as young adults. It is
necessary to point out that children and early adoles-
cents were not included in this study because schizo-
phrenia is relatively infrequent among these age groups.

The results validate the hypothesis, as stated, that
the rate of schiZOphrenia is not random throughout the

pOpulation by ten year age groups.2 The results obtained

 

2In studies of this type, statistical analysis is
not used to determine whether or not a difference between
two or more figures is significant. Since the whole universe
was used and not a random sample of the universe, differences
appearing are considered to be real differences. We are not
arguing here for Hana C. Selvin's position, as stated in his
article, "A Critique of Tests of Significance in Survey Research"

50
are similar to almost all studies done on the age distri-
bution of schiziophrenia. In a study done in New Jersey,
Frankel found the highest incidence rate to be in the

25-54 age group.3 The same general results are reported

 

2Continued

Vol. 22 of the American Sociological Review of Oct.,
1957, however correct or incorrect he may be, when he says
that the conditions under which, "... tests of significance
may validly be used are almost impossible of fulfilement in
sociological research..." The writer is agreeing only to
the extent that in this particular work such large population
figures are used that any test devised will show practically
any difference to be significant. As Selvin states, "A l per
cent difference may be significant at the .001 level if the
Sample is large enough, yet such a small difference is essen-
tially meaningless for sociology at present." Hence, rather
then expend effort on tests that will show a significant
difference no matter what the results are, statistical devices
were not utilized.

Selvin does mention the suggestion of Margaret J. Hagood
and Daniel 0. :rice in their book, Statistics for Sociologists,
that total populations be considered as "samples" from still
larger hypothetical universes of possibilities. However
Selvin says that, "This concept is difficult to grasp in-
tuitively, and it is largely unnecessary...". He states
further that tests of significance are useless and meaning-
less when used to test the difference of survey projects that
take in the whole universe and not just a random sampling of
a universe.

3Ernest Frankel, "Outcome of Mental—hospital Treatment
in New Jersey; A Statistical Review of State mental Hospital
Activities," Mental Hygiene, Vol. 52 (July, 1948) p. 461.

 

 

51
in numerous other studies. Landis and lage,4 in a study
using data from all the state mental hospitals in all
the states of the United States, found that the age
group from 20-40 had the highest rate of schizophrenic
incidence. Ealzberg? using data from all institutions
for mental disease in New York from 1929-51, follock6
using data from New York institutions for the mentally
ill from 1912-18, Slater7 using data from mental hospitals
in England and Wales in 1932, and fidegaardB using data
of Norwegian born immigrants in the dochester State Hos-

pital District of hinnesota, 1889-1929, all conclude

 

4Carney Landis and James D. Page, Modern Society and
Mental Disease, (New York: Farrar and Rinehart, Inc.,
19387 pp. 44 & 163.

 

 

bMalzberg, gp. cit.

6Horatio M. Pollock, "Frequency of Dementia Fraecox
in Relation to Sex, Age, Environment Nativity, and Race,"
Mental Hygiene, Vol. 10, (July, 19263 p. 598.

 

7E. Slater, "The Incidence of Mental Disorder,"
Annals pf Eugenics, V01. 6, (1934-1955), p. 180

80. fidegaard, "Emigration and Insanity: A Study of
Mental Disease Among the Norwegian Born fopulation of
hinnesota," Acta Fsychiatrica gt Neurologica, Vol. 5,

1932 .

 

 

52

that the 20-40 age group is productive of the highest
rate of schiz0phrenia, with the very highest rates in
the late twenties and early and middle thirties.
§;§_ .

Another hypothesis, stated earlier in this study,
was that females in Michigan have a higher rate of schizo-
phrenia than males. The findings in previous research has
been inconsistent as to whether males or females have
higher schizophrenic rates. In conformity with the
hypothesis tnat urban centers have a higher rate of schizo-
phrenia than rural areas, one would hypothesis that females
will have a higher rate of schizophrenia than males. The
reason for this is that urban areas have a low sex ratio
and the rural areas a high sex ratio. Hence one would
expect females to have a higher ratio of schizophrenia than
males. Urban, rural-nonfarm, and rural-farm sex ratios in
nichigan in 1950 stood at 99, 104, and 114 for the three
residence groups, respectively.9

As shown in Table II, females in Michigan for the
years reported had a higher rate of schiZOphrenia than

males.

 

9J. Allan Beegle and Donald Halsted, "Michigan's
Changing ropulation," Special Bulletin 415, June, 1957,
hichigan State University Agricultural Experiment Station,
E. Lansing, hich., p. 25.

53

TABLE II

SQhIZUIHRhEIC AATSQ BY SEA IR T53 anTJ OF

hICnIGAH 1949-50-51

 

SI‘JX ital; VE‘ 421/1112] o .1. 1.323. 100 LUOO .EIOJ.’ o

 

Hale 27.30 27.58
Female 28.61 28.48

 

 

 

As indicated in Table II the crude rate for females
is 28.61, or 1.51 per 100,000 higher than for males.
When the rates are standardized for age there is only
a slight change in the rates. As can be seen from Table
II the standardized rate for females was 28.48 which re-
presents a difference of .90 per 100,000 over the male
rate of 27.58. A difference of .90 between the two figures
is so slight that one can doubt the meaningfulness of the
difference, and conclude that sex was not a very important
factor in the schizophrenic rates in the years 1949, 1950
and 1951.

