posted
Tom Cruise aside, there are some fascinating data coming out of a study on schizophrenia from the World Health Organization. The short version is this: The severity and even the persistence of schizophrenia is heavily influenced by culture, specifically the amount of social support for individuals within a culture. Recovery rates for schizophrenia appear to be higher in India and Nigeria than they are in the United States.
Predictably, none of this seems to help promote a useful discussion here on mental health. On one side, you've got the Tom Cruise types calling chemical imbalances a "myth." But the adherents of the medical framework for mental health issues are increasingly offering medication as the be-all and end-all in how conditions such as schizophrenia can be impacted at all.
quote: Psychiatrist Naren Wig crossed an open sewer, skirted a pond and, in the dusty haze of afternoon, saw something miraculous.
Krishna Devi, a woman he had treated years ago for schizophrenia, sat in a courtyard surrounded by religious pictures, exposed brick walls and drying laundry. Devi had stopped taking medication long ago, but her articulate speech and easy smile were eloquent testimony that she had recovered from the debilitating disease.
Few schizophrenia patients in the United States are so lucky, even after years of treatment. But Devi had hidden assets: a doting family and an embracing village that never excluded her from social events, family obligations and work.
Devi is a living reminder of a remarkable three-decade-long study by the World Health Organization -- one that many Western doctors initially refused to believe: People with schizophrenia, a deadly illness characterized by hallucinations, disorganized thinking and social withdrawal, typically do far better in poorer nations such as India, Nigeria and Colombia than in Denmark, England and the United States.
To make it crystal clear:
quote: "If you have a cardiovascular problem, I would prefer to be a citizen in Los Angeles than in India," said Benedetto Saraceno, director of the department of mental health and substance abuse at WHO's headquarters in Geneva. "If I had cancer, I would prefer to be treated in New York than in Iran. But if you have schizophrenia, I am not sure I would prefer to be treated in Los Angeles than in India."
that was kind of my (no doubt poorly expressed) point. I know more about Scientology than I want to and neither they nor Cruise is helpful in terms of furthering a discussion about the complexities of psychiatric labels and medication.
But this study opens a fascinating door on a critique of the way in which conditions such as schizophrenia are defined by medicine in this country.
And a cynical part of me thinks maybe some in psychiatry and in big pharma are grateful that people like Cruise help prevent serious discussions from taking place. Posts: 4344 | Registered: Mar 2003
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posted
I suspect that human will does play a major part in the progression of many mental illnesses (though it is far from the only factor). If people can despair, and voluntarily give in to their illnesses, making them worse, then I imagine it must also be possible to do the opposite — through positive, healthy experiences, encourage someone to have hope and voluntarily improve.
Again, this isn't the only factor by any means, and it certainly DOESN'T mean that people who suffer from mental illnesses are "to blame" for their misfortune, and neither are their families.
But it is comforting to know that at least in some cases, love, attention, and involvement in a community can make a positive difference.
Posts: 1539 | Registered: Jul 2004
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posted
You need only watch an edition of a game show featuring celebraties to realize how intelligent most of them are.
Then you gotta wonder why those celebraties who cant get past the $1,000 marker on "Who Wants to be a Millionairre" without the help others yelling answers at them then get press attention when they talk about politics and science.
Posts: 375 | Registered: Mar 2005
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posted
"Human will" is easy to say and agree with for me here, believing that humans have a spiritual component which controls their physical one... but what would materialists say is at work in these type of scenarios? (genuinely curious, not trying to make a point at all).
Posts: 3846 | Registered: Apr 2004
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quote:The thing is, just because chemical imbalances are influenced by culture doesn't mean they don't exist.
You don't get an argument from me on this. But, to play devil's advocate, there's a fair amount of rhetoric and literature coming out of the mental health arena that implies (or says outright) that medication is the only thing that impacts symptoms of schizophrenia.
