National Association for Rights Protection and Advocacy

Outcomes Elsewhere:
What We can Learn from Cross-Cultural Psychiatric Research
about How Things Work at Home

Kim Hopper

This talk will review the upbeat (and increasingly suspect) picture of outcomes from (a western-based/measured) schizophrenia in low-income (or “developing”) countries, drawing heavily on 30 years of WHO-sponsored collaborative work. The intriguing finding – originally little more than rumor, but given research credence in the early 1970s – that the course of schizophrenia in resource poor areas of the world might be more favorable than in the U.S. and Europe has since been replicated several times. The most recent, lengthy and epidemiologically rigorous attempt, the International Study of Schizophrenia, recently published its results. It again found that outcome elsewhere (here, 3 sites in India) was considerably better than in nearly all western (U.S., Europe) and a few developed Asian sites (Hong Kong, Nagasaki). This finding has come under strong criticism citing counter-evidence from other studies. I review the critique, largely reject its reading of the evidence, and go on to suggest a more productive view of research, and of how we might learn from it on the home front. What might it mean that a therapeutic benefit could be salvaged from a resource-poor environment?