Mentally ill do better in Third World than in West

Schizophrenia: High toll of stigma and lack of family network

GLENDA COOPER

People who suffer from schizophrenia in the Third World are twice as likely to recover as sufferers in the West, according to a report by the World Health Organisation.

Stigma and lack of strong family networks mean that only 15 per cent of schizophrenics in the West are likely to have made a good recovery from the first attack of their illness compared with 37 per cent of those in underdeveloped countries, Professor Julian Leff told the Royal College of Psychiatrists yesterday.

The college, in collaboration with the National Schizophrenia Fellowship (NSF), was launching a leaflet, Help is at Hand, which aims to educate the public about the disease. Some 250,000 people suffer from the illness in the United Kingdom.

No one knows what causes schizophrenia, a group of psychotic illnesses characterised by disturbed thinking, emotional reactions and behaviours. But there is a genetic link, with a child of a schizophrenic having a 12 per cent chance of also suffering.

Professor Leff, of the Institute of Psychiatry in London, told the RCP that whereas 14 per cent of schizophrenics in Dublin and 29 per cent of those in Nottingham would have a good outcome after two years, 51 per cent of those in Ibadan, Nigeria, and 54 per cent of those in Agra, north India, would recover. The worst affected places were Honolulu (3.5 per cent), Nagasaki (5.7 per cent) and Moscow (7.9).

"In the West, about one in four people recover very well from a first attack of the illness and remain well for many years. In non-Western countries the outcome is conspicuously better; about one in two people do well," Professor Leff said.

He said the outcome was better in the latter because of strong support networks, the opportunity to work and lack of stigma in areas where beliefs in witchcraft and karma mean the condition is accepted more easily.

"The large number of people in households [in developing countries] means that there is a network of people who can share the responsibility for the patient's care and recovery. There is a strong sense of duty and they all share the burden. In the West you are more likely to find a middle- aged person with schizophrenia being cared for by one carer and the burden of emotional and physical care falls on one person."

Cultures that avoid confrontation also worked in schizophrenics' favour. Other advan- tages were the lack of competitiveness and more opportunities for unskilled labour in agrarian economies. "Sufferers feel they are contributing to the economy and they feel valued."

Professor Leff called for more resources, particularly more community psychiatric nurses who could work with families and sufferers.

A schizophrenic who has attempted suicide and spent two and a half years of the last decade in hospital, called for a culture change among Britain's psychiatrists.

Janey Antoniou, 38, a molecular biologist, said: "I've found police and social workers will listen to me. But I believe there needs to be a culture change among psychiatrists and nurses, who are much harder to talk to."