As stated before, the findings have been inconsistent
as to whether or not males have higher schizophrenic

, . . , - lO
rates than females. In tne studies by Landis and tags,

 

lOLandis and Page, 92. cit., pp. 44 a 163.

54

12 it was found that males

by Malzberg,ll and by Pollock
had higher rates than females. however in a study of state
hospitals in Georgia, Green and Jacob13 found that females
had a higher rate of schiz0phrenia than males. Slaterl4
in his studies in England and Wales, and fldegaard15 in
his studies of Norwegian immigrants both found that females
had higher rates of schiz0phrenia than males. Hence, the
fact that this study in Michigan revealed a small differ-
ence between the sexes is consistent with previous research
in that neither sex has had a consistently higher schizo-
phrenic rate. Whether or not the hypothesis, as stated

above, has been validated is Open to dispute. Ihe writer's

conclusion is that it has not been validated since the

 

llhalzberg, pp. cit., p. 80.
12

Pollock, 9p. cit. p. 598.
13J. E. Greene and J. S. Jacob, "Conditions in the
hilledgeville State Hospital (Bulletin of the University
of Georgia, No. 9a, Vol. XXXIX Athens, Ga., July, 1939)
Pp- 32-33-

l4Slater, op. cit.

15fidegaard, pp. cit.

55
difference of only .90 per 100,000 population is not
sufficiently large. A difference of this slight magnitude
may be due to the human element involved in collection
and compilation of data.

NATIVITY

Throughout the literature on schizophrenia one finds
consistent reports that the foreign born population has
higher schizophrenic rates than the native-born population.
In this study, however, the crude rates show a tremendous
difference, with the foreign-born having a much lower

rate than the native-born. See Table III.

TABLE III
SCHIZOIHRJHIC RATES bY NATIVITY IN THE STATE OF
A MICHIGAN 1949-50-51

 

 

 

 

NATIVITY BATH CF :CHIZ. 13R 100,000 POP.
CRUDE RATES AGE STLHDARDIZED RATES

Native-born 29.65 28.25

Foreign-born 18.49 25.91

 

The crude rates show a very large difference of
10.16 per 100,000 between the native-born and foreign-
born. When the rates are standardized for age, as could

anticipated, the native-born rate declined while the

56

foreign-born rate increased by more than 7.00 per
100,000. See Table III.

Lven after standardization, the native—born popula—
tion has a higher schiZOpnrenic rate than the foreign—
born, and this is contrary to the findings of other studies.
In his study of the New Iork state hospitals, Lialzbergl6
found that the native-born had a schiz0pnrenic rate of
22.2 while the foreign-born had a rate of 52.8. Hence
he found that the foreign-born had a very substantially
higher rate than the native-born, a difference of 10.6
per 100,000.

Pollock}7 in his study done in 1926, found that
the native-born had a schiZOphrenic rate of 12.2 while
the foreign-born had a schiz0phrenic rate of 26.8. Again
in this study a very large disparity between the native-
born and foreign-born rates is shown.

mven after standardization, the native-born popula—

tion of hichigan has a higher schiz0phrenic rate than the

 

16

Malzberg, pp. cit.
l7Horatio M. Pollock, "Frequency of Dementia iarecox
in Relation to Sex, Age, Environment, Nativity, and Race,"
Mental Hygiene, Vol. 10, (July, 1926) pp. 596-611.

 

57

foreign-born. In view of previous evidence, it would
seem all the more unusual that in Michigan the foreign-
born has a lower rate of schiz0phrenia than the native-
born.
LARITAL STaTUS

The rates of schiz0phrenia according to marital
status in this study in general follows the findings
of previous research. As can be seen in Table IV, the
divorced had the highest crude rate, 82.45, the separated
the second highest 80.19, followed by the single with a
rate of 52.56. The widowed had a lower rate (15.50 per
100,000) than the married (17.71 per 100,000 population).

TABLE IV

SCHIZOIHRENIC RATES BY MARITAL STATUS IN THE STATE OF
hICHIGhN 1949-50-51

 

 

 

 

MARITAL STaTUS RATE OF SCHIZ. BER lO0,000 POP.
CRUDE RATES AGE STARDARDIZED RATES

Divorced 86.90 85.25

Separated 80.19 75.25

Single 51.54 65.92

Married 18.20 17.54

Widowed 15.10 52.70

 

58

When the rates are standardized by age one major
change occurs, namely, that the rates of the widowed rose
from 15.10 to 52.70. As can be seen in Table IV, even
after standardization, the divorced and separated still
have the highest rates.

The rates shown in Table IV in general are supported
by the findings in almost all studies of schizonhrenia.

Several studies, however, have found that single persons

l

have the highest rate of schizophrenia. In this study,
however, the single have a considerably lower rate than
the separated and the divorCed. The hypothesis that the
married persons in michigan vill have a lower rate of
schiz0phrenia than the single, separated, divorced, or
widowed has been validated.

These results emphasize the fact found in many
other studies that the married element in our society
has consistently lower rates of schizophrenia than the
other marital status groups in our society. Leta Adler,

writing in Social Forces, states the hypothesis that,

 

"The emotional security and social stability afforded by

. . . .1 - 18
married life makes for low inCidence of mental illness".

 

18" . , . l. u . .
Leta Adler, ”The Relationsnip of marital Status
to Incidence of and Recovery from mental Illness," Social
Forces, Vol. 52, December, 1955.

59
whether this is true gr whether the low incidence of
scniz0phrenia among the married element is due to a
selective prOCe"S prior to marriage is a debatable
point. It could, however, be a combination or both.

