Schizophrenia outcome, as measured with a number of assessment instruments, has consistently been found to be better in so called third world communities [1-5]. Apparently, the course of change of a developing country into the industrial model seems to worsen the prognosis of schizophrenic patients overall [6]. The use of psychotropic medication has been ruled out as a factor [7-9].
Many explanations purported for these findings range from internal flaws of the methodology used for all the studies to a hypothetical diagnostic and treatment bias in the industrial world towards more severe cases. Actually, some articles question the initial results [10, 11]. Denial is usually an initial response when research results do not match commonly accepted opinions. It is a normal reaction.
A few workers dare to mention the cultural fabric of the patients’ community as a crucial factor [12]. In this vein, it is worth mentioning the encouraging results on a group of patients who availed themselves of a traditional resource in India [13, 14]. All this reminds me of Fritz Schumacher‘s ideas . In a highly technological society like ours, we tend to overlook the subtle cultural nuances that may work for or against us during the healing process. Maybe, in the long run, ethical and spiritual values may weigh more than the drug in fashion at the time.
References:
1. Mathews, M., B. Basil, and M. Mathews, Better outcomes for schizophrenia in non-Western countries. Psychiatr Serv, 2006. 57(1): p. 143-4.
2. Kulhara, P. and S. Chakrabarti, Culture and schizophrenia and other psychotic disorders. Psychiatr Clin North Am, 2001. 24(3): p. 449-64.
3. Jablensky, A., Epidemiology of schizophrenia: the global burden of disease and disability. Eur Arch Psychiatry Clin Neurosci, 2000. 250(6): p. 274-85.
4. Davidson, L. and T.H. McGlashan, The varied outcomes of schizophrenia. Can J Psychiatry, 1997. 42(1): p. 34-43.
5. Kendell, R.E., Long-term followup studies: a commentary. Schizophr Bull, 1988. 14(4): p. 663-7.
6. Douki, S., et al., [Schizophrenia and culture: reality and perspectives based on the Tunisian experience]. Encephale, 2007. 33(1): p. 21-9.
7. Kurihara, T., et al., Clinical outcome of patients with schizophrenia without maintenance treatment in a nonindustrialized society. Schizophr Bull, 2002. 28(3): p. 515-24.
8. Srinivasan, T.N., S. Rajkumar, and R. Padmavathi, Initiating care for untreated schizophrenia patients and results of one year follow-up. Int J Soc Psychiatry, 2001. 47(2): p. 73-80.
9. Srinivasa Murthy, R., et al., Community outreach for untreated schizophrenia in rural India: a follow-up study of symptoms, disability, family burden and costs. Psychol Med, 2005. 35(3): p. 341-51.
10. Cohen, A., et al., Questioning an axiom: better prognosis for schizophrenia in the developing world? Schizophr Bull, 2008. 34(2): p. 229-44.
11. Patel, V., et al., Is the outcome of schizophrenia really better in developing countries? Rev Bras Psiquiatr, 2006. 28(2): p. 149-52.
12. Luhrmann, T.M., Social defeat and the culture of chronicity: or, why schizophrenia does so well over there and so badly here. Cult Med Psychiatry, 2007. 31(2): p. 135-72.
13. Halliburton, M., The importance of a pleasant process of treatment: lessons on healing from South India. Cult Med Psychiatry, 2003. 27(2): p. 161-86.
14. Raguram, R., et al., Traditional community resources for mental health: a report of temple healing from India. Bmj, 2002. 325(7354): p. 38-40.
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