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Question:
Bob Whitaker: In response to a question online, you mentioned the "World Health Organization has twice found that outcomes for people with schizophrenia are much better in the poor countries of the world, like India, Nigeria and Colombia, than in the U.S. and other "developed" countries. And in those poor countries, the WHO reported, only 16% of patients are routinely maintained on antipsychotic medications."

I am very interested in this as my 29 year old son does not take medication, and after this many years I suspect he may never. What are these countries doing to help people live with this illness? Can you direct me to any articles where I might read up on this? Thank you.

M.L.C.
Orlando, Florida


Answered by Robert Whitaker:
One writer who addresses this question in some depth is Richard Warner, in his 1985 book, Recovery from Schizophrenia. He looked at the results of the first World Health Organization (WHO) study, and has a chapter titled "Schizophrenia in the Third World" that explores this issue. Among other things, he concluded that in the poor countries people with schizophrenia are less likely to be treated in a way that isolates them. They are much more likely to return to work, and work, he argues, provides its own therapeutic benefit. (His book also provides a number of citations on this topic.)

On an anecdotal level, I have talked to people who live in the northern part of Cameroon, and there -- or so I'm told -- they don't conceive of "madness" as a permanent illness or disease. They see it as more of an acute illness and thus expect that many people will recover and get on with their lives. And interestingly, whereas they recognize the benefits of Western medicine for infectious diseases, and will go to hospitals for such treatment, they prefer to go to their own medicine men, loosely known as "Curers of the Sickheads," for treatment for "madness." Traditional remedies may include herbal concoctions and various rituals for driving out the demons. But just as Warner found, what seems to be most important is that the mentally ill are not cut off from the community. They retain social roles, and the society at large is also fairly tolerant of behavior that may be strange, different, etc.

I think your question raises an obvious need. Given that the WHO twice found that outcomes are better in the developing countries, it would seem that we should be studying what they are doing so that we could learn from their success, and seek to emulate it in some manner.


Robert Whitaker


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