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If schizophrenia is a biological disease, then why do schizophrenics fare better in nonindustrial countries where schizophrenia is not viewed as a chronic disease requiring treatment with medication?

Ben Hansen
Interlochen, Michigan

Answered by John Hsiao, M.D.:
Schizophrenia is considered an illness and antipsychotic medications are used for its treatment in every country in the world -- industrialized or nonindustrialized. While there are individuals or groups who deny the overwhelming scientific evidence that schizophrenia is a brain disease, or who do not accept using drugs to alleviate its symptoms, they are not part of the mainstream in any land.

This was not always the case. Until the 1970s, there was active debate about whether schizophrenia was a disease of the brain and whether it existed in every culture. To answer this, the World Health Organization (WHO) carried out a large multi-national study in the early 1970s, and found remarkably similar incidence and prevalence rates for schizophrenia at various centers around the world (i.e., schizophrenia exists in all cultures). Patients who participated in this and other WHO multi-national studies of schizophrenia were followed for extended periods and some of this follow-up data suggest that patients treated in developing nations have better social and vocational outcomes than patients treated in more developed nations. This difference in outcome may be an artifact of how patients were recruited and followed in different countries, but if "real," it may reflect less demanding lifestyles and more intact family and community support in developing nations.

[Read Bob Whitaker's response to a similar question.]

John Hsiao, M.D.

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