Is Mental Illness Cultural?
Researchers have long sought to understand what may be the most perplexing finding in the cross-cultural study of mental illness: people with schizophrenia in developing countries appear to fare better over time than those living in industrialized nations.
This was the startling result of three large international studies carried out by the World Health Organization over the course of 30 years, starting in the early 1970s. The research showed that patients outside the United States and Europe had significantly lower relapse rates — as much as two-thirds lower in one follow-up study. These findings have been widely discussed and debated in part because of their obvious incongruity: the regions of the world with the most resources to devote to the illness — the best technology, the cutting-edge medicines and the best-financed academic and private-research institutions — had the most troubled and socially marginalized patients.
Full report from The New York Times Magazine on the Americanization of mental illness.
Very weird.
It’s hard to believe that schizophrenia recovery/suffering could be cultural.
Every year the incidence of people who theoretically fall into the autism spectrum disorder rises. I’ve often wondered if it isn’t because we live in a complex society with increasingly complex jobs, skill sets and social interactions. The degree to which you are “normal” versus autistic might have made less difference when your primary job was growing corn and tending farm animals on a subsistence farm in the 1800s. Yet, it undoubtedly makes a huge difference in an urban environment where workers must interact with customers, venders, coworkers, landlords, utility companies, etc.
Might this explain some of the difference in mental illness relapse rates between developed and undeveloped countries? Also, I suspect that reported relapse rates (and probably diagnosis rates) would be correlated with the resources at hand. It makes little sense for officials in less-developed societies to look for problems that they do not have the resources to fix.
No, it probably isn’t cultural and there really isn’t much evidence that people with schizophrenia do better in developing countries, unless you consider a trans-national sample of 807 people, just 76 percent of the initial cohort for a disease in which suicide is a major problem, definitive.
Cohen et al. say, in a 2008 paper, that that “Outcomes varied across the studies and the evidence suggests a need to reexamine the conclusions of the WHO studies. Additionally, assessments of outcomes should take excess mortality and suicide into account.”
Furthermore, schizophrena incidence seems to vary with latitude. If incidence really does vary by latitude rather than some unknown confounding factor, then the differences in incidence with latitude may mean, as Kinney et al. put it in the abstract of a 2009 paper, that “schizophrenia-producing environmental factors associated with higher latitude may be so powerful they overwhelm protective effects of better healthcare in industrialized countries.”
Sometimes it is wiser not to believe what you read in the newspapers.
Yes, a dominate culture of organized psychiatry decides who will be called “schizophrenic”. The culture of this industry says that only solution for treating people who are expressing extreme emotions or annying behavior is to drug or shock us. I know hundreds of people who recovered from their problems by avoiding or escaping from the cruel and costly methods used on vulnerable and powerless people.