Recovery From Schizophrenia: Psychiatry And Political Economy

150 SCHIZOPHRENIA IN THE THIRD WORLDpatients than was reported for Europeans. His observations were made, however,on patients treated in what appears to have been a particularly traditional andrestrictive Western-style hospital setting, which we now know can have aprofoundly deteriorating effect on the course of schizophrenia. Only a handful ofpatients in his 1943 sample were ever discharged from hospital, and these onlyafter several months confinement. Those who were discharged were the patientswho “completely recovered”; ten years later they were still doing well at home.None of the patients who remained in hospital regained anything but anindifferent functioning level or worse. The patients in De Wet’s 1953 sample allreceived 15–30 electroconvulsive treatments and none “was discharged until twomonths after E.C.T. in order that sudden relapses did not take place at home.” 14Again the results were not good. By contrast, others who are familiar with theBantu have described excellent recovery from schizophrenia-like psychoses intheir own communities. 15 Dr De Wet’s report demonstrates what happens to theusually excellent course of schizophrenia in African villages when people with theillness are managed in a traditional European hospital setting. The report is notevidence, despite De Wet’s claims, of generally poor outcome from psychosisamong the Bantu.Another study that found poor outcome from schizophrenia in a Third Worldpeasant society came from psychiatrist Joseph Westermeyer. Dr Westermeyerpublished a series of articles on 35 people with psychosis whom he located in 27villages of Ventiane province, Laos. The cases were selected by asking villagers ifany of their neighbors were considered baa or insane. Nine of the subjects soidentified were rated as suffering from organic psychoses and 24 as havingfunctional psychoses, mostly schizophrenia. Only two teenagers were consideredto be no longer suffering from psychosis. The group of subjects was clearly veryactively disturbed; only two were working and only five were lucid enough toprovide useful information about themselves. Dr Westermeyer compared thecurrent functioning of these disturbed people with their pre-illness state andconcluded, not unreasonably, “that severe social dysfunction was associated withpsychosis in a peasant society.” 16 He went on to argue, however:These findings are in contrast to the social functioning of psychotic patientswho are receiving psychiatric care. Follow-up studies of psychotic personsreceiving psychiatric care in North America and Europe have shown thatmany return to economic productivity (about half of schizophrenics do so)and make a fair to good social adjustment. 17A problem with this conclusion is not difficult to detect. Dr Westermeyer wascomparing Lao cases who were, by virtue of the selection technique, currentlyhighly disturbed, with Westerners suffering from psychosis who were followed upsome time after their acute episode. Later in this chapter we shall see that manypeople suffering from psychosis in Third World societies are never labeled insane.Dr Westermeyer himself, in an earlier paper, emphasized that “folk criteria for