The higher schiZOphrenic rate of the widowed would tend
to support the hypothesis that marriage does produce
emotional security. When one marriage partner is removed
through death one finds less emotional stability as
measured by schiZOphrenia. Bellin and Hardt19 state
that,

... loss of spouse may be viewed as tending to
disrupt the established modes of satisfying a variety
of needs, as well as establishing with traumatic
import the recognition of one's own mortality.
Futhermore, bereavement introduces a new social role,
widowhood, not only is this role generally evaluated
negatively, but the normative expectations attached
to it are vague and contradictory. To the extent
that some selection of individuals into the single
and divorced groups takes place on the basis of their
lack of personal adjustment the differences in the
rates of mental disorder between the single and
divorced and the married groups may have little to
to with the differential stresses and satisfactions
intrinsic to the Various marital statuses. It is
much less obvious as to how the married and the
widowed categories may be differentially selectivSO
of individuals on the basis of mental disorders".

 

20Bellin and Hardt, gp. cit., pp. 155-162.

6O

AREA

As stated in chapter I and II, the findings on urban
and rural differences in mental disease rates have not
been consistent. In attempting to clarify the situation,
the writer divided the state into areas on the basis of
their proximity to Standard Metropolitan Areas, assuming
that if a definite urban-rural difference exists that the
difference would appear between the areas delineated.
Hence, the state was divided by county units, into
three categories. One category consists of all Standard
Metropolitan Areas, that is, all counties having a city
of at least 50,000 pOpulation within its boundaries, or
has met other specified qualifications set forth by the
census bureau in 1950. Another category consists of all
contiguous counties, that is, counties that had a Standard
metropolitan Area on any of its borders. The third category
consists of all non-contiguous counties, that is, counties
that did not have a Standard Metropolitan Area on any
of their borders.

It has been stated repeatedly that there is a marked
difference in rural and urban life patterns, with rural

society having much more cohesion or integration than the

61
urban society, and that more anomie exists in urban
society. Dy anomie is meant that the ends of action
become contradictory, inaccessible or insignificant. It
is characterized by a general loss of orientation and
accompanied by feelings of "emptiness" and apathy.21
Durkheim in his monograph on suicide22 was one of the
first sociologists to state the principles of social
integration and anomie. At no point in Durkheim's
comments is there an explicit connotative definition of
social integration, much less an Operational definition.
Running throughout Durkheim's comments on the nature of
social integration is the suggestion that the concept has
to do with the strength of the individual's ties to his
society. In formal terms, the stronger the ties of the
individual members to a society, the lower the schizo-
phrenic rate of the society.23

Some authors claim that despite the fact that rural

 

lg . . a . . . .
hlw1n H. rowell, "Occupation, Status, and buiCide:
Toward A Redifinition of Anomie,“ American Sociological

Review, Vol. 25, April, 1958.
Emile Durkheim, Suicide, Translated by John A.

 

22

Spaulding and George Simpson, (Glencoe, Ill: The Free
Press, 1951).

2 v"'v '1 ' ~. ' '

3Jack F. 01008 and Halter N. Martin, "A Theory of
Status Integration and Its Relationship to Suicide,"
American Sociological Review, Vol. 25, April, 1958.

 

62
and urban "worlds" are merging, and that the rural society
presents wide variations, it can still be said that rural
life partakea more of the characteristics of the familistic
Gemeinschaft, and urban life of the contraCtual desellschaft.24
hence Leacock suggests that one might be led to expect
much more integration in the rural areas.25 She continues
that there 18 greater precision and stability in social
rOles in rural society, less marked status striving, more
intimate and personal forms of authority, greater security
of primary group ties, the specification of norms for all
life situations, and that the relative homogeneity of
the rural population reduces the risk of value conflict.
Hence, there would be more integration in the rural areas
and less in the urban areas.26

many others have written about the supposedly higher
rates of mental disease in urban areas due to a lack of
integration. Leighton writes that, "... psychiatry on the

one hand and the social sciences on the other were re-

 

24For a clear exposition of the concepts Gemeinschaft
and Gesellschaft see; F. Toennies, Fundamental Concepts 2;
Sociology: Gemeinschaft and Gesellschaft, translated and
supplemented by Charles P. Loomis, New York, 1940.

25Eleanor Leacock writing in, "Explorations in Social
Psychology, edited by Alexander H. Leighton, John A.
Clausen and Robert N. Wilson, (New York: Basic Books, Inc.,
1957) p. 314.

26

 

 

 

Ibid., p. 316.

63
cording from different points of view the difficulties
involved in adjusting to our contemporary urbanized
and industrialized form of life. The city became the
sinner and was compared to a somewhat ideal version of
rural living. 'The rural codes and customs have direct

I

and sustaining influence; wrote the author of a text-
book on rural sociology in the forties, 'Life is personal
and its crisis call out personal responses from neigh-

bors. There is thus less chance of maladjustment then

in the city, where primary groups do not come to the aid
'"27

Gist and halbert28 write that there is reason to

of the distressed.

believe that the urban milieu is more conducive. to
mental disabilities than rural society and that there
is reason to believe that the urban type of social
structure does lead to a higher rate of mental disease.

Clinard writes about the impersonality and lack
of social integration of the urban world as producing
a type of society which seemingly is more prone to

29

mental disorders.

 

27

28Noel P. Gist and L. A. Halbert, Urban Society,
(New York: Thomas Y. Crowell Company, 4th ed. 19567.

dgMarshall B. Clinard, Sociology of_Deviant Behavior,
(New York: Rinehart a 00., Inc., 1957).

