Dispelling a myth: developing world poverty, inequality, violence and social fragmentation are not good for outcome in schizophrenia

Abstract

The WHO multi-site studies of schizophrenia concluded that course and outcome of the disorder was better in developing countries. This has become psychiatric lore. However, the reality is that significant political, social and economic ills that characterize many countries in Africa, Latin America and Asia constitute psychosocial stressors that mediate strongly against better outcome in individuals living with this disorder. Outcome studies of schizophrenia in developing countries are reviewed and concepts of poverty, inequality and violence in relation to the course of the illness in this context are debated. The generally poor state of mental health services and policies in these regions are discussed. The belief that community and family life in the developing world is widely intact and that it provides a nurturing environment that facilitates recovery and promotes social and economic empowerment of seriously mentally ill individuals is dispelled as a myth. Idealisation of the under-developed South as a haven for schizophrenia sufferers will only add to the already heavy burden experienced by these individuals, their families and these societies in coping with this disabling disease.