Recovery From Schizophrenia: Psychiatry And Political Economy

THE POLITICAL ECONOMY OF SCHIZOPHRENIA 161education, however, is less easily changed. It is therefore interesting to note that ahigh level of education is one of the few strong and consistent indicators of pooroutcome in the Third World, 56 thus standing in contrast to Western patterns ofrecovery. This point, then, may be one of the most useful pieces of evidence inthe WHO study, pointing to a link between good outcome for schizophrenia inthe Third World and the maintenance of traditional occupational roles.STRESSUnemployment on the one hand and intensified work demands on the other arespecial stresses of modern industrial society. Are there other increased stresses oflife in the fast-paced industrial world that might account for the poor prognosis forschizophrenia in the West? It depends what we mean by stress. Urbanovercrowding, job insecurity, productivity pressure and alienation from thecreative process are all chronically stressful facets of industrial life. Those who livein peasant communities, however, must face equal levels of domestic discord andoften suffer problems of poor health, high infant mortality and inadequatehousing, clothing, food and water. With the development of state-level societiesand colonialism come increasing difficulties with authority, status disparity,poverty and starvation. To passing tourists, the palm-studded fishing village nearMazatlan on the west coast of Mexico might seem a subtropical paradise; butwhen Russell McGoodwin, an anthropologist, asked the inhabitants what causedthem most suffering they listed many complaints including poverty, familyproblems, the burden of work, inadequate water supplies and poor clothing. Inresponse to the question, “What do you enjoy?” nearly half answered,“Nothing.” 57 Life in non-industrial societies is not low in stress. Rousseau’s“noble savage” leading a life of peace and perfect order in “the state of nature”cannot be found. But some features of tribal and peasant life might well improvethe social integration and the outlook for those who suffer from a psychoticepisode.A PSYCHOTIC EPISODE IN GUATEMALAMaria, a young Indian woman living in a village on Lake Atitlan in Guatemala,alienates her close relatives and the people of the community by her irresponsiblebehavior before finally suffering a full-blown psychotic episode. She hallucinates,believing that spirits are surrounding her to take her to the realm of the dead, andshe walks about the house arguing with ghosts. A local shaman perceives that sheis loca (crazy) and diagnoses her as suffering the effect of supernatural forcesunleashed by the improper behavior of certain relatives. He prescribes a healingritual that calls for the active participation of most of her extended family. Hercondition requires her to move back to her father’s house, where she recoverswithin a week. Benjamin Paul, the anthropologist who describes Maria’s case,points out several features of interest. Maria is never blamed for her psychotic