Leighton, Clausen, and Wilson, op. cit., p. 516.

 

 

64

If it is true, that urban areas have less inte—
gration than rural areas, and if a lack of integration
can cause mental disease, as stated by several authors
referred to in chapter two, then we can hypothesize
that the rate of schizophrenia will Vary directly with
the amount of urbanity.

It was felt that if there was any relationship
between an urban like environment and the rate of
schiZOphrenia that this relationship would probably
appear in different rates for the different social
categories.

One hypothesis stated was tmat the rate of schizo—
phrenia in hichigan would be higher in Standard Metro-
politan Areas than areas outside such Standard metropolitan
Areas.

This hypothesis is supported since ooth the crude
and standardized rates were higher for the Standard
metropolitan Areas than for the other areas. See

Table V.

65

TnBLE V

SCflILOTZRLfiIJ 3414 BY nBJA IN THEgaTAlE 0F “ICnIGAN

1949-50-51

 

 

CiUDE RaTES AGE STaIDnXDIZED RATES

 

S. h. A. 30.75 30.13
Contiguous Counties 20.96 21.36
Non-bontiguous Counties 24.89 26.83

 

The crude rates show the btandard Metropolitan
Areas having a 9.59 rate higher than the contiguous counties
and 5.86 rate higher than the non-contiguous counties.

Similar results remain after standardization for
age differences as Table V shows.

Due to age standardization, the Dtandard Metropo-
litan Area rate decreased very slightly, or a drop from
30.75 to 30.13 per 100,000. The other categories had
a slight increase, with the non-contiguous counties having
the highest increase of all. The contiguous counties
increased from 20.96 to 21.36, a very slight increase of

.40 per 100,000. The non-contiguous counties, however,

had increased fron 24.89 to 26.83, an increase of 1.94

per 100,000.

66

Another hypothesis stated was that the rate of
schiz0phrenia in Michigan would be higher in counties
contiguous to Standard Metropolitan Areas tgan in those
counties non-contiguous to Standard Metropolitan Areas.
This ypothesis was not validated by the results of the
study, as can be seen from Table V. The contiguous
counties had a crude schiz0phrenic rate of 20.96 while
the non-contiguous counties had a crude soniZOphrenic
rate of 24.89. Hence the non-contiguous counties had a
crude schizophrenic rate of 3.98 higher than the contiguous
counties. When the rates were standardized they not only
did not come closer together but the non-contiguous county
rate increased more than the contiguous county rate
as can be seen in Table V. Hence the hypothesis stating
that the rate of schizophrenia in Michigan would be higher
in counties contiguous to Standard Metropolitan areas than
in those counties non—contiguous to standard Metropolitan
areas has not been validated by the results of the re-

search.

Ihis would seemingly mean that the major hypothesis
stating that the probability of acquiring schiZOpnrenia
Varies according to urban and rural residence has not

been validated by the evidence given here. While it is

67

true that the Standard metrOpolitan Area category had a
higher schiz0phrenic rate than the other categories, the
fact that the contiguous counties had a substantially
lower rate than the non-contiguous counties would seem to
indicate that the probability of an area having a high or
low schiz0phrenic rate does not necessarily depend upon
its urbanity as expressed by distance from large metro—
politan areas.

One may say that the differences found between the
areas might be due to differences in sex ratio or more
importantly due to the different marital composition of
the various populations. To determine if these could
have any appreciable effect upon the rates, all areask
were standardized for sex and marital composition.

If we standardize the various areas for marital
status the difference between the areas still remain
as can be seen in Table VI.

TABLE VI

MARITAL STATUS STANDARDIZED RATES BY AREA IN THE STATE
OF LICHIGAN 1949-50-51

 

AREA RATE OF SOHIZ. TER 100,000 POP.
801‘;vo 29°93
Contiguous County 20.61

Hon-Contiguous 23.71

 

 

I‘ll 'lIT IV Ill I {I'll l 'I'Illl lull Al I II.“ I

68

Hence we can see that if marital status is taken
into consideration the specific rates change slightly,
but the general differences between areas still remain.

If we standardize the various areas for sex the
differences between the areas also remains as can be

seen in Table VII.

 

 

ThBLm VII
SEX STnhDafluIZED flaTnb BY ARha IN THE STATE OF hICflIGAN
1949-50-51
ahEh iaTh 0F bofilz. 133 100,000 :0r.
8.m.a. 30-74
contiguous counties 20.95
Non-Contiguous 24.87

 

Table VII indicates that if sex is taken into con-
sideration the specific rates again change slightly but
the general differences betaeen the areas still remain.

1'his study has demonstrated that the schiz0phrenic

rate in Hichigan does not have a direct relationship

to urbanity.

69

CHAPTER IV

SUMHARY AND CONCLUSIONS

The empirical basis for this study of schizo-
phrenic differentials in Michigan consisted of 3,881
first admission schiZOphrenics. The data were obtained
from all the State Mental Hospitals, the Veterans
Administration Hospital at Battle Creek, and the two
largest private hospitals in Michigan for the years
1949, 1950, and 1951. These data were coded and
punched on IBM cards and analyzed by machine methods.
The following information was utilized in this study;
county of residence, age, sex, nativity, and marital
status.

In the analysis of data for Michigan it is
assumed that a statistical analysis of schiz0phrenia
is meaningful. The author does not agree with the
contention of some workers that the data are too
inadequate to merit credence. Perhaps, some cases
of schiz0phrenia have been concealed. It is felt
however that the data collected are representative of

the entire universe.

