[spiritual_emergency]

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The Many Mysteries Of Schizophrenia And Culture

Over the last few days, I have bumped into several interesting items concerning schizophrenia and culture. An article this week in the Washington Post which examined, post-Cho, problems faced by many immigrants in the DC-area with mental illness, especially schizophrenia. One of the big takeaways is that cultural barriers prevent immigrants from getting properly medicated American style. Nice simplistic thesis, especially in light of an article in the same paper two years ago by Shankar Vedantam, examining why schizophrenics in India do so much better than schizophrenics in the US and other developed countries, but which the present reporter fails to mention or account for in her piece. Nice 'dissing of your colleague! Wouldn't it be kind of interesting to ask about that little socio-cultural dynamic?

Whatever the case in the US, the fact remains that schizophrenics do much, much better in lesser-developed countries than in glossy high-tech ones. Which brings me to a fascinating book review in the current American Journal of Psychiatry. Thus:

<blockquote>"Outcome from schizophrenia is routinely better in developing world settings, and this difference becomes apparent during the initial 2 years of illness. But even for developing world patients with a poor early course, outcome is superior to that of developed world patients with an equivalent early course. Employment rates are substantially greater for developing world subjects, and some authors have attributed this to the freedom from the economic disincentives to employment that can accompany the provision of disability benefits in the industrial world. The editors, who include a well regarded medical anthropologist, are cautious about attributing the improved developing world outcomes to specific cultural factors. Shantytowns may not be ideal "communities of recovery," they point out, and extended families can be tyrannical as well as supportive. They conclude, however, that family involvement may be a key positive factor. They point to "the extraordinary engagement of Indian families in the course of treatment," coupled with low criticism and reduced demands. They also point to a startling difference in one component of social inclusion. Nearly three-quarters of Indian subjects with schizophrenia were married at follow-up, compared with about one-third of people with the illness in the developed world centers."</blockquote>
Well, lift the scales from my eyes. Looks like this op-ed Robert Whitaker penned in USA Today five years ago was dead on. And, it sure makes the Hearing Voices Network people look like geniuses. I don't really have any good answers for why folks do better in other countries than in the US, aside from families and support systems, but we are clearly doing something wrong in this country when most schizophrenics continue to see a lifetime of repeated psychosis, unemployment, rejection by families and friends, and the hard fist of the streets...

Source: The Many Mysteries of Schizophrenia &amp; Culture</blockquote>

[pachyderm]

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spiritual_emergency said:
<blockquote>
The Many Mysteries Of Schizophrenia And Culture

Over the last few days, I have bumped into several interesting items concerning schizophrenia and culture. An article this week in the Washington Post which examined, post-Cho, problems faced by many immigrants in the DC-area with mental illness, especially schizophrenia. One of the big takeaways is that cultural barriers prevent immigrants from getting properly medicated American style. Nice simplistic thesis, especially in light of an article in the same paper two years ago by Shankar Vedantam, examining why schizophrenics in India do so much better than schizophrenics in the US and other developed countries, but which the present reporter fails to mention or account for in her piece. Nice 'dissing of your colleague! Wouldn't it be kind of interesting to ask about that little socio-cultural dynamic?

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Did you relate your concerns to the piece's author? I have found it difficult to find ways of communicating with the authors of various pieces that have interested me. Maybe they feel overwhelmed with queries from "nuts" (like us).
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we are clearly doing something wrong in this country when most schizophrenics continue to see a lifetime of repeated psychosis, unemployment, rejection by families and friends, and the hard fist of the streets...

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II know someone now who has been diagnosed as schizophrenic (he says he hears voices) and has accepted that his case is "hopeless" and that he will have to take medications for the rest of his life. He is sometimes angry about it but believes nothing can be done. Any hint to the contrary naturally makes him anxious because it shakes the acceptance that he has won with such difficulty.

[spiritual_emergency]

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pachyderm: Did you relate your concerns to the piece's author? I have found it difficult to find ways of communicating with the authors of various pieces that have interested me. Maybe they feel overwhelmed with queries from "nuts" (like us).

For the sake of clarification, I'm not the author. If you follow the source link it leads to the blog of Furious Seasons, authored by a fellow named Philip Dawdy. However, I have contacted various authors whose online work I have admired -- Maureen Roberts, Anne Baring, David Lukoff and Michael O'Callaghan are a few that come to mind. Mind you, I wrote those individuals to express my gratitude for what they had written, done or created, and let them know that it was helpful to me. Each of those individuals was kind enough to write back although that usually entailed the extent of our correspondence. I imagine it might have been briefer yet if I'd been critical.

