Poverty and the course of schizophrenia: implications for research and policy

Interest in the relationship between social class and schizophrenia has diminished in recent years. However, these issues can usefully be reconsidered in light of increased recognition that schizophrenia has a protean course, that deinstitutionalization and community support of persons with schizophrenia are linked to welfare programs, and that conceptualizations and measurements of social class and its impact on the daily life of persons with schizophrenia have been rudimentary. The author examines the role that social class, especially poverty, plays in the course and outcome of schizophrenia. He reviews literature on the contributions of social structure and policy to the economic status of persons with schizophrenia, identifies variables associated with poverty that are found disproportionately among persons with schizophrenia, and examines the psychological significance of those variables. The overview is used to develop three approaches to research: examining the role of the chronic stress of poverty in the vulnerability model of schizophrenia, using poverty as a point of departure for investigation by considering persons with schizophrenia as primarily indigent rather than primarily mentally ill, and delineating how poverty and elements of schizophrenia influence each other.