Juanson World

Last week, in the wake of cult member Tom Cruise's disturbing comments about psychiatry, I came across a fascinating article in the Washington Post about a World Health Organization study on schizophrenia. The study, which was initially conducted in the 1970s and then repeated over a thirty year span, found that schizophrenia patients in poor Third World nations such as India did much better than in the US because of the family support and social networks that exist in the poorer countries:

In all, the study tracked about 3,300 patients, Sartorius said, and 30-year follow-ups confirmed the initial trends. The study spanned a dozen countries -- capitalist and communist, eastern and western, northern and southern, large and small, rich and poor.

The results were consistent -- and surprising. Patients in poorer countries spent fewer days in hospitals, were more likely to be employed and were more socially connected. Between half and two-thirds became symptom-free, whereas only about a third of patients from rich countries recovered to the same degree, Sartorius said.

Nigerian, Colombian and Indian patients also seemed less likely to suffer relapses and had longer periods of health between relapses. Doctors in poorer countries stopped drugs when patients became better -- whereas doctors in rich countries often required patients to take medication all their lives.

The reason for these surprising results? Cultural differences that led to different approaches to treatment:

Most people with schizophrenia in India live with their families or other social networks -- in sharp contrast to the United States, where most patients are homeless, in group homes or on their own, in psychiatric facilities or in jail. Many Indian patients are given low-stress jobs by a culture that values social connectedness over productivity; patients in the United States are usually excluded from regular workplaces.

Indian families sit in on doctor-patient discussions because families are considered central to the problem and the solution. In America, doctor-patient conversations are confidential -- and psychiatrists primarily focus on brain chemistry.

Thus, schizophrenics in India, Nigeria and Colombia are more likely to end up living productive lives within mainstream society, instead of being ostracized and sent to mental institutions.

Findings such as these, which demonstrate that social factors have just as much to do with recovery as psychosomatic drugs, could be interpreted as a threat to large pharmaceutical companies in the developed world. However, I see successful treatment of illnesses such as schizophrenia as a healthy combination of medication and therapy, which by extension includes family and societal support. What can we learn from the developing world?

First of all, mental illness in the US has not reached the point where it can be discussed freely and openly. Most of us know someone who has dealt with depression, but these cases are usually kept private and there is a lack of education and awareness. I can cite two well-known examples from football: Barret Robbins of the Oakland Raiders and Wyatt Sexton of FSU. Both players suffered from manic episodes stemming from bipolar disorder, and in both cases, media attention focused on their bizarre behavior rather than the fact that both suffered from bipolar disorder, which affects an estimated 2 million Americans (with many more cases undiagnosed). In these cases and others, the person with the illness is portrayed as being at fault for not "taking their medication," as if that is the cure-all. Tom Cruise's repulsive comments only serve to further alienate patients.

While I don't think that American culture will fully evolve such that family ties are as strong as in Latin America, for example, education is needed so that public perceptions on mental illness can be changed. Only then will family and community members be able to accept and support the millions of Americans suffering from treatable mental illnesses.