And recovery isn't really acknowledged - at least on the scale reported in some of the countries cited in the article:
quote:The results were consistent -- and surprising. Patients in poorer countries spent fewer days in hospitals, were more likely to be employed and were more socially connected. Between half and two-thirds became symptom-free, whereas only about a third of patients from rich countries recovered to the same degree, Sartorius said.
Nigerian, Colombian and Indian patients also seemed less likely to suffer relapses and had longer periods of health between relapses. Doctors in poorer countries stopped drugs when patients became better -- whereas doctors in rich countries often required patients to take medication all their lives.
posted
This subject is still a little raw to me. I'll try to read the article tonight.
But one thing is clear - what we do in this country to treat schizophrenia doesn't work on the whole. I know some people here get effective treatment and recover to some at least some extent, but far, far too many simply drop through.
I think (for no scientific reason) that we haven't defined different types of schizophrenia at a sufficiently granular level to select from different treatment options. Whatever the reason is, radical changes are needed in diagnosis and treatment.
Posts: 26071 | Registered: Oct 2003
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When I read this article, my mind flashed back to one of the closing scenes in the movie "Awakenings," which was central to my first and only landmark post here on Hatrack.
Almost at the end of the movie, when the "miracle" of the awakenings have played themselves out and the "sleepers" return to their premedicated states, Dr. Malcolm Sayer addresses an audience:
quote: Dr Malcolm Sayer: What we do know is that, as the chemical window closed, another awakening took place; that the human spirit is more powerful than any drug - and THAT is what needs to be nourished: with work, play, friendship, family. THESE are the things that matter. This is what we'd forgotten - the simplest things.
quote: This subject is still a little raw to me. I'll try to read the article tonight.
Sorry, Dag (and Eve). I forgot.
The main thing is that this pertains to cultures, rather than an individual family. Cultures like our own and others in which schizophrenics don't fare as well are not family and community-centered any more. It's not an issue of individual families, but the culture itself.
Posts: 4344 | Registered: Mar 2003
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posted
No apology needed. And Eve specifically asked for more information, so I'll be sure to point her here.
One wonders what else family and community-centred cultures would affect.
The sad thing would be if these findings just can't be applied here because of the way we've demoted family and community in our lives.
Posts: 26071 | Registered: Oct 2003
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posted
In my opinion, proper treatment of schizophrenia requires a combination of medical and social assistance. There are chemical imbalances that can be addressed through pharmaceuticals as well as relief from some symptoms of the illness.
However, pharmacology without guided or uplifting social interaction probably won't make a permanent cure. Analysis is a part of the solution, but perhaps in those countries listed, the entire community is more supportive.
Heck, I don't know, but the human interaction factor in mental health has to be the most important part of it. We do learn of ourselves the most when we interact with others.
Posts: 2848 | Registered: Feb 2003
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posted
Perhaps it's not culture and love and acceptance at all, but just some environmental factor, like a chemical thing, that's present in the U.S. and absent in India that is making the difference. That seems far more plausible to me.
quote:Originally posted by Jim-Me: "Human will" is easy to say and agree with for me here, believing that humans have a spiritual component which controls their physical one... but what would materialists say is at work in these type of scenarios? (genuinely curious, not trying to make a point at all).
Well, if you wanted a totally deterministic answer, you could try to trace the firing of neurons at the quantum level. Such a description is possible in principle, but rather intractable mathematically. You might as well ask "What do materialists say is going on at the heart of a star"; the answer is similar in kind, but much more detailed.
A more appropriate high-level description would say that emotions and thoughts are emergent properties of sufficiently complex neural networks, and that there exists a pattern we identify as schizophrenia. Then, some patterns of thought, identified as 'upbeat', correlate with an end to the 'schizophrenia' pattern.
