International studies conducted by the World Health Organization over the past three decades, have concluded that people with schizophrenia fare better over time in developing countries compared with industrialized nations. In the current issue of The New York Times Magazine, writer Ethan Watters has an article entitled The Americanization of Mental Illness, wherein he provides some interesting cross-cultural evidence of why this might be the case:
"…the anthropologist Juli McGruder from the University of Puget Sound spent years in Zanzibar studying families of schizophrenics. Though the population is predominantly Muslim, Swahili spirit-possession beliefs are still prevalent in the archipelago and commonly evoked to explain the actions of anyone violating social norms — from a sister lashing out at her brother to someone beset by psychotic delusions.
"McGruder found that far from being stigmatizing, these beliefs served certain useful functions. The beliefs prescribed a variety of socially accepted interventions and ministrations that kept the ill person bound to the family and kinship group. “Muslim and Swahili spirits are not exorcised in the Christian sense of casting out demons,” McGruder determined. “Rather they are coaxed with food and goods, feted with song and dance. They are placated, settled, reduced in malfeasance.” McGruder saw this approach in many small acts of kindness. She watched family members use saffron paste to write phrases from the Koran on the rims of drinking bowls so the ill person could literally imbibe the holy words. The spirit-possession beliefs had other unexpected benefits. Critically, the story allowed the person with schizophrenia a cleaner bill of health when the illness went into remission. An ill individual enjoying a time of relative mental health could, at least temporarily, retake his or her responsibilities in the kinship group. Since the illness was seen as the work of outside forces, it was understood as an affliction for the sufferer but not as an identity."
It's interesting to speculate about how these cultural practices influence the brain. In our fragmented Western culture, it seems that the best we can do for the schizophrenic brain is to provide psychoactive medications. Yet these other cross-cultural approaches seem to be more powerful in directing the course of the illness along favorable lines. Western rational scientists would perhaps call this "the placebo effect. " There's a kind of quiet denigration implied here. What it really is, is the organization of the entire culture (into a massive cultural placebo if you will), that serves to provide the positive context for healing. Unfortunately, we can't do controlled studies that have two matched groups of individuals with schizophrenia, one in an industrialized country, and the other in a developing country, because, as Watters points out in his article and his book Crazy Like Us, the Western model of mental illness has been exported to developing countries, and such a study would be skewed toward the Western rational viewpoint. The individuals in the developing countries cohort would still be viewed by western scientists through the lens of modern psychiatry.