Paranoia and Schizophrenia Are More Common in Cities

Did you know that the environment in which you live can affect your psychological well-being? In fact, science even claims that the most serious mental illnesses, such as schizophrenia, are more prevalent in urban than rural areas. Find out why here.
Paranoia and Schizophrenia Are More Common in Cities
Valeria Sabater

Written and verified by the psychologist Valeria Sabater.

Last update: 04 March, 2024

Writer Kate Milford said that “There are more hidden spaces in a city, more hidden lives and hidden emptinesses, and more darkened windows where shadow people pass fleetingly in and out of sight”. Indeed, there’s something devastating hidden in our cities, beneath their hectic and noisy exteriors. Some call them asphalt jungles.

While it’s true that cities give more access to work and leisure opportunities, there’s something wrong. In fact, they damage our health. You only have to look at the architecture of many of the buildings. They’re like beehives facing each other, hardly getting any sunlight. Others look like concrete barricades standing next to roads and highways.

It doesn’t matter if they’re the more disadvantaged periphery areas or the richer central zones. In reality, every urban area is oppressive to the mind and body, either because of its high-stress load or its environmental and noise pollution. This affects each and every one of us, regardless of our status and social class.

However, cities symbolize the essence of progress and are often the most distinctive hallmark of a country’s development. For example, think of Tokyo, Seoul, London, Copenhagen, and Singapore. That said, beyond being the economic and cultural centers of the world, they contain another reality. That’s the fact that urbanized areas have higher levels of serious mental illness.

Why is this? What lies behind the fact that there are higher numbers of schizophrenia sufferers in a south London town than in the Pembrokeshire area of Wales, for example?

Depression appears equally in urban and rural areas. However, conditions like schizophrenia are more common in big cities.

Contaminated city favoring the appearance of paranoia and schizophrenia
Big cities increase stress. This factor can act as a trigger for more serious mental disorders.

Paranoia and schizophrenia in cities

It’s long been established that mental disorders such as paranoia and schizophrenia are more common in urban centers. Indeed, throughout the 20th century, experts have speculated that cities cause ‘madness’. Although this term is somewhat stigmatizing, there’s an explanation behind it.

The most serious mental conditions are far more frequent in cities. On the other hand, disorders such as anxiety and depression (more manageable) appear equally in those who live in the countryside, by the sea, or in the center of New Delhi. This phenomenon has long been of interest to the fields of psychiatry, psychology, and neuroscience.

Now, there are some answers to the puzzle.

According to various studies, green spaces could reduce the risk of psychosis thanks to lower levels of stress and pollution.

Cities, stress, and genetic predisposition

In 2019, the University of London (UK) conducted research that clarified this issue. It states that, to date, epidemiological studies have associated life in the city with a high risk of psychosis and schizophrenia. This data hasn’t changed over the years. One thing that they know about these conditions is that they have a genetic component.

As a matter of fact, it’s been demonstrated that the heritability of schizophrenia is around 50 percent. Therefore, someone with an immediate family member suffering from this condition has a risk ten times greater of developing it as compared to someone with no genetic history. That said, there are certain factors that can greatly increase the risk of developing this condition.

Stress acts as a trigger. It can activate the gene that predisposes individuals to paranoia and schizophrenia. As is well-known, cities and urban environments are settings in which the lifestyle takes on another rhythm. There are greater pressures, anxieties, and uncertainties. This means city dwellers suffer from an almost chronic stress that acts as a trigger for these mental disorders.

Loneliness in urban centers increases paranoid ideas

Schizophrenia sufferers experience loneliness and feelings of disconnection from their environments. Moreover, cities encourage and reinforce the perception of feeling alone in individuals from a really early age. No matter how bustling a society is and how many people live there, it seems that feelings of disconnection and isolation are recurrent.

Fabian Lamster and his colleagues, from the University of Marburg (Germany), conducted research that claims that feelings of loneliness are more evident in cities than in rural areas. When this feeling becomes constant, another one appears, that of mistrust. That’s because when people feel isolated from their environment, they tend to develop paranoid ideas.

Obviously, those who live in villages in the country aren’t exempt from loneliness. But it can happen. On the other hand, in large urban centers, loneliness rates are overwhelming. This feeling is devastating to the brain. It can also be a trigger for paranoia and schizophrenia.

It seems to be proven that living in a big city often aggravates mental discomfort. In fact, it appears to be the most dangerous recipe for the appearance of paranoia or psychosis.

Sad man sitting in bed suffering paranoia and schizophrenia
We’re feeling increasingly alone in cities which has a cost for our mental health.


Although it’s true that paranoia and schizophrenia are more common in cities, more data is required to explain this relationship. For example, we need to understand how pollution mediates the cause-effect relationship. Likewise, we need to know to what extent mental disorders are diagnosed in rural areas.

Be that as it may, it’s an undeniable fact that cities reduce our psychological health. As well as the air we breathe in large cities containing higher levels of CO2, stress, pressure, fear, and loneliness also adhere to us in a toxic way in them.

It’s clear that many areas need restructuring. For instance, our asphalt jungles need to become more natural and less concrete. Other highly relevant elements that we can’t ignore are the psychological and social aspects. We require more resources in terms of mental health. We must also strengthen our quality social ties to avoid isolation.

Many people leave their hometowns to look for better jobs in big cities. It hardly seems fair that, to carve out a future, they end up damaging their health. Change is most definitely needed.

All cited sources were thoroughly reviewed by our team to ensure their quality, reliability, currency, and validity. The bibliography of this article was considered reliable and of academic or scientific accuracy.

  • Fett AJ, Lemmers-Jansen ILJ, Krabbendam L. Psychosis and urbanicity: a review of the recent literature from epidemiology to neurourbanism. Curr Opin Psychiatry. 2019 May;32(3):232-241. doi: 10.1097/YCO.0000000000000486. PMID: 30724751; PMCID: PMC6493678.
  • Lamster F, Nittel C, Rief W, Mehl S, Lincoln T. The impact of loneliness on paranoia: An experimental approach. J Behav Ther Exp Psychiatry. 2017 Mar;54:51-57. doi: 10.1016/j.jbtep.2016.06.005. Epub 2016 Jun 21. PMID: 27362838.

This text is provided for informational purposes only and does not replace consultation with a professional. If in doubt, consult your specialist.