Perhaps worth reading for the mods

Although I do agree with those of us taking a pro-med stance, I would also not like us to close our eyes to serious research that is around just because of that. I have always valued this community because of its valuation of scientific research, legitimate sources and all that. I would be disappointed to see that change. WHO seems a legitimate source to me:

A substantial body of evidence shows a more benign course and better outcome in developing countries. This observation, which has been one of the more striking conclusions of WHO studies, has been strengthened by prospective studies with long follow-up carefully conducted in Colombia and India (León, 1989; Thara et al., 1996). This undoubtedly means that environment plays a crucial role as an outcome determinant in schizophrenia. The factors that underlie higher improvement rates in developing countries, however, remain ill-defined, although better tolerance of the sick role, availability of suitable jobs, supportive family attitudes and extended family networks have been suggested as explanations (Leff et al., 1987; Leff et al., 1992; El-Islam, 1982).

Although generally worse than in developing countries, the outcome of schizophrenia in industrialized countries appears nevertheless better than previously described by classical psychiatry. Shepherd et al. (1989) reported the following five-year outcome data for a sample of first admission patients from a defined population in England: 22% had one episode with full remission, 35% several episodes with minimal impairment between episodes, 8% several episodes with continuous impairment, and 35% several episodes with increasing impairment.

http://www.who.int/mental_health/media/en/55.pdf, page 8 of the internal numbering, 15 of the pdf.

Now my take is that since I don’t live in the third world, and am not planning to move there either, nothing really follows from it for me. My best chances in the environment where I live are the medications.

aeon.co is not. It’s one of those sites pitching the Spiritual Emergency crap. They occasionally post something with scientific merit (when it agrees with their bumpf), but it’s a “stopped clock is right twice a day” type of thing.

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Yes of course, and it’s good to point that out, and perhaps close threads relying on those kind of sources. But I was a bit shocked to see a thread closed solely by reason of a mod not believing a pretty well established fact. Perhaps there were other reasons too. Perhaps it doesn’t matter that much effectively. But still when it comes to factual matters I always appreciate when these are settled by referencing legitimate sources and not a gut feeling.

that’s not true. The inner cities are the most underserved of any,

that’s why you’re not getting reporting.

I’d seen this, @flybottle, it’s pretty interesting. I’d made my own conclusions (which I’m not writing up and disseminating as fact) that the availability of options to support yourself if you’re experiencing paychosis plays a big role in people’s ability to remain integrated in their society. The lack of access to meds here, as you noted, doesn’t improve the prognosis, so that isn’t the best guess for what the difference is overall.

Honestly, though, I gotta say that stating that antipsychotics are the equivalent of painkillers and do more harm than good and then linking to a site like aeon to back it up is pretty much guaranteed to get your thread locked here, especially if you’d been pushing this view strongly but less explicitly in numerous threads over the past few days.

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Honestly, @flybottle, it wasn’t so much the content of the study, but that poster likes to make anti-med threads and also take everyone down with him. I don’t regret closing the thread.

And, there’s a significant difference between life in developed countries and life in third world countries for the mentally ill. First, if people even had the kind of access to meds in third world countries like we do in first world countries, things would be a lot different. Second, the types of hospitalizations and stigma that happens in third world countries scare the hell out of me, I don’t believe for one second it’s easier to recover in third world countries than it is in first world countries. Third, there’s a lot of studies out there, I take everyone of them with a grain of salt.

http://www.psychiatrictimes.com/articles/mental-health-care-developing-world says:

The WHO also launched a new worldwide effort called Project Atlas to catalogue mental health resources around the world. In its initial survey, the project found that, of the countries it surveyed:

41% have no mental health policy.
25% have no legislation on mental health.
28% have no separate budget for mental health.
41% do not have treatment facilities for severe mental disorders in primary health care.
37% have no community health care facilities.
About 65% of the beds for mental health care are in mental hospitals.

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Eats popcorn time…

Yeah I’m not saying you should regret that or anything like that. As said, there may very well be/have been other reasons for doing so. Just saying I was surprised by the reasons you gave for it. But then again, maybe the reasons for acting such or such don’t matter, and it’s all about the effects, I don’t know.

As regarding the last point… I’m not so sure. I like to believe there is information out there that I can safely rely on. I am in no position to verify such matters for myself, such that I will have to rely on others to have done so properly for me. I simply cannot suspend judgment on everything, and I will readily admit that I place my trust in such institutions as the WHO on reputation solely… what else? Even in case there are conflicting studies out there, of which I am not too sure in this particular case, what should be the criterion on which to base our trust?