71

In this report Durkheim's theory of anomie was
hypothesized as having a functional relationship in
producing a higher rate of schiZOphrenia in urban
places. Various authors were quoted stating that with
an increase in urbanism there is an increase in social
disorganization, and consequently an increase in
schiz0phrenia. Therefore, one hypothesis stated was
that there is a direct relationship between urbanity
and the rate of schiZOphrenia. To test this hypothesis
the state of hichigan was divided into three separate
areas, all three areas being in different stages of
urbanization. The criterion of urbanization used was
the nearness to, or the inclusion of, a Standard
hetropolitan Area.

The above stated hypothesis was not validated
as the data did not show a direct relationsnip between
urbanity and the rate of schiz0phrenia. Hence one is
led to the conclusion that urban living per se is
not more conducive to mental illness than rural
living.

another hypothesis stated was that the incidence

of schiz0phrenia is not random throughout the population

72
in regard to marital status, nativity, sex, and age.

The population of the state of michigan and
the schiZOphrenics were subdivided into 10 year
age groupings. It was found that the rate of schizo-
phrenia was highest in the age group 25-34, and that
there was a real difference in the rates between all
the age groupings. The schiz0phrenic rate declined
steadly after the 25—34 age group, with every sub-
sequent age group having a lower rate of sohizoyhrenia
than the one preceding it.

The population of the state of michigan and the
schizophrenics were separated by sex, 'fld the age stan—
dardized rate for each sex computed. It was found
that the difference between the sexes was so slight
that it was not considered to be a real difference.
The females had a slightly higher (.90 per 100,000
pOpulation) rate than the males.

The population of the state of Michigan and the
soniZOphrenics were also separated on the basis of
nativity. Separate schizoyhrenic rates, age standard-

ized, for the native born and the foreign born

73
population were computed. It was found that there was
a real difference between the native born and the foreign
born rates of schiZOQhrenia, with the foreign born
aving a substantially lower schiZOpnrenic rate than
the native born.

The pOpulation of the state of hichigan and the
schizophrenics were separated on the basis of marital
status. Separate age standardized schiZOphrenic rates
for the various marital groups; divorced, separated,
single, widowed, and married were computed. The results
show that the divorced had the highest rate followed
by the separated, single, widowed, and married.

The writer therefore found that the incidence
of schizophrenia is not random throughout the popu-
lation in regard to marital status, nativity, and
age. However, in the author's opinion, no real differ-
ence in the incidence of schizophrenia was found

between the sexes.

71L

Lb
I-‘i
U 7
U
P!
O
p _.
t‘,
.—
P1
» l
i4

9 Pr9ecox, or the Groun of Seiizo~nrcn cs
nslsted by Josczh“ Zinkcn. new fork:
ity PTOSS, l (3)0.

Eleuler, Eu ene. Den. t
lei sh edition t
Interactional l

 

f: "'3 HI

Clinard, E9 -aall B. SOClOlO”V of Dev'ant Bohavia9. New York:
Hine_-rt and 00., inc., 1957.

 

Dayton, N.H. New Foe we 5 on.Lert l D;sq~<eis. Springfield, Ill:
C . C 0 31111031518 0 O . , 1913-0 .

 

 

Treflnslo ed by John.A. Staulding and

Durkheim, Emile. I§Uici de
ncoe, Ill.: lhe Free Press 1951

Gedrce Simpson, Gl

 

 

('9.

Paris, Roiert E. L., Soci9l Psvccolo v. Lew'forc: The Ronald
Press, 1952.

 

Paris, dobert E. L., and H. Warren Dunhim. ”ent
'n'Urbon Areas. ChiCSTF” 31L7€r91ty Oi Cfiic"l
’

193 9.

 

Giddings, Franklin.H. Princ:Lples of Sociology. Lew Yorlm
Nacmillan Co., lees.

 

 

Gist, Noel P., and L. A. Halbert. Uroon Societv. hewffork:
Thomas Y. Crowell Co., .-‘j.th edit/i on, ”1956.

Green, Arnold W. Seziolowv. hem York: Redraw-Hill
Book Co., 1956

 

 

 

 

 

Kline, Lath9n. Svnonsis of Eugene Bleuler's De;nentia froecox or
.2236 rou2 2:_Scniggphrcnics. New lork: lnternational

LanTis, Ca rney, and K. N rjorie Bales. Textbook of Abnormal
s: ” : a J]

1: 0-711 _ -an Co. , 19‘20

 

Landis, Carney, and James D. Pace __ _ .
Discose. Lew fork: Farrer and nine; “L, lnc., 193p.

 

Loifihton, Alexander H., an? John A. Cl9_Usen, and Robert H. Wilson,
,hnrlorotions in Social lsychi9trj. Lew Vor‘.-:: 833' Books,

 

 

Loomis, Charles P. and J. Allen Beegle. hurt->3 Soci olomr; The
Stretemv 2f Chance. En lewood Clif s, 1.ew Jerse":
Ircntice-lall, Inc., 1957.

 

 

 

I" T 1 ' H {-1 . ’7 3 u“ I: - . .' .v'w '“ ('4 >'\' - 4- r“ ’x ‘1 ' r.

n31ZUCP3, lenjdrr in. Social “no niolo.-991 as-ecrs of I roll
' ' ”1' -- “ ' - 1 J— A - .' .2- u...- ('1 3:].
Dis 9se. Utica, new lorx: St to nospl.9l chss, ,HO.

