Recovery From Schizophrenia: Psychiatry And Political Economy

152 SCHIZOPHRENIA IN THE THIRD WORLDencompassed all the cases of the illness that existed in the community at a singlepoint in time—including those who had been ill for years (who would have beenin the majority) as well as those who had fallen ill recently. Most of the outcomestudies we examined in Chapter 3 were, in contrast, of people who had just beenadmitted to hospital for the first time. The outcome for such first-time admissionswill be much better on average than for those who have been ill for a long time.A prevalence sample of the type selected in Sichuan will contain many morepeople who have failed to recover and who will have a poor outcome at followup.22Two Indian studiesThe different outcomes to be expected from incidence and point prevalencestudies may be illustrated by two reports from India. One study, conducted atseveral sites, recruited people with schizophrenia at first contact with a mentalhealth facility. Most of these people had been ill for less than a year. In this group,nearly 60 per cent were completely recovered after one year and three-quartersshowed no continuing social impairment. 23 The second study selected peoplewith never-treated long-term schizophrenia detected by a door-to-door survey in the cityof Chennai in southern India. 24 Less than 30 per cent of this group recoveredcompletely after one year of treatment and two-thirds showed no socialimpairment. By Western standards the results are good for both groups.MauritiusA follow-up study of African and Indian people with schizophrenia 12 years aftertheir first admission to hospital was carried out in Mauritius, an island in theIndian Ocean, by the Canadian social psychiatrist Dr H.B.M.Murphy and thesuperintendent of the hospital, Dr A.C.Raman. They found that, although theincidence of schizophrenia was close to the British rate, the recovery rate wasoutstandingly better. Sixty-four per cent of the patients had maintained acomplete, symptom-free recovery, and over 70 per cent were functioningindependently. The patients were initially treated in hospital without the use ofantipsychotic drugs. Strenuous efforts were made to trace as many as possible forfollow-up, with the result that all but two per cent were found. 25Sri LankaVery similar results were obtained in Sri Lanka by anthropologist Nancy Waxler,who followed up patients five years after their first admission to hospital in 1970with schizophrenic episodes. Some of these patients had been ill for as long as fiveor ten years before admission. Most of the sample came from rural areas, generallyfrom families of farmers and laborers. All but one of the 44 patients withschizophrenia were traced. At follow-up, 45 per cent of the patients reported no