I would be interested to see studies saying recovery rates aren’t (in general) better in the developing countries. For I have the impression that this really is, and has been for quite some time, a well established fact, and sometimes is considered a painful one for that matter. If it weren’t the case, that would seem to fit my pro-med stance better also. It would seem so. But as can, or rather cannot be implied from the quote of the WHO study that I do trust, and as @Rhubot made explicit, this isn’t directly an issue of (no-)medication. Indeed, like you say, life is very different in such places of the world, hence the expectations that it is these environmental factors that are responsible for the better prognosis in such countries. Perhaps it could be said these people have a better chance of recovering despite the absence of medication, rather than because of it. If so, these figures may most of all play a role in arguing for more comprehensive care, rather than in discussions about abandoning medication.

I am not sure what you intend with the figures? That a lot can be done about mental health in those countries? The more the better, I would say, but it makes the recovery rates even more impressive to me.

You should read the rest of the article, it is a study from WHO, and it states the reality of mental health in developing countries.

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I can only read the first page, the rest is behind a paywall, unfortunately.

No, the registration is free.

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Eats more popcorn…

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On the third page it states:

Schizophrenia affects an estimated 33 million people in developing countries, with an average lifetime risk of about 1%. But, the study noted, “The social and economic costs of schizophrenia are disproportionately high relative to its incidence and prevalence…In terms of DALYs [disability adjusted life years], predicted demographic trends include more than a 50 percent increase in the disease burden attributable to schizophrenia in developing countries, a burden approaching that of malaria and nutritional deficiency.”

In both developed and developing countries, the burden of schizophrenia includes a high degree of stigmatization and social rejection. “Many schizophrenic patients end up on the streets or in the criminal justice system and are exposed to abuse, even in psychiatric hospitals.”

continues on the fourth page:

While many patients with schizophrenia respond to treatment, the authors found that relatively few developing countries are taking steps to provide care. “It is estimated that in 1990, over 67 percent of all persons with schizophrenia in developing countries [estimated at 17.2 million] were not receiving any treatment, and there is no evidence that the proportion of treated persons is increasing.”

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Thanks for that. Makes it all the more pressing it seems to me, if prognosis is better even when access to professional care is rare.

I’m not sure is better, it’s what I’m saying, I’ve seen a lot of documentaries and read a lot of articles that state it isn’t. People are tied to the floor or to the walls, put in cages, killed, tortured…

Anyway, I stick to my guns :wink:

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that’s okay, I’ll trust the research and remain puzzled.

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If you’re interested in reading, here’s WHO’s Mental Health Atlas:

http://www.who.int/mental_health/publications/mental_health_atlas_2011/en/

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@flameoftherhine eating popcorn

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@flybottle I found this. It says the study only lasted for two years, that’s not enough time to assess the prevalence of full recovery.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2632391/

On the 15 year study they found this:

The essence of the findings and conclusions of the study are best conveyed by quoting from the DOSMeD final report.4 The study demonstrated clearly a diversity of outcomes but “did not identify any particular pattern in the course and outcome of schizophrenic illnesses which could be regarded as specific to a given area or culture.” The outcome of patients in the developing countries was not uniformly better, as compared to the outcome in developed countries. While high rates of complete clinical remission were significantly more common in developing country areas (37%) than in developed countries (15.5%), the proportions of continuous unremitting illness (11.1% and 17.4%) did not differ significantly across the 2 types of setting. Patients in developing countries experienced significantly longer periods of unimpaired functioning in the community, although only 16% of them were on continuous antipsychotic medication (compared with 61% in the developed countries). Across all centers, the best predictors (P < .001) of outcome were type of onset (insidious vs acute) and type of setting (developed vs developing country), followed by marital status (P < .01) gender (P < .05), social isolation (P < .05), and drug abuse (P < .05). Neither type of family household (extended vs nuclear) nor experienced avoidance by others (a putative marker of stigma) reached statistical significance as predictor of outcome.

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From what I have read the evidence for better outcomes in third world countries is conflicting. Of course the anti meds crowd cherry pick the data and heavily promote the research that says people do better in third world countries with less medication.
I strongly suspect that those who do ok are those from wealthy backgrounds with a lot of support. There are many reports of the mentally ill being chained up in disgusting conditions in 3rd world countries. How that can be said to be a better outcome beggars belief.

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