3 912 oer3, Benjmnin, 9nd Everett S. Lee. _*3 _
Disesse. Dew York: J. D. Liypincott Co., 192

 

fioqper, firnes‘. Epsorsinizotion- -Pcrsonql 9nd SOClfll. New YO?{2
J. ‘. Lip incott Co., 1922.

 

O9burn, William F., 9nd Key or F. Nimjoff. Sggiolp3v. Eoufinton
Lif lin Co., l950.
Rose, Arnold K. Dental 1“Mlth 9rf.:;:+9l Di ler: i cocioleicsl

 

 

 

AUQEQZCL. fl. N. TO? ton C0-3 955'

Toennies, Ferdin9nd, Fundd:t: 9:nt9 1 Concents of S293 ole Trans-
l9tion by C. P. bO‘IlS Lew £02k, 1930.

 

Journal Articles

 

Adler, Lete.. "The “079tiorsrip of Enritnl Stétus to Incidence
of no Recov my from Iient al Illnesr." Social ‘Ebrces,
Vol. 32 (December, 1953), pf. lBS-l9n.

Bell in, Se S. and Robert H. Eardt. "Meritel St trs and
Lental Disorders Amons the Aged." Ameri’en Sociol03icsl
Review, Vol. 23 (April, 1956), pp. 1

 

Burses9,n r.est . "Social chtm9s in tae n‘iolo y 9nd Irovention .
of ' ntel Disorders." Social Iroblers, ("prll, 1953) pp. 53-56

 

Dunham, H. Warren. "Some Persistent Problems in the Boileniolngy
of Dental Disorders." Arericnn Journql of Psrchint-r,
Vol. 109 (Aurust, 195 ), p“. 567-577;

 

 

 

Paris, Retort E. L. "CUltUre, Isolo tion and tne Schi~0phrenic
Personality." Auerrc n Jourr9l o: Sociolo3g, (Sep—
tember, 195 "), p. 1.95-3.27

Frankel, Ernest. "Outcome of Mental hospital Treetrent in New
Jersey; A Statistical Review of Stste Dental Hospital
Activities." Mental Eyriene, Vol. 36 (July, 1920), p. U61

 

Gibbs, Jock P., and Walter W. Hertin. "A ineo?v of "tqtus Inte-
'r9tion 9nd Its Relationrnip to Suicide. ' American Socio-
I03icsl HevieW, Vol. 23 (April, 1958) pp .lLO-IMY

 

76

Gruerberé, Ernest fl. "T118 Ep idemiol o;y a? Rental Diseaze."
‘

Scientific xmerican, (Larch, 195A), p". 38-h2.

 

Hollincsie9 d, Au wu t B., anfl Frederick C. fledliclc. "Schizo-
phr::nia an. Sacial S erctnre. " Ame icen/ Jou.r;391 of I31-
chiatrr, ’Jcl. 110, (Au U.:t, l95T), p7; 695- 701.

u :3

 

'CAtion and IS"chL tric Disordé. " Aflc~TC9n

, Aujust 3., and Frederick C. Redlick. 00391
i
:ical Review, V01. 18 (April, 195:: ) T 103-169

 

 

Hollinésnc9d, Au ust 3., and Hr9d99' 1: "C. Redlick. "S 00191
Stratificatian 9nd Seii~cci°cfii9 'Ancrican Sociolo :c:1
Review, Vol. 19 (April, 195;Q p? 302-300.

Jrco, E. Sartly. "Inci dc “HOG of Psychoscs in Leras, 1952-1953."
TeX9s Stete Journil of Iedicine, (Feer9ry,1957) pp. 86-9lo

 

Jaco, E. Gartli. "S::cie Fectors in.Ienb91 Di sq~ders in.Texas."
Social Problems, Vol. 1, (April, 1957), pt. ;2 28.

(1))

 

J9fL Le, A. J., an:1 E. Shanas. Seahow c DiJTLe; ent:L9-Ls in
t19 Probe cility 01' Ins 9rity." American Journ91 of
SOCiolO”V, Vol. LA (Jantarj, 1935), pp. 53h-539.

 

 

KoLn,'Helvin L., ani John.A. Claucen. "Social IsolaTion and
ScuiA05~rcn1A." Am‘r'c n Se c:Lel c 1_Lovicv, Vol. 20

(June, 1955), p 501-511.

Lantz a, Her”:n R. "PO“HlQI')? Densi tv 91d I9"cA1 tr ic Die nosis
Sm iolojl and Secinl Qesec Arch, V01. 37 (1953), FT. “5 2 —326

 

Lemar , Ld in_I. "An 153391.079"torTT Strdv of Iental Diso: ders in
a :19r9_] Pr01_em.1reu." liur91 SI:iolcf3, V01. 13,
(Octo er, 1940), p . 645- 54.

 

  

 

 

Lemert, E win.K. "Lefml Connitficn' nwd Social Control." Sociolo v
and Social h999¢rch, (In; JLm wl9g6) pp. 222-227.

9 .- ~ “\ - - '

I'v-eyerson, Abr9.L19:r.1."-1ewer ci 10715.91 Di; 19 de- .3 in Urbe 11 Ar eis.’
Ageri09n Journsl of P3"ch :rg, Vol. 96 (19w0), pp. 995-997.

 

 

H.)

