Community appears to be a powerful healing force

Interesting extract from:

"Social Network's Healing Power Is Borne Out in Poorer Nations" from Washington Post
Author: Shankar Vedantam - Washington Post Staff Writer, Date: 12 July 2005, Submitted by: Dr. Morton Schatzman, Psychotherapist (GB)

Most people with schizophrenia in India live with their families or other social networks -- in sharp contrast to the United States, where most patients are homeless, in group homes or on their own, in psychiatric facilities or in jail. Many Indian patients are given low-stress jobs by a culture that values social connectedness over productivity; patients in the United States are usually excluded from regular workplaces.

Indian families sit in on doctor-patient discussions because families are considered central to the problem and the solution. In America, doctor-patient conversations are confidential -- and psychiatrists primarily focus on brain chemistry.

Norman Sartorius, the former head of WHO's mental health program, spearheaded the schizophrenia studies. He says there is much the United States and Europe could learn from villages such as Raipur Rani.

In an interview at his home in Geneva, he said Western countries could financially help families take care of their relatives, which would save money on hospitalization and incarceration. Caregivers might be given time off from jobs. And doctors could enlist recreational and religious groups to replace the social networks that patients lose.
"Social factors play a major and important role in the outcome of disease," Sartorius said. "Very few solutions are medical in medicine."

Decades of research have supported the WHO findings, but they have met with stony silence in the United States, in part because anti-psychiatry groups have argued erroneously that the studies prove that drugs and doctors are useless. Most U.S. psychiatrists see schizophrenia as an organic brain disorder, whose origins and outcome depend on genes and brain chemistry. They acknowledge the psychosocial aspects of disease, but the challenges of connecting patients with jobs, schooling and social networks are neglected -- often because they fall outside the bounds of traditional medicine.

Asked whether he would agree that schizophrenia patients might be better off in Nigeria than in New York, Darrel Regier, director of research at the American Psychiatric Association, was blunt: "God, no!"

Regier is not alone. Patient advocacy groups are also uneasy about giving families a central role because, in a previous era, a now-discredited theory blamed schizophrenia on poor parenting.

Drug manufacturers, too, are focused elsewhere. "Pharmaceutical companies, which control the scientific production of research at universities, are not interested in saying, 'Social factors are more important than my drug,' " said Jose Bertolote, a WHO psychiatrist. "I'm not against the use of medication, but it's a question of imbalance."
Western doctors cannot write prescriptions for stronger family ties, Bertolote said. But Indian psychiatrists, unlike their Western counterparts, dispense not only drugs but also spiritual advice, family counseling -- even matchmaking services. Indian doctors are seen not only as medical experts, but as wise authority figures.

In the south Indian city of Chennai, psychiatrist Shantha Kamath writes prescriptions for better family ties: When a father asked for her help in arranging the marriage of his daughter, who has schizophrenia, Kamath's written instructions told the parents how to interact with their daughter and listed the skills the young woman needed to learn before the doctor would arrange a match.

Trend Emerged Slowly
The International Pilot Study on Schizophrenia was launched in 1967 to determine whether the disease existed in all countries and whether it could be reliably diagnosed and treated.

The study quickly established that the disease occurs everywhere. Only gradually did it emerge that patients in poor nations had better outcomes. The second study, which had more rigorous guidelines, included Naren Wig's patients in Raipur Rani village.
In all, the study tracked about 3,300 patients, Sartorius said, and 30-year follow-ups confirmed the initial trends. The study spanned a dozen countries -- capitalist and communist, eastern and western, northern and southern, large and small, rich and poor.
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.

A separate study, in rural China, recently revealed that low doses of medication could be as effective as high doses, and virtually eliminated side effects, said Martin Gittelman, a clinical professor of psychiatry at New York University. And older medications, largely discarded in wealthier countries, were as effective as newer, expensive anti-psychotic drugs.

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