II know someone now who has been diagnosed as schizophrenic (he says he hears voices) and has accepted that his case is "hopeless" and that he will have to take medications for the rest of his life. He is sometimes angry about it but believes nothing can be done. Any hint to the contrary naturally makes him anxious because it shakes the acceptance that he has won with such difficulty.

I've encountered a lot of anger myself when I attempt to tell others that many people recover fully and completely from schizophrenia. As you note, it shakes up one's belief structure and that can be perceived as deeply threatening, whether you're a "professional" or a "patient". Like you, I have also met some individuals who insist that they will never get better and they must take medication for the rest of their life. This is what they have been told, this is what they have come to accept, and this is what they have come to believe. I've met others however, who were eager for knowledge and to explore their own potential for healing.

Ultimately, although those outside of one's personal experience can come up with a number of definitions of what recovery is, real recovery must be both self-defined and self-initiated. It is unfortunate that so many individuals in this culture have received and internalized the message of hopelessness that is often passed to them. I suppose this is why I keep pushing the message that recovery is possible for many. I respect that others have the right to reject that message, but there are also many people out there who have never had the option of hearing it.

I certainly do agree with Philip Dawdy in his assessment that we're doing something wrong in this culture but I'm not holding my breath waiting for psychiatry to fix what's wrong with it. I think if people want to get well in this culture they're going to have to educate themselves and create for themselves what has worked for others. That means learning from those who can actually produce recovery, not chronicity.

See also: Voices of Recovery

[pachyderm]

> I certainly do agree with Philip Dawdy in his assessment that we're
> doing something wrong in this culture but I'm not holding my breath
> waiting for psychiatry to fix what's wrong with it.

I am aware that I want/need/think I need that psychiatry change. It's for their own good, after all... And if no one points out their errors, will they ever change?

However, I am coming to a point of trying to work more on my own, believing that trying to change others is not very productive.

[spiritual_emergency]

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pachyderm: I am aware that I want/need/think I need that psychiatry change. It's for their own good, after all... And if no one points out their errors, will they ever change?

I could hardly claim to not be critical of psychiatry, in spite of which, I have a blog filled to the rim with quotes from psychiatrists and psychologists I sincerely admire. Overall, I think psychiatry has failed "schizophrenics" in this culture but that doesn't mean all psychiatrists/psychologists have failed -- a rare few have genuine insight into what is most helpful, and it's those rare few who are producing recovery. It's not enough to be "anti-psychiatry" but it's certainly beneficial to be "highly discriminating" which is another way of saying, "be choosy" about who you work with. If "schizophrenia" is what you're dealing with, there's little point in seeing a marriage counselor or heart specialist. There also may not be any point in seeing a psychiatrist. Psychiatrists treat with drugs and the individuals who are producing the best results in terms of recovery (80-85%) relied most heavily on talk therapy.

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Mosher points out that the kind of therapy dispensed at Soteria House differed profoundly from the work that went on at the famous Chestnut Lodge psychiatric hospital in the '50s and '60s. There psychiatrists had tried to cure patients with traditional Freudian-style psychotherapy. "I'm fond of saying psychosis does not fit the 50-minute hour -- because it goes on 24 hours," Mosher says. "So you ought to conform your treatment to fit the problem." Rather than scheduling specific sessions with their charges, the Soteria staff members made a commitment to be available every moment of the schizophrenic residents' waking hours. Mosher says the overall feeling had much in common with the "moral treatment" asylums that appeared in America in the first half of the 1800s.

Source: Still Crazy After All These Years

See also:
[*] Dialogue is the Change: Dr. Jaakko Seikkula[*] Diabasis: Dr. John Weir Perry[*] Schizophrenia &amp; Psychotherapy: Dr. Bertam Karon[*] Learning From Northern Europe: Dr. Daniel Fisher[*] The Experience of Schizophrenia: Dr. R.D. Laing


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However, I am coming to a point of trying to work more on my own, believing that trying to change others is not very productive.

I've come to accept that I can't change others. It's possible that something I say or do might cause them to change but this will only be true if somewhere, they agree with me already. Therefore, my actions haven't produced change, they have, at best, brought to the surface a form of agreement.

Nonetheless, I keep putting the information out there because those who go searching for programs that were offered by the likes of Loren Mosher, John Weir Perry and Jaakko Seikkula are going to find that they're not available. It's possible that in the years to come, psychiatry (if it can lose its addiction to big pharma) actually will change its tune, but that's not going to help the people who are suffering today. Those people will need to create for themselves what psychiatry is incapable of doing for them.