¢dCT99rd, g. "A St’tisticcl In"-st:99ti n c} the Incidence c
1-"e:1tc.1 Di sCIE“ er in 1 or” :13." Isrchintric l;:*::rtcrl_}1:,

(51313-9 19136), PB. 382-23830

Iastore, Escaol s. "The Senet -cs of Schisz:?en:r
I svcfleie 091 Sulletin, V01. T6 (

Pollock, Hezm+ie I. "firerueue" of Deien313 Praeeex in helztion
to Sex, A30, Environ136 _t, 136‘? '3, 33' Race." K3flfel

 

.L ibt
7"31ere, (Jvlgr, 1926), pp. 596-611.

Pewell, Elwin E. ”Oeeupetien, Stitflo 3nd Suicide: Toward a
Re-definitien e: Anemie." Amerieen Seeiole”i,nl Review,
'3, - :- 7-' O 3 ‘1 fl
Vol. c3, (1pr1l, 1956), p . l l-159.

":7 3 : .13 ... . .3 3: - (3-7-- 1.--- P
60:11.30 1731' 3".-!‘.'.‘.. PIEC- El" 01.33: u1.7=1°‘-77.Cbl.30o QC

(AU3u E, 1953) p. 32.

 

C" ‘ 7 I ., '7 1‘.- A- .' .. Ti ..
oneroeger 3. J. Mb 631 D1sereers

j
2:.gpiole3 , Vol. H7 (July, 1

 

n C t1es." “331101n Journal
P
9b 1 pp

), 0—T7.
Schroeder, Widiek W., uni J. Alla Bee le. "Suicide: An
Insfnnee of Hiiher Rural Rates." Rural SOClOlO:flh

(1551:3011, 1953),.1—‘W HIE-53-

Selvin, Han3n C. "A Cr161eue 01 Tests of ”igri1acagce in
Survey 13033313011. A33 = .7 0311 See 3' 33. 34-337 031 “icftew,

 

Vol. 22, (October, 1957), pp. 519—527.

' .-.J- .7 . - 1- H A -1 .1.“- 1 -. 1'
101131 D serdur. “n13ls .1 Lu-enxes,

W.—

F-fl

 

SI.ter, E. "T3e Incide13ee 01
’v‘el. 6, (19331-195), p77. 1723-1715.

Tietze, Chri be 3er and Paul LemEQu, 33’.I3r 13 Ceeper . "Schiz o-

ihr3n.I IIeie Dehrerei"e lsTc‘eses 366. See131-‘ 0030110

St: t1 ” A213? C"I1£NTT3131 of 81:101 , Vol. MO
(Se
Warner, U. L., "The Seeieey, the Ingividual 3nd 31': Rental Dis-

,
- o
3133 her, 793LT_66. 166-17.
ercers. Amerie3n.Jkn6fififil.g£ Payehiatry, Vol. 9Q (1937),
5p. 275-286

.10 (7)

x.

 

 

Eiseellaneeus

Beefle, J. A713 ..... 3:6 Denel' 331: On. giehifen's Cr n in: Popu-
lat1en." CWeevil. Bulletin ul5. mart Lansinf, Lie31f3n:
Kiehi33n St te University Awrieultur3l 3.1T m3r1;3ent Stat1on,

5130,1957.

-.L .‘

00311101313631). in a R 7 “1°31 Pej 11.73 61
7 T'hesis, IniiLq ana un1ver3a v, 1956.

Costner, Herbert L. "Different71 R”tes of esaWU3lizat
e 1L7-

l-Jo

S rate :OSpital (Bu_lletin of 613 Univerraty el Ueerg1a, L
9a, V01. 31.4., 1kt-‘ €11.67 , G95. ’ Jlllzl , 10 /_ 9 ) , :':‘:). 32-33.

Greene, J. 7 3113 J. S. J3eeb. Cen6131ens in the Killeflieville
V0

Sdhreeder, W:L dick 4., "SUicide Differenti3ls in Tiehig1
Unf-u-W 'Lo7715d I-I.A.71‘113.S1s, 111011157311 827127.133 U131_v 33.33

.s.’--— lJAL

AEBENDIX
TABLE I

AGE OF SOHIfiOLJRENICS ARD GEHERAL IOPULATION

78

 

 

 

 

 

 

 

 

AGE NO. OF SQHIZ. GEEEKAL :03.
15—24 849 922,277(3)
25-34 1,408 1,042,819(5)
39-44 903 897,891(3)
45-54 418 736,123(3)
55-64 201 566,461(3)
65+ 102 46l,bSO(3)
TABLE II

85; OF SUHIZOLdRLNICS AND GENEAAL -OPULATION

 

 

 

 

SEX NO. LE 50312. GLIERAL POP.

LALE 1,902 2,321,653(3)

FEMALE 1,979 2,309,568
TABLE III

AGE AND bEX OF SCHIZOLfiRfiNICS

 

 

 

AGE 15-24 25-34 55-44 45-54 55-64 65£
MALE 479 695 436 155 86 SI_*
FEMALE 370 713 467 263 115 51

 

ex‘

79

TABLE IV

NATIVITY OF SCHILOLHRLJICS ALD GEEERAL fOLULnTION

 

 

 

 

NLIIVIII no. OE SSEIE. GAEERAL EOE.

