Recovery From Schizophrenia: Psychiatry And Political Economy

THE POLITICAL ECONOMY OF SCHIZOPHRENIA 155Table 7.1 Percentage of patients with schizophrenia in different overall outcome groups inthe WHO International Pilot Studythe nine centers from among those patients applying for treatment during 1968and 1969. In seven of the centers (as mentioned in previous chapters) the patientsdiagnosed as suffering from schizophrenia were found to be essentially similar, butin Moscow and Washington, DC, the diagnosis of schizophrenia was distinctlybroader. At two-year follow-up the researchers were taken by surprise at themarked variability in the course and outcome of schizophrenia in the differentcenters. Patients in the developing world showed strikingly better results.Combining various factors, patients were categorized into five groupsaccording to overall outcome. As may be seen from Table 7.1, the best-outcomecategory includes 35 per cent of patients from centers in the Third World bycomparison with only 15 per cent from centers in the industrialized world. Thesepatients were suffering from psychosis for less than four months of the two-yearfollow-up period and developed a full remission with no social impairment. Thetwo best-outcome categories combined embrace 59 per cent of patients from thedeveloping world but only 39 per cent of those from industrial nations. Morethan a quarter of patients from the Developed World were in the worst-outcomecategory at follow-up, twice the proportion of those from the developing nations.These patients were suffering from psychosis for more than 18 months of thefollow-up period and were severely socially impaired. Nigeria and India, wherethe catchment areas were largely rural and most of the population was engaged inagriculture, recorded the best overall outcome. Urbanized Cali, whereunemployment was significant, showed somewhat less satisfactory outcome. InTaipei, the most industrially developed of the Third World centers and withserious levels of unemployment, the outcome was little better than in theindustrial West and less good than in Moscow. Although few patients in Moscowwere in the best-outcome group, a large proportion was in the best two groups