Recovery From Schizophrenia: Psychiatry And Political Economy

Chapter 7Schizophrenia in the Third WorldSixteen billion dollars was spent on the treatment of schizophrenia in the UnitedStates in 1990 1 —about 0.3 per cent of the gross domestic product. This figureexcludes social security benefits paid to people with schizophrenia and otherindirect costs. Such a substantial investment should surely have yielded Americanssignificantly better rates of recovery than in less affluent parts of the world. Bycontrast, psychiatric care is very low on the list of priorities in developingcountries. Despite this fact, the evidence points overwhelmingly to much betteroutcome from schizophrenia in the Third World. It is worth looking at thisevidence in some detail.BRIEF PSYCHOSES IN THE THIRD WORLDThere are numerous reports that psychoses have a briefer duration in the ThirdWorld, and virtually none to indicate that such illnesses have a worse outcomeanywhere outside the Western world. Transitory delusional states (bouféesdélirantes) in Senegal, for example, with such schizophrenia-like features as“derealization, hallucinations, and ideas of reference dominated by themes ofpersecution and megalomania” 2 occasionally develop the classic, chronic courseof schizophrenia, but generally recover spontaneously within a short period of time.Acute paranoid reactions with a favorable course and outcome are common inthe Grande Kabylie of northern Algeria 3 and throughout East Africa. 4 Acutepsychotic episodes with high rates of spontaneous remission are frequent inNigeria, 5 and brief schizophrenia-like psychoses have been reported to accountfor four-fifths of the admissions to one psychiatric hospital in Uganda. 6Indistinguishable from schizophrenia, acute “fear and guilt psychoses” in Ghanamanifest hallucinations, inappropriate emotional reactions, grotesque delusionsand bizarre behavior. Under treatment at local healing shrines, such illnesses aregenerally cured within a week or so, although they may occasionally progress tochronic schizophrenia. 7 Doris Mayer, a psychiatrist, also found typicalschizophrenic states to be more readily reversible in the Tallensi of northernGhana. 8 Many more examples could be given of the prevalence of such briefpsychoses in Singapore, Papua and other developing countries. 9 “Acute, shortlasting psychoses,” according to Dr H.B.M. Murphy, a Canadian psychiatrist with