CLINICAL HANDBOOK OF SCHIZOPHRENIA

CHAPTER 53SCHIZOPHRENIA INDEVELOPING COUNTRIESVIHANG N. VAHIAIPSIT V. VAHIADemographic projections in the year 2000 indicated that approximately 24.4 millionindividuals with schizophrenia live in undeveloped nations. Since the late 1960s, the issueof schizophrenia in the developing world has been a source of much study and debate. Inthe developing world, there is an intricate interplay among the biological illness, itsphenomenological manifestations, cultural interpretation of this illness, its contextualizationwithin society, and systems of care involved in its management. Moreover, researchfindings consistently indicate this affects outcome, and studies have consistently shownbetter outcome in the developing world. We aim to highlight this complex issue and itsimplications for the understanding and management of schizophrenia.THE NATURE OF SCHIZOPHRENIA ACROSS CULTURESThe Cross-Cultural Conflict in Systems of CareGlobalization of health care policies mandates that all member countries of the WorldHealth Organization (WHO) conform to a standardized pattern of curative, preventive,and epidemiological strategies. Health care guidelines are formulated along the theoriesof the allopathic or European system of care. Developing countries refer to this system ofmedicine as modern medicine, thus indicating that the “developing” countries have a parallelsystem of traditional medicine.Developing countries in India and South Asia, China and Far Eastern Asia, the MiddleEast, Latin and South America, and the Caribbean and Africa each have had a parallelstream of traditional health care that has retained its popularity despite the dominanceof allopathy in health education and policies. The traditional healers are the customarypractitioners of curative and preventive care. They continue to influence several treatment-relatedvariables, such as acceptance of care and outcome of the illness. The importanceof emotional and mental well-being is a part of the illness constructs and the healingprocess in these systems of medicine.549