If you've ever played Conway's Life, you may find the following analogy fruitful. (If not, I encourage you to google it forthwith, it's fun!) Imagine two huge blobs of squares, marching across the field in opposite directions. They meet, weird struggles ensue, and the end result is a slightly bigger blob going off in a third direction. Now, you could go back to the game-of-life rules and explain this in terms of what happens to the squares; that's the neuron-level explanation, above. Conway's Life is usually simple enough that such an explanation is appropriate, or at least possible. Or you could say that the blobs are animals, and when they meet up, they fight, with the strongest winning and eating its rival. That's the high-level explanation. Here you've resorted to a concept, 'strength', that isn't really defined at the lower level; it's an emergent property of the system, like 'being upbeat'. But it's a useful shorthand, especially if you can identify some other tests of strength than just running the experiment. For upbeatness, we can usually tell without actually testing whether someone will recover from schizophrenia, hence it is a very useful high-level concept. For 'strength' in the game-of-life sense, we probably need to run the experiment, so that's not such a useful concept. (Though no doubt some poor CS grad is writing a thesis on other tests for strength at this very moment.)
The point is that at no time do you need to appeal to any outside force to explain why one animal wins. It is completely deterministic from game-of-life rules. But it's a useful shorthand to say that one animal is stronger, or one brain is more upbeat. The only difference is that the rules governing neurons are not completely understood, and the overall pattern is many orders of magnitude more complex than any game of life ever started. Hence the high-level concepts become even more useful, since we cannot, at the current state of the art, drop down to the basic rules to predict what will happen. This also means that means for identifying high-level concepts become more useful, such as 'Upbeat people smile a lot' rather than 'Upbeat people have thus-and-so an arrangement of neuron firings.' We don't have a recognition algorithm of the second form, so we're forced to rely on rules of thumb like the first.
It's late and I'm rambling. To summarise, schizophrenia is caused by chemical imbalances; some bodies or brains have a better chance of recovering their balance. Such brains are identifiable by their behaviour. No human spirit is required.
Posts: 10645 | Registered: Jul 2004
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posted
From my limited experience, I'm not surprised at all. Everyone I've worked with does better with real relationships, care, and affection. In some people, it's a difference between laying curled up in the corner of a room, and wandering the room with a smile and a sense of fun, depending on who was working a shift. I've seen people progress from completely non-verbal to expressiveness and singing, in adulthood, when their care situation changed. It's totally subjective, I know. I'm not saying my experiences make up a study in themselves, but for me, they corroborate what this WHO study is saying.
Yeah, and institutional setting isn't great. But most of the folks who are residents now, I think, are there not just for care, but because their families can't handle the stress. A village could provide that extended respite that would enable a person to remain among family. (In some cases, I realize not all.) Communities aren't like that around here in urban North America (and probably not in rural either), which is why we have so many respite and relief organizations.
I think there's soemthing important in this study. I hope it gets taken seriously, and more investigation is done. I hope the message eventually percolates down to the front-line workers in homes and institutions and hospitals. I can see it, slowly, already happening, if not so explicitly. Our training now isn't just "What do do if omeone has an episode" but also "getting to know the person and treating them caringly, and personally, helps prevent episodes". We're not all the way there yet, but I think things are changing slowly. Now we just need to get ready for one step further, perhaps.
Posts: 2849 | Registered: Feb 2002
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posted
KoM, that was admirably clear and succinct for the complexity of what you were trying to describe. Thanks.
Posts: 3846 | Registered: Apr 2004
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quote: Perhaps it's not culture and love and acceptance at all, but just some environmental factor, like a chemical thing, that's present in the U.S. and absent in India that is making the difference. That seems far more plausible to me.
That might hold if it just appled to India vs. the U.S.
But it doesn't.
Read the article - the cultural differences jump out. Looking for environmental issues is a stretch, considering the data so far.
This shouldn't be shocking at all, in fact. In my undergrad studies, it was fascinating how "learned helplessness" was addressed in very different ways in various psych classes.
In abnormal psychology, we learned how animals were conditioned through random and unavoidable electric shocks to produce a state called "learned helplessness," which was treated as an animal model for depression at the time.