NATIVE 5,552 4,227,724(5)

FOEEIGN 529 399,497(5)
TABLE v

AGE AND NATIVITY OF SCHIZOEHRBNICS

 

 

 

AGE 15—24 25-54 55-44 45-54 55—64 654
NATIVE 855 1,556‘ 812 559 151 79
FOREIGN 14 52 91 79 7o 23

 

TABLE VI
hnRITAL STATUS OF SCHIZOLHRJNICS AND GELERAL lOPULATION

 

 

 

 

 

 

L1RIIEL STATUS NO. OF SCHIZ. GENERAL POP.
SINGLE 1,485 945,286(5)
jig—I‘m 1,679 3,158,620(3)
SEEARATED 175 71,9o5(5>
flIDOWED 15o 525,685(5)
DIVORCED 511 125,725(5)

 

UNKNOEN I03 ..........

 

’13.;ng VII

AG; 1.131) 1.'11-1:§.I’I‘_111 QI-.TU;3 6F bJrLIZOIJdJAICS

80

 

AGE 15-24 25-54 55-44 45-54_, 55—64
“81,61E 642 471 251 79 45

65+
i9

 

LBMIED 151 707 495 221 '18

29

 

..IDLQL..D 1 .L4 20 28 5O

37

 

11170110151) 16 I10 90 55 50

10

 

SJIILIDLALTJ‘J‘J 20 72 54 ' .L5 9

 

bl-f11;.L"..-.'1Q 19 5'4 15 20 11

TABLE VIII

SSAIEOIAEEAICS ALE GEAEEAL IOIUIAIIUJ BY AEEA

 

 

AREA 1J0. CF b‘JiIL. GBIQIELLIL 3:01).

 

STANDARD LETE. AREA 2,865 5,105,658(5)

 

 

CCETIGUCUS UOUNTIEd 641 1,019,397(5)

 

866111E6 Low CCLTIGUUUS 575 _502,166(5)

TABLE IX

IILIRITAL biATUS UF SUIIIZOILIRELQICS AND GENBRA“
SIAIJDQIRD LIETBOI- ULI‘LII-I AREAS

1- 05011111“ I U11" IN

 

1‘.111.-.;‘I'1-_; 6T-1TUS “JO. OF DUIII‘ZJ. GIIJIJLILAL BOP.

 

SILGLE 1,047 621,115(5)

 

LARRIED 8c SEL’ELRATED l , 592 2 , 179 , 301 ( 5)

 

JIDONED & LIVOECED 555 501,789(5)

 

UITKE‘TOVIN 105

 

81
TABLE X

LARITAL STATUS OF SCHIZOIARENICS AND GENERAL IOIULATION IN
TEE COLTIUUOUS COUNTIES

 

NO. OF SCEIZ. GENERAL LOP.

05

LAEITAL STAT’
SINGLE 247 207,696(5)
EAEEIEE a SEPARATED 514 557,577(5)

 

 

WIDOMED & DIVORCED 7o 99.908(5)

 

UNKNOWN O .........

TABLE XI
KARITA STETUS OF SOHIZOIHRJNICS AND GENERAL IOPULATION IN

COUNTIES NOT CONTIGUOUS

 

1

U}

C

IAAIIAL STAT NO. OF SGEIZ. GELEAAL EOE.
SIJGLE 191 116,477(5)

EAEEIEL & SEEAEATED 146 557,577(5)

 

 

WIDOWED & DIVORGED 58 49,715(5)

 

QEEAOAN o _________

TABLE X

SEX OF SOHIZOIHRENICS AND GENERAL POEULATION
IN STANDARD LETROLOLITAN AREAS

 

1‘!

SEX no. OF SGAIE. EGEEAL 105.
AALE 1,568 1,550.729(5)
EEAALE 1,497 1,554,929(3)

 

Q -‘~." ‘11
uuA L‘l‘

82
TABLE XIII

SCHIZOPHRENICS AND GENERAL IOEULATION IN CONTIGUOUS
COULTIES

 

 

 

SE1 E0. 0E QCHIE. GLLEEAL 103.
AALE 556 512.096(5)
FEMALE 505 5065501(3)

 

TABLE XIV

bCiIZOIHRENICS AND GENERAL IOLULATION IN COUNTIES
NOT OOHTIGLOUS

 

NO. OF SONIA. GELERAL LOB.

 

198 257,868(5)

 

AGE OF

177 244,558(5)

TABLE XV

SCHIZOIRRENICS AND GENERAL IOLQLATION IN STANDARD
ASTROLOLITAN AREAS

 

AGE

15-24

E0. 0E $3513. GEAEEAL POP.

609 611.755(5>

 

25-54

1,062 752,022(5)

 

55-44

681 620,858(5)

 

45-54

519 512,76l(5)

 

55—64

145 570,181(5)

 

654

51 258,083(3)

83
TABLE XVI

AGE OF SCHIZOIERENICS AND GENERAL IOLULATION IN COITIGUOUS

 

 

 

 

 

 

 

COUNTIES

AGE 30. CF SCHIZ. GELERAL TOP.
15-24 152 215,452(5)

25-54 210 217,267(5) “—_
55-44 158 185,979(5>

45-54 66 146,865(5)

55-64 54 126,197(5)

65+ 41 151,659(5)

 

TABLE XVII

AGE OF SCHILOLARLJICS AND GELERAL IOEULATIOH IL COULTIES
NOT 00EEIGU0US

 

 

 

 

 

 

 

 

AGE NO. 0E 50515.._ GENERAL 103.
15-24 88 97,092(5)
25-54 156 A ' 95,550(5)
55-44 84 95,054(5)
45-54 55 76,499(5)
55-64 - 24 70,085KE)

 

65+ 10 71,908(5l_

, .
‘ 3+ “ ‘ 6, $031..
Iv-Ut.