Recovery From Schizophrenia: Psychiatry And Political Economy

THE POLITICAL ECONOMY OF SCHIZOPHRENIA 149much research experience in cross-cultural psychiatry, “form a major part of allrecognized mental disorders…” in the Third World. 10NOT REALLY SCHIZOPHRENIABut are they schizophrenia? Some psychiatrists would argue that these acutepsychoses are indeed schizophrenia in view of the typical schizophrenic featuressuch as hallucinations, delusions, bizarre behavior and emotional disturbances.They would also point to the minority of cases, initially indistinguishable, whichdevelop the chronic schizophrenic picture. Others would deny that any briefpsychosis can be schizophrenia precisely because schizophrenia, by definition, is along-lasting illness. According to the American Psychiatric Association’s Diagnosticand Statistical Manual (DSM-IV), 11 a psychosis must last six months to be labeledschizophrenia. This is a terminological issue that must not be allowed to obscurethe point of logic. If schizophrenia has a more benign course in the developingworld (and there is considerable evidence to show that this is the case), then wemight well find many schizophrenia-like episodes in these societies that are of ashorter duration than six months. To argue that these are not schizophrenia is toprejudge the issue.Could these be cases of organic psychosis? Certainly, some could be. There is ahigh prevalence in Third World countries of trypanosomiasis, pellagra and relatedparasitic, nutritional and infectious disorders that may develop into psychoticstates. Malaria, in particular, is often associated with acute psychotic episodes. 12 Itis unlikely, however, that all brief episodes in the Third World are organic in origin.In conducting their social psychiatric survey of four aboriginal tribes in Taiwan,two psychiatrists, Hsien Rin and Tsung-Yi Lin, were particularly concerned aboutthe diagnosis of organic and functional psychoses. They carefully separatedschizophrenia from malarial psychosis, drug-induced psychosis and unclassifiablecases. Although skeptical at the outset of the study, after cross-checking theirinformation and cross-validating their diagnoses they were forced to concludethat psychoses in general, and schizophrenia in particular, had a particularlybenign course among these Formosan farmers and hunters. Of ten confirmedcases of schizophrenia only two had been active for more than two years and fivehad been ill for less than a year. 13 More recent data, presented below, from theWHO ten-country study confirm the impression that the superior outcome inThird World cases is not due to the inclusion of acute psychotic episodes of organicorigin.CONFLICTING REPORTSSome reports fail to show better outcome for schizophrenia and other psychosesin the Third World. They are relatively few and deserve a closer analysis. Dr J.DeWet, the assistant physician superintendent of a South African mental hospital,concluded that the recovery rate from schizophrenia was no greater in his Bantu