In biological psychology, the conditioning experiments on animals were explained as a way of producing serotonin depletion in the animal - also an animal model of depression.
What was really interesting to me was that the biological psychology course never talked about the "deconditioning" of animals - done through behavioral manipulation - that seemed to restore the animals' ability to act for themselves.
It struck me even then (I took one of these courses right after the other) there was a fascinating suggestion that the biochemistry of the animals may have been restored to normal along with the behavior. But no course I took at the time addressed that. Posts: 4344 | Registered: Mar 2003
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posted
This is a very interesting topic, one I've looked at quite a bit in the past.
I think one of primary arguments for greater recovery rates in India and other non-Western cultures is that they are still "developing." In other words, its easier for someone diagnosed with schizophrenia to be productive in society if he's farming and crafting rather than as a civil engineer or coporate executive.
Another thing to consider with these cross-cultural studies is how they measure the number of patients. In the West, people are relatively more aware of mental illness and most places have a hospital with a psyiatric unit. Countries, like India and Sri Lanka (one of the earliest studies took place there) have few such facilities. And, most in the community do not access mental health services. It has been argued that these countries DO have the same numbers as the US and other western countries, they just don't go to the doctor to get diagnosed.
Posts: 1 | Registered: Jun 2005
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posted
I agree that we ought to focus on treating people with schizophrenia like human beings. They need human contact, love, and community as much as anyone else.
I don't, however, think that this is always the answer. I have depression. My family is loving and supportive, and I have had few major stressors in my life (and most of the big ones happened after I was diagnosed). My positive environment did nothing to prevent my depression. There are two things that I have found to be effective: antidepressants and sunlight. Most of the time I have to have both. Also, chocolate works for short-term relief. Having said this, though, I suppose that I would not have gotten better without a good environment. I don't see how anyone can heal mentally when they are rejected by the people around them, or when all control over their lives is taken away from them.
I guess what I'm trying to say is that we should aim for the best of both worlds. Twin studies seem to indicate a combination of genes and environment, since having an identical twin with schizophrenia significantly raises the risk (yet some people with a schizophrenic identical twin did not develop the disease). Link. We need to better understand the biochemistry of schizophrenia and other mental illnesses so that we can develop more effective drugs with fewer side effects. Of course the environment should be as positive as possible. But I'm not sure that this study indicates that we ought to be satisfied with the social approach, and I would be sad to see it used to justify an end to research on the biochemistry of schizophrenia. It may be that all this study demonstrates is that the drugs we have now don't work that well, rather than indicating that a good environment is an effective cure in many cases. I guess I'd have to see the actual study to know.
Anyhow, interesting article. Thanks for sharing it.
Posts: 3546 | Registered: Jul 2002
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posted
I was just recalling our discussion on ethnocentricity in the "Lions save kidnapped girl" thread. India was actually one culture I believe I pointed out as having particularly abhorrent marriage practices (in my view). Huh.
Posts: 2010 | Registered: Apr 2003
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speaking of sunlight as curing depression, I have found that gentle sungazing is effective, more so than just sunbathing alone. Within one hour of sunset or sunrise is usually safe, or simply looking near the midday sun, although plenty of people (including me) look straight at the midday sun. It's a good idea to take it slow in the beginning, and be very gentle.
Posts: 3354 | Registered: May 2005
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posted
steven, why are you staring diectly into the sun?? And why are we not surprised?
Before you start rambling on about some fringe science beliefs or stating that "many ancient cultures practiced sungazing" (as sungazing websites do), let me quote an eye doctor: "retinopathy produced by prolonged sungazing has been known since antiquity; this is a classic form of photochemical damage."
Solar retinopathy is no joke.
Light levels that can possibly cure or allieviate depression do not and should not involve looking directly into the sun. Indirect sunlight is fine for this.
Posts: 6316 | Registered: Jun 2003
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Sorry, Dag (and Eve). I forgot.
