Recovery From Schizophrenia: Psychiatry And Political Economy

THE POLITICAL ECONOMY OF SCHIZOPHRENIA 151mental illness are determined primarily by the persistence of social dysfunctionalbehavior rather than by disturbances in thought and affect.” 18 People sufferingfrom psychosis but not disruptive were overlooked by this study, as well as thosewho were psychotic and who recovered. Drs Rin and Lin, in their communitysurvey, located subjects who had been psychotic previously and had become well.They found three times as many of these individuals as active cases. Rin and Lin’stechnique provided something close to lifetime prevalence data; Westermeyer,whose method detected only those who had been psychotic in the past year,provides period prevalence data. As Dr Westermeyer confirmed when questionedabout this issue, his method has “a built-in bias for prolonged cases.” 19 It gives usno indication of true recovery rates.Follow-up studies can give us a more definitive picture of recovery fromschizophrenia in the Third World. Several such reports are available, and onlytwo, the first two listed here, fail to reveal substantially better recovery rates forpeople with schizophrenia in the developing world.Chandigarh, IndiaDrs P.Kulhara and N.N.Wig, British-trained psychiatrists, reported that theoutcome for patients with schizophrenia treated by the Department of Psychiatryin the Postgraduate Institute of Medical Education and Research of Chandigarh,India, was no better than for similar patients in a previous study in London. 20Modern inpatient and outpatient services were offered to the Indian patientsadmitted in 1966 and 1967 and followed up four to six years later. A criticism ofthis study is that of 174 cases admitted, only 100 could be found for follow-up.These included, of course, all the patients who remained in hospital but excludedthose who had moved away and others who might have been expected to show agood outcome. 21 This problem may explain why these researchers reported amuch less impressive recovery rate for India than that found in the WHO studyto be described later.Sichuan, ChinaChinese researchers attempted to identify all the people with schizophrenia whohad never received any treatment in a rural county of Sichuan, China, in 1994,offered them treatment, and evaluated them again two years later. Of the 510people they identified, only six per cent took antipsychotic medication, and 31per cent received no treatment at all. The remainder were treated by traditionalChinese healers. Thirty-eight per cent of the group progressed to complete orpartial remission of symptoms and the remainder continued to suffer from markedsymptoms of the illness. It was striking, however, that more than three-quartersof the total group were working full-time or part-time at follow-up. The reasonthat overall outcome was not better for this group is probably because it was apoint prevalence sample, not an incidence sample (see Chapter 9). That is, the sample